Traumatic encephalopathy

Traumatic encephalopathy is a complex of neurological and mental disorders that occurs in the late or late periods of craniocerebral trauma. It is caused by degenerative, dystrophic, atrophic and cicatricial changes in brain tissue due to trauma. The timing of appearance, nature and severity of neuropsychic disorders in this case depends on the severity and location of the injury, the age of the victim, the effectiveness of treatment and other factors. Neurological disorders are expressed by vegetative and vasopathy, chronic hypertensive syndrome, cerebrospinal fluid dynamics disorders, traumatic arachnoiditis and arachnoencephalitis, epileptiform attacks and focal neurological disorders. Neurological disorders are accompanied by psychological disorders characteristic of psycho-organic syndrome.

Traumatic asthenia is manifested by weakness, increased fatigue, decreased efficiency, combined with irritability, weakness (crying with slight excitement), emotional lability, hyperesthesia (painful reaction to relatively weak stimuli-light, sounds, etc.). Patients are characterized by violent short flashes of irritation on minor occasions, followed by tears and remorse. Vegetative and vestibular disorders (headache, dizziness), sleep disturbances complete the clinical picture. External adverse effects - heat, travel in the transport, somatic diseases and mental trauma - worsen the condition of patients.

Traumatic apathy is, as it were, an extreme degree of asthenia with passivity, lethargy, slowness of movements, a low sensitivity to external impressions. Motivation for activity is sharply reduced. Patients lie a lot. Interests are limited to elementary life needs.

Psychopathic conditions (pathological changes in nature) occur gradually, against a background of gradual attenuation of symptoms of acute and late periods of trauma. Often there is only an increase in the traits of psychopathic traits before the trauma. The most-typical ex-plosiveness (explosiveness), a tendency to litigiousness, unmotivated mood swings. Explosiveness "is manifested by bouts of irritation with hysterical coloring or with anger, aggression and other dangerous actions." Incorrect behavior is aggravated by a propensity for drunkenness, chronic alcoholism.

Affective disorders most often represent a shallow, angry-irritable depression (dysphoria) that occur in a conflict situation, with overwork, intercurrent illnesses, and without any apparent cause. There are also contrasted states of complacently upbeat mood (euphoria) with lightness of judgments, uncriticality, low productivity, disinhibition of drives, drunkenness. The duration of the state of altered mood ranges from several hours to several months, but, as a rule, is calculated in days. More prolonged state of euphoria.

Paroxysmal (epileptiform) conditions (traumatic epilepsy) appear both soon after the injury, and after a few months and even years. Along with typical large, abortive, Jacksonian convulsive attacks, there are a variety of non-convulsive paroxysms - small seizures. Epileptiform states include states of confusion of consciousness (twilight states), during which patients can perform consecutive, outwardly expedient actions, of which memories are not preserved (ambulatory automatisms). The structure of the twilight state can include delusions, hallucinations, fear. These experiences determine the behavior of patients and can cause dangerous actions. Possible hysterical twilight states that arise in response to a conflictual psychotraumatic situation.

Traumatic dementia occurs as a distant consequence of severe craniocerebral trauma. For its development, additional harms-alcoholism, vascular disorders, infections and intoxications are important. Reducing the level of judgments, memory disorders in some cases are combined with indifference, lethargy, decreased motivation, in others-with a carefree-euphoric mood, lack of criticism, disinhibition of drives.

Relatively rare long-term effects of trauma in the form of affective and hallucinatory-delusional psychoses (traumatic psychoses).

Free traumatic encephalopathy requires a sparing regimen of life. Periodically prescribed dehydration and restorative therapy, nootropics (piracetam, pyriditol, pantogam, aminalon). With increased excitability, tranquilizers and neuroleptics are given [chlospide (elenium), sibasone (seduksen), nosepam (tazepam), phenazepam, sonapaks, tizercin], and with lethargy and apathy-stimulants (centedrin, sydnocarb, tincture of magnolia vine, eleutherococcus). Patients with paroxysmal disorders are treated in the same way as patients with epilepsy.