RU2533026C1 - Method for prediction of brain stem functional recovery accompanying axial dislocation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: brain imaging is performed. The maximum range of the cerebellar tonsil penetration into the great foramen is determined in a sagittal plane. Each 3 mm of the penetration is appraised as 1 point. That is followed by measuring the brain stem auditory evoked response and assessing: unilateral latency increase - 1 point, unilateral PQ interval increase - 1 point, bilateral latency increase - 2 points, bilateral PQ interval increase - 2 points. The derived points are summed. If the total score is through 7 points, the prediction is considered to be favourable for the brain stem functional recovery, and the total score of 8 points and more shows the unfavourable prognosis.

EFFECT: method enables providing the more reliable prediction ensured by the integral assessment of the morphological and functional changes accompanying the axial dislocation of the brainstem.

Description

The invention relates to medicine, namely to neurosurgery, neurology and radiation diagnostics, and can be used to predict restoration of brain stem function during axial dislocation in case of traumatic brain injury and diseases of the brain.

A known method for predicting the restoration of brain stem function during axial dislocation (RF patent No. 2276364, published May 10, 2006). When analyzing heparinized venous peripheral blood, which is centrifuged, surface lymphocyte receptors are examined by indirect immunofluorescence using monoclonal antibodies of the ICO series. If the relative content of CD3 + cells is lower than 30%, CD4 + cells are lower than 12.5%, and CD95 + cells are lower than 7.7%, then the prediction of dislocation is assessed as unfavorable for restoration of brain stem function and life. The disadvantages of the method are an indirect judgment on the prognosis of the restoration of the function of the brain stem during axial dislocation.

A known method for predicting the restoration of brain stem function (RF patent No. 2433782, published November 20, 2011), adopted as a prototype. Conducted computed tomography of the brain. Measure the distance between the lateral sections of the anterior horns of the lateral ventricles and the maximum distance between the inner plates of the bones of the skull at this level; the width of the lateral ventricles at the level of the heads of the caudate nuclei and the maximum distance between the inner plates of the bones of the skull at this level; and the width of the third ventricle and the maximum distance between the inner plates of the bones of the skull at this level. Then calculate the ventriculo-cranial indices: FRI 1 of the anterior horns of the lateral ventricles, FRI of 2 lateral ventricles at the level of the heads of the caudate nuclei, FRI 3 of the III ventricle according to the above formulas. After that, calculate the coefficient of hypertension (KG) according to the formula:

where VKib are the ventriculo-cranial indices of the patient, VKin are the age norms of the ventriculo-cranial indices for a given individual. With a CG value from -1 to -3, the prognosis is considered alarming, the dislocation syndrome is moderate, in the decompensation phase, intensive therapy is required, the prognosis for restoring the function of the brain stem is favorable. When the CG value is less than -3, the dislocation syndrome is considered pronounced, urgent surgical intervention is indicated, the prognosis for restoring the function of the brain stem can be either favorable or unfavorable.

However, the prototype does not accurately predict the restoration of brain stem function during axial dislocation.

The invention is aimed at creating a method for predicting the restoration of brain stem function during axial dislocation, which improves the accuracy of the assessment.

The specified technical result in the implementation of the invention is achieved by the fact that in the method for predicting the restoration of brain stem function during axial dislocation, including brain tomography and analysis of the results, the feature is that in the sagittal plane determine the maximum depth of penetration of the cerebellar tonsils into the large occipital hole, every 3 mm of insertion is assessed at 1 point, then short-latency auditory evoked potentials are measured, estimated they have a one-sided increase in latency by 1 point, a one-sided increase in inter-peak intervals - by 1 point, a two-sided increase in latency - by 2 points, a two-way increase in inter-peak intervals - by 2 points, summarize the points obtained, with a sum of up to 7 points inclusive the forecast is considered favorable for restoration of function brain stem, from 8 points and above - unfavorable for restoration of brain stem function and life.

The method is as follows. Patients with severe traumatic brain injury or brain diseases accompanied by axial dislocation of the brain undergo computed spiral and / or magnetic resonance imaging. In the sagittal plane, the maximum penetration depth of the cerebellar tonsils into the large occipital foramen is determined, each millimeter of the insertion is estimated at 1 point. Then, short-latency stem auditory evoked potentials are measured, a one-sided increase in latency is estimated at 1 point, a one-sided increase in peak-to-peak intervals is 1 point, a two-sided increase in latency is 2 points, a two-sided increase in peak intervals is 2 points. The scores are summarized, with a total of up to 7 points inclusive, the prognosis is considered favorable for restoring the function of the brain stem, from 8 points and above - unfavorable for restoring the function of the brain stem and life.

The claimed method for predicting the restoration of the function of the brain stem during axial dislocation was developed at the Russian National Research Chemical Institute. prof. A.L. Polenova underwent clinical trials in the treatment of 57 patients with severe traumatic brain injury and brain tumors, who, as a result of the examination, reliably predicted restoration of brain stem function during axial dislocation.

We give clinical examples - extracts from the medical history.

Example 1. Patient B., 37 years old, East. disease number 866, was admitted to the PHI them. prof. A.L. Polenova in a planned manner with complaints of headaches, decreased vision in both eyes, staggering when walking. Sick for about 2 months. Consciousness is not broken, oriented correctly, the movement of the eyeballs in full. Coordination tests are performed uncertainly, adiadokhokinez, in the Romberg position is unstable. Symptom of Babinsky on the left. There are dislocation symptoms in the form of paresis of the gaze upward and paresis of convergence, decreased corneal reflexes, dissociation of muscle tone along the longitudinal axis of the body. A comprehensive examination was carried out, with magnetic resonance imaging in the projection of the notch of the cerebellum on the left, a solid volume formation is determined, spreading sub- and supratentorially, with clear contours, sizes 62 × 53 × 55 mm, there are signs of axial dislocation. The penetration depth of the cerebellar tonsils into the large occipital foramen was determined, which was 13 mm, the penetration depth was estimated at 4 points. Short-latency stem auditory evoked potentials were measured, a one-sided increase in latency was found, which was rated at 1 point, and a one-sided increase in peak-to-peak intervals, which was rated at 1 point. The total score was 6, the prognosis is favorable for the restoration of brain stem function.

Diagnosis: meningioma of the tenderloin on the left cerebellum with axial dislocation and a favorable prognosis for restoration of brain stem function.

Surgery was performed in an accelerated manner - osteoplastic trepanation of the skull, total removal of meningiomas from combined supra- and subtentorial access, degree of radicalism Simpson I. Histological examination: atypical meningioma with increased proliferative activity, degree of anaplasia II, IBA 5-8%. The postoperative period without complications. Within 4 days after surgery, dislocation symptoms regressed. The wound healed by primary intention. Discharged on the 12th day under the supervision of a neurologist at the place of residence.

In the presented observation, a patient with a short history revealed a large tumor, which caused axial dislocation of the brain. Based on the proposed method, the prognosis of axial dislocation is assessed as favorable for the restoration of brain stem function, which was clinically noted for 4 days after surgery.

Example 2. Patient N., 18 years old, East. Disease No. 2782, was admitted to the Russian National Pedagogical Institute named after prof. A.L. Polenova was routinely transferred from the Mariinsky Hospital, where he was delivered on the eve of an ambulance with a diagnosis of a coma of unknown etiology. A comprehensive examination revealed data for a severe brain contusion. Upon admission, the condition is serious, compensated by vital functions, consciousness is impaired to a coma level (6 points on the Glasgow coma scale), the reaction to pain stimuli is uncoordinated, the pupils D = S, moderately dilated, no photoreaction, no oculocephalic reflex, no swallowing, deep reflexes D = S, low, dissociation of reflexes and muscle tone along the longitudinal axis of the body, Babinsky symptom on both sides. Spiral computed tomography revealed a fracture of the bones of the cranial vault, massive subarachnoid hemorrhage, foci of crushing of both frontal lobes, and there are signs of axial dislocation. The penetration depth of the cerebellar tonsils into the large occipital foramen was determined, which was 16 mm; the penetration depth was estimated at 5 points. Short-latency stem auditory evoked potentials were measured, a bilateral increase in latency, which was rated at 2 points, and a bilateral increase in peak-to-peak intervals, which was rated at 2 points, were detected. The total score was 9, the prognosis is unfavorable for the restoration of brain stem function and life.

Diagnosis: severe brain contusion with axial dislocation and poor prognosis for restoration of brain stem function and life.

In the intensive care unit, he was intubated, assisted ventilation was carried out, adequate conservative treatment was observed, against which deterioration was noted, hemodynamics instability, atony, areflexia, bilateral mydriasis were observed by 4 days, and respiratory and cardiac arrest stopped on the 5th day. Resuscitation measures did not bring effect, death was ascertained.

In the presented observation, the patient had a severe traumatic brain injury with the formation of centers of crushing of the brain, which caused axial dislocation of the brain. Based on the proposed method, the prognosis of axial dislocation is assessed as unfavorable for restoring the function of the brain stem and life.

Claims (1)

A method for predicting restoration of brain stem function during axial dislocation, including performing tomography of the brain and analysis of the results, characterized in that in the sagittal plane the maximum penetration depth of the cerebellar tonsils into the large occipital foramen is determined, every 3 mm of the wedge is assessed at 1 point, then measured short-latency stem auditory evoked potentials, estimate a one-sided increase in latency at 1 point, a one-sided increase in peak-to-peak intervals - by 1 point, bilateral increase in latency - by 2 points, bilateral increase in peak-to-peak intervals - by 2 points, summarize the obtained points, with a total of up to 7 points inclusive, the prognosis is considered favorable for restoration of brain stem function, from 8 points and above - unfavorable for restoration of brain stem function and life.