Brain concussion
The content of the article:
- Causes and risk factors
- Forms of the disease
- Stages
- Concussion symptoms
- Features of concussion in children
- Diagnostics
- Concussion treatment
- Possible complications and consequences of a concussion
- Forecast
Concussion (Latin commocio cerebri) is a closed craniocerebral injury (TBI) of mild degree, which does not entail significant deviations in the functioning of the brain and is accompanied by transient symptoms.
In the structure of neurotrauma, concussion accounts for 70 to 90% of all cases. Establishing a diagnosis is quite problematic, there are frequent cases of both hyper- and underdiagnostics.
Concussion is a mild form of brain damage
Concussion underdiagnosis is usually associated with hospitalization of patients in pediatric hospitals, surgical departments, intensive care units, etc., when the staff cannot with a high degree of probability verify the disease from the area of neurotrauma. In addition, it should be borne in mind that about a third of patients are injured, being under the influence of excessive doses of alcohol, without adequately assessing the severity of their condition and without seeking specialized medical care. The diagnostic error rate in this case can reach 50%.
Overdiagnosis of concussion is mainly due to aggravation and an attempt to simulate a morbid state due to the lack of unambiguous objective diagnostic criteria.
The defeat of brain tissue in this pathology is diffuse, widespread. There are no macrostructural changes during concussion, the integrity of the tissues is not disturbed. There is a temporary deterioration in interneuronal interaction due to changes in functioning at the cellular and molecular levels.
Causes and risk factors
Concussion as a pathological condition is the result of intense mechanical stress:
- direct (shock head injury);
- mediated (inertial or acceleration injury).
As a result of the traumatic effect, the brain mass is sharply displaced relative to the cranial cavity and the body axis, damage to the synaptic apparatus and redistribution of tissue fluid occurs, which is the morphological substrate of a characteristic clinical picture.
The most common causes of concussion are:
- road traffic accidents (direct blow to the head or sudden inertial change in the position of the head and neck);
- household injuries;
- work injuries;
- sports injuries;
- criminal cases.
Most often, a concussion is the result of head injuries and blows
Forms of the disease
Concussion is traditionally considered the mildest form of TBI and is not classified according to severity. The disease is also not subdivided into forms and types.
The three-degree classification, which was widely used in the past, is currently not used because, in accordance with the proposed criteria, a contusion of the brain was often misdiagnosed as a concussion.
Stages
During the course of the disease, it is customary to distinguish 3 basic stages (periods):
- The acute period, lasting from the moment of traumatic influence with the development of characteristic symptoms until the patient's condition stabilizes, in adults, on average, from 1 to 2 weeks.
- Intermediate - the time from the stabilization of the disturbed functions of the body in general and of the brain in particular, to their compensation or normalization, its duration is usually 1-2 months.
- A distant (residual) period in which the patient recovers or the emergence or progression of newly arisen neurological diseases caused by the previous trauma (lasts 1.5-2.5 years, although in the case of progressive formation of characteristic symptoms, its duration may be unlimited).
In the acute period, the rate of metabolic processes (the so-called metabolic fire) in damaged tissues increases significantly, and autoimmune reactions are triggered in relation to neurons and companion cells. The intensification of metabolism soon enough leads to the formation of an energy deficit and the development of secondary disorders of cerebral functions.
The intermediate period is characterized by the restoration of homeostasis either in a stable mode, which is a prerequisite for complete clinical recovery, or due to excessive stress, which creates the likelihood of the formation of new pathological conditions.
The well-being of the long-term period is purely individual and is determined by the reserve capabilities of the central nervous system, the presence of pre-traumatic neurological pathology, immunological features, the presence of concomitant diseases and other factors.
Concussion symptoms
Signs of a concussion are represented by a combination of cerebral symptoms, focal neurological symptoms, and autonomic manifestations:
- disturbances of consciousness lasting from several seconds to several minutes, the severity of which varies widely;
- partial or complete loss of memories;
- complaints of diffuse headache, episodes of dizziness (associated with a headache or occurring in isolation), ringing, tinnitus, feeling of heat;
- nausea, vomiting;
- oculostatic phenomenon of Gurevich (violation of statics with certain movements of the eyeballs);
- dystonia of the vessels of the face ("game of vasomotors"), manifested by alternating pallor and hyperemia of the skin and visible mucous membranes;
- increased sweating of the palms, feet;
- neurological microsymptoms - mild, quickly passing asymmetry of the nasolabial folds, corners of the mouth, positive finger-nose test, slight narrowing or dilation of the pupils, palmar-chin reflex;
- nystagmus;
- unsteadiness of gait.
Common Brain Symptoms - Headache, Noise, and Ringing in the Tinnitus
Consciousness disorders have different severity - from stunning to stupor - and are manifested by the complete absence or difficulty of contact. The answers are often one-word, short, followed with pauses, some time after the question asked, sometimes a repetition of the question or additional stimulation (tactile, speech) is required, sometimes perseverations are noted (persistent, multiple repetition of a phrase or word). Mimicry is depleted, the victim is apathetic, lethargic (sometimes, on the contrary, excessive motor and speech excitement is noted), orientation in time and place is difficult or impossible. In some cases, the victims do not remember or deny the fact of loss of consciousness.
Partial or complete loss of memories (amnesia), which often accompanies a concussion, can vary in time of occurrence:
- retrograde - loss of memories of the circumstances and events that took place before the injury;
- kongradnaya - the period of time corresponding to the injury is lost;
- anterograde - there are no memories that occurred immediately after the injury.
Combined amnesia is often observed, when the patient cannot reproduce either the preceding concussion or the subsequent events.
Active symptoms of concussion (headache, nausea, dizziness, asymmetry of reflexes, pain when moving the eyeballs, sleep disturbances, etc.) in adult patients persist for up to 7 days.
Features of concussion in children
Signs of concussion in children are more indicative, the clinical picture is stormy and rapid.
The peculiarities of the course of the disease in this case are due to the pronounced compensatory capabilities of the central nervous system, the elasticity of the structural elements of the cranium, and incomplete calcification of the sutures.
Concussion in children of preschool and school age in half of the cases proceeds without loss of consciousness (or it recovers within a few seconds), vegetative symptoms prevail: discoloration of the skin, tachycardia, rapid breathing, pronounced red dermographism. Headache is often localized directly at the site of injury, nausea and vomiting occur immediately or within the first hour after injury. The acute period in children is shortened, lasts no more than 10 days, active complaints are stopped within a few days.
In children, a concussion is manifested by pain at the site of injury, nausea and vomiting.
In children of the first year of life, characteristic signs of mild traumatic brain injury are regurgitation or vomiting both during feeding and without connection with food intake, anxiety, disturbances in the sleep-wake regime, and crying when changing the position of the head are noted. Due to the slight differentiation of the central nervous system, an asymptomatic course is possible.
Diagnostics
Diagnosis of a concussion is difficult due to the lack of objective data, the absence of specific signs and is mainly based on the patient's complaints.
One of the main diagnostic criteria for the disease is symptom regression within 3–7 days.
In order to differentiate a possible brain injury, the following instrumental studies are carried out:
- X-ray of the skull bones (absence of fractures);
- electroencephalography (diffuse cerebral changes in bioelectrical activity);
- computed or magnetic resonance imaging (no changes in the density of the gray and white matter of the brain and the structure of CSF-containing intracranial spaces).
Lumbar puncture in case of suspected brain injury is contraindicated due to the lack of information and threat to the patient's health due to possible dislocation of the brain stem; the only indication for it is the suspicion of the development of post-traumatic meningitis.
Concussion treatment
Patients with a concussion of the brain are subject to hospitalization in a specialized department, mainly to clarify the diagnosis and follow-up (the hospitalization period is 1-14 days or more, depending on the severity of the condition). Patients with the following symptoms are most closely monitored:
- loss of consciousness for 10 minutes or longer;
- the patient denies loss of consciousness, but there is supporting evidence;
- focal neurological symptoms complicating TBI;
- convulsive syndrome;
- suspicion of violation of the integrity of the bones of the skull, signs of penetrating injury;
- persistent impairment of consciousness;
- suspicion of a fracture of the base of the skull.
The main condition for a favorable resolution of the disease is psycho-emotional peace: before recovery, it is not recommended to watch TV, listen to loud music (especially through headphones), or play video games.
An indispensable condition in the treatment of the brain is complete psycho-emotional rest
In most cases, no aggressive treatment of concussion is required, pharmacotherapy is symptomatic:
- analgesics;
- sedatives;
- sleeping pills;
- drugs that improve cerebral blood flow;
- nootropics;
- tonics.
Prescription of theophyllines, magnesium sulfate, diuretics, B vitamins is not justified, since these drugs do not have proven efficacy in the treatment of concussion.
While prescribing nootropics is the most common practice in rebuilding brain cells after a concussion. One of the most effective drugs, doctors consider Gliatilin. Gliatilin is an original nootropic drug of central action based on choline alfoscerate, which improves the condition of the central nervous system (CNS). Due to its phosphate form, it penetrates the brain faster and is better absorbed. Choline alfoscerate also has a neuroprotective effect and accelerates the recovery of brain cells after damage. Gliatilin improves the transmission of nerve impulses, has a positive effect on the plasticity of neuronal membranes, as well as on the function of receptors.
Possible complications and consequences of a concussion
The most commonly diagnosed consequence of a concussion is post-concussion syndrome. This is a condition that develops against the background of a previous TBI and manifests itself as a spectrum of subjective complaints of the patient in the absence of objective disorders (within six months after a concussion, it debuts in about 15-30% of patients).
The main symptoms of post-concussion syndrome are headache and attacks of dizziness, drowsiness, depressed mood, numbness of the extremities, paresthesia, emotional lability, decreased memory and concentration, irritability, nervousness, increased sensitivity to light and noise.
Also, the following conditions can be a consequence of the postponed mild traumatic brain injury, which usually stop within a few months after the resolution of the disease:
- asthenic syndrome;
- somatoform autonomic dysfunction;
- decreased memory;
- emotional and behavioral disorders;
- sleep disorders.
Forecast
Patients who have suffered a concussion of the brain are recommended to follow up with a neurologist for a year.
Mortality in this pathology is not recorded, active symptoms are safely resolved within 2-3 weeks, after which the patient returns to the usual mode of work and social activity.
YouTube video related to the article:
Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
