In this article, we consider the severity of a concussion injury. This ailment is one of the types of closed head injury. Mostly this is an easily reversible defect in brain function that occurs due to a stroke, bruise, or sudden movement of the head. It is accepted that because of this interneuronal connections are temporarily disrupted.
What are the degrees of concussion of the brain is interesting to many.
Description
As a result of the contact of the substance of the brain with the cranial bones, as a rule, the following happens:
- a change in a number of chemical or physical signs of neurons, due to which the spatial organization of protein molecules can change;
- pathological influence lends itself to the substance of the brain of the head as a whole;
- temporary disconnection of signal transmission and the relationship between synapses (synapse refers to the place of contact of two neurons or a neuron and an effector cell receiving a signal) of cellular neurons and parts of the brain. This contributes to the appearance of functional defects.
Degree of concussion
Depending on how severe the patient's condition is, and what clinical signs are observed, three degrees of the disease are distinguished:
- Mild concussion. Consciousness is not broken. The victim may experience dizziness, disorientation, nausea, headache within the first twenty minutes after receiving an injury. Symptoms of mild concussion quickly go away. Then the general state of health is normalized. The temperature may rise briefly (up to 38 degrees).
- The average degree of concussion. There is no loss of consciousness, however, pathological signs such as nausea, headache, disorientation, dizziness are present. All of them last longer than twenty minutes. Also, with a concussion of moderate severity, amnesia (short-term memory loss) may occur. It has a predominantly retrograde character with the loss of several minutes of memories immediately before the injury.
- A severe concussion of the brain is very dangerous. Be sure to lose consciousness for a short period of time, usually from several minutes to several hours. At the same time, the patient does not remember what happened to him - retrograde amnesia occurs. For one to two weeks after a concussion of the 3rd degree, a person is disturbed by pathological symptoms: nausea, disorientation, headache, sleep and appetite defects, dizziness, and fatigue.
Signs and Symptoms
Concussion is characterized by the following symptoms:
- Consciousness is inhibited immediately after contact with a traumatic force. And this is not necessarily a loss of consciousness, it can be a stupor (stunning), a kind of incomplete consciousness. The defect in consciousness is short-term, lasting from several seconds to several minutes. This period most often reaches five minutes. When the victim is alone at this time, he will not even be able to say that he lost consciousness, as he simply does not remember this.
- Amnesia (memory defect) on the events that preceded the concussion, the concussion itself and a short time period after it. However, memory is recovered quickly.
- Single vomiting after injury. Vomiting has a brain origin, it is most often not repeated and is used as a clinical way to distinguish concussion from a mild bruise.
- Slow or rapid heart rate, higher blood pressure some time after injury. These changes usually go away on their own and do not require medical treatment.
- Immediately after the concussion, breathing quickens. It normalizes earlier than indicators of the heart and blood vessels, so this symptom may go unnoticed.
- The body temperature does not change (the absence of changes is also a differential diagnostic criterion regarding a bruise of the brain of the head).
- A specific "game of vasomotors." A condition in which the pallor of the skin changes to redness. It occurs due to a violation of the tone of the nervous autonomic system.
When consciousness is fully restored, the following symptoms appear:
- headache (can be felt both at the site of injury and on the head as a whole, has a different character);
- noise in ears;
- sweating (wet feet and palms all the time);
- dizziness;
- flushing of the face, accompanied by a feeling of heat;
- general malaise and weakness;
- sleep disturbances;
- decreased concentration, accelerated physical and mental fatigue;
- staggering while walking;
- high sensitivity to bright light and loud sounds.
Neurological type disorders, especially with severe concussion, are observed:
- pain when moving to the sides of the eyeballs, inability to take to the extreme position of the eye;
- in the first hours after injury, it is possible to detect a slight narrowing or expansion of the pupils, while their reaction to light is normal;
- slight asymmetry of skin and tendon reflexes, they differ when called on the right and left. Moreover, this symptom is quite labile, for example, during the initial examination, the left knee reflex is slightly more alive than the right one, when re-examined after just a few hours, both knee reflexes are identical, however, there is a difference in the Achilles reflexes;
- horizontal small nystagmus (trembling involuntary movements) in the most extreme positions of abduction of the eyeballs;
- shakiness of the patient in the Romberg position (straight arms extended forward to a horizontal level, legs together, eyes closed);
- slight neck muscle tension may occur, which lasts for three days.
A significant diagnostic criterion for mild concussion is that the symptoms are reversible (except subjective). All neurological signs disappear within a week. Asthenic complaints of dizziness, poor memory, headache, weakness, fatigue are not included in this account, as they may persist for some time.
It should also be noted that a concussion of the head is never accompanied by fractures of the cranial bones, even if it is a small crack. If there is a bone fracture, the diagnosis in any case is at least a mild degree of brain contusion.
How is the severity of health damage detected with a concussion?
Pathology diagnostics
This diagnosis is almost completely clinical, since the main criteria for the formulation are clinical signs. It is quite difficult to recognize the disease in cases where there are no witnesses of what happened, since most of the complaints in this condition are subjective in nature, the patient himself does not always remember the change in consciousness. In this case, external damage to the head comes to the rescue.
The degree of concussion in adults is established on the basis of anamnesis about the time of loss of consciousness and trauma, patient complaints, results of a neurological examination and instrumental examinations. In the immediate period after an injury, neurological status shows inconsistent and slight asymmetry of reflexes, fine-spreading nystagmus, in young patients - Marinescu-Radović syndrome (muscular homolateral contraction of the chin against the background of irritation of the elevation of the thumb), and sometimes mild meningeal symptoms (shell). Since more serious brain disorders can be hidden under a concussion, great importance is given to observing a person in dynamics. With a correctly established diagnosis, the deviations established during examination by a neurologist disappear 3-7 days after the incident.
Diagnosis in children and the elderly
Particular attention should be paid to the diagnosis of concussion in infants and young children, since it often passes without impaired consciousness:
- the skin turns pale at the time of the injury (primarily the face), the heartbeat becomes more frequent, after which drowsiness and lethargy appear;
- in infants, vomiting and regurgitation occur during feeding, sleep disturbance and anxiety are noted; all manifestations disappear after 2-3 days;
- in preschool young children, most often, a concussion occurs without loss of consciousness, and the condition as a whole improves over 2-3 days.
In elderly patients, primary loss of consciousness during concussion is much less common compared with people of middle and young age. At the same time, quite often there is a pronounced disorientation in time and space. Headaches often have a pulsating character and are localized in the occipital region. Such disorders are observed from three to seven days, are very intense in patients who suffer from hypertension. In this case, patients should be given special attention during the examination.
With a concussion, additional diagnostic methods are performed for differential diagnosis, so that the functionality of changes in the brain of the head is confirmed. With any traumatic brain injury of a more severe nature, structural disorders are found in the brain, but this does not happen with a concussion.
For example, if the patient has a neck muscle tension, which is a symptom of irritation of the meninges, it becomes necessary to confirm the absence of subarachnoid hemorrhage. For this purpose, a spinal puncture is performed. With a concussion, the results of the analysis of the obtained cerebrospinal fluid do not differ from normal indicators, which makes it possible to exclude such a diagnosis as subarachnoid hemorrhage (if there is one, a blood admixture is found in the cerebrospinal fluid).
Computed tomography, as the main research method for traumatic brain injuries, and also for brain concussion, does not detect pathological changes, due to which the diagnosis is confirmed. By analogy, neither echoencephalography nor MRI determines abnormalities if a person has a concussion.
The next retrospective confirmation of the correct determination of the diagnosis is the disappearance of neurological symptoms within a week after injuring the injured. With a mild concussion, they pass almost immediately.
First aid to the injured
If the victim is unconscious, you must immediately call an ambulance. An unconscious patient should be laid on his right side on a hard surface with bent elbows and legs. Tilt your head up, turn to the ground - a similar position allows you to provide excellent air passage through the respiratory tract, prevents aspiration, that is, ingestion of foreign substances, liquids during vomiting when inhaling.
In the event that a person is bleeding from a wound on his head, a bandage must be applied to stop it. If the victim regained consciousness or there was no fainting at all, he should be laid horizontally, his head raised, all the time monitoring his consciousness and not letting him sleep.
Not everyone knows the severity of a concussion. It is important to remember that all patients with a head injury, despite their state of health and severity, must be taken to a trauma center. The traumatologist will decide whether they can be outpatient by a neurologist, or whether hospitalization in the neurological department is required to monitor and diagnose the condition.
It should also be noted that in case of loss of consciousness of the victims and the impossibility of independently determining the degree of severity, it is recommended not to touch it at all, not to try to turn it once again or turn it over. If there are factors that threaten a person’s life, for example, loose substances, liquids, small objects that can get into the respiratory tract, you need to eliminate them.
Drug therapy
In the case of 1 and 2 degrees of concussion, drug treatment should be gentle. Primarily, it is necessary to prescribe symptomatic preparations to the patient:
- painkillers to eliminate headaches (combination drugs such as Solpadein, Pentalgin, anti-inflammatory non-steroidal drugs);
- drugs to relieve dizziness ("Platifillin" with "Papaverine", "Vestibo", "Betaserk");
- sedatives (to calm the nervous system), their spectrum is quite wide, depending on the individual need in each case: from plant extracts to tranquilizers;
- with insomnia - sleeping pills;
- general strengthening drugs (antioxidants, vitamins, tonic agents).
Metabolic maintenance of the brain is carried out through neuroprotectors. These include a large group of drugs. For example, it can be Nootropil (Piracetam), Pantogam, Encephabol, Glycine, Picamilon, Actovegin, etc.
On average, the patient will have to spend about a week in stationary conditions, and then he will be discharged and treated on an outpatient basis. In addition to symptomatic drugs, drugs are prescribed at this time that improve the blood supply to the brain of the head ("Nicergoline", "Trental", "Cavinton", etc.).
For absolute recovery, one patient will need a month of drug treatment, and another three months. But in any case, if all the points listed above are observed, recovery occurs.
Within a year after a concussion, it is necessary to periodically be examined by a neurologist who will conduct a follow-up observation of the patient.
Is outpatient treatment possible with varying degrees of severity of concussion?
Ambulatory treatment
Despite the fact that concussion is classified as a mild traumatic brain injury, it requires mandatory treatment in an inpatient setting. This is due to the unpredictability of the post-traumatic period, as there are situations when a patient has subarachnoid hemorrhage or intracranial hematoma against the background of symptoms of concussion (of course, this rarely happens, but it is possible). When the patient is on outpatient treatment, he may not notice the first signs of worsening of his condition, which is fraught with a risk not only for health but also for life. Staying in a hospital, he will be provided with qualified medical assistance throughout the entire period of treatment.
Post Concussion: Home Treatment
The most important thing in the treatment of concussion is to adhere to bed rest, prevent mental and physical stress, especially in the early days, proper rest and sleep. If the patient complies with all the doctor’s recommendations and begins treatment on time, concussion almost always ends in absolute recovery, his ability to work is resumed.
Some victims may still have residual effects of the injury over time. Among them - a decrease in concentration, high fatigue, irritability, depressive disorders, headaches, memory impairment, sleep disorders, migraine. As a rule, all of these symptoms soften after a year, but it happens when they disturb the victim throughout his life.
Within a month after receiving a concussion, it is undesirable to do difficult physical work, it is necessary to limit sports activities. It is strictly forbidden to violate bed rest, it is best to refuse to be at the computer, watch TV and continue reading books. It is recommended to listen to calm music, you cannot use headphones while doing this.
The prognosis depends on the severity of the health damage caused by concussion.
Forecast
In 97% of all concussion situations, a person recovers completely, without any consequences. The remaining three percent of cases are characterized by the development of post-mood syndrome, which consists of various asthenic manifestations (impaired concentration of attention, memory, increased anxiety and irritability, poor tolerance of various loads, dizziness, periodic headaches, impaired appetite and sleep, etc.).
According to statistics, a much larger percentage of the negative effects of concussion was previously observed. Most likely, this is due to the fact that there was no computed tomography, some bruises of the brain of the head of a mild degree were defined as concussions. With a bruise, brain tissue is always damaged, so it has consequences more often compared to functional changes.
We examined the severity of harm during concussion.