Traumatic brain injury
Traumatic brain injury is a condition that can be life-threatening, characterized as damage to the soft tissues of the brain with possible damage to the bones of the skull of varying severity. It is also customary to refer to traumatic brain injuries and lighter injuries – concussion, brain injury.
All types of traumatic brain injury are accompanied by a general clinical picture – headache, nausea, dizziness, periods of loss of consciousness. With more severe brain damage, memory loss is possible.
CLASSIFICATION OF TRAUMATIC BRAIN INJURIES
There are several groups of classifications of TBI.
The first group contains a sign by the type of damage:
Diffuse traumatic brain injury is the spread of disorders along the brain stem, in the corpus callosum, subcortical matter, in the semioval center.
Focal traumatic brain injury is a local lesion of brain tissues.
Combined injury.
ACCORDING TO BIOMECHANICAL PROCESSES:
Displacement of the cerebral hemispheres relative to the stationary brainstem.
The shock wave from the impact passes through all brain structures.
Combined injury.
By type:
Without the presence of damage outside the skull – isolated.
The presence of damage not to the skull as a result of mechanical action is combined.
Combined trauma – mechanical impact is accompanied by other damaging factors.
By the nature and depth of the damage:
Open penetrating trauma with damage to the solid medulla.
Open penetrating trauma without damage to the medulla.
Closed craniocerebral injury.
According to the severity of the condition:
Slight injury.
Injury of moderate severity.
Severe injury.
TYPES OF TRAUMATIC BRAIN INJURY
The easiest form is concussion (which is also commonly divided into degrees).
The average form is a brain injury (usually divided into three degrees of severity).
The severe form is diffuse damage to the axons of the brain.
An extremely severe form, often incompatible with life – compression of the brain.
SYMPTOMS OF TRAUMATIC BRAIN INJURY
In the development of any cranial brain injury, there are three successive stages – the acute period, the intermediate period, and the long-term period.
Concussion is characterized by the development of the following symptoms: sudden loss of consciousness – most often short-term. The patient complains of nausea, a single vomiting is possible. With severe degrees of concussion, retrograde amnesia develops. There are no specific focal symptoms.
With a brain injury, the clinical picture is more diverse. To the symptoms characterizing a concussion, symptoms indicating brain damage (focal) are added. With a brain injury, the lesion can occur both at the site of the impact and on the opposite side. The duration of loss of consciousness with a brain injury may be short-term, but more often reaches up to 10 minutes.
Compression of the brain is one of the more severe injuries. When the brain is compressed, a hematoma develops. When the brain is compressed, two situations can develop: the first is the development of the so–called light gap. during this period, the patient regains consciousness, but his mental activity is reduced, he remains in sopor. The second situation is when the patient is in a coma and cannot regain consciousness. In this case, it is most difficult to explain the compression of the brain, as well as to assess its degree. With a developing hematoma, the medulla may be pressed into the opening of the cerebellar namet.
With craniocerebral injuries, which are accompanied by fractures of the base or arch of the skull, the following symptoms are characteristic:
With a fracture of the base of the skull – a symptom of “glasses” – hemorrhage in the periorbital region, possible bleeding from the nose, ears.
DIAGNOSIS OF TRAUMATIC BRAIN INJURY
An external examination of the patient, collection of complaints, namnesis (circumstances of injury) is mandatory
The duration of loss of consciousness has an important diagnostic value
Assessment of hemodynamic parameters
The presence of anisocoria, focal symptoms of brain damage
The presence of rigidity of the occipital muscles, fractures
Craniography, MRI, CT
TREATMENT OF TRAUMATIC BRAIN INJURY
The main goal of treatment for any traumatic brain injury is to minimize all possible risks and long-term complications, restore impaired brain functions, and stabilize the condition.
Urgent measures should be aimed at relieving brain hypoxia, maintaining blood pressure at an optimal level. In the presence of airway obstruction – tongue entrapment, aspiration by vomit – it is necessary to restore the patency of the airways. In severe cases, artificial ventilation of the lungs is required.
In the hospital, the patient is provided with rehabilitation measures, ventilation. If an intracranial hematoma is detected on CT, the patient urgently needs to undergo surgery and eliminate the hematoma in order to avoid further compression and infringement of the brain.
After the stabilization of the condition, intensive therapy continues. The patient is prescribed drugs that reduce intracranial pressure, increase vascular tone, nootropics for early prevention of the consequences after hematoma, trauma and other brain damage.
