LV14933B - Method for post-mortem pathomorphologic examination of brain in cases of encephalopathy - Google Patents

Abstract

The invention relates to medicine, namely to pathomorphology, and it is associated with post-mortem pathomorphologic brain examination in cases of encephalopathy. The aim of the invention is to develop brain tissue post-mortem detection techniques for pathomorphologic brain examination in cases of encephalopathy, which would allow eliminating discrepancies and errors in post-mortem diagnosis of the disease. The goal is achieved by ensuring that during the pathomorphologic examination of post-mortem brain, it is removed from the skull, and the examination determines skull vault's largest span along the mid-line of the skull's inner surface CD, determines skull vault's largest span along the mid-line of the skull's outer surface GH, cuts a straight front-parietal line (starting from the frontal lobe) of the underside of the two hemispheres, exposing the brain's lateral and third ventricle, then placing it in the preparation bath, fixating both sides of the hemispheres and determining the outer distance between the brain's frontal horns AB, the distance along the midline EF of the lateral ventricle, and the ratio of the coefficient, thus determining post-mortem signs of encephalopathy.

Description

DESCRIPTION OF THE INVENTION

The invention relates to medicine, in particular to pathomorphology, and relates to pathomorphological examination of the post-mortem brain in encephalopathy.

TECHNICAL LEVEL

Encephalopathy or Encephalopathy Syndrome is a pathological condition of the brain caused by organic brain damage. The spectrum of diseases that cause the encephalopathy or encephalopathy syndrome can be wide: primary liver, kidney disease [1], infectious diseases, post-traumatic brain injury, prolonged exposure to toxic substances (pesticides, alcohol, other chemical agents) -metabolic encephalopathies, infectious viral infections, lymphotropic, neurotropic, immunomodulatory viruses, which may persist for a long time in a wide range of cellular groups and may, upon reaction, induce changes in the nervous system such as human herpesvirus -HHV-6 and HHV-7, 3]. Data from recent years show an increasing tendency for encephalopathies, which is why special attention is paid to the study of unspecified post-infectious encephalopathies. Patients are suffering from long-term disability, difficult diagnostics and expensive examinations.

In the clinic, encephalopathy is confirmed as a diagnosis by clinical symptoms in which the patient is diagnosed with asthenia and / or agitation or fatigue, emotional and vegetative lability. Asthenia can be combined with memory problems, difficulty in properly perceiving and understanding oneself, one's illness, the surrounding world. In mild cases, patients adjust to the situation but personality changes occur, in more severe cases, dementia may follow.

The clinic uses radiological examination methods to diagnose the condition of encephalopathy: computed tomography (CT) and magnetic resonance imaging (MRI) of the brain. Computed tomography (CT) of the brain produces images of sections of the brain at different levels and in different planes: sagittal, frontal, and horizontal [4-10].

Comparison of pathomorphological (radiation and pathological) characteristics is made after the patient's death by comparing the results of pathological preparations with those obtained by radiation methods during the life of the patient. Often these rates do not match, possibly due to changes in brain size [10]. The structure of the brain tissue is soft and elastic, preventing the skull bones from expanding, but, when removed from the skull, tends to expand laterally from 1.0 to 2.0 cm. This leads to errors and complicates the determination of adequate pathomorphological characteristics of ventricular ventricular measurements and comparison of MRI data obtained during the patient's lifetime.

The object of the present invention is to provide a pathomorphological method for determining the post-mortem status of brain tissue in the case of encephalopathy, which enables the prevention of misunderstandings and errors in the post-mortem diagnosis of the disease.

The objective is achieved by removing the cerebral cortex from the skull, determining the maximum transverse dimension of the cranial arch CD, determining the maximum transverse dimension of the cranial arch GH, separating the cerebral bridge and the two cerebral hemispheres from the brain; perform a frontoparietal straight cut (starting from the forehead lobes), both cerebral hemispheres, simultaneously from the forehead to the occipital lobes, 2 cm above the lower surfaces of the cerebral hemispheres; place the lower surface of both cerebral hemispheres of the cerebellum, exposing the lateral and ventral cerebellum of the cerebellum, into the bath being prepared, with the bath to the right of the side of the bath; press the preparation with a ruler at a force of 2.5 to 3.5 N (Newton); the length of the presser of the preparation must correspond to the internal length of the bath; with the preparation, press the lower surfaces of both cerebral hemispheres from the left lateral edge to the right side of the bath, with the middle of both broken cerebral hemispheres equidistant with the largest transverse dimension (CD) of the cranial vault surface; determining the distance between the external distance AB of the forehead horn without releasing the preparation by a ruler; without releasing the ruled compression, determine the distance of the lateral abdomen along the midline EF, determine the factor Ki as a percentage by the formula:

K, = AB xl00% _where ¹ CD

AB is the distance between the external distance of the cerebral horns,

CD is the maximum transverse dimension of the inner surface of the cranial arch and K2 as a percentage by the formula:

K ^{2 ==} X 100% ₅ where

EF is the median size of the lateral abdomen,

GH is the maximum transverse dimension of the external surface of the cranial vault and, if Kj is less than 30% and K2 is not more than 25%, encephalopathy is detected in brain tissue.

The newly developed pathomorphologic technique for post-mortem brain tissue post-mortem detection provides an opportunity to adequately compare patient lifetime magnetic resonance imaging (MRI) with pathomorphologic findings obtained during autopsy.

The invention is explained by Figures 1 and 2, which schematically show a section of the brain in the fronto-parietal plane, lateral and third cavity / ventricular level.

Method implementation:

1) open the skull, remove the skull arch,

(2) rupture the hard sheaths of the brain;

(3) digestion of the elongated brain, separation of the brain from the spinal cord,

(4) removal of the brain from the skull,

5) determine the weight of the brain, place the brain on the preparation table,

6) determine the maximum transverse dimension of the cranial vault's inner surface CD,

(7) determine the maximum transverse dimension GH of the external surface of the cranial vault,

8) determine the condition of the soft casings,

9) determine the position of the cerebral blood vessels,

10) separates the cerebral bridge and the two cerebral hemispheres from the brain,

11) the brain, with the lower surface of the brain, placed on the preparation table,

12) perform a fronto-parietal straight incision (starting from the forehead lobes), both cerebral hemispheres, simultaneously from the forehead to the occipital lobes, 2 cm above the lower surfaces of the cerebral hemispheres,

13) Place the lower surfaces of both cerebral hemispheres of the cerebellum, exposing the lateral and ventricle of the cerebellum, in a smooth square tub 3 cm high with the right side of the bath pressed against the ruler with a force of 2.5-3. , 5 N (Newton, 1 N = 0.1 kgf),

(14) The length of the binder of the preparation must be equal to the internal length of the bath and the height of the sides must not exceed 3 cm, solid foam or other polymeric product may be used as the cut material,

(15) With the preparation, press the lower surface of the cerebellum from the left lateral edge to the right side of the bath, with the middle of both broken cerebral hemispheres equal to the largest transverse CD of the cranial vault surface.

(16) without releasing the product by linear application, determine the distance AB between the outer horns of the forehead;

(17) Determine the size of the lateral abdomen along the midline EF without releasing the product by a linear application;

(18) Determine the coefficient Kj as a percentage by the formula:

K, = AB xl () 0% _where ¹ CD, '

AB is the distance between the external distance of the cerebral horns,

CD is the maximum transverse dimension of the inside surface of the cranial vault,

(19) Determine the factor K _{2 in} per cent by the following formula:

K? ~ - X 100% where ² GH,

EF is the median size of the lateral abdomen,

GH is the maximum transverse dimension of the external surface of the cranial vault and, if Ki is not more than 30% and K ₂ is not more than 25%, encephalopathy is detected in the brain tissue.

Example:

1) open the skull, remove the skull arch,

(2) rupture the hard sheaths of the brain;

(3) digestion of the elongated brain, separation of the brain from the spinal cord,

(4) removal of the brain from the skull,

5) determine the weight of the brain, place the brain on the preparation table,

6) determine the maximum transverse dimension of the cranial vault's inner surface CD,

(7) determine the maximum transverse dimension GH of the external surface of the cranial vault,

8) determine the condition of the soft casings,

9) determine the position of the cerebral blood vessels,

10) separates the cerebral bridge and the two cerebral hemispheres from the brain,

11) the brain, with the lower surface of the brain, placed on the preparation table,

12) perform a fronto-parietal straight incision (starting from the forehead lobes), both cerebral hemispheres, simultaneously from the forehead to the occipital lobes, 2 cm above the lower surfaces of the cerebral hemispheres,

13) Place the lower surfaces of both cerebral hemispheres of the cerebellum, exposing the lateral and ventricle of the cerebellum, in a smooth square tub 3 cm high with the right side of the bath pressed against the ruler with a force of 2.5-3. , 5 N (Newton),

(14) The length of the presser of the preparation must correspond to the internal length of the bath, and the height of the sides must not exceed 3 cm, rigid foam or other polymeric product may be used as the cut material,

15) with the preparation, press the lower surfaces of the cerebral hemispheres from the left lateral edge to the right side of the bath until the middle of the cerebral hemispheres is equal to the largest transverse dimension of the cranial vault's inner surface CD,

16) without releasing the preparation pressed with a ruler, measure the distance AB between the external distance of the cerebral horns;

(17) measure the size of the lateral abdomen along the midline EF without releasing the product using a ruler;

(18) Determine the coefficient Kj as a percentage by the formula:

K, = X 100%, where

AB = 3,8 cm is the distance between the external distance of the cerebral horns,

CD = 13,0 cm is the maximum transverse dimension of the inside surface of the cranial vault,

3.8 cm _ _Kl = AB x100% ^Kl CD

29.2%

13.0 cm

(19) Determine the factor K _{2 in} per cent by the following formula:

K ₂ = X 100% where ² GH, '

EF = 3,5 cm - centerline of lateral abdomen,

GH = 14,2 cm is the maximum transverse dimension of the external surface of the skull arch,

Ko

EF X 100% = E5_cm

GH

14.2 cm

24.6%, that is, a coefficient Ki = 29.2%, that is not more than 30%, a factor K ₂ = 24.6%, that is not more than 25%.

According to the new pathomorphologic technique for post-mortem brain tissue status determination, the patient's final diagnosis is encephalopathy of the brain tissue. The same diagnosis was also made clinically during the patient's lifetime using magnetic resonance imaging.

Adult autopsy tissue research was performed at the Riga 1st Hospital Hospital Pathology Department during the period 2009-2013. 267 autopsy studies of skull and brain elements were performed. Of the 267 autopaths with a pathomorphologic technique to detect post-mortem brain tissue, 51 were confirmed for pathomorphologic diagnosis of encephalopathies, as confirmed by magnetic resonance imaging during the patient's lifetime.

The concurrence of the results obtained with the patient's lifetime magnetic resonance imaging by this pathomorphological measurement method is of great importance to clinicians and pathologists as it prevents possible errors and complications in confirming the definitive pathomorphological diagnosis.

Sources of information

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3. Ward KN, Andrevs NJ, Verity CM, Millcr E, Ross EM. Iluman herpesvirus-6 and -7 each cause neurological morbidity in Britain and Ireland. Arch Dis Child 2008; 90: 619-623.

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Claims (1)

THE CLAIM The pathomorphologic technique for post-mortem brain tissue post-mortem examination is characterized by removal of the cranial cavity, the determination of the maximum transverse dimension of the cranial vault, from the brain; performs an ifonto-parietal straight incision (starting from the lobes of the forehead), along both cerebral hemispheres, at the same time from the forehead to the occipital lobes, 2 cm above the lower surfaces of the cerebral hemispheres; place the lower surface of both cerebral hemispheres of the cerebellum, exposing the lateral and ventral cerebellum of the cerebellum, into the bath being prepared, with the bath to the right of the side of the bath; press the preparation with a ruler at a force of 2.5 to 3.5 N (Newton); the length of the presser of the preparation must correspond to the internal length of the bath; with the preparation, press the lower surfaces of both cerebral hemispheres from the left lateral edge to the right side of the bath, with the middle of both broken cerebral hemispheres equidistant with the largest transverse dimension (CD) of the cranial vault surface; determining the distance between the external distance AB of the forehead horn without releasing the preparation by a ruler; without releasing the ruled compression, determine the distance of the lateral abdomen along the midline EF, determine the factor Ki as a percentage by the formula: AB is the distance between the external distance of the cerebral horns, CD is the maximum transverse dimension of the inner surface of the cranial arch and K ₂ per cent according to the formula: EF is the median size of the lateral abdomen, GH - the skull bone arch spans the largest external surface, and the Kj is not more than 30%, and K ₂ is not more than 25%, determine encephalopathy brain tissue.