Features of the Clinical Course and Prognosis of Severe Traumatic Brain Injury Outcomes

• Main Authors: Y. B. Vasilyeva, A. E. Talypov, M. V. Sinkin, S. S. Petrikov
• Format: Article
• Language: Russian
• Published: Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department 2020-01-01
• Series: Neotložnaâ Medicinskaâ Pomoŝʹ
• Subjects: severe traumatic brain injury; acute subdural hematoma; acute epidural hematoma; brain contusion; traumatic intracranial hemorrhage; neurological examination; glasgow coma scale; oculocephalic reflex
• Online Access: https://www.jnmp.ru/jour/article/view/749
• ISSN: 2223-9022; 2541-8017

BACKGROUND. Traumatic brain injury (TBI) is one of the most important contemporary health issues. According to the World Health Organization, TBI is one of three leading causes of death in the world. Despite the development and widespread use of neuroimaging tools and instrumental research methods, clinical diagnosis of TBI is preferred. It is especially relevant at the prehospital stage when it is impossible to use instrumental diagnostic methods.THE AIM OF THE STUDY. To determine the clinical course features and prognosis of treatment outcomes in patients with various types of traumatic brain damage.MATERIAL AND METHODS. We studied the results of examination and treatment of 100 victims with a severe head injury hospitalized during the first days after receiving an injury and undergoing treatment at the N.V. Sklifosovsky Research Institute in 2008–2017. Depending on the type of brain injury patients were divided into 3 groups: Group 1 — isolated hematoma (n=20), Group 2 — hematomas and injuries of the brain (n=40), Group 3 — injuries of the brain (n=40). All patients underwent neurological examination, CT scan of the brain upon admission and over time within 12 days after trauma. In 30 victims, intracranial pressure (ICP) was monitored.RESULTS. We revealed features of the dynamics of individual neurological symptoms in patients with different types of brain damage. In patients with isolated hematomas, neurological status was represented mainly with clinic dislocation syndrome and contralateral hematoma hemiparesis, and clinical pattern significantly depended on intracranial hemorrhage. In patients with combination of hematomas and contusions, the neurological status and its dynamics were less dependent on the volume of the hematoma and were mainly determined by contusions of the midline structures of the brain. In patients with brain injuries, neurological status reliably correlated with injuries of midline structures.CONCLUSION. We revealed significant differences in neurological status, its changes over time and correlation with CT findings in patients with different types of traumatic brain injury.Authors declare lack of the conflicts of interests.