Every year on March 20, World Head Injury Awareness Day is celebrated. Their number has not only not decreased in recent years, but, on the contrary, is growing. Numerous types of extreme leisure and the use of a variety of vehicles are “blame” for this.
About what craniocerebral injuries are, how to protect yourself from them and what to pay special attention to, aif.ru told neurosurgeon of the neurosurgical department of the Russian Children’s Clinical Hospital of the Russian National Research Medical University named after N.I. N. I. Pirogov of the Ministry of Health of Russia Dmitry Reshchikov.
The statistics on severe traumatic brain injuries does not depend much on the season, because most often people get injured in road accidents, accidents, in conflicts. Lighter head injuries occur in everyday life, in everyday life quite often.
In winter, adults and children get head injuries during ice or riding on “cheesecakes”. In the warm season, when daylight hours increase and it gets warmer outside, people’s physical activity increases. Children also have a higher craving for risky behavior than adults, so they have the highest number of domestic injuries in the spring, and even more so in the summer, during the holidays. Among all injuries, the most dangerous, of course, head injuries.
“First of all, traumatic brain injuries (TBI) are classified according to the nature of the damage,” says neurosurgeon Dmitry Reshchikov. – Head trauma can be open (when the cranial cavity opens) and closed. Separately, non-penetrating and penetrating craniocerebral injuries are distinguished – in the second case, damage to the hard shell of the brain occurs.
How to recognize a concussion
The most common traumatic brain injury of mild severity, or concussion. Many children and adults are familiar with this phenomenon. “The skull is a closed space, and the brain is not just inside it, but also in a limited aquatic environment,” the expert explains. – At the moment of impact, a small contusion occurs, in which the brain hits the walls of the skull from the inside. All this causes liquorodynamic and vascular disorders, the severity of which depends on the degree of traumatic effect.
If a child or adult has suffered a head injury (he hit his head himself, was hit on his head with a fist or ball, had an accident, or even just ran into someone head-on), then it is important not to miss the symptoms of a concussion. Therefore, immediately after such an injury, it is necessary to carefully monitor the victim. The typical symptoms of a concussion are:
- short-term loss of memory, consciousness;
- slight dizziness;
These symptoms usually go away after a few days. But during the first time after a head injury, even if the manifestations are very minor, it is better to take care of the child and limit his activity.
Take a look into your eyes
“In traumatic brain injuries, often even severe ones, there is a special “light period” during which the patient feels normal. It is up to 4-6 hours, after which the victim experiences a sharp deterioration in his condition, the expert warns. – The most unfavorable sign is the expansion of one of the pupils. This symptom is an urgent indication for surgical intervention.
But even if there are no dangerous symptoms, the victim feels great and, apart from a bump on his forehead, there are no signs of injury, rest is necessary. A concussion requires the exclusion of any physical, emotional and mental stress. Under these conditions, being in a calm state, the patient quickly returns to normal.
But with untimely diagnosis and lack of treatment, there is a risk of developing neurological complications – in the form of persistent headaches that can interfere with the child’s education, attending kindergarten.
A bruise is worse than a concussion
“If, after the start of treatment, persistent headaches persist or increase in the victim, vomiting does not stop, there is a violation of sensitivity or depression of consciousness, this is a good reason for more careful monitoring of the patient, as well as for an in-depth examination,” says Reshchikov.
A more severe form of TBI than a concussion is a contusion of the brain. “This injury is the result of the same concussion impact, just stronger. Such patients require a long stay in the hospital and special therapy, says the neurosurgeon. – In the event of a traumatic effect, the brain swells, the amount of fluid in the intercellular space increases, and the vessels are compressed. Due to excessive pressure, brain cells begin to die, and over time, the entire brain structure ceases to function. If an intracranial hemorrhage occurs – the body responds to this with a total spasm of the brain vessels, there is a risk of ischemia. Therefore, the main directions of conservative therapy are the reduction of cerebral edema and the prevention of vascular spasm.”
However, the course of treatment depends entirely on the nature of the injury and on the picture that the CT scan will show the doctor.
In cases where drug therapy does not help to cope with edema, the brain continues to swell, or, according to the results of studies, a hemorrhage, hematoma is observed – surgical intervention is necessary.
How brain surgery is performed
TBI treatment is a complex multidisciplinary issue involving many different specialists: first of all, neurosurgeons and neurologists, but depending on the nature and severity of injuries, maxillofacial surgeons, resuscitators, and subsequently rehabilitation specialists also come to the rescue.
The range of operations performed for traumatic brain injuries is quite extensive, they are mainly aimed at removing hematomas. Based on the results of CT scans, neurosurgeons can clearly know their location. This helps to determine in which area it is necessary to carry out a craniotomy. “During the operation, the hematoma is drained, all blood clots are removed, and active bleeding from the damaged vessel stops,” says Reshchikov. “The course of the operation depends on the depth of the hemorrhage – for example, with a subdural hematoma, it is necessary to dissect the dura mater after trepanation.”
There is another series of operations in which a wide window is made in the skull to prevent further squeezing of the brain. Such patients require an integrated approach – resuscitation therapy, monitoring of intracranial pressure.
What is the prognosis for recovery?
The outcome of treatment depends on the degree of brain damage. With a concussion, the prognosis is favorable, but with bruises, everything depends on the location, severity, timely diagnosis and the correctness of the treatment.
The neurosurgical department of the Russian Children’s Hospital has gained extensive experience in the treatment of patients with severe concomitant craniocerebral injuries. A global multidisciplinary interaction has been developed – with resuscitators, traumatologists, rehabilitation specialists and other specialists. This allows us to provide all the necessary medical care to patients, even with the most complex pathologies.