Cerebral edema subsided structures are visible. Clinical manifestations of cerebral edema. Symptoms of cerebral edema

In simple terms, cerebral edema is a disease in which the normal outflow of cerebrospinal fluid is disrupted. As a result pathological changes, pressure on tissues increases, blood circulation becomes difficult and necrotic phenomena are observed. With absence adequate therapy, edema ends with a fatal outcome.

What is cerebral edema

Symptoms of edema appear almost immediately. The disease progresses rapidly. The patient's condition is gradually deteriorating. At unfavorable development disease, death occurs.

Types of cerebral edema

Depending on its nature, it is customary to distinguish between several types of puffiness:

• Vasogenic edema - pathological disorders are preceded by increased capillary permeability. As a result, an increase in the volume of white matter is caused. Perifocal cerebral edema of the vasogenic type occurs as a result of internal hemorrhages, the development of tumor formations and lesions of the central nervous system.
• Cytotoxic edema - is the result of the destruction of the structure of brain cells due to toxic poisoning. Pathological changes are reversible only in the first 6-8 hours. There are critical changes in tissue metabolism. The causes of cerebral edema are poisoning, radiation and the development of coronary disease.
• Hydrostatic edema - appears with violations, which are characterized by an increase in ventricular pressure. This type of swelling is observed mainly in newborns. Periventricular cerebral edema is less common in adults, mainly due to trauma and surgery.
• Osmotic edema - occurs when the ratio of plasma and brain tissues deviates from the norm. Pathology appears as a complication of water intoxication of the central nervous system, metabolic encephalopathy, hyperglycemia and liver failure.

After diagnosing the disease and the factors that caused swelling, an ICD 10 code is assigned and an appropriate course of therapy is prescribed.

What causes cerebral edema

The clinical manifestations and prognosis of treatment are influenced by the etiology and pathogenesis of the disease. The degree of swelling and existing complications influence the choice of therapy and medicines.

How does cerebral edema manifest?

Symptoms pathological disorders are:

To the signs developing edema also include fainting, difficulty speaking, breathing and other manifestations. The intensity of symptoms gradually increases. Cerebral edema causes the death of nerve tissue, so the patient has symptoms characteristic of problems with the conduction function of the central nervous system.

What is dangerous cerebral edema

The mechanism of edema development is associated with the development of necrotic phenomena. It is impossible to completely restore dead nerve cells and soft brain tissue. The consequences depend on the degree of damage and the damaged area.

Even after effective therapy, the patient has the following complications:

AT severe cases, stroke and neoplastic diseases, cerebral edema is terrible in that it leads to partial or complete paralysis of the limbs and disability.

Oncological diseases, even after removal of the tumor, end in death in 85% of cases. Latest Research allow to establish the relationship between coma and swelling of the brain tissue.

Coma and cerebral edema

Coma with edema is defensive reaction. First, the patient falls into an unconscious state. If you do not provide prompt assistance, a coma is diagnosed. Depending on the degree of damage and the factors that caused changes in the brain, the patient is hospitalized in the appropriate department of the hospital.

Cerebral edema in a newborn

1. Toxicosis.
2. Hypoxia.
3. genetic predisposition.

1. developmental delays.
2. Hyperactivity.
3. Epilepsy.
4. Paralysis.
5. Hydrocephalus or dropsy.
6. Vegetative-vascular dystonia.

How and how to remove cerebral edema

Diagnosis of cerebral edema

Traditionally used following methods research:

Diagnostic criteria for edema take into account the total volume of the lesion, the localization of the process. This allows you to anticipate possible complications. For example, swelling of the left hemisphere significantly affects the intellectual abilities of the patient, and in severe conditions paralysis of the right side can be expected.

When examining a patient, a series of tests are performed to identify the catalyst for tissue swelling. So, neurological examination in alcoholism, along with the results clinical analyzes, helps to accurately determine the presence of violations even in the initial stages.

Emergency care for edema

Medicines for edema

If the factor - the catalyst that provoked the swelling, is a tumor, its removal is indicated.

Treatment of cerebral edema with folk remedies

Due to the risk of disease and high probability cause unwanted complications or provoke re-inflammation and swelling of tissues, take any herbal decoctions and tinctures are possible, only after agreement with the attending physician and only during the period of non-exacerbation.

Brain recovery after edema

The severity of complications depends on the speed with which treatment was started. The human brain has amazing feature. The functions of dead cells and areas of brain tissue are taken over by tissues located nearby. But this takes time. The patient, after suffering a stroke, will need to re-learn how to walk and talk. Over time, there is a partial restoration of lost functions.

Cerebral edema - dangerous state, health threatening and life of the patient. It is necessary to treat tissue swelling exclusively in a hospital. Any methods of self-treatment are unacceptable.

This dangerous rapidly developing disease can lead to an irreparable, unexpected and dangerous outcome. Puffiness of the brain can occur in every person and for many reasons.

For example, in a severe form of toxicosis during the gestation period, hypoxia may develop in the mother and fetus, which can later cause swelling of the child's brain.

A number of certain factors can cause brain pathology in newborns, namely:

• Getting a head injury during.
• Long difficult labor.
• Intrauterine oxygen starvation.
• Infections received in the womb.
• Infection during childbirth.
• Congenital oncology of the brain.

You can suspect a pathology in a baby based on the following symptoms:

• The child is very restless.
• Intense bursting cry.
• Refusal of food.
• Sleepy state.
• Slowdown in movement.
• Enlargement of a large fontanel.
• Vomit.
• Seizures.

In children, cerebral edema develops very quickly. The symptoms progress and increase, the baby's condition worsens. Frequently received brain injury are not subject to reverse development, and the child may die. Therefore, treatment should begin as soon as possible.

When treating newborns, doctors try not to resort to surgical intervention, because such a procedure can, with high probability end in the death of a small patient.

In the treatment of edema in children, drugs are used that remove fluid from the body, inhibit the development of edema, eliminate convulsions and normalize blood supply. In some cases, resort to artificial lowering of the body.

The consequences after suffering cerebral edema in children are very diverse. Often, parents of such children notice a developmental delay, impaired motor skills, speech, intellectual and physical abilities. In some cases, children develop or epilepsy.

After a long and successful treatment, the child will be registered with a pediatrician and a neurologist for a long time. In case of developmental delay or speech delay, the baby is additionally prescribed regular visits to a psychiatrist.

Planning for pregnancy should begin with a consultation with a gynecologist. It will determine the presence possible infections or viruses and will prescribe the proper treatment. The absence of health problems in the mother is a guarantee of the birth of a healthy baby.

Cerebral edema is a dangerous condition that requires immediate help injured patient!

Cerebral edema - pathological syndrome, characterized by the accumulation of a larger than normal volume of fluid in the brain (cells or intercellular space).

Since the cranial cavity is limited by rigid structures, the swollen brain has to “shrink” in the same amount of space provided. Due to this, cells and intracellular structures that provide energy metabolism are compressed. Metabolism is disturbed, and brain tissue ceases to function normally.

According to pathogenesis, they are distinguished:

Cytotoxic edema: Fluid accumulates predominantly in cells. Among etiological factors- and a violation of the supply of energy substrates to the brain cells. Due to this, membrane ion pumps stop working. accumulates in cells a large number of Na+ ions. Since these are osmotically active particles, they also retain water in the cells. Astroglial cells are predominantly affected. Moreover, the bodies of astrocytes "swell" only after the "swelling" of the processes, at the very last stages;

Vasogenic edema characterized by increased vascular permeability of the blood-brain barrier. In view of this, various osmotically active particles penetrate the barrier, which then entrain the liquid;

Interstitial edema develops in case of hyperproduction of cerebrospinal fluid. First of all, the pressure in the ventricles of the brain increases, then impregnation of the adjacent tissues may occur.

Cerebral edema can develop with traumatic brain injury, brain tumors, cerebral embolism, toxic damage body (alcohol, alcohol surrogates, poisons, drug overdose), with eclampsia, with severe renal or hepatic insufficiency, in cases of acidosis (ketoacidosis, lactate acidosis), with prolonged hypoxia of any genesis, with infectious diseases, with circulatory disorders of the brain, sometimes with prolonged convulsive syndrome.

Clinical picture

There are 3 groups of symptoms:

1. Syndrome intracranial hypertension (develops due to the fact that "the swollen brain does not fit in the cranium") - bursting intensive headache, nausea, vomiting (due to irritation of the trigger zone of the vomiting center). Distinctive feature- vomiting does not bring relief as in the case of gastrointestinal pathology. Decreased level of consciousness. The classic picture in stroke is Cushing's triad: bradycardia against the background of high blood pressure + decreased breathing.
2. Focal symptoms- develop when the zone (center) responsible for certain functions (speech, limb movements, vision ...) suffers.
3. stem symptoms- their development translates the course of the disease into a critical stage. Due to the general increase in the volume of the brain, he is "trying to find a way out" of the cranium and take up free space. The “exit” is located in the area of ​​the foramen magnum, in which the brain stem passes. With (dislocation) displacement of stem structures, the functioning of the centers responsible for vital functions - blood circulation and respiration - is disrupted. Thus, respiratory arrest (requirement for artificial ventilation) and circulation may occur ( different kinds arrhythmias with inefficient circulation).

Treatment

Since the supply of nutrients depends on the central perfusion pressure, the main goal of the treatment of cerebral edema will be to maintain it at the proper level.

Central perfusion pressure is defined as arterial pressure minus central venous pressure and . Since intracranial pressure is increased in cerebral edema, the resulting central perfusion pressure will be less than necessary.

Consequently primary goal– reduction of intracranial hypertension by all available means:

• Ensuring complete rest, if necessary - sedation (introduction of drugs that suppress arousal, motor activity).
• Elimination of pain (pain provokes arousal, even if it is not manifested by physical activity).
• Elimination of the causes that violate the general venous outflow from the brain (tight bandages in the neck, lowered head end of the bed).
• maintenance normal temperature body (in case of violations in the area of ​​​​the center of thermoregulation, it will increase, and the drugs that work with fever of inflammatory origin are usually inactive here, physical cooling helps more).
• Ensuring adequate oxygenation (up to transfer to a ventilator if necessary).
• the appointment of diuretics (removal of fluid from the body).

In the case of cytotoxic edema, it is recommended to maintain an increased arterial pressure(need to "push" nutrients into swollen cells that are more eager to "push out" something than to take in). Also, it is here that more than with other types, it is shown osmodiuretic mannitol. As noted above, with cytotoxic edema, osmoactive particles accumulate in the cells and attract fluid.

With the introduction of mannitol, the osmoactive substance in the blood will compete with intracellular osmotic particles for fluid. In the case of vasogenic edema, mannitol enters the cells through vessels with increased permeability and can only aggravate the condition.

With vasogenic cerebral edema, it is illogical to maintain high blood pressure, because. this will only cause more leakage. more liquids through vessels with increased permeability. AT this case it is worth focusing on the hydrostatic pressure gradient between the media. With vasogenic, more than with cytotoxic, cerebral edema, glucocorticoids are effective, which reduce vascular permeability.

With the inefficiency of all resampled methods conservative therapy performed decompression trepanation skulls. The point is to give extra space beyond the closed cranium until the situation can be corrected by other methods.

Consequences of cerebral edema

Even with a favorable outcome, cerebral edema does not pass without a trace. Patients may for a long time disturb headaches, mood lability, impaired concentration. If, as a result of diseases that accompany cerebral edema (for example, a stroke), a certain part of the brain responsible for some functions dies off, then they may fall out or be disturbed.

If these are centers that provide movement, then paralysis and paresis develop, in severe cases, swallowing disorders may develop. Cognitive impairment may also occur. Areas of the brain with impaired blood supply during edema can become epileptogenic foci. In children, a consequence of edema in early age may become cerebral palsy. But of course the most adverse effect(with increasing edema) - wedging with the development of a violation of vital important functions and lethal outcome.

cerebral edema- a disease that is accompanied by a violation of the outflow of cerebrospinal fluid. In this case, there is increased pressure on the brain tissue. There are problems with blood circulation. If the pathology is not removed in a timely manner, the disease will end in death. Therefore, it is important to know all the symptoms of cerebral edema and how it is treated.

Edema is a complication different pathologies in cranium. The substance from the vascular space is absorbed into the brain tissue. In this case, not one lobe is damaged, but the entire brain. But it spreads from one source. The cerebrospinal fluid is secreted more actively.

You can notice swelling on the first day. Pathology develops as quickly and suddenly as it appears. Therefore, it is extremely important to have an idea of ​​​​what cerebral edema is. The work of nerve cells and functionality is disrupted nerve center. Cells become enlarged as water enters them, binding to proteins.

The structures are then completely damaged, leading to consequences that may be irreversible. Sometimes the edema can pass quickly without leaving a single trace. This happens in lung case concussion.

Types of edema

Fluid may accumulate in different reasons. Depending on these reasons, they distinguish different types cerebral edema.

The vasogenic form is the most common. The cause of swelling is damage to the blood-brain barrier. white matter increases, which creates great pressure. The substance most often accumulates in damaged areas of the brain

Edema, puffiness and swelling of the brain may be cytotoxic in nature. In this case, the swelling appears from the gray matter. The disease can occur after ischemia, hypoxia, intoxication and other causes.

Osmotic edema or swelling of the brain appears if the osmolarity of the tissues of the nervous system is at elevated level. The causes can be both complications after other diseases, and wrong treatment or cleaning: after hypervolemia, polydipsia, metabolic disorders. Swelling may also occur if blood purification has not been carried out correctly.

It often happens interstitial edema brain. Happens when cerebrospinal fluid out of the ventricles through the walls of the cavity. This is a direct disruption of the nerve center, in which tumors can play their role.

Also, edema varies in the scale of the pathology. There may be local and generalized edema. Local is also called regional. Its distribution is limited by a certain border. This includes hematomas, tumors and other formations.

Generalized edema spreads throughout the cranium around the brain. There are many reasons why such a pathology can form. Among them are craniocerebral trauma, and impaired functionality, due to the exclusion of air from the brain, and intoxication, and many other reasons. Even high blood pressure can push to the formation of pathology.

What can cause swelling?

Signs of cerebral edema are usually immediately noticeable, as it usually appears after an illness or injury. Therefore, education may be suspected. There are 8 main reasons that have a beneficial effect on the formation of puffiness. The causes of cerebral edema are as follows:

1. Often, pathology occurs after a traumatic brain injury. The difficulty is that soft tissues are damaged during injuries. Most often there is swelling of the brain after surgery. Endoscopic method the operation does not exclude the appearance of subsequent swelling. The function of the musculoskeletal system is impaired, paralysis of the limbs is possible.
2. Infection. The inflammatory process damages nerve endings and cells, which causes tissue swelling. Such an infectious disease can be meningitis, encephalitis, empyema and other acute diseases. If the disease is accompanied by the release of pus, swelling develops faster with great consequences for the body.
3. Tumor. Puffiness can be caused by both benign and malignant tumors. Education puts pressure on soft tissues, thereby damaging them. Due to irritation, natural puffiness is born. After the neoplasm is removed, the swelling subsides quickly.
4. Internal hemorrhage in the head. Rupture of an artery causes inflammation of the tissues, which in turn causes swelling of the brain.
5. Ischemic stroke. A blood clot appears in the arteries, after which the cells do not receive oxygen and die. Cerebral infarction causes necrosis, which is accompanied by swelling.
6. Intoxication. Poisoning causes cell death and tissue damage. This has a positive effect on the formation of puffiness. Incorrectly administered anesthesia also causes intoxication, which can lead to the formation of edema.
7. Birth injury. During childbirth, there may be various injuries newborn baby. The fetus may also be crushed by the umbilical cord. Hypoxia may be complicated by edema.
8. Atmospheric pressure jumps. People working at heights or depths are susceptible to edema. The difference in external pressure causes an increase or decrease in intracranial pressure. The category prone to swelling includes pilots, climbers and scuba divers.

Diagnostics

The first step is to check with a neurologist. This is where the treatment begins. If the patient's condition steadily worsens, the doctor has the first suspicions. Symptoms of meningitis may also indicate the development of edema.

The final answer to the question of the presence of puffiness is given with the help of MRI or CT. For a complete picture, you also need to conduct a blood test, neurological status and determine possible factors that contributed to the formation of pathology.

Cerebral edema develops quite quickly, so the test should not be postponed. Treatment and diagnosis is best done on a stationary basis.

Symptoms

Cerebral edema has symptoms, like other pathologies in the cranium. Cerebral symptoms are necessarily present, as well as individual signs. Symptoms are affected by all features of education:

• development period;
• localization;
• development speed;
• scale and others.

If the number of symptoms increases, there is a suspicion that the edema damages different parts of the brain. In this case, you need to immediately start treatment.

Signs of cerebral edema are the symptoms high blood pressure, neurological manifestations and indicators critical condition patient, like coma and others.

Increased cranial pressure is always accompanied by headache and fatigue. The patient becomes excitable. Consciousness gradually becomes cloudy, nausea turns into vomiting. Sometimes cramps can occur, which accelerate the growth of edema. There are problems with the direction of eye movement.

Dangerous are the symptoms of cerebral edema caused by diffuse disorders. Damage to the nervous system introduces a state of coma. Consciousness is impaired possible easy delirium. Convulsions are not single, periodically repeated. There may be epileptic seizures. Incorrect functionality of reflex centers.

Cerebral edema can have consequences that cannot be eliminated. If the substance enters the hole in occipital lobe, may occur serious violations brain structures. The patient may enter a deep coma. There may be a fever that does not help with antipyretics. To lower the temperature, you need to cool large vessels, which are closest in the skin. The reaction of the pupils is inhibited, and one may be larger than the other. Children often develop strabismus. Heartbeat drops sharply.

In case of a critical condition, the patient must be connected to the device artificial respiration so that the consequences of the formation of cerebral edema are not lethal. The respiratory rate increases unsteadily, which leads to its final stop.

First aid

After the first signs of swelling of the tissues appear, you need to prepare for a set of measures for first aid, which can play a big role.

If the symptoms are already expressed, it is imperative to ensure the flow of clean air. Make sure that no vomit has entered the respiratory tract. The head can be cooled with ice packs. This method allows you to expand the vessels for normal blood circulation. If possible, the patient should be given an oxygen mask. The tool plays a significant role in saving lives.

After assistance is provided, the patient should be quickly transported to the hospital. The position of the head and body should be horizontal.

Medical treatment of pathology

If you don't make it on time hospital treatment, the effects of cerebral edema may be irreversible. The goal of medical care is to stabilize metabolic processes brain. Complex therapeutic actions consists of a combination of surgery and drug treatment.

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First of all, doctors will ensure the flow of oxygen to the brain. For this purpose, artificial oxygen supply devices are used. Oxygenated blood helps reduce brain swelling faster.

A dropper is administered drugs that help reduce cranial pressure. They can also inject solutions that can reduce body temperature, which also contributes to the resorption of puffiness.

There may be a situation where traditional measures are not enough to completely get rid of the swelling. A catheter can remove some of the fluid in the cerebral ventricles. Sometimes blood vessels require repair. For this, a surgical method is used. In the most extreme cases increased cranial pressure, it is possible to remove part of the skull. The operation is quite serious and complex.

Brain recovery after treatment

severity possible complications directly depends on how quickly treatment is started. Over time, the cells that surround the damaged part will perform the same functions. But it takes a lot of time for this. Sometimes recovery can be carried out permanently. After a stroke, the patient can learn to talk and walk again.

Recovery measures prevent the recurrence of fluid accumulation. Doctors prescribe drugs that help to quickly restore the functionality of parts of the brain. The sooner treatment begins, the less consequences will be after recovery.

Effects

Cerebral edema is always accompanied by consequences, which may not always be serious, but can sometimes lead to lethal outcome. Pathology is unpredictable, therefore, for treatment, you need to contact only a highly qualified doctor. There are three possible scenarios for the development of events after edema:

• further progression of the pathology with a fatal outcome;
• removal of edema with a consequence of disability;
• complete removal of puffiness without consequences.

Unfortunately, about 50% of edema cases are fatal. This is influenced by the causes of cerebral edema and its treatment. When the amount of fluid is critical, the cerebellar tonsils deepen into the brainstem, which provokes cardiac and respiratory arrest.

Small edema, following a concussion or other similar injury, can be successfully eliminated without a trace. Timely appeal the hospital plays a big role in this scenario. Usually full recovery possible after cerebral edema in adults who are somatically healthy with strong immunity.

Often, the ongoing disease can damage the brain tissue so that the consequences of improper functionality cannot be eliminated. Meningitis, traumatic brain injury and hematoma can have such consequences. Nerve cells the brain completely die off, and neighboring ones cannot perform a large number of functions. In this case, the life of the patient is saved, but with subsequent disability.

Cerebral edema is an excessive accumulation of fluid in its tissues, accompanied by an increase in intracranial pressure, and is the body's response to any irritation (presence of infection, intoxication as a result of poisoning, head injury). Usually this reaction develops rapidly, and if the patient is not provided with the necessary medical care in time, it leads to death. An increase in intracranial pressure leads, in turn, to impaired blood circulation in the brain and the death of its cells.

There can be several reasons for the occurrence of cerebral edema. Among them: trauma of the skull, infectious disease, diseases associated with disruption of the brain, brain tumor, intracranial hemorrhage. When a traumatic brain injury occurs, mechanical damage brain, sometimes it is complicated by the ingress of fragments of the cranial bone into the brain.

The resulting swelling prevents the normal outflow of fluid from the brain tissue. A similar phenomenon may occur as a result of a fall from high altitude, accidents, hard hit over the head. Directly to the development of cerebral edema is ischemic - a violation of blood circulation in the brain as a result of blockage of the vessel by a thrombus. In a stroke, brain cells do not receive required amount oxygen, which leads to their starvation and gradual death, as a result of which edema develops.

Many infectious diseases cause cerebral edema. The most common of them are:

• Encephalitis - viral disease associated with localized in the brain inflammatory process. Most often, various insects become carriers of encephalitis.
• -inflammation of the lining of the brain viral infection or uncontrolled use of medications.
• Subdural empyema - purulent complication brain infections.
• Toxoplasmosis is an infection caused by the presence in the human body of the simplest microorganism - toxoplasma.

The presence of a tumor in the brain is often accompanied by its edema. Growing rapidly, tumor cells press on healthy cells brain, causing swelling. In newborns, cerebral edema is most often caused by trauma received at birth. Predisposing factors in this case are the diseases suffered by the mother during pregnancy. Climbers often have the so-called mountain cerebral edema, which occurs when climbing to a height of more than one and a half thousand meters above sea level. This phenomenon is associated with sharp drop heights.

Symptoms of cerebral edema

The occurrence of cerebral edema can be suspected not by several main symptoms:

• Strong ;
• Dizziness accompanied by nausea and vomiting;
• Partial visual impairment;
• Loss of orientation in space;
• Uneven breathing;
• Difficulty in speech and falling into a stupor;
• Memory losses;
• short-term convulsions;
• Fainting.

If these symptoms occur, seek immediate medical attention medical care. Diagnosis of cerebral edema is based on the results computed tomography and magnetic resonance imaging of the brain. The cause of the development of edema can be established by a blood test.

Treatment of cerebral edema and its consequences

Cerebral edema resulting from a small concussion usually resolves on its own and does not require treatment. In all other cases, if there is bright severe symptoms brain damage requires qualified treatment, which is aimed primarily at supplying the brain enough oxygen. It involves intravenous infusion to the patient medicines that help reduce intracranial pressure and eliminate infection (if it was the infection that caused the development of edema). The choice of drugs depends on the cause of the edema and the severity of its main symptoms.

If necessary, for example, in case of a traumatic brain injury as a result of an accident, the method of oxygen therapy is used, which involves the artificial introduction of oxygen into the body of the victim. The blood saturated with oxygen nourishes the damaged brain and contributes to the speedy removal of its edema.

In especially severe cases of edema, apply surgical methods treatment. With excessive accumulation of fluid in the ventricles of the brain, it is removed using a special catheter. This procedure helps to eliminate fluid and reduce intracranial pressure.

Operations on the brain are among the most difficult, but their implementation in some cases is the only possibility saving the patient's life. So, surgical intervention it is necessary in the presence of a tumor, the entry of the skull bone into the brain, the restoration of a damaged blood vessel. The outcome of such an operation always depends on the level of professionalism of the surgeon.

The consequences of cerebral edema can be varied. First of all, you should pay attention to the consequences of those diseases that lead to it. A stroke is accompanied by the death of brain tissue that cannot be restored even after treatment. The consequence of a stroke and increased intracranial pressure may be partial or complete paralysis of the body and, accordingly, disability. Removal of a brain tumor is only initial stage cancer treatment. Therefore, the outcome of the disease depends on its further therapy.

For most patients, cerebral edema does not go away without a trace. Each of them in the future will have to face such backfire, as frequent headaches, insomnia, impaired ability to communicate with other people, depression, absent-mindedness and forgetfulness. With a slight swelling of the brain, for example, with a concussion as a result of a small accident, the consequences are usually minimal and disappear over time.