Craniocerebral injury: classification, symptoms and treatment

In modern society, great attention is paid to the prevention of cardiovascular diseases, oncopathology, but the specific increase in injuries continues to grow steadily and is catching up with widespread diseases with leaps and bounds. In pursuit of civilization and urbanization, humanity loses its best representatives - young people, because the number of road accidents is simply the nature of some kind of epidemic of the twenty-first century. The first place among injuries is head injury (TBI).

Classification of TBI

Craniocerebral injury is classified by many parameters, but in clinical practice it is not always in demand. Depending on the type of injury, the following injuries are identified:

• combined (except for the application of mechanical energy and the presence of head trauma there are also extracranial injuries - the abdominal, chest cavity, skeleton);
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• combined (for these injuries is characterized by the presence of several damaging factors that act simultaneously, for example, TBI and burns).

All neurotrauma according to the nature of damage are divided into the following groups:

• closed (trauma, in which it is possible to maintain the integrity of the skin, and if there is damage to them, it does not reach the level of aponeurosis);
• open (damage extends beyond the aponeurosis and is often combined with fractures of the base and cranial vault);
• penetrating (in this case there is a violation of the integrity of the dura mater and damage to the very substance of the brain, which prolaps through the wound).

Neurotrauma periods:

• acute (begins with the moment of the injury and lasts until the stabilization (if the patient survives) neurofunction of the brain. The duration of this period is up to 10 weeks).
• intermediate (in this period, lysis occurs and the damage is restructured with complete or partial restoration of the functions of the nervous system. With a neurotrauma of moderate severity is 6 months, and with severe - up to one year.)
• remote (in this period, the completion of recovery processes or the formation of degenerative processes. The duration of these processes takes several years.)

Symptoms of Neurotrauma

In an acute period after an injury with a concussion of the brain and his contusion of a mild degree of a patient, headache, nausea, vomiting can be disturbing.

Brain concussion.The main feature of this nosological unit is the reversibility of the process and the absence of pathological lesions. Loss of consciousness is short-lived for several minutes with the development of retrograde amnesia. The patient may be slightly deaf, emotionally labile, nausea, vomiting, headache. Neurological examination reveals nonspecific symptoms - cerebellar ataxia, suppression of abdominal reflexes, not pronounced pyramidal signs, symptoms of oral automatism. But the process is therefore considered reversible, that all symptoms disappear after three days.

A bruised brain of an easy degree.With this pathology, fractures of the bones of the skull and traumatic hemorrhages are possible. Loss of consciousness is possible up to half an hour. Neurological status is similar to concussion of the brain, but the symptoms are more pronounced and persist for three weeks.

A moderate brain contusion.The patient may be unconscious for several hours, the amnesia expressed. An intense headache, repeated repeated vomiting, motor anxiety indicate a significant subarachnoid hemorrhage. There are signs of a disturbance in the vital functions: bradycardia, hypertension, tachypnea. In the neurological status there is a meningeal syndrome, nystagmus, asymmetry of the muscle tone and tendon reflexes, pathological stop signs, paresis of limbs, impaired pupillary and oculomotor reflexes. Such organic symptomatology persists for a month, and recovery is probably incomplete.

A severe brain contusion.After the injury, the patient does not regain consciousness, if he survives, the forecast depends on the nature and extent of the damage. In neurological status, stem symptomatology predominates with the growth of brain edema and gross life-threatening disorders vital functions, frequent generalized epileptic seizures, which aggravate the patient's condition. Without timely emergency care, these patients do not survive. If, as a result of treatment, the patient comes to consciousness, then there remains a gross neurological deficit in the form of paralysis and paresis, disorders in the psychic sphere.

Brain compression.The clinic of compression of the brain can be both in the background of a bruised brain, and without it. The leading place belongs to hematomas, then depressed fractures, hygromes, pneumoencephaly. Clinically manifested as a severe bruise, but there is a so-called light gap - when the patient becomes easier for a short time, and then his condition worsens dramatically. Without timely decompression, the patient's life "hangs by a thread."

Fracture of base of skull.In fractures of the base of the skull, there is a specific clinic, because apart from the bruise of the brain, the poured blood penetrates into the nasopharynx, into the cavity of the middle ear, the periorbital cellulose. Therefore, it is necessary to clearly differentiate that periorbital hematomas (what is popularly called "fingal under the eye") can be not only a consequence of local trauma, but also a formidable symptom of cranial trauma, the so-called "symptom of glasses". To the same specific clinic is the presence of bleeding or liquorrhea from the nasal passages and external auditory canal. In support of the above, the literature describes the "teapot symptom": increased discharge from the nose with the head tilted forward. Despite the fact that the patient may be conscious and there are bruises of the soft facial tissues, the craniocerebral trauma must be suspected in the first place.

Diagnosis of Neurotrauma

Diagnosis of neurotrauma in some cases can be difficult, since very often accompanied by alcohol intoxication. In this case, it is difficult to assess the nature of the coma. Difficulties also arise in differential diagnosis with acute disorders of cerebral circulation (CABG), especially with the question of what was primary: trauma or ONMI. General signs of diagnosis are as follows:

• anamnesis of the disease (provided that the patient is conscious);
• clinical, biochemical analysis of blood and urine;
• a blood test for alcohol and other toxins if necessary;
• determination of blood type and Rh factor;
• examination of a neurologist, a neurosurgeon and related specialists;
• ECG;
• CT and MRI study;
• X-ray of the skull in two projections (if necessary, other areas of the body).

Treatment of Neurotrauma

Treatment of neurotrauma should be comprehensive. An easy degree of TBT is treated in conditions of traumatology department, and heavy - in the intensive care unit. The average period of hospitalization with a concussion of the brain is 7-10 days, and a prerequisite is compliance with bed rest.

In case of severe trauma, the primary and primary activities are the maintenance of vital functions (breathing and circulation) in the victim in order to save his life. In general, the following principles of conducting such a category of patients can be noted:

• restoration of airway patency. Absolutely all patients who are in a coma (on the scale of coma Glasgow - 8 points and below), should be intubated and transferred to the ventilator (artificial lung ventilation) to ensure adequate oxygenation;
• prevention of arterial hypotension. The average blood pressure should be at least 90 mm Hg. Infusion therapy is carried out by solutions of colloids and crystalloids. If the effect of the infusion therapy is not sufficient, sympathomimetics are added to the treatment;
• struggle against intracranial pressure. To reduce the increased intracranial pressure, use mannitol, elevated head position by 30 degrees, removal of ventricular cerebrospinal fluid, mild hyperventilation.Hormones are not used to treat brain edema, as they worsen survival in this category of patients;
• anticonvulsant therapy. In connection with the development of posttraumatic epilepsy, anticonvulsant preparations are mandatory, as convulsions significantly worsen the prognosis for recovery in such patients;
• control of septic complications. To this end, antibiotics of a wide spectrum of action are appointed with their subsequent rotation according to the results of a microbiological study;
• appointment of early nutrition of patients. Advantage is given to enteral nutrition, and if it is impossible, parenteral nutrition is prescribed, which must be started no later than 3 days;
• surgery. Epidural hematomas more than 30 cubic centimeters, subdural hematomas thicker than 1 centimeter in the presence of displacement midline structures, foci of brain contusion more than 50 cubic centimeters are necessarily subject to surgical treatment. Conservative treatment of bruises and bruises is prescribed according to the recommendations of a neurosurgeon, who in dynamics observes such a category of patients, and if necessary, surgical treatment will be offered.

The prognosis for neurotrauma is not always favorable, but the timely care given to the injured significantly affects the outcome of the disease.