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 occurs to the brain tissue, that is, foci of destruction of the brain substance are formed. The brain tissue is destroyed irreversibly. Among the total number of craniocerebral injuries, the brain contusion is about 20% - 25% of cases.
- 1Causes and mechanism of development of the state
2Types of brain contusion
- 2.1A bruised brain contusion of mild
- 2.2Contusion of the brain of medium degree
- 2.3A severe brain contusion
- 3Diagnosis of a brain injury
- 4Treatment of a brain injury
- 5Consequences of a brain injury
Causes and mechanism of development of the state
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.
Types of brain contusion
The most appropriate is the division of the brain contusion into three degrees:
- brain contusion of mild degree;
- a moderate brain contusion;
- severe brain contusion.
Each of these forms has its own clinical features and is characterized by a different prognosis.
A bruised brain contusion of mild
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:
- loss of consciousness from a few minutes to an hour, on average this figure is about 30 minutes. This is a mandatory symptom;
- retardation, drowsiness, delayed reaction after consciousness is restored;
- loss of memory. The patient can not remember the events that happened to him before the moment of injury (this is called retrograde amnesia), after trauma (anterograde amnesia), the moment of the trauma and the time interval with the altered consciousness (congressional amnesia). Most often there is retrograde amnesia, with the events of several days falling out of memory. The time that the patient needs to fully recover the memory is very individual. At an easy degree of a bruise of a brain usually on it it is required some hours or day. Memory abnormalities in this case are completely reversible, and one should not worry about this. Especially do not follow around on this phenomenon accent, traumatizing the psyche of the patient;
- a headache. It arises from a disturbance of the CSF current and an increase in intracranial pressure, due to the developing cerebral edema at the site of impact and shock;
- nausea and vomiting. With a slight contusion of the brain, these symptoms appear one to two times during the first day. They can be sudden and do not bring relief to the patient. Vomiting can occur without previous nausea. Their appearance is associated with irritation of the vomiting center located in the brainstem;
- changes in the activity of the heart. The heart rhythm is broken: either slows down (bradycardia), or it becomes more frequent (tachycardia). The arterial pressure rises to 140/80 mm Hg. These signs are transient, develop due to disorders in the autonomic nervous system, the centers of which are located in the brain and are very sensitive to traumatic factors. The rhythm of breathing with a bruised brain is not often more mild;
- a slight increase in temperature (up to 37 ° C);
- neurological symptoms. They are a consequence of the destruction of brain cells, as well as disruption of the circulation of cerebrospinal fluid, increased intracranial pressure and local edema of the brain. It can be a non-rash nystagmus (spontaneous trembling movements of the eyeballs in the outermost leads), anisocoria (the difference in pupil size is more than 1 mm), a weak reaction pupils to light, anisoreflexia (different degrees of expression of identical reflexes on the right and left), pathological stop symptoms (Babinsky and others), reduction of muscle tone. All neurological symptoms are reversible and do not leave consequences;
- meningeal symptoms. They develop due to irritation of the meninges and subarachnoid hemorrhage. The most typical are the slight tension of the occipital muscles, the symptoms of Kernig and Brudzinsky.
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).
Contusion of the brain of medium degree
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:
- loss of consciousness for 1 to 4 hours. When the mind returns, the patient is in a state of moderate or deep stupeage for a few more days. It does not orient in place and time. The first day is characterized by an underestimation of the severity of their condition, episodes of psychomotor agitation are possible;
- Memory disorders are more pronounced than with a mild brain contusion. There can be any kind of amnesia: retrograde, anterograde, congradation. It may take hours or even days to restore the memory, but the memory is restored completely;
- severe headache;
- severe dizziness, which can cause a fall when trying to stand up;
- nausea and repeated vomiting, which also do not bring relief, as with a mild brain contusion;
- acceleration of the heartbeat to 120 beats per minute (less slowly to 45), increasing blood pressure to 180/100 mm Hg. These symptoms last longer than with a mild brain contusion;
- acceleration of the rhythm of breathing to 30 per minute;
- increase in temperature to 37 ° - 3 ° C;
- coarser focal neurological signs (compared with a mild brain contusion). This decrease in muscle strength in the limbs (pareses), a pronounced change in muscle tone, pathological foot and wrist symptoms, loss of sensitivity in extremities of the eyeballs in the sides, the separation of joint movements of the eyeballs, strabismus (strabismus), spontaneous nystagmus, facial crossover, speech impairment. Epileptic seizures are possible;
- meningeal signs. They can have varying degrees of severity from minor to abrupt, depending on the volume of blood that has entered the subarachnoid space.
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.
A severe brain contusion
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:
- loss of consciousness for several hours or several days, in rare cases - several weeks. Almost always there is a coma, the exit from which remains for quite some time a change in consciousness as a type of sopor or stunning;
- possibly psychomotor agitation, turning into a convulsive syndrome;
- pronounced disturbances of the respiratory and circulatory system. The rhythm and frequency of breathing is disrupted to such an extent that it may require artificial ventilation. Pulse exceeds 120 or less than 40 (the latter carries a greater risk for life), blood pressure above 180/100 mm Hg. This is the result of pronounced disorders in the central part of the autonomic nervous system;
- hyperthermia up to 40 - 41 ° C, which can also be accompanied by the development of seizures;
- gross neurological symptoms. First of all, the so-called stem symptoms, which testify to the defeat of the deep parts of the brain, come to the fore. This narrowing or widening of the pupils of both eyes with a weak reaction to light, the floating movements of the eyeballs, the divergence of the eyes vertical or horizontal, rough nystagmus directed in different directions, disturbances of swallowing, oppression of all reflexes, periodic muscle spasms with a sharp increase in muscle tone throughout the body, which resembles cramps, bilateral multiple pathological symptoms. A few days later signs of damage to other parts of the brain show themselves. These are sharp paralysis, up to the complete absence of force in the extremities (plethia), loss of speech (both the ability to speak and understand what has been said), the lack of sensitivity in the limbs;
- expressed meningeal signs.
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.
Diagnosis of a brain injury
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 injury
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:
- if during the course of treatment the symptoms of cerebral edema increase, and dislocation of brain structures with displacement occurs. This is dangerous for the patient's life;
- if the site of injury has a size of more than 30 cm3 and is a brain tissue smashed;
- if intracranial pressure increases and can not be corrected by medication. Usually neurologic symptoms increase.
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.
Consequences of a brain injury
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:
- post-traumatic brain atrophy, that is, a decrease in the volume of brain tissue;
- post-traumatic inflammation of the meninges (arachnoiditis, leptomeningitis, pachymeningitis);
- posttraumatic epilepsy;
- post-traumatic hydrocephalus with intracranial hypertension;
- post-traumatic pantencephaly (cavities in the brain, connected to the ventricles and subarachnoid space);
- cerebrospinal fluid; cysts;
- scars in the area of brain tissue and its membranes;
- cerebrospinal fluid (outflow of cerebrospinal fluid outwards) in the presence of a fracture of the skull bones.
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.