Brain compression is called acute or chronic compression of brain tissue, which develops most often due to traumatic brain injury, volume formation in the cranial cavity, cerebral edema, or hydrocephalus. In a narrow sense, brain compression is a form of severe head injury. This pathology is clinically accompanied by severe cerebral symptoms up to the development of coma. Topical characteristics of the pathological process affect focal symptoms. The bright gap in the clinic is a characteristic, but not a mandatory sign. The basis of diagnosis is MRI and CT of the brain. Therapy is often surgical, aimed at eliminating hydrocephalus and removing the formation that led to compression.
Description
Compression of the brain is considered a life-threatening condition that occurs due to compression of the cerebral tissues and is accompanied by an increase in intracranial pressure. It is compression that causes necrosis and death of brain cells, which leads to irreversible neurological deficit. In general, compression of the brain can accompany many pathological processes that occur inside the cranium.
According to statistics, a small percentage (only about 5%) of brain injury is accompanied by compression of the brain. If we disassemble this concept more narrowly, then by the acute type of compression of the brain we understand the clinical form of severe head injury. A fatal outcome with severe trauma can occur in half the cases; head injury results in disability in 30%. An important task facing modern traumatology, neurology and emergency neurosurgery is to improve the outcomes of TBI and reduce mortality.
What causes brain compression?
Compression of brain tissue can provoke any volumetric formation. These include an intracerebral tumor (glioma, astrocytoma, pituitary adenoma), a tumor of the meninges, a hematoma, accumulation of blood, the brain abscess, hemorrhagic stroke, and cerebral cyst resulted in the outflow. Significant hydrocephalus, edema lead to a significant increase in intracranial pressure and compression of the brain.
A slowly growing tumor, a cyst, a gradually increasing hydrocephalus, an emerging abscess - all this provokes a compression of the brain in a chronic form. To some extent, neurons adapt to pathological conditions, the cause of which is exacerbated compression. In traumatic brain injury, cerebral edema, occlusal hydrocephalus or stroke, which are accompanied by acute compression of the brain, leads to a rapid increase in intracranial pressure and the death of brain cells begins.
Traumatic brain injury most often leads to acute brain compression. Its most common cause is post-traumatic hematoma. Sub - and epidural, intracerebral and intraventricular - it all depends on the location. Symptoms of compression of the brain are discussed below.
Compression of the brain causes the indentation of fragments or intracranial accumulation of air (pneumocephalus), which occurs during a fracture of the skull. Sometimes a cerebral compression results in an increase in the volume of the hygroma.
The principle of occurrence: when valve tear of the hard shell of the brain occurs, subarachnoid cisterns containing cerebrospinal fluid are damaged. From the subarachnoid space, cerebrospinal fluid is absorbed through an opening (fissure) in the meninges. All this leads to the formation of a subdural hygroma.
What are the signs of brain compression?
Symptomatology
The etiology, localization of the compression formation, its size and rate of increase, as well as the compensatory abilities of the brain affect the clinical picture of compression of the brain. For post-traumatic hematomas and hygromas, a “clear gap” is characteristic. This concept implies the condition of the victim when he is conscious, but there are no signs of severe brain damage.
Lucid interval
The light gap during compression of the brain lasts from several minutes to four days. With subarachnoid hemorrhage and subdural hematoma, light intervals last up to one week. If a severe brain damage is recorded (such as a severe bruise, axonal damage), then there is usually no clear gap.
What are the most common symptoms of cerebral compression?
Sharp squeezing
In case of acute compression of the brain, there is usually repeated vomiting, constant severe headache and psychomotor agitation, which is accompanied by sleep disturbance, sometimes delirium begins, hallucinations. Further, the excitement is replaced by general inhibition, apathy, lethargy, lethargy begins. The consciousness that develops from stupor to coma is disturbed. Respiratory and cardiovascular disorders, due to the arising mass effect, accompany diffuse inhibition in the central nervous system.
The increased intracranial pressure during the mass effect leads to the fact that cerebral structures are displaced towards the back of the head. As a result, the medulla oblongata in the occipital foramen is impaired and the work of the centers located in it is disrupted, respiratory and cardiac activities suffer.
Breath
There are still characteristic signs of brain compression. The breathing rhythm is upset. Tachypnea (rapidity) reaches sixty breaths per minute, inhalation and exhalation are accompanied by noise, Cheyne-Stokes breathing occurs. Heart rate decreases, bradycardia is fixed at the level of forty beats per minute and below, the blood flow rate drops, which leads to arterial hypertension. All this is accompanied by congestive pneumonia, pulmonary edema. The patient listens to wet rales. The skin of the limbs and face become cyanotic. Body temperature rises to 41 degrees. Meningeal symptoms are present. The terminal stage is characterized by tachycardia, arterial hypotension. The pulse is threadlike, there are episodes of apnea (breathing occurs with delays), the duration of which is increasing. Bruise and compression of the brain are manifested by other signs.
Focal symptoms
Cerebral symptoms accompany focal, which occur and are aggravated. They are affected by a pathological process. This leads to the omission of the upper eyelid, diplopia, strabismus, mydriasis, central facial paresis (asymmetry of the face, lagophthalmos, “sailing” cheek) on the side of the focus.
The opposite side heterolaterally suffers from paresis, paralysis, tendon hypo- or areflexia, and hypesthesia. Often the manifestation of epileptic seizures, hormone seizures (paroxysms of muscle hypertension), tetraparesis, coordination disorders, bulbar syndrome (dysarthria, swallowing disorders, dysphonia). How to diagnose compression injuries of the brain?
How to identify pathology?
Neurological examination and medical history data help a neurologist diagnose brain compression. If, due to the condition, the patient cannot be interviewed, relatives or persons who were near the victim at the time the injury occurred are interviewed. The nature of the pathology does not accurately establish the neurological status. If a brain injury has led to compression of the brain, the patient should be examined by a traumatologist. What is included in the diagnosis of cerebral compression?
Instrumental diagnostic methods
Instrumental diagnostic methods should be limited only to the most urgent and necessary studies. For example, echoencephalography and lumbar puncture proved their information content. The first can detect a mass effect with a shift in the middle M-echo, the second will reveal that there is increased cerebrospinal pressure, and there is blood in the cerebrospinal fluid. But neuroimaging techniques are currently available, so there is no longer any need for such studies. An MRI or CT scan of the brain is prescribed to the patient depending on the indications, and sometimes both of these studies are performed. Spiral CT scan of the brain is connected in emergency situations, which reduces the time of diagnosis.
Intracranial formation, its location, type and size, CT helps assess the dislocation of cerebral structures and diagnose cerebral edema. With the help of perfusion CT, cerebral perfusion and blood flow, secondary ischemia are detected. Areas of cerebral ischemia, foci of contusion, and dislocation of brain tissue are determined on an MRI of the brain, which is more sensitive. Diffusion-weighted MRI is used to study the state of the brain’s pathways and determine the degree of compression.
Brain Compression Treatment
Clinical and tomographic data determine the choice of treatment methods. Conservative therapy consists of dehydration and hemostatic treatment, normalization of hemodynamics, relief of respiratory disorders (if necessary, mechanical ventilation), preventive antibacterial therapy, anticonvulsant treatment in the presence of seizures. It is necessary to control arterial and intracranial pressure.
Surgery
Indications for surgical treatment are determined by a neurosurgeon. Most often it is prescribed for a large volume of hematoma, dislocation syndrome , displacement of cerebral structures, compression, which encompasses the brain center, persistent, uncurable increase in intracranial pressure, occlusal hydrocephalus. Endoscopic evacuation is carried out in relation to hematomas. With complex localization of intracerebral hematoma, stereotactic aspiration is indicated. If a post-traumatic hematoma is combined with a crush of brain tissue, during the operation, additional crush sections are removed, which requires the use of microsurgical technique. In the case of a cerebral abscess, it is completely removed, the tumor is radically excised. Hydrocephalus involves shunt surgery (ventriculoperitoneal or lumboperitoneal shunting).
Pathology Prevention and Prognosis
Brain compression always has a serious prognosis. Glasgow's coma scale helps determine the correlation of expected outcomes. Low scores indicate a high probability of a fatal outcome or a vegetative state, that is, the inability to think productively while maintaining reflex functions. Many surviving patients become disabled. Pathology leads to severe motor impairment, epiproteups, mental disorders, speech disorders. But modern approaches to diagnosis and therapy reduce mortality rates and increase the frequency of recovery of neurological deficits. Preventive measures include the prevention of injuries, as well as the timely and adequate treatment of intracranial pathology.