Sdavleniye of a brain
Sdavleniye of a brain — the sharp or chronic compression of tissues of brain developing owing to a craniocereberal trauma, existence in a cavity of a skull of volume education, hydrocephaly or hypostasis of a brain. In narrow value understand a form of heavy ChMT as a sdavleniye of a brain. Clinically the sdavleniye of a brain is shown by heavy all-brain symptoms up to development of a coma. Focal symptoms depend on topichesky characteristics of pathological process. Characteristic, but not obligatory, a sign is existence in clinic of a light interval. A basis of diagnostics makes brain KT and MPT. Treatment often surgical, is directed to removal of the education which caused a sdavleniye, and elimination of hydrocephaly.
Sdavleniye of a brain
Sdavleniye of a brain is the vitally dangerous state arising owing to a compression of cerebral fabrics and the progressing increase in intra cranial pressure. The compression leads to a necrosis and death of brain cages that is expressed by formation often of irreversible neurologic deficiency. In a broad sense the sdavleniye of a brain can be noted at many pathological processes happening in a cranium. In narrow sense the sharp sdavleniye of a brain is understood as one of clinical forms of a severe craniocereberal injury. According to about 5% of ChMT proceeds with a brain sdavleniye. The lethality at a severe injury makes from 30% to 50%, the invalidization after ChMT reaches 30%. Improvement of outcomes of ChMT and decrease in a lethality is an important problem of modern traumatology, neurology and urgent neurosurgery.
Brain sdavleniye reasons
Owing to limited space in a cranium, any volume education in a skull leads to a compression of brain fabrics. As similar education the intracerebral tumor (a glioma, an astrotsitoma, hypophysis adenoma, etc.), tumors of brain covers, hematomas, a congestion of the blood which streamed as a result of a hemorrhagic stroke, a cerebral cyst, brain abscess can act. Besides, substantial increase of intra cranial pressure and a compression of a brain can be caused by the expressed hydrocephaly, brain hypostasis.
Slowly growing tumors, cysts, gradually accruing hydrocephaly, the formed abscesses cause a chronic sdavleniye of a brain at which slowly aggravated compression gives the chance to neurons to adapt to the arisen pathological conditions to some extent. The sharp sdavleniye of a brain at ChMT, hypostasis of a brain, okklyuzionny hydrocephaly, a stroke is connected with bystry increase of intra cranial pressure and leads to mass death of brain cages.
The sharp compression of a brain most often results from a craniocereberal trauma. Her the post-traumatic hematoma acts as a common cause. Depending on the location it can be sub - and epiduralny, intracerebral and intra ventricular. The compression of a brain is caused by the vdavleniye of splinters or intra cranial accumulation of air (pnevmotsefaliya) happening at a skull fracture. In certain cases the sdavleniye of a brain is caused accruing in volume of gigromy which is formed at a valvate anguish of a firm cover of a brain and damage of the subarakhnoidalny tanks containing a likvor. Through defect of a firm brain cover there is an absorption under it tserebrospinalny liquid from subarakhnoidalny space. Thus the subduralny gigroma is formed.
Brain sdavleniye symptoms
The clinical picture of a sdavleniye of a brain depends on an etiology, localization of the squeezing education, its amount and speed of increase, and also on compensatory abilities of a brain. Patognomonichny for the majority of post-traumatic hematomas and gigry is existence of a so-called "light interval" when the victim is in consciousness without manifestation of signs of severe damage of a brain. Duration of a light interval can vary of minutes till 36-48 o'clock. Subarakhnoidalny hemorrhage and formation of a subduralny hematoma can be followed by a light interval lasting up to 6-7 days. At severe damage of a brain (a bruise of a brain of heavy degree, aksonalny damage) the light interval, as a rule, is absent.
The sharp sdavleniye of a brain usually demonstrates repeated vomiting, a constant intensive headache and psychomotor excitement with a sleep disorder, sometimes crazy and/or hallucinatory syndromes. Later excitement turns into the general braking which is shown apathy, slackness, block. There is a violation of consciousness which progresses from a sopor to a coma. The poured braking in TsNS is followed by respiratory and cardiovascular frustration which are also caused by the arising mass effect. The last represents the shift of cerebral structures towards a big occipital opening happening because of the increased intra cranial pressure. The prolapse and infringement of a medulla in an occipital opening with violation of work of the centers which are in it regulating respiratory and warm activity is result.
There is a frustration of a rhythm of breath. (breath increase) reaches 60 in min., is followed by a noisy breath and an exhalation, Cheyn's breath — Stokes is observed. Gradually ChSS decreases, bradycardia reaches 40 beats/min. below, blood-groove speed considerably falls, arterial hypertension is observed. In lungs stagnant pneumonia, hypostasis of lungs develops. Auskultativno multiple damp rattles are heard. Skin of extremities and the person to become tsianotichny. Body temperature rises to 40 — 41 °C. Meningealny symptoms are defined. In a terminal stage tachycardia, arterial hypotonia develops. Pulse becomes threadlike, there are episodes (breath delays) which duration grows.
In parallel against the background of all-brain symptoms arise and focal are aggravated. They entirely depend from topics of pathological process. On the party of the center omission of an upper eyelid, a diplopiya, squint, , the central front paresis (asymmetry of the person, , a "parusyashchy" cheek), on the opposite side (geterolateralno) — paresis, paralyzes, tendinous hypo - or an arefleksiya, a gipesteziya are possible. Epileptic attacks, gormetonichesky spasms (paroxysms of a muscular hypertension), tetraparesis, disorders of coordination, a bulbarny syndrome can be noted (a dizartriya, swallowing violations, a dysphonia).
Diagnostics of a sdavleniye of a brain
In diagnostics of a sdavleniye of a brain the neurologist relies upon data of the anamnesis and neurologic survey. If owing to the state the patient cannot be interviewed, whenever possible conduct survey of the relatives or persons who were near the victim at the time of a trauma and during the period after it. The neurologic status can specify on a topic of pathological process, however does not allow to establish its character precisely. In cases when the sdavleniye of a brain is caused by ChMT, the patient has to be examined by the traumatologist.
The list of tool methods of diagnostics has to be limited only to the most necessary and emergency researches. Earlier it included an ekhoentsefalografiya and a lyumbalny puncture. The first allowed to reveal mass effect — shift middle the M-echo, the second — the increased likvorny pressure, availability of blood in tserebrospinalny liquid. Today availability of methods of neurovisualization excludes need of carrying out similar researches. Depending on indications to the patient it is carried out by brain MPT or KT, and sometimes — both of these researches. In emergency situations it is essential to reduce time of carrying out a tomography spiral KT of a brain allows.
KT of a brain gives the chance to establish a look, an arrangement and the amount of intra cranial education, to estimate extent of dislocation of cerebral structures and to diagnose existence of hypostasis of a brain. Perfuzionny KT allows to estimate cerebral perfusion and a blood-groove, to reveal secondary ischemia. MRT of a brain is more sensitive in definition of sites of brain ischemia and the centers of a bruise, the direction of dislocation of brain fabrics. The diffusive weighed MRT gives the chance to investigate a condition of the carrying-out ways of a brain, to establish degree of their compression.
Treatment of a sdavleniye of a brain
The choice of medical tactics is carried out on the basis of clinical and tomographic data. Conservative therapy includes dehydrational and haemo static treatment, normalization of haemo dynamics, knocking over of respiratory frustration (if necessary carrying out IVL), preventive antibacterial therapy, in the presence of spasms — anticonvulsive treatment, etc. Monitoring HELL and intra cranial pressure is surely carried out.
Indications to surgical treatment are defined by the neurosurgeon. Treat them: the large volume of a hematoma, a dislocation syndrome, shift of cerebral structures more than 5 mm, a compression of the covering brain tank, the permanent not stopped increase in intra cranial pressure more than 20 mm of mercury., okklyuzionny hydrocephaly. Concerning hematomas transkranialny or endoscopic evacuation is possible, at an intracerebral hematoma of difficult localization — its stereotaksichesky aspiration. At a combination of a post-traumatic hematoma to a razmozzheniye of tissues of brain, operation is supplemented with removal of sites of a razmozzheniye that is carried out with use of the microsurgical equipment. At cerebral abscess make its total removal, at a tumor — its as much as possible radical excision. In the presence of hydrocephaly which cause does not manage to be removed carrying out the shunting operation (ventikuloperitonealny or lyumboperitonealny shunting) is shown.
Forecast and prevention
Sdavleniye of a brain always has the serious forecast. Correlation of outcomes of a sdavleniye with assessment of a condition of patients on a scale of Glasgow is noted. The balls are lower, the probability of a lethal outcome or transition to a vegetative state — impossibility of productive mental activity is higher at preservation of vegetative and reflex function. Among the survived patients the high percent of an invalidization is observed. Heavy motive violations, epipristupa, violations of mentality, speech frustration can be noted. In too time, thanks to modern approaches to diagnostics and treatment it was succeeded to lower indicators of mortality and to increase the volume of restoration of neurologic deficiency at patients with a brain sdavleniye. Prevention of a cerebral compression comes down to traumatism prevention, timely and adequate treatment of intra cranial pathology.