Commotio Cerebri

COMMOTIO CEREBRI (Latin), concussion. With various strong concussions of the entire body or head injuries, such as: falling from an airplane or other height, injuries in railroad or automobile accidents, explosions of boilers and in mines, being struck by lightning and especially from the bursting of artillery shells, the body is subjected to strong concussion, which leads to more or less significant disruption of the functions of the central nervous system. With these injuries, sometimes there are no external signs of the concussion having been sustained, but despite this, very significant disorders occur in the functions of the nervous system (especially the brain), manifesting as loss of consciousness, usually lasting 15-20 minutes, but sometimes several hours or even days, as paleness, slowing of the pulse, which becomes small, sometimes arrhythmic; breathing is shallow, pupils are either constricted or, conversely, dilated and do not react to light; muscles are hypotonic; to this may be added general convulsions and often vomiting. Upon regaining consciousness, patients usually complain of headache, dizziness, ringing in the ears; often in them one can note a number of symptoms of mental disorders: retrograde amnesia, apathy, confusion, uncertainty, sometimes mental sluggishness and drowsiness (Fuchs). More severe injuries are often accompanied by damage to the skull, most often fracture of its base, which usually leads to bleeding from the nose, ears and even from the eyes, and in such cases to the above-mentioned symptoms are added clearer symptoms of loss of function in the form of paralysis of cranial nerves, most often of the III, VI, VII and VIII pairs, and sometimes in the form of mono- or hemiparesis or hemiplegia. Sometimes brain concussion ends fatally, with death occurring either immediately after the concussion or after several hours. At autopsy, usually no gross anatomical disturbances are found; there are even fatal cases described where no anatomical changes were discovered at autopsy. In some cases, only upon microscopic examination were found multiple foci of softening and hemorrhages, which were the cause of death. Hauser showed that immediately after injury, as well as in embolism, areas of the brain that should subsequently necrotize cannot be recognized. At the same time, Hauptmann, using encephalography in brain concussion, found significant changes, sometimes in the form of obstruction of the ventricles, in other cases in the form of their asymmetry or expansion. and in only 13% did he find no deviations from normal. In those cases of commotio cerebri that ended in recovery, later small cysts, glial scars and areas with petrified ganglion cells were sometimes found in the brain, which can be considered traces of the changes that occurred during concussion. The course and prognosis of the disease are very diverse. If death did not occur immediately or soon after the injury, the outcome of the disease can be different. In many cases, despite the fact that loss of consciousness was very prolonged, complete restoration of all functions can occur; this is explained by the fact that here there were neither large foci nor multiple small foci of softening, and apparently only the finest changes in the tissues existed; nervous tissue was relatively little damaged, and due to this its functions could be fully restored. In mild cases with rapid return of consciousness, the prognosis is favorable, complete recovery is quite possible; with stronger concussions with prolonged loss of consciousness and especially with fracture of the base of the skull-the prognosis is poor; but even in these cases sometimes complete or almost complete recovery occurs. On the other hand, sometimes relatively mild cases with rapid return of consciousness after some time give a picture of traumatic neurosis, traumatic hysteria or commotional psychosis. Treatment for brain concussion is reduced to conservative and symptomatic: complete rest in a cool, dark room, ice on the head, it is necessary to monitor cardiac activity (camphor, caffeine, etc.); with signs of cerebral hyperemia-ergotin with hydrobromic quinine (Chinini hydrobromici 0.2, Ergotini Bonjeani 0.06); no less important is timely emptying of the intestines and bladder (enemas, laxatives, catheter). Prevention of C.C. should consist in ensuring that work in industrial and production enterprises, as well as in transport, is raised to the appropriate level and maximally guarantees the safety of workers. But one cannot limit oneself to this. The largest number of C.C. is observed during wars; it is war that gives tens or even hundreds of thousands of these cases. 'War to war'-this is the main slogan in the prevention of BRAIN CONCUSSIONS.

A. Kozhevnikov. Commotional psychoses, mental changes that are a consequence of commotio cerebri; being very diverse in severity and depth, they in most cases, however, present a number of common features in terms of both symptomatology and course. Usually in cases with loss of consciousness, after the return of mental functions, patients do not immediately come to their senses, but remain stunned, confused, poorly oriented, forgetful and apathic or angrily irritable, much more rarely-inappropriately euphoric. They with difficulty perceive and assimilate what is happening around them, confuse events of the recent past and usually show greater or lesser retrograde amnesia, extending mainly to events preceding the accident. Delirious (see Delirium) phenomena are also often noted: confusion, visual, more rarely auditory hallucinations and separate delusional thoughts predominantly of a depressive nature. Sometimes a picture of a true twilight state develops, in individual cases accompanied by severe excitement, aggressiveness and tendency to violent actions. Sometimes such a state drags on for several days; more often however it lasts only several hours and even minutes, giving way to another variant where the above-mentioned general mental lethargy and sharp weakening (and sometimes complete loss) of the ability to remember come to the fore, i.e. the picture of the so-called Korsakovsky, or amnestic symptom complex (see Korsakovsky psychosis) with abundant, often absurd confabulations. In mild cases this picture is only barely outlined, but in severe cases such a state can last weeks and even months, until finally mental activity is restored, and with it the ability to remember. However, even after recovery, there often remains more or less significant impairment of memory, with particularly great difficulty in restoring memory of events preceding the trauma: greater or lesser amnesias, concerning this period, sometimes remain for life. In addition to impaired memory, convalescents usually present a number of other phenomena of mental weakness (for example: severe fatigue, irritability, intolerance to alcohol, HEADACHES).