What Is a Closed Head Injury?

Closed craniocerebral injury refers to a craniocerebral injury where the dura mater is still intact. Although the scalp and open bone have open wounds, the contents of the cranial cavity are not communicated with the outside world, so it is still called closed craniocerebral injury. Most of them are head or head injuries caused by traffic accidents, falls, falls, and other direct or indirect effects of birth injuries.

Basic Information

English name

Closed Head Injuries

Visiting department

neurosurgery

Common locations

Head

Common causes

Traffic accidents, falls, falls and birth injuries, which directly or indirectly cause head injuries

Common symptoms

Disorders of consciousness, changes in vital signs, increased intracranial pressure, changes in pupils, impaired medullary function, changes in movement and reflexes, scalp damage, ear and nose bleeding and exudate, etc.

Causes of closed head injury

Closed craniocerebral injuries are mostly head or head injuries caused by direct or indirect effects of traffic accidents, falls, falls and other accidents and birth injuries. After the main trauma factors, craniocerebral injury occurs due to skull deformation and fracture; in addition, trauma factors may also cause linear or rotational movement of brain tissue in the cranial cavity and cause craniocerebral injury.

Direct violence

(1) Accelerated injury The relatively still head is suddenly hit by external force, forcing it to change from static to dynamic instantly, resulting in brain injury, such as stick or stone injury.

(2) Deceleration injury The moving head suddenly collided with a stationary object, forcing it to change from dynamic to static instantly, resulting in brain damage, such as falling and falling.

(3) Squeezing injury means that the external forces on both sides squeeze the head at the same time, causing the skull to deform and cause injury. A birth injury especially on a baby's head.

2. Indirect violence

(1) In the case of a transitive injury, such as a fall injury, the hips or feet first land, and the external force is transmitted along the spine to the occipital condyle of the skull base to cause injury.

(2) Whip-like injury Due to inertia, when the trunk is subjected to accelerated sexual violence, the body always moves first and then the head starts to move. The force is transmitted to the head through the craniocervical junction, and a shear stress is generated between the slow-moving skull and the cervical spine, which can cause injury at the craniocervical junction.

(3) Chest crush injury, also known as traumatic asphyxia, is caused by the sudden increase in intrathoracic pressure when the chest is strongly compressed, causing the blood flow of the superior vena cava to retrogradely perfuse into the skull. Because there is no venous valve structure in the head vein, recoil pressure often causes damage to the capillary wall, which causes diffuse point bleeding of the upper vena cava's upper chest, neck, head and face skin and mucosa, and brain tissue. Patients can show symptoms of brain injury.

Clinical manifestations of closed head injury

1. Disorder of consciousness: The degree and change of consciousness disturbance are important aspects of judging the injury.

2. Changes in vital signs (breathing, pulse, blood pressure, and temperature).

3. Increased intracranial pressure: headache, vomiting, and papillary optic edema.

4. Pupil changes: changes in pupil size, shape, direct reflection of light, indirect reflection of light, etc.

5. Impaired bulbar function.

6. Movement and reflection change.

7. Scalp injury, ear and nose bleeding and exudate.

8. May be accompanied by shock and other symptoms.

Closed head injury examination

Skull x-ray

As a routine examination, positive, lateral or special radiographs can be taken to help diagnose skull fractures, intracranial gas buildup, or foreign bodies.

2. Lumbar puncture

Determine intracranial pressure; understand cerebrospinal fluid biochemical changes and cell number.

3. Ultrasound inspection

Although craniocerebral ultrasound is currently rarely used in the diagnosis of patients with clinical traumatic brain trauma, it still has its unique role as a basic method. For the hematoma on the screen, the midline wave can be used to determine the fixed side of the hematoma; however, the hematoma cannot be ruled out. Especially in craniotomy, the position changes of various structures in the skull and the presence of abnormal waveforms can be determined according to the waveform characteristics of the reflections acquired when ultrasound is propagated in tissues of different media to determine the status of craniocerebral injury.

4. Cerebral angiography

In recent years, CT scans have largely replaced cerebral angiography, but patients with traumatic aneurysms and arteriovenous fistulas still have important diagnostic value.

5.CT and magnetic resonance examination

CT scan can accurately reflect the pathology and scope of craniocerebral injury. At the same time, it can also dynamically observe the scope and outcome of lesions. MRI uses the principle of magnetic resonance imaging to perform multi-directional tomography of craniocerebral diseases. The difference between the two relaxation times (T1, T2) improves the detection rate of lesions, especially for brain injury. Certain CT lesions, such as subdural hematoma of equal density, mild cerebral contusion, small focal hemorrhage, and thin-layer hematomas at the base of the skull, cranial or posterior skull, are obvious. Superiority. However, MRI imaging takes a long time, and it is difficult to check for patients with restlessness or emergency rescue.

Diagnosis of closed head injury

A diagnosis can be made based on the etiology, clinical manifestations, and CT scans, cerebral angiography, and magnetic resonance imaging.

Closed head injury treatment

Light

Bed rest and general treatment are the mainstay. Generally, it takes 1 to 2 weeks to stay in bed. Observe the vital signs, changes in consciousness and pupils, and normal diet. Most patients can work normally after a few weeks.

2.Medium

Absolute bed rest, regular vital signs should be measured within 48 hours, and pay attention to changes in consciousness and pupils. Awake patients can enter the ordinary diet or semi-liquid diet. Those who are not fully conscious will be treated by intravenous infusion and those with increased intracranial pressure will be given dehydration treatment. Antibiotics (ceftomycins, ofloxacin, metronidazole) are used when cerebrospinal fluid leaks.

3.Heavy

(1) Keep the airway open

(2) Observe the condition closely and check the changes in breathing, pulse, blood pressure, consciousness, and pupils at any time, and pay attention to any new symptoms and signs.

(3) Prevention and treatment of cerebral edema and reduction of intracranial pressure lying position. Except for those who are in shock, they are all head high; Limit the amount of intake, correct water and salt metabolism disorders, and give sufficient vitamins (cephanomycins, ofloxacin, metronidazole); dehydration treatment. It is effective to eliminate cerebral edema (mannitol) and reduce intracranial pressure; continuous drainage outside the brain or intermittently release a certain amount of cerebrospinal fluid in patients undergoing intracranial pressure monitoring, or after the condition is stable, a proper amount of cerebrospinal fluid is released by lumbar puncture; Hibernation and mild hypothermia therapy. Can reduce brain metabolism, reduce brain tissue oxygen consumption, prevent the occurrence and development of cerebral edema, and also play a role in reducing intracranial pressure; barbiturate treatment. Can reduce brain metabolism, reduce oxygen consumption and increase brain tolerance to hypoxia, and reduce intracranial pressure. Mechanical assisted hyperventilation treatment. The purpose is to make the body exhaust CO ₂ and decrease the cerebral blood flow, thereby reducing the intracranial pressure; hormonal therapy. The application of hormone therapy in eliminating cerebral edema and alleviating the increase in intracranial pressure is controversial.

(4) The application of neurotrophic drugs can be selected or combined according to the condition.

(5) Surgical treatment The purpose of surgery is to remove the occupying lesions such as intracranial hematoma, in order to relieve the increase of intracranial pressure, prevent the formation of cerebral hernia or relieve the cerebral hernia. The surgery includes: drilling of the skull, hematoma removal and reduction of brain tissue debridement. Pressure surgery.

(6) To prevent complications, intensive care should be based on the prevention of lung and urinary tract infections in the early stage, and nutritional supply should be guaranteed in the later stages to prevent bedsores and strengthen functional training.