Brain concussion — the slight closed craniocereberal injury caused by concussion in a cranium and leading to short-term functional deviations in work of TsNS. Act as symptoms of concussion: short-term loss of consciousness, kongradny and retrograde amnesia, headache, nausea, vasomotorial frustration, dizziness, anizorefleksiya, . In diagnostics the important place is taken by an exception of more serious cerebral damages. Therapy includes rest, symptomatic and vascular and neurometabolic treatment, vitamin therapy.
The Brain Concussion (BC) — the easiest type of the craniocereberal trauma (CT) which is characterized by short-term disorder of cerebral functions and not followed by morphological changes. In domestic medicine classification of ChMT taking into account consciousness loss time is standard. According to it, concussion is accompanied by loss of consciousness lasting from couple of seconds up to 20-30 minutes. In the western medicine the maximum time interval of loss of consciousness for SGM 6 h as the big duration of the unconscious period practically always demonstrates damage of cerebral fabrics are considered.
Concussion of a brain makes up to 80% of all cases of ChMT. It is most often observed at persons of young and middle age, children — in the age range have from 5 to 15 years. Differs in big variability of types of traumatism. The topical issues connected with diagnostics and treatment of concussion demand joint consideration of experts in the field of traumatology and neurology.
Brain concussion reasons
Brain concussion arises at direct mechanical impact on a skull more often (heading or on the head). Concussion is possible at sharp influence of the axial loading which is transferred by means of a backbone, for example, when falling to legs or to buttocks; at sharp delay or acceleration, for example, during transport accident.
In all these cases there is a sharp stirring of the head. The brain as if "floats" in tserebrospinalny liquid in a cranium. At concussion the brain has hydrodynamic blow owing to pressure difference of tserebrospinalny liquid extending as a shock wave. Along with it with the big force of the injuring influence the mechanical blow of a brain about a skull bone is possible from within.
The pathogenesis of the cerebral changes happening owing to concussion is up to the end not investigated. It is supposed that at the heart of the clinical manifestations characterizing brain concussion functional dissociation of a brain trunk and hemispheres lies. It is considered that mechanical concussion leads to temporary change of colloidal state and physical and chemical characteristics of cerebral fabrics. Loss of communications between various departments of a brain is a consequence of it. It is not excluded that similar functional separation is caused by violation of metabolism of neurons.
Brain concussion symptoms
Concussion of a brain is the closed ChMT, i.e. is not followed by a skull fracture. After traumatized consciousness loss can take place. Its duration varies and, as a rule, does not exceed several minutes. At some patients concussion of a brain does not involve consciousness loss, only some oglushennost is observed. In many cases retrograde and kongradny amnesia — loss of memories of the events preceding a trauma and about the events which were taking place in the period of the broken consciousness, respectively is noted. Less often anterograd amnesia — loss of memory on the events which arose after restoration of clear consciousness comes to light.
According to existence or lack of loss of consciousness and amnesia mark out 3 severity of SGM. At the first degree there is no both a consciousness loss period, and amnesia. The second degree is characterized by existence of amnesia against the background of confusion of consciousness, but without its loss. Concussion of the third degree assumes consciousness loss existence.
After consciousness restoration patients complain of nausea, a headache, weakness, dizziness, inflows to the head. Vomiting is often observed, single is more often. Noise in ears, pain is possible at the movement by eyes, perspiration. Can be noted: divergence of eyeballs, nasal bleeding, deterioration in appetite, sleep disorder. Arterial pressure unstable, pulse labile. The majority of the specified symptoms are leveled within the first several days after a trauma. It is long the headache, emotional unbalance, vegetative symptoms (perspiration, lability HELL and pulse), weakness can remain.
Brain concussion at children of younger age proceeds mainly without consciousness loss. As a rule, children are excited and cry, then sink into a sleep. After a dream they are whimsical, do not want to eat. Usually in 2-3 days the usual behavior and appetite of the child is completely restored.
Brain concussion complications
Repeated concussions of a brain can lead to development of post-traumatic encephalopathy. As the similar complication often occurs among boxers, it received the name "encephalopathy of boxers". As a rule, motility of the lower extremities suffers. The prishlepyvaniye by one foot or lag at the movement of one leg is periodically observed. The easy diskoordination of movements, a poshatyvaniye, problems with balance is in certain cases observed. Sometimes changes of mentality prevail: there are periods of confusion or block, in hard cases there is a noticeable impoverishment of the speech, there is a tremor of hands.
Post-traumatic changes are possible after any ChMT, regardless of degree of its weight. Episodes of emotional unbalance with irritability and aggression for which subsequently patients regret can be noted. There is a hypersensitivity to infections or alcoholic beverages under the influence of which patients have frustration of mentality up to a deliriya. Neurosises, a depression and fobichesky frustration, emergence of paranoid lines of the personality can act as a complication of concussion. Convulsive attacks, a persistent headache, increase in intra cranial pressure, vasomotorial violations are possible (an orthostatic collapse, perspiration, pallor, rushes of blood to the head). Less often the psychoses which are characterized by disorder of perception, hallucinatory and crazy syndromes develop. In some cases there is dementia with disorder of memory, violation of criticism, a disorientation.
In 10% of cases concussion of a brain leads to formation of a postkommotsionny syndrome. It develops several days later or months after the received ChMT. Patients are disturbed by an intensive headache, frustration of a dream, violation of ability to concentration of attention, dizziness, concern. The chronic postkommotsionny syndrome badly gives in to psychotherapy, and application of narcotic analgetics for knocking over of a headache often leads to dependence development.
Diagnosis of concussion of a brain
Concussion of a brain is diagnosed on the basis of anamnestichesky data on a trauma and time of loss of consciousness, complaints of the patient, results of objective survey of the neurologist and tool researches. In the neurologic status during the next period after a trauma it is observed melkorazmashisty , easy and changeable asymmetry of reflexes, young patients have Marinesku-Radovich's symptom (gomolateralny reduction of muscles of a chin at irritation of an eminence of a thumb of a palm), in certain cases — poorly expressed obolochechny (meningealny) symptoms. As behind a mask of concussion more serious injuries of a brain can disappear, observation of the patient in dynamics is important. If the diagnosis of SGM is established truly, then the deviations revealed at neurologic survey disappear 3-7 days later after a trauma.
After the received ChMT the skull X-ray analysis allowing to confirm absence/existence of fractures of skull without fail is carried out. For an exception of an intracerebral hematoma and other hidden injuries of a brain the electroencephalography, an ekhoentsefalografiya and an oftalmoskopiya (survey of an eye bottom) is appointed. But the best way of diagnostics of ChMT are neurovisualization methods. At concussion of MPT and KT do not reveal any structural changes in brain tissues. If petekhialny hemorrhages or hypostasis of a brain take place, then it is necessary to think of a brain bruise, but not of its concussion.
Treatment of concussion of a brain
As much more severe injury can be behind concussion, hospitalization is recommended to all patients. The basis of therapy is made by a healthy sleep and rest. In the first 1-2 days patients should observe a bed rest, to exclude viewing of the TV, work at the computer, reading and listening of audio recordings in earphones. After an exception of others cerebral damage patients with SGM can be written out for out-patient treatment.
The pharmacotherapy is required not in all cases of concussion and has mainly symptomatic character. Knocking over of a headache is carried out by means of anesthetics. At dizziness appoint , belladonna extract, extract of a ginkgo of a bilob, . As demulcents use a motherwort, phenobarbital, a valerian; at an insomniya — or for the night; according to indications — medazepa, fenozepa, oxazepam.
Brain concussion 3 degrees is the indication for performing course vascular and neurometabolic therapy which provides a combination of one of vascular means (a nitsergolin, cinnarizine, a vinpotsetin) and a nootropa (a noopepta, glycine, piracetam). Inclusion in the scheme of treatment of antioxidants (a meldoniya, a meksidola, a tsitoflavina) and magnesium medicines is effective (lactate magnesium with a pyridoxine, potassium and magnesium of asparaginate). At an adynamy reception of polyvitamins, an eleuterokokka, a magnolia vine is recommended.
Forecast and prevention of concussion of a brain
Observance of the mode and adequate treatment of SGM leads to an absolute recovery and restoration of working capacity. Some time (as much as possible within a year after a trauma) easing of memory and attentiveness, headaches, the increased light sensitivity and to sounds, sleep disorders, fatigue can be observed. The repeated trauma significantly increases risk of development of complications and an invalidization.
Prevention of concussion includes protection of the head on production and at sports activities. Work on building assumes carrying a helmet, some sports (a skateboard, hockey, baseball, driving the bicycle or the motorcycle, skating) demand wearing special helmets. At a trip in the car it is necessary to be fastened by seat belts. In living conditions it is necessary to watch that corridors were free for pass, and the liquid which is incidentally poured on a floor at once was wiped.