[Basilar skull fractures: clinical and prognostic aspects]. / Perelomy osnovaniia cherepa: klinicheskie i prognosticheskie aspekty.

The incidence of basilar skull fractures and their clinical and prognostic aspects were studied in victims with varying severity of brain injury. Of 947 cases, 449 (46%) patients were diagnosed as having basilar skull fracture and 181 (18.6%) had basal spinal fluid leakage. The frequency of fractures and basal spinal fluid leakage increased in proportion to the severity of brain injury. The above 14-day history of spinal fluid leakage was an absolute indication for surgical fistula closure.

[Involvement of thyroid hormones in mental recovery following severe craniocerebral trauma]. / Rol' tireoidnykh gormonov v protsesse vosstanovleniia psikhicheskoi deiatel'nosti posle tiazheloi cherepno-mozgovoi travmy.

To study a role of thyroid hormones in the recovery of mental performance, 71 patients (60 males, 11 females) aged 7 to 66 years (mean age 32.7 +/- 3.5) with severe brain injury (TBI). According to the stage of mental recovery (1--none; 2--elementary acts; 3--verbal contact; 4--spatial orientation; 5--intellectual and mnestic processes and emotional and personality traits), the study was divided into 5 series. Immunoradiometric assay of thyroid hormones (T3 and T4) and their free fractions (FT3 and FT4), thyroid-stimulating hormone (TSH), thyroxine-binding globulin (TBG), and prolactin (P) revealed significant alterations in thyroid metabolism at stages 1 to 4, which appeared as low T3 syndrome. The thyrotropin-releasing hormone (TRH) test made in study series 3 to 5 suggests that the patients have neuroendocrine dysfunctions at the mentioned recovery stages of mental functions of the brain. There was a close relationship of clinical parameters (mental time course) to alterations in the thyroid status and metabolism and to morphological impairments of brain tissues in their traumatic damage, which is evidenced by a correlation of the levels of blood and spinal fluid markers (neurone-specific enolase--NSE and protein S-100) of brain injury with psychopathological disorders (r = -0.96 and -0.6, respectively; p < 0.05) and by the assessment of TBI outcomes (r = -0.65 and -0.62, respectively; p < 0.05). Thus, the findings clinically confirm the neurotransmitter role of thyroid hormones at the stages of mental recovery. In addition, the results show that measurement of blood T3, FT3, TSH, T4, TBH, and NSE should be included into neurochemical monitoring in SBI as prognostically significant criteria. They also may serve as a basis for timely correction of thyroid metabolism.

Thyroid hormones in comatose patients with traumatic brain injury.

The objective was to study if thyroid hormones, cortisol, prolactin and brain injury marker levels were changed in traumatic brain injury (TBI) patients with changing levels of consciousness. We estimated the above named parameters in 32 patients (27 men and 5 women aged 11-55). Admission Glasgow Coma Score was < 8. Follow-up period--30 days. The length of coma was 3 to 25 days. There were significant decreases in TSH, TBG, FT3 and F_levels (p < 0.05, for each) and a T3 increase (as compared to very low preceding values) on day 1 before emergence from coma and considerable post-coma increase in TBG, FT3, TSH and F levels (p < 0.001 each) on days 1-3 in patients with diffuse axonal injury (DAI). In patients with contusions and epidural and subdural hematomas (CH) T3 and T4 levels continued to fall until 4-6 postcoma days. TSH values significantly increased up to average normal ranges (p < 0.05) on days "-" 2 and "-" 1 before emergence from coma and remained so. Significantly lower levels of TSH, F and PRL were found in patients with CH in the mostly remote period (on days "-" 12-"-" 8) before emergence from coma in comparison with DAI patients. In blood the following correlations of examined parameters were established: between NSE and T3 (r = -0.39), NSE and FT3 (r = -0.59), TNF alpha and TBG (r = -0.64), TNF alpha and T3 (r = -0.3) and S-100 and T3 (r = -0.3) (p < 0.05, for each). The results obtained confirmed a low T3 syndrome in comatose TBI patients. We demonstrated an objective and informative interdependence: the turning-point moment of the emergence from coma was accompanied by significant changes of examined hormone levels and brain injury marker levels. The results may serve as a base for recommending monitoring FT3 and T3 levels simultaneously with that of other injury markers and adequate T3 replacement therapy in the early posttraumatic period.

[Endogenous intoxication and its treatment with sodium hypochlorite in neurosurgical patients]. / Endogennaia intoksikatsiia i ee lechenie s primeneniem gipokhlorita natriia u neiroreanimatsionnykh bol'nykh.

Blood plasma levels of medium-mass molecules (MMM), antioxidant activity (AOA), and malonic dialdehyde (MDA) were measured in 51 neurosurgical patients before and directly and 24 h after intravenous drip infusion of sodium hypochlorite (SHC) solution. Preliminary in vitro studies showed the most expressed drop of initially high MDA and MMM levels to be associated with an increase of AOA. It was observed at SHC concentration of 0.05 mg/ml, corresponding to infusion of SHC in a concentration of 600 mg/liter in 0.1 of the total circulating blood volume. Even a single dose of SHC alleviated endogenous intoxication and decreased the concentration of MMM and lipid peroxidation products. The proper AOA of the blood did not drop in this case, and in patients with initially low AOA it appreciably increased. Infusion of SHC normalized the values of Kp, which reflected its high detoxifying activity in endogenous poisoning caused mainly by inflammatory changes.

[The clinico-anatomical characteristics and the reasons for diagnostic errors in vascular micromalformations and cavernous defects in the cerebral vessels]. / Kliniko-anatomicheskaia kharakteristika i prichiny diagnosticheskikh oshibok pri sosudistykh mikromal'formatsiiakh i kavernoznykh porokakh sosudov golovnogo mozga.

The presurgical clinical diagnosis of vascular micromalformations and cavernous defects of the brain vessels is one of the most intricate problems. Forty-seven observations of patients with verified histological diagnosis of various vascular micromalformations: arteriovenous, venous, cavernous, and undifferentiated ones were analyzed. There was a direct relationship between the clinical course of defects and difficulties in presurgical diagnosis, on the one hand, and the type of vascular micromalformations, the presence of hematomas, residual recurrent hemorrhages, vascular thromboses, the degree of glial hyperplasia and a tumor, on the other. The analysis of 50 observations of patients with cavernous malformations of different sizes demonstrated the heterogeneity of a histological pattern in this type of vascular pathology and the relationship of the clinical course to the morphological structure of cavernous malformations. This is indicative of the necessity of making a comprehensive examination of patients with cavernous malformations.

[The diagnosis of vascular micromalformations in the brain]. / Diagnostika sosudistykh mikromal'formatsii golovnogo mozga.

Ninety cases with cerebrovascular micro-malformations were analyzed. These abnormalities amount to 5.3% of the total number of patients with arteriovenous malformation. These include various vascular defects from 0.5 to 1.0 cm. Most of them run as strokes (80%); the others have a pseudotumorous course. Angiography reveals 60.5% of cerebrovascular micro-malformations. In other cases they are undetectable or their identification requires functional and gross angiography. Computed tomography and magnetic resonance tomography reveal intracranial hemorrhages from cerebrovascular micro-malformations, without identifying the latter. They cannot differentiate a tumor from parenchymatous hemorrhages from cerebrovascular micro-malformations in 37.7%. The greater diagnostic difficulties arise in subtentorial cerebrovascular micro-malformations having a pseudotumorous course. In these cases they are angiographically invisible, and CT (MRT) diagnosis prior to surgery is a volumetric brain formation, providing no specification of the process.

[The effect of visual deafferentation on changes in the cerebral blood flow during photic stimulation]. / Vliianie zritel'noi deafferentatsii na izmeneniia mozgovogo krovotoka pri svetovoi stimuliatsii.

With the aid of transcranial dopplerography, linear velocity of the blood flow was recorded in major cerebral vessels in resting and in photostimulation in 18 healthy subjects and 7 patients with unilateral lesion of visual pathway and exclusion of one half of the field of vision. The photostimulation accelerated the blood flow in middle cerebral arteries by 4.3% and in posterior cerebral arteries by 26.3% in healthy subjects. No acceleration of the blood flow occurred in posterior cerebral artery on the side of unilateral lesion of visual pathways.