Small scrapes, bruising, or swelling of the head may be indications of a skull fracture (up to 24 hours to see bruises and bumps) Tenderness or pain at the location of the injury is evidence that a skull fracture has been sustained. The severity of these injuries varies depending on how hard someone falls and where they hit their head. A patient who has a depressed skull fracture should be treated in the hospital. The patient needs to be watched for signs of increased pressure inside the skull, such as increasing headache or vomiting. CT scans can show whether there are other injuries associated with the depression fracture. The doctor may recommend surgery to treat these other injuries found during the examination of the brain. The patient will also need to be observed for any changes indicating a worsening condition. These include changes in level of alertness, vision, or speech. If any of these symptoms appear to be worsening, then emergency treatment should be initiated immediately. Skull fractures are usually caused by severe impacts to the head from heavy objects such as vehicles or buildings. Patients may have no apparent reason for the accident, but there could be evidence of trauma elsewhere on the body. Patients may have a sore spot on the scalp where they struck their head, along with blood coming from the nose or ears. Children may have trouble walking or talking after the injury.