The study of the function of attention in the dynamics of disturbed and recovering consciousness in severe cerebral pathology is becoming more relevant-due to the increasing number of patients with prolonged disorders of consciousness and significant difficulties in their rehabilitation.Objective: to determine the electroencephalographic correlates of modality-nonspecific attention using a clinical model of severe traumatic brain injury (STBI).Patients and methods: 35 patients with STBI in the dynamics of post coma recovery of mental activity (a study group) and 23 healthy subjects (a control group) were examined. Changes in the pattern of EEG and in the indices of its coherence in the presence and activation of different forms of attention (an orienting response to the sound and eye opening; involuntary and voluntary visual forms), by applying specially developed computerized techniques, were investigated. The features of associated with attention changes in interhemispheric EEG coherence (EEGInterCoh) with the data of 3T diffusion tensor tractography of the corpus callosum (CC) were compared.Results: Attention disorders were shown to be essential and an «axial disorder» in patients with SBI. There were statistically confirmed qualitative and quantitative differences attention-associated changes in the EEG pattern and inter hemispheric coherence in reversible and chronic unconsciousness. The important favorable prognostic sign proved to be reactive changes in inter hemispheric EEG relations, including frontal ones characterized by the absence of clear external manifestations of consciousness in the very earliest stages. There was a significant correlation between the preservation of CC tracts (primarily, the rostrum, anterior portion, and splenium) and attention-related reactivity of EEG Inter Coh, which reflects the specific, though nonrigid, structural determinacy of the latter.
We identified a set of neurological symptoms (increased muscular tone of extrapyramidal type, rest tremor, autonomic disorders, which were most characteristic of the autonomic state, and some forms of mutism associated, according to current conceptions, with the dopaminergic system deficiency syndrome. This clinical picture was accompanied by stable EEG changes: an increase in the severity of beta activity of 13-14 Hz, enhanced in the frontal and anterior temporal areas, synchronized with equivalent dipole source localization in subcortical and frontal/basal areas. Dopamine deficiency regression syndrome was accompanied by an increase in beta EEG activity (from 13 to 16 Hz), but with the persistent abnormal enhancement of coherent hemispheric relations, especially in the occipital-temporal areas.
Pneumocephalus is the ingress of air into the intracranial cavity. Pneumocephalus is associated with several etiological factors, such as head injuries, surgical interventions, infections and neoplasms. With spontaneous nasal liquorrhea, pneumocephalus is extremely rare, since a defect must be large in order to cause it. Clinical implications of pneumocephalus depend on location and volume of air in the cranial cavity. The most common and described symptoms are headache, "splashing sound", rhinorrhea and otorrhea, meningism, dysfunction of cerebrospinal nerves, hemiparesis, optic disc edema, epileptic seizures, collaptoid states, psychiatric symptoms. For treatment of pneumocephalus, both conservative and surgical methods are used. The choice of tactics depends on type, etiology and volume of the air that has entered the cavity of the skull.In this article, we describe the case of effective treatment of spontaneous nasal liquorrhea, complicated by pneumocephalus and meningitis.
This pilot study is dedicated to revealing features of resting-state wavelet synchrony in unconscious patients with severe brain injury. We suppose that revealed features could help in assessment of a current state and selection of efficient rehabilitation activity. Methods Brain activity of 9 in-patients with severe brain injury (TBI) treated in Burdenko National Medical Research Center of Neurosurgery was analyzed in the study. The experimental protocol was approves by the local Ethics Committee (Burdenko Neurosurgery Institute Research Center of Neurosurgery). Taking into accountthat all patients were in unconscious state the written informed consent was obtained from patients' relatives. Prior the experiment relatives of patients received complete information about the methods and goals of research. Patients' age varied from 15 to 72(33,8±18,3 years). The total of 22 studies was analyzed. Follow up was from 6 months to 8 years. Characteristics of patients, their functional state during the first EEGrecord after TBI and outcome are presented in Table 1.
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