Influence of structural and morphological changes in the brain in patients with severe combat traumatic brain injury on the features of the clinic, the course of the disease, and the state of cognitive functions

Background. Traumatic brain injury (TBI), in particular combat-related traumatic brain injury (CRTBI), is of enormous medical and social importance both for the patient and his/her family, and at the state level in general. At present, due to the outbreak of a full-scale military conflict in our country, the number of cases of TBI has increased significantly not only among the military at the front, but also in frontline towns and villages among civilians suffering from daily shelling. The consequences of TBI, which lead to long-term disability and disability, are an urgent problem. In the practice of neurologists, one of the most pressing consequences of TBI is cerebral cortical atrophy or secondary cerebral atrophy as a result of the traumatic factor. This became possible due to the analysis of the results of neuroimaging methods: computed tomography (CT) and magnetic resonance imaging (MRI). Purpose – study was to investigate clinical and neurological symptoms, as well as morphometric and structural features of the brain substance in patients with severe TBI (ScrTBI), depending on the history of the injury. Materials and methods. There were 80 patients with consequences of TBI (22.85%), mean age – 46.5 ± 0.85 years. The distribution of groups according to the history of TBI: from 6 months to 1 year – 20 (25.0%), from 1 to 3 years – 30 patients (37.5%), from 4 to 7 years – 30 (37.5%). We studied the complaints, medical history, life history, social status, and neurological symptoms of the patients studied. All patients underwent a detailed clinical and neurological examination and assessment of the autonomic nervous system – vegetative tone, vegetative reactivity (VR), vegetative activity support (VAS) were determined, neuroimaging methods of investigation were prescribed: magnetic resonance imaging (MRI), spiral computed tomography (SCT). Results. The study revealed that traumatic combat brain injury (TBI), regardless of the duration of the history, is accompanied by significant cognitive, neurological and psycho-emotional disorders that significantly affect the quality of life of patients. The dominant complaints of patients, regardless of the duration of the injury, include headache, dizziness, memory loss, mood changes and sleep disturbances. Most patients reported a combination of several syndromes, including cerebral-focal, mental dysfunction, epileptic and vestibulo-ataxic syndromes. Conclusions. Neuroimaging methods (CT, MRI) confirmed the presence of structural changes in the brain, such as an increase in the size of the ventricular system and subarachnoid spaces, which are signs of cerebral atrophy. The most pronounced changes were observed in patients with a history of 4 to 7 years, where ventricular enlargement reached its maximum. In all groups, a significant increase in the width of the third ventricle and the expansion of subarachnoid spaces was detected, indicating the progression of atrophic processes in the brain due to TBI. Thus, the consequences of TBI are characterised by long-term structural and functional changes in the central nervous system that require comprehensive treatment and rehabilitation aimed at improving cognitive and mental functions, as well as correcting somatic complications.