NEUROSURGERY DEPARTMENT OF SAMARKAND STATE MEDICAL INSTITUTE MINISTRY OF HEALTH OF UZBEKISTAN NEUROSURGERY DEPARTMENT OF SAMARKAND STATE MEDICAL INSTITUTE

Abdurakhmon M. Mamadaliyev THE IMPORTANCE OF THE DURATION OF DISORDERS OF CONSCIOUSNESS TO PROGNOSIS OF THE OUTCOME OF СRANIO-CEREBRAL TRAUMA Abdurakhmon M. Mamadaliyev  Professor, M.D., PhD. Academician of  the Academy medico-technics  science of Russian Federation,  The chairman of Neurosurgery Department  of Samakqand State Medical Institute,  Vice-president of the Association of Uzbekistan Neurosurgeons,  Member of Executive Committee ACNS.

The aim of the study was investigation of the prognostic value of the duration of the comatose condition and the duration of disorders of consciousness. Materials for the investigation were unified observation of 570 patients with severe cranio-cerebral trauma. The condition of consciousness was estimated by using Moscow scale of coma.

MOSCOW SCALE OF COMA № Condition of consciousness NEUROLOGICAL SIGN Opening the eyes on a sound or pain Doing the instructions Answering the questions Orientation Fixed midriasis on both sides Atonia of the muscles Code Average numbers on a scale (PAS) 1 Clear cosciousness + - 65 2 Moderate stupor 60 ±1 3 Deep stupor ± 54±3 4 Sopor (apallic syndrome)* 46±3 5 Moderate coma 32±5 6 Deep Coma 20±7 7 Terminal coma 6±6 * Periodical restoration of the elementary word contact

Neurological signs Points THE SCALE TO THE POINT ASSESSMENT OF THE CONDITION OF THE PATIENTS (PAS) Neurological signs Points Opening the eyes on a sound or pain 10 Doing the instructions 8 Answering the questions 5 Orientation The absence of the fixed midriasis on both sides The absence of the atonia of the muscles The absence of the breath disorders 4 Corneal reflexes Knee reflexes The reaction of the pupils for the light 3 Cough reflexes The absence Magandi symptom Spontaneous movements Movements for the pain Maximum level of points 65

In order of the outcomes of the trauma patients were divided for the following groups: deadly outcome (DO), rough neurological disorders (RND), moderate neurological disorders (MND) and compensated condition (CC). Average duration of coma in DO and RND was the same approximately 5 days, while in patients with restoration of the function to CC and MND this time was from several hours to 1 day. If the duration of coma was more than 5 days the probability of DO and RND was high. Average duration of disorders of consciousness on DO was 15 days. It is necessary to note that among the survival patients the duration of disorders of consciousness on RND was 5-7 times high than the left outcomes. In patients with CC the maximal duration of disorders of consciousness was 10 days.

Picture 1. Histograms the phase of the disorders of consciousness in the day of operation (before operation) for the different outcomes. Deadly outcome (DO), rough neurological disorders (RND), moderate neurological disorders (MND) and compensated condition (CC). By the axis of abscissa – the phase of the disorders of consciousness in the day of operation, by the axis of ordinates – the frequency of the phase the disorders of consciousness.

Picture 1. Histograms the phase of the disorders of consciousness in the day of operation (before operation) for the different outcomes. Deadly outcome (DO), rough neurological disorders (RND), moderate neurological disorders (MND) and compensated condition (CC). By the axis of abscissa – the phase of the disorders of consciousness in the day of operation, by the axis of ordinates – the frequency of the phase the disorders of consciousness.

Picture 1. Histograms the phase of the disorders of consciousness in the day of operation (before operation) for the different outcomes. Deadly outcome (DO), rough neurological disorders (RND), moderate neurological disorders (MND) and compensated condition (CC). By the axis of abscissa – the phase of the disorders of consciousness in the day of operation, by the axis of ordinates – the frequency of the phase the disorders of consciousness.

At the same time in group of patients with RND duration of disorders of consciousness in 50,7% was more than 16 days. The mortality was high according to the duration of the coma and in duration of coma from 5 to 10 days the mortality was 70%. In this case the probability of favorable outcome in MND and CC was low – 3,3%. If in patients the duration of disorders of consciousness was not more than 3 days in 90% they were survived in MND and CC. The duration of disorders of consciousness more than 10 days results either to mortality (29%), or patients were survived in RND (50%). The probability of CC in that patients were very low (5,2%) in spite of the duly surgical and intensive treatment by using neuroprotectors.

Picture 2. Mortality after the operation in the depends on the phase of the disorders of consciousness before the operation (in the day of the operation) By the axis of abscissa – the phase of the disorders of consciousness before the operation; by the axis of ordinates – the percentage of the mortality after operation.

Probability of favorable outcome 92% THE PROGNOSIS THE OUTCOMES OF CCT Points The Condition of consciousness 65 60 50 40 30 20 15 12 10 Probability of favorable outcome 92% Probability of favorable outcome 78% Probability of favorable outcome 43% Absolute unreliable the patients Mortality 100% Clear stupor Sopor Coma 1, 2, 3 Opportunities of the prognosis of the outcomes in the acute period cranio-cerebral trauma in the different intervals of PAS By the axis of ordinates – points and intervals of PAS. By the axis of abscissa – days after trauma. To the right conformity of the gradation of the condition of consciousness by the different intervals PAS-patients.

So, the carried out investigations were clearly showed the importance of the duration of the coma and duration of disorders of consciousness for the different outcomes cranio-cerebral trauma.