He Traumatic brain injury ( TCE T the Traumatic brain injury ( TBI ) Is an impact at the brain level that occurs as a consequence of an external force that can lead to a decrease or alteration of the level of consciousness, which in turn causes a decrease in cognitive and / or physical abilities (Portellano, 2005 ).
In other words, a TCE is any Trauma That occurs in the head, either superficial level affecting the scalp or More severe, affected skull and brain tissue (Ferrés Cuñado, 2016).
In addition, head trauma is one of the most common types of acquired brain damage. Specifically, in Spain and other countries Industrialized countries, TCEs are the leading cause of death in young adults (Jodar Vicente, 2013).
Trauma can occur when the head strikes or is struck suddenly and violently with an object or surface, or when an object Pierce the cranial vault and access the nervous tissue (National Institute of Neurological Disorders and Stroke, 2016).
Among the most common causes of TBI are traffic accidents, falls, accidents at work or violent assaults (Jodar Vincent, 2013).
The Signs and symptoms Of head injuries can vary on a continuum from Mild, moderate or severe , Depending on the extent of nerve damage and injury (National Institute of Neurological Disorders and Stroke, 2016).
So, Gravity can vary From a mild blow or bruise, to severe bruising in brain areas. Specifically, injuries Most common include: bruises, cranial fractures or wounds on the scalp (Reed-Guy, 2015).
The consequences and treatment of cranioencephalic trauma vary enormously between the different cases because they depend so much on the cause of The injury as of the severity of it (Reed-Guy, 2015).
Characteristics of traumatic brain injury
A Traumatic brain injury ( TCE T the Traumatic brain injury Occurs when a force External mechanics causes brain damage and injury (Mayo Clinic, 2014).
When an object hits the skull violently, a wide variety of medical conditions may appear: headache , Confusion, stun, Dizziness, blurred vision, fatigue, sleep, loss of consciousness and others Neurological symptoms And cognitive (National Institute of Neurological Disorders and Stroke, 2016).
Due mainly to the structural configuration of the skull, TCEs will produce Damage in the affected areas , that is to say, Those that receive the impact, As in other more remote As a consequence of the blow-counter effect (Pelegrín, Muñoz-Céspedez and Burned, 1997; However,
On the other hand, cranioencephalic trauma can be divided into two major groups:
Open TCE
In open cranioencephalic trauma the skull undergoes a fracture or penetration. In these cases, it is possible that the damage reaches the tissue Or fragments of bones are embedded (Ardila and Rosselli, 2007).
Normally, people with this type of traumatic brain injury usually do not lose consciousness and the clinical symptoms are usually Associated with focal neurological damage (Ardila and Rosselli, 2007).
In addition, as the brain mass is exposed to the outside, it will increase the risk of contracting an infection"(Portellano, 2005).
TCE closed
In closed cranioencephalic trauma brain injuries occur as a consequence of the mechanical effects of the traumatic event (Ardila & Otrosky, 2012).
In this case, the skull does not suffer a fracture and a concussion or contusion of the encephalic mass occurs (Ardila & Otrosky, 2012) and generally Produce more diffuse neurological and cognitive effects (Portellano, 2005).
About us
Cranioencephalic trauma represents an important public health problem because of its frequency in the general population and the consequences Or consequences associated with them (Esper et al., 2010).
In the United States, approximately 230,000 people are hospitalized every year in emergency medical services with traumatic brain injuries Severe injuries, while approximately one million people suffer minor or minor traumatic incidents (Cleveland Clinic, 2014).
Of the serious cases, more than 99,000 people will suffer important sequels, reason why they are possible to remain in a state of chronic disability (Cleveland Clinic, 2014).
In the case of Spain, there are around 200 cases of traumatic accidents per 100,000 inhabitants each year. Within this high figure, the Most of the cases (80%) will be considered mild, while 10% will be severe and another 10% will be moderate (Hospitals Nisa, 2016).
In addition, head injuries are two to three times more frequent in men than in women, while the most affected age group is Period from 15 to 24 years of age. However, after 60 years the risk is also increased (Cleveland Clinic, 2014).
symptom
The most characteristic signs and symptoms of cranioencephalic trauma are Physical injury to the head
- Scalp.
- Skull.
- Brain tissue.
In addition, damage to the brain or nerve tissue may occur at the time of impact or develop later. Some of the injuries Physical consequences of traumatic brain injury are (Portellano, 2005):
- Superficial bleeding on the scalp.
- Bruising on the surface of the scalp.
- Accumulation of blood in intracranial and intracerebral areas.
- Interruption of blood and oxygen flow in intra-abdominal areas.
- Development of blood clots.
- Cranial fracture with possible sagging of bony regions.
- Fracture of the meningeal layers.
- Brain concussion or concussion: violent shock of the brain against the walls of the skull due to external trauma.
- Laceration and / or tearing of brain tissue.
- Brain edema (Fluid accumulation in brain areas).
- Intracranial hypertension (increased blood pressure).
- Encephalic infection, Hydrocephalus , Convulsive episodes, etc.
In addition to these signs that are evident at the time of impact or trauma, there are cranioencephalic traumatisms may have significant Physical or neurological consequences. Although the clinical course is quite heterogeneous, a set of symptoms Frequently after the traumatic event or a few days later.
Specifically, depending on the severity of the traumatic injury we can distinguish various symptoms (Mayo Clinic, 2014):
Mild traumatic brain injury
Signs and symptoms related to mild traumatic brain injury may affect the physical, sensory and cognitive area.
to) Physical symptoms
- Alteration of the level of consciousness: loss of consciousness, numbness, confusion, temporo-spatial disorientation, etc.
- Headache.
- Fatigue, tiredness or drowsiness.
- Dizziness, loss of balance.
- Nausea, vomiting.
B) Sensory Symptoms
- Blurred or double vision.
- Auditory tinnitus.
- Light and auditory sensitivity.
- Changes in the perception of flavors and odors.
C) Cognitive and Neuropsychiatric Symptoms
- Problems of concentration and attention.
- Memory deficits.
- Humor changes .
- Feeling of anxiety.
Moderate-severe cranioencephalic trauma
In the case of signs and symptoms related to moderate-severe cranioencephalic trauma, they will mainly affect the physical and / or cognitive area And may include all those related to mild traumatic brain injury.
to) Physical symptoms
- Alteration of the level of consciousness: loss of consciousness, numbness, confusion, temporo-spatial disorientation, etc.
- Convulsive episodes.
- Pupil dilation.
- Presence liquid substance in powdery mildew and / or nose.
- Weakness and numbness of upper and lower extremities.
- Recurrent nausea and vomiting.
B) Cognitive and neuropsychiatric symptoms
- State of deep confusion.
- Agitation, aggressiveness.
- Patterns of abnormal behavior.
- Linguistic deficits.
Most Common Causes
There are numerous events or conditions that can cause traumatic brain damage.
The most common cause of head trauma is traffic accidents , Represent approximately 50% of the cases (Cleveland Clinic, 2014). On the other hand, Physical activity and some sports They can also cause accidents that Involve an TBI, is considered the second most prevalent cause (Cleveland Clinic, 2014).
In addition, Routine Accidents and Falls Are another frequent cause, especially in people over 65 years old (Cleveland Clinic, 2014).
Other less frequent causes have also been identified as bullet wounds Or use of forceps During birth (Ardila & Otrosky, 2012).
In a systematic way, Most common causes of TBI are (Mayo Clinic, 2015):
- Traffic accidents : Collisions between cars, motorcycles or bicycles is one of the most common casts of TCE.
- Sports Accidents : In relation to sport, injuries caused by accidents in football, boxing, baseball, skateboarding, hockey Etc., can also cause TBI.
- Falls : The most frequent TCE scenarios in the case of falls are stumbling on building stairs or ladders, Falls from the bed, slips during the shower or inside the bathroom.
- Violence : Many of the injuries involving TBI are caused by gunshot wounds, domestic violence, or child neglect.
Types of cranioencephalic trauma
There are a wide variety of classification criteria for cranioencephalic traumatisms: clinical factors, severity, lesion produced, etiology, etc.
to) Depending on the type of injury:
- Open TCE : When a cranial occurs and brain tissue is exposed to the outside (Jodar Vicente, 2013).
- TCE closed : When there is no open injury and damage occurs secondary to the traumatic event (Jodar Vicente, 2013).
B) According to the location of the lesion
- Encephalic: The lesions directly affect the brain tissue (Jodar Vicente, 2013).
- Cranial: The lesions affect the interior of the skull, but do not involve other secondary ones at the cerebral level (Jodar Vicente,
2013).
- Epicranals: The lesions affect the exterior of the skull (Jodar Vicente, 2013). Regardless of these classifications, the most common in head trauma is the criterion of severity:
- Light TCE : In patient is totally oriented and maintains the state of alert. Neurological deficits usually do not appear Significant and permanent. In spite of this, at the time of trauma there may be loss of consciousness and post-traumatic amnesia.
- Moderate TBI : In moderate TBI there is a decrease in the level of awareness or alert and signs of deficits may appear neurological.
- Severe TCE : In the most severe type there is a serious decrease in the level of consciousness. The patient appears fully Isolated from the surrounding environment without responding to verbal commands or environmental stimulation. Severe head injuries are associated with both brain damage As significant neurological consequences.
Diagnosis
Cranioencephalic traumatisms are considered an emergency medical condition, so they are treated in medical services with special priority.
The first diagnostic action used in TBI has to do with determining the patient's level of awareness. The biggest scale Employed is the Glasgow Coma Scale (GCS), It gives us an initial index of severity (Mayo Clinic, 2014).
On the other hand, all information regarding the traumatic event is collected: how it happened, where, initial symptoms, altered consciousness, etc. (May Clinic, 2014).
In addition, some brain imaging techniques are used ( magnetic resonance or Computed tomography ) To locate the possible presence of lesions Brain injury requiring emergency medical intervention (Mayo Clinic, 2014).
Consequences or possible complications
Cranioencephalic trauma will often cause different types of deficits: alterations in memory, attention, concentration , Taking of Decisions, Problem resolution Or even behavioral changes (Ardila and Rosselli, 2007).
Complications and sequelae will depend fundamentally on the severity of the traumatic event. In mild TBI, there may be sequelae However, in the most severe cases, more severe ones may appear: chronic coma, physical disability, profound cognitive deficits, etc. (Ardila and Rosselli, 2007).
Treatments employed
In any case, all those individuals who have just had an TCE should receive emergency medical care.
The treatments used in the acute phase are directed to control the immediate signs and symptoms of the traumatic event. It is Vital signs and control bleeding and fractures.
In addition to using pharmacological measures, in some cases it may be necessary to approach medical complications through procedures Surgical procedures to repair fractures, lacerations, bone inlays, clot development, etc.
In the sub-acute phase, all therapeutic interventions will be directed towards the recovery of the level of consciousness of the patient and of the areas Cognitive and physical impairments.
Bibliography
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González Rodríguez, E. Muñoz Marrón, & R. Viejo Sobera, Neuropsychology (Pp. 381-405). Barcelona: UOC. - Mayo Clinic. (2016). Head trauma: First aid . Obtained from Mayo Clinic.
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