Disease Name
Post-traumatic brain injury syndrome.
Disease Alias
postconcussion syndrome, posttraumatic brain injury neurosis, postconcussionalsyndrome.
Disease Classification
Neurosurgery.
Disease Overview
Headache, insomnia, memory loss, and fatigue are still present months after cranial injury. Dizziness and headache are most common, accounting for about 78% of cases, with diffuse head distension and pulsating headache predominating.
Disease description
Symptoms such as headache, insomnia, memory loss, and weakness persist for months after cranial injury. Dizziness and headache are the most common, accounting for 78% of cases, with diffuse head swelling and pulsating headache predominating.
Symptoms and signs
The clinical characteristics of post-traumatic brain injury syndrome are that the subjective symptoms are heavy while the objective signs are absent or mild, mainly dizziness, headache and neurological dysfunction.
1.Headache and dizziness: headache is the most common, accounting for about 78%, mainly diffuse head distension and pulsating headache, lasting and severe, with variable attack time, mostly in the afternoon, often in the frontotemporal or posterior occipital area, sometimes involving the whole head, or a sense of pressure on the top of the head, or a sense of ring-shaped tightness, so that the whole day drowsiness and restlessness. Headaches located in the posterior occipital region are often accompanied by tension and pain in the neck muscles and are mostly associated with craniocervical injuries. Headache attacks can be exacerbated by insomnia, fatigue, emotional distress, poor work performance, or external noise. Dizziness is also more common, accounting for about 50% of cases. Patients often complain of dizziness, but it is not really dizziness, but a subjective feeling of dizziness in the head, lack of clarity in thinking, or a feeling of confusion and disorientation. Sometimes they think that they cannot keep their balance, often aggravated by turning their head or changing their position, but there is no clear vestibular dysfunction or ataxia on neurological examination, and after giving appropriate symptomatic treatment and comfort and encouragement, the symptoms can be reduced or disappeared, but they will appear again soon.
2, hysteria-like reactions: the patient’s emotions fluctuate, easily provoked, anger, sometimes there may be myoclonic seizures, vision loss, hearing loss, closed eyes and involuntary crying and laughing, and even hysterical paralysis, or in severe cases, a state of rigidity or reticence.
3. Neurological examination mostly has no exact positive signs.
Etiology of the disease
Trauma.
Pathophysiology
The occurrence of post-traumatic brain injury syndrome may have a pathological basis in organic craniocerebral lesions, although some pathological changes are difficult to detect and are also related to the influence of personal qualities and social environment. Following a violent blow to the head, a series of pathophysiological changes in brain tissue of varying severity will be induced, regardless of the severity. In mild cases, there are only temporary changes in biochemistry and cerebral perfusion, for example, a slowing of intracranial circulation can last for several months after a head injury. In severe cases, they can cause not only cerebral contusions, intracranial hematomas, cerebral ischemia and hypoxia, but also subarachnoid hemorrhage, axonal disruption, and certain subtle injuries, including some minor lesions that are difficult to detect. For example, traumatic neuroma of the scalp, small intracranial and extracranial vascular communication, meningeal-mesencephalic adhesions, arachnoid villi closure, axonal rupture, microscopic hemorrhage and softening in the white matter of the brain or brainstem, and injury to the ligaments or muscles of the craniocervical joints that affect the cervical nerve roots can cause various symptoms.
Brain injury and its resulting cerebral edema, cerebral vasospasm and microcirculatory changes can lead to focal hemorrhage in brain tissue; brain ischemia, hypoxia, axonal rupture, myelin disintegration to form softening foci and degenerative lesions, meningeal brain adhesions and scar formation, intracranial and extracranial small vessel communication and other pathological changes can affect the function of cortical and subcortical autonomic nerve centers; brain injury occurs when brain tissue moves in large pieces, due to shear stress In addition, subarachnoid hemorrhage can cause closure of the arachnoid villi and obstruction of the cerebrospinal fluid circulation pathway, which can cause traumatic hydrocephalus, and in some cases, although the CT performance is not obvious, because it breaks the absorption and secretion of cerebrospinal fluid Some of them are not obvious on CT, but they disrupt the balance of cerebrospinal fluid absorption and secretion, thus causing corresponding symptoms.
However, there is no corresponding relationship between the occurrence of post-traumatic brain injury syndrome and the severity of brain tissue damage; on the contrary, there are more cases of mild brain injury without significant neurological deficits than those with heavy traumatic brain injury with neurological deficits. It has been suggested that the incidence of this syndrome is higher in the unemployed than in the employed, and lower in those with higher IQ and professional knowledge. The above-mentioned situation indicates that the patient’s physical and mental factors, social influence, and stability in life and work are closely related to the development of the syndrome.
Diagnostic tests
Diagnosis: The diagnosis of post-traumatic brain syndrome must be made carefully and should be considered firstly after careful exclusion of organic lesions, and in addition after exclusion of other chronic lesions of the whole body. Only when the above two types of conditions are ruled out and the above symptoms are still present after systematic treatment for more than six months or one year, the diagnosis of post-traumatic brain syndrome can be made. Patience in the medical history of such patients is required to understand the whole course of the disease since the injury until now, including the results of various examinations, treatment, surgical findings, as well as the diagnostic opinions and treatment effects once made.
After a thorough understanding of the patient’s condition, the necessary tests should be performed as needed. Although the neurological examination is often negative, careful examination is still important, and sometimes clues can be found from some traces to find the cause or exclude organic damage. Secondly, ancillary tests can be purposefully arranged according to the medical history and examination. Lumbar puncture can determine the intracranial pressure to clarify whether there is an increase or decrease in cranial pressure and whether the cerebrospinal fluid is normal; EEG can help detect focal damage and the presence of persistent abnormal waveforms to determine the direction of further examination; CT scan can clearly show the presence of cerebral atrophy, hydrocephalus or limited lesions; MRI is more conducive to the detection of small bleeding spots or softening foci in the brain parenchyma; radionuclide Cerebrospinal fluid imaging can understand the cerebrospinal fluid circulation.
Laboratory tests: Most of the cerebrospinal fluid tests are within the normal range, but in a few patients, the pressure may be slightly high or low, and the protein quantification may be slightly increased.
Other auxiliary examinations.
1, CT and MRI can show whether there are clear organic changes in the brain, such as cerebral atrophy, hydrocephalus, cerebral infarction, small hemorrhagic softening foci and other small lesions.
2, EEG may show widespread rhythm abnormalities or focal slow waves, fast waves or seizure waves, and some appear desynchronization.
3. Radionuclide cerebrospinal fluid imaging helps to understand whether there is obstruction of cerebrospinal fluid circulation.
Differential diagnosis
It is important to differentiate from organic cranial lesions and some chronic systemic diseases, and clinical manifestations and auxiliary examinations can help to differentiate. In addition, it should be differentiated from neurological disorders. The onset of neurosis is related to neurotic qualities, personality traits and mental stress, with a delayed and episodic course, relatively mild symptoms of autonomic dysfunction, and normal neurophysiological and neuroradiological examinations. Patients with neurosis lack specificity for anxiolytic and antidepressant treatment, while they achieve the same results with any treatment and suggestive therapy they believe in.
Treatment options
1.Psychological and behavioral therapy: Care for the disease, and be attentive to the patient’s misunderstanding that “concussion sequelae cannot be cured”. Patients should show concern for their illness, patiently guide them and relieve their worries, so that they can build up confidence in order to understand the disease and overcome it. Create a good medical living environment for the patient and avoid all kinds of adverse stimuli from outside. Encourage patients to get out of bed, participate in more outdoor activities, exercise, regularize life, correct bad habits and hobbies, resume work as soon as possible, learn new knowledge and skills, take the initiative to participate in social interactions, establish good interpersonal relationships, achieve cheerfulness, emotional stability, smooth work and family harmony, which is more beneficial to complete physical, mental and social adaptation recovery.
2, symptomatic treatment: headache can be given analgesics, but should not use narcotics or morphine drugs to avoid addiction. Such as Rotundine (cranial pain), levocetine lidine, naproxen, enteric aspirin, ibuprofen; dizziness can be given to Benadryl, trichloro tert-butyl alcohol, etc.; autonomic dysfunction can be given to glutathione, iproniazid, γ-aminobutyric acid (γ-aminobutyric acid), methylphenidate (methylphenidate), atropine (atropine sulfate), scopolamine, etc.; excitement patients can be given to Endorphin, diazepam (Valium), For depressed patients, glutamate and γ-aminotyrosine can be given. In addition, Chinese herbal medicine can be used for treatment. Commonly used Chinese medicines include: An Shen Tonic Heart Pill, Tian Ma Su Tablets, An Gong Niu Huang Pill, Brain Nimble Syrup, Encephalitis Nimble, etc. Physiotherapy, acupuncture and other measures can also be used.
Prognosis and prevention
Prognosis: The prognosis of this disease is generally good.
Prevention: Patience and guidance should be provided to relieve the patient’s worries and build up confidence to overcome the disease.
Epidemiology
No relevant information is available.
Health care tips
1, the treatment of post-traumatic neurasthenia syndrome should first of all ideologically relieve the patient’s mental burden, recognize the disease is functional, establish confidence to overcome the disease;
2, reasonable arrangements for the patient’s work and life, regular diet and living, encourage patients to participate in appropriate cultural and sports activities, enhance physical fitness, improve health;
3.Give appropriate sedative, tranquilizing and pain-relieving drugs.