Concussion: treatment, symptoms, diagnosis, consequences

Concussion in adults and children is a trauma caused by a brain stroke on the inside of the cranium. As a result, there is a violation of brain functions that do not pose a threat to human life. The disease refers to mild types of traumatic brain injury.

Features of the disease

With a concussion, the processes of nerve cells are stretched, and the vessels are not damaged. The disease is diagnosed in 80% of all traumatic brain injuries. How the development of the disease occurs is not reliably determined. Experts are absolutely sure that brain cells rarely receive significant damage, the structure of the brain does not change, but the functionality of the organ is impaired. Which factor causes the violation, it turns out.

To date, there are several versions of what happens as a result of an injury:

1. Disruption of neural connections.
2. Violation in the molecules of the brain tissue.
3. Short-term spasm of blood vessels.
4. Disruption of connections between brain structures.
5. The chemical composition of the cerebrospinal fluid is undergoing changes.

According to statistics, more than 400 thousand citizens of Russia are hospitalized annually with a concussion. About half of all cases occur in domestic injuries. The most susceptible to this type of injury are children and adolescents aged 8 to 18 years.

Treatment of concussion takes 1 to 2 weeks, subject to timely medical measures. In the absence of treatment, complications arise, for example, the probability of instant death increases by 7 times, the risk of alcoholism increases by 2 times.

Extremes of early diagnosis

The diagnosis, especially in the first stage, is fraught with difficulties. Often there is either a reassessment of the severity (overdiagnosis), or an insufficient assessment of the dangers of the injury (underdiagnosis).

Hyperdiagnosis often becomes the result of patient suspiciousness, a simulation of syndromes in the absence of a specialist neurologist on the staff of a medical institution, diagnostic tools, objective criteria for testing a patient.

Hypodiagnosis occurs in cases where the patient is hospitalized in departments that are not associated with neurotrauma, for completely different reasons. In addition, some patients are admitted to the clinic in an inadequate state of intoxication and cannot interpret their condition. According to statistics, the error of diagnosis in concussion is about half of all cases.

Difficulties with the diagnosis are related to the fact that the injury is diffuse in nature, no structural changes are observed, and the tissues maintain their integrity. Interneuronal connections are broken in cells, molecules and are temporary.

Causes

The cause of the concussion is always injury, and in order to receive it, it is not necessary to bump your head. It is enough to slip and fall, without touching the ground or any objects when the head falls, so that the consciousness becomes clouded. The patient often cannot remember what happened and where the fall occurred. A similar situation happens many times in the winter.

Intracranial injuries are not less frequent during a sharp start and braking of the car in case of an accident. Fighting is the most common cause of brain damage when opponents injure each other in a fist fight or using additional tools. Industrial, domestic, and sports injuries are not rare. In adolescence, the possibility of concussion is especially great.

To get a TBI, the child does not have to participate in a fight, sometimes innocent brawls are enough, in which the student gets a slight blow to the head with a textbook or moves down the railing of the stairs with subsequent unsuccessful landing. Most often, pranks do without consequences, but parents need to pay attention to the condition of the child and, at the slightest deviation (headache, nausea, dizziness, memory laps, etc.), consult a neurologist.

Symptoms of a concussion

Only a specialist can identify a concussion with full confidence. Signs appear gradually, as you move away from the fact of receiving a head injury.

Symptoms immediately after an injury:

1. Stupor - confusion, tightness and tension of the muscles of the body. At this point, emotions and motor activity are inhibited due to the failure of nerve impulses.
2. Loss of consciousness - there is no reaction to any stimuli, the process takes from several seconds to hours. The reaction is due to a lack of oxygen resulting from circulatory disorders.
3. Vomiting - single or multiple (disruption of the vestibular apparatus).
4. Nausea is a consequence of irritation of the medulla oblongata, where the vomiting center is located.
5. Dizziness is a violation of the reactions of the vestibular apparatus.
6. Malfunctions of the heart - increased / slowed strokes (increased intracranial pressure, compression of the cerebellum and vagus nerve).
7. A sharp change in complexion pallor / redness - malfunctions of the autonomic nervous system.
8. Headache at the site of the bruise with further spread - irritation of the receptors of the cerebral cortex, increased intracranial pressure.
9. Noise, ringing or hissing in the ears - increased intracranial pressure, malfunctions and irritations in the work of the hearing aid.
10. Pain with eye movement is a consequence of increased intracranial pressure.
11. Impaired coordination of movements - disturbances in the functioning of the vestibular apparatus and in the transmission of nerve impulses.
12. Sweating is an overexcitation of the sympathetic nervous system.

Signs of a concussion after a few hours after receiving a head injury:

1. Symmetric constriction / dilated pupils - tested by a specialist. If the reaction to the series of tests is incorrect, they diagnose a failure of the ANS as a result of increased intracranial pressure.
2. Shivering eyes when looking away to the side indicates damage to the vestibular apparatus, inner ear, cerebellum.
3. Asymmetric reactions of tendon reflexes (a blow with a hammer on the joint of the legs or hands should demonstrate the same flexion reaction on the right and left side of the body).

Long-term signs of concussion (after a few days):

1. Photophobia, a painful reaction to sounds - a consequence of disturbances in the nervous system. The usual intensity of light and sounds are perceived hypertrophied.
2. Irritability, nervousness, depression - symptoms appear due to disturbances in the connections between nerve endings in the cerebral cortex.
3. Sleep disorders - caused by a stressful state and circulatory disturbance in the brain.
4. Memory loss - as a result of stress, events before and after the traumatic situation were not recorded in long-term memory.
5. Stray attention - the inability to concentrate is due to disturbances in the connections between the cortex and subcortex of the brain.

Degrees

Treatment of concussion is based on the diagnosis and classification of injuries. In modern medicine, some experts believe that any TBI can lead to unpredictable consequences and there is no sense in dividing the disease by severity.

The second part of the doctors is sure that patients receive different injuries - someone spends a little time on a hospital bed with nausea and headache, and some patients lose consciousness for a long time, and feel unsatisfactory for several months. Due to the difference in complications and the course of the disease, a system for assessing the severity of injury was adopted.

Degrees of concussion:

• Easy (I degree) - is put to the patient in the absence of loss of consciousness, memory. The primary symptoms of a traumatic brain injury last no more than 15 minutes (lethargy, headache, vomiting and nausea).
• Medium (II degree) - short-term amnesia without loss of consciousness. Primary symptoms persist for up to several hours (nausea, vomiting, sudden changes in complexion, pulse disturbances, headache, lethargy).
• Severe (III degree) - is put in case of loss of consciousness up to 6 hours with accompanying primary symptoms (any).

Diagnostics

What to do with a concussion? First of all, to fix the symptoms, if the victim himself cannot do it, then this is done by loved ones or those whom he can rely on. If there is at least one symptom, you should contact a traumatologist or neurologist (preferably). The specialist considers a number of criteria in the diagnosis of the disease and can distinguish concussion from other brain pathologies.

Condition Assessment:

1. X-ray diagnostics demonstrate the integrity of the cranium.
2. The brain without damage (there are no hematomas, hemorrhages).
3. Cerebrospinal fluid unchanged.
4. MRI diagnostics did not reveal any damage (the density of gray and white matter is normal, brain tissue is integral, swelling is manifested gradually).
5. The patient shows retrograde amnesia, which indicates a concussion. Symptoms: there are no events in memory that occurred before the onset of a traumatic event.
6. Confusion, the patient is either lethargic or hyperactive.
7. There was a loss of consciousness from a few seconds to half an hour, while the patient does not know anything about it.
8. Violations of the ANS are manifested - pressure surges, pulse, change in complexion.
9. Neurological manifestations - an asymmetric arrangement of the corners of the mouth with the usual facial expression and with a smile (grin), there is a violation of skin reflexes.
10. Gurevich test - the patient loses balance and falls on his back when looking up or forward when looking down.
11. Symptom of Romberg - the patient closes his eyes and stands straight with his arms extended in front of him. Symptoms indicate concussion: trembling fingers, eyelids, balance is extremely difficult to maintain, the patient tends to fall.
12. Profuse sweating through the palms and feet.
13. Horizontal twitching of eyeballs.
14. Palmar-chin reflex - the patient strokes the palm of the hand in the area of ​​the thumb. With a concussion, the chin twitches reflexively. Reflex is especially pronounced 3 days after an injury and is possible up to 14 days after a head injury.

The doctor can prescribe diagnostics by additional methods: EEG, CT, ECHO, dopplerography of the vessels of the head, puncture of the cerebrospinal fluid.

Childhood injury

A concussion in children has the same manifestations as in adults, but a young body copes with this problem faster. In most cases, children of preschool and school age do not lose consciousness when injured. Symptoms occur in a change in complexion and skin, tachycardia, rapid breathing, headache, concentrated at the site of the bruise. The period of the acute phase does not exceed 10 days.

Concussion in children under one year of age is manifested by regurgitation, sometimes vomiting, at the time of feeding. The rest of the time, anxiety, lack of sleep, crying when changing the position of the body or head can occur. Sometimes the fontanel size increases. Due to the weak development of the brain, the disease at this age is without consequences and does not require special efforts in therapy.

Treatment of concussion in children is implemented according to the same scheme as for adults. Medication is prescribed (nootropic, sedatives, antihistamines, vitamin complexes, etc.). The patient is assigned rest for a recovery period.

Consequences of injury

According to medical observations, no more than 3-5% of patients with concussion have distant complications after receiving an injury. The basis for the consequences is the already existing pathologies of the nervous system, as well as non-compliance with the recommendations of the doctor. Complications are divided into two groups - early and distant reactions of the body.

What are the consequences after a concussion a few days after head injury?

1. For 10 days after the injury, the cells continue to break down, tissue swelling gradually increases.
2. Within 24 hours, post-traumatic epilepsy may occur.
3. Encephalitis, meningitis is an extremely rare manifestation caused by purulent or serous inflammation of the brain.
4. Post-traumatic syndrome - headaches, depression, insomnia, photophobia, etc.

Delayed consequences (from 1 to 30 years):

1. Emotional instability - bouts of hyperactivity, depression, aggressiveness for no apparent reason.
2. VVD - disturbances in heart contractions, lack of blood circulation.
3. Intellectual disorders - impaired memory and concentration, changing thinking and reaction to events. A person can completely change or get dementia.
4. Headaches - a consequence of circulatory disorders in the brain, changes in the vessels of the neck.
5. Vestibulopathy - changes in the functioning of the vestibular apparatus that have occurred as a result of an injury.

What to do in case of concussion and detection of its consequences? Contact a specialist and do not waste your energy on self-medication. Often, patients regard the complications after an injury as problems with perception of the world, and turn to a psychotherapist for advice, but in this case there will be no result. To exclude physiological causes, it is worthwhile to undergo a diagnosis by a neurologist and, after the verdict of this specialist, decide whether it is necessary to contact other doctors.

Therapy

First aid for concussion is in the emergency room. The next step is hospitalization in specialized departments of the hospital (neurology, neurosurgery). During the first 3-5 days, the patient is recommended strict bed rest and drug therapy. During this period, the doctor monitors the patient's condition. The goal of therapy is to bring the patient out of stress, improve brain functioning, and relieve pain.

Groups of drugs and drugs for concussion:

1. Painkillers - Pentalgin, Sedalgin, Analgin, etc.
2. Soothing botanicals - tincture of valerian, motherwort, peony, etc.
3. Tranquilizers - "Phenazepam", "Elenium", etc.
4. From dizziness - “Microzer”, “Betaserk”, “Bellaspon”, etc.
5. From insomnia - Reladorm, Phenobarbital, etc.
6. Stabilizing - vitamin-mineral complexes.
7. Normalization of blood circulation - vasotropic and nootropic drugs.
8. Tonic improvement - herbal tonics (eleutherococcus, ginseng), medications (Saparal, Pantocrine).

What to drink with a concussion - the doctor prescribes, self-medication can cause irreparable harm. Stabilization occurs 7-10 days after a head injury. With normal indicators, the specialist discharges the patient from the hospital. Treatment lasts for 1 to 3 months, depending on the reactions of the body. With the same degree of damage, two people go through the recovery phase at different times. The patient needs observation by a therapist and a neurologist throughout the year. A prophylactic visit is recommended once every three months.

After discharge

Increased care and the implementation of certain rules of behavior is required from people with a diagnosis of concussion. Treatment at home in the first stage is possible only with a mild degree of head injury. The specialist will give recommendations that must be strictly adhered to. No less important is the period of stay of the patient at home after discharge from the hospital.

It is recommended to avoid stressful situations, taking medications according to the scheme prescribed by the doctor, observing the sleep and rest regimen. Nutrition should be balanced, in addition, complexes of vitamins and minerals are prescribed. Vitamins A, E, group B, folic acid are of great benefit. They stimulate the regeneration of brain cells.

Vitamin C intake is also important, it is indicated for the prevention of hemorrhages, the speedy healing of injuries and wounds, increase immunity and overall well-being after a concussion. Treatment at home involves a number of restrictions - the rejection of tea, coffee, alcohol, heavy fatty foods, foods and dishes with preservatives and artificial colors, semi-finished products are excluded.

For a patient with traumatic brain injury, careful diagnosis is important to determine the disease. Often, concussion during examinations reveals more severe pathologies.