MECHANISMS OF SECONDARY BRAIN DAMAGE IN COMA DEVELOPED IN ACUTE PERIOD OF ISCHEMIC STROKE
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Abstract
The study of mechanisms of secondary brain damage in coma developedin acute period of ischemic stroke is essential for providing differentiated intensive therapy and disease outcome. However, this issue is not considered in workspublished.
Objective – to study mechanisms of secondary brain damage development in comatosepatientsin acute periodof ischemic stroke.
Materials and Methods. A retrospective and prospective study included 69 patients in coma in acute period of ischemic stroke. Clinical and neurological examination, CT and MRI, transcranial Doppler and neurophysiological research, central hemodynamics invasive assessment, gas exchange, lung mechanical properties and content of lung′s extravascular fluid were performed. Mean age was 62,5 ± 1,9 years, the long-term mortality rate was 60,9 % (42 people).
Results. The dependence of cerebral blood flow, central haemodynamics, mechanical and gas exchange properties of the lungs, and extravascular lung water dynamics, intracranial pressure and brainstem dysfunction were revealed.
Conclusions. One of the mechanisms of secondary brain damage in patients in coma in acute period of ischemic stroke is a worsening dysfunction of the brain stem followed bythe cerebral autoregulationdisturbance in the absence of a significant increase of intracranial pressure.This causes disturbances of the central hemodynamics, the mechanical and gas exchange properties,the accumulation of extravascular lung water.These processesresult in acute lung injury, itbeing a critical element in the development and progression of systemic hypoxia as a key mechanism of secondary brain damage.Keywords
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