International Medical Journal, Vol. 23., Iss. 3, 2017, P. 74−77.
PATHOPHYSIOLOGICAL ASPECTS OF ACUTE CRANIOCEREBRAL TRAUMA AS A BASIS FOR DETERMINING THE CAPABILITIES OF BRAIN FUNCTION RESTORATION
Kharkiv Medical Academy of Postgraduate Education
Scientific and Practical Rehabilitation Center «Nodus», Brovary, Kyiv region, Ukraine
Today acute craniocerebral trauma is an important medical and social problem. The advances of modern neurosurgery, neurotraumatology and resuscitation make it possible to preserve the lives of such patients, but most often the inability to return the brain its function, i.e. to ensure mental activity. This is due to the fact that the patients are in a post−traumatic unconscious state: vegetative or a state of minimal manifestation of consciousness. A key role in restoring consciousness is played by behavioral reactions associated with the cerebral cortex, thalamus, ascending reticular formation. An important issue is the study of the mechanisms underlying the formation of long unconscious states. This may be imbalance between various neurotransmitter systems, disorders in the interaction of large neuronal connections of the anterior brain, middle spiny neurons, interactions between noradrenergic and dopamine brain systems, etc. It is known that restoration of consciousness is often not accompanied by a significant change in the level of general metabolic activity of the brain; in this case, reactivation of cortico−thalamocortical bonds is due to axonal sprouting, restitution of synaptic activity and neurogenesis within the framework of neuroplasticity. The most informative in determining the metabolic death of the brain are super threshold critical values of such biochemical parameters of the liquor and the venous blood flowing out of the brain as lactate and pyruvate, phenol with a sharp decrease in pH with the predominance of critical levels of these parameters in the liquor compared to the blood. Thus, the knowledge of the anatomical, physiological, pathophysiological, metabolic and neurotransmitter mechanisms forming the structural and functional integrity of the brain underlying all mental activity are very important for resuscitators, neurosurgeons, neurologists, rehabilitation therapists, psychiatrists, psychologists who work with the patients requiring restoration of the brain function at CCT.
Key words: acute craniocerebral trauma, unconscious states, diagnosis, mental activity.