1. medical history: mainly including: (1) time, cause and external force of the head. (2) The change of consciousness disorder after injury. (3) What kind of treatment was done after the injury. (4) Pre-injury health status, mainly about cardiovascular, renal and liver diseases.
2. Physical examination: only a short examination will be given to those who are seriously injured.
(1) The degree and change of consciousness disorder is an important aspect to judge the injury. (2) Head examination, pay attention to scalp injury, otorhinorrhea and exudation. (3) The vital signs (respiration, pulse, blood pressure, body temperature) should be checked, and the functional status of increased intracranial pressure and medulla oblongata and the presence or absence of shock should be known. (4) The pupil should pay attention to compare the size, shape and light response of both sides. (5) Changes in motion and reflection.
3. Auxiliary inspection:
(1) X-ray plain film of skull: as long as conditions permit, routine examination should be carried out, and positive lateral position or special position should be taken. In order to know the location, type and intracranial foreign bodies of skull fracture, open wound is more necessary.
(2) Lumbar puncture: Understand the changes of cerebrospinal fluid pressure and composition, but contraindications should be considered for those with cerebral hernia or suspected hematoma in posterior cranial fossa.
(3) Ultrasonic examination: We can shift the supratentorial hematoma through the midline wave to determine the lateral direction of the hematoma, but if there is no displacement, the hematoma cannot be ruled out.
(4) Cerebral angiography: The accuracy of intracranial hematoma diagnosis is high, and it is a reliable diagnostic method.
(5)CT and MRI are advanced examination techniques for the diagnosis of craniocerebral injury.
(5) treatment
1. Mild: mainly bed rest and general treatment. Generally, you need to stay in bed for 1 ~ 2 weeks, pay attention to the changes of vital signs, consciousness and pupils, and eat normally. Most patients can work normally in a few weeks.
2. Medium-sized: stay in bed absolutely, regularly measure vital signs within 48 hours, and pay attention to the changes of consciousness and pupils. Sober patients can eat a normal diet or a semi-liquid diet. The total amount of intravenous infusion for patients with unconsciousness is about 2000 ml per day. Patients with increased intracranial pressure were treated with dehydration, and antibiotics were used when cerebrospinal fluid leakage occurred.
3. heavy:
(1) Keep respiratory tract unobstructed: Patients are prone to mechanical obstruction of respiratory tract due to deep coma, tongue coating shedding, cough and swallowing dysfunction, frequent vomiting and other factors. Respiratory secretions should be removed in time, and patients who are expected to be in a coma for a long time or complicated with severe maxillofacial injury and chest injury should be cut open in time to ensure smooth respiratory tract.
(2) Observe the condition closely, measure the breath, pulse and blood pressure every half hour or 1 hour within 72 hours after the injury, check the changes of consciousness and pupils at any time, and pay attention to whether there are any new symptoms and signs.
(3) Prevention and treatment of brain edema and reduction of intracranial pressure:
① Lying position: except for those who are in shock, outdoor high position.
(2) limit the intake, the infusion volume 1500 ~ 2000ml every 24h, and the urine volume within 24h is at least 600ml. On the basis of intravenous infusion of 5 ~ 10% glucose solution, correct the imbalance of water and salt metabolism, give enough vitamins, and nasal feeding can be carried out after the bowel sounds recover.
③ Dehydration treatment: At present, there are two commonly used drugs: osmotic dehydration drugs and diuretics. Commonly used oral drugs are: ① hydrochlorothiazide 25 ~ 50 mg, three times a day; ② acetazolamide 250mg, three times a day; ③ aminopterin 50mg, three times a day; ④ Furosemide 20 ~ 40 mg, 3 times a day; ⑤ 50% glycerol physiological saline 60ml, 2 ~ 4 times a day. Commonly used preparations for intravenous injection are: ① 20% mannitol, 250ml, rapid drip, 2 ~ 4 times a day; ② 200ml of 30% urea invert sugar or urea sorbitol solution, intravenous drip, 2 ~ 4 times a day; (3) furosemide 20 ~ 40 mg, intramuscular or intravenous injection, 1 ~ 2 times, daily 1 time, in addition, concentrated plasma100 ~ 200 ml can also be injected intravenously twice; Intravenous injection of 20% human serum albumin (20 ~ 40 ml) can effectively eliminate brain edema and reduce intracranial pressure.
④ Continuous ventricular drainage or intermittent release of a certain amount of cerebrospinal fluid under intracranial pressure monitoring, or release of a proper amount of cerebrospinal fluid through lumbar puncture after the condition is stable.
⑤ Hibernation hypothermia therapy: body surface cooling is beneficial to reduce brain metabolism, reduce oxygen consumption of brain tissue, prevent the occurrence and development of brain edema, and also play a role in reducing intracranial pressure.
⑥ Barbiturate drug therapy: High dose of pentobarbital or thiopental sodium can reduce brain metabolism, reduce oxygen consumption, increase brain tolerance to hypoxia and reduce intracranial pressure. The initial dose is 3 ~ 5 mg/kg intravenous drip, and the blood concentration should be determined during the administration. The effective blood concentration is 25 ~ 35 mg/L, and the increased intracranial pressure should be supplemented immediately, which can be calculated as 2 ~ 3 mg/kg.
⑥ Hormone therapy: dexamethasone 5 ~ 10 mg is injected intravenously or intramuscularly, 2 ~ 3 times a day; Hydrocortisone 100mg intravenously, 1 ~ 2 times a day; Prednisone 5 ~ 10 mg orally, 1 ~ 3 times a day, is helpful to eliminate brain edema and relieve increased intracranial pressure.
⑦ Auxiliary hyperventilation: The purpose is to excrete CO2. It is estimated that every 0. 13 kPa (1 mmHg) decrease in arterial CO2 partial pressure can reduce cerebral blood flow by 2%, thus reducing intracranial pressure accordingly.
(4) Application of neurotrophic drugs These drugs include: Konofin, glutamic acid, adenosine triphosphate (ATP), cytochrome C, coenzyme A, chlorhexidine, cytidine diphosphate choline, γ-aminobutyric acid, etc. Can be selected according to the condition or combined application. The commonly used mixture is cytochrome c 1.5 ~ 20 mg. Add 50μ m coenzyme A, 20 ~ 40mg adenosine triphosphate, 6 ~ 10μ m conventional insulin, 650 ~ 100mg vitamin B, 1g vitamin C and 1g potassium chloride into 500ml 10% glucose solution.
(5) Surgical treatment: Its purpose is to remove intracranial hematoma and other occupying lesions, so as to relieve increased intracranial pressure, prevent the formation of cerebral hernia or relieve cerebral hernia. Surgery includes skull drilling, hematoma removal and brain tissue debridement and decompression. ① Attention should be paid to intracranial drilling exploration and hematoma removal: 1, and surgery should be performed quickly after diagnosis. Correct selection of drilling sites, common drilling sites (Figure 4- 19) arrange drilling sequence according to injury mechanism, dilated pupils and possible hematoma types. 2. Before drilling, craniotomy with bone flap should be designed (Figure 6-20) for hematoma removal and hemostasis (4-2 1). 3, pay attention to the possibility of multiple hematoma, and strive to leave no hematoma. ② Debridement and decompression: Patients with severe brain contusion and brain edema should be treated with debridement and decompression (Figure 4- 19).
(6) Prevention of complications and strengthening nursing: prevention of pulmonary and urinary tract infections is the main thing in the early stage, and nutrition supply should be ensured in the later stage, and bedsore prevention and functional training should be strengthened.
Second, open brain injury.
Open brain injury can be divided into firearm injury and non-firearm injury. Usually, the latter is more common, such as knife injury and axe injury. , are caused by all kinds of firearms in wartime, and the handling principles of the two are basically the same. The injury of firearm brain injury is generally more complicated and serious.
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Figure 4- 19 Common borehole exploration locations
Fig. 4-2 1 incision design of craniotomy with bone flap
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(1) Incision (2) Hematoma removal and hemostasis
Figure 4-20 Removal of Epidural Hematoma
(a) the classification of firearm craniocerebral injury:
1. Non-penetrating injuries: accounting for 70% of the total firearm injuries, including scalp soft tissue injuries and open skull fracture, but the dura mater is intact, and a few cases may be complicated by brain contusion or intracranial hematoma.
2. Penetration: It accounts for about 30% of the total number of firearm injuries, including scalp injury, skull fracture, dural rupture, severe brain injury, and often complicated with hematoma. Its mortality rate was 49.3 ~ 60.6% in the early stage of World War I and about 30% in the later stage. It fell to 15% during World War II. In recent years, the mortality rate is still above 10%, and the causes of death are: ① brain injury; ② Intracranial hematoma; ③ Combined injury and shock; ④ Intracranial infection, etc. According to the shape of the scar, it can be divided into (Figure 4-22).
(1) Blind canal injury: shrapnel, bullets and other projectiles stay in the cranial cavity. Generally, there are many bone fragments near the wound or wound channel, while metal foreign bodies remain at the distal end of the wound channel. Wound paths vary in length, ranging from 1 ~ 2 cm short to the longitudinal or transverse diameter of cranial cavity in the elderly, and even the foreign body turns back to the contralateral medial plate, forming a rebound wound path.
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(1) Incision (2) Indication of resection range (3) After resection,
Fig. 4-2 1 brain decompression
(2) Penetration injury: multiple gunshot wounds, with entrance and exit, no metal foreign body in the skull, wide fracture range at the exit, and brain contusion and vascular injury are often more serious than at the entrance. Most of the bone fragments are left in the scalp soft tissue outside the exit. Brain injury is extensive and serious, and the mortality rate is the highest among penetrating injuries.
(3) Tangent wound: The bullet grazed the head tangentially, resulting in groove wound of scalp, skull and brain tissue. Metal foreign bodies have escaped, bone fragments are scattered in the superficial part of the brain, the brain injury area is long and narrow, and the incidence of encephalocele and epilepsy is high.
(2) Injury mechanism and pathology: High-velocity projectiles such as shrapnel or bullets penetrate the meninges and enter the skull, forming wound paths in the brain. The pathological changes of brain injury are as follows: (1) The primary injury area refers to the central area of the injury path, which contains damaged and liquefied brain tissue fragments, bleeding and blood clots. Skull fragments, hair, deposits, shrapnel or bullets, etc. Bone fragments are often entangled at the proximal end of the path. Shrapnel or bullets are located at the distal end of the wound. The injured meninges, cerebral vessels and brain tissues bleed, and it is easy to form epidural, subdural, brain or ventricle hematoma in the wound path. The location of hematoma in the wound channel can be located at the proximal, middle and distal ends. (2) Its periphery is the brain contusion and laceration area: it is a temporary cavity formed in the brain at the moment when the high-speed projectile penetrates into the cranial cavity, resulting in overpressure phenomenon, and the shock wave spreads to the surrounding brain tissue, so that the brain tissue is immediately subjected to high pressure and continuous negative pressure, resulting in brain contusion and laceration. Pathological manifestations were punctate hemorrhage and brain edema area. (3) The concussion area is located around the brain contusion and laceration area. There is no obvious pathological change in brain tissue under naked eye or general optical microscope, but temporary sexual dysfunction may occur. After brain injury, cerebral blood circulation and cerebrospinal fluid circulation are disturbed, and brain swelling and hematoma can occur rapidly. It can also be complicated by intracranial infection, causing increased intracranial pressure, etc., which complicates the lesion. The above lesions can be roughly divided into three stages: acute stage, inflammatory reaction stage and complication stage.
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Figure 4-22 Different forms of firearm craniocerebral injury
1. Tangent wound 2. Blind tube injury 3. Intracranial rebound injury 4. Extracranial rebound injury 5. Puncture wound
(3) The clinical features are: (1) disturbance of consciousness: initial coma, but some local brain injuries are severe, and sometimes coma does not occur. After the injury, those who are awake in the middle or in the improvement period or without coma at the beginning may have intracranial hematoma, and then there will be progressive disturbance of consciousness and then turn into coma. If similar manifestations appear later, brain abscess should be considered. Long-term coma, mostly due to large-scale brain contusion and laceration, brain stem injury or long-term brain hypoxia caused secondary brain injury. Severe compound injury, multiple injuries, shock, respiratory obstruction, hypoxia, infection and poisoning. It will aggravate brain damage and even deepen coma. Some wounded people may still have mental disorders. (2) Vital signs: Most of the seriously injured people have changes in breathing, pulse and blood pressure immediately after injury. If the brain stem is injured, early breathing may be rapid, slow or intermittent. Signs of central failure, such as slow or slow pulse, irregular pulse rate and blood pressure drop. Slow and deep breathing, slow and powerful pulse and high blood pressure after injury are the crisis of increased intracranial pressure, brain compression and cerebral hernia. Intracranial hematoma is often seen. Open injury leads to external bleeding and massive cerebrospinal fluid loss, which can lead to shock and failure. At the same time, we should pay attention to find out whether there are serious combined injuries such as chest and abdomen injuries and fractures. A high fever occurred after the injury. Besides hypothalamic injury, we should be alert to complications such as intracranial infection, pneumonia and urinary tract infection. When the whole body fails after injury, despite the above infection, the body temperature may not necessarily rise. (3) Eye signs: a supratentorial hematoma with progressive mydriasis. When the brain stem is injured, the pupil can be narrowed, enlarged or sometimes large and sometimes small. In the early stage of hematoma in posterior cranial fossa, there were few changes in pupils and obvious changes in vital signs. (4) Motor, sensory and reflex disorders depend on specific injuries. (5) Early increased intracranial pressure was caused by intracranial hematoma, acute brain edema and intracranial infection. The late stage is mainly caused by brain abscess. (6) Meningeal irritation sign: It is often caused by intracranial hemorrhage, infection and increased intracranial pressure, and attention should also be paid to the possibility of craniocervical injury.
(4) Diagnosis: It is necessary to quickly determine the nature of brain injury and whether there are other combined injuries. What needs to be emphasized is the X-ray examination of the head: it is also very important to know the situation of the injured track and determine the nature, quantity and position of the intracranial foreign bodies to guide the debridement operation. For those who are suspected of intracranial infection, lumbar puncture and cerebrospinal fluid examination can be performed. The diagnosis methods of complications after brain injury can be selected according to specific conditions, including brain ultrasound examination, cerebral angiography, CT and MR brain scanning.
(5) treatment
1. First aid and evacuation: (1) Keep the respiratory tract unobstructed to prevent suffocation, so the patient should take a lateral position. (2) quickly bandage the wounds on the head and other parts to reduce bleeding. When encephalocele occurs, wrap it with dressing to prevent brain tissue from being polluted and increasing damage. (3) Prevention of shock: For patients with shock, it is necessary to find out the reasons and deal with them in time. (4) First aid for life-threatening intracranial hematoma. (5) Routine use of antibiotics and injection of tetanus antitoxin.
2. Brain debridement: In principle, craniocerebral firearm injuries, whether penetrating or non-penetrating, should be thoroughly debrided at an early stage. Its purpose is to turn the polluted open wound into a clean closed wound after debridement, so as to reduce the chances of cerebrospinal fluid leakage, encephalocele and intracranial infection, and reduce the chances of brain scar formation and epilepsy in the future.
(1) Staged treatment: According to the time limit of debridement, it is divided into early stage, delayed stage and late stage.
Early treatment (within 3 days after injury), the wound has no obvious infection, generally according to the principle of thorough debridement.
Delayed treatment (4 ~ 6 days after injury), the wound has no obvious infection, and it is still suitable for thorough debridement. If there is obvious infection, the wound should be cleaned and drained. The second stage operation will be carried out after the infection is limited.
In the later stage (more than 7 days), most wounds have obvious infection or suppuration, so it is advisable to enlarge the bone window, take out the broken bone fragments and drain the wound passage, and then carry out the second-stage treatment in the later stage.
(2) The principle and method of debridement (Figure 4-23): (1) Remove the irregular and bruised part of scalp soft tissue, expand the original wound into an "S" shape, remove the dirt in scalp and subcutaneous tissue, stop bleeding by electrocoagulation, suture the cap aponeurosis and scalp intermittently, and conduct subcutaneous drainage 1 ~ 2 days. Scalp defects can be repaired by plastic surgery. (2) Skull treatment needs to expose the central part of the fracture and its surroundings, and remove the free and sunken bone fragments one by one, and remove dirt, foreign bodies and blood clots to make them into neat round or oval bone windows. If there is an epidural hematoma, it is necessary to enlarge the bone window to remove the hematoma.
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(1) superficial wound treatment (2) deep wound debridement (3) brain injury irrigation
Figure 4-23 Brain Debridement
In addition, the dura mater should be examined for injury and hematoma. Decide whether to open the dura mater for exploration. (3) Penetrating injury: repair the damaged edge of the dura mater, or cut and expose it, and use a brain pressure plate or a retractor to expand the wound path, so as to suck out the brain tissue, blood clots and foreign bodies inactivated in the wound path and the wall of the wound path, so as to truly stop bleeding. For the metallic objects that are too deep to be touched, it is not necessary to take them out during the first stage of debridement, and the metallic foreign objects that can be touched can be directly sucked out or sucked out with a magnetic needle. After debridement, the brain tissue should collapse and have brain pulsation compared with that before operation. For example, after debridement, the brain tissue is still swollen and there is no brain pulsation. Debridement may not be complete, and there may be hematoma or foreign body at the distal end of the wound path, which needs to be found out and treated. After thorough debridement, the dura mater should be tightly sutured in principle.
3. Treatment of special types of injuries:
(1) Injury of venous sinus: The injury of superior sagittal sinus is the most, followed by transverse sinus and sinus confluence, which can be divided into two types: partial tear and complete rupture. Fully prepare before operation, at least 2000~3000ml of blood. During the operation, a hole should be drilled around the fracture, a circle of bones should be bitten off around it, and traction lines should be made on both sides of the sinus to prepare muscle or fascia blocks. Then take out the bone fragments or metal foreign bodies that have penetrated into the sinus, and you can see the injury clearly under the attraction. Small wounds can be stitched up. Patients with suture difficulty can be covered with muscle or fascia for 5 ~ 10 minutes. If the bleeding stops, it can be sutured and fixed on the dura mater. The anterior 1/3 segment of the superior sagittal sinus is broken, which can be ligated when it is difficult to repair, and the middle or posterior 1/3 segment is broken, which can be repaired as much as possible, and can be anastomosed with artificial blood vessels or autologous great saphenous veins. When the treatment is really difficult and there is a danger of bleeding to death, ligation is necessary. It is best to avoid transverse sinus ligation.
(2) Craniofacial injury: The main complications are cerebrospinal fluid leakage and intracranial infection. The incidence of intracranial hematoma at the entrance of skull base is high. Of all the sinuses, frontal sinus is more likely to be injured. The mastoid sinus, ethmoid sinus, sphenoid sinus and maxillary sinus may also be involved. X-ray film, no skull fracture, no indication of emergency operation in clinic, so the condition should be closely observed. If there are bone fragments in the skull, it is necessary to cut the skull through the skull, explore the entrance to the skull base, and remove intracranial hematoma, bone fragments and inactivated brain tissue. Take out the bone slices in the sinus, scrape off the mucosa of the sinus wall, fill the sinus cavity with muscle slices and suture the dura mater. When the sphenoid sinus is injured, the mucosa of the sinus wall is scraped off through the nasal approach and the muscle piece is filled. Facial wounds were also debrided.
(3) Ventricular injury: There is often a large amount of cerebrospinal fluid flowing from the wound, intraventricular hemorrhage, deep coma, persistent high fever, stiff neck and serious injury. During debridement, the blood clot in the ventricle should be removed, the movable metal foreign body should be taken out, the ventricle should be washed repeatedly with normal saline, and the ventricle should be continuously drained after operation, usually about 3 days after extubation.
Prevention and treatment of complications and sequelae of craniocerebral injury
(1) Traumatic carotid cavernous fistula, skull base fracture or foreign body directly injured the cavernous sinus segment and its branches, and arterial blood was directly injected into the cavernous sinus from the crevasse. Typical symptoms: ① Pulsating exophthalmos; ② The compression of intracranial murmur and carotid murmur weakened or disappeared; ③ Eye movement disorder; ④ Glomerular joint ligament edema and congestion. Treatment: At present, the best method is to embolize the fistula with detachable balloon catheter and keep the internal carotid artery unobstructed. You can also use the method of "flying a kite" and spring embolization to embolize the fistula and keep the internal carotid artery unobstructed.
(2) Traumatic arterial nosebleed: Fracture of skull base, injury to internal carotid artery, sphenopalatine artery or ethmoidal artery can cause uncontrollable arterial nosebleed. (1) The rupture of cavernous sinus segment of internal carotid artery leads to nosebleed, which is characterized by head injury, blindness in one or both eyes and severe nosebleed. Emergency treatment: nasal packing to stop bleeding, blood transfusion for shock patients, and infusion to replenish blood volume. Severe cases need surgical treatment: carotid artery ligation, internal carotid artery pseudoaneurysm isolation or sphenoid sinus packing can be used. (2) Nosebleeds caused by injury of sphenopalatine artery or ethmoidal artery. Ligation of sphenopalatine artery or carotid artery is also feasible. It is necessary to determine the lesion site according to clinical manifestations and carotid angiography before operation in order to treat it correctly and effectively.
(3) encephalocele: It can be generally divided into early encephalocele and late encephalocele. ① Early encephalocele (within one week) is mostly caused by large area brain contusion, acute brain edema, intracranial hematoma or early intracranial infection. After symptomatic treatment, after increased intracranial pressure is relieved, the swollen brain tissue can return to the cranial cavity without obvious damage to brain function, which can be called benign encephalocele; ② Late encephalocele (more than one week). Most of them are due to incomplete initial debridement and foreign bodies in intracranial bone fragments, which cause brain infection, brain abscess, subacute and chronic hematoma and so on. And increase intracranial pressure. If the swollen brain tissue is hit, infected or necrotic, it can also affect the blood circulation disorder of the adjacent unexpanded brain tissue, forming malignant encephalocele or intractable encephalocele. During the treatment, the encephalocele should be wrapped with a cotton ring, properly protected and treated with dehydration and antibiotics. Hematoma or abscess should be removed.
(4) Brain abscess: It is a common complication of penetrating brain injury and one of the causes of late death. If debridement is not thorough, the incidence of abscess is about 10 ~ 15%, so early thorough debridement is the key measure to prevent abscess. Treatment: Timely surgical treatment, early abscess drainage and removal of foreign bodies. First, puncture and aspirate the abscess in the important functional area. Advanced abscess can be removed together with foreign body and sinus.
(5) Traumatic epilepsy: it is more common after penetrating brain injury, and can occur at any time, but the incidence rate is the highest from March to June after injury. The early attack is related to brain contusion, brain edema, hematoma and depressed fracture. Late attacks are mostly caused by brain abscess, brain scar and brain atrophy. Clinically, it is mainly localized seizures, and large seizures can also occur. Generally, drug therapy is the main treatment, and phenobarbital, phenytoin sodium, misoprostol and epilepsy can be selected. You can also perform corresponding surgical treatment according to the cause.
(6) Osteomyelitis of skull is often caused by open fracture of skull and untimely or incomplete debridement. Early local redness, swelling, heat and pain, purulent secretion. In the late stage, chronic sinus tract, epidural inflammatory granulation tissue or abscess were formed, and X-ray film showed dead bone or marginal destruction of bone defect. Treatment: Use antibiotics in acute phase to control and limit infection. In the later stage, sinus tract, dead bone, epidural granulation tissue and pus should be removed.
(7) Skull defect: Skull defect can be left after open debridement or closed decompression of craniocerebral injury. More than 3cm in diameter, dizziness, headache, sometimes nausea, vomiting and epilepsy. And patients feel insecure, such as fear of collision. The forehead affects the face and so on. Generally, the wound can be repaired within 3 months after healing, and the infected wound must be delayed for more than half a year. Any recent infection, incomplete debridement, or intracranial hypertension with encephalocele should not be repaired temporarily.
(8) Post-traumatic syndrome: After traumatic brain injury, many patients may have some neurological or mental disorders, which are collectively referred to as traumatic brain syndrome. Also known as brain injury sequelae, concussion sequelae and brain injury neurosis, the names of the diseases are different, which shows that there is still a lack of unified understanding and diagnostic criteria for this disease. Its pathogenesis may be based on mild organic brain injury and pathological changes (cerebral punctate hemorrhage, brain edema, cerebellar malacia and mild brain atrophy), as well as patients' ideological and mental factors. Patients often complain of dizziness, headache, nausea, anorexia, fatigue, irritability, tinnitus, hyperhidrosis, palpitation, memory loss, listlessness, insomnia, sexual dysfunction, menstrual disorders and so on. Symptoms are light and heavy, which has a certain relationship with mental and emotional state. Patients often complain about more than just the positive signs of the nervous system. Sometimes, although some slight signs are detected, it is difficult to locate. Some of the wounded may have mild and moderate EEG abnormalities, and CT brain scans may have mild brain atrophy. Treatment: Prevention and treatment are equally important. In the acute stage after injury, the wounded should stay in bed quietly, don't think too much, and don't read long books. After the acute phase, the wounded can be allowed to move early. Appropriate sedatives and analgesics should be given to the existing clinical symptoms, and the pain of the wounded should be cared for, so as to alleviate the tension and anxiety of the wounded about the so-called "sequela" that cannot be cured, and appropriate physical therapy, qigong, Tai Ji Chuan, etc. Combined with traditional Chinese medicine for promoting blood circulation and removing blood stasis, the wounded will gradually turn to normal life, study and work when their symptoms improve.