Вестник хирургии» • 2015 68 Ключевые слова: оториноларингологическая специализированная помощь, нейрохирургическая специализированная помощь, отогенные внутричерепные осложнения

No abstract

Based on available publications, the article systematizes information about some forms of lesions of the central nervous system (CNS), their pathogenesis and clinical manifestations in the case of COVID-19. The risk factors, mechanisms of development, diagnostic approach, and the age characteristics of patients with neurological complications of COVID-19 are discussed. The specific mechanisms of the neuroinvasiveness and neurovirulence of the SARS-CoV-2 virus, regardless of the age of patients and the presence of risk factors, lead to systemic damage to the endothelium of small-caliber vessels, generalized thrombovasculitis, and an increased risk of ischemic and hemorrhagic strokes. At the same time, the most vulnerable category is elderly and senile patients with cardiovascular and metabolic disorders (arterial hypertension, obesity, diabetes mellitus), which sharply worsen treatment outcomes. The clinical experience accumulated during the COVID-19 pandemic indicates the development of the following most frequent post-covid neurological complications and consequences in mainly elderly and senile patients: cranial mononeuropathies, chemosensory dysfunction, encephalopathy, insomnia, stroke, acute meningoencephalitis, acute disseminated encephalomyelitis, acute polyneuropathy Guillain–Barré syndrome, and transverse myelitis. The benefits of vaccination against COVID-19 far outweigh the risks of possible post-vaccination neurological complications and consequences, especially in elderly and senile patients.

The OBJECTIVE was to study the dependence of the results of neurosurgical treatment of elderly patients with severe TBI on the organizational transformations of the neurotraumatology care system on the metropolis – Saint Petersburg scale.METHODS AND MATERIALS. 1228 victims aged 60 to 75 years with severe TBI (men – 982 (80.0 %) people, women – 246 (20.0 %) people) who were treated in the neurotraumatology centers of St. Petersburg in the period before (2007–2009) and after (2010–2020) organizational transformations.RESULTS. The measures implemented on a megalopolis scale have made it possible to improve the system of neurotraumatology care in St. Petersburg due to optimal routing and rapid delivery of elderly victims with severe TBI to neurotraumatology centers, performing brain SCT scans around the clock during the first 6 hours from the moment of their delivery to the hospital, conducting minimally invasive including neuroendoscopic brain surgery, performing early rehabilitation treatment in the conditions of neurotraumatology centers with further continuation in inpatient centers and medical rehabilitation departments.CONCLUSION. Modernization of the system of neurotraumatology care for elderly patients with severe TBI on the metropolis – St. Petersburg scale allowed to reduce the frequency of functional disorders, infectious and inflammatory complications, the rate of temporary disability, disability and mortality of victims.

В в е д е н и е. Инсульт остаётся одной из основных проблем здравоохранения во всем мире, так как является второй по значимости причиной смерти и инвалидности. При этом риск развития инсульта существенно повышается с возрастом: если в возрасте 45-54 лет частота инсультов составляет один на 1000 человек в год, в возрасте 65-74 года -один на 100 человек, а старше 85 лет -один на 30 человек [2, 6, 10]. Выявлено, что у 75-89 % больных инсульт развивается после 65 лет, 50 % из них -старше 70 лет и около 25 % -старше 85 лет. При этом возраст отрицательно сказывается на исходах инсульта. Две трети ишемических инсультов связаны со стенозированием и деформацией сонных артерий. Около 30 % наблюдений составляют инсульты, обусловленные поражением артерий вертебрально-базилярного бассейна, кардиогенные инсульты и лакунарные