post-traumatic brain injury syndrome
Introduction
Introduction to post-traumatic syndrome After the brain injury syndrome refers to the brain injury for 3 months, the patient still has headache, dizziness, snoring-like episodes and other autonomic dysfunction or mental symptoms, but the neurological examination has no exact positive signs, even CT, MRI examination No abnormal findings have been known as post-concussion syndrome or neurosis after brain injury. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: coma
Cause
Causes of post-traumatic brain injury syndrome
(1) Causes of the disease
Mild or moderate closed head injury, general recovery after injury, but dizziness, headache and some degree of autonomic dysfunction or mental symptoms have not healed, it is currently believed that Under the premise of mild brain organic damage, coupled with the patient's psychosomatic factors and social factors.
(two) pathogenesis
The occurrence of post-cerebral injury syndrome may have the pathological basis of organic brain lesions, although some pathological changes are difficult to detect, but also related to personal quality and social environment.
After violently hitting the head, no matter how light or heavy, it will cause a series of different degrees of pathophysiological changes of brain tissue. The lighter only has temporary biochemical and cerebral blood perfusion changes, for example, the intracranial circulation after head injury can be slowed down. For several months, the severe person not only causes brain contusion, intracranial hematoma, cerebral ischemia, hypoxia, but also can cause subarachnoid hemorrhage, axonal rupture and some minor damage, some of which are difficult to check. Mild lesions, such as traumatic neuroma of the scalp, intracranial and extracranial vascular communication, meningeal-brain membrane adhesion, arachnoid villi closure, axonal rupture, microbleeds in the white matter or brainstem, softening, and craniocerebral Damage to the joint ligaments or muscles, such as the cervical nerve roots, can cause various symptoms.
Brain damage and cerebral edema caused by it, cerebral vasospasm and microcirculation changes, can lead to focal hemorrhage in brain tissue; cerebral ischemia, hypoxia, axonal rupture, softening lesions formed by disintegration of myelin and degenerative Lesions, meningeal cerebral adhesions and scar formation, intracranial and extracranial vascular communication and other pathological changes can affect the function of the cortical and subcortical autonomic nerve centers; brain tissue changes during brain injury, due to shear stress, can cause the diencephalon Impaired brainstem structure, autonomic dysfunction; patients with subarachnoid hemorrhage, arachnoid adhesions, stimulation of meninges and nerve roots, corresponding symptoms, and subarachnoid hemorrhage can cause arachnoid villi closure, Cerebrospinal fluid circulation pathway is blocked, which can cause traumatic hydrocephalus. Although CT is not obvious, it breaks the balance of absorption and secretion of cerebrospinal fluid, causing corresponding symptoms.
However, there is no corresponding relationship between the occurrence of post-traumatic brain injury syndrome and the severity of brain tissue damage. On the contrary, there are many patients with neurological deficits in the brain injury with specific neurological dysfunction without brain damage. Some scholars believe that The incidence of this syndrome is higher in the unemployed than in the employed, and there are fewer people with higher IQ and professional knowledge. The above situation is sufficient to explain the patient's physical and mental factors, social impact and life, and whether the work is stable and consistent. The incidence of the disease is closely related.
Prevention
Prevention of post-traumatic syndrome
First, the prevention of sequelae of brain trauma in the daily life, diet, sleep regularity. Pay attention to the quietness of the living room, the light should not be too bright, and reduce the disturbance to the patient. Gradually develop good living habits.
Second, the sequelae of traumatic brain injury should be given adequate nutrition and water according to the needs of the disease, if necessary, nasal feeding or intravenous high nutrition.
Third, when the patient's memory and intelligence are impaired, it makes it difficult to express symptoms, so the symptoms are concealed, atypical and multi-disease coexistence. What are the prevention methods for sequelae of brain trauma?
Fourth, patients with mental symptoms should pay attention to avoid various factors that stimulate mental symptoms.
5. Patients in the recovery period after traumatic brain injury should not change their original living habits. What are the preventive methods for sequelae of brain trauma, such as getting up early, washing, eating, placing items, etc., can be natural. Try to encourage individuals to take care of themselves and do what they like. Enhance the patient's sense of responsibility, such as responsible for the door and window switches of their own living room, cleaning the bedside table, sweeping the floor, etc., so that they can maintain confidence in life.
Complication
Complications of post-traumatic syndrome Complications
1. Brain oscillation syndrome
A transient loss of consciousness occurs after brain oscillations, usually recovering within 30 minutes. After waking up, the patient could not recall the situation at the time of the injury and the moment before the injury. Patients may have headache, vomiting, dizziness, irritability, emotional instability, lack of self-confidence, attention to looseness, autonomic symptoms such as pale skin, cold sweat, decreased blood pressure, slow pulse, slow breathing and so on.
2. Trauma caused by traumatic brain injury
After a traumatic brain injury, there will be a long-term coma, coma to the recovery process, and there may be drowsiness, turbidity, convulsions, etc. When the disturbance of consciousness is light, it re-emerges in volatility.
3. Caused by traumatic brain injury
is usually transferred from coma or lethargy. Some patients' behaviors at the time of sputum reflect pre-treatment occupational characteristics. Many patients show resistance, noisy, no cooperation, and others are more aggressive. There may be horror illusions, and serious patients may have chaotic excitement and even strong impulsive sexual violence. You can be replaced by other disturbances of consciousness such as shackles and dreams.
4. Forgetting syndrome caused by traumatic brain injury
Its most striking feature is the fiction based on forgetting, and patients are often irritated. Its duration is shorter than the alcoholic toxic amnesia syndrome. Compound sea snake capsule
5. Subdural hematoma caused by traumatic brain injury
Can occur soon after the injury, common headaches and lethargy. Occasionally accompanied by spastic exercise excitement, about half of the patients have papilledema. Chronic subdural hematoma is characterized by lethargy, dullness, memory loss, and severe dementia symptoms in some cases. Some patients have mildly elevated cerebrospinal fluid pressure, increased protein, and a yellow appearance.
Symptom
Symptoms of post-traumatic syndrome Syndrome Common symptoms Increased intracranial pressure, hearing loss, complete fatigue, amnesia, shock, nervous involvement, dizziness, wood stiffness, ataxia, insomnia, dizziness
The clinical features of post-traumatic trauma syndrome are subjective symptoms and lack of objective signs, mainly dizziness, headache and nervous system dysfunction.
1. Headache, dizziness, headache, most common, accounting for 78%, mainly diffuse head pain and pulsating headache, persistent and serious, seizure time is uncertain, more in the afternoon, the site is often in the frontal or occipital The back, sometimes involving the entire head, or the pressure on the top of the head, or a sense of circular tightness, so that all day long, dizzy, restless, headache behind the pillow is often accompanied by neck muscle tension and pain, mostly related to craniocerebral injury The onset of headache can be exacerbated by insomnia, fatigue, poor mood, unsatisfactory work or external paralysis.
Dizziness is also more common, accounting for about 50%. Patients often complain of dizziness. In fact, they are not really dizzy, but subjectively feel head turbid, thinking is not clear enough, or a confused and confused feeling, sometimes think of the body Can not maintain balance, often aggravated by turning the head or changing position, but the nerve examination has no clear vestibular dysfunction or ataxia. After appropriate symptomatic treatment and comfort encouragement, the symptoms can be alleviated or disappeared, but soon Reappear.
2. Symptomatic reaction: the patient's mood is fluctuating, irritating, irritating, sometimes there may be tendon attacks, decreased vision, hearing loss, closed eyes and involuntary crying, and even snoring paralysis, severe cases Stupor or silent state.
3. Neurological examination: There are no exact positive signs.
Examine
Examination of post-traumatic syndrome
Most of the cerebrospinal fluid examinations are within the normal range, and the pressure of a few patients may be slightly higher or lower, and the protein quantification may be slightly increased.
1. CT and MRI: It can show whether there are clear organic changes in the brain, such as brain atrophy, hydrocephalus, cerebral infarction, small hemorrhagic softening lesions and other small lesions.
2. EEG: There may be extensive rhythm abnormalities or focal slow waves, fast waves or attack waves, and some may be de-synchronized.
3. Radionuclide Cerebrospinal Fluid Imaging: Helps to understand whether there is a barrier to cerebrospinal fluid circulation.
Diagnosis
Diagnosis and diagnosis of post-traumatic brain injury syndrome
diagnosis
The diagnosis of post-traumatic syndrome must be cautious. First, it should be considered after carefully excluding organic lesions. In addition, other chronic diseases of the whole body should be excluded. Only after excluding the above two types of conditions, systemic treatment for six months or one year. Above, those with the above symptoms can be diagnosed as post-traumatic syndrome.
Such patients should be patiently inquire about the medical history and understand the whole process from the time of self-injury to the present, including the results of various examinations, treatment, surgical findings, and diagnostic opinions and treatment effects that have been made. And then carry out the necessary examinations as needed. Although the neurological examination is often negative, careful and careful examination is still important. Sometimes, clues can be found from some clues to find the cause or exclude organic damage. Secondly, according to Medical history and examination purposefully arranged auxiliary examination: lumbar puncture can measure intracranial pressure to determine whether there is increased or decreased intracranial pressure, and can understand whether cerebrospinal fluid is normal; EEG examination can help to find focal damage and presence or absence Long-lasting abnormal waveforms to determine further examination direction; CT scan can clearly show whether there is brain atrophy, hydrocephalus or localized lesions; MRI is more conducive to the discovery of tiny bleeding points or softening lesions in brain parenchyma; radionuclide cerebrospinal fluid Imaging can understand the circulation of cerebrospinal fluid.
Differential diagnosis
Attention should be paid to the identification of brain organic diseases and some chronic diseases of the whole body. Clinical manifestations and auxiliary examinations are helpful for identification. In addition, it should be differentiated from neurosis. The onset of neurosis is related to neurosis quality, personality characteristics and mental stress. The course of the disease is prolonged, episode, autonomic dysfunction is relatively mild, neuroelectrophysiology, neuroradiology are normal, neurotic patients lack specificity in anti-anxiety and anti-depression treatment, and any treatment they believe and Suggestive therapy can achieve the same effect.
