Brain compression: types, symptoms, diagnosis and treatment

The compression of the brain is called acute or chronic compression of the brain tissues, which develops most often due to craniocerebral trauma, volumetric formation in the cranial cavity, cerebral edema or hydrocephalus. In the narrow sense, compression of the brain is a form of severe TBT.This pathology is clinically accompanied by severe cerebral symptoms down to the development of coma. The topical characteristics of the pathological process affect the focal symptoms. A bright gap in the clinic is a characteristic, but not an obligatory, sign. The basis of diagnosis - MRI and CT of the brain. Therapy is often surgical, aimed at eliminating hydrocephalus and removing the formation, which led to compression.

Description

Brain compression is considered a life-threatening condition that occurs due to the compression of cerebral tissues and is accompanied by increased intracranial pressure. Necrosis and death of brain cells is caused by compression, which leads to an irreversible neurological deficit. In general, compression of the brain can accompany many pathological processes occurring inside the skull.

According to statistics, a small percentage( only about 5%) of TBI is accompanied by compression of the brain. If we disassemble this concept more narrowly, then the acute form of compression of the brain is understood as the clinical form of severe TBT.Lethal outcome in severe trauma can occur in half the cases, disability of CCT leads to 30%.An important task is facing modern traumatology, neurology and urgent neurosurgery - to improve outcomes of head injury and reduce mortality.

What are the causes of cerebral compression?

Compression of the brain tissue can provoke any voluminous formation. To similar it is possible to carry an intracerebral tumor( glioma, astrocytoma, pituitary adenoma), a tumor of meninges, a hematoma, a congestion of blood, to the outflow of which led to brain abscess, hemorrhagic stroke, cerebral cyst. A significant increase in intracranial pressure and compression of the brain leads to severe hydrocephalus, edema.

Slowly growing tumor, cyst, gradually increasing hydrocephalus, forming abscess - all this provokes compression of the brain in a chronic form. Neurons adapt to a certain degree to pathological conditions, the fault of which is aggravated compression. In cases of craniocerebral trauma, cerebral edema, occlusive hydrocephalus or stroke accompanied by acute compression of the brain lead to a rapid increase in intracranial pressure and the death of brain cells.

Craniocerebral trauma most often leads to acute compression of the brain. Its most common cause is post-traumatic hematoma. Sub- and epidural, intracerebral and intraventricular - all depends on the location. Symptoms of cerebral compression are discussed below.

Compression of the brain causes depression of the fragments or intracranial accumulation of air( pneumaticcephaly) that occurs when the skull is fractured. Sometimes, the compression of the brain is caused by a growing hygroma.

Principle of occurrence: when a valvular tear of the hard shell of the brain occurs, subarachnoidal tanks containing a CSF are damaged. From the subarachnoid space, the cerebrospinal fluid is absorbed through the opening( cracks) in the meninge. All this leads to the formation of subdural hygroma.

What are the signs of cerebral compression?

Symptomatic

Etiology, the localization of the compressive formation, its size and rate of increase, as well as the compensatory capacity of the brain affect the clinical picture of compression of the brain. For post-traumatic hematomas and gigrom, a "light gap" is characteristic. This concept implies such a condition of the victim when he is conscious, but signs of severe brain damage do not appear.

Light gap

The light gap in the compression of the brain continues from a few minutes to four days. With subarachnoid hemorrhage and subdural hematoma, light intervals last up to one week. If severe brain damage( such as a severe injury, axonal injury) is documented, then a light interval, as a rule, does not exist.

What are the symptoms of cerebral compression most often manifested?

Acute squeezing of

In the case of acute compression of the brain, there is often multiple vomiting, a constant severe headache and psychomotor agitation, which is accompanied by a sleep disturbance, sometimes delusions begin, hallucinations begin. Further excitation is replaced by general inhibition, apathy, lethargy, inhibition begins. The consciousness which develops from a sopor to a coma is broken. Respiratory and cardiovascular disorders due to the emerging mass effect accompany the diffuse inhibition in the central nervous system.

Increased intracranial pressure in the mass effect leads to the displacement of the cerebral structures towards the occiput. As a result, the oblong brain is obstructed in the occipital foramen and the work of the centers located in it is disrupted, respiratory and cardiac activities suffer.

Breathing

There are also characteristic signs of compression of the brain. The rhythm of breathing is upset. Tachypnea( rapidity) reaches sixty breaths per minute, inhalation and exhalation accompanied by noise, Cheyne-Stokes breathing. The heart rate decreases, the bradycardia is fixed at forty beats per minute and lower, the blood flow velocity decreases, which leads to hypertension. All this is accompanied by congestive pneumonia, pulmonary edema. The patient is listening to wet rales. The skin of the limbs and face become cyanotic. Body temperature rises to 41 degrees. There are meningeal symptoms. The terminal stage is characterized by tachycardia, arterial hypotension. The pulse is threadlike, there are episodes of apnea( breathing occurs with delays), the duration of which increases. Contusion and compression of the brain are also manifested by other signs.

Focal Symptoms

Cerebral symptoms accompany focal symptoms that arise and are aggravated. They are affected by the pathological process. This leads to the omission of the upper eyelid, diplopia, strabismus, mydriasis, central facial paresis( face asymmetry, lagophthalmus, "parousing" cheek) on the side of the hearth.

Opposite heterolateral side suffers from paresis, paralysis, tendon hypo- or areflexia, hypoesthesia. Often the manifestation of epileptic seizures, hormonal convulsions( paroxysms of muscle hypertension), tetraparesis, coordination disorder, bulbar syndrome( dysarthria, swallowing disorders, dysphonia).How to diagnose bruises of the brain with compression?

How to identify pathology?

Neurological examination and history data help the neurologist diagnose the compression of the brain. If due to the condition, a patient can not be interviewed, they interview the relatives or persons who were near the victim at the time when the injury occurred. The nature of the pathology does not allow to establish accurately the neurological status. If the cerebrovascular accident is caused by the head injury, the patient should be examined by a traumatologist. What is included in the diagnosis of cerebral compression?

Instrumental diagnostic methods

Instrumental diagnostic methods should be limited only by the most urgent and necessary research. For example, echoencephalography and lumbar puncture have proved their informativeness. The first one can detect a mass effect with a displacement of the middle M-echo, the second will reveal that the cerebrospinal pressure is increased, and in the cerebrospinal fluid there is blood. But now there are methods of neuroimaging, so there is no need for such studies. MRI or CT of the brain is prescribed to the patient depending on the indications, and sometimes both of these studies are performed. Spiral CT of the brain is connected in emergency situations, which reduces the time of diagnosis.

Intracranial formation, its location, appearance and size, to evaluate the dislocation of cerebral structures and to diagnose cerebral edema helps CT.Perfusion CT reveals cerebral perfusion and blood flow, secondary ischemia. Areas of cerebral ischemia, foci of injury and dislocation of brain tissue are determined on the MRI of the brain, which is more sensitive. Diffusion-weighted MRI is used to examine the state of the brain's conducting pathways and determine the degree of their compression.

Treatment of compression of the brain

Clinical and tomographic data determine the choice of therapy methods. Conservative therapy consists of dehydration and haemostatic treatment, normalization of hemodynamics, relief of respiratory distress( if necessary, artificial ventilation), preventive antibacterial therapy, anticonvulsant treatment in the presence of convulsions. It is necessary to keep under control arterial and intracranial pressure.

Surgical treatment

Indications for surgical treatment are determined by a neurosurgeon. Most often it is prescribed with a large volume of hematoma, dislocation syndrome, displacement of cerebral structures, compression, which encompasses the brain center, persistent intractable increase in intracranial pressure, occlusive hydrocephalus. Endoscopic evacuation is carried out with regard to hematoma. With complex localization of the intracerebral hematoma, stereotactic aspiration is shown. If the post-traumatic hematoma is combined with crushing of the brain tissue, during the operation, the sites of crushing are additionally removed, which requires the use of microsurgical techniques. In the case of a cerebral abscess, it is completely removed, the tumor is radically excised. Hydrocephalus presupposes a shunt operation( vascular hyperuritoneal or lumboritoneal bypass surgery).

Prophylaxis of pathology and prognosis

The compression of the brain is always a serious prognosis. The Glasgow Coma Scale helps to determine the correlation of the expected outcomes. Low balls indicate a high probability of a lethal outcome or a vegetative state, that is, it is impossible to think productively with preservation of reflex functions. Many surviving patients become disabled. Pathology leads to severe motor disorders, epipriphras, mental disorders, speech disorders. But modern approaches to diagnosis and therapy reduce mortality rates and increase the frequency of neurological deficit recovery. Preventive measures include prevention of injuries, as well as timely and adequate treatment of intracranial pathology.