Vol 7, No 3 (2013)

In 125 autopsies cases of massive intracerebral hemorrhages (ICH), caused by arterial hypertension (AH), retrospective clinical analysis and macro- and microscopic investigation of brain and its vascular system were conducted. There were 54 females and 71 males aged from 21 to 75 (average age is 53±11). 78% of patients suffered from essential AH, 22% – from nephrogenic AH. In 50% of cases duration of AH was over 10 years. In 62% of cases the disease was severe, with uneffective treatment, and often hypertensive cerebral crises. Over 30% of these patients suffered from strokes. In all cases brain  analysis showed large ICHs (over 40 cm3), which in 84% of cases were located in cerebral hemispheres (lateral ICHs – 49%, mixed – 38%, medial – 13%), in brainstem – 9%, and in cerebellum – 7%. In 79% of cases massive penetration of blood into ventricular system was noted. Macroscopic analysis revealed local brain changes in 63% of all cases: 35% in the form of large post-haemorrhagic cysts, 44% in the form of a single or multiple lacunar infarcts (LIs). In 38% of cases with multiple LIs lacunar condition of brain was diagnosed. In 16% of these cases both cysts and multiple LIs were revealed. Local changed were found in the same deep brain areas as ICHs: more often in basal ganglions and cerebral white matter, and less often – in thalamus, pons and cerebellum. In microscopic examination morphological changes characteristic of hypertensive angioencephalopathy were detected: LIs, incomplete necrosis foci, white matter spongiosis, perivascular encephalolysis foci, criblurs, microhemorrhages. Examination of hemorrhage foci revealed structural elements of LIs located on the edge and around hemorrhage. According to our data, we suppose, that previous local and diffuse brain tissue changes, which are typical for hypertensive angioencephalopathy and lacunar condition, are predictors of massive ICHs.

MRI morphometry of the substantia nigra (SN) and the red nucleus was performed in patients with Parkinson’s disease (PD) (1 and 3 stage by Hoehn and Yahr) and healthy individuals using modes T2 and T2*-WI on magnetic resonance system ”Initial Achieva 3.0T”. Nonsignificant volume decrease of SN was revealed in patients with early manifestations of PD, and vice versa, its increase in symptomatic PD, which can be regarded as an analogue of the well-known phenomenon of ultrasonography in PD. Significantly greater than in the control SN volume asymmetry was marked in PD patients, and asymmetry increased in the progression of the disease. The findings suggest the possibility of using MRI morphometry of the brainstem structures to assess the course of the neurodegenerative process in PD.

Anesthetic neurotoxicity and intraoperative cerebral neuroprotectioan is one of the important issues in modern anesthesiology. General anesthesia, in addition to its hypnotic effect, is considered to cause postoperative cognitive dysfunction as a manifestation of encephalopathy. Narcosis based on propofol is a “gold standard” of total intravenous anesthesia and is frequently used for surgery in patients of various ages. This experimental study investigates the effects of propofol on neuronal population in hippocampus of immature rats. In propofol-anesthezied rats within 30 min of exposition, a two-fold increase of altered hippocampal neurons was detected compared to control animals, however no neuronal cell death was observed. Intraoperative use of ethylmethylhydroxypyridine succinate ameliorates propofol-induced neuronal damagethat proves a neuroprotective effect of the drug tested.