Acute Disorders Of Cerebral Circulation Research Articles

Local Experimental Intracerebral Hemorrhage in Rats.

(1) Background: Hemorrhagic stroke is a lethal disease, accounting for 15% of all stroke cases. However, there are very few models of stroke with a hemorrhagic etiology. Research work is devoted to studying the development of cerebrovascular disorders in rats with an intracerebral hematoma model. The aim of this study was to conduct a comprehensive short-term study, including neurological tests, biochemical blood tests, and histomorphological studies of brain structures. (2) Methods: The model was reproduced surgically by traumatizing the brain in the capsula interna area and then injecting autologous blood. Neurological deficit was assessed according to the McGrow stroke-index scale, motor activity, orientation–exploratory behavior, emotionality, and motor functions. On Day 15, after the operation, hematological and biochemical blood tests as well as histological studies of the brain were performed. (3) Results: The overall lethality of the model was 43.7%. Acute intracerebral hematoma in rats causes marked disorders of motor activity and functional impairment, as well as inflammatory processes in the nervous tissue, which persist for at least 14 days. (4) Conclusions: This model reflects the situation observed in the clinic and reproduces the main diagnostic criteria for acute disorders of cerebral circulation.

SLEEP DISORDERS AND THEIR COMPLEX REHABILITATION USING TRANSCRANIAL MAGNETIC STIMULATION IN POST-STROKE REHABILITATION: STUDY DESIGN

In the Republic of Bashkortostan, a new original study of sleep-in patients in the recovery period of cerebral stroke is planned. One of the goals will be to improve the algorithms of sleep disorders management in complex post-stroke rehabilitation using rhythmic transcranial magnetic stimulation (rTMS). In this paper, we present the design of this study using modern instrumental and clinical technologies for the diagnosis of sleep disorders and rehabilitation. The work will be of practical importance in rehabilitation medicine and neurology for improving the quality of life of patients who have suffered acute cerebral circulatory disorders. We plan to study sleep disorders in patients in the early recovery period of stroke using clinical and polysomnographic techniques, to evaluate the safety and clinical effectiveness of rTMS in the studied patients with sleep disorders, to study the duration of the effects of rTMS on sleep normalization. The successful completion of the study will help to add to algorithms for correcting sleep disorders in post-stroke rehabilitation using transcranial magnetic stimulation.

Endovascular treatment of the rupture of thoracic aortic aneurysm, manifested by a neurological «mask»

The article describes a case of successful treatment of the rupture of aortic aneurysm by the endovascular method. Patient P., 71 years old, was hospitalized in a multidisciplinary hospital with a diagnosis of acute cerebral circulation disorder. The patient was examined in the intensive care unit. Signs of neurological symptoms regressed. Spiral computed tomography of the chest organs was performed with suspected pulmonary embolism, the results of which revealed an aneurysm of the descending thoracic aorta, complicated by a rupture with the formation of a right-sided hemothorax. The patient underwent endoprosthesis of the thoracic aorta with stent graft. After 2 days, thoracoscopic sanitation, drainage of the right pleural cavity was performed. The postoperative period proceeded without peculiarities. The patient was discharged on the 12th day in satisfactory condition. At control examination in 1, 6, 12 months, the long-term steady positive result was noted. Endovascular methods minimize the risk of postoperative complications, contributing to a favorable outcome of the disease.

Physical therapy of post-stroke patients in the residual period

The prevalence of ischemic stroke among people of working age requires a deep analysis of modern technologies of physical therapy at different periods of rehabilitation treatment. The issue of restoring working capacity and preventing repeated acute disorders of cerebral circulation is currently very acute. In modern scientific and methodological literature, more attention is paid to the effectiveness of physical rehabilitation in the acute and early periods of recovery. However, it should be noted that the duration of rehabilitation measures is not limited by time, rehabilitation treatment can occur in a later period, that is, in the residual. Rehabilitation of the effects of a stroke is the subject of close attention of physical therapists. The quality of life of patients depends on the timely and professional conduct of physical therapy at different periods of the disease. It has been proven that the basic method of physical therapy is kinesiotherapy, which must be carried out continuously. When conducting classes in the residual period, the emphasis should be on compensating for impaired functions and re-adaptation of the patient. In the classroom, it is recommended to repeat the training of isolated movements with a gradual transition from one type of movement to another, frequent repetition of complex movements that require more attention, aimed at coordination and balance. In addition to kinesiotherapy, the literature contains recommendations for the use of neurodynamic methods and high-tech robotic techniques. However, most authors note that only a differentiated approach and the complex use of kinesiotherapy with other methods of physical therapy are able to improve the quality of life of patients after an ischemic stroke.

Causes of ischemic stroke in patients younger than 45 years: analysis of data from the regional vascular center

In young patients, the causes of ischemic stroke (IS) are substantially different from those in older patients. Understanding the causes of the disease in patients younger than 45 years is needed to elaborate examination algorithms used in the country’s vascular departments.Objective: to present the nosological characteristics of IS in patients younger than 45 years according to the hospital register of the regional vascular center.Patients and methods. The data of the hospital register of the neurological unit for patients with acute cerebral circulatory disorders, who were in the Perm Territorial Vascular Center, City Clinical Hospital Four, in 2014 to 2020, were analyzed. The analysis included 126 patients under the age of 45 years with IS verified by magnetic resonance imaging.Results and discussion. The pathogenetic subtypes of IS according to the TOAST criteria were large artery atherosclerosis [n=10 (7.9%)], cardioembolism [n=27 (21.4%)], small vessel disease [n=15 (11.9%)], IS of other determined etiology [n=23 (18.3%)], and IS of undetermined etiology [n=51 (40.5%)]. After excluding incomplete examination cases (n=29), the most common causes of IS were cardiac embolism (patent foramen ovale, atrial septal defect, prosthetic valves, acute infective endocarditis, and chronic cardiac aneurysm) (27.8%), large artery disease (atherosclerosis and unspecified arteriopathy) (21.6%), small artery disease (15.5%), as well as cervical and cerebral artery dissection (10.3%). Cryptogenic stroke was observed in 13% of patients. There was a preponderance of cryptogenic IS in the age subgroup of 21–25 years, cardiac embolism (mainly patent foramen ovale) in the subgroup of 26–35 years; the proportions of cardiac embolism, large and small artery diseases, and dissections were comparable in the subgroup of 36–40 years; large and small artery diseases prevailed in the subgroup of 41–44 years.Conclusion. The most common causes of IS in 18–44-year-old patients are cardiac embolism (mainly through the mechanism of paradoxical embolism) and large artery disease, including dissection. The etiology of IS depended on age: cardiac embolism prevailed in the younger age range, whereas large and small artery diseases were dominant in the older age range.

Факторы риска и особенности течения инсульта у лиц молодого возраста в городской и сельской местности Тамбовской области

Since 2011 according to the national project “Health” the Regional Vascular Center has been operating on the basis of the Tambov Regional Clinical Hospital. This is a ward for patients with acute cerebral circulation disorder. Since 2017 there has been an increase in patients due to an increase in the number of attached population to Tambov Regional Clinical Hospital and, accordingly, unfortunately, the mortality rate from acute cerebral circulation disorder has been increasing. Between 2016 and 2020, a study was conducted based on the follow-up of young patients with hemorrhagic and ischemic stroke. In the study we emphasized the research of regional features of the structure, causes, and risk factors of stroke in persons in the city of Tambov and the districts of the Tambov Region. We verified pathogenetic subtypes of stroke among young patients. We identified and considered main and concomitant factors determining stroke outcome, degree of neurological deficiency, and disabled patients. We identified the leading causes of stroke in persons, the main of which were: arterial hypertension, cardiac pathology, atherosclerosis.

Медицинский логопед в мультидисциплинарной реабилитационной команде. Практический опыт Клиники Института Мозга

Background. In domestic and foreign publications, there are no descriptions of the principles of interaction between a medical speech therapist (MST) and other members of a multidisciplinary rehabilitation team (MDRT). Aim. To analyze our own experience in organizing the work of the speech therapy service of the regional neurorehabilitation Center. Materials and methods. We conducted a retrospective analysis of the activities of the division of MST of the interterritorial Center for Neurorehabilitation “Clinic of the Brain Institute“ (CBI) for the period 2015–2019. In the structure of the CBI, there is a 24-hour hospital with 45 beds, including a 9-bed intensive care unit, an 8-bed day hospital, a polyclinic with 50 visits per shift, and a telemedicine center. The speech therapy team of the MDRT consists of 8 specialists with higher education in the specialty “speech pathologist-defectologist“. Speech therapy examination consists of key blocks of clinical diagnosis of speech therapy syndromes: dysphagia, dysarthria, aphasia and prosoparesis. Each block represents a complex of a basic score scale and additional instrumental, including neurophysiological methods. The basis of speech therapy is voice training, articulation and probe massage and other standard procedures, combined in the concept of “basic techniques” for speech therapy syndromes. Drug and non-drug modulations are used to enhance the basic techniques. Results. In the period from 2015 to 2019, 5243 patients were treated in CBI after acute cerebral circulatory disorders and traumatic brain injuries, of which 4273 (81%) needed the help of clinical speech therapists. The most common problem was dysarthria – 55%. Speech breakdown in the framework of aphasia syndrome was noted in 26% of all hospitalized patients. Dysphagia was diagnosed in 30% of all hospitalized patients. During the hospitalization period of 14 days, each patient receives at least 45 minutes of daily individual training with a specialist and group articulation exercises, including weekends. The lesson is preceded by a modulating drug or non-drug procedure. For 5 years, 4273 patients were treated with speech therapy team. In 154 (11.6%) patients, speech therapy syndromes completely regressed, in 28% the severity of their manifestations decreased by 1–2 levels. Conclusion. At the early stage of rehabilitation, the speech therapist is called upon to solve priority tasks: achieving the maximum possible level of independence of the patient, at least staying at home with a minimum level of dependence on the help of a guardian. This is a prerequisite for the implementation of an individual comprehensive rehabilitation program. Despite many methodological and organizational problems, the MST is a key member of the MDRT, without which an effective rehabilitation process is impossible.

Venous thromboembolic complications in patients with intracerebral hemorrhage

To evaluate the effectiveness and safety of various heparin therapy regimens for venous thromboembolic complications in patients with acute cerebral circulatory disorders of the hemorrhagic type. In a prospective single-center study, treatment results of 62 patients with hypertensive brain hematoma were analyzed. All patients were divided into two comparable groups: the group of «very early» prophylactic heparin therapy or the first 48 hours from the moment of the disease (n=35) and the group of «early» prophylactic heparin therapy, or later than 48 hours from the moment of the intracerebral hematoma development (n=27). The end points of the study were: venous thrombosis, pulmonary embolism (fatal and non-fatal), recurrent intracerebral hemorrhage, other clinically significant hemorrhagic complications, and intrahospital mortality. In the group of «very early» and «early» prophylactic heparin therapy, the results were as follows: venous thrombosis 22.9% vs. 29.6% (p=0.36), total rate of PE 2.9% vs. 11.1% (p=0.03), nonfatal PE 0% vs. 7.4% (p=0.007), fatal PE 2.9% vs. 3.7% (p=0.76), recurrent intracerebral hemorrhage and other hemorrhagic complications 0% in both groups, intrahospital mortality was 54.3% versus 48.1% (p=0.54). The earliest administration of direct anticoagulants in prophylactic doses in patients with hemorrhagic stroke leads to the decrease in the frequency of venous thrombosis and thromboembolic complications, without being accompanied by the development of repeated intracranial and other hemorrhagic events.

Pathogenetic and therapeutic aspects of cardioembolic stroke

Cardioembolic stroke (CS) is the one of the most severe and requiring dynamic monitoring among the all subtypes of ischemic stroke. Patients with CS require joint treatment with cardiologists. CS is characterized by a greater severity of neurological deficits, a high risk of repeated acute cerebral circulatory disorders and fatal outcomes. This review considers the main causes of CS, the etiopathogenesis of thrombus formation in the heart chambers, current verification criteria and therapeutic aspects of CS, recommendations for the prescription of anticoagulant therapy for primary and secondary preventive treatment.

COVID-19 related stroke

The COVID-19 pandemic had a significant impact on both the incidence of acute cerebral circulatory disorders and the structure of mortality. SARS-CoV-2 increases the risk of both ischemic and hemorrhagic stroke. The key pathogenetic links underlying the development of cerebral stroke in COVID-19 are impaired functioning of angiotensin 2 receptors, accompanied by the accumulation of excess angiotensin 2, endothelial dysfunction, hypercoagulation, hyperproduction of proinflammatory cytokines and oxidative storm. In patients with stroke and COVID-19, the severity of the lesion is associated with a dual mechanism of ischemia - systemic and cerebral. The possibilities of medical correction of systemic disorders associated with coronavirus infection, as well as local ones caused by ischemic or hemorrhagic brain damage, are limited. Substances with antioxidant activity could potentially be effective in patients with stroke and COVID-1.

Quality of models of scales of consciousness level, functional state, and General somatic severity in patients with consequences of brain damage in intensive care and rehabilitation department.

Aims: development and substantiation of a typical scheme for the clinical use of scales of the level of consciousness, general somatic and functional status of patients with of brain damage. Methods: Included 118 patients on 20-50 days after traumatic brain injury, anoxic damage; consequences of acute cerebral circulatory disorders, and neurosurgical operations. In groups of patients who are in a coma, vegetative status, a state of minimal consciousness and a state of clear consciousness, the analysis of the statistical quality of clinical scales was carried out: scales of consciousness: the Glasgow coma Scale (GCS); FOUR (Full Outline of UnResponsiveness); CRS-R-Coma Recovery Scale-Revised; the Glasgow outcome Scale (COS); the extended scale of the Glasgow coma (COSE - Glasgow outcome scale extended); Rancho Los Amigos scale-scale of consciousness and interaction with the environment (the Rancho Los Amigos scale - RLAS); Functional status scales: DRS (the Disability Rating Scale); modified Rankin Scale mRS; Barthel Activities of Daily Living (ADL) Index; functional independence measure-FIM; Karnovsky Index; Rivermead Mobility Index self-assessment of everyday life opportunities in Merton and Sutton (checklist self-maintenance. Merton and Sutton community NHS trust); Scales of General somatic severity: assessment of multi-organ dysfunction on the APACHE II scale (Acute Physiology and Chronic Health Evaluation); APACHE IV scale; SAPS II scale (Simplified Acute Physiology Score); SOFA scale (Sequential Organ Failure Assessment). The functional state of the ANS was recorded using HRV parameters by recording 5-minute RR intervals of the electrocardiogram. Results: There are 4 groups of patients who are in a state of coma, vegetative status, a state of minimal consciousness and a state of clear consciousness. In 67 patients out of 118 examined (56.8%) the parameters of ANS functional activity are in the zone of pathological (sympathetic/parasympathetic hyperactivity) values. Conclusions: Various scales of the level of consciousness, functional and general somatic severity of patients objectively differ in clinical significance in the gradation of coma - vegetative status - minimal consciousness - clear consciousness.

Ефективність противірусної терапії у вторинній профілактиці ішемічного інсульту на тлі маніфестації вірусної інфекції

Recurrent stroke remains the key health issue in the world. A higher three-year recurrence rate of stroke in patients with persistence of the genome of herpes viruses, and with presence in the blood of the genome of at least 2 types of viruses was identified. These investigations demonstrate the importance of further research into the role of antiviral therapy in improving the rehabilitation and secondary prevention of stroke in patients with persistent viral infection The purpose of the study was to evaluate the effectiveness of antiviral therapy in the secondary ischemic stroke prevention on the viral infection manifestation background. Material and methods. The study included 105 patients with moderate to severe ischemic stroke with a viral manifestation confirmed by the detection of herpes virus’s DNA (HSV1, HSV2, EBV, CMV, HHV6) and Flu RNA. Patients who were additionally prescribed antiviral drugs on the background of traditional therapy were in the main group (n = 35). Patients who received only traditional, recommended by the modern stroke treatment guidelines, therapy and secondary stroke prevention measures were included in the comparison group (n = 70). Results and discussion. We found that the effectiveness of the proposed preventive treatment depended on the viral load of the patient. In the presence of three or more types of viruses, the proposed therapy provided a significantly lower ischemic stroke recurrence rate, compared to the patients who did not receive antiviral therapy 11.1% vs. 49.8%, p = 0.042. Prevention of recurrent ischemic stroke, which should have started as soon as possible after the development of the first stroke or transient ischemic attack occurrence, F. Rincon and R. L. Sacco (2008) consider the most relevant in this group of patients. Herewith, as emphasized by D. G. Hackam and J. D. Spence (2007), comprehensive prevention has reduced the risk of recurrent ischemic stroke by almost 80%, thus preventing 4 out of 5 possible disorders. However, both native and world literature still has a lack of systematic data of the problem of antiviral therapy using in patients with acute disorders of cerebral circulation, although it has been proven that infectious and inflammatory complications are an important pathogenetic factor of its unfavorable and severe outcome. M. S. Elkind et al. (2016) consider that antiviral drugs such as acyclovir may play an appropriate role in the prevention of recurrent ischemic stroke in children if their causal relation is confirmed. Conclusion. The use of acyclovir in complex rehabilitation therapy and secondary stroke prevention in patients with viral infection manifestation provided an increase in the average score of Bartel index after 1 year, p = 0.017. In the case of antiviral therapy using in the complex prevention of recurrent vascular events in patients with viral infection manifestation, the three-year recurrence rate of stroke is lower (p = 0.042)

New approaches for predicting outcomes in patients with atrial fibrillation

Aim:we aimed to assess the capabilities of “machine learning” methods in predicting remote outcomes in patients with non-valvular atrial fi brillation (AF).Methods.From 2015 to 2016 234 patients with non-valvular AF were included in the study (median age 72 (65; 79) years; 50.0% men). During the median follow-up of 2.9 (2.7; 3.2) years 42 patients died, 9 patients had non-fatal acute cerebral circulatory disorders and 3 patients had non-fatal myocardial infarction (MI). These events in 52 subjects (22.2% from all patients included) were combined into a combined endpoint (death and a nonfatal cardiovascular accident at the stage of remote observation). The first 184 patients comprised a “training” group. The next 50 patients formed the “test” group. The following methods of «machine learning» were used in the analysis: classifi cation trees, linear discriminant analysis, the k-nearest neighbor method, support vectors method, neural network.Results.Long-term outcomes were influenced by age, known traditional risk factors for cardiovascular diseases, the presence of these diseases, changes in intracardiac hemodynamics and heart chambers as evaluated by echocardiography, the presence of concomitant anemia, advanced stages of chronic kidney disease, and the administration of drugs associated with a more severe cardiovascular disease progression (amiodarone, digoxin). The best prognosis was created using the model of linear discriminant analysis, the complex neural network model, and the support vector machine.Conclusion.Modern methods aimed at prognosis estimation seem to be of importance in cardiology. These methods include big data analysis and machine learning technologies. The methods require further evaluation and confirmation, and in the future they may allow correcting cardiovascular risks, using data from real clinical practice and evidence-based medicine at the same time.

Our experience in using of intravascular recanalization methods for treatment of acute ischemic stroke

Objective ‒ to evaluate results of the introduction of intravascular recanalization in the provision of emergency care to patients with ischemic stroke.Materials and methods. The experience of intraarterial thrombolysis on the example of 25 clinical cases was analysed. In 22 patients was performed selective intra-arterial thrombolysis, in 3 cases ‒ with thrombaspiration. All patients had a severe stroke, ranging from 15 to 25 points NIHSS. Confirmation of the diagnosis was performed according to computed tomography scan), ultrasound of the precerebral and cerebral arteries. Selective cerebral angiography was performed up to 6 hours after the onset of stroke. Patients were infused with 3 ml of recombinant tissue plasminogen activator bolus into the occluded vessel, followed by infusion at a dose of up to 20 ml for 1 hour, in 2 cases ‒ internal carotid artery stenting. Outcomes were assessed according to computed tomography, NIHSS and a modified Rankin scale for 30 days.Results. The combination of methods of intra-arterial thrombolysis and stenting of the internal carotid artery made it possible to minimized the negative consequences with sufficient restoration of the arterial lumen, which was controlled with digital subtraction angiography.Conclusions. Intravascular thrombectomy is the most promising and actively develo-ping area of ​​interventional treatment of ischemic stroke. Indication for selective intraarterial infusion of thrombolytics is the presence of acute cerebral circulatory disorders of the ischemic type in the middle cerebral artery pool when it is impossible to conduct mechanical thrombextraction.

DIFFICULTIES IN DIAGNOSING MOYA-MOYA DISEASE (CLINICAL CASE)

Moya-Moya disease is a rare progressive chronic cer-ebrovascular disease characterized by a narrowing of the lumen of the intracranial segments of the internal carotid arteries, as well as the initial segments of the anterior and middle cerebral arteries with the devel-opment of a network of small vascular anastomoses. Violations of blood supply due to occlusion lead to the development of ischemic strokes in the correspond-ing pools, and ruptures of vascular anastomoses - to the development of hemorrhagic strokes, causing a variety of neurological disorders. The article presents a clinical case of Moya-Moya disease in a 31-year-old patient. The disease was manifested by acute disorders of cerebral circulation in ischemic and hemorrhagic types. The diagnosis was made in accordance with the diagnostic criteria of the disease based on the data of endovascular cerebral angiography.

Tactics of infusion therapy in patients with acute cerebral circulatory disorders in the prehospital stage

Objective. To streamline the tactics of infusion therapy in patients with acute cerebrovascular accident (ACVA) in the prehospital stage.
 Materials and methods. A retrospective, non-randomized study of 49 patients with ACVA who received emergency medical care in the prehospital phase.
 Results and discussion. Ensuring adequate brain perfusion in the area of ischemia is the main task of emergency medical care ACVA in the prehospital stage (Zozulya I.S., Volosovets A.O., Zozulya A.I. et al., 2019). Among the drugs that effectively improve blood circulation to the brain in the area of ischemia, an important place is occupied by infusion solutions (Semenenko A.I., Kobeliatskyi Yu.Yu., Kondratskyi B.O. et al., 2016). The choice of the optimal qualitative and quantitative composition of infusion solutions in patients with ACVA is one of the most difficult issues of treatment (Halushko O.A., 2017). Infusion therapy for patients with ACVA in the prehospital stage was used according to the Unified Clinical Protocol of Medical Care “Ischemic stroke (emergency, primary, secondary (specialized) medical care, medical rehabilitation)” (Order of the Ministry of Health of Ukraine from 03.08.2012 № 602) according to the following algorithm: 1) providing venous access by standard venous catheterization procedure with asepsis/antiseptics by intravenous catheter № 18; 2) carrying out infusion therapy by introducing 0,9 % sodium chloride solution at a rate of 100 ml×h-1; 3) the introduction of colloidal solutions in patients with ACVA in the prehospital stage was not carried out.
 Conclusions. The choice of the optimal qualitative and quantitative composition of infusion solutions in patients with ACVA in the prehospital stage is one of the most difficult issues of emergency care. After providing venous access by catheterization of the peripheral vein with a catheter № 18 infusion therapy is carried out by administering 0,9 % sodium chloride solution at a rate of 100 ml×h-1. The introduction of colloidal solutions in patients with acute cerebral circulatory disorders in the prehospital stage is contraindicated.

Results of carotidal endarterectomy in different age group

Background. Carotid endarterectomy is an effective and safe operation aimed at treating patients with hemo-dynamically significant stenosis of the carotid arteries, the outcomes of which are well studied, and the permissible levels of postoperative complications are presented in the current recommendations. Nevertheless, the issues related to the incidence of cardiovascular accidents in different age groups of patients have not been sufficiently studied. Objective. Analysis of hospital outcomes of carotid endarterectomy in different age groups. Design and methods. The study included 1416 patients who were operated on for stenotic lesions of the internal carotid arteries. According to the WHO classification, patients were divided into groups depending on age: up to 44 years — young age (n = 76); 45-59 years old — average age (n = 291); 60-74 — old age (n = 835); over 75 years old — old age (n = 214). The compensatory capabilities of cerebral blood flow were assessed by invasive measurement of the retrograde pressure in the internal carotid artery. The endpoints were death, myocardial infarction, acute cerebrovascular accident, transient ischemic attack, hemorrhagic complications, cranial nerve damage, combined endpoint. Results. There were no significant differences in the incidence of all cardiovascular events. In the group of young patients, no lethal outcomes, myocardial infarction, acute cerebrovascular accident, or transient ischemic attack were recorded. All deaths were caused by the development of ischemic stroke as a result of distal embolization. In cases of non-fatal acute disorders of cerebral circulation, transient ischemic attacks in 1 patient of the 60-74 year group, the catastrophe developed against the background of thrombosis of the internal carotid arteries. In other 3 cases, on the background of the development of hyperperfusion syndrome. In 1 patient of the 60-74 year group, hemorrhagic transformation of the old ischemic focus with the development of intracerebral hematoma was recorded. There was also no significant intergroup difference in the incidence of hemorrhagic complications. The total number of all cardiovascular events in each group and the sample as a whole did not exceed one and a half percent, which corresponded to the standards described in the current recommendations. Conclusion. There was no statistically significant difference in the development of adverse cardiovascular events depending on the patient’s age.

Acute coronary syndrome and transient ischemic attacks: clinical and therapeutic parallels

Transient ischemic attack is a clinical variant of acute cerebral circulatory disorders without signs of damage to brain tissue. A transient ischemic attack increases the likelihood of stroke, myocardial infarction, and other vascular events. There is an obvious similarity between transient ischemic attack and acute coronary syndrome without St elevation. The authors discuss the possibilities of aggressive therapeutic tactics for managing patients with transient ischemic attacks based on the results of high effi ciency of such treatment in acute coronary syndrome.

Клінічні та УЗДГ кореляції у хворих на ішемічний інсульт iз маніфестацією вірусної інфекції в анамнезі

The goal. The goal of the work was to study the structure of viral and non-viral infections in patients with ischemic stroke, as well as the relationship between neurological recovery and severity of cerebral atherosclerosis, depending on the type of infectious agent.Materials and methods. A total of 89 patients with ischemic acute cerebral circulation disorder and a history of clinical manifestations of a viral infection in the 3 months prior to the cerebrovascular accident were included in the study. Among the patients 44 (44.9%) were men and 54 (55.1%) were women with an average age of 62.08 ± 1.29 years (from 36 years to 92 years). 61 (81.9%) patients were diagnosed with ischemic stroke, and 28 (18.1%) patients were diagnosed with TIA.The diagnosis was confirmed by magnetic resonance imaging (MRI), and the severity of neurological status was assessed using the National Institute of Health Stroke Scale (NIHSS) on the first, 7th and 21st day. Patients' blood serum was examined for the presence of herpes viruses DNA, the RNA of influenza viruses, enteroviruses, the viruses of an acute respiratory infection (adenoviruses), as well as for the common non-viral infections: mycoplasma, ureoplasma, toxoplasma, and chlamydia. The method of polycytomerase chain reaction (PCR) for DNA and RNA viruses extraction from blood serum (6; 8) and the method of enterovirus antigens detection in a cell culture by enzyme-linked immunosorbent assay (ELISA) (21; 24; 40) were used.The degree of cerebral atherosclerosis was determined by ultrasound duplex scanning (UDS) of brachiocephalic arteries.Methods of descriptive statistics were used.Research results. The average period from the clinical manifestation of the infection to the development of stroke in patients with viral persistence was 11.8 ± 2.5 days (from 1 day to 90 days). Up to 7 days — 32 (36.0%) patients, from 7 days to 14 days inclusive — 44 (49.4%), more than 14 days — 13 (14.6%).There was a weak but definite inverse correlation between the term of the viral manifestation and the severity of the acute cerebrovascular accident (r = 0.237, p = 0.025).HSV1 (51) was detected most often in the acute period of stroke in 57% of patients, (p <0.05). The persistence of HSV2 and HHV6 was 38.2% and 32.6% respectively. A combination of two different HSV2 and HHV6 viruses was observed in 84 (89.9%) patients.The combination of HSV1 / HSV2 is most commonly observed (in 29 (32.6%) patients p <0.05). Coefficients of correlation between the presence of certain types of viruses, the number of stenoses, and the number of hemodynamically significant stenoses ranged from 0.19 with ARI to 0.33 in the case of a combination with HHV6.There was no detectable relationship between the severity of neurological deficiency on the first day after the stroke and the type of viral infection or a combination thereof, except for adV (r = 0.27, p = 0.01).The reduction in the NIHSS score on the 7th and the 21st day negatively correlated with the presence of certain viruses and their combinations, in particular herpesviruses or their associations HSV1, HSV1,2; HSV1,2-HHV6.Conclusion. The DNA of HSV1, HSV2, HHV6, HHV4, HHV5 viruses was most often found in patients with ischemic stroke and a clinical manifestation of a persistent viral infection in history (within 1-90 days before the development of symptoms),The presence of major vessels stenosis in the extracranial unit, the number of stenoses, and the presence of hemodynamically significant stenoses correlated with the presence of viral persistence of HHV6 and / or the association of HHV6 and influenza.The presence of HSV1, HSV2, HHV6 viruses and / or their associations worsens the restoration of neurological functions in the acute post-ischemic period setting.

Acute cerebral circulatory disorders and coronavirus disease

The new COVID-19 coronavirus infection caused by SARS-CoV-2 is a global health threat. Neurological disorders detected in patients with coronavirus infection have a wide range of clinical signs: headache, dizziness, altered level of consciousness, acute ischemic stroke, intracerebral hemorrhage, cerebral venous sinus thrombosis. Evidence suggests that patients with more severe systemic symptoms were more likely to experience neurological symptoms. The main risk factors for the development of ischemic stroke in patients with coronavirus infection are considered. It was shown that COVID-19 more often occurred in people with vascular risk factors, among which the mortality rate was higher. Various possible and not mutually exclusive mechanisms which may play a role in the development of ischemic stroke in patients with COVID-19 are described in detail, including hyper-inflammatory state («cytokine storm»), «COVID-19-associated coagulopathy», and disseminated intravascular coagulation syndrome. Stroke risk factors associated with the critical condition in these patients are presented. Stroke, the leading cause of death and disability worldwide, requires immediate treatment and decision-making as well as 24/7 availability for specialized vascular centers. The results of observation of patients with acute cerebral circulation disorder in specialized vascular centers 2 months before and 15 days after quarantine due to COVID-19 are presented. The tactics of managing patients with ischemic stroke under conditions of coronavirus infection is considered.