Brain pressure: symptoms, treatment

Brain compression is the most severe and most dangerous type of craniocerebral trauma, it is noted in 3-5% of victims with CCT. It is characterized by rapid growth after any time after trauma or immediately after it of cerebral and focal symptoms. First of all, violations of the functions of the stem departments, and represents an immediate threat to the life of the patient.

[1], [2], [3], [4], [5]

Causes Brain pressure: symptoms, treatment

What causes compression of the brain?

The main causes of cerebral compression are: the formation of intracranial hematomas, subdural hydra, piedmocephaly, depressed fractures of the bones of the cranial vault, foreign bodies and aggressive swelling-swelling of the brain, which develops mainly as a result of contusion of the brain tissue.

Symptoms Brain pressure: symptoms, treatment

Symptoms of compression of the brain

In the clinical picture of cerebral compression (primarily hematomas), the main pathognomonic symptoms are the presence of a light period (the period of imaginary well-being), anisocoria with mydriasis on the side of compression, bradycardia, hemiparesis or hemiplegia on the side opposite to compression.

Quite often, patients with cerebral compression (especially with depressed fractures and chronic hematomas) develop an episyndrom.

One of the main causes of cerebral compression in cases of head injury is the formation of intracranial hematomas, which, according to the classification, are:

• epidural (accumulation of blood between the inner surface of the bones of the skull and the dura mater more often within the same bone);
• subdural (accumulation of blood between the inner surface of the dura mater and the outer surface of the arachnoid shell, limited by the processes of the dura mater);
• intracerebral (accumulation of blood in the brain tissue);
• intragastric (accumulation of blood in the ventricles of the brain).

In addition to the formation of hematomas, bleeding may occur under the arachnoid membrane (subarachnoid hemorrhage), which often accompanies the bruise of the brain and does not lead to compression of the brain.

Depending on the period of formation of the hematoma may be: acute - up to 3 days; under acute - up to 2 weeks; chronic - more than 2 weeks. The timing of the onset of symptoms of compression of the brain with intracranial hematomas mainly depends on their location and source of bleeding. Hematomas can be multiple or bilateral. Sometimes there are variants of "floor" intracranial hematomas (episubdural, ziduralno-podnekostnichnye, etc.).

Symptoms of intracranial hematoma

In general, the symptoms of intracranial hematomas largely depend on the source of bleeding, the localization and size of the hemorrhage, the rate of development of compression of the brain, as well as the severity of concomitant damage to the skull and brain, the age of the patient and his individual characteristics (concomitant diseases, previously transmitted diseases, injuries and other).

Epidural hematomas

The source of bleeding with epidural hematomas is usually the trunk or branches of the middle shell artery, less often - the veins of the dura mater, dural sinuses and diploids. These hematomas occur usually at the site of the traumatic factor, sometimes quite insignificant. In this regard, many patients do not lose consciousness at all or notice a relatively short loss of consciousness (usually less than an hour in approximately 40% of cases). The light interval is often short. Chronic epidural hematomas are extremely rare. The diagnosis is based on CT or MRI, while the hematoma resembles a biconvex lens. Quite often in the place of formation of the hematoma there are fractures of the bones of the skull (mainly fractures of the temporal bone).

[6], [7], [8], [9], [10], [11]

Subdural hematomas

The source of bleeding in the formation of subdural hematomas is a vein damaged by head trauma, which enter the sinuses of the brain, damaged superficial vessels of the brain hemisphere, venous sinuses. This type of hematoma is the most common (more than half of the total number of intracranial hematomas). Unlike epidural hematomas, subdural can also form on the opposite side, and in 10-15% of cases - they are bilateral.

Symptoms of subdural hematomas are characterized by a long light interval, subacute and chronic variants of the flow are often found, focal symptomatology is less pronounced than with epidural haematomas, and more diffuse. When performing CT or MRI, the hematoma usually has the form of a convex-concave lens.

Intracerebral hematomas, as a rule, accompany a severe bruise to the brain, but sometimes arise even with brain contusions with minimal neurologic symptoms. The source of their formation is the veins and arteries of the brain. Intracerebral hematomas are much less common than other intracranial hematomas, they are often small in size. The clinical picture of intracerebral hematomas is characterized by the development of cerebral, focal and stem symptoms in the early periods after trauma, subacute flow is less common. The final diagnosis is based on CT or MRI.

Intraventricular bruises

Intragastric hematomas, as a rule, accompany intracerebral hematomas, they are isolated rarely. The source of bleeding is damage to the vascular plexus of the ventricles or breakthrough of the intracerebral hematoma into the cavity of the ventricle. Neurological symptoms develop rapidly, immediately after trauma, characterized by a short period of psychomotor agitation, an acute developing deep violation of consciousness with the appearance of hormoneotomy and decerebral rigidity. Rapidly growing pronounced vegetative disorders (hyperthermia, deep breathing disorder, arterial hypertension, which is replaced by hypotension). With worsening of the condition, seizures disappear and muscle hypotension appears, tendon tendons decrease and pathological reflexes disappear. The prognosis for intra ventricular hematomas is extremely unfavorable.

Subdural hydroma

Subdural hydroma is a local accumulation of liquor and subdural space (between the solid and arachnoid shells of the brain), formed as a result of tearing of the arachnoid shell with the formation of a valve that passes the liquor only in one direction. The clinical picture resembles a subacute or chronic subdural hematoma, and the final diagnosis can be left only using additional methods of investigation, and sometimes - intraoperatively.

Pneumotsephalus

Pneutmocephaly is the penetration of air into the cavity of the skull. It often occurs with fractures of the base of the skull with damage to the airways and rupture of the dura mater. Injection of air into the cavity of the skull is facilitated by the valve mechanism formed by the mucosa of the paranasal sinuses or the dura mater, Often pneumocephaly is accompanied by liquorrhea. In case of unexpressed pneumoniacephaly, which does not cause compression of the brain, the victims may experience headache, a gurgling sensation and a liquid transfusion in the head. The diagnosis is clarified craniographically, as well as when performing CT or MRI. With a well-formed valve mechanism, air can flow in large volumes and cause a squeezed and dislocation of the brain.

Impaired fracture of the brain

The depressed fracture often occurs in isolation, sometimes accompanied by comminuted fractures, in which damage to the dura mater and brain tissues is often observed. Clinically, symptoms of focal lesions are observed with marked compression of the brain. As a result of stimulation of the cerebral cortex with bone fragments, epileptic seizures may occur. Diagnostic difficulties in determining the depressed fracture, especially with gross impressions, but arises. It can be defined palpably, and sometimes further visually. For the final diagnosis it is necessary, as with other types of craniocerebral trauma, to use additional methods of examination - craniography (in two projections), CT, MRI.

Treatment Brain pressure: symptoms, treatment

Treatment of intracranial hematomas and compression of the brain

The compression and dislocation of the brain are indications for urgent surgical intervention - osteo-plastic or resection of the skull and removal of the pathological volumetric process that squeezes the brain.

Indications for surgical removal of intracranial hematomas

• Clinical signs of compression of the brain for at least one of the criteria: focal, cerebral or dislocation symptoms.
• Volume epidural or intracerebral hematoma (according to CT, MRI) more than 50 ml for supratentorial and more than 20 ml - for subtentorial.
• The thickness of the epidural hematoma is more than 1.5 cm irrespective of the clinical phase, including asymptomatic flow.
• Repeated violation or deterioration of consciousness in the presence of a light gap.
• The presence of at least one sign of CT (MRI): lateral displacement of the median structures more than 5 mm, deformation of the basal cisterns, coarse compression and e of the homolateral lateral ventricle with dislocation contralateral hydrocephalus irrespective of the size and localization of the hematoma.
• Hematomas of the posterior cranial fossa of small volume (<20 ml), if they lead to occlusive hydrocephalus.

When removing acute hematomas surgical tactics consists of the following activities: carrying out trepanation of the skull, removing the hematoma, stopping bleeding. If the location and size of the hematoma are determined by CT or MRI prior to surgery, osteoplastic trephination is preferable. In the absence of such data, it is advisable to perform a linear cut of the skin and perform resection trepanation.

In subacute and chronic hematomas, as well as subdural hydromas, the most appropriate surgical intervention is the removal of these formations by applying milling holes. Recently, one of the alternative methods of surgical treatment of some intracranial hematomas is endoscopic removal.

Methods for stopping bleeding depend on the nature of the bleeding and the type of damaged vessel: meningeal and cerebral vessels often coagulate, the sinus defect is closed by pressing the hemostatic sponge, suturing, plasticizing, and, in some cases, dressing over, with bleeding from the diploid veins, the edges of the bone fragments surgical wax.