traumatic amnesia
Introduction
Introduction Traumatic amnesia - Fictional syndrome is also known as traumatic Korsakov syndrome. It is a clinical manifestation of acute mental disorders caused by brain injury. Because the brain suffers from various traumas directly or indirectly, and the mental disorders and subsequent syndromes that appear on this basis are mental disorders associated with craniocerebral injury. The diagnosis should indicate the type of brain injury and the type of syndrome that remains; such as concussion syndrome, psychotic symptoms caused by brain contusion, personality changes caused by brain contusion, dementia, amnesia syndrome, etc. Mental disorders caused by craniocerebral injury are divided into acute mental disorders and chronic mental disorders.
Cause
Cause
Causes of traumatic amnesia:
Brain contusion and laceration caused by changes in the cerebral cortex joint zone can lead to this syndrome. Whether there are mental disorders and manifestations of mental disorders in craniocerebral injury are related to the degree and location of craniocerebral injury. The more severe the injury, the wider the site, and the more likely it is to cause mental disorders. The timing of the onset of mental symptoms is directly related to the severity of the trauma. In addition, it has a certain relationship with neurological types, environmental factors, individual qualities, and psychological factors such as before and after injury and mental state during injury. The mechanism may be transient cerebral circulatory dysfunction; cranial cell disorder leads to blockage of nerve conduction pathway; central nervous cell membrane discharge causes neuronal tissue excitability changes; brain neuron damage causes disturbance of consciousness; brain stem reticular structure is impaired Wait. In addition, negative evaluation of brain injury may be the main cause of psychogenic disorders.
Examine
an examination
Related inspection
Brain Doppler Ultrasound (TCD) Blood routine
Diagnosis can be performed based on clinical performance and laboratory tests.
Diagnosis
Differential diagnosis
Differential diagnosis of traumatic amnesia:
The differential diagnosis of acute and chronic mental disorders caused by or associated with craniocerebral injury is mainly reflected in how to distinguish post-concussion syndrome and neurosis, and how to determine the organic and non-organic nature of some chronic traumatic mental disorders. ingredient.
1. The difference between post-concussion syndrome and neurosis
(1) During the concussion, the third ventricle and the fourth ventricle are impacted, so that the surrounding autonomic nerve structure and vestibular device are damaged, so there are dizziness, headache, nausea and vomiting, pale skin, cold sweat, blood pressure change, heart palpitations, etc. Neurological symptoms. Although neurosis can also be associated with autonomic symptoms, it is mild.
(2) Some patients with post-concussion syndrome can detect EEG and brain evoked potential abnormalities, while neurosis is normal.
(3) Headache may be aggravated by factors such as loud noise, work fatigue, mental stimulation, eye strain, climate change, posture and head position changes. Neurotic patients do not have this characteristic, or are only affected by fatigue and mental stimulation. .
(4) The response to treatment is different. The post-concussion syndrome has a certain effect on antidepressants and anti-anxiety agents; the neurosis is lack of specificity, and the treatment trusted by patients helps to improve the condition.
(5) Image technology (CT, MRI, PET, BEAM, SPECT, etc.) is available, which can detect some abnormalities that can not be found in traditional examinations (neural examination, cerebrospinal fluid examination, EEG) (Lishman, 1988). Difficult cases should be applied as appropriate. Post-concussion syndrome needs to be differentiated from post-traumatic stress disorder (PTSD), which is caused by extreme or catastrophic psychological trauma, clinical intrusive recall (including nightmares and nightmares), mental numbness and avoidance behavior For the sake of PTSD, although it is common in war conditions, even the body may be injured, but there is no history of brain injury.
2. Chronic mental disorders caused by craniocerebral injury need to be distinguished from schizophrenia and bipolar disorder:
Craniocerebral injury can induce or promote these two kinds of non-organic mental disorders. The schizophrenic psychosis directly caused by craniocerebral injury has been put on the agenda, and some characteristics are also found, but it is related to schizophrenia. The difference still needs to be combined with pre-disease personality, previous history of mental illness, family history of mental illness, clinical symptoms, course of disease, response to treatment, and outcomes.
Acute craniocerebral injury is easily recognized. Mental disorders caused by brain injury must have the premise of head trauma, and mental symptoms may be directly related to brain trauma, or definitely related to it. Symptoms of general mental disorders are caused immediately after trauma, and gradually improve after a certain period of time. Diagnosis is generally not difficult. However, attention should be paid to the evidence of the degree of trauma, the extent of the injury, and the relationship between the extent of the injury and the psychiatric symptoms. The occurrence, development, and duration of the mental disorder are closely related to the traumatic brain injury. Generally, the more severe the traumatic brain injury, the more extensive the injury site, and the more likely it is to cause mental disorders. Extensive injury is likely to cause a total disorder of mental function; the most common cause of mental disorders is temporal lobe damage, followed by the prefrontal and frontal lobe, and the least chance of parietal and occipital lobe is the least. Temporal lobe injury often causes personality disorder, manifested as emotional instability and control disorder; personality disorder caused by prefrontal lobe, manifested as apathy, immature, decreased will, mental retardation; parietal lobe injury easily causes cognitive dysfunction; Sectional damage is likely to cause memory defects and the like.
However, regardless of the severity of the brain injury, post-concussion syndrome can occur, some people who do not really cause craniocerebral injury, or those with mild brain damage, do not cause mental disorders, can also produce a psychogenic cranial Brain damage symptoms and mental symptoms. Post-concussion syndrome usually occurs after trauma. These symptoms are significantly improved 2 weeks after trauma and are significantly relieved by the 4th week. If there is no psychosocial intervention, it is expected to disappear after 3 months. If there are quality and situation factors, symptoms such as headache, dizziness, fatigue and anxiety can exist for a long time, which creates conditions for the additional symptoms of secondary neurosis, and thus has a prolonged course. Therefore, it is necessary to ask about the medical history in detail and understand the injury at that time. In particular, whether it really hurts the head, the degree, the unconscious disorder and the duration of the time, and whether there is no memory disorder or forgetting after the injury are the main points of differential diagnosis.
