Traumatic skull lesions are of great importance in the origin of various types of mental pathology including psychoses of various natures. In our country, craniocerebral traumas (hereinafter referred to as CCT) are annually diagnosed in four per 1,000 people (L.B. Likhterman et al., 1993). In the United States, 2 million people have after-effects every year. The majority of CCT victims are men. The largest morbidity of disorders due to CCT is during wartime. N.I. Pirogov has characterised wars as traumatic epidemics. Nowadays, in Russia, in the structure of this pathology domestic CCT predominate, and recently there has been an increase in road traffic injuries.
Cellular injuries caused by CCT are divided into concussions (commotions), contusions (concussions), impactions (compressions). Such classification is at a certain extent, conventional, in many cases a polytrauma is diagnosed. For typical manifestations of CCT (T90), mental disorders caused by it are usually divided in accordance with stages of development of traumatic injuries. A mental pathology of the initial time interval is characterised by states of deprivation of consciousness (coma, sopor, stupor - see the Chapter "Pathology of Consciousness"). For the acute time interval, in patients predominantly acute psychoses develop with states of clouded consciousness: delirium, epileptiform, dream-like. In the time interval of convalescence or the late period, subacute and protracted traumatic psychoses prevail which can reiterate or have a periodic course. Mental disorders of the distant CCT time interval serve as variants of the psychoorganic syndrome in the structure of traumatic encephalopathy.
Clinical Picture
In the acute time interval (right away after injuring), loss of consciousness begins with stupor, sopor or coma. Further course and prognosis in such cases is determined by the duration of the unconscious state and degree of its severity. Nowadays, high-quality resuscitation care gives a possibility to