The prognosis and consequences of craniocerebral trauma

The consequences of craniocerebral trauma are memory disorders, both retrograde and antegrade amnesia are possible. Post-smoking syndrome, usually following a significant concussion, includes headache, dizziness, fatigue, difficulty concentrating, various amnesia options, depression, apathy and anxiety. Often observed violations or loss of smell (and, consequently, taste), sometimes hearing, less often sight. Symptoms usually disappear spontaneously within weeks or months.

A number of cognitive and neuropsychic problems can persist after severe and even moderate craniocerebral trauma, especially after significant structural damage. Typical consequences of craniocerebral trauma include amnesia, behavioral disorders (eg, excitability, impulsivity, disinhibition, unmotivated), emotional lability, sleep disturbances and decreased intellectual abilities.

Late epileptic seizures (more than 7 days after trauma) develop in a small percentage of cases, often in weeks, months and even years. Spastic motor disorders, gait disorder and balance-keeping problems, ataxia and loss of sensation may also occur.

A persistent vegetative state can develop after a traumatic brain injury with a violation of the cognitive function of the forebrain, but with the remaining trunk of the brain. The ability to self-induced mental activity is absent; However, autonomic and motor reflexes and the normal cycle of sleep and wakefulness are preserved. Some patients can restore the normal functioning of the nervous system if the persistent vegetative state lasts for 3 months after the trauma, and practically no one has 6 months.

Neurologic function is gradually improved over a period of 2 to several years after a traumatic brain injury, especially intensively in the first 6 months.

Forecast of craniocerebral trauma

In the United States, the mortality rate of adults with severe craniocerebral trauma is about 25 to 33%, and decreases with an increase in the Glasgow score. Mortality is lower in children older than 5 years (<10% with a score of SKG from 5 to 7). Children suffer comparative trauma better than adults.

In the vast majority of patients after a craniocerebral trauma of mild severity, the neurologic status is completely restored. After a craniocerebral injury of moderate severity and severe trauma, the prognosis is not as good, but much better than is commonly assumed. For prognostic evaluation, the scale of outcomes of Glasgow is widely used. According to this scale, the following outcomes are possible:

• good recovery (defined as the absence of new neurological deficits);
• average disability (defined as a new neurological deficit in patients who can service themselves);
• severe disability (defined as patients' inability to serve themselves);
• vegetative state (defined as the absence of cognitive function in patients);
• death.

Over 50% of adult patients with severe head injury recover well or to a level of average disability. In adults, after severe craniocerebral injuries, recovery occurs most rapidly in the first 6 months, small improvements are possible within a few years. In children, recovery immediately after traumatic brain injury proceeds better regardless of the severity of the trauma and lasts a longer period of time.

Cognitive deficits, with a lack of attention and memory, as well as various personality changes, are seen more as causes of social adjustment disorders and problems with employment than specific motor and sensitive disorders. Post-traumatic anosmia and acute traumatic blindness rarely disappears after 3-4 months. Manifestations of hemiparesis and aphasia usually weaken in all patients, except for the elderly.

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