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Closed Head Injury (CHI, Swollen Brain)

A definition of Closed Head Injury (CHI, Swollen Brain)

Closed head injury can occur when the brain swells inside of the skull, or when fluids build up causing excessive pressures to the tissues. The effects of this may be short term or long lasting. Often complications exist; weakness, higher than normal muscle tone, or spasticity can result. Complicating things further, people who have a closed head injury are often in the hospital bed for long periods with limited joint mobility. This weakness and immobility often complicated with tone or spasticity puts closed head injury patients at risk for contracture. Using a Dynasplint System® as part of a larger rehabilitation program may be quite beneficial.

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Even seemingly minor closed head injuries can have potentially serious consequences, including brain damage and spinal cord damage. Seeking immediate care can help avoid more significant damage.

The most common type of brain injury occurs as the result of concussion, when an impact causes the brain to become shaken. Concussions often occur as the result of sports injuries, falls and some auto accidents. These injuries can causes swelling and bleeding within the skull, including subarachnoid hemorrhage (bleeding within the space between the brain and the skull) and subdural hematoma (blood that pools on the surface of the brain). Both types of bleeding can cause serious injury to the tissues of the brain, resulting in irreversible brain damage and even death. Bleeding may also cause loss of one or more of the five senses; severe and persistent headaches; difficulty speaking; convulsions and seizures, paralysis; and coma.

Closed head injuries are often under-treated in comparison with open head injuries; those injuries where the skull has obvious damage and external bleeding occurs. Even if a patient appears normal following an injury, they should be carefully watched and monitored, as symptoms may develop in the hours following injury, when swelling increases within the skull. Symptoms to watch for include:

  • Pupils of unequal size
  • Pupils that are not reactive to light
  • Convulsions or seizures
  • Slackening or distortion of facial features
  • Slurred speech
  • Blurred vision
  • Impaired sensory perception
  • Confusion
  • Paralysis
  • Changes in behavior, including irritability, mood swings or personality changes
  • Headache
  • Vomiting
  • Stiff neck
  • Lack of coordination or clumsy movements
  • Loss of consciousness
  • Extreme drowsiness
  • Swelling at the injury site
  • Clear or bloody drainage from nose, mouth or ears


Mild head injuries can be treated with acetaminophen to reduce pain, but aspirin, ibuprofen and other anti-inflammatory medications should be avoided, since these may cause bleeding. In addition, patients on blood thinners or other types of medication should consult their doctor about continuing their medications during the 24 to 48 hours immediately following the injury. Patients with mild head injuries who do not appear to need a doctor’s care should be monitored for 24 hours following the initial injury, and should be woken every few hours during sleep to ensure the patient is coherent.

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Permanent brain damage can range in severity, from chronic headache, memory loss, loss of speech or motor skills, partial or complete loss of sensory perception (sight, hearing, taste, smell) and other symptoms, to coma or a persistent vegetative state or death. Prompt medical attention is essential to ensure the best outcome for the patient. In cases where speech or motor skills are impaired, speech, physical or occupational therapy may be required to regain all or some skills. Patients undergoing seizures, convulsions or have affected motor skills may benefit from dynamic splinting to avoid contractures or secondary damage from uncontrolled movements. Dynamic splinting may be also used as an adjunct therapy to help control tone, maintain flexibility and regain lost range of motion.

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