Synonym
Craniocerebral injury (SHV), SHT
- Commotio (concussion)
- Contusio (brain contusion)
- Severe trauma to the skull and brain
Concussion of the brain causes a disturbance of consciousness with nausea and vomiting. Neurological failures do not occur, and there may be only slight memory loss for events before and after the trauma. As a rule, commotio heals without consequences.
The cerebral contusion or squeezing results in an initial loss of consciousness. The patient is usually awake and oriented again after 24 hours. In severe craniocerebral traumas, the disturbances of consciousness last longer than 24 hours, because the brain tissue is damaged.
The assessment of the patient is mainly based on his state of consciousness. The international standard for this is the so-called Glasgow-Coma-Scale (GCS). It is a point system for the three most important reactions of a person: Eye opening, verbal response and motor response (movements).
The highest possible score is 15 points, the minimum is 3 points. The reaction of the pupils and their width, as well as muscle tone are also taken into account for evaluation. The breathing pattern allows certain conclusions to be drawn about the location of the damage.
In addition to GCS, there are imaging procedures that confirm the diagnosis of a basal skull fracture such as:
- CT of the head
- X-ray of the head
- MRI of the head
There are two different types of craniocerebral trauma: covered and open craniocerebral trauma. The classification criterion is an intact or injured meninges. The human brain and spinal cord are surrounded by meninges.
In the case of craniocerebral trauma, the outermost meninges, the so-called hard meninges (med. : dura mater) are the most severely affected. If the dura mater is intact, it is called a covered craniocerebral trauma, whereas if it is injured, it is called an open craniocerebral trauma.
Muted SCT can be divided into 3 different subgroups, which are already described above. A craniocerebral trauma (SHT) is called “open” if the hard meninges (dura mater) are injured and therefore cerebrospinal fluid (liquor) can leak. Such a SCT is accompanied by a fracture of the skull bone.
The problem here is not so much the cerebrospinal fluid flow as the entry port for bacteria into the brain. If the cerebrospinal fluid is able to escape, bacteria and viruses can also enter the body in the same way. This can cause serious infections.
- Commotio: The most important symptom here is the disturbance of consciousness immediately following the brain trauma, which lasts only briefly (seconds to minutes). This is accompanied by nausea and vomiting.
- Contusio: The difference to concussion (Commotio) is the fact that imaging (e.g. CT) shows damage to the brain substance. In addition, the disturbance of consciousness lasts much longer with days to weeks.
- Compressio: Here, for example, there may be bleeding in the brain substance, but also blood accumulation around the brain (under or between the different meninges).
Covered SHT: Questioning the patient provides information on the cause of the injury.
An examination of the skull by means of CT (computer tomography) shows any damage to the brain substance. Depending on the results the classification (Commotio, Contusio etc.) is made.
Open SHT: The detection of cerebrospinal fluid (leakage of cerebral fluid) can be extremely difficult. It is helpful to mark the cerebrospinal fluid with dyes or to detect glucose (quick test on the ward) in the fluid that may be leaking. Important, however, are the X-ray images in the CT.
Here, bone fractures can usually be easily detected. Of course, questioning the patient – if possible – is another important parameter. The therapy depends on the form and extent of the craniocerebral trauma.
Covered SHT: If there is only a concussion, there is usually no acute need for action. However, this may well occur within the next few hours. A CT must be ordered for any change in consciousness.
In the case of a cerebral contusion, conservative treatment, monitoring of the patient and possibly neurosurgical intervention are intertwined. Open SCT: In the case of open craniocerebral trauma, in addition to the surgically necessary measures not only to close the skull and repair fractures but also to relieve bleeding, antibiotic therapy is at least as important. In this way, ascending infections such as meningitis or meningitis are to be prevented.The prognosis, like the therapy, depends on the severity of the damage.
A cerebral concussion (commotion) heals without consequences, since the brain substance was only slightly affected. There are no neurological deficits. Complications such as secondary bleeding, infections or wound healing disorders are extremely rare.
There is a small number of deaths after craniocerebral trauma. These are caused by cerebral hemorrhages. However, substantial brain damage occurred in the case of a cerebral contusion.
The neurological deficits that existed at the beginning usually recede completely. The situation is different with severe or open SHT. It is difficult to make a general prognosis here.
Every patient recovers differently well from injuries of varying severity in the area of the skull and brain. However, a considerable impairment can be assumed. Some patients succumb to their injuries. Under the following topic “Skull fracture” you will also find helpful information that might be of interest to you.