Cerebral concussion
Summary
Cerebral concussion is the clinical comprehensive symptom group caused by slight brain injury, it features transient consciousness is lost after head traumatism, sober soon, besides nearing things to forget, there is not any nervous system defect to behave.
Pathology changes
Thinking all the time cerebral concussion was only the temporary dysfunction of the central nervous system in the past, there is no visible organic lesion, dissect on the whole and not find pathological change on pathologic histology, crossing brain functions displayed are inhibited, perhaps disorderly with the brain cell molecule that the violence causes, nerve block, brain blood circulatory adjustment obstacle, middle neuron damage and factors such as the shock wave of cerebrospinal fluid (CSF),etc. have something to do in the ventricles of the brain of centre line. Modern, according to nervous system physiological research, think and damage because of the reticular formation of brain stem, the walking function which activates the system is the important factor of causing the consciousness obstacle on influencing. But theory these can't yet explain all phenomenon of cerebral concussion satisfied, for example there is case dying of and cerebral concussion, chronic brain atrophy takes place and damage even dull-witted to the professional boxing coach, and also there are reports of the slight obstacle of brain functions in amateurish boxing person. Meanwhile, find from animal's experiment, suffers the nerve cells of the violence position, can be seen in mitochondrial swelling, passing, neuronal axis and dash for ward swelling and have a quality edema under the electron microscope. Biochemistry discover, have acetyl choline rise in the cerebrospinal fluid (CSF) not merely after the cerebral concussion, the density of potassium ion increases, the enzyme system that and there are a lot of influence axles to conduct the brain cellular metabolism suddenly gets muddled, cause then send and damage. It is late to be near, also find from new clinical observation, the sense of hearing of patient's brain stem of light cerebral concussion brings out the electric potential, half shows organic lesion, Jeret( 1993) Adopt prospective to study, until 712 GCS15 divide person who close hair injure patients act as CT, scan, check slightly continuously, find that there are acute persons who damage pathological change, accounts for 9.6%. Therefore cerebral concussion can't with " belong to, pass the intersection of and the intersection of brain and the intersection of function and obstacle and have definite organic lesion only " already Has come to summarize, with the constant further investigation and finding, will inject new meaning into this diagnosis noun of cerebral concussion of medical science.
Clinical manifestation
Lose transient consciousness immediately after cranium brain traumatism, lasts several minutes and even more than ten minutes, do not generally exceed half an hour; But even and there are patients and is shown as consciousness is confused in the twinkling of an eye or in a trance, have not gone into a coma; Also longer stupor appears by a definite date individually, even the persons who die, this may result from the reason that the violence conduct and cause life centres such as brain stem and after brain,etc. through the deep department structure of brain. The patient not merely has the breaking down temporarily of brain and upper brain stem function while suffering the external force, meanwhile, there is inhibition of lower brain stem, after brain and neck marrow too, and make nerve center and plant nervous regulation of blood vessel get muddled, cause the intersection of heart rate and slow down, blood pressure drop, look pale, appear cold sweat, breathe, suspend then shallow weak and the intersection of four limbs and a series of response such as being soft. The reversible slight cerebral concussion patient in most, nervous function of centre is from bottom to top rapidly, resumed to the cerebral cortex from the marrow of neck - after brain - brain stem; But irreversible serious cerebral concussion may be the inhibition course from top to bottom, the function of making the after brain breathe the centre and circulate the centre is cut off too long, therefore cause the death.
After consciousness resumes, the patient often has symptoms such as having a headache, nausea, vomiting, dizzy, photophobic and weak,etc., meanwhile, often forget (driving in the wrong direction is forgotten) with obviously nearing the thing Phenomenon is unable to remember to process injure. The intersection of intensity and serious original dizzy fan of cerebral concussion long time have, whom nearly thing its forget phenomenon the more prominent even, but not damaged the past old memory.
The convalescent patient of cerebral concussion often has symptoms such as giddy, headache, nausea, vomiting, tinnitus, insomnia,etc., generally more to fade from several weeks to several months, but symptom of some patients have long-term giddy, headache, insomnia, agitation, lack of concentration and memory that drop ing etc., among them it is a convalescent symptom to have partly, if exceed there is not March - June of hour while obviously taking a favorable turn, except considering that there is a spiritual factor, should also check, analyze in detail, whether the sending damage exists, make sure not to use " cerebral concussion and sequela " late In a word, increase the patient's mental burden instead.
Diagnosis
Diagnosis of cerebral concussion mainly history in order to injure in the past and consciousness transient to go into a coma and close thing forget, have no positive physical sign of nervous system as the basis after being wounded. But still there is not a reliable method in objective diagnosis basis and clinical differentiation that dampens with the slight brain. So, often need to diagnose clearly through various auxiliary inspection method beginning: If skull flat for block to meet fracture; The waist has no erythrocyte to press in normal range, cerebrospinal fluid (CSF) to examine to wear; Rarely seen and low electroencephalogram even having disseminated the intersection of and wave and the intersection of and wave in quick wave to high amplitude, 1- resume in 2 days, or a few patients are scattered returns to normal in the slow wave during 1- 2 weeks; The sense of hearing of brain stem is brought out the electric potential can have - one lengthens, lengthens or has amplitude reducing or wave form that disappear in wave incubation period among the wave waves; CT check, sweep and strengthen, it scans to be should negative, take place bone on being clinical a few patient CT scan negatively for the first time while being flat, and present secondary disease in the sending cranium late to change in observing dynamically continuously, should notice. In addition, scholar's report implements the single photon and launches CT to scan (SPECT) with the radioactive nuclide 123I-IMP and 99mTc-HM-PAO ,Check cerebral concussion patients of teenagers, find 70% have cerebellum and occipital lobe blood flow reducing.
Treat the measure
Cerebral concussion does not need special treatment, need only generally stay in bed for 5- 7 days, offer easing pain, calm medicine to the ill, reduce the external world to stimulate, do a good job of explanation, dispel patient's fear psychology to cerebral concussion, most patients return to normal within 2 weeks, the prognosis is good. But have secondary disease and becoming or other complications in the cranium may happen to a few patients, so, must observe the patient's state of mind closely during treatment to the ill, consciousness state, clinical symptom and life physical sign, should also carry on the essential inspection in time according to the situation. It influences the morphine medicine observed to avoid using, had better select easing pain, sedative with few side effect for use, .
Cerebral concussion
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