Vinnitsa National Medical University
Course of Neurosurgery
Methodological recommendations on the theme:
The craniocerebral trauma (CCT). Classification. An epidemiology. Closed CCT. A
syndrome of the compression of the brain. Clinical course of intracranial haematomas.
Methods of examination. Treatment. Early and late complications of CCCT. Treatment.
Combined CCT. Open craniocerebral trauma (OCCT). Classification. The first urgent
aid to the patient with OCCT. Initial surgical treatment of the penetrating and non
penetrating wounds of the skull and brain. Plastics of defects of bones of the skull.
Peculiarities of changes of CCT depending on the age of the patient.
Approved at a methodological meeting of the
course of Neurosurgery
The minute № 1
Head of the department
Moskovko S.P.
Head of the course
Olkhov V.M.
THEME OF PRACTICAL CLASS: “The craniocerebral trauma (CCT). Classification.
An epidemiology. Closed CCT. Concussion and contusion of the brain. A syndrome of
the compression of the brain. Clinical course of intracranial haematomas. Methods of
examination. Treatment. Early and late complications of CCCT. Treatment. Combined
CCT. Open craniocerebral trauma (OCCT). Classification. The first urgent aid to the
patient with OCCT. Initial surgical treatment of the penetrating and non penetrating
wounds of the skull and brain. Plastics of defects of bones of the skull. Peculiarities of
changes of CCT depending on the age of the patient. (For students)
Duration of the class: 2,7 hours.
I. Importance of the theme
Neurotraumatism is one of the important sections of modern medicine. Trauma of
CNS constitutes 30-40 % in the general structure of traumatism, and death rate in the
young and middle age considerably exceeds vascular and oncological diseases in peace,
time, and also is a principal cause of death in wartime. This problem has not only medical,
but also a big social significance as the level of traumatism tends to grow staidly.
2. The aims of the class:
2.1 The educational aims of the class
1. The student should know about an epidemiology of cranial brain trauma, the social
importance of the problem, a history of studying this section of neurosurgery,
biomechanism of the CCCT. I level
2. The student should know etiopathogenesis of the CCCT, classification, principles of
diagnostics and modern methods of examination of patients, the main kinds of
conservative and operative treatment, and early both late complications and methods of
their treatment, principles of rehabilitation and social adaptation. II level
3. The student should be able to render the urgent aid at a place of accident, to determine a
kind of the CCCT, to examine, estimate the received results of examination, to diagnose
and define tactics of treatment. To master skills of surgical treatment of the wound, of
2
controling bleeding, technique of carrying out a lumbar puncture, assistance in cranial
trepanation, as well to fill in the medical documentation correctly.
III-IV a level
2.2 The educational aims
To give a notion of importance of neurotraumatology being one of the key problems
of modern medicine.
To form preventive orientations of clinical thinking.
To form a notion of the responsibility for timely and correct professional actions,
system of the legal notions connected with treatment of patients with CCCT.
To be able to carry out the deontologycal approach to casualties, to master a skill of
establishing psychological contact with the patient and his relatives.
3. Interdisciplinary integration
Table 1
Discipline
To know
To be able
Normal anatomy
Anatomy of the brain
To differentiate pasts of the brain
Normal physiology
Functions of the brain
To differentiate functions of the
brain
Pathological anatomy, Morphology of the brain
To be able to impose to a mill
topographical and
aperture
substrata
operative surgery
General surgery,
Asepsis, antiseptics, set of To take the anamnesis, to carry out
faculty surgery
instruments, types of
clinical study, methods of stop of
bandages
bleeding control, ways of applying
and removing sutures, application
of bandages
Pharmacology
Neurology
Diuretics, hemostatics,
To administer conservative
nootropics, hormones
therapy in hemorrhage
To know section devoted To carry out psychoneurologic
to CCT
examination and list clinical signs
3
(general cerebral and focal)
Methods of diagnostics To name methods of
To estimate parameters of
of neurosurgical
treatment results
diagnostics
diseases
4. Contents of the class
Discussion of main principles of diagnostics of traumatic injuries of the skull and
brain. Significance of the anamnesis, the data of objective examination and auxiliary
methods of diagnostics at definition of a kind of a craniocerebral trauma. Rendering
assistance by the patient with the closed craniocerebral trauma at a pre-hospital stage of
treatment. The description by students of X-ray films with single and multiple linear and
splintered fractures of the skull. Demonstration of slides, preparations of bruises,
compressions of the brain, macroscopic signs of dislocations of the brain. Selection by
students of the instruments necessary for rendering urgent aid to the patient with the closed
craniocerebral trauma.
Analysis of the patients with concussion, compression and contusion of the brain.
Discussion of pathomorphologic changes in a brain, determination of the kind of
injury. The analysis of the general cerebral and focal manifestations, characteristic of
various kinds of the CCCT. Significance of auxiliary methods of diagnostics of the CCCT.
While discussing patients supervised by students differential diagnostics is made, medical
tactics, volume of conservative treatment is defined(determined) on clinical examples.
The compression of the brain can be caused by intracranial haematomas (epidural,
subdural, intracerebral, intra-ventricular), hydromas, the pressed-in fractures, and also by
growing edema of the brain, pneumocephalus. TREATMENT of intracranial haematomas
is SURGICAL, osteoplastic and resectional cranial trepanations.
Complications of CCT.
Abscess - a cavity filled with pus and delimited by a capsule from the brain substance.
Layers of the abscess:
4

zone of disintegration;

granulation a layer (vessels are located radially in it);

fibrous (several circularly located vessels);

perifocal zone.
The capsule is formed from vessels, hence, the deeper the abscess is located in the white
substance, the thinner is it capsule. The capsule is the thickest in the cortex.
Microbes: more often it is staphylococci (the thickest capsule), diplococci, coli facillus.
Pathogenesis: an embolus - ischemia - microbes with walls of the vessel - vasculitis perivasculitis - distribution of the abscess.
Kinds of abscess perforation:

microperforation - abscesses as "cluster of grapes";

macroperforation - abscesses can perforate in the brain substance, in ventricles of the
brain, in to the subarachnoidal space.
By terms of occurrence there are early (till 3 months) and late (after 3 months) abscesses.
The capsule of the abscess is formed not earlier than 3-6 weeks. Till this time it is possible
to wash it out with solutions of antiseptics and antibiotics (Canamycin, Levomycetin,
Gentamycin) through a fistula and drainage. As a result of it the cavity is formed which is
then removed, or the cavity is closed gradually by itself and pushes out a drainage. This
tactics is acceptable in deeply located abscesses.
Kinds of a surgery:

drainage;

puncture;

total removal.
The clinical picture of the early abscess develops from general brain and focal symptoms.
Late abscesses have a course as:
apoplexies: sudden development of general brain symptoms. More often death occurs the
first 24 hours. Blood and the eye fundus can not react in any way.
5
By the course there are acute the period, latent, marked clinical manifestation (or - early
manifestation, latent manifestation of the abscess, terminal. The latent period is a silent
course of the abscess).
pseudotumorous variant of the course. Blood does not react. On the eye fundus
stagnation is determined. The general brain and focal manifestations gradually grow.
More than 50 % of all abscesses are accompanied by epileptic attacks. In 30 % of cases
they are first signs of the abscess. They have s course as the general and focal generalized
attacks. There is marked polymorphism of attacks (multifoci in a trauma and growth of the
abscess).
Diagnostics:

examination of the head;

anamnesis;

R-graphy of the skull;

Echoencephalography;

investigation of the eye fundus;

EEG - in development of seizures (only for lateralization of the process);

angiography, CT-SCAN, MRI, scintigraphy.
LATE COMPLICATIONS OF CCT - THE POSTTRAUMATIC EPILEPSY
Epilepsy is a pathological excitation of the brain accompanying by convulsive or
convulsive-free attack.
Factors:

convulsive readiness of the brain;

presence of the epileptogenic center - cicatrices (cerebral, meningeal - cerebral, it is
cutaneous - meningeal-cerebral);

consequences of the inflammatory process;

development of subarachnoidal cysts (inflammation, subarachnoidal haemorrhages);

presence of foreign bodies (a bone, a bullet, splinters, soft tissues);

hydrocephalus of the brain.
6
Structure of epileptic attacks:
 great

the general the patient - suddenly loses consciousness, falls, the face reddens, the tonic
spasms passing in to clonicoues, cyanosis of integuments, involuntary urination.

the focal - always there is an aura (motor, sensor, psychosensor, vegetative)
 Jackson attacks without loss of consciousness and without generalization of spasms
(motor and sensor) - convulsive discharge in some group of muscles, paresthesias in some
extremity. It upper parietal lobule is affected the attack proceeds by hemitype.
 psychosensor equivalents - petit mall - short-term, loss of consciousness for 20-30
seconds without any convulsive component and without falling down.
Phases of formation of the cicatrix of the brain: glial, argirophil, collagenic.
Examination of the patient with seizures:

R-graphy of the skull in two projections;

EEG - acute wave are determined in the focus. In irritation (by light, sound,
hyperventilation, bemegrid 1 ml, thyopental sodium - slower waves are determined in the
focus)
Indications to the operation:
 morphological

cicatrices;

abscesses;

foreign bodies;

the pressed-in fractures;

adhesive or cystic arachnoiditis
 clinical

absence of effect of medicamentous treatment at often attacks;

progredient course of the disease;

increasing degradation of the personality.
7
Contra-indications to the operative intervention:

massive adhesive processes;

multiple wounds (fraction);

processes in the vital sections of the brain.
COMBINED CCT
The combined trauma - simultaneous injury by one kind of mechanical energy of two or
more anatomical-topographical systems (craniovertebral, cranio-transabdominal).
Multiple trauma - simultaneous injury by one kind of damaging energy of one body, or
several bodies of one system (multiple contusions of the brain, multiple fractures of the
lower extremity).
The combined affection - injury of the organism by various damaging factors working
simultaneously (mechanical, thermal, radial energy).
Classification:

damages of the facial skeleton

damages of the thorax and respiratory organs

damages of the abdominal cavity

damages of the spine and spinal cord

cranial damages
Classification of combined CCT by a degree of severity:

severe CCT and severe extracranial (shock in 70 %)

severe CCT and not severe extracranial (shock in 14-15 %)

not severe CCT and severe extracranial (shock in 40-50 %)

not severe CCT and not severe extracranial (shock in 4-5 %)
The leading part in development of shock in CCT is played by an extracranial pathology.
The shock in isolated CCT develops in:

multiple injures of the bones of the arch and the basis of the skull (of type)

multiple injures of soft tissues of the head (of hemorrhagic type)

in children (any haematomas can cause a hypovolemic shock)
8
Difference of shock from damages of the brain stem. If there is a decrease of
hemodynamics, disturbances of breath and stem (floating eyeballs, anisocoria, ChaineStocks respiration) it should be attributed to CCT. Isolated CCT has shock in 1-1.5 % of
cases.
In mild CCT there is an amplification of function of the hypophysis (secretion of СТH
grows), promoting the prompt formation of an osseous callous. And in severe CCT function of the hypophysis is suppressed.
Facial damages:

single fracture of the jaw

traumatic extraction of a tooth

injures of soft tissues, without a severe bleeding

Лефор 2, 3

multiple damages of the facial skeleton
Thoracic damages

fracture of the clavicle

fracture up to 3 ribs without damage of the organs of the chest, nerves and vessels

fracture of ribs with damage of the vessels

damage of the organs of the chest

hemo-pneumothorax

damage of the organs of the mediastinum
Transabdominal damages

subserous rupture of the gut

any damages of hollow and parenchymatous organs
Vertebral damages

fracture of bodies, arches, but without damage of the spinal cord and roots

fracture of bodies, arches with damage of the spinal cord or roots
Damages of the locomotor system:

the closed single fracture of the forearm, shin

fracture of the pelvis, hip, open fractures, multiple fractures of bones, tearing off of the
9
feet
FATTY EMBOLISM
Fatty embolism is characterized by sudden, quick onset (hemiparesis or a plegia,
disturbances of consciousness, narrow pupils). In LP - liquor is pure or hemorrhagic. On
the 2nd-3rd day there is fat in urine.
Typically haematoma has a gradual onset.
Fatty microthrombembolism occurs more often in the diencephalic areas.
Differential diagnostics of fatty embolism and intracranial haematoma
Intracranial haematoma
Fatty embolism
Severity of a craniocerebral trauma
characteristic severe CCT
the combined damages and CCT are usually a
little milder
Severity of the combined damages
various
usually severe
Disturbance of consciousness
gradual aggravation of a degree of
sudden sharp disturbance of consciousness
disturbance of consciousness
Pyramidal symptoms
gradual increase
are sharply expressed at once. If there is no
pyramidal manifestation, diencephalic and
mesencephalic signs develop (paresis of the look,
narrowing of pupils, floating eyeballs)
Eye fundus
vessels are dilated
spasm of the arteries, haemorrhages, veins are
fragmented
Echoencephalography
displacement of the M - echo
There is no displacement of the median structures
Lumbar puncture
10
the increased pressure, blood in
transparent or xanthochromatic
liquor
Diagnostic mill apertures
Haematoma
Nothing is defined
R-graphy of the lungs
There is no thing
The lung with "snow"
petechial rash on a lateral surface of the stomach,
fat in urine on the 2nd-3rd day
For the prevention of development of fatty embolism in patients with the combined trauma
it is necessary to administer the preparations having immediate effect:
 rheologic properties of blood
 Lipin, Lipostabil, Essentiale
 antagonists of calcium (Verapamil, Nifedipine)
 to increase ОЦК (10 % NaCl 100 ml + 100 ml Rheopolyglucin)
 ГОМК, Nootropics, Difenin
 transfusion of liquids under the control of intracranial pressure (the control of blood
osmolarity: if osmolarity is normal - intracranial pressure is normal too, if osmolarity of
plasmas is reduced - intracranial pressure is always increased). It implies, that in the first
2-3 days it is better to administer osmodiuretics, and then saluretics.
 Carrying out of functionally stable osteosynthesis (plates, a spoke, but not a nail):

the first 4-6 hours – in mild or moderate CCT without disturbances (shock)

on removing from a shock - in mild or moderate CCT and a shock accompanying it

after stabilization of vital functions – in severe CCT with vital disorders
If fatty embolism has developed, it is necessary to influence development of collateral
vessel. Transfusion of liquids under the control of intracranial pressure (the control of
blood osmolarity: if osmolarity is normal - intracranial pressure is normal too, if
osmolarity of plasma is reduced - intracranial pressure is always increased).

Antagonists of calcium
11

increase of resistency of the brain tissue to hypoxia

The Signay-cocktail - is introduced once a day intravenously
500 ml of 20 % Mannitol
50 mg Dexasone (Metipred)
500 mg of vitamin Е
500 mg Difenine

preparations increasing elasticity of vessels (Trentalum, Theonicol) in the acute the
period

solutions

Lipostabil, Inhibitors of proteases, Essentiale
Ether intramuscularly
Control questions:
1.
The causes of a compression of the brain of a traumatic genesis.
2.
The basic clinical signs of epidural haematoma.
3.
The basic clinical signs of subdural haematoma.
4.
The radiological characteristic of the pressed-in fracture of bones of the arch of
the skull.
5.
The clinical characteristic of intracerebral and intra-ventricular traumatic
haemorrhage.
6.
Early complications of CCT.
7.
Late complications of CCT.
8.
The basic clinical signs of a posttraumatic abscess of the brain.
9.
Combined CCT. Classification, rendering the specialized medical aid.
5. The plan and organizational structure of the class.
Maintenance of the class: a class room, tables, scheme, slides, x-ray films, slide
films, slide projector, macropreparations, sets of instruments for rendering the urgent aid
to- the patient with a craniocerebral trauma, cabinets(studies) of the auxiliary diagnostics,
working dressing and operational, thematic patients.
12
6. Materials of methodological maintenance of the class.
6.1 Materials of the control over a preparatory stage of the class.
1. Questions.
• anatomo-physiological peculiarities of the brain in various age groups;
• peculiarities of blood supply of the brain, membranes, bones of the skull; liquor system
of the brain;
• radiological methods of examination of the patient with CCCT;
• focal and general brain symptoms of CCCT;
• meningeal symptoms;
• groups of preparations for complex therapy of CCCT: dehydration, hemostitics,
hormonal, nootropics.
6.1.2 Materials of methodological maintenance of the basic stage of the class.
1. Tests of 1 level
1) In what space of the skull cavity there is liquor? Variants of the answer:
а) Epidural space.
b) Subarachnoidal space
c) Subdural space.
d) A sagittal crack.
e) A tentorium of the cerebellum.
Correct answer: b)
2) In injury of what area of the brain does sensor aphasia develop? Variants of the answer:
а) A pole of a frontal lobe.
b) Basal departments of the right frontal area.
c) Center of Broquar.
d) Center of Wernique.
e) A parietal lobe.
Correct answer: d)
13
6.1.3 Test of 2 level with a freely designed answer.
List general brain symptoms of the CCCT (eight). Correct answers:
а) A headache.
b) Dizziness.
c) Vomitting.
d) Developments of stagnation on the eye fundus.
e) Bradycardia.
f) Disturbances of consciousness.
j) Craniographic signs.
i) Episyndrome.
6.1.4 Tests of II level with a multiple choice.
Name the preparations related to group of nootropics. Variants of the answer:
а) Cinnarisin.
b) Cerebrolysin.
c) Furosemid.
d) Aminalon.
e) Pyracetam.
f) Nootropil.
g) Pantogam.
i) Cogitum.
j) Trentalum.
k) Sincumar.
Incorrect: а) c) f) k) j)
SITUATIONAL TASKS FOR CHECKING OF THE LEVEL OF KNOWLEDGE
OF STUDENTS WITH ANSWER STANDARDS:
№1. During quarrel the victim was knocked by a hammer on a head. He did not lose
consciousness. There was bleeding from a wound in the left parietal area. He was brought
14
to a neurosurgical hospital. On examination: a lacerated-contused, moderately bleeding
wound in the left parietal area, hemiparesis on the right. It is necessary to make the
preliminary diagnosis, to define the plan of examination and treatment.
The answer: the preliminary diagnosis - the open penetrating pressed-in fracture in
the left parietal area. The plan of examination – craniograms in two projections,
echoencephalography. The plan of treatment –establishment of the pressed-in fracture, a
decompression of the brain.
№ 2. The brick has fallen to the head of the patient 32 ages. There was a short-term
loss of consciousness. The wound in the frontal area was treated by iodine, the aseptic
bandage was applied. In the evening the condition of the patient and headache worsened,
there was, vomitting, weakness in the left extremities. On examination: anisocoria D is
more than S, a moderate hemiparesis on the left, in the posterior parts of the frontal area
on the right, parasacrally, a contused wound of 2,5 cm; on X-ray images – the pressed-in
fracture in this area. What is preliminary diagnosis and what tactics should be applied on
examination and treatment of this patient?
The answer: the preliminary diagnosis is the open penetrating pressed-in fracture
in the posterior part of the frontal area on the right. Medical tactics will consist in carrying
out primary surgical treatment of the wound, elimination of the pressed-in penetrating
fracture of the arch of the skull with administration of the anti-inflammatory therapy
directed at the prevention of early and late purulent processes.
№ 3. During hunting the victim has received a gunshot wound. The entrance
aperture was moderate bleeding, located in the right temporal area. Was at the moment of
examination the patient on conscious. Anisocoria D is more than S. Make the preliminary
diagnosis and defines methods of diagnostics and the treatments indicated to this patient.
The answer: the preliminary diagnosis is open gunshot injury of the skull and brain
of the right temporal area. It is necessary to make craniograms, CT-scan - study. Medical
tactics – to make primary surgical treatment of the entrance aperture with the subsequent
administration of anti-inflammatory and dehydration therapy.
№ 4. The patient was brought to the special traumatological department in the
condition of alcoholic intoxication. Psychomotor excitation was marked. In the area of the
left temple the ecchymosis is revealed, bloody fluid discharged from the external acoustic
meatus on the left. The diagnosis is alcoholic intoxication. Treatment was administered. In
15
6 hours after admission the patient had an attack of tonic spasms, the anisocoria (the left
pupil was more than right), a condition of deep sopor developed. Estimate the condition of
the patient; specify the plan of examination and treatment. What tactical mistake has been
made in establishing the diagnosis?
The answer: the condition of the patient is extremely severe with a syndrome of
dislocation and wedge of the brain stem in the big aperture of stem structures of the brain.
The plan of examination – a craniography, CT-scan - study. According to vital indications
urgent operation is indicated decompressive cranial trepanation in the left frontal-temporal
area, removal of haematoma. The tactical mistake was, that liquorrhoea from the left was
underestimated ear, as a symptom of fracture of the basis and the arch of the skull (middle
cranial fossa) and probability of development of intracranial traumatic haemorrhage that
has not been taken into account on primary examination of the patient because of his
alcoholic intoxication.
6.2 Materials of methodological maintenance of the basic stage of the class.
Professional algorithm of examination of the patient with CCCT:
1. Examination of the patient.
2. An anamnesis (duration of a trauma, heredity).
3. Complaints (a headache, vomitting, disturbances of sight, seizures).
4. Objective examination of internal organs (necessarily AP and pulse on both hands).
5. Study of disturbances of consciousness a degree (a coma by Glasgow from 3 up to 15).
6. Study of 12 pairs of the cranial nerves.
7. Study of the motor-sensitive sphere (reflexes, definition of sensitivity disorders).
8. Definition of statics and coordination.
9. Definition of the meningeal syndrome.
10. Local examination of the head.
11. Detection of liquid, outflow blood from the nose, ears.
12. Detection of external damages of the soft tissues.
13. Craniograms in two projections.
14. Additional methods of investigation if necessary.
Professional algorithm of carrying out a lumbar puncture:
16
1. Position of the patient on the right side.
2. Legs are bent in the knees and held against the stomach.
3. Treatment of the hands with an antiseptic, sterile gloves.
4. Treatment of the field with 5% iodine, then alcohol at the level of 3-5 lumbar vertebra.
5. Local anesthesia with 0,5% by a solution of Novocaine at the level of the intervertebral
fissure between the 4th and 5th lumbar vertebra.
6. The control of a needle (presence of a mandrin, an sharpness of the needle).
7. A lumbar puncture. During the puncture there is sensation of two obstacles (a yellow
ligament and the dura mater membrane) and downfall.
8. Slow pulling up of a mandrin from the needle, checking liquor presence.
9. In the extended mandrin evacuation of 1-2 ml of liquor for the analysis.
10. Removal of the needle and application of the aseptic label.
Educational task:
Define neurosurgical tactics and specify a method of treatment at each kind of fractures of
the skull bones:
а) Linear fracture;
б) Pressed-in fracture:
1 - closed
2 - open
в) Multisplintered:
1 - penetrating
2 - non penetrating
Correct tactics:
а) Conservative treatment.
б) 1 - conservative tactics is possible depending on the zone;
2 - operative tactics.
в) Operative tactics in all cases.
6.3 Materials of the control of the final stage.
17
The test of III level.
Symptoms
Bradycardia
Seizures
Blood in the liquor
Pleocytosis
Expansion of the 3th ventricle
Displacement the M - echo
Symptom Kernig’s
Hyperemia
Protein-cellular dissociacion
+
+
+
-
+
+
+
-
+
+
+
-
+
+
+
+
-
Tumour
Meningitis
haemorrhage
Subarachnoidal
haematoma
Intracerebral
haematoma
Subdural
Epidural
Diseases
haematoma
In what form of the disease are the following symptoms observed?
+
+
+
-
+
+
+
+
Situational tasks:
1) The patient is found in the yard without consciousness, a smell of alcohol from the
mouth.
Locally there are edema of soft tissues in the right temporal area, anisocoria on the right,
areflexia. Define the plan of examination, medical tactics.
ANSWER: hospitalization to the NEUROSURGICAL DEPARTMENT, CT-SCAN,
cranial trepanation, removal of the intracranial haematoma.
2) The patient was treated for the CCCT - fracture of the temporal bone on the left. In 10
hours after of the trauma - sharp deterioration, coma 4-5 Glasgow, breath disorder,
periodic tonic spasms, wide pupils have developed, photoreaction is languid, the left pupil
is a little bit wider then the right one.
QUESTION: What can the change of a clinical picture are caused by? Define tactics of the
doctor.
18
The ANSWER: Enlargement of the epidural haematoma on the left, a dislocation of the
median structures of the brain. Tactics of the doctor - urgent operative intervention due to
vital indications (cranial trepanation).
3) A youth of 18 years had CCCT at 12 years. The next years he periodically had
headaches, had two attacks of loss of consciousness. He finished school and studies in
college.
QUESTION: What is plan of examination and treatment?
ANSWER: Psychoneurologic inspection, EEG, CT-SCAN of the brain.
Control questions while analyzing patients with CCCT.
1. Classification of CCCT.
2. Name possible variants of traumatic injures of the skull.
3. What kind of trauma is fracture of the basis of the skull with liquorrhoea related to?
4. What can compression of the brain be caused by in CCCT?
5. In what cases of CCCT is the lumbar puncture made very cautiously?
6. In what cases of CCCT is the surgery applied?
7. How do you understand the term «the Light interval»? What kind of CCCT is it
characteristic of?
8. What are peculiarities of clinical course of CCCT, combined with alcoholism and
narcotism?
9. Describe early and late complications of CCCT.
10. Determine the scope of conservative therapy.
11.
The causes of a compression of the brain of a traumatic genesis.
12.
The basic clinical signs of epidural haematoma.
13.
The basic clinical signs of subdural haematoma.
14.
The radiological characteristic of the pressed-in fracture of bones of the arch of the
skull.
15.
The clinical characteristic of intracerebral and intra-ventricular traumatic
haemorrhage.
19
16.
Early complications of CCT.
17.
Late complications of CCT.
18.
The basic clinical signs of a posttraumatic abscess of the brain.
19.
Combined CCT. Classification, rendering the specialized medical aid.
6.4 Materials of methodological maintenance of self-preparation of students.
Orientation map for students’ work with the educational literature. This form does not
include student’s aid as training at the 5th year intends to develop skills of independent
work with the literature.
7. The literature.
The basic:
1. Иргер И.М. Нейрохирургия. М.: Медицина, 1982.
2. Ромоданов А.П. Нейрохирургия. Киев: Здоровье, 1990.
3. Нейротравматология. Справочник под. ред. Коновалова А.Н. М.:
Медицина, 1996.
Additional:
4. Арутюнов И.А. Тяжелая черепно-мозговая травма. М.: Медицина, 1969.
5. Исаков Ю.В. Острые травматические внутричерепные гематомы. М.:
Медицина, 1977.
6. Ромоданов А.П., Педаченко Г.А. Черепно-мозговая травма при алкогольной
интоксикации. Киев: Здоровье, 1982.
8. Task for Students’ Research on the given theme.
9. Theme of the following class «The clinical picture of intracranial traumatic
haematomas. Methods of examination. Treatment. Early and late
complications. »
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