|ICD-10||S 06 06.|
|ICD-9||800.0 800.0 - 801.9 801.9 , 803.0 803.0 - 804.9 804.9 , 850.0 850.0 - 854.1 854.1|
|eMedicine||med / 2820 neuro / 153 neuro / 153 ped / 929 ped / 929|
Craniocerebral trauma (TBI) is a complex of contact injuries (soft tissues of the face and head, bones of the skull and facial skeleton) and intracranial injuries (damage to the substance of the brain and its membranes), which have a single mechanism and prescription.
Classification| edit code]
The severity of the lesion distinguishes between mild, moderate and severe head injury. The Glasgow Coma Scale is used to determine the severity. In this case, the patient receives from 3 to 15 points, depending on the level of impaired consciousness, which is assessed by opening the eyes, speech and motor reactions to stimuli. A mild head injury is estimated at 13-15 points, moderate - at 9-12, severe - at 3-8.
Also distinguished are isolated, combined (trauma is accompanied by damage to other organs) and combined (various traumatic factors act on the body) TBI.
TBI are divided into closed and open. With an open traumatic brain injury, the skin is damaged, the aponeurosis and the bottom of the wound is bone or more deep-lying tissue. In this case, if the dura mater is damaged, then an open wound is considered penetrating. A special case of penetrating trauma is the outflow of cerebrospinal fluid from the nose or ear as a result of a fracture of the bones of the skull base. With a closed head injury, the aponeurosis is not damaged, although the skin may be damaged.
Clinical forms of head injury:
- Fracture of the skull bones - Fractures are more often bone-linear.
- Concussion is a trauma-induced impairment of neurological function. All symptoms that occur after a concussion usually disappear over time (within a few days - 7-10 days). Persistent persistence of symptoms is a sign of more serious brain damage. Concussion may or may not be accompanied by loss of consciousness. The main criteria for the severity of a concussion are the duration (from several seconds to 5 (in some sources up to 20) minutes) and the subsequent depth of loss of consciousness and state of amnesia. Non-specific symptoms - nausea, vomiting, pallor of the skin, impaired cardiac function. A neurological examination, as a rule, does not detect abnormalities, but somatic symptoms (headache), physical symptoms (loss of consciousness, amnesia), behavior change, cognitive impairment or sleep disturbance may be noted. Some of these effects may last several months after an injury.
- Brain contusion: mild, moderate and severe (clinically). A brain injury appears in a bruised wound in brain tissue. A bruise shock-shock is applied when the brain hits the wall of the skull in the place of direct impact of an external object on the head, receives one bruised wound and then a bruised wound is applied to the opposite side of the brain with a sharp slowdown in the movement of brain tissue. Clinical manifestations depend on the location of the bruise, and include a change in mental state, increased drowsiness, confusion, anxiety arousal. Small intraparenchymal hemorrhages and swelling of the surrounding tissue can often be detected by computed tomography.
- Diffuse axonal damage - severe damage to the axonal white matter of the brain as a result of the action of shearing force caused by strong acceleration or inhibition of the brain
- Brain compression
- Intracranial hemorrhage (hemorrhage in the cranial cavity: Subarachnoid hemorrhage, Subdural hematoma, Epidural hematoma, Intracerebral hemorrhage, Ventricular hemorrhage)
This type of damage refers to closed head injuries (ICD-10 code - S00-S09). Sometimes they are even more dangerous than open ones. After all, a person does not attach due importance to this state and does not seek medical help on time. The main risk factor is alcohol consumption. 70% of patients who were diagnosed with closed head injuries (code according to ICD-10-S00-S09) were intoxicated.
Mechanical damage to the head leads to the fact that the connections between neurons are broken, and nerve cells suffer from a lack of nutrients, and this negatively affects their functions. Do not underestimate the risk of closed injuries. After a strong blow or bruise, you must contact a medical institution. It is recommended to take an x-ray of the head to exclude the appearance of cracks, bruising.
In addition, a neurologist should undergo an examination. It is also important to know how to recognize a concussion in order to provide first aid to the victim in a timely manner.
Degrees of damage
They are determined depending on the severity of the injury and its clinical manifestations. There are three types of concussion:
- Light damage. It is not accompanied by impaired consciousness. The patient may appear disoriented in space. Dizziness, cephalalgia, nausea with a mild concussion usually go away a quarter of an hour after the injury. In some patients, the temperature rises to 37-38 degrees. However, the general condition of patients quickly returns to normal.
- The average degree of damage. With this pathology, there is no loss of consciousness. But the main symptoms (dizziness, cephalgia, nausea, disorientation) do not disappear within a quarter of an hour. Short-term memory loss is possible. As a rule, it is expressed in retrograde amnesia (the patient forgets the events that occurred a few minutes before the injury).
- Severe concussion. Accompanied by a swoon. Loss of consciousness can be both short-term (within one to two minutes), and long (up to several hours). The patient has a memory loss (by the type of retrograde amnesia). Symptoms characteristic of a head injury concern the patient for two weeks after the injury. Fatigue, sleep disturbances, lack of appetite, disorientation are observed.
How to recognize a concussion? It should be remembered that any, even minor injury or blow can lead to this damage. Therefore, if a similar event occurred, it is necessary to carefully monitor the human condition. If symptoms of pathology occur, you should consult a doctor.
Key signs of injury
This condition is characterized by the following manifestations:
- Impaired consciousness.
- Dizziness, which is felt at rest and intensifies with a change in body posture, turns, bends. The cause of this symptom is a circulatory disorder in the vestibular apparatus.
- Noise in ears.
- Feeling of nausea, vomiting.
- The feeling of being overwhelmed.
- Doubling in the eyes. During the movement of the organs of vision (for example, when trying to read), pain is felt.
- Headaches (with a concussion they have a pulsating character).
- Hypersensitivity to light, sounds (not even too loud).
- Motion coordination disorders.
Indirect manifestations of pathology
Additional symptoms of concussion in an adult include:
- Inhibition, slow speech, inability to answer questions normally.
- Violation of orientation in time, in space.
- Concentration disorders, memory impairment.
- Excessive activity or lethargy.
- Different pupil widths.
- Lack of appetite.
- Sleep disorders.
In elderly patients, loss of consciousness occurs with this damage less often than in young patients. However, in elderly people there is a violation of orientation in space and time. For them, a characteristic symptom of a concussion is a headache in the back of the head, which has a pulsating character. This symptom does not disappear for 3-7 days and is intensely manifested in people suffering from hypertension. Such patients need to be given special attention.
Ways to assist
It is important for everyone to have an idea of how to recognize a concussion and how to act correctly in the presence of signs of injury. First of all, if the victim lost consciousness, it is necessary to call an ambulance service.
The person should be laid on a flat hard surface, placed on the right side, bend your knees and elbows. The head must be thrown back and turned towards the floor (ground). This will prevent the entry of fluid into the respiratory tract in case of vomiting. If there are wounds on the head, a bandage should be applied to them to stop the bleeding. If the victim is conscious, it is necessary to lay him on a flat surface.
It is necessary to carefully monitor the condition of the person, not to allow the patient to fall asleep. It is recommended to raise his head, apply a cold compress. The victim, who is swooning, must not be moved or turned over. If small or sharp objects, loose solids or liquids are located next to the patient, these things are eliminated, otherwise they may get into the respiratory tract. A conscious person is not recommended to consume a lot of water. If thirsty, a small amount of sweet tea is allowed.
If you do not go to a medical institution and ignore therapy, health problems can occur after an injury. Three percent of patients have epileptic seizures, severe asthenic syndrome, hemicrania. Some patients experience minor complications that disappear after a while. The consequences of trauma include a decrease in memory and concentration, a feeling of weakness, depressive disorders, periodic cephalgia, emotional instability, irritability, and sleep disturbances. In most patients, these symptoms become less pronounced and disappear within a year. In others, these manifestations remain throughout life.
Some time after the injury, each patient is advised to undergo electroencephalography. This examination will allow you to identify the possible consequences of damage in time.
Symptoms of a Head Injury
- After a bruise, a hematoma forms on the affected area. Pain is localized in the area of damage. With a strong mechanical effect, bleeding is noted, which cannot be stopped independently. The patient develops severe dizziness. The pain can give to the neck. Light bruises do not require the attention of a doctor. If you have the following symptoms, you should seek help:
- colorless discharge from the nasopharynx and ears,
- bouts of cramps
- loss of consciousness,
- the inability to move independently
- serious disorders of the speech apparatus,
- deformation of the organs of vision,
- breathing problems
- oppression of consciousness.
The severity of the head injury depends on the severity. Slight injuries are characterized by the following symptoms:
- formation of abrasion at the site of injury
- nausea and bouts of vomiting that quickly go away on their own,
- loss of consciousness for a short period of time, up to 10 minutes,
- drowsiness for 6 hours,
- slight disturbances of the speech apparatus are possible.
Severe bruises are characterized by the following symptoms:
- prolonged loss of consciousness,
- drowsiness for several days,
- frequent bouts of vomiting
- the formation of a bump or wound at the site of injury,
- double vision, serious speech impairment,
- the patient is not able to clearly express the thought,
- limited movement.
Traumatic brain injuries are triggered by mechanical stress, more often diagnosed in the following situations:
- crashes and collisions on the road,
- injury due to non-observance of industrial safety,
- falling from a height
- suicide attempt
- attack on a person
- alcohol intoxication.
Several degrees are distinguished depending on the severity of a head injury:
- mild damage is not accompanied by complications, more often passes without medical attention. It is characterized by irritability, sleep disturbance, headache and dizziness for a short period of time,
- moderate head injuries involve severe bruising affecting the brain, such as a skull fracture. Damage can seriously affect your health. Doctors note mental disorders, memory loss, impaired heart rate, paroxysms of the upper and lower extremities, visual disturbances. Recovery takes several months,
- a severe degree is characterized by serious consequences that affect the quality of life of the victim. There is a chance of death and coma. It is characterized by loss of sensitivity, worsening of visual acuity and vision, impaired functioning of the cardiac system, memory failures, epileptic seizures.
Depending on the nature of the lesion, the following classification exists:
Implies reversible impairment of brain functionality. Often accompanied by loss of consciousness for up to 10 minutes, nausea and vomiting. It is characterized by pain during eye movement. Symptoms disappear on their own within a week. If there are signs of concussion, it is recommended to consult a neurologist.
A history is collected from the patient, a visual examination is performed. To determine the degree and type of head injury, use x-ray of the skull, computed tomography, MRI, angiography. If necessary, carry out a lumbar puncture. In the network of clinics CMRT for the diagnosis of head injury recommend the following procedures: