Traumatic brain injuries, even mild ones, can pose a serious threat to human health. That is why the sooner the patient gets into the hands of an experienced specialist, the more chances for a speedy recovery. The treatment of traumatic brain injury depends on many factors: the severity, age of the patient and the presence of other injuries and diseases.

Principles of therapy

With a 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 are necessarily hospitalized in the Department of Neurosurgery, where the doctor performs the initial diagnosis and assessment of the condition. 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 of the course of the disease, since not only 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 paramedics arrive - most people with TBI have multiple fractures and spinal injuries. Also, with open injuries, it is impossible to pull out fragments of the skull or foreign objects - only specialists can carry out such manipulations.

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, as a rule, stay in the hospital for no more than a day. If nothing threatens their condition, then after receiving 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 shown to the attending physician once a week. Patients with severe injuries for a long period are in stationary conditions. 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 during an accident, due to fights, falls or blows to the head. Such damage can be of a different nature: mild, moderate or severe, open or closed, with or without hemorrhage. According to the nature of the injury, the doctor determines how to treat each patient, and individually selects a treatment regimen.

Patients with brain contusion are treated only in stationary conditions, since the consequences of such injuries can cause serious harm to health. Patients with mild and moderate degrees are treated in intensive care units, and patients with severe trauma in the first days are in intensive care under the supervision of specialists.

In most cases, the treatment of a brain injury does not require surgery. First of all, it is necessary to restore such vital functions as breathing and blood circulation. To establish respiratory function and prevent asphyxia and oxygen starvation, oxygen inhalations are carried out. If the patient is not able 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. Bruising increases intracranial pressure, so the head of the patient's bed should be slightly elevated. To relieve swelling and normalize pressure, diuretic drugs are prescribed, for example: Furosemide or Lasix.

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

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

In rare cases, 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 trepanation and removal of the damaged area.

Help with Concussion

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

Mild concussion in adults is a condition that is rarely accompanied by complications. In many cases, no specific treatment is needed other than pain medication, sedatives, and bed rest.

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

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

In childhood, concussions of the brain are observed by specialists within 1-3 days, and if the child's condition does not cause concern, then he is released for outpatient treatment. It is very important for any blow to the head to show the child to the doctors to make sure that nothing threatens his health. A missed concussion can lead to impaired 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.
With residual neurosis, tranquilizers are prescribed: Afobazol, Phenazepam, Grandaxin, Rudotel.

Less often, concussions are prescribed drugs that promote blood microcirculation (Cavinton, Trental) and drugs with nootropic and neuroprotective effects. Especially often, such funds are prescribed in childhood and old age to help the brain cope with the residual effects after an 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 drugs that improve vascular tone and elasticity, as well as anti-sclerotic treatment that reduces cholesterol deposition on damaged vessels.

Treatment of severe injuries

The most severe TBIs are cerebral compression, diffuse axonal injury, brainstem ruptures, and intracranial hemorrhages. It is with such defeats that the score goes not only for hours and, but also for minutes. The life of the patient and whether he will be able to lead a normal life 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 injuries: 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 the acute condition is removed, patients who have suffered severe lesions are prescribed drugs that allow normalizing blood circulation in the vessels of the brain and restoring lost functions. The most effective drugs are Cortexin, Cerebrolysin, Mexidol and Actovegin. These funds not only nourish the brain tissue, but also relieve the effects of hypoxia, restore speech and other cognitive functions.

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

home remedies

For traumatic brain injuries, treatment at home should be carried out only after visiting a doctor, and make sure that life and health are not in danger. Principles of treatment at home:

At home, you can treat only a concussion and a mild bruise, or undergo recovery after discharge from the hospital.
Observe bed rest.
Exclude vigorous activity.
You can not watch TV, read and use a computer for at least three days.
Protect the patient from irritating factors: bright light, noise, unpleasant odors.
Exclude heavy foods from the 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.

Head injuries are not treated with folk remedies, but they can be used to eliminate unpleasant consequences, for example: dizziness, weakness, insomnia, lack of appetite. What can be taken:

It should not be forgotten that even mild traumatic brain injuries require a doctor's examination, and after discharge, it is necessary to see a specialist 2 times a year. In childhood, after 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 head injury in which the contents of the cranium (the brain, blood vessels and nerves, meninges) and the bones of the skull are damaged.

The peculiarity of this pathology is that after an injury, a number of complications may occur, to a greater or lesser extent affecting 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 the victim was assisted by a neurologist or neurosurgeon.

The following article aims to present in an 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 idea of the severity of this problem, and also get acquainted with the algorithm of urgent actions in relation to the victim.

Based on the experience of the world's leading neurosurgical clinics, a unified classification of traumatic brain injuries has been created, taking into account both the nature of brain damage and its degree.

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

A head injury accompanied by a mechanical injury to other systems or organs is called combined. Under the combined understand the damage that occurs when the victim is exposed to several pathological factors - thermal, radiation, mechanical effects, and the like.

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 does not have 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, depending on whether the integrity of the dura mater has been violated. Note that the volume of brain and cranial nerve damage does not determine the clinical affiliation of the injury.

Closed TBI has the following clinical variants:

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

Grades of severity of TBI

Depending on a complex of factors, a head injury can have one of three severity levels that determine the severity of a person's condition. So, the following severity levels are distinguished:

mild degree - concussion or minor bruising;
medium degree - with chronic and subacute compression of the brain, combined with brain contusion. With an average degree, the consciousness of the victim 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 skull bones.

As can be seen from the foregoing, the absence of pronounced defects in the head and bones of the skull 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 an urgent consultation with a neurologist or neurosurgeon to provide timely assistance.

Head injury symptoms

Although a head injury of any severity and under any circumstances requires urgent medical advice, knowledge of its symptoms and treatment is mandatory for every educated person.

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

Cerebral symptoms and syndromes. This symptom complex is characterized by:

loss of consciousness at the time of injury;
headache (stabbing, cutting, squeezing, girdle);
impaired consciousness some time after the injury;
nausea and/or vomiting (possible bad taste in the mouth);
amnesia - loss of memories of incidents that preceded the incident or followed it, 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, trunk, and so on, can suffer.

The specific localization of the focus always causes certain symptoms, while 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 the auricle, but 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 of the facial nerve on the injured side.

Grouping individual features

Classification focal signs are combined into the following groups:

visual (with damage to the occipital region);
auditory (with damage to the temporal and parietal-temporal area);
motor (with the defeat of the central departments, up to pronounced motor disorders);
speech (Wernicke and Broca center, frontal cortex, parietal cortex);
coordinating (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 classical examination algorithm is able to accurately determine the topic of focal lesions and their impact on the future quality of life, so never neglect seeking help in case of a head injury!

Syndrome of autonomic dysfunction. This symptom complex occurs as a result of damage to the autonomic (automatic) centers. Manifestations are extremely variable and depend purely on the specific center that has been damaged.

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

Classically, the following variants of autonomic disorders are distinguished:

violation of the regulation of metabolism;
changes in the functioning of the cardiovascular system (possible bradycardia);
dysfunction of the urinary system;
changes in the functioning of the respiratory system;
disorders of the gastrointestinal tract.
to their altered state of mind.

Mental disorders, which are characterized by changes in the human psyche.

Most often it is:

emotional disorders (depression, manic arousal);
twilight clouding of consciousness;
violation of cognitive functions (decrease in intelligence, memory);
personality changes;
the occurrence of productive symptoms (hallucinations, delusions of a different nature);
lack of critical

Please note that the symptoms of TBI can be both pronounced and invisible to the layman.

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

TBI diagnostics

Diagnosis of craniocerebral lesions includes:

Interrogation of the patient, witnesses of the incident. It is determined under what conditions the injury was received, whether it is the result of a fall, collision, impact. It is important to find out if the patient suffers from chronic diseases, whether there were previous TBI, operations.
Neurological examination for the presence of specific symptoms characteristic of a lesion of a particular area of the brain.
Instrumental methods of diagnostics. After a head injury, everyone, without exception, is assigned an X-ray examination, if necessary, CT and MRI.

Principles of therapy for TBI

There are two main approaches to managing patients with the consequences of a head injury: surgical and therapeutic. The period of treatment and the approach to it is determined by the general condition of the patient, the severity of the lesion, its type (open or closed TBI), localization, individual characteristics of the organism, 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 injury

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

Acute, or initial, which lasts for 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.
Long-term consequences of TBI, or residual period - from a year to the end of the patient's life.

Complications after TBI vary depending on the stage, severity and localization 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 a head injury as vegetative-vascular dystonia. VVD 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 craniocerebral injuries that are not accompanied by damage to the bones of the skull, complications occur more often than with a fracture.

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

Syndrome of CSF hypertension usually occurs two to three years after suffering a brain injury. The main symptoms of this disease are severe headaches of a bursting nature.

The pains are permanent and intensify at night and in the morning, because in a horizontal position the outflow of cerebrospinal fluid worsens. The feeling of nausea, periodic vomiting, severe weakness, convulsions, increased heart rate, jumps in blood pressure, and prolonged hiccups are also characteristic.

The characteristic neurological symptoms of traumatic brain injury are paralysis, impaired speech, vision, hearing, and smell. Epilepsy is a frequent complication of traumatic brain injury, which is a serious problem, as it is poorly amenable to drug treatment and is considered a disabling disease.

Mental disorders

Among mental disorders after TBI, amnesia occupies the most important place. They occur, as a rule, in the initial stages, in the period from several hours to several days after the injury. Forgetting may be events that precede the trauma (retrograde amnesia), following the trauma (anterograde amnesia), or both (anteroretrograde amnesia).

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

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

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

A few months after the incident, mental disorders of the type of depression often occur, patients complain of a depressed emotional state, a lack of desire to perform those functions that they previously performed without problems. For example, a person is hungry, but cannot force himself to cook something.

There are also various changes in the personality of the victim, most often of the hypochondriacal type. The patient begins to worry too much about his health, invents illnesses that he does not have, constantly turns to doctors with a demand to conduct another examination.

The list of complications of traumatic brain injury is extremely diverse and is determined by the characteristics of the injury.

Prognosis of traumatic brain injury

Statistically, about half of all TBI survivors make a full recovery and return to work and normal household chores. About a third of the victims become partially disabled, and another third lose their ability to work at all and remain severely disabled for the rest of their lives.

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

Rehabilitation measures must begin immediately, immediately after the patient exits the acute stage of the disease. This includes: working with a specialist to restore cognitive functions, stimulation of motor activity, physical therapy. 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 factor in predicting the outcome of TBI treatment 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 damage to be frivolous.

Under such circumstances, the effects of traumatic brain injury are manifested in a much more pronounced degree. People who are more severely injured after a TBI and seek help right away are much more likely to make a full recovery than those who suffered mild damage but chose to stay at home. Therefore, at the slightest suspicion of TBI in yourself, your relatives and friends, you should immediately seek medical help.

It is possible to undergo rehabilitation after a traumatic brain injury on credit. An untreated craniocerebral injury can subsequently lead to constant headaches and failures of intracranial pressure. To avoid complications after TBI and restore all body functions, it is recommended to undergo mandatory rehabilitation procedures. How to speed up the recovery of health after a sports injury and return to full training?

Traumatic brain injury (TBI): treatment and rehabilitation

Risk is an integral part of our life. Often, we are not even aware of it. Few people during a car trip think about a possible accident, in the midst of work - about unquestioning observance of safety regulations, while playing sports - about injuries. One of the most common injuries are head injuries, and a considerable percentage of the victims are athletes who have received a head injury during competitions or even in training.

TBI classification

It would seem that a strong skull is a reliable protection for the most important human organ. But, nevertheless, craniocerebral injuries are the most common type of damage, and mostly people under 50 years of age are subject to them.

Traumatic brain injury, or TBI, is mechanical damage to the soft tissues of the head, directly to the cranium and facial bones, as well as brain tissues. There are several classifications of craniocerebral injuries depending on their nature. So, according to the severity lungs , medium and severe injuries . In severe TBI, the patient is observed to lose 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 injury. The first is 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 with the preservation of the aponeurosis and bone; in others, the tightness of the skull is broken and the dura mater is damaged.

Open and closed injuries have different 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 bruising or swelling of the brain, as well as bone fragments during a fracture.
brain contusion, in which there is a lesion and necrosis of a certain area of \u200b\u200bthe brain tissue. 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 sharp 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 that causes damage to the nervous tissue and displacement of brain structures.

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

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

Sequelae of traumatic brain injury

Craniocerebral injuries are one of the most common causes of disability and death in general traumatology (up to 40% of the total). But the consequences of an injury cannot always be predicted: sometimes, it would seem, a slight concussion can lead to a sad outcome, and extensive penetrating injuries end in the recovery of the patient.

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

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

Long-term effects of traumatic brain injury are observed for a long 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 a brain injury

Timely diagnosis allows you to provide the necessary medical care in time and prevent the development of severe consequences of injury and complications. To do this, you need to pay attention to the signs of the presence of TBI and even if they are suspected, immediately call an emergency ambulance team.

Symptoms of skull and brain injuries:

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

In the presence of any of the signs of a traumatic brain injury or their complex, it is necessary, as already mentioned, to deliver the victim to the hospital, where he will be provided with the necessary assistance.

TBI treatment

The treatment of brain injuries proceeds in two stages: first aid (first aid or medical) and subsequent observation of the patient in the clinic, and then in the hospital. Primary measures will 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 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 (administration 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 hospital treatment ranges from 10 days (for bruises and mild concussions) to several months (for severe head injuries).

Rehabilitation after head injuries

The period of rehabilitation after TBI is no less important than the stage of intensive treatment, since it is the recovery course that makes it possible to avoid complications after trauma and repeated brain damage. Also, during the 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 to return to a full life in the family and society.

After discharge from the hospital, many patients do not consider it necessary to undergo an additional course of rehabilitation treatment in a sanatorium or a specialized clinic, believing that all the conditions necessary for rehabilitation can be provided at home. However, it is more advisable to spend some time in a specialized center, under the supervision of specialists: neurologists, physiotherapists, occupational therapists, and psychologists. Thus, the patient will be able not only to more effectively restore cognitive skills and mobility, but also to undergo the necessary socialization, adaptation to new living conditions for him. 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 diagnosed or treated incorrectly, can lead to disability or death of a person. 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 get a rehabilitation course after a traumatic brain injury?

In our country, until recently, little attention has been 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 deal with the rehabilitation of 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 sanatorium conditions undergo a course of post-hospital treatment after TBI under the supervision of qualified doctors and medical personnel. A neuropsychologist is constantly working at the center, who helps victims of brain injury regain all their lost skills and correct mental processes. All conditions for a quick and comfortable recovery of physical and emotional health are created here: medical procedures are interspersed with walks in the fresh air and recreational activities, in which both animators and psychologists with patients take part. The chefs of the Three Sisters restaurant prepare exceptionally healthy and tasty dishes, taking into account the diet recommended for each patient, and you can dine with the guests - the center is open to relatives and friends of its customers.

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 easy the injury may seem - a small bruise, a concussion - you should consult a doctor in any case. If we are talking about a serious injury, then an emergency call is necessary as soon as possible. Until the doctors arrive, it is necessary to constantly monitor the victim's breathing, to prevent the flow of liquids (saliva, vomit, blood) into the respiratory tract - for this it is necessary 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 brain dysfunction.

What is this problem

Traumatic brain injuries are considered mechanical damage in which the skull, its nerves, tissues and blood vessels are disturbed. Such violations are very common, 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 with severe tissue damage, brain function cannot be fully restored. This is the reason for the high mortality and frequent disability of the victims.

CMT: classification

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

Concussions.
bruises.
Squeezing. (With edema of brain tissue, internal, pressure of bone fragments of the cranial vault, accumulation of fluid under the hard shell, extensive foci of contusion, accumulation of air in the cranial cavity).
Severe axonal diffuse lesions.

Given the absence or presence of a violation of the integrity of the head, infection inside or the likelihood of air accumulation in the cranial cavity, injuries are:

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

Open injuries, in turn, can be:

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

Depending on the combination of craniocerebral 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, there are:

Light severity. The patient's condition remains satisfactory, the clarity of consciousness does not change, there are no violations of important brain functions, neurological symptoms are completely absent, primary focal symptoms are mild. With proper treatment, there is no threat to life. The victim can count on a quick recovery.
Average degree. Consciousness remains clear or moderately deafened. There are no violations of vital functions, in some cases a decrease in the frequency of heart contractions is observed. There are hemispheric or cranial symptoms. If properly treated, then the threat to life is small. Work capacity is restored in most cases.
Heavy. The victim is in a state of deep stupor or stupor. There is a violation of vital functions. Focal symptoms are pronounced. There are moderate manifestations of pyramidal insufficiency, pupillary reactions decrease, pupil size becomes different. Clear severity of hemispheric and craniobasal symptoms. This manifests itself in the form of epileptic seizures and serious motor disorders up to paralysis. The danger to life is very great. Working capacity is restored in rare cases.
Extremely heavy. The patient falls into a coma, vital signs are grossly violated. There is a presence of stem symptoms in the form of a sharp weakening of the reaction of pupils to light, divergence, 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 stays in a coma. It's almost impossible to get back to work.
terminal state. The patient is in a terminal coma. All vital functions are critically impaired. There are no pupillary and corneal reflexes. Cerebral and stem disorders are observed. It is impossible to survive in such a situation.

Symptoms in different forms of TBI

A concussion is a functionally reversible disorder. This condition is manifested by cerebral symptoms. In mild cases, the victim loses consciousness for a few seconds or minutes. There is some stupor, problems with orientation in time, place, consciousness narrows, it is difficult to perceive the world around.

In frequent cases, retrograde amnesia is diagnosed, that is, the patient does not remember the events that occurred before the injury. Rarely, anterograde amnesia is observed, in which memories of events after the injury fall out. 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 show uneven reflexes, oral automatism.

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

fluctuations in blood pressure;
the 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, they arise.

With a slight bruise, consciousness turns off for several minutes. After the victim comes to his senses, he begins to hurt and feel dizzy, he is worried about nausea with vomiting, manifestations of retrograde and anterograde amnesia. In some cases, arterial pressure and heart rate increase, but these deviations are moderate.

With moderately severe bruises, a person can lose consciousness for several hours. After that, the head hurts, repeated vomiting is observed. In some cases, mental disorders develop. Some functions of the body are disturbed, 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, the sensitivity and movement of the eyes are disturbed, limbs become paralyzed, and other symptoms occur.

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

In the case of skull fractures and subarachnoid hemorrhages, the neck is often very sore.

A severe contusion of the brain is manifested, first of all, by a prolonged loss of consciousness. In this state, the victim may be several days or weeks. The symptoms of a brain injury will be as follows:

impaired motor function of the limbs up to paralysis;
decreased muscle tone;
there are attacks of epilepsy;
there are violations of reflexes of oral automatism and others.

There is a slow development of focal symptoms. Residual effects often appear. Usually this applies to 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 recognized by the flow of cerebrospinal fluid from the nose or ears. If the cranial fossa is damaged, then hematomas occur in the area of \u200b\u200bthe eye orbits like 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 infringed and life-threatening disorders develop. Most often, such problems occur with bruises. Brain tissues are compressed by intracerebral and intraventricular hematomas. Pressure can be exerted by broken bones, hygromas, accumulations of air in the skull.

After a light interval, during which a person feels good, a dangerous clinical picture is growing. Focal and stem symptoms develop, consciousness is disturbed.

Diffuse axonal lesions are observed. In this case, axonal fibers and myelin sheaths are torn. This can happen even with minor injuries. Clinically, this condition is manifested by syncope lasting longer than six hours against the background of the absence of a specific lesion. After injury, edema 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 a head injury, then it is necessary:

To give a horizontal position, check breathing and pulse.
If the patient is unconscious, then it should be laid on its side so that in case of nausea the vomit does not get into the respiratory tract, and also to prevent the tongue from sinking.
Apply a bandage to the damaged area.
When an open craniocerebral injury is observed, the edges of the wound are first wrapped with bandages, after which they begin to apply the bandage itself.

It is imperative to call a medical team in case of heavy bleeding, blood from the ears and nose, confusion or loss of consciousness, respiratory failure, weakness in the limbs, convulsions, slurred speech, repeated vomiting.

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

In no case should you:

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

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

Diagnostics

The process of making a diagnosis consists of:

Identification of the circumstances of the injury.
Clinical assessment of the patient's condition.
Research of internal organs.
Neurological examination.
echoencephaloscopy.
X-ray of the skull.
Computed and magnetic resonance imaging.
Ophthalmological examination of the fundus.
Lumbar puncture. It is prescribed to all patients in the acute period, except for those who have increased intracranial pressure.

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

Treatment

Treatment is important immediately after injury. If all manipulations are performed correctly, then the chances of survival and recovery increase. After the arrival of the ambulance, the patient is hospitalized. Following the determination of the nature and severity of damage, therapy is prescribed.

If a person has received a minor injury, then he is prescribed drugs to relieve pain and recommend a good rest.

In severe situations, they begin with the restoration of respiratory function (if it is disturbed). The patient may be placed on a ventilator. If the wound is small, then a bandage is applied, in serious cases, stitches can be applied.

Serious injuries require surgical intervention, including the removal of foreign objects, fragments, craniotomy, and more.

In the future, they resort to drug treatment, with the help of which they restore and maintain the main indicators, return or stabilize the patient's consciousness. When it is possible to cross the acute phase, they proceed to further rehabilitation.

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

Rehabilitation

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

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

A person should be under the control of a traumatologist and a neuropathologist. The rehabilitator is in charge of compiling the treatment program.

Possible complications and prognosis

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

Violation of cognitive functions. This happens even with mild injuries. The patient suffers from confusion, decreased intellectual abilities, attention and memory. Moderate and severe injuries lead to amnesia, hearing and vision impairment, and decreased performance.
Deterioration of speech and swallowing skills. This occurs with moderate to severe injuries. In severe cases, after an injury, the patient's speech becomes slurred or completely lost.
Violation of motility and musculoskeletal functions. Moderate injuries lead to seizures, paralysis of the neck muscles. Severe injuries lead to partial paralysis of the patient, loss of sensation, paresis of the limbs, and failures in coordination of movements. Even with mild injuries, headaches are disturbing, which often become chronic. This happens especially often in the case of severe and moderate injuries.
Deterioration of the psychological state. Severe head injuries lead to similar consequences. Violations are observed not only in connection with injuries. Deterioration of body functions, partial or complete disability causes the patient strong feelings, because of which he suffers from apathy, irritability, depression.

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

What will be the forecast depends on many factors. This is affected by the severity of the damage, the speed and correctness of the assistance provided. The success of recovery directly depends on the age of the patient. Young victims have a better chance of a full recovery and preservation of brain function.

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

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

car crashes(accident) with non-fixed position of the passenger or driver;
sharp acceleration of the human body;
hit, applied with a hard object;
significant pressure on the head(compression);
generic process;
alcoholism(consumption of alcohol significantly increases the risk of injury in any situation).

Traumatic brain injury in these cases reaches the level of 25-30%. Under the influence of a negative external influence, a chain of pathological reactions occurs that destroys the connections between intracerebral structures and leads to organic changes in brain tissues.

Classification

According to the main classification used, TBI can be:

light;
moderate severity;
severe.

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 set from 3 to 15 points, which reflects the level of consciousness preservation.

To determine this indicator, the doctor must track how a person's eyes open, how well he speaks, moves, and responds to stimuli. If the score is less than 8, the patient is diagnosed with severe TBI, from 9 to 12 - moderate, and higher values indicate the presence of a mild form of pathology.

Also, traumatic brain injuries are 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, 3 more types of TBI are distinguished:

Focal lesion(only one of the areas of the cerebral cortex suffers, injury occurs during a concussion).
Diffuse axonal injury(it affects the white medulla and appears with bruises of the GM).
Combined lesion(noted by multiple injuries of the GM, blood vessels, etc.).

Clinical forms

According to the degree of penetration, there are two types of TBI: closed and open.

Closed traumatic brain injury

With closed craniocerebral injuries (CTBI), skin lesions can be observed, but the aponeurosis (wide tendon plate) remains intact. That is, there is no communication between the external environment and the intracranial cavity (there are no cracks or bone fractures).

Closed clinical forms of TBI include:

concussion (GM);
Accompanied by neurological disorders. Fainting is possible, but it is not necessary. If loss of consciousness did occur, then its duration, depth and subsequent memory impairment will indicate the severity of the injury.
Among the non-specific symptoms of the pathology are: blanching of the skin, disturbances in the work of the heart, nausea, turning into vomiting. The following signs may be noted: headache, unusual behavior, problems in the cognitive sphere, excessive sleepiness.
Symptomatic manifestations of concussion last no longer than 1.5 weeks. If this is not true, then we are talking about more serious injuries (although individual signs of pathology can last for a month even with a normal concussion).
GM injury;
Such an injury is the result of a blow to the brain on the inner surface of the skull. It has a two-sided character: on the one hand, the affected area coincides with the place where the external impact was exerted, and on the other (opposite), it corresponds to the point where the impact occurred at the moment of deceleration of the head movement. That is, one incident causes double harm.
The bruise is characterized by the following clinical picture: an altered psycho-emotional state, anxiety, confusion, a feeling of increased drowsiness.
squeezing GM.
As a result of trauma, 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. Expanding, it begins to put pressure on adjacent tissues, gradually worsening the victim's well-being.

Despite the possible absence of obvious external manifestations in CTBI, 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 violated. The wound reaches the bones of the skull or deeper. When the dura mater 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 the blood vessels in local areas of the brain:
anterior cranial fossa(marked ear and nosebleeds);
anterior and middle cranial fossa(liquor flows 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;
bouts of vomiting and nausea;
skin blanching;
headaches and dizziness;
memory loss;
increased irritability and aggressiveness;
inhibited perception of information coming from outside and slow reactions;
tinnitus;
incoordination and convulsions;
drowsiness or a state of stupor (immunity to weak stimuli);
delusions and hallucinations;
paralysis (with the defeat of a significant part of the cortex of one of the cerebral hemispheres);
visual disturbances that occur with injuries of the back of the head (strabismus appears, a feeling that objects are doubled);
changes in respiratory and heart rhythm;
high level of intracranial pressure;
muscle weakness and problems with sensation (numbness).

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

TBI in children

The head of a small child is disproportionately large relative to the body, its occiput protrudes, and the muscles of the cervical region are not yet strong enough. All this interferes with maintaining balance and increases the likelihood of TBI. In addition, the bone plate in the child's skull is still too thin, and the degree of myelinization of the brain is insufficient, so the resulting damage affects the health of the baby much more.

However, the recovery of a child's body occurs much faster than an adult's. This is more true for newborn babies (injured during childbirth) and one-year-old children in whom the bones of the skull have not yet fused, which means that it can expand in case of swelling or bleeding, reducing pressure on the cerebral (brain) tissues.

First aid

To provide first aid at home and save the victim a chance for life, you must perform the following steps:

Immediately call an ambulance.
If the 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, to provide the simplest artificial ventilation of the lungs("mouth to nose (mouth)").
Bandage all bleeding areas of the body.

After the performed procedures, it remains only to wait for the arrival of specialists. During this time, if the victim has regained consciousness, it is useful to evaluate:

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

It is possible to guarantee the accuracy of diagnosis in TBI only when using instrumental research methods. One of the commonly used diagnostic methods is non-contrast computed tomography (CT), which can detect fractures, edema and acute bleeding, as well as determine the level of intracranial pressure and brainstem dislocation.

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

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

electrolyte analysis;
detecting glucose levels(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

The development of the pathological condition in TBI occurs in three stages:

Sharpest.
All observed changes are a direct consequence of the influence exerted by damaging factors. Explicit and hidden symptoms will depend on the severity of the injuries, 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 tissues begin to return to normal, and with them the previously lost functions of the central nervous system return. Restorative, adaptive and compensatory mechanisms are noticeably activated. As a result, a person largely adapts to his condition even with severe TBI. This is a longer period: with mild and moderate injuries - 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, post-traumatic encephalopathy (non-inflammatory organic brain damage) is detected in many patients. In this case, neurological treatment will be required. If it is correct and timely, then the central nervous system will completely return to normal or adapt.

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

Treatment

Pathologies of this kind often lead to long-term nervous disorders and are difficult to treat. In case of TBI, treatment is aimed primarily at eliminating not primary, but secondary injuries (those that have arisen after trauma to the brain). The process of therapy itself includes two stages:

provision of first aid;
treatment in a hospital setting.

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

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

The most detailed anamnesis is also compiled (based on data received from the patient himself or witnesses to the incident). If the victim fainted, then inpatient treatment is mandatory. This will prevent most of the possible complications.

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

If the operation is not needed, then the treatment course will include only conservative methods, including the use of medications. Such 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 at the end of the acute period, vitamin therapy will help to fully recover.

The use of folk 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 under the constant supervision of doctors.

Even in the case when the patient seems to feel much better, one should not leave the clinic without the approval of the doctors. It is possible that a good condition is the result of a “light” period characteristic of TBI, after which the patient becomes much worse and again requires emergency medical care.

Rehabilitation

The passage of the rehabilitation stage is usually necessary for those individuals who have received a severe TBI. They have to deal with the restoration of elementary skills (the ability to walk, speak, carry out minimal self-service).

For this, all possible means are used:

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

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

However, it is not necessary to take on all the household duties 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 the injuries received. Minor injury is regarded as conditionally favorable. It is possible that for a complete rehabilitation with such a diagnosis, almost no medical assistance is required. In severe TBI, the picture is reversed.

Young children, as well as patients with scalped head wounds (when only skin damage occurs), concussions and minor skull fractures, can count on the absence of serious consequences.

However, with high-risk injuries (hemorrhage, diffuse edema, secondary pathologies, severe fractures or dislocation of the brain stem) and the simultaneous absence of medical care, the most likely consequences of the injury may be death or disability. A lethal outcome is possible even at the later stages of treatment due to complications provoked by purulent infections (pneumonia, meningoencephalitis, etc.).

In some cases, TBI causes infectious diseases of the brain, irreversible impairment of memory, behavior and mental development (most often observed when exposed to the frontal lobes of the brain).

Outcome

Knowledge of the causes of craniocerebral injuries, the stages of development of the subsequent pathological process and possible complications will allow a person affected by damage to brain structures to preserve all the functions of the central nervous system to the maximum extent or restore them as soon as possible. The main thing to remember is that TBI cannot be cured at home. In case of head injuries of any severity, it is strictly necessary to consult a doctor.