RESUMEN
Responses of 340 single units of the n. Rt of the human thalamus to significant and insignificant verbal and sensory stimuli during the performance of voluntary motor acts recorded by microelectrodes were investigated in dyskinetic patients in the course of 46 stereotaxic operations. Two types of polymodal units with irregular continuous (A-type, "triggered verbal command" units, 183 neurons, 56% reacting) and burst rhythmic (2-5 per s.) discharges (B-type, 139 neurons, 59% reacting) have revealed reactivity to a verbal command with a specialized multicomponent pattern at functionally different stages of purposive motor acts. The analysis of principal components has shown that the extracted components of responses correlated with the functional significance of verbal or sensory signals, especially with voluntary acts of the verbal message triggering, but not with physical, somatotopic or semantic parameters of stimulation. It was suggested that the transient time-connectivity of A and B neurons at the trigger stages of purposive tasks reflected the coexistence in the Rt of two functionally different cellular subsystems participating in the transmission of significant signals during speech-provoked voluntary acts.
Asunto(s)
Neuronas/fisiología , Sensación/fisiología , Núcleos Talámicos/fisiología , Conducta Verbal/fisiología , Estimulación Acústica , Electroencefalografía , Electromiografía , Electrooculografía , Potenciales Evocados Auditivos/fisiología , Humanos , Microelectrodos , Actividad Motora/fisiología , Tiempo de Reacción/fisiología , Técnicas EstereotáxicasRESUMEN
Dynamics of neuronal interaction in 90 ensembles of the RT including units of two types (A, B) recorded by microelectrodes was analyzed during verbal and sensory stimulation and voluntary motor acts in dyskinetic patients in the course of 38 stereotaxic operations. It was shown that high transient interneuronal cooperation in A and B units were selectively related to triggering stages of a purposive act: verbal commands presentation and movement initiation and realization. Specific character of dynamics of interneuronal cooperation determined both by the type of constituent elements and functionally different stages of voluntary acts was found. It is supposed that transient interneuronal cooperation of A and B units reflects dynamic conjugation of two functionally different cellular subsystems in the Rt which are probably connected with verbal-related processing and triggering as well as with movement-related voluntary acts.
Asunto(s)
Comunicación Celular/fisiología , Neuronas/fisiología , Núcleos Talámicos/fisiología , Conducta Verbal/fisiología , Estimulación Acústica , Electromiografía , Electrooculografía , Potenciales Evocados Auditivos/fisiología , Humanos , Microelectrodos , Actividad Motora/fisiología , Tiempo de Reacción/fisiología , Técnicas EstereotáxicasRESUMEN
The article gives an account of the classification of cranio-cerebral traumas recommended by the IIIrd All-Union Congress of Neurosurgeons. Main clinical forms of cranio-cerebral traumas are described: concussion of the brain, contusion of the brain of light, mild and critical degree, compression of the brain against the background of its contusion and without it. A uniform gradation of disturbed consciousness and criteria for the assessment of the patient's state are presented.
Asunto(s)
Conmoción Encefálica/clasificación , Trastornos del Conocimiento/clasificación , Trastornos de la Conciencia/clasificación , Síncope/diagnóstico , Conmoción Encefálica/diagnóstico , Trastornos de la Conciencia/diagnóstico , Humanos , Índice de Severidad de la Enfermedad , U.R.S.S.RESUMEN
The authors investigated the characteristics of motor disorders in patients with spastic torticollis. The study involved registration of volitional tensions of the neck muscles in isometric conditions, i.e., when the patient's head was rigidly fixed with regard to the body. Using a tensometric dynamometer the following three moments of force were measured: one responsible for bending the head forward or backward; the second, for bending the head to the right or left shoulder; and the third, for turning the head round the longitudinal axis. The electrical activity of the neck muscles was recorded with the help of surface electrodes. It has been established that the development of volitional efforts by the neck muscles under isometric conditions is difficult or impossible if directed to the side where the patient's forcible turn of the head is directed.
Asunto(s)
Músculos/fisiopatología , Músculos del Cuello/fisiopatología , Tortícolis/fisiopatología , Enfermedad Crónica , Electrofisiología , Femenino , Humanos , Contracción Isométrica , Masculino , Movimiento , Espasticidad Muscular/fisiopatología , Espasticidad Muscular/cirugía , Periodo Posoperatorio , Tortícolis/cirugíaRESUMEN
The article describes the results of electromyographic examination of the muscles of the neck in 26 patients with spasmodic torticollis. Electromyography was performed before and after stereotaxic operative interventions on the nucleus of Cajal or in combination with the diencephalic structures. It is shown that electromyographic examination of patients, especially with the use of functional motor and oculomotor tests, widens essentially the possibilities of the diagnosis by facilitating the identification or specification of the predominantly involved group of muscles. The discovery of concurrent oculographic and electromyographic changes in the dominant muscles of the neck during oculomotor tests is evidence of the connection of the system of concurrent movements of the eyes and head with the motor systems participating in the pathology of torticollis. Analysis of the dynamics of electromyographic changes in patients with predominance of the tonic component in the early and late postoperative periods is indicative of gradual increase of positive changes in the motor sphere, which, evidently, is due to the dynamic reorganizations in the previously formed stable pathological system.
Asunto(s)
Electromiografía , Músculos/fisiopatología , Músculos del Cuello/fisiopatología , Tortícolis/fisiopatología , Potenciales de Acción , Adulto , Anciano , Humanos , Persona de Mediana Edad , Movimiento , Espasticidad Muscular/fisiopatología , RotaciónRESUMEN
The neurons of mesencephalic nuclear structures were studied by microelectrode techniques for functional identification of the interstitial nucleus of Cajal during 18 stereotaxic operations on patients with torticollis. It is shown that the use of microneuronography for functional identification of structures of the pretectal region and mesencephalic structures bordering it is promising. The functional cellular complexes of these structures which respond selectively to voluntary movements of the eyes and head, rapid voluntary movements of the eyes, fixation and maintenance of the gaze, and combined movements of the eyes and head are characterized for the first time. In comparison with intracerebral radiological guiding points, the registration of these data makes possible intraoperative active search for functional neuronographically identified zones linked with the pathological mechanisms of torticollis and the performance of selective destruction with minimum volume of damage.
Asunto(s)
Mesencéfalo/cirugía , Técnicas Estereotáxicas , Tortícolis/cirugía , Adolescente , Adulto , Anciano , Movimientos Oculares , Femenino , Cabeza , Humanos , Masculino , Mesencéfalo/fisiopatología , Microelectrodos , Persona de Mediana Edad , Movimiento , Espasticidad Muscular/cirugía , Tortícolis/fisiopatologíaRESUMEN
Gamma-topography of the cerebrospinal fluid tracts of the spinal cord (GCTSC) was conducted in 28 patients with traumatic injuries of the brachial plexus at the preganglionic level. The object of GCTSC was to identify the character of damage inflicted to the spinal cord, its meninges, and the roots at the preganglionic level in the presence of the pain syndrome. Spatial-temporal distribution of the radiopharm agent in the submeningeal space served as the basis for setting apart radiological signs characterizing the anatomical disorders and disturbances in cerebrospinal fluid dynamics in the submeningeal space of the spinal cord. The radiological picture was always composed of adhesive-cicatricial and adhesive-cystic processes with arachnoid cysts or cerebrospinal fistulas in the cervicothoracic segment of the spinal cord.
Asunto(s)
Plexo Braquial/lesiones , Ácido Pentético , Heridas no Penetrantes/diagnóstico por imagen , Adulto , Humanos , Inyecciones Espinales , Masculino , Meninges/lesiones , Parálisis/etiología , Cintigrafía , Traumatismos de la Médula Espinal/diagnóstico por imagen , Síndrome , Heridas no Penetrantes/cirugíaRESUMEN
The article presents clinical criteria of the diagnosis of concussion, contusion and compression of the brain in the acute period of a craniocerebral injury. The authors specify the major signs of a moderate and deep stun, sopor, as well as moderate, deep and coma de passe. Unified evaluations of the severity of the state of a patient with a craniocerebral injury are described.
Asunto(s)
Lesiones Encefálicas/clasificación , Conmoción Encefálica/clasificación , Lesiones Encefálicas/complicaciones , Coma/etiología , Humanos , Pronóstico , Fracturas Craneales/complicaciones , Inconsciencia/etiología , Heridas no Penetrantes/clasificación , Heridas Penetrantes/clasificaciónRESUMEN
The effect of osmotic diuretics (mannite and glimarite, 29 studies), colloid-osmotic diuretic (algurin, 22 studies), and saluretic (lasix, 58 studies) on intracranial pressure (ICP) was studied in 30 patients in the acute period of severe craniocerebral injury. It was found that the hypotensive effect of the diuretics depended on the state of the water-electrolyte homeostasis, the time of medication with the agents, the severity of the patient's condition, and the initial ICP. The effect of osmotic diuretics was highest in normoosmia and normonatriemia in ICP of 20-45 mm Hg. Medication with osmotic diuretics and algurin in the first 2-3 days after the injury as usually attended by the "yield phenomenon"; the hypotensive effect of algurin in this period was less manifest. The effect of lasix was higher in hyperosmia caused by hypernatriemia but lower in patients who were in a terminal and extremely severe state.
Asunto(s)
Edema Encefálico/tratamiento farmacológico , Lesiones Encefálicas/tratamiento farmacológico , Diuréticos/uso terapéutico , Seudotumor Cerebral/tratamiento farmacológico , Edema Encefálico/etiología , Lesiones Encefálicas/complicaciones , Diuréticos Osmóticos/uso terapéutico , Furosemida/uso terapéutico , Humanos , Manitol/uso terapéutico , Compuestos Orgánicos , Seudotumor Cerebral/etiologíaRESUMEN
Altogether 100 patients with severe craniocerebral traumas seen during the acute period in a neurotraumatological hospital were entered into a clinico-psychopathological study. The authors traced the effect of the extent of the damage, the duration and depth of the comatose state, the localization of the injury and a number of other factors, including the therapy conducted, on the formation and time-course of individual psychopathological syndromes and patients' rehabilitation.
Asunto(s)
Lesiones Encefálicas/complicaciones , Trastornos Mentales/etiología , Inconsciencia/etiología , Enfermedad Aguda , Adolescente , Adulto , Conmoción Encefálica/complicaciones , Lesiones Encefálicas/tratamiento farmacológico , Humanos , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Psicotrópicos/uso terapéutico , Síndrome , Inconsciencia/tratamiento farmacológicoRESUMEN
The results of operation for interfascicular autotransplantation conducted on 50 patients with traumatic injuries to the median and ulnar nerves are analysed. The study confirmed the high efficacy of repairing defects in nerves with autografts and interfascicular apposition of the separate elements of the nerve trunks. The best results were produced with the use of short autografts. At the current stage of the development of the surgical treatment of injuries to the peripheral nerves, microsurgery with interfascicular suture and autotransplantation should be considered the method of choice.
Asunto(s)
Nervio Mediano/lesiones , Nervios Periféricos/trasplante , Nervio Cubital/lesiones , Adolescente , Adulto , Humanos , Métodos , Persona de Mediana EdadRESUMEN
The work is based on the analysis of computer tomographic findings in 196 patients (children and adults) with closed craniocerebral injury of different severity. The authors give a more precise definition of the tomographic characteristics of the different forms of craniocerebral damages and the dynamics of changes in the acute and subacute periods after the injury. Three types of intracerebral hematomas are distinguished according to the mechanism of their origin, location, and extent. The tomographic signs of cerebral contusion are systematized. The forms of traumatic edema-swelling of the brain are described according to the results of tomodensitometry. The rarity of hydrocephalus in the acute period is pointed out. Hydrocephalus was caused by dislocation of the cerebral structures with compression of the c.s.f. passages or their occlusion in intraventricular hemorrhages. The tomographic characteristics of chronic subdural hematomas are given. It is shown that dynamic tomographic control in patients with severe craniocerebral injury makes it possible to limit treatment to nonoperative measures in some cases with different forms of brain contusion and small intracerebral hematomas.