[Craniocerebral hypothermia in the acute period of ischemic stroke]

OBJECTIVE

To determine the effect of craniocerebral hypothermia (CCH) on neurological deficit regression, hemodynamics, fever and functional outcome of therapy in patients with moderate ischemic stroke (IS).

MATERIAL AND METHODS

This study included 60 patients with IS (the first day). The main group consisted of 30 patients who underwent CCH, and the comparison (control) group consisted of 30 patients without CCH. The National Institutes of Health Stroke Scale (NIHSS), the Glasgow Coma Scale (GCS), the modified Rankin Scale (mRs) were used. Recorded parameters were mortality, heart rate (HR), blood pressure (BP), axial temperature, cerebral temperature of the frontal cortex. Cerebral temperature was obtained noninvasively by using a RTM-01-RES radiothermometer (Russia). CCH (for 24 hours) in the main group was implemented by ATG-01 device (Russia). Results were recorded on the day of admission, after 24 hours and at discharge. In both groups, basic neuroprotective, hypotensive, antiplatelet and antiedemic therapy was administered.

RESULTS

No fatal outcomes were reported in both groups. Side-effects and complications of CCH were not recorded. In the main group, neurological deficit assessed by NIHSS decreased by 75% after the CCH procedure and by 93.75% at the time of discharge from the hospital. In patients of the comparison group, regression of neurological deficit was 35% on the second day and 55% at the day of discharge. The use of CCH suppressed systemic and cerebral hyperthermia. Functional outcome of therapy in the main group was higher compared to the comparison one. The dynamics in blood pressure and heart rate didn't differ in both groups.

CONCLUSION

A pronounced positive effect of CCH on the course of the acute period and therapy results in patients with IS was demonstrated.

Inflammatory Response in Patients with Spontaneous Intracranial Hemorrhages

Mortality and disability rates in spontaneous intracranial hemorrhages remain high despite medical advances. In recent decades, much attention has been paid to neuroinflammation as a typical response to brain damage. Inflammation plays an important role in the acute and chronic phases of the disease. The relationship between plasma and cerebrospinal fluid cytokines, as well as the factors affecting their ratios, is currently not completely clear.

The objective was to study the inflammatory response to spontaneous intracranial hemorrhage.

Subjects and Methods. 59 patients aged 18 to 72 years (48 ± 6) were enrolled in the study. Patients were admitted to the intensive care unit after an episode of spontaneous intracranial hemorrhage. The levels of interleukins in blood plasma were studied: 6, 8, 10, TNF-α, C-reactive protein,

blood leukocytes, and procalcitonin (by a semi-quantitative method). In the cerebrospinal fluid, the following parameters were evaluated: cytosis, protein, glucose, lactate, cytokines (6, 8, 10, TNF-α). Blood samples were collected on days 1, 2, 3, 5, 7, 9, 14, 21, 28, 35, and 45.

Results. Systemic inflammatory response developed in all patients from the first day of acute brain injury. The most significant response was formed by glial brain cells which was confirmed by high levels of cytokines in the cerebrospinal fluid, hundreds and thousands of times higher than blood levels of cytokines.

Conclusion. Levels of pro-inflammatory cytokines are predictors of an unfavorable outcome.

Some Aspects of Pituitary-Adrenal and Autonomic Nervous Systems Functioning in Patients with Chronic Consciousness Disorders

Patients with chronic disorders of consciousness (CDoC) have various variants of the pathological organization of functions including sympathetic hyperactivity and hormonal changes.

The objective: to determine the severity of paroxysmal sympathetic hyperactivity (PSH), the function of the pituitary-adrenal system in patients with CDoC.

Subjects and Methods. 54 patients with CDoC were enrolled in the study. Patients were randomized in the groups depending on assessment on the Coma Recovery Scale-Revised scale and CRS-R index calculation. PSH severity was assessed 7 times a day for two days. During the first week from the moment of admission, blood sampling was performed 7 times a day to study the levels of ACTH and cortisol.

Results. PSH syndrome was detected in all groups, there were no significant dependencies of its severity on the time of day. There were no significant differences in the levels of ACTH and cortisol during the day.

Conclusions: PSH syndrome is observed in most patients with CDoC. In patients with CDoC, the daily rhythm of ACTH and cortisol secretion are disrupted.

[N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE AS BIOMARKER OF ACUTE BRAIN INJURY]

Laboratory diagnostic is very important in treatment of acute brain injury, together with neurophysiology and neurovisualisation methods. Biomarkers measurements can provide early brain injury diagnostic, monitoring of treatment as well as outcome prediction. We studied dynamic of N-terminal pro-brain natriuretic peptide (n-proBNP) level in patients with acute brain injury (intracranial hemorrage, traumatic brain injury, tumors). All patients were divided into 3 groups (by etiology of injury), each group consist of 2 subgroups: a - survivors with good outcome (I-II group in Glasgow outcome scale (GOS)); b - dead or severe morbidity (III-V group in GOS). High level of n-proBNP was mentioned in all groups. N-proBNP level was not correlated with etiology of injury. In cases of n-proBNB increasing more than 700pg/ml outcome was poor - severe morbidity or death. We suppose N-proBNP can be significant acute brain injury biomarker, useful to outcome prediction.

[Neurovegetative stabilization as a pathogenetic therapy for brain damage]

The article deals with neurovegetative stabilization as a pathogenetic therapy for brain damage. The approach is based on hypothesis that pharmacological effecting on central nervous system is able to make a passive protective medical system which can be close to passive protective systems widely represented in the nature. Complex opioid and clonidine administration provides sufficient level of neurovegetative stability on account of effecting on neuro-regulative structures the brain steam. Neurovegetative stabilization should be carry out in order of warning principle. In our opinion optimal doses are fentanyl 0.2-1.4 mkg kg(-1) per hour, clonidine 0.2-0.7 mkg kg(-1) per hour, propofol 0.5-2 mkg kg(-1) per hour, penthonal sodium 1-4 mkg kg(-1) per hour; diazepam 0.4-0.5 mkg kg(-1), and midazolam 0.05-0.2 mkg kg(-1) per hour. A criterion of the therapy sufficiency is a consistency between changes of different functional parameters. We believe the most important that new level of functioning must be maximally integrated and harmonized. It is possible if all pharmacological agents include the most reliable programs of adaptation complex human body reactions.

[Treatment outcome of chemotherapy with superselective cerebral artery catheterization in vegetative state patients]

The purpose of the study is to assess the impact of superselective neurotransmitter metabolic therapy in patients in a vegetative state. Superselective intraarterial infusion was conducted on 26 patients with relevant international criteria for the diagnosis of vegetative state. Comprehensive assessment of neurologic symptoms and severity of low metabolism on PET scan allowed to select the vascular pool, for the catheter installation. The catheter was placed either in the carotid or the vertebrobasilar pool. Infusion of neurotransmitter agents was conducted for 7 days continuously. Control of the level of metabolism of labeled glucose in the brain (PET) was performed within 2 weeks after arterial infusion. 14 out of 26 patients showed a positive trend of changes in energy metabolism of the brain. However, only 7 out of 14 patients showed further recovery of consciousness. The data confirms that the delivery path and a combination of medications play a definite role in the effectiveness of vegetative state therapy.

[Centrogenic reactions and their prognostic value during surgeries for posterior cranial fossa tumors in children]

The purpose of the study was to define the parameters of intraoperative monitoring, which allowed the prediction of complications due to surgery for posterior cranial fossa in children and the planning postoperative treatment tactics. The hypnotic propofol and a combination of the narcotic analgesic fentanyl and alpha 2-adrenoblocker clofelin were used to induce and maintain anesthesia. All patients were operated on in the sitting position. Hemodynamic parameters, arterial blood saturation, end-expiratory carbon dioxide tension, and central venous pressure were intraoperatively studied. As electrophysiological monitoring, the authors studied electroencephalograms and brainstem auditory evoked potentials by an Indeaver monitor (Nicolet). The investigators analyzed readings and data on admission to the operating suite, at the stages of anesthesia maintenance and surgery. The findings were used to define indications for anesthesia using the narcotic analgesic fentanyl and alpha 2-adrenoblocker clofelin in the postoperative period.

[Variants of the course of early noncomplicated postoperative period following excision of hypothalamo-hypophysial region tumors in children]

A study of non-specific and specific reactions in neurosurgical patients as conducted in the early postoperative period revealed three main variations of an early postoperative clinical course, i.e. with a normal stress-reaction, with a normal stress-reaction concomitant with diabetes insi pidus, and with a lower reactivity to surgical intervention. The treatment algorithms were appropriately amended (the preventive component was added) with due respect to the above circumstances.