Brain contusion

Introduction to brain contusion Brain contusion refers to the violent action on the head, causing organic damage to the brain tissue. It includes both pathological types of contusion and laceration. It is the most common type of injury on gross anatomy and CT after craniocerebral injury, usually multiple and associated with other types of craniocerebral injury. Brain contusion can occur in or near the corresponding part of the direct action of violence, resulting in an impact injury, but it is usually the case that a severe and common brain contusion occurs at a location away from the strike point, and the corresponding point of the violent action point is severe. The impact of the injury. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: headache, memory impairment, cerebral palsy

Cause of brain contusion

(1) Causes of the disease

Violence acts on the head, causing brain contusion and laceration at the impact point and the hedging site. The contusion in the brain parenchyma is caused by the deformation and shearing force of the brain tissue, which is found between the white matter and the gray matter. Contusion and punctiform hemorrhage, such as the cerebral cortex and pia mater remain intact, that is, brain contusion, such as brain parenchymal damage, fracture, pia mater also tear, that is, brain contusion, severely combined with deep brain Structural damage.

The location of the cerebral contusion and laceration is closely related to the action point of the external force, the direction of action and the anatomical features of the skull. When the force at the top of the occipital force is applied, the contralateral pole, the frontal and the bungee are the most common. However, the occipital lobe's hedging damage is rare. This is due to the rough surface of the anterior skull base and the sphenoid ridge. The external force causes the contralateral frontal pole and the bungee to impinge on it, causing relative friction and causing damage. After the forehead is hit, the brain tissue moves backwards, but because the occipital lobe hits the smooth, flat cerebellum, the external force is buffered and rarely causes damage.

(two) pathogenesis

Pathological changes of brain contusion and laceration, light surface can be seen on the surface of the brain congestion, edema, flaky hemorrhage, cerebrospinal fluid; severe brain parenchymal rupture, rupture, local hemorrhage, even hematoma, damaged tissue necrosis, microscope The formation of neuronal cytoplasmic vacuoles, the disappearance of Nissl, the fragmentation of the nucleus, dissolution, and swelling of the axons.

In severe brain injury, especially with subdural hematoma, diffuse brain swelling often occurs, especially in children and young adults, generally occurring within 24 hours after injury, short-term injury occurs 20 to 30 minutes, its pathological morphology Changes can be divided into three phases:

1. Early: a few days after injury, under the microscope, the hemorrhage and necrosis of the brain parenchyma are the main changes, the stratification of the cerebral cortex is unclear or disappeared, the boundary between gray matter and white matter is unclear, and the large pieces of nerve cells disappear or are ischemic. Degeneration, axonal swelling, rupture, disintegration, astrocyte degeneration, swelling of oligodendrocytes, vascular congestion and edema, enlarged perivascular space.

2. Interim: Apparently in the days of damage to several weeks, there are repair pathological changes in the injured area, and there are bleedings of different sizes in the cortex. The cortical structure of the injured area disappears, and the lesions gradually appear microglial hyperplasia, forming lattice cells, phagocytosis. Disintegrated myelin and cell debris, astrocytes and oligodendrocytes proliferate hypertrophy, leukocyte infiltration, and thus enter the repair process.

3. Late stage: months or years after contusion, the lesion is replaced by glial scar, the meninges of the old lesion area and the scar of the brain parenchyma are adhered, and the nerve cells disappear or decrease.

Brain contusion prevention

The disease is a traumatic disease, pay attention to safety, drive carefully, keep the home environment bright, walk carefully, watch children and avoid trauma.

Complications of brain contusion Complications, headache, memory impairment, cerebral palsy

Brain contusion and laceration can be combined with brain stem injury, hypothalamic injury, cranial nerve injury, intracranial hematoma, or with physical injury. After surgery, postoperative intracranial hematoma may occur. , cerebrospinal fluid leakage, postoperative seizures.

1. Brain damage often causes varying degrees of permanent dysfunction. This depends mainly on whether the damage is in a specific area of the brain tissue (focal) or extensive damage (dispersion), and brain damage in different areas can cause different symptoms, and these special focal symptoms can help The doctor determines the site of the injury. Focal symptoms include symptoms such as exercise, sensation, speech, vision, and hearing abnormalities. Diffuse brain damage often affects memory, sleep, or causes confusion and coma.

2. Severe traumatic brain injury sometimes leads to forgetting, patients can not recall things before and after loss of consciousness, and patients who are awake within a week can often recover their memories. Some brain traumas (even if they are mild) can cause post-traumatic brain syndrome, and for a long time, patients have headaches and memory disorders.

3. Severe brain trauma can pull, twist or tear nerves, blood vessels and other tissues in the brain. The nerve pathway is damaged, or causes bleeding and edema. Intracranial hemorrhage and cerebral edema increase the contents of the cranial cavity, but the cranial cavity itself cannot be expanded accordingly. As a result, the intracranial pressure increases and the brain tissue is further damaged. At this time, the intracranial pressure increases and the brain moves downward, forcing the upper part. The brain tissue and brain stem enter the associated channel, a condition called cerebral palsy. The cerebellum and brainstem can be displaced from the hole in the base of the skull to the spinal cord. Because the brain stem has an important function of maintaining breathing and heartbeat, cerebral palsy is often fatal.

Symptoms of brain contusion and laceration Common symptoms Sensory disorder Crush injury Lowering blood pressure, high fever, nausea and coma

The clinical manifestations of brain contusion and laceration vary with the injury factors and the injury sites. The disparity is very large. There may be no primary disturbance of consciousness in the light, such as simple closed depression, which may be caused by skull crush injury. In this case, the severe one can cause deep coma, severe functional damage, and even death.

Consciousness disorder

It is one of the most prominent clinical manifestations of brain contusion and laceration. Immediately after injury, it is coma. Due to different injuries, the coma varies from several minutes to several hours, several days, several months, and even prolonged coma. Extensive cerebral cortical damage or brain stem injury exists, and the time limit for cerebral contusion and laceration is usually determined by the coma after injury for more than 30 minutes.

2. Vital signs changes

There are obvious changes. Generally, blood pressure drops in the early stage, the pulse is weak and the breathing is shallow. This is caused by the inhibition of brain function after injury. It usually recovers soon after the injury. If you continue to have low blood pressure, you should pay attention to whether there is compound damage, and vice versa. If the vital signs are quickly recovered in the short term and the blood pressure continues to rise, the pulse pressure difference is increased, the pulse is powerful, the pulse rate is slow, and the breathing is deepened and slowed down. The intracranial hematoma and/or cerebral edema should be guarded. Swelling, brain contusion and laceration of patients with body temperature, can also be mildly elevated, usually about 38 ° C, if sustained high fever is associated with hypothalamic injury.

3. Headache, vomiting

Symptoms of headache can only be stated after the patient is awake; if the patient continues to have severe headache after the injury, frequent vomiting; or once he is improved and then heavier, the reason should be investigated, if necessary, auxiliary examination can be performed to determine whether there is a hematoma in the skull, to the coma Patients should be aware of the possibility of aspiration during vomiting and the risk of suffocation.

4. Epilepsy

Early epilepsy is more common in children, manifested as epileptic seizures and localized seizures, with an incidence of about 5% to 6%.

5. Neurological signs

Depending on the location and extent of the injury, if only the amount of injury, the so-called "dumb zone" at the front end of the temporal lobe, there is no manifestation of the nervous system defect; if the functional area of the cerebral cortex is damaged, the corresponding sputum, aphasia, may occur. Visual field defects, sensory disturbances, and signs of focal epilepsy, there is no neurological positive signs in the early stage of brain contusion and laceration. If new localization signs appear during the observation, the possibility of secondary damage in the brain should be considered. , check in time.

6. Meningeal irritation

After brain contusion and laceration, due to subarachnoid hemorrhage, patients often have signs of meningeal irritation, which is characterized by closed eyes and gaze, lying and lying, early low fever and nausea and vomiting are also related to this, neck resistance is about 1 week. Gradually disappeared left and right, if you continue to improve, you should pay attention to the presence or absence of craniocerebral junction injury or intracranial secondary infection.

Brain contusion

Lumbar puncture helps to understand the condition of cerebrospinal fluid, which can be differentiated from concussion. It can also measure intracranial pressure and blood cerebrospinal fluid. Due to the popularity of CT, lumbar puncture is no longer used when patients are admitted to hospital because the lumbar puncture is not only long. There is a certain danger, and it is impossible to make a diagnosis. In addition, for patients with obvious intracranial hypertension, lumbar puncture should be avoided to avoid cerebral palsy. Lumbar puncture is only used for brain contusion without obvious intracranial hypertension. Inpatients with submucosal bleeding.

1. Skull X-ray film: Most patients can find skull fracture, intracranial physiological calcification (such as pineal gland) can be displaced.

2. CT scan: the brain contusion and laceration area can be seen in the high-density area, or the high density and low density are mixed with each other. At the same time, the ventricle can be deformed by cerebral edema. Diffuse brain swelling can be seen on one or both sides of the cerebral hemisphere. The lateral ventricle is compressed or disappeared, the midline structure is displaced to the contralateral side, and when the subarachnoid hemorrhage occurs, the longitudinal fissure pool has a longitudinally wide-banded high-density shadow, and the brain tissue is necrotic and liquefied after the brain contusion and laceration. The CT value is near the low-density area of the cerebrospinal fluid and can exist for a long time.

3. MRI: It is rarely used for the diagnosis of patients with acute brain contusion, because its imaging is slow and emergency equipment can not be brought into the computer room, but MRI for small hemorrhage, early brain edema, cranial nerve and posterior fossa structure The display is clearer and has its own advantages.

4. Cerebral angiography: In the absence of CT, the condition requires a feasible cerebral angiography to exclude intracranial hematoma.

Diagnosis and differentiation of brain contusion and laceration

diagnosis

According to the medical history and clinical manifestations and CT scan, the general case diagnosis is not difficult. Brain contusion and laceration may be combined with some other diseases. Therefore, detailed and comprehensive examination should be carried out to confirm the diagnosis and timely treatment.

Patients with brain contusion and laceration often have disturbances of consciousness, which often cause difficulties in neurological examination. For patients with positive signs of nervous system, the location and degree of damage can be judged according to the location signs and coma. Patients with poor stimulation response, even if there is a nervous system defect, it is difficult to determine, especially in patients with multiple brain contusion or deep brain injury, location diagnosis is difficult, often rely on CT scan and other necessary auxiliary examinations Make an exact diagnosis.

Differential diagnosis

1. Identification with concussion: The coma of brain contusion and laceration is longer, the nervous system has positive signs, and the cerebrospinal fluid is bloody; while the concussion coma is short, no nervous system is found, and the emergency CT scan can be clear.

2. Identification with intracranial hematoma: brain contusion and laceration can be coma after the occurrence, if not accompanied by other injuries, symptoms and signs can gradually improve after injury, tend to be stable; and symptoms and signs of the patient after intracranial hematoma Once again, even coma, the waking period between two coma is called "intermediate waking period", the symptoms and signs are progressively worsened, CT or MRI can make a clear judgment on both, but intracranial hematoma often in severe brain On the basis of the crack, the symptoms and signs overlap each other, and clinical identification is more difficult.

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