KEY FEATURES OF ANAMNESIS IN PATIENTS WITH POST-TRAUMATIC POST-COMA LONG-TERM DISORDERS OF CONSCIOUSNESS

Abstract

Problems of traumatic brain injury continues to acquire both medical and social significance due to high rates of disability and mortality. It is urgent to further study the causes, epidemiology and clinical variants of severe traumatic brain injuries (TBI), the consequences of which are not only neurological disorders, cognitive or psychological dysfunctions, but also long disturbances of consciousness. Therefore, the continuation of the search for new opportunities for effective treatment and outflow of patients with prolonged disorder of consciousness after severe TBI does not lose its relevance.

The aim of the study – to analyze key anamnestic factors and to investigate the relationship between causes, clinical variants of severe TBI, coma depth, and syndromes of post-motile consciousness disorder.

Materials and Methods. The work is based on the results of diagnostics, rehabilitation and restorative treatment of 220 patients with post-coma long-term consciousness disorders after severe traumatic brain injury. Description of clinical neurological picture of postcomathic disorder of consciousness in patients after severe TBI was performed depending on the clinical form of its severity and depth of traumatic cerebral coma, which had different expressiveness and similar in semiotics (signs) of neurological symptoms, but at the time of inclusion of the patient in the study, and then in the course of rehabilitation treatment, basically defining the stage of restoration of a post-comatose disorder of consciousness.

Results and Discussion. The focus is on anamnestic data on the clinical form of traumatic brain injury (TBI) and the depth of traumatic coma, as key factors influencing the development of long-term post-coma disorders of consciousness in patients, to which, later, medical (physical) rehabilitation methods were applied. The causes of injuries are disclosed, the combination of clinical forms of severe traumatic brain injury in patients with post-coma consciousness disorders is analyzed, and the linkage between them is investigated. The study focuses on the fact that in the majority of injured patients, moderate coma (coma I) was a manifestation of severe brain contusion, associated with compression of the brain with subdural, epidural hematoma, fragments of a depressed fracture of the cranial vault. Even with diffuse axonal injury (DAI), patients diagnosed with coma I were slightly predominant. At the time, deep coma, despite the different numerical values of the number of patients in whom it manifested itself, had a similar pattern of dependence on the combined clinical forms of severe TBI. Therefore, it was also often observed precisely in severe cerebral contusion associated with compression of the brain by the factors described above, leaving brain injuries with linear fractures of the cranial vault and skull base (with the epidural blood layers) in second place. And a very different situation is with terminal coma, which in the vast majority of patients, where it was diagnosed, was a manifestation of isolated DAI and its variants in combination with compression of the brain with epidural hematoma and fragments of a depressed fracture of the bones of the cranial vault.

Conclusions. On the basis of the obtained data, it is concluded that it is precisely severe cranial contusions with compression of the brain by various individual factors that are the most frequent organic substrates of post-coma disturbance of consciousness; coma I or coma II was independently diagnosed if its duration was more than 10 days. Isolated or combined DAI in the vast majority of cases compared with other clinical forms of severe TBI had symptoms of coma III. And if an accident, as the main cause of DAI is added, then coma III, as a manifestation of the extreme severity of TBI, was most typical for this type of injury, which, in turn, led to the fact that most patients awaken from coma III still remained in a vegetative state despite even long-term intensive restorative treatment and rehabilitation.