The Biggest Mistake People Make After a Head Injury — A Neurologist's Warning

A 35-year-old falls from a motorcycle, hits his head on the road, loses consciousness for 30 seconds, then wakes up and says he is fine. His family takes him home. Five hours later he becomes increasingly drowsy, stops responding, and by the time 108 is called, he is in a coma. The CT scan shows an expanding extradural haematoma — a blood clot compressing the brain from outside. He survives after emergency surgery, but barely.

The biggest mistake after head injury is the assumption that "if you wake up and seem fine, you are fine." The most dangerous head injuries have a lucid interval — a period of apparent normality — followed by rapid deterioration.

The Lucid Interval — Understanding the Danger

An extradural haematoma (EDH) — bleeding between the skull and the outer membrane of the brain — is typically caused by rupture of the middle meningeal artery following a temporal skull fracture. The initial trauma causes brief unconsciousness. Then, as the haematoma slowly expands, there is a lucid interval of 2–8 hours during which the person seems well. Then — as the expanding clot compresses the brain — rapid deterioration: drowsiness → confusion → fixed dilated pupil on one side → coma. Without surgery within the next 30–60 minutes, death or permanent disability results. This is a neurosurgical emergency where every minute matters.

Warning Signs That Must Not Be Missed in the Hours After a Head Injury

• Worsening headache: A headache that was mild and is getting progressively worse — not improving with paracetamol
• Vomiting more than twice: One vomit after a head injury is common. Repeated vomiting suggests rising intracranial pressure
• Increasing drowsiness: The person is harder to wake up, or sleeping much more than usual — this is not "resting," this is a red flag
• Confusion or personality change: Not acting like themselves; confused about place and time; agitated
• Seizure: Any seizure after a head injury requires immediate hospital assessment
• One pupil larger than the other: A dilated, unreactive pupil on one side is a sign of brain herniation — call 108 immediately
• Weakness on one side: New arm or leg weakness developing hours after a head injury

Who Needs CT Scan After Head Injury?

NICE head injury guidelines state CT brain is indicated for: GCS below 15 at 2 hours; suspected open or depressed skull fracture; any sign of basal skull fracture (Battle's sign, raccoon eyes, CSF from nose or ear); post-traumatic seizure; focal neurological deficit; more than 1 vomit; age above 65; anticoagulant use; amnesia for more than 30 minutes before the injury.

After a head injury, do not leave the person alone for 24 hours. Wake them every 2–4 hours to check responsiveness. Return to hospital immediately if any warning sign develops.

For head injury evaluation and neurological assessment: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.