Skull base fracture complicated by primary brain stem injury

Skull base fracture complicated by primary brain stem injury

Brainstem injuries are divided into primary and secondary. The former refers to brainstem injuries that occur directly during injury; the latter refers to damage caused by brain herniation compressing the brainstem due to intracranial hematoma or cerebral edema.

Primary brainstem injury accounts for about 2% of craniocerebral injuries; severe craniocerebral injuries account for about 5% to 7%. Pathological changes in brainstem injury are different. Mild patients only have microscopic punctate hemorrhages and localized edema. Severe patients may have ruptured neural structures, focal or massive hemorrhages, edema, and softening in the brainstem.

Clinical manifestations are as follows:

1. Impairment of consciousness: It appears immediately after injury, is more severe, and lasts longer. Severely injured patients are in a deep coma, with all reflexes gone and limbs flaccid. Mild patients may respond to painful stimuli, but corneal and swallowing still exist, and they are restless.

2. Pupil changes: The pupils are unequal, vary in size, or are extremely small or dilated.

3. Abnormal eye position and movement: Brainstem damage involving eye movement, sliding or nerve nuclei can lead to strabismus, diplopia and corresponding eye movement disorders; if the eye coordination movement center is damaged, eye coordination movement disorder may occur.

4. Pyramidal tract signs and decerebrate rigidity Brainstem injury: The early manifestations are mainly flaccid paralysis, loss of reflexes, hyperreflexia of tendons and pathological emission. In severe cases, decerebrate rigidity may occur, which is a characteristic manifestation of brainstem injury. Rigidity can be paroxysmal or continuous, or from paroxysmal to continuous.

5. Changes in vital signs: Respiratory dysfunction immediately after injury is one of the important signs of severe brainstem injury, manifested as irregular breathing rhythm, sobbing breathing or cessation of breathing. At the same time, circulatory function tends to fail, blood pressure drops and pulse is weak. Usually accompanied by high fever.

6. Other common symptoms include gastrointestinal bleeding and persistent hiccups.