Subject(s)
Spinal Cord Injuries/complications , Spinal Cord Injuries/diagnosis , Spinal Cord Injuries/therapy , Adult , Female , Humans , MaleABSTRACT
To study blood-brain barrier permeability and proteolytic changes in in patients with severe brain injury and to evaluate their impact on its course and outcome, the concentrations of albumin, plasminogen (plasmin), alpha 2-macroglobulin, alpha 2-antiplasmin, and alpha 1-antitrypsin were examined in 58 victims by enzyme immunoassay. The control group comprised 20 patients examined for lumbar discal hernia. The studies indicate that early severe brain injury showed blood-brain barrier dysfunction whose severity can be detected by the spinal fluid levels of albumin, plasminogen, and alpha 2-macroglobulin. Proteolytic changes in spinal fluid are determined by its albumin, plasminogen (plasmin), alpha 2-macroglobulin, alpha 2-antiplasmin, and alpha 1-antitrypsin concentrations and affect the development of secondary brain lesion and they are of practical value.
Subject(s)
Blood-Brain Barrier/physiology , Cell Membrane Permeability/physiology , Craniocerebral Trauma/cerebrospinal fluid , Craniocerebral Trauma/physiopathology , Peptide Hydrolases/cerebrospinal fluid , Acute Disease , Adolescent , Adult , Humans , Intervertebral Disc Displacement/cerebrospinal fluid , Intervertebral Disc Displacement/physiopathology , Lumbar Vertebrae , Middle Aged , Prognosis , Retrospective Studies , Time Factors , Trauma Severity IndicesABSTRACT
The CSF levels of albumin, alpha 2-microglobulin and IgG were studied in patients with severe brain injury. Elevated CSF levels of albumin and alpha 2-microglobulin were found in more severe patients. The level of IgG level was within the normal range. Endogenic protease-bound alpha 2-microglobulin may cause secondary cerebral tissue lesion, by closing the vicious circle.
Subject(s)
Albumins/cerebrospinal fluid , Blood-Brain Barrier , Brain Injuries/cerebrospinal fluid , Cell Membrane Permeability , Cerebrospinal Fluid Proteins/analysis , Immunoglobulin G/cerebrospinal fluid , alpha-Macroglobulins/cerebrospinal fluid , Acute Disease , Biomarkers/cerebrospinal fluid , HumansABSTRACT
The permeability of the blood-brain barrier for the cerebrospinal fluid marker proteins has been assessed in patients with grave craniocerebral injuries. The content of albumin and alpha 2-macroglobulin in the survivors decreased with time and by day 7 after the injury was virtually normal. In patients who died the content of these proteins was reliably increased starting from day 1. By day 7 the content of albumin in the cerebrospinal fluid approached the norm in this group, whereas the content of alpha 2-macroglobulin remained increased. The level of IgG surpassed the normal value on day 1 only in the patients who died, and later it did not differ from the norm in both groups.
Subject(s)
Albumins/cerebrospinal fluid , Brain Injuries/cerebrospinal fluid , Immunoglobulin G/cerebrospinal fluid , alpha-Macroglobulins/cerebrospinal fluid , Biomarkers , Brain Injuries/physiopathology , HumansABSTRACT
The paper summaries authors' experience with lifetime and postmortem pulmonary changes in 223 victims with severe craniocerebral injury, as well as the data available in literature on this point. The investigations have shown that microcirculatory disorders make a great contribution to the development of pulmonary complications and revealed specific feature of the natural history of the shock lung in patients with severe craniocerebral injury. The paper provides strong evidence for the neurotrophic pattern of pulmonary complications and proposes a scheme of their development in this injury.
Subject(s)
Brain Injuries/complications , Lung Diseases/etiology , Acute Disease , Adolescent , Adult , Aged , Brain Concussion/complications , Brain Concussion/physiopathology , Brain Injuries/physiopathology , Child , Female , Humans , Lung Diseases/physiopathology , Male , Middle Aged , Pneumonia/etiology , Pneumonia/physiopathology , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/physiopathology , Time FactorsABSTRACT
The symptomatology and results of treatment of 26 patients with traumatic hematomas of the posterior cranial fossa (PCF) are analysed. The hematomas were verified on operation in 19 patients and on postmortem examination in the other patients. It is concluded that the diagnosis of PCF hematomas is based on a combination of signs: cervico-occipital mechanism of the trauma, fracture of the occipital bone, cerebello-stem symptomatology, and acute hydrocephalus. The formation of trephination openings on the line of the fracture of the occipital bone is considered expedient in the presence of the above listed signs of affection of the PCF structures and the absence of computer tomography. Tests for induced stem potentials must also be included in the diagnostic complex. Total lethality was 53.8%, surgical lethality--25%.
Subject(s)
Cerebral Hemorrhage/diagnosis , Hematoma/diagnosis , Occipital Bone/injuries , Skull Fractures/diagnosis , Adult , Cerebellar Diseases/diagnosis , Cerebellar Diseases/etiology , Cerebellar Diseases/surgery , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/surgery , Cranial Fossa, Posterior , Female , Hematoma/etiology , Hematoma/surgery , Hematoma, Epidural, Cranial/diagnosis , Hematoma, Epidural, Cranial/etiology , Hematoma, Epidural, Cranial/surgery , Hematoma, Subdural/diagnosis , Hematoma, Subdural/etiology , Hematoma, Subdural/surgery , Humans , Male , Middle Aged , Skull Fractures/complications , TrephiningABSTRACT
Anterior compression of the spinal cord at the level of the thoracic vertebrae cannot be corrected adequately through a posterior approach (laminectomy). This widely encountered form of spinal cord compression calls for a differentiated use of the anterolateral or lateral approach to the vertebral canal, i.e. combination of osteotransversectomy with hemilaminectomy. A lateral access to the vertebral canal is indicated in most cases.
