RU2737490C1 - Method for predicting the risk of developing morphological changes of brain in the full-term newborns with perinatal hypoxic-ischemic involvement of the nervous system - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and can be used in pediatrics, neurology, neonatology and can be used for prediction of risk of developing morphological brain changes in full-term newborns with perinatal hypoxic-ischemic involvement of the nervous system. There are clinical and neurosonographic manifestations of cerebral ischemia. In children with severe manifestations of hypoxic-ischemic brain injury on 2-10th day of life, magnetic resonance imaging (MRI) is performed in the mode of diffusion-weighted images. An average value of the measured diffusion coefficient (AVMDC) of the gray matter of the frontal lobe bark and lenticular nuclei of both hemispheres is determined, AVMDC of white substance of brain at level of front and rear horns of side ventricles, bodies of side ventricles of both hemispheres. In AVMDC of gray matter of brain from 0.96×10^-3 to 1.09×10^-3 mm²/s, white substance of brain from 1.14×10^-3 to 1.35×10^-3 mm²/s is predicted development of bark necrosis, subcortical structures of cerebral hemispheres with incomplete destruction of nerve tissue manifested by reduced volume of brain parenchyma, expansion of subarachnoid space. With AVMDC of gray matter of brain from 0.57×10^-3 to 0.95×10^-3 mm²/s, white matter of brain from 0.60×10^-3 to 1.11×10^-3 mm²/s is used to predict development of multi-cystic transformation of brain nerve tissue.

EFFECT: method provides predicting a risk of developing morphological brain changes in full-term newborns with perinatal hypoxic-ischemic involvement of the nervous system by determining the AVMDC of gray and white brain substance.

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Description

The proposed invention relates to medicine and can be used in pediatrics, neurology, neonatology to determine the severity of cerebral ischemia and predict morphological changes in the nervous tissue in newborns with hypoxic-ischemic brain damage.

Perinatal hypoxia is one of the main causes of disorders in the further neuropsychic development of the child, the occurrence of serious disabling conditions, which have a predominantly delayed nature of clinical manifestations. In this regard, assessment of the state of the brain structures and cerebral circulation is of particular importance in young children.

Diffusion-weighted magnetic resonance imaging (MRI) is the most objective method for examining the nervous tissue in ischemic cerebral circulation disorders. Interpretation of changes in diffusion processes on diffusion-weighted images (DWI) is of paramount importance for the diagnosis of hypoxic-ischemic lesions of cerebral structures in newborns. Quantitative assessment of diffusion processes is carried out using the measured diffusion coefficient (MDC), which characterizes the diffusion of water molecules in biological tissues at the cellular level. Pathophysiological processes such as hypoxia and ischemia lead to membrane depolarization, impaired membrane permeability, changes in ion exchange and the flow of water into cells. Swelling of cells entails compression of the extracellular space and restriction of the diffusion of extracellular fluid (ischemia), manifested by low values of ICD [Karelskaya NA, Karmazanovsky GG, 2010; Westbrook K., 2018]. A quantitative assessment of the pathophysiological processes during MRI in the DWI mode makes it possible to objectively assess the morphological changes in the nervous tissue at the cellular level. One of the features of MRI is obtaining an image of tissue sections based on measuring the intrinsic signal of these tissues, which contributes to the high information content and reliability of the obtained clinical and diagnostic data.

A known method for predicting morphological changes in the brain in newborns with perinatal hypoxic damage to the central nervous system (CNS) by the level of neurospecific proteins in the blood serum, determined as a result of enzyme immunoassay [Golosnaya GS, Yakovleva AV, Zaplatnikov A.L. , Machevskaya O.E., Trepilets S.V., Dyakonova E.N., Shnitkova E.V., Zolnikova I.V. The diagnostic value of the level of trophic factors in newborns with perinatal hypoxic damage to the central nervous system. Pediatrics. 2017; 96 (1): 15-22. Golosnaya G.S. Neurochemical aspects of the pathogenesis of hypoxic lesions in newborns. M .: MEDPRAKTIKA-M, 2009, p. 128. Morgun A.V., Ovcharenko N.V., Taranushenko T.E., Ustinova S.I., Okuneva O.S., Antonova S.K., Gilyazova D.F., Uspenskaya O.A., Salmina A.B. Apoptosis markers and neurospecific proteins in the diagnosis of perinatal lesions of the central nervous system in newborns. Siberian Medical Review. 2013; 3: 3-11]. In a newborn, venous blood is taken in a volume of 0.3-1.0 ml from the umbilical vein at the birth of a child, and in subsequent periods from central and peripheral venous catheters. The serum obtained by centrifugation is used to determine the level of neurospecific proteins (brain neurotrophic factor BDNF, ciliary neurotrophic factor CNTF, vasculoendothelial factor VEGF, astrocytic glial protein S100β, activity of cell adhesion molecules ALCAM, marker of apoptosis DK5, etc.). Pathological changes in the balance of neuroprotective factors make it possible to determine the prognosis of morphological changes in the brain (periventricular leukomalacia, intraventricular hemorrhage, combined pathology) with hypoxic lesions of the central nervous system. The disadvantage of this method is the inconsistency of the levels of normative indicators of neurospecific proteins in newborns in various sources. Repeated studies of the level of neuroprotective factors in the neonatal period did not determine the standard indicators for each study period (1-2 days, 5-7 days, 12-14 days, 24-28 days of a child's life). In various publications, conflicting data are noted in the quantitative determination of neurospecific proteins in newborns with hypoxic brain damage. The literature provides insufficient information on a comprehensive study of markers of perinatal CNS damage.

The prognostic criterion of the severity of structural changes in the brain tissue of the periventricular and subcortical regions, intraventricular hemorrhage in newborns is the level of neuron-specific enolase, a marker of astroglial cells, determined once on 6-24 days of life [Taranushenko TE, Okuneva OS, Demyanova I. M., Salmina A.B., Malinovskaya N.A., Sharoglazova L.A., Kritskaya I.Y., Morgun A.V. The levels of neuronal and glial proteins in the blood of newborns with cerebral ischemia. Pediatrics. 2010; 89 (1).] A single determination of the level of markers of brain damage over a long period (6-24 days of a child's life) is not informative, since the damaged nerve tissue during this period undergoes dynamic changes, which is reflected in the level of neurospecific proteins and requires repeated research.

Especially a lot of publications are devoted to the study of neurospecific protein of astrocytic glia S100β, reflecting destructive changes in tissues [Akramova Kh.A. Neurospecific protein S100β in the prognosis of disorders of the early neonatal period in newborns. Educatio. 2015, No. 3 (10), p. 62-64.]. Studies show the role of the level of neurospecific protein S100β in predicting severe brain damage in children born with asphyxiation. One of the significant drawbacks that complicate the diagnosis is an increase in the level of the S100β protein, not only in hypoxic lesions, but also in intrauterine infection, neuroinfection.

For the closest analogue adopted a method providing for the clinical and neurosonographic determination of the manifestations of perinatal hypoxic-ischemic brain damage in newborns [Volodin N.N. Neonatology. National leadership. M: GEOTAR-Media, 2019: 896]. Clinical manifestations in II degree cerebral ischemia: excitement and / or depression of the central nervous system, muscle hypotension with a decrease in spontaneous motor activity, hyporeflexia, eye symptoms, seizures (more often multifocal clonic seizures, opercular paroxysms, less often tonic-clonic seizures), intracranial hypertension visceral disorders. According to neurosonography, an increase in the echogenicity of the brain tissue (ischemia) periventricular or subcortical, subependymal hemorrhage is revealed. Grade III cerebral ischemia is characterized by a progressive loss of cerebral activity for more than 10 days (deep depression or coma), convulsions, dysfunction of the brainstem, decortication, decerebration, progressive intracranial hypertension, vegetative-visceral disorders of the cardiovascular and respiratory systems, gastrointestinal intestinal tract, kidneys. According to neurosonography, an increase in the echogenicity of the brain tissue (ischemia) is detected periventricular or diffusely, intracranial hemorrhages, cystic encephalomalacia are determined. The consequences of cerebral ischemia-hypoxia of II-III degree are organic forms of mental development disorders, forming or formed infantile cerebral palsy (CP), symptomatic epilepsy.

The method has the following disadvantages: with the same severity of brain damage in the clinical picture (suppression of unconditioned neuro-reflex activity, muscle hypotonia) and according to neurosonography in newborns, various morphological changes in the nervous tissue and, accordingly, different neurological outcomes may be observed in the future , including lethal; when neurosonography is performed in a child at 1-2 weeks of age, even with severe hypoxic-ischemic brain damage, structural changes are not visualized (there are no cysts, expansion of CSF spaces).

The objective of the invention is to improve the accuracy of determining the damaging effect of hypoxia on the brain structures of the newborn for the reliability of predicting subsequent morphological changes in the brain, which is especially important for the timely selection of a set of therapeutic measures that improve the further neurological development of the child.

The essence of the invention is that in full-term newborns with severe manifestations of hypoxic-ischemic brain damage on days 2-10 of life, magnetic resonance imaging (MRI) is carried out in the mode of diffusion-weighted images, the average value of the measured diffusion coefficient (SZIKD) of gray matter is determined cortex of the frontal lobes and lenticular nuclei of both hemispheres, SZIKD of the white matter of the brain at the level of the anterior and posterior horns of the lateral ventricles, bodies of the lateral ventricles of both hemispheres and, subject to the detection of SZIKD of the gray matter of the brain from 0.96 × 10 ^-3 mm ² / sec to 1.09 × 10 ^-3 mm ² / sec, white matter of the brain from 1.14 × 10 ^-3 mm ² / sec to 1.35 × 10 ^-3 mm ² / sec predict the development of necrosis of the cortex, subcorical structures of the cerebral hemispheres brain with incomplete destruction of nervous tissue, manifested by a decrease in the volume of the brain parenchyma, expansion of the subarachnoid space; subject to the detection of SZIKD of gray matter of the brain from 0.57 × 10 ^-3 mm ² / sec to 0.95 × 10 ^-3 mm ² / sec, white matter of the brain from 0.60 × 10 ^-3 mm ² / sec to 1.11 × 10 ^-3 mm ² / sec predict the development of multicystic transformation of the nervous tissue of the brain.

EFFECT: identification during magnetic resonance imaging of additional indicators of the state of gray and white matter of the brain (SZIKD) in newborns with perinatal hypoxic-ischemic lesion of the nervous system, which allows at an early stage to predict subsequent morphological changes in the brain for the timely development of rehabilitation measures that reduce severity of neurological deficits that improve the quality of life of the child.

The proposed method was tested on the basis of the regional perinatal center of the state budgetary health care institution "Children's Regional Clinical Hospital" in 2012-2017. The study was carried out in 64 full-term newborns (gestational age 38-42 weeks) with severe perinatal hypoxic-ischemic brain damage, which subsequently manifested itself as psychoverbal developmental disorders (CPRD), cerebral palsy, symptomatic epilepsy, and death - in 9 children at 1-2 months life. The exclusion criteria from the study were toxic-septic conditions, respiratory distress syndrome, endocrine and genetic diseases, congenital malformations, hemolytic disease of the newborn.

The method is carried out as follows: a clinical and neurological examination of a newborn with perinatal hypoxic-ischemic brain damage is performed, then, during the first day of the child's life, neurosonography is performed to determine the structural pathology (intracranial hemorrhage, changes in the echogenicity of the brain tissue, anomalies in the development of the brain) and upon detection in a newborn with severe manifestations of cerebral ischemia, an MRI of the brain is performed on days 2-10 of a child's life to quantitatively assess hypoxic-ischemic damage. In the DWI mode, parametric diffusion maps are built, then in the axial plane, measurements of the ICD of the gray matter of the brain are made in the lenticular nuclei and in the cortex of the frontal lobes of both hemispheres. Measurements of the ICD of white matter are performed at the level of the anterior and posterior horns of the lateral ventricles, the bodies of the lateral ventricles of both cerebral hemispheres. By summing up the results of measuring the CDI in the lenticular nuclei and in the cortex of the frontal lobes of both hemispheres and dividing it by the number of measurement zones, the SZIKD of the gray matter of the studied areas of the brain is determined. Summing up the results of measuring the ICD at the level of the anterior and posterior horns of the lateral ventricles, the bodies of the lateral ventricles of both hemispheres and dividing by the number of measurement zones, the SZIKD of the white matter is determined. Further morphological changes in the brain are predicted by the ADI value (Table 1).

Anesthetic treatment is carried out using sevrflurane (sevoran) for inhalation anesthesia while maintaining adequate breathing and cardiac activity in newborns during the study. The safety of the study is ensured by monitoring the heart rate, respiration rate, blood pressure, and oxygen saturation.

Examples of application of the method.

Example 1. Child A. was born on 03/15/13 from II pregnancy (I pregnancy - miscarriage 6-7 weeks, II pregnancy - real), proceeding against the background of polycystic ovary, the threat of termination at 7-8 weeks, yeast colpitis. Mothers 25 years old, delivery I urgent at 40 weeks, weakness of labor, acute intrapartum fetal hypoxia, the application of obstetric forceps. Birth weight - 3700 g, height - 54 cm.Evaluation on the Apgar scale 3-4 points. Resuscitation measures in the delivery room: sanitation of upper respiratory tract, intubation, artificial lung ventilation (ALV). According to the severity of the condition, the child was transferred to the intensive care unit for further treatment and nursing. Apparatus mechanical ventilation 03/15/13 - 03/19/13, in the neurological status manifestations of cerebral depression, convulsive syndrome.

Neurosonography from 15.03.13 - periventricular ischemia. Diagnosis: cerebral ischemia II-III degree. On the 12th day, he was transferred to the Department of Pathology of Newborn Children (AMP). When performing MRI from 03/22/13, in the DWI mode, a focal increase in signal characteristics in the temporo-occipital region of the right hemisphere 12 × 10 mm was noted - ischemia zone, expansion of the external cerebrospinal fluid space, intergirdle spaces are not sharply deepened and locally expanded, the ICD values of gray matter are determined of the brain: cortex of the frontal lobe R - 1.09 × 10 ^-3 mm ² / sec, L - 1.12 × 10 ^-3 mm ² / sec, lenticular nuclei R - 1.06 × 10 ^-3 mm ² / sec, L - 1.08 × 10 ^-3 mm ² / sec. ICD of the white matter of the brain: in the anterior horns of the lateral ventricles R - 1.35 × 10 ^-3 mm ² / sec, L - 1.39 × 10 ^-3 mm ² / sec, in the posterior horns of the lateral ventricles R - 1.38 × 10 ^-3 mm ² / sec, L - 1.34 × 10 ^-3 mm ² / sec, at the level of the lateral ventricle bodies R - 1.31 × 10 ^-3 mm ² / sec, L - 1.32 × 10 ^-3 mm ² / sec. SZIKD of gray matter: (1.09 + 1.12 + 1.06 + 1.08): 4 = 1.09 × 10 ^-3 mm ² / sec. SZIKD of white matter: (1.35 + 1.39 + 1.38 + 1.34 + 1.31 + 1.32): 6 = 1.35 × 10 ^-3 mm ² / sec. The child was discharged home on the 29th day. According to the data of the NSG performed before discharge: expansion of the cerebrospinal fluid spaces - the interhemispheric fissure, the subarachnoid space, the formation of a cavity in the temporo-occipital region of the right hemisphere. Examination by a neurosurgeon: there are no signs of intracranial hypertension, replacement expansion of cerebrospinal fluid spaces, surgical treatment is not indicated. Up to a year he received courses of treatment (nootropic, vascular, metabolic drugs). When examining a child at the age of 12 months, the diagnosis was made: Syndrome of hyperactivity, affective-respiratory paroxysms. NPRD. Delayed motor development.

Example 2. Child F. was born on 08/10/12 from I pregnancy, which proceeded against the background of early toxicosis from 6-7 weeks, the threat of interruption at 10-11 weeks. Mothers 28 years old, delivery I urgent at 39 weeks, tight umbilical cord entanglement around the neck, short umbilical cord, acute intrapartum fetal hypoxia. Birth weight - 3300 g, height - 51 cm.Evaluation on the Apgar scale 2-4 points. Resuscitation measures in the delivery room: sanitation of the upper respiratory tract, tracheal intubation, mechanical ventilation with oxygen supply, chest compressions, adrenaline administration. Apparatus mechanical ventilation 08/10/12 - 08/16/12, in the neurological status manifestations of cerebral depression, convulsive syndrome. Neurosonography from 08/10/12 - periventricular ischemia. Diagnosis: cerebral ischemia II-III degree. On the 17th day he was transferred from RO to OPND. When performing MRI on 08/14/12 in the DWI mode, the ICD values of the gray matter of the brain were determined: the cortex of the frontal lobe R - 1.00 × 10 ^-3 mm ² / sec, L - 1.02 × 10 ^-3 mm ² / sec, lenticular nuclei R - 0.91 × 10 ^-3 mm ² / sec, L - 0.90 × 10 ^-3 mm ² / sec. ICD of the white matter of the brain: in the anterior horns of the lateral ventricles R - 1.17 × 10 ^-3 mm ² / sec, L - 1.13 × 10 ^-3 mm ² / sec, in the posterior horns of the lateral ventricles R - 1.15 × 10 ^-3 mm ² / sec, L - 1.14 × 10 ^-3 mm ² / sec, at the level of the lateral ventricle bodies R - 1.13 × 10 ^-3 mm ² / sec, L - 1.14 × 10 ^-3 mm ² / sec. SZIKD of gray matter: (1.00 + 1.02 + 0.91 + 0.90): 4 = 0.96 × 10 ^-3 mm ² / sec. SZIKD of white matter: (1.17 + 1.13 + 1.15 + 1.14 + 1.13 + 1.14): 6 = 1.14 × 10 ^-3 mm ² / sec. The child was gradually transferred from tube feeding to feeding from the bottle, and was discharged home on the 38th day of life. According to the NSG, at discharge from the hospital, an expansion of the cerebrospinal fluid was revealed - the interhemispheric fissure, the subarachnoid space, dilatation of the lateral ventricles up to 11 mm (cortical-subcortical atrophy). Examination by a neurosurgeon: atrophic changes in the cerebral hemispheres, there are no indications for neurosurgical treatment. Up to a year he received courses of treatment (nootropic, vascular, metabolic drugs), the dose of anticonvulsants was adjusted in a hospital setting. When examining a child at the age of 12 months, the diagnosis was made: Organic lesion of the central nervous system, secondary microcephaly, cerebral palsy, spastic-hyperkinetic form. Н11РР. Symptomatic epilepsy.

Example 3. Child N. was born on April 15, 2013 from I pregnancy, which proceeded against the background of the threat of termination at 13-14 weeks, mild gestosis, and chronic placental insufficiency. Mothers 25 years old, delivery I urgent at 40 weeks, premature rupture of amniotic fluid, weakness of labor, acute intrapartum fetal hypoxia, vacuum extraction for deterioration of the fetus, tight entanglement of the umbilical cord around the neck. Birth weight - 3700 g, height - 53 cm.Evaluation on the Apgar scale 3-4 points. Resuscitation measures in the delivery room: sanitation of the upper respiratory tract, tracheal intubation, mechanical ventilation with oxygen supply. Diagnosis: cerebral ischemia II-III degree. According to the severity of the condition, the child was transferred to the RC for further treatment and nursing. Apparatus mechanical ventilation 04/15/13 - 04/20/13, in the neurological status of the manifestation of cerebral depression, convulsive syndrome. Neurosonography from 15.04.13 - diffuse changes in the brain parenchyma of hypoxic-ischemic genesis. On the 15th day, he was transferred to the OPND. When MRI was performed on April 20, 2013 in DWI mode, a diffuse increase in signal characteristics in the structures of the cerebral hemispheres was noted, the values of the ICD of the gray matter of the brain were determined: frontal lobe cortex R - 0.96 × 10 ^-3 mm ² / sec, L - 0, 98 × 10 ^-3 mm ² / sec, lenticular nuclei R - 0.91 × 10 ^-3 mm ² / sec, L - 0.94 × 10 ^-3 mm ² / sec. ICD of the white matter of the brain: in the anterior horns of the lateral ventricles R - 1.12 × 10 ^-3 mm ² / sec, L - 1.11 × 10 ^-3 mm ² / sec, in the posterior horns of the lateral ventricles R - 1.10 × 10 ^-3 mm ² / sec, L - 1.12 × 10 ^-3 mm ² / sec, at the level of the lateral ventricle bodies R - 1.11 × 10 ^-3 mm ² / sec, L - 1.09 × 10 ^-3 mm ² / sec. SZIKD of gray matter: (0.96 + 0.98 + 0.91 + 0.94): 4 = 0.95 × 10 ^-3 mm ² / sec. SZIKD of white matter: (1.12 + 1.11 + 1.10 + 1.12 + 1.11 + 1.09): 6 = 1.11 × 10 ^-3 mm ² / sec. Neurosonography from 05/11/13 - multicystic encephalomalacia of both hemispheres of the brain. On the 31st day, the child was transferred to the pediatric department for further treatment for microaspiration syndrome due to pseudobulbar disorders, selection of anticonvulsants. When examining a child at the age of 12 months, the diagnosis was made: Organic lesion of the central nervous system, multicystic encephalomalacia, secondary microcephaly, pseudobulbar syndrome, cerebral palsy, spastic tetraparesis. NPRD. Symptomatic epilepsy.

Example 4. Child Ch. Was born on 25.03.14 from I pregnancy, which proceeded against the background of ARVI at 10-11 weeks, threats of termination at 18-19 weeks. Mothers 27 years old, delivery I urgent at 38 weeks by emergency caesarean section. Detachment of the normally located placenta, critical condition of the fetus. Birth weight - 3000 g, height - 50 cm.Evaluation on the Apgar scale 1-3 points. Resuscitation measures in the delivery room: sanitation of the upper respiratory tract, tracheal intubation, mechanical ventilation with oxygen supply, chest compressions, endotracheal and intravenous adrenaline. In the neurological status, pronounced depression of the central nervous system with the development of cerebral coma, convulsive syndrome. Hardware mechanical ventilation 03/25/14 - 04/21/14, Neurosonography from 03/25/14 - diffuse changes in the brain parenchyma of hypoxic-ischemic genesis. When MRI was performed on March 29, 2012 in DWI mode, there was a diffuse increase in signal characteristics, lack of differentiation between the gray and white matter of the cerebral hemispheres as a result of cytotoxic edema, ischemic foci in the thalamus, stem structures, the ICD values of the gray matter of the brain were determined: frontal lobe cortex R - 0.61 × 10 ^-3 mm ² / sec, L - 0.59 × 10 ^-3 mm ² / sec, lenticular nuclei R - 0.55 × 10 ^-3 mm ² / sec, L - 0.54 × 10 ^-3 mm ² / sec. ICD of the white matter of the brain: in the anterior horns of the lateral ventricles R - 0.65 × 10 ^-3 mm ² / sec, L - 0.60 × 10 ^-3 mm ² / sec, in the posterior horns of the lateral ventricles R - 0.61 × 10 ^-3 mm ² / sec, L - 0.63 × 10 ^-3 mm ² / sec, at the level of the lateral ventricle bodies R - 0.57 × 10 ^-3 mm ² / sec, L - 0.56 × 10 ^-3 mm ² / sec. SZIKD of gray matter: (0.61 + 0.59 + 0.55 + 0.54): 4 = 0.57 × 10 ^-3 mm ² / sec. SZIKD of white matter: (0.65 + 0.60 + 0.61 + 0.63 + 0.57 + 0.56): 6 = 0.60 × 10 ^-3 mm ² / sec. Neurosonography from 04/19/14 - multicystic encephalomalacia of both hemispheres of the brain. Diagnosis: Perinatal hypoxic-ischemic brain damage resulting in total encephalomalacia. Brain coma. Lethal outcome 04/21/14

The use of the method made it possible at the early stages to identify in newborns indicators of ICD, reflecting the severity of structural changes in the brain, which is especially important for the timely implementation of rehabilitation measures corresponding to damage to the nervous tissue. Improving the indicators of muscle tone and reflex activity, reducing the manifestations of spasticity made it possible to reduce the severity of neurological deficit, to improve the quality of life of the child.

Claims (1)

A method for predicting the risk of developing morphological changes in the brain in full-term newborns with perinatal hypoxic-ischemic damage to the nervous system, including the identification of clinical and neurosonographic manifestations of cerebral ischemia, characterized in that children with severe manifestations of hypoxic-ischemic brain damage on days 2-10 of life carry out magnetic resonance imaging (MRI) in the mode of diffusion-weighted images, determine the average value of the measured diffusion coefficient (SZIKD) of the gray matter of the cortex of the frontal lobes and lenticular nuclei of both hemispheres, SZIKD of the white matter of the brain at the level of the anterior and posterior horns of the lateral ventricles, bodies of the lateral ventricles of both hemispheres and subject to the detection of SZIKD of the gray matter of the brain from 0.96 × 10 ^-3 to 1.09 × 10 ^-3 mm ² / s, of the white matter of the brain from 1.14 × 10 ^-3 to 1.35 × 10 ^-3 mm ² / s predict the development of necrosis of the cortex, subcorical structures of the cerebral hemispheres iy of the brain with incomplete destruction of nervous tissue, manifested by a decrease in the volume of the brain parenchyma, expansion of the subarachnoid space; subject to the detection of SZIKD gray matter of the brain from 0.57 × 10 ^-3 to 0.95 × 10 ^-3 mm ² / s, white matter of the brain from 0.60 × 10 ^-3 to 1.11 × 10 ^-3 mm ² / s predict the development of multicystic transformation of the nervous tissue of the brain.