Closed-head injury

closed head injury

Closed-head injury is a type of traumatic brain injury in which the skull and dura mater remain intact. Closed-head injuries are the leading cause of death in children under 4 years old and the most common cause of physical disability and cognitive impairment in young people. Overall, closed-head injuries and other forms of mild traumatic brain injury account for about 75% of the estimated 1.7 million brain injuries that occur annually in the United States. Brain injuries such as closed-head injuries may result in lifelong physical, cognitive, or psychological impairment and, thus, are of utmost concern with regards to public health.


If symptoms of a head injury are seen after an accident, medical care is necessary to diagnose and treat the injury. Without medical attention, injuries can progress and cause further brain damage, disability, or death.

Common symptoms

Because the brain swelling that produces these symptoms is often a slow process, these symptoms may not surface for days to weeks after the injury. Common symptoms of a closed-head injury include:

slurred speech

Severe injury symptoms

Severe head injuries can lead to permanent vegetative states or death, therefore being able to recognize symptoms and get medical attention is very important. Symptoms of a severe closed-head injury include:

coma or vegetative states
seizures or convulsions
loss of consciousness

Secondary symptoms

Secondary symptoms are symptoms that surface during rehabilitation from the injury including social competence issues, depression, personality changes, cognitive disabilities, anxiety, and changes in sensory perception. More than 50% of patients who suffer from a traumatic brain injury will develop psychiatric disturbances. Although precise rates of anxiety after brain injury are unknown, a 30-year follow-up study of 60 patients found 8.3% of patients developed a panic disorder, 1.7% developed an anxiety disorder, and 8.3% developed a specific phobia. Patients recovering from a closed-head or traumatic brain injury often suffer from decreased self-esteem and depression. This effect is often attributed to difficulties re-entering society and frustration with the rehabilitation process. Patients who have suffered head injuries also show higher levels of unemployment, which can lead to the development of secondary symptoms.


Closed-head injuries are caused primarily by vehicular accidents, falls, acts of violence, and sports injuries. Falls account for 35.2% of brain injuries in the United States, with rates highest for children ages 0–4 years and adults ages 75 years and older. Head injuries are more common in men than women across every age group. Boys aged 0–4 years have the highest rates of brain injury related hospital visits, hospitalizations, and deaths combined. Multiple mild traumatic brain injuries sustained over a short period of time (hours to weeks), often seen with sports-related injuries, can result in major neurological or cognitive deficits or fatality.

Closed-head injuries can range from mild injuries to debilitating traumatic brain injuries and can lead to severe brain damage or death. Common closed-head injuries include:

concussion – a head injury resulting in temporary dysfunction of normal brain function. Almost half of the total concussions reported each year are sports-related

intracranial hematoma – a condition in which a blood vessel ruptures causing a pool of blood to form around the brain (subdural hematoma) or between the brain and the skull (epidural hematoma). Intracranial hematoma causes an increase in pressure on the brain and requires immediate medical attention.

cerebral contusion – a bruise to the brain tissue as a result of trauma. Contusions are local in nature, separating them from concussions.

diffuse axonal injury – These injuries are frequently seen in car accidents and cause permanent damage to the brain. Severe diffuse axonal injuries often lead to comas or vegetative states.