Contusion (contusion) of the brain is traumatic damage to the structures related to the brain that occurs when the mechanical force is applied. Any part of the brain can be affected, but most often these are the poles of the frontal lobes, the basal (lower) sections of the frontal and temporal lobes. The clinical picture of a brain contusion is formed from a combination of cerebral, focal and vegetative symptoms. The degree of their severity and stamina depends on the severity of the bruise of the brain.
Treatment of this condition must necessarily be complex and performed exclusively in a hospital. Cerebral contusion is a disease that can not leave after itself any consequences, but can make a person disabled for the rest of his life. In this article we will try to understand the types of brain contusion and their corresponding symptoms, get acquainted with the methods of treatment and find out what consequences this injury.
A brain contusion is a kind of craniocerebral trauma, at which structural damage oc
A bruise of the brain can occur with any mechanical trauma. Most often these are road and domestic injuries. Injury can be inflicted to a person himself when falling as a result, for example, of an epileptic attack.
How is the contusion of the brain formed? In the place of action of mechanical force, a zone of impact with increased pressure is formed. In this zone, primary lesions of nerve cells, their processes, blood vessels arise. On the opposite side of the impact there is a zone of shock, characterized by a low pressure, where also there are destructive processes. Moreover, in the zone of an anti-shock, the defeat can be even more extensive than in the place where the force is applied.
During the impact, the hemispheres of the brain are displaced. At this point, deeper lying sections remain relatively immobile, but they do not receive impulses from the cortex of the cerebral hemispheres. This situation leads to the oppression of the reticular formation (a special structure of the brain), which is manifested by a violation of consciousness. The stronger the impact, the longer the time spent unconscious.
Another damaging moment in brain contusion is the movement of cerebrospinal fluid (CSF) under the influence of mechanical force. Accelerated movement of fluid under pressure leads to the formation of point hemorrhages. And although they are microscopic, nevertheless, they also become significant in the general picture of brain damage.
After the action of mechanical striking force in the brain as a result of the emergence of foci of damage the processes of swelling and swelling of intact brain tissue develop again, the processes blood supply.
In some cases, the appearance of a brain contusion is combined with other varieties craniocerebral trauma: subarachnoid hemorrhage, fractures of the arch and base of the skull, intracranial hematomas. Subarachnoid hemorrhage and intracranial hematomas may form a few days after the brain contusion, therefore the patient's condition requires a careful dynamic medical control. The appearance of additional pathological changes in the brain worsens the prognosis for the patient.
The most appropriate is the division of the brain contusion into three degrees:
Each of these forms has its own clinical features and is characterized by a different prognosis.
This type of craniocerebral trauma refers to traumas of mild severity, along with concussion of the brain. She has the best prognosis for recovery compared to the other types of brain contusion and does not pose a threat to human life.
Clinically, the brain contusion of this degree is characterized by:
The duration of the neurological symptoms with a mild concussion usually does not exceed 2-3 weeks. The outlook for recovery is favorable. Sometimes it is very difficult sometimes only by clinical signs to distinguish the bruise of a mild brain from a concussion of the brain. For this purpose, additional methods of research are used (in particular, to computed tomography).
This is the next most severe lesion of brain tissue. Almost always combined with a fracture of the skull bones, often there is a subarachnoid hemorrhage. Signs of a brain contusion of this severity are:
Symptoms of a moderate brain contusion remain from several weeks to 2 months, gradually the neurologic symptoms come to naught, but a number of changes can be irreversible.
This is a serious craniocerebral trauma, which carries a threat to the life of the patient. According to statistics, from 30% to 50% of cases of brain contusions of a serious degree result in a fatal outcome. Persons who underwent a severe brain contusion have been recovering for a long time (not one month) and, unfortunately, this process is not always complete.
A bruise of the brain of this severity is recognized by the following criteria:
The majority of neurological signs with a brain contusion of a severe degree are very slow to reverse development. Recovery is, literally, by grains. This can take 6 months and even more. Quite often gross mental and motor disturbances persist for a long time, in a number of cases becoming the cause of disability.
In addition to the clinical examination and the circumstances of the trauma, computed tomography (CT) plays a very important role in establishing an accurate diagnosis. It is the "gold standard" for head injury. CT reveals the slightest changes in the substance of the brain, allows you to differentiate shocks and bruises the brain, bruises of different severity, reveals fractures of the bones of the skull, subarachnoidal hemorrhage. In some cases, of course, other additional methods of investigation may be needed (for example, lumbar puncture, electroencephalography and others).
Treatment of a brain contusion should be carried out only in a hospital setting, and a brain contusion severe at the initial stage in intensive care with subsequent transfer to a hospital after stabilization state.
Basically, the treatment of brain contusion is carried out in a conservative way. Sometimes patients with this diagnosis need surgical treatment. The main criterion determining the volume of medical care is the severity of the injury.
In the first place are activities aimed at restoring and maintaining vital functions (if they are violated): breathing and circulatory system. Conduct inhalation of oxygen, and if necessary - artificial ventilation of the lungs. Since almost always the brain contusion is accompanied by a decrease in the volume of circulating blood, it is necessary to replenish it with intravenous solutions of colloids and crystalloids.
To reduce intracranial hypertension, the head of the bed should be raised by 30 °, it is necessary to reduce the elevated body temperature, maintain a sufficient level of oxygen in the blood. Of the medicines used Mannitol followed by the introduction of diuretics (Lasix, Furosemide).
Neuroprotective therapy is used to maintain the brain tissue. It consists in the use of funds that provide brain tissue with nutrients that protect brain cells from secondary disorders that result from circulatory disorders and development of edema the brain. As neuroprotectors are used Ceraxon (Citicoline), Cerebrolysin, Semax, Actovegin, vitamin E, Erythropoietin and many other means. What neuroprotective to choose for this patient, can only be decided by the attending physician. Cavinton, Trental, can be used to improve microcirculation.
Symptomatically, anticonvulsants can be used if the patient has epileptic seizures.
Surgical treatment may be needed in the following cases:
Surgical treatment consists of trepanation of the skull (sometimes this alone is enough to reduce intracranial pressure) and removal of the focus of the destroyed brain tissue (if necessary).
An important role in the treatment of brain contusion plays a full-fledged care for the patient, prevention of development of bedsores. If there is a threat of development of bacterial complications, antibiotic therapy is performed.
With a mild brain contusion of almost 100% of cases, no complications are observed.
A moderate brain contusion may not affect the patient's later life, especially if subarachnoid hemorrhage and skull fractures do not occur simultaneously. However, for a favorable outcome, a full treatment is required. And yet in a number of patients the trauma does not pass without a trace. The most frequent consequences are post-traumatic arachnoiditis, post-traumatic hydrocephalus, posttraumatic epilepsy, vegeto-vascular dystonia syndrome, posttraumatic encephalopathy.
A severe brain contusion has a worse prognosis. About 30-50% of the cases of this trauma are fatal in the acute period. Among the survivors, the frequency of the following complications is quite high:
All these conditions are clinically manifested by motor disorders (paresis and paralysis) that impede movement and self-maintenance, impaired speech, coordination, mental disorders, decreased intelligence, frequent headaches, dizziness, convulsive seizures. In such cases, patients are identified with a disability group, as they permanently lose their ability to work.
Such a craniocerebral trauma, as a brain contusion, is a serious pathological condition requiring compulsory treatment in a hospital setting with observance of all medical recommendations. The fastest medical care in this trauma can save the life of the victim, and subsequent full treatment - to avoid a number of complications.
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