Neurotrauma care

Neurotrauma includes brain injury caused by a blow, a fall, or an accident—from a concussion to a hematoma that compresses the brain. In Mexico City, initial care takes place in the emergency department, not in an office. A neurosurgeon then determines whether the hematoma needs to be drained, pressure needs to be monitored, or the person can simply be observed as their condition evolves.

A concussion affects brain function even when an injury is not always visible on a CT scan: confusion, amnesia of the event, and nausea. Increasing drowsiness, repeated vomiting, a seizure, weakness on one side, or a dilated pupil are more concerning. People taking blood thinners and older adults can bleed after trauma that seemed minor. Writing down the time of the injury and whether there was a loss of consciousness can help; it does not replace a CT scan when these signs are present.

An epidural hematoma is usually arterial and can have a lucid interval: the person talks and then becomes unresponsive. An acute subdural hematoma accompanies contusions and swelling; a chronic one, more typical in older adults or people taking anticoagulants, appears days or weeks later as confusion, headache, or unsteadiness while walking. A contusion is a bruise on the brain that can grow during the first few hours. A skull fracture matters if it is depressed, open, or crosses a venous sinus. The name in the report alone does not determine the situation: what matters is the mass effect and how the person is doing.

The airway, blood pressure, coma scale, and a CT scan are assessed. If the patient is seriously ill, care includes intensive care, sometimes measurement of intracranial pressure and measures to reduce swelling. Repeating the CT scan makes sense if the examination worsens, not according to a rigid schedule. The neurosurgeon determines whether a blood clot needs to be removed, whether a depressed fracture needs to be elevated, or whether it is safer to observe a small bleed in someone who is stable.

Draining a large hematoma can save a life by relieving pressure; it does not repair fibers already torn by the impact. A small bleed, with no midline shift and a stable exam, is often managed with monitoring and by stopping anything that promotes bleeding, as determined by the treating team. Other issues remain that cannot be resolved in the operating room: delayed seizures, dizziness, difficulty concentrating, and returning to work or sports. None of these can be assigned a date with a promise.

If someone talked after the injury, does that mean they’re okay? Not necessarily. The lucid interval exists precisely because someone may talk and then deteriorate. New drowsiness is a reason to seek emergency care.

Does a subdural hematoma always require surgery? No. Small ones and chronic ones with few symptoms are sometimes monitored. Those that cause compression or a worsening exam are usually drained.

When can I return to contact sports? When the exam and, if requested, imaging allow it, and after a symptom-free period. Returning sooner based on a message increases the risk of a second impact to a brain that has not yet recovered.

A recent head injury with vomiting, drowsiness, a seizure, or weakness should be treated in the emergency department or by calling 911, not by message. If the injury has already been evaluated and you are looking for a follow-up, write to +52 55 2193 8191 and mention the date of the CT scan.