concussion
Introduction
Introduction to Concussion Concussion is usually defined as temporary dysfunction of the central nervous system. It is usually caused by a brief loss of consciousness after the head is hit by mild violence. It is immediately awake, and there may be near forgotten, and the pathological anatomy of the nervous system is not obvious. Changes, no organic damage, it shows transient neurological changes, may be related to the pathophysiological changes caused by brain tissue after violence, but in some cases due to concussed death and boxers repeatedly received brain Chronic brain atrophy and even some serious neurological diseases occur after the impact. basic knowledge The proportion of illness: 0.035% Susceptible people: no special people Mode of infection: non-infectious Complications: brain edema cerebral hemorrhage
Cause
Concussion cause
Causes:
In the past, it has been thought that concussion is only a temporary dysfunction of the central nervous system. There is no visible organic damage. No lesions are found in gross anatomy and histopathology. The transient brain function inhibition may be related to The brain cell molecular disorder caused by violence, nerve conduction block, cerebral blood circulation regulation disorder, interneuronal damage and mid-line intraventricular cerebrospinal fluid shock wave and other factors are related. In modern times, according to the study of nervous system electrophysiology, it is thought that the brain stem network Impaired structure, affecting the function of the ascending activation system is an important factor causing disturbance of consciousness. However, these theories cannot explain satisfactorily all the phenomena of concussion, such as cases of death due to concussion, chronic occurrence of professional boxers. Brain atrophy damage and even dementia, as well as amateur boxers also reported mild brain disorders.
(two) pathogenesis
The mechanism of concussion injury is still unclear. The existing various theories cannot fully explain all the problems related to concussion. There are many different explanations for the post-traumatic transient disturbances caused by concussions, possibly with violence. Caused by cerebral blood circulation disorders, cerebrospinal fluid shock in the ventricular system, abnormal damage of brain interneurons and abnormal discharge caused by brain cell physiological metabolism disorder. In recent years, it is considered that the brain stem network structure up-link activation system is damaged. The key factors that cause loss of consciousness are based on:
1, all of the above factors can cause direct and indirect damage to the brain stem.
2, concussion animal experiments found medullary mitochondria, Nissl, chromosome changes, and some with lysosomal membrane rupture.
3. In biochemical research, in the cerebrospinal fluid test of patients with concussion, the concentration of acetylcholine and potassium is increased, and the increase of the concentration of these two substances causes the conduction block of the synapse of the neurons, so that the brainstem network can not maintain the human body. In the state of awakening, there is a disturbance of consciousness.
4, clinical findings, patients with mild concussion brainstem auditory evoked potential examination, half of the cases have organic damage.
5, late thought of concussion, primary brain stem injury, axonal injury, the mechanism of injury is similar, but the degree of injury is different, is a continuum of different degrees of pathology, some people concealed concussion to the most diffuse axonal injury Light type, but the lesion is limited, the damage is more functional and easy to repair by itself, so the disturbance of consciousness is transient.
Prevention
Concussion prevention
1. The concussion has a good prognosis. Most patients return to normal within 2 weeks, but a few patients may also have secondary intracranial lesions or other complications. Therefore, the mental state and consciousness of the patient must be closely observed during symptomatic treatment. Clinical symptoms and vital signs should be checked in a timely manner according to the situation.
2. First aid measures:
The child's head is easily damaged by external forces, and thus causes concussion, parents should pay special attention. For children of different ages, the causes of head injuries vary. The baby in 3-4 months will just turn over, and the family will fall off the bed if they don't pay attention. 6-7 months old baby, because of the active, careless, can fall back from the adult hand. When learning to walk and just walking, when there is a step closer to the stairway, there is often a lack of self-control ability and rolling down. When a child falls to the ground, if it encounters a hard object such as cement or tile, it is vulnerable to more serious injuries. Parents should be alert to whether it will cause concussion.
When a child collides and is injured, there will be a temporary disturbance of consciousness, such as crying, confusion, etc., which lasts about half an hour. Those who are injured are only conscious (consciously confused), and those who are severe may experience loss of consciousness (coma), irritability, mild shock, paleness or nausea and vomiting. Some sleepiness, waking up after hours or overnight, can still be accompanied by headaches (children knocking their heads by hand), irritability, vomiting or dizziness after recovery of consciousness, and some may even lose consciousness for a long time. If such a phenomenon occurs, it may be a skull fracture, a head hematoma, or a cerebral hemorrhage.
First-aid treatment: When the child's head is damaged, it should be given enough attention. If the situation is mild, you can rest in bed for 1-2 days. If you have no special performance, you can get out of bed and should continue to observe for one week. If the head is found to have a hematoma, you should go to the hospital to take a film to check whether there is a skull fracture. Anyone with obvious disturbance of consciousness, accompanied by shock, should immediately lie flat, fix the head, and rush to the third-level hospital for rescue.
Complication
Concussion complications Complications cerebral edema
The clinical manifestations of concussion sequelae are various, generally speaking, the cerebral cortex function is weakened, autonomic dysfunction and rickets-like symptoms are dominant. This disease belongs to the scope of Chinese medicine "dizziness", "not swearing", and "depression". Due to the sudden head trauma, the spirit produces a high degree of panic, which makes the kidneys dark and dark, the liver loses its reach, the stagnation and the fire, and the disturbance is empty. Or traumatic head shots lead to damage to the medullary collateral blood vessels, resulting in qi stagnation and blood stasis and water retention symptoms. Or because of internal pain, spleen, biochemistry is not prosperous, blood is not good, blood deficiency can not be enshrined in the brain.
In severe cases, it can be complicated by cerebral edema and cerebral hemorrhage.
Symptom
Symptoms of concussion Common symptoms Head injury, near-forgotten phenomenon, memory impairment, coma, concussion, nerve involvement, tinnitus, nausea, slow breathing
1, transient brain stem symptoms
Constipation affects the head immediately after the disturbance of consciousness, manifested as unconsciousness or complete coma, lasting for a few seconds, minutes or tens of minutes, but generally no more than half an hour, the patient can be accompanied by pale, sweating, blood pressure drop , slow heartbeat, slow breathing, decreased muscle tone, slow or disappeared physiological reflexes, in most reversible mild concussion patients, central nervous function rapidly from the bottom, from the cervical spinal cord - medullary brainstem Recovery to the cerebral cortex; and in the irreversible severe concussion may be a top-down inhibition process, causing the function of the medullary respiratory center and the circulatory center to be interrupted for too long, resulting in death.
2, retrograde forgetting (nearly forgotten)
After the patient's consciousness is restored, he can't recall the situation at the time of injury and even before the injury. The more severe the concussion, the longer the time of the original coma, the more obvious the phenomenon of recent oblivion, but the memory of the past (far memory) This may be related to the damage of the hippocampus.
3, the nervous system physical examination
No positive signs were found.
4, patients with concussion recovery period
Frequent symptoms such as dizziness, headache, nausea, vomiting, tinnitus, insomnia, etc., usually disappear gradually in weeks to months, but some patients have long-term dizziness, headache, insomnia, irritability, inattention and memory loss. Some of the symptoms are symptoms of recovery. If there is no obvious improvement after 3 to 6 months, in addition to considering whether there are mental factors, it should be examined and analyzed in detail, with or without late-onset damage. Do not use the "concussion sequelae" to say a word, but increase the patient's mental burden.
Examine
Concussion check
Lumbar puncture intracranial pressure is normal, some patients may have decreased intracranial pressure, cerebrospinal fluid colorless and transparent, no blood, white blood cell count is normal, biochemical examination is mostly in the normal range, and some can detect the increase of acetylcholine content, choline ester The enzyme activity is lowered and the potassium ion concentration is increased.
1, skull X-ray examination: no fracture found.
2, brain CT scan: no obvious abnormal changes in the skull and intracranial.
3, EEG examination: EEG for several months after injury is mostly normal.
4, cerebral blood flow examination: early cerebral blood flow can be reduced.
Diagnosis
Concussion diagnosis
diagnosis
The diagnosis of concussion in the past mainly relies on the history of injury, short-term coma after injury, recent forgotten, no neurological positive signs, but there is no reliable method for objective diagnosis and clinical identification of mild brain contusion. It is often necessary to use a variety of auxiliary examination methods to determine the diagnosis: if the skull has no fractures, the lumbar puncture is in the normal range, the cerebrospinal fluid has no red blood cells; the EEG only sees low to high amplitude fast waves occasionally with diffuse delta waves and wave, recovered within 1 to 2 days, or a few patients have scattered slow wave to return to normal within 1 to 2 weeks; brainstem auditory evoked potential may have I to V wave interval prolonged, V wave latency extended or decreased amplitude or The waveform disappeared; CT scans should be negative for both plain and enhanced scans, but a small number of patients were found to have negative CT scans for the first time, but delayed intracranial secondary lesions in continuous dynamic observation should be noted. In addition, there are Scholars reported that radionuclide 131I-IMP and 99mTc-HM-PAO performed single-photon emission CT scan (SPECT) to examine adolescent concussion patients, and found that 70% of the cerebellum and occipital lobe blood flow decreased.
Differential diagnosis
Difficulties in clinical identification with mild brain contusion, such as the discovery of disturbance of consciousness, headache, vomiting and other symptoms of increased intracranial pressure, suspected of delayed intracranial hematoma, CT should be promptly reviewed, clear diagnosis, timely treatment.
Brain contusion identification; often headache, vomiting consciousness varies depending on the location and extent of the injury, without the manifestation of nervous system defects; if the functional area is impaired, corresponding sputum, aphasia, visual field defect, sensory disturbance and bureau Signs of focal epilepsy.
