Even traumatic brain injuries mild degree may pose a serious threat to human health. That's why than faster patient falls into the hands of an experienced specialist, the greater the chance of speedy recovery. Treatment for traumatic brain injury depends on many factors: severity, age of the patient, and the presence of other injuries and diseases.

Principles of therapy

In case of brain injury, the speed of first aid is very important. Even a small blow to the head, after which there are no signs of damage: dizziness, nausea, vomiting, loss of coordination, can subsequently lead to serious problems.

Survey

Patients with TBI in mandatory are hospitalized in the neurosurgery department, where the doctor conducts primary diagnosis and condition assessment. Only after the examination is carried out an individual algorithm for the treatment and recovery of the patient is built. It is very important to correctly assess the patient’s condition and determine the prognosis for the course of the disease, since not only the health, but also the life of the patient depends on this.

What examinations are needed:

First aid

Much depends on the speed and quality of first aid. First aid consists of the following:

It is important to know that unconscious patients with open injuries should not be turned over until doctors arrive - most people with TBI have multiple fractures and injuries to the spine. Also when open injuries you cannot remove skull fragments or foreign objects– such manipulations can only be carried out by specialists.

The course of TBI involves several periods:

spicy;
intermediate (compensatory);
restorative.

For each period, a specific treatment is selected, which depends on many factors:

Patients with minor injuries usually stay in the hospital for no more than a day. If their condition is not in danger, then after receiving their appointments they can go home. Patients with moderate injuries are treated in a hospital.

As a rule, the treatment period is at least a month, but if possible, after 2 weeks the patient goes home and is seen by the attending physician once a week. Patients with severe injuries remain in hospital for a long period. And even after discharge, they undergo a rehabilitation course to restore speech, motor and other lost functions.

How to help with a brain injury?

Brain contusion is a fairly common injury that occurs in road accidents due to fights, falls or blows to the head. Such damage can be of various types: mild, moderate or severe, open or closed, with or without hemorrhage. Based on the nature of the injury, the doctor determines how to treat each patient and individually selects a treatment regimen.

Patients with a brain contusion are treated only in an inpatient setting, since the consequences of such injuries can cause serious harm to health. Patients with mild and moderate injuries are treated in intensive care wards, and patients with severe trauma are in the intensive care unit under the supervision of specialists in the first days.

In most cases, treatment for a brain contusion does not require surgery. First of all, it is necessary to restore such vital important functions like breathing and blood circulation. To improve respiratory function and prevent asphyxia and oxygen starvation, carry out oxygen inhalations. If the patient is unable to breathe on his own, then for this period he is connected to a ventilator.

In 90% of patients with such injuries, there is a decrease in the volume of circulating blood, so its volume is restored by administering drugs with solutions of colloids and crystalloids. With a bruise, intracranial pressure increases, so head part The patient's bed should be slightly elevated. To relieve swelling and normalize blood pressure, diuretics are prescribed, for example: Furosemide or Lasix.

Since brain tissue is damaged during a bruise, drugs are needed to provide nutrition and restoration of brain cells. For this purpose, agents with neuroprotective and antioxidant effects are used:

It is mandatory to take medications that improve microcirculation: Cavinton, Trental, Sermion, as well as sedatives and vitamins E and group B. In case of open brain injury, it is necessary to take antibiotics (Cefotaxime, Azithromycin) to avoid infection and the development of complications, such as sepsis, meningitis and encephalitis.

In rare cases, a brain contusion requires neurosurgical care. The operation is performed if cerebral edema increases, intracranial pressure does not decrease, or a large area of crushed brain tissue is observed. The operation is based on trephination and removal of the damaged area.

Help with concussions

The most common traumatic brain injury is a concussion. It is very common in both adults and children. Like other injuries, a concussion is divided into three degrees, which determines the treatment tactics.

Mild concussion in adults is a condition that is rarely accompanied by complications. In many cases, no specific treatment is required other than painkillers and sedatives and compliance with bed rest.

Therefore, after the examination, the patient is sent home under several conditions:

Sick leave will be taken.
Bed rest is necessary.
You need to see a doctor at least once a week.
Take prescribed medications regularly.

In childhood, concussions are observed by specialists for 1-3 days, and if the child’s condition does not cause concern, then he is released for treatment. ambulatory treatment. It is very important to show the child to doctors if there is any blow to the head to make sure that his health is not in danger. A missed concussion can lead to memory, speech and future learning problems.

The main drugs prescribed for concussion:

Painkillers and non-steroidal anti-inflammatory drugs: Analgin, Ibuprofen, Pentalgin, Maxigan.
Sedatives: Valerian, Corvalol, Motherwort, Novo-Passit.
For sleep disorders: Relaxon, Donormil.
For residual neuroses, tranquilizers are prescribed: Afobazol, Phenazepam, Grandaxin, Rudotel.

Less commonly, for concussions, medications that promote blood microcirculation (Cavinton, Trental) and drugs with nootropic and neuroprotective effects are prescribed. Especially often, such drugs are prescribed in childhood and old age to help the brain cope with residual effects after injury.

What drugs are prescribed:

Cerebrolysin.
Piracetam.
Pantogam.
Encephabol.
Semax.
Cogitum.

If long-term asthenic signs are observed, then complex treatment is necessary, which includes antipsychotics or nootropics, vitamin-mineral complexes, antioxidant drugs and tonics. Elderly patients need to take medications that improve the tone and elasticity of blood vessels, as well as anti-sclerotic treatment that reduces the deposition of cholesterol on damaged vessels.

Treatment of severe injuries

The most severe TBIs are cerebral compression, diffuse axonal injury, brainstem ruptures, and intracranial hemorrhage. It is with such defeats that the count goes not only on hours and, but also on minutes. The life of the patient and whether he will be able to lead his usual lifestyle depends on how quickly treatment is started in the acute period. Many patients with severe TBI remain disabled for life.

The patient’s condition depends not only on the nature of the injury, but also on secondary damage: hypoxia, hypothermia, intracranial pressure, spasms, convulsions, infection. That is why medical measures are aimed at eliminating these symptoms.

Treatment methods in the acute period:

After removal acute condition patients who have suffered severe injuries are prescribed medications to normalize blood circulation in the vessels of the brain and restore lost functions. The most effective drugs Cortexin, Cerebrolysin, Mexidol and Actovegin are considered. These remedies not only nourish brain tissue, but also relieve the effects of hypoxia, restore speech and other cognitive functions.

After discharge, patients who have suffered severe brain injury undergo a long course of rehabilitation, which includes: exercise therapy, electrophoresis, magnetic therapy, acupuncture, massage and other measures to restore lost functions.

Home Remedies

In case of traumatic brain injuries, treatment at home should be carried out only after visiting a doctor, and making sure that nothing threatens life and health. Principles of treatment at home:

Only concussions and concussions can be treated at home lung bruise degrees, or undergo recovery after discharge from hospital.
Maintain bed rest.
Avoid vigorous activity.
You cannot watch TV, read or use a computer for at least three days.
Protect the patient from irritating factors: bright light, noise, unpleasant odors.
Eliminate heavy foods from your diet, add more fresh vegetables, fruits, cottage cheese and juices.
If symptoms of TBI occur or worsen: dizziness, nausea, convulsions, loss of consciousness, you should seek medical help.

There is no cure for head injuries folk remedies, but with their help you can eliminate unpleasant consequences, for example: dizziness, weakness, insomnia, lack of appetite. What you can take:

We should not forget that even mild traumatic brain injuries require examination by a doctor, and after discharge, it is necessary to see a specialist 2 times a year. In childhood, after a TBI, the child is shown to a neurologist every 2 months to exclude residual effects.

Traumatic brain injury (TBI), according to the classical definition, is a type of mechanical injury to the head that damages the contents of the cranium (brain, blood vessels and nerves, meninges) and the bones of the skull.

The peculiarity of this pathology is that after an injury a number of complications may arise, which to a greater or lesser extent affect the quality of life of the victim. The severity of the consequences directly depends on which specific important systems were damaged, as well as on how quickly assistance was provided to the victim by a specialist neurologist or neurosurgeon.

The following article aims to present in accessible and understandable language all the necessary information on the issue of traumatic brain injuries and their consequences, so that, if necessary, you have a clear understanding of the seriousness of this problem, and also familiarize yourself with the algorithm urgent action towards the victim.

Based on the experience of leading neurosurgical clinics in the world, it was created unified classification traumatic brain injuries, taking into account both the nature of the brain damage and its degree.

To begin with, it should be noted that isolated trauma is distinguished, which is characterized by an absolute absence of damage outside the cranium, as well as combined and combined TBI.

Head injury accompanied mechanical injury other systems or organs is called combined. By combined we mean damage that occurs when the victim is exposed to several pathological factors - thermal, radiation, mechanical influence, etc.

With regard to the possibility of infection of the contents of the cranial cavity, there are two main types of TBI - open and closed. Thus, if the victim has no damage to the skin, then the injury is considered closed. The proportion of closed TBI is 70-75%, the frequency of open fractures is 30-25%, respectively.

Open traumatic brain injury is divided into penetrating and non-penetrating, which depends on whether the integrity of the dura mater has been compromised. Note that the volume of brain damage and cranial nerves do not determine the clinical affiliation of the injury.

Closed TBI has the following clinical variants:

concussion is the mildest type of head injury in which reversible neurological disorders are observed;
Brain contusion is an injury characterized by damage to brain tissue in a local area;
diffuse axonal damage – multiple breaks of axons in the brain;
compression of the brain (with or without a bruise) - compression of brain tissue;
fracture of the skull bones (without intracranial hemorrhage or with its presence) - damage to the skull, resulting in injury to the white and gray matter.

Severity of TBI

Depending on a set of factors, a head injury can have one of three degrees of severity, which determine the severity of a person’s condition. So, the following degrees of severity are distinguished:

mild degree - concussion or minor bruise;
medium degree - with chronic and subacute compression of the brain, combined with brain contusion. At medium degree the victim’s consciousness turns off;
severe degree. It is observed with acute compression of the brain in combination with diffuse axonal damage.

Often, with TBI, a hematoma appears on the skin at the site of injury due to damage to the tissues of the head and bones of the skull.

As can be seen from the above, the absence of pronounced defects of the head and skull bones is not a reason for the inaction of the victim and the people around him. Despite the conditional differentiation of mild, moderate and severe injuries, all of the above conditions necessarily require urgent consultation with a neurologist or neurosurgeon to provide timely assistance.

Symptoms of head injury

Despite the fact that a head injury of any severity and under any circumstances requires urgent consultation with a doctor, knowledge of its symptoms and treatment is mandatory for every educated person.

Symptoms of head injury, like any other pathology, form syndromes - complexes of signs that help the doctor determine the diagnosis. The following syndromes are classically distinguished:

General cerebral symptoms and syndromes. This symptom complex is characterized by:

loss of consciousness at the time of injury;
headache(stabbing, cutting, squeezing, encircling);
disturbance of consciousness some time after the injury;
nausea and/or vomiting (possible bad taste in the mouth);
amnesia - loss of memories of incidents that preceded or followed the incident, or both (respectively, retrograde, anterograde and retroanterograde types of amnesia are distinguished);

Focal symptoms are characteristic of local (focal) lesions of brain structures. As a result of injury, the frontal lobes of the brain, temporal, parietal, occipital lobes, as well as structures such as the thalamus, cerebellum, brainstem, and so on.

The specific localization of the lesion always causes certain symptoms, but it should be taken into account that external (noticeable) violations of the integrity of the cranium may not be observed.

Thus, a fracture of the pyramid of the temporal bone may not always be accompanied by bleeding from auricle, however, this does not exclude the possibility of damage at the topical (local) level. One of the variants of these manifestations may be paresis or paralysis facial nerve on the injured side.

Grouping of individual characteristics

Classification focal signs are combined into the following groups:

visual (if the occipital area is affected);
auditory (with damage to the temporal and parietotemporal areas);
motor (in case of damage central departments, up to pronounced motor disorders);
speech (Wernicke and Broca's center, frontal cortex, parietal cortex);
coordinator (with damage to the cerebellum);
sensitive (if the postcentral gyrus is damaged, sensitivity disorders are possible).

It is worth noting that only a certified specialist who follows the classic examination algorithm is able to accurately determine the topic of focal lesions and their impact on the future quality of life, so never neglect to seek help in case of a head injury!

Autonomic dysfunction syndrome. This symptom complex occurs due to damage to the autonomic (automatic) centers. Manifestations are extremely variable and depend solely on the specific center that was damaged.

In this case, a combination of symptoms of damage to several systems is often observed. Thus, changes in breathing rhythm and heart rate are possible at the same time.

The following types of autonomic disorders are classically distinguished:

metabolic dysregulation;
changes in work of cardio-vascular system(possible bradycardia);
dysfunction of the urinary system;
changes in the functioning of the respiratory system;
gastrointestinal disorders.
solutions to your altered state of mind.

Mental disorders that are characterized by changes in the human psyche.

Most often this is:

emotional disturbances (depression, manic agitation);
twilight stupefaction;
impairment of cognitive functions (decreased intelligence, memory);
personality changes;
the occurrence of productive symptoms (hallucinations, delusions of various types);
lack of critical

Please note that the symptoms of TBI can be either pronounced or invisible to a layperson.

In addition, some symptoms may occur a certain time after the injury, so if you receive a head injury of any severity, you should consult a doctor!

Diagnosis of TBI

Diagnosis of craniocerebral lesions includes:

Questioning the patient and witnesses to the incident. It is determined under what conditions the injury was received, whether it was the result of a fall, collision, or blow. It is important to find out whether the patient is suffering chronic diseases whether there have been previous TBIs or surgeries.
Neurological examination to determine whether specific symptoms, characteristic of damage to one or another area of the brain.
Instrumental diagnostic methods. After a head injury, everyone without exception is prescribed an X-ray examination, and, if necessary, CT and MRI.

Principles of TBI Therapy

There are two main approaches to managing patients with the consequences of head trauma: surgical and therapeutic. The period of treatment and the approach to it are determined by the general condition of the patient, the severity of the lesion, its type (open or closed TBI), location, individual characteristics of the body, and response to medications. After discharge from the hospital, the patient most often needs a course of rehabilitation.

Possible complications and consequences of traumatic brain injuries

In the dynamics of the development of the consequences of head injuries, there are 4 stages:

Acute, or initial, which lasts during the first 24 hours from the moment of injury.
Acute, or secondary, from 24 hours to 2 weeks.
Convalescence, or late stage, its time frame is from 3 months to one year after the injury.
The long-term consequences of TBI, or the residual period, range from a year to the end of the patient’s life.

Complications after TBI vary depending on the stage, severity and location of the injury. Among the disorders, two main groups can be distinguished: neurological and mental disorders.

Neurological disorders

First of all, neurological disorders include such a common consequence of head trauma as vegetative-vascular dystonia. VSD includes changes in blood pressure, a feeling of weakness, fatigue, poor sleep, discomfort in the heart area and much more. In total, over one hundred and fifty signs of this disorder have been described.

It is known that with traumatic brain injuries that are not accompanied by damage to the skull bones, complications occur more often than with a fracture.

This is mainly due to the syndrome of so-called liquor hypertension, in other words, an increase in intracranial pressure. If, after receiving a traumatic brain injury, the skull bones remain intact, intracranial pressure increases due to increasing cerebral edema. This does not happen with skull fractures, since bone damage makes it possible to obtain additional volume for increasing swelling.

CSF hypertension syndrome usually occurs two to three years after a brain contusion. The main symptoms of this disease are severe, bursting headaches.

The pain is constant and intensifies at night and in the morning, because in a horizontal position the outflow of cerebrospinal fluid worsens. There is also a feeling of nausea, occasional vomiting, severe weakness, convulsions, increased heart rate, surges in blood pressure, prolonged hiccups.

Characteristic neurological symptoms of traumatic brain injury are paralysis, impaired speech, vision, hearing, and smell. A frequent complication of a TBI is epilepsy, which poses a serious problem because it is difficult to treat. drug treatment and is considered a disabling disease.

Mental disorders

Among mental disorders after TBI, amnesia occupies the most important place. They usually occur in the initial stages, from several hours to several days after the injury. Events that precede the trauma (retrograde amnesia), follow the trauma (anterograde amnesia), or both (anterograde amnesia) may be forgotten.

At the late stage of acute traumatic disorders, patients experience psychoses - disorders of mental activity in which the objective perception of the world changes, and a person’s mental reactions grossly contradict the real situation. Traumatic psychoses are divided into acute and protracted.

Acute traumatic psychoses are manifested by a wide variety of changes in consciousness: stupor, acute motor and mental agitation, hallucinations, paranoid disorders. Psychosis develops after the patient regains consciousness after a TBI.

A typical example: a patient wakes up, comes out of an unconscious state, begins to respond to questions, then excitement appears, he breaks out, wants to run away somewhere, hide. The victim may see some monsters, animals, armed people, and so on.

A few months after the incident, mental disorders such as depression often occur; patients complain of depression emotional condition, lack of desire to perform those functions that were previously performed without problems. For example, a person is hungry, but cannot bring himself to cook anything.

Various changes in the victim’s personality are also possible, most often of the hypochondriacal type. The patient begins to worry excessively about his health, invents diseases that he does not have, and constantly turns to doctors demanding that they conduct another examination.

The list of complications of a TBI is extremely diverse and is determined by the characteristics of the injury.

Prognosis of traumatic brain injury

Statistically, approximately half of all people who suffer a TBI recover fully and return to work and normal household duties. About a third of the victims become partially disabled and another third lose their ability to work completely and remain deeply disabled for the rest of their lives.

Restoration of brain tissue and lost body functions after a traumatic situation occurs over several years, usually three to four, while in the first 6 months regeneration occurs most intensively, then gradually slowing down. In children, due to the higher compensatory capabilities of the body, recovery occurs better and faster than in adults.

Rehabilitation measures must begin immediately, immediately after the patient leaves the hospital. acute stage diseases. This includes: work with a specialist to restore cognitive functions, stimulation motor activity, physiotherapy. Together with a well-chosen drug therapy A rehabilitation course can significantly improve the patient’s standard of living.

Doctors say that the most important role in predicting the results of treatment for TBI is how quickly first aid was provided. In some cases, a head injury remains unrecognized because the patient does not go to the doctor, considering the injury not serious.

Under such circumstances, the effects of traumatic brain injury are much more pronounced. People who are in more in serious condition after a TBI and who immediately sought help have a much better chance of a full recovery than those who suffered minor damage but decided to rest at home. Therefore, at the slightest suspicion of TBI in yourself, your loved ones and friends, you should immediately seek medical help.

It is possible to undergo rehabilitation after a traumatic brain injury on credit. An untreated traumatic brain injury can subsequently lead to constant headaches and disturbances in intracranial pressure. To avoid complications after TBI and restore all body functions, it is recommended to undergo rehabilitation procedures without fail. How to speed up recovery after a sports injury and return to full training?

Traumatic brain injuries (TBI): treatment and rehabilitation

Risk is an integral companion of our lives. Often, we are not even aware of it. Few people think about a possible accident while driving a car, about unquestioning compliance with safety regulations in the midst of work, or about injuries while playing sports. One of the most common injuries is head injuries, and a considerable percentage of victims are athletes who received a traumatic brain injury during competitions or even in training.

Classification of TBI

It would seem that a strong skull is reliable protection for the important body person. But, nevertheless, traumatic brain injuries are the most common type of injury, and they mainly affect people under 50 years of age.

Traumatic brain injury, or TBI, is mechanical damage to the soft tissues of the head, the skull itself and facial bones, as well as brain tissue. There are several classifications of traumatic brain injuries depending on their nature. So, according to the degree of severity they divide lungs , average And severe injuries . At severe TBI the patient experiences loss of consciousness (up to coma) for more than an hour, and in mild cases, the victim can remain conscious all the time.

Also classified open , closed And penetrating traumatic brain injuries. The former are characterized by the presence of a wound in which the bone or aponeurosis is exposed; for the second – the presence or absence of damage to the skin while the aponeurosis and bone are intact; in the third case, the tightness of the skull is broken and the dura mater is damaged.

Open and closed injuries have various clinical forms:

Brain concussion. The mildest of the injuries, the symptoms of which usually cease to be noticeable after a few days. All brain damage in this case is reversible.
Brain compression. It can be caused by severe contusion or swelling of the brain, as well as bone fragments from a fracture.
Brain contusion, in which damage and necrosis of a certain area of \u200b\u200bbrain tissue occurs. Depending on the size of the lesion and the depth of loss of consciousness, three degrees of brain contusion are distinguished: mild, moderate and severe.
Axonal damage- a type of injury in which excessively sudden movements of the head (for example, during a fall or after a blow) cause axonal rupture. Subsequently, microscopic hemorrhages in the brain can lead to coma.
Intracranial (including intracerebral) hemorrhage. One of the most serious pathologies, causing damage nervous tissue and displacement of brain structures.

Each of the forms may be accompanied by cracks or fractures of the skull bones and/or fractures of the facial skeleton.

TBI statistics
According to the statistics of recorded cases, most head injuries occur due to household injuries (60%), followed by injuries from road accidents (30%), and 10% are sports injuries.

Consequences of traumatic brain injuries

Traumatic brain injuries are one of the most common causes of disability and death in general traumatology (up to 40% of total number). But the consequences of an injury cannot always be predicted: sometimes a seemingly mild concussion can lead to a sad outcome, and extensive penetrating injuries can result in the patient’s recovery.

However, in most cases, both severe and mild injuries have unpleasant consequences, both early (onset immediately) and delayed ( post-traumatic syndrome). The early ones include:

coma;
constant dizziness;
hemorrhages;
hematomas;
sleep disorders;
development infectious diseases.

Long-term consequences of traumatic brain injury are observed over a long period of time. It can be:

sleep, speech, memory disorders;
fast fatiguability;
various mental disorders;
chronic headache;
depression.

The severity of the consequences depends not only on the nature and complexity of the injury, but also on the age of the victim, as well as the promptness of the assistance provided.

Signs of Brain Injury

Timely diagnosis allows you to provide the necessary medical care in a timely manner and prevent the development of severe consequences injuries and complications. To do this, you need to pay attention to the signs of a TBI and, even if you suspect them, immediately call an emergency ambulance.

Symptoms of skull and brain injuries:

loss of consciousness (even short-term - for a few seconds);
dizziness and headaches of various types (acute or aching);
nausea, vomiting;
noise or ringing in the ears, momentary loss hearing, speech disorders;
bleeding or discharge colorless liquid from the nose and ears (a sign of severe traumatic brain injury);
amnesia, clouding of consciousness: hallucinations, delusions, inappropriate behavior (aggressive or overly apathetic);
short-term or ongoing blindness (partial or complete);
manifestation of hematomas on the face, behind the ears, on the neck;
curvature of the face (with fractures of the base of the skull).

If there are any signs of a traumatic brain injury or a complex of them, it is necessary, as already mentioned, to take the victim to the hospital, where he will receive the necessary assistance.

Treatment of TBI

Treatment of brain injuries occurs in two stages: provision of first aid (pre-hospital or medical) and subsequent observation of the patient in the clinic and then in the hospital. Primary measures will help avoid the development of secondary damage and prevent brain hypoxia and intracranial hypertension.

When the victim is admitted to the hospital, diagnostics (x-ray or tomography) are performed to determine the nature and extent of the damage. Based on the results of the examination, a course of treatment is developed: in severe cases, neurosurgical intervention, in the absence of the need for surgery, conservative measures. Non-surgical treatment includes pharmacological methods (introduction of calcium channel blockers, nootropics, corticosteroids, etc.)

In general, the course of treatment is always developed individually, taking into account all factors: the age and general condition of the patient, the nature of the injury, the presence of concomitant injuries and diseases. The duration of treatment in a hospital ranges from 10 days (for bruises and mild concussions) to several months (for severe traumatic brain injuries).

Rehabilitation after head injuries

The period of rehabilitation after TBI is no less important than the stage intensive treatment, since it is the recovery course that allows you to avoid complications after injury and repeated brain damage. Also during rehabilitation period the patient restores body functions lost during the illness (speech, motor skills, memory), a number of measures are taken to stabilize the psycho-emotional state of the victim, preparing him for a return to full life in family and society.

After discharge from the hospital, many patients do not consider it necessary to take an additional course rehabilitation treatment in a sanatorium or specialized clinic, believing that at home all the conditions necessary for rehabilitation can be provided. However, it is more advisable to spend some time in a specialized center, under the supervision of specialists: neurologists, physical and occupational therapists, psychologists. Thus, the patient will be able not only to more effectively restore cognitive skills and mobility, but also undergo the necessary socialization and adaptation to new living conditions. This is especially true for patients who have suffered severe brain injuries.

Traumatic brain injuries are very dangerous for human health; their consequences, especially if incorrectly diagnosed or treated, can lead to disability or death. Therefore, it is very important to provide the victim with timely first aid, conduct a thorough diagnosis and develop the right course of medical measures. The patient, in turn, must not only undergo inpatient treatment, but also rehabilitation.

Where can I take a course in recovery from a traumatic brain injury?

In our country, until recently, little attention was paid to the need for rehabilitation treatment after various injuries and diseases, even such serious ones as brain damage, strokes, hip fractures, etc. Therefore, there are few clinics that provide rehabilitation for patients after such diseases and they are mostly private.

One of the most famous centers that we recommend paying attention to is the rehabilitation clinic. Here, patients in a sanatorium undergo a course of post-hospital treatment after TBI under supervision qualified doctors And medical personnel. The center constantly employs a neuropsychologist who helps victims of brain injury regain all lost skills and correct mental processes. All conditions have been created here for quick and comfortable recovery of physical and emotional health: treatment procedures are interspersed with walks on fresh air and entertainment events, in which both animators and psychologists with patients take part. The cooks of the Three Sisters restaurant prepare exceptionally healthy and delicious dishes, taking into account the diet recommended for each patient, and you can dine with guests - the center is open to relatives and friends of its clients.

License of the Ministry of Health of the Moscow Region No. LO-50-01-009095 dated October 12, 2017.

Wednesday, 03/28/2018

Editorial opinion

No matter how minor the injury may seem - a small bruise, a concussion - you should consult a doctor in any case. If we are talking about serious injury, then calling emergency help is necessary as soon as possible. Until doctors arrive, you need to constantly monitor the victim’s breathing and prevent fluids (saliva, vomit, blood) from flowing into the respiratory tract - to do this, you need to lay the patient on his side. A sterile bandage should be applied to the open wound.

Shoshina Vera Nikolaevna

Therapist, education: Northern medical University. Work experience 10 years.

Articles written

Traumatic brain injury is the most common of those that often lead to disability of the patient. The clinical picture depends on the severity of the damage. It is important to start treatment on time to avoid serious violations brain functions.

What is this problem

Traumatic brain injuries are considered mechanical injuries that damage the skull, its nerves, tissues and blood vessels. Such disorders occur very often, in most cases in people under fifty years of age. The danger of the problem lies in the fact that in the absence of timely assistance and in case of severe tissue damage, brain function cannot be completely restored. This is precisely what causes the high mortality rate and frequent disability of victims.

TBI: classification

Depending on the nature and severity of damage to the brain substances, injuries are divided into:

Concussions.
Bruises.
Squeezing. (For swelling of brain tissue, internal swelling, pressure from bone fragments of the cranial vault, accumulation of fluid under the hard shell, extensive areas of contusion, accumulation of air in the cranial cavity).
Severe axonal diffuse damage.

Taking into account the absence or presence of a violation of the integrity of the head, infection getting inside or the likelihood of air accumulation in the cranial cavity, injuries occur:

Closed, in which the soft tissues are kept intact or a wound appears on them, but without damaging the aponeurosis of the skull. In this case, meningitis and pneumoencephaly cannot occur. Closed head injury is less dangerous.
Open when there is damage to soft tissues, the aponeurosis of the skull and its deep formations, the membranes and tissues of the brain. In this state they sometimes develop purulent-septic complications, pneumoencephaly, areas of the brain are compressed by fragments of the skull.

Open injuries, in turn, can be:

Penetrating, in which the hard membranes of the brain are damaged. May leak from the nose or ear cerebrospinal fluid. The likelihood of developing purulent processes is very high.
Non-penetrating. The integrity of the hard shells remains unchanged.

Depending on the combination of traumatic brain injuries with other TBI injuries, there are:

Isolated.
Combined, in which the chest, abdominal cavity, limbs or other parts of the body are damaged.
Combined. In this case, the victim is affected by mechanical, thermal, radiation and chemical factors.

Severity

Depending on the severity of the injuries received, the following are distinguished:

Mild severity. The patient's condition remains satisfactory, clarity of consciousness does not change, there are no violations of important brain functions, neurological symptoms are completely absent, primary focal symptoms are mild. Given that proper treatment there is no threat to life. The victim can count on a quick recovery to work capacity.
Average degree. Consciousness remains clear or moderately stunned. There is no disruption of vital functions; in some cases, a decrease in heart rate is observed. There are hemispherical or craniobal symptoms. If treated correctly, there is little threat to life. In most cases, ability to work is restored.
Heavy. The victim is in a state of deep stupor or stupor. There is a violation of vital functions. Focal symptoms are clearly expressed. Moderate manifestations of pyramidal insufficiency occur, pupillary reactions decrease, and the size of the pupils becomes different. Clear expression of hemispheric and craniobasal symptoms. This manifests itself in the form of epileptic seizures and serious motor disorders, including paralysis. The danger to life is very great. Working capacity is restored in rare cases.
Extremely heavy. The patient falls into a coma, vital life is severely impaired important indicators. The presence of brainstem symptoms is observed in the form of a sharp weakening of the pupillary response to light, divergence, and anisocoria. Craniobasal and hemispheric manifestations are sharply expressed. The patient's life is in danger. The chances of survival depend on how long a person remains comatose. It is almost impossible to restore working capacity.
Terminal state. The patient is in a terminal coma. All vital functions are critically impaired. There are no pupillary and corneal reflexes. General cerebral and brainstem disorders are observed. It is impossible to survive in such a situation.

Symptoms for different forms of TBI

Concussion is a functionally reversible disorder. This condition manifests itself with general cerebral symptoms. In mild cases, the victim loses consciousness for several seconds or minutes. There is some stupor, problems with orientation in time and place, consciousness narrows, and it is difficult to perceive the surrounding world.

In frequent cases, retrograde amnesia is diagnosed, that is, the patient does not remember events that occurred before the injury. Rarely observed is anterograde amnesia, in which memories of events following trauma are lost. Some develop speech and motor excitation.

Most patients after a concussion suffer from headaches and dizziness, nausea, accompanied by vomiting. During a neurological examination, they are found to have uneven reflexes and oral automatism.

With concussions, cerebellar symptoms are often observed, manifested in the form of nystagmus, decreased muscle tone, instability and tremor. Distinctive feature damage is that over the course of several days all signs gradually smooth out. Vascular and autonomic disorders may last longer:

blood pressure fluctuates;
heart rate increases;
limbs take on a blue tint;
sweating increases.

With a brain contusion, focal macrostructural damage from hemorrhage to destruction is observed. During an injury, the bones of the input and the base of the skull may break, and arise.

With a slight injury, consciousness turns off for several minutes. After the victim comes to his senses, he begins to feel pain and dizziness, nausea with vomiting, and manifestations of retrograde and anterograde amnesia. In some cases, the pressure in the arteries and the heart rate increase, but these deviations are moderate.

With moderately severe bruises, a person may lose consciousness for several hours. After this, there is a headache and repeated vomiting. In some cases, they develop mental disorders. Some body functions are disrupted, which is accompanied by:

bradycardia and tachycardia;
increased blood pressure;
persistent increase in body temperature up to 37 degrees;
increased shallow breathing without disturbing its rhythm.

Often observed. Depending on which part of the brain is damaged, sensitivity and eye movements are impaired, limbs are paralyzed, and other symptoms occur.

The main manifestations disappear within a few weeks, but some symptoms can bother you for a very long time.

In cases of skull fractures and subarachnoid hemorrhages, the neck often hurts severely.

Severe brain contusion is manifested, first of all, by prolonged loss of consciousness. The victim may remain in this state for several days or weeks. Symptoms of a brain contusion will be as follows:

motor function of the limbs is impaired up to paralysis;
muscle tone decreases;
epilepsy attacks appear;
violations of oral automatism reflexes and others occur.

There is a slow development of focal symptoms. Residual effects often appear. This usually concerns the motor and mental spheres.

With severe bruises, the skull, its vaults and bases sometimes break, and severe hemorrhages occur in the subarachnoid space. A fracture can be identified by the leakage of cerebrospinal fluid from the nose or ears. If the cranial fossa is damaged, then hematomas occur in the area of the eye orbits, similar to glasses. A fracture of the temporal bone is manifested by bruising in the mastoid process.

A progressive pathological condition after injury is. In this case, the trunk is displaced and pinched and life-threatening disorders develop. More often, such problems occur with bruises. Brain tissue is compressed by intracerebral and intraventricular hematomas. Pressure can be exerted by broken bones, hygromas, and air accumulations in the skull.

After a clear interval, during which the person feels well, a dangerous clinical picture develops. Focal and stem symptoms develop, consciousness is impaired.

Diffuse axonal damage is observed. In this case, axonal fibers and myelin sheaths are torn. This can happen even with minor injuries. Clinically, this condition is manifested by fainting lasting longer than six hours in the absence of a specific lesion. After injury, swelling occurs, which leads to increased intracranial pressure.

Providing first aid

TBI is a dangerous condition that can lead to the death of the victim. Therefore, it is important to help him before the doctor arrives.

If a person has suffered a head injury, then it is necessary:

Place in a horizontal position and check breathing and pulse.
If the patient is unconscious, then he should be placed on his side, so that in case of nausea, vomit does not enter the respiratory tract, and also to prevent the tongue from sticking.
Apply a bandage to the damaged area.
When an open head injury is observed, first wrap the edges of the wound with bandages, after which they begin to apply the bandage itself.

It is imperative to call a medical team when heavy bleeding, bleeding from the ears and nose, confusion or loss of consciousness, difficulty breathing, weakness in the limbs, convulsions, unclear speech, and repeated vomiting.

If an open injury occurs, an ambulance should be called immediately. Even if the patient feels well, he needs to visit a traumatologist.

Under no circumstances should you:

plant the victim;
lift the patient;
leave it unattended;
do not consult a doctor.

First aid for a traumatic brain injury will help reduce the risk of complications.

Diagnostics

The diagnosis process consists of:

Identifying the circumstances of the injury.
Clinical assessment of the patient's condition.
Research of internal organs.
Neurological examination.
Echoencephaloscopy.
X-rays of the skull.
Computer and magnetic resonance imaging.
Ophthalmological examination of the fundus.
Lumbar puncture. It is prescribed to all patients in the acute period, except for those with increased intracranial pressure.

The diagnosis is made based on the nature and type of damage, the presence or absence of compression, hemorrhages, intoxication and other features.

Treatment

It is important to carry out treatment immediately after damage. If all manipulations are performed correctly, the chances of survival and recovery increase. After the ambulance arrives, the patient is hospitalized. After determining the nature and severity of the damage, therapy is prescribed.

If a person has suffered a minor injury, he is prescribed medications to relieve pain and recommend proper rest.

In difficult situations, they begin with recovery respiratory function(if it is violated). The patient may be placed on a ventilator. If the wound is small, then apply a bandage; in serious cases, stitches may be applied.

Serious damage requires surgical intervention, including removal of foreign objects, fragments, craniotomy and more.

Subsequently, they resort to drug treatment, with the help of which they restore and maintain basic indicators, return or stabilize the patient’s consciousness. When you manage to cross acute phase, move on to further rehabilitation.

The duration of the recovery period and its success depend on the severity of the injury and the correctness of the selected treatment.

Rehabilitation

After discharge from the hospital, the victim must undergo a rehabilitation course, which includes:

restoration of self-care skills;
elimination of speech disorders;
restoration of motor functions;
correction of pain syndrome;
psychological adaptation to new living conditions.

The person must be under the supervision of a traumatologist and neurologist. A rehabilitation specialist is involved in drawing up a treatment program.

Possible complications and prognosis

Traumatic brain injury can have very serious consequences. Such damage is considered the most dangerous and life-threatening person. This condition leads to the development of complications that may not appear immediately, but after a certain time:

Impaired cognitive functions. This happens even with minor injuries. The patient suffers from confusion, decreased intellectual abilities, attention and memory. Moderate and severe injuries lead to amnesia, deterioration of hearing and vision, and decreased performance.
Deterioration of speech and swallowing skills. This occurs with moderate to severe injuries. In severe cases, after injury, the patient's speech becomes slurred or completely lost.
Impaired motor skills and musculoskeletal functions. Moderate injuries lead to seizures and paralysis of the neck muscles. Severe injuries lead to partial paralysis of the patient, loss of sensitivity, paresis of the limbs, and failure to coordinate movements. Even with mild injuries, headaches occur, which often become chronic. This happens especially often in cases of severe and moderate injuries.
Deterioration of psychological state. Severe traumatic brain injuries lead to similar consequences. Violations are observed not only in connection with injuries. The deterioration of body functions, partial or complete loss of ability to work causes strong feelings in the patient, which is why he suffers from apathy, irritability, and depression.

Statistics show that most injuries occur in the home. These include beatings and fights. Most often the head is injured during a fall. In 70% of cases, victims end up in hospital in drunkenness, which makes treatment much more difficult. 15% of people admitted to a medical facility are diagnosed with severe head injuries.

What the forecast will be depends on many factors. This is influenced by the severity of the injury, the speed and correctness of the assistance provided. The success of recovery directly depends on the age of the patient. Young victims are more likely to full recovery and preservation of brain function.

Traumatic brain injury (TBI) is a combination of contact-type injuries (in which the soft tissues of the face, its skeleton or skull are affected) and intracranial (the membranes and substance of the brain are affected), which appeared simultaneously under the influence of the same factors.

Most often, traumatic brain injuries are the result of mechanical force on the neck or head. Possible causes of TBI include:

car crashes(road accident) with an unfixed position of the passenger or driver;
sudden acceleration of the human body;
hit, caused by a hard object;
significant compression of the head(compression);
birth process;
alcoholism(alcohol consumption significantly increases the risk of injury in any situation).

Traumatic brain injury in these cases reaches a level of 25–30%. Under the influence of negative external influences, a chain of pathological reactions occurs, destroying connections between intracerebral structures and leading to organic changes in brain tissue.

Classification

According to the main classification used, TBI can be:

light;
moderate severity;
heavy.

To determine which of these groups the patient's injuries belong to, specialists use the Glasgow Coma Scale. According to it, the victim can be given from 3 to 15 points, which reflects the level of preservation of consciousness.

To determine this indicator, the doctor must track how a person’s eyes open, how well he speaks, moves, and reacts to stimuli. If the score is less than 8, the patient is diagnosed with severe TBI, from 9 to 12 – moderate, and more high values talk about availability light form pathology.

Traumatic brain injuries are also divided into:

isolated(only the head is affected under the influence of one factor);
combined(damage to other organs is detected);
combined(formed under the influence of several types of traumatic factors).

Depending on the nature of the damage caused to the central nervous system, there are 3 more types of TBI:

Focal lesion(only one area of the cerebral cortex is affected; injury occurs during a concussion).
Diffuse axonal injury(it affects the white medulla and appears with bruises of the brain).
Combined lesion(marked by multiple injuries to the brain, blood vessels, etc.).

Clinical forms

Based on the degree of penetration, there are two types of TBI: closed and open.

Closed head injuries

With closed traumatic brain injury (CTBI), skin damage may be observed, but the aponeurosis (wide tendon plate) remains intact. That is, the message between external environment and there is no intracranial cavity (no cracks or bone fractures).

Closed clinical forms of TBI include:

concussion (CM);
Accompanied by neurological disorders. Fainting is possible, but not necessary. If loss of consciousness did occur, then its duration, depth and subsequent memory impairment will indicate the severity of the injury.
In number nonspecific symptoms pathologies include: pale skin, disturbances in the functioning of the heart, nausea, turning into vomiting. The following symptoms may occur: headache, unusual behavior, cognitive problems, excessive sleepiness.
Symptomatic manifestations concussions last no longer than 1.5 weeks. If this is not true, then we are talking about more serious damage(although some signs of pathology may persist for a month even with a normal concussion).
GM injury;
This injury is the result of the brain hitting the inside of the skull. It is two-sided: on one side, the affected area coincides with the place where it was external influence, and on the other (opposite) - it corresponds to the point where the impact occurred at the moment of braking of the head movement. That is, one incident causes double harm.
The following clinical picture is typical for a bruise: altered psycho-emotional state, anxious arousal, confusion, feeling of increased drowsiness.
compression of the GM.
As a result of the injury, an intracranial hematoma appears, which can be located between the walls of the skull and the dura mater, under it, as well as in any part of the brain. As it expands, it begins to put pressure on adjacent tissues, gradually worsening the victim’s well-being.

Despite possible absence in cases of obvious head trauma external manifestations, this is not a reason to ignore the severity of a person’s condition. In any case, you should definitely consult a doctor.

Open TBI

With open injuries (TBI), the integrity of the skin and aponeurosis is disrupted. The wound reaches the bones of the skull or deeper. When the dura mater of the brain is damaged, the damage is classified as penetrating.

There are two main types of TBI:

Fracture of the vault or base of the skull accompanied by soft tissue injuries.
Fracture of the base of the skull with damage to blood vessels in local areas of the brain:
anterior cranial fossa(ear and nose bleeding are noted);
anterior and middle cranial fossa(cerebrospinal fluid leaks from the ears and nose, and the victim loses hearing and smell);
periorbital region(characterized by the expressive “symptom of glasses”).

In addition, TBI can be classified as non-gunshot and gunshot injuries, depending on the factor that provoked its occurrence.

Symptoms

Typical signs of TBI are:

ruptures of the skin and other soft tissues;
fainting;
external hematomas;
attacks of vomiting and nausea;
pale skin;
headaches and dizziness;
memory loss;
increased irritability and aggressiveness;
inhibited perception of information coming from outside and slow reactions;
tinnitus;
impaired coordination and convulsions;
drowsiness or state of stupor (immunity to weak stimuli);
delusions and hallucinations;
paralysis (with damage to a significant part of the cortex of one of the hemispheres of the brain);
visual disturbances that occur due to injuries to the back of the head (strabismus appears, a feeling that objects are double);
changes in respiratory and heart rhythm;
high level of intracranial pressure;
muscle weakness and sensory problems (numbness).

Also, the development of TBI often occurs with disturbances of consciousness in the form of confusion, stupor (a condition in which only reflex reactions remain intact), and deep coma.

TBI in children

Head small child disproportionately large relative to the body, the back of the head protrudes, and the muscles cervical region not yet strong enough. All this interferes with maintaining balance and increases the likelihood of TBI. In addition, the bone plate of a child’s skull is still too thin, and the degree of myelination of the brain is insufficient, so the resulting damage has a much greater impact on the baby’s health.

However, recovery child's body occurs much faster than in adults. This applies to a greater extent to newborn infants (who were injured during childbirth) and one-year-old children whose skull bones have not yet fused, which means that it can expand in case of swelling or bleeding, reducing pressure on the cerebral (brain) tissue.

First aid

To provide first aid at home and preserve the victim’s chance of life, you must perform the following steps:

Immediately call an ambulance.
If a person is unconscious, then turn him over on his stomach and tilt his head down(this will prevent blood or vomit from entering the respiratory tract).
If the victim is not breathing, provide the simplest artificial ventilation lungs(“mouth to nose (mouth)”).
Bandage all bleeding areas of the body.

After completing the procedures, all that remains is to wait for the specialists to arrive. During this time, if the victim has regained consciousness, it would be useful to evaluate:

pupils (dilated, vary in size or squint);
color of the skin;
body temperature;
blood pressure level;
heart rate.

All data obtained must be provided to the doctor when he arrives. This will help him quickly assess the patient’s condition.

Instrumental and laboratory diagnostics

The accuracy of diagnosis for TBI can only be guaranteed by using instrumental research methods. One of the frequently used diagnostic methods is non-contrast computed tomography(CT), which can detect fractures, swelling and acute bleeding, and also determine the level of intracranial pressure and brain stem dislocation.

In addition, it is possible to use radiography, which allows you to diagnose the presence of bone tissue damage. However, it does not provide any insight into the state of the brain itself.

Additional information about the victim’s health can be obtained through a number of laboratory tests:

electrolyte analysis;
glucose level detection(if the patient loses consciousness, is in a state of stupor or coma);
general blood test.

The examination stage for serious TBI is carried out simultaneously with the provision of emergency care.

Course of the disease

Development pathological condition TBI occurs in three stages:

The sharpest.
All observed changes are a direct consequence of the influence exerted by damaging factors. Overt and hidden symptoms will depend on the severity of the injuries received, the presence of cerebral edema, as well as other wounds and damage to the human body. This period lasts at least two weeks.
Intermediate.
During the second stage, the injured nerve tissue begins to return to normal, and with it the previously lost functions of the central nervous system return. Regenerative, adaptive and compensatory mechanisms. As a result, a person largely adapts to his condition, even with severe TBI. This is a longer period: for mild to moderate injury - about 6 months, in the case of severe TBI it will take at least a year.
Final(stage of long-term consequences).
This period is also called the recovery period. Its duration can be more than two years. During the final stage, many patients develop post-traumatic encephalopathy (non-inflammatory organic brain damage). In this case, neurological treatment will be required. If it is correct and timely, the central nervous system will completely return to normal or adapt.

Only after the completion of the third stage can we talk about the patient’s recovery.

Treatment

Pathologies of this type often lead to long-term nervous disorders and are difficult to treat. In case of TBI, treatment is aimed, first of all, at eliminating not primary, but secondary damage (those that arose after the injury to the brain). The therapy process itself includes two stages:

provision of first aid;
treatment in a hospital setting.

During initial examination The doctor most carefully evaluates the following indicators:

airway patency;
mobility of the cervical spine;
features of respiratory and heart rhythms.

The most detailed medical history is also compiled (based on data obtained from the patient himself or witnesses to the incident). If the victim faints, then hospital treatment is mandatory. This will prevent most possible complications.

The neurosurgeon decides how to treat the patient. If a specialist of this profile is not in the clinic, the appropriateness of surgical intervention is assessed by a traumatologist.

If surgery is not needed, then the treatment course will include only conservative methods, including the use medications. This therapy is aimed primarily at eliminating the symptoms of TBI.

It may be necessary to use drugs that improve the functioning of the cardiovascular system, and after the acute period is over, vitamin therapy will help to fully recover.

The use of traditional methods of treatment and homeopathy for traumatic brain injuries is allowed only during the recovery period and only with the permission of a specialist. The entire initial post-traumatic stage should be carried out in a hospital setting under the constant supervision of doctors.

Even if the patient feels that his health has improved significantly, he should not leave the clinic without the approval of doctors. It's possible that good condition is the result of a “light” period characteristic of TBI, after which the patient becomes significantly worse and again requires emergency medical care.

Rehabilitation

The rehabilitation stage is usually necessary for those individuals who have suffered a severe TBI. They have to restore basic skills (the ability to walk, talk, perform minimal self-care).

To achieve this, all possible means are used:

physiotherapy;
massage, including those carried out independently;
Exercise therapy(physiotherapy);
speech therapy classes;
manual therapy (acupressure performed by hand).

However, even with active and regular implementation of these procedures, damaged functions will be restored extremely slowly. The feasible help of loved ones will be a serious help.

In this case, there is no need to take on all the responsibilities around the house if the patient is able to at least partially perform them himself. It is much more important to provide him with regular everyday communication and emotional support.

Forecast

The prognosis for TBI is largely determined by the type and severity of injuries received. A minor injury is regarded as conditionally favorable. It is possible that for complete rehabilitation with such a diagnosis, practically no medical assistance will be required. With severe TBI, the picture is the opposite.

For absence serious consequences children can count younger age, as well as patients with scalped head wounds (when there are only injuries to the skin), concussions and minor skull fractures.

However, with high-risk injuries (hemorrhage, diffuse edema, secondary pathologies, severe fractures or brain stem dislocation) and the simultaneous absence medication assistance the most likely consequences of damage are death or disability. Death is possible even in the later stages of treatment due to complications caused by purulent infections (pneumonia, meningoencephalitis, etc.).

In some cases, TBI becomes the cause of infectious diseases of the brain, irreversible disorders of memory, behavior and mental development(most often observed when affecting the frontal lobes of the brain).

Bottom line

Knowledge of the causes of traumatic brain injuries, the stages of development of subsequent pathological process and possible complications will allow a person who has suffered from damage to brain structures to preserve all functions of the central nervous system to the maximum extent or restore them in as soon as possible. The main thing to remember is that TBI cannot be cured at home. For head injuries of any severity, seeking medical attention is strictly necessary.