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Diagnosis of craniocerebral trauma
Last reviewed: 23.04.2024
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First, you need to evaluate the damage in general; Diagnosis and treatment of severe patients are carried out simultaneously.
A quick and focused neurological examination is part of the assessment of the general condition. It should include an assessment of the level of consciousness according to the ShCG, the state of the upper respiratory tract and respiration, assessment of oculomotor activity. Ideally, the examination should be carried out before the introduction of relaxants and opioid analgesics. The patient is examined repeatedly at short intervals (for example, every 15-30 minutes at the beginning, then every hour after stabilization). The subsequent improvement or deterioration helps to determine the severity of the injury and the prognosis. A full neurologic examination is performed immediately after the patient's condition is stabilized. Children are carefully examined for hemorrhages in the retina, which may indicate a "baby shaking" syndrome. Investigation of the fundus in cases of craniocerebral trauma in adults is diagnostically insensitive and difficult to perform.
The diagnosis of concussion is established clinically, but radiodiagnosis can help in detecting more significant brain damage and identifying hematomas. Radiation diagnosis is mandatory for all patients with impaired consciousness, <15 SCG, focal neurological symptoms, recurrent vomiting, convulsions or clinical suspicion of fractures. However, many clinicians perform CT in all patients, even after minor head injuries, because the clinical and medical and legal consequences of undiagnosed hematoma are extremely severe.
CT is the best choice for primary radiation diagnosis. With the help of this method, it is possible to detect fractures of the skull (thin sections are made for the detection of clinically suspected fractures of the base of the skull, it is impossible to see these fractures with the help of other research methods), bruises, bruises and sometimes diffuse axonal lesions. Although standard radiography can detect some fractures of the skull, it does not provide an opportunity to assess changes in brain tissue and is rarely used. MRI can help later in the course of the disease to detect smaller bruises and diffuse axonal damage; MRI is usually more sensitive than CT to diagnose small acute, subacute and chronic subdural hematomas. Arteriography is used in some cases with suspected vascular damage or when CT data contradict the results of a clinical examination.
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