Head injury ( traumatic brain injury , traumatic brain injury ) - Causes, Symptoms and Treatment .MF .
Among the causes of death in young and middle age ranks first injury.Traumatic brain injury (TBI) is the most common types of injuries and up to 50% of all injuries.The statistics of injuries brain injury is 25-30% of all injuries, they account for more than half the deaths.Mortality from traumatic brain injury is 1% of the general mortality.
Traumatic brain injury - is damage to the skull bone or soft tissue, such as brain tissue, blood vessels, nerves, meninges.There are two groups of head injuries - open and closed.
Classification of TBI
When open craniocerebral injury damaged skin, the fascia and the bottom of the wound is a bone or a deep-lying tissue.Penetrating trauma is considered, in which the damaged dura mater.A special case of penetrating trauma - otolikvorreya resulting fracture of the skull base.
When closed craniocerebral injury aponeurosis is not damaged, although the skin can be damaged.
All head injuries are divided into:
- Concussion - injury, which is not marked with persistent disturbances in the brain.All symptoms occur after shocks, typically with time (over several days) disappear.Persistent symptoms preservation is a sign of more serious brain damage.The main criteria are the gravity of the concussion duration (from a few seconds to hours) and the subsequent loss of depth of consciousness and state of amnesia.No specific symptoms - nausea, vomiting, pale skin, cardiac abnormalities.
- brain compression (hematoma, foreign body, air, fireplace injury).
- brain contusion: mild, moderate and severe degree.
- Diffuse axonal injury.
- Subarachnoid hemorrhage.
At the same time there may be a combination of different types of traumatic brain injury: contusion and compression of hematoma, injury and subarachnoid hemorrhage, diffuse axonal injury and contusion, brain contusion with compression of hematoma and subarachnoid hemorrhage.
Symptoms of TBI
symptoms of impaired consciousness - stunning, stupor, coma.Indicates the presence of traumatic brain injury and its severity.
symptoms of cranial nerves, indicate compression and brain contusion.
symptoms of focal brain lesions indicate damage certain areas of the brain are at injury, brain compression.
stem symptoms - are a sign of compression and brain injury.
shell symptoms (meningeal) - their presence indicates the presence of a brain injury or subarachnoid hemorrhage, and a few days after the injury can be a symptom of meningitis.
Treatment of concussion
All the victims with brain concussion, even if the injury from the start seems easy, to be transported to the standby hospital where further diagnosis shows the execution, radiography of the skull bones, for a more accurate diagnosis, the presence of equipmentIt may be carried brain CT.
affected in acute injuries should be treated in the neurosurgical department.Patients with a concussion prescribe bed rest for 5 days, which is then, taking into account peculiarities of the clinical course and gradually expand.In the absence of complications is possible discharge from the hospital on the 7-10th day for outpatient treatment for up to 2 weeks.
Medical treatment for concussion is aimed at the normalization of the functional state of the brain, relieve headaches, dizziness, anxiety, insomnia.
usually range prescribed for admission of drugs includes analgesics, sedatives and opiates:
Analgesics (. Analgin, pentalgin, baralgin, sedalgin, maksigan etc.) select the most effective drug in this patient.
When dizziness choose any one of the available drugs (Reglan)
Sedatives.Use extracts of herbs (valerian, motherwort), preparations containing phenobarbital (Corvalol, valokordin) and tranquilizers (elenium, sibazon, Phenazepamum, nozepam, rudotel et al.).
Along with symptomatic treatment for concussion is expedient to conduct the course of vascular and metabolic therapy for a more rapid and complete recovery of disorders of brain functions and prevention of various symptoms of commotion.Appointment vasotropic and tserebrotropnoy therapy is possible only after 5-7 days after injury.Preferably a combination vasotropic (cavinton, stugeron, teonikol et al.) And nootropic (nootropil, aminolone, pikamilon et al.) Drugs.Daily three-time reception Cavintonum on 1 tab.(5 mg) and nootropil 1 caps.(0.4) for 1 month.
To overcome the frequent asthenic phenomena after concussion appoint a multivitamin such as "Complivit", "Centrum", "Vitrum" and so on. N. 1 tab.in a day.
From tonics used ginseng, Siberian Ginseng Extract, Schisandra fruit.
Concussion never not accompanied by any organic lesions.If found some post-traumatic changes on CT or MRI, you need to talk about more serious injury - brain injury.
brain contusion with TBI
brain contusion called a violation of the integrity of brain matter in a limited area.Usually at the point of application of force traumatic, but may also occur on the opposite side with respect to injury (injury from protivoudara).Thus there is destruction of a part of the brain tissue of blood vessels, the histological cell bonds with the subsequent development of traumatic edema.Zone of violations varies and is determined by the severity of the injury.
There are brain injuries mild, moderate and severe.
Mild brain injury
mild contusion of the brain characterized by loss of consciousness after the injury duration from a few to tens of minutes.
- After regaining consciousness typical complaints of headache, dizziness, nausea and others.
- Usually, there is retro, concentration, anterograde amnesia.Amnesia (. Greek amnesia forgetfulness, memory loss) - memory impairment as a loss of the ability to store and play back previously acquired knowledge.
- vomiting, sometimes repeated.May include the moderate bradycardia bradycardia - a decrease in heart rate to 60 and less than 1 minute in an adult.
- tachycardia - increased heart rate over 90 beats per minute for 1 adult.
- sometimes - systemic hypertension hypertension - elevated hydrostatic pressure in the blood vessels, hollow organs or body cavities.
- Breath and body temperature without significant deviations.
- Neurological symptoms are usually mild (clonic Nystagmus - involuntary rhythmic movements of the eyeballs biphasic, drowsiness, weakness)
- anisocoria slight signs of pyramidal insufficiency, meningeal symptoms and other, often regressing to 2-3 weeks..after injury.
Distinguish concussion and brain contusion (bruise) mild for the duration of coma and post-traumatic amnesia, as well as clinical manifestation is almost impossible.
Classification, adopted in Russia, admits the presence of linear fracture of the cranial vault with brain contusion mild.
analogue of injury cerebral mild domestic classification - slight head injury (minor head injury) American authors, which includes the state that meets the following criteria:
1) more than 12 points on the Glasgow coma scale (under the supervision of the clinic);
2) loss of consciousness and / or post-traumatic amnesia, does not exceed 20 minutes;
3) hospitalization for at least 48 hours;
4) the absence of clinical signs of stem contusion or cerebral cortex.
Most American authors excluded patients with linear fractures of the cranial vault of this group of patients, emphasizing the fact that the skull fracture fundamentally more serious condition.
Unlike concussion of the brain injury is a violation of the structure of the brain tissue.So when injury is determined microscopically mild brain damage structurally unstable substances in the form of local edema areas, cortical hemorrhage point, vozmozhno combined with limited subarachnoid hemorrhage due to rupture of the pial vessels.
When blood enters the subarachnoid hemorrhage under the arachnoid and spreading basal cisterns, furrows and crevices of the brain.Hemorrhage can be local or to fill in all the subarachnoid space with the formation of clots.Develop acute: patient suddenly experiences a "blow to the head", there is a strong headache, vomiting, photophobia.There may be one-time generalized convulsions.Paralysis is usually not observed, however, pronounced meningeal symptoms - stiff neck (tilt head can not touch the patient's chin, sternum) and Kernig symptom (bent at the hip and knee joints of the foot can not straighten the knee).Meningeal symptoms indicate irritation of the meninges streamed blood.
average degree of brain injury Bruising
moderate brain characterized by loss of consciousness after an injury from a few tens of minutes to several hours.Expressed amnesia (retro, concentration, anterograde).Headache is often severe.There may be repeated vomiting.Sometimes there mental disorders.There are transient disorders of vital functions: bradycardia or tachycardia, increased blood pressure, tachypnea - rapid surface (not a deep) breath without breaking the rhythm of breathing and airway, subfebrilitet- fever within 37-37,9 ° C.
often identified shell and stem symptoms, dissociation muscle tone and tendon reflexes of the body axis, bilateral pathological signs, etc. is clearly manifested focal symptoms, the character of which is due to the localization of brain injury.;pupillary and oculomotor disturbances, paresis of the extremities, sensory disorders, speech and so on. These symptoms gradually (within 3-5 weeks.) smoothed, but can stay and long.When brain contusion moderate frequently observed fractures vault and skull base, as well as significant subarachnoid hemorrhage.
When computed tomography in most observations detect focal changes in the form of non-compact located in the zone of low density high density of fine inclusions or moderate homogeneous density increase (which corresponds to the small hemorrhages in the area of injury or moderate hemorrhagic impregnation without its rough destruction of brain tissue).The observations of the only low-density areas are identified with a clinical picture of moderate injury on CT scans (local edema) or signs of a brain injury do not rendered.
Severe brain injury
severe contusion of the brain, intracerebral hematoma (accumulation of blood in a limited closed and open injuries of organs and tissues to rupture (wound) of vessels, thereby forming a cavity containing liquid or clotted blood) of both frontal lobes.
severe contusion of the brain characterized by loss of consciousness after a long injury from a few hours to several weeks.Often pronounced motor excitation.There are severe violations of vital functions: arterial hypertension (sometimes hypotension), bradycardia or tachycardia, the frequency of the disorder and the respiratory rhythm, which may be accompanied by impaired patency of the upper airway.Expressed hyperthermia.Often it dominated by primary stem neurological symptoms (floating movement of the eyeballs, paresis gaze, tonicity nystagmus, swallowing disorders, bilateral mydriasis or ptoz- drooping of the upper eyelid, eye divergence in the vertical or horizontal axis, changing the muscle tone, decerebrate rigidity, depression or increased tendonreflexes, reflexes from mucous membranes and skin, bilateral pathological stopnye signs, etc..), which in the first hours and days after the injury obscures focal hemispheric symptoms.Can identify limb paresis (until paralysis), subcortical disorders of muscle tone, reflexes of oral automatism, etc.Sometimes there generalized or focal seizures.Focal symptoms regress slowly;frequent coarse residual effects, especially in the motor and mental health.brain contusion, severe often associated with fractures of the skull base and vault, as well as a massive subarachnoid hemorrhage.
When computed tomography in 1/3 observations revealed focal lesions of the brain in the form of an inhomogeneous density increase.Determined alternating sections having increased (density of fresh blood clots) and reduced density (density edematous and / or smashed brain tissue).In the most severe cases, the destruction of brain substance is distributed in depth, reaching the subcortical nuclei and the ventricular system.Observation of the dynamics shows the gradual decrease in the volume of sealing areas of mergers and transformation into a homogeneous mass already in 8-10 days.The volume effect of pathological substrate regresses slowly, pointing to the existence of non-resorbed in the hearth injury smashed tissue and blood clots, which by this time become ravnoplotnymi in relation to the surrounding edematous brain substance.The disappearance of the volume effect for 30-40 days.after trauma pathological evidence of resorption and formation to the substrate place his zones atrophy (reduced organ mass and volume or tissue, accompanied by a diminution or cessation of their functions) or cystic cavities.
Approximately half of the cases of severe brain injury by computed tomography revealed a significant size increase of the centers of intense homogeneous density with indistinct borders, indicating a significant content in the area of traumatic lesions of the brain and liquid blood clots it.In dynamics there is a gradual and simultaneous decrease over 4-5 weeks.Plot sizes destruction, its density and the volume effect caused by them.
lesions of the posterior fossa structures (PCF) is one of the severe forms of traumatic brain injury (TBI).Their feature is extremely difficult clinical diagnosis and higher mortality.Before the advent of computed tomography mortality in trauma PCF close to 100%.
for clinical lesions PCF structures characteristic of a serious condition that occurs immediately after the injury: depression of consciousness, a combination of cerebral, meningeal, cerebellar, stem symptoms as a result of the rapid compression of the brain stem and liquor circulation disorders.If there is significant damage to the cerebral substance joined hemispheric symptoms.
proximity of damage to the posterior cranial fossa structures likvoroprovodyaschim paths causes their compression and disruption of liquor circulation hematoma small volume.Acute occlusive hydrocephalus - one of the most severe complications of damage to the posterior cranial fossa structures - diagnosed in 40%.
Brain Injury Treatment
compulsory hospitalization !!!Bed rest.
duration bed rest with mild injury is 7-10 days., With an average degree of injury up to 2 weeks.depending on the clinical course and instrumental studies.
In severe traumatic brain injury (crush lesions, diffuse axonal injury) needed resuscitation, which dates back to pre-hospital and continue in the hospital.Art.