Keeping a head: a head injury case study

Posted by Jeremy Windsor and George Rodway on 04/03/2006
The consequences of a bare head?

Doctors Jeremy Windsor and George Rodway take a sobering look at the effects of head injury.

Karl had been climbing for almost ten years, first on the end of his father’s rope and later with his mates from school and university. The summer holidays had given Karl and his dad a chance to spend a couple of days together in the Peak District. Following a day picking their way along Stanage, the pair headed towards Burbage North. Arriving early, with a fine mist still clinging to the rock, Karl geared up below Brooks’ Layback, pulled on his beanie and stepped up to the start.

Two pieces of gear in, he began to layback the long right-facing feature. As he stepped above the last cam, Karl slipped and fell. With his foot caught in the rope, his head, neck and shoulders were first to make contact with the rock face. For a few long seconds Karl’s body hung lifeless, but as his Dad lowered him to the ground he slowly began to stir. As he awoke it was clear that Karl had suffered a serious injury. Not only was the skin over his scalp swollen and matted with blood, but he was also agitated and confused, slurring his words and unable to make much sense. Quickly other climbers appeared and the rescue services were called. He was eventually transferred to a specialist neurosurgical unit and that evening underwent surgery to remove a blood clot from his brain.

During the fall Karl had suffered a fractured skull and damage to the blood vessels surrounding the outermost layers of his brain. The first CT scan, above, shows a very obvious fracture of the skull’s temporal bone, sustained in a fall similar to Karl’s, whilst the second scan below shows the damage that resulted to the brain. The dark collection in-between the skull and the pale brain tissue is blood, known in medical terminology as an extradural haemorrhage. As the haemorrhage continues, pressure starts to build and the soft brain tissue (nothing more resilient than jelly) is squashed. With little free space inside the skull, even a small amount of bleeding causes the pressure inside to grow, rapidly starving cells of their vital fuel supply. And unfortunately, while cells in other parts of the body have the potential to regenerate, cells in the brain and spinal cord are usually lost forever. Head injury

The way Karl behaved was typical of anyone who had just sustained a serious head injury. Immediately on impact the brain tends to “switch off” causing a brief loss of consciousness, before some sort of “normal service” is resumed. In those who sustain a serious brain injury this return can be limited, with the individual soon passing in and out of consciousness, slurring their speech and behaving erratically. However in many cases there is a period of normal behaviour. There are stories of jockeys remounting their horses and surfers searching for the next wave before eventually complaining of nausea, headaches and later, signs and symptoms similar to Karl’s. Therefore it’s vital that anyone who’s lost consciousness following a head injury is watched closely for at least four hours in case serious damage has been done.

Once surgery has removed the blood clot the real work begins. A visit to any neurology ward is a sobering sight. There, young men and women can be found slowly coming to terms with their injuries and learning to live independently again. The range of injuries is enormous, varying from subtle changes to the senses to profound muscle weakness that leaves even the beefiest canoeist or mountain biker confined to a wheelchair. Do you remember the times when you’ve fallen asleep on one side and woken with a numb arm or a dead leg? What if that never went away? As a climber how would you cope with losing the sensation in your fingers or toes? Alternatively, what if you developed epilepsy as so many do after a head injury? Could you climb or belay not knowing when your next fit might come?

Away from the crags life can be just as hard. We both know teenagers who spend their lives in wheelchairs following sporting accidents, whilst others lucky enough to walk have been unable to control their bladder or bowels for long enough to visit the shops. Some who appear to have completely recovered are unable to recognise their family or even recall what happened only an hour ago.

After further operations Karl spent almost a year in hospital. At first he was wheelchair bound, too weak to stand alone or even feed himself. But thanks to his own determination and the help of those around him he was eventually able to walk again and lead an independent life. However his recovery was no fairytale story. Painful muscle cramps, pressure sores and numerous infections all caused setbacks. Whilst for years after the accident Karl was plagued with violent mood swings and bouts of depression that were far beyond his control. Despite all this, two years later Karl eventually returned to university and finished his degree. He never climbed again.

Now it’s uncertain whether Karl’s injuries could have been prevented by wearing a helmet, but really, what’s the harm in placing a well-fitted layer of plastic between you and the rock? In mountaineering circles helmets are treasured objects, yet on the cliffs and crags of the UK they’re often forgotten and left behind. I suspect this might be due to two reasons. First, people tend to believe that head injuries come from above. Therefore so long as no one else is on the route and the area doesn’t have a reputation for loose rock the helmet can stay at home. Sadly, as Karl’s example shows this isn’t the case. Secondly I reckon there’s a problem with vanity.

In years gone by helmets were uncomfortable and cumbersome, worn only by those who had no choice, namely children and beginners. Therefore only those who wanted to look like “gumpies”, as a US climbing magazine once put it, chose to wear them. Fortunately, much has now changed - helmets no longer have the style of a pencil eraser and are smaller, safer and lighter than ever before. A glance along the shelves of your local climbing shop will reveal an enormous range of sizes, shapes and styles that will fit most heads and tastes. Most weigh in at less than 500g. So perhaps now there’s little excuse - And it might just stop you from losing your head.

Jeremy Windsor and George Rodway have both worked extensively in Emergency Medicine and undertaken climbing expeditions to the Andes, Greenland, Alaska, East Africa and the Himalaya. Some details in this article have been changed to maintain confidentiality.
 



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1) Anonymous User
12/08/2013
Whilst climbing in Spain we overheard some Germans laughing and commenting that you could spot the English because we all had helmets on. It was only about 5 minutes before his mate kicked off a large rock above him that narrowly missed his head. I do love a bit of karma!

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