What are the common manifestations of severe head injury?

Classification of clinical applications.

It is based on the location of the head injury and the pathological morphological changes of the injury. First, according to the location of the injury, it is divided into two parts: cranial injury and brain injury, which are further divided into open and closed injuries.

Brain injuries are classified into open craniocerebral injury and closed craniocerebral injury based on whether the dura mater is intact or not. The diagnosis of the former is based on dural rupture, cerebrospinal fluid efflux, and communication between the cranial cavity and the outside world. Patients with basilar skull fracture and cerebrospinal fluid leak are also referred to as open brain injury in the brain.

Closed brain injuries can be further divided into two categories: primary and secondary.

Classified according to the severity of the disease.

Clinical classification can only diagnose and classify patients with head injury based on the location and pathological type of injury, but cannot judge the severity of the patient's condition. It was first formulated in 1960"Classification of acute closed head injury"The standard, which is divided into three types according to the time of coma, positive signs and vital signs, is divided into three types: mild, moderate and severe, which has been relatively improved after two revisions and has become a recognized standard in China.

1. Lightweight. 1) post-injury coma time o 30 minutes;

2) Have slight headache, dizziness and other self-conscious symptoms;

3) There were no significant changes in the nervous system and CSF examination. It mainly consists of simple cerebral **, with or without skull fractures.

2. Medium-sized. 1) The post-injury coma time is less than 12 hours;

2) have mild positive neurological signs;

3) Slight changes in body temperature, respiration, blood pressure, and pulse. It mainly includes mild cerebral contusion and laceration, with or without skull fracture and subarachnoid hemorrhage, and no cerebral compression.

3. Heavy duty. 1) Coma for more than 12 hours after injury, and the consciousness disorder gradually worsens or coma occurs again;

2) have obvious positive signs of the nervous system;

3) Significant changes in body temperature, respiration, blood pressure, and pulse. These include extensive skull fractures, extensive cerebral contusions, and brainstem injuries or intracranial hematomas.

4. Extra-heavy.

1) Severe primary brain injury, deep coma after injury, cerebral rigidity or organ injuries accompanied by other parts, shock, etc.;

2) Pre-existing advanced brain herniation, including bilateral mydriasis, severe disturbance of vital signs, or near-cessation of breathing.

Xu Yueqiao, Deputy Chief Physician, Xuanwu Hospital, Capital Medical University: What are the types of head injuries according to their structure?

1.General presentation.

1) Impairment of consciousnessThe vast majority of patients lose consciousness immediately after injury, and the length of time varies. Impairment of consciousness varies from mild to severe manifestations of drowsiness, blindness, shallow coma, coma, and deep coma.

2) Headache and vomiting are common symptoms after injury, and if they continue to worsen, intracranial hematoma should be alerted.

3) If the pupil on one side is dilated immediately after injury, the light response disappears, and the patient is conscious, which is generally a direct primary injury to the oculomotor nerve; If the size of the pupils is unequal and variable bilaterally, it indicates damage to the midbrain; If the bilateral pupils are extremely constricted and the light response is absent, pontine injury is usually present; If one side of the pupil is first narrowed and then dilated, the light response is poor, and the patient's consciousness is aggravated, which is a typical tentorial herniation; If the bilateral pupils are dilated and fixed, the photoresponse is absent, and most of them are endangered.

4) Vital signs: Weak breathing, pulse, rhythm disorder, and blood pressure drop after a vital sign injury, which generally gradually returns to normal after a few minutes or more than ten minutes. If the vital signs are disturbed for a prolonged period of time and there is no sign of recovery, the brainstem damage is severe; If vital signs have returned to normal after injury, then a gradual increase in blood pressure and slowing of breathing and pulse often suggests a secondary intracranial hematoma.

2.Special performances.

1) Neonatal head injuries are almost always caused by birth trauma, which is generally manifested as scalp hematoma, skull deformation, high fontanelle tension or frequent vomiting. Subperiosteal hematomas are more common in infants and young children, and they are prone to calcification. Children are prone to ping-pong pong ball depression fractures.

Infants, toddlers and preschool children have severe post-injury reactions, obvious disturbances in vital signs, and are prone to shock symptoms. Delayed impaired consciousness is common. The clinical manifestations of intracranial hematoma in children are mild, the onset of cerebral herniation is late, and the condition changes abruptly.

2) After head injury in the elderly, consciousness is impaired for a long time, vital signs change significantly, and the early symptoms are mostly not obvious when complicated by intracranial hematoma, but vomiting is common and the symptoms develop rapidly.

3) Severe head injury can often cause water and salt metabolism disorders, hyperosmolar hyperglycemic non-ketotic coma, cerebral pulmonary edema and brain death.

Analysis: What is the response to various nerve reflexes. The reflection is still there.

Guidance: The evaluation of a vegetative person requires many conditions. It's a very cautious thing. Don't give up**, miracles will happen.

Refers to a brain injury in which the dura mater is still intact, characterized by the fact that the contents of the cranial cavity are not communicated with the outside world after injury, and the dura mater is intact and there is no cerebrospinal fluid leakage. Clinical classification of closed head injury 1Minor, pure brain**, or localized skull fractures:

brief coma, more than half an hour; After waking up, he has mild headache, dizziness, nausea, vomiting and other self-conscious symptoms; Forgetting the recent; Neurologic symptoms and lumbar puncture are normal. 2.Moderate, mild cerebral contusion, with or without skull fracture, suboomental hemorrhage, cerebral compression:

coma within 12 hours; have mild neurological symptoms; Vital signs: light reading changes in body temperature, pulse, respiration, and blood pressure; 3.Heavy Duty:

Extensive basilar skull fracture, extensive cerebral contusion, brainstem injury or intracranial hematoma deep coma for more than 12 hours, or relapse into coma; have significant neurological symptoms; There are significant changes in vital signs, body temperature, pulse, respiration, and blood pressure. **；1. Closely observe the changes in vital signs and nervous system signs, and monitor intracranial pressure if necessary, so as to dynamically understand the evolution process of the disease and deal with it in time. 2. Brain ** and mild cerebral contusions should be properly rested, given spiritual encouragement, clear thoughts and concerns, symptomatic**, observe for several days, and pay attention to secondary intracranial lesions.

3. Maintain adequate nutrition, maintain water and electrolyte balance, and rationally use neurotrophic drugs. 4. Prevent and treat lung infections, keep the respiratory tract open, and prevent suffocation. Timely tracheotomy can improve cerebral hypoxia and reduce cerebral edema.

5. Prevention and treatment of urinary tract infections. Prevention and treatment of gastrointestinal bleeding caused by stress ulcers. 6. Rational use of antibiotics to prevent and treat superinfection.

7. Reduce intracranial hypertension and apply mannitol, albumin, hormones, dried plasma and other drugs. 8 Hypothermia brain protection** (see Severe Brain Injury Hypothermia Brain Protection**). Good luck soon**.

Brain damage is caused by violence.

The mortality rate of severe trauma to the head is between 4% and 7%, and the mortality rate of severe brain injury is as high as 50% to 60%. Brain injuries can be divided into closed and open injuries.

There are two main categories, the former refers to brain tissue.

Injuries that are out of contact with the outside world are usually closed brain injuries; The latter refers to the injury of brain tissue to communicate with the outside world, and when there is a crack in the scalp and skull, and there is an overflow of cerebrospinal fluid and/or brain tissue, it is an open brain lesion. In addition, when the head is hit by a high-velocity bullet, the bullet or shrapnel can penetrate the scalp and skull and cause brain damage, which is called a firearm injury and is usually an open brain injury.

It can be conditioned by traditional Chinese medicine, and the effect is still good.