What Are the Different Chancroid Symptoms?

The lower thalamic injury refers to a special clinical syndrome that occurs directly during injury to the lower thalamus due to a fracture of the skull base or a violent blow to the skull. The lower thalamus is an important subcortical center of the autonomic nervous system, and has important relations with internal organ activities, endocrine, material metabolism, body temperature regulation, and maintenance of consciousness and sleep. Therefore, the clinical manifestations of the lower thalamus are often severe. Simple lower thalamic injuries are rare, and most are associated with severe contusion and / or brain stem injury.

Basic Information

English name

hypothalamus injury

Visiting department

neurosurgery

Common causes

Caused by trauma

Common symptoms

Disorders of consciousness and sleep, central high fever, endocrine and metabolic disorders, etc.

Causes of lower thalamic injury

The lower thalamus is hidden deep above the saddle of the skull base. Therefore, those who directly or indirectly pass through the lower thalamus may cause local damage. In addition, this area can also be involved in cerebellar herniation.

Clinical manifestations of hypothalamic injury

It is generally believed that there is a parasympathetic center in the lower part of the thalamus and a sympathetic center in the posterior area. The two regulate each other under the control of the cerebral cortex. Therefore, when the lower part of the thalamus is damaged, it is easier to cause autonomic dysfunction.

1. Consciousness and sleep disorders

Both the posterolateral area of the lower thalamus and the midbrain tegmental area are ascending reticular agonistic systems, which are the stimulating mechanisms for maintaining awakening. They are important for managing awakening and sleep. Once damaged, patients can have drowsiness symptoms, although they can wake up. , But spin and fall asleep, in severe cases can be manifested as lethargy.

2. Temperature regulation disorder

The lower thalamus has the function of regulating body temperature. When the lower part of the thalamus is damaged, the body's heat dissipation function is impaired, and central high fever can occur. The body temperature usually rises suddenly, as high as 41 ° C or even 42 ° C, but the skin is dry and less sweaty, and the skin temperature is unevenly distributed. The limbs are lower than the trunk, and there is no inflammation and poisoning, and the antipyretics are not effective; the posterior injury appears to cause hypothermia due to heat generation and thermal insulation failure: if the joint nodules are injured, metabolic disorders and body temperature may occur Will be further reduced, such as extensive damage to the lower thalamus, the body temperature will rise and fall accordingly with the ambient temperature.

3. Endocrine and metabolic dysfunction

(1) The supraoptic nucleus, paraventricular nucleus of the hypothalamus is damaged, or the pituitary stalk superior optic nucleus-pituitary tract is involved in the release of antidiuretic hormone synthesis, causing central diabetes insipidus. At 1.005.

(2) Dysfunction of hypothalamus-pituitary-target gland axis may appear dysregulation of glucose and fat metabolism, especially disturbance of glucose metabolism, manifested as hyperglycemia, often coexist with disturbance of water metabolism. The patient's blood osmotic pressure increased, and no ketones appeared in the urine. The patient suffered severe dehydration, blood concentration, shock, and hypertonic hyperglycemic non-keto coma, with extremely high mortality.

4. Circulatory and respiratory disorders

After hypothalamic injury, there may be various changes in cardiovascular function, including high and low blood pressure, and the pulse may be fast or slow, but in general, low blood pressure, pulse rate are more common, and fluctuations are large. If hypotension is combined With low temperatures, the prognosis is poor. Respiratory rhythm disorders are related to impaired thalamic posterior respiratory management centers, often manifested as slowing or even stopping breathing. Acute central pulmonary edema can occur when the preoptic area is injured.

5. Digestive system disorders

There is a nerve bundle from the anterior area of the lower thalamus to the dorsal nucleus of the medullary vagus nerve, which manages the upper gastrointestinal autonomic nerve. Any damage to it can cause upper gastrointestinal disease. Therefore, when severe traumatic brain injury affects the lower thalamus, it is easy to cause gastric erosion, duodenal mucosa erosion, necrosis, ulcer and bleeding. The cause may be vasoconstriction and ischemia of the upper gastrointestinal tract; excessive excitement of the vagus nerve; or hypergastric secretion and hyperacidity. In addition, these patients often experience symptoms of refractory hiccups, vomiting, and bloating.

6. Local nerve signs

It is mainly the signs of cerebral nerve involvement near the saddle area, including the optic nerve, optic bundle, and pulley nerve.

Subthalamic Injury Examination

1. X-ray examination of the skull

Suspected skull fractures should be taken positive and lateral radiographs. Occipital trauma and forehead occipital (Tang's) films, slicing fractures for sacral fractures. Optic nerve nerve films were taken for suspected optic nerve damage, and Koch's films were taken for orbital fractures.

2. Waist wear

To understand the extent of subarachnoid hemorrhage and intracranial pressure. Lumbar puncture is contraindicated in patients with severe intracranial hypertension or signs of cerebral hernia.

3.CT scan

It is an important basis for assisting the diagnosis of craniocerebral injury. It can show skull fracture, cerebral contusion and laceration, intracranial hematoma, subarachnoid hemorrhage, ventricular hemorrhage, pneumonia, cerebral edema or brain swelling, compression and displacement of cerebral cistern and ventricle, and displacement of midline structure. CT review should be performed when the condition changes.

4. Magnetic resonance (MRI) examination

Patients with acute craniocerebral injury usually do not undergo MRI. However, MRI is often superior to CT scans for stable axonal injury, the base of the hemisphere, the brain stem, focal contusion and small hemorrhages, and sub-acute intracranial hematomas of equal density.

Diagnosis of lower thalamic injury

1. Patients with cerebral contusion and laceration are accompanied by obvious hypothalamic dysfunction, and sometimes persistent high fever reaches 41 ° C.

2. Some cases have diabetes insipidus, the urine output in 24 hours can reach thousands to 10,000 milliliters, and the specific gravity is below 1.010. Or accompanied by gastrointestinal bleeding, and sometimes with peripheral circulation disorders.

Differential diagnosis of hypothalamic injury

Intercranial seizures: also known as subcranial seizures or intercranial epilepsy. It is a paroxysmal flushing of the face and neck, sweating, palpitations, tears, salivation, tremors, and gastrointestinal discomfort. Each episode lasts several minutes to 1 ~ 2 hours, but no convulsions, occasional urination.

Complications of lower thalamic injury

Damage to the lower thalamus can cause erosion of the stomach and duodenum, necrosis, ulcers, and bleeding.

Treatment of lower thalamic injury

The treatment of lower thalamic injury is basically the same as that of primary brain stem injury. There are many neuro-endocrine disorders and metabolic disorders caused by the lower thalamic injury only. It is more difficult and complicated to treat. It must be carefully observed, cranial Under the premise of internal pressure monitoring, blood biochemical detection and water-electrolyte balance, the treatment and care are carefully and carefully.

Prognosis of lower thalamic injury

Pay attention to the treatment of complications, such as bleeding in the digestive system, and especially pay attention to the prevention and treatment of hypertonic hyperglycemic non-keto coma. If the treatment is not timely, the prognosis is poor and the mortality is extremely high.