[Water electrolyte disorders in the postoperative clinical picture of basal-diencephalitic tumors]. / Vodno-élektrolitnye narusheniia v klinike posleoperatsionnogo perioda pri opukholiakh bazal'no-diéntsefal'noí lokalizatsii.

The paper deals with the relationship of homeostatic and motivational disorders in the postoperative clinical picture in basal-diencephalic tumors. The material included 354 clinical observations of: hypophysial adenoma (n = 135); craniopharyngioma (n = 71); tumors of the third ventricle (n = 88); basal meningiomas (n = 60). A comparative analysis of the findings allowed the authors to support that there are typical variants of changes in the patients' status, which reflect the nature of ion-osmotic disorders. The most significant mental disorders were transient hyperosmolar-hypernatriemic disturbances. The poor predictors were persistent hypernatriemia concurrent with evolving coma, systemic hemodynamic and respiratory disorders. Hyponatriemia is a better predictor of ionosmotic disorders, which requires a careful postoperative monitoring and a comparison of its findings with the specific features of intensive care performed.

[The psychopathology of tumors of the 3rd cerebral ventricle]. / Psikhopatologiia opukholei III zheludochka mozga.

36 patients with tumors of diencephalic region of different histologic nature involving cavity of the third ventricle of the brain were observed. 27.7% of the patients had disorders of mental and physical development from the very first years of life. In presurgical period there was a wide spectrum of paroxysmal and permanent mental disorders from asthenia to rude disturbances of memory and consciousness which regressed or disappeared after the operation. The correlation was observed between such disorders, histologic structure and location of the tumor; individual characteristics of the patient (age, dextrality, sinistrality); scope and character of the operation (approach to the tumor, surgical interventions on the structures of the third ventricle).

[Clinical picture of colloid cysts of the III ventricle]. / Klinika kolloidnykh kist III zheludochka.

Clinical analysis of 74 cases of colloid cysts of the III-d ventricle was performed. Dynamics of clinical symptom complex was studied both in preoperative and early postoperative period as well as in remote periods after surgery. Most of the patients were treated in N.N. Burdenko Institute of Neurosurgery during 1980-1995. Peculiarities of the disease development before clinical manifestation, variations of complicated postoperative period, prognostically significant symptoms, possible mechanisms of clinical syndromes development were considered.

[The effect of shunting operations on the psychopathological symptoms of posttraumatic hydrocephalus]. / Vliianie shuntiruiushchikh operatsii na psikhopatologicheskuiu simptomatiku posttravmaticheskoi gidrotsefalii.

A total number of 35 patients underwent CSF diversion procedures for posttraumatic hydrocephalus (HCP). To facilitate the analysis of correlation between the onset and clinical course of HCP and psychopathology, all patients were divided into 2 groups. Group 1 consisted of patients who developed HCP within the first 6 months after head injury interfering with the psychiatric recovery. Group 2 was formed by patients who developed HCP after being stable for more than 6 months after injury and having some sort of psychiatric condition (e.g., vegetable status, dementia) before HCP was evident. We considered surgery to be effective if patients had signs of postoperative psychiatric improvement. This was demonstrated in 68.8% of the cases. Mental changes were more prominent in Group 1 vs Group 2. Worsening of the condition was noted only in six patients, all from the second group. It was transient in 4 cases and progressive in 2 cases. All complications occurred due to intracranial infections.

[The age-related factor in the pathology of consciousness in craniocerebral trauma]. / Vozrastnoi faktor v patologii soznaniia pri cherepno-mozgovoi travme.

In children (n = 103), elderly and old persons (n = 42), abnormal consciousness was comparatively studied in the acute period of brain injury. The revealed clinical features were compared with the previously described syndromes of consciousness disorders in young and middle-aged patients. The authors consider it appropriate to identify quantitative (deafening, sopor, coma) and qualitative (obscure consciousness, confusion, and mixed types differing in the ratio of productive to deficiency symptoms). Depressed consciousness was found to be prevalent in children, obscure consciousness was most typical in adults, confusion was common in elderly and old patients. The low presentation of productive disorders and their low association mainly with brain injury in patients who are on the different poles of ontogenesis are explained in the context of the teaching of cerebral functional asymmetry.

[The differential treatment of focal lesions of the frontal lobes]. / Differentsirovannoe lechenie ochagovykh povrezhdenii lobnykh dolei golovnogo mozga.

The differential policy of surgical and drug therapies was evidenced by comprehensive clinical, computed and magnetic resonance tomographic studies and follow-up of 113 patients with focal frontal lobar lesions. Five-year follow-up findings show that mild and moderate posttraumatic focal changes and mild posttraumatic diffuse changes detected by CT and MRT data favour a better clinical recovery and satisfactory social and working rehabilitation in most victims with crushing foci and intracerebral hematomas of the frontal lobes.

[The diagnosis and surgical treatment of posttraumatic hydrocephalus]. / Diagnostika i khirurgicheskoe lechenie posttravmaticheskoi gidrotsefalii.

Posttraumatic hydrocephalus is an active progressive process of excessive accumulation of cerebrospinal fluid due to liquorodynamic disturbances following cerebrocranial injury. In addition to clinical assessments, it is necessary to use special diagnostic techniques to define indications for bypass surgeries which are an effective therapy for progressive posttraumatic hydrocephalus.

[The asymmetrical brain--asymmetrical consciousness]. / Asimmetrichnyi mozg--asimmetrichnoe soznanie.

To substantiate a term "asymmetry of consciousness", to throw light on it are compared disturbances of consciousness in dextral and sinistral persons with selective lesions in the right or left brain hemispheres. Is supposed a fundamental role of the spatial-temporal factors. By them are mediated relations "brain-consciousness", asymmetry of consciousness. The latter is expressed in dextral persons by an opposite spatial-temporal organization of psycho-sensory (which are realized in individual present and past) and psychomotor (which are displayed in external present and future) processes. This contrast is not observed in sinistrals or only in some of them. Is assumed a probability of evolution of space and time with appearance of their forms having been absent before the human level. They are presumably described by the authors as individual space and time, on the one hand being determined by the functioning brain of each dextral and sinistral person, on the other hand defining the limits and limitations of the mental abilities of each person. Individual space and time may be other in a sinistral person than in a dextral one.

[The reflection of different levels of the regulation of human brain activity in spectrally coherent EEG parameters]. / Otrazhenie raznykh urovnei reguliatsii mozgovoi deiatel'nosti cheloveka v spektral'no-kogerentnykh parametrakh EEG.

On the basis of clinico-anatomo-electroencephalographic studies it was shown, that in early terms of cerebral trauma, at gross disturbances of the cortical functions and safety in some cases of only vital regulation, the parameters of the EEG stability or variability are of distinct information value for estimation of the functional state of patients. It was established, that changes of stability of the frequency, power, and coherent EEG characteristics correlate with different parameters of changes of the structural-functional brain organization. At this stage the greatest connection with the disease outcome reveals the EEG coherence parameters of the cortical symmetrical points reflecting the state of predominantly median formations and general brain reactions to traumatic action. In the process of restoration of disturbed neuromental functions priority prognostic significance is acquired by parameters of intrahemispheric coherence as well as by frequency-regional properties of interhemispheric asymmetry of coherence of the brain electrical processes, characterizing functional features of the lesion focus.

[The psychiatric aspect in the current periodization of craniocerebral trauma]. / Psikhiatricheskii aspekt sovremennoi periodizatsii cherepno-mozgovoi travmy.

The expediency of distinguishing three periods of craniocerebral trauma--initial, early, and late with two subperiods--is substantiated by the results of psychiatric studies. The terms used reflect a common criterion--the lapse of time between the period and the moment of the trauma. The changes in and the supplements to the periodization accepted in the fifties were suggested by the results of examination of patients with cerebral trauma of such severity which was considered then incompatible with life but is marked today by prolonged coma and extremely protracted (up to 12 months and more) recovery of consciousness after coma. For such patients (a) each period (the initial one in particular) lasts longer and (b) syndromes occurring in each period are attended by new conditions which were not encountered in the fifties--the apallic syndrome or vegetative status, akinetic mutism, and other conditions.

[Diffuse axonal damages to the brain (the clinical picture, diagnosis and outcome)]. / Diffuznye aksonal'nye povrezhdeniia golovnogo mozga (klinika, diagnostika i iskhody).

On the basis of complex clinical, computed tomographic, catamnestic, and pathomorphological examination of 336 patients with severe cerebrocranial injury the authors substantiate the need to distinguish, along with localized contusions and intracranial hematomas, diffuse axonal injuries of the brain whose biomechanics and pathogenesis are linked with trauma of angular or rotational acceleration-deceleration. The clinical manifestations and the course of diffuse axonal injuries are characterized by protracted coma occurring immediately after the injury with marked disorders of stem functions, postural motor reactions, slow recovery from coma, with the formation of a stable or transitory vegetative state, the development of syndromes of disconnection of the cerebral hemispheres and the brain stem, and severe invalidization of the patients due to mental and neurological deficits.