Compressio cerebri is the term used to describe a cerebral contusion. It represents a 3rd-degree traumatic brain injury.
What is compressio cerebri?
Compressio cerebri is the medical term for a severe form of traumatic brain injury (SHT). In this case, the brain is bruised by internal or external pressure due to swelling or bleeding in the brain. Medical professionals also refer to this as 3rd-degree traumatic brain injury, which scores 3 to 8 on the Glasgow Coma Scale. Other forms include concussion (commotio cerebri), which is 1st-degree traumatic brain injury, and cerebral contusion (commotio cerebri), also called 2nd-degree SHT. In addition to cerebral contusion, minor bleeding is also possible. It is considered typical for a compressio cerebri that injuries do not occur exclusively at the site of the violent impact, but also in the areas located on the opposite side. It is not uncommon for additional injuries to occur with a cerebral contusion. Basically, craniocerebral traumas such as compressio cerebri are among the relatively common injuries. In Germany, approximately 250,000 citizens suffer a traumatic brain injury every year. In about five percent, there is a severe cerebral contusion, which can result in a permanent coma or even lead to death in the worst case.
Causes
The brain is surrounded by the skull bone, which serves to protect it. The anterior portion of the skull is composed of the upper jaw, lower jaw, and bony nasal and eye sockets. The largest section of the brain is enveloped by the posterior cranium. On its underside, the brain is surrounded by the base of the skull. Here, there is an opening that acts as a passage for the spinal cord. If these structures are affected, it is called a traumatic brain injury. Most of the people affected suffer a traumatic brain injury or a compressio cerebri as a result of an accident. In most cases, these are falls during sports activities in which the injured person is not wearing a protective helmet, such as skiing or cycling. However, a cerebral contusion can also be suffered in the course of risky work activities. In addition to blunt force trauma such as falls and blows to the head, piercing of the skull bone by sharp objects is also possible. About one-third of all traumatic brain injuries are the result of traffic accidents. About 30 percent of all patients have additional injuries, which physicians refer to as polytrauma.
Symptoms, complaints and signs
In the case of a compressio cerebri, the symptoms of the injury are more severe than in the case of a concussion or brain contusion, but basically correspond to their symptoms. The unconsciousness that occurs lasts for at least 60 minutes and can sometimes even last for several days. Unconsciousness is caused by entrapment of the brain due to bleeding or edema. Furthermore, the affected person suffers memory lapses that, as in the case of concussion, are not limited to the phase immediately after the injury, but also extend to the time before the accident, which is referred to as retrograde amnesia. Furthermore, symptoms such as hemiparesis (hemiplegia), psychological changes or speech problems may occur in the context of a brain contusion. If there is a permanent increase in pressure and entrapment of the brain, there is a risk of prolonged coma. In the worst case, death may also occur. There is also a risk of chronic injury to the brain, although this does not occur in every case. In compressio cerebri, it is not uncommon for the patient to suffer other injuries. These include skull fractures or a subdural hematoma (bruise below the meninges).
Diagnosis and course
Compressio cerebri is diagnosed using the Glasgow Coma Scale (GCS). It forms a scoring system that includes the three main human responses. These are eye opening, movements, and verbal communication. The highest score on the GCS is 15 points, while the minimum is 3 points. Brain contusion is said to occur when a score between 3 and 8 points is reached. Also of importance are the reactions of the pupils and the muscle tone.The most important examination methods for a traumatic brain injury include imaging procedures such as X-rays of the head and a computer tomography (CT) scan, which can be used to determine damage to the tissue, bleeding foci and signs of intracranial pressure. Sometimes magnetic resonance imaging (MRI) of the head is also useful. The course of a cerebral contusion depends on its extent. Thus, in compressio cerebri, there is substantial damage to the brain. In most cases, however, the neurologic damage recedes completely.
Complications
In most cases, compressio cerebri results in a relatively long period of unconsciousness that lasts at least an hour. Complications can occur primarily when compressio cerebri has occurred as a result of an accident or blow to the head. However, these then depend on the exact accident. Often, bleeding on the head or even internal bleeding occurs. It is not uncommon that after the accident the patient can no longer remember what happened shortly before. This can especially prevent the reconstruction of the course of the accident. Due to the contusion, paralysis and dysfunction of various areas of the body may occur. Likewise, mental problems occur, such as speech disorders or word-finding disorder. In the worst case, the patient is paralyzed and can no longer move independently. If the brain has become too trapped, unconsciousness may progress to coma, eventually leading to death. Treatment is usually symptomatic, primarily treating pain. If the patient cannot remember what happened in the accident, he or she is usually monitored further and all functions of the body are tested. Certain paralyses or other disorders are treated therapeutically. No further complications occur in the process. However, there is no guarantee that the symptoms can be completely treated.
When should you see a doctor?
In the event of compressio cerebri, the emergency physician must be called immediately. Visible skull fractures and loss of consciousness are clear signs that a severe traumatic brain injury has occurred. Only a medical professional can determine whether the injury is a brain contusion or otherwise. Therefore, the following applies: after an accident or a fall, immediately alert the rescue service and provide first aid if possible. The injured person must be treated as quickly as possible and then taken to a hospital, where the brain contusion can be clarified and intensive medical treatment provided. If complications arise during recovery, the nursing staff or doctor must be called in immediately. If the affected person suffers memory lapses, therapeutic help must be called in. Further measures must also be taken in the event of speech problems or psychological changes in order to limit complications as far as possible. In the case of severe complications such as hemiplegia, support should be sought at an early stage. The relatives or the affected person himself must also arrange for physiotherapy measures and seek support in everyday life.
Treatment and therapy
Treatment of compressio cerebri also depends on the extent of the injuries. While a few days of bed rest are usually sufficient for a mild concussion, the patient must go to the hospital for a cerebral contusion. In case of unconsciousness, vital functions such as circulation and breathing are secured. If there is an open craniocerebral trauma, surgical intervention is required, which also applies to some extent to cerebral hemorrhages and skull fractures. Close monitoring of the patient for several days is also important. If the clouding of consciousness persists for a longer period of time, the patient is sometimes treated in the intensive care unit. If there is a risk of cerebral edema, draining drugs must be administered. For further treatment of compressio cerebri, admission to a specialized clinic is considered advisable. There, specialists, specialized occupational therapists, speech therapists, and physical therapists can be consulted.
Outlook and prognosis
The prognosis of compressio cerebri depends on several factors. The severity of the injury as well as the present cause is decisive for a successful healing. In addition, there is the age of the patient and the duration of unconsciousness experienced.In many cases, the extent of the compressio cerebri is only clear after several years. Trends can be given by the treating physicians shortly after the onset of the cerebral contusion. However, all permanent damage is only clear after 2-3 years. Due to medical progress, various therapy methods have been developed in recent years that contribute to a significant improvement in health. Thus, with regular exercises and targeted methods, relief of the intensity of paralysis or gait insecurity can be achieved. There is a possibility with Compressio cerebri that permanent impairments may occur. These have a strong impact on the quality of life and often lead to a restructuring of everyday life and occupation. The longer unconsciousness was present, the more unfavorable the further development often is. If there were disturbances in breathing, this also plays a significant role in the possibility of recovery. The disease triggers a stressful experience as well as excessive demands in many patients. The prognosis worsens as soon as a psychological disturbance occurs.
Prevention
The best preventive measure against traumatic brain injury or compressio cerebri is to wear a protective helmet. This should be used especially by high-risk groups such as inline skaters, cyclists, motorcyclists, and climbers.
Aftercare
Aftercare is particularly important for a compressio cerebri, or brain contusion, resulting from a traumatic brain injury. First and foremost, professional acute treatment of the severe symptoms is needed. The question is whether the patient can survive the serious consequences of the brain contusion at all. Compressio cerebri is the result of a severe, often accidental traumatic brain injury or increased intracranial pressure due to other causes. Permanent coma is possible with particularly severe traumatic brain injury. Many affected persons cannot be saved in the case of severe compressio cerebri. They die of the consequences. In these cases, follow-up care takes care of itself. In the case of survival in a coma, extensive treatment and care measures are necessary as long as the patient survives. In five percent of all cases of traumatic brain injury, this is the case. Polytrauma is often present. This complicates treatment as well as follow-up care. Depending on the patient’s condition, follow-up care for compressio cerebri can be very extensive. In many cases, medically trained personnel are required to place follow-up care in professional hands. Physical therapy, speech therapy, or respiratory therapy are possible interventions. Often, the necessary aftercare measures for severe compressio cerebri can only be provided in the clinical setting. Complications may occur even after acute treatment and must be treated promptly.
Here’s what you can do yourself
When there is damage to the brain, the options for self-help are limited. Nevertheless, the affected person can make sure that he does not expose his head to jerky movements, if possible. Fast twisting movements, hopping, jumping and also running should be avoided. To ensure that brain swelling recedes as quickly as possible, vibrations of the head of any kind should be reduced or completely prohibited. Sports activities can be limited until recovery is achieved. Participation in ball sports should not take place under any circumstances. When driving a car or bicycle, a quiet and very sunny driving style should take place to avoid full braking or vibrations triggered by bumps in the road. The head should be relieved as often as possible and should only be exposed to slow movements. Taking regular breaks and resting the head will aid the healing process by helping to relieve stress. Strenuous cognitive loads should also be avoided. Arguing, intellectual tasks or stress increase brain activity and thus stimulate blood flow as well as supply to the nerves. It is also advisable to avoid subjecting the sensory systems to heavy loads. Reading in dim light or listening to loud music leads to increased activity of muscles, nerves and brain areas involved in processing. Relaxing and calming environmental influences, on the other hand, are helpful.
