Head Injuries

Head bleeds, which cannot be seen and may cause permanent brain damage or death, can occur with or without injury to the area. This type of bleed is life-threatening if not treated immediately.

Head bleeds pose one of the most dangerous health hazards to people with bleeding disorders. Unless injury or trauma is obvious, early symptoms can be easily missed. More subtle symptoms might present themselves in the following ways: a newborn who becomes unusually fussy or refuses to eat; a toddler who sleeps more than usual and is not easily awakened; a teenager who has an unsteady gait or who complains of a headache or stiff neck.

Although head bleeds are not as common as joint or muscle bleeds, you should nevertheless become informed and educated to learn the subtle signs and symptoms of a head bleed. Symptoms of a head bleed caused by major trauma/injury are more easily recognized than those that result from mild head trauma. Bleeding into the brain can be slow and take several days to detect. The sooner these injuries are identified, the greater the chance of avoiding long-term damage and the shorter the recovery time may be.

Following are some of the symptoms to be aware of:

Headache – one that is consistent or gets worse and is not gone in 24 hours
Lethargy – drowsiness and difficulty waking up
Slurred speech
Uunusual irritability
Nausea and vomiting – when not sick to the stomach
Dizziness – difficulty walking straight
Stiff neck
Vision problems – blurred, double, sensitive to light
Confusion
Inability to concentrate
Numbness or tingling
Seizure
Unsteady gait or unusual clumsiness
Loss of consciousness – passing out
Dilated pupils or eyes not moving together

If any of these symptoms do occur, notify your physician immediately and infuse with factor as directed. Then quickly get to the emergency room.

What to Do

Infuse factor to raise levels between 80% and 100% if on home infusion
Call your hemophilia treatment center (HTC) or hemophilia doctor
Go into the emergency room for an exam and tests (CT or MRI)
Call EMS (emergency medical services) if unconscious or having other medical problems
Avoid any pain medication till seen by a doctor

At the emergency room, your role should be that of an advocate for yourself or your child. Be certain that, upon registration, you inform the staff that you (or your child) have a bleeding disorder. Let them know that you are concerned about a head bleed. In addition, provide the staff with the following information to ensure a speedy evaluation:

factor deficiency type (factor VIII or IX),
severity of deficiency (mild, moderate or severe),
name, time and prescribed amount of factor you infused before visiting the ER, and
the name and phone number of your treatment center physician

Be Head Smart

For people with hemophilia, an intracranial hemorrhage, or head bleed, is the leading cause of death. Without early recognition and treatment, death or severe neurological impairment can occur. All significant head trauma, with or without external hematoma, must be treated promptly with a major dose of clotting factor.

Remember:

Bleeding into the head can be slow
Head bleeds can occur without injury
Signs/symptoms may appear slowly over several days
Even though there may not be visible signs of an injury (e.g., bumps, bruises), bleeding may be occurring inside
Treatment may be needed for a period of time after a bleeding episode
For parents and caregivers, always treat a head injury with factor even if the injury was not witnessed

When in doubt about treating a head injury, GO AHEAD AND TREAT. It can only help.