[Cerebrolysin in the treatment of brain injuries of moderate severity].

OBJECTIVE: To assess the efficacy of cerebrolysin in patients with cranial/brain injury of moderate severity. MATERIAL AND METHODS: The main group included 30 patients treated with cerebrolysin from the first day of disease, the comparison group included 32 patients matched for age, sex and disease severity. RESULTS AND CONCLUSION: Cerebrolysin promoted the early and complete reduction of common symptoms of brain injury as well as autonomic and asthenic disorders, restoration of cognitive functions, normalization of emotional condition, improvement of spontaneous bioelectrical activity. The drug was well-tolerated.

[High-flow extracranial-intracranial (EC-IC) bypass surgery in a patient with giant right cavernous ica aneurysm].

To present the clinical case of successful extracranial-intracranial (EC-IC) high-flow bypass performance. Patient, female, 51 years old, was suffered from giant cavernous aneurysm of right internal carotid artery (ICA), presented with mass effect. The EC-IC high-flow bypass using radial artery was performed between M2 segment of right middle cerebral artery and right external carotid artery. Bypass patency was confirmed by intraoperative dopplerography, postoperative digital subtraction angiography and by ultrasound examination of anasthomosis. Patient was discharged in 3 weeks after operation in satisfactory condition. The EC-IC high-flow bypass is one of effective method for cavernous aneurysm treatment, allowing excluding aneurysm from cerebral blood flow and decreasing its mass effect.

[Levels of S100ß protein in patients with mild traumamic brain injury].

The prospective study of plasma S100ß protein levels in 19 patients with mild traumamic brain injury treated with conservative methods was carried out. The S100ß protein levels were measured on the admission of the patient and after 24 and 48 h. The level of S100ß increased above normal values (>0,105 mkg/l) in 11 patients (58%) in the first 6 h after the trauma. The CT analysis revealed brain matter lesions in 8 patients (42%), MRI - in 11 (58%) cases. The increase of baseline S100ß levels above normal values was found in all patients with brain matter lesions seen in CT and in 27% of patients with the normal CT. CT revealed brain lesions in 73% and MRI in 100% of patients with mild traumamic brain injury and increased plasma S100ß levels. There was no correlation between the S100ß level and the type of brain lesion, its localization or volume and the fracture of cranial bones. Also, no correlation was found between S100ß levels and EEG changes (p>0,05).

[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.

[Time course of toxic hypoxic encephalopathy during combined therapy including hyperbaric oxygenation]. / Dinamika toksikogipoksicheskoi éntsefalopatii pod vozdeistviem kompleksnogo lecheniia s primeneniem giperbaricheskoi oksigenatsii.

The mechanisms of action of hyperbaric oxygenation (HBO) in toxic hypoxic encephalopathy (THE) were studied using clinical psychopathological examinations, functional and laboratory tests in 268 patients with THE treated by a therapeutic complex including HBO and 75 patients with THE treated routinely (controls). The earliest possible addition of HBO to a complex of treatment of THE patients led to involution of signs of brain edema shown by computer tomography (CT) and improvement of its functional activity, while in patients exposed to HBO later the psychoorganic symptoms and CT signs of cerebral ischemia did not disappear. Detoxifying, neuroimmunomodulating, and neuroimmunostimulating effects of HBO in THE were demonstrated. Early HBO treatment decreased the dysfunction of various compartments of the brain characteristic of THE. The technology of HBO developed by the authors prevented the development of socially dysadapting psychoneurological disorders and reduced the mortality of THE patients.

[Role of hyperbaric oxygenation in the treatment of posthypoxic encephalopathy of toxic etiology]. / Rol' giperbaricheskoi oksigenatsii v lechenii postgipoksicheskoi éntsefalopatii toksicheskogo geneza.

Hyperbaric oxygenation (HBO) was used in the treatment of 475 patients with toxic encephalopathy (TE) developing as a result of exo- and endotoxicosis. HBO promoted correction of all components of homeostasis, decreased endotoxicosis, reduced psychopathological and neurological disorders, and promoted social adaptation.

[The procedure for the surgical treatment of intracranial arterial aneurysms in cerebral vascular spasm and ischemia]. / Taktika khirurgicheskogo lecheniia vnutricherepnykh arterial'nykh anevrizm pri sosudistom spazme i ishemii mozga.

Analysis of the data of clinical neurological examinations, cerebral angiography, computed tomography, and electroencephalography in 77 patients with early cerebral aneurysmal rupture made it possible to identify three clinical types of vascular spasm-induced cerebral ischemia: compensated, subcompensated, and decompensated. specific characteristics of each type of cerebral ischemia are given. It is shown that early surgical treatment policy for aneurysms in vascular spasm must be determined by the clinical type of cerebral ischemia.

[The diagnosis of multiple aneurysms in the acute period of subarachnoid hemorrhage]. / Diagnostika mnozhestvennykh anevrizm v ostrom periode subarakhnoidal'nogo krovoizliianiia.

Among arterial aneurysms of the brain, multiple aneurysms occur on the average in 12.9% patients as evidenced by angiographic studies and in 22.7 as shown by autopsies. The study was undertaken to examine 66 patients with multiple aneurysms who had undergone surgical treatment. Their mean age was 45 years. The examination has demonstrated that total cerebral angiography should be performed to diagnose multiple aneurysms. The comprehensive studies of the patients that involved neurological examinations, computed tomography of the brain and total cerebral angiography have enabled the ruptured aneurysms to be detected in 68% of cases and in 85% when aneurysms are located in various vascular beds. While defining the surgical policy for patients with multiple aneurysms in the acute hemorrhagic period, it is necessary to bear in mind that there can be repeated hemorrhages from the previously unbled aneurysms.

[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.

[An analysis of the level and bilateralness of disorders of the brain stem auditory evoked potential in tumors of the posterior cranial fossa with different locations]. / Analiz urovnia i bilateral'nosti narushenii stvolovogo slukhovogo vyzvannogo potentsiala pri opukholiakh zadnei cherepnoi iamki razlichnoi lokalizatsii.

The method of stem auditory evoked potential was used in the examination of 39 patients with tumors of the posterior cranial fossa of various localization. The time indices of the response were analysed: the peak latency of components I, III, and V and interpeak I-III, III-V, and I-V intervals. The most coarse disorders were revealed in patients with tumors of the cerebellopontile angle (100% of cases), which were clearly lateralized. Changes of stem auditory evoked potential in patients with cerebellar tumors were encountered somewhat less frequently (in up to 90%) and the response was asymmetric in most cases. As compared to the first group, however, a high percentage of disorders of component V to stimulation of the intact side was noted. Among patients with median localization of the tumor (vermis cerebelli, floor of fourth ventricle) changes were found in 62% of cases (component V). No authentic differences to stimulation of different sides were revealed. The authors discuss problems on the levels of occurrence of disorders of stem auditory evoked potential in patients with lesions of posterior cranial fossa structures.

[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.

[Surgical treatment of cerebral aneurysms complicated by vasospasm in the acute period]. / Khirurgicheskoe lechenie anevrizm golovnogo mozga na fone sosudistogo spazma v ostrom periode.

The results of clipping of an aneurysm in the acute period of subarachnoid hemorrhage are analysed. It is shown that vascular spasm is an increased risk factor if it involves up to 3-4 and more arterial basal segments and is attended by marked general cerebral and focal neurological symptomatology and gross disorders of cerebral function. Such vascular spasm is unfavourable from the standpoint of prognosis in determining the outcomes of the operation.

[Functional status of the brain stem in cerebral circulatory disorders according to the results of a study of evoked brain-stem auditory potentials]. / Funktsional'noe sostoianie stvola mozga pri narushenii mozgovogo krovoobrashcheniia po dannym issledovaniia vyzvannykh stvolovykh slukhovykh potentsialov.

Patients with various forms of cerebral circulation impairment were examined. The changes of evoked truncal acoustic potentials (ETAP) point to a lesion of the brain stem formations predominantly at a mesencephalic level. It has been shown that ETAP correlate with the neurological symptomatology.