Brain contusion: symptoms, treatment

Brain contusion is a more severe brain injury accompanied by macroscopic morphological changes in the brain matter. Depending on the nature and severity of the injury, brain contusion can be quite varied - from relatively mild single ones to severe multiple ones affecting vital structures. Morphologically, depending on the nature of the injury, changes in the contusion area can vary from pinpoint hemorrhages and small areas of crushing to the formation of large foci of brain detritus, rupture of blood vessels, hemorrhages in the destroyed tissue, pronounced edema-swelling phenomena, sometimes spreading to the entire brain. Most often, brain contusion is formed in the area of application of force, and lesions are also possible on the side diametrically opposite to the blow (counter-blow mechanism).

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Symptoms of a Brain Contusion

Clinically, there are mild, moderate and severe degrees of brain contusion. Neurological symptoms associated with brain contusion are quite polymorphic. The main clinical symptoms of brain contusion are general cerebral symptoms (usually, there is a fairly long loss of consciousness), persistent focal symptoms (depending on the affected area) and meningeal symptoms (as a result of damage to the integrity of convexital vessels with subarachnoid hemorrhage).

Mild brain contusion is characterized by such symptoms as loss of consciousness (from several to tens of minutes), persistent headache, dizziness, weakness, noise in the ears. Amnesia, severe nausea, and often repeated vomiting are quite common. There is no impairment of vital functions, sometimes moderate tachycardia or, less commonly, bradycardia, flushes of blood to the face, sleep disturbances, and other vegetative phenomena may be observed. Neurological symptoms of mild brain contusion are usually “soft” (nystagmus, mild anisocoria, signs of pyramidal insufficiency, mild meningeal symptoms, etc.). Usually, neurological symptoms completely regress in 2-3 weeks.

A moderate brain contusion is accompanied by loss of consciousness from several tens of minutes to several hours. Amnesia is almost always observed, headache is intense and long-lasting, repeated vomiting appears, mental disorders are possible. This form of injury is characterized by transient disturbances of vital functions (brady-, tachycardia, increased blood pressure, tachypnosis without disturbance of respiratory rhythm, subfebrile condition, sometimes stem symptoms may occur). Meningeal symptoms are well expressed, there is a clear focal symptomatology, which is determined by the localization of the contusion (oculomotor disorders, paresis of the limbs, sensitivity disorders, etc.)

A brain contusion, the consequences of which gradually regress (but often not completely) within 2-5 weeks, is called moderate.

Severe brain contusion is manifested by loss of consciousness from several hours to several weeks, psychomotor agitation, severe, often life-threatening neurological symptoms, with stem symptoms dominating. Meningeal symptoms are pronounced, generalized or focal epileptic seizures often occur.

A brain contusion, the consequences of which regress slowly and incompletely, leaving behind gross residual effects, primarily in the motor and mental spheres, is called severe.

How is a brain contusion diagnosed?

Brain contusion is diagnosed, especially during the initial examination, with great difficulty. Craniography often reveals skull fractures and foreign objects, which (regardless of the clinical picture) indicate a brain contusion. Echoencephalography may reveal a large number of high-amplitude additional echo signals, and pronounced foci of contusion of one hemisphere of the brain with significant edema may result in an M-Echo shift of up to 3-4 mm. Brain contusion is determined using computed tomography and magnetic resonance imaging. Lumbar puncture makes it possible to detect the presence of blood in the cerebrospinal fluid, which, like a skull fracture, is an unconditional sign of brain contusion. Sometimes the main diagnosis, especially regarding the volume and degree of damage, can only be made at the time of discharge of the patient from the hospital, since it is often possible to diagnose the degree of brain contusion only through clinical observation of the patient and data from additional examination methods.

Treatment of brain contusion

Treatment of brain contusion depends on its degree. Mild brain contusion is treated mainly conservatively - includes moderate dehydration therapy, antihistamines, as well as sedatives, nootropic and vascular drugs, symptomatic treatment. In case of subarachnoid hemorrhage, hemostatic therapy, therapeutic and diagnostic lumbar punctures are performed. Moderate brain contusion is treated according to intensive care algorithms. Infusion therapy with a positive fluid balance predominates in treatment. Repeated lumbar punctures until cerebrospinal fluid sanitation are justified.

In case of depressed fractures, in almost all cases, if the fragments of the depressed fracture penetrate at least the thickness of the bone, surgical intervention is indicated, even if the brain contusion does not have neurological symptoms.

Indications for surgical treatment of brain contusions:

• Pronounced clinical signs of brain dislocation.
• CT (MRI) - signs of lateral (displacement of midline structures more than 5 mm) and axial (deformation of basal cisterns) dislocations of the brain.
• Signs of growing drug-resistant intracranial hypertension (increase in intracranial pressure by more than 20-25 mm Hg, blood plasma osmolarity below 280 mmol/l or above 320 mmol/l).

Brain contusion is treated with palliative (ventriculopuncture with installation of long-term external ventricular drainage, installation of long-term external lube drainage, cerebrospinal fluid shunting operations, decompressive craniotomy) and radical (osteoplasty trepanation, aspiration and washing of brain detritus) operations.

Severe brain contusion requires inpatient treatment in the intensive care unit under the supervision of a neurosurgeon. The tactics of managing such patients comes down to a differentiated approach to their treatment depending on the clinical course.