Patients with various craniocerebral traumas are frequently encountered in clinical practice. Most of them are in the prime of life. It feels very sorry for a youth at life's full flowering to die or to be disabled in a twinkling. The treatment of craniocerebral trauma is emergent and complicated. The diagnosis and treatment of clinicians in the forefront is of vital importance to the life, death, wound and disablement of the patients.
There may be loss of consciousness of short duration following craniocerebral trauma, the patient may be conscious without positive signs of nervous system when admitted to hospital, and it is too early to make a diagnosis of concussion of brain. Observation must be made to exclude intracranial hematoma. Fracture of skull, especially the fracture of squamotemporal part or spanning venous sinus, will lead to meningovascular or venous sinus laceration, which will cause epidural hematoma 1-4 days after injury. Despite the absence of fracture of skull in a small number of patients, the local deformation of cranial bones may also damage the blood vessels, causing epidural hematoma. The hematoma is most commonly observed in the temple but may also occur in the forehead, parietal region, occiput and posterior cranial fossa. Laceration of venous sinus has large
amount of bleeding and rapid onset of disease.
Delayed treatment of epidural hematoma will
result in intracranial hypertension, cerebral
hernia and death of the patient.

Author's unit: Guangdong Gaoming Medical and Medicinal Institute of Encephalopathy, Gaoming, Guangdong 528500, P.R. China
Cranial injury may be followed, after transient disturbance of consciousness, by exacerbated headache, gradual loss of consciousness, dyskinesia and change of pupils, and skull CT scanning is helpful to early diagnosis. The prompt operation of simple epidural hematoma has favourable prognosis.
Severe cranial injury or depressed cranial fracture or basicranial fracture with severe disturbance of consciousness and long duration, focal symptoms and signs of nervous system and hematic cerebrospinal fluid should be diagnosed as contusion and laceration of brain. Reduction of intracranial pressure to control cerebral edema is a matter of top priority. The state of illness should be observed strictly, if coma or focal sign is in progressive exacerbation with occurrence of new focal sign, especially platycoria and disappearance of photoreaction on one side, subdural or intracerebral hematoma should be considered, and definite diagnosis can be made with the help of CT and MRI. Inequality of pupils, bilateral pyramidal sign and respiratory and circulatory dysfunction are all manifestations of brain stem injury. Rapid elimination of hematoma or operative decompression is often necessary in the case of contusion and laceration of brain with secondary intracranial hematoma. Care must be taken not to miss the diagnosis of chronic subdural hematoma if an old person has not severe trauma in the head with later occurrence of increasingly exacerbated headache, somnolence and reactive retardation. The use of CT scanning examination can prevent a doctor from leaving out the diagnosis. Trephination and irrigation for chronic subdural hematoma or craniotomy for removal of hematoma has satisfactory results.
Craniocerebral trauma rarely exists in isolation, attention must be simultaneously paid to spinal or other skeletal and visceral injuries. Severe brain trauma may also give rise to neural pulmonary edema. Every effort should be made to keep the respiratory tract unimpeded, the treatment of pulmonary edema is also one of the important measures of rescuing a patient with brain trauma.
Severe craniocerebral trauma or its delayed or irrational diagnosis and treatment not only has high mortality but also brings about various knotty problems to the doctors, patients, family members and society. A patient who has intracranial hypertension, cerebellar tonsillar hernia and respiratory and cardiac arrest in succession and is rescued from danger and made to restore heart beats and to breathe by means of respirator with rigidity of extremities, platycoria, disappearance of photoreaction and straight line of brain wave for over half an hour can be judged as having brain death. Looking at the young wounded, the family members look forward to seeing a marvel. They should be definitely told that continued emergency treatment is of no significance, for it has been recognized by law circles and all social strata that brain death can be used as a criterion for human death. Maintenance of cardio-pulmonary function with machine or drugs is of no significance. Brain trauma causes severe injury and dysfunction of cerebral hemisphere with the result that the patient loses psychological or mental activities, manifested as coma or agrypnocoma, but still have diencephalic, brain stem and vegetative nerve functions. The patient is still able to maintain heart beats, respiration, blood pressure and natural sleep-awakening period, this is the vegetative state. A small number of patients may show some improvement after maintaining the vegetative state for several months. Traditional Chinese medicine and material medica has its unique characteristics in treating vegetative state. All patients in post-traumatic vegetative state we treated with prescription of Chinese drugs became conscious, with nasal feeding removed, and quite a few patients had improvement in movement and restoration in speech. An experimental study directed by Professor Liu Guoqing, a neuropharmacologist of Chinese Pharmaceutical University, showed that the prescription of Chinese drugs does have the effect of promoting proliferation of nerve cells, the proliferation rate being 63.9% and that the inhibition rate of death of nerve cells under the state of ischemia and anoxia was as high as 93%.
The correct and prompt diagnosis and treatment of acute craniocerebral trauma, early implementation of rehabilitation of limbs, speech and social life and the use of traditional Chinese medicine as accessory treatment will necessarily reduce the mortality and disability rate of brain trauma