Craniocerebral injury: Answers to your questions

Craniocerebral trauma (CCT) is considered to be damage to the substance of the brain and skull bones as a result of the impact of a traumatic factor (mechanical force). TBT can be combined with damage to the soft tissues of the head and facial skeleton. If the lesions affect only soft tissues or bones of the facial skeleton, then such a trauma is not craniocerebral. There are several types of TBI that differ from each other in the nature of the damage to the brain substance and clinical signs. TBI can be successfully treated, without any consequences for the patient, and can leave behind a significant defect with which a person will have to live the rest of his life. About what kinds of TBI are, what are their consequences, how is rehabilitation after CCT, and also on the types of generic TBI, you can learn from this article.

Content

1Types of TBI
2Signs of TBI
3Consequences of head injury
4Rehabilitation after CCT
5Birth traumatic brain injury

Types of TBI

To understand the classification of CCT, it is required to clarify thataponeurosisIs a wide tendon plate located between the skin and the periosteum, otherwise calleda tendon helmet.

TBI can be:

open (if it is accompanied by damage to the soft tissues of the head with the wound of the aponeurosis, or it is a fracture bones of the cranial vault with injury of adjacent tissues, or a fracture of the base of the skull with the expiration of the cerebrospinal fluid). If, with an open CTB, the dura mater is damaged, then such a trauma is called penetrating, if this shell remains intact, the trauma is non-penetrating;
closed (when there is no damage to soft tissue, or they are damaged, but the whole aponeurosis).

It is common to divide TBT into several types (clinical types of damage to the brain and skull bones):

fracture of the skull bones;
concussion of the brain (does not have degrees of severity contrary to the general opinion of the population). This is a transient disruption of the brain after the impact of the traumatic factor. With concussion of the brain, changes occur at the molecular level;
bruise of the brain (mild, moderate or severe). It's like a wound inside the brain;
compression of the brain (foreign body, hematoma, depressed skull fracture, hygroma (accumulation of cerebrospinal fluid in the shell), accumulation of air in the cavity of the skull);
intracranial hemorrhage (subarachnoid hemorrhage, cerebral hemorrhage, intracerebral haemorrhage, epi- and subdural hematomas);
diffuse axonal lesion (DAP). At this type of TBI, axons that connect the cerebral cortex with stem structures are broken. This is a very serious trauma with poor rehabilitation potential.

The concussion of the brain and the bruise of a mild degree are the lungs of the head injury, a bruised brain of an average degree - a trauma of an average severity, a severe brain contusion and a DAP - a serious trauma. Brain compression, intracranial hemorrhage can be both traumas of moderate severity, and severe (which depends on the specific situation). There may be simultaneous presence in the patient of several types of TBI (for example, brain contusion and SAK, fracture of the skull bones and hematoma).

Hematomas can be:

epidural - are formed as a result of fractures of the bones of the skull with rupture of the shell artery or its branches. In this case, the blood accumulates between the skull bone and the outer shell of the brain;
subdural - occur when the connecting veins of the subdural space break or the arteries and veins of the cerebral cortex break. The blood accumulates between the arachnoid membrane and the dura mater of the brain;
intracerebral - when there is a rupture of the blood vessel in the depth of the brain substance.

Signs of TBI

TBI is a travesty. Of course, in most cases, its presence is easy to establish for a number of symptoms. However, sometimes the first signs may appear a few days or even weeks after the injury.

The signs of TBI are usually:

loss of consciousness or confusion. Most often this occurs at the time of CCT, but may also occur remotely. Violation of consciousness after some time after trauma is characteristic of intracranial hematomas;
headache;
dizziness, unsteadiness in walking;
nausea and vomiting;
blurred vision, doubling of objects;
noise in ears;
weakness and numbness in one or more limbs;
speech impairment;
loss of memory for a certain period of time (most often for the period before the injury or immediately afterwards);
epileptic seizure;
inadequate behavior (agitation, disorientation, inhibition).

It should be understood that each individual symptom is by no means an indispensable trait of TBT. The presence of speech impairment without information about the traumatic factor is unlikely to be a sign of TBI. And just nausea and vomiting without hitting the head or the head can generally be associated with completely different diseases. Therefore, of course, the first sign of TBI is information about the traumatic factor. The remaining symptoms should already be considered in the context of a possible CCT. Sometimes it happens that the person himself amneses events related to the trauma (that is, denies its fact), there are no witnesses, and there are no external damages either. In such cases, it is not immediately possible to suspect CCT.

Consequences of head injury

Usually, under the term "consequences" of TBI, medics are referring to those health changes that result from trauma after at least 12 months after CCT. An easy TBI with proper treatment, observance of all medical recommendations most often passes without a trace. It is rather difficult to predict how other traumatic events will end.

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In general, the consequences of CCT may be as follows:

posttraumatic skull defects (remain after splintered, depressed skull fractures, gunshot wounds, and after operations on the brain);
foreign bodies in the cranial cavity (bone fragments, bullets, shot, pieces of glass, plastics, etc.). Foreign bodies can become a source of infection for the brain and its membranes;
post-traumatic cerebrospinal fluid (when the outflow of cerebrospinal fluid from the cranial cavity occurs through the formation of a cranial cavity with the environment formed as a result of trauma);
post-traumatic hydrocephalus (excessive accumulation of cerebrospinal fluid in the subarachnoid space of the brain);
post-traumatic atrophy of the brain substance (when the brain tissue decreases in volume);
post-traumatic arachnoiditis (a chronic autoimmune inflammatory process involving the arachnoid and soft shells of the brain. Between these membranes there are connective tissue connections, the circulation of cerebrospinal fluid disrupted);
post-concomitant syndrome (this is the consequence of mild TBI). Characterized by persistent headache, dizziness, violation of attention and memory, sleep, emotional instability, changes in the autonomic nervous system;
posttraumatic epilepsy (appearance of various types of seizures after CCT). The most common cause is formed scarring and adhesions on the surface of the brain and its membranes. Usually epileptic seizures occur for the first time during the first 1.5 years after CCT;
lesions of cranial nerves (for example, damage to the optic nerve can cause blindness, and facial - a cosmetic defect in the form of a skewed face);
posttraumatic pneumocerephaly (penetration of air into the cranial cavity);
post-traumatic pantencephaly (formation of canals and cavities in the brain, connected with the subarachnoid space, cysts, ventricular system of the brain);
posttraumatic meningoencephalocele. These are hernial protrusions, which can occur in the presence of defects of the skull and the outer cerebral casing (solid). If the hernial sac is covered with skin and contains the shell of the brain (arachnoid and soft), then this is called a meningocele. If there is a brain substance in the hernial sac, then this is a meningoencephalocele;
liquor cysts. These are limited concentrations of cerebrospinal fluid within the brain or in the region of the subarachnoid space;
chronic hematomas. Most often they are subdural. About a chronic hematoma it is accepted to speak, if its age is more than 15 days;
aneurysms and arterio-sinus anastomoses (communication between the arterial and venous systems of the brain). Aneurysms are formed as a result of partial tearing of the wall of the blood vessel, when the blood forms a pathological protrusion of the vessel wall;
posttraumatic encephalopathy. This is the most common formulation of the consequences of CCT, because it includes many neurological manifestations. This includes disorders of the cognitive and mental sphere, coordination, speech, movements and strength levels in the limbs, vegetative symptoms, parkinsonism and much more.

Rehabilitation after CCT

Restorative treatment after CCT has a significant role in terms of capacity. After all, the recovery period after CCT is in some cases 2 years. This means that those violations that persist in the patient at the time of discharge from the hospital can be completely eliminated in the process of rehabilitation treatment. Consequently, it is possible to return to work and full social demand.

Rehabilitation after TBI begins already in an acute period. For serious injuries in the concept of rehabilitation in this period includes prevention of pressure sores, breathing exercises, treatment by position (giving the limb or body part of a certain posture), passive limb movements. From these simple measures, the further opportunities for rehabilitation largely depend. In the intermediate and long-term periods of moderate to severe TBI, the range of rehabilitation measures is significantly expanded.

It would be more appropriate to consider the volume of restorative treatment in terms of the severity of TBI. First, let's talk about the rehabilitation of patients after a lung injury.

The majority of patients with mild degree of CCT completely recover. To avoid postcombotion syndrome in the recovery period of such traumas, medicinal treatment is used (nootropic drugs, muscle relaxants, antidepressants, antioxidants, non-steroidal anti-inflammatory drugs and others), as well as non-drug therapies. The latter include:

therapeutic gymnastics (basically it is general strengthening methods with elements of vestibular gymnastics);
post-isometric relaxation (with post-traumatic headache);
massage the collar zone to improve blood flow in the brain and improve venous outflow;
acupuncture;
physiotherapy.

Among the methods of physiotherapy apply:

electrophoresis with medicinal preparations (Aminalon, Ascorbic acid, Sodium bromide, Magnesium sulfate, Euphyllinum;
electrosleep;
various types of shower (rain, circular, underwater shower massage), coniferous and oxygen baths.

The need for a drug or a method of non-drug treatment is determined individually, depending on the patient's symptoms. Sometimes, several courses of rehabilitation treatment are needed to say goodbye to TBM forever.

Rehabilitation of patients with moderate to severe TBI in the recovery period includes significantly more activities. This is due, first of all, to the presence of motor disorders, gross coordination disorders (which are not give the patient a normal movement, despite the presence of sufficient strength in the limbs), problems with speech. Vegetative disorders and disorders of the psycho-emotional sphere after severe head injury can be very pronounced, so the rehabilitation program should be developed taking into account such changes.

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Drug treatment should be aimed at normalizing cerebral blood flow, improving the metabolism of brain tissue, eliminating disorders cerebrospinal fluid circulation, prevention of formation of adhesions of cerebral membranes, correction of psychopathological symptoms.

From non-pharmacological methods can be used:

treatment by position (in the first place it is necessary for those patients who do not stand up alone or can not move a limb due to a sharp muscle weakness or increased muscle tone). For this, additional supporting devices and objects (cushions, rollers, spacers, orthoses and tires) are used. If the patient can sit on his own, then for a stable and symmetrical position can be used for seating. To ensure vertical posture, special verticalizers are used;
passive and active therapeutic gymnastics. In addition to our usual motor exercises, this includes methods for improving postural control, that is, the ability to maintain a stable vertical posture (for example, increasing or decreasing the footprint, maintaining balance on swinging platforms, standing on uneven surfaces, etc.). The list of gymnastic procedures is determined by the level of neurological deficit. To the same group of activities can be attributed special receptions for muscle relaxation, exercises for stretching muscles to deal with emerging contractures;
neuromuscular electrostimulation. It is necessary for correcting muscle weakness, eliminating the increase in muscle tone;
massage (selective, point, classical);
acupuncture;
individual and group psychotherapy;
lessons with a speech therapist;
physiotherapy.

Physiotherapy plays a significant role in rehabilitation after moderate to severe TBI. Among them, the most common use is:

magnetotherapy;
Thermotherapy (paraffin or ozocerite applications for spastic muscles, cryotherapy);
hydrotherapy (various baths);
mud treatment;
diadynamic and sinusoidal modulated currents;
electrophoresis or phonophoresis with medications.

In spasmodic muscles, local administration of botulinum toxin type A is possible, which helps to reduce muscle tone. If as a result of head injury in the long-term period, despite the ongoing treatment, contractures have been formed and can not be eliminated conservatively, then resort to various plastic operations on soft tissues and bones (for example, dissection of tendons, muscles, cutaneous platics and others).

Four months after the closed TBI and 6 months after the open TBI, in the absence of contraindications, sanatorium-and-spa treatment in local neurological sanatoriums is shown. Rehabilitation complexes include most of the above measures.

Birth traumatic brain injury

Birth trauma occurs during childbirth. In this case, trauma can occur both with natural childbirth and with caesarean section. The cause of birth trauma is mechanical compression. Nature is intelligent and has created adaptations for the child to go through the pelvic bones without harming himself. And this happens in most cases. But sometimes, when, for example, the size of a child does not correspond to the size of a woman's pelvis, childbirth lasts too long or vice versa, the birth of TBM is possible.

To the generic types of CCT include:

subaponeurotic hemorrhage (when blood flows between the aponeurosis and the underlying bone);
cephalohematoma - a hemorrhage between the periosteum and the bone itself. Usually located above the parietal bone. Never goes beyond the limits of one bone. Can occur only with natural childbirth;
epidural hemorrhage;
subdural hemorrhage;
subarachnoid hemorrhage;
hemorrhage in the cerebellar nerve or crescent process;
intraventricular hemorrhage;
intracerebral hemorrhage (including intracerebral hemorrhage);
fractures of the bones of the skull (linear, dented, discrepancy of the occipital bones).

Generic TBI is defined by a set of different characteristics. Children with a birth trauma can have irregular breathing and heart disorders, low muscle tone, poor sucking reflex. They are lethargic and inhibited. Frequent regurgitation and vomiting are possible. Often there is a convulsive syndrome. To clarify the diagnosis can be performed neurosonography (ultrasound of the brain of a newborn), X-ray methods of research. Generic TBI can threaten the life of the child, so its timely diagnosis is very important.

Thus, proceeding from all the above, it becomes clear that TBI is a trauma that can occur in a person at any age. There are many types of TBI and their combinations. It is not always possible to immediately diagnose the presence of CCT, sometimes trauma is masked for a while. TBI can be as easy, not dangerous for human life, and severe, threatening fatal outcome. Any TBI requires treatment and rehabilitation, on which the outcome of the disease largely depends: whether the person remains disabled or can be a full-fledged member of society. It is impossible to predict the outcome even of mild TBT, therefore any TBI is an occasion for immediate medical treatment.

The neurologist M. M. Sperling talks about a traumatic brain injury:

CRANIAL-BRAIN TRAUM. TRAUMA OF HEAD. WHAT TO DO WITH THE INJURY OF THE HEAD?