RESUMO
The investigation was undertaken to elucidate the specific features of cerebral blood flow in acute brain injury (BI) in relation to its severity. Cerebral circulation (CC) was studied in 83 patients aged 5 to 64 years in the acute period of BI. The authors estimated the consciousness by the Glasgow coma scale and CC from the mean linear blood flow velocity (LBFV) in both middle cerebral arteries (MCA). To calculate the hemispheric index (HI), blood flow was examined in the extracranial portion of the ipsilateral internal carotid artery. The traumatic lesion substrate was verified by computed tomography and magnetic resonance imaging. Intracranial and cerebral perfusion pressures were continuously monitored in 39 patients. The outcomes of BI were assessed by means of the Glasgow outcome scale. In accordance with the values of LBFV, all the patients were divided into 3 groups: 1) patients in whom MCA LBFV throughout the acute period of BI remained within the range of normal or low values (30-70 cm/sec); 2) those in whom MCA LBFV ranged from 80 to 120 cm/sec at a HI of less than 3.0; 3) those with vasospasm in whom MCA LBFV was more than 120 cm/sec at a HI of more than 3.0. Analysis of the studies revealed that despite the same consciousness impairments, the magnitude of CC disorders was appropriate to the severity of brain lesions in all three groups. At the same time severe and mixed brain lesions as intracranial hematomas, type 3 contusion foci, and profuse subarachnoidal hemorrhages were attended by the development of unilateral or bilateral vasospasm of MCA. In addition, the low CC values mainly associated with prehospital overall cerebral hypoxia were ascertained to be a poor factor of the outcome of BI. The best results of treatment for BI are achieved in moderate CC disorders as a moderate LBFV increase.
