CONCUSSION OF THE BRAIN

From Big Medical Encyclopedia

CONCUSSION OF THE BRAIN (commotio cerebri; synonym commotio of a brain) — the form of the closed injury of a brain which is characterized by reversibility of clinical symptoms. Earlier This year m on weight subdivided into three degrees: easy, average and heavy. At the same time with heavy degree This year m carried persons to victims, at to-rykh duration of a loss of consciousness reached 1 — 3 hour and more, pronounced all-brain symptoms, disturbances of vegetative and vital signs were noted. However the analysis of these observations showed that in all specified cases it is about contusional defeats of diencephalic and trunk departments of a brain and consequently, they shall be carried to classification group of bruises of a brain (see. Contusion of a brain ). It is accurate to differentiate m of easy and average degree because of lability nevrol This year. symptoms very difficult; besides, in peace time such division does not define therapeutic tactics. Therefore This year the m is not distinguished on severity. Only in the conditions of wartime and at mass defeats during medical sorting of victims with This year m it is reasonable to subdivide into two categories: 1) victims with insignificant a wedge, manifestations (short-term — 3 — 5 min. a loss of consciousness, short amnesia, a weak headache, lack of vegetative and neurotic manifestations, active behavior, etc.), to-rykh it is possible to leave in team recovering since terms of their treatment make 7 — 10 days, or to evacuate in-tsy a country zone in a sitting position; 2) victims with expressed a wedge, manifestations (a loss of consciousness within 10 — 20 min., a headache, the expressed amnesia, all-brain and vegetative symptoms, the general weakness, an adynamy, etc.), to-rye need in specialized nevrol. treatment in stationary conditions and evacuation in a prone position.

The pathogeny

m develops This year at single-step short-term influence of mechanical energy on brain (see), being in the closed head cavity. At the same time direct action of a motive energy on tissue of a brain is combined with the hydrodynamic impacts on it caused by jumps of intracranial pressure and moving of cerebrospinal liquid to head cavities and cerebral cavities, and also blood in its vascular system.

In mechanisms of action of the injuring force on a brain at its concussion shifts of a brain at the level of a tentorial opening with impact of surrounding shell and bone structures on trunk departments of a brain have great value.

In the existing ideas of a pathogeny This year m occupy an important place physical. - chemical theories, according to the Crimea at this type of an injury there is a disturbance of colloid balance in nervous elements of tissue of brain, in particular in proteinaceous components of nervous cells, to-rye change towards enlargement of dispersion, increase in viscosity and reduction of water content.

The great value is attached to the functional asinapsiya developing at This year m, patomorfol. substrate a cut are changes of membranes of neurons and swelling of the synapses conducting to the block of an afferent and efferent impulsation.

In a pathogeny a wedge, manifestations This year the m a big role plays the developing diffuse braking (see), taking bark and underlying departments of a brain, at Krom the ascending activating influences are broken reticular formation (see) on cortical departments of a brain. Primary defeat of formations of a brain trunk at This year m, in particular a reticular formation, in addition to influence of mechanical force is caused by an arrangement of nuclear structures of diencephalic and hypothalamic area and underlying trunk educations in close proximity to the spaces containing cerebrospinal liquid — to cerebral cavities and basal tanks, in to-rykh sudden short-term sharp differences of hydrostatic pressure with movements of cerebrospinal liquid can cause disturbances of a functional condition of trunk structures.

In a complex patofiziol. the processes developing at This year m, also vegeto-vascular and endocrine frustration owing to changes of a functional condition of dien-tsefalno-hypothalamic educations and underlying trunk structures are of great importance.

Pathological anatomy

Morphological changes of a brain at concussion are shown by diffusion dystrophic disturbances in neurons of a brain in the form of the central chromatolysis, changes of intracellular fibrilla, axial cylinders, synapses. Usually these disturbances are combined with distsirkulya-even disturbances in a brain — a spasm and vasodilatation, small scattered diapedetic hemorrhages (see). The melkoochagovy parenchymatous hemorrhages described at so-called heavy concussion with micronecroses, small hemorrhages in walls of the fourth ventricle and a water supply system of a brain (Dyure's hemorrhage), to-rykh connect education with hydrodynamic mechanisms, shall be carried to morfol. to symptoms of a bruise of a brain.

At This year m note short-term general wet brain (see. Swelled also swelling of a brain ).

The clinical picture

One of the most characteristic symptoms of m is This year loss of consciousness (see). It can be instant, proceed several seconds or minutes. The loss of consciousness lasting St. 30 min. should be considered as a symptom of more severe injury, to-ruyu qualify as a bruise of a brain. In nek-ry cases patients note short-term stupefaction with incomplete orientation in surrounding. Seldom This year the m is not followed by a loss of consciousness. In these cases This year m make the diagnosis on the basis of the symptom complex including headache (see), nausea (see), vomiting (see), dizziness (see), spontaneous nystagmus (see), vegeto-vascular frustration, etc. Disturbance of memory on the events which were directly preceding an injury (retrograde amnesia), the moment of an injury and the following of an event behind it (ecmnesia) is characteristic of This year m. At most of patients amnesia (see) disappears in the first few days. The most constant symptom is the headache, edges the long time after an injury can remain. The nausea observed at most of patients usually stops during 1 — 2 days. Single or repeated vomiting is possible. Dizziness is observed almost at a half of patients. It arises right after an injury and usually disappears on 2 — the 3rd days.

The meningeal phenomena in the form of a small stiff neck and a Kernig's sign (see. Kerniga symptom ), revealed at a number of patients in the first days after an injury, quickly regress. Focal nev-rol. symptoms are expressed slightly and on the manifestations very of a labilna. At nek-ry patients note easy functional asymmetry of cranial nerves, a tendinous aiizorefleksiya (see. Reflex ).

Not rough, but clearly expressed symptoms from trunk structures of a brain are the most characteristic of This year m. In most cases they are presented by a spontaneous nystagmus, disturbances caloric and optokinetic nystagmus (see).

An important place in a wedge, manifestations This year m occupy vegetative disturbances: changes of the ABP, pulse, body temperature, etc. Unsharply expressed tachycardia, a tendency to arterial hypertension, subfebrile temperature in the first days after an injury are characteristic.

On EEG at electroencephalography (see) the alpha rhythm is kept, but its irregularity on amplitude and frequency comes to light; expressiveness of the beta fluctuations indicating the phenomena of irritation of a cerebral cortex is increased. Rheoencephalography (see) allows to reveal not rough decrease in a pulse krovenapolneniye of brain vessels at a normal vascular tone. At an ekhoentsefalografiya (see) lack of shift of the M-echo, but increase in amplitude of ekhopul-sation is noted that can serve as additional criterion of traumatization of a brain.

Pressure of cerebrospinal liquid determined with the help spinal puncture (see), at most of patients remains within norm, in 39% of cases happens raised willows of 4% of cases — lowered. Cerebrospinal liquid (see) transparent, colourless. Even small impurity of blood in it shall be regarded as the certificate of a bruise of a brain.

Treatment

At This year m rest with observance of a bed rest within 7 days is necessary. In the subsequent the expansion of the mode allowing movement within chamber, visit of the dining room, a toilet is possible. Patients with poorly expressed subjective symptomatology and lack of objective symptoms can use a semi-bed rest with 4 — the 5th day of stay in a hospital.

From medicines recommend sedatives — Phenazepamum, Rudotelum; in cases of concern, a sleep disorder — Tisercinum; at an alarming state — the azohair dryer, Pyrazidolum; nootropic means — Aminalonum, nootropil, piracetam; analgetics — analginum, pyramidon. From the first day appoint spasmolytic drugs — a papaverine with Dibazolum, Nospanum, and at increase in the ABP — antihypertensives — Reserpinum, Raunatinum, hypothiazid, etc. Easy neurovegetative blockade is shown by mix of Pipolphenum, Dimedrol and analginum (2 times a day or for the night during 4 — 6 days). At expressed a wedge, a picture intravenously enter 40% solution of glucose with polyneuramins and Page.

At povyshennokhm pressure of cerebrospinal liquid appoint dehydrating agents — furosemide in a dose of 0,04 g every other day or 2 times a week with salts of potassium (potassium chloride, Pananginum). At intracranial hypotension 2 — 3 times a day intravenously kapelno enter Ringer's solution or 5% of solution of glucose with hormones (50 mg of a hydrocortisone or 2 — 4 mg of Dexasonum), redoxons and Vkh.

Patients are written out on 10 — the 12th days, and in the absence of objective symptomatology — on 7 — the 8th days, in some cases at an asymptomatic current — on 4 — the 5th. To the subsequent 1 — 2 weeks carry out out-patient treatment.

The forecast

the Forecast at 80% of victims favorable; they remain almost healthy and do not show the complaints connected with the postponed concussion. At 20% of victims after an injury the aggravation of symptoms of health is observed: develops asthenic syndrome (see) with emotional lability, increased fatigue at physical and intellectual loadings, decrease in memory, a sleep disorder with sleeplessness and frequent dreams. A part of patients complains of bad portability of transport, bystry fatigue during the reading, viewing of telecasts and movies, bad portability of a heat. These patients sometimes need long observation of the neuropathologist and a sanatorium therapy.

See also Craniocereberal injury .



Bibliography: Grashchenkov N. I. Functional asinapsiya, Neuropath, and psi-hiat., t. 15, No. 1, page 53, 1946; JI e piece ev V. V., etc. Visual evoked potential as diagnostic criterion at a concussion of the brain, Owls. medical, No. 9, page 8, 1978; Maggi-dov N. M., etc. Concussion of the brain of easy degree, Tashkent, 1980: Marchenko JI. And. and Marchenko N. A. Some disturbances of vestibular functions in the remote period after a concussion of the brain, Zhurn. ushn., nose. and throats, Bol., No. 3, page 93, 1976; The Guide to neurotraumatology, under the editorship of A. I. Arutyunov, p.1, M., 1978; Harkevich N. G. Neuroendocrinal disturbances at patients with a concussion of the brain, Owls. medical, No. 10, page 83, 1980; De Coster J. Le syndrome postcommo-tionnel, Acta oto-rhino-laryng. belg., t. 28, p. 761, 1974; Guthkelch A. N. Post-traumatic amnesia, post-concussional symptoms and accident neurosis, Europ. Neurol. (Basel), v. 19, p. 91, 1980; About m-m and at an A. K. a. G e n n a r e 1 1 i T. A. Cerebral concussion and traumatic unconsciousness, correlation of experimental and clinical observations of blunt head injuries, Brain, v. 97, p. 633, 1974; V i about 1 about n A. La nation de syndrome postcommotionnel, Acta psychiat. belg., v. 77, p. 468, 1977.


H. Ya. Vasinonim

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