Concussion in adults and children is an injury caused by the impact of the brain on the inside of the skull. As a result, there is a violation of brain functions that do not pose a threat to human life. The disease refers to mild types of traumatic brain injury.
Features of the disease
During a concussion, the processes of nerve cells are stretched, and the vessels are not damaged. The disease is diagnosed in 80% of cases of all traumatic brain injuries. How the disease progresses has not been reliably determined. Experts are absolutely sure that brain cells rarely receive significant damage, the structure of the brain does not change, but the functionality of the organ is impaired. What factor causes violations, it turns out.
Today, there are several versions of what happens as a result of injury:
- Violation of neural connections.
- Disturbance in brain tissue molecules.
- Short-term vasospasm.
- Violation of connections between brain structures.
- The chemical composition of the paracerebral fluid undergoes changes.
According to statistics, more than 400,000 Russian citizens are annually hospitalized with a concussion. About half of all cases are domestic injuries. Children and adolescents between the ages of 8 and 18 are most susceptible to this type of injury.
Treatment of a concussion takes 1 to 2 weeks, provided timely medical measures are taken. In the absence of treatment, complications arise, for example, the probability of instant death increases by 7 times, the risk of alcoholism increases by 2 times.
Extremes of early diagnosis
Establishing a diagnosis, especially at the first stage, is difficult. Often there is either an overestimation of the severity (overdiagnosis) or an underestimation of the dangers of the injury (underdiagnosis).
Overdiagnosis is often the result of the patient's suspiciousness, simulation of syndromes in the absence of a specialist in the staff of a medical institution - a neuropathologist, diagnostic tools, objective criteria for testing the patient.
Underdiagnosis occurs when a patient is hospitalized in departments not related to neurotrauma for completely different reasons. In addition, some patients enter the clinic in an inadequate state of alcoholic intoxication and cannot interpret their condition. According to statistics, the misdiagnosis of concussion is about half of all cases.
Difficulties with diagnosis are due to the fact that the injury is diffusecharacter, no structural changes are observed, the tissues retain their integrity. Interneuronal connections are broken in cells, molecules and are temporary.
Reasons
A concussion is always caused by trauma, and you don't have to hit your head to get it. It is enough to slip and fall, without touching the ground or any objects with the head when falling, so that the consciousness becomes clouded. The patient often cannot remember what happened and where the fall happened. This situation happens many times in winter.
No less frequent are intracranial injuries during a sharp start and braking of a car, in an accident. Fighting is the most common cause of brain damage, when opponents injure each other in fisticuffs or with the use of additional weapons. Occupational, domestic, sports injuries are not uncommon. During adolescence, the possibility of getting a concussion is especially high.
To get a head injury, a child does not have to participate in a fight, sometimes innocent brawls are enough in which the student receives a slight blow to the head with a textbook or slides down the railing of the stairs, followed by an unsuccessful landing. Most often, pranks do without consequences, but parents need to pay attention to the child's condition and, with the slightest deviation (headache, nausea, dizziness, memory lapses, etc.), contact a neurologist.
Concussion symptoms
Only a specialist can detect a concussion with complete certainty. signsappear gradually, as we move away from the fact of receiving a TBI.
Symptoms immediately after injury:
- Stupor - confusion, tightness and tension in the muscles of the body. At this point, emotions and motor activity are inhibited due to the failure of nerve impulses.
- Loss of consciousness - there is no reaction to any stimuli, the process takes from several seconds to hours. The reaction is due to a lack of oxygen resulting from circulatory disorders.
- Vomiting - single or multiple (violations of the vestibular apparatus).
- Nausea is the result of irritation of the medulla oblongata, where the vomiting center is located.
- Dizziness is a violation of the reactions of the vestibular apparatus.
- Failures of the heart - quickening / slowing down of beats (increased intracranial pressure, compression of the cerebellum and vagus nerve).
- A sharp change in complexion pallor / redness - malfunctions of the autonomic nervous system.
- Headache at the site of injury with further spread - irritation of the receptors of the cerebral cortex, increased intracranial pressure.
- Noise, ringing or hissing in the ears - increased intracranial pressure, malfunctions and irritation in the hearing aid.
- Pain when moving the eyes is a consequence of increased intracranial pressure.
- Disturbance of coordination of movements - disturbances in the functioning of the vestibular apparatus and in the transmission of nerve impulses.
- Sweating is an overexcitation of the sympathetic nervous system.
Signs of concussionbrain several hours after TBI:
- Symmetrical pupillary constriction / dilation - tested by a specialist. With an incorrect reaction to a series of tests, a failure of the ANS is diagnosed as a result of increased intracranial pressure.
- Eye trembling when looking away indicates damage to the vestibular apparatus, inner ear, cerebellum.
- Asymmetric tendon reflex responses (a hammer blow to the joint of the legs or arms should show the same flexion response on the right and left side of the body).
Remote signs of concussion (after a few days):
- Photophobia, a painful reaction to sounds - a consequence of disturbances in the functioning of the nervous system. The usual intensity of light and sounds are perceived hypertrophied.
- Irritability, nervousness, depression - symptoms are manifested due to disruption of connections between nerve endings in the cerebral cortex.
- Sleep disorders - caused by stress and impaired blood circulation in the brain.
- Memory loss - as a result of stress, events before and after the traumatic situation are not recorded in long-term memory.
- Distracted attention - the inability to concentrate due to impaired connections between the cortex and subcortex of the brain.
Degrees
Treatment of a concussion is based on the diagnosis and classification of the resulting injuries. In modern medicine, some experts believe that any head injury can lead to unpredictable consequences andthe division of the disease according to severity does not make sense.
The second part of the doctors is sure that patients receive various injuries - someone spends a little time in a hospital bed with nausea and headaches, and some patients lose consciousness for a long time, feel unsatisfactory for several months. Due to the difference in complications and the course of the disease, a system for assessing the severity of the injury was adopted.
Degrees of concussion:
- Mild (I degree) - is given to the patient in the absence of loss of consciousness, memory. The initial symptoms of TBI last no more than 15 minutes (lethargy, headache, vomiting and nausea).
- Medium (II degree) - short-term amnesia without loss of consciousness. Primary symptoms persist for up to several hours (nausea, vomiting, sudden changes in complexion, pulse disturbances, headache, inhibition of reactions).
- Severe (III degree) - put in case of loss of consciousness up to 6 hours with accompanying primary symptoms (any).
Diagnosis
What to do with a concussion? First of all, fix the symptoms, if the victim himself cannot do it, then close people or those on whom he can rely do it. If there is at least one sign, you should contact a traumatologist or neurologist (preferably). The specialist considers a number of criteria in diagnosing the disease and can distinguish concussion from other brain pathologies.
Status score:
- X-ray diagnostics demonstrate the integrity of the cranium.
- The brain is intact (no hematomas, hemorrhages).
- Cerebrospinal fluid unchanged.
- MRI scan showed no damage (gray and white matter density normal, brain tissue intact, swelling progressive).
- Patient shows retrograde amnesia, indicative of a concussion. Symptoms: There is no memory of events that happened before the onset of the traumatic event.
- Confusion, patient is either lethargic or hyperactive.
- There was a loss of consciousness from a few seconds to half an hour, while the patient does not know anything about it.
- Violations of the ANS appear - jumps in pressure, pulse, change in complexion.
- Neurological manifestations - asymmetric location of the corners of the mouth with a normal facial expression and with a smile (grin), there is a violation of skin reflexes.
- Gurevich test - the patient loses balance and falls on his back when looking up or forward when looking down.
- Romberg's symptom - the patient closes his eyes and stands straight with his arms outstretched in front of him. Symptoms indicate a concussion: trembling of the fingers, eyelids, balance is extremely difficult to maintain, the patient tends to fall.
- Profuse perspiration through palms and feet.
- Horizontal eyeball twitching.
- Palmar-chin reflex - the patient strokes the palm in the area of the thumb in a stroke-like manner. Reflex twitches during concussionchin. The reflex is especially pronounced 3 days after the injury and is possible up to 14 days after TBI.
The doctor may prescribe diagnostics using additional methods: EEG, CT, ECHO, dopplerography of the vessels of the head, puncture of the cerebrospinal fluid.
Childhood trauma
Concussion in children has the same manifestations as in adults, but the young body copes with this problem faster. In most cases, children of preschool and school age do not lose consciousness when they are injured. Symptoms occur in a change in complexion and skin, tachycardia, rapid breathing, headache, concentrated at the site of injury. The acute phase period does not exceed 10 days.
Concussion in children under one year is manifested by regurgitation, sometimes vomiting, at the time of feeding. The rest of the time, anxiety, lack of sleep, crying when changing the position of the body or head may appear. Sometimes the size of the fontanel increases. Due to the poor development of the brain, the disease at this age is without consequences and does not require much effort in therapy.
Treatment of concussion in children is carried out according to the same scheme as for adults. Drug treatment is prescribed (nootropic, sedative, antihistamines, vitamin complexes, etc.). The patient is assigned rest for the recovery period.
The consequences of injury
According to medical observations, no more than 3-5% of patients with concussion have long-term complications after injury. The basis for the occurrence of consequences is the already existing pathologies of the nervous system, as well as non-compliance with the recommendations of the doctor. Complications are divided into two groups - early and late reactions of the body.
What are the consequences of a concussion a few days after receiving a TBI:
- For 10 days after the injury, the cells continue to break down, tissue swelling gradually increases.
- Post-traumatic epilepsy may develop within 24 hours.
- Encephalitis, meningitis is an extremely rare manifestation caused by purulent or serous inflammation of the brain.
- Post Traumatic Syndrome - headaches, depression, insomnia, photophobia, etc.
Delayed effects (1 to 30 years):
- Emotional instability - bouts of hyperactivity, depression, aggressiveness for no apparent reason.
- VSD - disturbances in heart contractions, lack of blood circulation.
- Intellectual disorders - impaired memory and concentration, changes in thinking and reaction to events. A person can change completely or get dementia.
- Headaches are a consequence of circulatory disorders in the brain, changes in the vessels of the neck.
- Vestibulopathy - changes in the functioning of the vestibular apparatus due to an injury.
What to do in case of a concussion and its consequences? Contact a specialist and do not waste energy on self-treatment. Patients often report complicationsafter a trauma, as a problem with the worldview, and they turn to a psychotherapist for advice, but in this case there will be no result. To exclude physiological causes, it is worth undergoing a diagnosis by a neurologist and after the verdict of this specialist, decide whether it is necessary to consult other doctors.
Therapy
First aid for concussion is provided in the emergency room. The next stage is hospitalization in specialized departments of the hospital (neurology, neurosurgery). During the first 3-5 days, the patient is recommended strict bed rest and drug therapy. During this period, the doctor monitors the patient's condition. The goal of therapy is to remove the patient from stress, improve brain function, and relieve pain.
Drug groups and drugs for concussion:
- Painkillers - Pentalgin, Sedalgin, Analgin, etc.
- Soothing herbal - tincture of valerian, motherwort, peony, etc.
- Tranquilizers - Phenazepam, Elenium, etc.
- From dizziness - "Mikrozer", "Betaserk", "Bellaspon", etc.
- From insomnia - Reladorm, Phenobarbital, etc.
- Stabilizing - vitamin-mineral complexes.
- Normalization of blood circulation - vasotropic and nootropic drugs.
- Improve tone - herbal tonics (eleutherococcus, ginseng), medications ("Saparal", "Pantokrin").
What to drink with a concussion - a doctor prescribes, self-medication cancause irreparable harm. Stabilization of the condition occurs on the 7-10th day after TBI. With normal indicators, the specialist discharges the patient from the hospital. Treatment continues for 1 to 3 months, depending on the reactions of the body. With the same degree of damage, two people go through the recovery phase at different times. The patient needs to be monitored by a therapist and a neurologist for a year. A preventive visit to the doctor is recommended once every three months.
After discharge
Increased care and compliance with certain rules of conduct is required of people diagnosed with a concussion. Treatment at home at the first stage is possible only with a mild degree of TBI. The specialist will give recommendations that must be strictly followed. No less important is the period of the patient's stay at home after discharge from the hospital.
It is recommended to avoid stressful situations, take medicines according to the scheme prescribed by the doctor, adhere to the sleep and rest regimen. Nutrition should be balanced, supplemented with vitamins and minerals. Vitamins A, E, group B, folic acid bring great benefits. They stimulate the regeneration of brain cells.
It is also important to take vitamin C, it is indicated for the prevention of hemorrhages, the speedy healing of injuries and wounds, increasing immunity and general well-being after a concussion. Treatment at home involves a number of restrictions - the rejection of tea, coffee, alcohol, heavy fatty foods, foods and dishes withpreservatives and artificial colors, semi-finished products are excluded.
For a patient with a traumatic brain injury, a thorough diagnosis is important to determine the disease. Often concussion during examination reveals more severe pathologies.
