Penile injuries: mechanical damage, frostbite and burns of the penis. A fracture of the penis is a serious and extremely painful injury. Damage to the corpus spongiosum.

Cylinder head gasket defects are often easy to recognize. Read here what the symptoms are and how much it will cost to change one head gasket.

A blown cylinder head gasket may seem minor, but it can have critical consequences affecting engine performance. Depending on the nature of the damage, the engine cooling system or engine lubrication system may be affected. In other cases, problems may occur with both systems. If a gasket is suspected of being broken, the vehicle must be immediately sent to a workshop. Perhaps the work of replacing the cylinder head gasket is not the cheapest repair option, which will cost several thousand rubles and more, but it is much cheaper than the case of ignoring a defect, which will very quickly lead to irreparable consequences in the engine, to eliminate which you will have to resort to a major overhaul ICE.

How do you know if the cylinder head gasket is damaged?

The symptoms of the disease are quite numerous and all of them may indicate problems with the cylinder head gasket.

1. A typical symptom is the presence of motor oil in the engine cooling system.

2. Also, the coolant itself can get into the oil circuit.

In both cases, the verification takes a couple of seconds. Open the hood, unscrew the cap of the expansion tank with coolant (Attention! This must be done exclusively on a cold car engine). If you find dark foam inside the expansion tank or you see brown oily streaks on its walls, things are bad.

In the same way, you can calculate the presence of “coolant” in the engine oil; light foam (white emulsion) may be located on the inside of the engine filler plug; to identify it, you need to unscrew the plug or pull out the oil dipstick, on which you can also detect the presence of coolant in the form whitish foam.

How are two working fluids mixed? The oil and water passages in the engine block are quite close to each other and pass directly through the cylinder head. A damaged gasket in this area will no longer effectively separate the circuits from each other. The liquids will begin to mix and enter adjacent circuits. Therefore, car owners often observe an increase in the engine oil level in the engine of cars whose cylinder head gasket has burned out.

Coolant leaking into the oil circuit can also quickly become a serious problem.

Firstly, the cooling intensity is reduced as a result of a lack of fluid and the engine is at risk of overheating. Secondly, oil diluted with a less viscous liquid with a completely different consistency reduces the effectiveness of lubrication of rubbing parts. As a result, the crankshaft and camshafts come under attack. As a rule, a healthy engine does not consume coolant. If the fluid leaves, but no visible leaks can be detected, and is in order, be sure to check the oil for the presence of antifreeze, it may be getting into the car's lubrication system. A sudden increase in oil consumption may also be a sign that it has started to leak into the cooling system.

For this reason, it is extremely IMPORTANT to check the oil level and remember to look into the coolant expansion tank. These simple manipulations are especially relevant with old cars.

Signs of a blown gasket are not always the mixing of oil and coolant

However, damage to the gasket cannot always be determined by the two previously mentioned signs. Fluids may also leak from the engine. They can be easily identified by a wet or oily engine block just below the cylinder head.

It often happens that antifreeze gets into the cylinders and at high temperatures begins to evaporate there (depending on where the seal was damaged). In this case, mixed with exhaust gases. It's easy to spot.

If oil gets into the combustion chamber, the exhaust turns bluish.

Tip: Discoloration of the exhaust gases due to a defective cylinder head gasket is most noticeable under load.

Risk of serious engine damage due to cylinder head gasket

The greatest danger with unpredictable consequences awaits the car owner in the case where the damage to the seal is significant. Through the formed channel, a large amount of antifreeze begins to flow into the cylinder; sooner or later, an increasing amount of liquid accumulates in the combustion chamber, and this occurs. The piston, making reciprocating movements, “bumps” into a layer of liquid above it, which, as everyone knows, is incompressible, a water hammer occurs, or as wits romantically called it, “the fist of friendship.”

In this case, the consequences can be the most fatal; expensive engine overhauls (at best) cannot be avoided. At worst, if the connecting rod has penetrated the wall of the engine block, the engine can be taken to a landfill. Damage is typical for water hammer: bending of the connecting rod, destruction of the piston, breakage of the connecting rod, damage to the cylinder head, crankshaft or crankcase.

In addition, not only an antifreeze leak can lead to cooling problems, impairing its efficiency, but also engine oil entering the coolant circulation channels, clogging small channels designed for less thick technical fluid. If you ignore this breakdown, the engine may soon overheat.

In some cases, exhaust gases may escape due to the cylinder head gasket not being tightly sealed into the cooling system. This is also an extremely dangerous “bell”, which can be diagnosed by the appearance of exhaust gas bubbles in the expansion tank. At the same time, during operation it will quickly go into the red zone, and the power unit may quickly overheat.

And finally, one more point that will tell you about the malfunction. Exhaust gases may escape into the engine compartment. The smell, noise when the engine is running and exhaust gases under the hood is what you will see in this case.

In general, with this malfunction, a general loss of engine power, decreased traction, unstable engine operation, and low compression will be noticeable.

Causes of cylinder head defects

In principle, the cylinder head gasket is included in the list of so-called “lifelong” car parts, the wear of which is impossible if the engine is used correctly. In most cases, the head gasket fails due to high thermal stress. This could be caused by a faulty water pump or a defective thermostat.

Too low a coolant level, the wrong brand of antifreeze, or poor-quality radiator sealant can also cause overheating, which can cause the cylinder head to move and the cylinder head gasket not to fit tightly to the main parts of the engine.

In addition, the Top includes incorrect installation of the cylinder head seal. For example, cavities and microcracks may be present on adjacent planes of the head and block. Or, when assembling the motor, the torque and sequence of tightening the head bolts was not observed. A poor-quality gasket or its incorrect installation can also affect the performance of the engine.

Those who like to drive a car should be wary; this can lead to overheating of the working engine and, as a result, burnout of the cylinder head gasket.

How to change the cylinder head gasket?

Replacement of the cylinder head gasket should only be performed in a workshop, since repairs are quite expensive and require qualified repairs. Even improper disassembly of the cylinder head can lead to significant problems in the future. The head gasket is the connection between the engine block and the cylinder head. To get to it, you need to dismantle the cylinder head with accompanying units. The cylinder head screws must be unscrewed in the correct order, and they must also be tightened in a certain order and with the exact force on a torque wrench.

In workshops, as a rule, replacing the cylinder head gasket takes from three to ten hours, depending on the engine. The cost of repairs varies depending on the type of motor and the breakdown, usually between 2,000 and 10,000 rubles. Repairs can become even more expensive if grinding of the cylinder head is required, which is carried out on a special high-precision machine.

Attention! Usually it is driven by an aluminum “head”, so you should not overheat such motors. Cast iron cylinder heads usually suffer from cracks, which also affects the possible breakdown of the gasket.

The most expensive repairs are known for V-shaped engines, boxer engines and W-shaped engines. More standard hours are spent on replacement, since both cylinder head gaskets need to be replaced.

Material cost. In addition to the head gasket and new screws, the oil and coolant should also be changed, since the quality of the engine oil and antifreeze in general has most likely been reduced due to a defective head gasket. If it comes to oil getting into the coolant, the cooling circuit must also be cleaned.

The male penis is one of the most important organs in the male body. It is responsible for several functions at once: urinary and reproductive. The corpus cavernosum of the penis is one of the main functionally active units, which plays formative, skeletal and erectile functions in this organ. It is the corpus cavernosum that forms the corpus spongiosum of the penis and forms the body of the male penis. Since the corpora cavernosa occupy most of the volume of the tissues of the penis, many diseases of the external male genitalia are associated precisely with dysfunction in the corpora cavernosa.

Anatomical features and structure

The structure of the corpus cavernosum involves a complex connection of small cells, which upon histological examination resemble small caves or caverns. By the way, speaking in medical language, the cavernous bodies are called cavernous.

The corpora cavernosa form two longitudinal formations that form the body and root of the male penis; at the base of the penis, the corpora cavernosa merge into a single formation, which has a groove in which the corpus spongiosum of the penis is formed and fixed. Externally, the cavernous bodies of the male penis are covered with a tunica albuginea, mainly consisting of connective tissue without smooth muscle inclusions.

The tunica albuginea, despite its small thickness, has high strength and elasticity, which allows you to give the penis the desired shape. The corpus spongiosum is not covered by the tunica albuginea and runs along the lower surface of the body of the penis, ending in the glans penis. The urethral canal passes through the thickness of the corpus spongiosum, which ends at the head of the penis with the external urethra. From the tunica albuginea, special trabeculae, or beams in other words, extend into the thickness of the cavernous bodies, which divide the cavernous bodies into small segments. The deeper the trabeculae extend into the thickness of the cavernous bodies, the more smooth muscle fibers extend from them, which divide the segments of the cavernous bodies into small cells. The cellular structure is precisely responsible for blood supply during an erection.

Microscopically, the spongy and cavernous bodies resemble a complex system of lacunae and caverns, which expand and fill with blood when the smooth muscle elements of the trabeculae contract. The blood supply to the cavernous bodies occurs due to the deep celiac artery, which branches into arterioles and small capillaries that flow into the caverns of the cavernous bodies. A feature of the vessels located in the male penis is a thickened muscle layer, due to additional muscle fibers extending from the trabeculae. When an erection occurs, these muscle fibers contract and block the lumen of the capillaries anastomosing with the corpora cavernosa, which leads to their filling with blood and stretching, which visually leads to an increase in the volume of the penis, mainly in length.

Functional Features

A little higher, we explained in general terms how the formation of an erection occurs based on the anatomical features of the structure of the penis, however, an erection is the result of not only the active contraction of the smooth muscle fibers of the vessels of the penis, but also a complex neuro-hormonal mechanism. Filling of the cavernous bodies occurs both due to the influx of arterial blood and as a result of spasm of the venous system of the penis, which leads to the accumulation of blood inside the man’s penis and an increase in the organ’s size.

The lacunae and caverns of the cavernous bodies are distinguished by a high degree of elasticity, which allows them to actively stretch and increase their internal volume, several times greater than that in a non-erect state. The absence of the tunica albuginea in the corpus spongiosum ensures the normal functioning of the urinary function, since the urethral canal is not compressed. Also, during an erection, there is no compression of the urethral lumen, which allows the ejaculation process to proceed normally, since the corpus spongiosum remains soft throughout the erection.

Pathological conditions

There are a huge number of urological diseases that, to one degree or another, manifest themselves due to pathology associated with the anatomical structure or functioning of the cavernous bodies of the penis. Among the most common diseases, two categories can be distinguished: diseases associated with penile deformation and erectile dysfunction. Diseases can be either congenital developmental anomalies or acquired as a result of injuries, infectious and inflammatory diseases and the use of certain medications.

Peyronie's disease

One of the most common problems in urological practice is curvature or deformation of the external male genitalia. At the moment when the penis is in a non-excited state, the curvature can be practically unnoticeable, but with the onset of an erection and blood filling of the cavernous bodies, the penis begins to bend, which leads to mechanical difficulties during sexual intercourse. Not to mention the psychological discomfort that a man experiences during sexual intercourse.

Peyronie's disease, with sufficiently active movements, can also lead to additional trauma to the cavernous bodies, which only aggravates the pathological condition.

Visually, the disease manifests itself in the form of characteristic plaques on the surface of the penis. Plaques are formed by dense fibrous connective tissue, which is formed due to constant microtrauma of the tunica albuginea. Subsequently, the plaques undergo calcification - the deposition of calcium crystals inside, which leads to their wrinkling and thickening and increases the deformation of the penile body. As a result, these plaques lead to disruption of the normal blood supply to the cavernous bodies and organic erectile dysfunction. Typically, plaques form on the top surface or back of the penis, causing it to curl upward during an erection.

Penile injuries

There are often cases when, during too active movements during sexual intercourse, trauma to the cavernous bodies or even a fracture of the penis occurs. But if the fracture is severe and an acutely developing pathological condition, then trauma to the cavernous bodies without their rupture may, at first glance, not be such an obvious problem.

A fracture of the corpus cavernosum or a fracture of the penis occurs more often in a position when the partner is on top and makes too active movements. When a large physical force is applied to the penis while the penis is erect, the tunica albuginea ruptures and the corpus cavernosum fractures. This condition is accompanied by the occurrence of instant subcutaneous hemorrhage with the development of an extensive hematoma and deformation of the body of the penis. A penile fracture requires immediate medical attention, as the risk of subsequent complications is very high.

With minor injuries or tears, hemorrhage into the penis and deformation do not occur, but after some time a condition such as fibrosis of the cavernous bodies develops.

Cavernous fibrosis

Cavernous fibrosis develops in men of any age with a predisposition to fibrosis. The process of fibrosis occurs very slowly. As the pathological condition progresses, the elastic tissue of the corpora cavernosa is gradually replaced by rigid connective tissue cords that do not have sufficient elasticity and resilience. Ultimately, with advanced fibrosis of the cavernous bodies, sclerosis of the cavernous bodies occurs, which entails a permanent loss of erection of the male penis.

The most common cause of progression of fibrosis of the cavernous bodies is a condition with a pathologically long erection - priapism. Excessive duration of erection leads to overstretching of the walls of the cavernous bodies and their local inflammation. Inflammation of the cavernous bodies leads to vascular spasm and a decrease in the trophism of the tissues of the male penis, which entails a loss of elasticity and restructuring of the cellular components of the cavernous bodies with a predominance of fibrous connective tissue. With the development of fibrosis, the external male genitalia visually become somewhat deformed, the penis becomes unusually dense and decreases in size.

erectile disfunction

The most common condition that forces a man to seek advice and medical help from a specialist urologist or sexologist. Erectile dysfunction of the penis may be associated with pathology in the anatomical structure of the corpora cavernosa, which leads to functional failure, or it may be a psychological problem. In the second case, erectile dysfunction does not arise as a result of pathology on the part of the cavernous bodies and can be corrected quite easily, but in the case of organic damage to the tissues of the cavernous bodies, things are more serious.

Erectile dysfunction can occur due to impaired sensitivity and innervation of the lacunar and trabecular systems, which are responsible for the blood supply to the cavernous and spongy bodies during erection. In other cases, blood supply is impaired due to severe deformation of the corpora cavernosa and disruption of the tunica albuginea.

In any case, erectile dysfunction leads to a persistent impossibility of sexual intercourse, which makes the man functionally infertile.

Treatment

Treatment of pathological conditions associated with anatomical features or improper functioning of the cavernous bodies can be completely different. Treatment can be conservative, surgical or combined. In some cases, in the absence of pathology, consultation with a psychotherapist or sexologist can help. Treatment of cavernous bodies is a complex process that requires endurance and patience from a man.

Drug therapy

Conservative treatment consists of prescribing a man drugs that affect the formation and metabolic processes in the connective tissue of the body. The drugs can be either systemic or local. Local medications are often used, which enhance metabolism in the tissues of the penis and help increase the elasticity of the walls of the cavernous bodies. Drugs are used that include anti-inflammatory, enzymatic substances that can increase the elasticity of connective tissue.

In case of trauma to the tunica albuginea and hemorrhage in the subcutaneous area of ​​the body of the penis, conservative treatment is also possible, which consists of using an ointment containing heparin. Heparin can effectively combat hematomas and prevent the development of fibrous connective tissue, which causes deformation of the penis.

Intracavernous therapy

This is a minimally invasive treatment method where a urologist performs a series of injections into the cavernous bodies. For microinjections, papaverine is used, a substance better known as No-shpa. An antispasmodic drug, when administered into the corpora cavernosa, leads to normalization of erection and also relieves vascular spasm, which improves trophism of penile tissue. Injections are made using an insulin syringe with a very thin needle to reduce trauma to the penis and the tunica albuginea itself.

Surgical intervention

Surgery is required when the disease has progressed too far, i.e. The patient experiences severe deformation of the penis in combination with persistent loss of erection. Both removal of the corpora cavernosa, followed by plastic surgery and replacement with silicone implants, and restoration of the cavernous bodies can be carried out.

Restoration is a microsurgical operation during which the anatomical integrity of the torn tunica albuginea is restored or areas in places of severe deformation of the penis are excised. The plaques are removed and with proper postoperative therapy no longer progress. To eliminate severe deformation, it is possible to create special folds on the side of the penis body opposite to the curvature.

After surgery, it is very important to follow all the recommendations of the attending physician, since the lack of adequate therapy can lead to the re-development of the fibrous component in the cavernous bodies.

Injuries to the penis can be of a different nature; they can be open or closed. Closed injuries are characterized by damage to the skin and subcutaneous tissue. Closed injuries are often accompanied by damage to the tunica albuginea of ​​the corpora cavernosa. This tunica albuginea is a tissue with increased density; it helps the cavernous bodies to remain in a certain shape.

Injuries of this nature are often accompanied by large hemorrhages into the subcutaneous tissues and skin. All this is accompanied by swelling and cyanosis; it often happens that the penis becomes black. If the corpora cavernosa rupture, a large hematoma may occur. Such situations often arise because a blow is struck with a heavy object. Then the blood that accumulates goes to the scrotum, inner thighs and pubis. Injuries that are open in nature most often occur as a result of exposure to various objects. Injuries can also be caused by animal bites (dogs, horses, cows, etc.).

What are the types of damage?

Whatever the nature of such injuries, you should definitely seek medical help.

If the tunica albuginea is damaged or bruised and a hematoma has formed, it must be opened in order to remove blood clots. The tunica albuginea must be sutured. If this is not done, a purulent infection may occur. This can cause the penis to become permanently curved. The situation is aggravated by the fact that all this can cause amputation of the penis.

If the damage is open, then the wound must be carefully treated, necrotic tissue must be removed, and the tunica albuginea must be restored. If we are talking about amputation of the penis, then in all likelihood you will need phalloplasty, that is, plastic surgery to restore the penis. The part of the penis that was amputated must be replaced with a stem; it is cut out of the skin and a rib or plastic structure is fixed into it.

Often open injuries are accompanied by damage to the urethra. This means that a fistula needs to be placed on the bladder. When such an operation comes to an end, urine will flow out through a special hole. When the urethra is restored, the fistula needs to be closed.

What to do in case of such injuries: first aid

If an injury to the penis occurs, then you should forget about embarrassment and consult a doctor. The fact is that often it is ethical reasons that prevent a man from seeing a doctor. It should be noted that timely medical intervention can cure such wounds 100%. If you do not seek medical help in time, then there is a high chance of becoming impotent - from 25 to 75%. Some injuries of this nature can cause a sharp deterioration in general health. This occurs most often when it comes to testicular injuries. Penis wounds can often cause very severe pain, which in itself can lead to serious problems.

When such injuries occur, it is very important to provide first aid correctly. It is necessary to apply an antiseptic pressure bandage. If a complete traumatic amputation of the penis occurs, it is very important to keep the organ safe and sound. Be sure to put the penis in ice; the faster you sew it on, the greater the chance of a speedy recovery. If the foreskin is damaged, it will need to be stitched or trimmed.

It should be noted that most often such wounds must be treated surgically. If an injury such as a frenulum rupture occurs, then the intervention of a plastic surgeon is necessary. Penile injuries are often accompanied by damage to the pelvic organs and fractures of the pelvic bones. All this can significantly complicate treatment. If such injuries are not treated on time, it can cause suppuration, which can lead to the absence of a normal erection.

If injuries or damage to the penis occur, it is necessary to immediately conduct examinations of the genitourinary system.

If we are talking about a bruise of the penis, it most often occurs as a result of blows with a stick or foot. In this case, there is no damage to the tunica albuginea, the cavernous bodies swell, and a hematoma occurs. Treatment in this regard is conservative; hemostatic and anti-inflammatory drugs will be needed. 3-4 days after the injury, it is necessary to apply a warm compress, dry heat is needed.

Damage to the penis may look like a dislocation. Most often, this situation occurs when the penis is in an erect state. This may be the result of a strong push or blow. The pubic ligaments are torn, if the head is torn off from the foreskin, the penis simply slips out of the skin sheath. In this case, surgical intervention will be required; the ligaments of the penis must be exposed and stitched.

If we are talking about such damage as a fracture of the penis, then most often it occurs in an erect state with sharp flexion. Such an injury is accompanied by a characteristic crunch and sharp pain, which can cause a state of shock. In this case, the erection ceases, the size of the penis increases significantly (as the hematoma grows, which can spread to the scrotum, as well as to the perineum).

Additional Information

In this case, surgical intervention is necessary; the rupture site must be isolated and sutured with catgut sutures. As a result, curvature of the penis may occur. If we are talking about puncture, cut and bruised wounds, then they are treated according to the general principle of treating such injuries. The damage must be treated; if there is bleeding, it must be stopped. It is necessary to administer antitetanus serum. It should be noted that the main principle of surgical intervention is maximum tissue preservation.

Symptoms here may be as follows:

1. Severe swelling.
2. Presence of hematomas.
3. Sharp pain.

It should be noted that most often injuries to the penis are treated successfully; if you seek medical help in time, your reproductive function will remain in perfect order. But the best way to avoid such injuries is to exercise extreme caution.

The penis is a sensitive organ that is easily injured. One of the most serious injuries is rupture of the tunica albuginea of ​​the penis. It occurs as a result of excessive axial load and is very rare - occurring in 1 in 100,000 cases.

Causes and symptoms

Ruptures of the tunica albuginea of ​​the penis can occur when:

• aggressive sexual contacts, in which the erect penis bends to the side more than its anatomical capabilities allow;
• a sharp blow to the male organ;
• serious injuries - bites, gunshot and knife wounds, thermal, chemical and electrical burns.

Rupture of the tunica albuginea of ​​the corpora cavernosa is accompanied by:

• a sharp click or crunch,
• immediate disappearance of erection,
• severe pain syndrome,
• unnatural deviation of the organ to the side or acquisition of an S-shape,
• “eggplant symptom” - cyanosis and darkening of the penis.

In 10-20% of cases, the urethra is injured simultaneously with rupture of the tunica albuginea of ​​the penis. In this case, blood is released from the urethra, making the outflow of urine difficult.

At the first symptoms of tissue rupture, you should immediately consult a doctor. Timely medical care will help avoid necrosis, erectile dysfunction and other serious complications.

Treatment methods

For ruptures of the tunica albuginea of ​​the penis, surgical intervention is indicated. It is necessary to restore tissue integrity and can be carried out in three ways:

• open access through dissection of the penis,
• inguinal access,
• using a circumferential incision with bilateral exposure of the corpora cavernosa.

In case of late presentation to the clinic and tissue gangrene during the operation, the doctor removes all necrotic areas and treats the working area with antibacterial drugs.

The next stage is to fix the damaged organ in the desired position using a splint or medical bandage. For quick recovery, a course of drug therapy is carried out, which includes antibiotics, painkillers, anticoagulants against blood clots, and estrogens to temporarily suppress libido.

If you contact a urologist-andrologist in a timely manner, rehabilitation lasts 4-8 weeks; if you contact a urologist-andrologist late, it will last several months. The effectiveness of treatment exceeds 92%.

Qualified assistance for rupture of the tunica albuginea and other injuries will be provided by specialists from our clinic. Make an appointment by phone.

Head injury is a collective concept. These include:

trauma to the soft tissues of the head (wounds, bruises);

trauma to the sensory organs (eyes, auditory and vestibular apparatus, nasal cavity and sinuses);

trauma to the maxillofacial apparatus;

traumatic brain injury (TBI).

Classification of skull and brain injuries

Classification of TBI by depth of injury.

closed (damage to the skull and brain without damage to the integumentary tissue);

open (damage to the skull and brain with damage to the skin or mucous membranes);

a) non-penetrating (the wound channel does not penetrate the dura mater, i.e. there is no communication between the subarachnoid space and the external environment);

b) penetrating (the wound channel penetrates under the dura mater and as a result of communication between the subarachnoid space and the external environment, liquorrhea occurs, as well as infection of the cerebrospinal fluid and meninges, and there is a great danger of developing meningitis).

Classification of skull fractures:

fractures of the facial skull bones;

cranial vault fractures;

fractures of the base of the skull;

a) through the anterior cranial fossa;

b) through the middle cranial fossa;

c) through the posterior cranial fossa.

Classification of intracranial hematomas:

epidural (the source can be emissary veins, dural sinuses and the middle meningeal artery);

subarachnoid (source - sinuses of the dura mater or arteries of the brain: anterior, middle, posterior and basilar);

intraventricular (source – choroid plexuses of the ventricles);

intracerebral (source - intracerebral arteries and veins).

Classification of brain damage:

concussion (commotio cerebri);

brain contusion (contusio cerebri);

a) mild degree;

b) moderate;

c) severe.

compression of the brain (compressio cerebri).

Pathogenesis of TBI. In addition to the direct effect of the traumatic agent, the “counter-impact” of the brain freely lying in the cerebrospinal fluid against the opposite wall of the skull and bone protrusions is important. Secondary damage to the brain and cranial nerves occurs with skull fractures with displacement of fragments. In the early post-traumatic period, disturbances in hemo- and liquorodynamics pose a danger. Severe disorders in the form of bleeding into the cranial cavity or severe liquor hypertension lead to compression of the brain and wedging of the medulla oblongata into the foramen magnum, which is accompanied by depression of the respiratory and vasomotor centers in it and death. Bleeding into the cranial cavity in a volume of 150 ml. fatal to humans. Local hemodynamic disturbances in the form of venous congestion, stasis and edema lead to ischemic and subsequent reperfusion (lipid peroxidation) local brain damage. Nervous tissue is extremely sensitive to ischemia. Clinical manifestations depend on the functional significance of the affected area.

Clinic. There are 5 groups of symptoms for TBI:

1. General cerebral symptoms: loss of consciousness, retrograde amnesia, headache, dizziness.

2. Autonomic symptoms: nausea, vomiting, tachycardia, bradycardia, pulse instability, hypotension, impaired thermoregulation, breathing disorders.

3. Focal symptoms: cramps, paresis and muscle paralysis, expressed in impaired active movements or decreased muscle strength, absence or asymmetry of reflexes, sensory disturbances, motor and sensory aphasia (loss of speech or speech understanding, respectively). Their appearance is associated with brain contusion or intracerebral hemorrhage. Due to the intersection of nerve pathways, focal symptoms in the area of ​​innervation of the somatic nervous system appear on the side opposite to the lesion in the brain. Of particular importance are the symptoms of dysfunction of the cranial nerves: nystagmus, anisokaria, decreased direct and friendly reaction of the pupil to light, smoothness of the nasolabial fold, inability to close the eye and puff out the cheeks, tongue deviation, vestibular disorders and visual impairment. Most often, these symptoms are associated with damage to the cranial nerves themselves during fractures of the base of the skull and appear on the side of the injury. Less commonly, it is caused by damage to the nuclei in the brain stem, with pronounced autonomic symptoms.

4. Symptoms of brain compression: Compression of the brain occurs under the influence of a hematoma or depressed fractures of the skull. The classic triad of symptoms is formed by anisokaria, bradycardia and repeated loss of consciousness. The last symptom is due to the fact that after the first loss of consciousness after a blow, it returns, but at the same time, the accumulation of blood in the cranial cavity increases the pressure in it. This is accompanied by impaired venous outflow and increased cerebral symptoms up to repeated loss of consciousness. Naturally, with depressed fractures and bleeding from a large artery, this symptom does not develop. The beginning of herniation of the medulla oblongata into the foramen magnum is indicated by progressive respiratory failure and progressive hypotension.

5. Meningeal symptoms: They are a consequence of irritation of the dura mater with blood rich in pain receptors and indicate the presence of subarachnoid hemorrhage or the penetrating nature of the injury. Most of the meningeal symptoms are a type of protective muscle tension. These include:

symptom of stiff neck when bending the head;

Kernig's symptom - rigidity of the leg flexors when trying to straighten a leg bent at the hip and knee joints;

upper Brudzinski symptom – bending of the legs with forced bending of the head;

the average Brudzinski symptom is bending of the legs when pressing on the area of ​​the symphysis pubis;

lower Brudzinski's symptom - bending of the leg when trying to straighten the other leg, bent at the hip and knee joints;

severe headache upon percussion of the zygomatic arches;

headache when looking at light;

blood in the cerebrospinal fluid during puncture.

Concussion. The main and obligatory component of the clinical picture is loss of consciousness immediately after the injury. Retrograde amnesia (the patient does not remember what happened to him immediately before the injury), headache, nausea, and vomiting is also characteristic. There are no other groups of symptoms.

Brain contusion. What is important is the appearance of focal symptoms and the severity of autonomic symptoms. With a mild contusion, loss of consciousness lasts up to 30 minutes, focal symptoms manifest themselves in the form of reflex asymmetry, the rest of the symptoms are similar to a concussion. With a moderate injury, the duration of loss of consciousness does not exceed 2 hours, focal symptoms take the form of paresis, aphasia, etc., characterized by repeated vomiting and pulse lability. In case of severe bruise, the main factors are loss of consciousness from 2 hours to several days (coma) and extreme severity of vegetative symptoms (uncontrollable vomiting, thermoregulation disorders, disturbances in cardiovascular activity and breathing until they stop). Symptoms of intracranial hypertension, cerebral compression and herniation of the medulla oblongata do not appear immediately and are associated with cerebral edema.

Brain compression. Symptoms of brain compression due to intracranial bleeding may not appear immediately after injury, but after some time (bright interval), so underdiagnosis of the injury is possible. All other groups of symptoms may occur, but their presence is secondary. The predominance of meningeal symptoms indicates subarachnoid hemorrhage, focal hemorrhage indicates intracerebral hemorrhage. Epidural hemorrhage may not be accompanied by these groups of symptoms.

Open TBI accompanied by bleeding and liquorrhea from the wound, nose or ear. Accordingly, meningeal symptoms appear. With a fracture of the base of the skull Nasal or auricular liquorrhea, hematomas in the orbital area (a symptom of glasses) and the mastoid process of the temporal bone, meningeal symptoms and signs of damage to the cranial nerves are common.

Diagnosis of TBI A fracture of the skull bones is determined by radiography in 2 projections, which is mandatory for a skull injury. Intracranial hematoma is diagnosed using echography, computed tomography, nuclear magnetic resonance imaging and the application of search burr holes. If subarachnoid hemorrhage is suspected, a spinal puncture has diagnostic value. Its technique is identical to that of spinal anesthesia. During puncture, you can assess the pressure in the subarachnoid space and the presence of blood in the cerebrospinal fluid. Spinal puncture is strictly contraindicated when the medulla oblongata is wedged into the foramen magnum.

First aid. According to indications, perform cardiopulmonary resuscitation and stop bleeding (pressure bandage, wound packing). When vomiting, the patient should be positioned in such a way that free flow of vomit is possible to avoid aspiration. An important point is the use of local hypothermia. In addition, analgesics should be used in case of pain, and an aseptic bandage should be applied in the presence of wounds. The specialized stage of providing care for TBI is the neurosurgical department. Patients with injuries to the skull and brain are transported exclusively in a prone position.

Treatment In case of a concussion, hospitalization, bed rest from 14 days to 1-2 months, dehydration therapy, the use of bromides, analgesics, tranquilizers, and, if indicated, a spinal puncture are indicated (removal of 5-8 ml of cerebrospinal fluid usually improves the patient’s condition).

Treatment of a brain contusion is conservative, the same as for a concussion, but longer bed rest is used. In the presence of paresis and paralysis, massage and exercise therapy are prescribed. For severe bruises, symptomatic treatment is carried out (antiemetic drugs, hemodynamic stimulation, mechanical ventilation). If intracranial pressure increases, repeated spinal punctures are performed.

Treatment of brain compression is only surgical - emergency craniotomy, elimination of compression by fragments, removal of hematoma and cerebral detritus, careful hemostasis. In the postoperative period, treatment is prescribed for concussions and bruises.

In case of open TBI, primary surgical treatment of the wound is required and antibacterial therapy is prescribed.

Consequences of TBI.

Direct: cardiac and respiratory arrest, aspiration of vomit, traumatic shock.

Immediate: meningitis, cerebral edema.

Remote: persistent neurological disorders (paresis, visual and hearing disorders, etc.), adhesive arachnoiditis, epilepsy.