Contusion of the brain - Causes, symptoms and treatment. MF.
A brain contusion is a craniocerebral injury with damage to the structure of the brain.
Classification of craniocerebral trauma:
• concussion of the brain - 80 - 90%;
• brain contusion - 5 - 12%;
• compression of the brain - 3 - 5%.
Symptoms of craniocerebral trauma
Trauma can be obtained as a result of an accident, injuries at work and at home, with beatings and beatings, falling from a height, often when falling from balconies and windows during intoxication, during an epileptic seizure, at diving, falling of heavy objects on the head, at blockages in mines, caves, military operations.
Damage to the brain in the fracture of the bones of the skull arch .
As a result of the trauma, there is a violation of higher nervous activity, which is manifested by cerebral and focal symptoms. The brain contusion can develop at the site of the impact and in the zone opposite to the impact( when striking against the skull) - a shock. The brain cells, vessels and their interconnections are damaged, the products of decomposition of the affected cells and hemoglobin of the blood act toxic on the brain. In severe cases, the brain substance is crushed. The most serious damage is the diffuse axonal brain damage that occurs when the head moves rapidly, when the brain is given a rotational motion. In this case axons of the cranial nerves break out of the brain or axon breaks occur in the white substance, numerous fine-focal hemorrhages are revealed in the brain material. The patient falls into a deep coma, the lethality of this condition is 90%.Often this happens with traffic accidents, falling from a height or with a strong blow to the chin.
Brain Injury Symptoms
Craniocerebral trauma can be open with a violation of the integrity of the skin and bones and closed, in which the integrity of the skin is preserved, the skull bones may have integrity disorders, or may not have, and brain functions are violated. With fractures of the base of the skull, it is possible to develop a liquorrhea - leakage of the cerebrospinal fluid from the ears and nose and bleeding from the ear. This is a very serious sign of severe head injury.
Bleeding from the ear with a bruised brain and fracture of the base of the skull.
Brain contusion can have mild, moderate severity and severe course.
The slight severity of a brain injury is characterized by loss of consciousness from a few minutes to an hour, retrograde amnesia( loss of memory for events preceding trauma, injury itself and some period after trauma), vomiting, hyperthermia, cardiovascular system disorders - increased blood pressure, rapidity or slowing of the pulse, lack of appetite, sleep disturbance, dizziness, staggering. Life functions are not violated. Upon examination, a neurosurgeon or neurologist will detect diffuse neurologic symptoms - nystagmus, possibly anizocaria, pyramidal insufficiency, possible meningeal signs.
There may be fractures of the skull and subarachnoid hemorrhages.
With lumbar puncture, liquor pressure is increased.
The regression of neurologic symptoms occurs within 2 to 3 weeks - up to 2 months.
The average severity of the brain contusion is characterized by the disconnection of consciousness from several tens of minutes to 4-6 hours, expressed by retrograde amnesia, headache, repeated vomiting, mental disorders, disruption of vital functions - bradycardia up to 45 per minute, tachycardia up to 120 vminute, increased arterial pressure to 180., tachypnea( rapid breathing) to 30 per minute without disturbance of the tracheobronchial tree patency, meningeal symptoms. The neurologist will see meningeal signs, changes in muscle tone, the difference of tendon reflexes, pathological pyramidal signs, focal symptoms pointing to the place of damage - oculomotor disorders - restriction of eyeball movements, convergence, strabismus, doubling, ptosis, paresis of limbs.
With lumbar puncture, liquor pressure is increased. With subarachnoid hemorrhage, the blood in the cerebrospinal fluid.
Symptom recurrence occurs within 4 to 5 weeks to 2 months.
With lumbar puncture, pressure is significantly increased. With subarachnoid hemorrhage, the blood in the cerebrospinal fluid.
With computer tomography and magnetic resonance tomography, the hypotensive focus of brain contusion, signs of cerebral edema, small foci of hemorrhages are determined. There may be fractures of the bones of the arch and the base of the skull, subarachnoid hemorrhages.
Divergent strabismus in severe craniocerebral trauma.
Survey
When getting a head injury, even insignificant in your opinion, you need to see a doctor to exclude head injury or timely treatment in the presence of brain trauma. If you lose consciousness as a result of an injury, you need to call an ambulance. The necessary examinations will be X-ray examination - from the x-ray of the skull and cervical spine to computed tomography( depending on the detected neurologic symptoms), the examination of the oculist, electroencephalography, examination of the neurosurgeon, lumbar puncture - may be repeated. When diagnosing a brain contusion, 100% hospitalization in a specialized neurosurgical department is necessary. Bed rest from 7 days to 2 weeks, depending on the severity of the brain contusion. In case of severe brain contusion, resuscitative measures are necessary, with brain contusion with crushing of brain matter or with expressed brain edema, neurosurgical surgical treatment is indicated - osteoplastic trepanation, application of milling holes.
On the tomogram, the hematoma that squeezes the brain substance
is seen. Treatment of brain contusion
Treatment is prescribed depending on the degree of severity and the clinic of the disease. Neuroprotectors are used - cerebrolysin, somazine, ceraxone, cortexin, semax, antioxidants - solcoseryl, actovegin, mildronate, vitamin E, mexidol, venotonic drugs - L-lysine escinate, vascular drugs for improving microcirculation - cavinton, sermion, trental, dehydration, sedatives, B vitamins, antibiotics. In severe cases, caring care is important to prevent the possible formation of bedsores and the development of hypostatic pneumonia. With open trauma, it is possible to join the infection and develop meningitis, encephalitis, which greatly complicates the course of the trauma and worsens the prognosis.
Consequences of brain contusion
Periods of craniocerebral trauma:
- acute - 2 to 3 weeks - until function stabilizes;
- subacute - 2( with minor injury) - 4( with moderate severity of injury) - 6( with severe brain contusion) months;
- long-term consequences - over 6 months - indefinitely - vegetative-vascular symptoms( dystonia), astheno-neurotic, liquorodynamic, epileptic, psycho-organic syndromes, disorders of eyeball movements, strabismus and diplopia, paresis and paralysis of the extremities, defects of the skull bones, posttraumatic cysts of the brain, posttraumatic encephalopathy 1 - 2 - 3 degrees with various symptoms.
Often there is a complete restoration of the functions, ability to work of the victim. In case of severe craniocerebral injuries, lethality is 30-50%.After severe injuries, disability can occur due to mental changes - cognitive impairment( intellectual), development of epileptic seizures, the presence of defects in the bones of the skull, persistent disorders of liquorodynamics, paresis of the limbs, and visual impairment. Patients are referred to the neuro-ophthalmologic MSEC, which determines% of disability or disability.
The traumatic brain injury is seen in a neurologist, taking course medication - mainly neuroprotectors( the evidence base for neuroprotective effectiveness is cerebrolysin, glycine), vitamins, vascular drugs, venotonic drugs, sedatives, and electroencephalography is being made in dynamics. If necessary, doctors - psychiatrist, ENT, oculist participate in treatment. Spa treatment in cold season, psychotherapy, acupuncture, aromatherapy is shown.
Consultation of a doctor on the brain contusion
Question: Is hospitalization necessary for a fracture of the skull bones, if the state of health does not suffer?
Answer: hospitalization in the neurosurgical department is compulsory. Ambulatory can be treated only with a concussion of the brain with an easy type of flow.
Question: before the discharge after a brain injury without a skull fracture, I was assigned a second examination - a computer tomograph. What for?
Answer: To determine the outcome of a brain injury, a complete restoration or a liquor cyst was formed( determine its size, location, presence of intracranial hypertension) or there were cystic and gliotic changes with the development of arachnoiditis. This is necessary to address issues of work capacity, further rehabilitation.
Doctor of neurologist of the highest category Kobzeva Svetlana Valentinovna