primary brainstem injury
Introduction
Introduction to primary brain stem injury Primary brain stem injury accounts for 7% to 10% of severe craniocerebral injury, because the brain stem is the conduction pathway of sensory and motor fibers and the location of the cardiovascular center and respiratory center. More serious, high mortality. When the injury is in the lower part of the middle brain and the upper part of the pons, it appears as a respiratory rhythm disorder; when the injury is in the lower part of the pons, there is sore-like breathing; when the injury is in the medulla, the respiratory arrest often occurs. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: coma, gastrointestinal bleeding, acute pulmonary edema
Cause
Cause of primary brain stem injury
Trauma (60%):
The head is struck or the other parts of the body are struck, causing the brain stem to impinge on the incision edge of the cerebellar lobes or on the slope of the occipital bone, or to move or twist along the longitudinal axis to cause damage to the brain stem; or Partial trauma caused severe deformation of the skull, and damage to the midbrain aqueduct or the bottom of the fourth ventricle was caused by intracranial cerebrospinal fluid shock. Primary brain stem injury often involves diffuse damage to the cerebral hemisphere.
Prevention
Primary brain stem injury prevention
Primary brain stem injury often occurs simultaneously with brain contusion or intracranial hemorrhage, and the clinical symptoms are complex. Therefore, except for a few patients who have symptoms of brain stem injury immediately after injury and no patients with increased intracranial pressure, most of the patients need to use CT or MRI to confirm the diagnosis of mild brain stem injury. Treatment principles for treatment can restore some patients. Severe brain stem injury is very ineffective, and its mortality rate accounts for almost one-third of the mortality of brain injury. If the pons and medullary plane are damaged, there is little hope for treatment. The acute phase is mainly to give hormones, dehydration, cooling, oxygen therapy, correct breathing and circulation disorders, and maintain the balance of the body and the environment as much as possible. Note that this type of patient has a long time of consciousness disorder, and needs to perform tracheotomy as early as possible. Dehydration agents should be used with caution in cases with unstable blood pressure. The recovery period should focus on the improvement of brainstem function, and can be used to treat complication by awakening drugs and hyperbaric oxygen chambers.
Complication
Primary brain stem injury complications Complications, coma, digestive tract bleeding, acute pulmonary edema
There may be central hyperthermia, gastrointestinal stress ulcers, intractable hiccups, paralysis of the limbs, midbrain injury, and brain rigidity.
Symptom
Symptoms of primary brain stem injury Common symptoms Changes in vital signs, reflexes, disappearance, light reflection, disappearance, coma, quadriplegia, deep coma
The typical manifestations of primary brain stem injury are persistent coma immediately after injury. The degree of coma is different. A few light people may respond to painful stimuli, but in severe cases, they are often deep coma, all reflexes disappear, and limbs are soft. The vital signs are obviously disordered. When the injury is in the lower part of the middle brain and the upper part of the pons, it appears as a respiratory rhythm disorder; when the injury is in the lower part of the pons, there is sore-like breathing; when the injury is in the medulla, the respiratory arrest often occurs. In the early stage of brain stem injury, due to the acute stage of brain shock, all reflexes can disappear, and the pyramidal tract sign can not be detected. When the condition is stable, it is characterized by limb paralysis, increased muscle tone, hyperreflexia and pathological reflex. . When the muscle tension of the limbs changes from increased to slack, it indicates that the condition is critical. Other organ dysfunction often occurs after brain stem injury, such as gastrointestinal bleeding, pulmonary congestion or acute pulmonary edema. Therefore, such patients are prone to complications such as pulmonary infection.
Examine
Examination of primary brain stem injury
1, CT examination: due to the interference of the posterior cranial fossa bone, the diagnosis of mild brain stem injury is difficult. Common CT findings are ring pool, basal pool disappearance, small high-density hemorrhage in the brain stem, or low-density edema.
2, MRI examination: is the most ideal method for the diagnosis of brain stem injury, can clearly show the location and extent of the injury. However, it is often difficult to use this test in critically ill patients in the early stages.
3, lumbar puncture: intracranial pressure is not increased, cerebrospinal fluid increased red blood cells.
Diagnosis
Diagnosis and diagnosis of primary brain stem injury
Primary brain stem injury often occurs simultaneously with brain contusion or intracranial hemorrhage, and the clinical symptoms are complex. Therefore, except for a few patients who have symptoms of brain stem injury immediately after injury and no patients with increased intracranial pressure, most of the patients need to be diagnosed by CT or MRI. In patients with primary brain stem injury, most of the adults have a poor prognosis, and because the child is in the brain development stage, the compensatory ability is extremely strong. As long as the acute phase is passed, most of them can have a satisfactory recovery, and some coma for several months. After waking up, I can gradually go to school and work.
