From Big Medical Encyclopedia

PROLAPSE OF THE BRAIN (Latin prolabor to move ahead, fall) — protrusion of a brain and its covers out of limits of defect of a skull. It is observed after some craniocereberal injuries, sometimes develops after neurosurgical operations, in t, h at inf. complications (encephalitis, abscesses of a brain, etc.).

P. which is found in literature at the description of m the name «brain hernias» is unsuccessful; this term should be used only in relation to malformations of a brain and skull.

In field neurosurgery distinguish several forms P. of of m at the getting wounds of the head: the expiration of a brain — allocation of a brain detritis owing to self-cleaning of a brain wound; protrusion and loss of a brain (see. Cherepnomozgovaya injury ). In turn, in each of forms depending on time of emergence of process allocate primary (early) and secondary (late) P. to of m. On a wedge, to P.'s current of of m happens high-quality (primary, aseptic) and malignant (secondary, infected). During the Great Patriotic War of P. of of m took place almost in 35% of cases of the getting craniocereberal wounds.

It is reasonable to consider mechanisms P. of of m separately for cases with slow (not acute) and bystry (acute) development of process.

Makropreparat of cerebral hemispheres with an intracerebral tumor of the right parietal lobe after a decompressive craniotrypesis (a frontal section): a prolabiruyushchy tumor (it is specified by an arrow) with massive hemorrhages.

Slow development of P. of of m usually happens against the background of the increased intracranial (intracerebral) pressure (see. Intracranial pressure ) also it is connected with hypertensive syndrome (see). Sometimes prolabiruyushchy sites have considerable volume. In this case as proximate causes of P. of of m serve the metabolic, hemodynamic and liquorodynamic disturbances which developed at infection of brain wounds, existence in a brain of foreign bodys at local circulatory disturbances (infringement of the site of a brain in defect of a firm cover of a brain or a bone window). All this leads to hypostasis and swelling brain (see). In some cases loss of a brain is caused by continuation of growth of a cerebral tumor in trepanation defect (fig). P.'s volume of of m depends on individual reactivity of c. N of page, age of the patient and some other factors.

Quickly developing P. of m (an acute vspuchivaniye of a brain) — a complication of neurosurgical interventions (hl. obr., in basal area), at Krom the brain suddenly and impetuously (with cracking) directs out of limits of defect of a skull. Under the name of «acute hypostasis (swelling) of a brain» this phenomenon is described by Vincent (S. Vincent), Le J. Le Beau, Bonvalle (M. Bonvallet), etc. H. N. Burdenko established that the vspuchivaniye is caused by impact on reflexogenic zones of the basis of a brain. B. N. Klosovsky reproduced acute P. of m in an experiment at mechanical irritation of certain kernels of pituitary and hypothalamic area. A. I. Arutyunov with sotr. proved idea of acute P. of of m as about the composite neurovascular reaction which is not in direct dependence on hypostasis and swelling of substance of a brain (in this regard acute P.'s designation by of m as acute wet brain illegally). Acute P.'s pathogeny of of m is connected also with disturbances of density and elasticity of brain fabric.

Wedge, a picture P. of of m is defined by the nature of defeat (basic disease). Locally in a wound it is possible to see sites of the dropped-out brain fabric not changed (light gray, whitish-pink color) or a congestive look (cyanotic-gray color), sometimes with imbibitsiy blood; hypostasis and brain swelling is noted staz in expanded vessels. The size of the dropped-out site depends on the extent of defect of a skull. Any independent general symptomatology caused only by a prolapse does not exist. Focal symptoms at P. of m depend on what area of a brain underwent a prolapse.

Lech. actions shall be directed to elimination of the prime causes of P. of of m. They include timely and radical processing bone p a brain wound; use of streptocides and antibiotics; normalization of intracranial pressure with the help antihypertensives (see) and dehydrational therapy (see), sometimes repeated lumbar punctures (see. Spinal puncture ); locally (at an open wound) — not injuring bandages with oil emulsions, barrier of the prolabiruyushchy site wadded and gauze «bagel», UF-radiation. Removal of prolabirovavshy sites of a brain is inadmissible.

In P.'s prevention of m the prevention inf is of great importance. complications; acute P.'s prevention of of m in neurosurgical practice provides improvement of the technology of interventions on the basis of a brain and use of a complex of resuscitation actions.

See also Craniocereberal injury .

Bibliography: Kvitnitsky-Ryzhov Yu. N. The pathomorphologic characteristic of an acute prolapse (vspuchivaniye) of a brain in experimental conditions, Vopr. neyrokhir., No. 1, page 12, 1964; it, About the factors influencing the volume of a brain, Zhurn. neuropath, and psikhiat., t. 73, century 7, page 1002, 1973, bibliogr.; Kovalyov O. A. Technique of experimental reproduction and objective registration of an acute prolapse of brain fabric, Stalemate. fiziol. and ekspery. ter., t. 4, No. 4, page 87, 1960; it, Experimental studying of an acute prolapse of a brain at various functional condition of the central nervous system, Vopr. neyrokhir., No. 6, page 35, 1960; Places N and A. Ya. Biochemical changes of brain fabric at hypostasis swelling and an acute prolapse of a brain, in book: Probl. neyrokhir., under the editorship of A. I. Arutyunov, page 203, Kiev, 1955; Neurosurgery, under the editorship of. And. P. Romodanova, century 7 — Diagnosis and surgical treatment of tumors of sellyarny area of a brain, Kiev, 1974; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 4, page 425, M., 1950; The Guide to neurotraumatology, under the editorship of A. I. Arutyunov, the p. 2, M., 1979; Samotokin B. A. Loss and protrusion of a brain at cherepnomozgovy damages, Voyen. - medical zhurn., No. 10, page 33, 1960; In e i g A. Adverse mechanical tension in the central nervous system, Stockholm, 1978; Intracranial pressure, ed. by J. W. Beks and. lake, V. a. o., 1976.

A. P. Romodanov, BB. H. Kvitnitsky-Ryzhov.