Head trauma: classification. Head trauma: symptoms, first aid and treatment

Head trauma, the consequences of which can be completely different (up to a lethal outcome), is one of the most common causes of disability in middle and young age. About half of all cases are CCT. According to statistics, about 25-30% of all injuries are brain injuries. These cases account for more than half the deaths. Further in the article will be presented the classification of injuries, a description of some of them is given.

General information

A craniocerebral trauma is the damage to the bones of the skull or soft tissue. The latter, for example, include the meninges, nerves, vessels and others. Injuries to the head are divided into several groups. Let's consider some of them in more detail.

Classification of injuries

Damage can be open. In this case, aponeurosis and skin are injured. As the bottom of the wound is the bone or tissue lying deeper. Penetrating trauma is characterized by damage to the hard shell of the brain. As a special case can be considered otlkvoreya, caused by a fracture of bones at the base of the skull. A closed head injury may occur. In this case, the skin can be damaged, and the aponeurosis retains its integrity. Also distinguish the following groups:

• Concussion. These are head injuries that are not characterized by persistent impairments in the functioning of the brain. All manifestations of the state after a time (usually a few days) disappear on their own. If the symptoms persist more persistently, a more severe head injury with probable brain damage occurs. The main criteria for assessing the condition is the duration of the tremor (from seconds to several hours) and subsequently having a depth of amnesia and loss of consciousness. Among nonspecific symptoms, mention should be made of vomiting, nausea, irregularities in the heart activity, blanching of the skin.
• The compression of the brain with a focus of bruise, air, foreign body, hematoma.
• Subarachnoid hemorrhage.
• Diffuse axonal lesion.

In practice, there are quite a few combined cases. Combine, for example, may be a hematoma and bruise, a bruise with subarachnoid hemorrhage and compression, diffuse damage and bruise and others. Often, damage is caused by a trauma to the face.

Brain Injury

It occurs against the background of a head injury. A bruise is a violation of the integrity of the brain substance in a certain limited area. As a rule, such a region arises at the point of application of force. However, there are cases when a bruise appears from the opposite side (from the counter-blow). Against the background of this condition, part of the brain tissue, blood vessels, histological cell connections is destroyed, followed by the formation of traumatic edema. The area of such lesions is different. Such a head injury in a child is especially dangerous.

Easy degree

Such head traumas are characterized by disconnection of consciousness for a short period - up to several tens of minutes. After its termination, complaints of nausea are typical. The patient also has a dizziness and dizziness. Vomiting may occur, in some cases repeated. In a number of cases moderate bradycardia is observed - a decrease in the frequency of cardiac contractions to 60 or less per minute. The patient may experience con-, retro- and anterograde amnesia - memory impairment in the form of a loss of ability to preserve and reproduce previously acquired knowledge. After a mild head injury, tachycardia is noted (an increase in the frequency of cardiac contraction to 90 beats / min). Some patients may experience pressure. At the same time, body temperature and breathing, as a rule, remain unchanged. As for neurologic symptoms, manifestations are usually of an easy nature. Thus, the patient may have weakness, drowsiness, clonic nystagmus (biphasic rhythmic involuntary eye movements ). There is also a slight anisocoria, meningeal symptoms, pyramidal insufficiency. These manifestations usually regress at 2-3 weeks after a head injury.

Characteristics of violations

On the background of a bruise, a non-structured brain damage is detected microscopically. It manifests itself as areas of local edema, cicatricial acuity, probably in conjunction with subarachnoidal hemorrhage. It, in turn, is caused by rupture of the pial vessels. Blood with subarachnoid hemorrhage penetrates the arachnoid membrane and spreads along the basal cisterns, cracks and fissures of the brain. It can be local or fill the entire space with the formation of clots. The condition develops quite sharply. The patient suddenly feels a "blow to the head," quickly there is photophobia, vomiting, a very strong headache. Multiple generalized seizures are possible. Usually the condition is not accompanied by paralysis. However, meningeal symptoms are likely. In particular, stiff neck muscles can be noted (with the head tilted, the sternum can not touch the patient's chin) and Kerning's symptom (unable to unbend the knee bent in him and the hip joint). In the presence of meningeal symptoms, irritation of the meninges with bleeding occurs.

Medium bruise

This head trauma is characterized by a longer shutdown of consciousness (up to several hours). The patient has marked amnesia. The following signs of head trauma are also observed: severe headache, repeated vomiting, mental disorders. Probable transient disturbances in vital functions. In particular, tachycardia or bradycardia, increased pressure, tachypnea (shallow rapid breathing without disturbance of rhythm and pathway), subfebrile condition (body temperature rises to 37-37.9 degrees) may be noted. Frequent are stem and shell symptoms, dissociation of tendon reflexes and muscle tone, bilateral pathological manifestations. The focal symptomatology is quite clear. Its nature is determined by the localization of the injury. Oculomotor and pupil disorders are detected, speech disorders, sensitivity, paresis of limbs, and others. These symptoms are gradually smoothed out within three to five weeks, as a rule. However, in some cases, the described clinical picture persists long enough. With a bruise of moderate severity, fractures in the bones of the base and the cranial vault, extensive subarachnoid hemorrhage, are often found. On CT, focal changes are detected in the form of small high-density inclusions or homogeneous moderate increase in density. This corresponds to minor hemorrhages in the area of the injury or hemorrhagic impregnation of the brain tissue without gross destruction.

Severe head injury

In this case, intracerebral hematomas are noted in both frontal lobes in the form of limited blood clusters with different injuries with vascular rupture. In this case, a cavity is formed, which contains coagulated or liquid blood. The bruise is heavily characterized by a prolonged disconnection of consciousness (up to several weeks). Often there is marked motor excitement. Also, there are disorders of vital functions in the body. However, in comparison with the average degree, in severe, they are more pronounced. So, for example, there is a breakdown in the respiratory function with a violation of the patency of paths and rhythm. The patient has hyperthermia, dominance of primary-stem neurological symptoms. In particular, swallowing disorders, floating eye movements, ptosis or mydriasis, paresis of the eye, decerebral rigidity, nystagmus, an increase or suppression of reflexes of the mucous membranes, skin, tendons, etc., are revealed. Neurological symptoms at the initial period (in the first hours or days) prevail over focal hemispheric manifestations. The patient may experience paresis of the limbs, subcortical muscle tone disorders and the like. In some cases, focal or generalized epileptic seizures are likely . The regression of focal manifestations occurs rather slowly. Why is such a head injury dangerous? The consequences can be quite serious. Often there are pronounced residual phenomena, mainly in the mental and motor sphere.

CT indices

In severe trauma, in the third part of cases, focal lesions in the brain are noted in the form of inhomogeneous areas of increased density. In this case, there is an alternation of zones. Areas with high and low density are allocated. In the most severe course of the condition, the destruction of the medulla is directed inward and can reach the ventricular system and subcortical nuclei. Observations of the dynamics show a gradual decrease in the volume of densified areas, their merging and transformation into a more homogeneous mass. This occurs on the 8th or 10th day after the incident. The regression of the bulk effect of the pathological substrate occurs more slowly, which indicates the presence of unbundled clots and crushed tissue in the lesion focus. At this point, they become even-dense relative to the surrounding papular medulla. Disappearing after 30-40 days. Volume effect indicates a resorption of the substrate and the formation of instead areas of atrophy or cystic cavities.

Damage to the structures of the posterior cranial fossa

This defeat is considered the most severe of all head injuries. The condition is characterized by the following symptoms: depression of consciousness and a combination of stem, cerebellar, meningeal and cerebral symptoms, due to rapid compression and disorders of liquor circulation.

Therapeutic measures with a bruise

Regardless of the degree of damage, the patient should receive medical care. In case of trauma, the victim's head should be transported to the hospital as soon as possible. X-rays and CT are shown for an accurate diagnosis. The patient needs bed rest. Its duration for mild cases is 7-10 days, at an average - up to 14 days. In the case of severe head injury, resuscitative measures need to be taken. They are started in the pre-hospital period and continue in the hospital. To normalize breathing, it is necessary to provide free patency in the upper respiratory tract - they release them from mucus, blood, vomit. An air duct is introduced, tracheostomy is performed (dissection of tracheal tissues and installation of a cannula or the formation of a permanent opening - stoma). Inhalation using an oxygen-air mixture is also used. If necessary, ventilator is used.

Therapy with concussion

If it is determined that the patient has a head injury, the treatment should be performed in a neurosurgical hospital. With a concussion, a five-day bed rest is shown. In the absence of complications, the patient can be discharged on the 7-10th day. In this case, he is given outpatient treatment, the duration of which is up to 14 days. Drug therapy with concussion is aimed at stabilizing the functional state of the brain, eliminating pain, insomnia, anxiety. As a rule, the spectrum of prescribed medicines includes sleeping pills, sedatives and pain medications. As analgesics, such drugs as "Baralgin", "Pentalgin", "Maxigan", "Sedalgin" and others are used, and "Cerukal" can be prescribed for dizziness.Sedatives include such medications as "Valocordin", "Corvalol" And other containing phenobarbital.Use infusions of herbs (motherwort, valerian).

Tranquilizers are also recommended. They include, for example, such means as Rudotel, Nosepam, Fenazepam, Sibazon, Elenium and others. In addition to symptomatic therapy, metabolic and vascular treatment are prescribed. It promotes faster and full recovery of impaired brain functions, prevents various post-comon symptoms. The appointment of cerebrothropic and vasotropic therapy is allowed after 5-7 days after injury. The combination of nootropics (preparations "Pikamilon", "Aminolone" and others) and vasotropic drugs (medications "Theonikol", Stugeron "," Cavinton ") are worthwhile.To overcome asthenic manifestations, patients are prescribed vitamin complexes: Centrum, Komplivit, . Vitrum "and other tonics are recommended: the fruits of Schisandra, Siberian ginseng extract . ginseng root must be said that the shake does not appear any organic lesions, we should talk about more serious if there are any changes on MRI or CT. in injuries - brain injury.

Operative intervention

Mechanical injuries require surgical intervention. The operation is indicated in case of a bruise with crushing of the brain tissue. As a rule, such mechanical injuries occur in the zone of the poles of the temporal and frontal lobes. As a surgical manipulation is osteoplastic trepanation. The operation consists in forming a hole in the bone to penetrate into the cavity and washing the detritus with sodium chloride solution (0.9%).

Forecast

With an easy degree of damage, as a rule, the outcome is quite favorable (in case the patient complies with recommendations regarding the regimen and therapy). With an average condition it is often possible to achieve absolute recovery and restoration of social and labor activity of the victims. Some patients may have hydrocephalus and leptomeningitis, which cause asthenia, vegetovascular dysfunction, pain, coordination disorders, statics and other neurological symptoms. Against the backdrop of severe trauma, a fatal outcome occurs in 30-50% of cases. Among the surviving patients is very common disability, the main causes of which are disorders of a mental nature, gross speech and motor disorders, epileptic seizures. With open head injuries, inflammatory complications are likely. In particular, the risk of developing abscesses of the brain, ventriculitis, encephalitis, and meningitis is great. Likvorea, which is the outflow of cerebrospinal fluid from natural openings or formed due to various factors in the bones of the spine and skull, is also likely. Half of the deaths due to CCT are caused by accidents on the roads (road accidents).