Brain bruise — the type of a craniocereberal trauma which is followed by limited morphological changes of cerebral fabrics. It is shown by consciousness loss, amnesia, vomiting, dizziness, an anizokoriya, various focal symptomatology, meningealny simptomokompleks, changes of a warm and respiratory rhythm. The main method of diagnostics — brain KT. Conservative treatment: correction of the vital functions, normalization of intra cranial pressure, neurotyre-tread therapy. Surgical treatment is made strictly according to indications, includes cranial trepanation, a decompression and removal of the centers of a bruise.
The Brain Bruise (BB) makes about 25-30% of all craniocereberal injuries (CI). Difference of a bruise of a brain from its concussion is existence of morphological post-traumatic changes in cerebral fabrics. Distinguish three severity of a bruise. The first, along with brain concussion, treats easy ChMT, the second — ChMT of average weight, the third — heavy ChMT. Assessment of weight of a bruise is carried out on extent of disorders of consciousness, weight of a condition of the victim, expressiveness of neurologic deficiency, data of tomographic researches. On statistical data, in Russia the bruise of a brain is distributed on severity as follows: easy — 33%, average weight — 49%, heavy — 18%.
The bruise of a brain 2-3 times more often is observed at males. According to various data in 5-20% of cases of this type of ChMT alcoholic intoxication of the victim comes to light. Now the heavy bruise of a brain acts as one of the leading reasons of a lethality and an invalidization among persons aged up to 45 years. In this regard timeliness of diagnostics and search of optimum ways of treatment of UGM are priority problems of traumatology, neurosurgery, neurology and rehabilitology.
Brain bruise reasons
The bruise of a brain is possible as a result of transport accident, a professional, home, criminal or sports injury. At children's preschool age of UGM it is caused by mainly different falling. The bruise of a brain can occur at sudden falling of patients during a paroxysm of epilepsy or the drop-attack. Often UGM is followed by a skull fracture, in half of cases — intra cranial bleeding (subarakhnoidalny hemorrhage, formation of a subduralny or intracerebral hematoma).
The pathophysiology of UGM includes primary and secondary damage. Primary damage happens directly at a trauma and is caused by brain shift in a cranium, the shift of hemispheres in relation to a brain trunk, a hydrodynamic factor. Structural damages of neurons and cages of a glia, ruptures of synoptic communications, vascular damages and thromboses result. The centers of UGM can have single and multiple character, are localized not only in a blow zone, but also in the field of antiblow. Secondary damage is a consequence of the destructive metabolic processes initiated by primary damage. In the field of a bruise the aseptic inflammation and hypostasis develops, blood circulation and metabolism of neurons is broken. All this leads to expansion of a zone of a bruise. The result of primary and secondary damage is the necrosis of neurons which causes emergence of neurologic deficiency.
Brain bruise symptoms
UGM of easy degree is followed by loss of consciousness to tens of minutes. Then the moderate oglushennost, drowsiness is observed, there can be an incomplete orientation in time and in surrounding. Victims complain of a constant tsefalgiya (headache), weakness, nausea, dizziness. The vomiting which is not giving simplification, perhaps repeated is noted. Amnesia is observed: the patient does not remember the previous event ChMT (retrograde amnesia) and still some time after a trauma cannot remember what happens to it (anterograd amnesia). Often tachycardia or, on the contrary, bradycardia develops, is more rare — arterial hypertension.
In the neurologic status: the anizokoriya, , asymmetry of tendinous reflexes, not expressed meningealny simptomokompleks, can be a slight hemiparesis. When UGM is followed by subarakhnoidalny hemorrhage, the meningealny simptomokompleks is pronounced. At easy degree of a bruise all specified manifestations regress during the period from 2nd to 3 weeks.
UGM of average degree is shown by unconsciousness during of tens of minutes to 4-5 h. At restoration of consciousness the intensive tsefalgiya, repeated vomiting, a game - antero-and retrograde amnesia is observed. Amnesia, moderate or deep devocalization and a disorientation can remain up to several days. Mental deviations are possible. Often takes place subfebrilitt, bradi-or tachycardia, arterial hypertension, the speeded-up breath. In the neurologic status the focal symptoms varying depending on localization of a zone of a bruise come to light. As a rule, a hemiparesis and a gemigipesteziya, violations of the speech (motor aphasia), an anizokoriya and glazodvigatelny frustration are noted various expressiveness. Usually specified symptomatology gradually disappears 4-6 weeks later after ChMT.
UGM of heavy degree differs in the bigger duration of unconsciousness (up to several weeks). Often motor excitement takes place. The heavy bruise of a brain proceeds with dysfunction of the vital systems: arterial hypotonia or hypertensia, takhi-or a bradiaritmiya, violation of a respiratory rhythm against the background of . In an initial stage after ChMT the stem symptomatology dominates: tonic , bilateral and , the detserebratsionny rigidnost, a dysphagy, bilateral-foot pathological reflexes symmetric hypo - or a hyper reflection. On this background signs of defeat of hemispheres come to light: hemiparesis, gemigipesteziya, oral automatism, etc. The hyperthermia to 41 °C, convulsive paroxysms is possible. The neurologic symptomatology has a long current and does not regress fully. Various expressiveness mental and/or neurologic changes remain as the permanent residual investigations of ChMT.
Diagnosis of a bruise of a brain
The main method of diagnostics of UGM in modern conditions is brain KT. The tomographic picture differs depending on weight of a bruise. At easy degree the centers with the reduced density come to light only in 40-50% of cases. In a bruise zone on tomograms puffiness, petekhialny hemorrhages is noted. Puffiness can extend to all share of a brain or even to the whole hemisphere, lead to moderate narrowing of likvorny spaces.
The bruise of average weight is characterized by existence on tomograms of the centers of a bruise in the form of zones of the lowered density. At hemorrhagic treatment the center of a bruise can have the increased density. At a heavy bruise the tomography visualizes the centers of density both increased, and lowered. In the first case it is about blood clots, in the second — about sites of a razmozzheniye and hypostasis. At extremely severe defeats the zone of destruction of cerebral fabric leaves deep into to subcrustal structures.
During treatment of KT also carry out in dynamics. Observations show that in case of easy or average weight of a bruise there is a total disappearance of focal changes eventually. In case of heavy UGM reduction of the area of the centers of destruction, and then their transformation in cysts of a brain or sites of an atrophy is observed. Than ChMT is heavier, especially slowly there take place the specified changes visualized by means of KT.
Treatment of a bruise of a brain
The bruise of a brain is the unambiguous indication to hospitalization of the victim. Treatment is carried out by neurologists and neurosurgeons, and then rehabilitology. Conservative therapy includes, first of all, normalization of the vital functions: correction of haemo dynamics with continuous monitoring HELL, respiratory support, monitoring and correction of intra cranial pressure (furosemide, acetazoleamide, ). Neurotyre-tread treatment (erythropoietin, , progesterone, statins) and symptomatic therapy (correction of a hyperthermia, anticonvulsive therapy, knocking over of a headache, antivomitives, etc.) is carried out.
In 15-20% of UGM surgical treatment is performed. It is shown at development of a sdavleniye of a brain and a dislocation syndrome, in the presence of the center of a razmozzheniye more than 30 cm ³, the center of 20-30 cm ³ with mass effect and with a shift of median structures more than 5 mm or in the presence of smaller centers which are followed by progressive aggravation of neurologic symptomatology.
Operation is performed by cranial trepanation. In the presence of the volume center of a razmozzheniye its removal is made. Bone and plastic cranial trepanation at which after removal of the center bone and skin rags are established into place is performed. At high figures of intra cranial pressure operation is supplemented with decompressive cranial trepanation. If the centers of a razmozzheniye have small volume, but are followed by the expressed puffiness of brain fabrics, decompressive trepanation without removal of the centers is shown.
The forecast at a brain bruise
Can be consequences of UGM post-traumatic hydrocephaly; local cerebral atrophy; formation of a subduralny gigroma, chronic subduralny hematoma, post-traumatic cerebral cyst; emergence of a post-traumatic arakhnoidit, the obolochechno-brain solderings leading to developing of epilepsy or various forms of a psychopathia. In the long-term future the bruise of a brain can cause development of a disease of Parkinson or Alzheimer's disease.
Easy UGM usually has a favorable outcome with a complete recovery of neurologic and mental functions. UGM of average weight at timely and adequate treatment also leads to recovery. After it hydrocephaly, vegeto-vascular dystonia, an adynamy, a slight incoordination of movements can be observed. Heavy UGM leads to a lethal outcome approximately in 30% of cases. Among survivors there is a big percent of disabled people. Act as the main reasons for an invalidization: epilepsy, mental disorders, paresis and paralyzes, violations of the speech.