What drugs can be used after a brain injury. List of effective drugs for concussion. Traumatic brain injuries: the use of modern nootropic drugs in the acute period and in the treatment of post-traumatic encephalopathy

From the article you will learn about the drugs that are prescribed for concussion, indications and contraindications for the use of drugs, side effects from taking.

Symptoms requiring medication

With a concussion, negative symptoms occur, correlated with the degree of damage to the brain structures. Distinguish:

mild concussion with short-term clouding or loss of consciousness, slurred speech, disorientation in space, pale skin, vertigo, flies before the eyes;
middle - with fainting up to half an hour, severe headache, double vision, ringing in the ears, loss of orientation in space and time, numbness of the fingers;
severe - long-term loss of consciousness, amnesia, nausea or vomiting, ataxia up to the inability to stand on their own, vertigo, darkness before the eyes, noise in the head, numbness of the limbs.

List of drugs

In addition to the degree of concussion, when prescribing drugs, the patient's age, physiological characteristics of the body, and the severity of symptoms are taken into account. In accordance with the clinical picture, drugs of several pharmacological groups are used in the complex therapy of the disease.

Painkillers

Pills for concussion of the brain, the main purpose of the appointment are the removal of pain, relief of cephalalgia. The essence is the blocking of pain receptors and the removal of vascular spasm to expand the lumen of the capillaries. The drugs of the group are toxic, so they should not be taken for a long time. Tablets are prescribed only after the diagnosis is made, the pain is not stopped immediately after the injury due to the diagnostic importance of the symptom. Despite the different points of application, all concussion medicines have common characteristics:

quickly relieve pain;
eliminate spasm of smooth muscles;
lower the temperature.

The most commonly used are the following analgesic tablets or:

Nootropics

Medications for group concussion restore normal neuronal metabolism, normalize nutrition and oxygen supply to the brain, and eliminate post-hematoma symptoms.

Vasodilators

Medicines for concussion of the vasotropes group improve the general condition of patients, normalize the elasticity of the vascular walls, which helps to withstand the high pressure that occurs due to the formed hematoma. Preparations for concussion of this direction vector normalize blood viscosity, which accelerates the delivery of oxygen to the damaged organ, helping regeneration, activating metabolic processes.

The most sought after are:

Diuretics

A concussion of the brain is quite often accompanied by swelling of the tissues, which aggravates the negative symptoms and worsens the general well-being of the patient. Diuretic tablets are designed to remove excess fluid from the body, but are prescribed strictly according to indications.

Pills for dizziness

Vertigo is one of the main symptoms of a concussion. different pharmaceutical groups. But they are allowed to be taken only with persistent dizziness until the intensity of the symptom decreases. More often than others, the following drugs are recommended for concussion, which normalize the patient's condition:

Sedatives

Sedative drugs for concussion are prescribed to relieve psycho-emotional overstrain, sedative, hypnotic effect (the patient is shown a restful sleep for recovery).

More often than others they use: Valocordin (125 rubles), Corvalol (16 rubles), Motherwort (72 rubles). You can drink medicines only with water.

tranquilizers

The purpose of prescribing the pills of the group is similar. However, the drugs are addictive, so the treatment is prescribed in short courses under the supervision of a doctor in a hospital.

Use the following medicines:

vitamins

Vitamin preparations of groups A, E, B, C, folic acid and microelements: phosphorus, magnesium, selenium must be included in the complex treatment regimen for concussion of the brain. These substances provide proper cell nutrition and accelerated tissue repair.

Contraindications

A concussion is treated with a whole range of drugs from different groups, while in the hospital injection therapy prevails, and during the rehabilitation period at home - tablets and capsules. Contraindications to taking pills are individual for each group of drugs, but there are also general restrictions, which include:

individual intolerance;
inhibition of bone marrow bleeding;
IHD: angina pectoris;
intestinal obstruction;
glaucoma;
disruption of the liver and kidneys;
pregnancy and lactation;
asthma;
fluctuations in blood pressure;
childhood;
sleep disorders, memory;
atherosclerosis;
violation of blood viscosity;
erosive processes in the intestine;
lactose-lactase deficiency;
arrhythmia;
Parkinson's syndrome;
brain tumor;
ONMK;
convulsions;
pulmonary edema;
diabetes;
mastopathy, breast enlargement;
violation of menstruation.

Side effects

allergy;
dyspepsia;
vertigo;
lack of appetite;
change in taste perception;
dry mucous membranes;
acrocyanosis;
myopathy;
tremor;
impaired visual acuity;
skin rashes;
apathy;
blurred consciousness;
pastosity;
drug addiction.

An overdose causes symptoms of acute poisoning: nausea, vomiting, chills, convulsions, interruptions in the work of the cardiovascular system.

Chronic intoxication with drugs is manifested in pain, trophic disorders (up to gangrene), blood circulation, arrhythmias, and sharp jumps in blood pressure. Severe cases are fraught with shock or coma, collapse with a fatal outcome. Therefore, all drugs for any degree of concussion are prescribed by the doctor after a complete examination of the patient, he also makes decisions on further tactics for managing the patient. Self-treatment is dangerous due to the unpredictability of possible complications.

Last updated: November 7, 2019

In the event of a blow against a hard object or surface, as well as in the event of a blow to the head, you can get a bruise of the brain. With a slight bruise, soft tissue injury occurs, so it does not carry any special consequences. During the impact, blood vessels rupture, which causes the formation of a hematoma.

When receiving a slight bruise, the appearance of pain in the area of injury, and subsequently the formation of bumps, is observed. However, with a serious blow to the head, serious disorders in the brain can be obtained, while the manifestations of bruising may not be observed.

Brain contusions can be divided into 3 degrees of severity:

Mild bruising;
Moderate injury;
Severe injury.

In the treatment of mild and moderate degrees, it is necessary to undergo a course of intensive care, as well as take drugs for brain bruises. And in case of severe injuries, patients are in intensive care under the supervision of specialists.

Upon receipt of bruises of the brain, breathing and the circulatory system are restored. To restore respiratory function, asphyxia is prevented, use oxygen inhalers. If necessary, connect to an artificial respiration apparatus.

Necessary actions

When receiving a head injury, the first thing to do is to apply ice to the injured area, the so-called compress. It is necessary to apply ice for 15-20 minutes, after which it should be repeated periodically throughout the day. Ice promotes the outflow of blood from the site of injury, which helps to reduce the resulting hematoma.

You can also apply hot salt wrapped in a bag or a freshly boiled chicken egg to the injury site. A compress with vegetable oil helps very well.

You can also use for bruises:

Bodyaga;
Heparin ointment;
Alcohol solution of iodine.

Before use, carefully read the attached instructions.

Drugs for treatment

In the treatment of brain bruises, you can resort to the use of drugs. Each of them has an effect on certain foci. To strengthen the walls of blood vessels, as well as to prevent pain and swelling, you can use painkillers ointments:

Troxevasin;
Dolobene-Gel;
Fastum-gel;
Rescuer and others.

In the treatment of brain bruises for the purpose of physiotherapy, a solution of manganese, furacilin, brilliant green, iodine and other means are used. Tonic preparations for the treatment of bruises use tincture of ginseng, eleutherococcus.

When pain is eliminated, all drugs for brain contusion are prescribed taking into account the patient's condition. These drugs include:

Sedalgin;
Analgin;
Pentalgin;
Baralgin.

In the treatment of brain injuries, they try to abandon aggressive drugs, since the main task is to restore the functioning of the gray matter. Also, the primary tasks are: the elimination of pain, symptoms of dizziness and other adverse conditions. Doctors try to prescribe medicines in the form of capsules or injections.

If dizziness occurs, the following drugs are prescribed for brain bruises:

Papaverine;
Tanakan;
Belloid;
Bellaspon.

To improve sleep, Phenobarbital or Reladorm is prescribed, you can also use the usual Dimedrol.

If it is necessary to take sedatives, they resort to taking:

Valoserdin;
Corvalol;
Valerian or motherwort tincture.

With a brain injury, brain tissue is disrupted, so drugs should be used to provide nutrition to the brain cells. Use the following tools:

Semax;
Actovegin;
Ceraxon;
Cerebrolysin;
Mildronate;
Somazin.

You should also use drugs in parallel that will improve microcirculation: Cavinton, Sermion, do not forget about taking vitamins E and B. If an open injury occurs, antibiotics should be used: Azithromycin or Cefotaxime to prevent infection.

With the use of drugs for brain contusion, it is also necessary to carry out procedures for the treatment of the metabolic and vascular system to prevent post-commotion disorders.

It is also necessary to provide peace to the victim, and if complications arise in the form of persistent headaches, bleeding, the appearance of new symptoms, it is worth calling for medical help.

the duration and severity of which depends on the degree of mechanical impact on the brain tissue.

Long-term consequences

Long-term consequences of TBI can be manifested by neurological disorders:

sensitivity disorders (numbness of the hands, feet, burning sensations, tingling in various parts of the body, etc.),
movement disorders (trembling, coordination disorders, convulsions, blurred speech, stiffness of movements, etc.),
vision changes (double vision, blurred focus)
mental disorders.

Mental disorders and behavioral disorders due to brain injuries can be expressed in different conditions: from a state of fatigue to a pronounced decrease in memory and intelligence, from sleep disturbances to incontinence of emotions (attacks of crying, aggression, inadequate euphoria), from headaches to psychoses with delusions and hallucinations.

The most common disorder in the picture of the consequences of brain injuries is asthenic syndrome.

The main symptoms of asthenia after traumatic brain injury are complaints of fatigue and rapid exhaustion, the inability to endure additional stress, unstable mood.

Characterized by headaches, aggravated by exertion.

An important symptom of an asthenic condition that has arisen after a traumatic brain injury is increased sensitivity to external stimuli (bright light, loud sound, strong smell).
It is very important to know that a lot depends on whether the concussion or brain contusion happened for the first time, or whether the patient has repeatedly been able to endure such injuries at home. This directly affects the outcome and duration of treatment.

If the patient has more than 3 concussions in the anamnesis, the period of treatment and rehabilitation is significantly lengthened and the likelihood of complications also increases.

Diagnosis of traumatic brain injury

With craniocerebral injuries, it is necessary to undergo diagnostic procedures urgently.

It is also important to be examined and observed by specialists every month after injury.
As a rule, in the diagnosis of TBI, methods of magnetic resonance imaging, computed tomography, and radiography are used.

Treatment of TBI and consequences of brain injuries

In the acute period, decongestant, neurometabolic, neuroprotective, symptomatic therapy is carried out, which consists in the selection of several drugs offered both in the form of tablets and in the form of injections (drip and intramuscular).

This treatment is carried out for about a month. After that, the patient remains under the supervision of his attending physician, depending on the severity of TBI, from six months to several years.

For at least three months after a TBI, the intake of alcoholic beverages and heavy physical exertion is strictly prohibited.

In addition to traditional methods of treating TBI, there are no less effective methods:

In combination with drug therapy and physiotherapy, these techniques can have a more pronounced and faster effect. However, in some cases they are contraindicated for use.

Everyone knows the fact that treatment should be complex, and the more techniques will be used during treatment, the better.

After the end of the course of treatment, the patient must be under the supervision of a doctor, and in the future he may need repeated courses, as a rule, once every half a year.

Possible Complications

If left untreated, brain injury often leads to complications. The most dangerous consequences are remote, which are initially formed hidden. When, against the background of general well-being, without visible symptoms, a complex pathology is formed. And only after a few months, or even years, an old brain injury can make itself felt.

The most common among them are:

headaches, often with nausea and vomiting,
dizziness,
memory impairment,
the formation of mental pathology, etc.

Traumatic brain injuries are a danger that the patient may not be aware of.

After hitting the head, various kinds of problems can occur, even when there are no visible symptoms of a concussion (headache, dizziness, vomiting, pressure on the eyes, feeling overtired, drowsiness, a veil before the eyes).

In many cases, the consequences of a brain injury can be accompanied by a displacement of the cervical vertebrae, which can also lead to:

headaches,
pain in the neck
memory impairment,
increased fatigue afterwards.

Brain injury is often the "trigger" of diseases such as:

facial neuritis,
pathology of the trigeminal and other facial nerves.

this may be accompanied by pain on one side of the face or muscle weakness on one side of the face.

The clinic "Brain Clinic" conducts all types of research and complex treatment of the consequences of brain injuries.

First aid to a victim with a traumatic brain injury is to give him a comfortable horizontal position with a slightly raised head.

If the person who received a head injury continues to be unconscious, the so-called rescue position is preferable - on the right side, the head is thrown back or turned to the ground, the left arm and leg are bent at a right angle in the elbow and knee joints (fractures of the limbs and spine must first be excluded) .

This position, ensuring the free passage of air into the lungs and the unimpeded outflow of fluid from the mouth, prevents respiratory failure due to retraction of the tongue, leakage of saliva, blood, and vomit into the respiratory tract.

All victims with a traumatic brain injury, even if it seems to be mild from the very beginning, are subject to transportation to the emergency hospital, where the diagnosis is specified.

The basis of treatment tactics in patients with brain injury should be based primarily on the data of an objective examination, and not the fact of a traumatic brain injury suffered by the patient.

Conservative symptomatic treatment is carried out when the patient has:

Brain concussion;

mild brain injury;

Moderate and severe brain contusion without signs of brain compression;

Diffuse axonal damage to the substance of the brain.

In the case of minor injuries that occur with a concussion picture, the treatment is purely individual.

Medical treatment for concussion should not be aggressive.

It is mainly aimed at normalizing the functional state of the brain, relieving headaches, dizziness, anxiety, insomnia and other complaints.

Conservative treatment of severe forms of traumatic brain injury (severe brain contusion, diffuse axonal brain damage) has its own characteristics and should be carried out in specialized neurosurgical hospitals, in intensive care units.

Principles of conservative treatment of mild traumatic brain injury:

Bed rest depending on the course of the disease;

Symptomatic treatment of headache;

Appointment of tranquilizers;

Normalization of CSF pressure;

Vagosympathetic blockade or blockade of the vertebral artery;

On the 5-7th day, the appointment of nootropic drugs, vitamins, vascular drugs.

The impact of a traumatic agent is a starting point for a complex of pathogenetic mechanisms, which are mainly reduced to disturbances in neurodynamic processes, disorders of tissue respiration and energy metabolism, changes in cerebral circulation in combination with a restructuring of hemodynamics, homeostatic reactions of the immune system and subsequent development of an autoimmune syndrome. The complexity and variety of pathological processes resulting from TBI, which are closely intertwined with the processes of adaptation and compensation of impaired functions, make it necessary to carry out conservative treatment of TBI in a differentiated manner, taking into account the clinical form of the lesion, age and individual characteristics of each victim.

With a concussion(SHM) pathogenesis is based on temporary functional disorders of the central nervous system, in particular its autonomic centers, which leads to the development of asthenovegetative syndrome. This determines the therapeutic tactics aimed at reducing the dysfunction of individual groups of neurons and restoring their functional synergy. When treating a concussion as the mildest form of traumatic brain injury, doctors at medical institutions often underestimate the severity of its consequences, which leads to a persistent asthenovegetative state and impaired liquorodynamics.

The complex of therapy for patients with concussion includes mandatory within 7-10 days in combination with sedative treatment, which consists in prescribing drugs that prolong physiological sleep (andante, etc. ) in the afternoon and at night. Dosing regimen The duration of therapy should not exceed 2 weeks. The drug should be taken orally immediately before going to bed, 2 hours after a meal, or after the patient feels that he cannot fall asleep. Recommended dose for adults- 10 mg. The maximum daily dose is 10 mg (the patient must be warned about the dangers of taking a repeated dose within one night). For the elderly, the drug is prescribed at a dose of 5 mg (due to greater sensitivity to sleeping pills).

A hypnotic drug of the pyrazolo-pyrimidine type, differs in chemical structure from benzodiazepines and other hypnotics. Significantly reduces the latent time of falling asleep, prolongs the time of sleep (in the first half of the night), does not cause changes in the ratio of different phases of sleep. When used at a dose of 5 mg and 10 mg for 2-4 weeks, it does not cause pharmacological tolerance. Except

In addition, it has a sedative, slightly pronounced anxiolytic, anticonvulsant and central muscle relaxant effect. It excites benzodiazepine receptors (ω) of GABA type A receptor complexes. Interaction with ω receptors leads to the opening of neuronal ionoform channels for chloride ions, the development of hyperpolarization and increased inhibition processes in the CNS.

Headache is the main clinical symptom of traumatic brain injury. A large number of medications are used to relieve headaches. The appointment of painkillers should be made taking into account the cerebrospinal fluid pressure. For example, with increased cerebrospinal fluid pressure, the appointment of citramone containing caffeine is not advisable.

In the treatment of concussion, the use of glutamic acid, picamilon (0.5 g orally 3 times a day), which is an amino acid that is oxidized directly in the brain and takes part in the regulation of oxidative metabolism. It promotes the release of mediators (adrenaline) and exhibits pronounced depolarizing properties. The drug showed itself well in the treatment of concussion mexidol. The mechanism of action of the drug is primarily determined by its antioxidant properties, the ability to stabilize cell biomembranes, activate the energy-synthesizing functions of mitochondria, modulate the work of receptor complexes and the passage of ionic currents, enhance the binding of endogenous substances, improve synaptic transmission and interconnection of brain structures.

Due to this mechanism of action, the drug has a cerebroprotective, nootropic, antihypoxic, tranquilizing, anticonvulsant, anti-alcohol, anti-stress and vegetotropic effect. In addition, it has the ability to improve cerebral circulation, inhibit platelet aggregation. Mexidol increases the body's resistance to the action of various extreme damaging factors, such as hypoxia, ischemia, and various intoxications. Mexidol has a distinct antihypoxic and anti-ischemic effect. With a concussion of the brain, it is used in a dosage: 100-250 mg (2-5 ml) intravenously or intramuscularly 2-3 times a day for 10-15 days, then 125-250 mg (1-2 tabs) 3 times a day 2-4 weeks.

The criteria for expanding the regimen should be considered the stabilization of autonomic reactions, the disappearance of headaches, dizziness (Betaver - inside, 8-16 mg 3 times a day. ) normalization of sleep and appetite.

Given the fact that CSF pressure during concussion is increased in 19-20% of cases, decreased in 25%, and normal in 55%, upon admission to the hospital, the patient must perform a lumbar puncture, which allows determining the level of intracranial pressure and choosing the right therapy. In this case, a manometric measurement of CSF pressure is mandatory with fixing its result in the medical history.

For hypertension administered orally lasix (furosemide) 40 mg 1 time per day or veroshpriron 1 tab. 1 time per day.

Under reduced pressure, intravenous administration of isotonic solutions (0.9% saline solution, 5% glucose solution) 500-600 ml 1 time per day for three to four days is necessary. The term of inpatient treatment for concussion is 1-2 weeks, followed by outpatient monitoring for 7-10 days.

In case of concussion, the complex of therapeutic measures should include the so-called reflex-drug therapy - carrying out novocaine blockades - the vagosympathetic node, the sympathetic plexus of the vertebral arteries with posterior access, etc.). This is especially important when a patient receives a craniocervical brain injury. The cause of this type of combined craniocerebral injury is the extensor-flexion mechanism in the cervical region when receiving a craniocerebral injury. This mechanism of injury in road traffic accidents is most typical.

Mild to moderate brain contusions unlike concussions, they are accompanied by morphological damage to the vessels and (or) the substance of the brain, which is manifested by focal neurological symptoms of varying intensity, subarachnoid and intracerebral hemorrhage, as well as fractures of the bones of the vault and (or) the base of the skull. Subarachnoid hemorrhage, even the smallest one, leads to vascular spasm, which, in turn, contributes to cerebral hypoxia with metabolic disorders and edema-swelling of the brain tissue. Cerebral symptoms of mild traumatic brain injury are more intense and last longer than with concussion, which determines the timing of drug therapy.

The complex of therapy for patients with cerebral contusion also includes the obligatory bed rest within 10-12 days in combination with sedative treatment, which consists in prescribing drugs that prolong physiological sleep (andante, (zaleplon) etc.). The recommended dose for adults is 10 mg. Elderly people - 5 mg. Take orally, just before bedtime, preferably in bed. Duration of treatment: no more than 2 weeks.

Upon admission to the hospital, the patient, before carrying out diagnostic manipulations, it is necessary to perform echoencephaloscopy, and after that, a lumbar puncture to determine the CSF pressure and the presence of subarachnoid hemorrhage. Lumbar punctures should be carried out before sanitation of the cerebrospinal fluid once every three to four days.

For the relief of vascular spasm, which, with a mild traumatic brain injury, causes transient neurological focal symptoms, apply stugerone (cinnarizine), papaverine, eufillin in therapeutic doses along with. The rapid elimination of vascular spasm and the removal of outflowing blood reduce the exposure of brain antigens to immunocompetent blood cells, which reduces the effect of the antigenic stimulus and reduces the intensity of the immune response. The autoimmune process either does not develop or proceeds less intensively. This is also facilitated by the appointment of antihistamines and desensitizing agents in therapeutic dosages for 1-1.5 weeks.

Recently, for the treatment of cerebral contusions of varying severity, especially those accompanied by subarachnoid hemorrhage, the drug cerebrolysin has been widely used.

Cerebrolysin contains low molecular weight biologically active neuropeptides that penetrate the blood-brain barrier and directly enter the nerve cells. The drug has an organ-specific multimodal effect on the brain, i. provides metabolic regulation, neuroprotection, functional neuromodulation and neurotrophic activity.

Cerebrolysin protects neurons from the damaging effects of lactic acidosis, prevents the formation of free radicals, increases survival and prevents neuronal death under conditions of hypoxia and ischemia, reduces the damaging neurotoxic effect of excitatory amino acids (glutamate).

In acute conditions (ischemic stroke, traumatic brain injury, complications of neurosurgical operations), it is recommended to administer cerebrolysin as drip infusions at a daily dose of 10-60 ml in 100-250 ml of saline for 60-90 minutes. The duration of the course is 10-25 days. According to research Koenig et al , 2000 The greatest effect of treatment is achieved when using Cerebrolysin 50 ml IV in 50 ml NaCl 6 hours after injury. The duration of treatment should be up to 21 days

Dehydration in traumatic brain injury is carried out depending on the magnitude of intracranial pressure and consists in the use lasix(0.5-0.75 mg/kg) parenterally or orally, glycerine(70-75 ml) inside. The criterion of effectiveness is a diuresis of 1.5-2 liters, caused by the intake of this saluretic. Glycerin at a dose of 1-1.5 g/kg reduces intracranial pressure by 50-120 mm of water. Art. for a period of 3-3.5 hours. By alternating the intake of this drug with Lasix, a uniform hypotensive effect should be achieved throughout the day. When carrying out dehydration, it must be remembered that in elderly patients in 20-30% of cases in the acute period, cerebrospinal fluid hypotension is noted. This point emphasizes the importance of lumbar puncture for determining treatment tactics.

According to the combination of pathogenetic factors, moderate brain contusion does not differ from mild brain contusion, however, persistent focal disorders, more pronounced cerebral symptoms and autonomic disorders indicate a very significant intensity of pathogenetic disorders, which strongly dictates the need for careful monitoring of the patient's condition and more active therapy. . A characteristic feature of moderate brain contusion is the instability of compensation in the acute period and the possibility of deepening disorders with untimely or inadequate therapy. With a moderate brain injury, morphological damage to the structure of the latter and massive subarachnoid hemorrhage leads to the penetration of proteolytic enzymes through the blood-brain barrier, which leads to an aggravation of neurological symptoms and the condition of patients. Therefore, already with this form of damage, the use of protease inhibitors is indicated ( contrical, gordox, trasylol), which contribute to a decrease in the permeability of the vascular wall and brain capillaries. Currently, the most widely used for this purpose contrykal 10,000 IU 3 times a day for 150 ml of 5% glucose solution for 4-6 days intravenously. With moderate brain contusion, glutamic acid is more appropriate to use in the form of a 1% solution, administered 400 ml intravenously once a day. With preserved consciousness, instead of aminalon, nootropil is prescribed in capsules of 0.4 g 3-4 times a day, and with impaired consciousness, piracetam (5 ml of a 20% solution 2 times a day intravenously).

Dehydration therapy is enhanced by the introduction of 10 ml of a 2.4% solution of aminophylline in combination with lasix (20-40 mg) intravenously up to two times a day. Such stimulation of diuresis creates a favorable gradient in the system: tissue - interstitial space - blood.

At present, approaches have also changed in the appointment of physiotherapeutic procedures for traumatic brain injury.

The difficulties of a purposeful and systematic search for the specific effects of therapeutic factors of physiotherapeutic procedures led to the exaggeration of the principles of the universality of the use of any physical factors used in physiotherapy for various diseases, the unity of the mechanisms of therapeutic and preventive action of natural and artificial physical factors that dominated in physiotherapy of the XX century. Meanwhile, doctors are well aware that physical factors in various diseases have different physiotherapeutic effectiveness. The unequal nature of diseases suggests a combination of different pathogenetic variants (syndromes).

Based on this, the reactions of the organism to the physical factor of the physiotherapeutic procedure are specific for a certain state of the organism, although therapeutic effects sometimes develop on the basis of general (non-specific) reactions of the organism.

Such specificity requires a purposeful choice of the physiotherapy factor and the method of its application, which is the essence of the pathogenetic action of therapeutic physical factors. Under these conditions, adherence to the principles of "universality" and imaginary "unity" of the mechanisms of the therapeutic effect of physiotherapy practically deprives the doctor of the possibility of the optimal choice of therapeutic physical factors. It is difficult to draw a line between the specific and non-specific action of many therapeutic factors of physiotherapy. Many of them have several effects, expressed in varying degrees, so it is better to focus on the dominant therapeutic effect.

Physical methods of treatment are aimed at improving cerebral hemodynamics (vasodilating, hypocoagulant methods), activating the metabolism of the nervous tissue and its functional properties (enzyme-stimulating methods), correcting the consequences of injuries (psychostimulating methods), increasing body tone (tonic methods) and reducing increased CSF pressure (diuretic methods).

Vasodilator methods: galvanization and medicinal electrophoresis vasodilators and stimulators of cerebral circulation. (actovegin, instenon, potassium hydroxide, eufillin, chlorpromazine, etc.)

Enzyme-stimulating methods: medicinal electrophoresis metabolism stimulants, air baths, transcerebral UHF therapy, IR laser therapy.

Diuretic methods: low intensity UHF therapy, sodium chloride baths.

Hypocoagulant method.LOC.

Psychostimulating method: oxygen baths.

Sedatives: currents of Darsonval, Faraday on the head, electrosleep, massage of the collar zone, cervical region.

Clinical picture of severe brain injury due to the involvement in the pathological process of subcortical formations and the brain stem, which is manifested by the predominance of diencephalic and mesencephalobulbar syndrome. In this regard, the volume of therapeutic measures is expanding significantly and should be directed primarily to the elimination of pathological factors that are of decisive importance in the chain of pathogenesis. At the same time, pathogenetic therapy should be carried out simultaneously with symptomatic correction of systemic hemodynamics and respiration. In the complex of therapeutic measures for cerebral contusion, the appointment of mexidol. Studies have shown that Mexidol has a cerebral vasodilation effect, reduces cerebral vascular resistance, significantly increases the pulse fluctuations of the cerebral vessels and promotes hemodynamic shifts that improve blood outflow into the venous system, without having a significant effect on systemic arterial pressure. In patients with TBI who received Mexidol, there was a significant regression of disorders of consciousness when assessed by GCS. The functions of the motor sphere were restored much faster and more distinctly, at an earlier date, there was a positive trend in the restoration of coordinating, mnestic and cognitive functions. Mexidol had a positive effect on patients with vestibular disorders, reducing uncertainty when walking, non-systemic dizziness, and oral automatism reflexes regressed faster. With a brain contusion, the therapeutic dosage is usually as follows: 200-500 mg (4-10 ml) intravenously by stream or drip 1-2 times a day for 10-15 days. Subjective and objective positive effect in the treatment with Mexidol is observed, as a rule, by the end of the week after the start of therapy.

In case of violation of peripheral breathing, the free patency of the airways is restored, the trachea is intubated with an endotracheal tube for up to 3 days. In the future, in the absence of the possibility of adequate breathing, a tracheostomy should be performed. Violation of the central regulation of respiration in most cases requires transfer to artificial ventilation of the lungs until the normal rhythm of respiratory movements is restored. Considering the development of the so-called "shock lung" syndrome in patients with STBI, particular importance should be given to measures aimed at preventing aspiration pneumonia, the development of which is very likely against the background of this syndrome. The most effective in these cases are percussion massage of the chest, vibration massage followed by aspiration of the contents of the tracheobronchial tree, soda inhalations to alkalize acidic contents that enter the lungs from the stomach and oropharynx, as well as inhalations of proteolytic enzymes, phytoncides at least 4-6 times a day. With massive aspiration with atelectasis, sanitation bronchoscopy is indicated. In specialized institutions, in the presence of an experienced anesthesiologist, a high (at the level of II-VI thoracic segments of the spinal cord) long-term epidural blockade (5 ml of 2% lidocaine solution) is advisable 4-6 hours after admission of the victim with STBI within 24-48 hours (not more!). This method is effective in the prevention of "shock lung" syndrome, but its implementation requires some experience of doctors and nurses. Treatment of systemic hemodynamic disorders should be carried out according to the principle "from simple to complex", since iatrogenic errors in the treatment of patients with severe brain contusion are fraught with serious consequences.

Elimination of hypovolemia by intravenous administration of large molecular weight dextrans (400 ml polyglucin), rheogluman and hemodez, as a rule, contributes to the stabilization of blood pressure. For the same purpose, a solution of mannitol on polyglucin has proven itself well: 30 g of mannitol and 400 ml of polyglucin (Uvarov B.S. et al., 1983). The instability of blood pressure with a full plasma volume of the bcc indicates a decrease in vascular tone, with dysfunction of the vasomotor center as a result of reversible hypoxic changes or morphological damage. This condition is stopped by the introduction of 50 mg of a 5% solution of ephedrine, as the most mildly acting vasopressor (15 mg intravenously per 10 ml of a 5% glucose solution and 35 mg intramuscularly). The absence or short-term effect of the above measures may indirectly indicate the development of acute adrenal insufficiency, and only then there is a need for the use of corticosteroids. Fundamental in this sense is the use of hydrocortisone suspension, since only it contains a fraction of mineralocorticoids, which determine the vascular effect of hormones. A more rare cause of systemic hemodynamic disorders is hypocapnia, resulting from hyperventilation, when this technique is used to stop swelling and swelling of the brain. With severe intracranial hypertension, an increase in blood pressure is compensatory in nature - it is aimed at maintaining cerebral blood flow. Therefore, measures to reduce blood pressure should be carried out with caution, since relative arterial hypotension can lead to an uncompensated decrease in cerebral blood flow, up to its termination. The use of antihypertensive drugs should be accompanied by an adequate decrease in intracranial pressure, which, in severe brain contusion, reaches critical values (more than 350 mm of water column). In such cases, it is necessary to observe the principle of uniformity of dehydration therapy. In practice, this is carried out as follows: in the morning, during a lumbar puncture, 10-15 ml of liquor is slowly removed (under the mandrin) for 10-15 minutes; after 2-3 hours, 10 ml of a 2.4% solution of aminophylline with lasix (20 mg) is injected; after another 3-4 hours, an infusion of a 5-10% solution of mannitol (30-60 g) follows, after which, after 4-5 hours, intravenous administration of lasix and aminophylline is repeated, and 50-70 g of glycerol is given orally at night. If necessary, at 6-7 am, an additional 20 mg of Lasix is administered intravenously. The above scheme of dehydration in most cases provides a steady decrease in intracranial pressure, which contributes to a spontaneous decrease in blood pressure to normal values. High arterial hypertension at a safe level of intracranial pressure may prevent the restoration of autoregulation of cerebral circulation. Therefore, it must be corrected by intramuscular injection of 0.5-1 ml of a 5% solution of pentamine or 4-6 ml of a 0.5% solution of dibazol. It should always be remembered that it is advisable to always precede the infusion of mannitol or other osmodiuretic with the introduction of lasix. This will avoid overloading the pulmonary circulation (pulmonary edema) as a result of transient hypervolemia and will contribute to unhindered venous outflow from the cranial cavity. Intensive diuretic therapy leads to the rapid development of potassium deficiency in the patient's body, which must be compensated by Laborie's glucose-potassium-insulin mixture. This mixture is 400 ml of 10% glucose solution with the addition of 10 units of insulin and 5% potassium chloride solution so that the patient receives at least 3-4 g of potassium per day. In the absence of renal failure and profuse diuresis, you can not be afraid of hyperkalemia. Potassium ions, penetrating into brain cells, compete with sodium ions, which reduces the hydrophilicity of tissues. Reducing the spasmodic effect of the sympathetic nervous system is achieved by blockade of the stellate ganglion or carotid sinus zone with 1% novocaine solution up to 4 times a day. Reopoliglyukin (400 ml) has a good therapeutic effect in the treatment of microcirculation disorders in the brain, the introduction of which can be repeated twice a day. In diencephalic syndrome with a tendency to hyperergic reactions (high blood pressure, tachycardia, tachypnea, persistent hyperthermia), a neurovegetative blockade is necessary, the depth and duration of which depend on the severity of diencephalic-catabolic manifestations that occur on the 2-3rd day after a severe brain injury and lasting for 4-6 days. For neurovegetative blockade, droperidol (5-10 mg), seduxen (10 mg), diphenhydramine (40 mg) and pyrroxane (10-20 mg) are preferable, which are administered simultaneously intramuscularly or (less often) intravenously. It is advisable to alternate the introduction of this lytic mixture with the use of sodium thiopental (300 mg of a 10% solution intramuscularly up to 3 times a day). Without interfering with the spread of excitation along the axons of neurons, they reduce the excitability of the cerebral cortex, reduce the brain's need for oxygen and at the same time increase the excretion of CO 2 .. Like other barbiturates, these drugs reduce lactate levels and restore the metabolism of buffer bases in the brain. In case of insufficiency of drug-induced neurovegetative blockade and resistance to hyperthermia, physical cooling is resorted to (drying wet tissues on the patient with a fan, wrapping with ice packs) until the body temperature drops to a normal or subnormal level (36.5-37.5 C). Before the start of physical cooling, it is advisable for the patient to intravenously inject 20 ml of a 20% solution of sodium oxybutyrate, 5 mg of droperidol and 50-100 mg of a 5% solution of nicotinamide. The use of prostaglandin inhibitors (acetylsalicylic acid, less often indomethacin), which improves microcirculation in the brain and normalizes thermoregulation, has also been shown. In case of hyperthermia of infectious genesis, broad-spectrum antibiotics should be used, the route of administration of which (intramuscularly, intravenously, endolumbally, intracarotidally) depends on the type and severity of the inflammatory complication. Indications for surgical treatment in severe brain contusion occur with intracranial hematomas, foci of brain crush, pneumocephalus, depressed skull fractures, edema and dislocation of the brain caused by the growth of an unremoved contusion focus. Hyperbaric oxygenation is an effective method of treatment and prevention of hypoxic conditions in case of severe brain contusion with foci of crushing of the cerebral hemispheres. It is most effective in patients with lesions of the diencephalic and mesencephalic parts of the brain stem of secondary origin. The optimal mode is a pressure of 1.5-1.8 atm for 25-60 minutes (with mesencephalic lesions 1.1-1.5 atm for 25-40 minutes). Contraindications to hyperbaric oxygenation in case of severe brain contusion are: unremoved intracranial hematoma, unresolved upper respiratory tract obstruction, bilateral pneumonia, severe epileptic syndrome, primary brainstem suffering at the bulbar level and other individual contraindications established by a specialist (Kasumov R.D. et al., 1982). The period of inpatient treatment depends on the intensity of the recovery processes, the activity of rehabilitation measures and averages 1.5-2 months.

Traumatic brain injuries, even mild ones, can pose a serious threat to human health. That is why the sooner the patient gets into the hands of an experienced specialist, the more chances for a speedy recovery. The treatment of traumatic brain injury depends on many factors: the severity, age of the patient and the presence of other injuries and diseases.

Principles of therapy

With a brain injury, the speed of first aid is very important. Even a small blow to the head, after which there are no signs of damage: dizziness, nausea, vomiting, loss of coordination, can subsequently lead to serious problems.

Survey

Patients with TBI are necessarily hospitalized in the Department of Neurosurgery, where the doctor performs the initial diagnosis and assessment of the condition. Only after the examination is carried out, an individual algorithm for the treatment and recovery of the patient is built. It is very important to correctly assess the patient's condition and determine the prognosis of the course of the disease, since not only health, but also the life of the patient depends on this.

What examinations are needed:

First aid

Much depends on the speed and quality of first aid. First aid consists of the following:

It is important to know that unconscious patients with open injuries should not be turned over until paramedics arrive - most people with TBI have multiple fractures and spinal injuries. Also, with open injuries, it is impossible to pull out fragments of the skull or foreign objects - only specialists can carry out such manipulations.

The course of TBI involves several periods:

spicy;
intermediate (compensatory);
restorative.

For each period, a specific treatment is selected, which depends on many factors:

Patients with minor injuries, as a rule, stay in the hospital for no more than a day. If nothing threatens their condition, then after receiving appointments they can go home. Patients with moderate injuries are treated in a hospital.

As a rule, the treatment period is at least a month, but if possible, after 2 weeks the patient goes home and is shown to the attending physician once a week. Patients with severe injuries for a long period are in stationary conditions. And even after discharge, they undergo a rehabilitation course to restore speech, motor and other lost functions.

How to help with a brain injury?

Brain contusion is a fairly common injury that occurs during an accident, due to fights, falls or blows to the head. Such damage can be of a different nature: mild, moderate or severe, open or closed, with or without hemorrhage. According to the nature of the injury, the doctor determines how to treat each patient, and individually selects a treatment regimen.

Patients with brain contusion are treated only in stationary conditions, since the consequences of such injuries can cause serious harm to health. Patients with mild and moderate degrees are treated in intensive care units, and patients with severe trauma in the first days are in intensive care under the supervision of specialists.

In most cases, the treatment of a brain injury does not require surgery. First of all, it is necessary to restore such vital functions as breathing and blood circulation. To establish respiratory function and prevent asphyxia and oxygen starvation, oxygen inhalations are carried out. If the patient is not able to breathe on his own, then for this period he is connected to a ventilator.

In 90% of patients with such injuries, there is a decrease in the volume of circulating blood, so its volume is restored by administering drugs with solutions of colloids and crystalloids. Bruising increases intracranial pressure, so the head of the patient's bed should be slightly elevated. To relieve swelling and normalize pressure, diuretic drugs are prescribed, for example: Furosemide or Lasix.

Since brain tissue is damaged during a bruise, drugs are needed that provide nutrition and restoration of brain cells. For this, agents with neuroprotective and antioxidant actions are used:

It is obligatory to take drugs that improve microcirculation: Cavinton, Trental, Sermion, as well as sedatives and vitamins E and group B. With an open brain injury, antibiotics (Cefotaxime, Azithromycin) are necessary to avoid infection and the development of complications, such as sepsis, meningitis and encephalitis.

In rare cases, brain contusion requires neurosurgical care. The operation is performed if cerebral edema increases, intracranial pressure does not decrease, or a large area of crushed brain tissue is observed. The operation is based on trepanation and removal of the damaged area.

Help with Concussion

The most common traumatic brain injury is a concussion. It is very common in both adults and children. Like other injuries, concussion is divided into three degrees, which determines the tactics of treatment.

Mild concussion in adults is a condition that is rarely accompanied by complications. In many cases, no specific treatment is needed other than pain medication, sedatives, and bed rest.

Therefore, after the examination, the patient is sent home under several conditions:

Sick leave will be taken.
Bed rest is required.
You need to see a doctor at least once a week.
Take prescribed medications regularly.

In childhood, concussions of the brain are observed by specialists within 1-3 days, and if the child's condition does not cause concern, then he is released for outpatient treatment. It is very important for any blow to the head to show the child to the doctors to make sure that nothing threatens his health. A missed concussion can lead to impaired memory, speech, and future learning problems.

The main drugs prescribed for concussion:

Painkillers and non-steroidal anti-inflammatory drugs: Analgin, Ibuprofen, Pentalgin, Maxigan.
Sedatives: Valerian, Corvalol, Motherwort, Novo-Passit.
For sleep disorders: Relaxon, Donormil.
With residual neurosis, tranquilizers are prescribed: Afobazol, Phenazepam, Grandaxin, Rudotel.

Less often, concussions are prescribed drugs that promote blood microcirculation (Cavinton, Trental) and drugs with nootropic and neuroprotective effects. Especially often, such funds are prescribed in childhood and old age to help the brain cope with the residual effects after an injury.

What drugs are prescribed:

Cerebrolysin.
Piracetam.
Pantogam.
Encephabol.
Semax.
Cogitum.

If long-term asthenic signs are observed, then complex treatment is necessary, which includes antipsychotics or nootropics, vitamin-mineral complexes, antioxidant drugs and tonics. Elderly patients need to take drugs that improve vascular tone and elasticity, as well as anti-sclerotic treatment that reduces cholesterol deposition on damaged vessels.

Treatment of severe injuries

The most severe TBIs are cerebral compression, diffuse axonal injury, brainstem ruptures, and intracranial hemorrhages. It is with such defeats that the score goes not only for hours and, but also for minutes. The life of the patient and whether he will be able to lead a normal life depends on how quickly treatment is started in the acute period. Many patients with severe TBI remain disabled for life.

The patient's condition depends not only on the nature of the injury, but also on secondary injuries: hypoxia, hypothermia, intracranial pressure, spasms, convulsions, infection. That is why medical measures are aimed at eliminating these symptoms.

Treatment methods in the acute period:

After the acute condition is removed, patients who have suffered severe lesions are prescribed drugs that allow normalizing blood circulation in the vessels of the brain and restoring lost functions. The most effective drugs are Cortexin, Cerebrolysin, Mexidol and Actovegin. These funds not only nourish the brain tissue, but also relieve the effects of hypoxia, restore speech and other cognitive functions.

After discharge, patients who have suffered a severe brain injury undergo a long rehabilitation course, which includes: exercise therapy, electrophoresis, magnetotherapy, acupuncture, massage and other measures to restore lost functions.

home remedies

For traumatic brain injuries, treatment at home should be carried out only after visiting a doctor, and make sure that life and health are not in danger. Principles of treatment at home:

At home, you can treat only a concussion and a mild bruise, or undergo recovery after discharge from the hospital.
Observe bed rest.
Exclude vigorous activity.
You can not watch TV, read and use a computer for at least three days.
Protect the patient from irritating factors: bright light, noise, unpleasant odors.
Exclude heavy foods from the diet, add more fresh vegetables, fruits, cottage cheese and juices.
If symptoms of TBI occur or worsen: dizziness, nausea, convulsions, loss of consciousness, you should seek medical help.

Head injuries are not treated with folk remedies, but they can be used to eliminate unpleasant consequences, for example: dizziness, weakness, insomnia, lack of appetite. What can be taken:

It should not be forgotten that even mild traumatic brain injuries require a doctor's examination, and after discharge, it is necessary to see a specialist 2 times a year. In childhood, after TBI, the child is shown to a neurologist every 2 months to exclude residual effects.