A role of stress-induced neuroendocrine disorders and tissue hypoxia in the thanatogenesis of traumatic intracranial hematomas

Abstract

Objective. To study the dynamics of plasma concentration of stress hormones (ACTH and cortisol) and lactate as well as the integrative stress level indicator at neuroreanimation stage of severe cranial-brain injury. Material and methods. Authors examined 34 patients with traumatic intracranial hematomas including 19 patients who died during the first two weeks after admission to the hospital and 15 patients who were discharged for outpatient treatment. To assess stress level, we used the indicator of stress level estimated as body mass x 1/3 x heart rate frequency x pulse pressure x 0,000126. Contents of blood plasma ACTH and cortisol were determined using radioimmune method, lactic acid was measured with enzyme colorimetric method. A control group included the indicators of 10 healthy people aged from 24 to 44 years. Results and conclusion. In the first 24 h, the overstrain of the neuroendocrine system in response to strong stress influence of the trauma was noted in all patients. In patients with fatal outcome, an increase in cortisol in the first 24 h was excessive and lactate level was significantly higher during the observational period compared to the patients with favorable outcome. The peak of mortality was at 1—5 days when the stress level indicators, contents of ACTH, cortisol and lactate reached maximal values indicating the stress-induces overstrain of the hypothalamic- pituitary-adrenal axis and promoting the development of brain tissue hypoxia.