Among the causes of death in young and middle age, trauma ranks first. Traumatic brain injury (TBI) is one of the most common types of injuries and accounts for up to 50% of all types of injuries. In injury statistics, brain injuries account for 25-30% of all injuries, accounting for more than half of deaths. Mortality from traumatic brain injury accounts for 1% of total mortality.

Traumatic brain injury is damage to the bones of the skull or soft tissues, such as brain tissue, blood vessels, nerves, and meninges. There are two groups of traumatic brain injuries - open and closed.

Classification of TBI

Open damage

With an open craniocerebral injury, the skin and aponeurosis are damaged and the bottom of the wound is bone or deeper tissue. A penetrating injury is one in which the dura mater is damaged. Special case penetrating trauma - otoliquorrhea as a result of a fracture of the bones of the base of the skull.

Closed damage

In a closed head injury, the aponeurosis is not damaged, although the skin may be damaged.

All traumatic brain injuries are divided into:

• A concussion is an injury in which there are no permanent disturbances in the functioning of the brain. All symptoms that occur after a concussion usually disappear over time (within a few days). Persistent symptoms are a sign of more serious brain damage. The main criteria for the severity of a concussion are the duration (from several seconds to hours) and the subsequent depth of loss of consciousness and the state of amnesia. Not specific symptoms- nausea, vomiting, pallor skin, cardiac dysfunction.
• Compression of the brain (hematoma, foreign body, air, contusion).
• Brain contusion: mild, moderate and severe.
• Diffuse axonal damage.
• Subarachnoid hemorrhage.

At the same time, various combinations of types of traumatic brain injury can be observed: bruise and compression by a hematoma, bruise and subarachnoid hemorrhage, diffuse axonal damage and bruise, brain contusion with compression by a hematoma and subarachnoid hemorrhage.

Symptoms of TBI

symptoms of impaired consciousness - stupor, stupor, coma. Indicate the presence of a traumatic brain injury and its severity.
symptoms of damage to the cranial nerves indicate compression and contusion of the brain.
symptoms of focal brain lesions indicate damage to a certain area of ​​the brain; they occur with a bruise or compression of the brain.
stem symptoms are a sign of compression and contusion of the brain.
meningeal symptoms - their presence indicates the presence of a brain contusion or subarachnoid hemorrhage, and a few days after the injury it can be a symptom of meningitis.

Treatment for concussion

All victims with a concussion, even if the injury seems mild from the very beginning, must be transported to an emergency hospital, where, to clarify the diagnosis, radiography of the skull bones is indicated; for a more accurate diagnosis, if equipment is available, a CT scan of the brain can be performed.

Victims in the acute period of injury should be treated in the neurosurgical department. Patients with a concussion are prescribed bed rest for 5 days, which is then, taking into account the characteristics clinical course, are gradually expanding. In the absence of complications, discharge from the hospital on the 7-10th day for outpatient treatment lasting up to 2 weeks is possible.

Drug treatment for concussion is aimed at normalizing functional state brain, relieving headaches, dizziness, anxiety, insomnia.

Typically, the range of drugs prescribed upon admission includes analgesics, sedatives and hypnotics:

Painkillers (analgin, pentalgin, baralgin, sedalgin, maxigan, etc.) select the most effective drug for a given patient.

If you feel dizzy, choose one of the available medicines(cerucal)
Sedatives. They use infusions of herbs (valerian, motherwort), drugs containing phenobarbital (Corvalol, Valocordin), as well as tranquilizers (Elenium, Sibazon, phenazepam, nozepam, rudotel, etc.).

Along with symptomatic treatment for a concussion, it is advisable to conduct a course of vascular and metabolic therapy for faster and full recovery disorders of brain function and prevention of various post-concussion symptoms. Prescription of vasotropic and cerebrotropic therapy is possible only 5-7 days after injury. A combination of vasotropic (Cavinton, Stugeron, Teonicol, etc.) and nootropic (nootropil, aminolon, picamilon, etc.) drugs is preferable. Take Cavinton three times a day, 1 tablet. (5 mg) and nootropil 1 cap. (0.4) for 1 month.

To overcome frequent asthenic phenomena after a concussion, multivitamins such as “Complivit”, “Centrum”, “Vitrum”, etc. are prescribed, 1 tablet each. in a day.

Tonic preparations include ginseng root, eleutherococcus extract, and lemongrass fruit.

A concussion is never accompanied by any organic lesions. If any post-traumatic changes are detected on CT or MRI, it is necessary to talk about a more serious injury - brain contusion.

Brain contusion due to TBI

A brain contusion is a violation of the integrity of the brain matter in a limited area. It usually occurs at the point of application of the traumatic force, but can also be observed on the side opposite to the injury (contusion from a counter-impact). In this case, destruction of part of the brain tissue, blood vessels, and histological cell connections occurs, with the subsequent development of traumatic edema. The area of ​​such violations varies and is determined by the severity of the injury.
There are mild, moderate and severe brain contusions.

Mild brain contusion

A mild brain contusion is characterized by loss of consciousness after injury lasting from several to tens of minutes.

• After restoration of consciousness, typical complaints are headache, dizziness, nausea, etc.
• As a rule, retro-, con-, and anterograde amnesia is noted. Amnesia (Greek: amnesia forgetfulness, memory loss) is a memory impairment in the form of loss of the ability to retain and reproduce previously acquired knowledge.
• Vomiting, sometimes repeated. Moderate bradycardia may be observed. Bradycardia is a decrease in heart rate to 60 or less per minute in an adult.
• tachycardia - an increase in heart rate over 90 beats per minute for adults.
• sometimes - systemic arterial hypertension; hypertension - increased hydrostatic pressure in blood vessels, hollow organs or body cavities.
• Breathing and body temperature without significant deviations.
• Neurological symptoms are usually mild (clonic nystagmus - involuntary rhythmic biphasic movements of the eyeballs, drowsiness, weakness)
• slight anisocoria, signs of pyramidal insufficiency, meningeal symptoms, etc., often regressing within 2-3 weeks. after injury.

It is almost impossible to differentiate between a concussion and a mild cerebral contusion (concussion) by the duration of coma and post-traumatic amnesia, as well as by clinical manifestation.

The classification adopted in Russia allows for the presence of linear fractures of the cranial vault with mild brain contusion.
An analogue of a mild brain contusion in the domestic classification is a minor head injury by American authors, which implies a condition that meets the following criteria:

1) more than 12 points on the Glasgow Coma Scale (during observation in the clinic);
2) loss of consciousness and/or post-traumatic amnesia not exceeding 20 minutes;
3) hospitalization for less than 48 hours;
4) absence clinical signs contusions of the brain stem or cortex.

Unlike a concussion, with a brain contusion, the structure of the brain tissue is disrupted. So, with a mild bruise, a mild damage to the brain substance is microscopically determined in the form of areas of local edema, pinpoint cortical hemorrhages, possibly in combination with limited subarachnoid hemorrhage as a result of rupture of the pial vessels.

With subarachnoid hemorrhage, blood enters under the arachnoid membrane and spreads through the basal cisterns, grooves and fissures of the brain. Hemorrhage can be local or fill the entire subarachnoid space with the formation of clots. It develops acutely: the patient suddenly experiences a “blow to the head”, severe headache, vomiting, and photophobia appear. There may be one-time generalized seizures. Paralysis, as a rule, is not observed, but meningeal symptoms are pronounced - rigidity occipital muscles(when the head is tilted, the patient’s chin fails to touch the sternum) and Kernig’s sign (the leg bent at the hip and knee joints cannot be straightened at the knee joint). Meningeal symptoms indicate irritation of the membranes of the brain due to bleeding.

Moderate brain contusion

Moderate brain contusion is characterized by loss of consciousness after injury lasting from several tens of minutes to several hours. Amnesia is pronounced (retro-, con-, anterograde). The headache is often severe. Repeated vomiting may occur. Mental disorders are sometimes observed. Transient disorders of vital functions are possible: bradycardia or tachycardia, increased blood pressure, tachypnea - rapid shallow (not deep) breathing without disturbing the rhythm of breathing and airway patency, low-grade fever - increased body temperature within 37-37.9 ° C.

Often, meningeal and brainstem symptoms, dissociation of muscle tone and tendon reflexes along the body axis, bilateral pathological signs, etc. are detected. Focal symptoms are clearly manifested, the nature of which is determined by the localization of the brain contusion; pupillary and eye movement disorders, paresis of the limbs, disorders of sensitivity, speech, etc. These symptoms gradually (within 3-5 weeks) smooth out, but can persist for a long time. With moderate brain contusion, fractures of the bones of the vault and base of the skull, as well as significant subarachnoid hemorrhage, are often observed.

Computed tomography in most cases reveals focal changes in the form of high-density small inclusions, non-compactly located in a zone of reduced density, or a moderate homogeneous increase in density (which corresponds to small hemorrhages in the bruise area or moderate hemorrhagic impregnation of brain tissue without gross destruction). In some observations, with a clinical picture of a moderate bruise, a computed tomogram reveals only zones of reduced density (local edema) or signs of brain injury are not visualized at all.

Severe brain contusion

Severe brain contusion, intracerebral hematomas (limited accumulation of blood when closed and open damage organs and tissues with rupture (injury) of blood vessels; in this case, a cavity is formed containing liquid or coagulated blood) of both frontal lobes.

Severe brain contusion is characterized by loss of consciousness after injury lasting from several hours to several weeks. Motor agitation is often pronounced. Severe disturbances in vital functions are observed: arterial hypertension (sometimes hypotension), bradycardia or tachycardia, disorders of the frequency and rhythm of breathing, which may be accompanied by disturbances in the patency of the upper respiratory tract. Hyperthermia is pronounced. Primary brainstem neurological symptoms often dominate (floating movements of the eyeballs, gaze paresis, tonic nystagmus, swallowing disorders, bilateral mydriasis or ptosis - drooping of the upper eyelid, divergence of the eyes along the vertical or horizontal axis, changing muscle tone, decerebrate rigidity, depression or increase in tendon reflexes, reflexes from the mucous membranes and skin, bilateral pathological stop marks etc.), which obscures focal hemispheric symptoms in the first hours and days after injury. Paresis of the limbs (up to paralysis), subcortical disorders of muscle tone, reflexes of oral automatism, etc. can be detected. Generalized or focal epileptic seizures are sometimes observed. Focal symptoms regress slowly; often rude residual effects, primarily in the motor and mental sphere. Severe brain contusion is often accompanied by fractures of the vault and base of the skull, as well as massive subarachnoid hemorrhage.

Computed tomography reveals focal brain lesions in the form of a heterogeneous increase in density in 1/3 of cases. An alternation of areas with increased (density of fresh blood clots) and decreased density (density of edematous and/or crushed brain tissue) is determined. In the most severe cases, the destruction of the brain substance spreads in depth, reaching the subcortical nuclei and the ventricular system. Observation over time shows a gradual decrease in the volume of compaction areas, their merging and transformation into a more homogeneous mass already in 8-10 days. The volumetric effect of the pathological substrate regresses more slowly, indicating the existence of unresolved crushed tissue and blood clots in the focus of the contusion, which by this time become equally dense in relation to the surrounding edematous substance of the brain. The volume effect disappears by 30-40 days. after injury indicates the resorption of the pathological substrate and the formation in its place of zones of atrophy (a decrease in the mass and volume of an organ or tissue, accompanied by a weakening or cessation of their function) or cystic cavities.

In approximately half of the cases of severe brain contusion, computed tomography reveals significant areas of intense homogeneous increase in density with unclear boundaries, indicating a significant content of liquid blood and its clots in the area of ​​traumatic brain injury. The dynamics show a gradual and simultaneous decrease over 4-5 weeks. the size of the destruction area, its density and the resulting volumetric effect.

Damage to the structures of the posterior cranial fossa (PCF) is one of the severe types of traumatic brain injury (TBI). Their peculiarity lies in their extremely difficult clinical diagnosis and high mortality. Before the advent of computed tomography, the mortality rate for PCF injury was close to 100%.

The clinical picture of damage to the PCF structures is characterized by a severe condition that occurs immediately after the injury: depression of consciousness, a combination of cerebral, meningeal, cerebellar, and brainstem symptoms due to rapid compression of the brainstem and impaired cerebrospinal fluid circulation. If there is significant damage to the substance of the cerebrum, hemispheric symptoms are added.
The proximity of the location of damage to the PCF structures to the liquor-conducting pathways causes their compression and disruption of liquor circulation by a small-volume hematoma. Acute occlusive hydrocephalus - one of the most severe complications of damage to the structures of the posterior follicle - is detected in 40%.

Treatment of brain contusion

Mandatory hospitalization!!! Bed rest.

The duration of bed rest for a mild bruise is 7-10 days, for a moderate bruise up to 2 weeks. depending on the clinical course and results of instrumental studies.
In case of severe traumatic brain injury (foci of crush injury, diffuse axonal damage), resuscitation measures are necessary, which begin at the prehospital stage and continue in a hospital setting. In order to normalize breathing, ensure free patency of the upper respiratory tract (freeing them from blood, mucus, vomit, introducing an air duct, tracheal intubation, tracheostomy tracheostomy (an operation of dissecting the anterior wall of the trachea with subsequent insertion of a cannula into its lumen or the creation of a permanent opening - stoma)) , use inhalation of an oxygen-air mixture, and, if necessary, perform artificial ventilation.

Surgical treatment is indicated for brain contusion with crushing of its tissue (most often occurs in the region of the poles of the frontal and temporal lobes). The essence of the operation: osteoplastic trephination (a surgical operation consisting of creating a hole in the bone in order to penetrate into the underlying cavity) and washing out brain detritus with a stream of 0.9% NaCl solution, stopping bleeding.

The prognosis for mild TBI (concussion, mild brain contusion) is usually favorable (subject to the recommended regimen and treatment for the victim).

In case of moderate injury (moderate brain contusion), it is often possible to achieve complete restoration of work and social activity of the victims. A number of patients develop leptomeningitis and hydrocephalus, causing asthenia, headaches, vegetative-vascular dysfunction, disturbances in statics, coordination and other neurological symptoms.

With severe trauma (severe brain contusion, diffuse axonal damage, brain compression), mortality reaches 30-50%. Among survivors, disability is significant, the leading causes of which are mental disorders, epileptic seizures, gross motor and speech disorders. With an open head injury, inflammatory complications can occur (meningitis, encephalitis, ventriculitis, brain abscesses), as well as liquorrhea - the leakage of cerebrospinal fluid (CSF) from natural holes or holes formed due to various reasons in the bones of the skull or spine, which occurs when integrity is violated.

Half of all deaths from traumatic brain injury are caused by road traffic accidents. Traumatic brain injury is one of the leading causes of disability in the population.

What is traumatic brain injury (TBI)?

Traumatic brain injury includes all types of head injury, including minor bruises and cuts to the skull. More serious injuries from traumatic brain injury include:

skull fracture;

concussion, concussion. A concussion is manifested by a short, reversible loss of consciousness;

accumulation of blood above or below the dural membrane of the brain (the dural membrane is one of the protective films that envelops the brain), respectively, epidural and subdural hematoma;

intracerebral and intraventricular hemorrhage (bleeding into the brain or into the space around the brain).

Almost every person has experienced at least once in their life a minor traumatic brain injury - a bruise or cut to the head that required minimal or no treatment.

What are the causes of traumatic brain injury?

Causes of traumatic brain injury may include:

skull fracture with tissue displacement and rupture of the protective membranes around the spinal cord and brain;

bruises and ruptures of brain tissue due to concussions and blows in a confined space inside the hard skull;

bleeding from damaged vessels into the brain or into the space around it (including bleeding due to a ruptured aneurysm).

Brain damage can also occur due to:

direct injury to the brain by objects penetrating the cranial cavity (for example, bone fragments, bullets);

increased pressure inside the skull as a result of cerebral edema;

a bacterial or viral infection that penetrates the skull in the area of ​​its fractures.

The most common causes of traumatic brain injury are motor vehicle accidents, sports injuries, assaults, and physical abuse.

Traumatic brain injury can develop in anyone at any age because it is the result of trauma. Brain damage can occur during childbirth.

Classification of traumatic brain injuries (TBI).

The following main clinical forms of traumatic brain injury: concussion, mild, moderate and severe brain contusion, compression of the brain.

According to the risk of infection of the brain and its membranes traumatic brain injury is divided into closed and open.

With a closed craniocerebral injury, the integrity of the soft tissues of the head is not violated or there are superficial wounds of the scalp without damage to the aponeurosis.

With an open traumatic brain injury, fractures of the bones of the vault or base of the skull are observed with injury to adjacent tissues, bleeding, leakage of cerebrospinal fluid from the nose or ear, as well as damage to the aponeurosis in wounds of the soft integument of the head.

When the dura mater is intact, open craniocerebral injuries are classified as non-penetrating, and when it is ruptured, they are classified as penetrating. If there are no extracranial injuries, the traumatic brain injury is isolated. When extracranial injuries occur simultaneously (for example, fractures of limbs, ribs, etc.), they speak of a combined traumatic brain injury, and when exposed to different types of energy (mechanical or chemical, radiation or thermal) - a combined one.

Based on severity, traumatic brain injury is divided into mild, moderate and severe. A mild traumatic brain injury includes a mild concussion and contusion, a moderate traumatic brain injury includes a moderate brain contusion, a severe traumatic brain injury includes a severe brain contusion and compression of the brain in the acute period.

There are several main types of interrelated pathological processes that occur at the time of injury and some time after it:

1) direct damage to the brain substance at the time of injury;

2) cerebrovascular accident;

3) violation of liquor dynamics;

4) disturbances of neurodynamic processes;

5) formation of scar-adhesive processes;

6) processes of autoneurosensitization.

The basis of the pathological picture of isolated brain injuries is primary traumatic dystrophies and necrosis; circulatory disorders and organization of tissue defect.

Concussions are characterized by a complex of interconnected destructive, reactive and compensatory-adaptive processes occurring at the ultrastructural level in the synaptic apparatus, neurons, and cells.

Brain contusion- damage characterized by the presence in the substance of the brain and in its membranes of macroscopically visible foci of destruction and hemorrhages, in some cases accompanied by damage to the bones of the vault and base of the skull.

Direct damage to the hypothalamic-pituitary, brainstem structures and their neurotransmitter systems during TBI determines the uniqueness of the stress response. Impaired metabolism of neurotransmitters is the most important feature of the pathogenesis of TBI. It is highly sensitive to mechanical stress cerebral circulation. The main changes developing in this vascular system, are expressed by spasm or dilation of blood vessels, as well as increased permeability of the vascular wall. Another pathogenetic mechanism for the formation of the consequences of TBI is directly related to the vascular factor - a violation of liquor dynamics. Changes in the production of cerebrospinal fluid and its resorption as a result of TBI are associated with damage to the endothelium of the choroid plexuses of the ventricles, secondary disorders of the microvasculature of the brain, fibrosis of the meninges, and in some cases liquorrhea. These disorders lead to the development of liquor hypertension, and less commonly, hypotension.

In TBI, hypoxic and dysmetabolic disorders play a significant role in the pathogenesis of morphological disorders, along with direct damage to nerve elements. TBI, especially severe, causes respiratory and circulatory disorders, which aggravates existing cerebral dyscirculatory disorders and collectively leads to more pronounced brain hypoxia.

Currently, there are three basic periods during traumatic brain disease: acute, intermediate, and long-term.

The acute period is determined by the interaction of the traumatic substrate, damage reactions and defense reactions and is the period of time from the moment of the damaging effects of mechanical energy until the stabilization at one level or another of impaired cerebral and general body functions or the death of the victim. Its duration ranges from 2 to 10 weeks, depending on the clinical form of TBI.

The intermediate period is characterized by the resorption and organization of areas of damage and the deployment of compensatory and adaptive processes until complete or partial recovery or sustainable compensation of impaired functions. The length of the intermediate period for non-severe TBI is up to 6 months, for severe TBI - up to a year.

The long-term period is the completion or coexistence of degenerative and reparative processes. The length of the period of clinical recovery - up to 2-3 years with a progressive course - is not limited.

All types of TBI are usually divided into closed injuries brain (ZTM), open and penetrating. Closed TBI is a mechanical damage to the skull and brain, resulting in a number of pathological processes that determine the severity of the clinical manifestations of the injury. Open TBI should include injuries to the skull and brain in which there are wounds to the integument of the skull (damage to all layers of the skin); penetrating injuries involve disruption of the integrity of the dura mater.

Classification of traumatic brain injury according to Gaidar:

brain concussion;

brain contusion: mild, moderate, severe;

compression of the brain against the background of a bruise and without a bruise: hematoma - acute, subacute, chronic (epidural, subdural, intracerebral, intraventricular); hydro wash; bone fragments; edema-swelling; pneumocephalus.

It is very important to determine:

condition of the intrathecal spaces: subarachnoid hemorrhage; cerebrospinal fluid pressure - normotension, hypotension, hypertension; inflammatory changes;

condition of the skull: no bone damage; type and location of the fracture;

condition of the skull: abrasions; bruises;

associated injuries and diseases: intoxication (alcohol, drugs, etc., degree).

It is also necessary to classify TBI according to the severity of the victim’s condition, the assessment of which includes the study of at least three components:

state of consciousness;

state of vital functions;

state of focal neurological functions.

There are five gradations of the condition of patients with TBI.

Satisfactory condition. Criteria:

1) clear consciousness;

2) absence of violations of vital functions;

3) absence of secondary (dislocation) neurological symptoms; absence or mild expression of primary focal symptoms.

Threat to life (if adequate treatment) absent; the prognosis for recovery is usually good.

Moderate condition. Criteria:

1) state of consciousness - clear or moderate stun;

2) vital functions are not impaired (only bradycardia is possible);

3) focal symptoms - certain hemispheric and craniobasal symptoms may be expressed, often appearing selectively.

The threat to life (with adequate treatment) is insignificant. The prognosis for restoration of working capacity is often favorable.

Serious condition. Criteria:

1) state of consciousness - deep stupor or stupor;

2) vital functions are impaired, mostly moderately according to 1-2 indicators;

3) focal symptoms:

a) brainstem - moderately expressed (anisocoria, decreased pupillary reactions, limited upward gaze, homolateral pyramidal insufficiency, dissociation of meningeal symptoms along the body axis, etc.);

b) hemispheric and craniobasal - clearly expressed both in the form of symptoms of irritation (epileptic seizures) and loss (motor disorders can reach the degree of plegia).

The threat to life is significant and largely depends on the duration of the serious condition. The prognosis for restoration of working capacity is sometimes unfavorable.

Extremely serious condition. Criteria:

1) state of consciousness - coma;

2) vital functions - gross violations in several parameters;

3) focal symptoms:

a) stem - expressed roughly (plegia of upward gaze, gross anisocoria, divergence of the eyes along the vertical or horizontal axis, a sharp weakening of the pupils’ reactions to light, bilateral pathological signs, hormetonia, etc.);

b) hemispheric and craniobasal - pronounced.

The threat to life is maximum; largely depends on the duration of the extremely serious condition. The prognosis for restoration of working capacity is often unfavorable.

Terminal state. Criteria:

1) state of consciousness - terminal coma;

2) vital functions - critical impairment;

3) focal symptoms:

a) stem - bilateral fixed mydriasis, absence of pupillary and corneal reflexes;

b) hemispheric and craniobasal - blocked by general cerebral and brainstem disorders.

Survival is usually impossible.

Clinic of various forms of traumatic brain injury

Clinical picture (symptoms) of acute traumatic brain injury

Brain concussion.

A concussion is characterized by a short-term loss of consciousness at the time of injury, vomiting (usually one-time), headache, dizziness, weakness, painful eye movements, etc. There are no focal symptoms in the neurological status. Macrostructural changes in the brain substance during a concussion are not detected.

Clinically, it is a single functionally reversible form (without division into degrees). With a concussion, a number of general cerebral disorders occur: loss of consciousness or, in mild cases, a short-term blackout from several seconds to several minutes. Subsequently, a stunned state persists with insufficient orientation in time, place and circumstances, unclear perception of the environment and narrowed consciousness. Retrograde amnesia is often detected - loss of memory for events preceding the injury, less often anterograde amnesia - loss of memory for events subsequent to the injury. Speech and motor agitation are less common. Patients complain of headache, dizziness, nausea. An objective sign is vomiting.

Neurological examination usually reveals minor, diffuse symptoms:

symptoms of oral automatism (proboscis, nasolabial, palmomental);

unevenness of tendon and skin reflexes (as a rule, there is a decrease in abdominal reflexes and their rapid exhaustion);

moderately expressed or unstable pyramidal pathological signs (Rossolimo, Zhukovsky, less often Babinsky symptoms).

Cerebellar symptoms are often clearly manifested: nystagmus, muscle hypotonia, intention tremor, instability in the Romberg position. Characteristic feature concussions is a rapid regression of symptoms; in most cases, all organic signs disappear within 3 days.

Various vegetative and, above all, vascular disorders are more persistent in cases of concussions and mild bruises. These include fluctuations in blood pressure, tachycardia, acrocyanosis of the extremities, diffuse persistent dermographism, hyperhidrosis of the hands, feet, and armpits.

Brain contusion (CBM)

Brain contusion is characterized by focal macrostructural damage to the brain matter of varying degrees (hemorrhage, destruction), as well as subarachnoid hemorrhages, fractures of the bones of the vault and base of the skull.

Mild brain contusion characterized by loss of consciousness up to 1 hour after injury, complaints of headache, nausea, vomiting. In the neurological status, rhythmic twitching of the eyes when looking to the sides (nystagmus), meningeal signs, and asymmetry of reflexes are noted. X-rays may reveal fractures of the cranial vault. There is an admixture of blood in the cerebrospinal fluid (subarachnoid hemorrhage). .Mild brain contusion is clinically characterized by a short-term loss of consciousness after the injury, up to several tens of minutes. Upon its recovery, typical complaints are headache, dizziness, nausea, etc. As a rule, retro-, con-, anterograde amnesia, vomiting, and sometimes repeated are noted. Vital functions are usually without significant impairment. Moderate tachycardia and sometimes arterial hypertension may occur. Neurological symptoms are usually mild (nystagmus, mild anisocoria, signs of pyramidal insufficiency, meningeal symptoms, etc.), mostly regressing 2-3 weeks after TBI. With mild UHM, in contrast to concussion, fractures of the calvarial bones and subarachnoid hemorrhage are possible.

Moderate brain contusion clinically characterized by a loss of consciousness after injury lasting up to several tens of minutes or even hours. Moderate brain contusion. Consciousness turns off for several hours. There is a marked loss of memory (amnesia) for the events preceding the injury, the injury itself, and the events after it. Complaints of headache, repeated vomiting. Short-term disorders of breathing, heart rate, and blood pressure are detected. There may be mental disorders. Meningeal signs are noted. Focal symptoms manifest themselves in the form of uneven pupil size, speech impairment, weakness in the limbs, etc. Craniography often reveals fractures of the vault and base of the skull. Lumbar puncture revealed significant subarachnoid hemorrhage. Con-, retro-, anterograde amnesia is expressed. Headache, often severe. Repeated vomiting may occur. Mental disorders occur. Transient disorders of vital functions are possible: bradycardia or tachycardia, increased blood pressure; tachypnea without disturbances in the rhythm of breathing and patency of the tracheobronchial tree; low-grade fever. Meningeal symptoms are often prominent. Brainstem symptoms are also detected: nystagmus, dissociation of meningeal symptoms, muscle tone and tendon reflexes along the body axis, bilateral pathological signs, etc. Focal symptoms are clearly manifested, determined by the localization of the brain contusion: pupillary and oculomotor disorders, paresis of the limbs, sensitivity disorders, etc. . Organic symptoms gradually smooth out over 2-5 weeks, but some symptoms can persist for a long time. Fractures of the bones of the vault and base of the skull, as well as significant subarachnoid hemorrhage, are often observed.

Severe brain contusion. Severe brain contusion is clinically characterized by loss of consciousness after injury lasting from several hours to several weeks. Characterized by prolonged loss of consciousness (lasting up to 1-2 weeks). Gross violations of vital functions are detected (changes in pulse rate, pressure level, frequency and rhythm of breathing, temperature). The neurological status shows signs of damage to the brain stem - floating movements of the eyeballs, swallowing disorders, changes in muscle tone, etc. Weakness in the arms and legs, up to paralysis, as well as convulsive seizures may be detected. A severe bruise is usually accompanied by fractures of the vault and base of the skull and intracranial hemorrhages. .Motor agitation is often expressed, and severe, threatening disturbances in vital functions are observed. The clinical picture of severe UHM is dominated by brainstem neurological symptoms, which in the first hours or days after TBI overlap focal hemispheric symptoms. Paresis of the limbs (up to paralysis), subcortical disorders of muscle tone, reflexes of oral automatism, etc. can be detected. Generalized or focal epileptic seizures are noted. Focal symptoms regress slowly; gross residual effects are frequent, primarily in the motor and mental spheres. Severe UHM is often accompanied by fractures of the vault and base of the skull, as well as massive subarachnoid hemorrhage.

An undoubted sign of fractures of the base of the skull is nasal or auricular liquorrhea. In this case, a “spot symptom” on a gauze napkin is positive: a drop of bloody cerebrospinal fluid forms a red spot in the center with a yellowish halo along the periphery.

Suspicion of a fracture of the anterior cranial fossa arises with the delayed appearance of periorbital hematomas (a symptom of glasses). When the pyramid is fractured temporal bone Battle's symptom (hematoma in the mastoid region) is often observed.

Brain compression

Compression of the brain is a progressive pathological process in the cranial cavity that occurs as a result of trauma and causes dislocation and infringement of the brainstem with the development of a life-threatening condition. With TBI, compression of the brain occurs in 3-5% of cases, both with and without UGM. Among the causes of compression, intracranial hematomas come first - epidural, subdural, intracerebral and intraventricular; This is followed by depressed fractures of the skull bones, areas of brain crushing, subdural hygromas, and pneumocephalus. .Compression of the brain. The main cause of brain compression during traumatic brain injury is the accumulation of blood in a closed intracranial space. Depending on the relationship to the membranes and the substance of the brain, epidural (located above the dura mater), subdural (between the dura mater and the arachnoid mater), intracerebral (in the white matter of the brain and intraventricular (in the cavity of the ventricles of the brain) hematomas are distinguished. The cause of compression of the brain can be there may also be depressed fractures of the calvarial bones, especially penetration bone fragments to a depth of more than 1 cm.

The clinical picture of compression of the brain is expressed by a life-threatening increase after a certain period of time (the so-called light interval) after the injury or immediately after it of general cerebral symptoms, the progression of impaired consciousness; focal manifestations, stem symptoms.

In most cases, there is loss of consciousness at the time of injury. Subsequently, consciousness can be restored. The period of restoration of consciousness is called the lucid interval. After a few hours or days, the patient may again fall into an unconscious state, which, as a rule, is accompanied by an increase in neurological disorders in the form of the appearance or deepening of paresis of the limbs, epileptic seizures, dilation of the pupil on one side, slowing of the pulse (rate less than 60 per minute), etc. .d. According to the rate of development, acute intracranial hematomas are distinguished, which appear in the first 3 days after the injury, subacute - clinically manifested in the first 2 weeks after the injury, and chronic, which are diagnosed after 2 weeks from the injury.

How does traumatic brain injury manifest?
Symptoms of traumatic brain injury:

loss of consciousness;

Strong headache;

increasing drowsiness and lethargy
vomit;

discharge of clear fluid (cerebrospinal fluid or cerebrospinal fluid) from the nose, especially when tilting the head face down.

Call emergency medical services immediately for a person with a traumatic brain injury, no matter how minor the injury.

If you think you have suffered a traumatic brain injury, get medical help or ask someone to help you.

With extensive head wounds penetrating into the cranial cavity, there is a high probability of brain damage. However, in 20% of cases, death after a traumatic brain injury occurs without the presence of skull fractures. Therefore, a person with a traumatic brain injury in the presence of the above symptoms must be hospitalized

Diagnosis of traumatic brain injury.

If the patient is conscious, careful identification of the circumstances and mechanism of injury is necessary, since the cause of a fall and head injury may be a stroke or an epileptic seizure. Often the patient cannot remember the events preceding the injury (retrograde amnesia), those immediately following the injury (anterograde amnesia), as well as the moment of injury itself (cograde amnesia). It is necessary to carefully examine the head to look for signs of injury. Hemorrhages over the mastoid process often indicate a fracture of the temporal bone. Bilateral hemorrhages in the orbital tissue (the so-called “spectacles symptom”) may indicate a fracture of the base of the skull. This is also indicated by bleeding and liquorrhea from the external ear canal and nose. With fractures of the calvarium, a characteristic rattling sound is heard during percussion - the “symptom of a cracked pot.”

To objectify disturbances of consciousness during traumatic brain injury, a special scale has been developed for nursing staff - the Glasgow Coma Scale. It is based on the total score of 3 indicators: eye opening to sound and pain, verbal and motor responses to external stimuli. The total score ranges from 3 to 15.

Severe traumatic brain injury corresponds to 3-7 traumatic brain injury points, moderate - 8-12 points, mild - 13-15.

Glasgow Coma Scale

Index	Score (in points)
Eye opening:
arbitrary
absent
Best verbal answer:
adequate
confused
individual words
individual sounds
absent
Best motor response:
follows instructions
localizes pain
withdraws a limb
pathological flexion
pathological extension
absent

A qualitative assessment of consciousness in traumatic brain injury should be performed. Clear consciousness means wakefulness, complete orientation in place, time and environment. Moderate confusion is characterized by drowsiness, mild errors in time orientation, and slow comprehension and execution of instructions. Deep Stun characterized by deep drowsiness, disorientation in place and time, following only basic instructions (raise your hand, open your eyes). Sopor- the patient is motionless, does not follow commands, but opens his eyes, defensive movements are expressed in response to local painful stimuli. At moderate coma it is not possible to wake up the patient, he does not open his eyes in response to pain, defensive reactions without localization of painful stimuli are uncoordinated. Deep coma characterized by a lack of response to pain, pronounced changes in muscle tone, respiratory and cardiovascular disorders. At terminal coma There is bilateral dilation of the pupils, immobility of the eyes, a sharp decrease in muscle tone, absence of reflexes, severe disturbances of vital functions - breathing rhythm, heart rate, drop in blood pressure below 60 mm Hg. Art.

A neurological examination allows you to assess the level of wakefulness, the nature and degree of speech disorders, the size of the pupils and their reaction to light, corneal reflexes (normally, touching the cornea with a cotton swab causes a blinking reaction), strength in the limbs (decreased strength in the limbs is called paresis, and complete absence active movements in them - paralysis), the nature of twitching in the limbs (convulsive seizures).

Play an important role in the diagnosis of traumatic brain injury instrumental methods tests such as echoencephalography, cranial radiography and computed tomography of the head, including contrast-enhanced computed tomography (angiography).

What examinations are needed after a traumatic brain injury?

Diagnosis of traumatic brain injury:

assessment of airway patency, respiratory and circulatory function;

assessment of the visible area of ​​skull damage;

if necessary, X-rays of the neck and skull, CT (computed tomography), MRI (magnetic resonance imaging);

monitoring the level of consciousness and vital functions of the body (pulse, breathing, blood pressure).

In cases of severe traumatic brain injury, it may be necessary to:

observation by a neurosurgeon or neurologist;

MRI and CT as necessary;

tracking and treatment high blood pressure inside the skull due to swelling or bleeding;

surgical intervention for blood accumulation (hematoma);

prevention and treatment of seizures.

Scheme of examination of victims with traumatic brain injury

1. Identifying the history of the injury: time, circumstances, mechanism, clinical manifestations of the injury and the amount of medical care before admission.

2. Clinical assessment of the severity of the victim’s condition, which has great importance for diagnosis, triage and provision of stage-by-stage assistance to victims. State of consciousness: clear, stunned, stupor, coma; the duration of loss of consciousness and the sequence of exit are noted; memory impairment, antero- and retrograde amnesia.

3. State of vital functions: cardiovascular activity - pulse, blood pressure ( common feature with TBI - difference in blood pressure on the left and right limbs), breathing - normal, impaired, asphyxia.

4. Condition of the skin - color, moisture, bruises, presence of soft tissue damage: location, type, size, bleeding, liquorrhea, foreign bodies.

5. Examination of internal organs, skeletal system, concomitant diseases.

6. Neurological examination: the state of cranial innervation, reflex-motor sphere, the presence of sensory and coordination disorders, the state of the autonomic nervous system.

7. Meningeal symptoms: stiff neck, Kernig’s and Brudzinski’s symptoms.

8. Echoencephaloscopy.

9. X-ray of the skull in two projections; if damage to the posterior cranial fossa is suspected, a posterior semi-axial image is taken.

10. Computer or magnetic resonance imaging of the skull and brain.

11. Ophthalmological examination of the condition of the fundus of the eye: swelling, congestion of the optic nerve head, hemorrhages, condition of the vessels of the fundus.

12. Lumbar puncture - in the acute period, it is indicated for almost all victims with TBI (with the exception of patients with signs of compression of the brain) with measurement of cerebrospinal fluid pressure and removal of no more than 2-3 ml of cerebrospinal fluid, followed by laboratory testing.

13. Computed tomography with contrast in the case of hemorrhagic stroke (in the presence of blood in the cerebrospinal fluid, step 12) and suspected aneurysm rupture, or others additional methods diagnostics at the discretion of the doctor.

14. Making a diagnosis. The diagnosis reflects: the nature and type of brain damage, the presence of subarachnoid hemorrhage, compression of the brain (cause), liquor hypo- or hypertension; condition of the soft covers of the skull; fractures of the skull bones; the presence of concomitant injuries, complications, intoxications.

First aid for victims with severe traumatic brain injury

The results of treatment of traumatic brain injury largely depend on the quality of prehospital care and the speed of hospitalization of the victim. It is unlikely to find another type of injury where a delay in transporting the patient to the hospital for an hour or two made a significant difference. Therefore, it is generally accepted that an ambulance service that is unable to transport a victim with a severe traumatic brain injury to a neurosurgical hospital within a few minutes is not doing its job. In many countries, patients with severe traumatic brain injury are transported to hospitals by helicopter.

When providing first aid at the scene of an accident, it is first necessary to restore the airway. Along with oxygen starvation(hypoxia) a common complication of traumatic brain injury is increased accumulation of carbon dioxide in the body (hypercapnia). During transport, patients must breathe 100% oxygen. In case of multiple injuries accompanied by shock, they begin simultaneously intravenous administration Ringer's solution, rheopolyglucin, etc. Ischemia, hypoxia or hypotension for a short period, even with moderate traumatic brain injury, can lead to further irreversible consequences. If a high spinal cord injury is suspected, the cervical spine should be immobilized.

Bleeding must be stopped by applying a tight bandage or quickly suturing the wound. Damage to the scalp, especially in the elderly, can lead to a sharp worsening of the condition.

Indications for hospitalization for TBI

The generally accepted criteria for hospitalization for traumatic brain injury are:

1) a clear decrease in the level of consciousness,

2) focal neurological disorders (paresis of the limbs, uneven pupil width, etc.),

3) open fractures of the skull bones, bleeding or liquorrhea from the nose or ear canal,

4) epileptic seizures,

5) loss of consciousness as a result of injury,

6) significant post-traumatic amnesia.

Patients with severe headaches, restless, and disoriented are hospitalized until these symptoms disappear.

Treatment is carried out in neurosurgical hospitals.

Caring for patients with severe traumatic brain injury involves preventing bedsores and hypostatic pneumonia (turning the patient in bed, massage, skin toilet, cupping, mustard plasters, suction of saliva and mucus from the oral cavity, sanitation of the trachea).

Complications of traumatic brain injury

Violations of vital functions - a disorder of the basic life support functions (external respiration and gas exchange, systemic and regional circulation). In the acute period, TBI is among the causes of acute respiratory failure(ADN) are dominated by pulmonary ventilation disorders associated with impaired airway patency caused by the accumulation of secretions and vomit in the nasopharynx cavity with their subsequent aspiration into the trachea and bronchi, and retraction of the tongue in comatose patients.

Dislocation process: temporotentorial inclusion, representing a displacement of the mediobasal sections of the temporal lobe (hippocampus) into the fissure of the tentorium of the cerebellum and herniation of the cerebellar tonsils into the foramen magnum, characterized by compression of the bulbar sections of the trunk.

Purulent-inflammatory complications are divided into intracranial (meningitis, encephalitis and brain abscess) and extracranial (pneumonia). Hemorrhagic - intracranial hematomas, cerebral infarctions.

What is the prognosis for traumatic brain injury?
Chances of recovery

The outcome of a traumatic brain injury can vary, just as the response to a traumatic brain injury varies from person to person. Some extensive penetrating wounds to the skull eventually end full recovery patient, and fairly minor injuries can have the most serious consequences. Usually the damage is more severe in cases of severe cerebral edema, increased intracranial pressure and prolonged loss of consciousness.

A fairly small number of people may remain in a permanent vegetative state after a traumatic brain injury. Qualified neurological and neurosurgical treatment in the early stages after traumatic brain injury can significantly improve the prognosis.

Recovery from traumatic brain injury can be very slow in severe cases, although improvement may last up to 5 years.

Consequences of traumatic brain injury.

The outcomes of traumatic brain injury are largely determined by the age of the victim. For example, with severe traumatic brain injury, 25% of patients under 20 years of age and up to 70-80% of victims over the age of 60 die. Even with mild traumatic brain injury and moderate traumatic brain injury, the consequences become apparent over a period of months or years. So-called " post-traumatic syndrome"characterized by headache, dizziness, increased fatigue, decreased mood, memory impairment. These disorders, especially in old age, can lead to disability and family conflicts. To determine the outcomes of traumatic brain injury, the Glasgow Outcome Scale (GOS) has been proposed, which includes five possible outcomes.

Glasgow Outcome Scale

Outcome of traumatic brain injury	Definitions
Recovery	Return to previous employment levels
Moderate disability	Neurological or mental disorders that prevent return to previous work while being able to care for oneself
Gross disability	Inability to self-care
Vegetative state	Spontaneous opening of the eyes and maintenance of the sleep-wake cycle in the absence of response to external stimuli, inability to follow commands and make sounds
	Stopping breathing, heartbeat and electrical activity in the brain

We can talk about outcomes 1 year after the traumatic brain injury, since in the future there are no significant changes in the patient’s condition. Rehabilitation measures include physical therapy, physiotherapy, taking nootropic, vascular and anticonvulsant drugs, and vitamin therapy. The results of treatment largely depend on the timeliness of assistance at the scene of the incident and upon admission to the hospital.

What are the consequences of traumatic brain injury?

The consequences of traumatic brain injury can be associated with damage to a specific area of ​​the brain or be the result of general brain damage with swelling and high blood pressure.

Possible consequences of traumatic brain injury:

epilepsy,
decrease in a certain degree of mental or physical abilities,
depression,
memory loss,
personal changes,

How is traumatic brain injury treated?

First of all, an accurate diagnosis of the nature of the injury is important; the method of treatment depends on this. A neurological examination is performed to assess the level of damage and the need for further rehabilitation and treatment.

Surgery is necessary to remove the blood clot and reduce intracranial pressure, restore the integrity of the skull and its membranes, and prevent infection.

Medicines are needed to control the degree of increased pressure inside the skull, swelling of the brain, and improve blood flow to the brain.

After discharge from the hospital, it may be necessary to observe various specialists: a neurologist, a therapist, etc.

Organization and tactics of conservative treatment of victims with acute TBI

In general, victims with acute TBI should go to the nearest trauma center or medical facility where initial medical examination and emergency medical care are provided. The fact of injury, its severity and the condition of the victim must be confirmed by appropriate medical documentation.

Treatment of patients, regardless of the severity of TBI, should be carried out in an inpatient setting in a neurosurgical, neurological or trauma department.

Primary medical care is provided for urgent reasons. Their volume and intensity are determined by the severity and type of TBI, the severity of the cerebral syndrome and the possibility of providing qualified and specialized assistance. First of all, measures are taken to eliminate airway and cardiac problems. For convulsive seizures and psychomotor agitation, 2-4 ml of diazepam solution is administered intramuscularly or intravenously. If there are signs of compression of the brain, diuretics are used; if there is a threat of cerebral edema, a combination of “loop” and osmodiuretics is used; emergency evacuation to the nearest neurosurgical department.

To normalize cerebral and systemic circulation during all periods of traumatic illness, vasoactive drugs are used; in the presence of subarachnoid hemorrhage, hemostatic and antienzyme agents are used. The leading role in the treatment of patients with TBI is given to neurometabolic stimulants: piracetam, which stimulates the metabolism of nerve cells, improves cortico-subcortical connections and has a direct activating effect on the integrative functions of the brain. In addition, neuroprotective drugs are widely used. To increase the energy potential of the brain, the use of glutamic acid, ethylmethylhydroxypyridine succinate, and vitamins B and C is indicated. Dehydration agents are widely used to correct liquorodynamic disorders in patients with TBI. To prevent and inhibit the development of adhesive processes in the membranes of the brain and to treat post-traumatic leptomeningitis and choreoependymatitis, so-called absorbable agents are used.

The duration of treatment is determined by the dynamics of regression of pathological symptoms, but requires strict bed rest in the first 7-10 days from the moment of injury. The duration of hospital stay for concussions should be at least 10-14 days, for mild bruises - 2-4 weeks.

It is possible to undergo rehabilitation after a traumatic brain injury on credit. An untreated traumatic brain injury can subsequently lead to constant headaches and disturbances in intracranial pressure. To avoid complications after TBI and restore all body functions, it is recommended to mandatory undergo rehabilitation procedures. How to speed up recovery after a sports injury and return to full training?

Traumatic brain injuries (TBI): treatment and rehabilitation

Risk is an integral companion of our lives. Often, we are not even aware of it. Few people think about a possible accident while driving a car, about unquestioning compliance with safety regulations in the midst of work, or about injuries while playing sports. One of the most common injuries is head injuries, and a considerable percentage of victims are athletes who received a traumatic brain injury during competitions or even in training.

Classification of TBI

It would seem that a strong skull is reliable protection for the most important human organ. But, nevertheless, traumatic brain injuries are the most common type of injury, and they mainly affect people under 50 years of age.

Traumatic brain injury, or TBI, is mechanical damage to the soft tissues of the head, the skull itself and facial bones, as well as brain tissue. There are several classifications of traumatic brain injuries depending on their nature. So, according to the degree of severity they divide lungs , average And severe injuries . In case of severe TBI, the patient experiences a loss of consciousness (up to coma) for more than an hour, and in case of mild TBI, the victim can remain conscious all the time.

Also classified open , closed And penetrating traumatic brain injuries. The former are characterized by the presence of a wound in which the bone or aponeurosis is exposed; for the second – the presence or absence of damage to the skin while the aponeurosis and bone are intact; in the third case, the tightness of the skull is broken and the dura mater is damaged.

Open and closed injuries have various clinical forms:

• Brain concussion. The mildest of the injuries, the symptoms of which usually cease to be noticeable after a few days. All brain damage in this case is reversible.
• Brain compression. It can be caused by severe contusion or swelling of the brain, as well as bone fragments from a fracture.
• Brain contusion, in which damage and necrosis of a certain area of ​​\u200b\u200bbrain tissue occurs. Depending on the size of the lesion and the depth of loss of consciousness, three degrees of brain contusion are distinguished: mild, moderate and severe.
• Axonal damage– a type of injury in which excessively sudden movements of the head (for example, during a fall or after a blow) cause axonal rupture. Subsequently, microscopic hemorrhages in the brain can lead to coma.
• Intracranial (including intracerebral) hemorrhage. One of the most serious pathologies that causes damage to nerve tissue and displacement of brain structures.

Each of the forms may be accompanied by cracks or fractures of the skull bones and/or fractures of the facial skeleton.

TBI statistics
According to the statistics of recorded cases, most head injuries occur due to household injuries (60%), followed by injuries from road accidents (30%), and 10% are sports injuries.

Consequences of traumatic brain injuries

Traumatic brain injuries are one of the most common causes of disability and death in general traumatology (up to 40% of the total). But the consequences of an injury cannot always be predicted: sometimes a seemingly mild concussion can lead to a sad outcome, and extensive penetrating injuries can result in the patient’s recovery.

However, in most cases, both severe and minor injuries have unpleasant consequences, both early (onset immediately) and delayed (post-traumatic syndrome). The early ones include:

• coma;
• constant dizziness;
• hemorrhages;
• hematomas;
• sleep disorders;
• development of infectious diseases.

Long-term consequences of traumatic brain injury are observed over a long period of time. It can be:

• sleep, speech, memory disorders;
• fast fatiguability;
• various mental disorders;
• chronic headache;
• depression.

The severity of the consequences depends not only on the nature and complexity of the injury, but also on the age of the victim, as well as the promptness of the assistance provided.

Signs of Brain Injury

Timely diagnosis allows you to provide the necessary medical care in a timely manner and prevent the development of severe consequences of injury and complications. To do this, you need to pay attention to signs of TBI and even if you suspect them, immediately call emergency team Ambulance.

Symptoms of skull and brain injuries:

• loss of consciousness (even short-term - for a few seconds);
• dizziness and headaches of various types (acute or aching);
• nausea, vomiting;
• noise or ringing in the ears, short-term hearing loss, speech impairment;
• bleeding or discharge of colorless fluid from the nose and ears (a sign of severe traumatic brain injury);
• amnesia, clouding of consciousness: hallucinations, delusions, inappropriate behavior (aggressive or overly apathetic);
• short-term or ongoing blindness (partial or complete);
• manifestation of hematomas on the face, behind the ears, on the neck;
• curvature of the face (with fractures of the base of the skull).

If there are any signs of a traumatic brain injury or a complex of them, it is necessary, as already mentioned, to take the victim to the hospital, where he will receive the necessary assistance.

Treatment of TBI

Treatment of brain injuries occurs in two stages: provision of first aid (pre-hospital or medical) and subsequent observation of the patient in the clinic and then in the hospital. Primary measures will help avoid the development of secondary damage and prevent brain hypoxia and intracranial hypertension.

When the victim is admitted to the hospital, diagnostics (x-ray or tomography) are performed to determine the nature and extent of the damage. Based on the results of the examination, a course of treatment is developed: in severe cases, neurosurgical intervention, in the absence of the need for surgery, conservative measures. Non-surgical treatment includes pharmacological methods (introduction of calcium channel blockers, nootropics, corticosteroids, etc.)

In general, the course of treatment is always developed individually, taking into account all factors: the age and general condition of the patient, the nature of the injury, the presence of concomitant injuries and diseases. The duration of treatment in a hospital ranges from 10 days (for bruises and mild concussions) to several months (for severe traumatic brain injuries).

Rehabilitation after head injuries

The rehabilitation period after TBI is no less important than the intensive treatment stage, since it is the rehabilitation course that allows one to avoid complications after injury and repeated brain damage. Also during rehabilitation period the patient restores body functions lost during the illness (speech, motor skills, memory), a number of measures are taken to stabilize psycho-emotional state the victim, preparing him for his return to a full life in the family and society.

After discharge from the hospital, many patients do not consider it necessary to take an additional course rehabilitation treatment in a sanatorium or specialized clinic, believing that at home all the conditions necessary for rehabilitation can be provided. However, it is more advisable to spend some time in a specialized center, under the supervision of specialists: neurologists, physical and occupational therapists, psychologists. Thus, the patient will be able not only to more effectively restore cognitive skills and mobility, but also undergo the necessary socialization and adaptation to new living conditions. This is especially true for patients who have suffered severe brain injuries.

Traumatic brain injuries are very dangerous for human health; their consequences, especially if incorrectly diagnosed or treated, can lead to disability or death. Therefore, it is very important to provide the victim with timely first aid, conduct a thorough diagnosis and develop the right course of medical measures. The patient, in turn, must not only undergo inpatient treatment, but also rehabilitation.

Where can I take a course in recovery from a traumatic brain injury?

In our country, until recently, little attention was paid to the need for rehabilitation treatment after various injuries and illnesses, even such serious ones as brain damage, strokes, hip fractures, etc. Therefore, there are few clinics that provide rehabilitation for patients after such diseases and they are mostly private.

One of the most famous centers that we recommend paying attention to is the rehabilitation clinic. Here, patients in sanatorium conditions undergo a course of post-hospital treatment after TBI under the supervision of qualified doctors and medical personnel. The center constantly employs a neuropsychologist who helps victims of brain injury to regain all lost skills and correct mental processes. All conditions have been created here for a quick and comfortable restoration of physical and emotional health: healing procedures are interspersed with walks in the fresh air and recreational activities, in which both animators and psychologists with patients take part. The cooks of the Three Sisters restaurant prepare exceptionally healthy and delicious dishes, taking into account the diet recommended for each patient, and you can dine with guests - the center is open to relatives and friends of its clients.

License of the Ministry of Health of the Moscow Region No. LO-50-01-009095 dated October 12, 2017.

Wednesday, 03/28/2018

Editorial opinion

No matter how minor the injury may seem - a small bruise, a concussion - you should consult a doctor in any case. If we are talking about serious injury, then calling emergency help is necessary as soon as possible. Until doctors arrive, you need to constantly monitor the victim’s breathing and prevent fluids (saliva, vomit, blood) from flowing into the respiratory tract - to do this, you need to lay the patient on his side. A sterile bandage should be applied to the open wound.

Traumatic brain injuries rank first among all injuries (40%) and most often occur in people aged 15–45 years. The mortality rate among men is 3 times higher than among women. In large cities, every year out of a thousand people, seven receive traumatic brain injuries, while 10% die before reaching the hospital. In the case of a mild injury, 10% of people remain disabled, in the case of a moderate injury - 60%, severe - 100%.

Causes and types of traumatic brain injuries

A complex of injuries to the brain, its membranes, skull bones, soft tissues of the face and head is a traumatic brain injury (TBI).

Most often, participants in road accidents suffer from traumatic brain injuries: drivers, passengers of public transport, pedestrians hit by vehicles. In second place in terms of frequency of occurrence are household injuries: accidental falls, blows. Next come injuries sustained at work and sports.

Young people are most susceptible to injuries in the summer - these are so-called criminal injuries. Elderly people are more likely to get a TBI in the winter, and the leading cause is a fall from a height.

Statistics
Residents of Russia most often suffer a TBI while intoxicated (70% of cases) and as a result of fights (60%).

One of the first to classify traumatic brain injuries was the 18th century French surgeon and anatomist Jean-Louis Petit. Today there are several classifications of injuries.

• by severity: light(brain concussion, slight bruise), average(serious injury) heavy(severe brain contusion, acute compression of the brain). The Glasgow Coma Scale is used to determine severity. The victim's condition is assessed from 3 to 15 points depending on the level of confusion, ability to open eyes, speech and motor reactions;
• type: open(there are wounds on the head) and closed(no damage to the scalp);
• by type of damage: isolated(damage affects only the skull), combined(the skull and other organs and systems are damaged), combined(the injury was not only mechanical, the body was also affected by radiation, chemical energy, etc.);
• according to the nature of the damage:
• shake(minor injury with reversible consequences, characterized by a short-term loss of consciousness - up to 15 minutes, most victims do not require hospitalization, after examination the doctor may prescribe a CT or MRI);
• injury(a disruption of brain tissue occurs due to an impact of the brain on the wall of the skull, often accompanied by hemorrhage);
• diffuse axonal brain injury(axons - the processes of nerve cells that conduct impulses - are damaged, the brain stem suffers, microscopic hemorrhages are noted in the corpus callosum of the brain; such damage most often occurs in an accident - at the time of sudden braking or acceleration);
• compression(hematomas form in the cranial cavity, the intracranial space is reduced, crush areas are observed; emergency surgical intervention is required to save a person’s life).

It is important to know
Brain injury most often occurs at the site of impact, but often damage occurs on the opposite side of the skull - in the impact zone.

The classification is based on the diagnostic principle; on its basis, a detailed diagnosis is formulated, according to which treatment is prescribed.

Symptoms of TBI

The manifestations of traumatic brain injuries depend on the nature of the injury.

Diagnosis « brain concussion» diagnosed on the basis of anamnesis. Typically, the victim reports that there was a blow to the head, which was accompanied by a short-term loss of consciousness and a single vomiting. The severity of the concussion is determined by the duration of loss of consciousness - from 1 minute to 20 minutes. At the time of examination, the patient is in a clear state and may complain of a headache. No abnormalities other than pale skin are usually detected. In rare cases, the victim cannot remember the events that preceded the injury. If there was no loss of consciousness, the diagnosis is considered doubtful. Within two weeks after a concussion, weakness, increased fatigue, sweating, irritability, and sleep disturbances may occur. If these symptoms do not disappear for a long time, then it is worth reconsidering the diagnosis.

At mild brain contusion And the victim may lose consciousness for an hour, and then complain of headache, nausea, and vomiting. Eye twitching when looking to the side and asymmetry of reflexes are noted. An X-ray may show a fracture of the bones of the skull, and blood in the cerebrospinal fluid.

Dictionary
Liquor - liquid transparent color that surrounds the head and spinal cord and also performs protective functions.

Moderate brain contusion severity is accompanied by loss of consciousness for several hours, the patient does not remember the events preceding the injury, the injury itself and what happened after it, complains of headache and repeated vomiting. The following may be observed: disturbances in blood pressure and pulse, fever, chills, soreness of muscles and joints, convulsions, visual disturbances, uneven pupil size, speech disturbances. Instrumental studies show fractures of the vault or base of the skull, subarachnoid hemorrhage.

At severe brain contusion the victim may lose consciousness for 1–2 weeks. At the same time, gross violations of vital functions (pulse rate, pressure level, frequency and rhythm of breathing, temperature) are detected. The movements of the eyeballs are uncoordinated, muscle tone is changed, the swallowing process is impaired, weakness in the arms and legs can reach convulsions or paralysis. As a rule, this condition is a consequence of fractures of the vault and base of the skull and intracranial hemorrhage.

It is important!
If you or your loved ones suspect that you have suffered a traumatic brain injury, you need to see a traumatologist and neurologist within a few hours and carry out the necessary diagnostic procedures. Even if it seems that you are feeling fine. After all, some symptoms (cerebral edema, hematoma) may appear after a day or even more.

At diffuse axonal brain damage a prolonged moderate or deep coma occurs. Its duration ranges from 3 to 13 days. Most victims have a respiratory rhythm disorder, different horizontal positions of the pupils, involuntary movements of the pupils, and arms with hanging hands bent at the elbows.

At compression of the brain two may be observed clinical pictures. In the first case, there is a “light period”, during which the victim regains consciousness, and then slowly enters a state of stupor, which is generally similar to stupor and numbness. In another case, the patient immediately falls into a coma. Each condition is characterized by uncontrolled eye movements, strabismus, and cross-limb paralysis.

Long-term head compression accompanied by swelling of the soft tissues, reaching a maximum 2–3 days after its release. The victim is in psycho-emotional stress, sometimes in a state of hysteria or amnesia. Swollen eyelids, impaired vision or blindness, asymmetrical swelling of the face, lack of sensitivity in the neck and back of the head. A computed tomography scan shows swelling, hematomas, skull fractures, areas of brain contusion and crush injuries.

Consequences and complications of TBI

After suffering a traumatic brain injury, many become disabled due to mental disorders, movements, speech, memory, post-traumatic epilepsy and other reasons.

Even mild TBI affects cognitive functions- the victim experiences confusion and decreased mental abilities. More severe injuries may result in amnesia, impairment of vision, hearing, speech and swallowing skills. In severe cases, speech becomes slurred or even lost completely.

Disorders of motor skills and functions of the musculoskeletal system are expressed in paresis or paralysis of the limbs, loss of sensitivity of the body, and lack of coordination. In cases of severe and moderate injuries, there is failure to close the larynx, as a result of which food accumulates in the pharynx and enters the respiratory tract.

Some TBI survivors suffer from pain syndrome - acute or chronic. Acute pain syndrome persists for a month after injury and is accompanied by dizziness, nausea, and vomiting. Chronic headache accompanies a person throughout his life after receiving a TBI. The pain can be sharp or dull, throbbing or pressing, localized or radiating, for example, to the eyes. Attacks of pain can last from several hours to several days, intensifying during moments of emotional or physical stress.

Patients have a hard time experiencing the deterioration and loss of body functions, partial or complete loss of performance, and therefore suffer from apathy, irritability, and depression.

Treatment of TBI

A person who has suffered a traumatic brain injury needs medical attention. Before the ambulance arrives, the patient must be placed on his back or on his side (if he is unconscious), and a bandage must be applied to the wounds. If the wound is open, cover the edges of the wound with bandages and then apply a bandage.

The ambulance team takes the victim to the trauma department or intensive care unit. There the patient is examined and, if necessary, an X-ray of the skull, neck, thoracic and lumbar spine is taken, chest, pelvis and limbs, perform an ultrasound of the chest and abdominal cavity, take blood and urine for analysis. An ECG may also be ordered. In the absence of contraindications (state of shock), a CT scan of the brain is performed. Then the patient is examined by a traumatologist, surgeon and neurosurgeon and a diagnosis is made.

The neurologist examines the patient every 4 hours and assesses his condition using the Glasgow scale. If the patient's consciousness is impaired, tracheal intubation is indicated. A patient in a state of stupor or coma is prescribed artificial ventilation. Intracranial pressure is regularly measured in patients with hematomas and cerebral edema.

The victims are prescribed antiseptic, antibacterial therapy. If necessary, anticonvulsants, analgesics, magnesia, glucocorticoids, sedatives.

Patients with a hematoma require surgery. Delaying surgery within the first four hours increases the risk of death by up to 90%.

Prognosis of recovery for TBI of varying severity

In the case of a concussion, the prognosis is favorable provided that the victim follows the recommendations of the attending physician. Full recovery of working capacity is observed in 90% of patients with mild TBI. In 10%, cognitive functions remain impaired and there is a sharp change in mood. But these symptoms usually disappear within 6–12 months.

The prognosis for moderate and severe forms of TBI is based on the number of points on the Glasgow scale. An increase in points indicates positive dynamics and favorable outcome injuries.

In victims with moderate TBI, it is also possible to achieve complete restoration of body functions. But often headaches, hydrocephalus, vegetative-vascular dysfunction, coordination problems and other neurological disorders remain.

With severe TBI, the risk of death increases to 30–40%. Among survivors there is almost one hundred percent disability. Its causes are severe mental and speech disorders, epilepsy, meningitis, encephalitis, brain abscesses, etc.

Of great importance in returning the patient to an active life is the complex of rehabilitation measures provided to him after the acute phase has stopped.

Directions for rehabilitation after traumatic brain injury

World statistics show that 1 dollar invested in rehabilitation today will save 17 dollars to ensure the life of the victim tomorrow. Rehabilitation after TBI is carried out by a neurologist, rehabilitation specialist, physical therapist, occupational therapist, massage therapist, psychologist, neuropsychologist, speech therapist and other specialists. Their activities, as a rule, are aimed at returning the patient to a socially active life. The work to restore the patient’s body is largely determined by the severity of the injury. Thus, in case of severe injury, the efforts of doctors are aimed at restoring the functions of breathing and swallowing, and improving the functioning of the pelvic organs. Specialists are also working to restore higher mental functions (perception, imagination, memory, thinking, speech) that may have been lost.

Physical therapy:

• Bobath therapy involves stimulating the patient’s movements by changing the positions of his body: short muscles are stretched, weak ones are strengthened. People with mobility limitations get the opportunity to learn new movements and hone those they have learned.
• Vojta therapy helps connect brain activity and reflex movements. The physical therapist stimulates various areas of the patient's body, thereby encouraging him to perform certain movements.
• Mulligan therapy helps relieve muscle tension and pain-free movements.
• Installation "Exart" - suspension systems, with the help of which you can relieve pain and return atrophied muscles to work.
• Exercise classes. Shown are classes on cardio equipment, exercise machines with biological feedback, as well as on a stabilization platform - for training coordination of movements.

Occupational therapy- a direction of rehabilitation that helps a person adapt to environmental conditions. The occupational therapist teaches the patient to take care of himself in everyday life, thereby improving his quality of life, allowing him to return not only to social life, but even to work.

Kinesio taping- applying special adhesive tapes to damaged muscles and joints. Kinesitherapy helps reduce pain and swelling, without limiting movement.

Psychotherapy- an integral component of high-quality recovery after TBI. The psychotherapist carries out neuropsychological correction, helps to cope with apathy and irritability characteristic of patients in the post-traumatic period.

Physiotherapy:

• Drug electrophoresis combines the introduction of drugs into the victim’s body with the influence of direct current. The method allows you to normalize the state of the nervous system, improve blood supply to tissues, and relieve inflammation.
• Laser therapy effectively combats pain, tissue swelling, and has an anti-inflammatory and reparative effect.
• Acupuncture can help reduce pain. This method is part of a complex of therapeutic measures in the treatment of paresis and has a general psychostimulating effect.

Drug therapy is aimed at preventing brain hypoxia, improving metabolic processes, restoring active mental activity, and normalizing a person’s emotional background.

After moderate and severe traumatic brain injuries, it is difficult for victims to return to their usual way of life or come to terms with forced changes. In order to reduce the risk of developing serious complications after a TBI, you need to follow simple rules: do not refuse hospitalization, even if you seem to be feeling fine, and do not neglect the various types of rehabilitation that integrated approach capable of showing significant results.

Which rehabilitation center after TBI can I go to?

“Unfortunately, there is no single rehabilitation program after traumatic brain injury that would allow the patient to return to his previous condition with a 100% guarantee,” says a rehabilitation center specialist. - The main thing to remember: with TBI, much depends on how quickly rehabilitation measures begin. For example, “Three Sisters” admits victims immediately after hospitalization; we even provide assistance to patients with ostomies, bedsores, and work with the youngest patients. We accept patients 24 hours a day, seven days a week, and not only from Moscow, but also from the regions. We devote 6 hours a day to rehabilitation sessions and continuously monitor the dynamics of recovery. Our center employs neurologists, cardiologists, neurourologists, physical therapists, occupational therapists, neuropsychologists, psychologists, speech therapists - all of them are experts in rehabilitation. Our goal is to improve not only physical condition victim, but also psychological. We help a person gain confidence that, even after suffering severe trauma, he can be active and happy.”

License to carry out medical activities LO-50-01-009095 dated October 12, 2017 issued by the Ministry of Health of the Moscow Region

Editorial opinion

If there is a suspicion of a TBI, then under no circumstances should you attempt to sit the victim down or lift him. You cannot leave him unattended and refuse medical care.

The most common type of injury is traumatic brain injury. This is a lesion of the skull bones and adjacent soft tissues. Modernity provides an intense rhythm of life that is full of dangers. This increases the possibility of injury. The main thing is to divide TBI into two types:

• Open - in which the wound communicates with environment. The injury can be penetrating, involving the dura mater. Non-penetrating - without damaging the outer skin;
• Closed provides conditions under which the integrity of the skin is not compromised and the injury has no communication with the outside world.

Regardless of the mechanism of TBI, it can be of the following degrees:

• Light;
• Average;
• Heavy.

Depending on the type of impact force, injury occurs:

• Blunt;
• Acute;
• Chopped;
• cut;
• Firearms;
• Crushed.

The severity of the wound, its location, type, and age of the patient determine his condition.

Symptoms of TBI

Signs of a head injury are not universal. They vary. However, the following are common:

• Impaired consciousness in the form of stupor, stupor or coma. Judging by these symptoms, we can talk about the presence of brain injury and its severity;
• Damage to the cranial nerves;
• Signs of focal damage indicate a specific area. This may be the frontal lobe or the occipital, parietal or temporal. And also the base of the brain or its vault;
• Stem symptoms are a sign of compression and bruise;
• Meningeal or meningeal manifestations.

Any head injury requires immediate initiation of therapy.

• Treatment for concussion

One of the most common types of TBI injuries is concussion. The first thing to do for a conscious patient in such a situation is to give him a horizontal position with the head of the bed slightly raised. Otherwise, you should lie on your right side. This is necessary for the unhindered passage of air into the lungs and to prevent the tongue from retracting, as well as vomit, saliva and blood into the respiratory tract.

If there is a bleeding wound on the head, you need to apply an aseptic bandage. It is mandatory to transport the victim to a hospital with necessary research, to establish severity pathological process. A concussion is not a life-threatening condition. Often the damage is not noticeable and is reversible. They do not require excessive active drug therapy.

The main goal of such treatment is to normalize the functional state and relieve pain through analgesics and sedatives.

• Brain contusion due to TBI

This type of damage is characterized by the presence of visible areas of damage in the substance of the brain or its membranes, often with hemorrhages. The injury is often accompanied by damage to the bones of the vault or base of the skull. According to statistics, mild traumatic brain injury is most often detected - in 10 - 15% of cases. Moderate is diagnosed in 8–10% of patients, and severe cases are diagnosed in 5–7%. This more serious condition, unlike a concussion, is accompanied by changes in the brain matter.

• Mild brain contusion

This type of TBI is characterized by minimal transformations. Vital processes such as breathing and cardiac activity are not at risk. Diagnostic data do not reveal serious changes in the brain substance, however, foci of post-traumatic ischemia may be observed. Neurological symptoms are moderate. Their regression occurs in 2-3 weeks.

• Moderate brain contusion

Accompanied by disturbances in mental and vital functions. Often combined with fractures of the vault and base of the skull, hemorrhages under the membrane of the brain or into its substance. Symptomatically, changes in pupillary reactions can be detected, paresis and pathological reflexes are observed.

• Severe brain contusion

Serious damage, which is accompanied by massive hemorrhage. There is loss of consciousness and significant impairment of vital functions. Typically, such victims are sent to intensive care units.

• Treatment of brain contusion

Therapy for this injury cannot be carried out at home. Patients need to restore vital functions. If necessary, oxygen inhalation, blood volume replenishment, or artificial ventilation are performed.

To reduce increased intracranial pressure, the head end of the bed is raised 30° and diuretics are used - Mannitol, Lasix or Furosemide.

Neuroprotective therapy with Cerebrolysin or Semax or Actovegin is prescribed. To improve microcirculation in brain tissue, Cavinton or Trental is prescribed. In some cases, surgery is indicated. It is prescribed when:

• Increasing swelling of the brain, which causes dislocation of its structures, which is fraught with displacement and danger to the patient’s life;
• The focus of the injury is more than 30 cm3 in the form of crushed brain tissue;
• Growing intracranial pressure, which cannot be corrected with medication.

What is traumatic brain injury (TBI)

According to the WHO definition, this lesion is represented by a complex of contact injuries, which includes the soft tissues of the face and head, bone structure, as well as intracranial disorders of the brain and its membranes, which have a common development mechanism.

• What are the causes of traumatic brain injury?

There are countless factors that trigger TBI. According to statistics, the most common in Russia are:

• Falling from height. In 70% of cases, they occur during alcohol intoxication;
• Criminal injury accounting for more than 50% of the total;
• Road transport;
• Household;
• Production;
• Sports;
• Military.

Some causal factors are seasonal. In the summer, “criminal trauma” predominates. In the autumn-winter period, there is a peak in casualties in accidents - road traffic accidents, as well as plane crashes.

• Classification of traumatic brain injuries (TBI)

Damage can be divided into a large number of types. Depending on the mechanism of damage, its localization, prevalence and origin, many classifications are formed. Depending on the type of injury, it can be:

• Focal, in which local areas of damage are formed;
• Diffuse with a chaotic arrangement of disturbance zones;
• Combined.

According to the biomechanics of the injury received, it can be:

• Shock - shockproof;
• Accelerated-slow;
• Combined.

Depending on the origin, TBI can be:

• Primary, when the cause of the injury directly caused the damage;
• Secondary, caused by other intracranial lesions - the outcome of delayed hematoma, subarachnoid hemorrhage or cerebral edema. Or extracranial - arterial hypertension, hypercapnia, hypoxemia and anemia.

Depending on the areas of the brain involved in the process, trauma can be:

• Isolated – with the absence of extracranial injuries;
• Combined, when the patient has a head injury and disorders of other organs;
• Combined, in the presence of several violations.

The main application in clinical practice is the Gaidar classification of traumatic brain injury:

• Shake;
• Bruise: mild, moderate, severe;
• Compression: intracranial hematoma, depressed fracture;
• Diffuse axonal injury (DAI).

There are five gradations of the condition of patients with TBI

• Satisfactory;
• Moderate;
• Heavy;
• Extremely heavy;
• Terminal.

The doctor assesses the patient's situation based on its clinical manifestations and diagnostic markers. According to the established procedure, appropriate treatment is prescribed. Criteria for satisfactory condition:

• Clarity of consciousness;
• No violations of vital functions;
• Little severity or absence of focal, hemispheric or craniobasal symptoms.

A slight bruise does not pose a threat to the patient's life. The prognosis is favorable. Criteria for a moderate condition:

• Consciousness clear or moderately stunned;
• The absence of disturbances in vital functions or the presence of slight changes in cardiac activity in the form of bradycardia - a decrease in heart rate;
• The severity of focal signs such as paresis, sharp decrease in vision or aphasia.

A serious condition is characterized by:

• Depression of consciousness to moderate or deep coma;
• The presence of gross defects in vital functions;
• The appearance of pronounced focal symptoms in the form of paresis, anisocoria, nystagmus, a sharp weakening of the pupils’ reactions to light, and bilateral pathological signs.

This poses a great threat to the patient's life. The duration of this situation plays a big role. With regard to restoration of working capacity, the prognosis is unfavorable. The criteria for a terminal condition are:

• Coma;
• Critical disruption of vital functions;
• Focal symptoms with absence of pupillary and corneal reflexes.

This position of the patient indicates the final stage of the course of TBI. The prognosis for life is unfavorable. The patient may die.

Brain concussion

One of the least severe TBIs is a concussion. This condition occurs when exposed to a minor traumatic force. Manifests itself as reversible functional changes in the brain. This condition accounts for 70% of cases. It is usually accompanied by a short-term loss of consciousness, lasting up to 15 minutes. Typical manifestations are:

• Headache;
• Nausea and vomiting;
• General weakness;
• Painful sensations accompanying eye movements.

Clinical symptoms disappear after a week. Despite the favorable prognosis, 50% of patients experience delayed complications. An examination by a doctor with the implementation of diagnostic measures is mandatory.

Brain contusion (CBM)

Trauma is accompanied by damage to the substance of the organ itself. The force applied to the affected area causes intracranial changes. Hemorrhages are common. This type of TBI is divided into three types based on severity:

• Easy;
• Average;
• Heavy.

In case of a brain injury, patients need to be examined by a doctor with mandatory diagnostic tests. A hospital stay is recommended for patients.

Brain compression

TBI can be caused by the accumulation of blood in the cranial cavity. The cranium is a closed space in which all structures are arranged in an orderly manner. In case of injury, accompanied by the formation of hematomas, dislocation occurs, that is, displacement of the brain. This leads to disruption of vital functions and can pose a great danger to the patient.

The peculiarity of this type of TBI is that the clinic does not appear immediately after the action of the traumatic force, but after a while. The period is called the “light interval”. Compression causes pinching of brain structures. If the trunk is subjected to this process, breathing and heartbeat disturbances occur. This poses a great danger to life. Compression is an indication for surgical intervention, which will help reduce pressure and prevent barrel wedging.

Diagnostics

The determination of the fact of traumatic brain injury is carried out by a doctor through the collection of anamnesis, clinical data and research activities. It can be difficult to make a diagnosis immediately due to the serious condition of the patients, combined trauma to the head and other organs, and alcohol intoxication.

The most common hardware diagnostic methods are:

• CT scan, which allows you to assess the state of affairs in a short time. Tomography of the head and spine is often combined;
• MRI is a more time-consuming method, but compared to computed tomography it is more accurate and sensitive;
• X-ray to detect calvarial fractures.

Glasgow Coma Scale

The degree of depression of the patient's consciousness can be assessed quantitatively. There is a special gradation for this - the Glasgow Coma Scale or GCS. In Russian, this scale is called Glasgow. It is needed to assess the depth of coma in a child over 4 years of age and in an adult. It can be displayed in table form as follows:

Index	Score in points
Eye opening:
Arbitrarily	4
Sound only	3
In response to pain	2
Absent	1
Verbal answer:
Adequately	5
Confused	4
Just a few words	3
Only sounds	2
Absent	1
Motor response:
Able to follow instructions	6
Shows the place of pain	5
Can move a limb	4
Pathological flexion	3
Pathological extension	2
Absent	1

Depending on the points received, there are:

• Clear consciousness – 15;

• Moderate stun – 14-13;
• Glubokoe – 12-11;
• Stupor – 10-8;
• Moderate coma – 7-6;
• Deep – 5-4;
• Transcendent – ​​3.

• Heavy – 3-7;
• Moderate – 8-12;
• Light – 13-15.

What examinations are needed after a traumatic brain injury?

For dynamic monitoring of the patient, repeated diagnostic examinations are necessary. The condition of both the membranes of the brain and its substance, as well as the bones of the skull, is monitored. The patient's position is monitored using CT, MRI and X-rays.

This is necessary until the function of the damaged organ is completely restored. If lesions are found again, measures to eliminate them begin. allows to reduce the number of complications after TBI.

In case of severe traumatic brain injury, you must:

Serious damage requires emergency measures. The doctor must quickly assess the situation and make a presumptive diagnosis. Large intracerebral hematomas are removed in full. Otherwise, they cause compression of the brain and displacement of all its structures, which can lead to a life-threatening condition.

Emergency treatment consists of removing the hematoma by puncture aspiration and local fibrinolysis. The techniques are used when localizing the accumulation of blood inside the brain and subdurally. Such TBIs are especially dangerous for persons with combined trauma to other organs and for the elderly.

If there is no doctor near a person in such a serious condition, it is necessary to urgently call an ambulance and not try to solve the problem on your own. The patient needs to be kept at rest and placed on a hard surface. A sufficient supply of fresh air is necessary.

Scheme of examination of victims with traumatic brain injury

The study of the condition of patients admitted to TBI is carried out in a certain order:

• General examination with palpation and percussion, auscultation;
• X-ray of the skull and spine in two projections - frontal and lateral;
• Ultrasound of the abdominal cavity and chest - to exclude secondary complications;
• Lab tests - total blood and urine, biochemical with determination of creatinine, urea, bilirubin, sugar, electrolytes;
• ECG to identify the state of the functional abilities of the heart muscle;
• Toxicological examination;
• Consultation with a neurosurgeon and traumatologist.

First aid for victims with severe traumatic brain injury

The severity of complications of TBI dictates the need for timely assistance. Emergency measures should be provided in the following order:

• Calling an ambulance;
• The patient assumes a supine position. To do this, he needs to be provided with a hard surface and controlled general state with respiratory rate and pulse;
• If unconscious, place the patient on his side. This prevents the root of the tongue from retracting and vomit from entering the respiratory tract;
• If there is an open wound, apply a clean aseptic dressing on top. It should not compress the lesion, but prevents the entry of bacteria with the development of intense infection.

Indications for hospitalization for TBI

Not all patients with head trauma require hospital treatment. Patients with mild impairment of consciousness can receive therapy at home after examination by a doctor. Mandatory hospitalization is required for persons with:

• Progressive neurological picture;
• Persistent loss of consciousness;
• Severe cerebral symptoms;
• Penetrating wounds;
• Open or depressed skull fracture.

A doctor's examination and the results of diagnostic tests are key points in determining the patient's situation - whether his rehabilitation will take place in a hospital or at home.

Complications of traumatic brain injury

The consequences of TBI are very diverse:

• Memory loss – amnesia, which can be retrograde or anterograde;
• Persistent headaches;
• Decreased performance;
• Purulent foci in the form of an abscess or empyema;
• Post-traumatic inflammation of the arachnoid membrane of the brain - arachnoiditis, which can be adhesive, cystic, adhesive-cystic; diffuse, convexital, basal, subtentorial, focal;
• Hydrocephalus;
• Pneumocephalus;
• Deformations in the structure of the skull;
• Formation of a liquor fistula;
• Damage to the cranial nerves;
• Brain atrophy;
• Cysts;
• Epilepsy;
• The appearance of a carotid-cavernous anastomosis;
• Ischemic changes;
• Aneurysms;
• Mental or autonomic dysfunction.

Forecast

Depending on the severity of the injury, the location of the lesion, the age of the patient, and the presence of concomitant pathologies, one can judge how a TBI will end for a person. In most patients, the disorders are reversible.

90% of TBI cases result in recovery and restoration of performance. Some patients have post-traumatic complications, which smooth out over time or disappear altogether. Or they can develop into a persistent dysfunction and result in disability. In severe cases, the outcome of traumatic brain injury is death.

There is a special rating scale Glasgow, which allows us to assume possible consequences for the patient. By analyzing the patient’s medical history, the specific case of his TBI, the combination of other pathologies and his individual characteristics, the doctor can make a prognosis regarding the patient’s recovery. The sooner appropriate treatment is started, the higher the chance of full recovery.

Consequences of traumatic brain injury

ICD-10 classifies this category as class T90. TBI can lead to a variety of conditions. They cannot always be predicted. Severe traumatic brain injury does not necessarily end in massive complications. And also, a mild TBI does not necessarily end well. However, if we consider ordinary cases, severe traumatic brain injury can lead to early consequences that appear immediately after the event, as well as to long-term consequences that make themselves felt much later. The first includes:

• Coma;
• Frequent dizziness and pain;
• Hemorrhages and hematomas;
• Attachment of infections.

Long-term manifestations of traumatic brain injury include:

• Sleep disorders;
• Speech and memory disorder;
• Excessive fatigue;
• Chronic fatigue;
• Mental changes;
• Frequent headache.

Glasgow Outcome Scale

A certain scheme can help the doctor predict the consequences of an injury. According to it, the patient’s condition is assessed according to a special plan. Points are assigned based on the results obtained. This scheme is called the Glasgow Outcome Scale. It can be presented in the form of the following table:

Points	Outcomes
1	Death.
2	The vegetative state is coma, while the patient’s hemodynamics and breathing are stable, basic reflexes are preserved, but contact with him is impossible due to lack of consciousness. The motor sphere is absent; nutrition is provided through a probe.
3	Failure of the neuromuscular link. The patient is conscious, however, there are severe neurological disorders, forcing him to receive treatment in the intensive care unit.
4	Severe disability with a gross neurological defect that requires outside care for the patient.
5	Moderate level of disability. In this case, no psychopathologies are observed. But the patient requires outpatient observation.
6	Mild lack of independence, in which the patient does not need outside help in self-care, however, moral support and adaptation in work activities are necessary.
7	Progressive restoration of lost functions. The minor neurological picture gradually disappears. The patient does not need outside help.
8	Full recovery.

Organization and tactics of conservative treatment of victims with acute TBI

Therapeutic measures for patients with head injuries are carried out in two stages:

• Pre-medical first aid;
• Inpatient or outpatient observation.

Treatment depends on the type of TBI. More than one dissertation has been written about this. First, causes that threaten the patient’s life are eliminated—respiratory obstruction or cardiac dysfunction.

Then they begin to correct brain symptoms. If there are convulsions, 2-4 ml of Diazepam solution is administered intramuscularly or intravenously. In case of increased intracranial pressure, diuretics are prescribed. They allow fluid not to be retained and eliminated from the body faster.

To prevent cerebral edema, loop and osmodiuretics, as well as dehydration ones, are used. Conservative therapy in such cases is not the first choice.

If possible, they try to hospitalize the patient in the surgery department. The only solution to traumatic brain injury is surgery. Normalization of cerebral circulation is possible through the use of vasoactive drugs. In case of hemorrhages under the membranes, hemostatic agents are required.

Among other things, neurometabolic stimulants are used in the treatment of patients with TBI. Piracetam is widely used, which activates the work of nerve cells and strengthens the cortico-subcortical connection.

It also acts directly on the integrative function of the brain. Both neuroprotective drugs and those that increase the energy potential of the brain are prescribed.

Absorbable agents play a significant role. They prevent the formation of adhesions in the membranes, and also have a beneficial effect on post-traumatic leptomeningitis and choreoependymatitis.

TBI requires bed rest, which varies depending on the severity of the injury. The optimal period is from 7 to 10 days. The more serious the damage, the longer the treatment. Concussions require a hospital stay of at least 2 weeks, and bruises up to 2–4.

The prescription of drugs, strategy and duration of treatment must be strictly determined by the doctor. The lack of special diagnostics can lead to disastrous consequences.

TBI does not need to be treated on its own. Any head injury should be examined by a doctor. The brain is one of the most important and fragile systems in the human body. A permissive attitude is unacceptable here.