Cerebral compression

Brain compression is a condition in which the brain is subjected to pressure, compression, or displacement within the cranial cavity. This can be caused by various factors, such as tumors, hemorrhages, swelling of the brain, trauma, or other abnormalities within the skull. Brain compression can pose a serious health risk and requires medical attention.

Brain compression can lead to a variety of symptoms and complications, including:

1. Headache: This may be severe and worsen over time.
2. Nausea and vomiting: These symptoms may be caused by irritation of the brain and intracranial structures.
3. Seizures: Compression of the brain can cause a disruption in the brain's normal electrical activity, which can lead to seizures.
4. Decreased consciousness: Patients with brain compression may experience slowed reaction times, anxiety, or even loss of consciousness.
5. Loss of sensory or motor function: Compression of the brain can damage nerve pathways and cause loss of sensation or movement problems.
6. Breathing problems: In some cases, compression of the brain can affect the breathing centers in the brain, which can cause breathing problems.

Treatment for brain compression depends on its cause and severity. It may include surgery to remove the tumor or relieve pressure, medication to reduce swelling in the brain, and other medical procedures and rehabilitation.

Brain compression is a serious condition, and it is important to see a doctor if symptoms occur. Prompt evaluation and treatment can help prevent complications and minimize risks to brain health.

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Epidemiology

Brain compression is the most severe and dangerous type of craniocerebral injury, observed in 3-5% of victims with TBI. It is characterized by a rapid increase in general cerebral and focal symptoms after some period of time or immediately after the injury. First of all, dysfunction of the stem sections, and poses an immediate threat to the patient's life.

Causes brain compression

Causes of brain compression may include:

1. Subdural or epidural hematoma: This is a collection of blood under the skull bone (subdural hematoma) or above the meninges (epidural hematoma). Hematomas can occur after a head injury, such as a blow, accident, or fall.
2. Cerebral edema: Cerebral edema can occur as a result of inflammation, infection, injury, or other medical conditions. It causes the brain to increase in volume and put pressure on the blood vessels and structures of the brain.
3. Brain Tumors: Malignant or benign brain tumors can grow and press on surrounding tissues and structures.
4. Cerebral edema: This is a condition in which excess fluid builds up in the brain, which can lead to increased pressure.
5. Hydrocephalus: Hydrocephalus is a condition in which the intracranial fluid (CSF) cannot circulate properly and accumulates inside the skull. This can cause the brain to enlarge and put pressure on it.
6. Stroke: A stroke can cause a disruption in the blood supply to the brain, which can lead to pressure on the brain around the area of injury.
7. Inflammatory processes: Inflammation of the meninges (meningitis) or inflammatory diseases of the brain can cause compression of the brain.
8. Mass: Any mass within the skull, including cysts or abscesses, can cause compression of the brain.

Pathogenesis

The pathogenesis of brain compression depends on its specific causes and mechanisms, but the general mechanism is an increase in intracranial pressure (ICP) and compression of brain tissue within the cranial cavity. This can be caused by various factors and conditions. Let's look at some examples:

1. Brain Tumors: Tumors can grow inside the skull and take up space that is normally occupied by brain tissue. This causes increased ICP, which can put pressure on blood vessels and brain tissue. It can also cause swelling of the brain around the tumor.
2. Hemorrhages: Hemorrhages in the brain, such as strokes, can cause compression of the brain. The blood that spills inside the cranial cavity creates additional pressure and can damage surrounding tissue.
3. Cerebral edema: Cerebral edema can occur due to a variety of causes, including infections, injuries, or heart attacks. It results in an increase in brain tissue volume and increased ICP.
4. Head Injuries: Severe head injuries, such as concussions or traumatic brain injuries, can cause pressure on the brain due to swelling or bleeding.
5. Infections: In some cases, infections such as pus-filled abscesses or meningitis can cause swelling and pressure on the brain.

Increased intracranial pressure and brain compression can cause serious disruptions in the blood supply to the brain, which in turn can lead to hypoxia (lack of oxygen) and damage to brain cells. In addition, brain compression can cause compression of the fluid circulating within the skull (cerebrospinal fluid), which also impairs metabolism in the brain.

Symptoms brain compression

In the clinical picture of cerebral compression (primarily by hematomas), the main pathognomonic symptoms are the presence of a clear interval (period of apparent well-being), anisocoria with mydriasis on the side of compression, bradycardia, hemiparesis or hemiplegia on the side opposite to compression.

Quite often, patients with brain compression (especially with depressed fractures and chronic hematomas) develop epilepsy syndrome.

One of the main causes of brain compression in traumatic brain injury is the formation of intracranial hematomas, which, according to the classification, are:

• epidural (accumulation of blood between the inner surface of the skull bones and the dura mater, usually within one bone);
• subdural (accumulation of blood between the inner surface of the dura mater and the outer surface of the arachnoid membrane, limited by the processes of the dura mater);
• intracerebral (accumulation of blood in the brain tissue);
• intraventricular (accumulation of blood in the ventricles of the brain).

In addition to the formation of hematomas, bleeding under the arachnoid membrane (subarachnoid hemorrhage) is possible, which often accompanies a brain contusion and does not lead to compression of the brain.

Depending on the period of formation, hematomas can be: acute - up to 3 days; subacute - up to 2 weeks; chronic - more than 2 weeks. The timing of the onset of symptoms of brain compression in intracranial hematomas mainly depends on their localization and the source of bleeding. Hematomas can be multiple or bilateral. Sometimes there are variants of "floor-by-floor" intracranial hematomas (episubdural, epidural-subperiosteal, etc.).

Symptoms of intracranial hematomas

In general, the symptoms of intracranial hematomas largely depend on the source of bleeding, the location and size of the hemorrhage, the rate of development of compression of the brain, as well as the severity of concomitant injuries to the skull and brain, the age of the patient and his individual characteristics (concomitant diseases, previous illnesses, injuries, etc.).

Epidural hematomas

The source of bleeding in epidural hematomas is usually the trunk or branches of the middle meningeal artery, less often - the veins of the dura mater, dural sinuses and diploic vessels. These hematomas usually occur at the site of application of a traumatic factor, sometimes quite insignificant. In this regard, many patients do not lose consciousness at all or note a relatively short-term loss of consciousness (usually less than an hour in approximately 40% of cases). The lucid interval is usually short. Chronic epidural hematomas are extremely rare. The diagnosis is made on the basis of CT or MRI, and the hematoma resembles a biconvex lens in appearance. Quite often, there are skull fractures (mainly temporal bone fractures) at the site of hematoma formation.

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Subdural hematomas

The source of bleeding in the formation of subdural hematomas are veins damaged as a result of a head injury, which flow into the sinuses of the brain, damaged superficial vessels of the hemispheres of the brain, venous sinuses. This type of hematoma is the most common (more than half of the total number of intracranial hematomas). Unlike epidural hematomas, subdural hematomas can also form on the side opposite to the blow, and in 10-15% of cases they are bilateral.

Symptoms of subdural hematomas are characterized by a long clear interval, subacute and chronic variants of the course are often encountered, focal symptoms are less pronounced than with epidural hematomas, and more diffuse. When performing CT or MRI, the hematoma most often has the appearance of a convex-concave lens.

Intracerebral hematomas usually accompany severe brain contusion, but sometimes they also occur with brain contusions with minimal neurological symptoms. The source of their formation are the veins and arteries of the brain. Intracerebral hematomas are much less common than other intracranial hematomas, and are often small in size. The clinical picture of intracerebral hematomas is characterized by the development of general cerebral, focal, and brainstem symptoms early after injury, with a subacute course occurring less frequently. The final diagnosis is based on CT or MRI.

Intraventricular hematomas

Intraventricular hematomas usually accompany intracerebral hematomas; they are rarely found in isolation. The source of bleeding is damage to the choroid plexus of the ventricles or a rupture of an intracerebral hematoma into the ventricular cavity. Neurological symptoms develop quickly, immediately after the injury, and are characterized by a short period of psychomotor agitation, acutely developing profound impairment of consciousness with the appearance of hormeotonia and decerebrate rigidity. Expressed vegetative disorders (hyperthermia, profound respiratory failure, arterial hypertension, which is replaced by hypotension) rapidly increase. As the condition worsens, convulsions disappear and muscle hypotonia appears, tendon reflexes decrease and pathological reflexes disappear. The prognosis for intraventricular hematomas is extremely unfavorable.

Subdural hydroma

Subdural hydroma is a localized accumulation of cerebrospinal fluid in the subdural space (between the dura mater and arachnoid membranes of the brain) that occurs as a result of ruptures of the arachnoid membrane with the formation of a valve that allows cerebrospinal fluid to pass in only one direction. The clinical picture resembles subacute or chronic subdural hematoma, and the final diagnosis can only be made using additional research methods, and sometimes intraoperatively.

Pneumocephalus

Pneumocephalus is the penetration of air into the cranial cavity. It most often occurs with fractures of the skull base with damage to the air sinuses and rupture of the dura mater. The pumping of air into the cranial cavity is facilitated by a valve mechanism formed by the mucous membrane of the paranasal sinuses or the dura mater. Pneumocephalus is often accompanied by liquorrhea. With mild pneumocephalus that does not cause compression of the brain, victims may experience headaches, a sensation of gurgling and transfusion of fluid in the head. The diagnosis is clarified craniographically, as well as by performing CT or MRI. With a well-formed valve mechanism, air can enter in large volumes and cause compression and dislocation of the brain.

Depressed brain fracture

A depressed fracture often occurs in isolation, sometimes accompanying comminuted fractures, in which damage to the dura mater and brain tissue is often observed. Clinically, symptoms of focal damage are observed with severe compression of the brain. As a result of irritation of the cerebral cortex by bone fragments, epileptic seizures may occur. Diagnostic difficulties in determining a depressed fracture, especially with gross depressions, but arise. It can be determined by palpation, and sometimes further visually. For a final diagnosis, as with other types of craniocerebral trauma, it is necessary to use additional examination methods - craniography (in two projections), CT, MRI.

Stages

The stages of brain compression depend on the severity of the situation and the cause of the brain compression. There is no generally accepted classification of the stages of brain compression, as each case is unique and treatment may vary depending on the specific circumstances. However, it is possible to identify several main phases or stages that characterize brain compression:

1. Cerebral Circulation Disruption: In the initial stage of brain compression, there may be a disruption in the blood supply to the brain due to the pressure exerted on the vessels. This may cause headache, dizziness, nausea and other symptoms.
2. Increased intracranial pressure: Gradually, with prolonged compression of the brain, an increase in intracranial pressure (ICP) may occur. This may be accompanied by worsening symptoms such as more severe headache, vomiting, and changes in consciousness.
3. Seizures and loss of consciousness: As ICP increases further, seizures and loss of consciousness may occur. This is a serious symptom and requires immediate medical attention.
4. Serious consequences: If brain compression is not treated, it can lead to serious and irreversible consequences, including neurological impairment, cerebral infarction, coma, and even death.

It is important to emphasize that the rate of progression and severity of brain compression can vary greatly depending on the cause and individual characteristics of the patient.

Complications and consequences

Brain compression is a serious and extremely dangerous condition that can cause numerous complications and have serious consequences, including:

1. Loss of consciousness: When the brain is compressed, normal brain function may be disrupted, which may lead to loss of consciousness.
2. Neurological impairment: Basic brain functions such as motor skills, speech, vision, hearing and sensation may be impaired as a result of brain compression.
3. Stroke: If the pressure on the brain is caused by bleeding, it can lead to a stroke, which can have serious health consequences.
4. Epilepsy: Compression of the brain may be associated with the development of epileptic seizures.
5. Paralysis: If there is compression of the brain that affects certain motor areas of the brain, paralysis may develop.
6. Impaired ability to think and make decisions: Brain compression can affect the brain's cognitive functions, which can lead to problems with memory, judgment, analysis, and problem solving.
7. Coma and Death: If normal blood supply to the brain cannot be ensured, compression of the brain can cause coma and even death.
8. Post-traumatic stress disorder: Survivors of brain compression may experience post-traumatic symptoms and disorders, including headaches, anxiety, depression, and loss of ability to function normally.

The consequences of brain compression can be very serious and may depend on the degree of compression, its duration, and the success of medical intervention.

Diagnostics brain compression

Diagnosis of brain compression is an emergency medical procedure and involves a series of steps to determine the cause of the compression, assess the extent of brain damage, and choose the best treatment. The main steps in diagnosis are:

1. Clinical examination: The physician examines the patient, assessing symptoms and clinical signs, such as the presence of head injury, changes in consciousness, motor impairment, sensory impairment, and other neurological symptoms.
2. Biomarker testing: Biomarkers can be measured in the blood that may indicate the presence of brain damage, such as platelet levels, D-dimers, and other biochemical markers.
3. Computed tomography (CT) scan of the brain: A CT scan may be done to look for bleeding, tumors, subdural or epidural hematomas, and other changes that may be causing pressure on the brain.
4. Magnetic resonance imaging (MRI): MRI provides a more detailed image of the brain and may be useful in determining the nature and location of damage.
5. Electroencephalography (EEG): EEG can be used to assess the brain's electrical activity and detect abnormalities in brain function.
6. Cerebrospinal fluid (CSF) testing: By removing and analyzing cerebrospinal fluid (CSF), the pressure inside the skull can be assessed and infections or inflammation can be detected.
7. Angiography: This is a technique that allows visualization of the blood vessels in the brain and detection of aneurysms, narrowings, or other vascular abnormalities.
8. Additional tests: Depending on the clinical situation, additional tests such as scintigraphy, positron emission tomography (PET) and others may be required.

Diagnosis of brain compression requires urgent intervention by medical specialists, exclusion of life-threatening conditions and immediate treatment.

Differential diagnosis

Differential diagnosis of brain compression involves identifying the cause of the symptoms of compression and ruling out other conditions that may mimic brain compression. This is important to determine the best treatment and patient management. Some conditions to consider in the differential diagnosis include:

1. Brain tumors: Malignant or benign tumors can cause compression of the brain and symptoms related to increased pressure within the skull. Magnetic resonance imaging (MRI) and computed tomography (CT) scans can be used to diagnose them.
2. Stroke: A stroke can mimic brain compression, especially if it causes swelling of the brain and increased intracranial pressure. Tests such as MRI and CT scans can help determine if a stroke is present.
3. Inflammatory diseases of the brain: Inflammatory conditions such as meningitis or encephalitis can cause symptoms similar to brain compression. Laboratory tests of the cerebrospinal fluid and imaging tests such as MRI or CT scans may be used to diagnose these conditions.
4. Brain Injuries: After a brain injury, swelling of the brain and compression of the brain may develop. X-rays, MRI, or CT scans may be needed for diagnosis.
5. Hypoxia or ischemia: Insufficient oxygen supply to the brain can also lead to symptoms similar to brain compression. This can be due to various medical conditions such as cardiac arrest or asphyxia.
6. Epilepsy: Symptoms of epilepsy can be similar to brain compression and can sometimes be caused by seizures.

Differential diagnosis of brain compression requires extensive medical testing, including education and laboratory testing. Doctors use this information to pinpoint the cause of symptoms and develop an appropriate treatment plan.

Treatment brain compression

Compression and dislocation of the brain are indications for emergency surgical intervention - bone-plastic or resection trepanation of the skull and removal of the pathological space-occupying process compressing the brain.

Indications for surgical removal of intracranial hematomas

• Clinical signs of cerebral compression according to at least one of the criteria: focal, general cerebral or dislocation symptoms.
• The volume of epidural or intracerebral hematoma (according to CT, MRI) is more than 50 ml for supratentorial and more than 20 ml for subtentorial.
• The thickness of the epidural hematoma is more than 1.5 cm, regardless of the clinical phase, including in the asymptomatic course.
• Repeated disturbance or deterioration of consciousness in the presence of a clear interval.
• The presence of at least one sign on CT (MRI): lateral displacement of midline structures by more than 5 mm, deformation of the basal cisterns, gross compression of the homolateral lateral ventricle with dislocation contralateral hydrocephalus regardless of the size and location of the hematoma.
• Small volume posterior fossa hematomas (<20 ml) if they lead to occlusive hydrocephalus.

When removing acute hematomas, surgical tactics consist of the following measures: performing craniotomy, removing the hematoma, stopping the bleeding. If the location and size of the hematoma are determined before the operation using CT or MRI, it is preferable to perform osteoplastic trepanation. In the absence of such data, it is advisable to perform a linear skin incision and perform resection trepanation.

In subacute and chronic hematomas, as well as subdural hydromas, the most adequate surgical intervention is the removal of these formations by creating burr holes. Recently, one of the alternative methods of surgical treatment of some intracranial hematomas is their endoscopic removal.

Methods for stopping bleeding depend on the nature of the bleeding and the type of damaged vessel: meningeal and cerebral vessels are most often coagulated, the sinus defect is closed by pressing a hemostatic sponge to it, suturing, plastic surgery, and in some cases by bandaging along the length, in case of bleeding from diploid veins, the edges of bone fragments are smeared with surgical wax.

Forecast

The prognosis for brain compression depends on many factors, including the cause of the compression, its severity and duration, the patient's age, overall health, and the speed with which medical attention is sought. Brain compression can be caused by a variety of reasons, such as tumors, injuries, strokes, inflammatory processes, and others. Here are some common factors that can affect the prognosis:

1. Cause of Brain Compression: The prognosis will depend on the underlying cause of the brain compression. For example, tumors can be malignant or benign, and their nature and stage will affect the prognosis.
2. Degree of compression: Mild or mild brain compression may have a better prognosis than moderate or severe compression. The degree of compression can be assessed using medical imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI).
3. Timing of treatment: The speed with which you seek medical attention and initiate treatment can have a dramatic impact on your prognosis. The sooner you begin treatment, the better your chances of a positive outcome.
4. General health: The patient's health, presence of underlying medical conditions, and age can also influence the prognosis.
5. Treatment and rehabilitation: The effectiveness and adequacy of treatment, as well as rehabilitation measures carried out after brain compression, can significantly affect the prognosis and recovery.

It is important to note that brain compression is a serious condition that can have a variety of consequences, including impaired brain function, paralysis, impaired consciousness, and even death. The prognosis should be assessed by a physician and may vary from case to case. Each patient with this condition will have a different prognosis and is best discussed with a medical professional who is familiar with the specific details of your case.