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Craniocerebral injuries are caused by a direct trauma to the head or an indirect trauma. The damage to the brain structures is determined not by the force acting on the head itself, but by the sudden movement of the head caused by it.
Types of craniocerebral injuries
There are open and closed head injuries. In open injuries, the continuity of the integuments and bones of the skull are broken.
Among the fractures of the skull bones, we distinguish fractures of the vault and fractures of the skull base. As a result of such an injury, communication between the inside of the skull and the outside world occurs. Here, the extent of intracranial damage is not determined by the wound appearance, but by the degree of disturbance in the patient’s reactivity. In the case of closed injuries, the continuity of the integuments are not broken and there is no damage to the dura mater, although there are various types of brain damage. Concussion syndrome, contusion syndrome, and pressure syndrome may be present.
Concussion and contusion of the brain
Most of the craniocerebral injuries are present concussioncharacterized by a loss of consciousness lasting from a few seconds to several or several minutes as a result of a violent head injury. It is the result of brain dysfunction. It also occurs retrograde amnesia, i.e. extinguishing from memory the very moment of the accident, and sometimes even the event preceding the injury. Symptoms usually occur within 3 days. Each unconscious patient with craniocerebral trauma should be hospitalized and monitored.
The consequence of a craniocerebral trauma may be contusion of the brainwhich is a structural damage usually affecting the surface of the brain. It manifests itself as blood extravasation, necrosis of the brain tissue with subsequent edema. The initial symptom is usually loss of consciousness, which may vary in duration, usually longer than in concussion. Immediately after an injury, it is impossible to distinguish between contusion and concussion. Any area of the brain may suffer contusions, and the symptoms depend on the extent of the damage and the bruised area. The patient requires observation and hospital treatment.
Craniocerebral injuries and the pressure syndrome of the brain
Brain Oppression Syndrome (intracranial tightness syndrome) is caused by an increase in intracranial content caused by a hematoma or swelling of the brain. The brain, which is almost incompressible, has little compensation capacity and does not tolerate increasing pressure. After a closed craniocerebral trauma with a short-term loss of consciousness, the patient regains consciousness, so that after some time there is a gradual extinction of consciousness, until loss of consciousness.
These signs may be associated with unilateral paresis or epileptic symptoms. They are a consequence of the increasing pressure on the brain caused by the hematoma. Arterial hematoma grows rapidly, producing stormy symptoms that can occur within one to several hours. The patient requires rapid radiological diagnostics (CT scan of the head) or neurosurgery and rapid surgical removal of the hematoma. Such a procedure gives a chance of survival and full recovery.
Another cause of post-traumatic brain compression is swelling of the brain. It can occur in any form of craniocerebral trauma, and sometimes develops soon after the injury. The appearance of acute cerebral edema usually causes hypoxia. Symptoms may be similar to intracranial hematoma, but the resolution is provided by computed tomography, thanks to which it is possible to exclude the presence of intracranial hematomas with absolute certainty and clearly recognize cerebral edema. The patient requires pharmacological treatment in a hospital setting.
First aid for craniocerebral injuries
Patients with craniocerebral trauma should be provided immediate assistance. Unconscious patients should have a secure airway by pulling the tongue out and removing the mucus and vomit from the mouth. Casualties breathing without other serious injuries can be placed on their side.
In the event of cardiac arrest, indirect cardiac massage with artificial respiration should be performed. Head wounds should be covered with a sterile dressing. In case of profuse bleeding from the head wound, carefully apply a pressure dressing. When transferring the patient to a stretcher, immobilize the head, torso and limbs. The patient should be transported to hospital as quickly as possible.
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