Concussion of the brain is a mild closed craniocerebral injury caused by a concussion inside the skull and leading to short-term functional abnormalities in the central nervous system. Symptoms of concussion are: short-term loss of consciousness, congradic and retrograde amnesia, headache, nausea, vasomotor disorders, dizziness, anisoreflexia, nystagmus. In the diagnosis, an important place is occupied by the exclusion of more serious cerebral injuries. Therapy includes rest, symptomatic and vascular-neurometabolic treatment, vitamin therapy.
Concussion of the brain (SGM) is the most mild type of traumatic brain injury (TBI), characterized by a short — term disorder of cerebral functions and not accompanied by morphological changes. In domestic medicine, the classification of TBI is generally accepted, taking into account the time of loss of consciousness. According to it, concussion is accompanied by loss of consciousness lasting from a couple of seconds to 20-30 minutes. In Western medicine, the maximum time interval of loss of consciousness for SGM is considered to be 6 hours, since the long duration of the unconscious period almost always indicates damage to the cerebral tissues.
Concussion accounts for up to 80% of all TBI cases. It is most often observed in young and middle-aged people, in children – in the age range from 5 to 15 years. It is characterized by a large variability in the types of injuries. Current issues related to the diagnosis and treatment of concussion require joint consideration by specialists in the field of traumatology and neurology.
Concussion of the brain often occurs with a direct mechanical impact on the skull (a blow to the head or on the head). Concussion is possible when the axial load transmitted by the spine is sharply affected, for example, when falling on the legs or on the buttocks; when decelerating or accelerating sharply, for example, during a traffic accident.
In all these cases, there is a sharp shaking of the head. The brain seems to “float” in the cerebrospinal fluid inside the skull. In a concussion, the brain experiences a hydrodynamic shock due to a pressure drop in the cerebrospinal fluid that propagates like a shock wave. Along with this, with a large force of traumatic impact, a mechanical impact of the brain on the bones of the skull from the inside is possible.
The pathogenesis of cerebral changes resulting from concussion has not been fully investigated. It is assumed that the basis of the clinical manifestations that characterize the concussion of the brain is the functional disconnection of the brain stem and hemispheres. It is believed that mechanical concussion leads to a temporary change in the colloidal state and physical and chemical characteristics of the cerebral tissues. The consequence of this is the loss of connections between different parts of the brain. It is possible that such a functional separation is caused by a violation of the metabolism of neurons.
Symptoms of concussion
The concussion is a closed TBI, i.e. it is not accompanied by a skull fracture. After the injury, there may be a loss of consciousness. Its duration varies and, as a rule, does not exceed several minutes. In some patients, a concussion of the brain does not cause loss of consciousness, there is only some deafness. In many cases, there is retrograde and congradic amnesia-the loss of memories of events preceding the trauma and of events that occurred during the period of disturbed consciousness, respectively. Less often, anterograde amnesia is detected — loss of memory for events that occurred after the restoration of clear consciousness.
In accordance with the presence or absence of loss of consciousness and amnesia, there are 3 degrees of severity of SGM. In the first degree, there is no period of loss of consciousness, and amnesia. The second degree is characterized by the presence of amnesia against the background of confusion, but without its loss. Concussion of the third degree suggests the presence of loss of consciousness.
After regaining consciousness, patients complain of nausea, headache, weakness, dizziness, hot flashes to the head. Often there is vomiting, more often a single one. Possible tinnitus, pain when moving the eyes, sweating. There may be: divergence of the eyeballs, nosebleeds, decreased appetite, sleep disorders. Blood pressure is unstable, pulse is labile. Most of these symptoms are eliminated within the first few days after the injury. Headache, emotional instability, vegetative symptoms (sweating, lability of blood pressure and pulse), weakness may persist for a long time.
Concussion of the brain in young children occurs mainly without loss of consciousness. As a rule, children are excited and cry, then fall asleep. After sleep, they are capricious, do not want to eat. Usually, after 2-3 days, the normal behavior and appetite of the child is completely restored.
Repeated concussions of the brain can lead to the development of post-traumatic encephalopathy. Since this complication is often found among boxers, it is called “encephalopathy of boxers”. As a rule, the motor skills of the lower extremities suffer. Periodically, there is a spanking with one foot or a lag when moving one leg. In some cases, there is a slight discoordination of movements, staggering, problems with balance. Sometimes mental changes prevail: there are periods of confusion or lethargy, in severe cases there is a noticeable impoverishment of speech, there is a tremor of the hands.
Post-traumatic changes are possible after any TBI, regardless of its severity. There may be episodes of emotional instability with irritability and aggression, which patients later regret. There is a hypersensitivity to infections or alcoholic beverages, under the influence of which patients have mental disorders up to delirium. A complication of concussion can be neurosis, depression and phobic disorders, the occurrence of paranoid personality traits. Possible convulsive attacks, persistent headache, increased intracranial pressure, vasomotor disorders (orthostatic collapse, sweating, pallor, flushes of blood to the head). Less often, psychoses develop, characterized by a perception disorder, hallucinatory and delusional syndromes. In some cases, dementia occurs with a memory disorder, a violation of criticism, disorientation.
In 10% of cases, a concussion of the brain leads to the formation of post-concussion syndrome. It develops a few days or months after receiving a TBI. Patients are concerned about intense headache, sleep disorder, impaired ability to concentrate, dizziness, anxiety. Chronic postcommunication syndrome is difficult to psychotherapy, and the use of narcotic analgesics to relieve headaches often leads to the development of addiction.
Concussion of the brain is diagnosed on the basis of anamnestic data on the injury and the time of loss of consciousness, the patient’s complaints, the results of an objective examination by a neurologist and instrumental studies. In the neurological status, in the period immediately following the injury, there is a fine-grained nystagmus, a slight and unstable asymmetry of reflexes, in young patients — a Marinescu-Radovich symptom (homolateral contraction of the chin muscles with irritation of the thumb elevation), in some cases-weakly expressed shell (meningeal) symptoms. Since concussion can hide more serious brain damage, it is important to observe the patient in dynamics. If the diagnosis of SGM is correct, then the abnormalities detected during a neurological examination disappear 3-7 days after the injury.
After the received TBI, an X-ray of the skull is performed without fail, which allows you to confirm the absence/presence of skull fractures. To exclude intracerebral hematoma and other hidden brain injuries, electroencephalography, echoencephalography and ophthalmoscopy (examination of the fundus) are prescribed. But the best way to diagnose TBI is to use neuroimaging techniques. In concussion, MRI and CT scans do not reveal any structural changes in brain tissue. If there are petechial hemorrhages or edema of the brain, then you should think about the brain injury, and not about its concussion.
Since a concussion can hide a much more serious injury, all patients are recommended to be hospitalized. The basis of therapy is healthy sleep and rest. In the first 1-2 days, patients should observe bed rest, exclude watching TV, working at the computer, reading and listening to audio recordings with headphones. After excluding other cerebral injuries, patients with SGM may be discharged for outpatient treatment.
Pharmacotherapy is not required in all cases of concussion and is mainly symptomatic. Relief of headaches is carried out with the help of painkillers. For dizziness, ergotoxin, belladonna extract, ginkgo biloba extract, and platyphylline are prescribed. As sedatives, use motherwort, phenobarbital, valerian; with insomnia-zopiclone or doxylamine at night; according to indications — medazepam, phenosepam, oxazepam.
Concussion of the brain of the 3rd degree is an indication for the course of vascular-neurometabolic therapy, which provides a combination of one of the vascular agents (nicergoline, cinnarizine, vinpocetine) and nootropics (noopept, glycine, piracetam). It is effective to include in the treatment regimen antioxidants (meldonium, mexidol, cytoflavin) and magnesium preparations (magnesium lactate with pyridoxine, potassium and magnesium asparaginate). For asthenia, it is recommended to take multivitamins, eleutherococcus, and lemongrass.