To Cherepno - brain injuries of
of Cherepno - brain injuries (ChMT) present very serious and actual problem. Their prevalence is rather big, the contribution to this sad statistics is made also by falling from height, both fights, and sports injuries, and dorozhno - transport incidents...
In the general structure of mortality the role of ChMT is very high
, among adult ChMT is the reason of 1% of all death that there is a lot of. At children the death from ChMT makes according to some information 10% of all death. In recent years the quantity cherepno - brain injuries steadily grows that usually connect with increase in number of cars (the autotrauma is the most frequent reason of injury of a brain).
the Anatomy of a brain and its covers
the Brain is a vital and therefore it is quite well protected by the nature from casual damages. Skull bones at adults strongly grew together among themselves and are quite reliable protection. Besides a skull, the brain is surrounded with three covers. The firm brain cover prilezhit to skull bones from within, in it there pass ways of outflow of a blue blood from a brain. Soft and web brain covers adjoin directly to a brain, they are rich with vessels and participate in its blood supply. Besides, the web cover produces cerebrospinal fluid, important for food and protection of a brain. The brain as if floats in cerebrospinal fluid which plays a role of the hydraulic shock-absorber, in addition protecting it from injuries.
At children of the first year of life the structure of a skull has certain features. The main thing from them is an existence of fontanels and open seams that, on the one hand, protects the child`s brain from damage (bones of a skull can be displaced a little at a trauma that reduces risk of a change; at brain hypostasis owing to a trauma intra cranial pressure at the expense of elastic fontanels increases less). On the other hand, the same features do babies by more vulnerable - even the blow of small force will be dangerous if it gets directly on area of a fontanel. There are features and in a structure of the brain is a functional immaturity and weak differentiation of the cortical centers (the sites of a brain which are responsible for mobility, sensitivity, the speech, reading etc.), and also considerably the best, in comparison with a brain of adults, blood supply. Thanks to all this at babies and children of early age the forecast after even heavy cherepno - brain injuries is much more favorable, than at a similar trauma at the adult. It is known that at timely and correct treatment children can recover completely from injuries with damage of a site of a brain which at the adult inevitably would result in disability (to extremity paralysis, loss of the speech etc.)Should notice
that in connection with these features at children of younger age even at rather severe injuries loss of consciousness happens seldom. Statistically, the main reason for the address to the doctor with children 1 - oho years of life is the extensive hypodermic hematoma (“cone“).
Types cherepno - brain injuries
brain Concussion - the least heavy damage at which there are practically no organic changes in brain tissue. The most typical displays of concussion - directly after a trauma single short-term (for several seconds or minutes, no more than half an hour) loss of consciousness and loss of memory for the short period (several minutes) which is directly preceding a trauma. In the subsequent also other symptoms are shown: nausea, vomiting, general weakness, dizziness, headache. Vomiting seldom happens repeated, usually it repeats 1 - 2 time. The increased irritability, fatigue, drowsiness is noted. Bright light, sharp sounds are unpleasant to the victim.Should notice
that such symptom as memory loss, the victim practically can never independently notice. The mentality of the person is so arranged that even at loss from memory and 2 - 3 hours, and several minutes subconsciousness “darns“ these tears false memoirs. And often it is possible to establish existence of a lapse of memory only by detailed inquiry of the victim, whenever possible comparing his answers to the story of eyewitnesses. In many cases of people cannot judge also whether it had a loss of consciousness, these data can be obtained only from witnesses of an event.
As a rule, all this symptomatology is normalized within 1 - 2 weeks.
At children of younger age, especially the first year of life, loss of consciousness happen very seldom. Such symptomatology as sharp pallor (especially the person considerably turns pale) is characteristic of chest babies, then weakness and drowsiness develops (the concern, irritability, frustration of a dream is more rare, on the contrary). Often there is vomiting when feeding. At favorable succession of events these symptoms pass in 2 - 3 days. At children of babyhood (1 - 3 years) the most frequent and significant symptom is repeated vomiting.At old men losses of consciousness are also rare
, but often there are disorientation episodes (when the victim hardly understands where it is, than is engaged, how old is he and that occurs around) proceeding from several hours to 2 - 3 days after a trauma.
the Contusion (bruise) of a brain
Is the injury of a brain following on weight at which in tissue of a brain the damage centers are defined. Clinically it is shown by existence, except symptoms of concussion, so-called focal symptomatology. Depending on the place of damage it can be full or partial paralysis of a hand or leg, violation of the speech, disorders of sight or hearing are more rare. Loss of consciousness is more long, than at concussion (in hard cases from 2 hours to 1 days). Nausea, dizziness and a headache are expressed much stronger. Vomiting, as a rule, repeated, sometimes unrestrained. Memory loss as for time, directly preceding a trauma, and on the subsequent to it events is noted. In hard cases repeated loss of consciousness, coming after a while after the victim recovers is possible. Various “eye symptoms“, from an insignificant difference in the size of pupils (anizokoriya) are noted at slight injuries to the dispersing squint and “floating“ eyeballs at heavy.Sdavleniye`s
of a brain (subduralny, epiduralny and intracerebral hematomas)
At rather strong blow the victim can have a rupture of blood vessels over or under a firm brain cover, and is more rare in the tissue of a brain. At the same time from the burst vessel blood and as the volume of a cavity of a skull is invariable, it leads to a sdavleniye of certain sites of a brain streams. Heavy damage, the shown such symptoms as oppression of consciousness from drowsiness to a coma, the expressed headache on the party of defeat, unilateral expansion of a pupil, vomiting develops. Are possible focal symptomatology (extremity paralysis). At a “classical“ course of disease repeated loss of consciousness arises through “a light interval“ (the period of external wellbeing) proceeding several hours or days. So the clinic of a subduralny hematoma (a blood congestion under a firm brain cover) in 1/3 all cases looks. Long, till 2 weeks, “the light interval“ is characteristic of people of advanced and senile age and patients with alcoholism. In hard cases of full normalization of health in “a light interval“ does not occur, the condition of the victim remains heavy though some improvement and is observed. In such cases speak about an abortive “light interval“.
At an epiduralny hematoma when hemorrhage occurs between a firm brain cover and a skull, “the light interval“ meets slightly less often. It develops quicker than subduralny. Their symptoms are very similar though the epiduralny hematoma proceeds, as a rule, heavier.are similar
of Display of an intracerebral hematoma to displays of a stroke (which it in fact also is).
the Change of the basis and the arch of a skull
All injuries of a brain described above can how to occur without violation of integrity of bones of a skull, and to be followed by their changes.
the Change of the arch of a skull happens linear and pressed. Linear changes arise at blow with a big area of contact (for example, when falling from height on a plain surface). If the area of a shock surface is small, then there is a pressed change when the fragment of a bone is as if shipped in a skull cavity. At the same time the change form, as a rule, corresponds to a trauma tool form. At children of the first year of life peculiar changes of the arch of a skull are sometimes noted. So, kids with not up to the end stiffened seams can have linear changes at the expense of a divergence of seams, so-called diastatic changes. The pressed changes at babies also differ in an originality - it is so-called changes as “a ball for a ping - a pong“, vdavleny bones without violation of its integrity, at the expense of a bend. Such changes do not demand surgical treatment, excepting localizations at which it results in cosmetic defects.
One of the most known symptoms of a change of the basis of a skull is the paraorbital hematoma (“a symptom of points“). It is necessary to remember that this symptom has diagnostic value only in case the victim had no trauma of okologlaznichny area or a nose bridge. Also the expiration of an ichor or cerebrospinal fluid from a nose and ears is observed. A characteristic symptom of a fracture the basis of a skull is the so-called “symptom of a teapot“ - when the expiration of an ichor or colourless transparent liquid from a nose amplifies at a ducking forward, from an ear - at an inclination in the relevant party. The expiration of pure blood speaks rather about an injury of an ear or nose, than about a skull fracture. Besides, at a change of the basis of a skull can be damaged cherepno - brain nerves. Depending on the place of a change at the same time violations of sense of smell, sight, hearing, asymmetry of the person can be observed. Among complications of a change of the basis of a skull the complications connected with hit in an infection skull cavity from a nasopharynx, a middle ear or additional bosoms are very dangerous: abscesses (abscesses) of a brain and meningitis.Fractures of bones of a skull are usually combined by
with various injuries of a brain. There is no direct correlation between weight of injury of a brain and type of a change. However as a rule, the pressed changes are followed by heavier damage, than linear, at them often there is a development of Epi - and subduralny hematomas whereas at linear changes injury of a brain can be limited to a contusion, and even concussion.
About opened cherepno - a brain trauma are told in case there was a damage of soft tissues of the head and bones of a skull at the same time. If at the same time also the firm brain cover is damaged, then the trauma is called getting. Opened cherepno - the brain trauma is more dangerous closed first of all by high risk of infection. Besides, at it hit in tissue of a brain of splinters of a bone or foreign matters is possible.
the Help at ChMT
First and the basic that needs to be made at cherepno - a brain trauma with loss of consciousness, nausea and vomiting is to see a doctor. It is not necessary to hesitate here, timely and correct diagnostics considerably increases chances of the victim to get out of the situation with the minimum consequences. It is desirable that “ambulance“ brought to medical institution of the victim, and before its arrival he has to keep the maximum rest. If for any reasons of the victim in a serious condition, unconscious, it is necessary to transport by own efforts, then it is necessary to remember that it is desirable to do it in a prone position on a back, whenever possible on the rigid basis (as in such cases it is impossible to exclude as well a trauma of cervical department of a backbone). As a last resort (transportation in the car) it is necessary to provide an immovability of cervical department (for example, having recorded shoulders and the victim`s neck a blanket, the curtailed clothes etc.) .
If damage of soft tissues of the head takes place, then the wound should be closed a sterile bandage.cannot leave to
of the Victim in an unconsciousness one as at any moment of its state can worsen. It is necessary to watch it constantly to exclude a possibility of aspiration (hit in airways) emetic masses, and any minute to be ready to resuscitation actions (artificial respiration).If the patient in consciousness and the general state is regarded by
as satisfactory, then he can address to hospital independently. But even in this case it is desirable not to leave it without supervision and maintenance, in a type of possible deterioration.
Diagnostics cherepno - brain injuries
First what inspection of the victim with an injury of the head has to begin with is survey of the neuropathologist . At this stage it is possible to diagnose brain concussion (I will remind what at concussion of changes in tissue of a brain is not present and therefore tool methods are ineffective, survey of the doctor plays a major role in diagnostics), and also to suspect heavier damage and to resolve an issue of further inspection.
Obligatory in such cases is also x-ray research of a skull that in most cases allows to reveal a fracture of bones of a skull. It is necessary to remember, however, that in certain cases the change is not visible in a x-ray picture, as well as the fact that even heavy injuries of a brain can happen at preservation of integrity of bones of a skull.the shift of so-called “median structures“ allows to reveal
of EhoEG (ultrasonic research of a brain) that gives the chance to assume existence of some asymmetric education in a skull (in case of a trauma - a hematoma). The value of this method is not really big, but thanks to the low cost and availability it is widely applied.such phenomenon as stagnant disks allows to reveal
of Oftalmoskopiya (survey of an eye bottom) that is an indirect sign increase of intra cranial pressure (including at the expense of a hematoma).the Greatest diagnostic value such methods as a brain tomography - computer (KT) and magnitno - have
resonant (MRT). They allow to reveal authentically existence of a hematoma, to distinguish the damage centers at a bruise. Unfortunately, this research expensively and not always well. However in difficult and not clear cases carrying out a tomography of a brain becomes absolutely necessary.
Treatment of patients with ChMT
Treatment of patients with heavy injuries of a brain happens, as a rule, in neurosurgical office. At sub - and epiduralny hematomas surgical intervention quite often is required, bruises and intracerebral hematomas treat medicamentally.
Patients with concussion are subject to hospitalization in neurologic office. However in some cases treatment of not heavy concussion of a brain can take place also in house conditions under supervision of the neuropathologist. The main thing that is required to it bolny is a rest. Within several days (till 7 - 10 days) the bed rest has to be observed. It is recommended to avoid any strong irritants - bright light, loud music, unpleasant talk. It is necessary to remember that viewing of the TV, reading books is not rest! Drug treatment is usually reduced to the preparations improving a metabolism in brain fabric (nootropit, pikamilon), and to vascular preparations (kavinton, stugeron). If necessary appoint also symptomatic therapy - the anesthetizing preparations (analginum, sedalgin, maksigan), soothing (extract of a valerian or a pustyrnik, elenium, to fenazepa), the preparations reducing dizziness (betaserk, bellaspon, tanakan). For overcoming of the asthenic phenomena during restoration recommend polyvitaminic preparations (neyromultivit, a milgamma).
Even if during treatment of the victim with ChMT the obvious invalidization managed to avoid
of the Consequence of ChMT (a paralysis, decrease in intelligence, violation of the speech), not always further it will be possible to speak about an absolute recovery.
the Remote consequences cherepno - brain injuries can be the most various. Such phenomenon as the astenisation which is shown decrease in working capacity, fast fatigue and an exhaustion is the most typical. Hypersensibility to alcohol when even the insignificant dose of alcohol leads to inadequate reaction, up to pathological intoxication and alcoholic psychoses is rather often observed. One of the most frequent consequences is meteosensitivity when the person painfully reacts to changes of atmospheric pressure, and vasomotorial frustration (violation of a tone of blood vessels) which are shown persistent and long headaches and tendency to dizzinesses, especially at physical activity and at change of position of a body. After severe or repeated injuries epileptopodobny attacks (post-traumatic epilepsy) can develop. Rather seldom there can be changes of the personality - emotional lability (fast change of mood), irritability, tearfulness. Various neurosises and psychoses are even less often observed. Traumatic weak-mindedness is considered very unusual occurrence.the Probability of the expressed residual phenomena after a trauma of subjects is higher than
, than the trauma was heavier. In most cases an outcome of concussion of a brain is the absolute recovery, the expressed residual phenomena are observed at 3% of victims whereas after brain bruises their frequency reaches, on different sources, to 18 - 30%. The risk of the residual phenomena grows also in case injuries, even not heavy, happen repeatedly (such known phenomenon as encephalopathy at boxers can be an example of that).