How is a bruise different from a concussion?
When a concussion occurs, the functioning of nerve cells is disrupted, but there are no structural changes in the photographs, and the condition usually recovers in one to two weeks. A bruise is already physical damage to tissue: areas of the brain that hit the inner surface of the skull are crushed, swelling develops around them and pinpoint hemorrhages appear. Such lesions are visible on CT. Often damage occurs not only at the site of impact, but also on the opposite side, where the brain hits the bone due to inertia. Concomitant symptoms may include skull fractures and intracranial hematomas.
- Concussion - functional impairment without a focus on CT
- Contusion - visible damage to the brain substance
- Foci according to the mechanism of impact and counter-impact
- Possible skull fractures and hematomas
- Three degrees of severity of bruise according to the clinic and CT data
Symptoms
With a slight bruise, loss of consciousness is short, followed by headache, nausea and vomiting, dizziness, tinnitus, weakness and difficulty concentrating. A person often does not remember the moment of injury and the events before and after it. With a moderate or severe injury, consciousness is disrupted for a long time, focal symptoms appear: weakness in the limbs, speech impairment, facial asymmetry, different pupils, convulsions. Particular vigilance is needed for patients who felt normal after an injury, and then began to quickly deteriorate - this may mean a growing hematoma.
- Loss of consciousness lasting several minutes or longer
- Headache, nausea, repeated vomiting
- Loss of memory for events surrounding the trauma
- Dizziness, unsteadiness, tinnitus
- Weakness in an arm or leg, difficulty speaking
- Convulsive attack
- Drowsiness, lethargy, confusion
Diagnostics
The main method for acute head trauma is computed tomography: it quickly shows areas of contusion, hemorrhage, swelling and fractures of the skull bones. Indications for CT include loss of consciousness, repeated vomiting, convulsions, focal symptoms, suspected fracture, taking blood thinning medications, old age and alcohol intoxication, which makes examination difficult. MRI is more informative at a later date and in cases of diffuse damage. A dynamic neurological examination and monitoring of respiratory and blood circulation parameters are required, and in case of injury in an accident, an examination of the cervical spine.
- CT scan of the brain in the first hours after injury
- Repeat CT scan if condition worsens
- MRI to assess late changes
- X-ray of the skull and cervical spine according to indications
- Neurological examination over time
- Assessing the level of consciousness using the Glasgow Coma Scale
Treatment
A patient with a brain contusion is hospitalized - at least for observation in the first day, when the risk of hematoma growth is maximum. Treatment for a mild injury is mostly supportive: bed rest, pain relief, antiemetics, and rest away from bright lights, reading, and screens. In moderate and severe cases, breathing and blood pressure are controlled, cerebral edema is combated, and anticonvulsants are prescribed for seizures. Surgery is required if a large hematoma has formed, there is a depressed skull fracture or increasing compression of the brain. No vascular or nootropic drugs replace observation and should not be taken independently.
- Hospitalization and observation on the first day
- Rest, limiting exercise and screens
- Pain relief and antiemetics
- Control of breathing, pressure, level of consciousness
- Anticonvulsant therapy as indicated
- Surgery for hematoma and depressed fracture
- Avoiding alcohol during recovery
Recovery and aftermath
After a minor injury, headaches, fatigue, irritability, sleep disturbances, and difficulty concentrating may persist for several weeks. You need to return to work, study, driving and sports gradually and only with a doctor’s permission: repeated injury during the recovery period is especially dangerous. With moderate and severe injury, permanent consequences are possible - decreased memory and attention, speech and movement disorders, post-traumatic epilepsy; in these cases, rehabilitation with a speech therapist, neuropsychologist and physical therapist is included. Regular examinations by a neurologist help to adjust treatment in a timely manner.
- Gradual return to exercise
- Limiting screens and noise in the first days
- Refusal from contact sports until approved by a doctor
- Observation by a neurologist after discharge
- Rehabilitation for persistent disorders
- Managing the risk of recurrent falls in older people