[Brain concussion--a minor craniocerebral injury]

Brain concussion is a brain dysfunction without any macroscopic structural damage, caused by mechanical force. This research paper presents the occurrence and basic characteristics of patients with brain concussion without skull fracture. The second aim of this paper is to answer questions, related to this problem, neurosurgeons are most often asked by doctors of other specialties.

Posttraumatic amnesia (patient unable to remember events before and/or after injury) was a condition to diagnose the brain concussion. In 1995 there were 240 patients with brain concussions without skull fracture at the Department of Urgent Surgery of our Institute. Eighty of them (33%) have been admitted to the Neurosurgical Clinic for observation and/or treatment. In all patients with brain concussion the following diagnostic procedure was applied: personal history, physical and neurological examination, basic blood tests and skull x-rays. CT imaging of the brain is not a routine because of our economic and technical circumstances.

240 patients were examined; 67% were males. Glasgow coma score (GSC) was 13-15 in all patients, while in nonhospitalized patients it was 15 (GSC = 15). 54% of patients were 15-40 years old; 35% were 41-60 years old and 11% were older than 60 years of age. Average hospitalization lasted for 3.48 days. According to the Glasgow outcome scale all patients had a good recovery.

Patients with brain concussion have always amnesia with normal neurologic status. Legal and clinical definition of the minor head injury are not completely equal. Brain concussion is legally always a minor head injury. Patients with organic damage of brain (legally severe injury) can clinically look like having minor injury initially or till the end of the illness. Risk for brain damage in patients with amnesia is about 3%. Posttraumatic amnesia is always established by asking patients to remember events and not asking them if they were unconscious. Brain concussion is often associated with headache, vegetative or/and psychotic difficulties. Diagnostic protocol should comprise at least personal history, physical and neurological examination and skull x-ray. Consultation of a neurosurgeon and hospitalization are not indicated in all cases. In our series it was done in 33% according to indications which are established. In these cases patients should be transported with documents describing the type of injury, diagnostic results and treatment performed. The therapy is symptomatic. After brain concussion gradual return to everyday activities is indicated. Sick leave of 7-10 days is usually sufficient. Postconcussion syndrome (headache, vegetative or psychotic disturbances) occurs often and may last for a long period of time.

We tried to describe a doctrine for diagnostic and treatment of patients suffering from brain concussion most appropriate according to our technical and economical circumstances.