Symptoms of traumatic brain injury

Initially, most patients with craniocerebral trauma lose consciousness (usually within seconds or minutes), although with minor trauma, some can only have stunning or amnesia (amnesia is usually retrograde and lasts from seconds to several hours). In young children, excitability may simply increase. Some patients may have seizures, often during the first hour or day. After these initial symptoms, some patients may be in clear consciousness and reason; in others, the level of consciousness can range from mild confusion to stupor or coma. The duration of loss of consciousness and the severity of stunning is directly proportional to the severity of the damage, but not specific. The Glasgow coma (SHKG) scale is a fast and reproducible point scale used for initial examination to determine the severity of the head injury. The SCG is based on the level of consciousness (reflected in the ability to open eyes) and the level of motor and speech reactions. 3 points indicate potentially fatal damage, especially if both pupils do not respond to light, and there is no oculo- vestibular reaction. The higher the score at the initial examination, the higher the probability of complete recovery. It is generally accepted to determine the severity of craniocerebral trauma on the basis of the cardiovascular system (scores from 14 to 15 - craniocerebral trauma of light degree, 9-13-average, scores from 3 to 8 - severe craniocerebral injury, but the severity and the forecast can be more accurately determined , if you take into account the data of CG and other factors.The condition of some patients with primary signs of craniocerebral trauma of medium degree, and in some cases with mild ones, may worsen.For infants and small children, the modified scale of coma Glasgow for newborns and small nkih children.

Scale Coma Glasgow *

Estimated parameter	Reaction	Points
Opening the eyes	Spontaneously	4
	To vote	3
	On a pain stimulus provided in the region of the extremities or sternum	2
	No reaction	1
Speech Reaction	Oriented, answers questions	5
	Disoriented, the questions answered in a confused way	4
	Unrelated set of words	3
	Inarticulate sounds	2
	No reaction	1
The motor reaction	Executes commands	6th
	Appropriate movement to pain	5
	Twitching of the limb in response to pain (withdrawal, bending)	4
	Flexion of the limb (decortication pose)	3
	Extension of the limb (decerebrate pose)	2
	No reaction	1

* A total of <8 points usually corresponds to a coma.

Modified scale of coma Glasgow for newborns and small degies

Estimated parameter	Newborns	Small children	Points *
Opening Eye	Spontaneously	Spontaneously	4
	To vote	To vote	3
	Only on a pain stimulus	Only on a pain stimulus	2
	No reaction	No reaction	1
Speech Reaction	Gulit, babbling	Oriented, answers questions
	Easy crying	Confused speech	4
	Crying in response to pain	Unrelated set of words	3
	Groans in response to pain	Inarticulate sounds	2
	No reaction	No reaction	1
The motor reaction **	Spontaneous and purposeful movements	Executes commands	6th
	Leaving in response to a touch	Localization of pain stimulus
	The withdrawal in response to	The withdrawal in response to	4
	Response to pain in the form of decorticative posture (pathological flexion)	Response to pain by flexion	3
	Response to pain in the form of a de-reticular posture (pathological extension)	Response to pain by extension	2
	No reaction	No reaction	1

"A total of 12 points corresponds to a severe head injury, with intubation and artificial ventilation for a total of <8. A total of 6 points shows monitoring of intra-arterial pressure.

** If the patient is intubated, unconscious, still does not know how to speak, then the most important part of this scale is the motor reaction, it is necessary to carefully evaluate this section.

Symptoms of epidural hematoma usually develop from a few minutes to several hours after trauma and include an increasing headache, decreased level of consciousness, hemiparesis, dilated pupils with loss of their response to light. Some patients lose consciousness, with the subsequent development of the so-called light intermittent period, after which the neurological symptoms progress.

A noticeable increase in intracranial pressure classically manifests a combination of arterial hypertension, bradycardia and respiratory depression (Cushing's triad). Vomiting is possible, but this symptom is nonspecific. Severe diffuse brain damage or a significant increase in intra-arterial pressure can lead to decortication and decortication rigidity. Both signs make the forecast unfavorable.

Inflammation of the cerebellum can lead to coma, one- or two-sided dilatation of the pupils and / or lack of pupillary response to light, hemiplegia (usually on the side opposite to the dilated pupil), arterial hypertension, bradycardia and respiratory depression (superficial and irregular).

Fractures of the base of the skull can cause the expiration of CSF from the nose (rhinorrhea) and the ears (otorrhoea), blood in the tympanum (gemotimpanum) or in the internal auditory canal, if the eardrum is ruptured, ecchymosis in the behind-eye area (Battle's symptom) or periorbital ecchymosis ("eyes raccoon "). The loss of smell, sight, hearing, or impaired facial nerve function sometimes occurs immediately, sometimes after a while. Other fractures of the skull can sometimes be palpated, especially through a soft tissue injury, in the form of an indentation or gradual deformation. It should be remembered that step deformation can mimic blood under the aponeurosis.

Patients with chronic subdural hematomas may complain of headaches that intensify during the day, pathological (fluctuating) drowsiness or "headache" (which may mimic an early dementia) and hemiparesis of mild or moderate severity.