RU2257579C2 - Method for predicting the result of ischemic cerebral lesion - Google Patents

Abstract

FIELD: medicine, clinical neurology, neurosurgery, neurotraumatology.

SUBSTANCE: one should obtain and study graphic values of thermal dependence of liquor's electric impedance. In case of flattened curve at temperature of phase transition being below 70 C one should predict unfavorable result of the above-mentioned disease. In case of a double-peaked curve at temperature of phase transition ranged 70-90 C one should predict a severe progredient flow of the disease mentioned. In case of a curve with pronounce "peaks-waves" complexes at temperature of phase transition being above 90 C one should predict favorable result of the given disease. The method enables to carry out a single lumbar puncture that enables to decrease traumatism and risk for infectioning.

EFFECT: higher accuracy of prediction.

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Description

The invention relates to medicine, namely to clinical neurology, neurosurgery, neurotraumatology, and can be used to predict the outcome of ischemic damage to the brain, vascular and traumatic genesis.

A known method for predicting the outcome of ischemic damage to the brain by determining the titer of autoantibodies to glutamate NMDA receptors in the blood serum using the standard enzyme-linked immunosorbent assay (ELISA) (Skvortsova V.I. Diagnostic and prognostic use of biochemical markers of ischemic brain damage. - M .: Russian State Medical University. 2001, 28 p). The concentration of autoantibodies in blood samples of patients is determined by the calibration curve based on the values of optical densities. An increase in the titer of autoantibodies to glutamate NMDA receptors correlates with the severity of the ischemic process. In severe strokes, the titer of autoantibodies is significantly higher than in moderate strokes, which is typical for an unfavorable prognosis. In patients with the most severe forms of ischemic stroke, the titer of autoantibodies does not go beyond normal limits. With a titer showing a tendency to decrease compared with the initial level, a lethal outcome is predicted.

The disadvantages of the method:

- lack of accuracy, since they examine the blood, and not the cerebrospinal fluid, which directly contacts the brain tissue and the first reflects the degree of damage;

- refers to expensive methods, requires special equipment and reagents.

As a prototype, a method for predicting the outcome of ischemic damage to the brain was selected (Skvortsova V.I. Diagnostic and prognostic use of biochemical markers of ischemic damage to the brain. - M .: Russian State Medical University. 2001, 28 pp.), In which cerebrospinal fluid is examined, determining the content of neurotransmitter amino acids (glutamate) in cerebrospinal fluid using high performance liquid chromatography with electrochemical detection according to the Pearson SS method et al. Samples of cerebrospinal fluid are taken on the 1st and 3rd day of illness. The concentration of amino acids in the cerebrospinal fluid (μmol / L) is calculated using a calibration curve. The dynamics of concentrations of neurotransmitter amino acids depends on the severity of ischemic stroke. With an increase in the concentration of glutamate in the first 6 hours of the disease, exceeding the norm by 18 times, decreasing by 3 times by 12 hours, compared to the first 6 hours, and remaining moderately elevated by the 3rd day, a favorable outcome is predicted. With an increase in the concentration of glutamate over 1 day, and after 24 hours - 21 times higher than normal, and by 3 days - with a tendency to decrease to moderately elevated, a progressively severe course is predicted. With an increase in glutamate concentration only after 12-18 hours, and then a sharp decrease, and in some cases the absence of it in the cerebrospinal fluid, an unfavorable outcome is predicted.

The disadvantages of the prototype: trauma and the risk of infection, since the method requires repeated lumbar puncture or staging lumbar drainage.

The invention is aimed at creating a method for predicting the outcome of ischemic brain damage, which reduces the morbidity and risk of infection.

The task in the implementation of the method is achieved by the fact that in the known method for predicting the outcome of ischemic brain damage by examining cerebrospinal fluid, graphical indicators of the temperature dependence of the electrical impedance of the cerebrospinal fluid are obtained and studied in the presence of a curve that has a gentle shape with a phase transition temperature below 70 ° C, predict an unfavorable outcome of the disease, in the presence of a curve having a two-humped character, with a phase transition temperature in the range from 70 ° to 90 ° C, a severe, progressive course of the disease is predicted, and in the presence of a curve with pronounced peak-wave complexes, with a phase transition temperature above 90 ° C, a favorable outcome of the disease is predicted.

The method is as follows. The patient has a single cerebrospinal fluid sampling by lumbar puncture. Then examine the temperature dependence of the total electrical impedance of the measuring cell of the cerebrospinal fluid in the installation for determining the electrical parameters of the fluid developed in the Physicotechnical Institute. A.F. Ioffe (RF patent No. 220539, 2003). Using a syringe, 1.2 ml of cerebrospinal fluid is injected into the cuvette. An alternating voltage with a frequency in the range of 0.6-10 MHz and an amplitude of 80-1400 mV is supplied to the cuvette from the generator. The value of the reference resistance is set to 30-100 Ohms. On the recording device, graphs of the temperature dependence of the phase difference between the oscillations of the generator voltage and the voltage on the measuring cell are graphically recorded. The next step is the computer processing of the obtained data, which boils down to the decomposition of the obtained curves of the temperature dependence of the impedance into Gaussian. In the presence of a sloping curve with a phase transition temperature below 70 ° C, an unfavorable outcome of the disease is predicted. In the presence of a curve having a two-humped character, with a phase transition temperature ranging from 70 ° to 90 ° C, a severe, progressive course of the disease is predicted. In the presence of a curve with pronounced “peak-wave” complexes, with a phase transition temperature above 90 ° C, a favorable prognosis of the disease is predicted.

The proposed method for predicting the outcome of ischemic damage to the brain was developed at the State Research Institute of Chemical Physics named after A.L. Polenova and passed clinical trials during examination in 62 patients. The predictions obtained were confirmed by the clinical and neurological picture of diseases. We give examples - extracts from the medical history.

Example 1. Patient A., No. and / b-93-03. He has a history of hypertension for 10 years. 12/31/2002, speech disorders (elements of sensorimotor aphasia), asymmetry of the right half of the face appeared sharply against the background of increased blood pressure. In neurological status: clear consciousness, elements of sensorimotor aphasia, lack of function of the 7th nerve on the right in the central type, right-sided pyramidal symptoms. Examination of an oculist-angiosclerosis of the retinal vessels according to the hypertonic type. Signs of early atherosclerosis. According to TCD, a diffuse decrease in perfusion of cerebral arteries due to their hypotension. Diagnosis: Atherosclerosis of cerebral vessels. Hypertension 3. stroke in ischemic type in the pool of the left ICA from 12/31/02. According to the claimed method investigated the temperature dependence of the electrical impedance of the cerebrospinal fluid. The following indicators were obtained - phase transition temperature 97 ° C (more than 90 ° C), t2-75.17 ° C, dt2-29.42, t3-86 ° C, dt3-1.3, ht2 / t3-1.22 , st2 / t3-2.34, t3-t-13.5 (Fig. 1). Based on the study, a favorable prognosis was given, which is confirmed by the patient’s discharge in a satisfactory condition.

Example 2. Patient W., and / b No. 601-03. He suffered a head injury. Upon admission, the neurological status is presented: level of consciousness - stupor, tries to open his eyes to pain stimuli. Pupils D = C, pupil reaction to light is reduced, corneal reflexes are live, OCR +, divergent strabismus, independent swallowing, monoparesis of the right hand, increased muscle tone on the right by the pyramidal type in the right limbs, periosteal and tendon reflexes above the right, pathological stop signs more right, meningial symptoms. CT scan revealed acute epidural hematoma in the left parietal-temporal region. Surgical intervention: decompressive trepanation of the skull in the left parietal-temporal region, removal of the hematoma. In the control CT state, after removal of the epidural hematoma in the left parietal-temporal region, cerebral detritus prolapses into a trepanation defect by 20 mm, postischemic changes in the medial sections of the right occipital lobe. According to the claimed method, the temperature dependence of the electrical impedance of the liquor was determined, the graphical indicators were as follows: phase transition temperature 81 ° C (more than 70 ° C, less than 90 ° C), t2-47 ° C, dt2-24, t3-66 ° C, dt3-25.5, st2 / t3-0.62, ht2 / t3-1.3, t2-t3-19 (figure 2). Based on the study, a prognosis with severe progressive course was given. After the treatment, this patient showed a positive dynamics in cerebral symptoms, but the focal one remained in the form of speech disorders of right-sided hemiparesis of static ataxia.

Example 3. Patient U., 50 years old, and / b, No. 193-03. Delivered to the institute after receiving a head injury. Upon admission, neurological status is represented by a disturbance of consciousness - coma 2, pupils D = C, divergent strabismus, corneal reflexes and pupil reactions to light were absent, CCR is negative, extensities in the extremities were observed for pain stimuli, bilateral pathological stop reflexes, more pronounced on the left. On CT of the brain, the ventricular system is displaced from right to left by 20 mm, a cloak-like subdural hematoma of 122-18-80 cm (175 cm in volume) in the right frontotemporal-temporal region, small contusion foci in the basal parts of the right frontal lobe. Surgery was performed urgently - DKPT of the skull in the right parietal-temporal region, removal of the acute subdural hematoma. On the control CT scan, the displacement of the middle structures from right to left is 12 mm due to edema of the right hemisphere, ischemic changes in the right frontal and temporal lobe. Neurological status was maintained without significant dynamics. According to the claimed method, the temperature dependence of the electrical impedance of the cerebrospinal fluid is determined. The graphical indicators were as follows: phase transition temperature - 66.5 ° C (less than 70 ° C), t2-49.89 ° C, dt2-36.82, t3-73.84 ° C, dt3-12.07, st2 / t3-13.43, ht2 / t3-4.4, t2-t3-23.15 (Fig. 3). Based on the study, an unfavorable prognosis was given, which was confirmed fatal.

In none of the studies conducted, complications after lumbar puncture were observed.

Claims (1)

A method for predicting the outcome of ischemic damage to the brain by examining the cerebrospinal fluid, characterized in that graphical indicators of the temperature dependence of the electrical impedance of the cerebrospinal fluid are obtained and studied, and in the presence of a curve having a gentle shape with a phase transition temperature below 70 ° C, an unfavorable outcome of the disease is predicted in the presence of a curve having a two-humped character, with a phase transition temperature in the range from 70 to 90 ° C, a heavy, progressive flow is predicted e disease, and the presence of complexes with marked curve "peaks - wave", with the phase transition temperature above 90 ° C, predict favorable outcome.

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