[Actovegin in the treatment of brain injuries of mild and moderate severity].

Sixty-eight patients, including 32 patients of the main group who received aktovegin in addition to standard therapy and 36 patients of the control group with standard therapy only, have been studied. In both groups, various traumatic injuries (small focal injuries, subdural and epidural hematomas, traumatic subarachnoid hemorrhages, a combination of covering hematoma and small focal injuries) have been found. Aktovegin has been used in drops in dosage 400 mg per 200 ml physiological solution for 10 days. A comparative analysis of clinical data and results of instrumental studies (EEG, CT etc) in the main and control groups gives grounds to conclude that the use of aktovegin in the complex with standard therapy improves the course of brain injuries thus promoting the earlier compensation of disturbed functions and shortening the terms of treatment. The regress of asthenic symptoms as well as positive EEG changes are most pronounced.

[The surgical treatment of arterial aneurysms in the acute period of subarachnoid hemorrhage]. / Khirurgicheskoe lechenie arterial'nykh anevrizm v ostrom periode subarakhnoidal'nogo krovoizliianiia.

The paper presents the surgical outcomes of 300 patients with brain arterial aneurysms. A total of 43% of the patients were admitted to the unit within the first 72 hours of the onset of hemorrhage, 165 patients were operated on within the first fortnight, 135 were operated on in later periods. The aneurysms of the anterior communicating artery, internal carotid, middle cerebral artery were 42, 24, and 22%, respectively. Multiple aneurysms were 12% according to the Hunt and Hess classification, the preoperative severity of the patients was as follows: Degree I, 39 (13%), patients, Degree II, 130 (43%), Degree III, 106 (36%), Degree IV, 18 (6%), Degree V, 7 (2%). In 14% of the patients, aneurysm rupture was accompanied by the formation of intracerebral hematoma. The qualitative analysis of angiograms revealed vascular spasm in 70% of cases, the quantitative one indicated it in 80%. Aneurysm clipping was performed in 269 patients, its wrapping with a free muscle flap was done in 31 patients. Among the patients operated on, the mortality was 35% in the first fortnight of the onset of the disease and 17% during operations in later periods.

[Cerebral artery aneurysms: Clinico-anatomic analysis of 610 cases]. / Anevrizmy arterii golovnogo mozga: kliniko-anatomicheskii analiz 610 nabliudenii.

Analysis of 610 aneurysms in 537 patients is performed. Main localization of aneurysms (88.7%) was the anterior region of Willis's circle. Congenital dysplasias of the arterial wall are transformed into the aneurysm when the risk factors join (essential or transitory arterial hypertension, atherosclerosis) this being confirmed by an advanced age (63%). Subarachnoidal hemorrhages predominated (29.9%). Most frequent immediate causes of death were hemorrhage into the brain ventricles (42.9%), edema and brain dislocation (40.7%). Ischemic brain softening played a role in the anatogenesis among non-operated patients in 7.3% cases and in 37.1% among operated patients. Histologic examination revealed that the maximum of repeated hemorrhages occur during the first 14 days after the aneurysm rupture-the time of noncompleted thrombus organization.

[The clinico-angiographic manifestations of vascular spasm in the acute period of an aneurysm rupture]. / Kliniko-angiograficheskie proiavleniia sosudistogo spazma v ostrom periode razryva anevrizm.

The clinical picture was compared to angiographic findings on the spasm in 85 patients in acute period of an aneurysmal rupture in the absence of the intracranial hematoma. Spasm-induced ischemia was responsible for cerebral dysfunction and neurological symptoms. Days 5-13 since the aneurysmal rupture can be viewed as a functionally significant spasm interval. To prevent repeat hemorrhages and brain ischemia, aneurysmal intervention should be conducted on early hours and days of the disease, before or during a less severe vascular spasm.

[The assessment of brain stem function in the acute period of aneurysm rupture]. / Otsenka funktsional'nogo sostoianiia stvola golovnogo mozga v ostrom periode razryva anevrizm.

The functional status of the brain stem was assessed by recording evoked stem auditory potentials (ESAP) in 76 patients in the acute period of arterial aneurysm rupture. Abnormalities of ESAP were detected in 39.4% of the patients. The determinant of ESAP disorder in aneurysm rupture is the occlusive-dislocation syndrome caused by intracranial hematoma, more than 50 ml in volume, ventricular tamponade or extensive vascular spasm.

[The clinical picture of hemorrhages as a consequence of the rupture of cerebral arterial aneurysms]. / Klinicheskaia kartina krovoizliianii vsledstvie razryva arterial'nykh anevrizm golvonogo mozga.

Arterial aneurysms were found in 516 (45.9%) patients among 1,124 patients with subarachnoid hemorrhage (SH). Five clinical and anatomical types of hemorrhages in ruptures of arterial aneurysms were distinguished. The degree of the clinical manifestations of dislocation of the brain stem and/or occlusion of the CSF tract were taken into account, which plays a role in the choice of the tactics of management. SH took an atypical course in 28% of patients. Six variants of the atypical course were distinguished.

[The information value of the EEG in the acute period of subarachnoid hemorrhage as a consequence of rupture of intracranial aneurysms]. / Informativnost' EEG v ostrom periode subarakhnoidal'nogo krovoizliianiia vsledstvie razryva vnutricherepnykh anevrizm.

The article deals with the results of electroencephalographic (EEG) examination of 65 patients in the acute period of subarachnoid hemorrhage of nontraumatic genesis. The revealed changes in the electrical activity of the brain are compared with the level of disturbed consciousness, the severity of the clinical condition, and the presence of complicated or noncomplicated form of subarachnoid hemorrhage. The main factors determining the degree of disorders of the EEG pattern are discussed. It is shown that the EEG data possess high prognostic significance in determining the outcome of operative treatment of patients in the acute period of the disease.