What is a concussion?
Regular people generally think that concussions are particularly serious and are frightened of them. Brain experts suggest us that concussions are the mildest form of brain injury. Characteristics: Transient impairment of consciousness and near-event amnesia occur immediately after the injury.
Mechanism of occurrence: It is generally believed that impaired consciousness is associated with damage to the brainstem reticular formation. Recently, electron microscopy has revealed mitochondria, axonal swelling, and interstitial edema in neurons at the site of stress.
Clinical manifestations and diagnosis.
1. Transient loss of consciousness immediately after the injury;
2.After waking up, there is no recollection of the injury and pre-injury situation, i.e., retrograde amnesia or proximal amnesia;
3, other symptoms (blood pressure pulse, respiration, etc.) autonomic and brainstem dysfunction;
4.Headache, dizziness, etc. There are no special positive signs in the neurological examination.
How to treat: Concussions are mostly treated without special treatment. Bed rest, symptomatic treatment, about two weeks recovery.
What is brain injury?
Classification of brain injury: primary and secondary two categories.
1, primary brain injury: including concussion, brain contusion and diffuse axonal injury.
2, secondary brain injury: including cerebral edema, brain swelling and intracranial hematoma.
Occurrence mechanism.
1, external force on the head, due to brain injury caused by skull inversion and rapid rebound or fracture. It is common in the area of force;
2, the head by the moment of external force, the relative movement between the brain and the skull caused by the injury, this injury can occur in the force site, can also occur in the hedge site.
Accelerated injury, the first factor plays a role: external force acting on the head, the skull quickly inward and rebound or fracture caused by brain injury. Mostly at the site of impact.
Decelerative injury, both factors play a role: the moment of force on the head, the relative movement between the brain and the skull caused by the injury. Can occur at the site of impact and at the site of hedge. Deceleration injuries have both of these factors at play.
Brain injuries caused by relative motion between the brain and the skull are more common and more severe. When the occipital or frontal force, brain injury is more often seen in the frontal, temporal lobe tip and base (caused by the anterior and middle skull base structures).
1, closed brain injury
Etiology: closed brain injury is mostly due to traffic accidents, falls, falls and other accidental injuries and birth injuries. In wartime, see in the work collapse injury or explosion caused by high-pressure gas wave impact injury. All due to violence directly or indirectly caused by the role of the head injury.
2, open brain injury
(1) non-sharps open brain injury: open brain injury caused by sharps, brain contusions or hematomas caused mainly by the contact, the brain contusions and hematomas are often limited to the point of impact site; caused by blunt force injuries, in addition to the point of impact of open brain injury, there can still be due to inertial force caused by the presence of hedonic brain contusions and hematomas. The trauma is often mixed with a large amount of foreign bodies such as hair, cloth, sand, glass fragments and broken bone fragments. If the trauma is not completely removed, it can be combined with cranial or intracranial infection.
Open brain injury is caused by the spillage of cerebrospinal fluid and necrotic liquefied brain tissue from the wound, or the outward expansion of brain tissue from the dura mater and skull defect. Therefore, the increase in intracranial pressure is moderated to a certain extent; however, most open brain injuries with combined depressed fractures have small dural fissures due to overlapping fracture fragments embedded with each other. The intracranial pressure increase is no different from that of closed brain injury.
(2) open brain sprain caused by sharps: in addition to the characteristics of non-sharp open brain injury, there are still shrapnel or slug formed by the characteristics of the wound channel. Shrapnel is usually located at the proximal end of the wound channel. Radial distribution, shrapnel or slug if not penetrated outside the skull, often in the distal end of the wound channel. Based on the mode of injury, the location of the wound, focal symptoms and signs, and the distribution of fracture fragments and foreign bodies seen on cranial radiographs, the site and type of injury can be approximated. The progressive worsening of consciousness suggests the emergence of brain herniation, and according to its early appearance combined with other clinical manifestations, it can be presumed whether there is intracranial hematoma, cerebral edema or intracranial infection.
What is craniosynostosis?
Craniocerebral injury refers to the injury of the skull and brain under the action of external forces, whether in peacetime or wartime is an extremely common type of injury disease, the central problem is brain injury, and often occurs simultaneously with scalp and skull injury. As a result of traffic, industrial and mining accidents, natural disasters, explosions, firearm injuries, falls, falls and various sharp and blunt objects to the head produced injuries.
Skull injury, namely skull fracture, is caused by external forces acting directly or indirectly on the skull. Its formation depends on both the nature and size of the external force and the structure of the skull.
Skull fracture can be classified into skull cap fracture and skull base fracture according to the fracture site.
1. Skullcap fracture
According to the fracture form, it is divided into
Linear fracture (linear fracture): it can be single or multiple, and multiple may be several fracture lines scattered in multiple places, or multiple fracture lines interlaced in one place to form a comminuted fracture. The incidence of linear fracture is highest in the skullcap, and the diagnosis can be confirmed mainly by cranial radiographs. If the fracture line passes through the dural vascular sulcus or venous sinus, the occurrence of epidural hematoma should be alerted; close observation or CT examination is required; if the fracture line passes through the air sinus, it may lead to intracranial pneumatization and intracranial infection should be prevented.
Depressed fractures: The fracture is either total or only the inner plate is depressed into the cranial cavity. The clinical manifestations and effects vary depending on the location and depth of the fracture, ranging from local compression in mild cases to damage to the local meninges, blood vessels and brain tissue in severe cases, which can lead to intracranial hematoma. Some depressed fractures can be palpated, but the diagnosis often depends on radiographic examination.
Clinical manifestations: most often associated with scalp injury.
Definitive diagnosis: relies on imaging – X-ray or CT of the skull (bone window position).
2. Skull base fracture.
The ratio of the incidence of the two is 4:1. The clinical significance of skull fractures lies mainly in the concurrent meningeal, vascular, cerebral and cranial nerve injuries.
Clinical manifestations: mainly ear, nasal bleeding or cerebrospinal fluid leakage; cranial nerve injury; subcutaneous or submucosal petechial hemorrhages. The majority of skull base fractures are linear fractures, with individual depression fractures, which are classified according to their occurrence sites as
(1) Fracture of the anterior fossa of the skull: it often involves the orbital plate of the frontal bone and the sieve bone, causing bleeding through the anterior nostril; or flowing into the orbit, forming petechial hemorrhagic spots under the periorbital skin and bulbous conjunctiva, which is called “panda” eye sign. When the meninges rupture at the fracture, cerebrospinal fluid may flow out from the anterior nostril through the frontal sinus or septal sinus, which becomes cerebrospinal fluid nasal leakage, and air may also enter the cranial cavity retrogradely to form intracranial pneumatosis. Fracture of the sieve plate and optic nerve canal can cause damage to the olfactory and optic nerves.
Features: panda eyes; nasal bleeding or cerebrospinal fluid nasal leak; air cranium; olfactory nerve injury.
(2) Fracture of the middle fossa of the skull: it often involves the rocky part of the temporal bone, and when both the meninges and periosteum are ruptured, cerebrospinal fluid flows out through the middle ear through the tympanic fissure to form cerebrospinal fluid aural leakage; if the tympanic membrane is intact, cerebrospinal fluid flows to the nasopharynx through the eustachian tube, often combined with the injury of the VII or VIII cranial nerve. If the fracture involves the butterfly and medial temporal bone, the pituitary gland and the Ⅱ, Ⅲ, Ⅳ, Ⅴ and VI cranial nerves may be injured. If the cavernous sinus segment of the internal carotid artery is injured, a pulsatile proptosis may occur due to the formation of an internal carotid artery cavernous sinus fistula; fatal rhinorrhea or ear hemorrhage may occur if the internal carotid artery ruptures at the rupture hole or at the internal carotid canal.
Features: cerebrospinal fluid or blood flow through the ear and nose; facial and auditory nerve injury; injury around the supraorbital fissure can lead to multiple groups of nerve injury.
(3) Posterior cranial fossa fracture: when the fracture involves the posterior lateral part of the temporal bone rock, subcutaneous petechial hemorrhage in the mastoid area is mostly seen 2~3 days after the injury. If the fracture involves the base of the occipital bone, suboccipital swelling and subcutaneous petechial hemorrhage may appear a few hours after the injury; if the fracture involves the posterior edge of the foramen magnum or the tip of the rock bone, individual or all of the posterior cranial nerves (i.e., Ⅸ~ Ⅻ cranial nerve) may be involved, such as hoarseness and difficulty in swallowing.
Features: mastoid and suboccipital petechiae; posterior group nerve injury.
Diagnosis: skull base fracture diagnosis, mostly relying on clinical manifestations; CT, which may reveal intracranial pneumatization and occasionally fracture lines.
Treatment: skull base fractures can be considered as (internal) open fractures, and treatment is based on anti-infection.