Brain injury, also known as traumatic brain injury, can be classified into two types: open traumatic brain injury and closed traumatic brain injury. Open traumatic brain injury is typically caused by direct impact to the head from sharp objects such as knives, bullets, or shrapnel, and is accompanied by skull fractures; closed traumatic brain injury, on the other hand, is most often caused by accidental head injuries resulting from traffic accidents, trips, or falls, and is less likely to involve skull fractures. Head injuries from traffic accidents are particularly common in urban areas.
Lesions caused by brain injury include concussion and cerebral contusion; common secondary complications include cerebral edema, cerebral hemorrhage, and hematomas (including epidural hematoma, subdural hematoma, subarachnoid hemorrhage, and intracerebral hematoma and hemorrhage). Cerebral edema and hematomas are the primary causes of increased intracranial pressure, which can easily lead to cerebral herniation—a leading cause of death.
Concussion: Immediate impairment of consciousness following the injury, ranging from drowsiness to complete unconsciousness, lasting from a few seconds to over ten minutes, but generally not exceeding half an hour. After regaining consciousness, retrograde amnesia may occur, possibly accompanied by headache, dizziness, nausea, and vomiting. Neurological examination reveals no positive findings, and cerebrospinal fluid contains no red blood cells.
Cerebral Contusion and Laceration: Impaired consciousness lasting more than half an hour or even persistent coma; prolonged headache; marked autonomic nervous system dysfunction; red blood cells visible in cerebrospinal fluid; elevated cerebrospinal fluid pressure.
Ten Key Observation Points for Patients with Traumatic Brain Injury:
1. Level of consciousness: Distinguish between alertness, shallow coma, and deep coma; be alert for a “coma–awake–recomma” pattern, which may indicate an intracranial hematoma.
2. Respiration: Deep and rapid breathing may indicate increased intracranial pressure.
3. Body temperature: Elevated body temperature may indicate adverse signs such as subarachnoid hemorrhage.
4. Blood pressure: Monitor for hypotension to prevent shock; persistently elevated blood pressure may indicate cerebral edema or hematoma.
5. Pupils: Check for bilateral equality and light reflex; pupils that first constrict and then dilate may signal a brain herniation.
6. Limb movement: Paralysis on one side of the body suggests a contralateral cerebral hematoma.
7. Ear and Nose Discharge: Discharge of blood or clear fluid suggests a skull base fracture.
8. Nuchal Rigidity: Most commonly associated with subarachnoid hemorrhage.
9. Headache and Vomiting: Severe headache and frequent vomiting suggest increased intracranial pressure.
10. Speech: Observe for aphasia or slurred speech.
Post-Traumatic Brain Injury Syndrome: Following treatment for traumatic brain injury, subjective discomfort persists for more than 3 months without obvious positive neurological signs. Symptoms include headache, dizziness, insomnia, palpitations, memory loss, emotional instability, excessive sweating, and tinnitus. According to Traditional Chinese Medicine (TCM) pathogenesis, this condition is primarily characterized by blood stasis obstructing the cerebral meridians, deficiency of nourishment to the “Marrow Sea,” and disharmony between the Heart and Kidney.
Key Treatment Points: Alleviate psychological concerns; engage in moderate exercise (walking, Tai Chi); use Western medicine for symptomatic relief; in TCM, promote blood circulation to resolve stasis and tonify the kidneys to nourish the brain—formulas such as Tongluo Rongnao Decoction or Fuyuan Huoxue Decoction may be selected.
Prevention: Avoid hinting at potential sequelae in the early stages of injury; conduct a comprehensive examination to rule out intracranial lesions; regulate emotions and maintain a balance between work and rest; take Chinese herbal medicine early on to address both the root cause and symptoms.