The leading syndromes of remote period of traumatic brain injury were distinguished: mental dysfunctional and cerebral-focal. Negative dynamics was due to joining convulsive syndrome and cognitive disorders (moderate severity craniocerebral trauma and severe traumatic brain injury), as well as extrapyramidal and cognitive disorders (mild traumatic brain injury). The presence of mild neurological deficiency in the remote period of traumatic brain injury was confirmed and peculiarities of its formation in groups with different severity and catamnesis of injury were described.
Three variants of the remote period of traumatic brain injury were distinguished: hospital (35,56 %), paroxysmal (27,46 %) and progressive (36,98 %).
At 73,3 % of patients during the remote period of TBI there was diagnosed with subclinical or clinical levels of anxiety, at 60,2 % – subclinicall or clinical levels of depression (with HADS). Peculiarities of impact of the above factors into groups with different catamnesis injury were determined. At 88,0 % of patients during the remote period of TBI there was diagnosed cognitive decline with MoCA-test. There have been established negative effect of age, catamnesis of TBI of over 6 years, neurological deficits and combination of syndromes, anxiety and depression.
The morphometric features of posttraumatic cerebral atrophy at 52,5 % of patients, mainly its external (22 %) and mixed (21 %) variants were diagnosed. The predominance of the focal type of external posttraumatic cerebral atrophy in the group with the consequences of mild and severe TBI, diffuse – in the group with the consequences of moderate severity TBI, as well as features of distribution of certain types of posttraumatic cerebral atrophy depending on the catamnesis of TBI, nature of the injury (open, closed) and surgical intervention during acute period were established. The presence of clinico-morphometric correlation and syndromological features of each type posttraumatic cerebral atrophy were confirmed. Connection of separate morphometric characteristics of cerebrum with values that characterize cognitive (MoCA-test) and neurological (NOS-TBI scale) deficiency was established.
Significant increase in part of РІ+- AnV+- and ROS+ cells was diagnosed. It was established that progression of traumatic brain disease occurs on the background of activation of peripheral blood leukocyte necrosis/apoptosis processes. Significantly higher values of AnV+-cells were at patients with extrapyramidal insufficiency and cognitive deficiency syndrome. The part of cells in apoptosis stage was inversely correlated with the MoCA test (r=-0.61, p=0.001) and increased in parallel with the level of depression (r=0.50, p=0.005). The negative dynamics of the AnV+ / MoCA-test ratio increased with age (r=-0.54, p=0.001).
In the thesis there were also analyzed the structural and functional features of the state of the microcirculatory channel. The dominance of stagnant type of microcirculation with moderate (56,5 %) and expressed (37,4 %) slowing of blood flow and І (51,0 %) and ІІ (44,0 %) degrees of violation of blood viscosity were determined. Clinical and morphometric relationships depending on the type of microangiouarchitectonics, type and catamnesis of TBI were investigated. At 41,38 % of patients with progressive disease, a large-calibre type of microangiouarchitectonics was diagnosed.
The evaluation of cellular immunity was performed based on CD3+, CD4+, CD8+, CD16+, CD22+ - lymphocytes, and significant decrease in the content of CD3+, CD4+, CD8+, CD22+ with CD16+ growth was established.
TBI prognostic model of the progressive course of remote period was created. The factors confirming the theory of “accelerated aging” of cerebrum after TBI (clinical – cognitive deficiency, extrapyramidal insufficiency, sub- and clinical manifestations of depression, morphometric – formation of signs of posttraumatic cerebral atrophy, growth of the coefficient of arteriol tortuosity, laboratory – activation of oxidative processes and apoptosis, immune-suppression). Scheme of interconnection of the main pathogenetic links of the remote period of TBI was proposed.
Key words: traumatic brain injury, remote period, flow, cognitive deficiency, NOS-TBI scale, posttraumatic cerebral atrophy, microcirculation, РІ+- AnV+- ROS+- cells, СD+- lymphocytes, prognosis.
