brain contusion

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brain contusion

Brain contusion – TBI, characterized by focal macrostructural damage to the medulla of varying severity. It is diagnosed in cases where cerebral symptoms complement the signs of focal brain damage.

Pathomorphology

    • Changes in the focus of injury
    • Destruction (crushing) of the brain substance
    • Small-point hemorrhages (due to rupture of blood vessels under the influence of a mechanical factor) in the brain parenchyma
    • Perifocal cerebral edema
    • Traumatic subarachnoid hemorrhage as a result of ruptured vessels of the pia mater
    • Skull fractures
    • Fractures of the bones of the cranial vault without compression (linear and comminuted)
    • Fractures of the base of the skull (with rupture of the membranes) – CSF leakage through the nose (rhinorrhea) or external auditory canal (otorrhea)
    • Depressed fractures – compression of the brain
    • Fractures of the bones of the cranial vault – the formation of intracranial hematomas, compression of the brain.

Clinical picture

    • Mild brain injury
    • Loss of consciousness (minutes to hours)
    • After regaining consciousness, complaints of headache, dizziness, nausea, vomiting (sometimes repeated)
    • Retro-, con- and anterograde amnesia
    • Vital functions are not impaired
    • Neurological symptoms are mild, regress after 2-3 weeks after injury: clonic nystagmus, mild anisocoria, signs of pyramidal insufficiency (the mildest degree of dysfunction of the pyramidal tract without muscle weakness is anisoreflexia, pathological reflexes), meningeal symptoms
    • Possible fractures of the bones of the cranial vault and subarachnoid hemorrhage.
    • Moderate brain injury
    • Loss of consciousness lasting from several tens of minutes to several hours
    • Intracranial hypertension: severe headache, repeated vomiting
    • Mental disorders – psychomotor agitation, decreased critical abilities
    • Transient disorders of vital functions (bradycardia or tachycardia, increased blood pressure, tachypnea)
    • Severe meningeal syndrome
    • Amnesia for a significant amount of time
    • Severe focal symptoms of dysfunction of the cerebral hemispheres (paresis, paralysis, aphasia, etc.)
    • Linear fractures of the bones of the vault and base of the skull, subarachnoid hemorrhages.
    • Severe brain injury
    • Loss of consciousness lasting from several hours to several weeks
    • Stem neurological symptoms dominate (disorders of the functions of the respiratory and vasomotor centers)
    • Focal symptoms regress slowly, gross residual effects are frequent
    • Characterized by linear fractures of the bones of the vault and base of the skull, as well as massive subarachnoid hemorrhage.

Diagnostics

    • Lumbar puncture – erythrocytes in CSF
    • The final diagnosis is made according to the results of X-ray of the skull in frontal and lateral projections (presence of bone damage), CT and MRI.

Treatment:

Conservative treatment is the main method

    • Mandatory hospitalization, bed rest
    • Diet. In the unconscious state – parenteral nutrition, in the semi-conscious state – diet number 0
    • Maintenance of vital functions, if necessary – resuscitation
    • Therapy for cerebral edema – see Cerebral edema
    • Analgesics as needed
    • For seizures, anticonvulsants (carbamazepine)
    • With motor restlessness – chlorpromazine (chlorpromazine) 50 mg / m, haloperidol 2-5 mg / m
    • For open TBI, broad-spectrum antibiotics
    • Means that improve cerebral circulation and metabolism, nootropics (dimephosphone, sermion, nicergoline, piracetam, reopoliglyukin, pentoxifylline, aminalon, encephabol, cerebrolysin)
    • Protease inhibitors (gordox, contrykal, trasilol).

Surgical treatment is indicated for brain contusion with crushing of its tissue (most often occurs in the region of the poles of the frontal and temporal lobes). The essence of the operation: osteoplastic trepanation and washing out of cerebral detritus with a jet of 0.9% NaCl solution, stopping bleeding.

Synonym. brain contusion

See also Fractures of the bones of the cranial vault without compression of the brain, Fractures of the base of the skull, Fractures of the skull depressed, Traumatic brain injury, Compression of the brain ICD

    • S06 Intracranial injury
    • S06.2 Diffuse brain injury
    • S06.3 Focal brain injury