Problem description:
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Analysis:
Clinically, concussion refers to the temporary sexual dysfunction of the central nervous system caused by external forces. It used to be thought that concussion was only a dysfunction, not an organic damage. Now pathological research thinks that this concept is not comprehensive. Although concussion can have no organic changes in most cases, some patients may be accompanied by slight lesions. Some people think that concussion is a pathological change of brain stem neurons, which may include nucleolar translocation, chromatin dissolution and partial rupture of nerve fibers.
1. Concussion is the lightest kind of head injury, which can occur alone or simultaneously with other head injuries. It is characterized by temporary delirium and loss of consciousness, usually less than 30 minutes. After waking up, I often can't remember the situation and process of the injury at that time. I may have a headache and dizziness for a while, but further examination shows that there is no other abnormality. Blood pressure, pulse and breathing are normal.
Simple concussion is not terrible. The terrible thing is that we can't find other more serious head injuries in time. For example, after a head injury, the patient is unconscious for more than 30 minutes, and then coma again after waking up, or severe headache, frequent vomiting, restlessness, eye, ear and nose bleeding, and the pupils (black eyes) of both eyes are different. When one lower limb can't move, you should go to the hospital for further examination immediately to prevent serious intracranial injury and life-threatening.
Concussion generally does not require hospitalization and stays in bed at home. If you have a headache, you can use painkillers. If you have dizziness, you can use sedatives such as diazepam and tribromide tablets for treatment. It will be cured in about 1 week. In addition, traditional Chinese medicine can be selected to treat extracerebral sequelae as needed.
2. It has always been thought that concussion is only a temporary dysfunction of the central nervous system, and there is no visible organic damage. Gross anatomy and histopathology showed no pathological changes. The short-term inhibition of brain function may be related to factors such as molecular disorder of brain cells, nerve conduction block, disorder of cerebral blood circulation regulation, injury of intermediate neurons, shock wave of cerebrospinal fluid in midline ventricle and so on. According to the electrophysiological study of nervous system, it is considered that the function of ascending activation system is affected by the injury of brainstem reticular structure, which is an important factor causing consciousness disorder. However, these theories can not satisfactorily explain all the phenomena of concussion, such as cases of professional boxers dying from concussion, chronic brain atrophy and even dementia, and reports of amateur boxers with mild brain dysfunction. At the same time, from animal experiments, it is found that the nerve cells in the violent part can see mitochondrial swelling, displacement, axonal swelling and interstitial edema under electron microscope. Biochemical studies have found that after concussion, not only acetylcholine in cerebrospinal fluid increases, but also the concentration of potassium ions, and many enzyme systems that affect axonal conduction or brain cell metabolism are disordered, resulting in secondary damage. Recently, new clinical observation also found that half of patients with mild concussion had organic damage. Jeret( 1993) used a prospective study to scan 7 12 consecutive patients with mild closed craniocerebral injury in GCS 15, and found that there was acute injury, accounting for 9.6%. It can be seen that concussion can not be summarized as "only temporary brain dysfunction, no clear organic damage." With the continuous in-depth research and discovery of medical science, it will inject new meaning into the diagnostic term concussion.
clinical picture
A brief loss of consciousness occurs immediately after craniocerebral trauma, lasting for several minutes or even ten minutes, generally not more than half an hour; However, occasionally some patients have instant confusion or trance, and there is no coma; There are also some cases of long-term coma or even death, which may be caused by the transmission of violence through deep brain structures leading to life centers such as brain stem and medulla oblongata. When the patient is subjected to external force, not only the functions of the brain and upper brain stem are temporarily interrupted, but also the lower brain stem, medulla oblongata and cervical spinal cord are inhibited, which makes the regulation of vascular nerve center and autonomic nerve disorder, causing a series of reactions such as slow heart rate, blood pressure drop, pale face, cold sweat, apnea, shallow weakness and limb weakness. In most patients with reversible mild concussion, the function of central nervous system recovers rapidly from bottom to top, from cervical spinal cord-medulla oblongata-brain stem to cerebral cortex; In irreversible severe concussion, it may be a top-down inhibition process, which interrupts the function of the respiratory center and circulatory center of the medulla oblongata for too long, thus leading to death.
After the recovery of consciousness, patients often have symptoms such as headache, nausea, vomiting, dizziness, photophobia and fatigue, and are often accompanied by obvious recent amnesia (retrograde amnesia), that is, they can't remember what happened before and after the injury. The more severe the concussion, the longer the initial coma time, and the more obvious the phenomenon of forgetting recent events, but it does not damage the old memories of the past. [Gourmet China]
Patients with concussion in convalescence often have dizziness, headache, nausea, vomiting, tinnitus, insomnia and other symptoms, which generally disappear gradually within a few weeks to several months. However, some patients have long-term symptoms such as dizziness, headache, insomnia, irritability, inattention and memory loss, and some of them belong to recovery symptoms. If there is still no obvious improvement after 3 ~ 6 months, besides considering whether there are mental factors, we should check and analyze them in detail.
Diagnosis and differentiation
In the past, the diagnosis of concussion was mainly based on the history of trauma, brief coma after injury, forgetfulness of recent events and no positive signs of nervous system. However, there is still no reliable method for objective diagnosis and clinical differentiation of mild brain contusion. Therefore, it is often necessary to use various auxiliary examination methods to make a diagnosis: for example, no fracture was found on the plain film of the head; Lumbar puncture pressure measurement is in the normal range, and there are no red blood cells in cerebrospinal fluid; The EEG only showed low to high amplitude fast waves, occasionally diffuse δ waves and θ waves, which recovered within 1 ~ 2 days, or a few patients with scattered slow waves returned to normal within 1 ~ 2 weeks. Brainstem auditory evoked potentials may have prolonged Ⅰ ~ Ⅳ wave interval, prolonged Ⅴ wave latency, decreased amplitude or disappeared waveform. Both plain scan and enhanced scan of CT examination should be negative, but a few patients with bone are negative for the first time in clinic, and delayed intracranial secondary lesions appear in continuous dynamic observation, which should be paid attention to. In addition, some scholars reported using radionuclide 123I-IMP and 99mTc-HM-PAO for single photon emission CT scanning to examine adolescent patients with concussion, and found that 70% of the patients had decreased blood flow in cerebellum and occipital lobe.
treat cordially
Concussion doesn't need special treatment. Generally, you only need to stay in bed for 5 ~ 7 days, give analgesic and sedative drugs, reduce external factors, do a good job of explanation, and eliminate patients' fear of concussion. Most patients returned to normal within 2 weeks, and the prognosis was good. However, a few patients may also have secondary intracranial lesions or other complications. Therefore, in the process of symptomatic treatment, we must closely observe the patient's mental state, consciousness, clinical symptoms and vital signs, and make necessary examinations in time according to the situation. Avoid using morphine drugs that affect observation, and it is best to choose analgesic and sedative drugs with little side effects, such as craniotomidine, ibuprofen, naproxen, diazepam, bromadiolone, diazepam, oryzanol, a drug for improving autonomic nervous function, and nimodipine, a calcium blocker.