A method for predicting the development of pathology of the optic nerve at the closed craniocerebral trauma

 

(57) Abstract:

The invention relates to medicine and can find application in neuro-ophthalmology. Perform fundus examination, determine the state of the microcirculation of the brain by the method of rheoencephalography, localisation focus the maximum electrical activity of the cerebral cortex, the amplitude of the alpha rhythm and the threshold electric lability of the optic nerve. With increasing lability of the optic nerve, the increase of the resistance of the microvasculature of the brain by 10% or more relative to the physiological norm, a shift of the maximum of the electrical activity of the cortex of the occipital region with a decrease in the amplitude of the alpha rhythm below 40 µv and electrical lability of the optic nerve below 30 Hz, predict the development of pathology of the optic nerve in closed craniocerebral injury with a high probability of a downward atrophy of the optic nerve. The method improves the accuracy of diagnosis and to justify the tactics of treatment.

The method relates to medicine and can be used to diagnose pathology of the visual analyzer in traumatic brain injury.

In recent years znahodzjatsa treated in the neurosurgical or neurological Department, where the focus is on General and neurological condition of the victim. While visual acuity in patients with head injury for a long time may remain high and the picture of the fundus does not differ from the norm, i.e., the indicators do not reflect the state of the intracranial section of the visual analyzer. At the same time, the presence of increased intracranial pressure, development of edema of the brain tissue, has a negative impact on pathways and cortical center of the visual analyzer. Late diagnosis of pathological changes of the optic nerve leads to a reduction of visual functions leading to blindness due to atrophy of the optic nerve.

In ophthalmic literature notes that brain injury leads to damage of the optic analyzer up to 20% according to some authors: O. N. Sokolova, N. L.Parfenova, I. N. Osipova "Opticochiasmatic the arachnoiditis". M., 1990; B. N.Nepomnyashchy et al. Traumatic brain injury: a Clinical guide. - M - 1998. - T. 1. - S. 129-151.

Given the social importance of blunt head injury leading to disability persons at a young age due to a sharp reduction of view, the development of methods for early diagnosis of damage to the visual analyzer is of great importance and is the orbital trauma (RF patent 2077255 from 20.04.1997, And 61 In 3/10), which produce light stimulation of the retina of the injured eye through the closed eyelid or hematoma and during the stimulation register the effect of pupil diameter of the second open eyes of the patient and the presence of a normal friendly reaction of the pupil to light for healthy eye diagnose intactness of the eyeball and the optic nerve and preservation of vision on the side of the injury.

The disadvantage of this method is the low diagnostic value, because the reaction of the pupil to light on the side of the injury is saved with a sharp decrease in visual acuity up to light perception, reaction of the pupil to light disappears only when complete blindness when visual acuity is equal to 0. In this regard, this method can not be attributed to early diagnosis of pathology of the optic nerve in head injury.

Currently the most sensitive and informative methods of diagnostics of the functional state of the optic nerve include electrophysiological methods: definition of indicators electrical lability, foveolar the light sensitivity of the retina. There is a method of determining the functional status of the visual analyzer based on data electrophysioenligne is to determine the electrical lability, fivealarm density, area livestock in the field of view, the depth range of the optic nerve head, and with an electrical lability more than 21 Hz, foveolar sensitivity over 18 LW, square absolute cattle less than 40%, the depth range of more than 0.6 mm conclude about the relative safety of the optic nerve and the feasibility of electrical stimulation of the optic nerve with the aim of improving visual function.

The disadvantage of this method is the definition of indicators, bordering on complete loss of visual functions, but not the initial changes. The disadvantages are the lack of signs of intracranial blood and of CSF dynamics significantly influence the functional integrity of the visual analyzer.

There is a method that identifies the most informative intracranial factors affecting the decline of visual functions in optimiazation arachnoiditis, which often develops in closed head injury (RF patent 2159074 from 20.11.2000, And 61 In 5/03, G-01 33/48).

The essence of this method is that patients opticochiasmatic arachnoiditis is determined by the condition of microcirculation holoprotein microvasculature to 15% and reducing immunoregulatory index of not more than 30% predict the possibility of restoring vision, with an increase in resistance of the microvasculature by 50% or more in combination with secondary immunodeficiency by reducing immunoregulatory index more than 50% predict a decrease of the view below 0.1.

The disadvantage of this method is the lack of data about changes in electrophysiological indices of visual analyzer, which has a significant influence changes of CSF dynamics, which tends to increase with closed craniocerebral injury.

The disadvantages of this method include the lack of data on early damage of the optic nerve, because the indicators of immune status change only after quite a long period after a head injury or the beginning of Aharonot.

The closest analogue, taken as a prototype, is a method for diagnosing pathology of the optic nerve (RF patent 2134054, AND 61 IN 3/00, BI 22 from 10.08.1999), in which the diagnostics of pathology of the optic nerve is based on fundus examination, evaluation of the optic disc (optic nerve disc).

This produces a picture of the optic nerve disc in normal and in various pathologies, taken as the benchmark, diagnose pathology of the optic nerve.

The disadvantage of this method is what allows us to estimate the damage of the optic nerve intracranial level. Given that in a closed head injury is cerebral edema, increased intracranial pressure, impaired microcirculation of the brain and optic nerve, passing through the base of the brain, creates a complex adverse effects on the optic nerve and cortical center of the visual analyzer. The combination of these factors often leads to the development of the descending optic nerve atrophy and significant reduction of vision in patients with closed head injury.

The purpose of this invention is the early prediction of the development of pathology of the optic nerve with a closed head injury that will justify the tactics of treatment of such patients, aimed at maintaining high visual functions.

Achieving this goal provides a method for predicting the development of pathology of the optic nerve with a closed head injury, including fundus examination with additional identifying the status of the microcirculation of the brain by the method of rheoencephalography, localisation focus the maximum electrical activity of the cerebral cortex, the amplitude of the alpha rhythm and the threshold electric lability of the optic nerve, with increasing resistance microvasculature goal is aktivnosti cortex of the occipital region with a decrease in the amplitude of the alpha rhythm below 40 µv and electrical lability of the optic nerve below 30 Hz, predict the development of pathology of the optic nerve with a closed head injury with a high probability of a downward atrophy of the optic nerve.

Theoretical justification of this method was based on the literature data and our own research that under normal physiological functioning of the visual analyzer focus maximum electrical activity of the cortex located in the occipital region, and the amplitude of the alpha rhythm is in the range of 50-60 mV. The threshold electric lability of the optic nerve, which characterizes the speed of transmission of nerve impulses in the intracranial portion of the optic nerve, is 40-50 Hz normal (A. M. Samsonova, centuries wolves Functional methods of research in ophthalmology. M., 1998; E. M. Shcherbakova visual functions in children with optical distacom given neurophysiological features. //Abstract. dis. Kida. the honey. Sciences. Rostov-on-don, 2000).

In various pathologies of the brain decreased vision, accompanied by a prior reduction neurophysiological indicators.

The method is as follows. A patient with a closed head injury check visual acuity, visual field, visiting glasnovic microvasculature then perform electroencephalography (EEG) to determine the amplitude of the alpha rhythm and localisation focus the maximum electrical activity; and determine the threshold electric lability (EL) of the optic nerve.

If REG indicates the deterioration of the microcirculation of the brain, i.e., increase the resistance level of arteriovenous of postcapillary 10% and higher than the physiological norm, while EEG documents the absence of zonal differences and localization of the focus of maximal activity in the occipital region with a decrease in the amplitude of the alpha rhythm below 40 µv in combination with a threshold E below 30 Hz, despite the high visual acuity and normal picture of the fundus, predict the development of pathology of the optic nerve.

Example.

The Patient Gasnev M M (East.bol. to 131/2002) received a closed head injury in 2001, When admitted to hospital complaining of headache, dizziness. Ophthalmologic examination gave the following data.

Visual acuity of both eyes=1,0. The field of vision of both eyes was normal. The fundus of both eyes: the optic nerve disc is pale pink, boundary - clear, veins slightly extended, the ratio of the caliber of vessels And/=2/4. The threshold E=30 Hz n is - zonal differences significantly disturbed, the focus of the maximum electrical activity of the cortex is not detected, the amplitude of the alpha rhythm - 30 µv (at a rate of on average 55 µv). Hemispheric asymmetry in the range of Delta in the frontal area with right-sided localization to 60%.

This indicates depression of alpha activity, irritation diencephalic region, indirect signs of intracranial hypertension.

REG - allocating a pool of carotid arteries: eographically index - 0,041 (at the rate of 0.08 to 0.16). Vascular resistance at the level of arterioles - 90% (at the rate 55-70%), level postcapillary and venules' - 90% (at the rate of 60-80%), the index of the venous outflow from the left - 50%, right - 30 (at the rate of 20%). The asymmetry of the pulse of the blood - 237% (at the rate of 20%). Allocating a pool of vertebral arteries: eographically index - 0,06, vascular resistance at the level of arterioles - 80%, postcapillary and venules 90%, the index of the venous outflow from the left - 50, right - 103. The asymmetry factor of 500%, which indicates increased intracranial pressure, decreased blood 2 times in relation to the physiological norm, the obstruction of the blood flow at the level of the microvasculature, a significant asymmetry cravenplan the optic nerve, the amplitude of the alpha rhythm and electrical activity of the cerebral cortex, the deterioration of the microcirculation of the brain gives a basis to predict the development of descending atrophy of the optic nerve as a consequence of brain injury and its consequences.

The patient was prescribed treatment by place of residence: drugs, improves microcirculation (Cavinton, pharmacological), diuretics (diacarb -), improves trophism of the optic nerve (ATP, Cortexin/m).

However, a patient at the place of residence (Chechnya) the treatment is not conducted. When you re-inspection after 4 months, the visual acuity of the right eye=0,6't Corr., left eye=0.5, no Corr. The field of vision narrowed on bitemporally type 50ofrom the point of fixation. The fundus of the eye - the optic nerve disc is pale, especially the temporal half, boundary - clear, arteries narrowed caliber a/b=1/3. The threshold E=28 Hz.

On the basis of the received data to a patient diagnosed with post-traumatic atrophy of the optic nerves of both eyes.

Thus, the above example confirms the possibility to predict the development of pathology of the optic nerve on the basis of the aggregate early neurophysiological changes in closed craniocerebral injury early eappraiseit of the proposed method lies in the possibility of early detection together the most informative indicators affecting the functional activity of the intracranial portion of the optic nerve and with high probability to predict the development of pathology of the optic nerve to the high visual acuity and normative picture of the fundus in patients with closed head injury. The proposed method enables to expand the treatment regimen of patients with closed head injury, including the preparations normalizing impaired electrophysiological indices, thereby profilaktorua decrease of vision in such patients.

A method for predicting the development of pathology of the optic nerve at the closed craniocerebral trauma, including fundus examination, characterized in that it further determine the state of the microcirculation of the brain by the method of rheoencephalography, localisation focus the maximum electrical brain activity and the amplitude of the alpha rhythm, the threshold electric lability of the optic nerve, with increasing vascular resistance microvasculature of the brain by 10% or more compared to normal physiological focus shift of the maximum of the electrical activity of the cortex of the occipital region with a decrease in the amplitude of the alpha rhythm below 40 µv and electric labile is

 

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