In the article we will consider the severity of a concussion injury. This disease is one of the types of closed craniocerebral injury. This is mainly an easily reversible defect in the functions of the brain, which occurs due to a blow, bruise or sudden movement of the head. It is accepted that because of this, interneuronal connections are temporarily disrupted.
What are the degrees of concussion, it is interesting to many.
Description
As a result of the contact of the substance of the brain with the cranial bones, as a rule, the following happens:
- change in a number of chemical or physical features of neurons, which can change the spatial organization of protein molecules;
- substance of the brain of the head as a whole lends itself to pathological influence;
- temporal decoupling of signaling and relationshipsbetween synapses (a synapse is a place of contact between two neurons or a neuron and an effector cell that receives a signal) of cellular neurons and parts of the brain. This contributes to the appearance of functional defects.
Degrees of concussion
Depending on how severe the patient's condition is and what clinical signs are observed, three degrees of the disease are distinguished:
- Mild concussion. Consciousness is not disturbed. The victim may experience dizziness, disorientation, nausea, headache during the first twenty minutes after the injury. Symptoms of a mild concussion pass quickly. Then the general state of he alth is normalized. The temperature may briefly rise (up to 38 degrees).
- Medium concussion. There is no loss of consciousness, but there are pathological signs such as nausea, headache, disorientation, dizziness. All of them last more than twenty minutes. Also, with moderate concussion, amnesia (short-term memory loss) may be noted. Has a predominantly retrograde character with loss of a few minutes of memory just before the injury.
- Severe concussion is very dangerous. There is necessarily a loss of consciousness for a short time period, usually from several minutes to several hours. In this case, the patient does not remember what happened to him - retrograde amnesia occurs. A person within one to two weeks after a concussionGrade 3 brain is disturbed by pathological symptoms: nausea, disorientation, headache, sleep and appetite defects, dizziness, fatigue.
Signs and symptoms
A concussion is characterized by the following symptoms:
- Consciousness is oppressed immediately after contact with a traumatic force. And this is not necessarily a loss of consciousness, it may be a stupor (stunning), a kind of incomplete consciousness. The defect of consciousness is short-term, lasting from a few seconds to several minutes. This interval most often reaches five minutes. If the victim is alone at this time, he will not even be able to say that he was losing consciousness, because he simply does not remember it.
- Amnesia (memory defect) for the events that preceded the concussion, the concussion itself and a short time period after it. However, memory is restored quickly.
- Single vomiting after injury. Vomiting is of cerebral origin, most often does not recur and is used as a clinical way to distinguish between concussion and mild bruising.
- Slower or faster heart rate, higher blood pressure some time after injury. These changes usually resolve on their own and do not require medical treatment.
- Immediately after a concussion, breathing quickens. It normalizes earlier than the indicators of the system of the heart and blood vessels, so this sign may go unnoticed.
- Does not changebody temperature (lack of changes is also a differential diagnostic criterion for head brain contusion).
- Specific "game of vasomotors". This is a condition in which the pallor of the skin of the face changes to redness. It occurs due to a violation of the tone of the nervous autonomic system.
When consciousness is fully restored, the following signs appear:
- headache (it can be felt both at the site of injury and in the head as a whole, has a different character);
- tinnitus;
- sweating (wet feet and hands all the time);
- dizziness;
- flashing of blood to the face, accompanied by a feeling of heat;
- general malaise and weakness;
- sleep disorders;
- decrease in concentration, accelerated physical and mental fatigue;
- staggering while walking;
- high sensitivity to bright light and loud sounds.
Disorders of the neurological type, especially with severe concussion, are observed as follows:
- pain when moving to the sides of the eyeballs, inability to move the eyes to the extreme position;
- in the first hours after the injury, a slight narrowing or dilation of the pupils may be detected, while their reaction to light is normal;
- slight asymmetry of skin and tendon reflexes, they differ when called on the right and left. Moreover, such a sign is quite labile, for example, during the initial examination, the left knee jerksomewhat livelier than the right one, upon re-examination literally a few hours later, both knee jerks are identical, however, there is a difference in the Achilles reflexes;
- horizontal fine nystagmus (tremulous involuntary movements) in the most extreme positions of abduction of the apples of the eyes;
- unsteadiness of the patient in the Romberg position (straight arms stretched forward to a horizontal level, legs together, eyes closed);
- there may be a slight tension in the muscles of the back of the head, which disappears for three days.
A significant diagnostic criterion for mild concussion is that the symptoms are reversible (except subjective). All neurological signs disappear within a week. Asthenic complaints of dizziness, poor memory, headache, weakness, fatigue are not included in this account, as they may persist for some time.
It should also be noted that a concussion of the head is never accompanied by fractures of the cranial bones, even if it is a small crack. If there is a fracture of the bones, the diagnosis in any case is at least a mild degree of brain contusion.
How is the severity of harm to he alth detected in a concussion?
Diagnosis of pathology
This diagnosis is almost entirely clinical, since clinical signs become the main criteria for making a diagnosis. It is quite difficult to recognize the disease in cases where there are no witnesses to what happened, since most of the complaints in this condition are subjective in nature, the patient himself is not alwaysremembers the change of consciousness. In this case, external head injuries come to the rescue.
The degree of concussion in adults is established on the basis of anamnesis data on the time of loss of consciousness and trauma, patient complaints, results of neurological examination and instrumental examinations. In the immediate period after the injury in the neurological status, unstable and slight asymmetry of reflexes, small-scale nystagmus are observed, in young victims - Marinescu-Radovich syndrome (muscular homolateral contraction of the chin against the background of irritation of the elevation of the thumb), sometimes - mild meningeal (shell) symptoms. Since more serious brain disorders can be hidden under a concussion, great importance is given to observing a person in dynamics. With a correctly diagnosed diagnosis, the abnormalities established during the examination by a neurologist disappear 3-7 days after the incident.
Diagnosis in children and the elderly
Especial attention should be paid to diagnosing concussion in infants and young children, as it often resolves without impairment of consciousness:
- skin turns pale at the time of injury (primarily of the face), heart rate increases, after which drowsiness and lethargy appear;
- in infants, vomiting and regurgitation occur during feeding, sleep disturbance and anxiety are noted; all manifestations disappear after 2-3 days;
- preschoolers are most likely tothe concussion resolves without loss of consciousness and generally improves within 2-3 days.
In older patients, the initial loss of consciousness during a concussion is much less common than in middle-aged and young people. At the same time, quite often there is a pronounced disorientation in time and space. Headaches often have a pulsating character and are localized in the occipital region. Such violations are observed from three to seven days, they are distinguished by a strong intensity in patients who suffer from hypertension. In this case, patients should be given special attention during the examination.
In case of concussion, additional diagnostic methods are carried out for differential diagnosis in order to confirm the functionality of the changes in the brain of the head. In any more severe traumatic brain injury, structural abnormalities are found in the brain, but this does not happen with a concussion.
For example, if a patient has tension in the muscles of the back of the head, which is a symptom of irritation of the meninges, it becomes necessary to confirm the absence of subarachnoid hemorrhage. For this purpose, a lumbar puncture is performed. With a concussion of the brain, the results of the analysis of the obtained cerebrospinal fluid do not differ from normal values, which makes it possible to exclude such a diagnosis as subarachnoid hemorrhage (if any, blood impurities are found in the cerebrospinal fluid).
Computertomography as the main research method for traumatic brain injuries, as well as for concussion of the brain, does not reveal pathological changes, due to which the correctness of the diagnosis is confirmed. By analogy, neither echoencephalography nor MRI can detect abnormalities if a person has a concussion.
The next retrospective confirmation of the correct diagnosis is the disappearance of neurological symptoms within a week after the injury to the victim. With a mild degree of concussion, they disappear almost immediately.
First aid to the victim
If the victim is unconscious, you should immediately call an ambulance. The unconscious patient should be placed on the right side on a hard surface with elbows and legs bent. Tilt your head up, turn to the ground - this position allows you to provide excellent airflow through the respiratory tract, prevents aspiration, that is, the ingress of foreign substances into the respiratory tract during inhalation, fluid during vomiting.
If a person is bleeding from a head wound, a bandage should be applied to stop it. If the victim regained consciousness or did not faint at all, he should be laid horizontally, raise his head, monitor consciousness all the time and keep him awake.
Not everyone knows the severity of a concussion. It is important to remember that all patients with a head injury, regardless of their state of he alth and severity, must be taken to a trauma center. Traumatologistwill decide whether they can be under outpatient observation with a neurologist, or whether hospitalization in a neurological department is required for the purpose of monitoring and diagnosing the condition.
It should also be noted that if the victim loses consciousness and it is impossible to independently determine the severity, it is recommended not to touch it at all, not to try to turn it over again or turn it over. If there are factors that threaten human life, for example, bulk substances, liquids, small objects that can enter the respiratory tract, they must be eliminated.
Drug therapy
In case of 1st and 2nd degree concussion, drug treatment should be gentle. It is mainly necessary to prescribe symptomatic drugs to the patient:
- painkillers to eliminate headaches (combined drugs such as Solpadein, Pentalgin, anti-inflammatory nonsteroidal drugs);
- drugs to relieve dizziness ("Platifillin" with "Papaverine", "Vestibo", "Betaserc");
- sedatives (to calm the nervous system), their range is quite wide, depending on the individual need in each case: from plant extracts to tranquilizers;
- for insomnia - sleeping pills;
- general strengthening drugs (antioxidants, vitamins, tonics).
Metabolic maintenance of the brain is carried out through neuroprotectors. These include a large group of medicinaldrugs. For example, it can be Nootropil (Piracetam), Pantogam, Encephabol, Glycine, Picamilon, Actovegin, etc.
The patient, on average, will have to spend about a week in a hospital, and then he is discharged and treated on an outpatient basis. In addition to symptomatic drugs, drugs are prescribed at this time that improve the blood supply to the brain of the head (Nicergoline, Trental, Cavinton, etc.).
Some patients will need a month of drug treatment for absolute recovery, others three months. But in any case, if all the points listed above are observed, recovery occurs.
Within a year after the concussion occurred, you need to periodically be examined by a neurologist who will conduct dispensary monitoring of the patient.
Is it possible to receive outpatient treatment for different degrees of severity of concussion?
Outpatient care
Despite the fact that a concussion is classified as a mild traumatic brain injury, it requires mandatory treatment in an inpatient setting. This is due to the unpredictability of the course of the post-traumatic period, since there are situations when a patient has subarachnoid hemorrhage or intracranial hematoma against the background of concussion symptoms (of course, this happens rarely, but possible). When a patient is on outpatient treatment, he may not notice the first signs of a deterioration in his condition, which is fraught with a risk not only for he alth, but also for life. stayingin a hospital, he will be provided with qualified medical assistance throughout the entire period of treatment.
After a Concussion: Treatment at Home
The most important thing in the treatment of concussion of the head is to adhere to bed rest, prevent mental and physical stress, especially in the early days, good rest and sleep. If the patient follows all the doctor's recommendations and starts treatment on time, a concussion almost always ends in an absolute recovery, his ability to work resumes.
Some victims may still have residual effects of the injury over time. Among them - a decrease in concentration, high fatigue, irritability, depressive disorders, headaches, memory impairment, sleep disorders, migraine. As a rule, all these symptoms soften after a year, but it happens when they bother the victim all his life.
Within a month after receiving a concussion, it is undesirable to do hard physical work, you need to limit sports activities. Violation of bed rest is strictly prohibited, it is best to refuse to be at the computer, watch TV and read books for a long time. It is recommended to listen to calm music and do not use headphones.
The prognosis depends on the severity of damage to he alth during a concussion.
Forecast
In 97% of all concussion situations, a personrecovers completely, without any consequences. The remaining three percent of cases are characterized by the development of postconcussion syndrome, which consists in various asthenic manifestations (impaired concentration, memory, increased anxiety and irritability, poor tolerance to various loads, dizziness, recurrent headaches, disturbances in appetite and sleep, etc.).
According to statistics, there used to be a much higher percentage of negative consequences of a concussion. Most likely, this is due to the fact that there was no computed tomography, some mild brain injuries of the head were defined as concussions. A bruise always damages the brain tissue, so it has consequences more often than functional changes.
We looked at the severity of concussion injury.
