Complaints & connections · borters.ch
Trauma cranio-cerebrale
The dangerous window after a head knock often opens hours later — hence 24 to 48 hours of watching and knowing the warning signs.
Also known as: traumatic brain injury · TBI · head injury · head trauma · brain bleed after a fall · subdural haematoma
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A traumatic brain injury is any force to the head that also affects the brain — from a fall on ice to a bike crash to a knock while playing sport. Severity is graded mainly by how clear a person is afterwards: mild means brief or no loss of consciousness and a quick return to being alert and oriented; moderate and severe mean longer unconsciousness, lasting drowsiness or failure to wake. Losing consciousness is a serious signal, but it does not prove a severe injury — and staying awake does not rule out a dangerous bleed. The heart of this topic is the warning signs: worsening headache, repeated vomiting, unequal pupils, increasing sleepiness or confusion, a seizure, weakness or numbness on one side of the body, clear fluid or blood from the nose or ear, bruising around both eyes. Any one of these means: call 144 immediately. The dangerous window often does not open at the moment of the fall but hours to days later — which is why a head knock deserves 24 to 48 hours of observation, with a second person nearby who will notice a change and act. On blood thinners, in infants and in older people the threshold is far lower: here it is better to be checked once too often. A chronic subdural haematoma, slowly causing headache, personality change or unsteady walking weeks after a long-forgotten fall, is the classically missed picture in the elderly. In infants and children under two, signs of their own come in, because they cannot say how they feel: a tense, bulging fontanelle, skull sutures pushed apart, and eyes turned downwards like a setting sun. And the mechanism of the accident counts on its own: a fall from a height, a bicycle or car crash, an impact at speed — that is reason to have it assessed even with no sign at all.
Worsening headache, repeated vomiting, unequal pupils, drowsiness, seizure, one-sided weakness, blood or clear fluid from nose or ear.
A second person stays nearby, reachable at night, and knows what to watch for. Sleeping is fine; being rousable is not optional.
Here: get any notable head knock looked at, even if the person seems perfectly well.
Alcohol and sedatives blur exactly the signs that matter. No driving while still dazed.
Whether a CT is needed is decided by tested criteria. Not needing one is good news, not a brush-off.
Once the acute danger has passed, the graded return to school, work and sport begins — see concussion.
Fainting, heart rhythm, blood pressure, medication, vision and balance deserve review — otherwise the next fall follows.
Bike, ski and site helmets clearly reduce severe head injury. At home: light, grab rails, loose rugs removed.
No drug repairs brain tissue. What counts in the acute phase is avoiding the second injury: enough oxygen, enough blood pressure, no rise in pressure inside the skull. Cortisone raised mortality in a large trial and is not given in head injury — one of the clearest examples that a plausible-sounding treatment can harm. Tranexamic acid, given early within three hours, lowers mortality in mild to moderate injury.
The Glasgow scale runs from three to fifteen: thirteen to fifteen counts as mild, nine to twelve as moderate, eight and below as severe. A CT is done with certain signs — repeated vomiting, a seizure, disturbed consciousness, signs of fracture, older age, blood thinners. A bleed under the tough covering of the brain can only become apparent weeks later in older people; so with any worsening it is still considered at four to six weeks.
Being out for seconds or not recalling the accident counts — even if everything seems normal afterwards.
It is not the headache right afterwards that worries, but the one growing stronger hour by hour.
Hard to rouse, slowed, talking oddly or not recognising familiar people: the single most important change.
These three point to pressure inside the skull. Do not watch, do not wait — call 144.
Clear fluid or bruising around both eyes suggests a skull base fracture — straight to hospital.
Especially in older people and on blood thinners, a bleed can stay silent and then creep in.
The most important value after a fall onto the head: under blood-thinning treatment the threshold for immediate imaging is markedly lower, even when one feels fine.
Low blood sugar can have caused the fall and can explain the confusion afterwards. So it is measured at once.
A low sodium explains unsteadiness and confusion — both as the cause of the fall and as the reason for the complaints afterwards.
Without B12 the insulating layer of the nerves is not maintained. A lack causes tingling, numbness and unsteadiness in the dark — and it is one of the few reasons for nerve trouble that can be fully undone if found early.
The nerves cover their energy needs through thiamine. It runs short with alcohol, after stomach operations, with long-lasting vomiting and under water tablets.
Here both count: a lack harms the nerves, and too high an intake over months harms them as well. Supplements therefore belong taken in a dose that has a reason.
Works together with B12. Given alone, folate can improve the blood count while the B12 deficiency goes on damaging the nerves — which is why both are looked at together.
In animal experiments after concussion impressive, in humans so far weakly supported — the studies are small and inconsistent. Tolerable and inexpensive; only a blood thinner is a reason for a conversation, because from about 3 g daily the bleeding time lengthens.
One of the few substances for which a small controlled trial in children and adolescents after severe head injury found an advantage in tiredness and headache — 0.4 g per kilogram daily over six months. The trial is small and was not repeated; it is a pointer, not a basis.
In the first days after a concussion sleep is the most effective remedy, and caffeine in the late afternoon is what most reliably prevents it. Later, in recovery, it is unproblematic — the period decides.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
After a severe head injury a considerable share of those affected has a lasting failure of one or more hormone axes. That is rarely looked for — and it explains exhaustion, lack of drive and weight gain months afterwards.
Failure of the stress axis is the most dangerous of the possibilities: low blood pressure, nausea, craving salt, in the extreme a crisis. It is well treatable once found.
Large amounts of urine and constant thirst in the days and weeks afterwards lead to this hormone. Both can be checked in five minutes — with the urine volume and the sodium in the blood.
After more severe injury needs rise for weeks. 1.2–1.5 g protein per kg a day is the usual frame; with swallowing trouble the texture is adapted, not the amount reduced.
The brain recovers in sleep. After a head injury sleep problems are common and lengthen the complaints — fixed times and no alcohol are the two most effective points.
The old complete rest has been abandoned: after 24–48 hours light movement below the symptom threshold measurably improves the course. Too much too early, however, lengthens it.
AWMF 024-018 · S2k · 2023-03 — in force
Das Schädel-Hirn-Trauma im Kindes- und Jugendalter
checked 2026-09