CCT brain contusion severity of harm to health

Traumatic brain injuries are the most common ailments that result in visits to emergency rooms and forensic medical examinations.

The relevance of the issue of the severity of different types of damage is due to the increasing increase in the number of general cases of injuries and citizens seeking help, and cases of concussion and other harm to health have begun to occur more often.

This diagnosis sounds scary, so let’s try to understand the details so that people can be more knowledgeable on this issue.

What is a traumatic brain injury?

This is a closed (CTBI) or open (depending on the classification) traumatic brain injury, damage to soft tissues, cerebral membranes, blood vessels and nerves of the brain. Most often, injuries are caused by mechanical impact and most are combined - they include several types of trauma (bruises, fractures, ruptures).

Traumatic brain injury is divided into two main types – open and closed.

• In the first option, there are ruptures of the skin and connective tissue, as well as a possible violation of the integrity of the skull. If an open injury is accompanied by involvement of the subdural membrane, then the injury is considered penetrating.
• With the closed type, there is no damage to the connective tissue aponeuroses of the head, although the skin may be cut.

Classification

In medical terminology, skull injuries are distinguished by severity, depending on the clinical form and combination of injuries.

According to the degree of severity, they are distinguished:

1. A mild one is a concussion or bruise of the brain.
2. Moderate – moderate brain injury.
3. Severe – acute compression of brain tissue and severe brain injury.

Another classification includes a combination of injuries. I distinguish between isolated cases, in which the patient only experiences damage to the cranial bones. Combined - combined with trauma to other organs, and combined - when the mechanism of injury combines several types of effects (mechanical, electrical, thermal, radiation).

For clinical variation, we can distinguish:

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• Fractures.
• A concussion is a health injury caused by mechanical impact and a violation of neurological functions. It goes away on its own after a few days, but persistence of symptoms is a more serious injury.
• Bruise in varying degrees of severity.
• Damage to white matter as a result of braking force. Accompanied by small focal hemorrhages and axonal separation.
• Compression - occurs when the space of the cranium decreases.
• Intracranial hemorrhage is divided into subarachnoid, intracerebral, ventricular and epidural.

For clinical forms, a combination of different types is possible.

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Kinds

Speaking about determining the severity of harm to health when receiving a brain injury, one must rely on the Order of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008 No. 194n “On approval of Medical criteria for determining the severity of harm caused to human health.” Only it describes in detail all the signs on which the forensic medical expert relies when analyzing the victim and making his decision on the degree of severity.

Since we are talking about brain injuries, we draw attention to paragraph 6.1 of the Order and its subparagraphs. Now in more detail.

In forensic medical practice, the basis of the conclusion for closed craniocerebral injuries is assessed based on the duration of the health disorder. Attention should be paid to the clinically proven diagnosis made by a neurologist. To do this, functional tests, EEG, and cerebrospinal fluid puncturing should be performed for research. Based on the results of the study, long-term health problems may be established due to possible functional disorders - hydrocephalus, encephalopathy and vegetative-vascular dystonia.

The bruise is often combined with a concussion. One of the complications of such an injury is the development of inflammation of the sphenoid sinus. These signs can be observed with a mild concussion or bruise of the brain; they are regarded as causing harm of moderate severity due to the delayed consequences of the damage and an unfavorable outcome, which can lead to permanent loss of performance.

For moderate brain contusions, it is necessary to evaluate brainstem symptoms and the duration of the health disorder. If there are no signs of damage to the trunk and the health disorder lasted less than 120 days, the damage is assessed as moderate. If a concussion affects the functions of the medulla oblongata, midbrain and cerebellum, then only severe harm to health, and in no case any minor harm. This is due to the development of danger to life at the time of injury.

Attention! All open craniocerebral injuries are classified as causing grievous harm to health, even in the absence of damage to the brain matter.

Severe bruises, intracranial bleeding, crush injuries, the presence of focal and brain stem symptoms are defined only as severe bodily injuries, according to paragraph 6.1.3. Part two of the order on assessing degrees of severity.

Diagnostics

This disease is diagnosed based on anamnesis of trauma and time of unconsciousness. Noteworthy are nystagmus, asymmetry of reflexes, and Marinescu Rodovich's sign.

To diagnose the disease, the following is carried out:

• radiography;
• encephalography;
• echoencephalography;
• examination of the fundus of the eye;
• magnetic resonance imaging.

All of these procedures allow us to assess the extent of brain damage.

Qualifying features

Qualifying criteria include aggravating conditions of the crime. The corpus delicti necessarily takes into account the premeditation of the action, the number of participants and the motive.

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The qualifying signs of causing grievous harm to health in accordance with Article 111, Part 2 and Part 3 include:

1. An act against a person in the performance of official duties.
2. A crime with special torment and bullying.
3. If the actions were performed on a person in a helpless state.
4. It was done with danger to society and carrying great destructive power.
5. Performed for hire.
6. Had antisocial motives.
7. Committed by a group – refers to the category of particularly aggravating circumstances.
8. Caused death by negligence.

According to this article, a crime that occurs without the above listed qualifying features is punishable by imprisonment for 8 years. In the presence of aggravating circumstances, the court provides for liability for up to 12 years.

According to the last point, when the act entailed death through negligence, two motives are regarded - intentionality of causing harm and subsequent death. For this offense, the offender faces up to 15 years in prison.

With regard to the qualifying characteristics under Article 112 “Intentionally causing harm to health of moderate severity”, the same circumstances are considered as for Art. 111. Exceptions include clauses on execution for hire, creating a public danger and causing death by negligence. A crime without qualifying characteristics is subject to liability - imprisonment for up to 3 years or forced correctional labor for up to 3 years.

In aggravating circumstances under Art. 112 according to part 2 is punishable by arrest for up to 5 years.

Important! In these cases, the assessment of the degree of responsibility is based more on the danger of the act than on medical criteria.

Restrictions from other species

Intentional harm of moderate and severe severity should be distinguished from beatings and torture:

• Batterings are most often characterized by inflicting injuries of mild severity. A head injury that occurs as a result of numerous beatings is regarded as severe or moderate harm. Which automatically equates the act to Articles 111 and 112.
• Torture is characterized by the infliction of suffering, both physical and psychological, but the main thing is the systematic infliction of damage to a person. This punishment is considered provided there are no serious consequences for health and loss of performance from parts 2 and 3 of the articles on causing harm.
• Separately, it is worth considering the third part of 111 about the grave consequences of bodily injuries in the head area that resulted in death due to negligence. It is distinguished from murder, since this crime also contains intent, but the accused did not foresee the lethal outcome or believed that the actions would not entail consequences.

Treatment of concussion

During treatment you need to rest. The victim needs to lie down and avoid any mental or physical stress that could adversely affect brain function. If a person follows all the necessary recommendations on time, then the treatment ends with recovery.

Some people may have residual effects from the injury. These are decreased attention, fatigue, forgetfulness, depression, migraines.

Patients are prescribed medications to relieve unpleasant symptoms: headache, syncope, nausea. At the same time, medications are used, the action of which is aimed at improving physiological processes in the brain. The use of sleeping pills and sedatives is indicated: they help compensate for brain function.

It is prohibited to do any physical work for 30 days after the incident. Mental work and watching videos should be limited. There is no need to use headphones when listening to music.

A severe brain injury is an indication for a deferment from the army.

Is it possible to determine the degree yourself based on the symptoms?

After receiving an injury, you should still seek help from a medical facility. Specialists will provide a reliable diagnosis and also provide qualified treatment. Determining the disease in case of a closed craniocerebral injury, and specifically a concussion, will help to accurately determine the severity of the harm to health.

You can do this, in fact, it’s not difficult. We turn to the same Order that we described above and look for a brain injury that matches the injury received by the victim. If there is one, we look at what degree of severity it is.

If not, the same Order contains an Appendix - “Table of percentages of permanent loss of general ability to work.” We are looking for trauma in it. Found - we look at the % of loss and correlate it with paragraphs 7.2 and 8.2 of the Order (moderate severity = from 10 to 30% inclusive, mild = up to 10%, the rest = severe).

Of course, this is just a rough definition. A forensic medical expert will tell you exactly - only his word will be authoritative.

Or, you can do it simpler: knowing your diagnosis, you can approximately determine the severity of the damage:

• A concussion or mild bruise is regarded as causing moderate harm to health - more details.
• For open craniocerebral injuries, only a severe degree is assigned - more details.
• Severe and moderate bruises, bleeding, cerebral hematomas, etc. are also severe.

How do I know the severity of health damage from a concussion?

Even such active actions that we are not accustomed to consider in the context of danger to health and life can provoke a concussion. And the reluctance to be examined in a hospital after an injury often results in serious consequences.

A concussion means an inert displacement of the brain in the skull and its collision with the inner bone shell.

How to stop beatings and bring the offender to justice?

The sooner you contact a forensic expert, the easier it will be for specialists to establish the fact of harm. This can be done even before writing the application.

You can contact both specialized authorities - a forensic medical examination, and a hospital, having received a certificate from a traumatologist or neurologist.

If you write a statement about beating, then an examination will be ordered by law enforcement agencies.

What to do when contacting the police:

1. How to stop beatings and bring the offender to justice? Write a statement with a detailed description of the crime, the characters involved, the methods of inflicting pain and the locations of the blows.
2. Examination by an expert in the direction of the police, followed by a conclusion on the severity level.

If you decide to identify harm yourself, then you should adhere to the following algorithm:

1. Visiting a clinic, hospital, or emergency room. There, a certificate is issued with the diagnosis upon application, the nature of the injuries and the time of admission to the medical facility.
2. With all the documents, go to the police to write a statement.
3. Repeated examination with the participation of forensic doctors.

The last point is not always fulfilled, since the investigation may only need documents from the hospital.

Important! Battery is a serious offense. Do not be afraid to seek help from law enforcement agencies; beatings can be repeated and lead to more serious consequences.

Treatment of TBI

Treatment for a concussion is prescribed on an individual basis after collecting the necessary information and conducting research.

Immediately after an injury, it is necessary to provide first aid. The patient is placed horizontally, the head is raised. If the victim is unconscious, it is better to place him on his right side, tilting him slightly back and turning his head towards the ground.

Once a diagnosis is made, a rest regimen is prescribed. For 3-5 days, the patient should lie down, excluding watching TV, listening to music, and reading. Gradually, the patient is recommended to return to active mode, increasing mobility 2-3 days before discharge.

Drug therapy is aimed at reducing intracerebral pressure, relieving psycho-emotional stress, pain relief if necessary, improving metabolism and nutrition of brain cells, and dehydration therapy for nausea.

With proper treatment, the effects of a concussion completely disappear within 6-12 months.