Petrenko V. Structural and Functional Brain Disorders and Children’s Conjunctive Tissue Condition within the Recovery Period of Craniocerebral Injury

The author of the work through a comprehensive study of clinical and anamnestic, instrumental (hemodynamic, neuroimaging, neurophysiological) and biochemical parameters has clarified the role of conjunctive tissue in the pathogenesis and in the course of closed craniocerebral injury of different degree of severity. The study involved 115 children. Selection criteria were: recovery period of closed craniocerebral injury (6.1 ± 0.8 months after injury) of different degree of severity, age of patients from 3 to 17 years, no history of neurosurgical intervention and somatic pathology in the anamnesis. On the basis of a comprehensive study, the author has defined the prognostic criteria for the adverse course of children’s closed craniocerebral injury in the recovery period: the degree of severity of the injury; predominance of parasympathetic tone of the autonomic vegetative nervous system the presence of phenotypic signs of undifferentiated connective tissue dysplasia pronounced diffuse disorders of cortical rhythm with a decrease in the regularity of the main physiological rhythm; increase in chondroitin sulfate, decrease in total glycosaminoglycans level, its II and III fractions in the blood and increase of hydroxyl-proline in urine. The leading syndromes in the conducted research were: epileptic, cerebra-hypertensive, ataxic and syndrome movements disturbance. The relationship between the most significant phenotypic markers has been established as signs of severity of restorative course of the closed craniocerebral injury. The author has analysed the indicators of the vegetal tonus of cardiovascular system depending on the age periods and has proved the marker role of the activity indicator of the parasympathetic nervous system, but children of pre-school age and younger school age predominantly had the sympathetic division of the autonomic vegetative nervous system, which can be attributed to the age-specific maturation of the nervous system. According to the magnetic resonance examination, the author has proved the correlation between the injury load and the morphs-functional trauma of brain structures, namely, children with severe brain contusion rather than children with moderate brain contusion more frequently had haemorrhages and loci of contusion. Analysis of the functional state of the brain according to electroencephalography showed that the more severe was the craniocerebral trauma, the more pronounced were diffuse disorders of cortical rhythm. The author has determined the predictive role of biochemical parameters of conjunctive tissue of children with closed craniocerebral injury, namely, the fact that the severity of trauma influences on the increase in chondroitin sulfate and I glycosaminoglycans fraction in the blood serum against the background of a simultaneous decrease in the level of general glycosaminoglycans, II and III fractions and increase of hydroxyl-proline in the urine, indicating a lack of synthesis and growth of collagen catabolism. The author has proved the marker role of the dysplasia of biochemical parameters depending on the phenotypic manifestations on the part of the musculoskeletal system and visual organs. Based on the obtained results, the author has developed an algorithm of complex diagnostics with the inclusion of specially developed diets aimed at normalization of connective tissue metabolism during the recovery period of closed craniocerebral injury.