Craniocerebral injuries are often seen in industrial and mining, traffic accidents, firearm injuries, sharp force injuries, blunt force injuries, etc., and are often compounded with injuries to other parts of the body, craniocerebral injuries can be divided into: scalp injury, skull injury and brain injury, although all three can occur separately, but need to be alert to their combined existence, of which, the prognosis plays a decisive role is the degree of brain injury and its treatment effect. For more information about hydrocephalus, concussion and brain herniation, please click on the corresponding pages.
Disease Management
Management of craniocerebral injury: There are many issues to be covered, focusing on the management of secondary brain injury, with emphasis on the prevention and early detection of brain herniation, especially the early detection and management of intracranial hematoma for good outcome. The management of primary brain injury is mainly the care and symptomatic treatment of coma and hyperthermia that have been produced, in addition to the observation of the condition, and the prevention of complications to avoid further harm to brain tissue and the organism.
(A) Grading of brain injury
The purpose of grading is to facilitate the development of treatment routines, evaluation of the effectiveness and prognosis, and the identification of the injury.
1, according to the severity of the injury grading
(1) light (grade I): mainly refers to simple concussion, with or without skull fracture, coma within 20 minutes, with mild headache, dizziness and other conscious symptoms, no significant changes in the nervous system and cerebrospinal fluid examination.
(2) Medium-sized (grade II): mainly refers to mild cerebral contusion or small intracranial hematoma with or without skull fracture and subarachnoid hemorrhage, no cerebral pressure sign, coma within 6 hours, mild positive neurological signs, and mild alteration of vital signs.
(3) Heavy (grade III): mainly refers to extensive skull fracture, extensive cerebral contusion, brain injury or intracranial hematoma, coma for more than 6 hours, gradual worsening of consciousness or recurrent coma, with obvious positive neurological signs and obvious changes in vital signs.
2. According to Glasgow coma scale
The impaired consciousness for more than 6 hours, at 13-15 points is defined as mild, 8-12 points as moderate, 3-7 points as severe. Regardless of which grading method, it must be linked to the pathological changes of brain injury, clinical observation and CT examination, in order to reflect the injury dynamically and comprehensively. For example, the casualty who shows simple concussion at the beginning of the injury belongs to light, can become heavy due to intracranial hematoma and coma again during observation; small intracranial hematoma found by CT examination, no midline structure displacement, only brief coma or no coma at the beginning of the injury, and no change of condition during observation. It belongs to medium-sized; the early casualties belonging to light and medium-sized, no intracranial hematoma by CT examination within 6 hours, and hematoma with obvious displacement of midline structures is found in the subsequent reexamination, and at this time, although consciousness is still clear, it is already heavy.
(II) Emergency treatment requirements
1. Mild (grade I)
(1) Stay in the emergency room for 24 hours for observation.
(2) Observe changes in consciousness, pupils, vital signs and neurological signs.
(3) Skull X-ray and, if necessary, cranial CT examination.
(4) Symptomatic management.
(5) Advise the family of the possibility of delayed intracranial hematoma.
2. Medium-sized (grade II)
(1) Stay in the emergency room or hospital for 48-72 hours for consciousness, and hospitalization for those with impaired consciousness.
(2) Observe changes in consciousness, pupils, vital signs and neurological signs.
(3) Cranial X-ray, CT head examination.
(4) Symptomatic management.
(5) If there are changes in the condition, head CT review and prepare for surgery at any time.
3. Heavy (Grade III)
(1) Hospitalization or intensive care unit is required.
(2) Observe changes in consciousness, pupils, vital signs and neurological signs.
(3) Use CT head monitoring, intracranial pressure monitoring or brain evoked potential monitoring.
(4) Active management of off fever, agitation. epilepsy, etc., and those with manifestations of increased intracranial pressure are given treatment such as dehydration to maintain good peripheral circulation and cerebral perfusion pressure.
(5) Pay attention to the care and treatment of coma, first of all to ensure the unobstructed airway.
(6) If surgery is indicated, operate as soon as possible; if brain herniation is present, give 20% mannitol 250ml and tachyphylaxis 40mg as pulse push, and operate immediately.
(3) Care and treatment of comatose patients
Long-term coma is mostly caused by severe primary brain injury or secondary brain injury that is not treated in time. During coma, if we can prevent various complications and keep the internal and external environment stable, so that the body is no longer affected by cerebral ischemia, hypoxia, nutritional disorders or water and electrolyte disorders and other unfavorable factors, a significant proportion of patients can be expected to strive for a better prognosis.
1.Respiratory tract
Ensuring the unobstructed airway and preventing insufficient gas exchange is the first priority. Attention should be paid to the removal of respiratory secretions during on-site first aid and transportation, turning the head to the side when vomiting to avoid accidental aspiration, and lifting the jaws in deep coma or putting the pharyngeal ventilation tube into the oropharyngeal cavity to prevent the tongue from falling back to obstruct breathing. If the patient is not expected to wake up in a short time, tracheal intubation or tracheotomy should be performed as soon as possible. If the tidal volume of breathing is insufficient, early ventilator-assisted breathing should be used to adjust and maintain normal respiratory physiology, relying on blood gas analysis monitoring. Remove respiratory secretions in a timely manner and maintain the humidity and temperature of the inhaled air. Pay attention to disinfection and isolation and aseptic operation, as well as regular bacterial culture of respiratory secretions and drug sensitivity testing and other measures. Is the key to prevent and treat respiratory tract infections.
2.Head position and body position
Elevation of the head by 15?is conducive to venous reflux in the brain, which is helpful for the treatment of cerebral edema. In order to prevent decubitus ulcers, it is necessary to insist on methods such as regular turning and changing the parts of the body in contact with the mattress, so as to avoid continuous pressure on the skin of the protruding parts of the bone and ischemia.
3. Nutrition
Nutritional disorders will reduce the immunity and repair function of the body, making it easy for complications to occur or worsen. In the early stage, parenteral nutrition, such as intravenous input of 20% fat emulsion, 7% amino acid, 20% glucose and insulin, as well as electrolytes and vitamins, is used to maintain the needs; after intestinal peristalsis is restored, enteral nutrition can gradually replace the intravenous route, and the daily required nutrition is given through nasogastric tube or nasogastric tube; for more than 1 month of enteral nutrition, gastrostomy can be considered to avoid nasal, pharyngeal and For more than 1 month, gastrostomy can be considered to avoid inflammation and erosion of nose, pharynx and esophagus. In addition to milk, egg yolk, sugar and other mixed meals, prepared into 4.18kl/ral (1kcal/m1) well plus a variety of vitamins and trace elements, also available commercial preparations, usually casein, vegetable oil, maltose dextrin as a base, containing a variety of vitamins and trace elements, prepared into 4.18kJ/ml. total calories and protein, adults daily about Total calories and protein, about 8400kj (2000kcal) and 10g of nitrogen supply per day for adults is sufficient, and must be increased as appropriate when there is high fever, infection, increased muscle tone or epilepsy. Measure body weight and muscle fullness regularly. Monitor nitrogen balance, plasma protein, blood glucose, electrolytes and other biochemical indicators. Immunological tests such as lymphocyte count should be performed in order to adjust the supply of heat and various nutrients in time.
4. Urinary retention
Long-term retention of catheter is the main cause of urinary tract infection. Non-catheterization methods should be used whenever possible. For example, when the bladder is not overly distended, heat and massage are used to promote urination; when catheterization is necessary, aseptic operation is strictly enforced. Choose high-quality silicone catheter with capsule and remove the catheter as soon as possible, the retention time should not exceed 3-5 days; check urinary routine, urine bacterial culture and drug sensitivity test frequently. For those who need long-term catheterization, suprapubic cystostomy can be considered to reduce urinary tract infection.
5. Promote awakening
The key lies in early prevention and control of cerebral edema and timely release of increased intracranial pressure, and to avoid further harm to brain tissue from hypoxia, hyperthermia, epilepsy, infection and other adverse factors; if the condition is stable and still not awake. Cytophosphorylcholine, ether glutamine, chlorine lipid awakening, grams of brain fascination and energy combination drugs or hyperbaric oxygen warehouse treatment can be used. For part of the casualty’s awakening can be helpful.
(D) treatment of cerebral edema
1.Dehydration therapy
It is applicable to the more serious cerebral contusion, with headache, vomiting and other manifestations of increased intracranial pressure, lumbar puncture or intracranial pressure monitoring pressure deviation, CT found cerebral contusion combined with cerebral edema, and before and after surgical treatment. The commonly used drugs are mannitol, furosemide (tachyphylaxis) and clear protein. The methods used are.
(1) 20% mannitol by 0.5-1g/kg (250m1 per adult) intravenous drip in 15-30 minutes, repeated every 6, 8 or 12 hours according to the severity of the disease.
(2) The combined application of 20% mannitol and furosemide can enhance the therapeutic effect, the former with 125-250ml for adults, once every 8-12 hours; the latter with 20-60mg, intravenous or intramuscular injection, once every 8-12 hours, both can be used simultaneously or alternately; the combined application of serum protein and furosemide can maintain normal blood volume, does not cause blood concentration, adult dosage of the former 10g / d, intravenous drip; the latter with 20-60mg, intravenous or intramuscular injection, once every 8-12 hours.
(3) glycerol, rarely cause electrolyte disorders, adult just R amount 1-2e/(kg/d), divided into 1-4 times. Intravenous drip amount of 10% glycerol solution 500ml / d, within 5 hours of infusion. In the case of acute intracranial pressure increase has brain herniation symptoms, must be immediately with 20% mannitol 250m1 intravenous push, at the same time with furosemide 40mg intravenous injection. In the process of applying dehydration therapy, fluid and electrolytes must be appropriately supplemented to maintain normal urine volume and good peripheral circulation and cerebral perfusion pressure. And monitor blood electrolytes, red blood cell pressure volume, acid-base balance and renal function at any time. When mannitol is applied, hematuria may occur, and attention should be paid to the transient increase in blood volume that may cause heart failure in patients with existing occult heart disease.
2.Hormone
Corticosteroids are used in heavy brain injury, and their effect on prevention and control of cerebral edema is not very certain; if used, early short-term use is appropriate. The following methods are used.
① Dexamethasone adult amount of 5mg intramuscular injection, 6 hours once. or 20mg/d intravenously, usually for 3 days.
②ACTH adult amount 25~50U/d, intravenous drip, usually for 3 days. During the drug may occur gastrointestinal bleeding or aggravate the infection, it is appropriate to apply H2 receptor antagonists such as ranitidine and high-dose antibiotics at the same time.
3.Hyperventilation
For severe brain injury in the early stage, has been endotracheal intubation or tracheotomy. After the intravenous administration of muscle relaxants, controlled hyperventilation with the help of ventilator can lower the partial pressure of blood CO2, which can cause moderate constriction of cerebral blood vessels and reduce the intracranial pressure from the surface. It should not be lower than 3.33kPa (25mmHg) and should not last more than 24 hours to avoid cerebral ischemia. 4. Other
Oxygen therapy, subhypothermia therapy, barbiturate therapy, etc. have been used in clinical practice.
(E) Surgical treatment
1, open brain injury
In principle, it must be performed as soon as possible to clear the suture, so that it becomes a closed brain injury. Clear suture should strive to be carried out within 6 hours after the injury; under the premise of applying antibiotics, clear suture can still be performed within 72 hours. Preoperatively, the shavings should be carefully examined, and the cranial x-ray and L-ring films should be analyzed to fully understand the distribution of fractures, fragments and foreign bodies, the relationship between fractures and large venous sinuses, cerebral contusions and intracranial hematomas, etc.; firearm injuries also need to understand the direction of the injury. The pathway, scope and its hematoma, foreign body and other conditions. Clean up the wound from shallow to deep, layer by layer, thoroughly remove foreign bodies such as broken bone fragments and hair, aspirate the clot and broken brain tissue in the brain or the wound channel, and completely stop the bleeding. The broken bone fragments are most likely to cause infection and form traumatic brain abscess, so they must be completely removed; in order to avoid increasing brain injury, the metal foreign body in deeper position or scattered presence can be temporarily not removed. If there is no obvious intracranial hemolysis, no obvious cerebral edema or signs of infection exist. The dura should be sutured or repaired to reduce the incidence of intracranial infection and epilepsy. Drainage can be placed outside the dura mater. Other principles of surgical treatment are the same as closed brain injury.
2.Closed brain injury
Surgery for closed brain injury is mainly for intracranial hematoma or severe cerebral contusion combined with cerebral edema caused by increased intracranial pressure and brain herniation, followed by focal brain damage caused by intracranial hematoma. As CT examination is widely used in clinical diagnosis and observation, the previous view that “hematoma is an indication for surgery” has been changed. Some patients with intracranial hematoma can be treated with non-surgical treatment such as dehydration under strict observation and special monitoring, and good results can be achieved. The indications that intracranial hematoma can be suspended without surgery are: no symptoms of impaired consciousness or increased intracranial pressure, or no symptoms of impaired consciousness or increased intracranial pressure but significant improvement has been seen; no signs of focal brain damage; and the hematoma seen on CF examination is not large (<40ml for supratentorial and <10ml for infratentorial), no significant displacement of midline structures, and no significant compression of the ventricles or brain pool; and intracranial pressure monitoring pressure <2.7kpa (270mmhpa). 7kpa (270mmh2o). The above-mentioned casualties should be closely observed and monitored by special examination while using dehydration and other treatments, and be prepared for surgery at any time, such as blood preparation and head shaving, etc. Once there are indications for surgery, surgery can be performed as soon as possible. >In the case of a temporal lobe hematoma, the patient should be under observation and monitored by special examination. Temporal lobe hematoma due to the tendency to herniate the cerebellar curtain notch. The indication for surgery should be relaxed; the indication for surgery should also be relaxed for epidural hematoma because it is not easily absorbed.
The indications for surgery for severe cerebral contusion combined with cerebral edema are.
(1) progressive worsening of consciousness or brain herniation with dilated pupil on one side.
(2) Significant displacement of midline structures and significant compression of the ventricles on CT examination.
(3) deterioration of the disease during treatment such as dehydration.
All patients with indications for surgery should be operated on promptly in order to remove the cause of the increased intracranial pressure and relieve the brain compression as soon as possible. If the pupil of one side is dilated and the cerebellar curtain is herniated, the hematoma should be removed or the bone flap decompressed within 30 minutes or one hour at the latest; if it takes more than three hours, it will have serious consequences.
Commonly used surgical procedures are.
1.Craniotomy hematoma removal
If the site of the hematoma is clear by CT examination before surgery, the hematoma can be removed by direct craniotomy. For epidural straight swelling, the bone flap should be larger than the range of the hematoma in order to facilitate hemostasis and hematoma removal. In case of bleeding from the main trunk of the middle meningeal artery, if it is difficult to stop the bleeding, the sphenoid hole can be searched for at the base of the middle cranial recess, and the bleeding can be stopped by blocking the sphenoid hole with small cotton balls. In cases where there are obvious signs of brain herniation before surgery or obvious displacement of midline structures on CT examination, the dura mater should be opened and decompressed with bone flaps to reduce the increase in intracranial pressure caused by postoperative cerebral edema, even though the brain is not inflated at that time after hematoma removal. For subdural hematoma, after opening the dura mater, the clot can be flushed out with saline flushing method with the assistance of brain pressure plate. Since subdural hematoma is often combined with cerebral contusion and cerebral edema, the dural well is not sutured for decompression after removing the hematoma. For intracerebral hematoma, because of the combination of cerebral contusion and cerebral edema, after removing the hematoma by puncture or incision of the cortex to the hematoma cavity, it is appropriate not to close the dura and decompress the bone flap.
2.Decompression by debridement
For severe cerebral contusion combined with blind edema with surgical indications, a large bone flap craniotomy, open the dura and decompress the bone flap, and also remove the contusion erosion and poor blood circulation of brain tissue, as internal decompression. For severe extensive cerebral contusion or brain herniation with severe cerebral edema in the late stage, decompression with debridement of both sides can be considered.
3.Borehole exploratory surgery
If the patient has indications for surgery such as progressive increase of post-injury impairment of consciousness or recurrent coma, and CT examination cannot be performed before surgery due to the limitation of conditions, or the brain herniation is already obvious at the time of consultation. If there is no time for CT examination, borehole exploration is an effective diagnostic and salvage measure. Drilling starts on the side where the pupil dilates first, or is selected according to the neurological signs, scalp injuries, and skull fractures; most boreholes need to be performed in multiple places on both sides. If no hematoma is found or if another hematoma is suspected, the holes are drilled at the top of the forehead, above the brow arch, the posterior temporal area, and the lower occipital area, in that order. If a blood clot is seen after drilling through the skull, it is an epidural hematoma; if no hematoma is found, the bone hole is slightly enlarged so that the dura mater can be cut to find a subdural hematoma, and a cerebral puncture or ventricular puncture is performed to find an intracerebral or intraventricular hematoma. When a hematoma is found, a larger bone flap or enlarged bone hole is made in order to remove the hematoma and stop the bleeding; in most cases, the dura mater must be opened and the bone flap decompressed to reduce the increased intracranial pressure caused by postoperative cerebral edema.
4.Ventricular drainage
If intraventricular hemorrhage or hematoma is combined with ventricular enlargement, ventricular drainage should be performed. If the ventricle is mainly uncoagulated blood, cranial borehole puncture for ventricular drainage is feasible; if it is mainly blood clot, craniotomy should be performed to enter the ventricle to remove the hematoma and then place a tube for drainage.
5.Borehole drainage
For chronic subdural hematoma. The main method is to drill a hole in the skull, cut open the dura mater to reach the hematoma cavity, and place a tube to remove the hematoma fluid. If the hematoma is small, top hole drainage is performed, and if the hematoma is large, top and temporal double hole drainage is feasible. Postoperative drainage is performed for 48-72 hours. The patient is placed in a head-down position and given a larger amount of saline and isotonic solution intravenously to induce the original compressed brain tissue to expand and reset and eliminate the dead space.
(F) Symptomatic treatment and complication management
1. Hyperthermia
The common causes are brainstem or hypothalamic injury and respiratory, urinary or intracranial infection. Hyperthermia causes relative hypoxia of brain tissue and aggravates brain damage, so active cooling measures must be taken. Commonly used physical cooling methods are ice caps, or head, neck, axilla, groin and other places to place ice bags or ice water towels. If the body temperature is too high and physical cooling is ineffective or causes chills, hibernation therapy should be used. The physical cooling is started 20 minutes after the drug is administered, and the rectal temperature is maintained at 36°C. The drug can be repeated every 4-6 hours according to the presence or absence of chills and the patient’s tolerance of the drug, and is generally maintained for 3-5 days. Hibernation drugs can reduce vascular tone and weaken the cough reflex, so care must be taken to maintain the dose to maintain blood pressure: tracheotomy is often required to ensure smooth aspiration and aspiration.
2. Agitation
Sudden agitation during observation is often a precursor of deterioration of consciousness and suggests the possibility of intracranial hematoma or cerebral edema; agitation in a patient who is unconscious may be caused by pain, increased intracranial pressure, urinary retention, postural or environmental discomfort, etc. The cause must be sought first for appropriate treatment before sedation is considered.
3.Subarachnoid hemorrhage
It is caused by brain laceration. With headache, fever and cervical tonicity, antipyretic and analgesic drugs can be given as symptomatic treatment. 2-3 days after the injury when the injury tends to stabilize, in order to release the headache, daily or every other day for lumbar puncture, release the appropriate amount of bloody cerebrospinal fluid, until the cerebrospinal fluid is clear. Injury early when the intracranial hematoma can not be excluded, or intracranial pressure increased significantly brain temple can not be excluded, lumbar puncture is contraindicated, so as not to promote the formation of brain herniation or aggravate brain herniation.
4, traumatic epilepsy
Epilepsy can occur in any part of the brain injury, but the highest incidence of damage to the motor area of the cerebral cortex, frontal lobe, and parietal cortex area. Early seizures (within 1 month after injury) are often caused by depressed skull fractures, subarachnoid hemorrhage, intracranial hematoma and brain contusions; late seizures (more than 1 month after injury) are mainly caused by brain scarring, brain atrophy, intracerebral cysts, arachnoiditis, infection and foreign bodies. Phenytoin sodium 0.1 per time, three times a day is used to prevent seizures, when seizures with diazepam (Valium) 10 ~ 20mg intravenous injection slowly, if it fails to stop the convulsions, must repeat the injection until the convulsions are stopped, and then Valium added to 10% glucose solution intravenous drip, the daily dosage does not exceed 100mg for 3 days. After complete control of epilepsy, medication should be continued for 1-2 years and must be gradually reduced before stopping. Sudden interruption of medication is often a trigger for seizures. If the EEG still has spikes, spikes and slow waves or paroxysmal slow waves, the dosage should not be reduced or discontinued.
5. Gastrointestinal bleeding
It is caused by hypothalamic or brainstem injury that causes ulcers, and can also be triggered by heavy use of corticosteroids. In addition to blood transfusion to replenish blood volume, stop using hormone, apply proton pump inhibitor omeprazole (Loxacol.) 40mg intravenously once every 8-12 hours until bleeding stops, followed by H2 receptor antagonist ranitidine 0.4g or simitidine (methicillin) 0.8g intravenously. Once a day for 3-5 days.
6.Urinary collapse
For hypothalamic damage, urine volume >4000ml per day, urine specific gravity <1.005. Give the first 2.5-5U subcutaneous injection of posterior pituitary hormone, record the hourly urine volume, if it exceeds 200ml/h, add one more dose. Desmopressin acetate can also be used intravenously, orally or as nasal drops, and for longer periods of time, long-acting ellagitannin oil can be injected intramuscularly. During the period of increased urine output, attention should be paid to potassium supplementation (calculated as lg KCl per 1000 ml of urine output) and regular monitoring of blood electrolytes. The conscious casualty can drink water on his own because of thirst, but the comatose casualty must adjust the amount of intravenous or nasal rehydration according to the amount of urine per small call.
7.Acute neurogenic pulmonary edema
Can be seen in the hypothalamus and brainstem injury. The main manifestations are dyspnea, coughing up hemorrhagic foamy sputum, lung full of water bubble sound; blood gas analysis shows PaO2, decreased and PCO2 increased. The patient should be placed in a slightly elevated cephalothoracic position, with both lower limbs hanging down to reduce the amount of blood returning to the heart; tracheotomy, keeping the airway open, inhalation of oxygen at 40%-60% concentration after 95% ethanol in a water-sealed bottle to eliminate the foam; preferably with ventilator-assisted breathing, end-expiratory positive pressure ventilation: and dry furosemide 40mg, dexamethasone lOmg, trichothecene C ( The best way to increase the cardiac output, improve pulmonary circulation and reduce pulmonary edema is to use a ventilator to assist ventilation.
Craniocerebral traumatic mental disorder is a mental disorder that occurs when the cranial brain is directly or indirectly affected by external forces, causing organic or functional brain disorders. It is mostly seen in young adults.
Etiology (pathogenesis) of mental disorders due to craniocerebral trauma
Various causes of closed and open craniocerebral injury are the main factors in the pathogenesis, and the quality characteristics of the individual and the post-traumatic psychosocial factors play a role. The more severe the craniocerebral trauma, the greater the chance of mental disorder and the longer it lasts.
Clinical manifestations of mental disorders due to craniocerebral trauma
(A) Acute mental disorder
1, consciousness disorder: seen in closed traumatic brain injury, probably as a result of the larger rotational movement of brain tissue in the cranial cavity. Concussion degree of consciousness impairment is relatively mild, can occur immediately after the injury, the duration is mostly within half an hour. Patients with brain contusion have a severe degree of impaired consciousness that can last from several hours to several days. Malorientation, nervousness, fear, excitement and restlessness, and abundant delusions and hallucinations can occur during wakefulness and are called traumatic delirium. If the initial coma in traumatic brain injury is awake, after an intermediate period of wakefulness from several hours to several days, subdural hematoma should be considered when consciousness becomes impaired again.
2. Amnesia: When the patient regains consciousness there is often memory impairment. The period of post-traumatic amnesia is defined as the recovery of normal memory from the time of injury. Retrograde amnesia is uncommon (i.e., it refers to the amnesia of a pre-injury experience) and mostly recovers within a few weeks. Some patients may experience persistent near-event amnesia, fictitious and misconstruction, called post-traumatic amnesia syndrome.
3, acute post-traumatic brain injury disorder: easy fatigue and depression, or impulsive behavior, may also appear delirium state.
(B) late mental disorder
1, post-traumatic brain injury syndrome: common. Performance headache, heavy head, dizziness, nausea, easy fatigue, concentration, memory loss, emotional instability, sleep disorders, etc., usually referred to as post-concussion syndrome, the symptoms can generally last for several months. Some of them may have an organic basis, and if they persist for a long time, they are often related to psychosocial factors and susceptibility qualities.
2.Post-traumatic neurosis: there may be suspicion, anxiety, hysteria and other manifestations, such as spasticity occurrence, deafness, hemiparesis, paraplegia, etc. The onset may be related to psychological factors at the time of trauma.
3, traumatic brain psychosis: less common. It can have schizophrenia-like state, with hallucinatory delusions as the main symptom, and the majority of victimization content. May also present bipolar disorder-like state.
4, traumatic brain dementia: some patients who have been in a coma for a long time with severe traumatic brain injury can be left with a dementia state, showing a significant decrease in memory, understanding and judgment, and slow thinking. And often accompanied by personality changes, showing a lack of initiative, emotional retardation or irritability, euphoria, loss of sense of shame, etc.
5, traumatic epilepsy.
6, post-traumatic personality disorder: mostly occurs in severe punishment craniocerebral trauma, especially when the frontal lobe injury, often coexists with dementia. Become emotionally unstable, irritable, self-control ability is reduced, the character is perverse, rude, stubborn, selfish and loss of aggressiveness.
Examination of mental disorders due to craniocerebral trauma
Cranial plain film (front and side view, skull base view), brain ultrasound diagnosis, electroencephalogram, cranial CT examination and psychological test, etc.
Diagnosis of mental disorder due to craniocerebral trauma
(a) First of all, we should determine whether there is traumatic brain injury.
(2) Detailed neurological examination: the presence or absence of restrictive signs.
(c) Auxiliary examination: cranial plain film (front and side, skull base), brain ultrasound diagnosis, EEG, cranial CT examination and psychological test, etc.
(D) Exclude various neurological disorders: schizophrenia, affective disorders, pathological personality, chronic subdural hematoma and other mental disorders caused by organic brain diseases.
Treatment of mental disorders due to craniocerebral trauma
The treatment of the acute phase of mental disorders due to craniocerebral trauma consists mainly of neurosurgical management. After the danger period, psychiatric symptoms should be treated actively. The principles of treatment of traumatic delirium are the same as those of other deliriums, but psychotropic drugs should be used with caution for those who still have impaired consciousness.
substances, and for symptoms such as hallucinations, delusions, and psychomotor excitement, antipsychotic drugs can be given, either orally or by injection. Patients with mental retardation should first undergo neuropsychological measurements and then develop a rehabilitation program according to the specific situation.
For patients with personality changes, behavioral therapy can be tried, and family members and colleagues should be helped to understand and accept the patient’s behavior correctly and try to involve them in the treatment plan. For psychiatric symptoms associated with traumatic brain injury, antipsychotic drugs can be used according to the situation.
The use and dosage of antipsychotic drugs are the same as those used for functional psychiatric disorders. Unnecessary physical examinations and repeated history taking should be avoided in patients with post-traumatic neurological disorders. Supportive psychotherapy, behavioral or cognitive-behavioral therapy with appropriate
medications (e.g., antidepressants, anxiolytics) are all viable treatments. If symptoms persist, the presence of psychosocial factors, such as work problems and lawsuit compensation issues, should be identified.
Prognosis of mental disorders caused by craniocerebral trauma
The prognosis is closely related to the nature, type and location of the trauma, the duration of the disturbance of consciousness and amnesia, the presence of complications, the treatment conditions, as well as the quality of the individual and psychosocial factors. It is generally believed that milder acute mental disorders with active treatment
can be recovered within 1 to 2 months. Later psychiatric disorders have a more prolonged course, such as traumatic neurosis and post-traumatic syndrome, which can last for many years, but with appropriate treatment it is still possible to recover from traumatic dementia and personality changes with a poor prognosis.