Craniocerebral trauma is a common type of injury that occurs in the skull, with fall and impact injuries being the most common, followed by bruises. Often occur in disasters, war or traffic accidents.
First, in general, cranial trauma is divided into.
1, closed: the brain tissue is not connected to the outside world after the injury.
2, open brain injury: after the injury, brain tissue through the skull and scalp wounds and the outside world.
Second, according to the degree of injury will be divided into the following levels of cranio-cerebral injury.
1, light: mainly including simple concussion, with or without skull fracture, coma time within half an hour; there are mild headache, dizziness and other conscious symptoms; neurological and cerebrospinal fluid examination without significant changes.
2, medium: refers to mild cerebral contusion with or without skull fracture and subarachnoid hemorrhage, no cerebral compression signs, coma time not exceeding 12 hours, with mild positive neurological signs and mild changes in body temperature, respiration, pulse and blood pressure.
3, heavy: mainly refers to extensive cerebral contusion, extensive skull fracture, brainstem injury or intracranial hematoma, deep coma or coma for more than 12 hours, gradual worsening of consciousness impairment or re-coma, with obvious positive neurological signs, and significant changes in body temperature, respiration, pulse, and blood pressure.
4, extra heavy: brain primary injury is heavy, coma immediately after the injury, go to the brain tonic or with other organ damage, shock, etc. Or there has been late brain herniation, double pupils dilated, severe disorder of vital signs or respiratory arrest.
Third, if there is intracranial hematoma, according to the time of hematoma can be divided into.
1. Acute: brain compression signs appear within 3 days after injury.
2. subacute: cerebral compression signs appear within 3 days to 3 weeks after injury.
3, chronic: more than 3 weeks after injury, subdural hematoma, intracerebral parenchymal hematoma and multiple hematomas.
Fourth, the injury mode of brain injury is divided into.
1, accelerated craniocerebral injury: the head at rest is struck by an object in motion, the head along the direction of the external force for accelerated movement, the injury site to the strike site. Such as stick blows injury.
2, deceleration injury: the movement of the head hit a stationary object or the ground, although the skull movement state into a stationary state and brain tissue due to inertia in the cranium continue to move, the opposite side of the brain tissue hit the opposite side of the inner surface of the skull to cause brain contusions, brain contusions are often located on the opposite side of the impact point, as common as falling injuries.
In a specific case, accelerated cranial injury and decelerative injury often coexist, such as the head is hit by an external force to show accelerated injury, followed by a fall, the head hit the ground and show decelerative injury. In the deceleration injury, in addition to the head at the point of impact with cranial injury, the relative parts of the point of impact brain tissue also have hedge injury.
Fifth, in the diagnosis of craniocerebral injury, careful understanding of the mode of injury is very important. From the pathological point of view.
1, primary brain injury for brain contusion, there are soft meninges and cerebral cortex fracture, destruction. There are scattered foci of hemorrhage in the brain tissue. White matter is also involved, showing changes such as softening hemorrhage and edema. Cerebral contusions are often combined with cerebral lacerations. In cases with hedgehog brain injury, the brain injury at the hedgehog site is heavier than at the point of impact. The frontal lobe and temporal lobe brain tissues have hedge injuries because of the occipital force in hedge brain injury, and the anterior cranial fossa of the frontal lobe has an uneven bone ridge, and the anterior part of the temporal lobe also has a sharp butterfly bone ridge, which can cause serious brain contusion.
2. Secondary pathological changes are intracranial hematoma and cerebral edema. Intracranial hematoma forms an occupying lesion, resulting in increased intracranial pressure, which compresses important brain structures and forms brain herniation in the case of loss of compensation, endangering life. Cerebral edema can occur locally in and around cerebral contusions or extend to the entire hemisphere and the whole brain, where it exacerbates increased intracranial pressure and promotes the formation of brain herniation. Severe cerebral contusions and cases of intracranial hematoma and cerebral edema are often combined with hypothalamic injury, which can cause changes in vital signs and the development of stressful peptic ulcers and hemorrhage.