Concussion is a traumatic brain injury, which is a mild manifestation of it, but occurs quite often. This phenomenon is most common in children who are hyperactive. As a result, the functions performed by the brain are disrupted. However, this is easily reversible, since it does not have the nature of organic damage.
The concept
Concussion - a closed head injury, as a result of which the following processes occur:
- the dynamics of the properties of neurons changes, which changes the spatial orientation of protein molecules;
- all the substance of the brain suffers;
- between synapses (places of contact of brain cells) a temporary break in relations and signal transmission occurs.
Classification
Three degrees of concussion are distinguished.
- Easy. Consciousness is not disturbed. In the first 20 minutes, the patient notes nausea, dizziness and headache, disorientation in space, for a short period of time, body temperature can increase to 38 ° C.
- Medium. The same symptoms are observed, but they have been going on for more than 20 minutes. In this case, retrograde amnesia may be noted, characterized by the fact that the patient cannot remember the last few minutes before he was injured.
- Heavy. It is accompanied by a loss of consciousness, which can range from several minutes to several hours. Retrograde amnesia is present. The main symptoms are: loss of sleep, appetite, nausea, disorientation in space, fatigue, dizziness, and associated pain, which are present in the patient for 7-14 days.
Concussion according to CCMT ICD-10
This classification has been used by states participating in the WHO agreement since 1994. Various classes of ICD are combined in 22 categories. It is planned that in 2018 the 11th edition of this classification will be released, while 10 continues to operate.
According to ICD-10, a concussion of brain injury refers to CCT (closed craniocerebral trauma) and has code S 06.0.
Causes
The occurrence of the pathology in question can lead to:
- intense motion sickness of the child;
- fall on the buttocks;
- jumping to feet from a height;
- bruises of the head;
- falling from a height of one's own body;
- sharp head movements;
- blow to the head with a heavy object.
Sudden movements or power strikes lead to the displacement of the substance of the brain, intracerebral fluid and blood vessels in the opposite direction. As a result, brain tissue is damaged. There is no clear theory of the occurrence of concussion today. However, there are several versions:
- the dynamics of the physicochemical properties of the substance of the brain and the colloidal equilibrium of cellular proteins are observed;
- there is a disconnection between the cells and parts of the brain, which leads to a violation of its functions;
- suggest that it can also be functional in the area of the brain stem and hemispheres without observing macroscopic and histological changes;
- the nutrition of brain cells may deteriorate, which leads to a displacement of brain tissue in the layers, which breaks the connection between different centers;
- when striking through the brain, a shock wave propagates in the opposite direction with simultaneous pressure drops in these directions.
Thus, at the time of concussion, there is no structural and morphological dynamics in the brain. This is revealed with the help of ongoing computed tomography. If this absence is detected, a brain injury will be diagnosed.
Symptomatology
Even a minor head injury can lead to this problem.
The main symptoms are as follows:
- impaired coordination of movements;
- hypersensitivity to sounds;
- photophobia;
- double vision
- when reading, pain is felt in them;
- incoherent speech is observed , which can be confused and slow;
- confusion and lethargy are noted;
- nausea with a single vomiting may be present;
- weakness;
- noise in ears;
- throbbing headache;
- dizziness due to impaired blood movement in the vestibular apparatus.
For older people, disorientation is characteristic both in time and in space in the first days after receiving an injury, as well as dizziness and memory lapses. Headaches appear that are pulsating and located in the occipital region. The most dangerous injury for hypertensive patients. Symptoms of concussion in elderly patients disappear after 3-7 days.
Diagnosis of concussion
The doctor interrogates the patient, as a result of which it turns out:
- whether tension of the occipital muscles is present, passing within three days;
- is there any shakiness when taking the Romberg pose (legs are located together, arms are extended forward at right angles, eyes are closed);
- whether small trembling movements of an involuntary nature are detected when the eyes are diverted to extreme positions; the doctor can pick up a small object and ask the patient to follow it - in extreme positions there are return movements of the pupil in a mild form;
- whether there is a slight asymmetry of skin and tendon reflexes - this symptom is unstable and changes over time;
- whether there is a narrowing or expansion of the pupils in the first few hours after the injury with a normal response to light;
- whether the patient complains of pain when the eyes are moved to the side.
Signs of a concussion in a child.
- In preschool children, it often proceeds without loss of consciousness, after 2-3 days there is an improvement in the general condition.
- In infants, during the same period, the following symptoms disappear: sleep disturbance, anxiety, vomiting, regurgitation during feeding.
- During injury, pallor of the skin (mainly the face), a frequent pulse, then drowsiness and lethargy are noted.
Signs of a concussion in an older child can manifest as loss of consciousness, severe dizziness, repeated vomiting, post-traumatic blindness that occurs after a short time interval.
To exclude more severe conditions, radiography of the cervical spine and skull, EEG is prescribed to detect abnormalities in the cerebral cortex. A CT scan is performed to identify any effects of the concussion.
Using radiography, information about possible fractures of the skull during injury is obtained. However, it does not give an idea of the state of the substance of the brain. Indirect information about this can be obtained by conducting an echo-EG. With its help, information about hematomas and tumors is also obtained. However, the method does not give reliable results. Using EEG, the bioelectric activity of the brain is studied. It is used to determine foci of epileptic activity, which leads to the occurrence of eponymous seizures in the future.
Small children (up to 2 years old) are often prescribed neurosonography, which is understood as brain ultrasound. With its help, they get an idea of the substance of the brain and the ventricular system. Cerebral edema, foci of bruises, hemorrhages, and hematomas can be detected. The procedure is ineffective for older children due to fusion of the skull bones.
In this case, lumbar puncture is rarely prescribed, it can be prescribed only as an additional measure in clarifying the complex picture. In this case, the cerebrospinal fluid is removed and the presence of blood in it is determined.
First aid
When the victim is in an unconscious state, emergency medical assistance should be called immediately. Before her arrival, a person is laid on his right side on a hard surface with bent elbows and legs. The head throws up and turns to the ground, which will prevent foreign objects from entering the respiratory tract when inhaling when vomiting, and will provide good airflow through them.
In the presence of bleeding from a wound on the head, assisting with a concussion consists in applying a hemostatic dressing.
In the absence of a fainting state or if the victim has recovered, he should be laid horizontally, with his head raised and making sure that he does not fall asleep.
After receiving an injury, the victim must be taken to the emergency room, where he will receive medical care for concussion. Treatment can be carried out on an outpatient basis under the supervision of a neurologist or inpatiently.
If it is impossible to determine the severity of the injury resulting from concussion, it is better not to touch the injured person. In the presence of bulk substances, liquids that can enter the human body, measures must be taken to eliminate them.
It must be remembered that during the course of the ailment a period of imaginary well-being is allocated, in which the symptoms of the injury are leveled for several hours or days. The condition of the patient may worsen, since an intracranial hematoma is formed.
Healing
How to treat concussion at home? The most important thing is compliance with bed rest. At the same time, proper rest, sleep, lack of loads should be provided, excluding them completely within a few days after the injury.
What pills for a concussion are prescribed by a doctor? First of all, those that contribute to the removal of signs of the disease and the normalization of the functions of the organ in question.
Concussion pills:
- "Pentalgin", "Baralgin", analgin - painkillers;
- “Cerucal”, “Metoclopramide” - antiemetics, are prescribed symptomatically as appropriate signs occur;
- "Phenazepam", Corvalol, tincture of motherwort - sedatives;
- "Furosemide", "Diacarb" - in the presence of concomitant arterial hypertension or an increased risk of edema as diuretics;
- "Tanakan", "Betaserk" - to relieve symptoms of dizziness.
Symptomatic therapy is prescribed to prevent complications and restore impaired functions. It begins to be carried out 5-7 days after the injury was received.
Concussion pills in this case:
- vasotropic - “Theonikol”, “Cavinton”;
- nootropic - "Piracetam", "Nootropil".
With their help, cerebral circulation and the activity of this organ are improved. They are taken after the patient is discharged from the medical institution for several months.
In addition, therapy involves the use of tonic and vitamin preparations:
- Schisandra
- ginseng root;
- eleutherococcus extract.
Within one month after receiving the diagnosis of “concussion of the brain,” you can not perform heavy physical exercises and difficult work. It’s better to stop watching TV, movies, working on a PC and reading books for a long time. Relaxation should be achieved by listening to calm music without headphones.
Forecast
It is favorable at the early start of treatment.
In some patients, residual effects are felt throughout life. As a rule, they soften after one year. These include:
- sleep disturbance;
- persistent headaches;
- memory impairment;
- Depression
- fatigue;
- irritability;
- decreased attention span.
If you ignore the advice of the attending physician, serious conditions can occur, characterized by constant migraines, epilepsy, insomnia, etc.
Complications
A huge number of them can develop. With repeated tremors, for example, in boxers, encephalopathy is sometimes observed. Its first symptoms are associated with the work of the lower extremities. The state of balance is disturbed, there is staggering. Movements may slow down, mental confusion may occur.
Symptoms in some patients with illness may remain pronounced after recovery:
- noticeable dragging of legs;
- slow motion;
- mental changes;
- tremor of the head and hands;
- depletion of the lexical stock.
In traumatic brain injuries, including concussion, the following constitutional features are observed.
- When taking alcohol or the effects of infection on the body, mental disorders may appear: the appearance of visual hallucinations, impaired consciousness with delirium, severe excitement.
- Constant headache, increasing at the time of sudden movements, as a constant flow of blood to the head. There is intense sweating, there is a pallor of the epidermal integument, and this can occur only on one side of the face. All this can be accompanied by rapid fatigue and the inability to concentrate on something.
- Increased irritability and irritability with fits of rage with pronounced aggression, followed by embarrassment and apologies for the lack of balance.
- Paranoid traits.
- Attacks similar to epileptic appear.
- There are neuroses, accompanied by fears and anxiety.
Sometimes, against the background of progressive psychoses, dementia can develop.
In addition, a concussion syndrome is characteristic of a concussion of the brain, which consists in the fact that the patient who has had this ailment begins to complain of a very severe headache with irritability and anxiety after some time. Painkillers in this case can be addictive.
Prevention
Preventing a concussion is quite difficult. However, following certain recommendations can reduce the likelihood of injury.
If possible, you must refuse to engage in traumatic sports:
- football;
- hockey;
- boxing and others
When practicing sports such as horse riding, skateboarding, ice skating and inline skating, helmets with special tabs that are correctly sized for use should be used.
During the performance of auto walks, it is necessary to fasten your seat belts. At the same time, children must be transported in car seats intended for them.
In winter, shoes should use anti-slip devices or walking sticks with sharp tips.
Finally
A concussion is caused by a head injury. It is mild, moderate and severe. The first two are not accompanied by loss of consciousness, and, as a rule, end favorably. A severe stage is characterized by loss of consciousness and the presence of symptoms for a long time. Usually, various complications can develop after it. Treatment mainly consists of providing bed rest and maintaining peace. To prevent the occurrence of this ailment, it is necessary to limit the occupation of traumatic sports, in winter wear shoes with special devices that prevent slipping. You also need to learn to fall correctly.