Head trauma, the consequences of which can be completely different (up to death), is one of the common causes of disability in middle and young age. About half of all cases are TBI. According to statistics, about 25-30% of all injuries are brain damage. These cases account for more than half of the deaths. Further in the article, a classification of injuries will be presented, a description of some of them will be given.
General information
Traumatic brain injury is called damage to the bones of the skull or soft tissues. The latter, for example, include the meninges, nerves, blood vessels, and others. Head injuries are divided into several groups. Let's take a closer look at some of them.
Injury classification
Damages may be open. In this case, the aponeurosis and skin are injured. The bottom of the wound is a bone or tissues lying deeper. Penetrating trauma is characterized by damage to the dura mater of the brain. As a special case, oliquorrhea can be considered,caused by a fracture of the bones at the base of the skull. Closed head trauma can also occur. In this case, the skin can be damaged, and the aponeurosis retains its integrity. The following groups are also distinguished:
- Concussions. These are head injuries that are not characterized by persistent disturbances in the functioning of the brain. All manifestations of the condition after a while (usually a few days) disappear on their own. With a more persistent persistence of symptoms, there is a more severe head injury with probable brain damage. The main criteria for assessing the condition is the duration of the concussion (from seconds to several hours) and the subsequent depth of the state of amnesia and loss of consciousness. Among non-specific symptoms, it should be noted vomiting, nausea, disturbances in cardiac activity, blanching of the skin.
- Compression of the brain by a focus of contusion, air, foreign body, hematoma.
- Subarachnoid hemorrhage.
- Diffuse axonal lesion.
In practice, quite a lot of combined cases have been registered. For example, compression by a hematoma and contusion, contusion with subarachnoid hemorrhage and compression, diffuse injury and contusion, and others can be combined. Often injuries occur due to facial trauma.
Bruised brain
It occurs against the backdrop of a head injury. A bruise is a violation of the integrity of the substance of the brain in a certain limited area. As a rule, such a region occurs at the point of application of force. However, there are caseswhen a bruise appears on the opposite side (from a counterblow). Against the background of this condition, part of the brain tissue, blood vessels, histological cellular connections are destroyed, followed by the formation of traumatic edema. The area of such lesions is different. Of particular danger is such a head injury in a child.
Mild degree
Such head injuries are characterized by loss of consciousness for a short period - up to several tens of minutes. After its completion, complaints of nausea are typical. The patient also has headaches and dizziness. Vomiting may occur, in some cases repeated. In some cases, moderate bradycardia is observed - a decrease in the frequency of heart contractions to 60 or less per minute. The patient may experience con-, retro- and anterograde amnesia - a memory impairment in the form of a loss of the ability to preserve and reproduce previously acquired knowledge. After a mild head injury, tachycardia is noted (an increase in the heart rate up to 90 bpm). Some patients may develop high blood pressure. At the same time, body temperature and respiration, as a rule, remain unchanged. With regard to neurological symptoms, the manifestations are usually mild. So, the patient may experience weakness, drowsiness, clonic nystagmus (two-phase rhythmic involuntary eye movements). There is also a slight anisocoria, meningeal symptoms, pyramidal insufficiency. These manifestations usually regress 2-3 weeks after the head injury.
Characteristicviolations
Against the background of a bruise, a non-rough damage to the medulla is revealed microscopically. It manifests itself as areas of local swelling, cortical pinpoint bruising, probably in combination with subarachnoid limited hemorrhage. It, in turn, is due to rupture of the pial vessels. Blood with subarachnoid hemorrhage penetrates under the arachnoid membrane and spreads along the basal cisterns, crevices and furrows of the brain. It can be local or fill the entire space with the formation of clumps. The condition develops quite sharply. The patient suddenly feels a "blow to the head", photophobia, vomiting, and a very severe headache quickly appear. Repeated generalized convulsions are likely. Usually the condition is not accompanied by paralysis. However, meningeal symptoms are likely. In particular, stiff neck muscles may be noted (when the head is tilted, it is not possible to touch the sternum with the patient's chin) and Kerning's symptom (it is not possible to unbend the leg bent in it and the hip joint at the knee). In the presence of meningeal symptoms, there is irritation of the meninges by the outflow of blood.
Medium bruise
This head injury is characterized by a longer loss of consciousness (up to several hours). The patient has severe amnesia. The following signs of a head injury are also observed: severe headache, repeated vomiting, mental disorders. Transient disturbances in vital functions are likely. In particular, there may be tachycardiaor bradycardia, increased pressure, tachypnea (shallow rapid breathing without disturbing the rhythm and patency of the ways), subfebrile condition (body temperature rises to 37-37.9 degrees). Stem and sheath symptoms, dissociation of tendon reflexes and muscle tone, and bilateral pathological manifestations are common. Sufficiently clear is the focal symptomatology. Its nature is determined by the localization of the bruise. Oculomotor and pupillary disorders, speech disorders, sensitivity, paresis of the limbs and others are found. These symptoms gradually subside within three to five weeks, as a rule. However, in some cases, the described clinical picture persists for a long time. With a bruise of moderate severity, fractures in the bones of the base and calvarium of the skull, extensive subarachnoid hemorrhage are often found. On CT, focal changes are detected in the form of small high-density inclusions or a homogeneous moderate increase in density. This corresponds to minor hemorrhages in the area of injury or hemorrhagic impregnation of the brain tissue without gross destruction.
Severe head injury
In this case, intracerebral hematomas are noted in both frontal lobes in the form of limited blood accumulations with various injuries with vascular rupture. This forms a cavity that contains clotted or liquid blood. A severe bruise is characterized by a prolonged loss of consciousness (up to several weeks). Often marked motor excitation. Also, there are disorders of vital functions inbody. However, in comparison with the average degree, in severe they are more pronounced. So, for example, there is a disorder of the respiratory function with a violation of the patency of the paths and rhythm. The patient has hyperthermia, dominance of primary stem neurological symptoms. In particular, swallowing disorders, floating eye movements, ptosis or mydriasis, gaze paresis, decerebrate rigidity, nystagmus, increased or inhibited reflexes of mucous membranes, skin, tendons, and so on are detected. Neurological symptoms in the initial period (in the first hours or days) prevail over focal hemispheric manifestations. The patient may experience paresis of the limbs, subcortical disorders of muscle tone, and so on. In some cases, focal or generalized epileptic seizures are likely. Regression of focal manifestations occurs rather slowly. What is the danger of such a head injury? The consequences can be quite serious. There are often pronounced residual effects, mainly in the mental and motor spheres.
CT indicators
In severe trauma, in a third of cases, focal lesions in the brain are noted in the form of heterogeneous areas of increased density. In this case, an alternation of zones is observed. Areas with high and low density are distinguished. In the most severe course of the condition, the destruction of the medulla goes deep and can reach the ventricular system and subcortical nuclei. Observations of the dynamics show a gradual decrease in the volume of compacted areas, their merging and transformationinto a more homogeneous mass. This happens 8 or 10 days after the incident. The regression of the volumetric effect of the pathological substrate is slower, which indicates the presence of unresolved clots and crushed tissue in the contusion focus. By this time, they become equal in density relative to the surrounding edematous medulla. Disappearance after 30-40 days. volume effect indicates the resorption of the substrate and the formation instead of areas of atrophy or cystic cavities.
Damage to the structures of the posterior cranial fossa
This lesion is considered the most severe of all head injuries. The condition is characterized by the following symptoms: depression of consciousness and a combination of stem, cerebellar, meningeal and cerebral symptoms caused by rapid compression and impaired CSF circulation.
Therapeutic measures for injury
Regardless of the extent of the injury, the patient must receive medical attention. In case of a head injury, the victim must be transported to the hospital as soon as possible. X-ray and CT are indicated for an accurate diagnosis. The patient needs bed rest. Its duration with a mild degree is 7-10 days, with an average degree - up to 14 days. In case of severe TBI, resuscitation measures must be taken. They begin in the prehospital period and continue in stationary conditions. To normalize breathing, it is necessary to ensure free patency in the upper respiratory tract - they are freed from mucus, blood, and vomit. The air duct is inserteda tracheostomy is performed (dissection of the tissues of the trachea and installation of a cannula or the formation of a permanent opening - a stoma). Inhalation using an oxygen-air mixture is also used. If necessary, apply mechanical ventilation.
Concussion Therapy
If it is determined that the patient has a head injury, treatment should be carried out in a neurosurgical hospital. With a concussion, a five-day bed rest is indicated. In the absence of complications, the patient can be discharged for 7-10 days. At the same time, he is prescribed outpatient treatment, the duration of which is up to 14 days. Drug therapy for concussion is aimed at stabilizing the functional state of the brain, eliminating pain, insomnia, and anxiety. As a rule, the range of prescribed medications includes sleeping pills, sedatives and painkillers. As analgesics, drugs such as "Baralgin", "Pentalgin", Maksigan", "Sedalgin" and others are used. In case of dizziness, the remedy "Cerukal" can be prescribed. Sedative drugs include such medicines as "Valocordin", "Corvalol" and others containing phenobarbital. Use herbal infusions (motherwort, valerian).
Tranquilizers are also recommended. These, for example, include such funds as Rudotel, Nozepam, Phenazepam, Sibazon, Elenium and others. In addition to symptomatic therapy, course metabolic and vascular treatment is prescribed. It promotes faster andfull restoration of impaired brain functions, prevents various postconcussion symptoms. The appointment of cerebrotropic and vasotropic therapy is allowed 5-7 days after the injury. It is advisable to combine nootropic (drugs "Pikamilon", "Aminolone" and others) and vasotropic (drugs "Teonikol", Stugeron, "Cavinton") means. To overcome asthenic manifestations, patients are prescribed vitamin complexes: "Centrum", "Complivit", " Vitrum "and others. Tonics are recommended: lemongrass fruit, eleutherococcus extract, ginseng root. It should be said that no organic lesions appear during concussion. If any changes are found on MRI or CT, then we should talk about a more serious injury – bruised brain.
Surgery
Mechanical injuries require surgical intervention. The operation is indicated in case of a bruise with crushing of the brain tissue. As a rule, such mechanical injuries occur in the area of the poles of the temporal and frontal lobes. Osteoplastic trepanation acts as a surgical manipulation. The operation consists in making a hole in the bone to penetrate into the cavity and wash out the detritus with a solution of sodium chloride (0.9%).
Forecast
With a mild degree of damage, as a rule, the outcome is quite favorable (if the patient follows the recommendations regarding the regimen and therapy). In a moderate condition, it is often possible to achieve absoluterecovery and restoration of social and labor activity of the victims. Some patients may experience hydrocephalus and leptomeningitis, which provoke asthenia, vegetative vascular dysfunction, pain, coordination disorders, statics and other neurological symptoms. Against the background of a severe injury, death occurs in 30-50% of cases. Among surviving patients, disability is very common, the main causes of which are mental disorders, gross speech and movement disorders, and epileptic seizures. With open head injuries, inflammatory complications are likely. In particular, there is a high risk of developing brain abscesses, ventriculitis, encephalitis, and meningitis. Liquorrhea is also likely, which is the outflow of liquor (cerebrospinal fluid) from natural holes or formed due to various factors in the bones of the spine and skull. Half of TBI deaths are from road accidents.
