Contents
Concussion occupies from 70 to 80% of the total number of all CNS injuries. This type of injury is of great importance for both the social and medical spheres.
Reasons for increased attention to the problem of treatment and diagnosis of brain damage:
A wide range of areas of human life in which there is a possibility of getting this injury – household, sports, children’s, industrial, transport, etc.
The complexity of diagnosing this condition due to the difficulty of differentiating with diseases similar in symptoms – osteochondrosis of the cervical spine, chronic cerebrovascular insufficiency, hypertension, a combination of concussion with the intake of large doses of alcohol, the absence of specific symptoms, the unpredictability of the dynamics and the scarcity of manifestations. In half of the recorded cases, either overestimation or underestimation of the severity of the patient’s condition takes place.
Insufficient qualifications of medical staff who do not have specialization in this area.
Postcommation syndrome, which is expressed in the symptoms of the immediate and long-term consequences of the injury.
Based on the results of such studies, it can be concluded that not only severe trauma is subject to treatment, but also a mild degree of brain damage.
What is a concussion?
Concussion – this is damage to the bones of the skull or soft tissues, such as brain tissue, blood vessels, nerves, meninges. An accident can happen to a person, in which he can hit his head on a hard surface, this just entails such a phenomenon as a concussion. In this case, some disturbances in the functioning of the brain occur, which do not lead to irreversible consequences.
There is no exact description of the course of all stages of this pathogenic process, but most experts argue that during a concussion, disturbances in the functions of nerve cells occur: their nutrition worsens, a slight displacement of the layers of brain tissues appears, and the connection between the brain centers collapses. As a result, multiple microcontusions, numerous tiny perivascular edema and hemorrhages develop. At the same time, obvious morphological changes and changes on MRI are not observed.
A severe concussion is dangerous in that serious injury to certain areas of the brain or rupture of blood vessels inside the skull can occur.
From such a traumatic brain injury, a person can lose consciousness lasting from a couple of seconds to several minutes. The time spent unconscious determines the severity of the concussion. The extreme form is coma.
When the victim wakes up, he often does not understand where he is and what happened to him. Sometimes – does not recognize others. You can also judge the severity of the injury by retrograde amnesia: the longer the period of time has fallen out of memory, the more serious the damage. The appearance of these signs is due to the fact that the vital centers of the brain are affected – the regulation of respiration and cardiovascular activity.
In the first hours or days after the concussion, the victim turns pale, complains of weakness and dizziness, tinnitus. The headache has a pulsating character and is localized in the occipital part. Nausea and vomiting may appear, breathing becomes more frequent, the pulse changes in the direction of increased or slowed down. After a while, these indicators will normalize. Depending on the injury itself and on the accompanying stress factors, blood pressure can either quickly return to normal or increase. Body temperature remains unchanged.
In connection with the dysfunction of the nerve cells of the brain after a concussion, negative phenomena are observed in the organs of vision: pain when moving the eyes, difficulty focusing the gaze, constricted or dilated pupils, pupils of different sizes, divergence of the eyeballs when reading.
There may be other symptoms: sweating, flushing of the face, discomfort or sleep disturbances.
During the first two weeks, the general condition of the victim improves. However, it should be borne in mind that health disorders can last much longer. For example, a headache in those who suffer from hypertension is particularly intense.
With a concussion, the symptoms are largely subjective. Often they are determined by the age factor. In infants and young children, concussion occurs without loss of consciousness. During a blow, the skin (especially the face) turns pale sharply, the heartbeat quickens. A little later, drowsiness and lethargy appear. When feeding, regurgitation and vomiting occur more often than usual. Sleep disturbances and general anxiety are noted.
In preschool children, all manifestations of concussion disappear within two to three days.
People of young and middle age at the time of injury lose consciousness much more often than children and the elderly. At the same time, representatives of the older generation show a pronounced disorientation in space and time.
As a rule, for most people, the neurological symptoms of a mild form of concussion go away after a few weeks. However, after any concussion, the energy metabolism in the brain remains in an altered state for a long time (a year or more).
Symptoms of a concussion
In order to help a victim with a traumatic brain injury resulting from an accident, it is important to identify the symptoms that accompany a concussion. It should be noted that not all of the following symptoms may appear immediately. It all depends on the severity of the concussion, some symptoms may not appear at all.
The most common symptoms of a concussion are:
Nausea and gag reflex in the case when it is not known about what happened to the person and he is unconscious;
Headache is normal after hitting a person in the head;
The victim wants to sleep or, on the contrary, is hyperactive;
A violation of coordination also testifies to a brain injury, a person also feels dizzy;
One of the most important symptoms is loss of consciousness. The time of loss of consciousness can be long or, conversely, short;
It is necessary to check the size of the pupils: with a concussion, pupils of different shapes are possible;
Direct confirmation of concussion convulsions;
If the victim is conscious, he may experience discomfort in bright light or loud sound;
When talking with the victim, he may experience confusion. He may not even remember what happened before the accident;
Sometimes speech can be incoherent.
After a while, all signs of a concussion weaken and completely disappear. If the symptoms persist for a long time, this may indicate more serious disorders that have occurred in the brain. Perhaps this indicates swelling of the brain, its bruise or hematoma of the brain.
Causes of a concussion
A concussion can be caused by bruises, blows, or sudden movement (either accelerating or decelerating). Most often, concussions are caused by traffic accidents, industrial, sports or household injuries.
Criminal circumstances can also play a negative role.
Mechanical causes of traumatic brain injury
Having an understanding of the mechanisms of brain injury, it is possible to predict the consequences of even the most minor forms of concussion in various age categories.
The cerebrospinal fluid (CSF), which fills the closed space between the brain and the bones of the skull, protects the brain “floating” in it from serious physical impacts. During a sudden blow, the brain moves by inertia in the opposite direction for some time. The pressure of the cerebrospinal fluid between the inner shell of the skull and the brain at this moment increases many times. As a result, the brain receives a mechanical or hydraulic shock.
A counterblow on the side opposite to the area of increased pressure creates an impact of the same force with a “minus” sign. Forced oscillations produced by the brain, “floating” in the cerebrospinal fluid, subject it to repeated damage. In addition, the brain receives additional trauma as a result of its rotational displacements around the axis, as a result of which it hits the protrusions of the cranium. There is a directly proportional relationship – the more sudden and strong was the mechanical impact, the more significant damage the brain received.
Biological causes of traumatic brain injury
The vessels of the brain during this injury do not receive significant damage, however, the concussion triggers the mechanism of inadequate reactions of the vessels themselves, nerve cells of the brain and intracranial nerve pathways. Studies conducted with the participation of animals, after modeling a concussion in them, showed the following results: when examining brain tissues under a microscope, displacements of the nuclei of nerve cells, damage to their elements – membranes, mitochondria, as well as pathologically altered space between them, an increase in the size of axons (nerve fibers).
Such damage indicates that there is a traumatic brain disease.
Symptoms of a traumatic illness:
Pathological expansion of cerebral vessels that occurs after their initial spasm leads to impaired cerebral circulation. It is quickly restored with a mild degree of concussion, however, this recovery occurs unevenly in different departments. Complications of this process are slowing of blood flow, vascular overflow, intracellular edema.
Changes in the metabolism of brain structures, colloidal balance, chemical and physical properties of the medulla, resulting from changes in intracranial pressure at the time of traumatic exposure. Studies conducted with the participation of experimental animals have recorded in rodents an increased vulnerability of nerve cells, a violation of extracellular and intracellular ion metabolism, an imbalance between the energy supply from blood cells and the need for it.
A short-term violation of the conduction of axons, expressed in the loss of relationships between nerve cells and the centers of regulation of their vital activity. At the same time, the structure of nerve tissues retains physical integrity.
Disruption of coordination between the important functional centers of the cerebral hemispheres (respiration, thermoregulation, cardiovascular activity) due to rupture of connections between them and the rest of the brain due to rotational displacement.
Analysis of the mechanism of concussion makes it possible to adequately assess the symptoms of trauma and first aid tactics.
A sleepless night is tantamount to a concussion
According to a study conducted by Swedish scientists, a night without sleep, no matter for what reason it happened (insomnia, night shifts, entertainment), is equated in its consequences to a concussion. A sleepless night negatively affects the state of health, human performance and mood.
Their findings confirmed the data of an experiment conducted at the University of Uppsala, with 15 volunteers in excellent health. The results of blood samples taken from participants after a sleepless night were analyzed. Brain damage was indicated by 20% higher levels of calcium-binding protein (S-100B) and neuron-specific enolase (NSE). This is a dangerous sign, since the indicators differ from the norm, but are close to those in patients after a concussion.
During a sleepless night, there is no cleansing of the tissues of the human body at the cellular level from toxins received by it during wakefulness. Violation of this physiological process leads to an increase in the concentration of markers in the biochemical parameters of the blood, similar to the same results after a concussion. The symptoms experienced by those who have been forced to spend the night without sleep are similar to those of a concussion: headache, noise in the head, impaired memory and attention, and nausea.
Toxins tend to accumulate in the body, so several sleepless nights in a row are comparable in severity to a physical brain injury.
Complications of a concussion
The list of possible complications after traumatic brain injury is very diverse. The most common is the so-called post-concussion syndrome. After some time – and it can be days, months, and sometimes even years – a person begins to worry about headaches. These pains can be excruciating – so to speak, “the head is splitting.” A person is disturbed by disturbing thoughts, he is irritated, cannot concentrate on something specific. Sleep is disturbed, it becomes very difficult to do work.
In such a situation, it is necessary to start treatment with medications. Turning to a psychotherapist does not bring relief. When prescribing painkillers from the narcotic series, it is important to remember the negative consequences in the form of drug addiction.
For treatment, it is very important to observe peace and strict bed rest. There should be no bright light in the room to avoid pain. Of the drugs used sedatives, hypnotics and painkillers. Elderly people are being treated for multiple sclerosis and its accompanying diseases.
In order to avoid complications after a traumatic brain injury, it is necessary to have a dispensary observation for one year with a neurologist in a polyclinic at the place of residence.
In people involved in boxing, as a complication, “boxer’s encephalopathy” may occur. Its symptoms are as follows: imbalance, changes in the psyche and trembling of the limbs.
Principles of treatment
Most often, a concussion occurs due to mechanical injury, so the first thing you need is to provide first aid. If the victim quickly regained consciousness or did not lose consciousness, put him on a horizontal surface so that his head was slightly raised. If the person is unconscious, turn him to his right side, tilt his head back, turn his face to the ground, bend his left leg and arm at a right angle at the knee and elbow joints. In this position, the air will easily pass into the lungs, there will be no risk of blocking the airways.
Immediately after a concussion, the victim must be taken to the hospital. Symptoms of different traumatic brain injuries may initially be identical, so the doctor will make an accurate diagnosis based on the results of an x-ray examination. The victim is prescribed bed rest for at least two days. At the same time, complete rest is necessary: it is forbidden to watch TV, read and listen to music. The spectrum of prescribed medications is mainly aimed at relieving dizziness, headache, insomnia and anxiety.
As a rule, the condition of the victims returns to normal within one to two weeks after the injury, but it is important to know that 35% of mild concussions lead to severe complications if the disease is carried on the legs. In this case, there is a danger of developing post-traumatic neurosis or epilepsy. In special cases, neurosurgical intervention may be necessary.
In the elderly, concussion causes neurological symptoms, vascular complications, high blood pressure, and increases the risk of stroke and Alzheimer’s disease. To prevent the negative consequences of this category of persons, in addition to direct treatment, anti-sclerotic therapy is prescribed.
Patients with a history of brain concussion are registered with a neurologist for a year. During this observation, the likely consequences of the injury that negatively affect the quality of life of the patient are monitored, and the consequences of a concussion are treated.
The basic principle of treating the consequences of an injury is bed rest for 10 to 14 days, rest for the nervous system, created by refusing to read, watch TV shows and listen to music.