Concussion is a mild closed craniocerebral injury caused by a concussion inside the skull and leading to short—term functional abnormalities in the work of the central nervous system. Symptoms of concussion are: short-term loss of consciousness, congrade and retrograde amnesia, headache, nausea, vasomotor disorders, dizziness, anisoreflexia, nystagmus. In the diagnosis, an important place is occupied by the exclusion of more serious cerebral injuries. Therapy includes rest, symptomatic and vascular-neurometabolic treatment, vitamin therapy.
ICD 10
S06.0 Concussion
General information
Concussion is the most mild type of traumatic brain injury (TBI), characterized by a short—term disorder of cerebral functions and not accompanied by morphological changes. In American medicine, the maximum time interval of loss of consciousness for concussion is considered to be 6 hours, since the long duration of the unconscious period almost always indicates damage to cerebral tissues.
Concussion accounts for up to 80% of all TBI cases. It is most often observed in young and middle—aged people, in children – in the age range from 5 to 15 years. It is characterized by a large variability of types of injuries. Topical issues related to the diagnosis and treatment of concussion require joint consideration by specialists in the field of traumatology and neurology.
Causes
Concussion occurs more often with direct mechanical impact on the skull (a blow to the head or on the head). Concussion is possible with a sharp impact of the axial load transmitted through the spine, for example, when falling on the legs or buttocks; with a sharp deceleration or acceleration, for example, during a transport accident.
In all these cases, there is a sharp shaking of the head. The brain seems to “float” in the cerebrospinal fluid inside the skull. With a concussion, the brain experiences a hydrodynamic shock due to the pressure drop of the cerebrospinal fluid, which propagates like a shock wave. Along with this, with a large force of traumatic impact, a mechanical impact of the brain on the bones of the skull from the inside is possible.
The pathogenesis of cerebral changes due to concussion has not been fully investigated. It is assumed that the basis of the clinical manifestations characterizing concussion is the functional separation of the brainstem and hemispheres. It is believed that mechanical concussion leads to a temporary change in the colloidal state and physico-chemical characteristics of cerebral tissues. The consequence of this is the loss of connections between different parts of the brain. It is possible that such a functional separation is due to a violation of the metabolism of neurons.
Concussion symptoms
Concussion is a closed TBI, i.e. it is not accompanied by a skull fracture. After the injury, loss of consciousness may occur. Its duration varies and, as a rule, does not exceed several minutes. In some patients, a concussion does not entail loss of consciousness, there is only some deafness. In many cases, retrograde and congrade amnesia is noted — the loss of memories of events preceding the trauma and of events that occurred during the period of disturbed consciousness, respectively. Less often, anterograde amnesia is detected — loss of memory for events that occurred after the restoration of clear consciousness.
In accordance with the presence or absence of loss of consciousness and amnesia, there are 3 degrees of severity of concussion. In the first degree, there is no period of loss of consciousness, and amnesia. The second degree is characterized by the presence of amnesia against the background of confusion, but without its loss. Concussion of the third degree suggests the presence of loss of consciousness.
After regaining consciousness, patients complain of nausea, headache, weakness, dizziness, hot flashes to the head. Vomiting is often observed, more often once. Possible tinnitus, pain when moving the eyes, sweating. There may be: divergence of eyeballs, nosebleeds, decreased appetite, sleep disorders. Blood pressure is unstable, the pulse is labile. Most of these symptoms are leveled during the first few days after the injury. Headache, emotional instability, vegetative symptoms (sweating, lability of blood pressure and pulse), weakness may persist for a long time.
Concussion in young children occurs mainly without loss of consciousness. As a rule, children are excited and cry, then fall asleep. After sleeping, they are capricious, do not want to eat. Usually, after 2-3 days, the normal behavior and appetite of the child is fully restored.
Complications
Repeated concussions of the brain can lead to the development of post-traumatic encephalopathy. Since such a complication is often found among boxers, it has been called “encephalopathy of boxers”. As a rule, the motor skills of the lower extremities suffer. Periodically, there is a spanking with one foot or lagging when moving one leg. In some cases, there is a slight discoordination of movements, staggering, problems with balance. Sometimes mental changes prevail: there are periods of confusion or inhibition, in severe cases there is a noticeable impoverishment of speech, there is a tremor of the hands.
Post-traumatic changes are possible after any TBI, regardless of its severity. There may be episodes of emotional imbalance with irritability and aggression, which patients later regret. There is hypersensitivity to infections or alcoholic beverages, under the influence of which patients have mental disorders up to delirium. A complication of concussion can be neurosis, depression and phobic disorders, the occurrence of paranoid personality traits. Convulsive seizures, persistent headache, increased intracranial pressure, vasomotor disorders (orthostatic collapse, sweating, pallor, blood flushes to the head) are possible. Psychoses characterized by perception disorder, hallucinatory and delusional syndromes are less likely to develop. In some cases, dementia occurs with a memory disorder, a violation of criticism, disorientation.
In 10% of cases, concussion leads to the formation of post-concussion syndrome. It develops a few days or months after the received TBI. Patients are concerned about intense headache, sleep disorder, impaired ability to concentrate, dizziness, anxiety. Chronic post-concussion syndrome is difficult to psychotherapy, and the use of narcotic analgesics to relieve headaches often leads to the development of addiction.
Diagnostics
Concussion is diagnosed on the basis of anamnestic data on the injury and the time of loss of consciousness, patient complaints, the results of an objective examination by a neurologist and instrumental studies. In the neurological status, in the period immediately after the injury, there is a fine—grained nystagmus, slight and unstable asymmetry of reflexes, in young patients – Marinescu—Radovich symptom (homolateral contraction of the chin muscles with irritation of the elevation of the thumb of the palm), in some cases – weakly expressed shell (meningeal) symptoms. Since more serious brain damage can be hidden under the mask of a concussion, it is important to observe the patient in dynamics. If the diagnosis of concussion is established correctly, then the abnormalities detected during neurological examination disappear 3-7 days after the injury.
After the received TBI, an X-ray of the skull is mandatory, which allows confirming the absence / presence of skull fractures. To exclude intracerebral hematoma and other hidden brain damage, electroencephalography, echoencephalography and ophthalmoscopy (fundus examination) are prescribed. But neuroimaging methods remain the best way to diagnose TBI. In concussion, MRI and CT scans do not reveal any structural changes in brain tissues. If there are petechial hemorrhages or swelling of the brain, then you should think about a bruise of the brain, and not about its concussion.
Concussion treatment
Since a concussion can hide a much more serious injury, hospitalization is recommended for all patients. The basis of therapy is a healthy sleep and rest. In the first 1-2 days, patients should observe bed rest, exclude watching TV, working at the computer, reading and listening to audio recordings with headphones. After excluding other cerebral lesions, patients with concussion may be discharged for outpatient treatment.
Pharmacotherapy is not required in all cases of concussion and is mainly symptomatic. Headache relief is carried out with the help of painkillers. For dizziness, ergotoxin, belladonna extract, ginkgo biloba extract, platyphylline are prescribed. As sedatives, motherwort, phenobarbital, valerian are used; for insomnia — zopiclone or doxylamine at night; according to indications — medazepam, phenozepam, oxazepam.
Concussion of the 3rd degree is an indication for the course of vascular-neurometabolic therapy, which provides a combination of one of the vascular agents (nicergoline, cinnarizine, vinpocetine) and nootropics (noopept, glycine, piracetam). It is effective to include antioxidants (meldonium, mexidol, cytoflavin) and magnesium preparations (magnesium lactate with pyridoxine, potassium and magnesium asparaginate) in the treatment regimen. With asthenia, multivitamins, eleutherococcus, and lemongrass are recommended.
Forecast
Compliance with the regime and adequate treatment of concussion leads to full recovery and restoration of working capacity. For some time (for a maximum of a year after the injury), there may be a weakening of memory and attentiveness, headaches, increased sensitivity to light and sounds, sleep disorders, fatigue. Repeated trauma significantly increases the risk of complications and disability.
Prevention
Concussion prevention includes head protection at work and during sports. Working on a construction site involves wearing a hard hat, some sports (skateboard, hockey, baseball, cycling or motorcycle, roller skating) require the wearing of special helmets. When traveling in a car, you must fasten your seat belts. In domestic conditions, it is necessary to ensure that the corridors are free for passage, and the liquid accidentally spilled on the floor was immediately wiped off.