Brain prelum

Description:

Brain prelum (Xing. a brain compression) - the combination of signs of the increased intracranial pressure to focal neurologic symptoms caused by existence in a head cavity of volume education (for example, tumors, hematomas). The prelum (compression) of a brain is noted at 3-5% of victims.

Brain prelum reasons:

Among the reasons causing a brain prelum intracranial hematomas are on the first place (Epi - subdural, intracerebral, intra ventricular). Further depressed fractures of bones of a skull, the centers of crush of a brain follow, the accruing brain hypostasis swelling, the acute subdural gidroma resulting from a rupture of subarachnoidal tanks is more often - the brain basis, and bystry accumulation of cerebrospinal fluid in a subdural space, a pneumocephalus the air voniknoveniye in a head cavity arising at a fracture of base of the skull (a trellised labyrinth). In the latter case the valve mechanism is formed, during the sneezing, cough, a natuzhivaniye air is forced in a head cavity.

Pathogeny:

The prelum of a brain is characterized by vitally dangerous increase through various period after an injury or directly after it all-brain symptoms. The prelum of a brain is characterized by volume accumulation of the liquid or turned blood, cerebrospinal fluid or air under covers. It causes a local and general prelum of substance with the shift of median structures of a brain, deformation and compression of ventricles, infringement of a trunk.

Head prelum - the special type of an injury resulting from consecutive influence of dynamic (short-term) or static (long) mechanical load.

It is characterized by damages of soft covers of the head, skull and brain. More exact is the term "long prelum of the head" (minutes, hours, days) unlike less significant short-term prelum of the head (second).

The long prelum of the head occurs at victims owing to earthquakes, explosions and collapses in mines and mines. For adequate and unambiguous assessment of clinical forms of craniocereberal injuries it is necessary to qualify consciousness disturbances correctly.

Brain prelum symptoms:

The prelum (compression) of a brain is characterized by increase through this or that period after an injury or directly after it all-brain symptoms (emergence or deepening of disturbances of consciousness, strengthening of a headache, repeated vomiting, psychomotor excitement, etc.), focal (emergence or deepening of a hemiparesis, a unilateral mydriasis, focal epileptic seizures, etc.) and trunk symptoms (emergence or deepening of bradycardia, increase in the ABP, restriction of a look up, a tonichny spontaneous nystagmus, bilateral pathological signs, etc.).

Depending on a damage form (concussion, a bruise of a brain of various degree) against the background of which the traumatic prelum of a brain develops the light interval before increase of vitally dangerous manifestations can be developed, erased or is absent.

Brain prelum symptoms without its accompanying bruise in initial stages proceeds easier and has a little excellent characteristic due to clearer dynamics of neurologic symptomatology when the clinical syndrome of a prelum of a brain develops not sharply at the time of an injury, and develops gradually. During the first period after an injury the clinical manifestations characteristic of a slight craniocereberal injury are observed, then throughout the period of several o'clock or even days relative wellbeing then the state and health worsen again is observed, the loss of consciousness can develop, the headache amplifies, psychomotor excitement develops, amplifies astheno - a vegetative syndrome. In process of formation of an intracranial hematoma and development of a decompensation of a zta of the phenomenon accrue, at the expense of irritation of a cerebral cortex the epileptic attack, repeated vomitings, on the party of a compression narrowing quite often develops (?) pupil, delay of pulse. On this background disturbances of consciousness gradually go deep and the effort is howled symptomatology of focal damage of a brain. In an initial stage of a compression of a brain the tachypnea, replaced in several hours брадипноэ is noted, up to emergence of pathological breath at the expense of a dislocation syndrome. On the second - third day when forming an intracranial hematoma on an eyeground can be revealed signs of stagnation of disks of optic nerves, sometimes it is more on the party of a compression. More clearly meningeal symptoms are defined. At inopportuneness of assistance the terminal state which is characterized by the rough dislocation phenomena with sharp disturbance of vital functions develops. Types of intracranial hematomas

Types of intracranial hematomas
Epidural hematomas form at a local injury against the background of a slight injury of a brain of a pla of a moderately severe bruise more often.

Subdural and intracerebral hematomas develop, as a rule, against the background of a bruise of a moderately severe brain or its heavy bruise.

The pneumocephalus testifies to a fracture of base of the skull.

Prelums depressed fractures can be limited and widespread. They arise against the background of a bruise of a moderately severe brain or its heavy bruise.

The brain prelum, as a rule, is observed by the accruing wet brain at severe a craniocereberal injury.

Intracranial hematomas happen acute (shown during the first 3 days), subacute (during 4-14 days) and chronic (in 2 weeks after an injury). At a chronic hematoma around hemorrhage the capsule forms.

Epidural hematoma. Traumatic hemorrhage is localized between the internal surface of a bone of a skull and a firm meninx. Injury mechanism impression.

Can be bleeding points:
- the average shell artery passing in a duplikatura of a firm meninx. The rupture of an artery happens in a furrow on site of its crossing to the line of a change. The anguish of a vascular wall can result and from deformation of a bone;
- the shell veins, sine, veins диплоэ.

Epidural hematomas are characterized by a triad of symptoms:
1. existence of a light interval;
2. a mydriasis and a ptosis on the party of a hematoma;
3. pyramidal insufficiency preferential.

The main sign of increase of intracranial pressure is deepening of extent of disturbance of consciousness (slackness, devocalization, psychomotor excitement, a sopor and a coma in a late stage).

There are vegetative disturbances caused by increase of intracranial pressure and a hypoxia of a brain - change of pulse, arterial pressure, disorder of breath. It becomes frequent, and in a decompensation stage - is oppressed, shallow breathing and periodic breathing as Cheyna-Stokes, etc. appear.
Owing to increase in intracranial pressure and dislocation of a trunk kernels of a vagus nerve are reflex excited - bradycardia develops. Pulse urezhatsya to 50 - 60 in 1 min., as a rule, it intense, good filling.
Constant level of a blood-groove in the conditions of increase in intracranial pressure and a hypoxia of a brain is supported at the expense of Cushing's reflex (increase in arterial pressure upon 20-30 mm and more).

At further increase of a hematoma, spread of hypostasis and brain swelling are displaced and trunk educations are restrained (temporal and tentorial, later - occipital and dural a vklineniya).

Mezentsefalno-trunk symptoms develop: a mydriasis, lack of reaction of a pupil to light, look paresis up, a symptom of Gertviga - Marangdi. There can be gormetonichesky spasms, the tone of muscles sometimes raises to cerebrate rigidity degree, tetraparesis develops. Srednemozgova the syndrome develops most often owing to a temporal and tentorial vklineniye, dislocations and infringements of a brainstem in an opening of cerebellar is mashed. At further dislocation there are "floating" movements of eyeglobes, a coma, tonic spasms develop, disturbances of breath and a hemodynamics accrue, the hyperthermia is observed.

Further decrease a muscle tone, respiratory and cardiovascular activity, pulse becomes frequent and weak, arterial pressure decreases that demonstrates infringement of a trunk in a big occipital opening (axial shift of a trunk).

Diagnosis of epidural hematomas at a pre-hospital stage is based on clarification of such factors:
1. injury mechanism;
2. loudspeakers of neurologic symptomatology - all-brain and focal, disturbances of consciousness and vegetative functions - pulse, the arterial pressure, breath;
3. detection of pain at skull percussion;
4. an antalgichesky pose (the patient lies on the party of a hematoma);
5. existence of meningeal symptoms;
6. existence of a fracture of bones of the calvaria crossing furrows of the shell vessels;
7. swellings on the course of changes in temporal area.

Given to a computer and magnetic and resonant tomography, and also confirm to a carotid angiography the diagnosis.

Hematomas of a back cranial pole happen seldom and are usually formed at a severe injury of back departments of the head.

The cervicooccipital area where the fracture of an occipital bone is defined happens a place of application of the injuring agent more often.

The volume of hematomas usually small (to 30 ml) because of the small sizes of subtentorial space.

Early there are occlusal hydrocephaly, trunk disturbances.

Source of epidural hematomas often is venous bleeding from a cross sine that causes the subacute course of hematomas. Quite often they have supratentorial distribution.

The following clinical signs are characteristic of epidural hematomas of a back cranial pole:
1. Hypostasis and consolidation of soft tissues in cervicooccipital area. At a kraniografiya reveal a fracture of an occipital bone.
2. Local pain in cervicooccipital area which sharply amplifies at a head postural change.
3. A tendency to the fixed position of the head: the patient, as a rule, lies on the party of a hematoma.
4. Clear muscle tension of a nape.
5. The syndrome of a compression of a brain has occlusal character: strengthening of a headache in cervicooccipital area, in attempt to change position of the head or body there are dizziness, vomiting, the headache amplifies.
6. The focal symptomatology indicates damage of a cerebellum and a brainstem: hypotonia of muscles of extremities, lacks of coordination, spontaneous nystagmus, bulbar frustration, pyramidal symptomatology. At the same time on the party of a hematoma cerebellar pathology, and on opposite - soft pyramidal symptomatology can be more expressed.

The light interval lasts several tens of minutes, more often erased. After a loss of consciousness the sopor which is replaced in several hours or days by devocalization and a coma develops.

Subdural hematomas of a back cranial pole arise at a heavy bruise of a brain. Injuries of bones of a skull can not be. Formation of subdural hematomas is connected with damage of a cross or sigmoid sine, and also the veins falling into these sine or with damage of cortical vessels of a cerebellum.

The clinical picture is variable. The expressed all-brain symptoms develop: secondary disturbance of consciousness after a light interval, a headache, vomiting. Intracranial pressure increases. There are focal symptoms, in particular cerebellar and trunk disturbances - a hypomyotonia, an ataxy, a nystagmus, bulbar symptomatology, oppression of lid reflexes, etc.

Subdural hematomas - accumulation of blood between firm brain and arachnoidal covers. Subdural hematomas develop at a craniocereberal injury of varying severity.

Acute subdural hematomas are shown in the first 3 days after an injury. They form on site a heavy bruise of a brain, arise at the injury of acceleration and a rotational injury conducting to a rupture of vessels.

Subacute and especially chronic subdural hematomas develop at a medium-weight or slight craniocereberal injury.

Unlike epidural, subdural hematomas arise not only on the party of the appendix of the injuring agent, but also on opposite.

Place of application of the injuring agent most often are occipital, frontal and sagittal areas.

The volume of subdural hematomas makes 80-150 ml. They freely spread on a subdural space (over 2-3 shares of a brain), cause the expressed wet brain.

Bleeding points are the veins falling into an upper sagittal sine ("bridge" veins). Bleedings from a sine, from the injured cortical arteries, and also a rupture of vessels of a firm meninx, gaps are possible at an injury of arterial and arteriovenous aneurisms.

At acute subdural hematomas the light interval happens erased or in general is absent. The progressing deterioration in the general condition of the patient is characteristic. All-brain (a headache, nausea, vomiting, consciousness disturbance) and focal symptoms (an anisocoria, pyramidal insufficiency, spasms) accrue against the background of vegetative disturbances. Bradycardia and arterial hypertension are replaced by tachycardia and arterial hypotension, a tachypnea - pathological types of breath.

Subacute subdural hematomas are shown on 4 - the 14th days after a craniocereberal injury. They should be differentiated with concussion or a bruise of a brain, and sometimes and with such diseases as flu, meningitis, subarachnoidal hemorrhage, a drunkenness.

Three-staging of change of consciousness is characteristic of subacute subdural hematomas. Duration of primary loss of consciousness from several minutes to an hour, then comes a light interval. Consciousness is clear, or there is a moderate devocalization. Functions of vitals are not broken, slight arterial hypertension and bradycardia can be noted. Neurologic symptomatology quite often minimum.

Changes of mentality - a disorientation in time, euphoria, inadequacy of behavior, psychomotor excitement can be observed.

The main complaint - a headache. If the dominant hemisphere suffers, then speech disturbances can be observed.

The subacute hematoma quite often demonstrates focal spasms on the opposite side.

At increase of a hematoma appear vomiting, raises arterial pressure, pulse is slowed down. The gomolateralny mydriasis and pyramidal insufficiency on the opposite side develop. On an eyeground reveal developments of stagnation which appear on the party of a hematoma in the beginning.

Diagnosis of a subdural hematoma. Consider existence of the next moments:
1. primary disturbance at the time of an injury;
2. light interval;
3. repeated compression switching off of consciousness.

At heavy injuries of a brain the light interval is absent or erased. It is necessary to consider biomechanics of a craniocereberal injury (an injury of acceleration or a rotational injury), all-brain symptomatology which dominates over focal, and the researches given additional methods.

Treatment of a prelum of a brain:

And also at identification of this prelum on KT or MPT at heavy patients urgent operation - removal of a hematoma is shown to all patients with clinical signs of a prelum of a brain.