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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Lump On Head,nose Bleed And Dilated Pupil After Hitting Head?

Yesterday my mother was at our local pub, I went to collect her, she was rambling, falling over, stumbling, completely paralytic. I could see she was about to fall off of a ledge about 3 inches tall so I went to grab her, she spun around and tripped, falling over the ledge, she landed on her elbow I believe, but did hit her head. She didn't get knocked out but was screaming in agony, she had grazed her elbow, shoulder and bruised her leg. I took her home and she went straight to sleep, waking up briefly to ask for water (still /extremely/ drunk,) the next morning she was up before me, around 7am to be exact. She then went downstairs and watched television for a bit, she's been smoking, drinking water and I think she may have had coffee. I checked her pupils, one looks bigger but it may just be me. They both look big to be honest. She has a headache but I'm not sure if it's just the hangover or something worse.



Also, she refuses to seek medical advice and one of her pupils is a fraction larger, not noticeable unless you look her dead in the eye - face to face.

Just checked.. she has another lump on the top of her head; so it's at the front and the top.

When I first became worried was 0:00 last night when it first happened, then she woke up before me, still has a headache, though I think it's going away, she also has a nosebleed out of her left nostril (tiny bit of blood,) at 9am. She /refuses/ to go to the hospital and I'm so worried about her.
Tue, 12 Jan 2016
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Neurologist, Surgical,  's  Response
Hello. Thanks for asking from HCM.


I can understand your concern. It is good that you have evaluated and mentioned your sister's symptoms in such detail. After going through your history, it appears that the mode of injury was non dangerous (fall from 3 inch ledge) which is good. Now coming to her symptoms, she is conscious, oriented and her symptom of headache is decreasing which is also good.


The points against her mild injury are nasal bleed, alcohol intake and abnormal pupil reaction. Regarding nasal bleed, first check is there any injury/swelling over nose. If it is present it means bleed was due to direct injury and not because of head injury.

If no evidence of nasal injury, it needs evaluation to confirm it was because of head injury. You have to consult doctor for it.

Dilatation of pupil not responding to light or one pupil larger than other is a very significant finding after head injury. As it has been evaluated by you only, you have to confirm it from doctor. If doctor confirms it, he will advise CT head to rule out fracture or brain bleed. Further management will be decided after CT report.

Meanwhile at home, you can follow few tips
: Apply icepack at swelling
: Keep her head at higher level than chest
: You can give her painkiller like Diclofenac sodium after proper prescription
: Avoid pressure at injury site
: Observe her for other signs of dangerous head injury like vomiting, loss of consciousness or decreasing consciousness, fits, onset of new focal deficit. If any of these signs, consult ER as soon as possible.

Hope it will help you to reach unto some conclusion and get her appropriate treatment.

Thanks. Take care.
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What Causes Lump On Head,nose Bleed And Dilated Pupil After Hitting Head?

Hello. Thanks for asking from HCM. I can understand your concern. It is good that you have evaluated and mentioned your sister s symptoms in such detail. After going through your history, it appears that the mode of injury was non dangerous (fall from 3 inch ledge) which is good. Now coming to her symptoms, she is conscious, oriented and her symptom of headache is decreasing which is also good. The points against her mild injury are nasal bleed, alcohol intake and abnormal pupil reaction. Regarding nasal bleed, first check is there any injury/swelling over nose. If it is present it means bleed was due to direct injury and not because of head injury. If no evidence of nasal injury, it needs evaluation to confirm it was because of head injury. You have to consult doctor for it. Dilatation of pupil not responding to light or one pupil larger than other is a very significant finding after head injury. As it has been evaluated by you only, you have to confirm it from doctor. If doctor confirms it, he will advise CT head to rule out fracture or brain bleed. Further management will be decided after CT report. Meanwhile at home, you can follow few tips : Apply icepack at swelling : Keep her head at higher level than chest : You can give her painkiller like Diclofenac sodium after proper prescription : Avoid pressure at injury site : Observe her for other signs of dangerous head injury like vomiting, loss of consciousness or decreasing consciousness, fits, onset of new focal deficit. If any of these signs, consult ER as soon as possible. Hope it will help you to reach unto some conclusion and get her appropriate treatment. Thanks. Take care.