The research deals with optimization of the diagnostic-prognostic tactics in the system of clinical-neurological monitoring of patients with post-comatose prolonged loss of consciousness (PPLC) of the non-traumatic genesis. In particular, the general clinical-neurological status of patients with a permanent and persistent state of PPLC and cerebral metabolism by data of spectroscopy, neurovisualization, were studied. Systemic vascular-reflex responses in patients with a permanent and persistent state of PPLC were examined by data of rheoencephalography. Peculiarities of cerebral haemodynamics in patients with a permanent and persistent state of PPLC were studied by data of extra- and transcranial Doppler sonography. The phenotype of cells in extracerebral arteries of the base of brain and the level of tissue hypoxia in the vascular wall of patients with a permanent and persistent state of PPLC were revealed. Diagnostic-prognostics tactics of the case-specific clinical-neurological monitoring of patients with PPLC were substantiated. At the fourth stage of the research a quantitative-qualitative assessment of the phenotype of cells in the vascular wall of extracerebral arteries in the base of brain was made; the morphological material was taken from 50 patients with atherosclerosis without ischaemic stroke, 50 cases in a post-comatose state with a prolonged loss of consciousness resulting from ischaemic stroke, and 20 people who died from accidents or injuries. A complex use of clinical, functional, biochemical and immunohistochemical techniques and methods of neurovisualization served as the basis for revealing peculiarities in the neurological status, cerebral haemodynamics, morphology of extracerebral arteries in the base of brain and the level of tissue hypoxia in the vascular wall in a permanent and persistent state of patients with PPLC of the non-traumatic genesis: 1) it is for the first time that prognostically unfavourable haemodynamic patterns of vascular-reflex responses in permanent LC were revealed; these are: an increase in the intensity and formation of asymmetry in blood filling of the brain based on a decrease in the elasticity of fine vessels in case of an increased tone of arteries and arterioles with a simultaneous decrease in the vascular wall compliance with dilatation; 2) a dissociative character of blood supply was discovered: unlike patients with a persistent VS, in those with a permanent VS the above blood supply takes place (р≤0.05) as a result of an increased circulatory resistance in the territories of blood supply by the middle cerebral artery, common cerebral artery, vertebral artery (VA) and basilar artery (BA) with a simultaneous deceleration (р≤0.05) of the maximum blood flow in the common carotid artery (CCA), internal carotid artery (ICA) and its acceleration (р≤0.05) in VA and BA. That is, unlike patients with a permanent VS, those with a persistent VS develop functional incoordination of vascular responses, this fact manifesting an impairment of the central mechanisms of vascular tone regulation; 3) it is for the first time that a reliably higher level of a disorder (disorganization) of regulatory mechanisms in a persistent VS, where vascular-reflex responses are of differential-diagnostic and prognostic significance, was revealed. It has been found out that reflex responses of CCA, ICA and VA are the most informative for prognosticating a persistent course of VS; 4) it is for the first time that on the basis of immunohistochemical studies it has been proved that smooth muscle cells (SMC) of extracerebral arteries in the base of brain are able to change their phenotype from contractile to synthetic and this change of phenotype is one of significant phenomena in the formation of clinical variants of the course of VS, since a change of phenotype of SMC in the intima of arteries is accompanied with activation of proliferation and synthesis of collagen, while modified SMC with their high activity of proliferation and synthesis of components of connective tissue matrix are responsible for formation of a fibrous islet of plaques; 5) the concept of consistency of relationships between metabolic and haemodynamic (systolic-diastolic coefficient) indices and their effect on manifestations of tissue hypoxia in patients with PPLC was further developed. The tactics of giving specialized medical aid to patients with PPLC was improved in the process of the research and on the basis of its findings. A range of clinical-technological (sequence, scopes of use, frequency) requirements for diagnostic procedures and their inclusion into standards and clinical protocols for managing patients with PPLC resulting from ischemic stroke were substantiated. Variants of reintegration as well as prognostic criteria and causes of mortality in patients with PPLC of the non-traumatic genesis were revealed on the basis of a 10-year research.
