Craniocerebral trauma

Trauma to the skull and brain can result in deathor severe permanent damage to an individual. They occur independently or are part of polytraumas. The most common are traffic, industrial and sports injuries.

Mechanisms of craniocerebral trauma
Two basic physical mechanisms apply to head injuries:


 * A translational head injuryoccurs when the head hits an object. There will be a mutual transfer of kinetic energy..


 * An acceleration head injury occurs without a direct impact of the head on another body. We distinguish between linear and rotational acceleration injury.

Classification of craniocerebral trauma

 * Primary craniocerebral trauma

They arise immediately in connection with trauma.


 * Fractures of the skull;
 * brain injury:
 * concussion (concussion);
 * brain contusion (contusion);
 * laceration of the brain (laceration);
 * diffuse axonal injury.


 * Secondary craniocerebral trauma

They arise with a time gap from the trauma (as a delayed consequence). They can be influenced therapeutically.


 * Intracranial hematomas:right|300px
 * epidural hematoma;
 * subdural hematoma;
 * subarachnoid hemorrhage;
 * intracerebral hemorrhage;
 * cerebral edema;
 * injury of supply and cerebral arteries;
 * intracranial infection;
 * liquorice;
 * other post-traumatic complications.

Classification according to clinical severity and duration of unconsciousness : light, medium and severe injuries.

Fractures of the skull
Closed × open.

Penetrating × non-penetrating.

According to the fracture line:


 * linear (cracks, fissures);
 * fragmentary (cominutive)with impression or elevation of the edges;
 * impressive (impressive).

The brain is most damaged at the site of the skull injury (coup) and at the site of the opposite impact (contre coup).

Diagnosis: X-ray of the skull.

Brain injury
Primary × Secondary.

Focal × diffuse.

Concussion
A brain concussion (commotio cerebri, concussion) is a sudden, short-term, reversible traumatic disorder of CNS. It has no lasting effects. The objective neurological findings are without focal changes.

Etiology: dysfunction of the ascending reticular formation.

Clinical picture:


 * loss of consciousness for 5 minutes or less, max 30 minutes;
 * pretraumatic amnesia (retrograde);
 * post-traumatic amnesia (anterograde)lasts less than 1 hour.

After awakening from unconsciousness:


 * nausea, vomitting, diffuse headache;
 * diziness, uncertainty in space during sudden movements, looking up, walking up stairs;
 * orthostatic tachycardia and hypotension;
 * disorders of concentration, memory, sweating, palpitations, [sleep disorders]].

In 50% of those affected, these symptoms persist as the so-called post-concussion syndrome , sometimes developing several days after discharge from the hospital. This condition can last for several months.

Diagnosis: medical history + normal neurological findings.

Auxiliary examinations: Xray of the skull and cervical spine.

Treatment: hospitalization in the surgical department, bed rest, observation for 3–5 days – monitoring of the state of consciousness (every 2 hours.),mobility and pupils, symptomatic therapy, incapacity for work for 7–14 days ev. up to 3 weeks.

Prognosis: good, resolves without lasting effects.

Brain contusion
thumb|Kontuze na CT snímku Zhmoždění mozku (contusio cerebri, contusion) je morfologické poškození mozkové tkáně často spojené s krvácením.

Etiologie: translační či akcelerační mechanismus poranění.

Klinický obraz:


 * velmi variabilní;
 * příznaky často způsobeny perifokálním edémem;
 * ztráta vědomí na minuty až hodiny;
 * několikadenní či několikatýdenní zmatenost;
 * často kardiální dysrytmie.