Differential possibilities of classical histological research methods for establishing the genesis of hemorrhages in the human brain substance

Verification of the cause of death (CD) from ischemic cerebral infarction (ICI), hemorrhage of traumatic (GTG) and non-traumatic (GNG) genesis eliminates the violent origin of death. Very often it is difficult to diagnose the genesis of hemorrhage only macroscopically when performing an autopsy, so additional material should be selected for forensic histological examination. Aim of the work. To develop forensic criteria for the differentiation of ICI, GTG and GNG of the brain by light microscopy of histological sections of the human brain (HB). Material and methods. For the study were used native sections and stained histological specimens of HB from 110 corpses in the case of: death from ICI – 30 histological specimens (1 group), which were made of 30 speciments stained by the methods of Nissl and Spiel-Mayer; GNG – 30 histological samples (group 2) – 30 speciments, stained similarly to the previous group; GNG – 30 histological samples (group 3) – 30 speciments stained similarly to the previous group. Brain preparations in case of death from coronary heart disease were selected for control – 20 samples (4 groups) – 20 speciments stained by the methods of Nissl and Spiel-Mayer. Results. Analysis of the obtained data of histological examination of morphological changes of tissue elements of the human brain with different genesis of hemorrhage did not reveal stable relationships between changes in the structure of nervous tissue and the cause of hemorrhage. Conclusion. Given the nonspecificity of degenerative changes in the structural elements of the brain, depending on the genesis of hemorrhage, it can be concluded that morphological methods of histological preparations of the brain do not provide accurate and objective information about the genesis of hemorrhage.

ADRENALINE, AND WHAT PROCESSES OCCUR UNDER ITS ACTION IN OUR BODY

In this article, we will consider the principle of one of the most tangible and powerful mediators functioning in the body. Adrenaline (epinephrine - in the USA) is simple to outrage, in super stressful situations it turns on and saves a life. He, as a professional bodyguard, is inactive 99% of the time, but at 1%, works quickly, hard, effectively. Adrenaline is generally a hormone, but structurally close to noradrenaline. Similar effects, only with a sense of fear and anxiety. The hormone, which is produced by the brain substance of the adrenal glands, which plays a special role in the adaptation mechanism of the body to stressful circumstances (often they say this: "struggle or flight"). Its effect on the body is quite diverse, it increases the strength and speed of the heartbeat, the frequency and depth of breathing, causes a cast of blood from the skin and digestive system, and flushes to the heart and mice, and also stimulates the production of glucose in the liver to increase the amount of energy by increased breathing. Synthetic adrenaline is used in some cases as a medicine, especially when removing patients from a state of shock or after cardiac arrest.

Tactics of a general practitioner in case of suspected acute cerebrovascular accident and measures to prevent it

Acute cerebrovascular accident (stroke) is a fairly common severe pathology, which is one of the main causes of death in most countries. Every year in the world, a stroke occurs in 15 million people, of whom about 5 million die, and the same number become disabled. The disease is based on a sudden sharp failure of the normal blood supply to the brain substance due to a rupture or blockage of a blood vessel. Mortality in the first weeks after a stroke can reach 30-35%. Depending on the pathogenesis of the lesion, stroke can be ischemic and hemorrhagic (ischemic occurs about 6 times more often); clinical symptoms will depend on which area of the brain is involved in the pathological process. Predisposing factors include heredity, gender (more often observed in men), age (in elderly age, the risk of stroke increases every year), arterial hypertension, diabetes mellitus, obesity, hypodynamia. Since in 80% of cases after a stroke people become disabled, often unable to take care of themselves, the problem of acute cerebrovascular accident has long passed from the category of purely medical issues to the category of socio-economic ones. The tasks of the general practitioner include the timely identification of factors predisposing to the development of a stroke and minimization of the possible risks of this formidable condition, and in the case of a stroke, active participation in the patient's rehabilitation process.

Neuroimaging predictors of structural epilepsy in the COVID-19 catamnesis

Respiratory system pathology is the most common clinical disorder associated with COVID-19. However, there are also lesions of the immune, cardiovascular, genitourinary, endocrine systems, and digestive tract. In addition, there are numerous reports on infection-related neurological manifestations, which can be divided into 3 groups: central nervous system manifestations (headache and dizziness, stroke, encephalopathy, encephalitis, acute myelitis), lesions of the peripheral nervous system (anosmia, Guillain–Barre syndrome), secondary lesions in the skeletal muscles. Brain damage that occurs during novel coronavirus infection and determines some of the above-mentioned manifestations often account for the development of structural epilepsies. Only a few scarce review articles on neuroimaging features in patients with COVID-19 have been found in Russian research publications.The objective of the review was to collect, analyze and summarize the results of brain magnetic resonance imaging (MRI), currently accumulated worldwide in patients with COVID-19. We present the most common diagnoses based on brain MRI in patients with COVID-19 established by foreign researchers from March 2020 to March 2021, as well as initial attempts to interpret the pathophysiological mechanisms of the changes observed in the brain substance.

Forensic medical evaluation of hemorrhages into the brain of traumatic and non-traumatic genesis by the Mueller matrix microscopy of circular dichroism

The aim of the work is to develop forensic criteria for differentiation of hemorrhages of traumatic and non-traumatic genesis by digital Mueller matrix (MM) polarization microscopy of histological sections of human brain substance (HBS).Material and methods. Native histological preparations of HBS from 32 corpses with ischemic stroke (1 group), 35 corpses with hemorrhages of traumatic origin (2 groups), 33 corpses with hemorrhages in HBS of non-traumatic genesis (3 group) and 30 corpses caused by acute coronary insufficiency (4 control group). The method of research is azimuthal-invariant MM microscopy of circular dichroism (CD) of histological sections of the brain.Results. The results of studies of the coordinate and statistical structure of maps of the size of values at the points of digital microscopic images of histological sections of HBS of the dead of all groups revealed a coordinate-inhomogeneous structure of all distributions of the size of the CD of microscopic images of histological sections of the dead of all groups. Probable distributions that characterize MM invariants CD maps of histological sections of brain samples from all groups have a small scatter of values of the statistical moment of the 2nd order, as well as significant values of statistical moments of the 3rd and 4th orders.Conclusion. The efficiency of using the Mueller-matrix mapping method in diagnosing of hemorrhage genesis in the brain substance in the differentiation of the set of samples of control and experimental groups reaches a satisfactory level - 77% - 78%.

Diagnostic imaging in patients with mucopolysaccharidosis: important imaging patterns.

Background: the need for systematization, generalization and analysis of structural changes in various organs and systems that occur in patients with mucopolysaccharidosis (MPS). MPS is a rare disease, therefore, there is a lack of structured information in the field of radiology among Russian publications. Aims: The puspose of the study is to summarize our own experience, compare it with the literature data, and describe the most significant changes and their causes in MPS. Methods: Retrospectively, 303 children with MPS were examined (the sample included 70 cases verified by laboratory and molecular genetics) of different types, revision of tomograms and radiographs was carried out among studies from 2015 to 2021. All patients underwent MRI of the brain and cervical spine, X-ray of the bones of the skeleton. Results: Analysis of the images obtained revealed the most common changes, such as dysostosis (in 100%, 70 patients), stenosis of the spinal canal at the craniovertebral level (73%, 51 patients), atrophy (47%, 33 patients) and focal lesions of the brain substance ( 67%, 47 patients), hydrocephalus (28%, 20 patients), expansion of the perivascular spaces (70%, 58 patients). The pathophysiological mechanisms of the occurrence of structural changes have been analyzed and described. Conclusions: The assessment and comparison of various diagnostic methods for different organs and systems was carried out: for the assessment of the craniovertebral junction, the most informative imaging method is MRI. Given the lower radiation exposure compared to computed tomography, it is preferable to use digital radiography for examining the bones of the extremities.

Decompressive craniectomy in the treatment of supratentorial hypertensive intracerebral hematomas

The study objective is to evaluate feasibility and effectiveness of decompressive craniectomy (DC) for treatment оf supratentorial hypertensive intracerebral hematomas (ICH).Materials and methods. Between 1996 to 2019, 97 patients with supratentorial hypertensive ICHs underwent surgical treatment. DC was performed in 50 patients (primary - in 41, secondary - in 9). Putaminal hematomas were diagnosed in 30 patients, subcortical - in 20. The comparison group consisted of 47 patients, of which 20 had osteoplastic craniotomy (OPC) with microsurgical removal of ICH, and 27 had endoscopic aspiration (EA). The performed DCa were treated as unjustified (decreased brain dislocation without prolapse of the brain substance into the trepanation defect), ineffective (preservation of brain dislocation and absence of prolapse of the brain substance into the trepanation defect, as well as small size of the trepanation hole) and effective (prolapse of the brain substance into the trepanation defect and regression of transverse brain dislocation).Results. DC was effective only in 22 (44 %) patients (13 - primary, 9 - secondary). Among patients with subcortical ICH, mortality rate after DC was equal to that after OPC and EA. Among patients with putaminal ICH, the mortality rate after DC was significantly higher than after OPC and EA. Among the patients who underwent primary EA and delayed DC (due to recurrent ICH), postoperative mortality rate was significantly higher than among the patients who underwent repeated EA of recurrent ICH. However, there were no fatal outcomes among patients who underwent delayed DC due to increased edema and transverse dislocation of the brain without recurrent ICH.Conclusion. In the surgical treatment of supratentorial hypertensive ICH, decompressive effect of DC was achieved only in 44 % of patients. Open removal of putaminal hematomas in combination with DC was unjustified, mortality rate was 66 %. Primary DC with removal of ICH is indicated in patients with subcortical hematomas with a volume >50 cm3 , with transverse dislocation >7 mm, deep deafness or sopor. Delayed DC, regardless of the location of ICH, is recommended in case of increased edema and transverse dislocation of the brain in patients without recurrent hemorrhage.

Differential diagnosis of spontaneous intracranial hemorrhage in young

In recent years, cerebral vascular diseases have been increasingly detected in young patients. It is due not only to better physicians’ knowledge about this pathology, but also to the improvement of its diagnosis methods. Modern neuroimaging techniques allow us to clarify the nature of hemorrhage, to determine the volume and location of intracerebral hematoma, and to establish the degree of concomitant edema and dislocation of the brain. However, despite the high accuracy of the research, it is not always possible to establish the cause that led to a brain accident, which greatly affects the tactics of management and outcomes in this category of patients. A special feature of the structure of cerebrovascular diseases of young people is the high proportion of hemorrhagic stroke, the causes of which are most often arterio-venous malformations. Meanwhile, there are a number of other causes that can lead to hemorrhage into the brain substance. These include disorders of blood clotting, and various vasculitis, and exposure to toxic substances and drugs, and tumor formations (primary and secondary). All these pathological factors outline the range of diagnostic search in young patients who underwent hemorrhagic stroke. Diagnosis of these pathological conditions with the help of modern visualization techniques is considered to be easy, but this is not always the case. In this article, the authors give their own clinical observation of a hemorrhagic stroke in a young patient, which demonstrates the complexity of the diagnostic search in patients with this pathology.

METHODS TO DETERMINE COMPLEX DEGREES OF MUTUAL ANISOTROPY FOR THE DIFFERENTIATION OF HEMORRHAGES IN THE HUMAN BRAIN SUBSTANCE RESULTING FROM TRAUMATIC AND NON-TRAUMATIC GENESIS

An issue that is often debated in forensic traumatology is the differential diagnosis of hemorrhages into the human brain substance (HBS) of traumatic and non-traumatic genesis. Objectives. This study aims to identify new criteria for objective forensic differentiation of hemorrhages of traumatic origin, cerebral infarction of ischemic and hemorrhagic genesis by using the method of complex degree of mutual anisotropy. For this study native sections of HBS from 125 corpses were used in the case of: death from coronary heart disease - 35 (28%) of native sections (Group 1 - control); hemorrhages of traumatic genesis - 30 (24%) sections (Group 2); ischemic cerebral infarction - 30 (24%) native sections(Group 3); and hemorrhages of non-traumatic genesis - 30 (24%) native sections (Group 4). Results. The statistical moments of the third and fourth orders, which characterize the asymmetry and excess of the complex degree of mutual anisotropy module size distributions, the strength of the method of polarization-correlation microscopy in the differentiation of the samples of the histological sections of the brain of control and experimental groups reached a good level — 87%-90%. Conclusion. The method of complex degree of mutual anisotropy allows differentiating with great precision the genesis of hemorrhage into the substance of the brain.