Mental disorders during traumatic brain injury. Traumatic brain injury: features, consequences, treatment and rehabilitation After a traumatic brain injury, I’m very worried about everything

Among possible injuries to areas of the human body, traumatic brain injuries occupy a leading position and account for almost 50% of recorded cases. In Russia, almost 4 such injuries are registered every year per 1000 people. Quite often, TBI is combined with trauma to other organs, as well as parts: thoracic, abdominal, upper and lower extremities. Such combined injuries are much more dangerous and can lead to more serious complications. What are the dangers of a traumatic brain injury, the consequences of which depend on various circumstances?

The consequences of traumatic brain injury are largely influenced by the injuries received and their severity. The degree of TBI is as follows:

light;
average;
heavy.

By type, open and closed injuries are distinguished. In the first case, the aponeurosis and skin are damaged, and bones or tissues located deeper are visible from the wound. When a penetrating wound occurs, the dura mater is damaged. In the case of a closed TBI, partial damage to the skin is possible (not necessary), but the aponeurosis remains intact.

Brain injuries are classified according to possible consequences:

compression of the brain;
head bruises;
axonal damage;
brain concussion;
intracerebral and intracranial hemorrhage.

Squeezing

This pathological condition is the result of voluminous accumulations of air or cerebrospinal fluid, liquid or coagulated hemorrhage under the membranes. As a result, compression of the midline structures of the brain occurs, deformation of the cerebral ventricles, and brain stem infringement. The problem can be recognized by obvious inhibition, but with preserved orientation and consciousness. Increasing compression entails loss of consciousness. This condition threatens not only the health, but also the life of the patient, so immediate help and treatment is required.

Concussion

One of the common complications of TBI is concussion, accompanied by the development of a triad of symptoms:

nausea and vomiting;
loss of consciousness;
memory loss.

A severe concussion can cause prolonged loss of consciousness. Adequate treatment and the absence of complicating factors results in absolute recovery and the return of the ability to work. After the acute period, many patients may experience disturbances in attention, memory concentration, dizziness, irritability, increased light and sound sensitivity, etc. for some time.

Brain contusion

Focal macrostructural damage in the medulla is observed. Depending on the severity of the traumatic brain injury, brain contusion is classified into the following types:

Mild degree. Loss of consciousness can last from several minutes to 1 hour. The person, upon regaining consciousness, complains of severe headaches, as well as vomiting or nausea. Brief blackouts lasting up to several minutes are possible. Functions important for life are preserved or changes are unexpressed. Moderate tachycardia or hypertension may occur. Neurological symptoms are present for up to 2–3 weeks.
Average degree. The patient remains unconscious for up to several hours (possibly several minutes). Amnesia concerning the moment of injury and those events that preceded or already occurred after the injury. The patient complains of pain in the head and repeated vomiting. Upon examination, respiratory distress, heart rate and pressure are detected. The pupils are unevenly enlarged, weakness is felt in the limbs, and there are problems with speech. Menigial symptoms are often observed, likely a mental disorder. There may be temporary disturbances in the functioning of vital organs. Smoothing of organic symptoms occurs within 2–5 weeks, then some signs may still appear for a long time.
Severe degree. In this case, blackout can last for several weeks. Severe malfunctions in the functioning of vital organs are detected. The neurological status is complemented by the clinical severity of brain injury. In severe cases of injury, weakness in the limbs develops to the point of paralysis. There is deterioration in muscle tone, epileptic seizures. Also, such damage is often accompanied by massive subarachnoid bleeding due to a fracture of the vault or base of the skull.

Axonal damage and hemorrhage

Such an injury entails axonal ruptures, combined with hemorrhagic small focal hemorrhages. In this case, quite often the “field of view” includes the corpus callosum, brain stem, paraventicular zones, and the. The clinical picture changes rapidly, for example, coma turns into a transistor and vegetative state.

Clinical picture: how are the consequences of TBI classified?

All consequences of TBI can be classified into early (acute) and long-term. Early ones are those that occur immediately after receiving damage, while late ones appear after some time, perhaps even years later. Absolute signs of head injury are nausea, pain and dizziness, as well as loss of consciousness. It occurs immediately after injury and can last for a variable period of time. Early symptoms also include:

facial redness;
hematomas;
seizure;
visible bone and tissue damage;
liquor leakage from the ears and nose, etc.

Depending on how much time has passed since the injury, the severity of the injuries, as well as their location, various types of long-term consequences of traumatic brain injury are distinguished.

Location of damage	Possible consequences
Temporal lobe	convulsive attacks throughout the body; speech and vision disorder.
Frontal lobe	tremor (shaking) of the upper and lower extremities; slurred speech; unsteady gait, weakness in the legs and possible falls on the back.
Parietal lobe	sharp deterioration of vision up to the formation of blindness; lack of manifestation of sensitive reactions on one half of the body.
Cranial nerve injuries	hearing impairment; pronounced asymmetry of the oval of the face; the appearance of strabismus.
Cerebellar region	nystagmus (involuntary eye movements from side to side); disturbances in coordination of movements; hypotonia of muscle mass; “shaky” gait and possible falls.

Glasgow scale - what to expect from TBI

Doctors usually classify the consequences of traumatic brain injury using a special system - the Glasgow scale. So, the result of the damage received is as follows:

The patient experiences absolute recovery and, as a result, recovery, after which he returns to his usual life and work.
Moderate disability. The patient has mental and neurological disorders that prevent him from returning to work, but his self-care skills are preserved.
The disability is severe. The patient is not capable of self-care.
Vegetative states. Inability to perform certain movements, sleep disturbances and other autonomic symptoms.
Death. Termination of activity of vital organs.

The outcome of the injury can be judged as early as a year after it was received. All this time, rehabilitation therapy must be present, including physical therapy, medication, physiotherapeutic procedures, a vitamin and mineral complex, work with neurologists and psychiatrists, etc.

What determines the severity of TBI and its types?

All, including long-term types of consequences of traumatic brain injury, are subject to many factors:

Nature of injury. The stronger and deeper it is, the greater the likelihood of complications and, as a result, long-term treatment.
Patient's age. The younger the body, the easier it is for it to cope with the injuries received.
Speed of medical care. The sooner the victim is shown to a doctor and the stage of treatment begins, the easier it will be for him to recover.

As already mentioned, there are mild, moderate and severe forms of damage. According to statistics, there are almost no complications with minor injuries in young people aged 20–25 years.

Consequences in mild form

A mild form of head trauma is the most favorable option of all existing ones. Treatment usually does not take much time, and patients recover quickly. All complications are reversible, and symptoms are either early (acute) or last a short time. The following signs can be noted here:

dizziness and headaches;
profuse sweating;
nausea and vomiting;
irritability and sleep disturbance;
weakness and fatigue.

Typically, therapy, after which the patient returns to normal life, takes 2 to 4 weeks.

Consequences in moderate form

Moderate severity is a more serious reason for concern about the patient’s health. Most often, such conditions are recorded with partial brain damage, severe bruise or fracture of the base of the skull. The clinical picture can last for quite a long time and includes symptoms:

speech impairment or partial loss of vision;
problems with the cardiovascular system, or more precisely with heart rhythm;
mental disorders;
paralysis of the cervical muscles;
seizures;
amnesia.

Rehabilitation after a traumatic brain injury can take from 1 month to six months.

Consequences in severe form

Severe injuries are the most dangerous and are the most likely to cause death. Most often, this type of injury is recorded after open skull fractures, severe brain contusions or compression, hemorrhages, etc. The most common type of complication after severe TBI is coma.

According to statistics, every second person in severe cases will experience the following types of consequences:

Partial or complete disability. In case of partial disability, the ability to work is lost, but self-care skills are retained, mental and neurological disorders are present (incomplete paralysis, psychosis, movement disorders). With complete disability, the patient requires constant care.
Coma of varying degrees of manifestation and depth. Coma due to traumatic brain injury can last from several hours to several months or years. At this time, the patient is on artificial life support devices or his organs are working independently.
Death.

Also, even the most effective treatment and a favorable outcome of the measures taken necessarily entail the appearance of the following signs:

problems with vision, speech or hearing;
abnormal heart rhythm or breathing;
epilepsy;
seizures;
partial amnesia;
personality and mental disorder.

They can be combined and appear immediately after a head injury or years later.

It is impossible to give an accurate assessment of the patient’s recovery, because each organism is individual, and there are multiple examples of this. If in one case, even with severe injuries, patients endured rehabilitation with resilience and returned to normal life, then in other situations, even a mild head injury did not have the best effect on the neurological status and health in general. In any case, rehabilitation and psychological support play an important role in cases of traumatic brain injury.

After receiving a head injury, the consequences will depend on the severity of the injury. In some situations, injury can be disabling or fatal. Therefore, it is recommended to learn to recognize the severity of injury and be able to provide first aid. Timely and correct assistance very often helps to avoid serious consequences of a head injury.

According to statistics, about 30% of all traumatic brain injuries occur due to damage to the integrity of the cranium, the brain.

1 Classification of traumatic brain injuries

Traumatic brain injury (TBI) is a complex of contact (soft tissues of the face and head, bones of the skull and facial skeleton) and intracranial injuries (the substance of the brain and its membranes), having a single mechanism and the same age of formation.

Open. Caused by severe mechanical damage to the head, resulting in a violation of the integrity of the skull. As a result of such trauma, the meninges are damaged. There is also a risk of infection.
Closed. The soft tissues of the head are damaged without compromising the integrity of the skull.

In contrast, a closed one is considered less dangerous, since the contents of the skull do not come into contact with the external environment.

Depending on the form of TBI and the force that provoked the mechanical damage, head injuries vary in severity:

Mild degree. Does not pose a particular danger to the patient's life. As a rule, with a mild degree, the integrity of the skin is not compromised, but a hematoma may form. After an injury, the victim may experience slight dizziness, headache and nausea. Sometimes there are cases when the victim experiences amnesia of varying degrees of duration.
Average degree. With a bruise of this severity, bone fractures at the base and vault of the skull, as well as extensive fractures, can be diagnosed. After such an injury, the patient experiences severe headache and nausea. Vomiting may occur. The victim may have memory loss, tachycardia or bradycardia. Depending on the area of the head that was hit, the victim experiences focal symptoms. Pupillary and oculomotor disturbances, loss of sensitivity, weakened motor function of muscles and problems with speech occur.
Severe degree. Violation of the integrity of the cranial cavity, the occurrence of intracerebral hematomas and damage. In addition to symptoms characteristic of moderate severity, in severe cases the patient may experience neurological symptoms in the form of epileptic seizures.

2 Consequences of traumatic brain injury

In case of a closed TBI, formed as a result of a mild mechanical impact on a flat surface, as a rule, a violation of the integrity of the skin is not observed. There is a possibility of loss of consciousness, but it is short-lived and can last a few seconds. Feelings such as headache, dizziness, nausea and vomiting indicate a concussion. For some period, the patient will experience a disruption in the interaction between different parts of the brain. The patient's condition improves within 24-48 hours after injury.

In case of concussion, the consequences will depend on the severity of the injury. Depending on which area of the brain was exposed to mechanical action, corresponding consequences arise.

As a result of a bruise, small vessels may rupture, which will lead to the formation of small hemorrhages.

If the brain tissue is ruptured by a fragment of the skull bone, a contusion occurs. In such a situation, the consequences of a head injury occur immediately. The victim loses consciousness for a long time. Upon regaining consciousness, the victim may experience partial or complete memory loss, as well as local neurological symptoms. Some consequences of this type of head injury can manifest themselves after a certain period of time in the form of epilepsy or sudden coma.

If, as a result of the injury, there is compression of the brain by the skull due to hemorrhage or pressing of the skull bones themselves inward, then the victim, in addition to headache and nausea, experiences a change in the heartbeat and drowsiness.

The consequence of tension and rupture of axons (non-branching processes of neurons that are responsible for conducting signals to muscles) leads to diffuse axonal damage, which manifests itself in the form of coma. Coma can last up to 3 weeks. There is a possibility that she may enter a vegetative state. While a person is in a coma, changes occur in the functioning of vital functions. Their rhythm changes. The further prognosis of the patient's condition will depend on his age and severity of the injury.

The consequences of a TBI can make themselves felt even after a full course of recovery, especially if the degree of damage was severe. As a rule, disorders of the central nervous system are observed. They appear as:

temporary or permanent loss of sensation in the limbs;
impaired coordination of movements;
decreased quality of vision;

When providing first aid, you must behave very carefully. Pressure and unnecessary movements should be avoided. It is very important not to get an infection, because a head injury can be accompanied by meningitis or encephalitis, which will complicate the treatment process.

Do you still find it difficult to overcome headaches?

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Do you take out your irritability on your loved ones and colleagues?

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The consequences of traumatic brain injury are memory impairment, both retrograde and antegrade amnesia are possible. Post-concussion syndrome, which usually follows a significant concussion, includes headache, dizziness, fatigue, difficulty concentrating, various types of amnesia, depression, apathy and anxiety. Often there are disturbances or loss of smell (and, consequently, taste), sometimes hearing, and less often vision. Symptoms usually disappear spontaneously within weeks or months.

A range of cognitive and neuropsychiatric problems may persist after severe or even moderate traumatic brain injury, especially after significant structural damage. Typical consequences of traumatic brain injury include amnesia, behavioral disturbances (eg, excitability, impulsivity, disinhibition, lack of motivation), emotional lability, sleep disturbances, and decreased intellectual abilities.

Late epileptic seizures (more than 7 days after injury) develop in a small percentage of cases, most often after weeks, months and even years. Spastic movement disorders, gait disturbances and problems with balance, ataxia and sensory loss may also occur.

A persistent vegetative state may develop after traumatic brain injury with impaired cognitive function, but with a preserved brain stem. The ability for self-induced mental activity is absent; however, autonomic and motor reflexes and the normal sleep-wake cycle are preserved. In some patients, it is possible to restore normal functioning of the nervous system if the persistent vegetative state lasts for 3 months after the injury, and in almost none for 6 months.

Neurological functions gradually improve over a period of 2 to several years after traumatic brain injury, especially rapidly in the first 6 months.

Greetings, dear guests and readers of my blog. A neurologist blog dedicated to rehabilitation after strokes and injuries leading to disruption of the nervous system (head injuries, infectious diseases, surgeries, etc.). Today we'll talk about traumatic brain injury and what it means for future life, that is, the prognosis, both for health and life itself, taking into account its social side. For many who have been affected by a traumatic brain injury, be it the person who suffered it or their loved ones, sooner or later the question arises: “What’s next...? ...what next?” and so on. And what happens next very closely depends on the degree of injury received.

The consequences of TBI directly depend on the severity of the injury, and only then on the quality of care provided, the duration of rehabilitation, etc.

Severity of traumatic brain injury (TBI) and consequences.

I will briefly write what I wanted to say regarding the quality of life and the consequences of the experience. traumatic brain injury from its heaviness. I will describe using specific examples from my practice, without going into details of their classification and dry terms. I will describe 3 typical cases corresponding to the severity of the injury; we will analyze them in more detail later in the article.

Case No. 1. Pronounced consequences that can turn a healthy person into a disabled person can occur after a severe injury, accompanied by a fracture of the bones of the base of the skull, and multiple contusion lesions in the substance of the brain. The presence of contusion lesions was established using. The prognosis for recovery is worsened by prolonged coma, when an injured person can remain unconscious for weeks or even months.

Example : a mature man was admitted to the hospital in an unconscious state and was transported from the scene of the accident by ambulance. After examination and examination by specialists (neurologist, neurosurgeon, resuscitator), a diagnosis was made: Open traumatic brain injury (OTBI). Severe brain contusion dated December 1, 2014 with multiple contusion lesions in both frontal lobes. Post-traumatic (SAH). Coma 1 st. Bruised wound of soft tissues of the left temporo-frontal region. Facial abrasions. Hospitalized in the intensive care unit.

Case No. 2. Moderate-severe consequences of TBI usually occur after a moderate injury and represent functional impairment that may persist for weeks or months, but is not severe.

Example : a young man, after blows to the head inflicted in a fight, lost consciousness for 10 minutes, after which he came to his senses and independently went to the hospital, where, after undergoing an examination, a diagnosis was made: closed head injury (closed traumatic brain injury). Moderate brain contusion dated December 1, 2014, with the formation of a single contusion lesion in the left temporal lobe. (the contusion lesion was identified during computed tomography). Hospitalized in the neurosurgery department.

Case No. 3. A mild traumatic brain injury, as a rule, does not leave lasting consequences. The recovery period is often limited to one month, in some cases there may be sleep disturbances, periodic headaches, panic attacks, and memory impairment. These consequences are more likely to occur with repeated head trauma.

Example : An elderly woman slipped on a slippery surface, fell and hit her head on a hard surface. She lost consciousness for a short period of time (up to 30 seconds); upon coming to her senses, she felt nausea and a headache. She turned to emergency medical services for help. She was hospitalized in the emergency department of a local hospital, where, after examination by the on-duty traumatologist and neurologist, the diagnosis was made: traumatic brain injury. Brain concussion (CMC) dated December 1, 2014. She was hospitalized in the trauma department for further treatment.

Bruise and concussion: prognosis for health and life.

Now let’s look at the prognosis for life and health for each case mentioned above in order.

Case No. 1. This case is the most serious of the 3 described. With such injuries there is a very high risk to life and the mortality rate is high. If a person survives, there will most likely be severe damage to the central nervous system. This concept is broad and I will try to describe in more detail what we are talking about. Large areas of the brain are damaged and the loss of function can be significant: in relation to movements, there may be a decrease in strength in all extremities of the body, as well as in half the body or hemiparesis, which after a few months (usually from 3) is accompanied by an increase in muscle tone (spasticity). This makes it difficult to move independently. It is impossible to say for sure, sometimes such people are restored to a good level when they walk without assistance, but cases of further remaining in a supine position are not uncommon.

Often such damage is accompanied by decreased vision as a result of loss of visual fields (hemianopia), which is caused by damaged areas of the brain or injuries to the optic nerves, which can lead to their complete atrophy in the future. A person's character can change greatly, along with loss or decline in mental abilities. There may be loss of memory for past or current events.

The personality of the victim changes, sometimes he may become unrecognizable to his loved ones, due to a radical change in character traits and the emergence of new features, often negative. These include outbursts of aggression, indifference, apathy, or periods of irritability. Epileptic seizures are not uncommon after severe brain contusion.

Case 2. A brain contusion of moderate to mild severity can disable a person for at least 3-4 weeks, sometimes more. Despite the loss of functions of the nervous system - decreased sensitivity (hypesthesia), impaired coordination of movements, they are rarely persistent and recover within a couple of months. A common consequence is headaches, which can bother you for several months, then go away.

There is usually no permanent decrease in working capacity; after a couple of months, victims of head trauma live their previous lives without any significant differences from ordinary people. Up to six months you may experience periodic headaches and (or) panic attacks - attacks of palpitations, sweating, fear and lack of air, but this does not always happen.

Predicting the course of a traumatic illness is very difficult for many reasons. This depends on the severity of the injury suffered and on the time that has passed since the TBI, on the severity of the existing limitations in the victim’s life, his gender, age, profession, educational level, etc. Therefore, from the point of view of the possibility of eliminating or minimizing limitations in life and the possibility of maximum social and labor readaptation of the victim, the following prognostically significant points should be taken into account:

Despite the development of modern technologies for providing care to patients who have suffered a traumatic brain injury, unfortunately, many more people die or become disabled as a result of a brain injury. F.V. Oleshkevich (1998) indicates that the mortality rate for severe brain injury reaches 50%-60%, while 25%-50% of victims with severe TBI die at the scene or on the way to the hospital. Yu.V. Alekseenko, R.N. Protas (1995) confirm these data, indicating that the mortality rate for all forms of severe TBI is up to 30%. E.I. Gusev et al. (2000) provide data that in Russia about 10% of victims die annually from all forms of TBI and the same number become disabled.

Long after TBI, the consequences of not only severe, but also moderate and even mild brain injury actively manifest themselves, often leading to disability.

The age of the victim at the time of injury.

The outcome of severe brain damage accompanied by a long-term disorder of consciousness largely depends on the age of the patient.

Scientists and practicing neurologists are unanimous that the prognosis for life and restoration of mental functions is quite favorable for young people, in whom neuropsychic functions are restored more fully than in older people.

These data are confirmed by the research of A.N. Konovalova et al. (1994), who claim that with severe traumatic brain injury there is a correlation between a decrease in good functional recovery from 44% in children and 39% in young people to 20% in the elderly and elderly.

Topic of the lesion and nature of the clinical syndrome.

Of course, having suffered an open head injury with pronounced general cerebral disorders does not allow us to count on a more favorable course and outcome than having suffered a closed craniocerebral injury, manifested in the form of a moderately severe cerebral focal syndrome. The course of the post-traumatic period is determined by many complexly intertwined factors, among which great importance is attached to the nature and mechanisms of injury, the preferential localization of anatomical changes, the severity of dysfunction of nonspecific structures of the limbic-reticular complex, the complex relationship of organic, reactive-neurological and personal components, the relationship of cerebral and general somatic disorders, various exogenous-social and endogenous factors .

However, Yu.D. Arbatskaya points out that only in the first 6-12 months after a traumatic brain injury there is a certain parallelism between the severity of the injury and the disability of patients. In the long-term period of injury, there are no significant differences in the consequences of mild and moderate injury. The clinical picture of the disease is gradually becoming closer, in which the focal organic symptoms are smoothed out and general neurodynamic disorders of the post-concussion type with neurosis-like and other manifestations are increasingly coming to the fore.

In the future, the structure and severity of disorders of various functions, the type of course of the disease, the patient’s profession and working conditions become of great importance. Behind the external clinical recovery and good health of the patient, reduced mobility of the nervous system is often hidden, which easily manifests itself in unfavorable working and living conditions.

Timely and high-quality assistance to victims.

The successful course of the post-traumatic period, a favorable not only clinical, but also labor prognosis for people who have suffered a brain injury, largely depends on the timely provision of qualified first aid, long treatment and rehabilitation periods aimed at maximizing the elimination of the consequences of the injury.

Particular attention should be paid to ensuring that strict adherence to the treatment regimen and terms of temporary disability in the acute period of traumatic brain injury is combined with the timely return of the patient to work indicated by his state of health. In this case, special attention is paid to minor injuries, in which there is an underestimation of the condition, refusal of hospitalization, early discharge, premature return to work and, as a result, unfavorable course of the disease.

These injuries are distinguished by the fact that they are absent or there is a very short-term loss of consciousness, there are no significant disturbances in the general condition of the patients and persistent neurological syndromes. Those who have suffered this type of injury often do not even seek medical help during the acute period of the disease.

Meanwhile, even after a mild TBI, changes in the meninges, inferiority of vegetative and nonspecific structures, which over time increasingly affect the patient’s adaptive capabilities, may persist for many years.

Quite often, mild traumatic brain injuries are a “risk factor” for the development of hypertension and cerebral atherosclerosis, potentiate and aggravate the course of cardiovascular diseases, aggravate the pathology of the respiratory system, gastrointestinal tract and psychopathology of various origins.

Social factors: education, profession, qualifications, working conditions, living conditions, etc.

Social factors are also of great importance when assessing the outcome of TBI, since the presence of higher and secondary specialized education, high qualifications in their profession imply a greater range of offers in the rational employment of the victim. In this case, the patient’s work orientation, his personal character traits, his orientation toward rehabilitation, etc. are of great importance.

Currently, the problem of consequences is acquiring particular relevance and socio-economic significance. industrial traumatic brain injuries due to higher socio-labor disadaptation of patients than with domestic injuries.

The dissociation often observed in these patients between the abundance of complaints, the paucity of objective manifestations and the variety of behavioral deviations ( aggravation, claim, pseudodementia, explosive, litigious-querulant, etc.) lead to the use of unacceptable terms “traumatic neurosis” and “subjective post-traumatic syndrome” in clinical practice.

Here the moral aspect comes out very clearly, expressed in the socially significant positions of patients, significant to them in relation to the state’s concern for the fate of disabled people. These positions have a significant impact on the level of social and labor prognosis and legal ability of patients and are manifested both in counteracting the disease and in the desire to maintain benefits due to traumatic brain injuries.

Many authors indicate that approaching work should be carried out in the hospital, in which psychological laboratories, “patient schools” and workshops should be provided. Already in the early recovery period of TBI, professional orientation of patients is necessary. Return to work should occur gradually, against the backdrop of ongoing physical therapy, therapeutic exercises, classes to restore speech and professional skills.

In general, it should be noted that with mild TBI, the prognosis for life and work ability is in most cases favorable , although this type of injury can lead to decompensation of pre-existing diseases and/or the emergence of new syndromes of varying severity.

The outcome of moderate TBI is also favorable in most cases. , however, there may be varying degrees of disability, which can lead to disability of the patient.

Severe brain injury, as mentioned above, often leads to death, and almost half of the survivors have significant limitations in their life activities, resulting in social impairment of varying severity.

Variants of the course of traumatic illness.

In this case, the following may occur variants of the course of traumatic disease:

1) regredient with continued stabilization of clinical symptoms and maximum rehabilitation of the patient; observed mainly in children, young and middle-aged people. In the elderly and elderly, this outcome is rare;

2) relapsing with periods of decompensation of direct consequences of injury and remissions; reasons – repeated injuries, intoxication, infections, contraindicated working conditions, etc.; there is no direct relationship between the nature, severity of injury, time of decompensation and progression;

3) progressive with increasing severity of neurological symptoms, mental disorders, manifestation and development of vascular lesions (arterial hypertension, atherosclerosis); vascular manifestations of traumatic disease in 40% of elderly patients significantly aggravate other consequences of TBI.

L.B. Lichterman, in a systematic classification of traumatic brain injury, gives options for the outcome of brain injury according to the Glasgow outcome scale: good recovery, moderate disability, severe disability, vegetative state, death.

Consequences after traumatic brain injury

In general, it can be stated that the factors contributing to a good outcome of TBI are: mild or moderate severity of injury, young age, absence of neurological and/or mental deficits, timely provision of assistance, rehabilitation measures, maintaining the patient’s professional fitness, positive attitude to work.

Factors contributing to the disability of a patient who has suffered a TBI are: severe injury, pre-retirement or retirement age, the presence of a neurological and/or mental deficit, untimely provision of assistance, lack of clinical observation and rehabilitation measures, loss of professional suitability, negative attitude towards work, the presence of a skull defect corresponding to the concept of “severe anatomical defect”. Ctrl+Enter.

Course and consequences after traumatic brain injury

Even seemingly minor injuries (a concussion) can lead to long-term disorders of the nervous system, and often do not respond well to traditional therapy. Severe TBI (brain contusion, diffuse axonal torsion) sometimes leads to the patient’s death or severe disability.

TBI remains one of the main causes of disability in the population

Statistics show that in recent years the incidence of traumatic brain injuries has been steadily increasing, especially in young people. Moreover, the proportion of severe injuries to the skull and brain has increased significantly, the consequences of which are post-traumatic encephalopathy, intellectual impairment, and liquor hypertension.

Pathogenesis of TBI

Most often, traumatic brain injury is the result of mechanical impact on the head and neck area. The most common situations are: road accidents, being hit by a hard object, falling from a height, less often the cause is compression of the head or sudden acceleration of the human body.

Thus, the following main causes of brain damage during trauma can be identified:

Local disruption of tissue structure due to sudden impact with a heavy object (impact, fall).
Diffuse damage to brain tissue, for example due to acceleration.
Compression of intracranial structures.

As a result of the damaging factor, a cascade of pathological reactions is triggered, leading to disruption of the interaction of intracerebral structures, and in case of severe injuries, organic changes in brain tissue with progressive swelling. Scientists have proposed several theories of the pathogenesis of brain injury: displacement of the brain inside the skull, changes at the molecular level, impact mechanism, and others. The whole complex of pathological changes is called traumatic brain disease.

Classification of TBI

All types of TBI are usually divided into closed and open

Depending on the characteristics of damage to the soft tissues of the head and bones of the skull, traumatic brain injury can be open or closed.

Closed skull injury is characterized by a lack of communication between the intracranial cavity and the external environment. Moreover, even the presence of cracks or fractures of bones does not violate the closed space of the cranium. The presence of damage to the soft tissues of the head (wounds, abrasions) with preserved integrity of the bone tissue allows us to consider such a head injury closed.

In turn, open TBI is a head injury in which there is communication between the cranial cavity and the external environment. If at the same time there is a violation of the integrity of the dura mater, then such head injuries are penetrating; in other cases, a non-penetrating injury is diagnosed.

In modern neurology, traumatic brain injury is classified as follows:

Brain concussion.
Brain contusion (mild, moderate, severe).

One type of traumatic brain injury is bruise

Compression of intracranial structures.

A concussion is considered a relatively mild type of head injury. More severe ones include bruise and compression of the brain, which can additionally be aggravated by skull fractures, subarachnoid hemorrhage, cerebral edema, and intracranial hematoma. The latter, depending on the location, can be: intracerebral, epidural, subdural, intraventricular.

Course of traumatic brain injury

Any traumatic brain injury has three periods in its development: acute, intermediate and long-term consequences.

First period characterized by the development of pathological changes in brain tissue immediately after exposure to a damaging factor. Symptoms depend on the degree of changes occurring in the brain, swelling of brain structures, the presence or absence of other injuries (combined injury), and the initial somatic status of the patient. Its duration is at least two weeks or more.

In the interim Damage to the nervous tissue and, accordingly, lost functions are restored. Compensatory and adaptive mechanisms in the body are also activated, which contributes to the patient’s adaptation in the presence of severe damage to the central nervous system. The duration of this period for a concussion and mild bruise of the brain is up to six months, for more severe injuries – about a year.

Final period head injuries – restorative. Depending on the severity of the damage, it may last a year or two or more than two years. As a rule, during the first two years after injury, most patients develop post-traumatic encephalopathy, which requires treatment in neurology. With the right therapeutic approach, restoration or adaptation of the central nervous system occurs.

Symptoms

Symptoms of traumatic brain injury largely depend on the degree of brain damage, the presence of focal changes and swelling associated with encephalopathy. An important criterion for the severity of TBI is the patient’s state of consciousness and the presence of focal and cerebral symptoms.

Brain concussion

This type of head injury is classified as mild brain injury. Its characteristic features are:

Loss of consciousness for a short time (seconds, several minutes).
A state of mild stupor after injury.
Presence of diffuse headache.
Nausea, less often single vomiting.
Sometimes retrograde amnesia, less often anterograde.

With a concussion, the fact of impaired consciousness occurs in almost all cases and can vary from complete loss of consciousness to a state of “cloudness” in the head, slight stunning. When examining the patient, diffuse symptoms are revealed: nystagmus, sluggish reaction of the pupils to light, asymmetry of reflexes, pathological reflexes (Marinescu, Rossolimo, Babinsky). Again, against the background of existing encephalopathy, these signs are persistent, and with a concussion they disappear within 3-5 days. Disturbances of autonomic innervation are common consequences of a concussion; instability of blood pressure, sweating, a feeling of “heat” in the body, and coldness of the extremities are usually observed.

Symptoms of concussion depending on severity

Brain contusion

This type of head injury is characterized by focal damage to brain structures. Often a brain contusion is accompanied by fractures of the skull bones, hemorrhages under the membranes of the brain, and rapidly increasing swelling. Subsequently, this often leads to post-traumatic encephalopathy.

Depending on the degree of damage (mild, moderate or severe), the severity of symptoms may vary. The following signs are characteristic of a mild brain contusion:

Loss of consciousness (tens of minutes).
Nausea, sometimes repeated vomiting.
Amnesia, retrograde or anterograde.
Diffuse headache, dizziness.

The neurological status determines diffuse or focal symptoms. Most patients have skull fractures and subarachnoid hemorrhage.

With moderate to severe brain contusion, the severity of symptoms is much higher. In this case, the duration of loss of consciousness can be several hours, and in severe cases, several weeks. For such injuries, the characteristic signs are focal changes: impaired oculomotor function, damage to the cranial nerves, sensory and motor disorders (paresis, paralysis).

Symptoms of traumatic brain injury

In severe TBI, brainstem disorders occur, which is caused by swelling of brain structures: fluctuations in blood pressure, pathological breathing rhythms, disturbances in thermoregulation, and muscle tone. Meningeal signs are determined (stiff neck, Kernig's, Brudzinski's symptoms). Serious head trauma may be accompanied by seizures.

Severe brain contusions are almost always combined with fractures of the cranial bones, often the base of the skull, traumatic hemorrhages, and swelling of brain tissue. Externally, the “symptom of glasses” is sometimes determined - a sign of a fracture of the front part of the skull, liquorrhea from the nose or ears.

Severe traumatic brain injury almost always leaves consequences in the form of post-traumatic encephalopathy. Symptoms regress after a few months, but residual effects can be persistent, sometimes for life.

Brain compression

This type of traumatic brain injury is particularly severe and, if left untreated, often leads to the death of the patient. Compression of the brain by an intracranial hematoma (epi-, subdural or intracerebral) leads to displacement of stem structures and, as a result, disruption of vital functions. This type of injury can be an independent pathology or combined with other types of brain damage (for example, brain contusion).

Compression of the brain may be caused by an intracranial hematoma

Characterized by a gradual increase in the severity of general cerebral, focal symptoms, signs of cerebral edema with dislocation (displacement) of brain structures. The onset of compression symptoms is often preceded by a so-called “lucid period” after the injury, when the patient feels well for some time. It is especially common in children.

Complications of TBI

Traumatic brain disease can have both early and long-term consequences. Early complications of traumatic brain injury include:

Brain swelling.
Displacement of the median stem structures.
Secondary intracranial hemorrhages (hematomas, subarachnoid hemorrhage).
Secondary inflammatory process (meningitis, encephalitis).
Extracranial inflammatory phenomena (pneumonia, bedsores, sepsis).
Respiratory failure.

Long-term consequences are largely determined by the severity of the traumatic brain injury. The most common include:

Post-traumatic encephalopathy (asthenia, headaches, autonomic disorders).
Persistent focal disorders (paresis, paralysis, visual impairment, hearing, speech).
Epileptic syndrome.
Mental disorders.

Diagnostics

Methods for diagnosing traumatic brain injuries

The diagnosis of traumatic brain injury is established in neurology on the basis of an initial examination by a doctor, medical history and patient complaints. Additional examination methods are required.

At a minimum, an X-ray of the skull is required for a concussion; for more severe injuries, a computed tomography or magnetic resonance imaging of the brain is required.

In the hospital, a neurologist or neurosurgeon also prescribes general clinical and biochemical blood tests and an ECG. If combined traumatic injuries are suspected, R-graphy of the chest organs, extremities, ultrasound of the abdominal organs. According to indications in neurology, a lumbar puncture is performed, which helps to identify subarachnoid hemorrhage and secondary purulent meningitis.

Treatment

Any traumatic brain injury requires observation and treatment in an inpatient setting (neurosurgery, neurology, traumatology). In exceptional cases, outpatient treatment of a mild concussion is permitted, but only after preliminary diagnosis and examination by a neurosurgeon or neurologist. Therapy for mild brain damage involves prescribing bed rest for at least a week, eliminating autonomic dysfunction, prescribing nootropic and sedatives, and normalizing blood pressure.

Treatment of patients with TBI should be carried out in a hospital setting

For more serious injuries, therapy includes the following measures:

Maintaining vital functions of the body: breathing at an optimal level (ventilation if necessary), correcting blood pressure numbers to ensure sufficient brain perfusion. To increase blood pressure, colloidal solutions and sympathomimetics are administered intravenously. High blood pressure numbers are corrected by prescribing antihypertensive drugs.
Fighting cerebral edema. For this purpose, osmotic diuretics (mannitol) are used. Elimination of cerebrospinal fluid hypertension is achieved by drainage of the cerebrospinal fluid ducts.
In the presence of hemorrhagic complications, hemostatic agents (aminocaproic acid) are used.
To improve microcirculation in affected tissues and prevent secondary ischemia, antiplatelet agents, vasoactive agents (Trental, Cavinton), and calcium channel blockers are prescribed.
Elimination of hyperthermia is achieved by the introduction of non-steroidal anti-inflammatory drugs, neuroleptics, artificial hypothermia, and the administration of neuroleptics.
Antibacterial therapy for the prevention of secondary purulent complications. Especially indicated for open injuries of the skull and brain.

Surgical treatment is mandatory in case of rapidly increasing swelling and compression of the brain by intracranial hematoma. It is indicated when the volume of the latter is more than 30 cm³, as well as signs of dislocation of the middle structures. Modern methods of eliminating hematomas involve minimally invasive intervention using endoscopic equipment.

Rehabilitation

The rehabilitation plan for patients with TBI is drawn up individually

The effects of a head injury can vary greatly depending on the severity of the damage to brain structures. This may be a mild asthenic syndrome after a concussion, or post-traumatic encephalopathy with focal neurological disorders and cerebrospinal fluid discirculation.

Therefore, a rehabilitation plan is drawn up for each patient strictly individually.

If treatment is carried out in neurology or a rehabilitation center, it includes several main points:

Drug therapy. Nootropics (Phenotropil, Encephabol, Ceraxon, Cerebrolysin), adaptogens (tincture of ginseng, Eleutherococcus, Leuzea and others), multivitamin complexes, B vitamins (neurorubin, milgamma). After severe TBI, anticonvulsants (Depakine, carbamazepine) are prescribed.
Physiotherapeutic treatment. Darsonval, magnetic therapy, IRT; restorative massage, as well as aimed at restoring movements in paretic limbs.
Psychotherapy. Here, the help of a psychologist is needed; both individual psychotherapeutic sessions and group sessions are conducted. Children who have suffered severe traumatic brain injuries especially need the help of a psychologist.

Patient consulting with a psychotherapist

Kinesiotherapy. This includes various types of physical activity, exercise therapy, exercises in the pool, and elements of sports.

After completing the main course of rehabilitation in neurology, sanatorium-resort treatment is recommended. It is better to take it in a specialized sanatorium for people with central nervous system diseases. If necessary, cosmetic surgeries are performed to restore post-traumatic defects of the face and head.

Rehabilitation after a traumatic brain injury is especially difficult for people with intellectual and mental disorders. Such consequences are sometimes observed after severe traumatic brain injuries.

In this case, treatment of traumatic encephalopathy is carried out in specialized centers or neurology under the supervision of a psychiatrist.

Even after a mild TBI, post-traumatic encephalopathy can manifest itself through depression, dyssomnia, decreased performance and chronic fatigue. In such cases, the prescription of antidepressants is required, and for increased anxiety - daytime tranquilizers.

Post-traumatic encephalopathy may develop after a traumatic brain injury.

A full range of rehabilitation measures helps not only restore the patient’s health, but also return him to a full social life and restore professional skills. After severe injuries with persistent dysfunction of the nervous system, a disability group is established by decision of the MSEC. To obtain it, you must submit an extract from neurosurgery or neurology to the district clinic.

The duration of treatment is determined by the dynamics of regression of pathological symptoms, but requires strict bed rest in the first 7-10 days from the moment of injury. The duration of hospital stay for concussions should be at least 24 hours; for mild bruises, 2-4 weeks.

After a TBI, the doctor advised me to take Bilobil, supposedly a good drug for recovery. But I wouldn’t say that. I didn’t feel much of a difference. Perhaps the most effective thing for recovery is bed rest, and everything else is not so important.

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The consequences of traumatic brain injury are very diverse.

The disorders that occur after a traumatic brain injury are very varied and often very dangerous.

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According to statistics, after traumatic brain injury acute symptoms develop within three days; this is the critical period after which, most likely, severe consequences of the injury should no longer be expected.

This is the great danger, because symptoms of cerebral edema or subarachnoid hematoma can develop only after 24 hours or more. In this case, the patient is in great danger.

I have heard more than once from emergency department doctors how subarachnoid or subdural hematomas went unnoticed, which leads to a high risk of patient mortality.

Hence, after traumatic brain injury , even if you feel well, you urgently need to, within a few hours, seek help from a specialist, a neurologist, and carry out the necessary diagnostic procedures.

As a result traumatic brain injuries Concussion (commotion) may occur - a relatively mild injury or contusion (contusion) of the brain - a more serious condition.

Most often they manifest themselves as gross disturbances of consciousness in the form of:

coma (unconscious state) or

stupor (a condition resembling stupor),

Long-term consequences of traumatic brain injury may manifest as neurological disorders:

sensitivity disorders (numbness of the hands, feet, burning sensations, tingling sensations in various parts of the body, etc.),

movement disorders (tremors, coordination disorders, convulsions, slurred speech, stiffness of movements, etc.),

changes in vision (double vision, blurry focusing)

mental disorders.

Mental disorders and behavioral disorders due to brain injuries can be expressed in different states: from a state of fatigue to a pronounced decrease in memory and intelligence, from sleep disturbances to incontinence of emotions (attacks of crying, aggression, inadequate euphoria), from headaches to psychoses with delusions and hallucinations.

Most common in the picture consequences of brain injuries disorder – asthenic syndrome.

An important symptom of an asthenic condition that occurs after a traumatic brain injury is increased sensitivity to external stimuli (bright light, loud sound, strong smell).

It is very important to know that much depends on whether the concussion or brain injury occurred for the first time, or whether the patient has repeatedly suffered such injuries at home. The outcome and duration of treatment directly depends on this.

If the patient has more than 3 concussions history, the period of treatment and rehabilitation is significantly longer and the likelihood of complications also increases.

As a rule, methods of magnetic resonance imaging, computed tomography, and radiography are used in the diagnosis of TBI.

For at least three months after a TBI, drinking alcoholic beverages and strenuous physical activity is strictly prohibited.

In addition to traditional methods of treating TBI, there are no less effective methods:

Everyone knows the fact that treatment must be comprehensive, and the more techniques are used during treatment, the better.

The most common among them are:

headaches with nausea and vomiting,

dizziness,

memory impairment, etc.

Traumatic brain injuries pose a danger that the patient may not be aware of.

In many cases the consequences traumatic brain injuries There are displacements of the cervical vertebrae, which can also lead to:

headaches,

neck pain,

memory impairment,

increased fatigue subsequently.

Frequent manifestations consequences of traumatic brain injury are:

facial neuritis,

trigeminal or other nerves,

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What can traumatic brain injuries lead to?

One of the most common causes of disability and death among the population is head injury. Its consequences can appear immediately or after decades. The nature of the complications depends on the severity of the injury, the general health of the victim and the assistance provided. To understand what consequences a TBI can cause, you need to know the types of injuries.

All traumatic brain injuries are divided according to the following criteria:

Nature of damage. TBI occurs:

open. They are characterized by: rupture (separation) of the soft tissues of the head, damage to blood vessels, nerve fibers and the brain, the presence of cracks and fractures of the skull. Separately, penetrating and non-penetrating TBI are distinguished;
closed craniocerebral injury. This includes injuries in which the integrity of the scalp is not broken;

The severity of the injury. There are the following types of brain injuries:

According to statistics, in 60% of cases, head injuries occur at home. The cause of injury is most often a fall from a height associated with drinking large amounts of alcohol. In second place are injuries received during an accident. The proportion of sports injuries is only 10%.

Types of consequences

All complications arising from traumatic brain injuries are conventionally divided into:

Early - appear within a month after injury. These include:

meningitis - the appearance of this complication of traumatic brain injury is characteristic of an open type of injury. The development of pathology is provoked by untimely or improper treatment of the wound;
encephalitis – develops with both open and closed TBI. In the first case, it occurs due to infection of the wound and appears 1-2 weeks after the injury. With a closed head injury, the disease is a consequence of the spread of infection from purulent foci existing in the body (possibly due to diseases of the ENT organs). Such encephalitis develops much later;
prolapse, protrusion or abscess of the brain;
massive intracranial hemorrhages – consequences of closed craniocerebral injury;
hematoma;
leakage of cerebrospinal fluid;
coma;

Late – appear in the period from 1 to 3 years after injury. These include:

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arachnoiditis, arachnoencephalitis;
parkinsonism;
occlusive hydrocephalus;
epilepsy;
neuroses;
osteomyelitis.

Head injuries lead not only to the development of pathologies of the brain, but also of other systems. Some time after receiving it, the following complications may occur: bleeding of the gastrointestinal tract, pneumonia, DIC syndrome (in adults), acute heart failure.

The most dangerous complication of a head injury is loss of consciousness for several days or weeks. Coma develops after a traumatic brain injury due to excessive intracranial bleeding.

Based on the nature of the disorders that occur during the period when the patient is unconscious, the following types of coma are distinguished:

superficial. It is characterized by: lack of consciousness, preservation of the reaction to pain, environmental factors;
deep. A condition in which the victim does not respond to people’s words or environmental stimuli. There is a slight deterioration in the functioning of the lungs and heart, and a decrease in muscle tone;
terminal. Consequence of a severe closed craniocerebral injury. Its main signs are: severe dysfunction of the respiratory system (asphyxia) and heart, dilated pupils, muscle atrophy, lack of reflexes.

The development of terminal coma after traumatic head injury almost always indicates the presence of irreversible changes in the cerebral cortex. Human life is maintained with the help of devices for stimulating the heart, urinary organs and artificial ventilation. Death is inevitable.

Disorder of systems and organs

After a head injury, disturbances in the functioning of all organs and systems of the body may appear. The likelihood of their occurrence is much higher if the patient has been diagnosed with an open head injury. The consequences of the injury appear in the first days after receiving it or several years later. There may be:

Cognitive disorders. The patient has complaints about:

memory loss;
confusion;
the fact that your head constantly hurts;
deterioration in thinking, concentration;
partial or complete loss of ability to work.

Violations of the organs of vision - appear if there is an injury to the occipital region of the head. Signs:

blurred vision, double vision;
gradual or sudden loss of vision.

Dysfunctions of the musculoskeletal system:

impaired coordination of movements, balance;
change in gait;
paralysis of the neck muscles.

The acute period of TBI is also characterized by respiratory, gas exchange and circulatory disorders. This leads to respiratory failure in the patient, and asphyxia (suffocation) may develop. The main reason for the development of this kind of complications is a violation of pulmonary ventilation associated with obstruction of the respiratory tract due to the ingress of blood and vomit into them.

If the frontal part of the head is injured or there is a strong blow to the back of the head, there is a high probability of developing anosmia (unilateral or bilateral loss of smell). It is difficult to treat: only 10% of patients experience restoration of their sense of smell.

Long-term consequences of traumatic brain injury can be:

Nervous system dysfunctions:

tingling, numbness in different parts of the body;
burning sensation in the arms and legs;
insomnia;
chronic headache;
excessive irritability;
epileptic seizures, convulsions.

Mental disorders in traumatic brain injuries manifest themselves in the form of:

depression;
attacks of aggression;
crying for no apparent reason;
psychoses accompanied by delusions and hallucinations;
inadequate euphoria. Mental disorders in traumatic brain injuries seriously aggravate the patient’s condition and require no less attention than physiological disorders.

Loss of some speech skills. The consequences of moderate to severe injury can include:

slurred speech;
loss of ability to speak.

Asthenic syndrome. It is characterized by:

increased fatigue;
muscle weakness, inability to endure even minor physical exertion;
mood swings.

In children who have suffered intrauterine hypoxia, birth asphyxia, or after a traumatic brain injury, the consequences occur much more often.

Prevention of complications, rehabilitation

Only timely treatment can reduce the risk of negative consequences after a head injury. First aid is usually provided by medical personnel. But people who were close to the victim at the time of his injury can also help. You need to do the following:

Turn the person over to a position in which the likelihood of hypoxia and asphyxia is minimal. If the victim is conscious, you should turn him on his back. Otherwise, you need to lay it on its side.
Treat the wound with water or hydrogen peroxide, apply bandages and a bandage to it: this will reduce swelling and the risk of developing infectious complications with an open head injury.
If signs of asphyxia, difficulty breathing, or heart rhythm disturbances appear, perform cardiopulmonary massage and provide the patient with access to air.
Stop accompanying bleeding, treat other damaged areas of the body (if any).
Wait for the ambulance to arrive.

Treatment of head injuries is carried out exclusively in a hospital, under the strict supervision of a doctor. Depending on the type and severity of the pathology, drug therapy or surgical intervention is used. The following groups of drugs may be prescribed:

Typically, a patient's condition after an injury improves over time. But the success and duration of recovery depends on the measures taken during the rehabilitation period. Lessons from the following specialists can return the victim to normal life:

occupational therapist. Works on renewing self-care skills: moving around the apartment, driving a car as a passenger and driver;
neurologist. Deals with issues of correction of neurological disorders (decides how to restore the sense of smell, reduce seizures and what to do if you constantly have a headache after suffering an injury);
speech therapist. Helps improve diction, cope with the problem of slurred speech, restores communication skills;
physiotherapist. Carries out pain correction: prescribes procedures to reduce headaches after head injury;
kinesitherapist. Its main task is to restore the functions of the musculoskeletal system;
psychologist, psychiatrist. Help eliminate mental disorders due to brain injuries.

Forecasts

Rehabilitation needs to be thought about even before the victim is discharged from a medical facility.

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Late seeking help from specialists does not always give a good result: after several months after an injury, it is difficult, and sometimes simply impossible, to restore the functions of internal organs and systems.

With timely treatment, recovery usually occurs. But the effectiveness of therapy depends on the type of injury and the presence of complications. There is also a direct relationship between the patient’s age and the speed of recovery: in older people, treatment of traumatic brain injuries is difficult (they have fragile skull bones and many concomitant diseases).

When assessing the prognosis for all categories of patients, experts rely on the severity of the injury:

the consequences after a mild brain contusion are insignificant. Therefore, in almost all cases it is possible to restore the functions of the body. But periodic exposure to this form of head injury (for example, during boxing) increases the likelihood of developing Alzheimer's disease or encephalopathy in the future;
blows and moderate injuries cause more complications and consequences of traumatic brain injuries. Rehabilitation lasts a long time: from 6 to 12 months. As a rule, after therapy all disorders disappear. Disability occurs in rare cases;
Severe traumatic brain injury most often leads to the death of patients. About 90% of surviving people partially lose their ability to work or become disabled, suffering from mental and neurological disorders.

Consequences after a head injury: from brain pathology to loss of vision, hearing and sense of smell, deterioration of blood circulation. Therefore, if, after undergoing it, your sense of smell has disappeared or your head hurts regularly, or problems with thinking are noted, you should immediately consult a doctor: the sooner the cause of the disturbance is identified, the higher the chance of recovery. Even with mild brain damage, body functions are not restored if treatment is not chosen correctly. Patients with head trauma should only be treated by a qualified physician.

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Traumatic brain injury (TBI), head injuries: causes, types, signs, help, treatment

Traumatic brain injury (TBI), among other injuries to various parts of the body, accounts for up to 50% of all traumatic injuries. Often, TBI is combined with other injuries: the chest, abdomen, bones of the shoulder girdle, pelvis and lower extremities. In most cases, head injuries are sustained by young people (usually males) who are in a certain stage of alcoholic intoxication, which significantly worsens the condition, and by unintelligent children who do not sense danger well and cannot calculate their strength in some amusements. A large share of TBI occurs in road traffic accidents, the number of which is only increasing every year, because many (especially young people) get behind the wheel without sufficient driving experience and internal discipline.

Every department can be at risk

Traumatic brain injury can affect any structure (or several simultaneously) of the central nervous system (CNS):

The most vulnerable and susceptible to injury main component of the central nervous system is the gray matter of the cerebral cortex, concentrated not only in the cerebral cortex, but also in many other parts of the brain (GM);
White matter, located mainly deep in the brain;
The nerves that penetrate the bones of the skull (cranial or cranial) are sensitive, transmitting impulses from the sense organs to the center, motor, responsible for normal muscle activity, and mixed, having a dual function;
Each of the blood vessels that supply the brain;
Walls of the ventricles GM;
Pathways ensuring the movement of cerebrospinal fluid.

Simultaneous injury to different regions of the central nervous system significantly complicates the situation. Severe traumatic brain injury changes the strict structure of the central nervous system, creates conditions for edema and swelling of the brain, which leads to disruption of the functional capabilities of the brain at all levels. Such changes, causing serious disorders of important brain functions, affect the functioning of other organs and systems that ensure the normal functioning of the body, for example, systems such as the respiratory and cardiovascular systems often experience suffering. In this situation, there is always a danger of complications in the first minutes and hours after injury, as well as the development of serious consequences that are distant in time.

With TBI, you should always keep in mind that the brain can be injured not only at the site of the impact itself. No less dangerous is the impact of counter-impact, which can cause even more harm than the force of the impact. In addition, the central nervous system may experience suffering caused by hydrodynamic fluctuations (CSF push) and a negative effect on the processes of the dura mater.

Open and closed TBI - the most popular classification

Probably all of us have heard more than once that when it comes to brain injuries, there is often a clarification: it is open or closed. What's the difference?

Invisible to the eye

Closed traumatic brain injury (in which the skin and underlying tissues remain intact) includes:

The most favorable option is a concussion;
A more complex option than just a concussion is a brain contusion;
A very serious form of TBI is compression as a result of the development of an intracranial hematoma: epidural, when blood fills the area between the bone and the most accessible one - the outer (dura) meninx, subdural (blood accumulation occurs under the dura mater), intracerebral, intraventricular.

If cracks in the cranial vault or fracture of its base are not accompanied by bleeding wounds and abrasions that damage the skin and tissue, then such TBIs are also classified as closed craniocerebral injuries, although conditionally.

What's inside if it's already scary outside?

An open craniocerebral injury, which has its main signs of a violation of the integrity of the soft tissues of the head, skull bones and dura mater, is considered to be:

Fracture of the vault and base of the skull with damage to soft tissues;
A fracture of the base of the skull with damage to local blood vessels, which results in blood leaking out of the nostrils or from the auricle during an impact.

Open TBIs are usually divided into gunshot and non-gunshot, and, in addition, into:

Non-penetrating lesions of soft tissues (meaning muscles, periosteum, aponeurosis), leaving the outer (dura) meninges intact;
Penetrating wounds that disrupt the integrity of the dura mater.

Video: about the consequences of closed TBI - “Live Healthy” program

The division is based on other parameters

In addition to dividing brain injuries into open and closed, penetrating and non-penetrating, they are classified according to other criteria, for example, TBI is distinguished by severity:

Mild brain injury is said to occur with concussions and bruises of the brain;
The average degree of damage is diagnosed for such brain contusions, which, taking into account all the violations, can no longer be classified as mild, and they do not yet reach a severe traumatic brain injury;
Severe contusion includes severe contusion with diffuse axonal damage and compression of the brain, accompanied by profound neurological disorders and numerous disruptions in the functioning of other vital systems.

Or according to the characteristics of lesions of the central nervous system structures, which allows us to distinguish 3 types:

Focal damage, which mainly occurs against the background of a concussion (impact-counter-impact);
Diffuse (acceleration-deceleration injury);
Combined lesions (multiple injuries to the brain, blood vessels, liquor pathways, etc.).

Considering the cause-and-effect relationships of head trauma, TBI is described as follows:

Traumatic brain injuries that occur against the background of complete health of the central nervous system, that is, a blow to the head is not preceded by brain pathology, are called primary;
We talk about secondary TBI when they become a consequence of other cerebral disorders (for example, the patient fell during an epileptic attack and hit his head).

In addition, when describing brain injury, experts emphasize such points as, for example:

Only the central nervous system, namely the brain, was damaged: then the injury is called isolated;
TBI is considered combined when, along with damage to the brain, other parts of the body (internal organs, skeletal bones) are damaged;
Injuries caused by the simultaneous damaging influence of various unfavorable factors: mechanical stress, high temperatures, chemicals, etc., as a rule, are the cause of the combined variant.

And finally: there is always a first time for something. So it is with a TBI - it can be the first and the last, or it can become almost habitual if it is followed by a second, third, fourth, and so on. Is it worth reminding that the head does not like blows and even with a mild concussion from a head injury one can expect complications and consequences that are distant in time, not to mention a severe traumatic brain injury?

More favorable options

The mildest type of head injury is considered to be a concussion, the symptoms of which can be recognized even by non-medics:

As a rule, having hit his head (or received an external blow), the patient immediately loses consciousness;
More often, loss of consciousness is followed by a state of stupefaction, less often psychomotor agitation can be observed;
Headache, nausea, and vomiting are commonly perceived as characteristic symptoms of a cervical concussion;
After an injury, signs of ill health such as pale skin, heart rhythm disturbances (tachy- or bradycardia) cannot be ignored;
In other cases, there is a memory impairment of the retrograde amnesia type - the person is unable to remember the circumstances that preceded the injury.

A more severe TBI is considered to be a bruise of the brain, or, as doctors call it, a concussion. With a bruise, general cerebral disorders (repeated vomiting, severe headache, impaired consciousness) and local lesions (paresis) are combined. How pronounced the clinical picture is, which manifestations occupy a leading position - all this depends on the region in which the lesions are located and the scale of the damage.

As evidenced by the trickle of blood flowing from the ear...

Signs of fractures of the base of the skull also appear depending on the area in which the integrity of the cranial bones is compromised:

A stream of blood flowing from the ears and nose indicates a fracture of the anterior cranial fossa (AC);
When not only the anterior but also the middle CN is damaged, cerebrospinal fluid leaks from the nostrils and ear, the person does not react to odors, and ceases to hear;
Bleeding in the periorbital region gives such a clear manifestation that does not raise doubts about the diagnosis as a “symptom of glasses”.

As for the formation of hematomas, they occur due to injury to arteries, veins or sinuses and lead to compression of the brain. These are always severe traumatic brain injuries that require emergency neurosurgical surgery, otherwise the rapid deterioration of the victim’s condition may leave him no chance of life.

An epidural hematoma is formed as a result of injury to one of the branches (or several) of the middle meningeal artery that supplies the dura mater. In this case, the blood mass accumulates between the skull bone and the dura mater.

Symptoms of the formation of an epidural hematoma develop quite rapidly and manifest themselves:

Unbearable pain in the head;
Constant nausea and repeated vomiting.
The patient's lethargy, sometimes turning into excitement, and then into a coma.

This pathology is also characterized by the appearance of meningeal symptoms and signs of focal disorders (paresis - mono- and hemi-, loss of sensitivity on one side of the body, partial blindness of the homonymous hemianopia type with loss of certain halves of the visual fields).

A subdural hematoma is formed against the background of injury to the venous vessels and its development time is much longer than that of an epidural hematoma: at first it clinically resembles a concussion and lasts up to 72 hours, then the patient’s condition seems to improve and within about 2.5 weeks he believes that is on the mend. After this period, against the background of general (imaginary) well-being, the patient’s condition sharply worsens, and pronounced symptoms of general cerebral and local disorders appear.

Intracerebral hematoma is a rather rare phenomenon that occurs mainly in elderly patients; their favorite location is the middle cerebral artery basin. Symptoms tend to progress (general cerebral disorders appear first, then local disorders increase).

Post-traumatic subarachnoid hemorrhage is a serious complication of severe traumatic brain injury. It can be recognized by complaints of intense headache (until consciousness leaves the person), rapid loss of consciousness and the onset of a coma, when the victim no longer complains. These symptoms are also quickly joined by signs of dislocation (displacement of structures) of the brain stem and cardiovascular pathology. If at this moment a lumbar puncture is performed, then in the cerebrospinal fluid you can see a huge amount of fresh red blood cells - erythrocytes. By the way, this can also be detected visually - the cerebrospinal fluid will contain blood impurities, and therefore will acquire a reddish tint.

How to help in the first minutes

First aid is often provided by people who, by chance, find themselves close to the victim. And they are not always health workers. With TBI, however, it should be understood that loss of consciousness can last a very short time and therefore not be recorded. However, in any case, a concussion, as a complication of any (even seemingly mild) head injury, should always be kept in mind and, taking this into account, help the patient.

If a person who has received a TBI does not come to his senses for a long time, he needs to be turned over on his stomach and his head tilted down. This must be done in order to prevent vomit or blood (in case of injuries to the oral cavity) from entering the respiratory tract, which often happens in an unconscious state (absence of cough and swallowing reflexes).

If the patient has signs of impaired respiratory function (there is no breathing), measures should be taken to restore the patency of the airways and, before the ambulance arrives, provide simple artificial ventilation (mouth-to-mouth, mouth-to-nose).

If the victim has bleeding, it is stopped with the help of an elastic bandage (a soft lining on the wound and a tight bandage), and when the victim is taken to the hospital, the surgeon will suture the wound. It’s worse when there is a suspicion of intracranial bleeding, because its complication is most likely hemorrhage and hematoma, and this is already a surgical treatment.

Due to the fact that a traumatic brain injury can occur in any place that is not necessarily within walking distance of a hospital, I would like to introduce the reader to other methods of primary diagnosis and first aid. In addition, among the witnesses trying to help the patient, there may be people with certain knowledge in medicine (nurse, paramedic, midwife). And here's what they should do:

The first step is to assess the level of consciousness in order to determine the patient’s further condition (improvement or deterioration) based on the degree of response (improvement or deterioration), and at the same time - psychomotor status, severity of pain in the head (not excluding other parts of the body), the presence of speech and swallowing disorders;
If blood or cerebrospinal fluid leaks from the nostrils or ears, assume a fracture of the base of the skull;
It is very important to pay attention to the victim’s pupils (dilated? different sizes? how do they react to light? strabismus?) and report the results of your observations to the doctor to the arriving ambulance team;
You should not ignore such routine activities as determining the color of the skin, measuring pulse, respiratory rate, body temperature and blood pressure (if possible).

With TBI, any part of the brain can suffer, and the severity of one or another neurological symptoms depends on the location of the lesion, for example:

A damaged area of the cerebral cortex will make any movement impossible;
If the sensitive cortex is damaged, sensitivity will be lost (all types);
Damage to the frontal lobe cortex will lead to a disorder of higher mental activity;
The occipital lobes will no longer control vision if their cortex is damaged;
Injuries to the cortex of the parietal lobes will create problems with speech, hearing and memory.

In addition, we should not forget that cranial nerves can also be injured and give symptoms depending on which area is affected. And also keep in mind fractures and dislocations of the lower jaw, which, in the absence of consciousness, press the tongue against the back wall of the pharynx, thereby creating a barrier to the air flowing into the trachea and then into the lungs. To restore the passage of air, it is necessary to push the lower jaw forward, placing your fingers behind its corners. In addition, the injury can also be combined, that is, with a TBI, other organs can be damaged at the same time, so a person who has received a head injury and is in an unconscious state must be treated with extreme care and caution.

And one more important point when providing first aid: you need to remember about the complications of a TBI, even if at first glance it seemed mild. Bleeding into the cranial cavity or increasing cerebral edema increases intracranial pressure and can lead to compression of the brain (loss of consciousness, tachycardia, increased body temperature) and irritation of the brain (loss of consciousness, psychomotor agitation, inappropriate behavior, obscene language). However, let's hope that by that time the ambulance will have already arrived at the scene and quickly taken the victim to the hospital, where he will receive proper treatment.

Video: first aid for TBI

Treatment is exclusively in a hospital setting!

Treatment of TBI of any severity is carried out only in a hospital setting, because loss of consciousness immediately after receiving a TBI, although it reaches a certain depth, does not in any way indicate the real condition of the patient. The patient can prove that he feels fine and can be treated at home, however, given the risk of complications, he is provided with strict bed rest (from one week to a month). It should be noted that even a concussion of the brain, having a favorable prognosis, in the case of large-scale damage to parts of the brain can leave neurological symptoms for life and limit the choice of profession and the patient’s further ability to work.

Treatment of TBI is mainly conservative, unless other measures are provided (surgery if there are signs of brain compression and hematoma formation), and symptomatic:

The gag reflex and psychomotor agitation are suppressed with haloperidol;
Brain edema is relieved with the help of dehydrating medications (mannitol, furosemide, magnesium, concentrated glucose solution, etc.);
Long-term use of dehydration medications requires the addition of potassium preparations (panangin, potassium chloride, potassium orotate) to the prescription list;
For severe pain effects, analgesics, as well as sedatives and tranquilizers are indicated (the patient should rest more);
Antihistamines, medications that strengthen the walls of blood vessels (calcium preparations, ascorrutine, vitamin C), improve the rheological properties of blood, ensuring water-electrolyte balance and acid-base balance have a good effect;
If necessary, the patient is given medications that help normalize the activity of the cardiovascular system;
Vitamin therapy is prescribed when the acute period is behind us - it is more indicated at the stage of recovery after injury.

The Hard Way - Brain Injuries in Newborns

It is not uncommon for newborns to be injured when passing through the birth canal or when using obstetric instruments and certain obstetric techniques. Unfortunately, such injuries do not always cost the baby “a little bloodshed” and the parents “a little fright”; sometimes they leave consequences that become a big problem for the rest of their lives.

At the very first examination of the baby, the doctor pays attention to the following points that can help determine the general condition of the newborn:

Is the baby capable of sucking and swallowing?
Is his tone and tendon reflexes reduced?
Is there any damage to the soft tissues of the head;
What condition is the large fontanel in?

In newborns who received injuries during passage through the birth canal (or various obstetric injuries), complications such as:

Hemorrhages (in the brain, its ventricles, under the membranes of the brain - in connection with which subarachnoid, subdural, epidural hemorrhage are distinguished);
Hematomas;
Hemorrhagic permeation of the brain substance;
CNS lesions caused by contusion.

Symptoms of birth injury to the brain mainly come from the functional immaturity of the brain and reflex activity of the nervous system, where consciousness is considered a very important criterion for determining disorders. However, it should be borne in mind that there are significant differences between changes in consciousness in adults and babies who have just seen the light, therefore, in newborns, for a similar purpose, it is customary to study the behavioral states characteristic of children in the first hours and days of life. How does a neonatologist find out about problems in the brain of such a young child? Pathological signs of impaired consciousness in newborns include:

Constant sleep (lethargy), when the baby can only be awakened by severe pain caused to him;
Stunned state – the child does not wake up when exposed to pain, but reacts by changing his facial expressions:
Stupor, which is characterized by a minimum of the baby’s reactions to stimuli;
A comatose state where there are no reactions to pain.

It should be noted that to determine the condition of a newborn who was injured at birth, there is a list of various syndromes that the doctor focuses on:

Hyperexcitability syndrome (the child does not sleep, constantly writhes, grunts and screams);
Convulsive syndrome (convulsions themselves or other manifestations that may correspond to this syndrome - apnea attacks, for example);
Meningeal syndrome (increased sensitivity to irritants, reaction to percussion of the head);
Hydrocephalic syndrome (restlessness, large head, increased venous pattern, bulging fontanel, constant regurgitation).

Obviously, diagnosing pathological conditions of the brain caused by birth trauma is quite difficult, which is explained by the immaturity of brain structures in children in the first hours and days of life.

Medicine can’t do everything...

Treatment of birth brain injuries and care of a newborn require maximum attention and responsibility. A severe traumatic brain injury in a child received during childbirth requires the baby to stay in a specialized clinic or department (with the baby placed in an incubator).

Unfortunately, birth injuries to the brain are not always without complications and consequences. In other cases, the intensive measures taken save the child’s life, but cannot ensure his full health. Leading to irreversible changes, such injuries leave a mark that can significantly negatively affect the functioning of the brain and the entire nervous system as a whole, posing a threat not only to the child’s health, but also to his life. Among the most severe consequences of birth trauma, the following should be noted:

Dropsy of the brain or, as doctors call it, hydrocephalus;
Cerebral palsy (CP);
Mental and physical retardation;
Hyperactivity (increased excitability, impaired attention, restlessness, nervousness);
Convulsive syndrome;
Speech impairment;
Diseases of internal organs, allergic diseases.

Of course, the list of consequences can be continued... But whether the treatment of birth injury to the brain will cost with conservative measures or will have to resort to neurosurgical operation depends on the nature of the injury received and the depth of the disorders that followed it.

Video: head injuries in children of different ages, Dr. Komarovsky

Complications and consequences of TBI

Although there has already been mention of complications in various sections, there is still a need to touch upon this topic again (in order to understand the seriousness of the situation created by TBI).

Thus, during the acute period the patient may face the following troubles:

External and internal bleeding, creating conditions for the formation of hematomas;
Leakage of cerebrospinal fluid (cerebrospinal fluid rhinorrhea) - external and internal, which threatens the development of an infectious-inflammatory process;
Penetration and accumulation of air in the skull (pneumocephalus);
Hypertensive (hydrocephalic) syndrome or intracranial hypertension - increased intracranial pressure, as a result of which vegetative-vascular disorders, impaired consciousness, convulsive syndrome, etc. develop;
Suppuration of wound sites, formation of purulent fistulas;
Osteomyelitis;
Meningitis and meningoencephalitis;
GM abscesses;
Bulging (prolapse, prolapse) of the GM.

The main cause of death of the patient in the first week of illness is considered to be cerebral edema and displacement of brain structures.

TBI does not allow either doctors or the patient to calm down for a long time, since even in the later stages it can present a “surprise” in the form of:

Formation of scars, adhesions and cysts, development of hydrocele and arachnoiditis;
Convulsive syndrome with subsequent transformation into epilepsy, as well as astheno-neurotic or psychoorganic syndrome.

The main cause of death of the patient in the late period is complications caused by purulent infection (pneumonia, meningoencephalitis, etc.).

Among the consequences of TBI, which are quite diverse and numerous, I would like to note the following:

Movement disorders (paralysis) and persistent sensory impairment;
Impaired balance, coordination of movements, changes in gait;
Epilepsy;
Pathology of ENT organs (sinusitis, sinusitis).

Recovery and rehabilitation

If a person who has received a mild concussion in most cases is safely discharged from the hospital and soon remembers his injury only when asked about it, then people who have experienced severe traumatic brain injury face a long and difficult path of rehabilitation in order to restore lost basic skills . Sometimes a person needs to learn to walk, talk, communicate with other people, and take care of himself independently. Here, any means are good: physical therapy, massage, all kinds of physiotherapeutic procedures, manual therapy, and classes with a speech therapist.

Meanwhile, to restore cognitive abilities after a head injury, sessions with a psychotherapist are very useful, who will help you remember everything or most of it, teach you to perceive, remember and reproduce information, and adapt the patient in everyday life and society. Unfortunately, sometimes lost skills never return... Then all that remains is to teach a person to serve himself and contact people close to him to the maximum (as far as intellectual, motor and sensory abilities allow). Of course, such patients receive a disability group and need outside help.

In addition to the listed activities during the rehabilitation period, people with a similar history are prescribed medications. As a rule, these are vascular drugs, nootropics, vitamins.

Head injuries are one of the most common physical injuries. According to statistics, every second person receives them. Moreover, injuries to the skull and brain are considered the most dangerous for a person in terms of consequences that may not appear immediately, but weeks and even months after a bruise, blow, or fall.

Severity of consequences after traumatic brain injury

Why does one person suffer from an injury, and another becomes bedridden for the rest of his life? Why does some of the victims experience head and even brain damage without consequences, while someone else’s life after a TBI will never be the same? The success of recovery and complications after traumatic brain injury depend on several factors:

character - the more damage, the deeper their penetration, the more difficult the healing process;
speed of medical care - the sooner the victim gets to the doctor, the higher the likelihood that the consequences will be minimized as much as possible;
patient’s age – the younger the victim, the easier the recovery will be.

According to statistics, every second person aged about 20 years with a mild head injury experiences virtually no consequences. If the patient is aged 60 or older and the nature of the TBI is defined as severe, then the chance of death is about 80%.

Minor head injury and its consequences

A mild head injury may have no consequences at all, or they will be mild and short-term. In other cases, after a concussion or a slight injury, the victim may briefly lose consciousness and memory. All consequences of such trauma are reversible and are present in a person’s life for a short time:

headaches after head injury;
after a head injury;
vomiting, nausea;
sleep problems;
irritability;
excessive sweating;
fast fatiguability.

For mild head injuries, the patient returns to normal life within two weeks. If minor injuries occur repeatedly, then sleep disturbances, headaches, and memory problems may be present in a person’s life periodically throughout life, but not affect his ability to work.

Moderate head injury and its consequences

The consequences of a moderate traumatic brain injury (severe bruise, partial brain damage, fracture of the base of the skull) are more serious. The patient may experience:

partial loss of vision;
limb cramps, paralysis of the cervical muscles;
mental disorders;
amnesia;
heart rhythm disturbance.

The recovery process from such damage can take from one to one and a half months or even more.

Severe head injury and its consequences

The consequences of severe traumatic brain injury (after severe bruises of the brain, its compression, hemorrhage, open fractures of the skull itself) can permanently exclude a person from normal life, even lead to death. This happens in every second case. Coma as a consequence of traumatic brain injury is also very common after severe TBI.

But even in a favorable scenario, when the patient manages to maintain a meaningful life, it is not possible to talk about a complete restoration of his health. Memory loss, problems with vision, hearing and speech, breathing problems, heart rhythm disturbances, loss of sensitivity, weakness and convulsions - all this can be the consequences of a severe traumatic brain injury for a long period.

These consequences can appear either immediately after the incident or years later, but often they bother a person throughout his life. In addition, every second person after severe TBI expects:

partial disability, when mental disorders, neurological pathologies (acute psychoses, impaired coordination, partial paralysis) are diagnosed, in which a person’s ability to work is lost, but he is able to care for himself;
complete disability, when the patient requires constant care because he cannot take care of himself;
coma of varying degrees of depth, in which the body supports the functioning of organs, but the person himself does not respond to the outside world;
death.

Important! After a TBI, a person’s personality can change to such an extent that family and friends no longer recognize him. The emergence of new, most often negative character traits, together with uncontrollable outbursts of aggression, can make living together with a patient unbearable.

Is there life after a traumatic brain injury?

Traumatic brain injury is not a death sentence. The consequences after it are not unambiguous - they are individual. If rehabilitation is carried out in a timely and competent manner, if the victim is provided with not only surgical, medicinal, but also psychological support, there is a chance that he will retain his legal capacity, even despite the severity and nature of the injuries.

Based on the mechanism of injury and the fact of the integrity of the cutaneous aponeurosis, the following types of traumatic brain injury (abbreviated as TBI) are distinguished:

Open traumatic brain injury

It is characterized by damage to the bones of the skull, meninges (hard and soft), and brain tissue. Wounds can be either non-penetrating (the bone plate remains intact, the wound cavity does not communicate with the external environment) or penetrating.

Closed head injury

This category includes injuries in which the skin remains completely intact or its defect does not reach the level of the aponeurosis: concussion, barotrauma, bruises, compression. They are often combined with internal hemorrhages.

As a result of trauma, damage to brain tissue occurs due to disturbances in the dynamics of blood circulation and cerebrospinal fluid. During concussions (shakes), pinpoint hemorrhages and ruptures of small vessels occur. Also, during trauma, the brain hits the base of the skull, causing a cerebrospinal fluid concussion, which damages the walls of the ventricles of the brain. The pathogenesis of mental disorders in the first stages is due to increased permeability of small vessels, oxygen starvation and edema.

Clinical picture of traumatic brain injury

There are three stages in the development of consequences after a traumatic brain injury:

Initial period. It is manifested by deficit disorders that appear precisely during the period of trauma. Their severity and duration depend on the strength of the traumatic factor and the presence of associated complications (hemorrhage, compression of the brain). Therefore, there may be states of stunned, obliterated, stupor, as well as coma.

Acute period. After the restoration of consciousness, asthenia occurs - exhaustion, lack of vitality. Patients complain of eye pain, tinnitus, and high sensitivity to external stimuli. There is retrograde memory loss at the time of injury, as well as for time periods before it. With severe trauma, memory for subsequent events is impaired (retroanterograde amnesia). In parallel with this, autonomic disorders are observed: increased sweating (hyperhidrosis), instability of blood pressure and pulse, blue discoloration of the fingertips, ears, and nose (acrocyanosis).

Period of residual changes. Manifests itself in the form of headaches, sleep disturbances, memory impairment, and asthenia.

Psychoses associated with the acute period of traumatic brain injury

Psychoses can appear in the first days after a traumatic brain injury, sometimes after 3-4 weeks. Characterizing the mechanism of their development, these disorders are also called “edema psychoses” or “exhaustion psychoses.”

Traumatic twilight state

In the twilight state, a narrowing of consciousness occurs, that is, a person perceives the external world in fragments, seeing only a narrow circle of its elements. Adequacy of thinking and orientation are lost. Outpatient automatisms may be observed (a person performs ordinary everyday activities with a narrowed consciousness), trance episodes, and a disorder of orientation in one’s personality and locality.

Delirium

The state of delirium develops with severe traumatic brain injuries, accompanied by intracerebral hemorrhages and swelling of the brain. A person with delirium experiences multiple, scene-like visual hallucinations. At the same time, he feels fear, anxiety, which can quickly change to anger, complete complacency and euphoria. A severe variant is occupational delirium, when the patient begins to automatically perform actions that he performs in his work life.

Amentia

For it to occur, there must be a combination of two factors: severe traumatic brain injury and exhaustion due to massive blood loss, intoxication or infection. With this disorder, the patient completely loses coherence of thinking, attention, there is no consciousness and orientation. The motor sphere is characterized by confusion and lack of coordination. The prognosis is unfavorable, since traumatic amentia can be fatal.

Korsakov's syndrome

It can be observed either in the acute period or as part of long-term consequences. It is characterized by pseudoreminescence - a shift in the memory of events from the past to the present. This is a distinctive feature from Korsakoff syndrome in alcoholism, when vivid confabulations - false memories - come first.

Traumatic deafness

Basically, this type of injury occurs after a person is thrown back by a shock wave and further injured. In its mild form, deafness lasts 2-3 weeks. In a more severe version, it is combined with severe adynamia (lack of motor activity), dyssomnia (insomnia), and depressed mood. Hearing and speech are restored to normal gradually, over about a month.

Cerebrostenia

This is the most common disorder in which there is increased exhaustion, intolerance to mental, physical stress and external stimuli (temperature, sound, auditory). The patient's ability to concentrate is impaired, emotional lability is present (mood instability, incontinence of affect - the patient's elation and euphoria quickly change to depression, tearfulness). It is difficult for a person to concentrate attention and remember new material, due to which the ability to work and social adaptation are lost.

Psychopathic-like syndrome

Occurs against the background of traumatic brain injury, moderate in severity. The patient’s environment, social support and family circumstances also play a role here. There are two main variants of psychopathic syndrome: explosive and hysterical. In the case of hysterical syndrome, a person always tries to be the center of attention (egocentrism), greatly exaggerate the severity of the disease, and hysterical reactions such as paralysis, paresis, and hysterical seizures occur. In the event that an explosive variant develops, the patient is prone to aggressive, rash actions, he is quick-tempered and cannot contain his affect, which creates problems for interpersonal communication, as well as work activity.

Organic brain damage due to traumatic brain injury is a serious pathology that requires long-term observation and treatment by neurologists and psychiatrists.