General principles of diagnostics of CCT

The main task of examining the patient with CCT are: identification of the type of trauma (closed, open, penetrating) and the nature of damage of the brain (concussion, contusion, compression, diffuse axonal injury); specification of the cause of compression (hematoma, depressed fracture and others); determination of the severity of the patient's state; evaluation of the nature of bone damages, the nature of severity of general somatic and neurological state of the patient.

To recognize the nature of damage in CCT is often not easy. Usually the clinic of CCT consists of the following syndromes which to this degree or another are ap­parent in certain forms of damage of the brain:

1. General cerebral symptoms (loss or disturbances of consciousness, headache, nausea, vomiting, amnesia).

2. Focal symptoms (permanent or transitory).

3. Astenovegetative syndrome (fluctuations of the pulse and arteriotony, hyperhydrosis, pallor, acrocyanosis and others).

4. Meningeal syndrome or symptoms of meningism.

5. Dislocation syndrome.

A loss or disturbances of consciousness are one of the main general cerebral symptoms in CCT. The nature of these disturbances is traditionally evaluated in scores after the Glasgow coma scale (Table 1).

One of the most essential constituents in diagnostics of CCT is the observance of the principle of dynamic supervision over the patient. The patient's state, especially in severe CCT, can quickly change, first of all in the development of symptoms of compression of the brain, therefore its permanent neurological evaluation can be of crucial importance. At the same time, to date, it is impossible to imagine diagnostics of CCT without modern additional methods of research, among which computer tomography (CT) and magnetic resonance imaging (MRI) are of indisputable advantages.

To make and specify the diagnosis for patients with CCT, a whole complex of checkups is performed.

Table 1. Glasgow coma scale (1974)

.

1. General examination of the patient.

2. Collecting the anamnesis of the disease (information about the time and mechanism of trauma).

3. Neurological checkup.

4. Roentgenography of the skull (craniography) minimum in two projections.

5. Echoencephalography.

6. Neurovisualizing investigations (CT, MR]).

7. Lumbar puncture (in the absence of symptoms of the dislocation of the brain).

8. In the absence of the possibility to carry out neurovisualizing investigations - application of burr holes.

Additional methods of checkup:

1. Laboratory investigations:

- general blood and urine test;

- biochemical blood test;

- liquor test.

2. Examination by related specialists:

- ophthalmologist;

- otorhinolaryngologist;

- traumatologist.

The carrying out of such a complex of checkups allows to get a valuable objective information about the state of the brain (the presence of foci of contusion, intracranial hemorrhages, signs of dislocation of the brain, the position of the ventricular system and others). At that, in spite of visible advantages of neurovisualizing methods, craniography has not lost its diagnostic value as well, which allows to reveal fractures of the bones of the skull, metallic foreign bodies and other (secondary) craniographycal signs as a result of the given pathology. Types of fractures of the bones of the skull:

1. Depending on the state of soft tissues;

- closed;

- open.

2. By localization:

- convexital;

- basal.

3. By the mechanism of trauma:

- direct;

- indirect.

4. By form:

- complete;

- incomplete.

5. By appearance:

- linear;

- splinter;

- depressed;

- perforated;

- crushed;

- particular forms (gunshot, growing, ruptures of sutures, concave).

When there is no possibility to perform CT or MR], in diagnostics of CCT preference should be given to echoencephalography (determination of the displacement of the middle echo) and application of the diagnostic searching burr holes.

In cases of severe CCT, importance is given to monitoring of intracranial pressure with the purpose of performing the proper therapy and preventing the most dangerous complications. For this, they use special sensors for measuring pressure which are placed in the epidural space by applying burr holes. With the same purpose, they carry out the catheterization of the lateral ventricles of the brain.

Date: 2015-01-02; view: 1097