Cerebral compression is a progressive pathological process in the cranial cavity that causes compression of the brain resulting from trauma. With any morphological substrate (epidural, subdural or intracerebral hematoma, brain crush site, hydroma), compensatory mechanisms can be depleted, which leads to compression, dislocation, herniation of the brain stem and the development of a life-threatening condition. Depressed fractures of the cranial vault are the root cause of local brain compression. Causes (morphological substrate causing compression)
- intracranial hematoma
- Epidural (in 20% of cases)
- Subdural (70-80%)
- Depressed fracture of the bones of the cranial vault (see Depressed fractures of the skull)
- Subdural hydroma (limited accumulation of CSF, occurs when the arachnoid membrane is torn, the flow of cerebrospinal fluid into the subdural space through the valve mechanism)
- Pneumocephalus (accumulation of air in the cranial cavity) – extremely rare
- Center of crushing of the brain, perifocal edema (see Cerebral edema).
- Primary damage leads to a temporary loss of consciousness followed by a light interval (lasting several minutes or hours) – the patient’s condition is satisfactory
- Signs of herniation (dislocation syndrome): increased severity of the cerebral syndrome, the appearance or increase of focal hemispheric and stem symptoms, depression of consciousness
- Contralateral hemiplegia (on the side opposite the compression site), mydriasis, lack of response to light, irregular breathing, coma
- The Cushing reflex is not often observed: an increase in blood pressure with a decrease in heart rate and respiration (to improve brain perfusion with increased ICP).
- CT and MRI
- Diagnostic trepanation. If it is improbable to perform CT or MRI, an increase in the clinical picture of brain compression, a displacement of the median structures of the brain, diagnostic burr holes are applied. differential diagnosis. The period of the light gap will need to be differentiated from concussion.
- The main method is surgical
- Management tactics and conservative therapy – see Traumatic brain injury
- emergency operation
- Osteoplastic or resection trepanation
- Decompression (removal of blood, clots, depressed bone fragments) – elimination of the cause of brain compression
- Stop bleeding (risk of re-hematoma formation)
- Evacuation of intracranial hematomas should be performed within the first 4 hours after injury.
- Purulent: brain abscess, subdural empyema, meningitis
- Re-formation of a hematoma
- Post-traumatic epilepsy.