Neurosurgery

doi: 10.25005/2074-0581-2017-19-3-325-330
DIFFERENTIAL DIAGNOSIS OF SEVERE COMBINED CRANIOCEREBRAL INJURY AND FAT EMBOLISM SYNDROME

A.A. Razzokov1, M.K. Nazarov2

1Department of Traumatology, Orthopaedics and Military Field Surgery, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
2Tursunzade Central Regional Hospital, Tursunzade, Tajikistan

Objective: To improve the differential diagnosis of severe combined craniocerebral injury (SCCI) and the fat embolism syndrome (FES)

Methods: The analysis of data on 338 patients with SCCI was carried out. There were 236 men (69.8%), women – 102 (30.2%) at the age of 18 to 68 years. Eligible patients were the presence of a concomitant injury with symptoms of traumatic shock and a violation of consciousness. In the control group (42.6%) performed the traditional tactics of diagnostics. In the main group (57.4%), in preventive diagnostic algorithm mode consisted of the identification of the fat globulemia (FG) according to Kornilov, a purposeful diagnosis of SFE, and an assessment of the severity of the craniocerebral components of the considered injury using computed tomography

Results: In the control group, FES was set only 12 (8.3%) cases, which have been fatal. Total deaths in the control group took place in 58 (40.3%) observations. In the main group among SCCI FES was established in 33 (17.0%) patients; CCI in 99 (51.0%) and FES + CCI in 62 (32.0%) patients. Various manifestations of FES were revealed in 95 (49.0%) patients, which were presented classical – 15 (7.7%), clinical – 29 (15.0%) and subclinical forms – 51 (26.3%). Based on the results of the work, a scale was proposed for the differential diagnosis of FES and CCI, the efficiency of which was 97.4%.

Conclusions: Optimization of SCCI treatment, with regard to the identification of FG, diagnosis of various forms of FES and computer tomography data, allowed to reduce the lethality by 13.5% compared to traditional approaches (26.8% and 40.3%, respectively). With a differentiated analysis in the main group, the specific gravity of lethality among patients with FES was 12.1%, with CCI – 23.2% and with CCI + FES – 40.3%.

Keywords: Сombined injury, craniocerebral injury, fat globulemia, fat embolism syndrome, differential diagnosis, lethality.

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References
  1. Gabdullin MM, Mitrakova NN, Gatiatulin RG. Sindrom zhirovoy embolii [Syndrome of fat embolism]. Sovremennye meditsinskie tekhnologii. 2012;1:108-14.
  2. Salimov NF, Razzokov AA. Vliyanie vnedreniya sovremennykh tekhnologiy i novykh mekhanizmov finansirovaniya na pokasateli resursnogo obespecheniya travmatologo-ortopedicheskoy sluzhby [The influence of adoption of modern technologies and new mechanisms of financing to indications of resource support of traumatologic-orthopedic service]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;1:128-35.
  3. Salimov NF, Razzokov AA. Profilaktika dorozhno-transportnogo travmatizma v Tadzhikistane [Prevention of traffic accident in Tajikistan]. Vestnik Avitsenny [Avicenna Bulletin]. 2013;1:54-9.
  4. Shteynle AV. Sindrom zhirovoy embolii (analiticheskiy obzor) [The syndrome of fat embolism (analytical review)]. Sibirskiy meditsinskiy zhurnal. 2009;2:117-26.
  5. Roozenbeek B, Maas AI, Menon D. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013;9:231-6.
  6. Agadzhanyan VV, Kravtsov SA, Shatalin AV, Levchenko TV. Gospital’naya letal’nost’ pri politravme i osnovnye napravlenya eyo snizheniya [Hospital lethality at polytrauma and basic directions of its reduction]. Politravma. 2015;1:1-15.
  7. Puras YV, Talypov AE, Krylov VV. Letal’nost’ u posrtadavshikh s tyazhyoloy sochetannoy cherepno-mozgovoy travmoy [The lethality at suffered by severe combined craniocerebral trauma]. Neyrokhirurgiya. 2010;1:31-9.
  8. Volpin G. Fat embolism syndrome following injuries and limb fractures. Harefuah. 2010;149(5):304-35.
  9. Razzokov AA, Salimzoda NF, Nazarov MK, Razokov FA, Batyrov FO. Organizatsiya meditsinskoy pomoshchi, diagnostiki i lecheniya sindroma zhirovoy embolii pri sochetannoy i mnozhestvennoy travme [Organization of medical aid, diagnostics and treatment of syndrome of fat embolism at combined and multiple trauma]. Dushanbe, RT: Maorif; 2015. 216 р.
  10. Kalinkin OG, Kurapov EP, Gridasova EI. Sovremennye predstavleniya o sindrome posttravmaticheskoy zhirovoy embolii [Modern ideas of a syndrome of the post-traumatic fat embolism]. Tavricheskiy medikobiologicheskiy vestnik. 2012;2:117-20.
  11. Chen S, Wu H, Tang J. Neurovascular events after subarachnoid hemorrhage. Focusing on subcellular organelles. Acta Neurochirurgica Supplement. 2015;120;39-46.
  12. Trofimov AO, Kalentyev GV, Voennov OV, Yuriev MYu, Trofimova SYu, Agarkova DI. Narusheniya tserebral’noy mikrotsirkulyatsii pri cherepno-mozgovoy travme [The disturbances of cerebral microcirculation in severe head injury]. Regional’noe krovoobrashchenie i mikrotsirkulyatsiya. 2015;2:4-15.
  13. Davydova NS, Shen NP, Boltaev PG, Vasilenko PB, Skorokhodova LA. Sindrom zhirovoy embolii pri skeletnoy travme: osobennosti diagnostiki, ekonomicheskie aspekty i rol’ neinvazivnoy ventellyatsii lyogkikh v intensivnoy terapii [Fat embolism in skeletal trauma: particularities of the diagnosis, economic aspects and the role of non-invasive ventilation in intensive care]. Anesteziologiya i reanimatologiya. 2014;4:60-3.
  14. Potapov AA, Zakharova NE, Kornienko VN. Neyroanatomicheskie osnovy travmaticheskoy komy. Klinicheskie i magnitno-rezonsnsnye korrelyaty [Neuroanatomic bases of a traumatic coma. Clinical and magnetic and resonant correlates]. Voprosy neyrokhirurgii im. N.N. Burdenko. 2014;78:4-14.
  15. Radevska NS, Ovchinnikov LV. Profilaktika sindroma zhirovoy embolii pri tyazhyolykh sochetannykh travmakh [Рrevention of fat embolism syndrome with severe concomitant injuries]. Evraziyskiy soyuz uchyonykh. 2015;11(20):159-62.

Authors informations:

Razzokov Abduvali Abduhamitovich, Doctor of Medical Sciences, Full Professor, Head of the Department of Traumatology, Orthopedics and Military Field Surgery, Avicenna Tajik State Medical University

Nazarov Mahmadali Kadyralievich, Head of the Neurosurgical Department of the Tursunzade Central Regional Hospital

Address for correspondence:

Razzokov Abduvali Abduhamitovich

Doctor of Medical Sciences, Full Professor, Head of the Department of Traumatology, Orthopedics and Military Field Surgery, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: (+992) 915 046001

E-mail: rfiruz@mail.ru

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