Concussion is a mild reversible brain dysfunction caused by traumatic effects. It is believed that the basis of the manifestation of concussion is a breakdown of connections between nerve cells, mainly functional.
Concussion of the brain in frequency of occurrence ranks first in the structure of traumatic brain injury. Causes of concussion are both traffic accidents and domestic, occupational and sports injuries; criminal circumstances also play a significant role.
The main symptom of a concussion of the brain is loss of consciousness at the time of the injury. The exception may be only children and the elderly. Immediately after concussion may also occur.
- single vomiting,
- some faster breathing
- increased or slow pulse,
- memory impairment of current or prior events,
but these figures are soon normalized. Blood pressure quickly returns to normal, but in some cases it can rise steadily – this is due not only to the injury itself, but also to the accompanying stress factors. Body temperature with concussion remains normal.
Regaining consciousness is typical of complaints
- noise in ears,
- flushing of the face
- sleep disturbance.
With a concussion of the brain, the general condition of the victims usually improves rapidly during the first, or less often the second week. However, it should be borne in mind that headaches and other subjective symptoms may last much longer for various reasons.
Features of the manifestations in children and the elderly
The picture of brain concussion is largely determined by age factors.
In infants and young children, concussion often proceeds without disturbing consciousness. At the time of injury – a sharp pallor of the skin (especially the face), heart palpitations, then lethargy, drowsiness. There are regurgitation during feeding, vomiting, anxiety, sleep disorders are noted. All manifestations pass in 2-3 days.
In children of younger (preschool) age, concussion of the brain can proceed without loss of consciousness. The general condition improves within 2-3 days.
In elderly and old people, primary loss of consciousness during brain concussion is observed much less frequently than in young and middle-aged people. However, pronounced disorientation in time and place is often manifested. Headaches are often pulsating in nature, localized in the occipital region; they last from 3 to 7 days, differing in considerable intensity in persons suffering hypertensive disease. Frequent dizziness.
In the diagnosis of concussion, it is especially important to take into account the circumstances of the injury and the information of witnesses to the incident. Traces of trauma to the head and such factors as alcohol intoxication, the psychological state of the victim, etc. can play a dual role.
Concussion of the brain often has no objective diagnostic signs. In the first minutes and hours, the doctor and other witnesses can see a loss of consciousness (for a few minutes), twitching of the eyeballs when looking to the side (nystagmus), an imbalance and coordination of movements, double vision.
Laboratory and instrumental signs of diagnosis of tremor does not exist.
- When concussion fractures of the skull bones are absent.
- The pressure and composition of cerebrospinal fluid without deviations.
- With ultrasound (M- echoscopy ), the displacement and expansion of the median structures of the brain is not detected.
- Computed tomography in patients with concussion does not detect traumatic abnormalities in the state of the brain substance and other intracranial structures.
- Magnetic resonance imaging data for concussion also do not reveal any lesion.
Concussion of the brain often masks more severe traumatic brain damage and therefore patients are subject to emergency hospitalization in the neurosurgical profile of the hospital (or other profile, where neuro-trauma care is provided) mainly for examination and observation.
Thus, concussion of the brain can be identified on the basis of:
- Observed or reported to patients about loss of consciousness at the time of injury.
- Nausea, vomiting, complaints of dizziness and headache.
- No signs of more severe injury (loss of consciousness for more than 30 minutes, convulsive seizures, paralysis of the limbs).
First steps for suspected brain concussion:
- Call an ambulance or contact the emergency room.
- There the patient will be examined by a traumatologist or a neurologist, a radiograph of the skull will be performed. And if necessary, and if possible, CT or MRI of the brain (preferably, these examinations are a chance to avoid underestimating the severity of the injury, but such equipment is not always available), in the absence of CT or MRI, M- echoscopy is performed .
- When the diagnosis is confirmed, patients are hospitalized in the neurosurgical or trauma ward for observation, so as not to miss a more serious injury and to avoid complications.
First aid for tremors
First aid to a victim with a concussion, if he quickly regained consciousness (as is usually the case with a concussion of the brain), is to give him a comfortable horizontal position with his head slightly elevated.
If the concussion continues to be in an unconscious state, the so-called saving position is preferable
- on the right side,
- head thrown back, face turned to the ground,
- the left arm and leg are bent at a right angle at the elbow and knee joints (fractures of the limbs and the spine should be excluded first).
This position, ensuring the free passage of air into the lungs and the unobstructed discharge of fluid from the mouth to the outside, prevents respiratory failure due to sticking of the tongue, leaking into the respiratory tract of saliva, blood, vomit. If there are bleeding wounds on the head, bandage.
All victims of concussion, even if it appears to be light from the outset, must be transported to an on-duty hospital, where the primary diagnosis is clarified. The victim is given a bed rest for 1-3 days, which then, taking into account the course of the disease, gradually expands over 2-5 days, and then, in the absence of complications, discharge from the hospital to outpatient treatment is possible (up to 2 weeks). ).
Drug treatment for concussion is often not required and is symptomatic (the main treatment is rest and healthy sleep). Pharmacotherapy is mainly aimed at normalizing the functional state of the brain, removing headaches, dizziness, anxiety, insomnia, and other complaints.
Typically, the range prescribed for intake of drugs includes painkillers, sedatives and hypnotics, mainly in the form of tablets, and, if necessary, in injections. Among painkillers (analgin, pentalgin , dexalgin , sedalgin , maxigan , etc.) select the most effective drug in this patient. Likewise receives and dizziness, selecting that any one of the available drugs (Belloidum, cinnarizine, papaverine with platifillin, Tanakan, micrograins, and the like).
As used soothing valerian, motherwort, Corvalolum, valokordin and tranquilizers (afobazol, grandoksin, sibazon, phenazepam, nozepam, rudotel et al.). To eliminate insomnia, donarmil or relaxon is prescribed for the night .
Conducting a course of vascular and metabolic therapy for tremors contributes to a more rapid and complete restoration of disorders of brain functions. Preferably, a combination of vasitous ( cavinton , stugeron , sermion , instenon , etc.) and nootropic (glycine, nootropil , pawnthog , noopept , etc.) drugs.
As options for possible combinations, daily three times daily use of Cavinton 1 tab. (5 mg) and nootropil 2 capsules. (0.8) or stegerone 1 tab. (25 mg) and noopept 1 tab. (0,1) for 1-2 months. The positive effect brings inclusion in course of therapy preparations containing magnesium (magnesium B6 Magnelis, Panangin)and antioxidants Citoflavin 2 m 2 p daily Mildronat 250 mg 1 m 3 per day p.
To overcome the frequent asthenic phenomena after a concussion, the following is prescribed: fenotropil 0.1 1 time in the morning, a kogitum of 20 ml 1 time a day, vazobral 2 ml 2 times a day, polyvitamins- polyminerals like ” Unicap -T”, ” Tsentrum ” , ” Vitrum “, etc. 1 tab. 1 per day. From tonic preparations use ginseng root, extract of Eleutherococcus, lemongrass, saparal , pantocrinum. In elderly and senile patients who have had a concussion, anti- sclerotic therapy is enhanced . Also pay attention to the treatment of various associated diseases.
To prevent possible deviations in the successful completion of a concussion, a dispensary observation is required for a year by a neurologist at the place of residence.
With adequate observance of the regime and the absence of aggravating circumstances of the trauma, concussion of the brain ends with the recovery of the injured with full restoration of working ability.
In a number of patients, by the passing of an acute period of concussion, there is a weakening of concentration, memory, depression, irritability, anxiety, dizziness, headaches, insomnia, fatigue, hypersensitivity to sounds and light. After 3-12 months after concussion, these signs disappear or are significantly smoothed out.
According to the forensic criteria, concussion refers to minor bodily harm and the percentage of disability is usually not determined.
When medical labor examination determined temporary disability from 7 to 14 days. Long-term and persistent disability usually does not occur.
However, in 3% of patients after concussion due to exacerbation and decompensation of already existing chronic diseases, as well as with multiple repeated injuries, moderate disability occurs, especially if the recommended treatment regimen and behavior are not followed .