Non-firearm open craniocerebral injury

Introduction to non-firearm craniocerebral open injury Non-firearm-type craniocerebral open injury refers to an open brain injury caused by a sharp attack by a sharp or blunt instrument. Unlike a firearm wound, it has no central coagulative necrosis caused by the divergence of energy, nor does it Produces a penetrating injury to the stressed part. Head injury is often limited to the vicinity of the point of force. The severity of craniocerebral injury depends on the location and depth of the injury. In general, the forehead injury can cause personality changes, but the prognosis is better. The injury of the ankle is due to the close proximity of the ankle to the brainstem and the main blood vessels. The damage is greater. Can cause cavernous sinus, 3 to 6 damage to the cranial nerve or internal carotid artery (anterior), and damage to the basilar artery or brain stem (posterior), damage to the posterior fossa may be fatal. basic knowledge The proportion of illness: the incidence rate is about 0.01%, caused by multiple traffic accidents Susceptible people: no special people Mode of infection: non-infectious Complications: somatosensory disturbance

The cause of non-fired craniocerebral open injury

Sharp cuts (30%):

The sharp-edged sharps cause cuts, strip wounds, scalp wounds are neat, no obvious rubbing, contusion marks, skulls are also trough-shaped or trapped, and the dura mater and brain tissue also have lacerations and hemorrhage. The sharps often cause puncture wounds, and the scalp punctures are small and tidy. The size and shape of the scalp are often similar to those of the injured sharps. The depth of penetration varies according to the intensity of the violent effect, causing a chance of hematoma in the brain. The temporal lobe is less multi-frontal, usually the sharp injury is less polluted, and the intracranial foreign body is also rare, so the infection rate is low. However, occasionally, small broken bone pieces can be brought into the brain, which becomes the core of future infection. .

Blunt laceration (30%):

The long blunt device causes a strip of scalp contusion and laceration, the wound edge is not complete, the skull is comminuted with a strip-shaped depression, the dura mater is often pierced by the fracture piece, and the brain tissue has a large area of contusion and laceration, and occasionally A certain degree of brain injury, blocky blunt often causes sag fractures or cave fractures with different degrees of radial linear fractures, scalp contusion is similar to the shape of the wound, but the laceration is often triangular or star-shaped, wound edge Incomplete, contusion is severe, the dura mater can be torn, and the skull fragments are more likely to penetrate into the brain. Such blunt instruments are heavily polluted, foreign bodies in the brain, hair, sand are common, infection is easy, and intracranial hematoma is complicated. There are many opportunities. In addition, there is a special blunt open injury, that is, children fall accidentally when they run, and they hold bamboo sticks, pencils or long-handled toys in their hands, through the eyelids, nasal cavity, frontal sinus or upper jaw. Skull and other bones are weak, puncture into the skull, causing brain tissue damage and bleeding, if the pollution is more serious, often lead to intracranial infection.

Collision damage (30%):

Open cranial injury caused by collision is a kind of violent injury, although it is a decelerating injury, but because of its small area and high speed, it is similar to the external force of the skull. It is caused by accelerated injury, that is, the local deformation of the skull is The main depression or cavity fracture, but the accompanying brain hedging injury and shear stress injury is still heavier than the general accelerated injury, and there are more opportunities for intracranial hemorrhage and infection.

Common injuries caused by sharp injuries include knives, axes, spears, steel rods and cones, nails, scissors, daggers, etc. Common injuries caused by blunt injuries include sticks, bricks, stones and hammers, axe and other irons. The open head injury caused by the rapid movement of the head is caused by an angular or protruding fixture, such as falling on a rock or falling on an iron pile.

Non-firearm craniocerebral open injury prevention

Avoid injury caused by severe impact from sharps or blunt instruments.

Non-firearm traumatic brain injury Complications

Speech disorder, sensory disorder, and state of consciousness.

Non-fired craniocerebral open injury symptoms Common symptoms Open injury, sensory disturbance, consciousness disorder, coma, intracranial hemorrhage, skull fracture, neck stiffness, high fever

The clinical manifestations of open brain injury vary depending on the cause of injury, the location of the injury, and the presence or absence of secondary bleeding or infection.

Systemic symptoms

(1) Change of consciousness: There is a big difference in consciousness of patients with open brain injury. Lighter people can always be awake. For example, sharp puncture wounds, if they do not hurt the functional area, and do not cause intracranial hemorrhage, the situation is often good, and the situation is severe. Sudden coma can occur. If the brain stem or the hypothalamus is injured, the patient often has cortical tonic and hyperthermia. If the intracranial hematoma is secondary, it can also cause signs of cerebral palsy.

(2) Vital signs: Open brain damage often has blood loss, so it often shows pale, weak pulse, blood pressure and other manifestations, even with intracranial hematoma, the changes in vital signs are more atypical.

(3) Combined injury: The presence of combined injury is another common cause of shock. Common compound injuries are mostly closed injuries of the chest and abdomen. If the head injury is more serious than the composite injury, most of the clinical signs are mainly brain injury, which is easy to miss diagnosis. Combined injuries, especially for patients with conscious disabilities, should not be overlooked.

(4) Epilepsy: more common than closed brain injury, early post-injury epilepsy may be related to injury stimulation or cerebral cortical contusion, localized depression, acute subdural hematoma, brain contusion, subdural or subarachnoid space Bleeding and late-stage infections, meningeal brain scars are all factors that cause epilepsy.

(5) Intracranial infection: open brain injury often has foreign bodies, bone fragments, hair is brought into the skull, brain invasive is a good medium, so it is more susceptible to infection, mostly in the early stage of infection, meningitis and suppuration Encephalitis, patients often have headaches, vomiting, neck stiffness, high fever and pulse rate and other toxic reactions, late in the formation of cerebral palsy and/or brain abscess.

2. Local signs

There are many cases of facial injury, wounds on the craniofacial surface, open wounds, visible wounds open, skull exposed, brain overflow, patients are often in an endangered state, minor wounds can be small, even by the hair Covering, sometimes steel needles, nails, bamboo chopsticks and other injuries, through the eyelids, nasal cavity or ear canal into the skull, the inspection should pay attention to the size, direction and depth of the wound, the wounds left in the wound Do not touch, so as not to cause bleeding, according to the injured part, the amount of blood loss or the presence of a large amount of cerebrospinal fluid outflow, you can determine the brain damage and whether there is venous sinus or ventricle penetrating injury.

3. Brain symptoms

Due to the location and extent of the injury, common brain damage is: hemiplegia, aphasia, partial sensory disturbance and visual field defect. Cranial nerve injury is more common in olfactory, visual, facial and auditory nerves. Severe open brain injury can involve important structures such as brain stem or basal ganglia. Patients have severe clinical manifestations and poor prognosis.

Non-firearm craniocerebral open injury examination

The purpose of lumbar puncture is to measure intracranial pressure, to detect and treat subarachnoid hemorrhage and intracranial infection, and generally do not perform lumbar puncture before debridement.

1. X-ray film: X-ray plain film examination of the skull is necessary to help the extent of the fracture, the understanding of the retention of bone fragments and foreign bodies in the skull.

2. Cranial CT scan: It can show the damage of the skull and brain tissue. More importantly, it can accurately locate the broken bone fragments and foreign bodies, and find secondary changes such as intracranial or intracerebral hematoma. CT is more horizontal than X-ray. The sheet more clearly shows non-metallic foreign matter with a low X-ray absorption coefficient.

Diagnosis and identification of non-fired open brain injury

Diagnostic criteria

Open craniocerebral injury is generally easy to diagnose. According to the medical history, the presence or absence of cerebrospinal fluid or brain tissue in the wound can determine the condition of open injury. X-ray plain film and CT scan are more conducive to the diagnosis of injury. In a few cases, The dural rupture is small and there is no cerebrospinal fluid leakage.

1. X-ray plain film examination: It is very important to understand the trend of skull fracture line, depression depth, intracranial foreign body, bone fragment distribution and gas cranium. As long as the patient's condition permits, it should be used as routine examination, including positive lateral position and depression. A tangential photo of the area.

2. CT scan: You can see the exact location and extent of the injury, and can accurately locate the location and distribution of foreign bodies or bone fragments, especially when the intracranial hematoma, effusion or late hydrocephalus, Brain swelling, brain penetrating malformation and epileptic foci have important diagnostic value.

3. Cerebral angiography: mainly for the complications and sequelae of open craniocerebral injury, such as traumatic aneurysm or arteriovenous fistula. In the absence of CT equipment, cerebral angiography is still an important diagnostic tool.

Differential diagnosis

Different from closed head injury, the latter has no dural cleft, no cerebrospinal fluid leakage, X-ray film and CT scan are helpful for judging. In some cases, it is difficult to determine whether it is open brain injury at the time of initial diagnosis, and often requires surgical exploration. Can be clear.

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