The thesis is devoted to improving the efficiency of diagnosing acute meningitis and meningoencephalitis of bacterial and viral etiology by defining criteria for early diagnosis of CNS damage based on a comprehensive assessment of impaired blood brain barrier (BBB), metabolic and endocrine disorders and levels of neuro-specific markers in cerebrospinal fluid (CSF) in patients. Cross-sectional, retrospective, controlled cohort studies were conducted to solve the tasks set in the work, the data of 809 patients with acute meningitis (M) and meningoencephalitis (ME) were analyzed and an in-depth comprehensive study of 203 people was conducted. As part of the study, all patients on the first, on the 10th - 12th day of treatment, had tests for lactate, LDH, CPK, acid phosphatase, cholinesterase, albumin, TTH, T3, T4, ACTH, aldosterone, cortisol, NSE, S-100, GFAP, MBP, BDNF in CSF. The analysis of morbidity, etiological structure and mortality of acute M/ME in Kharkiv and Kharkiv region was carried out. The data on the pathogenesis of CNS cell lesions were supplemented on the basis of a comprehensive analysis of the effect of hypoxic and metabolic disorders, changes in the BBB permeability in the damage of various brain cells, the severity and duration of clinical symptoms of acute bacterial and viral M /ME. The data obtained allow us to conclude that for assessing the severity of metabolic disorders in the tissues of the central nervous system the indices of CPK, lactate, LDH, and cholinesterase have the greatest diagnostic value in CSF of the patients. The dynamics of the content of neurospecific markers NSE, S-100, GFAP, MBP and BDNF in the CSF of adult patients with bacterial and viral M/ME was determined. Based on changes in the levels of neuro-specific markers in the CSF, the presence of lesions of mature neurons, glial cells, astrocytes and myelin cells was confirmed, both in M/ME. It has been proved that the lesion of neurons, glial cells and myelin cells is more pronounced in patients with ME compared to M. For the first time, the effect of the BDNF level in the CSF on the duration of focal neurological symptoms was determined. For the first time, the possibility of using levels of neurospecific markers NSE and GFAP in the CSF of patients for predicting the unfavorable outcome of acute bacterial M/ME was determined. The determination of levels of neurospecific markers NSE, S-100 and GFAP in the CSF to assess the effectiveness of treatment and predict the unfavorable outcome of acute M/ME was proposed. According to the results of the studied parameters of the dysfunction of the BBB, endocrine and metabolic disorders, the content of neurospecific markers, the pathogenesis pattern of lesions of the CNS cells in acute M / ME was supplemented.
