Download presentation on the topic of traumatic brain injury. Presentation on the topic: Damage to the skull and brain

PATHOGENESIS OF CRANIOBRAIN INJURY

Modern representations

MODERN CLASSIFICATION OF TRANO BRAIN INJURY

Concussion Clinic

Mild brain contusions

Moderate brain contusions

Severe brain contusions

Diffuse axonal brain injury

Fractures of the skull bones

Clinical manifestations of skull base fractures

Intracranial hematomas

Depressed fractures of the calvarial bones

Contusion lesion of the brain

Acute subdural hydroma

Diagnostic methods

Quantitative assessment of disturbances of consciousness (Glasgow Coma Scale)

Assessment of brain injury severity using the Glasgow Coma Scale

Computed tomography is the primary method for diagnosing traumatic brain injury

Echoencephaloscopy

CT scan. Magnetic resonance imaging

Overlaying diagnostic milling holes

TREATMENT OF TRANO BRAIN INJURY

Conservative treatment of mild traumatic brain injury

Conservative treatment of moderate traumatic brain injury

Conservative treatment of severe traumatic brain injury

Surgical treatment of intracranial hematomas

Surgical removal of depressed calvarial fractures

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The presentation on the topic “Medical care for traumatic brain injuries” can be downloaded absolutely free on our website. Subject of the project: life safety. Colorful slides and illustrations will help you engage your classmates or audience. To view the content, use the player, or if you want to download the report, click on the corresponding text under the player. The presentation contains 15 slide(s).

Presentation slides

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First aid for traumatic brain injuries and spinal injuries

Completed by: life safety teacher Savustyanenko Viktor Nikolaevich G. Novocherkassk MBOUSOSH No. 6

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CRANIOUS BRAIN INJURY Causes What is happening? How to recognize? What to do? Diagnosis Treatment Procedure for providing first aid to a victim of an accident Procedure for providing first aid to a victim

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CRANIOUS BRAIN TRAUMA

Treatment of victims with open and closed injuries to the skull and brain has much in common, since they almost always involve a concussion or bruise of the brain, which requires protective therapy, rest, the use of sedatives, and careful monitoring of patients, starting from the advanced stages of evacuation. Providing first aid consists primarily of preventing blood, cerebrospinal fluid or vomit from entering the respiratory tract, for which the wounded person or his head is turned to the side. An aseptic bandage is applied to the wound. At the stage of first medical aid, if necessary, the bandage is corrected and an antibiotic, tetanus toxoid, is administered intramuscularly.

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Concussion, traumatic brain injury

It would seem that there is little threat to our brain, because it is protected like no other organ. It is washed by a special liquid, which not only provides the brain with additional nutrition, but also serves as a kind of shock absorber. The brain is covered by several membranes. After all, it is securely “hidden” in the skull. However, head injuries very often result in serious brain problems for a person. All traumatic brain injuries are divided into open and closed. Open injuries are those that damage the soft tissues of the head (skin, subcutaneous tissue, fascia) and the bones of the skull. Closed injuries are somewhat less dangerous, but still unpleasant. They, in turn, are divided into concussion, contusion and compression. Among all brain injuries, concussion ranks first in frequency. Moreover, according to the observations of traumatologists, it occurs more often in women. Although, perhaps they simply seek professional help more often than men.

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A concussion can occur as a result of blows, bruises and sudden movements: acceleration or deceleration, such as a fall. The causes of concussions are usually road traffic accidents, domestic, sports and work-related injuries, as well as injuries received as a result of street fights.

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What's happening?

What exactly happens to our brain as a result of a concussion is still difficult for doctors to answer unambiguously. After all, if you examine the injured brain using computed tomography, then practically no organic disorders will be detected. Most likely, as a result of a concussion, certain problems arise with the functioning of nerve cells in the brain. At the same time, their nutrition may deteriorate, a slight displacement of the layers of brain tissue may appear, and the connection between some brain centers may be disrupted. A severe concussion can rupture blood vessels and seriously injure certain areas of the brain. The main danger with traumatic brain injuries is intracranial bleeding, since leaked blood can compress and permeate brain structures, disrupting their function and viability. In addition, injury can lead to another serious complication - cerebral edema. Particularly severe are brain injuries complicated by shock and injuries affecting the brain stem, where breathing and blood pressure are regulated.

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How to recognize?

After an injury, a person often loses consciousness. This can last from a few seconds to several minutes. The time spent in this state may be one indicator of the severity of the concussion. The extreme degree of loss of consciousness is coma. When a concussion occurs, a person often does not understand where he is, what happened, and has difficulty recognizing the people around him. Another important indicator by which one can judge the severity of brain damage is memory loss: whether a person remembers the moment of injury, and if not, how much of the time before the injury has disappeared from his memory. The greater the memory loss, the more serious the injury. When the victim comes to, he may feel sick and vomit. He often turns pale, feels dizzy and has a headache, there is noise in his ears, it is difficult for him to focus his eyes, his breathing becomes rapid, and his pulse jumps. In the first hours after a concussion, the victim’s pupils are dilated or constricted - a traumatic brain injury of any severity leads to disruption of the nerve pathways responsible for the functioning of the eyes. Surely in the movies you have seen more than once how, when examining an unconscious person, a doctor directs a flashlight beam into the victim’s eyes. This is done to determine the reaction of the pupils. With a mild concussion, the pupils react to light, but sluggishly, and with a severe concussion, there is no reaction at all. In this case, the dilation of only one of the pupils and the lack of reaction in the second is a formidable symptom and may indicate severe damage to one of the hemispheres of the brain.

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What to do?

If you suspect a concussion, you must provide first aid to the victim. First, you need to provide the person with complete peace, put him on the bed in a quiet, darkened room. It is better to raise your head slightly. It is very useful to apply cold compresses to the head. Drinking a lot if you have a concussion is not recommended. If the victim is thirsty, make him sweet tea. Alcohol is strictly contraindicated for him! And, of course, be sure to call a doctor, since it is possible that the brain damage is more severe than it seems at first glance. If the patient is in shock, carefully monitor his breathing and blood pressure before the ambulance arrives. In emergency cases, begin artificial respiration and chest compressions.

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If you have a concussion, you should consult a traumatologist. He will examine and interview the patient, check reflexes, prescribe an X-ray of the skull, and if more complex brain damage is suspected, refer him for a consultation with a neurologist. There, the patient will undergo a full-scale examination: electroencephalography (EEG), echoencephalography, computed tomography or magnetic resonance imaging of the brain, Dopplerography of cerebral vessels, and spinal puncture. An MRI of the spine may be needed to rule out spinal problems.

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Patients with a concussion should remain in bed for at least several days. However, you cannot read, listen to loud music or watch TV. It is necessary to follow all the doctor’s instructions and carefully take the medications prescribed by him. In case of a concussion, the general condition of the victims usually normalizes during the first, less often, the second week after the injury. It must be remembered that a person who has suffered even a mild concussion may develop post-traumatic neurosis or other more serious complications, such as epilepsy. Therefore, some time after recovery, you should definitely visit a neurologist and undergo electroencephalography. Treatment for more serious traumatic brain injuries depends on their severity. In some complicated cases, the help of neurosurgeons may be required.

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Procedure for providing first aid to a victim of an accident

In most cases, road traffic accidents occur far from medical facilities and you have to wait a long time for an ambulance. It is this circumstance, as well as the fact that drivers can be useful to victims before others, that obliges them to be able to provide first aid, that is, carry out the simplest emergency measures to save the lives of victims. Drivers of cars and other vehicles, both those involved and not involved in a traffic accident, but who are nearby, are obliged to immediately stop and provide assistance to those in need. Failure to provide assistance to a person in a life-threatening condition is punishable by law. The sequence of actions when providing assistance to victims should be as follows.

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Procedure for providing first aid to the victim

1. Organizing an ambulance call. 2. Extracting victims from a broken car. Traffic accidents on the roads are often accompanied by complex fractures, traumatic brain injuries, and spinal injuries. The victim may have several injuries at once. Therefore, you should take it out of the car very carefully. You cannot pull or bend his torso, arms or legs, or pull them out by force. We must first try to eliminate everything that holds the victim back. If a person has lost consciousness and is in an unnatural position, two or three people need to carry him out of the car, trying not to change this position. Special attention should be paid to victims if a spinal fracture is suspected; do not move them unless absolutely necessary, as this can cause paralysis. Such a person must be placed on his back or stomach in such a way that the injury site is not infringed. 3. Providing first aid. When removed from the car, you need to loosen your tie, unfasten your collar and belt so that breathing does not become difficult. For fractures and dislocations of the limbs, it is necessary in all cases to apply splints, and in their absence, fix them with improvised objects (boards, sticks); If the victim experiences bleeding, measures should be taken to temporarily stop it. First aid should be provided quickly and not cause unnecessary pain to the victim. 4. Transportation of victims to a medical facility. When everything possible to save the victims at the scene has been done, but an ambulance cannot be called or it is clear that it will arrive late, care must be taken to transport the victims to the nearest medical facility. You must act with the same caution and attention as when removing them from an emergency vehicle.

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When it becomes necessary to lift the victim, you should use the following methods: kneel on the side of the victim, place your hands under the shoulder blade, head, neck and lift him; kneel at the head of the victim, place your hands under the shoulders and lift him up. Under no circumstances is a victim allowed to move independently if the lower extremities, skull, or thoracic or abdominal organs are damaged. If it is necessary to transfer the victim on a stretcher, he is placed carefully, without shaking and in a position comfortable for him. The stretcher is placed next to the victim on the side of the injury. Two people stand next to the patient on one knee, one of them puts his hands under the head, neck and back, the other - under the sacrum and legs. A third person moves a stretcher under the victim. You need to lift the stretcher carefully and at the same time, be sure to walk in step, in short steps, slightly bending your knees. The person walking in front is obliged to warn the person behind about all obstacles on the road. When climbing uphill, the victim is carried head first, when descending from the mountain - feet first, with the exception of cases of damage to the lower extremities. You should always try to keep the victim horizontal. Transportation, depending on the nature of the injury, is carried out according to the following rules: in case of fractures of the skull bones, injuries to the head and brain, in case of fractures of the spine and pelvic bones, the victim is transported only in a horizontal position; for fractures of the ribs and collarbones, transportation in a sitting position is most painless, but when the victim cannot sit, transportation is carried out on a stretcher, giving him a semi-sitting position; for chest injuries, the victim is placed on the wounded side or on the back in a semi-sitting position; when the neck is wounded from the front, the victim is given a semi-sitting position with the head tilted to the chest in the direction of the wound; in case of abdominal wounds and internal bleeding, the victim is placed on his back, a pillow or other object replacing it is placed under the knees and sacrum; in case of fainting, the victim is placed so that his head is lower than his legs.

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It is necessary to provide for all the features of the upcoming transportation: its distance and quality of the road, frost and bad weather, the nature of the injuries received, the condition of the victim; take care that it does not deteriorate as a result of transportation. In all cases, take measures to prevent and combat traumatic shock. If there is a large hospital or clinic relatively nearby, it is better to take the victim directly there, bypassing even the nearest medical center. If it is far from a large medical facility, the wounded person should be taken to the nearest medical facility. Upon arrival, do not take him out of the car, but ask medical workers to approach the victim to examine him and decide on further actions. Never leave the wounded unaided and send them without an accompanying person, who may be required to provide the necessary assistance along the way. In addition, through his behavior and conversations, he must strengthen the victim’s confidence in the successful outcome of the incident.

A brain contusion is a traumatic brain injury in which brain tissue is damaged and is characterized by the presence of a focus of necrosis of nervous tissue. Damage after injury can be unilateral or bilateral. The most common sites of damage are in the occipital, temporal and frontal lobes of the brain. Classification of traumatic brain injury: concussion – 80 – 90%; brain contusion – 5 – 12%; compression of the brain – 3 – 5%.

Causes of occurrence Injury can be obtained as a result of a road traffic accident, injury at work and at home, beatings and beatings, falling from a height, often falling from balconies and windows while intoxicated, during an epileptic attack, diving, falling on the head of heavy objects, during rubble in mines, caves, military operations. Brain damage due to a fracture of the cranial vault.

Symptoms of a brain contusion In general, symptoms that depend on the severity of the injury include the following: loss of consciousness; headache, dizziness; retrograde amnesia; lack of coordination; nausea and vomiting; changes in consciousness; dysfunction of vision, speech and hearing; dilated pupils; violation of the swallowing reflex; low heart rate; weak, rare breathing; increased blood pressure; loss of sensation in body parts; loss of control over bowel movements and urination; bloody discharge from the nose and ears; paralysis; coma.

Degrees of brain contusion The severity of brain contusion is determined by the severity of certain clinical manifestations of this condition. A mild degree of brain contusion is characterized by the presence of symptoms that are similar to those of a concussion. However, they are more pronounced. As a rule, in all cases, complete recovery occurs. The average degree of injury is manifested by loss of consciousness, which can vary in duration. Vomiting, headache, and changes in the respiratory and cardiovascular systems appear. The greatest danger to health and life is a severe degree of brain contusion.

Severe brain contusion Severe brain contusion is a life-threatening condition. It is characterized by a comatose state that lasts several hours; the person may be in a state of psychomotor agitation, which is abruptly replaced by a decadent mood. Depending on the location of the lesion in the brain tissue, focal symptoms appear, which are characterized by disruption of swallowing processes, the functioning of the respiratory and cardiovascular systems, convulsive syndrome, etc.

First aid for a head injury You must call an ambulance. The victim should be helped to lie on his side to prevent vomit from entering the respiratory tract. It is better to raise your head slightly. It is very useful to apply cold compresses to the head. Drinking a lot if you have a concussion is not recommended. If the victim is thirsty, make him sweet tea. In case of vomiting, it is necessary to empty the oral cavity of vomit, help rinse the mouth, and provide fresh air access to the room. In case of injuries to the soft tissues of the skull, it is necessary to apply a sterile bandage. Sometimes, with minor head injuries, small arteries are damaged, which can lead to massive blood loss. In this case, it is necessary to stop the bleeding. This can usually be done well by pressing the skin against the skull with your fingers in the area of ​​the bleeding vessel, after which a tight sterile bandage with a roller should be applied to this place. In some cases, the cervical spine is immobilized with a rigid collar or improvised material. This is due to the fact that head injuries can often be combined with damage to the cervical spine. For intense headaches, analgesics are used: up to 4 ml of a 50% solution of metamizole sodium intramuscularly or intravenously, 2 ml of ketorolac (30 mg in 1 ml) intramuscularly, etc. Giving tablet forms of analgesics is acceptable in the absence of nausea and vomiting. It is not recommended to use narcotic analgesics for pain relief, as they can depress breathing. The use of analgesics is unacceptable in the presence of concomitant abdominal trauma (it complicates diagnosis); it is inappropriate in patients with deep depression of consciousness. For vomiting and severe nausea, administer 2 ml of metoclopramide solution intramuscularly. Its use is unjustified in case of severe injury, since it depresses the respiratory center. As an antiemetic, you can use 2 ml of a 2% solution of platyphylline hydrotartrate intramuscularly. If possible, the victim is given oxygen inhalations, which prevents oxygen starvation of the brain and its swelling. And, of course, you should definitely call a doctor, since it is possible that the brain damage is more severe than it seems at first glance.

Prevention and protection measures. There is no specific prevention. In a broader sense, the prevention of traumatic brain injury is: In case of an accident, compliance with traffic and safety rules. In case of sports injury, this is training athletes to fall, wearing protective equipment, training (in boxing and hand-to-hand combat) methods of passive and active protection from blows. In the event of a work injury, this means following safety regulations.

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Traumatic brain injury is damage caused by mechanical energy to the skull and intracranial contents (brain, meninges, blood vessels, cranial nerves).

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Traumatic brain injuries are the most common among all types of injuries (45%). Among the causes of traumatic brain injuries, the first places are occupied by domestic and road traffic injuries. Traumatic brain injury, as a cause of death, is in first place among people aged 20 to 40 years, so the problem is not only medical, but also social.

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PATHOGENESIS OF CRANIOBRAIN INJURY

History of the issue The term “concussion” was first introduced by Hippocrates. I. Petit in 1774 identified three main forms for traumatic brain injury: concussion, bruise and compression (commotio, contusio, compressio).

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I. Petit put forward the theory of “molecular vibrations”. He believed that trauma causes vibration of nerve elements and molecular changes in brain cells, which causes disruption of its function as a whole.

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E. Bergmann (1880) assumed that in case of brain injury, the damaging force is concentrated at the junction of the brainstem and hemispheres. He compared the brain to a mushroom, in which, when injured, the massive cap (the cerebral hemispheres) is displaced, and the thin leg (the medulla oblongata) is bent and twisted.

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Modern representations

1. Pressure gradient theory When an injury occurs, the brain accelerates, which leads to high pressure on the side of the impact. At the opposite pole, low (negative) pressure occurs.

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In the brain tissue located in the negative pressure zone, cavities and gas bubbles of various sizes (cavitation) are formed. The negative pressure lasts for a very short time (within a millisecond), gas bubbles burst, resulting in damage to capillaries and brain tissue.

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2. Rotation theory In an experiment on monkeys in which the cranial vault was replaced with a transparent material, using high-speed filming, it was established that severe head injury leads to complex rotational movements of the brain simultaneously in 2 - 3 planes (horizontal, sagittal, vertical). Rotational movements are mainly manifested in the cerebral hemispheres, and the fixed brainstem sections are injured due to their twisting.

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The pathogenetic mechanisms of all types of traumatic brain injuries are divided into three main groups. 1. Acceleration injury (diffuse) - occurs when the head hits a large mass, a wide plane, or this mass hits the skull at different speeds. The skull and its contents gain speed. Damage occurs predominantly on the opposite side (like a counter-impact).

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2. Impression (local) injury - when a small object (stone, stick, hammer, etc.) hits the head. The skull, due to its elasticity, bends upon impact, then the depressed area straightens. In this case, the bone can crack and a linear fracture of the cranial vault is formed. Negative pressure develops under the impact site, causing brain damage to occur. More severe local trauma leads to a depressed fracture of the skull bones.

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3. Compression injury occurs when a gunshot passes through the skull. In this case, intracranial pressure can reach 20–40 atmospheres, which leads to the destruction of brain tissue and the skull.

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MODERN CLASSIFICATION OF TRANO BRAIN INJURY

Traumatic brain injury is divided into two main types - closed and open. Closed craniocerebral trauma should include injuries in which there are no violations of the integrity of the skin and the aponeurosis of the cranial vault.

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An open traumatic brain injury consists of injuries in which there are injuries to the soft tissues of the head, including the aponeurosis. Fractures of the base of the skull, accompanied by leakage of cerebrospinal fluid from the nose or ear, indicate a violation of the tightness of the skull and also belong to open injuries.

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In the Russian Federation, a classification of closed craniocerebral injury is used, according to which the following forms are distinguished: concussion; mild, moderate and severe brain contusion; diffuse axonal brain damage; compression of the brain due to a bruise and without an accompanying bruise.

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Concussion (commotio cerebri) is the mildest and most common type of closed head injury. Patients with concussion account for 75-80% of all hospitalized patients.

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According to electron microscopy, this type of injury is characterized by only minor changes in cell membranes and intercellular contacts of nerve cells. A concussion is not divided into grades and is a functional, reversible injury to the nervous system.

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Concussion Clinic

The leading ones are three syndromes: cerebral, vegetative and neurotic. The cerebral syndrome is manifested by impaired consciousness (stunning or short-term loss for a few seconds), headaches, dizziness, and vomiting.

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Neurotic syndrome is manifested by general weakness, apathy, drowsiness, sleep disturbance, appetite, irritability, sometimes euphoria, and decreased criticism of one’s condition.

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Vegetative syndrome is manifested by hyperhidrosis of the palms, pallor or hyperemia of the skin, and impaired dermographism. There is instability of blood pressure, lability of pulse, attacks of chills, fever.

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During their hospital stay, patients must undergo vegetative tests (once every 2-3 days). This is done to objectify the diagnosis and identify the dynamics of the pathological process. An orthostatic test is used - measuring the patient's pulse rate in a horizontal position and then standing. Normally, the heart rate should not exceed 20 beats per minute.

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Regression of cerebral symptoms and normalization of autonomic tests indicate clinical cure of concussion. The duration of clinical manifestations usually does not exceed 5-7 days.

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Brain contusions (Contusio cerebri) are distinguished by the predominance of irreversible morphological changes in the area of ​​concussion foci.

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Subarachnoid hemorrhage always accompanies a brain contusion, since inevitable damage to the vessels of the pia mater at the site of contusion leads to blood entering the cerebrospinal fluid.

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Mild brain contusions

Focal symptoms are caused by damage to the cortical parts of one hemisphere of the brain. Mild motor disturbances are noted in the form of asymmetry of reflexes and pathological foot signs on one side.

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Due to subarachnoid hemorrhage, cerebral, autonomic and neurotic disorders are more pronounced than with a concussion. Meningeal syndrome is added: rigidity of the neck muscles, Kernig's and Brudzinski's symptoms, photophobia, pain when moving the eyeballs. The duration of clinical manifestations is usually 2-3 weeks.

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Moderate brain contusions

They are characterized by the appearance of foci of damage to the basal parts of the cerebral hemispheres and the convexital surface of the brain. This type of brain injury is diagnosed in 100% of patients with basal skull fractures.

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Clinic: Prolonged loss of consciousness (from a few seconds to 1-2 hours). General cerebral symptoms are expressed. Psychomotor agitation, euphoria, and mental disorders may occur. Rough focal symptoms. When the central gyrus is damaged, motor and sensory disorders of the hemitype occur.

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In cases of fractures of the base of the skull, lesions of the cranial nerves occur, most often the VIII, VII, II, III, VI nerves. The duration of clinical manifestations is 3-6 weeks. Persistent focal symptoms of damage to the nervous system may remain, which leads to disability of patients.

Slide 30

Severe brain contusions

They are characterized by the occurrence of foci of contusion not only in the cortex and basal parts of the brain, but to a greater extent by damage to the stem parts of the brain and the diencephalic region.

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Clinic: From the moment of severe injury, the victims are in a comatose state. The duration of loss of consciousness can be from several days to several weeks or months. Central respiratory disorders immediately occur, which are quickly joined by peripheral respiratory disorders.

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Severe autonomic, oculomotor and bulbar disorders. Tetraparesis, changes in muscle tone, bilateral pathological reflexes.

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Diffuse axonal brain injury

More common in children and adolescents. Pathomorphological changes - tension and rupture of axons in the white matter of the hemispheres and the brain stem.

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Clinic: prolonged coma, severe increase in muscle tone (hormetonia), autonomic disorders.

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Fractures of the skull bones

Brain contusions in 20 - 35% of cases are accompanied by fractures of the bones of the vault and base of the skull.

Slide 36

Fractures of the bones of the cranial vault are: open (damage to the soft tissue in the area of ​​the bone fracture); closed (soft tissues are not damaged); penetrating (with damage to the dura mater); non-penetrating (dura mater remains intact).

Slide 37

Linear fractures are the most common type of injury to the skull bones.

Slide 38

Depressed fractures are impression (A) - funnel-shaped depression of fragments, depression (B) - uniform depression of the entire fragment.

Slide 39

Clinical manifestations of skull base fractures

Fracture of the anterior cranial fossa The symptom of “glasses” is hemorrhage into the periorbital tissue, which appears several hours or days after the injury.

Slide 40

Nasal liquorrhea is the leakage of cerebrospinal fluid from the nose. To detect the presence of cerebrospinal fluid in bloody fluid, the symptom of a “blurring spot” on a gauze napkin is used.

Slide 41

Fracture of the middle cranial fossa: bleeding and liquorrhea from the ear; on the side of the fracture, the functions of the vestibulocochlear and facial nerves are lost (deafness, paresis of facial muscles); hemorrhage under the temporalis muscle.

Slide 42

Posterior fossa fracture: Hematoma under the aponeurosis behind the mastoid process.

Slide 43

Compression of the brain Can be caused by: Intracranial hematoma (epidural, subdural, intracerebral, intraventricular). Depressed fracture of the bones of the cranial vault. A contusion lesion that causes swelling and displacement of the brain. Subdural hydroma.

Slide 44

Intracranial hematomas

An epidural hematoma is a limited collection of blood between the outer surface of the dura mater and the bones of the skull.

Slide 45

The source of an epidural hematoma is a damaged branch of the meningeal arteries. Most often, the middle meningeal artery ruptures.

Slide 46

A subdural hematoma is an accumulation of blood under the dura mater. It occurs, most often, when the veins running from the surface of the brain to the venous sinuses are damaged.

Slide 47

An intracerebral hematoma is formed when blood vessels are damaged in areas of contusion and crushing of the brain.

Slide 48

Clinic: First, compensation for compression of the brain occurs due to the displacement of cerebrospinal fluid from the ventricles and subarachnoid fissures of the brain. This is manifested by an asymptomatic period after injury - the so-called “lucid interval”

Slide 49

A further increase in intracranial pressure causes displacement (dislocation) of the brain under the falciform process, into the notch of the cerebellar tentorium, into the foramen magnum.

Slide 50

Brain dislocation is manifested by: paresis of the limbs (mono- or hemiparesis) on the side opposite to the hematoma; dilation of the pupil on the side of the hematoma; bradycardia; epileptic seizures.

Slide 51

If the victim has a combination of any three of the listed signs (for example, “light gap”, bradycardia, focal epileptic seizure), the probability of diagnosing an intracranial hematoma reaches 90%.

Slide 52

Depressed fractures of the calvarial bones

Clinic: General cerebral symptoms characteristic of brain contusion. Symptoms corresponding to focal brain damage due to deep penetration of fragments

Slide 53

Contusion lesion of the brain

A large area of ​​destruction of the brain substance, imbibed by the blood, causes swelling and dislocation of the brain. The clinical picture is similar to that of an intracranial hematoma.

Slide 55

Diagnostic methods

Clinical examination: History (mechanism of injury, duration of loss of consciousness, presence of a “light gap”) Objective examination (damage to the soft tissues of the head, skull bones, etc.) Neurological examination

Slide 56

Quantitative assessment of disturbances of consciousness (Glasgow Coma Scale)