Craniocerebral Trauma
If in the course of an injury (usually caused by an accident) both the cranial bone and the brain are affected, the specialist speaks of a craniocerebral trauma (SHT). Depending on whether the violent impact breaks through the outer meninges (dura mater) or not, it is either a more serious open SCT or a covered trauma. A further distinction is made as to whether the violence directly injures the brain (direct damage), or whether the brain is put into distress by bleeding or swelling as a result of the injury.
Depending on an evaluation of the state of consciousness of the SHT patient using the so-called Glasgow Coma Scale (GCS), at which a maximum of 15 points can be achieved, the clinician assesses the severity of the SHT. A GCS score of 13-15 points corresponds to an SHT grade 1 (concussion), no permanent brain damage is to be expected. A GCS score of 8-12 points corresponds to a brain contusion (SHT grade 2).
Longer unconsciousness and more pronounced symptoms than with a concussion are typical. Below 8 points on the GCS scale indicate a so-called brain contusion (SHT grade 3). In order to be able to at least partially heal the resulting severe injuries to the brain, the affected person often remains unconscious for weeks. A complete restoration of all brain functions is possible, but very unlikely.
Skull MRTMRT of the head
Magnetic resonance imaging of the skull, also known as magnetic resonance imaging, is a radiation-free imaging procedure that is used in medicine primarily to assess soft tissue structures. Compared to the CT method, which also provides sectional images, but uses X-rays and, above all, provides better images of bony structures, the MRI is louder, more expensive and takes much longer (for example, 10 to 30 minutes for an MRI of the skull). In emergencies, therefore, an MRI image of the head is generally not needed.
For other questions concerning (possible) diseases of the skull or the interior of the skull, especially concerning the soft tissue, where there is no such time pressure, an MRI examination is often the imaging method of choice. In addition to its increased informative value, this can be explained above all by the fact that it does not use X-rays or other ionizing (and thus potentially carcinogenic) radiation. However, since the examination requires the patient to lie still for many minutes in a very loud, narrow tube, the MRI of the head is perceived by some as unpleasant.
The magnetic resonance tomograph works with rapidly changing, strong magnetic fields, which in the body mainly orient hydrogen nuclei in one direction, such as a large comb. If these then jump back into their original alignment, a small electromagnetic pulse is generated and measured. Depending on how and how much hydrogen is bound in a tissue, this so-called resonance signal varies in strength and time delay for “combing”, resulting in image contrast.
Depending on the weighting of the signals, either fat-rich or water-rich tissue appears bright in the image. An additional venous administration of contrast medium, in this case gadolinium, can further increase the information content of an MRI image series. Especially when searching for tumorous tissue or inflammation foci, a so-called additional contrast agent sequence is of inestimable diagnostic value.Frequent indications for a cranial MRI are therefore the suspicion of a tumorous event (such as a tumor of the brain or metastases from an original tumor located elsewhere) and the suspicion of an inflammatory process (such as in multiple sclerosis).
