Contusion of the brain: symptoms, treatment

A bruise of the brain is a more severe brain damage, accompanied by macroscopic morphological changes in the brain substance. The brain contusion, depending on the nature and severity of the trauma, can be quite diverse - from comparatively unstable individual, to expressed multiple, affecting vital structures. Morphologically, depending on the nature of the injury, the changes and the area of the injury can vary from point hemorrhages and small areas of crushing to the formation of large foci of cerebral detritus, rupture of vessels, hemorrhages into the destroyed tissue, pronounced swelling-swelling phenomena, sometimes spreading to the entire brain. More often the bruise of the brain is formed in the zone of application of force, and also the defeats with diametrically opposite side impact (the mechanism of a counter-attack) are possible.

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

Symptoms of a brain injury

Clinically, a brain contusion of mild, moderate and severe degree is isolated. Neurological symptoms that have a brain contusion are polymorphic enough. The main clinical symptoms of cerebral contusion are cerebral symptoms (as a rule, there is a fairly long loss of consciousness), persistent focal symptoms (depending on the site of the lesion) and meningeal symptoms (and the result of violation of the integrity of convective vessels with the phenomena of subarachnoid hemorrhage).

The bruise of the mild brain is characterized by such symptoms as loss of consciousness (from several to tens of minutes), persistent headache, dizziness, weakness, noise and ears. Quite often observed amnesia, severe nausea, often repeated vomiting. Violations of vital functions do not occur, sometimes a mild tachycardia or, more rarely, a bradycardia, a flush of blood to the face, sleep disturbances and other vegetative phenomena. Neurological symptoms of a mild brain contusion are usually "mild" (nystagmus, mild anisocoria, signs of pyramidal insufficiency, mild meningeal symptoms, etc.). Usually neurologic symptoms completely regress after 2-3 weeks.

A bruised brain of moderate severity is accompanied by loss of consciousness from several tens of minutes to several hours. Almost always there is amnesia, the headache is intense and prolonged, there is a multiple vomiting, mental disorders are possible. This form of lesion is characterized by transient disturbances of vital functions (brady, tachycardia, increased arterial pressure, tachypnosis without disturbing the rhythm of breathing, subfebrile, sometimes stem symptoms may appear). Meningeal symptoms are well pronounced, there is a clear focal symptomatology, which is determined by the localization of the injury (oculomotor disorders, paresis of limbs, sensitivity disorders, etc.).

The brain contusion consequences of which gradually regress (but often not completely) within 2-5 weeks, are called middle-severe.

A severe brain contusion is manifested by loss of consciousness from several hours to several weeks, psychomotor agitation, severe neurological symptoms that are often life-threatening, and stem symptoms dominate. Meningeal symptoms are pronounced, often there are generalized or focal epi-seizures.

The bruise of the brain whose consequences regress slowly and not completely, leaving gross residual effects, primarily from the motor and mental sphere, is called heavy.

How is the contusion of the brain determined?

The bruise of the brain is diagnosed, especially during the initial examination, very difficult. When craniography is often found fractures of the skull bones, foreign objects, which (regardless of the clinical picture) indicates a bruise of the brain. With echoencephalography, a large number of high-amplitude additional echoes can appear, and the expressed foci of a bruise of one hemisphere of the brain with significant edema can give an M-Echo displacement of 3-4 mm. A bruise of the brain is determined using computer and magnetic resonance imaging. Lumbar puncture makes it possible to detect the presence of blood in the cerebrospinal fluid, which, like the fracture of the bones of the skull, is an unconditional sign of brain contusion. Sometimes the main diagnosis, especially regarding the extent and extent of the lesion, can be made only at the time of discharge from the hospital, since it is often possible to diagnose the degree of brain contusion only due to clinical observation of the patient and additional survey methods.

Treatment of a brain injury

Treatment of a brain contusion depends on its degree. The brain contusion of mild degree is treated mainly conservatively - it includes moderate dehydration therapy, antihistamines, as well as sedative, nootropic and vascular preparations, symptomatic treatment. With subarachnoid hemorrhage, haemostatic therapy, therapeutic and diagnostic lumbar punctures are performed. The brain contusion of moderate severity is treated according to intensive care algorithms. The treatment is dominated by infusion therapy with a positive fluid balance. Justify repeated lumbar punctures before the rehabilitation of liquor.

With depressed fractures, in almost all cases, if the fragments of the depressed fracture penetrate no less than the thickness of the bone, surgical intervention is indicated, even if the brain contusion has no neurologic symptoms.

Indications for surgical treatment of brain contusions:

• Expressed clinical signs of the dislocation of the brain.
• CT scan (MRI) is a lateral sign (displacement of median structures more than 5 mm) and axial (deformation of basal cisterns) of brain dislocations.
• Signs of growing drug-resistant intracranial hypertension (increased intracranial pressure by more than 20-25 mm Hg, plasma osmolality values below 280 mmol / l or above 320 mmol / l).

The brain contusion is treated with the help of palliative (ventriculopuncture with the installation of a prolonged external ventricular drainage, the installation of a long external subcultural drainage, liquor-shunting operations, decompressive trepanation of the skull) and radical (osteoplastic trepanation, aspiration and washing detrimental detritus) operations.

A severe brain contusion requires hospital treatment in the intensive care unit under the supervision of a neurosurgeon. The tactics of management of such patients is reduced to a differentiated approach to their treatment depending on the clinical course.