The method of differential diagnosis of cerebral concussion and brain injury, mild

 

The invention relates to medicine, in particular to neurology. The method provides accuracy and efficiency differential diagnosis of cerebral concussion and brain injury mild. Examine the blood of the patient, while conducting infrared spectroscopy blood of patients ranges 3500-363 cm-1within 1 minute every second measure transmittance, calculate the amount of the total variance for each channel, derive the generalized dispersion and the index of the generalized variance 9282,53121,35 diagnosed with a concussion, and when the value of 0.830,007 - brain contusion, mild, at the rate of 0.620,003. 1 Il.

The invention relates to medicine, namely to neurology.

Mild traumatic brain injury - induced traumatic impact of dysfunction in the brain, including two clinical forms: concussion (SGM) and brain contusion, mild (PMLS). Mild head injury is 73,8-88% of all traumatic brain injuries, which are recorded with a frequency of 200 cases per 100 thousand nanaline reversible form of CCT, characterized by coarse diffuse axonal injury with no macroscopically detectable plots the destruction of brain matter. Clinically evident functional-dynamic syndrome with predominantly cerebral symptoms and ephemeral, scattered, unstable micro-organic signs of brain damage, disappearing within 3-7 days.

Brain contusion, mild characterized by the presence of structural damage to the brain tissue in the form of macroscopically detectable lesions destruction and hemorrhage. Clinically manifested by loss of consciousness from a few minutes up to 1 hour. Expressed human vital functions are missing. Objective neurological symptoms presented, as a rule, slightly acute focal cerebral and meningeal symptoms, regressing within 2-3 weeks. Possible skull fracture and bleeding in the spinal fluid.

Differential diagnosis of the two clinical forms of mild head injury - concussion and brain injury, mild - relevant from the point of view of approaches to the treatment of patients and for solutions expert questions. However, differentially brain injury in the acute period is carried out on the basis of clinical and anamnestic data and therefore is inevitably subjective, largely depends on the care, diligence and skill of a physician who examines a victim with a head injury. Objective difficulties of diagnosis due to the fact that neurological symptoms detected by routine methods, the most pronounced immediately after the injury, and then quickly regresses, and the later examined the victim, the less likely it is to detect. The data obtained in the analysis of the results of additional methods of research (computed tomography, magnetic resonance imaging - MRI, electroencephalography), uninformative for the differential diagnosis of SGM, PMLS. Meanwhile, the decision of the clinical and expert issues requires early and accurate diagnosis.

A known method for the diagnosis of SGM, PMLS, which takes into account the totality of anamnestic, clinical and neurological and paraclinical data: cranial x-ray, CT/MRI, the study of the cerebrospinal fluid - CSF [Konovalov A. N., Lichterman L. B., A. Potapov A. Classification of traumatic brain injury. - M, - 1992. - S. 28-29], which the authors consider as equivalent.

The disadvantage of this method is the complexity of the examination of the victim with impaired consciousness, nestola informative CT and MRI.

The prototype of the proposed method, the authors propose a method for diagnosing the severity of brain injury, including the definition of neurospecific proteins (neurospecific enolase and the basic protein of myelin) in the blood by the method of indirect noncompetitive enzyme-linked immunosorbent assay (ELISA) [Lisany I. I., Cherenko I. I., Komissarenko C. C. and others Definition of neurospecific proteins in the blood of patients with closed craniocerebral trauma and their diagnostic value, Zh. neuropathol. and the psychiatrist. - 1993. - T. 93, 2. - S. 50-53]. This method allows to differentiate mild head injury are heavier, but its disadvantage is the inability to distinguish SGM, PMLS content neurospecific proteins in the blood due to the wide range of fluctuations in their levels, which is not possible to clearly determine the severity of the injury. In addition, the definition of neurospecific proteins by ELISA is a lengthy and expensive process that requires a special test systems that do not help to solve the current clinical question about the severity of traumatic brain injury to determine adequate therapy and duration of inpatient treatment. More preferred for clinical practice I peculiarities of structural and metabolic abnormalities in the brain and the blood-brain barrier permeability in sum, PMLS.

For the operational separation of two forms of mild head injury (SGM, UGMLC), the authors propose a method for studying the blood of patients based on the analysis of changes in transmittance (CRC) infrared (IR) radiation by the blood of patients, reflecting the combined impact of those present in the blood of substances on the degree of water absorption of infrared radiation of different frequencies. Infrared spectroscopy is performed using the original hardware-software system "Icarus", which allows using a 9-channel IR spectrometer to analyze the rapid changes in complex chemical bonds of blood components. The system includes a device having a set of narrowband filters, providing the analysis of certain classes of compounds in characteristic zones of absorption. The device has a high sensitivity (up to 1 ág) maintained by the original detector and the amplifier. The principle of operation of the analyzer is a 9-channel spectrophotometer operating in the wavelength range from 2 to 12 μm (3500-363 cm-1). The blood is examined ranges 3500-3100, 3085-2732, 2120-1880, 1831-1623, 1729-1533, 1543-1396, 1470-1330, 1170-1057, 1087-963 cm-1that allows you to get information about the changes in the number of chemical bonds of the protein substances and lipice SGM, PLMS in the acute period after injury infrared spectroscopy of a sample of venous blood (0.1 ml) patients carried out immediately after delivery in the hospital. Blood examined by passing infrared radiation through the sample and measuring the CRC for 1 minute every second on each channel of data all measurements are estimated using analysis of covariance the amount of the total variance for each of the channels and on the basis of these data derive generalized variance. The variance (D =2wheredeviation), characterizing the dynamics of the investigated parameters. The peculiarities of the temporal changes of the variance reflect the total effect present in the blood of substances on the degree of water absorption of infrared radiation of different frequencies in the investigated range.

The drawing shows the indices of the total variance of the CRC infrared radiation blood of patients with SHM (1), UMLS (2) normal (3) for each of the nine investigated ranges.

When the indicator of the generalized variance - 9282,53121,35 diagnosed SGM, and when the variance value 0,840,007 - PMLS. OK - 0,620,003. Inter-group differences are statistically significant (p<0.01) and are identified by the multivariate criterion of Bartlett.

The low indices of the generalized variance of membran due to their conformational rearrangements due to the impact of embryotoxic substances, which enter the bloodstream as a result of increased BBB permeability. For areas characterized by higher rates of generalized variance that is due, apparently, activation STRESSOMETER system with the functional reorganization of membranes, adequate acting damaging agents.

This method was tested in the survey 36 victims (17 women and 19 men) aged 20 to 45 years old on the first day after injury. In 19 patients were diagnosed with SGM, 17 PMLS. The control group served 18 healthy persons.

Upon admission to the hospital we all studied our patients the degree of oppression of consciousness on a scale Glasgow coma was 13-15 points. Analysis of clinical and neurological status of patients in the dynamics of acute mild head injury revealed some differences in the frequency and severity of subjective and objective symptoms in patients with PMLS and SGM. When both clinical forms of mild head injury objective neurological symptoms was most pronounced in the first hours and days after injury, and the sooner looked sick, more likely to register neurological disorders. In patients with PMLS highlighted the high severity of cerebral venous blood average values of the generalized variance at the SGM was 9282,53121,35, PMLS - 0,830,007, in control - 0,620,003 (p<0,01).

When receiving a satisfactory condition, the mind clear, the degree of oppression of consciousness on a scale Glasgow - 15 points. The pulse of 90 beats per minute, rhythmic. HELL 130/85 mm RT.article The skin is clean. In the right parietal region - contused wound of irregular shape, size 4 x 2 cm deep to the aponeurosis. Internal organs without features.

Complains of diffuse swelling headache, weakness, dizziness in the form of instability when walking, nausea, double vomiting, increased sensitivity to sounds and light. Alcohol negates. Notes loss of consciousness for a few minutes after injury. Retrograde amnesia.

Meningeal signs. Cranial nerves: bilateral spontaneous horizontal melcorazmashisty nystagmus, weak convergence on both sides. The tone and strength of muscles in the norm. The abdominal reflexes are invoked. Entrelace tendon and periosteal re the Vici. The Romberg test is positive. Palanisamy and heel-knee-sample performs with intentsionnogo tremor. Excessive sweating of the hands and feet. Red persistent dermographism.

On radiographs of the skull and computer tomography (CT) pathology was not detected. Blood and urine without pathological changes. Lumbar puncture: a protein 0,37%, lymphocytes 5, erythrocytes 3, the reaction Pandi (+). IR-spectroscopy of 0.1 ml of venous blood collected at admission: generalized dispersion was 8034,72 that allows according to the claimed method to diagnose SGM.

The diagnosis of Closed head injury. A concussion. Contused wound of the parietal region of the head to the right. Examination of the victim in the dynamics of the correctness of the diagnosis.

Example 2. East. b-nor 3912. B-th K-O., 39 years old, delivered by ambulance 21.03.2000 at 8: 30, half an hour after a trauma (car accident, during which the "whiplash" injury as a result of strong be careful of the neck at the moment of collision).

When entering a state of moderate severity, moderate stun, the degree of oppression of consciousness on a scale Glasgow 14 points. Pulse 110 beats per minute, rhythmic. HELL 140/85 mm RT.article The skin is clean. Internal organization is rowallane" when changing body position), nausea, repeated vomiting, increased sensitivity to sounds and light. Alcohol negates. Congrega amnesia.

Meningeal symptoms: stiff neck +2 cm, bilateral symptom of Cernica, lower symptom Brudzinskogo. Cranial nerves: bilateral spontaneous horizontal krupnorazmernyj nystagmus, weak convergence, smoothness of the right nasolabial fold. The tone of the muscles of the extremities is increased. The strength of the muscles in the norm. Abdominal reflexes evenly quickened. Tendon and periosteal reflexes of the hands and feet live, D>s Positive pathological reflexes Babinski and Oppenheim on the right. Revealed bilateral symptom Marinescu-Radovici. The Romberg test is positive. Paranosema and heel-knee test with promahivayas right.

Cranial x-ray computed tomography (CT) brain: pathology was not detected. Blood and urine without features. Lumbar puncture: a protein 0,78%, leucocytes - 10, erythrocytes - 5600, the reaction Pandi (++). IR-spectroscopy of 0.1 ml of venous blood collected at admission: generalized variance of 0.87, which allows according to the claimed method to diagnose PMLS.

The diagnosis of Closed head injury. Brain contusion light efficiency (in several minutes) diagnosis of cerebral concussion and brain injury, mild, which allows you to accelerate the examination of patients, before prescribing pathogenetic therapy.

Claims

The method of differential diagnosis of cerebral concussion and brain injury, mild, including the study of blood, characterized in that the hold-infrared spectroscopy blood of patients ranges 3500-363 cm-1within 1 min after every second measure transmittance, calculate the amount of the total variance for each channel, derive the generalized dispersion and the index of the generalized variance 9282,53121,35 diagnosed with a concussion, and when the value of 0.830,007 - brain contusion, mild, at the rate of 0.620,003.

 

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FIELD: medicine.

SUBSTANCE: invention relates to laboratory methods for blood analysis. Plasma is dropped in copper sulfate solution with density 1.023 g/cm3, not above, and time for drop falling on bottom of graduated cylinder with column height 243 mm is measured. The blood plasma density value is calculated by the formula:

wherein is the unknown blood plasma density (g/cm3); is copper sulfate solution density measured by areometer (g/cm3); t is average falling time of plasma drop in the copper sulfate solution (as seconds); 0.260130126 and 0.00290695 are correction coefficients. Temperature of plasma and copper sulfate solution is 20oC. Method is simple and suitable and allows carrying out analysis of small volumes of blood plasma and to reduce analysis time.

EFFECT: improved assay method.

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