RU1821128C - Method of diagnosing type of dislocation syndrome in case of craniocerebral trauma - Google Patents

Abstract

The invention relates to medicine and can be used in neurosurgery. The method improves diagnostic accuracy. For this, intracranial pressure is measured supra- and subtentorially, the difference between the obtained values is calculated and when the subtentorial pressure is exceeded by 25 ml of mercury. and more, they diagnose a dislocation syndrome with a downward tenorial wedging of the diseased brain, and when the supradentorial pressure is exceeded by 25 mmHg. and more, dislocation syndrome with ascending tentorial wedging of the cerebellum.

Description

The invention relates to medicine, in particular to neurosurgery.

The aim of the invention is to improve the accuracy of diagnosis.

The goal is achieved in that the epidural ICP is measured simultaneously in both cavities of the skull - in the temporal (frontal or parietal) region and in the posterior cranial cervix, i.e. supratentorial and subtentorial, and by the difference in pressure between the cavities of more than 25 mm Hg. judges the type of brain dislocation.

The essence of the method is as follows.

When a patient with a brain contusion and with symptoms of increasing pressure or a patient who is in a severe (coma) state is admitted when the dynamics of the development of the dislocation syndrome is unknown, epidural ICP in supra and subtentorial is separately measured in addition to conventional examination methods spaces of the brain at the same time.

To do this, under local anesthesia with a solution of novocaine of 0.5% -10 in the temporal (frontal or parietal) regions of the skull, a milling trepanation hole is applied according to the standard technique (up to 1 cm). Epidurally. those. a latex balloon catheter is inserted between the skull bone and the dura mater, which is fixed when suturing the skin.

In the occipital region under local anesthesia with a solution of novocaine of 0.5% S, 0 from the paramedian incision (3 cm), the occipital bone is cleaved. The wound is spread with a retractor and on the scales of the occipital bone

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impose a milling trepanation pertension), which allows accurate diagnosis of the hole, up to 1.0 cm in size. Between the closure of the type of dislocation in a short time

the canal bone and dura mater- (after 5-10 min) after installing the balloon, which (i.e. epidurally) install the tethers and choose the appropriate method for the healing lateral balloon catheter. With ushivanmi5 ni (conservative therapy, supra- or

its wounds are fixed to the skin. decompression is subventorial). The operation does not require anesthesia, the technical choice of an adequate method is simple, bloodless and does not aggravate the condition, which reduces mortality by two

N. and the patient. Through the milling cut,

trepanation holes can be performed Example 1. Patient P. Zblet, and B. 2000,

thread revision of the shell spaces is delivered to a neurosurgical clinic

brain, if there is a suspicion on 10/15/86 at 22.15 an ambulance for a severe intracranial hematoma, a scrap condition. The circumstances of the injury are not known for determining intracranial pressure; they are picked up on the street,

laziness in the hydraulic system of the cylinder - 15. Traces of injury-abrasion in the right side of the head through the tee enter the 1.0 block area, bleeding from the right

furatsillina or physiological solution-auditory meatus. Vomiting, smell of alcohol,

pa At the same time, the hydraulic pressure of evil is in neurological status: a deep ogthmic balloon from the cavity is tearing. On examination, the psychomotor is redirected to the electrometric pre-20 stimulation. Respond to pain

the educator (strain gauge) and registers-purposefully. Rotiros Eye Blocks on an electronic recorder to the right. Pupils isometric, reaction

equipment. For research by us, the light is saved. Corneal reflexes

used standard balloon-cathete-living: Active limb movements

company ry. .25 a complete burr. Muscle tone is low. Dry Measurement is performed simultaneously. core reflexes of medium vivacity, without

two systems - supra and subtentorial-difference sides. Pathological signs

but. Normally, the epidural is intracranial.

pressure is relatively constant n-On radiographs of the skull: linear

as in the suprathetorial30 fracture of the occipital bone on the right,

cavities, and in the posterior cranial lobe and :; 10.16.86, at 9.00 the patient's condition

varies from 3 to 20 mmHg. deteriorates. Coma P. Pupils are narrow, without reaction. In pathological conditions of intravenous exposure to light, diverging strobism. Hyporetic pressure may increase from 60 tons of limb muscles. Periodically

80 mmHg Pressure difference between 35 extensor cramps in the hands. 2-sided cranial cavities of 25-30 mm Hg, and higher pathological stop signs,

indicates the dislocation of the brain from od-Pri This-ES- displacement of the median

cranial cavity in another, i.e. from the cavity of brain structures at temporal points 2-3 mm

with more pressure into the cavity with less right-left,

(a descending displacement of the cerebrum at 40 V at 10.00 for a patient with a diagnostic pachyoon hole, an upward displacement for the purpose were superimposed with milling cutters of a trepan-retentive posterior cranial mucosa or niche holes in the right temporal-lobar dislocation of the cerebellum). scale line

Measurement of the occipital bone is generally accepted. No hematoma detected,

ICP gradient in one of the cranial cavities45 brain is edematous, crimson, without detritus,

(either catheter balloon supratentorial or subtentoral-epidural

ally). This measurement is not indicative of ICP recording. Ventricular

about the presence of a dislocation of the brain, since onodrainage.

can be compensated by analog dav-ICP in the posterior cranial lobe 21 mm

lazy in another cavity and operational bm-50 Hg in the right frontotemporal region - 35

In this situation, the situation may be reduced to Hg. Supratentoralis pulsation

to the development of dislocation and death. Therefore, the brain is weakened,

based on an ICP value of only od-17.10.86, 10.00. Despite the conductive cavity for choosing a therapeutic tactical intensive therapy, the patient is ill. Simultaneous measurement of ICP in progressively worsens. Both cavities (supra- and subtentorial) showed hemodynamic instability. In c.ch. . allows you to determine the direction of the gradient-intracranial pressure - 27 mm Hg, enth ICP (i.e., a simultaneous increase in supratentorial-56 Mm Hg. There is supra-pressure in both cavities; there is practically no supratentor-torial pulsation, while hypertension, subtentorial gy-time as a pulse wave in rh is good.

The dynamics of the hourly registration of the VID is reflected graphically in figure 2,

Death 10/17/86 at 19.00. During a forensic study, it was revealed: a contusion of the brain with multiplication of the pole and basal parts of the right frontal lobe with the development of the temporal-tentorial insertion of the mediobasal parts of the right temporal lobe into the cerebellar tenderloin.

This case illustrates the dependence of the dynamics of the growth of supratentorial ICP on the development of the temporal-tentorial dislocation of the brain. The ICP in the posterior cranial cervix remained close to normal. The pressure gradient was 30 mmHg.

PRI me R 2. Patient S., 22, and 6, No. 695, was admitted to the neurosurgical clinic 03.25.87, at 9.25. Delivered by ambulance immediately after an injury in a serious condition. Fell from the window of the entrance of the second floor, hit the occipital region on the step of the stairs. In the occipital region of the bruise, abrasion.

In neurological status: coma I. They respond inappropriately to pain irritations with weak, non-targeted hand movements. The pupils are constricted, there is no reaction to light. Periodically, floating movements of the ocular block appear. Muscular hypotension .. Tendon reflexes of average vivacity, 2-sided pathological signs. AD-100/70 mm Hg pulse number 102 beats. Independent breathing is arrhythmic.

On the roentgenograms of the skull: a gaping linear fracture in the left half of the scales of the occipital bone, close to the midline, with a transition to the large occipital foramen.

Taking into account the severity of the patient’s condition, the site of injury, the presence of a fracture of the occipital bone and the symptoms of damage to the structures of the posterior cranial ulcer, it was decided to perform an audit through the milling hole. When a milling trepanation opening was applied to the line of fracture of the occipital bone, a cerebellar contusion was revealed, i.e. the left hemisphere of the cerebellum is purple-red in color, with the opening of the dura mater a small amount of detritus was released. The audit was completed by installing an epidural catheter balloon to record pressure in the gastrointestinal tract. A similar epidural balloon catheter is installed in the left temporal region.

In this case, intracranial pressure: in the cerebrospinal fluid - 45 mm Hg, in the supratentorial region - 24 mm Hg.

The patient's condition progressively worsened. On the day of admission, 11 hours after the injury, the patient died.

The pressure difference an hour before death was 42 mm Hg

Autopsy data: brain contusion with foci of crushing of the hemispheres and cerebellum worm. An ascending cerebellar-tentorial insertion and dislocation of the cerebellum into the cervical-occipital dural funnel.

Thus, the data of the forensic autopsy confirmed that the progressive increase in ICP in the posterior cranial ulcer was a consequence of cerebellar edema and the subsequent dislocation of the cerebellum into the large opening of the occipital bone and the opening of the cerebellar bast ..

PRI me R 3. Sick Sh., 20 years old and.b. No. 756 was admitted to the neurosurgical department on 06.06.88 g from the place of injury. Shot down by a car, while there was a fall in the back. Abrasions of the occipital region.

In neurological status: moderate stunning; ill-timed in the setting and time. Complaints of intense headache in the occipital region, the eyes are equal, the reaction to the light is preserved. The movements of the ocular block are in full, nystagmus with the rotator component when viewed from side to side and up. Parino's syndrome. The face is symmetrical. Tongue in the midline. The soft palate sags, the pharyngeal reflex is reduced. The range of motion in the limbs is sufficient, hypotonia of the muscles of the limbs. Tendon reflexes of medium vivacity, pathological signs of no.

X-ray of the skull: no traumatic injuries.

During dynamic observation, the patient's condition worsened. After 3 hours, she is ill in stupor, contact is impossible. A distinct increase in cerebral and focal (cerebellar-stem) symptoms.

Taking into account the place of application of the injury - the occipital region and the presence of symptoms from the posterior cranial uterus, indications are laid for the application of a freean treponeal foramen to the scales of the occipital bone. During the audit of the contents of the posterior cranial lump hematomas were not found. Massive foci of contusion-crushing of cerebellar hemispheres have been detected. Simultaneous recording of epidural ICP in the posterior cranial PMC and supratentorial revealed a sharp increase in pressure in the posterior cranial pit (48 mmHg) at normal pressure above the tentorium (25 mmHg).

Taking into account the progression of cerebellar-stem symptoms and a marked increase in ICP in the posterior cranial cyst, an operation was performed - resection trepanation of the occipital bone (decompression), washing and aspiration of cerebral detritus. After trepanation of the occipital bone and dissection of the dura mater, the hemispheres of the cerebellum began to prolapse into a defect, significantly increased in volume, and pulsation of the brain tissue appeared.

In the immediate postoperative period, the patient's condition improved significantly, and cerebellar-venous symptomatology regressed quickly. Discharged in satisfactory condition.

This case illustrates well how important it is to know the ICP value for choosing the right treatment tactics in patients with severe traumatic brain injury.

The claimed method has significant advantages ..

Diagnostic efficiency is not lower than 91%.

The time for diagnosing the type of brain dislocation is reduced to 5-10 minutes.

High neurological training by a doctor is not required.

It allows you to choose the most appropriate tactics for treating dislocation syndrome and reduce mortality in this group of patients by half.

Formulas of the invention

A method for diagnosing the type of dislocation syndrome in case of traumatic brain injury by measuring intracranial pressure, with the exception of the fact that, in order to improve accuracy, intracranial pressure is measured simultaneously supra- and subtentorially, the difference is obtained values, and when the subtentorial pressure is exceeded by 25 mmHg and more, they diagnose a dislocation syndrome with a descending tenorial wedge of the cerebrum, and when the supratentorial pressure is exceeded by 25 mm Hg. and more, dislocation syndrome with ascending tentorial wedging of the cerebellum.