Abstracts

Rationale: To study structure and risk factors of ES in patients with severe traumatic brain injury. Methods: Retrospective analysis of clinical and instrumental data examinations of 1770 patients with severe head injury (consciousness level is from 4 till 8 scores according to Glasgow Coma Scale) who we treated in institute from January 2002 to December 2009. Results: ES were seen in 140 patients (7.9%). Men were 86,4 %, women - 13,6%. The median age was 46,5 years Immediate seizures (developed within the first 24 hours after injury) were reveal in 114 patients (81.7%), early seizures (in the period from 1 to 7 days after trauma ) - 22 cases (15,7 %), delayed seizures (more than 7 days after trauma) - in 4 patients (3%). Among patients with acute and subacute subdural hematomas (n = 609) ES developed in 74 patients (12,2%), with multiple brain injuries (n = 303) - 31 ( 10,2% ) with intracerebral hematomas and cerebral contusions (n = 178 ) - 17 ( 9,6 %), with depressed skull fractures - 8 (3,2 %) (n=249), chronic hematomas - 6 (3,4%) (n=178), with epidural hematomas - in 4 cases (1,8%) (n=225). We divided patients to 7 different age groups and noted that frequency of ES were different. The highest frequency of ES were in able-bodied group - ES in 73 patients (11,6%) (n=627) (41 to 60 years (p <0.05)). On CT scans were noted that in 80 of 140 patients with ES (57,1%) we detected accompanied cerebral lesions (Marshall II of diffuse injury). We obtained a statistically significant correlation between localization of accompanied cerebral lesions and development of ES (p <0.05). In 20 (25%) patients with ES (n=80) cerebral lesions were detected only in the frontal lobes, 30 (37.5%) - in the frontal and temporal lobes, 23 ( 28.8 %) - in the frontal, temporal and parietal lobes, in 5 cases ( 6.2%) - in the parietal and occipital, and in 2 cases (2,5%) cerebral contusions were located in cerebellar. We identified that in patients with accompanied cerebral lesions (n = 80) in 48 (60%) were immediate ES and in 28 cases (35%) - early ES, in 4 patients (5%) delayed seizures. Frequency of early ES increased in case of progression of the stages of brainsteam shift in patients with TBI (p <0.05). There were relationship between the development of ES and inflammatory complications of the central nervous system (CNS) (meningitis, encephalitis, ventriculitis ) ( p <0.05) . Among 1770 patients with severe TBI increased amount of leucocytes in cerebrospinal fluid (CSF) - more than 100 cells per 1 mcl were in 198 cases (11,2%) . Among this patients ES developed in 28 cases (14,1%), in the absence of inflammatory complications (n = 1572 ) - in 112 cases (7,1%). Conclusions: ES developed in 7,9 % patients with severe TBI. Most often ES mentioned in patients with: acute subdural hematomas 12,2%, hematomas and cerebral contusions 9,6 % and multiple brain injuries 10,2%. Risk factors for ES: < 60 years old, subdural hematomas, development of acute brainsteam shift, accompanied cerebral lesions located in the frontal and temporal lobes, inflammatory complications.