Is mild craniocerebral injury a minor injury?

Anyone who is not seriously injured or slightly injured is slightly injured.

Evaluation of the degree of craniocerebral injury

Cranium includes scalp, skull and brain. Because of the different structures and functions of the three tissues, the same external force can affect or hurt one of them at the same time. The brain is the center of human spiritual activities. When evaluating the degree of injury, we should not only pay attention to the degree of injury, but also ignore the sequelae and social adaptability after injury.

1 damage classification

Common symptoms and signs of craniocerebral injury.

In the criteria for identifying serious human injuries, it is mentioned in many places that injuries must be accompanied by symptoms and signs of the nervous system. Therefore, understanding the common neurological symptoms and signs of craniocerebral injury is helpful to correctly judge whether the tests in the forensic identification book are correct.

Symptoms:

Headache, nausea and vomiting: Brain edema caused by trauma or intracranial hemorrhage often leads to intracranial hypertension. Headache, vomiting and papillae edema are also called intracranial hypertension.

Consciousness disturbance: it is the most common symptom of craniocerebral injury, and it is also an important symptom to judge the type and degree of injury. According to its degree, it can be divided into ① shallow coma: partial loss of consciousness, no voluntary movement, no response to acousto-optic stimulation, response to pain stimulation, eye movement, corneal reflex, pupil reflex to light, swallowing reflex and leg reflex. ② Moderate coma: responding to intense pain stimuli, corneal reflex, swallowing reflex and tendon reflex weakened. ③ Deep coma: loss of consciousness, disappearance of response to strong stimulus, and disappearance of shallow-deep reflex.

Dizziness: Dizziness is different from dizziness. The former refers to feeling black at the moment, top-heavy, and often disappears as soon as you close your eyes; Vertigo refers to seeing external objects rotating or moving up and down, left and right when you open your eyes, and feeling yourself rotating or shaking when you close your eyes, often accompanied by nystagmus, nausea, vomiting, ataxia and so on.

Tinnitus and deafness: when the skull base is fractured and the inner ear is injured, it may cause tinnitus or deafness.

Pathology/physical signs

Eye signs: changes in eye fissure, eyelid, pupil shape and pupil's reflection of light.

Meningeal irritation signs: severe headache, nausea, vomiting, stiff neck, positive Kriging sign (kerning sign) and Brudzinsk sign.

Paralysis: paralysis refers to the decrease of muscle strength of a limb, which leads to motor dysfunction; Hemiplegia refers to the dysfunction of limb movement caused by the decrease of muscle strength of one limb.

Cone beam sign: manifested as muscle strength, muscle tension, bond reflex and pathological reflex changes.

3 Examination methods of craniocerebral injury

Clinical physical examination

Careful physical examination of nervous system is a preliminary screening method to find the location and severity of injury. The inspector's experience and methods directly affect the inspection results. Attention should be paid to pulse, blood pressure, respiration, pupil, state of consciousness, cranial nerve examination, limb muscle strength, muscle tension, motor function, physiological reflex and pathological reflex.

X-ray examination (image examination)

Imaging examination plays an important role in the diagnosis of craniocerebral injury, which can determine the location, nature and degree of the lesion and is an important objective basis for evaluating the degree of injury. With the development of imaging equipment and technology, the imaging of craniocerebral injury has undergone great changes. Previously only plain films and cerebral angiography were used. Now, in conditional areas, head CT scanning (computed tomography) has become the first choice. Head MRI (magnetic resonance imaging) is an important auxiliary means. Brain CT scan can better show acute brain and external lesions, and MRI can also show these lesions. However, due to the long imaging time of MRI, it is difficult to apply it to patients with acute stage of craniocerebral injury. At present, MRI is generally used to check the sequela of injury, judge the prognosis and brain injury in special parts (such as hypothalamus, sellar region, cranial nerve and brain injury) that are difficult to display by CT.

4 Matters needing attention in the evaluation of the degree of craniocerebral injury

(1) Open craniocerebral injury refers to the rupture of scalp, skull and dura mater, and the communication between brain tissue and the outside world.

(2) For serious complications after craniocerebral injury, such as intracranial infection, epilepsy, hypothalamus-pituitary dysfunction and other diseases, the causal relationship between injury and disease should be determined.

(3) Cerebrospinal fluid leakage can be divided into three types: cerebrospinal fluid rhinorrhea, ear leakage and eye leakage. The occurrence of cerebrospinal fluid leakage is an important diagnostic basis for skull base fracture. Long-term nonunion of cerebrospinal fluid leakage means that cerebrospinal fluid leakage lasts for more than 4 weeks.

(4) The degree of complications and sequelae of craniocerebral injury should be evaluated about 3-6 months or longer after the injury is stable.

(5) Mental disorder after craniocerebral injury belongs to the scope of serious injury, which refers to the pathological basis of organic brain injury, nervous system signs or positive laboratory results. It is characterized by schizophrenia-like or bipolar symptoms, dementia (excluding pseudodementia) and so on.

Mental disorder after craniocerebral injury belongs to the category of minor injuries, which refers to nervous system syndrome with no positive signs of nervous system and positive laboratory results after craniocerebral injury.