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16RELEVANT ASPECTS OF TRAUMATIC BRAIN INJURIES' PROBLEM MODERN STAGE
Nazarova Zhanna Abzalovna Tashkent Institute of Doctors Improvement Fayzullahuzhayev Khasankhon Jaloliddin ogli Turabbaev Mirzokhid Bakhodirovich Berdieva Kamola Akhatovna Juraev Bekhzod Eshmvurodovich Tashken t Medical Academy
Traumatic brain injuries remain leading cause of death for young men in developed countries. For survivors, this is often significant personal suffering, problems for the family and a significant increase in social costs for society. According to WHO injuries, along with cancer and cardiovascular diseases, are one of the three main causes of death in the world. The literature describes a variety of clinical and neurological manifestations developing in the remote post-traumatic period, which in some cases leads to the designation of similar conditions in different terms and creates diagnostic difficulties for practical neurologists.
Key word: traumatic brain injury (TBM), neurotraumatism, intracerebral hematoma, complications of craniocerebral trauma.
БОШ МИЯ ТРАВМАТИКЖАРОХАТИМУАММОСИНИНГЗАМОНАВИЙБОСЦИЧДАГИДОЛЗАРБ
ЖИХАТЛАРИ
Бош мия жарохати ривожланган давлатларда ёш эркаклар улим сабабларидан бири хисобланади. Бу эса уз навбатида жарохат олганларда депрессияга, оилавий, кундалик ва социал холатига хам таъсирини кузсатмай цолмайди. ЖССТ маълумотига кура, усма ва юрак-^он томир касалликларидан кейин, улимга олиб келувчи касалликлар орасида траваматизм учинчи уринада туради. Ма^олада амалий неврологлар учун ташхисда цийинчилик тугдирадиган бош мия жарохати кеч ривожланадиган асоратларининг турли клинико-неврологик куринишлари, ва ухшаш холатларнинг турли терминлар билан ифодаланганлиги келтирилган.
Калит сузлар: бош мия травматик жарохати (БМТЖ), нейротравма, интрацеребрал гематома, бош мия травмаси асоратлари.
АКТУАЛЬНЫЕ АСПЕКТЫ ПРОБЛЕМЫ ЧЕРЕПНО- МОЗГОВЫХ ТРАВМ НА СОВРЕМЕННОМ
ЭТАПЕ
Черепно-мозговые травмы остаются основной причиной смертности мужчин молодого возраста в развитых странах. Для выживших это часто значительные личные страдания, проблемы для семьи и существенный рост социальных затрат для общества. По данным ВОЗ — травматизм, наряду с раковыми и сердечно-сосудистыми заболеваниями, является одной из трёх основных причин смертности населения в мире. В литературе описаны разнообразные клинико-неврологические проявления развивающиеся в отдаленном посттравматическом периоде, что в ряде случаев приводит к обозначению различными терминами сходных состояний и создает диагностические трудности практическим неврологам.
Ключевые слова: черепно- мозговая травма (ЧМТ), нейротравма, внутримозговая гематома, осложнения черепно-мозговой травмы.
DOI: 10.24411/2181-0443/2020-10017
At the start of the XXI century one of the characteristic features is increasing of injuries among the population due to disasters caused by forces of nature, human technological activity and social epidemics in society. In the United States, approximately 95 out of 100,000 residents receive traumatic brain injuries annually severe enough to require hospitalization, or even fatal ones [8,11]. Neurotraumatism was even called Andrew I.R [8] a silent epidemic. In Germany, annual CNS injuries are approximately 10,000 [13]. In Western Europe, as well as in the USA, in recent years it has declined
somehow thanks to preventive measures as helmets, seat belts, air bags, and speed limits. Traumatic brain injuries remain the leading cause of death for young men in developed countries. For survivors, this is often significant personal suffering, problems for the family and a significant increase in social costs for society [12]. According to the WHO, injuries, along with cancer and cardiovascular diseases, are one of the three main causes of death in the world [11].
In the structure of traumatic brain injury (TBI), hematomas comprise from 2.0% to 16.6% [1, 5]. Before the appearance of computed tomography (CT), the treatment tactics regarding hematomas were unambiguous - the hematoma was removed at the earliest possible time after its detection.With the advent of CT and MRI, it became possible to determine the quantitative (size, volume) characteristics of the hematoma, the timing of its formation, localization, appearance, and also the degree of its effect on the brain [3]. It became possible to dynamically monitor the evolution of intracranial pathology in general and hematomas in particular [10]. With the advent of CT and MRI, it became possible to determine the quantitative (size, volume) characteristics of the hematoma, the timing of its formation, localization, appearance, and also the degree of its effect on the brain [3]. It became possible to dynamically monitor the evolution of intracranial pathology in general and hematomas in particular [10].).
The term "intracerebral hematoma" refers to a hemorrhage resulting from an injury located in the substance of the brain with the formation of a cavity filled with liquid blood or its bundles or blood with an admixture of brain detritus, the amount of which is significantly inferior to the amount of spilled blood, from 5 to 100 cm3 (less hemorrhage called point or petechial) [6]."Traumatic Intracranial Hematoma of the Brain"s larger than 100 cm3 are very rare. According to the literature, the frequency of intracerebral hematomas varies in a very wide range from 2 to 30% with respect to all traumatic intracranial hematomas [8,11]. According to some authors, operations for traumatic intracranial hematomas account for about 56% of all neurosurgical interventions for TBI, the average mortality rate is from 36.5 to 42.3% of all patients with Traumatic Intracranial Hematoma. Mortality in TIH is up to 30%. Interesting data are presented on mortality depending on the severity of the condition [10]. Upon admission, patients in a coma make up 70.3%, and those who enter in stupor or stunning 22.9%. Mortality with massive TIH (more than 100 ml) reaches 100%, although such cases are very rare.
Intracerebral hematomas occur in approximately 2% of all serious traumatic brain injuries, but at autopsy they are found in half of all fatal cases [94]. In the acute stage, changes caused by large hematomas are difficult to distinguish from the clinical consequences of a severe brain injury as such, but the clinical significance of intracerebral hematomas is more important when they cause subacute and delayed neurological disorders [4]. According to various authors, the incidence of localization of intracerebral hematomas varies significantly: 11% - 25% in the frontal lobe, 25% - 39% - temporal lobe, 20% - 40% - parietal, and 5%-9% - occipital [5.8]. When considering the combination of TIH with other lesions, it turns out that single hematomas are more often located in the frontal lobe (up to 50%). In 11% of cases, TIHs spread over two lobes; in 14% of cases, TIH break into the ventricles of the brain, in 23% they are combined with shell hematomas. Of the concomitant TIH of sheath hematomas, the subdural hematomas are most often encountered; their unilateral combination is determined in 50%. Epidural hematoma with the same frequency is located both on the side of TIH and on the opposite side [13]. An analysis of the literature on the long-term consequences of TIH showed that the problem of a high percentage of disability of persons of young and working age (35.7-55.2%), the average age of 40.4 years (group I invalids - 2.4-4, remains relevant). 6%, invalids of the II group - 26.2-33.5%, invalids of the III group - 7.1-10.4%) [2.14]. These data indicate the
extreme diversity of distant neurological manifestations of thyroid hypertrophy. Despite this diversity, changes in the form of diffuse microsymptomatics were most often detected, among which the first place was occupied by disorders of the craniocerebral innervation (69.9-81.5%) and autonomic nervous system dysfunction (71.6-84.3%) [ 2.14]. The literature describes a variety of clinical and neurological manifestations developing in the distant post-traumatic period, which in some cases leads to the designation of similar conditions in different terms and creates diagnostic difficulties for practical neurologists. In view of this, among the polymorphism of clinical manifestations, it is advisable to distinguish leading syndromes, the clinical manifestations of which are the main determining factors in the social and labor adaptation of patients: asthenic (34.6%), psychoorganic (19.8%), epileptic (16%), vegetative vascular (14.8%;), cortical-focal (6.2%), extrapyramidal (3.7%), vestibular (2.5%) and trephine syndrome (2.5%) [11]. According to the literature, the dependence of the formation of distant clinical and neurological syndromes on the nature of the course of traumatic intracranial hematomas and the level of clinical compensation (quantitative disturbances of consciousness) of the victims in the acute period is noted. When patients were admitted to the neurosurgical department (in the acute period of TIH) with quantitative impairment of consciousness to stupor and coma, the development of the psycho-organic syndrome dominated in the long-term period, and asthenic syndrome dominated before stunning. Psycho-organic syndrome is one of the most severe manifestations of the long-term effects of TIH; dominant in the clinical picture of which were intellectual-mnestic and emotional-volitional disorders [2]. In the vast majority of patients, both short-term and long-term memory was reduced, attention was superficial, torpid thinking, specific in form. There is a tendency to perseveration, a tendency to frequent changes in mood, inhibition of motor acts (speech, active movements). Patients were often not critical to their defect and actions. In neurological status, in addition to focal microsymptomatics, pronounced reflexes of oral automatism were noted in all sources.
According to various authors, epileptic syndrome is clinically manifested by generalized (25.3-53.8%) and partial (33.2-46.2%) seizures [2.8]. In approximately 31% of patients, a manifestation of partial epileptic seizures with a transition to generalized was noted. The interictal period was characterized by severe asthenoneurotic manifestations, diffuse headaches, mild mental-intellectual disorders, and focal neurological microsymptomatics. EEG recorded the diffuse distribution of pathological slow activity with the localization of paroxysmal discharges in a certain area of one of the hemispheres. The clinical picture of cortical-focal syndrome was determined by the localization and severity of structural changes in the brain and was manifested by focal symptoms of damage to the central nervous system, which are characterized by disabling defects (central paresis, aphasia, apraxia, etc.) up to 75%. According to the EEG data, the local nature of the pathological slow activity corresponded to the location of cerebral focal CT or MRI changes, however, most researchers note the non-specificity of these changes to confirm intracranial hematoma. Vegetative-vascular syndrome is most often described as instability of blood pressure, the vascular nature of headaches, severe vasomotor disorders, aggravated by various exogenous and endogenous factors, and sleep disturbances [9,11]. Extrapyramidal syndrome is represented by tremulous hyperkinesis, increased muscle tone by plastic type, difficulty in voluntary movements, oligo - and bradyknesia, acherokinesis and dissenergy. The vestibular syndrome was manifested by constant noise in the head, dizziness of a systemic nature, ataxia and the presence of horizontal nystagmus. The leading clinical manifestations of trephined syndrome consisted of the presence of a defect in the bones of the cranial vault, cerebral symptoms, local pain in the area of the defect, aggravated by changing weather and physical stress, focal
microsymptomatics. Asthenic syndrome was the easiest manifestation of the long-term effects of TIH. The clinical manifestations of which were periodic or constant headaches, general weakness, fatigue, irritability, increased exhaustion of attention and focal neurological microsymptomatics [1,11,14]. On the EEG, diffuse disorganization of the bioelectric activity of the brain was detected at a high (47.8%) and low (34.8%) amplitude level, or conditionally normal EEG (17.4%) was recorded [1]. .A study of structural brain disorders in patients with long-term consequences of traumatic extracorporeal infections showed that significantly significant computed tomographic changes were manifested in the form of external (up to 69%) and internal (up to 68.2%) diffuse or local hydrocephalus, focal CT changes (53 5) mild (15.5%), moderate (19%) and severe (19%) severity, manifested by the presence of isolated cystic cavities, porencephaly, local atrophic and scar adhesions [8].In all patients with cortical-focal syndrome, focal structural changes in the brain of moderate or severe severity (porencephalic cysts, gross scar adhesions and atrophic processes) were found, combined with asymmetric expansion of the ventricles of the brain, more pronounced on the side of the location of local CT changes [3]. Moreover, the localization of focal structural cerebral disorders has a complete topical correspondence to the clinical and neurological manifestations of this syndrome. In addition, all researchers noted a direct relationship between the characteristics of TIH (volume, localization, the degree of concomitant damage to brain matter) and the severity of clinical manifestations [2,3,11,14]. In the operated patients, indicators of quality of life in the long term are worse on average by 19% [5.11]. This is due to more severe damage to brain tissue and the traumatic nature of craniotomy. Thus, in the literature there is not enough information about the quality of life of patients with unremoved intracranial hematomas, some publications relate to the quality of life of operated patients with severe head injury, more often the total volume of traumatic substrate (hematomas along with foci of crushing) is taken into account.
Objectives: to analyze the features of the clinical course and diagnosis of severe traumatic brain injuries.
Conclusion: There is no single position in assessing the course of the long-term TBI depending on the duration of removal and the volume of hematomas, as well as the course of traumatic disease in non-operated patients with intracranial hematomas. The features of the course of severe head injury in the acute period and the immediate results are described in detail. The long-term results of surgical treatment of traumatic intracranial hematomas have not been sufficiently studied. Meanwhile, the regularities of the formation of long-term consequences after surgical treatment of traumatic intracranial hematomas depending on the age of the victims, the timing and nature of the surgical intervention in the acute period of the injury, the post-operative recovery therapy and its volume have been little studied to date.
The prospects for studying this important problem of neurotraumatology are of not only scientific, but also practical interest.
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