Trauma Brain Injury
The concept of head trauma or cranio-cerebral injury (TBI) covers injuries the neurocranium (top part of the skull containing the brain) and brain.
The clinical manifestations depend on the size of the impact and associated factors (age, other existing conditions, associated injuries). By the anatomical location of the head, brain injury is often associated with cervical spine injuries (sprains, dislocations, fractures), face (bruises, wounds, fractures, maxillo-facial) and eye.
The immediate aftermath and distance of head injury are often the result of damage caused on the central nervous system (brain and cervical spinal cord). They incurred in the future victims and their families and their social and financial costs are high.
Clinically there are three main categories of brain injury: mild (no loss of consciousness and without skull fracture), medium (with loss of consciousness exceeding initial few minutes or skull fractures) and severe (coma of outset - with or without associated skull fracture).
Significant progress has been made in the medical management of victims early and rapid diagnosis and specific lesions that may benefit from surgical treatment. Despite this progress, more than 50% of serious cases die or remain disabled for life. The prognosis is so often linked to the importance of initial signs and lesions (occurring at the time of the accident).
Head injuries are the leading cause of mortality and severe disability before age 45. The principal reasons are: accidents highway (approximately 50%), sports accidents, work accidents, domestic accidents, assaults. There are also indirect mechanisms without head injury itself, but which create lesions similar. In this category we find the anoxic brain injury (false paths) or hypoglycemia (eg through overdoses of insulin, particularly in diabetics).
It is a brain concussion resulting from a fall or a blow to the skull, with or without a temporary loss of consciousness or initial. This is a temporary dysfunction of the ascending reticular (SRA) located deep in the brain and is responsible for maintaining wakefulness. This is a consequence of the spread concentrically and concentration of shock waves to the center of the brain (stereotaxic phenomena).
The picture most banal and there is no radiologically visible lesions in the brain. The head trauma caused an immediate loss of consciousness. The patient was "stunned", "KO". The awakening occurs spontaneously a few seconds - minutes - hours after the injury depending on the level of shock. Sometimes there are transient disturbances in recent memory setting. A neurosurgical or medical surveillance needed to detect possible complications: extra-dural hematoma, subdural hematoma, cerebral edema.
Fainting or a slight concussion are often isolated without consequences. They can cause post-concussion syndrome. Repeated concussions can, however, favors the onset of neuro-degenerative diseases like severe Parkinson's disease or Alzheimer's disease even after several decades.
The cerebral contusion
In this case, there are anatomical lesions of the brain (hemorrhagic necrosis with edema), not necessarily at the level of impact.
The brain edema is a common complication of head injuries (excluding concussions). These cause brain damage signs of neurological localization deficit: reduced muscle strength or sensitivity of a limb, asymmetric tendon reflexes, Babinski sign, aphasia, etc..
These disorders regress under medical treatment. Diuretics are used to reduce cerebral edema, and mannnitol which can dehydrate the brain tissue. Sometimes, brain edema is large enough to cause the onset of cerebral involvement (engagement of the lower part of the brain under the falx to the contralateral cerebral hemisphere, involvement of the lower part of the brain in the foramen magnum). A subarachnoid hemorrhage may be associated with cerebral contusion, and results in headache, neck stiffness and impaired consciousness.
The deep coma immediately
It is a maximum severity of concussion. The patient has a deep and persistent coma after the impact because the dysfunction of the reticular bottom is deeper. Signs of decerebration are possible reflecting the presence of lesions and diffuse axonal mesencephanliques associated with concentric spread and concentration of shock waves to the center of the brain (stereotaxic phenomena).
The scan is performed urgently seeking surgically curable lesions. If a hematoma is operable, the operation is performed immediately. Otherwise, treatment for resuscitation is undertaken in a specialized (anti-edema, respiratory etc..) And begins monitoring clinical and radiological evolution. If secondary worsening, new radiological seek especially lesions occurred secondarily and that could benefit from surgery (epidural hematoma, subdural hematoma, hydrocephalus)
The prognosis depends on the size of initial lesions, age and general condition before the accident. More coma is superficial and the patient young and healthy before the accident, the greater the chances of cure are high. It can lead to brain death.
Initial evaluation of head trauma
It allows to separate clearly mild trauma and those who will require care in hospital.
The questioning of the victim and / or witnesses trying to learn the type of occurrence and impact, it does not, however, to anticipate the severity of injuries.
Disorders of consciousness should be investigated and quantified according to the Glasgow Coma Scale.
It is always wary of a possible neck injury with a potential risk of quadriplegia (paralysis of all four limbs) in case of mobilization imprudent. Similarly, trauma associated with another body part must be sought systematically.
A brain scan should be done urgently in case of a deficit of consciousness, even transient or occurred secondary in case of neurological deficit (downward mobility of a limb, speech disorder, amnesia), at least doubt on a cranial fracture, on the occurrence of seizure or vomiting. In children, the indication of a scanner is all the greater because he is young.
They depend heavily on the location of the trauma. A proper balance check, after regaining consciousness:
* Signs plegiques or paralytic
* Of balance disorders
* Disorders symbolic type aphasia or agnosia
* Signs of cranial nerve lesions
The psychological aspect of brain injury resulting from regular anxiety when the patient becomes aware of potentially irreversible sequelae. These fears can exacerbate the disorder. Some psychological disorders are not uncommon after trauma, even minor. Among the common symptoms, disorders of the sympathetic nervous system entrainant such as hot flashes, difficulty concentrating, fatigue or intellectual deterioration, sleep disturbances and emotional control. In some cases, we speak freely of PTSD.
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