Closed craniocerebral injury what harm to health. Complications of a severe degree of chmt. Causing harm to health in an accident

Injury brain, or TBI is divided into mild, moderate and severe injuries. Mild degrees include concussion and brain contusion. In the classification of mild TBI, foreign and domestic authors have disagreements, in contrast to the classification of severe TBI.

In foreign medicine, the classification of TBI includes severe, moderate and moderate. American authors sometimes divide moderate into mild and minimal. In turn, minimal trauma correlates with concussion in domestic classification, and light - with a bruise of the brain.

In this article, the term mild brain injury (LTBI) will be used in the future, due to the fact that the trauma of the skull in the clinic and the severity of the damage is of secondary importance.

Statistical data

For example, in the United States, the frequency of hospitalizations of patients with THM is 130 cases per 100,000 population. These data correspond to an average of 70% of all hospital admissions for head injuries. These are quite serious figures that translate this pathology into the category of epidemic conditions and is rightly called a "hidden epidemic". About 4 billion dollars a year is spent on such patients annually.

Definition of mild brain injury

Two forms are included in LTGM - brain concussion and brain contusion

Signs of a concussion(SGM)

This is a clinical syndrome that occurs as a result of a mechanical effect on the brain of external damaging forces. This syndrome is manifested by loss of consciousness after an injury on a short time. Structural damage to the brain does not occur. By at least there is no evidence for this. There are no residual effects in SGM other than some non-specific clinical symptoms ( headache, dizziness) and short-term post-traumatic amnesia. An accurate diagnosis is made only retrospectively. SGM occurs both with an acceleration or deceleration injury, and with an injury during which the head rotates. Presumably, there is a separation of functions between the hemispheres of the brain and its trunk. There are no histological changes in the brain tissue.

Loss of consciousness in CGM can last from seconds to several minutes, while in brain contusion this state lasts up to an hour. The time frame in practice is rather conditional. Sometimes with a concussion, the authors allow a coma for up to 6 hours. When leaving the coma before 6 hours, the forecasts are interpreted as favorable and the diagnosis of CGM is established. If you are in a coma for more than 6 hours, there will certainly be damage to the brain tissue, which in itself aggravates the condition and prognosis. Diffuse brain damage occurs, which is defined as diffuse axonal brain damage.

Many specialists in our country paid attention to the incompatibility of diagnoses in boxers who get knockdowns quite often within a few seconds, and in patients who are in a coma for more than 1 hour. Such thoughts were embodied in the classification of SGM according to degrees of severity, where three degrees were distinguished (classification of domestic authors of the 60-70s) and four degrees (foreign authors).

Brain contusion (UGMLS)

With this damage, a non-rough damage to the brain tissue occurs. This lesion is manifested by local edema, hemorrhages of a point character. It is almost impossible to draw a line between SGM and UGMLS, guided by the duration of the coma and the amnesia that developed after the injury.

Western experts classify UGMLS as minor injury heads. This state meets the following criteria:

More than 12 points on the Glasgow scale;
Amnesia and loss of consciousness no more than 20 minutes;
The patient is hospitalized for no more than 2 days;
There are no signs of contusion of the brainstem or cortex.

Symptoms of LTGM

When the patient wakes up from him, you can expect an adequate reaction. Confusion may be present up to 24 hours after the injury. Anterograde or retrograde amnesia is noted in all patients. Floating eye movements of a friendly or unfriendly type may also occur. The reaction of the pupils to light is always preserved, but often there is a spontaneous change in their diameter, spontaneous nystagmus occurs with fast phases. If there is no nystagmus, a caloric test can easily cause it.

There are practically no long-term persistent violations. Sometimes there is an increased muscle tone and pathological signs on the feet. After some time, muscle hypotension develops. Rarely, decortication or decerebration rigidity occurs.

With LTGM vital functions don't suffer. Sometimes meet consequences of a concussion, such as vegetative manifestations in the form of tachycardia or bradycardia, hypertension, or a decrease in pressure.

Diagnostic research methods

In addition to a general examination and questioning of the patient, one can also distinguish additional methods diagnostics.

X-ray methods of research

X-ray of the skull. Previously this method was widely used in skull injuries, but now computed tomography (CT) is more informative. Discussing the need for x-ray examination patients who did not lose consciousness after a head injury and were in a clear mind during the examination. The only exceptions are those patients who are suspected of having a depressed fracture. Also in patients with linear fracture the probability of forming an intracranial hematoma increases by 400 times;
CT scan. CT is the method of choice for head trauma. During this study, it is possible to identify intracerebral hemorrhages, skull fractures, cerebral edema, concussion. On CT scan, patients with THM do not have any pathological changes. In half of the cases, UGMLS also does not reveal changes;
Carotid angiography. If CT is available this technique not used, however, in its absence, using carotid angiography, a traumatic volumetric process can be detected;
Magnetic resonance imaging (MRI). This study can help identify damage to brain tissue in the late post-traumatic stages. MRI is the preferred method over CT in the diagnosis of UGMLS.

Lumbar puncture

The first thing to say - lumbar puncture(LP) in traumatic brain injury is contraindicated. Its informativeness has the minimum indicators:

There is no way to determine the severity and extent of brain damage by blood in the cerebrospinal fluid;
There is no correlation between the number of erythrocytes in the CSF and the prevalence of subarachnoid hemorrhage;
It is not always possible to speak of intracranial pressure by the pressure of the cerebrospinal fluid;
With LP there is real threat life of the patient due to the dislocation of the brain stem.

The indication for LP is post-traumatic meningitis, which, however, does not occur in the first days after injury.

Electroencephalography (EEG)

For the diagnosis of LTGM, this method is used. EEG also helps to clarify the prognosis in case of a severe head injury. With its help, the issue of prophylactic prescription of anticonvulsants is solved.

Echoencephaloscopy (ECHOES)

With it, you can easily determine the presence of a supratentorial hematoma. At the same time, the method is quite simple, economical and generally available. This method is good to use in the dynamics of the disease, as its value increases.

It is impossible to conduct an ECHOES with pneumocephalus, that is, the presence of air in the cranial cavity. Should not be carried out this study and adequate patients without neurological symptoms and only with soft tissue damage.

At the beginning of its use, the ECHOES method was overestimated

Possibilities of hospitalization with LTGM

Of course, with injuries of medium and severe degrees severity must be hospitalized. Patients with a mild degree without loss of consciousness and neurological abnormalities may be sent home for outpatient treatment.

A controversial and incomprehensible situation in many issues arises with patients whose condition is assessed on the Glasgow scale by 13-15 points, and this is a borderline state between mild and moderate severity of brain damage.
Patients are hospitalized if

A concussion is a type of closed craniocerebral injury. As a result of CBI, a transient disorder of brain functions occurs. The danger of injury lies in the fact that the entire substance of the brain is subject to pathological effects. This is manifested in the temporary separation of the transmission nerve impulses between synapses. During treatment normal work the brain is gradually recovering.

We will learn what harm to health from a concussion of the brain, and how to get rid of its consequences.

Causes of the disease

Closed cranial brain injury happens due to a rough impact on the cranium (a blow to the head or on it). Intentional bruising on the skull with any blunt object is a criminal offense. The punishment for this bodily injury is determined by the relevant article of the Criminal Code.

If there is any doubt as to whether the contusion of the brain was accidental as a result of a careless fall, or it was caused by violent actions, an examination is appointed. Concussion occurs when there is axial load that is transmitted through the spine. Such conditions arise when falling on lower limbs, buttocks, accidents, with a broken nose.

In these situations, there is strong shaking cranium. The brain is subject to severe hydrodynamic shock because it is in the spinal fluid. With a huge destructive force, a bruise of the brain tissue on the cranial bone is possible.

Concussion pathogenesis

At the heart of the manifestations of TBI is a disorder of normal communication between the brain stem and its hemispheres. The mechanical effect on the tissue is a factor in changing the state of the brain tissue. It is not excluded that brain dysfunction is associated with metabolic disorders in neurons.

Common signs of injury

The general symptoms of the disease in question are:

transient confusion;
syncope, observed at rest and aggravated by changing the posture of the body or head;
soreness of a pulsating nature;
extraneous sounds in the ears;
general weakness;
nausea or single vomiting;
retardation of movements;
slowing down the pace of speech;
feeling of double objects;
overreaction to sounds;
photophobia;
violation of the coherence of movements.

When diagnosing, there are such symptoms that are among the most important.

The patient complains of soreness in the eyes, he has difficulty moving them to the sides.
Immediately after the injury, a change in the diameter of the pupils is noticeable.
There is a difference in reflexes from different sides.
There may be uncontrolled eye movements.
In the Romberg position (legs should be together, arms straightened, horizontal and extended forward, with closed eyes) is determined by the shakiness and instability.
Spasms of the occipital muscles.

In the elderly, coma is rare. They are more likely to suffer from disorientation. In a child, the frequency of contractions of the heart sometimes becomes more frequent, the skin turns pale.

The severity of the disease

Depending on the severity of the damage to health from a concussion of the brain is different. We learn the main differences between the manifestations of mild, moderate and severe contusion.

Light degree

It is characterized by a short loss of consciousness (sometimes it is completely preserved), a satisfactory condition afterwards. All complaints go away within 7 days. Residual phenomena are not observed.

At mild form pallor is noticeable, a decrease in the tone of the muscles of the limb (sometimes it disappears completely). There may be no vomiting. Distinctive feature this degree - the absence of amnesia, that is, the person remembers the events preceding the concussion.

A mild degree of closed requires bed rest for at least 2 days. Improvement in health comes fairly quickly.

Average degree

With a moderate concussion, a short loss of consciousness is always recorded. There are a lot of pathological neurological symptoms- dizziness, prolonged lethargy, disorientation, severe nausea. Vomiting almost always occurs. For some time, the victim has a subfebrile temperature. A short-lived amnesia develops.

Moderate concussions always require bed rest for at least a week. This category of patients is indicated for the prophylactic use of nootropic drugs.

Severe degree

It is characterized by a coma (sometimes for several hours), partial or complete loss of memory. Persistent disturbances in well-being, headaches last more than 2 weeks due to damage to brain tissue. It is all this time that the patient needs bed rest.

With a severe degree of closed TBI, the patient does not remember what happened to him. long time he is disturbed by dysfunctions of a dream, appetite.

If the patient is in a coma for more than 6 days, then damage to the brain tissue is not excluded.

Diagnostics

This disease is diagnosed according to the history of trauma, the time of unconsciousness. Noteworthy is nystagmus, asymmetry of reflexes, a sign of Marinescu Rodovic.

For the diagnosis of the disease is carried out:

radiography;
encephalography;
echoencephalography;
examination of the bottom of the eye;

All these procedures allow you to assess the degree of brain damage.

First aid for a stroke of the brain

In any case, you must call medical care especially if the patient is unconscious. The person must be placed on hard surface, with bent joints. The face must be tilted to the ground. If the wound is bleeding, a bandage should be applied to stop the bleeding. Availability extensive hematoma- Indication for immediate hospitalization.

If there was no fainting, the patient is placed horizontally with his head slightly raised. All people with a similar injury should go to a trauma center.

Concussion treatment

Rest must be observed during treatment. The victim needs to lie down, avoid any mental or physical overload that can adversely affect the brain. If a person followed all the necessary recommendations on time, then the treatment ends with recovery.

Some people may have residual effects after injury. This is a decrease in attention, fatigue, forgetfulness, depression, migraines.

Patients are prescribed medications that relieve unpleasant manifestations: soreness of the head, syncope, nausea. Simultaneously apply medications, whose action is aimed at improving physiological processes in the brain. The use of sleeping pills and sedative medications is shown: they help to compensate for the work of the brain.

Within 30 days after the incident, it is forbidden to make any physical work. Limit mental work and video viewing. When listening to music, you do not need to use headphones.

A severe brain blow is an indication for a deferment from the army.

Complications of severe CTBI

Severe brain contusion can cause. The motor skills of the legs are disturbed, manifested in some disunity of well-coordinated movements. If the disease is not treated, patients experience such phenomena.

Confusion and lethargy, impoverishment of speech, change in behavior.
There are episodes mental imbalance, aggressive behavior(they are later regretted by the patients).
Hypersensitivity to alcohol and infectious pathologies. Moreover, as a result of drinking alcohol, patients develop delirium.
Convulsive attacks.
Sharp.
Psychoses and hallucinations rarely occur.
AT rare cases patients develop dementia, lack of orientation and impaired criticism.

In 1 out of 10 cases, severe brain contusion contributes to postconcussion syndrome. It manifests itself in the sharpest pains, insomnia, attention disorder. This syndrome is poorly treated.

Concussion: signs in children and adults, what to do, consequences

Of all types of injuries, TBI is perhaps the most common, especially in childhood when “adult” proportions have not yet been determined, and the head, when falling, pulls the body down and suffers first. Any blow to the head is perceived as serious injury, even if at first glance everything is in order. People who are next to the fallen baby immediately begin to look for signs of a concussion in the child, in order to call an ambulance faster if necessary.

A concussion can also be obtained by landing on the buttocks, so TBI often accompanies other damage to the body (chest, lower leg, pelvis) and is less likely to be isolated. The only question here is which organ needs to be saved in the first place? But the head is always important, so:

Even a mild concussion requires a thorough examination in a hospital to determine real harm health and prevention of possible consequences.

Concussion is one of the forms of TBI.

Usually, people by concussion mean any traumatic brain injury, and this, of course, cannot be reproached, since all these head injuries are the competence of doctors. In medical circles called a concussion mild degree traumatic brain injury, which is not characterized by focal neurological symptoms, there are no signs of vascular damage, and the functional disorders that occur after the injury are reversible. However, given the interest of readers not only in this form of pathology, we will try to stop and explain the essence of those head injuries that are popularly considered concussion, since everyone interprets this term in their own way and is often confused with the concept of a brain contusion or the formation of an intracranial hematoma from compression.

As experience shows, each of us may find ourselves in a situation where it becomes very important to determine the degree of damage, since not only a person’s life, but also its quality in the future often depends on this. The symptoms of a concussion are both meager and very diverse, it all depends on the strength of the impact or the strength of the head of a given person.

Thus, a concussion is the result of soft matter shaking and hitting the hard cranium in which it is located. During the movement of the brain to the bones of the skull, the cells (their processes) are stretched and experience some discomfort, which affects their functional abilities, which are lost for a while.

Doctors have not yet come to a consensus on what actually happens in the head at the moment of impact, so there are several versions. possible events, knocking out the work of the central nervous system from the usual track:

Neurons lose connection with each other.
Violations in nervous tissue brain occur at the molecular level.
A sharp spasm of the vessels of the microvasculature makes it difficult to feed the brain.
Unbalancing the interaction between the cortex and other brain structures.
Change chemical composition cerebrospinal fluid.
short term boost intracranial pressure due to physicochemical disorders and colloidal imbalance.
Violation of the movement of cerebrospinal fluid, which, upon impact, leaves the cavities of the ventricles of the brain and is directed to the interventricular spaces.

Which of these hypotheses is correct, probably, is not for us to judge, but it is important that they all agree on one thing - with CGM, reversible functional disorders occur, but brain structures do not suffer, morphological changes are not observed in them. The veracity of this assertion is also supported by the data computed tomography, which is usually prescribed for bruises of the head.

Danger can lurk at every turn

In adults, concussion often occurs against the background of alcohol intoxication: either he lost his balance, then he actively got involved in a fight, then he got into an accident. Alcohol in such cases becomes a factor that aggravates the patient's condition and makes it difficult early diagnosis because it obscures Clinical signs underlying pathology. It is difficult to understand: lethargy and other manifestations are the result of intoxication or indicate the development of symptoms of a concussion. True, there are other options when an adult, completely sober person gets a TBI in transport, on the road, at work due to circumstances beyond his control.

Head injuries often haunt children in games and adolescents due to carelessness (slamming a book or a briefcase on the head, other fun) or overestimation of opportunities when spending leisure time, because you really want to show adult prowess by riding an “iron horse” or jumping over roofs and fences.

Meanwhile, I would like to remind you that a concussion can occur without a blow. Harsh braking vehicle or attempts to maintain balance in winter ice sometimes also end with a known diagnosis.

Everyone knows that there are frequent cases of TBI and injury to other parts of the body among those for whom "sport is life." Chess does not carve out an athletic figure and does not add physical strength, but "a person strives for perfection", therefore, he is looking for new types sports exercises, borrowing them from overseas peers. What it can result in - further.

The signs of a concussion in a child who already knows how to speak and knows his "I" are practically no different from those in adults. But recognizing the symptoms of a concussion in infants can be very difficult even for a health worker, if he doesn't pediatric neurologist therefore, if this pathology is suspected, it is better for parents not to try to take responsibility and make a diagnosis on their own. The baby should immediately be shown to a doctor who is able to distinguish the normal behavior of the baby from the behavior of a sick child.

How to recognize a concussion in young children?

In general, concussion in infants is a rather rare phenomenon, everything is so soft and elastic in them that the risk of getting a concussion is very small, and, as the saying goes: “A child falls - God lays straws.” However, it is still not necessary to relax unnecessarily, parents must be constantly on the alert and know the main signs of a concussion in a child:

Frequent regurgitation, refusal to eat, which, however, can be caused by other reasons ( intestinal colic, weather change, SARS).
Increased excitability, anxiety, or, conversely, lethargy and drowsiness also does not say much.
Twitching of the muscles of the limbs.
Unnatural pallor or redness of the face.

You should especially pay attention to the appearance of unusual signs if the child hit his head the day before. More often this happens with children who have learned to roll over, sit and crawl, but have not yet acquired a sense of danger. For such a fidget, an eye and an eye are needed, but he already has more concussion symptoms than very small ones, for example:

The child hit, was silent, and then began to cry bitterly (perhaps he lost consciousness for a few seconds).
In such "large" children, it is easier to distinguish vomiting from regurgitation and notice sleep disturbance, since the time for play and wakefulness has lengthened.

In a word, with children who have left the newborn state, it is already somehow possible to “agree” and understand the cause of anxiety.

Unfortunately, it is not uncommon for a visit to a doctor to be postponed or completely canceled, time passes and everything seems to normalize, however, the harm to health caused by a seemingly insignificant blow can be significant, and the consequences are not very comforting:

Intense headaches after a concussion that occurred many years ago can torment you for a lifetime.
Disorder of thinking processes, poor mastering of the school curriculum.
Convulsive syndrome.

Clinical picture of mild traumatic brain injury

Signs of TBI are not always present all together and give a bright clinical picture. In general, the symptoms of a concussion depend on the severity of the condition and include:

Considering that such a diagnosis as a concussion is in itself the first and most mild degree serious pathology associated common name“traumatic brain injury”, then the modern classification does not provide for the division of this form according to degrees of severity separately. However, we can agree that not all blows and bruises proceed in the same way, so there are some varieties that allow you to determine and convey (rather verbally) the degree of damage, which is sometimes used by doctors and quite often by patients:

mild concussion does without loss of consciousness and amnesia, signs of trouble in the head (lethargy, nausea, severe headache) usually disappear in a quarter of an hour.
At 2nd degree loss of consciousness is usually absent, but stupor, memory loss, and other symptoms do occur.
For severe concussion can be characterized by both memory loss and loss of consciousness in combination with the entire set of objective clinical manifestations pathology, because the patient can present complaints only upon returning to real life(recovery of consciousness).

The health damage caused by TBI can be significant and depends on what kind of injury the person received: a slight concussion in an adult with timely first aid and adequate further treatment may pass and be forgotten. However, this only seems to be. Seizures after a concussion are a common and understandable phenomenon, but the patient himself rarely connects these events, believing that too much time has passed. As for the bruise of the brain, then, depending on the severity, it can leave the most serious consequences.

What consequences can be expected from TBI?

Why, when taking an anamnesis to establish any diagnosis that is not related to the brain, the doctor never forgets to ask about the presence of traumatic brain injuries in the past? And all because TBI in any form and severity often gives far-reaching consequences:

The consequences of any form of TBI, even the mildest, can be very serious, so it will be useful for everyone to know what to do with a concussion and be able to provide first aid.

Lay down, watch and wait

It is unlikely that the victim in a state of lethargy can quickly orient himself and independently assess the situation. It should be noted that the first symptoms of TBI in case of a concussion and in case of a brain injury or may be identical, therefore, the first aid in the situation that has arisen is to monitor the behavior of the patient who needs to be laid down, since excessive activity can bring additional harm to health.

What to do with a concussion? For this you need to be sure that this is still a concussion, and not another, more severe, form of TBI, so when the slightest sign traumatic brain injury (the clinic is described above), a person should be shown to a doctor. If the accident took place at home, the patient did not lose consciousness, the condition did not change for the worse for half an hour and is assessed as quite satisfactory, then you should contact a neurologist at the place of residence. Unfortunately, patients often let everything go “on the brakes” and do not go anywhere, and then they wonder where causeless headaches come from? After a concussion, of course, which was not diagnosed in time.
Loss of consciousness or lack thereof, nausea and vomiting, deterioration, which initially did not cause much concern - alarming symptoms requiring immediate medical attention. Such patients need hospitalization, but you should not try to transport the patient yourself if there is no urgent need for this (lack of communication, remote area). Meanwhile, having decided on independent transportation, if there is no other way out, you need to keep in mind that other organs (spine, for example) can be damaged in the victim, in addition to the head, so all actions should be as gentle as possible, but fast.

You should not offer a person medicines at your own discretion or (even worse) his discretion, if he is conscious. You just need to put the patient to bed, provide first aid, call an ambulance and wait for her arrival.

The actions of a bystander who happened to be nearby and trying to somehow help should look like this:

Gently lay in a horizontal position, but if a person is unconscious, then with a head injury, vomiting cannot be ruled out, so it is better to turn the patient over to the right side, bending the arm and leg on the left side.
Unfasten the collar, loosen the tie, in general, remove unnecessary accessories and allow the victim to breathe freely.
Put cold on the bruised place, treat wounds, make dressings, stop the bleeding.
Monitor pulse (rate, filling, tension) and blood pressure, if possible.
In case of respiratory arrest, start exercising ( artificial respiration, indirect massage hearts).

Unfortunately, life is full of surprises, sometimes very unpleasant, and situations in which concussions sometimes occur can be so different ....

Diagnosis and treatment - the task of the hospital

As a rule, a neurologist will suspect a mild TBI, that is, a concussion, even for 2-3 signs.

However, in order to properly treat the patient, it is necessary to establish accurate diagnosis by doing some research:

Craniography (overview R-graphy of the skull) to exclude skull fractures;
Study blood vessels fundus (consultation of an ophthalmologist);
Lumbar (spinal) puncture to study the composition of cerebrospinal fluid;
or ;

The patient is in the hospital mainly for the purpose of monitoring him, where he is given preventive and symptomatic treatment:

In the hospital, the victim, if everything goes well and manages only with a concussion, will spend about a week, but this does not mean that all questions are closed, and he can consider himself completely healthy. More whole year he will be seen by a neurologist, visiting the polyclinic every quarter and receiving the treatment prescribed by the doctor.

In this way, treat a concussion on your own, it is not recommended to take any medications, especially since often patients, reacting to all external influences(voices of people, light, etc.), become even more irritated, lose the ability to correctly assess their condition. They have a negative attitude towards hospitalization and believe that they themselves know how best to deal with an unexpected problem. This should be taken into account by relatives or people who happened to be nearby.

Brain contusion and other TBI

At the beginning of the article, it was noted that not all TBIs are concussions, but all concussions are traumatic brain injuries. What does it mean? People often refer to the concept of "concussion" all injuries, including bruises, compression of the brain, intracranial hematoma. Traumatic brain injury is a collective term. With TBI, in addition to concussion, brain structures, cranial nerves, the paths along which cerebrospinal fluid moves, as well as blood vessels can be damaged. nutrients and oxygen.

In addition, it should be borne in mind that not only the blow itself can be dangerous for the victim, when the brain is damaged at the site of application, but also the counter-strike coming from fluctuations in the cerebrospinal fluid or from the impact on the processes of solid meninges. Thus, not only the cerebral hemispheres can suffer, but also the trunk, in which the centers responsible for the activity of many the most important organs and systems, and the exchange processes will be disrupted. To help the reader to correctly assess the situation and navigate in such diagnoses if necessary, we will try to briefly dwell on other TBIs:

brain injury, which, unlike concussion, in addition to general cerebral symptoms, gives local and focal symptoms depending on the location of the injury. Brain contusion has 3 degrees of severity, affected with mild and medium degree are sent to the departments of neurosurgical profile, and with the 3rd degree they are subject to hospitalization in hospitals with departments intensive care, resuscitation and neurosurgery.
brain compression, as a rule, it occurs against the background of a severe degree of bruising of the GM and is usually a consequence of the formation of an intracranial hematoma. It is manifested by psychomotor agitation, an increase in cerebral symptoms, and the development of a convulsive syndrome.
intracranial hematoma needs urgently surgical intervention in the Department of Neurosurgery. It can manifest itself some time after the injury, which is why seemingly well-being after TBI does not really give grounds for peace. This symptom is called bright gap, are among the important and insidious signs of a hematoma, and its underestimation is fraught with the development of life-threatening consequences for the victim.

Of course, the therapeutic approach to conditions of this kind differs markedly from the treatment of concussion:

The victim requires not only emergency hospitalization, but also the immediate start of all activities, including surgical intervention if an intracranial hematoma is diagnosed, which is able to "deceive" both others and the doctor of the arrived ambulance team.

Often misleading light gap that occurred immediately after the injury(the person came to his senses and claims that his health is normal). The thing is that post-traumatic intracranial hematoma can initial stage proceed without much suffering of the brain, especially if the source of bleeding is venous (when bleeding from an arterial vessel, the light interval lasts minutes). Intensive increase in symptoms of respiratory and vascular disorders, the development of mental disorders, With decrease in heart rate against the background of an increase blood pressure reinforce suspicions in favor of an intracranial hematoma, so the patient should never be left without hospitalization.

typical areas of hemorrhage and hematoma formation due to head trauma, or

Traumatic brain injury is a frequent occurrence in our lives, because there are so many dangers around. Often it is limited to a mild degree - a concussion, which, however, does not allow you to relax. Always keep in mind the possibility of hidden damage and development serious complications. Ignorance and underestimation of the whole insidiousness of TBI can become a tragic mistake that interrupted someone's life, therefore, in all cases of head injuries, the patient should not be left without attention and help, even if he confidently claims that he is all right.

Example 2. Citizen N., aged 23, on May 20, 1997, during a fight, was hit on his left hand with a bottle, fragments of which caused injuries to his left forearm. Primary processing the wound was made in the hospital. On the 4th day after the injury, the left hand was edematous, active movements 2nd finger is missing. On May 28, 1997, the stitches were removed, healing by primary intention. However, the movements of the 2nd finger did not recover. Consulted in the traumatology department, where complete break tendon of the 2nd finger. After a course of physiotherapy, an operation was performed to stitch the tendon. The operation was successful, the postoperative course without complications. The victim had sick leave from May 20 to July 17, 1997. On examination on August 28, 1997, there was a slight stiffness of the 2nd finger of the left hand.

Forensic medical assessment of the severity of harm to health in traumatic brain injury

Attention

Therefore, in doubtful cases qualification of the severity of bodily injuries in these forms of closed craniocerebral injury should be carried out on the basis of the outcome and consequences of the injury, which led to a health disorder associated with permanent disability. Moderate brain contusion is manifested by more pronounced cerebral and focal hemispheric symptoms, and in some patients with stem disorders. The victims have a prolonged impairment of consciousness (up to several hours) in the form of stunning, stupor or coma.

Info

After leaving the unconscious state, there is a long period of lethargy, confusion and psychomotor agitation with disorientation and illusory perceptions. During the period of recovery of consciousness, amnestic disorders (retrograde and anterograde amnesia) are manifested. In most cases, there is repeated vomiting.

Determining the severity of damage to health

The expert must analyze the results of the examination, the data of medical documents and, taking into account the characteristics of a closed craniocerebral injury and the body, resolve issues individually in each case. Methodological recommendations were prepared by: Honored Worker of Science of the RSFSR, Professor A.S. Litvak, Professor V.G. Naumenko, candidates medical sciences K.I.
Kildishev and E.A. Redko. Main court medical expert Ministry of Health of the USSR, Honored Worker of Science of the RSFSR, Professor - V.I.

legal social network

If the responsibility of the owner of the car to third parties is not insured or he himself is unknown, then the victims can apply to the Russian Union of Motor Insurers to receive compensation. Also, the victim has the right to apply to the court with a claim for compensation for harm that was caused to health. How to file a claim for damages If the culprit refuses to pay compensation for harm caused to health in an accident, then you can sue.
The statement of claim is written in any form. The following package of documents must be attached to it:

a certificate of an accident, drawn up in accordance with all the rules by the traffic police;
expert opinion, where he assesses the injuries of the victim;
checks, receipts that confirm the cost of treatment;
certificates that determine the amount of income for the time associated with the accident.

Accidents happen every day.

Question answer

Criminal law

BUT he got a fracture of the ribs from a fall on the stairs, as a result of a blow inflicted on him. The investigator declares that the case was opened illegally, tk. there was no direct blow to the ribs, and a broken nose and a concussion are slight harm health... the criminal case is closed. The attacker remains innocent.

Causing harm to health in an accident

It depends on what article a crime can be qualified and an appropriate punishment imposed. In such cases, there is always medical expertise. Only by its conclusion, the judge can determine the extent of responsibility of the accused.

Concussions of the brain, as you described the consequences, can be qualified as minor harm to health under Article 115 of the Criminal Code of the Russian Federation. Perhaps you misunderstood the inspector. If he sent the documents to the court, then the case was already initiated by him at your request. The infliction of minor harm to health refers to the cases of the so-called private prosecution and is further investigated by the Magistrate's Court without involving an additional side of the defense in the person of the prosecutor.
You should find out what date the case is scheduled to be heard on the merits, since the documents are already in court.

Criminal Lawyer

Important

Transactions Labor law and social security Biography: 35 years old, higher legal education, more than 13 years of work experience in the specialty. From 2001 to 2014 - assistant judge. From 2014 to the present — private practice on legal issues (arbitration, courts of general jurisdiction). 3 Svetlana Bubnova Ordering a lawyer's consultation Topics for a lawyer: Bodies of justice. Prosecutor's office. Advocacy. Notaries Family. Marriage. Children Law enforcement agencies Biography: Education: - "Central Russian University (humanitarian - technological Institute)”, in the direction of jurisprudence.

Concussion of what severity harm to health

The same act committed: a) against two or more persons; b) in relation to a person or his relatives in connection with the performance of official activities by this person or the performance of public duty; c) with special cruelty, mockery or torment for the victim, as well as in relation to a person who is obviously in a helpless state for the guilty person; d) a group of persons, a group of persons by prior agreement or an organized group; e) out of hooligan motives; f) motivated by national, racial, religious hatred or enmity; g) repeatedly or by a person who has previously committed intentional infliction of grievous bodily harm or murder, as provided for in Article 105 of this Code, is punishable by deprivation of liberty for a term of up to five years. Thus, signs of harm to health of moderate severity are: 1. Absence of danger to life. 2. Absence of the consequences specified in Art.

Upon admission to the hospital, the patient's condition was satisfactory. On the left forehead there is a hematoma measuring 5.5x4.3 cm. left ear. In the process of treatment, the patient's condition improved, hearing in the left ear began to recover.

Clinical diagnosis: hematoma of the frontal region on the left, head contusion, concussion of the 1st - 2nd degree, traumatic neuritis of the left auditory nerve. Was in the hospital for 18 days, and then 25 days was treated on an outpatient basis in the clinic at the place of residence. Complains during examination fatigue, staggering in the Romberg position and vegetative lability are objectively noted.

Expert's conclusion: the injuries described - concussion of the 1st - 2nd degree, traumatic neuritis of the left auditory nerve could have been caused on July 28, 1997.

Concussion damage to health of what severity

The majority of forensic physicians adhere to the same point of view. The unification of the diagnosis of concussion or brain contusion is important not only for clinicians, but also for forensic doctors; Otherwise, the same condition can be regarded both as a concussion and as a brain contusion, depending on which point of view this or that specialist adheres to. Uniformity and right approach contribute to the diagnosis of bruises and concussions of the brain guidelines Leningrad Research Neurosurgical Institute.
prof. A. L. Polenov of the Ministry of Health of the RSFSR " Clinical forms and targeted treatment closed injury skull and brain" (1969, 1973). They are based on the data of a long-term study of traumatic brain injury in specialized neurosurgical institutions and in 1970.
In the first days after injury, symptoms organic damage nervous system manifest as convergence disorders, nystagmus, asymmetry of the nasolabial folds, tongue deviation, asymmetry deep reflexes, meningeal symptoms. In addition, there are: hyperhidrosis, blanching of the skin, tachycardia (rarely bradycardia), asymmetry of blood pressure, changes in its level, subfebrile condition. From the side of peripheral blood - accelerated ESR and leukocytosis.
Compound cerebrospinal fluid normal, rarely slight increase the amount of protein and the admixture of blood. The pressure of the cerebrospinal fluid is lowered or increased. For 3-4 days general state satisfactory, but some subjective and objective signs can be expressed. By 9-10 days there is a significant reduction in symptoms and improvement in general condition.

of the Criminal Code of the Russian Federation, namely: those that did not cause loss of vision, hearing, language, arm, leg, productive ability, mental illness, abortion, permanent disfigurement of the face. 3. Prolonged health disorder. A long-term health disorder should be understood as a temporary disability lasting more than 3 weeks (more than 21 days). When examining injuries that caused a long-term health disorder, it is necessary to carefully analyze medical documents, since in some cases a patient’s long stay in treatment is not due to the injury itself, but to the need for a clinical examination or other factors.

Example 1. Citizen Sh., aged 31, on July 28, 1997, received a series of punches on the head and body during a drunken brawl, after which he fell and lost consciousness for a short time.