Pressure in traumatic brain injury. Treatment of traumatic brain injuries. Treatment for a concussion in the hospital

Shoshina Vera Nikolaevna

Therapist, education: Northern Medical University. Work experience 10 years.

Articles written

Traumatic brain injury is the most common of those that often lead to disability of the patient. The clinical picture depends on the severity of the damage. It is important to start treatment on time to avoid serious disorders of brain function.

What is this problem

Traumatic brain injuries are considered mechanical injuries that damage the skull, its nerves, tissues and blood vessels. Such disorders occur very often, in most cases in people under fifty years of age. The danger of the problem lies in the fact that in the absence of timely assistance and in case of severe tissue damage, brain function cannot be completely restored. This is precisely what causes the high mortality rate and frequent disability of victims.

TBI: classification

Depending on the nature and severity of damage to the brain substances, injuries are divided into:

1. Concussions.
2. Bruises.
3. Squeezing. (For swelling of brain tissue, internal swelling, pressure from bone fragments of the cranial vault, accumulation of fluid under the hard shell, extensive areas of contusion, accumulation of air in the cranial cavity).
4. Severe axonal diffuse damage.

Taking into account the absence or presence of a violation of the integrity of the head, infection getting inside or the likelihood of air accumulation in the cranial cavity, injuries occur:

• Closed, in which the soft tissues are kept intact or a wound appears on them, but without damaging the aponeurosis of the skull. In this case, meningitis and pneumoencephaly cannot occur. Closed head injury is less dangerous.
• Open when there is damage to soft tissues, the aponeurosis of the skull and its deep formations, the membranes and tissues of the brain. In this condition, purulent-septic complications, pneumoencephaly, and areas of the brain are sometimes compressed by skull fragments.

Open injuries, in turn, can be:

• Penetrating, in which the hard membranes of the brain are damaged. Cerebrospinal fluid may leak from the nose or ear. The likelihood of developing purulent processes is very high.
• Non-penetrating. The integrity of the hard shells remains unchanged.

Depending on the combination of traumatic brain injuries with other TBI injuries, there are:

1. Isolated.
2. Combined, in which the chest, abdominal cavity, limbs or other parts of the body are damaged.
3. Combined. In this case, the victim is affected by mechanical, thermal, radiation and chemical factors.

Severity

Depending on the severity of the injuries received, the following are distinguished:

1. Mild severity. The patient's condition remains satisfactory, clarity of consciousness does not change, there are no violations of important brain functions, neurological symptoms are completely absent, primary focal symptoms are mild. Provided proper treatment there is no threat to life. The victim can count on a quick recovery to work capacity.
2. Average degree. Consciousness remains clear or moderately stunned. There is no disruption of vital functions; in some cases, a decrease in heart rate is observed. There are hemispherical or craniobal ​​symptoms. If treated correctly, there is little threat to life. In most cases, ability to work is restored.
3. Heavy. The victim is in a state of deep stupor or stupor. There is a violation of vital functions. Focal symptoms are clearly expressed. Moderate manifestations of pyramidal insufficiency occur, pupillary reactions decrease, and the size of the pupils becomes different. Clear expression of hemispheric and craniobasal symptoms. This manifests itself in the form of epileptic seizures and serious motor disorders, including paralysis. The danger to life is very great. Working capacity is restored in rare cases.
4. Extremely heavy. The patient falls into a coma, vital signs are grossly disturbed. The presence of brainstem symptoms is observed in the form of a sharp weakening of the pupillary response to light, divergence, and anisocoria. Craniobasal and hemispheric manifestations are sharply expressed. The patient's life is in danger. The chances of survival depend on how long a person remains comatose. It is almost impossible to restore working capacity.
5. Terminal state. The patient is in a terminal coma. All vital functions are critically impaired. There are no pupillary and corneal reflexes. General cerebral and brainstem disorders are observed. It is impossible to survive in such a situation.

Symptoms for different forms of TBI

Concussion is a functionally reversible disorder. This condition is manifested by general cerebral symptoms. In mild cases, the victim loses consciousness for several seconds or minutes. There is some stupor, problems with orientation in time and place, consciousness narrows, and it is difficult to perceive the surrounding world.

In frequent cases, retrograde amnesia is diagnosed, that is, the patient does not remember events that occurred before the injury. Rarely observed is anterograde amnesia, in which memories of events following trauma are lost. Some develop speech and motor excitation.

Most patients after a concussion suffer from headaches and dizziness, nausea, accompanied by vomiting. During a neurological examination, they are found to have uneven reflexes and oral automatism.

With concussions, cerebellar symptoms are often observed, manifested in the form of nystagmus, decreased muscle tone, instability and tremor. A distinctive feature of the damage is that over the course of several days all signs gradually smooth out. Vascular and autonomic disorders may last longer:

• blood pressure fluctuates;
• heart rate increases;
• limbs take on a blue tint;
• sweating increases.

With a brain contusion, focal macrostructural damage from hemorrhage to destruction is observed. During an injury, the bones of the input and the base of the skull may break, and arise.

With a slight injury, consciousness turns off for several minutes. After the victim comes to his senses, he begins to feel pain and dizziness, nausea with vomiting, and manifestations of retrograde and anterograde amnesia. In some cases, the pressure in the arteries and the heart rate increase, but these deviations are moderate.

With moderately severe bruises, a person may lose consciousness for several hours. After this, there is a headache and repeated vomiting. In some cases, mental disorders develop. Some body functions are disrupted, which is accompanied by:

• bradycardia and tachycardia;
• increased blood pressure;
• persistent increase in body temperature up to 37 degrees;
• increased shallow breathing without disturbing its rhythm.

Often observed. Depending on which part of the brain is damaged, sensitivity and eye movements are impaired, limbs are paralyzed, and other symptoms occur.

The main manifestations disappear within a few weeks, but some symptoms can bother you for a very long time.

In cases of skull fractures and subarachnoid hemorrhages, the neck often hurts severely.

Severe brain contusion is manifested, first of all, by prolonged loss of consciousness. The victim may remain in this state for several days or weeks. Symptoms of a brain contusion will be as follows:

• motor function of the limbs is impaired up to paralysis;
• muscle tone decreases;
• epilepsy attacks appear;
• violations of oral automatism reflexes and others occur.

There is a slow development of focal symptoms. Residual effects often appear. This usually concerns the motor and mental spheres.

With severe bruises, the skull, its vaults and bases sometimes break, and severe hemorrhages occur in the subarachnoid space. A fracture can be identified by the leakage of cerebrospinal fluid from the nose or ears. If the cranial fossa is damaged, then hematomas occur in the area of ​​the eye orbits, similar to glasses. A fracture of the temporal bone is manifested by bruising in the mastoid process.

A progressive pathological condition after injury is. In this case, the trunk is displaced and pinched and life-threatening disorders develop. More often, such problems occur with bruises. Brain tissue is compressed by intracerebral and intraventricular hematomas. Pressure can be exerted by broken bones, hygromas, and air accumulations in the skull.

After a clear interval, during which the person feels well, a dangerous clinical picture develops. Focal and stem symptoms develop, consciousness is impaired.

Diffuse axonal damage is observed. In this case, axonal fibers and myelin sheaths are torn. This can happen even with minor injuries. Clinically, this condition is manifested by fainting lasting longer than six hours in the absence of a specific lesion. After injury, swelling occurs, which leads to increased intracranial pressure.

Providing first aid

TBI is a dangerous condition that can lead to the death of the victim. Therefore, it is important to help him before the doctor arrives.

If a person has suffered a head injury, then it is necessary:

1. Place in a horizontal position and check breathing and pulse.
2. If the patient is unconscious, then he should be placed on his side, so that in case of nausea, vomit does not enter the respiratory tract, and also to prevent the tongue from sticking.
3. Apply a bandage to the damaged area.
4. When an open head injury is observed, first wrap the edges of the wound with bandages, after which they begin to apply the bandage itself.

It is imperative to call a medical team in case of heavy bleeding, blood from the ears and nose, confusion or loss of consciousness, difficulty breathing, weakness in the limbs, convulsions, unclear speech, and repeated vomiting.

If an open injury occurs, an ambulance should be called immediately. Even if the patient feels well, he needs to visit a traumatologist.

Under no circumstances should you:

1. plant the victim;
2. lift the patient;
3. leave it unattended;
4. do not consult a doctor.

First aid for a traumatic brain injury will help reduce the risk of complications.

Diagnostics

The diagnosis process consists of:

1. Identifying the circumstances of the injury.
2. Clinical assessment of the patient's condition.
3. Research of internal organs.
4. Neurological examination.
5. Echoencephaloscopy.
6. X-rays of the skull.
7. Computer and magnetic resonance imaging.
8. Ophthalmological examination of the fundus.
9. Lumbar puncture. It is prescribed to all patients in the acute period, except for those with increased intracranial pressure.

The diagnosis is made based on the nature and type of damage, the presence or absence of compression, hemorrhages, intoxication and other features.

Treatment

It is important to carry out treatment immediately after damage. If all manipulations are performed correctly, the chances of survival and recovery increase. After the ambulance arrives, the patient is hospitalized. After determining the nature and severity of the damage, therapy is prescribed.

If a person has received a minor injury, he is prescribed medications to relieve pain and is recommended to get proper rest.

In severe situations, they begin with restoring respiratory function (if it is impaired). The patient may be placed on a ventilator. If the wound is small, then apply a bandage; in serious cases, stitches may be applied.

Serious injuries require surgical intervention, including removal of foreign objects, fragments, craniotomy, and more.

Subsequently, they resort to drug treatment, with the help of which they restore and maintain basic indicators, return or stabilize the patient’s consciousness. When it is possible to overcome the acute phase, they move on to further rehabilitation.

The duration of the recovery period and its success depend on the severity of the injury and the correctness of the selected treatment.

Rehabilitation

After discharge from the hospital, the victim must undergo a rehabilitation course, which includes:

• restoration of self-care skills;
• elimination of speech disorders;
• restoration of motor functions;
• correction of pain syndrome;
• psychological adaptation to new living conditions.

The person must be under the supervision of a traumatologist and neurologist. A rehabilitation specialist is involved in drawing up a treatment program.

Possible complications and prognosis

Traumatic brain injury can have very serious consequences. Such injuries are considered the most dangerous and life-threatening. This condition leads to the development of complications that may not appear immediately, but after a certain time:

1. Impaired cognitive functions. This happens even with minor injuries. The patient suffers from confusion, decreased intellectual abilities, attention and memory. Moderate and severe injuries lead to amnesia, deterioration of hearing and vision, and decreased performance.
2. Deterioration of speech and swallowing skills. This occurs with moderate to severe injuries. In severe cases, after injury, the patient's speech becomes slurred or completely lost.
3. Impaired motor skills and musculoskeletal functions. Moderate injuries lead to seizures and paralysis of the neck muscles. Severe injuries lead to partial paralysis of the patient, loss of sensitivity, paresis of the limbs, and failure to coordinate movements. Even with mild injuries, headaches occur, which often become chronic. This happens especially often in cases of severe and moderate injuries.
4. Deterioration of psychological state. Severe traumatic brain injuries lead to similar consequences. Violations are observed not only in connection with injuries. The deterioration of body functions, partial or complete loss of ability to work causes strong feelings in the patient, which is why he suffers from apathy, irritability, and depression.

Statistics show that most injuries occur in the home. These include beatings and fights. Most often the head is injured during a fall. In 70% of cases, victims are admitted to the hospital under the influence of alcohol, which makes treatment much more difficult. 15% of people admitted to a medical facility are diagnosed with severe head injuries.

What the forecast will be depends on many factors. This is influenced by the severity of the injury, the speed and correctness of the assistance provided. The success of recovery directly depends on the age of the patient. Young victims have a better chance of making a full recovery and maintaining brain function.

Traumatic brain injury (TBI), among other injuries to various parts of the body, accounts for up to 50% of all traumatic injuries. Often, TBI is combined with other injuries: the chest, abdomen, bones of the shoulder girdle, pelvis and lower extremities. In most cases, head injuries are sustained by young people (usually males) who are in a certain stage of alcoholic intoxication, which significantly worsens the condition, and by unintelligent children who do not sense danger well and cannot calculate their strength in some amusements. A large share of TBI occurs in road traffic accidents, the number of which is only increasing every year, because many (especially young people) get behind the wheel without sufficient driving experience and internal discipline.

Every department can be at risk

Traumatic brain injury can affect any structure (or several simultaneously) of the central nervous system (CNS):

• The most vulnerable and susceptible to injury main component of the central nervous system is gray matter of the cerebral cortex, concentrated not only in the cerebral cortex, but also in many other parts of the brain (GM);
• White matter, located mainly deep in the brain;
• Nerves piercing the bones of the skull (cranial or cranial) - sensitive, transmitting impulses from the senses to the center, motor, responsible for normal muscle activity, and mixed, having a dual function;
• Each of them blood vessels, nourishing the brain;
• Ventricular walls GM;
• Pathways ensuring the movement of cerebrospinal fluid.

Simultaneous injury to different regions of the central nervous system significantly complicates the situation. Severe traumatic brain injury changes the strict structure of the central nervous system, creates conditions for edema and swelling of the brain, which leads to disruption of the functional capabilities of the brain at all levels. Such changes, causing serious disorders of important brain functions, affect the functioning of other organs and systems that ensure the normal functioning of the body, for example, systems such as the respiratory and cardiovascular systems often experience suffering. In this situation there is always a danger of complications in the first minutes and hours after receiving damage, as well as the development of serious consequences remote in time.

With TBI, you should always keep in mind that the brain can be injured not only at the site of the impact itself. No less dangerous is the impact of counter-impact, which can cause even more harm than the force of the impact. In addition, the central nervous system may experience suffering caused by hydrodynamic fluctuations (CSF push) and a negative effect on the processes of the dura mater.

Open and closed TBI - the most popular classification

Probably all of us have heard more than once that when it comes to brain injuries, there is often a clarification: it is open or closed. What's the difference?

Invisible to the eye

Closed head injury(with it the skin and underlying tissues remain intact) includes:

1. The most favorable option is;
2. A more complex option than just a concussion is a brain contusion;
3. A very serious form of TBI is compression resulting from: epidural when blood fills the area between the bone and the most accessible one - the outer (dura) meninges, subdural(blood accumulation occurs under the dura mater), intracerebral, intraventricular.

If cracks in the cranial vault or fracture of its base are not accompanied by bleeding wounds and abrasions that damage the skin and tissue, then such TBIs are also classified as closed craniocerebral injuries, although conditionally.

What's inside if it's already scary outside?

An open craniocerebral injury, which has its main signs of a violation of the integrity of the soft tissues of the head, skull bones and dura mater, is considered to be:

• Fracture of the vault and base of the skull with soft tissue damage;
• Fracture of the base of the skull with damage to local blood vessels, which entails the flow of blood during a blow from the nostrils or from the auricle.

Open TBIs are usually divided into gunshot and non-gunshot, and, in addition, into:

1. Non-penetrating lesions of soft tissues (meaning muscles, periosteum, aponeurosis), leaving the outer (dura) meninges intact;
2. Penetrating wounds with disruption of the integrity of the dura mater.

Video: about the consequences of closed TBI – “Live Healthy” program

The division is based on other parameters

In addition to dividing brain injuries into open and closed, penetrating and non-penetrating, they are also classified according to other criteria, for example, TBI is classified according to severity:

• ABOUT easy brain injury is referred to as concussion and bruises of the brain;
• Average the degree of damage is diagnosed in cases of brain contusions that, taking into account all the violations, can no longer be classified as mild, and they do not yet reach a severe traumatic brain injury;
• TO severe degrees include severe contusion with diffuse axonal damage and compression of the brain, accompanied by profound neurological disorders and numerous disruptions in the functioning of other vital systems.

Or according to the characteristics of lesions of the central nervous system structures, which allows us to distinguish 3 types:

1. Focal damage that mainly occurs against the background of a concussion (impact-counter-impact);
2. Diffuse(acceleration-deceleration injury);
3. Combined lesions (multiple injuries to the brain, blood vessels, liquor pathways, etc.).

Considering the cause-and-effect relationships of head trauma, TBI is described as follows:

• Traumatic brain injuries that occur against the background of complete health of the central nervous system, that is, a blow to the head is not preceded by brain pathology, are called primary;
• ABOUT secondary TBI is discussed when they become a consequence of other cerebral disorders (for example, the patient fell during an epileptic attack and hit his head).

In addition, when describing brain injury, experts emphasize such points as, for example:

1. Only the central nervous system, namely the brain, was damaged: then the injury is called isolated;
2. TBI is considered combined when, along with damage to the brain, other parts of the body (internal organs, skeletal bones) were damaged;
3. Injuries caused by the simultaneous damaging influence of various unfavorable factors: mechanical stress, high temperatures, chemicals, etc., as a rule, are the cause combined option.

And finally: there is always a first time for something. So it is with a TBI - it can be the first and the last, or it can become almost habitual if it is followed by a second, third, fourth, and so on. Is it worth reminding that the head does not like blows and even with a mild concussion from a head injury one can expect complications and consequences that are distant in time, not to mention a severe traumatic brain injury?

More favorable options

The mildest type of head injury is a concussion. the symptoms of which even non-medics can recognize:

• As a rule, having hit his head (or received an external blow), the patient immediately loses consciousness;
• More often, loss of consciousness is followed by a state of stupefaction, less often psychomotor agitation can be observed;
• Headache, nausea, and vomiting are commonly perceived as characteristic symptoms of a cervical concussion;
• After an injury, signs of ill health such as pale skin, heart rhythm disturbances (tachy- or bradycardia) cannot be ignored;
• In other cases, there is a memory impairment of the retrograde amnesia type - the person is unable to remember the circumstances that preceded the injury.

A more severe TBI is considered to be a bruise of the brain, or, as doctors call it, a concussion. With a bruise, general cerebral disorders (repeated vomiting, severe headache, impaired consciousness) and local lesions (paresis) are combined. How pronounced the clinical picture is, which manifestations occupy a leading position - all this depends on the region in which the lesions are located and the scale of the damage.

As evidenced by the trickle of blood flowing from the ear...

Signs of fractures of the base of the skull also appear depending on the area in which the integrity of the cranial bones is compromised:

1. A stream of blood flowing from the ears and nose indicates a fracture of the anterior cranial fossa (AC);
2. When not only the anterior but also the middle CN is damaged, cerebrospinal fluid leaks from the nostrils and ear, the person does not react to odors, and ceases to hear;
3. Bleeding in the periorbital region gives such a clear manifestation that does not raise doubts about the diagnosis as a “symptom of glasses”.

As for the formation of hematomas, they occur due to injury to arteries, veins or sinuses and lead to compression of the brain. These are always severe traumatic brain injuries that require emergency neurosurgical surgery, otherwise the rapid deterioration of the victim’s condition may leave him no chance of life.

Epidural hematoma is formed as a result of injury to one of the branches (or several) of the middle meningeal artery, which supplies the dura mater. In this case, the blood mass accumulates between the skull bone and the dura mater.

Symptoms of the formation of an epidural hematoma develop quite rapidly and manifest themselves:

• Unbearable pain in the head;
• Constant nausea and repeated vomiting.
• The patient's lethargy, sometimes turning into excitement, and then into a coma.

This pathology is also characterized by the appearance of meningeal symptoms and signs of focal disorders (paresis - mono- and hemi-, loss of sensitivity on one side of the body, partial blindness of the homonymous hemianopia type with loss of certain halves of the visual fields).

Subdural hematoma is formed against the background of injury to the venous vessels and the time of its development is significantly longer than that of an epidural hematoma: at first it clinically resembles a concussion and lasts up to 72 hours, then the patient’s condition seems to improve and within about 2.5 weeks he believes that he is going to amendment. After this period, against the background of general (imaginary) well-being, the patient’s condition sharply worsens, and pronounced symptoms of general cerebral and local disorders appear.

Intracerebral hematoma- a rather rare phenomenon that occurs mainly in elderly patients; their favorite place of localization is the basin of the middle cerebral artery. Symptoms tend to progress (general cerebral disorders appear first, then local disorders increase).

Post-traumatic refers to serious complications of severe traumatic brain injury. It can be recognized by complaints of intense headache (until consciousness leaves the person), rapid loss of consciousness and the onset of a coma, when the victim no longer complains. These symptoms are also quickly joined by signs of dislocation (displacement of structures) of the brain stem and cardiovascular pathology. If at this moment a lumbar puncture is performed, then in the cerebrospinal fluid you can see a huge amount of fresh red blood cells - erythrocytes. By the way, this can also be detected visually - the cerebrospinal fluid will contain blood impurities, and therefore will acquire a reddish tint.

How to help in the first minutes

First aid is often provided by people who, by chance, find themselves close to the victim. And they are not always health workers. With TBI, however, it should be understood that loss of consciousness can last a very short time and therefore not be recorded. However, in any case, a concussion, as a complication of any (even seemingly mild) head injury, should always be kept in mind and, taking this into account, help the patient.

If a person who has received a TBI does not come to his senses for a long time, he needs to be turned over on his stomach and his head tilted down. This must be done in order to prevent vomit or blood (in case of injuries to the oral cavity) from entering the respiratory tract, which often happens in an unconscious state (absence of cough and swallowing reflexes).

If the patient has signs of impaired respiratory function (there is no breathing), measures should be taken to restore the patency of the airways and, before the ambulance arrives, provide simple artificial ventilation (mouth-to-mouth, mouth-to-nose).

If the victim has bleeding, it is stopped with the help of an elastic bandage (a soft lining on the wound and a tight bandage), and when the victim is taken to the hospital, the surgeon will suture the wound. It’s worse when there is a suspicion of intracranial bleeding, because its complication is most likely hemorrhage and hematoma, and this is already a surgical treatment.

Due to the fact that a traumatic brain injury can occur in any place that is not necessarily within walking distance of a hospital, I would like to introduce the reader to other methods of primary diagnosis and first aid. In addition, among the witnesses trying to help the patient, there may be people with certain knowledge in medicine (nurse, paramedic, midwife). AND here's what they should do:

1. The first step is to assess the level of consciousness in order to determine, based on the degree of response, the patient’s further condition (improvement or deterioration), and at the same time – psychomotor status, the severity of pain in the head (not excluding other parts of the body), the presence of speech and swallowing disorders;
2. If blood or cerebrospinal fluid leaks from the nostrils or ears, assume a fracture of the base of the skull;
3. It is very important to pay attention to the victim’s pupils (dilated? different sizes? how do they react to light? strabismus?) and report the results of your observations to the doctor to the arriving ambulance team;
4. You should not ignore such routine activities as determining the color of the skin, measuring pulse, respiratory rate, body temperature and blood pressure (if possible).

With TBI, any part of the brain can suffer, and the severity of one or another neurological symptoms depends on the location of the lesion, for example:

• A damaged area of ​​the cerebral cortex will make any movement impossible;
• If the sensitive cortex is damaged, sensitivity will be lost (all types);
• Damage to the frontal lobe cortex will lead to a disorder of higher mental activity;
• The occipital lobes will no longer control vision if their cortex is damaged;
• Injuries to the cortex of the parietal lobes will create problems with speech, hearing and memory.

In addition, we should not forget that cranial nerves can also be injured and give symptoms depending on which area is affected. And also keep in mind fractures and dislocations of the lower jaw, which, in the absence of consciousness, press the tongue against the back wall of the pharynx, thereby creating a barrier to the air flowing into the trachea and then into the lungs. To restore the passage of air, it is necessary to push the lower jaw forward, placing your fingers behind its corners. In addition, the injury can also be combined, that is, with a TBI, other organs can be damaged at the same time, so a person who has received a head injury and is in an unconscious state must be treated with extreme care and caution.

And one more important point when providing first aid: you need to remember about the complications of TBI, even if at first glance it seemed mild. Bleeding into the cranial cavity or increasing cerebral edema increases intracranial pressure and can lead to compression of the GM(loss of consciousness, tachycardia, increased body temperature) and brain irritation(loss of consciousness, psychomotor agitation, inappropriate behavior, obscene language). However, let's hope that by that time the ambulance will have already arrived at the scene and quickly taken the victim to the hospital, where he will receive proper treatment.

Video: first aid for TBI

Treatment is exclusively in a hospital setting!

Treatment of TBI of any severity is carried out only in a hospital setting, because loss of consciousness immediately after receiving a TBI, although it reaches a certain depth, does not in any way indicate the real condition of the patient. The patient can prove that he feels fine and can be treated at home, however, given the risk of complications, he is provided with strict bed rest (from one week to a month). It should be noted that even a concussion of the brain, having a favorable prognosis, in the case of large-scale damage to parts of the brain can leave neurological symptoms for life and limit the patient’s ability to choose a profession and further ability to work.

Treatment of TBI is mainly conservative, unless other measures are provided (surgery if there are signs of brain compression and hematoma formation), and symptomatic:

The Hard Way – Brain Injuries in Newborns

It is not so rare for newborns to be injured when passing through the birth canal or in the case of the use of obstetric instruments and certain obstetric techniques. Unfortunately, such injuries do not always cost the baby “a little bloodshed” and the parents “a little fright”; sometimes they leave consequences that become a big problem for the rest of their lives.

At the very first examination of the baby, the doctor pays attention to the following points that can help determine the general condition of the newborn:

• Is the baby capable of sucking and swallowing?
• Is his tone and tendon reflexes reduced?
• Is there any damage to the soft tissues of the head;
• What condition is the large fontanel in?

In newborns who received injuries during passage through the birth canal (or various obstetric injuries), complications such as:

1. Hemorrhages (in the brain, its ventricles, under the membranes of the brain - in connection with which subarachnoid, subdural, epidural hemorrhage is distinguished);
2. Hematomas;
3. Hemorrhagic permeation of the brain substance;
4. CNS lesions caused by contusion.

Symptoms of birth injury to the brain mainly come from the functional immaturity of the brain and reflex activity of the nervous system, where consciousness is considered a very important criterion for determining disorders. However, it should be borne in mind that there are significant differences between changes in consciousness in adults and babies who have just seen the light, therefore, in newborns, for a similar purpose, it is customary to study the behavioral states characteristic of children in the first hours and days of life. How does a neonatologist find out about problems in the brain of such a young child? Pathological signs of impaired consciousness in newborns include:

• Constant sleep (lethargy), when the baby can only be awakened by severe pain caused to him;
• Stunned state – the child does not wake up when exposed to pain, but reacts by changing his facial expressions:
• Stupor, which is characterized by a minimum of the baby’s reactions to stimuli;
• A comatose state where there are no reactions to pain.

It should be noted that to determine the condition of a newborn who was injured at birth, there is a list of various syndromes that the doctor focuses on:

1. Hyperexcitability syndrome (the child does not sleep, constantly writhes, grunts and screams);
2. Convulsive syndrome (convulsions themselves or other manifestations that may correspond to this syndrome - apnea attacks, for example);
3. Meningeal syndrome (increased sensitivity to irritants, reaction to percussion of the head);
4. (anxiety, large head, increased venous pattern, bulging fontanel, constant regurgitation).

Obviously, diagnosing pathological conditions of the brain caused by birth trauma is quite difficult, which is explained by the immaturity of brain structures in children in the first hours and days of life.

Medicine can’t do everything...

Treatment of birth brain injuries and care of a newborn require maximum attention and responsibility. A severe traumatic brain injury in a child received during childbirth requires the baby to stay in a specialized clinic or department (with the baby placed in an incubator).

Unfortunately, birth injuries to the brain are not always without complications and consequences. In other cases, the intensive measures taken save the child’s life, but cannot ensure his full health. Leading to irreversible changes, such injuries leave a mark that can significantly negatively affect the functioning of the brain and the entire nervous system as a whole, posing a threat not only to the child’s health, but also to his life. Among the most severe consequences of birth trauma, the following should be noted:

• Dropsy of the brain or, as doctors call it - ;
• Cerebral palsy (CP);
• Mental and physical retardation;
• Hyperactivity (increased excitability, restlessness, nervousness);
• Convulsive syndrome;
• Speech impairment;
• Diseases of internal organs, allergic diseases.

Of course, the list of consequences can be continued... But whether the treatment of birth injury to the brain will cost with conservative measures or will have to resort to neurosurgical operation depends on the nature of the injury received and the depth of the disorders that followed it.

Video: head injuries in children of different ages, Dr. Komarovsky

Complications and consequences of TBI

Although there has already been mention of complications in various sections, there is still a need to touch upon this topic again (in order to understand the seriousness of the situation created by TBI).

Thus, During the acute period, the patient may experience the following troubles:

1. External and internal bleeding, creating conditions for the formation of hematomas;
2. Leakage of cerebrospinal fluid (cerebrospinal fluid rhinorrhea) – external and internal, which threatens the development of an infectious and inflammatory process;
3. Penetration and accumulation of air in the skull (pneumocephalus);
4. Hypertensive (hydrocephalic) syndrome or - increased intracranial pressure, as a result of which the development of impaired consciousness, convulsive syndrome, etc.;
5. Suppuration of wound sites, formation of purulent fistulas;
6. Osteomyelitis;
7. Meningitis and meningoencephalitis;
8. GM abscesses;
9. Bulging (prolapse, prolapse) of the GM.

The main cause of death of the patient in the first week of illness is considered to be cerebral edema and displacement of brain structures.

TBI does not allow either doctors or the patient to calm down for a long time, since even in the later stages it can present a “surprise” in the form of:

• Formation of scars, adhesions and, development of hydrops GM and;
• Convulsive syndrome with subsequent transformation into, as well as astheno-neurotic or psychoorganic syndrome.

The main cause of death of the patient in the late period is complications caused by purulent infection (pneumonia, meningoencephalitis, etc.).

Among the consequences of TBI, which are quite diverse and numerous, I would like to note the following:

1. Movement disorders (paralysis) and persistent sensory impairment;
2. Impaired balance, coordination of movements, changes in gait;
3. Epilepsy;
4. Pathology of ENT organs (sinusitis, sinusitis).

Recovery and rehabilitation

If a person who has received a mild concussion in most cases is safely discharged from the hospital and soon remembers his injury only when asked about it, then people who have experienced severe traumatic brain injury face a long and difficult path of rehabilitation in order to restore lost basic skills . Sometimes a person needs to learn to walk, talk, communicate with other people, and take care of himself independently. Here, any means are good: physical therapy, massage, all kinds of physiotherapeutic procedures, manual therapy, and classes with a speech therapist.

Meanwhile, to restore cognitive abilities after a head injury, sessions with a psychotherapist are very useful, who will help you remember everything or most of it, teach you to perceive, remember and reproduce information, and adapt the patient in everyday life and society. Unfortunately, sometimes lost skills never return... Then all that remains is to teach a person to serve himself and contact people close to him to the maximum (as far as intellectual, motor and sensory abilities allow). Of course, such patients receive a disability group and need outside help.

In addition to the listed activities during the rehabilitation period, people with a similar history are prescribed medications. As a rule, these are vitamins.

Traumatic brain injury (TBI) is damage to the brain, skull bones and soft tissues. Every year, about two hundred people per thousand of the population face such trauma, with varying degrees of severity. The most common cause of TBI is car accidents, and WHO statistics are inexorable. Every year the number of injuries received in this way increases by 2%. The reason for this is the increase in the number of vehicles on the roads or the excessive recklessness of drivers... a mystery.

Types of injuries

There are two types of TBI:

• open craniocerebral injury - accompanied by a skull fracture and damage to the integrity of the soft tissues of the brain structures. This form of injury is considered the most dangerous, as the risk of brain infection is high. Diagnosed in 30% of cases;
• closed craniocerebral injury may be accompanied by a skull fracture, brain contusions, but without affecting the integrity of the soft tissues.

Interesting fact! According to statistics, 2/3 of all traumatic brain injuries are fatal!

CCI has its own gradation, according to the disorders caused:

• brain contusion without compression;
• brain contusion with compression;

According to severity they are distinguished:

• mild degree. This may be a concussion or contusion of the brain, accompanied by slight stunning, while consciousness remains clear. To determine the severity of TBI, the Glazko coma scale is used. On this scale, with a mild degree, the patient scores 13-15 points. Treatment in this case lasts no more than two weeks, neurological disorders do not occur. Most often, treatment is outpatient, rarely in a hospital setting;
• Moderate severity with a closed injury is accompanied by brain contusion and deep stupor. On the Glazko scale, the patient scores 8-12 points. Treatment lasts on average up to a month in a hospital setting. The condition is not accompanied by a prolonged loss of consciousness, but by the presence of neurological signs that may persist during the first month after the injury;
• severe degrees are accompanied by prolonged loss of consciousness and even coma. Occurs with acute compression of the brain; the patient scores no more than seven points on the scale. Persistent neurological disorders occur, surgical treatment is often required, and the pathological outcome is often unfavorable. Even with recovery, persistent neurological changes remain, and death is often diagnosed.

There is also a gradation of the state of consciousness:

• clear. There is a quick reaction and complete orientation in the surrounding space;
• moderate stupor is accompanied by slight retardation and slow execution of certain instructions;
• deep stupor - there is disorientation, the ability to carry out only simple commands, mental difficulties;
• stupor is a depressed consciousness during which there is no speech, but the patient is able to open his eyes, feels pain, and can indicate the location of the pain syndrome;
• moderate coma is characterized by loss of consciousness, tendon reflexes are preserved, eyes are closed, but pain receptors are not turned off, pain is felt;
• deep coma. Breathing and heart rate are disrupted, but they are preserved, tendon reflexes are absent, there is no reaction to external stimuli;
• extreme coma is incompatible with life, complete muscle atony, breathing is supported by ventilation.

Interesting fact! About 75% of the victims are men under 45 years of age.

Causes

CCI as well as the open form occurs as a result of:

• traffic accident, this category includes lovers of skateboards, rollerblades and bicycles. This reason is the most common when diagnosing traumatic brain injury;
• injuries at work;
• falling from a height;
• domestic injuries, including fights.

Pathological conditions such as:

• sudden dizziness and loss of coordination, falling and resulting injury;
• alcohol intoxication;
• epileptic seizure;
• sudden fainting.

Possible signs

• Symptoms of TBI can vary depending on whether the injury is open or closed, such as a concussion, bruise, or compression of the brain. But despite this, there are a number of common symptoms that are characteristic of any brain injury. These signs include:
  fainting occurs with moderate or severe head injury. In mild cases, loss of consciousness is possible, but usually does not occur for just a few seconds or minutes;
• loss of orientation in space, unsteadiness of gait and coordination of movements. The severity of this symptom also depends on the complexity of the injury;
• headache and dizziness, these signs are characteristic of any severity of the pathology;
• nausea, vomiting, the latter is a consequence of painful shock and is not associated with the gastrointestinal tract;
• slowness of reaction, slowness of answers to questions posed, paucity of speech;
• increased sweating, pale skin;
• sleep disturbances and loss of appetite occur later;
• Bleeding from the nose or ears may occur with moderately severe injury.

Brain concussion

One of the types of TBI is a concussion, which is considered the mildest possible TBI, the consequences of which are reversible. Pathology occurs as a result of vibration in the brain structures. The clinical picture increases instantly, following the injury, and depending on the severity of the concussion, it also recedes quickly, not counting severe forms. Among the characteristic symptoms are:

• vomiting, often repeated;
• short-term fainting, usually lasting several minutes;
• tinnitus and dizziness;
• painful reaction to bright lights and loud sounds;
• headache;
• sleep disturbance;
• tachycardia;
• increased sweating;
• irritability, etc.

The prognosis for a concussion is usually favorable for any severity of the pathology. The symptoms that arise can be controlled with medication and rest, and eventually they disappear completely.

Patients with a concussion are hospitalized in a hospital, where treatment usually lasts from three to fourteen days, depending on the severity of the situation.

First aid for a concussion:

• call an ambulance;
• lay the patient on a flat surface;
• turn your head to the side;
• unbutton your shirt, jacket, remove your tie and other items that may impede breathing;
• if there is a bleeding wound on the head, apply a sterile bandage.

Upon admission to a medical facility, the patient is x-rayed to exclude the possibility of a skull fracture and then treatment is prescribed.

Patients with a concussion require bed rest with complete rest. You should not watch TV, read or write. To eliminate cerebral symptoms, ganglion-blocking drugs are prescribed, including chlorpromazine or pentamin. To improve brain activity in the treatment of concussion, nootropic drugs are prescribed:

• piracetam;
• aminalon;
• pyriditol.

It is also recommended to take B vitamins, calcium supplements, and anesthetics for headaches. If the patient has injuries to the soft tissues of the head, antibacterial therapy is carried out to avoid infection and suppuration of the wound.

In severe cases, when 3-5 days after the start of treatment the symptoms do not subside or, on the contrary, increase, a lumbar puncture is prescribed to examine the cerebrospinal fluid. If increased intracranial pressure is detected, dehydration drugs are prescribed:

• mannitol;
• diacarb;
• magnesium sulfate;
• albumen.

If the pressure, on the contrary, is reduced, intravenous administration of drugs such as:

• polyglucin;
• peptides;
• hemodesis;
• sodium chloride solution.

In the case of a favorable course of treatment of the pathology, patients are discharged from the hospital after 7-10 days of their stay there. In cases where general cerebral and focal symptoms persist, hospital stay is extended. After discharge from the hospital, patients require gentle treatment.

Brain contusion

Another type of TBI is a brain contusion, which is a more serious injury compared to a concussion. The pathology is accompanied by necrosis of neurons at the site of injury. Often a bruise is accompanied by rupture of small vessels in the brain, hemorrhage or leakage of cerebrospinal fluid.

A bruise may occur with or without tissue compression. Just like other TBIs, there are three degrees of severity from mild to severe.

The main symptoms of brain contusion:

• loss of consciousness, diagnosed in moderate and severe cases, in the second case there is a deep coma;
• vestibular disorders;
• paresis of limbs and impaired coordination of movements;
• metabolic disorders;
• Skull fractures and blood in the cerebrospinal fluid are common;
• meningeal symptoms are often added to the general clinical picture, in particular, severe headaches that persist for a long time;
• repeated vomiting;
• rapid, shallow breathing;
• arrhythmia and tachycardia;
  high blood pressure;
• increased body temperature as a response to a stressful situation.

With severe brain contusions, the prognosis is extremely unfavorable, and death is more common.

Treatment in this case directly depends on the severity of the process. For mild bruises, treatment is the same as for a concussion.

If the bruise is of moderate or severe severity, treatment is aimed at normalizing cardiac and respiratory function, as well as nervous reactions. It is possible to prescribe surgical treatment, which consists of excision of necrotic brain tissue. To combat a number of symptoms, the following are prescribed:

• for high blood pressure - antipsychotic medications, for example, diprazine or aminazine;
• to eliminate tachycardia - novocainamide, strophanthin;
• antispasmodic and sympatholytic agents;
• at elevated body temperature above 38 degrees, antipyretics are prescribed;
  in case of severe cerebral edema, diuretics are administered, for example, furosemide, as well as drugs such as aminophylline, diacarb, etc.;
• nootropics to improve cerebral circulation and the activity of its structures: aminalon, Cerebrolysin, piracetam.

Brain compression

This pathological condition can occur immediately at the time of injury or later as a result of the formation of a hematoma. In the first case, a depressed fracture requires surgical intervention. Depressed fragments are usually straightened after surgery and recovery, and the person continues his normal life. Neurological symptoms disappear if surgical treatment is not performed; especially in childhood, there is a high risk of epileptic seizures in the future.

In 2-16% of all TBIs, compression of the brain occurs through the development of an intracranial hematoma. The cause of its occurrence can be either a bruise or a stroke. A hematoma after an injury develops in a matter of hours, but begins to show its symptoms of compression of the brain later. Most often, as a result of injury, a single hematoma occurs, but multiple hematomas can be diagnosed.

Hematomas can be:

• sharp;
• subacute;
• chronic.

In the case of acute hematoma, the patient's condition progressively worsens, prompt surgical intervention is necessary. With the second two types of hematomas, symptoms increase gradually, and their progress can be noticeable days, weeks and even months after the injury, as a result of a slow increase in the volume of the hematoma.

When the brain is compressed by a hematoma, signs such as:

• decreased tendon and abdominal reflexes;
• convulsions;
• the occurrence of hallucinations and delusions;
• decreased sensitivity of the limbs, up to paresis or paralysis;
• increased ICP;
• disturbances in the functioning of the optic nerves.

Traumatic brain injury is damage to the brain of varying severity. Each of the injuries: concussion, bruise or compression of the brain requires serious medical attention. The severity of the consequences of a TBI can vary greatly, depending on the complexity of the injury. A mild degree of TBI, as a rule, leaves no consequences; as a result of moderate severity, persistent neurological disorders are possible. The consequences of severe form can be fatal.

Reading strengthens neural connections:

Traumatic brain injury (TBI) is a combination of contact-type injuries (in which the soft tissues of the face, its skeleton or skull are affected) and intracranial (the membranes and substance of the brain are affected), which appeared simultaneously under the influence of the same factors.

Most often, traumatic brain injuries are the result of mechanical force on the neck or head. Possible causes of TBI include:

• car crashes(road accident) with an unfixed position of the passenger or driver;
• sudden acceleration of the human body;
• hit, caused by a hard object;
• significant compression of the head(compression);
• birth process;
• alcoholism(alcohol consumption significantly increases the risk of injury in any situation).

Traumatic brain injury in these cases reaches a level of 25–30%. Under the influence of negative external influences, a chain of pathological reactions occurs, destroying connections between intracerebral structures and leading to organic changes in brain tissue.

Classification

According to the main classification used, TBI can be:

• light;
• moderate severity;
• heavy.

To determine which of these groups the patient's injuries belong to, specialists use the Glasgow Coma Scale. According to it, the victim can be given from 3 to 15 points, which reflects the level of preservation of consciousness.

To determine this indicator, the doctor must track how a person’s eyes open, how well he speaks, moves, and reacts to stimuli. With a score of less than 8, the patient is diagnosed with severe TBI, from 9 to 12 - moderate, and higher values ​​indicate the presence of a mild form of pathology.

Traumatic brain injuries are also divided into:

• isolated(only the head is affected under the influence of one factor);
• combined(damage to other organs is detected);
• combined(formed under the influence of several types of traumatic factors).

Depending on the nature of the damage caused to the central nervous system, there are 3 more types of TBI:

1. Focal lesion(only one area of ​​the cerebral cortex is affected; injury occurs during a concussion).
2. Diffuse axonal injury(it affects the white medulla and appears with bruises of the brain).
3. Combined lesion(marked by multiple injuries to the brain, blood vessels, etc.).

Clinical forms

Based on the degree of penetration, there are two types of TBI: closed and open.

Closed head injuries

With closed traumatic brain injury (CTBI), skin damage may be observed, but the aponeurosis (wide tendon plate) remains intact. That is, there is no communication between the external environment and the intracranial cavity (there are no cracks or bone fractures).

Closed clinical forms of TBI include:

• concussion (CM);
  Accompanied by neurological disorders. Fainting is possible, but not necessary. If loss of consciousness did occur, then its duration, depth and subsequent memory impairment will indicate the severity of the injury.
  Nonspecific symptoms of the pathology include: pale skin, disturbances in the functioning of the heart, nausea, turning into vomiting. The following symptoms may occur: headache, unusual behavior, cognitive problems, excessive sleepiness.
  Symptomatic manifestations of a concussion last no longer than 1.5 weeks. If this is not true, then we are talking about more serious damage (although some signs of pathology can persist for a month even with a normal concussion).
• GM injury;
  This injury is the result of the brain hitting the inside of the skull. It has a two-sided nature: on the one hand, the affected area coincides with the place where the external impact was applied, and on the other (opposite) it corresponds to the point where the impact occurred at the moment of braking of the head movement. That is, one incident causes double harm.
  The following clinical picture is typical for a bruise: altered psycho-emotional state, anxious arousal, confusion, feeling of increased drowsiness.
• compression of the GM.
  As a result of the injury, an intracranial hematoma appears, which can be located between the walls of the skull and the dura mater, under it, as well as in any part of the brain. As it expands, it begins to put pressure on adjacent tissues, gradually worsening the victim’s well-being.

Despite the possible absence of obvious external manifestations of TBI, this is not a reason to ignore the severity of a person’s condition. In any case, you should definitely consult a doctor.

Open TBI

With open injuries (TBI), the integrity of the skin and aponeurosis is disrupted. The wound reaches the bones of the skull or deeper. When the dura mater of the brain is damaged, the damage is classified as penetrating.

There are two main types of TBI:

1. Fracture of the vault or base of the skull accompanied by soft tissue injuries.
2. Fracture of the base of the skull with damage to blood vessels in local areas of the brain:
   anterior cranial fossa(ear and nose bleeding are noted);
   anterior and middle cranial fossa(cerebrospinal fluid leaks from the ears and nose, and the victim loses hearing and smell);
   periorbital region(characterized by the expressive “symptom of glasses”).

In addition, TBI can be classified as non-gunshot and gunshot injuries, depending on the factor that provoked its occurrence.

Symptoms

Typical signs of TBI are:

• ruptures of the skin and other soft tissues;
• fainting;
• external hematomas;
• attacks of vomiting and nausea;
• pale skin;
• headaches and dizziness;
• memory loss;
• increased irritability and aggressiveness;
• inhibited perception of information coming from outside and slow reactions;
• tinnitus;
• impaired coordination and convulsions;
• drowsiness or state of stupor (immunity to weak stimuli);
• delusions and hallucinations;
• paralysis (with damage to a significant part of the cortex of one of the hemispheres of the brain);
• visual disturbances that occur as a result of injuries to the back of the head (strabismus appears, a feeling that objects are double);
• changes in respiratory and heart rhythm;
• high level of intracranial pressure;
• muscle weakness and sensory problems (numbness).

Also, the development of TBI often occurs with disturbances of consciousness in the form of confusion, stupor (a condition in which only reflex reactions remain intact), and deep coma.

TBI in children

The head of a small child is disproportionately large relative to the body, the back of his head protrudes, and the muscles of the cervical spine are not yet strong enough. All this interferes with maintaining balance and increases the likelihood of TBI. In addition, the bone plate of a child’s skull is still too thin, and the degree of myelination of the brain is insufficient, so the resulting damage has a much greater impact on the baby’s health.

However, the recovery of a child’s body occurs much faster than that of an adult. This applies to a greater extent to newborn infants (who were injured during childbirth) and one-year-old children whose skull bones have not yet fused, which means that it can expand in case of swelling or bleeding, reducing pressure on the cerebral (brain) tissue.

First aid

To provide first aid at home and preserve the victim’s chance of life, you must perform the following steps:

1. Immediately call an ambulance.
2. If a person is unconscious, then turn him over on his stomach and tilt his head down(this will prevent blood or vomit from entering the respiratory tract).
3. If the victim is not breathing, provide basic artificial ventilation(“mouth to nose (mouth)”).
4. Bandage all bleeding areas of the body.

After completing the procedures, all that remains is to wait for the specialists to arrive. During this time, if the victim has regained consciousness, it would be useful to evaluate:

• pupils (dilated, vary in size or squint);
• color of the skin;
• body temperature;
• blood pressure level;
• heart rate.

All data obtained must be provided to the doctor when he arrives. This will help him quickly assess the patient’s condition.

Instrumental and laboratory diagnostics

The accuracy of diagnosis for TBI can only be guaranteed by using instrumental research methods. One of the commonly used diagnostic methods is non-contrast computed tomography (CT), which can detect fractures, swelling and acute bleeding, and also determine the level of intracranial pressure and brain stem dislocation.

In addition, it is possible to use radiography, which allows you to diagnose the presence of bone tissue damage. However, it does not provide any insight into the state of the brain itself.

Additional information about the victim’s health can be obtained through a number of laboratory tests:

• electrolyte analysis;
• glucose level detection(if the patient loses consciousness, is in a state of stupor or coma);
• general blood test.

The examination stage for serious TBI is carried out simultaneously with the provision of emergency care.

Course of the disease

The development of the pathological condition during TBI occurs in three stages:

1. The sharpest.
   All observed changes are a direct consequence of the influence exerted by damaging factors. Overt and hidden symptoms will depend on the severity of the injuries received, the presence of cerebral edema, as well as other wounds and damage to the human body. This period lasts at least two weeks.
2. Intermediate.
   During the second stage, the injured nerve tissue begins to return to normal, and with it the previously lost functions of the central nervous system return. Regenerative, adaptive and compensatory mechanisms are noticeably activated. As a result, a person largely adapts to his condition, even with severe TBI. This is a longer period: for mild to moderate injury - about 6 months, in the case of severe TBI it will take at least a year.
3. Final(stage of long-term consequences).
   This period is also called the recovery period. Its duration can be more than two years. During the final stage, many patients develop post-traumatic encephalopathy (non-inflammatory organic brain damage). In this case, neurological treatment will be required. If it is correct and timely, the central nervous system will completely return to normal or adapt.

Only after the completion of the third stage can we talk about the patient’s recovery.

Treatment

Pathologies of this type often lead to long-term nervous disorders and are difficult to treat. In case of TBI, treatment is aimed, first of all, at eliminating not primary, but secondary damage (those that arose after the injury to the brain). The therapy process itself includes two stages:

• provision of first aid;
• treatment in a hospital setting.

During the initial examination, the doctor most carefully evaluates the following indicators:

• airway patency;
• mobility of the cervical spine;
• features of respiratory and heart rhythms.

The most detailed medical history is also compiled (based on data obtained from the patient himself or witnesses to the incident). If the victim faints, then hospital treatment is mandatory. This will prevent most possible complications.

The neurosurgeon decides how to treat the patient. If a specialist of this profile is not in the clinic, the appropriateness of surgical intervention is assessed by a traumatologist.

If surgery is not necessary, then the treatment course will include only conservative methods, including the use of medications. This therapy is aimed primarily at eliminating the symptoms of TBI.

It may be necessary to use drugs that improve the functioning of the cardiovascular system, and after the acute period is over, vitamin therapy will help to fully recover.

The use of traditional methods of treatment and homeopathy for traumatic brain injuries is allowed only during the recovery period and only with the permission of a specialist. The entire initial post-traumatic stage should be carried out in a hospital setting under the constant supervision of doctors.

Even if the patient feels that his health has improved significantly, he should not leave the clinic without the approval of doctors. It is possible that good condition is the result of a “light” period characteristic of TBI, after which the patient becomes significantly worse and again requires emergency medical care.

Rehabilitation

The rehabilitation stage is usually necessary for those individuals who have suffered a severe TBI. They have to restore basic skills (the ability to walk, talk, perform minimal self-care).

To achieve this, all possible means are used:

• physiotherapy;
• massage, including those carried out independently;
• Exercise therapy(physiotherapy);
• speech therapy classes;
• manual therapy(acupressure performed with hands).

However, even with active and regular implementation of these procedures, damaged functions will be restored extremely slowly. The feasible help of loved ones will be a serious help.

In this case, there is no need to take on all the responsibilities around the house if the patient is able to at least partially perform them himself. It is much more important to provide him with regular everyday communication and emotional support.

Forecast

The prognosis for TBI is largely determined by the type and severity of injuries received. A minor injury is regarded as conditionally favorable. It is possible that for complete rehabilitation with such a diagnosis, practically no medical assistance will be required. With severe TBI, the picture is the opposite.

Young children, as well as patients with scalped head wounds (when there are only injuries to the skin), concussions and minor skull fractures can expect no serious consequences.

However, with high-risk injuries (hemorrhage, diffuse edema, secondary pathologies, severe fractures or dislocation of the brain stem) and the simultaneous lack of medical care, the most likely consequences of the injury may be death or disability. Death is possible even in the later stages of treatment due to complications caused by purulent infections (pneumonia, meningoencephalitis, etc.).

In some cases, TBI becomes the cause of infectious diseases of the brain, irreversible disorders of memory, behavior and mental development (most often observed when affecting the frontal lobes of the brain).

Bottom line

Knowledge of the causes of traumatic brain injuries, the stages of development of the subsequent pathological process and possible complications will allow a person who has suffered from damage to brain structures to preserve all the functions of the central nervous system to the maximum extent or restore them in the shortest possible time. The main thing to remember is that TBI cannot be cured at home. For head injuries of any severity, seeking medical attention is strictly necessary.

Traumatic brain injury (TBI) is a pathological condition in which bone and soft tissue, as well as other components within the skull, are damaged.

The safety of the brain is ensured by cerebral fluid (CSF), which also protects the brain by acting as a shock absorber.

Head injuries account for fifty percent of all reported traumatic cases in medicine, with a slow upward increase every year.

In most cases, brain injuries are sustained in various stages of alcohol intoxication, as well as by children who have just begun to move and do not yet fully understand the dangers of movement. Also, most traumatic brain injuries occur in traffic accidents.

Treatment of skull injuries is subject to qualified traumatologists and neurosurgeons; in case of damage to individual tissues, consultation with a psychotherapist or neurologist is required.

Classification of traumatic brain injuries

Brain injuries are classified according to a variety of factors.

The most common is the division of injuries according to their form:

• Open (OCMT)– determined by damage with deformation of layers of skin and/or cranial tissue;
• Closed (CCMT)– defined as an injury that is not characterized by external deformation of the skin, but the development of internal injuries to the head is noted, with the manifestation of defining clinical signs;
• Penetrating trauma– determined by deformation of the bone shell.

The following features of deformation of the structural components of the central nervous system are noted:

• Diffuse– with this type, axons (a long process of a nerve cell that transmits nerve excitations from cells to organs and other cells) are stretched to the limit, after which they rupture;
• Focal– this type of TBI is caused by local damage to the cerebral substance at the macrostructural level. Exceptions include areas of destruction, small and large cerebral hemorrhage at the site of impact, shock wave and kickback. Most often appear if a concussion occurs;
• Combined TBI– are caused by a combination of the two types listed above. It is observed with a large number of damage to the brain, cerebral vessels, cerebrospinal fluid pathways, etc.

Based on the nature of the damage, the following are distinguished:

• Primary damage, which are provoked by individual bruises, hematomas inside the skull, ruptures of the brain stem, multiple purulent processes inside the brain, diffuse axonal lesions. They arise against the background of an absolutely healthy central nervous system, that is, before the blow to the head, no pathological conditions of the brain were noted;
• Secondary damage caused by secondary factors located inside the cranium (damage to the cerebral fluid due to hemorrhages, delayed hematomas, swelling of the brain, overflow of blood vessels in the brain). Also, secondary damage may be caused by factors that are not localized inside the skull (high blood pressure, excess carbon dioxide in the blood, decreased oxygen content in the blood for various reasons, anemia, etc.). We are talking about such injuries if traumatic brain injuries become a consequence of other pathological processes in the body (epileptic seizure, which may result in a fall and head injury;

The division also occurs according to the biomechanical processes occurring in the cranium.

Among them are:

• TBI deceleration and acceleration– caused by the movement of the two hemispheres to the brain stem;
• TBI counter-impact and blow– characterized by the propagation of a shock wave from the local site of impact, passing through the brain to its reverse side, with an accompanying rapid drop in intracranial pressure;
• Combined TBI– is caused by the action of the two above-mentioned mechanisms of influence simultaneously.

Traumatic brain injuries are also divided according to the severity of the injury, among which are:

• Mild degree is registered if there is a concussion or head injury. Consciousness, with such injuries, is clear, the functions responsible for life processes are not impaired. There are no symptoms of neuralgia. Recovery and the absence of a threat to life is possible with timely provision of medical care;
• Moderate severity diagnosed if there are injuries that cannot be attributed to a mild degree, but a bruise cannot be attributed to a severe degree. Important functions are not affected, but heartbeat disturbances may occur. There is almost no threat to life if qualified medical care is provided in a timely manner. After a moderate traumatic brain injury, complete recovery is possible;
• Severe degree(STBI) is noted with a clearly visible contusion with tears and ruptures of axons and compression of brain tissue, which is accompanied by profound neurological disorders and a large number of malfunctions in the functioning of other important structures of human life. The prognosis for eventual recovery from this level of traumatic brain injury is poor;
• Very severe. With this degree of severity, there is a coma, suppression of a number of functional abilities that ensure the vital functions of the body, and clearly present symptoms of neuralgia. This condition is a serious threat to the life of the victim. Even with treatment, complete recovery from damage does not occur;
• Terminal degree. It is the most dangerous degree of traumatic brain injury, in which there is coma, extreme impairment of the functionality of the vital structures of the body, as well as deep damage to the tissues of the brain and trunk. At this stage, saving a person was possible in especially rare cases.

What are the features of closed and open TBI?

1. Concussion (CHM)

The most common and most frequently reported traumatic brain injury is concussion, accounting for up to eighty percent of all reported head injuries.

A concussion is a type of mild traumatic brain injury that occurs when intracranial injury occurs to blood vessels in the middle of the cranial cavity.

Some symptoms of a mild concussion include:

• Severe injury to the head or cervical spine;
• Headache(with a cervical injury, radiating to the head) - the main signs of a concussion in both adults and children;
• Dizziness that increases in strength when moving the head and tilting it;
• Feeling of “sparks from the eyes”;
• Cloudiness in the eyes.

When more severe injuries to the skull occur, the following clinical signs of a concussion are observed:

• The main symptom is unconsciousness, the loss of which can be either for a short period of time (up to 10-15 minutes) or for more than fifteen minutes (up to several hours);
• Headache after injury– a sign of a concussion, accompanying almost every impact on the skull;
• Loss of space, loss of coordination, dizziness;
• Nausea and vomiting, even in an unconscious state;
• The person feels sleepy or is overly active;
• Convulsions are the most pronounced symptoms of a concussion;
• After the patient comes to, he feels irritability when exposed to loud noises or bright lights;
• Rambling speech;
• Memory loss– the victim does not remember what happened before the injury;
• Pain in the eyeballs (especially when moving them). It manifests itself as pain in the temple area.

Over time, the following signs appear and may be present for several days after the injury:

• Increased or slowed heart rate;
• Increased sweating;
• Facial redness;
• Feeling of tinnitus;
• Feeling of discomfort;
• Pale skin tone;
• Inability to concentrate the gaze on one object;
• Loss of appetite.

A patient may have one or several symptoms at once. If the first signs of a concussion are detected, you need to urgently call an ambulance.

To avoid progression of complications, it is recommended not to self-treat.

The choice of additional research method is made by the attending physician based on an assessment of the severity of the patient’s condition and accompanying symptoms.

All victims of traumatic brain injury are taken to the inpatient department without fail. The duration of recovery depends on the severity and type of injury.

For therapy for such injuries, a large number of medications are not used. The main goals of treatment are aimed at restoring brain function, eliminating headaches and restoring sleep patterns.

Medications used for concussions consist of sedatives and analgesics.

1. Brain contusion (CBM)

UGM is a traumatic brain injury when there is injury to brain tissue, always accompanied by a focus of necrosis (death) of nervous tissue. Symptoms that appear with brain contusions are divided into three degrees of severity, each of which is characterized by specific symptoms.

The main difference between a brain contusion and a concussion is the possibility of the presence of a fracture of the vault bones during UGM and the registration of hematomas in the cavity between the arachnoid and pia mater.

The main symptoms of mild cerebral contusion are:

• Loss of consciousness (twenty to forty minutes);
• Pain in the head;
• Nausea and vomiting;
• Memory loss;
• Moderate slowing or increased rhythm of heart contractions;
• Rarely, high blood pressure occurs.

The general body temperature is within normal limits, and mild symptoms subside after a couple of weeks.

The main clinical manifestations of moderate UGM are:

Symptoms subside 3-5 weeks after injury, but the resulting injuries may recur more than once.

The main symptoms of a severe form of bruise are:

• The main symptom of extreme severity of UGM is the release of cerebral fluid (CSF) from the sinuses, or ears;
• Loss of consciousness, for a period of time from 4-8 hours to two weeks. It is often accompanied by a cerebral fracture of the base of the skull and massive bleeding in the tissue between the arachnoid and soft membranes of the brain.
• There are deviations in the functions of the human body necessary for life (impaired breathing, strong jumps in blood pressure, decrease, increase in heart rate);
• Seizures;
• Partial or complete paralysis;
• Excessive relaxation or tension of body muscles;
• Motor excitation;
• Glasses on impact syndrome may manifest as symmetrical hematomas under both eyes, suggesting a fracture of the anterior fossa of the skull.

In most cases, the affected person is left with gross deviations of the musculoskeletal system and mental disorders.

Diagnosis of UGM is carried out using CT (computed tomography). Its results indicate a low-density zone with obvious boundaries and possible subarachnoid hemorrhages.

If there is a moderate bruise, then the CT scan mainly shows lesions.

If the affected person has an extreme bruise, computed tomography shows areas of increased density of a heterogeneous nature. There is clearly visible swelling of the brain.

The development of brain compression is recorded in more than fifty-five percent of cases of traumatic brain injury. In the vast majority of cases, the causes of this condition are hematomas inside the skull.

There is an increased risk of further life activity of the affected person, because the symptoms progress rapidly. This condition often accompanies brain contusions. In some cases, cerebral edema can provoke compression of brain tissue.

The manifested clinical picture can rapidly increase immediately after a traumatic brain injury, or after some period of time, called “light”, and depending on the severity of the condition of the affected person.

The main clinical picture shown is:

• Developing impairment of consciousness;
• General brain disorders;
• Signs of lesions and damage to the brain stem.

Diagnosis occurs during a computed tomography study, which reveals a convex in two directions, or a flat-convex zone with obvious high-density boundaries.

In the presence of multiple bleedings, the high-density zone can be large in size and marked in the form of a sickle.

1. Diffuse axonal brain injuries

The main clinical manifestations of this pathological condition are the following:

• Prolonged coma after TBI;
• Clear signs of trunk deformation;
• Changes in muscle tone;
• Partial paralysis of the limbs;
• Severe disruptions in the frequency and rhythm of breathing;
• Increased body temperature;
• Increase in blood pressure;
• The patient’s transition from a coma to a transistor vegetative state (lack of ability to move due to major injuries, or disruption of the functionality of the cerebral hemispheres while maintaining the functionality of motor and autonomic reflexes).

Consequences of TBI

When you receive a traumatic brain injury, you may experience:

• Structural disorders of brain tissue;
• Formation of scar tissue;
• Blood circulation disorders;
• Nervous system disorders;
• Abnormalities in cerebral fluid.

The entire period when receiving a traumatic brain injury is divided into the following three periods:

• Spicy– depends on the severity and type of traumatic brain injury (closed, open, etc.). It can last from two weeks to three months. This period is characterized by processes of damage and the corresponding protective reaction of the body. This is the period of time from receiving a traumatic brain injury to the restoration of the functionality of the body, or death;
• Interim period characterized by actively occurring processes of a slow drop in temperature with a gradual weakening of the signs of the disease, and in the restoration at the cellular level of chemical damage and breaks in DNA molecules in areas of damage. During this period, the body’s compensation and adaptation mechanism is activated, which helps restore impaired functions to normal. The duration of the intermediate stage can range from six months to a year;
• Remote period, also called final, which is due to the completion of recovery processes. In some cases, the continued existence of pathological conditions is noted. The duration of the recovery period is up to three years, but if the process develops, the final time frame is difficult to determine.

It is important to understand that the victim may suffer consequences several years after the head injury and complications can be serious pathological conditions.

In the acute period The victim may experience the following complications:

• Purulent formations at the wound site;
• Pneumocephalus – entry and accumulation of air inside the skull;
• Increased pressure on the walls of blood vessels inside the skull, provoking vegetative-vascular disorders, loss of consciousness, convulsions, etc.;
• Hemorrhages, both internal and external, contributing to the formation of hematomas;
• Brain abscesses are focal accumulations of pus in the substance of the brain;
• Osteomyelitis is a purulent-necrotic process that progresses in the bone, bone marrow and soft tissues that surround it, provoked by pus-producing bacteria;
• Bulging of the brain.

Please note that the most dangerous consequence is death in the first seven days after a traumatic brain injury due to displacement of brain structures and swelling.

These consequences include:

• Formation of scar tissue, cysts, progression of cerebral hydrocele;
• Attacks of convulsions, with further development to epileptic seizures and psychoorganic syndrome.

The main factor in death in the late period of development is complications that are provoked by pneumonia, meningoencephalitis and other purulent infections.

In the final period, the following complications may progress:

• Partial or complete paralysis;
• Loss of sensitivity in areas damaged by paralysis;
• Epileptic seizures;
• Loss in space;
• Changes in gait;
• Sinusitis(serious infectious and inflammatory disease of the paranasal sinuses), or sinusitis(inflammation of the mucous membrane of the maxillary sinus).

Features of TBI in infants

Quite often, infants receive traumatic brain injuries when they pass through the birth canal, or during certain birthing techniques and the use of obstetric instruments. Such injuries can leave consequences that appear both immediately and over time.

During the initial examination of the newborn, the specialist records the following factors:

• Ability to suck and swallow;
• Muscle tone;
• The presence of reflexes in the tendons;
• Examines the baby's head for integrity;
• Examines the condition of the large fontanel.

If the baby received a traumatic brain injury during childbirth, then The following complications may progress:

• Formation of hematomas;
• Purulent formations in the brain;
• Damage to the central nervous system due to contusion of a newborn;
• Internal and external bleeding.

Clinical signs of birth trauma are formed as a result of incomplete development of the infant’s brain, as well as an incompletely developed nervous system.

The behavior of infants and adults in normal consciousness is different.

Pathological conditions of newborns are:

• A state of constant sleep, when the child wakes up only because he is in severe pain;
• Coma, with absence of any reactions;
• Stupor, in which the baby does not respond to light and sound stimuli;
• Stupefaction, characterized by the fact that the baby does not wake up from the pain caused, but changes his facial expressions.

To record the pathological condition of a baby who received a traumatic brain injury during childbirth, identified the following list of syndromes:

• Hydrocephalic syndrome, which is characterized by a large head size of the newborn, increased manifestation of veins, constant vomiting, a prominent fontanel and a state of general anxiety;
• Convulsive syndrome manifests itself in convulsions, respiratory arrests, etc.;
• Hyperexcitability syndrome is caused by the fact that the child does not sleep, constantly screams, and makes sounds;
• Meningeal syndrome is characterized by increased sensitivity to light and sound stimuli.

Consequences in infants

If a newborn receives a traumatic brain injury during childbirth, certain consequences may progress. In some cases, effective treatment helps save the baby's life, but does not alleviate his condition.

Irreversible changes progress, leaving a mark that negatively affects the functioning of the brain and nervous system, putting the health and life of the newborn in danger.

The most severe consequences of traumatic brain injury received during childbirth are:

• Deviations in normal speech;
• Seizures;
• Excessive activity (loss of attention, severe excitability);
• Retarded physical and intellectual development;
• Dropsy of the brain;
• Pathologies of internal organs;
• Allergies.

Therapy is selected individually; in severe cases, surgical intervention is used.

What to do if you have a skull injury?

Proper first aid can save the victim's life. That is why you should clearly distinguish the signs of brain injury and know exactly how to properly help a person.

If there are bleeding wounds, you need to apply a bandage with an antiseptic to them. In the absence of an antiseptic, it is recommended to use an elastic bandage.

If you do not have such means at hand, you need to limit access to the wound from outside influences and make a bandage from improvised means (just not dirty ones).

If it is discovered that a person has suffered a traumatic brain injury, the following procedure must be followed:

• Initially, it is necessary to determine the level of consciousness of the victim, psychomotor skills and the specificity of pain in the head. It is also necessary to monitor the swallowing reflex and defects of the human speech apparatus;
• If cerebrospinal fluid or blood leaks from the ear or sinuses, a fracture of the skull at the base may be suspected;
• Determine the width of the victim’s pupils, informing the emergency doctor;
• Determine skin color, measure approximate pulse, respiratory rate, body temperature and blood pressure, if possible. If not, be with the victim and wait for an ambulance;
• If the victim has regained consciousness due to a traumatic brain injury, then he needs to be placed in a suitable horizontal position, with his head elevated above the body. If a person is unconscious, then you need to lay him on his right side, and turn his face towards the ground, bending his left arm and leg at an angle of ninety degrees at the elbow and knee;
• If there is no breathing, you need to perform artificial ventilation (mouth-to-mouth breathing) until the ambulance arrives;
• Ensure a state of rest until the doctors arrive;

Additional hardware studies for traumatic brain injury may include:

• Spinal (lumbar) puncture during this study, a needle is inserted into the bone marrow space at the lumbar level. An analysis is carried out to study the composition of the cerebrospinal fluid;
• Craniography- This is an X-ray examination of the bones of the skull. Using this study, fractures of the skull bones are excluded;
• Examination by an ophthalmologist– performed for fundus examination;
• MRI (Magnetic Resonance Imaging) AND CT (Computed Tomography)– are carried out to exclude traumatic conditions of the brain and skull. With a normal concussion, it can be noted that changes in the structure are not recorded;
• Electroencephalography (EEG)- a method for studying brain activity by recording electrical impulses emanating from different areas of the brain;
• Doppler study of blood vessels– ultrasound examination (ultrasound) and Doppler ultrasound (USDG) are used simultaneously, which helps to study the vessels of the brain and the speed of blood circulation in them.

Treatment of TBI

Any treatment of traumatic brain injuries is carried out only when the victim is hospitalized in a hospital department. The patient undergoes a series of examinations that show the exact injuries to determine the types and nature of the injuries.

Treatment is selected based on what type of traumatic brain injury the patient has suffered.

It is important to understand that even a concussion, which has a favorable prognosis, can leave symptoms of neuralgia in the victim for the rest of his life, limiting a person’s life activity and performance.

Treatment is carried out, in most cases, with medication, with the exception of situations that require surgical intervention. The main goal of therapy is to eliminate symptoms and restore the normal state of the body.

In most cases, the following drugs are prescribed:

• Severe pain is relieved with analgesics, sedatives and tranquilizers. When using them, for the fastest possible effect, the patient should rest as much as possible;
• Swelling of the brain is relieved with dehydrating drugs (Furosemide, Magnesia, etc.);
• Long-term use of medications with dehydrating properties requires the inclusion of drugs saturated with potassium in the medications taken;
• Antihistamines strengthen the walls of blood vessels (vitamin C, Ascorutin, etc.), improve blood properties, maintain the balance between acids and alkalis and water-electrolyte balance;
• Haloperidol suppresses gagging and psychomotor agitation;
• During the recovery period, vitamin complexes are prescribed.

The use of certain drugs is allowed only after the appointment of the attending physician, with a medical history and studies of the body, and only in a hospital setting.

Preventive actions

In order to prevent traumatic brain injury in people of any age category, it is necessary to observe preventive safety measures.

These include:

• Observe professional safety measures (wear a helmet, work with insurance, etc.);
• Monitor the child, as children are often susceptible to falls and injuries;
• Eliminate risk (jumping without insurance, riding motorcycles, bicycles, roller skates without helmets, etc.).

During the recovery phase after a traumatic brain injury, the following recommendations must be followed:

• Maintain bed rest and normal sleep patterns;
• Use folk remedies for calming (valerian, mint tea, etc.);
• Follow a dairy-vegetable diet with limited salt intake;
• Avoid stressful situations;
• Do not watch TV, do not play computer games and consoles (all moments when the screen quickly changes frames);
• Do not read;
• Do not listen to music on headphones;
• Don't play sports.

Music can only be listened to through speakers and not loudly.

Expert forecast

Prognosis for traumatic brain injuries depends on the severity and nature of the injury, and of course on the timeliness of assistance provided. Forecasting is done in each individual case individually.

In order to prevent traumatic brain injury, you need to closely monitor your child when playing, and also be careful about work-related injuries, observing all safety precautions.

You also need to maintain personal safety when doing household work, since concussions due to household injuries are among the most common. When driving a car, you must wear a seat belt to avoid injury in the event of an accident.

If you notice the slightest symptoms or head injuries, you should urgently call an ambulance.

Do not self-medicate and be healthy!