Concussion of the brain

Concussion of the brain belongs to a mild craniocerebral trauma and makes on average up to 70-80% of traumatic damages of the central nervous system.

In concussion of the brain, there are no macroscopic morphological changes in its tissue. Changes in the brain are only determined in microscopic investigation as disturbances of the structure of neurons, changes of cellular membranes, mitochondrias and other organoids.

A characteristic clinical sign of concussion of the brain is a rapid development of symptoms and their subsiding after trauma. The main symptom is a short-term (often instantaneous) loss of consciousness which extremely rarely can last up to 10-20 min. Against the background of the unconscious state, reactions to pain stimuli persist. Loss of consciousness in concussion of the brain in children from the infantile to the school age period is of great rareness. Short-term loss of consciousness turns into the state of stunning. At that, one observes somnolence, languor, indifference to the patient's associates. Often the second permanent sign of concussion of the brain is nausea and sometimes a single vomiting which in infants can take the form of re­gurgitation. In the clinical picture there prevail general cerebral symptoms: headache, dizziness, sonitus, pretty often amnesia arises. Practically always in concussion of the brain there arises mild focal symptomatology which has a tendency to a rapid regression already during the first 24 hours. To the most diagnostically significant focal symptoms in concussion of the brain belong: a spontaneous horizontal nystagmus, Marinesco-Radovich's symptom, disappearance or weakening of abdominal reflexes, Sedan's symptom, Gurevich-Mann's symptom, weakness of convergence, a mild tendinous hypo- or hyperanisoreflexia. Patients are irritated by bright light, noise, different vegetative disorders being characteristic (an increase of the body temperature, hyperhydrosis, rapid fatigueability, psychical exhaustion, languor).

The diagnosis of concussion of the brain is a clinical one; applying additional methods of investigation does not reveal any changes.

In concussion of the brain, they prescribe conservative treatment, the basis of which is a dynamic supervision and a strict bed regime for the term of 7-10 days, as well as carrying out symptomatic therapy, including analgetics, sedatives, and if necessary, antiemetic drugs. In the first 24 hours after the trauma, prescription of antihistaminic preparations and natural antioxidants (vitamin E) is justified. In case of an incessant headache which does not subside due to analgetics, it is obligatory to carry out lumbar puncture with measurement of the liquor pressure and prescription, depending on this index, the proper treatment.

Date: 2015-01-02; view: 1373