Traumatic brain injury: consequences and rehabilitation

Traumatic brain injury (TBI) is damage to the bones of the skull or its soft tissues, which can be of a different nature. TBI is classified according to its type, type, form, biomechanics, clinical phase and other nuances. But whatever it may be, a traumatic brain injury always entails consequences. And now they should be considered.

Classification

It should be studied before proceeding to consider the consequences of a traumatic brain injury. The ICD codes are as follows:

  • Concussion - S06.0.
  • Traumatic edema - S06.1.
  • Diffuse injury - S06.2.
  • Focal injury - S06.Z.
  • Epidural hemorrhage - S06.4.
  • Subdural hemorrhage - S06.5.
  • Subarachnoid hemorrhage - S06.6.
  • Coma Injury - S06.7.
  • Other injuries - S06.8.
  • Damage without specification - S06.9.
  • NOS head injury - S09.9.

Each case is characterized by its own characteristics, symptoms and treatment principles. To systematize these codes are needed. The consequences of traumatic brain injuries in the comprehensive international classification of diseases are also indicated, and now they are worth exploring.

The consequences of a head injury according to ICD-10

Concussion

This is the most common head injury. It is characterized by a displacement of the brain within the intracranial box with a return, occurring as a result of a jump from a height, a blow, a jerk of the head, etc. And here are the consequences of a head injury of this kind:

  • Stretching and rupture of nerve fibers, blood vessels.
  • Violation of the relationship of brain centers with vital systems and with each other.
  • Violation or partial loss of cerebral functions.
  • Dizziness and headaches, aggravated by changing weather, drinking alcohol, physical activity and stress.
  • Change of characteristic qualities and behavior.
  • Unreasonable outbursts of anger, excessive impulsiveness, aggression, irritation, apathy, despondency.
  • Decreased mental activity and mental functions, memory impairment.
  • Weakness and fatigue.
  • Nightmares and insomnia.
  • The appearance of anxiety, panic fear, paranoia and phobia.
  • Cramps and muscle cramps.
  • Obsessive thoughts, psychosis, delirium, hallucinations.

In some cases, a person develops the so-called post-commotion syndrome. This complication is characterized by the manifestation of a number of severe symptoms, against which the quality of life is significantly reduced.

Concussion rehabilitation

To minimize the consequences after a traumatic brain injury, a person needs to drink a course of drugs prescribed by a doctor. Among them:

  • Analgesics: Maxigan, Nimesulide, Ibuprofen. Effectively relieve pain.
  • Sedatives and tranquilizers: tincture of motherwort, valerian, "Adaptol", "Afobazol". Eliminate anxiety, tension and fear.
  • Sleeping pills: Donormil and Relaxon. Facilitate the onset of sleep, ensure its sufficient duration.
  • Nootropic: Glycine and Nootropil. They activate metabolism, improve mental processes.
  • Toning: Eleutherococcus and Ginseng. Strengthen the body, have a beneficial effect on all systems and organs, shorten the rehabilitation period.
  • Means that improve cerebral circulation: Cavinton, Piracetam, Sermion.
  • Preparations containing magnesium: "Magne-B6." This substance is involved in many metabolic processes, in particular in the transmission of nerve impulses.

Medication is necessarily supplemented with physiotherapy. Patients are usually prescribed electrophoresis with vasodilators, galvanization of the brain and segmental zones, aerotherapy, laser therapy, transcerebral UHF therapy and oxygen baths.

Maxigan in the treatment of traumatic brain injury

Injury

This traumatic brain injury is characterized by limited morphological changes in cerebral tissues (this is the main difference from concussion). That bruise is about 30% of all cases of head injury. Its consequences can be identified in the following list:

  • Amnesia.
  • Dizziness.
  • Nausea, vomiting.
  • Headache.
  • High blood pressure.
  • Increased heart rate.
  • Clonic nystagmus, anisocoria, meningeal symptoms.
  • Motor excitement.
  • Paralysis, paresis.
  • Violation of swallowing, frequency and rhythm of respiration.
  • Inhibition of tendon reflexes.
  • Change in muscle tone.
  • Cramps.

In severe cases, focal and cerebral symptoms do not completely disappear. If we talk about the long-term consequences of a traumatic brain injury, we can distinguish an episindrom, mental disorders, post-traumatic encephalopathy and neurological disorders.

Injury rehabilitation

After an injury, a person should observe bed rest for 7-14 days, as well as take medication. In addition to the previously listed drugs, they are also prescribed:

  • Antiemetics: Domperidone and Metoclopramide.
  • Psychotropic: Haloperidol and sodium hydroxybutyrate. They help to cope with severe excitement.
  • Diuretics: "Furosemide", "Mannitol", "Diacarb." Inhibit reabsorption of water and salts in the renal tubules, improve their excretion from the body with urine.
  • Antihistamines: Suprastin, Tavegil. Prevent the formation of edema and inhibit exudation, reduce the permeability of capillaries and blood vessels.
  • Hemostatic: Etamzilat and Dicinon.
  • Metabolism enhancing agents: Cerebrolysin and Piracetam.
  • Nootropics: Nootropil and Encephabol. Positive effect on higher mental functions of the brain.
  • Vitamins of group B: Neurovitan and Milgamma.

To eliminate the consequences of traumatic brain injury, drug treatment will be few. Also, the patient is shown a lumbar puncture to reduce pressure and reorganize the cerebrospinal fluid.

If the bruise is severe, resuscitation measures cannot be dispensed with. With large foci of tissue crushing, surgical intervention is indicated.

All patients who suffered a brain bruise for a long time are in the dispensary under the supervision of specialists. Rehabilitation also includes physical therapy, courses of vascular therapy, spa and physiotherapy.

surgery for head injury

Diffuse Axonal Damage (DAF)

In this case, the consequences of a traumatic brain injury (according to the ICD code - S06.2) will be very serious, since this type of damage is characterized by diffuse ruptures or tears of axons.

TBI occurs due to an injury that occurred as a result of angular acceleration of the head. Direct contact of the head with a solid object may not even be. Therefore, many patients have no skull fractures.

The main consequence of a traumatic brain injury is a coma with symptoms of a stem lesion. It is observed from the first minutes and often goes into a vegetative state.

Survivors can regain consciousness. But the longer the coma lasts, the greater the likelihood of severe disability in the event a person regains consciousness. If the patient wakes up within the first 7 days, there is a chance of recovery.

But the consequences are difficult to avoid, and most often they become the following pathologies:

  • Weakening of the hands and random muscle movement.
  • Rapid shallow breathing (tachypnea).
  • Neurotrophic Disorders.
  • Dementia.
  • Confusion.
  • Lability of mood.
  • Aspiration.
  • Depletion of neurotransmitters.

After a person leaves a coma, he is overcome by extrapyramidal and nervous disorders, amnesia and aggression. Somatic complications may occur, and then the likelihood of a fatal outcome will increase.

Haloperidol in the treatment of traumatic brain injury

Rehabilitation for DAF

To stabilize the condition of patients with diffuse axonal damage to the brain, doctors carry out the following activities:

  • Long-term mechanical ventilation.
  • Parenteral nutrition - the introduction of substances necessary for the body to bypass the gastrointestinal tract through intravenous infusion.
  • Prevention of infectious complications.
  • Therapy aimed at maintaining the basic systems of the body and self-regulation (homeostasis).
  • Stopping cerebral edema.

After a person comes to his senses, intensive treatment begins. It includes such events:

  • Psychostimulotherapy. It is necessary for the regression of psychoemotional disorders.
  • Physiotherapy. Helps restore motor activity and prevent joint contractures.
  • Logopedic correction of speech disorders.
  • Reception of nootropic drugs: gamma-aminobutyric acid, "Piracetam", "Nicergoline", "Cortexin".
  • The use of vascular agents: "Cinnarizine" and "Vinpocetine."
  • Receiving anticholinesterase drugs (Galantamine and Neostigmine) and neurotransmitters (Piribedil and Levadopa).

Surgical treatment is not performed. It is indicated only in the case of intracranial injuries, which include depressed fractures, crushing lesions and hematomas (intracerebral or subdural).

They must be eliminated necessarily, otherwise serious, albeit long-term consequences of traumatic brain injury are possible - compression of the brain.

Closed TBI

This is also a very common type of damage. With a closed head injury, there is no violation of the integrity of the soft tissues, only fractures of the bones of the cranium are diagnosed. As a rule, the causes are accidents, falls, as well as injuries received at work, at home or during sports.

The following consequences of a closed head injury are distinguished:

  • Serous inflammation of the arachnoid membrane of the brain or spinal cord (arachnoiditis).
  • Porencephaly
  • Hydrocephalus.
  • Epilepsy.
  • Atrophy of the brain.
  • Hematoma of a chronic nature.
  • Cerebrospinal fistula.
  • Chronic hygroma.
  • Pneumocephalus.
  • Arachnoencephalitis.
  • Damage to cranial nerves.
  • Parkinsonism.
  • Cyst.
  • Violations of the carotid-cavernous message.
  • Pachymeningitis.
  • Foreign intracerebral body.
  • Damage ischemic in nature.
  • Mental and autonomic dysfunctions.

In addition to the consequences of a closed head injury, there can also be complications. Most often, venous and sinus thrombosis, post-traumatic granuloma and circulatory disorders are found.

The consequences of an open head injury

Closed head injury rehabilitation

To minimize the consequences of a traumatic brain injury (according to ICD-10 code S06.8, protocol E-008), doctors prescribe a conservative pathogenetic treatment to the patient.

In mild cases, a person takes vasodilator drugs (Cavinton, Eufillin, Halidor, Papaverine) and desensitizing drugs (Diphenhydramine, Pipolfen, Tavegil and calcium). Also, the patient is shown the use of funds aimed at improving blood microcirculation.

Treatment is not complete without taking analgesics, tranquilizers, as well as venotonic and diuretic drugs. To normalize the excitability of the autonomic nervous system, a person is prescribed "Belloid", "Butyroxan", "Phenibut", "Bellataminal".

To maintain immunity, the reduction of which is also one of the consequences of a traumatic brain injury, patients drink Aminalon, Nootropil, Encephabol, glutamic acid and vitamins.

What are the consequences of a traumatic brain injury?

Open TBI

Damage to this species is characterized by the presence of wounds of the soft integument of the head, in which the integrity of the aponeurosis is impaired. Bone fractures can also be. But at the same time, the adjacent soft tissues are injured. Often there is bleeding or the expiration of brain detritus.

The main consequence of an open head injury is infection of the intracranial contents.

Often there are complications:

  • Intracranial hematomas.
  • An outpouring of cerebrospinal fluid (cerebrospinal fluid).
  • Shock.
  • Ventricular hemorrhage and edema.
  • Prolapse of the brain and cerebral
  • Meningoencephalitis.
  • Meningitis
  • Abscesses.
  • Osteomyelitis.
  • Ventriculitis.
  • Scars and adhesions.

What are the consequences of a traumatic brain injury after treatment? As a rule, patients subsequently suffer from increased fatigue, dizziness and headaches. Some completely or partially lose their functionality. Many have low moods, impaired memory functions, and personality changes also develop.

Rehabilitation with an open head injury

The treatment of a person who is diagnosed with damage of this type includes a number of measures:

  • Constant monitoring of the respiratory system.
  • The use of drugs of the diazepine series, as well as lidocaine, verapamil, antioxidants and magnesia.
  • Monitoring cerebral perfusion and blood pressure.
  • Normalization of water-salt metabolism and intracranial pressure.
  • Conducting corticosteroid therapy.
  • Maintaining normal acid-base balance.
  • Normalization of metabolism by nootropic drugs.
  • The use of drugs based on the inhibition of proteolytic enzymes.
  • Conducting therapy with sedatives and anticonvulsants.
  • Systematic anesthesia.

But before that, surgical treatment is mandatory. This is done in stages. First, soft tissue wounds are treated. Then - bone damage. Then the surgeon processes damage to the dura mater and directly to the brain itself.

Closed head injury

Brain compression

According to statistics, it develops in 55% of TBI cases. Compression is dangerous because when it occurs, focal, cerebral and stem symptoms increase, and this poses a threat to the patient's life.

Symptoms depend on what exactly provoked the occurrence of this complication. As a rule, it all starts with repeated vomiting and intense headache. Also, a person begins to worry about psychomotor agitation, and if he does not pay attention to it, then sleep disturbance also joins the symptoms. Sometimes patients complain even of hallucinatory and delusional syndromes.

Over time, excitement is replaced by apathy, lethargy, lethargy. As a result, the personโ€™s consciousness is disturbed, and at best there is a stupor, and in the worst, a coma.

With brain compression, surgical treatment is often indicated. If it turns out that a person has developed a large hematoma, a displacement of cerebral structures or a dislocation syndrome has occurred, then an operation will be issued immediately.

In cases where one of the above is combined with a crush of brain tissue, a microsurgical technique is used. If a tumor was detected, it is excised. Cerebral abscess is removed.

Be that as it may, patients affected by a TBI of any kind will for a long time be forced to be in a hospital under the supervision of specialists and undergo specific treatment.


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