Psychic Disorders in Cases with Traumatic Lesions of Deep-Lying Cerebral Structures

Zaycev O.S.*, Potapov A.A.*, Sharova E.V.**, Kornienko V.N.*, Zaharova N.E.*, Tenedieva V.D.*, Aleksandrova E.V.*, Kravchuk A.D.*, Gavrilov A.G.*, Ohlopkov V.A.*, Sokolova E.Yu.*, Chelyapina M.V.**

* Burdenko Research Institute of Neurosurgery, Moscow, Russia
** Scientific Research Institute of Central Nervous System, Russian Scientific Academy, Moscow, Russia

 

The study goal has been revealing peculiarities of psychic disorders in casualties with lesions of deep-lying cerebral structures, being a result of severe craniocerebral trauma (CCT), verified with the help of modern means of neurovisualization.

Material and Methods. There were 163 cases with severe CCT, whose acute period was characterized by coma with a score of 8 and duration of more than 12 hours. The analysis of data allowed to form and to compare two groups. The first group comprised cases (57) with injuries of deep-lying cerebral structures (stem, subcortical and diencephalic). The second group consisted of cases (106) without injuries of these structures.

Results. There was considerable difference between the first and second groups, which lied not only in coma duration (11.1±1.8 and 2.9±0.6 days, respectively), but also in percentage of cases with deep coma (74% and 21%), post-comatose unconsciousness (81% and 12%), minimum manifestations of consciousness (93% and 12%) and subsequent aspontaneity (91% and 65%) and field behavior (46% and 20%). The first group was characterized by a longer period of posttraumatic (109±35 and 35±9 days, respectively)) and retrograde (162±124 and 12±11 days) amnesia. The mildest (borderline) level of psychic disorders (30% and 80%, respectively), as well as a good outcome according to the Glasgow Coma Scale (43% and 82%) were achieved rather rarely. A key role of cerebral dissociations (stem-thalamic, cortical-thalamic, interhemispheric) in formation of psychic disorders in cases of the first group was ascertained. It was found out, that they could manifest themselves both in coherent bonds, watched on EEG examination, and catecholamine dissociation (between changes of levels of norepinephrine and dopamine in blood serum).

Conclusion. The obtained results, confirming a negative effect of an injury depth on psychic activity of casualties, can promote elaboration of therapeutic measures, substantiated pathogenetically.