What Is Diffuse Brain Injury?

Brain injury refers to the organic damage of brain tissue caused by violence on the head. According to whether the brain tissue after injury is the same as the outside world, it is divided into open and closed brain injury. It is divided into primary brain injury and secondary brain injury according to whether the brain injury occurs immediately when the violence acts on the head.

Basic Information

English name

brain damage

Visiting department

neurosurgery

Common locations

brain tissue

Common causes

Sharp or firearm violence on the head

Common symptoms

Retrograde amnesia, headache, dizziness, insomnia, irritability, headache and vomiting, dilated pupils on one or both sides, etc.

Causes of brain injury

Open brain injuries are often caused directly by sharp or firearms, all with scalp lacerations, skull fractures, dural rupture, and cerebrospinal fluid leakage; closed brain injuries are caused by blunt objects or indirect violence on the head, often the scalp, The skull is intact.

Clinical manifestations of brain injury

Concussion

At the time of the injury, a brief disturbance of consciousness occurred, often for seconds or minutes, and no more than half an hour. The patient had retrograde amnesia, headache, dizziness, and insomnia. Irritability and other symptoms, no positive signs of neurological examination.

2. Brain contusion and laceration

At the time of the injury, there was a disturbance of consciousness, usually for a long time. Vital signs were more obvious, with symptoms such as focal symptoms, increased intracranial pressure, and headache and vomiting.

3. Diffuse axonal injury

A coma occurred immediately after the injury, and the coma lasted longer. There may be dilated pupils on one side or both sides.

4. Brainstem injury

At the time of the injury, a coma appeared immediately, with a deeper coma and a longer duration. The pupils on both sides are unequal in size or variable in size. The patient developed denervated tonicity. Changes in vital signs included respiratory dysfunction, cardiovascular dysfunction, and temperature changes. Visceral symptoms included gastrointestinal bleeding and refractory hiccup.

Brain injury examination

Concussion

Lumbar puncture examination showed normal intracranial pressure, cerebrospinal fluid was colorless and transparent, and contained no blood or white blood cells. X-ray of the head and CT examination were normal.

2. Brain contusion and laceration

Cerebrospinal fluid examination Cerebrospinal fluid has red blood cells or bloody cerebrospinal fluid. CT of the head was performed to determine if there was a fracture. Subarachnoid hemorrhage, with or without midline shift, and exclusion of intracranial hematoma. Head MRI understands the specific injury site, extent, and surrounding edema.

3. Diffuse axonal injury

Head CT showed multiple spots or patchy bleeding spots at the junction of the cerebral cortex and medulla, the corpus callosum, the brain stem, and the inner capsule. The head MRI can accurately reflect the changes of early ischemic focus and small bleeding focus.

4. Brainstem injury

Cerebrospinal fluid is mostly bloody. X-rays of the head are usually accompanied by skull fractures. A CT scan of the head shows a flaky, high-density area of the brainstem with enlarged brainstem, compressed or occluded brain pools. MRI can accurately show the location and extent of the lesion.

Brain injury diagnosis

Concussion

He had a clear history of trauma and clinical symptoms of transient loss of consciousness, retrograde amnesia, no significant changes in vital signs, and no positive signs.

2. Brain contusion and laceration

According to the history of trauma, there was a longer coma after injury. Presence of positive signs of the nervous system and CT findings of the skull can confirm the diagnosis.

3. Diffuse axonal injury

A clear history of traumatic brain injury, post-injury and conscious disturbance, pupil size changes, no obvious localized signs of the nervous system, and no obvious abnormalities in the skull CT.

4. Brainstem injury

Coma appeared after the injury with progressive aggravation, changes in pupils, early onset of respiratory and circulatory failure, denervation of the brain, and positive bilateral pathological signs.

Brain injury treatment

Concussion

Closely observe the changes of consciousness, physical activity and vital signs shortly after the injury. Bed rest in the acute phase can be treated symptomatically with cranial pain.

2. Diffuse axonal injury

Lighter with concussion, severe with contusion and laceration. Dehydration treatment. Prevent secondary infection during coma. In severe cases, keep the airway open and perform tracheotomy if necessary. Hyperbaric oxygen and rehabilitation treatment.

3. Brain contusion and laceration

For patients with mild contusion and laceration, the treatment is the same as diffuse axonal injury. The coma patient keeps the airway unobstructed, and tracheostomy is performed if necessary. Patients with cerebral edema should be treated with dehydration. For patients with severe cerebral contusion and cerebral edema, if there is a disturbance of consciousness and neurological function, high intracranial pressure cannot be controlled by drugs, and craniotomy should be performed urgently.

4. Brainstem injury

It is mainly to maintain the internal and external environmental balance of the body, to protect the brain stem function from being further impaired, and the efficacy of hibernation cryotherapy and hyperbaric oxygen is positive.