Contusion of the brain

Contusion of the brain is a more serious damage accompanied by macroscopic morphological changes of the brain substance. Contusions of the brain, depending on the nature and severity of trauma can be various enough, from comparatively mild single to apparent plural affecting vitally important structures. Morphologically, depending on the nature of trauma, changes in the area of contusion can vary from punctual hemorrhages and small areas of crushing to the formation of large foci of the cerebral detritus, rupture of vessels, hemorrhages into the destroyed tissue, apparent phenomena of edema-swelling, sometimes spreading over the whole brain. More frequently, damages are formed in the area of applying force, as well as damages are possible from the side diametrically opposite to the blow (the mechanism of counterblow).

Clinically one distinguishes contusions of a mild, moderate and severe degree. Neurological symptomatology in contusions of the brain is polymorphic enough. The basic clinical symptoms of contusion of the brain are general cerebral symptomatol­ogy (as a rule, a long-term enough loss of consciousness takes place), persistent focal symptomatology (depends on the area of damage), and meningeal symptomatology (as a result of a disturbance of the integrity of convexital vessels with the phenomena of subarachnoid bleeding.

In mild contusion, there arise there is a loss of consciousness (from a few to tens of minutes), persistent headache, dizziness, weakness, sonitus. Pretty often there are amnesia, apparent nausea, often repeated vomiting. Disorders of vitally impor­tant functions do not arise, sometimes one can note moderate tachycardia, or, rarer, bradicardia, hot flashes to the face, parahypnosis and other vegetative phenomenas. Neurological symptomatology is usually "mild" (nistagmus, a mild anisocoria, signs of pyramidal insufficiency, mild meningeal symptoms and others). Usually neuro­logical symptomatology regresses completely in 2-3 weeks.

Contusion of the brain of a moderate degree of severity is accompanied by a loss of consciousness from a few tens of minutes to a few hours. Virtually always there are: amnesia, intensive and long-term headache, there arises frequent vomiting psychical disorders are possible. For this form of damage transitory disorders of vitally important functions are typical (bradi-, tachycardia, an increase of arterial pressure, tachypnea without a disturbance of the breathing rhythm, subfibrility, sometimes there can be truncal symptoms. Meningeal symptoms are well apparent, a distinct focal symptomatology takes place, which is determined by the localization of contu­sion (oculomotor disorders, pareses of the limbs, disorders of sensitivity and others) which gradually regress (but often not completely) during 2-5 weeks.

Severe contusion of the brain becomes apparent as a loss of consciousness which lasts from a few hours to a few weeks, psychomotor excitation, severe neurological symptomatology, often threatening vital functions, truncal symptoms. Meningeal symptoms are full-blown, there often arise generalized or focal epiattacks. Focal symptoms regress slowly and not fully, leaving rough residual phenomena from the side of the motor and psychical sphere.

Diagnostics of contusion of the brain, especially in the period of primary examination, happens to be difficult. On craniography one often enough discovers fractures of the bones of the skull, foreign objects, that (despite the clinical picture) testifies to contusion of the brain. In echoencephalography the appearance of a great amount of high-amplitude additional echosignals is possible and the apparent foci of damage of one of the hemispheres of the brain with a considerable edema can give the displacement of M-echo up to 3 - 4 mm. The basis of diagnostics of damages of the brain is maid up of computer and magnetic resonance tomography (Fig. 4). Lumbar puncture enables to find out the presence of blood in liquor, that, as well as fractures of the bones of the skull, is an unreserved sign of contusion of the brain. Sometimes the diagnosis especially in respect of the size and degree of damage, can be only made by the moment of the patient's discharge from the in-patient establishment, because to diagnose the degree of contusion of the brain is often only possible due to the clinical observation of the patient and findings of additional methods of checkup.

The treatment of contusion of the brain depends on its degree. In mild contu­sion of the brain the basic method is conservative and moderate dehydration therapy, antihistaminic as well as sedative, nootropic, and vascular drugs, symptomatic therapy. In subarachnoid hemorrhage they carry out hemostatic therapy, medical- diagnostic lumbar punctures. In contusion of a middle degree, the basic treatment is performed after algorithms of intensive therapy. In the treatment, infusional therapy with a positive balance of liquid prevails.

Repeated lumbar punctures are justified before sanation of liquor. In severe contusion of the brain patients are subject to stationary treatment at the department of intensive therapy under the observation of the neurosurgeon. The tactics of man­aging such patients is constrained to the differentiated approach to their treatment depending on the clinical course.

Date: 2015-01-02; view: 1257