Traumatic brain injury
Traumatic brain injury (SHV), SHT
English: intracranial injury, traumatic brain injury
Of a traumatic brain injury one speaks with injuries of the scalp, des Skull and the brain, which have arisen through external violence.
The injuries can be present individually or in combination - in any case, however, it will brain affected. A pure laceration on the head does not make it Traumatic brain injury - As the name indicates.
Under a Traumatic brain injury one understands an injury of the external skull in connection with a Brain damage.
There are injuries of different severity: from the concussion to open ones SHT with connection of the nerve water to the outside world. Symptoms, diagnosis, therapy and prognosis also depend on this severity.
Generally speaking, comes for a traumatic brain injury any external force on the Skull bones in question. This can be direct violence, such as blows to the head, or the traumatic brain injury is caused indirectly, for example by falls (in sports, at home, etc.). This is the most common injury in traffic accidents.
Basic requirement of the SHT is the skull bone fracture. Our brain lies directly under the bone (covered by meninges and embedded in nerve water). This close proximity makes it easy to imagine that the risk of brain injury is great.
Symptoms / complaints
The symptoms depend on the severity of the finding. It is divided into the following subgroups:
- Commotio (Concussion)
- Contusio (Brain bruise)
- traumatic brain injury severe expression
Depending on the severity, those affected suffer from the following symptoms:
Concussion leads to impaired consciousness with nausea and vomiting. There are no neurological failures, there may be only a slight loss of memory for events before, but also after the trauma. As a rule, the commotio heals without consequences.
The brain contusion or bruise leads to an initial loss of consciousness. The patient is usually awake and oriented again after 24 hours.
In severe craniocerebral trauma, the impaired consciousness persists for more than 24 hours, as the brain tissue is damaged.
Please also read our article on this Memory loss.
The patient's state of consciousness is primarily used to assess the patient. The international standard for this is the so-called Glasgow Coma Scale (GCS).
It is a point system for the three most important reactions of a person: opening eyes, verbal answer and motor reaction (Movements).
The highest possible number of points is 15 points, the minimum is 3 points. The reaction of the pupils and their size, as well as the muscle tone are also used for the assessment. The form of breathing allows certain conclusions to be drawn about the location of the damage.
In addition to GCS, there are imaging tests that confirm the diagnosis of a skull base fracture such as:
- CT of the head
- X-ray of the head
- MRI of the head
Read more on the topic: What are the consequences of a cerebral hemorrhage
There are two different types of traumatic brain injury: covered and open traumatic brain injury. The classification criterion is an intact or injured meninges. The human brain, as well as that Spinal cord are surrounded by meninges. In a traumatic brain injury, the outermost meninges are the so-called hard ones Meninges (med .: Dura mater) the most affected. If it is intact, one speaks of covered head traumabut if it is injured then one speaks of one open head trauma.
The covered SHT can be divided into 3 different subgroups, which are already described above.
- Commotio: The most important symptom here is the disturbance of consciousness immediately following the brain trauma, which only lasts for a short time (seconds to minutes). This is accompanied by nausea and vomiting.
- Contusio: The difference from concussion (Commotio) is the fact that in imaging (e.g. im CT) shows damage to the brain substance. In addition, the disturbance of consciousness lasts for days to weeks for much longer.
- Compressio: Here, for example, there may be bleeding in the brain matter, but also accumulations of blood around the brain (under or between the different meninges).
A Traumatic brain injury (SHT) is called "open" when the hard meninges (Dura mater) is injured and thus nerve water (Liquor) can leak. One such SHT is associated with a fracture of the skull bone. The problem is less the flow of cerebrospinal fluid than the entry portal for bacteria into the brain. If the nerve fluid has the opportunity to escape, bacteria and viruses can also enter the body in the same way. This can cause serious infections.
The questioning of the patient provides information about the course of the injury. An examination of the skull using CT (C.omputer–Tomography) shows possible damage to the brain matter. Depending on the results, the classification (Commotio, contusio etc.).
The detection of CSF flow (leakage of brain water) can be extremely difficult. It is helpful to mark the nerve water by means of dyes or to detect glucose (rapid test on the ward) in any fluid that may leak out. However, they are important X-rays in the CT. Broken bones can usually be easily recognized here. Of course, questioning the patient - if possible - is another important parameter.
The therapy depends on the form and extent of the Traumatic brain injury.
There is only one concussion before, there is usually no acute need for action. However, this can certainly arise in the next few hours. If there is any change in the state of consciousness, a CT must be initiated.
If the brain is crushed, conservative treatment, patient monitoring and possibly neurosurgical intervention are intertwined.
In the case of open traumatic brain injury, antibiotic therapy is at least as important in addition to the surgically necessary measures not only to close the skull and repair fractures, but also to relieve bleeding. So should ascending infections, such as meninges or Inflammation of the brain be prevented.
The prognosis is just like that therapy according to the severity of the damage. A concussion (Commotio) heals without consequences, since the brain matter was only very slightly affected. There are no neurological failures. Complications such as bleeding, infections or wound healing disorders are extremely rare. There is a small number of deaths from traumatic brain injuries. These are caused by bleeding in the brain.
However, there was substantial brain damage in one Bruised brain instead of. The neurological deficits that existed at the beginning usually regress completely.
The situation is different with severe or open SHT out. A general statement on the prognosis is difficult to make here. Each patient recovers to different degrees from injuries of varying severity to the skull and brain. However, a significant impairment can be assumed. Some patients succumb to their injuries.
Under the following topic "Skull fracture"you will also find helpful information that may be of interest to you.