Acute Disorders Of Cerebral Circulation Research Articles

Cerebral disorders as a complication of whooping cough in a child under one year old

Whooping cough is a widespread infectious disease, the manifestations of which vary from nonspecific cough to life-threatening conditions with the development of apnea, hypoxic damage to the central nervous system, and respiratory failure, especially in young children. Against the background of a severe form of whooping cough, hemorrhages of various types can be observed, including in the brain. The team of authors describes a clinical case of cerebral impairment in a child under one year of age, which is associated with whooping cough. A day after discharge from the infectious diseases hospital, the child developed a generalized convulsive attack. Clinical, instrumental and objective data allowed us to establish a diagnosis: acute disorder of cerebral and spinal circulation of the hemorrhagic type. Subarachnoid hemorrhage. Severe anemia. Convulsive syndrome. Whooping cough. Subsequently, the development of signs of hydrocephalus was observed over time, with the further formation of multiple cysts and hemiatrophy of the right hemisphere of the brain.

New atherosclerosis progression markers in patients with post-Chernobyl metabolic syndrome

Relevance. As an epidemiologically proven consequence of the Chernobyl NPP accident, circulatory diseases are among the leading morbidities in liquidators. To predict the development of adverse cardiovascular events in patients with metabolic syndrome, there is the ongoing search for informative laboratory markers.The objective is to show how osteopontin, osteoprotegerin, fetuin-A, and risk factors for genetic circulatory disorders are associated with traditional risk factors for circulatory disorders in Chernobyl nuclear power plant accident liquidators suffering metabolic syndrome. Another objective is to explore the perspectives to use these indicators to forecast coronary atherosclerosis progression.Methods. The study group included 50 male liquidators of the Chernobyl nuclear power plant accident who suffered metabolic syndrome. The patients were split in two groups depending on osteopontin concentration in blood serum, i.e. above or under the upper reference limit. Medical history data, biochemical parameters, including inflammatory proteins, osteoprotegerin, fetuin-A, and genotyping of polymorphic variants of genes associated with the risk of circulatory diseases were analyzed. A control group of 30 conditionally healthy men was formed to determine the normal osteopontin, osteoprotegerin and fetuin-A values in blood serum.Results and discussion. With osteopontin value exceeding 21.4 ng/mL, the liquidators’ medical history showed 1.5 times higher frequency of myocardial infarction, 2.5 times higher frequent history of acute cerebral circulation disorder; ischemic heart disease was associated with type 2 diabetes mellitus. It was shown that the group of liquidators (osteopontin over 21.4 ng/ml) was characterized by a reliable increase in atherogenicity coefficient and osteoprotegerin level. Meanwhile, when compared to the control group, the same group of patients showed lower fetuin-A values and elevated high-sensitivity C-reactive protein, homocysteine, leptin and ghrelin. It was found that in liquidators, the presence of the A allele in the vitamin B12-dependent methionine synthase (MTR) gene (2756 A>G) is associated with more pronounced biochemical markers of atherosclerosis progression compared to GG genotype carriers.Conclusion. Osteopontin performs a protective role in tissue damage, being is practically undetectable in normal conditions. However, in case of pathology its value increases dramatically. In patients with metabolic syndrome, decreased fetuin-A and osteopontin values exceeding 21.4 ng/mL require additional examination with a focus on cardiovascular pathology (coronary artery calcinosis), as well as a dual-energy X-ray absorptiometry to ensure early detection of diminished bone mineral density and body mass. It was found that in liquidators, the presence of A-allele (genotypes AA and AG) in the MTR 2756 A>G gene is characterized by deeper atherogenic changes in the lipid spectrum, increased atherogenicity coefficient and decreased adiponectin content. This justifies the need for genotyping to build individual forecast for atherosclerosis progression in this category of patients.

STROKE: A COMPREHENSIVE OVERVIEW OF TRENDS, PREVENTION, AND TREATMENT (LITERATURE REVIEW)

A stroke is an emergency medical condition, commonly referred to as a cerebrovascular accident, occurs when the blood supply to the brain is interrupted, depriving brain tissue of oxygen and essential nutrients. This interruption can lead to rapid neurological impairment and, if not treated promptly, permanent brain damage or even death. Stroke is primarily categorized into two types: ischemic, resulting from arterial blockage, and hemorrhagic, caused by a ruptured blood vessel. Conditions such as acute cerebral circulatory disorder, atherosclerosis, and carotid artery stenosis are strongly associated with an increased stroke risk. Understanding these underlying factors is crucial for effective prevention, early detection, and management of stroke. Globally, stroke ranks as the second lead in cause of disability and mortality, disproportion at early affecting low-and-middle - income countries. Efforts in stroke prevention emphasizes the significance of early detection, management, promoting healthy lifestyles, and implementing legislative measures. The healthcare costs associated with stroke are substantial and projected to grow significantly. Socioeconomic factors and adverse working conditions also influence stroke incidence. Advancements in surgical revascularization techniques, such as carotid endarterectomy and stenting, have demonstrated efficacy in reducing stroke risk. Continuous research and development of optimal treatment strategies and monitoring protocols are essential for improving stroke outcomes and mitigating its global burden.

Cyanotic heart defects in children: neurological aspects of the problem

Background. The goal is to justify the need to monitor neurodevelopment in children with congenital heart defects (CHD) and to study neurological disorders in patients under 3 years of age with cyanotic heart defects. Materials and methods. Modern research on the neurodevelopment of children with CHD were analyzed. Sixty-two patients with cyanotic heart defects who underwent examination and surgical treatment at the Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine were studied. They are divided into 2 groups: group 1 are children with critical cyanotic CHD and group 2 — with non-critical cyanotic CHD. The control group consisted of 35 healthy patients. A neurological examination was performed using standardized neurological scales. Data processing was carried out using the Stata 12.1 licensed statistical package. Results. Neurodevelopmental disorders were diagnosed in 33 (53 %) of 62 children with cyanotic CHD: in group 1 — in 29 % of cases and in group 2 — in 24 %. These groups were statistically homogeneous in terms of gestational age (p = 0.492) and body weight at birth, with no significant difference from the control group. Older age is characterized mainly by delays in the stages of motor development (16 % in group 1 and 15 % in group 2) and speech disorders (7 % in group 1 and 3 % in group 2). Acute disorders of cerebral circulation (6 % in group 2) and the presence of epileptic seizures (up to 3 %) were characteristic of children under 1 year. Apgar score was lower in patients with critical cyanotic CHD with neurodevelopmental delay and a longer duration of artificial circulation during surgical treatment. Conclusions. 1. Neurological disorders were diagnosed in 53 % of patients with cyanotic heart defects: in 29 % with critical heart defects and 24 % with non-critical heart defects. 2. Older children are characterized mainly by delays in the stages of motor development and speech disorders. Behavioral disorders are more typical for children with non-critical CHD. Acute disorders of cerebral circulation and the presence of epileptic seizures were characteristic of children under 1 year of age. 3. The influence of body weight and gestational age on neurodevelopmental disorders is excluded. The severe state of children with neurodevelopmental delay at birth and an increase in the duration of artificial circulation during surgical treatment were found. 4. Interdisciplinary examination of patients with cyanotic heart defects, including examination by a pediatric neurologist, as well as a follow-up is necessary for timely referral to the next stages of rehabilitation.

Improving the organization of specialized and high-tech medical care for patients with acute cerebral circulatory disorders on the example of the Almaty region

Introduction: acute disorders of cerebral circulation are currently one of the main socio-medical problems of clinical neurology.Objective: to conduct a comprehensive review of relevant literature sources regarding the state of the organisation of medical care for patients with acute cerebral circulatory disorders in the Almaty region, the role of stroke centres in providing high-tech medical services, the results of the application of telemedicine achievements in this area and the search for ways to improve established practices.Method: analysis, systematisation, induction, bibliographic, generalisation, method of analogy, and synthesis.Results: examines the features of the organisation of assistance to people with acute cerebral circulatory disorders in the Almaty region and analyses the model of a stratified three-level system of stroke centres in the Republic of Kazakhstan. The prospects of applying modern achievements of telemedicine in the field of emergency neurology and neurosurgery are analysed. The main global trends in the organisation of assistance to people with acute cerebral circulatory disorders are highlighted, and the prospects for further integration of a number of information technologies and mobile stroke centres in Kazakhstan in general and the Almaty region in particular are highlighted.Conclusions: the result of the study is a comprehensive analysis of modern scientific literature on the topic of optimising the provision of specialised and high-tech care to patients with acute cerebral circulatory disorders in the example of the Almaty region

The development of approaches to medical rehabilitation under after-troubles of acute disorders of cerebral blood circulation using International Classification of Functioning

The article presents social hygienic characteristics of contingent of persons admitted to second stage of rehabilitation in specialized rehabilitation department after ischemic stroke at early recovery period. The attention is focused on necessity of multidisciplinary approach to rehabilitation measures, taking into account the International Classification of Functioning that permits to achieve more significant results in implementation of rehabilitation measures, to reduce the number of possible complications of this disease in later period, as well as to accelerate process of returning of studied category of patients to full-fledged life.

Abilities of diagnostic tools for deep vein thrombosis of the lower extremities in stroke patients (literature review)

One of the significant causes of disability and mortality both in Russia and around the world remains acute cerebral circulatory disorders, which combines ischemic and hemorrhagic strokes, and transient ischemic attack. Deep vein thrombosis (DVT) has a significant prevalence in patients with stroke, and venous thromboembolism (VTE) significant impact on the prognosis. The development of technologies, the emergence of new research methods made it possible to accurately determine the presence of DVT in patients with stroke using duplex ultrasound, using reserve methods, if necessary — CT, MRI, CV. However, there is currently no data that would allow to effectively determine the timing for the diagnosis of DVT in patients with stroke, as well as to identify patients who need such evaluation. Additional studies are needed to determine the timing of the screening for DVT, by assessing the prevalence of DVT in various periods of stroke, as well as evaluating the identifying factors.

Thrombus extraction in acute ischemic stroke: three years of experience at the regional vascular center

From a modern perspective, the key to successful treatment of ischemic stroke is early reperfusion with systemic thrombolytic therapy and thrombus extraction. Thrombectomy is the only reliable method of recanalization in patients with thrombosis of a large cerebral artery. Despite the fact that thrombus extraction has proven its effectiveness in the treatment of acute ischemic stroke in a number of large randomized trials, there are still issues that have not been fully studied, on which there are controversial opinions among specialists. For instance, there is different information about whether direct thrombectomy or thrombus extraction after systemic thrombolysis is more effective and safer. Moreover, in accordance with modern procedures for providing care to patients with acute cerebral circulatory disorders, patients admitted in the «therapeutic window» should receive intravenous thrombolytic therapy even if thrombectomy is planned. Based on the analysis of 164 thrombus extractions in patients with acute ischemic stroke admitted to the regional vascular center in 2020–2023, the results of direct thrombus extraction and staged reperfusion (systemic thrombolytic therapy + thrombectomy) were compared. It has been found that compared to direct thrombus extraction, staged reperfusion provides more frequent achievement of 2b-3 recanalization (71.83 % and 78.49 %, respectively), accompanied by lower mortality (45 % and 23.66 %, respectively) and more frequent achievement of Rankin 0–2 functional status at the time of discharge (48.72 % and 61.96 %, respectively). The worst results were observed among patients with vascular occlusion in the vertebrobasilar basin, at TICI 0-2a and the age of patients over 80 years.

Experience and prospects of introducing information technologies in the program of medical rehabilitation of patients with cerebral circulation disorders

Objective. To assess the rehabilitation potential of patients with cerebrovascular disorders for prospective follow-up and effective medical rehabilitation. Materials and methods. The study group included patients with cerebrovascular diseases (n=20) and acute cerebrovascular accident (n=22). Integral assessment of the state of health was carried out using diagnostic complex “Computer dermograph for the topical diagnosis of pathology lesions of internal organs” (DgKTD-01). Following studying the baseline indicators, a comparative analysis of the study group and the control group (n=10) was carried out. The patients of the study group had their state of health corrected by means of the Computerized corrector ANKF-01 using low-intensity electromagnetic field for normalization of functional activity of the central and peripheral nervous system. The course consisted of 10 sessions weekly with preliminary functional and topical diagnostics using the DgKTD-01 complex. Results. Patients with acute cerebrovascular accident revealed a functional restructuring of autonomic regulation with a greater severity of activation of the sympathetic link, patients with cerebrovascular diseases – of the parasympathetic one. The determining factor in cerebral circulation disorder consists in the indices of basic functions F2 and F3. The study identified a model for predicting the likelihood of acute recurrent disorders of cerebral circulation, as well as additional diagnostic criteria for differential diagnosis. Purposeful change of excitatory (inhibitory) potentials in cortical-subcortical relations changes vegetative balance, stimulates microcirculation, muscle-tonic function, neurotrophic regulation. These effects stabilize and improve the condition of patients. The effectiveness of rehabilitation measures using ANKF-01 is considered to be higher in patients with acute cerebrovascular accident. Conclusion. Patients with cerebral circulation disorders have specific features of the adaptive capabilities of the body. This indicates the differentiation in the formation of the functional status of the body, taking into account the characteristics of the disease, individual resources and compensatory capabilities. Rehabilitation based on the use of ANKF-01 increases the effectiveness of measures aimed at preventing organic changes in the brain, and can significantly improve the prognosis and reduce the percentage of disability in this category of patients.

The efficiency of X-Ray endovascular care in decreasing of population mortality from acute coronary syndrome and acute disorder of cerebral circulation

The article considers results of assessment of dynamics of mortality from cardiovascular diseases and the most important nosologic forms - acute cerebrovascular disorders and coronary heart disease with acute coronary syndrome and development of accessibility of X-Ray endovascular care of patients in the Oblast. The results of analysis of changes in mortality after implementation of new model of care of patients with acute vascular diseases are presented. The relationship between accessibility of X-Ray endovascular interventions and decrease of mortality was analyzed. The reliable significantly strong connection was found for cerebrovascular diseases, and medium negative connection for coronary heart disease with acute coronary syndrome.

Efficacy of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1h-1,2,4-triazol-4 bromide in the rat model of inferior vena cava thrombosis

Introduction. According to WHO, acute disorders of cerebral circulation are anticipated to become a predominant contributor to the global disease burden by 2030. The comprehensive management of vascular depression entails not only the use of antidepressants but also fundamental interventions. The development of a novel molecule based on thietane-containing heterocycles, merging the attributes of an antidepressant and an antiplatelet agent, holds promise for enhancing therapeutic efficacy in patients with acute cerebrovascular accidents through multimodal action. Objective is to conduct a preclinical assessment of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4-th bromide concerning model thrombosis in rats. Materials and Methods. The investigation involved the evaluation of thrombosis processes and the haemostasis system in rats subjected to complete occlusion of the inferior vena cava within 24 hours post-thrombosis induction. Techniques employed included thromboelastography, Born aggregometry, standard clotting assays to appraise the coagulation facet of haemostasis, and morphological examinations. Results. The results demonstrate that 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4-th bromide mitigates thrombosis mass, restores platelet hyper aggregation, and counters hypercoagulation observed in acute inferior vena cava thrombosis in rats. Comparative analysis with reference drugs substantiates the superior effectiveness of the chosen compound in thrombosis prevention. Conclusion. The preclinical investigation of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4-th bromide unveils a fusion of established antidepressant and antithrombotic activities, laying groundwork for further drug development endeavours.

ВТОРИЧНЫЕ ГНОЙНЫЕ ОТОГЕННЫЕ МЕНИНГИТЫ У ВЗРОСЛЫХ: ОСОБЕННОСТИ ПРОТИВОМИКРОБНОЙ ТЕРАПИИ

Secondary purulent otogenic meningitis (SPOM) in adult patients is less common than in children, but among all intracranial complications of middle ear pathology it occupies the leading position. In the absolute majority of cases, a patient with SPOM on admission to the emergency room is supervised by a neurologist with a suspicion of acute cerebral circulation disorder, and an otorhinolaryngologist, along with other subspecialists, is initially an invited consultant. All this is associated with the risks of untimely diagnosis of SPOM and inadequate tactics of medical care, including the rationality of prescribing the choice of systemic antimicrobial therapy (SPMT), which increases the likelihood of unfavorable outcomes. As a result of retrospective analysis of medical records of 33 completed cases of SPOM for the period from 2017 to October 2023, the features of the course of SPOM microbial landscape in this pathology and the nature of SPMT were studied. It was revealed that in the structure of secondary meningitis of otogenic and rhinosinusogenic etiology VHOM took the leading positions (81.1%). In 62.5% of cases, patients had comorbid pathology, which negatively affected the course of the underlying disease and worsened the prognosis of the disease. Such manifestations as headache, vomiting, disorders of consciousness were observed in 62.5%, 57.6%, 62.1% of cases, respectively. Clearly expressed signs of inflammatory process on the part of general blood analysis and cerebrospinal fluid were revealed. The structure of etiologic factors in adult SPOM was dominated by coccal microflora (S.pneumoniae, Streptococcus spp., Staphylococcus spp.). In 81.8% of cases of SPOM we started with recommended ceftriaxone, but absence of positive dynamics, severity of the course of the inflammatory process required correction of SPMT and transition to meropenem. Timely diagnosis, clear tactics of medical care, including the choice of effective SPMT using, including de-escalation schemes, led to favorable outcomes in 87.9% of patients.

Emergency neurosurgical care for patients with acute cerebral circulation disorders

Aim. To improve the results of neurosurgical treatment of patients with acute cerebrovascular disorders.Material and Methods. An analysis of the results of neurosurgical treatment of 48 patients admitted to the Department of Neurosurgery of the State Institution National Medical Center - “Shifobakhsh” was carried out. The age of patients ranged from 30 to 75 years. In each case, patients underwent clinical and laboratory studies, including using CT and MRI, as well as using three-dimensional (3D) and four-dimensional (4D) reconstruction methods of cerebral vessels.Result and Discussion. The most common cause leading to the formation of intracranial hematomas was hypertension, found in 32 (66.6%) patients, while other causes were identified in 12 (25%) patients (including angiopathy, cerebral vascular pathologies, amyloidosis, and the use of certain medications, among others). All patients underwent neurosurgical operations. The highest frequency of recurrences (4.1%) was observed after surgical interventions performed within the first 24 hours following the hemorrhagic event.Conclusion. With early detection of intracranial hematomas and with the optimal choice of method for their treatment, good functional results are observed with a low incidence of deaths.

Results of Preclinical Studies of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4-th Bromide in Relation to the Hemostasis System <i>in vivo</i>

Introduction. A characteristic manifestation of vascular brain damage is depressive disorders that accompany both acute and chronic disorders of cerebral circulation. Depression not only reduces the patient's quality of life, but also complicates the treatment of basic vascular disease, increases the risk of stroke and death. Therefore, complex therapy of vascular depression includes not only antidepressants, but also basic means to correct the consequences of disorders of cerebral blood flow, including with antiplatelet activity. In this regard, the development of a new molecule based on thietane-containing heterocycles, combining the properties of an antidepressant and an antiplatelet agent.Aim. To conduct a preclinical evaluation of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazol-4 bromide when administered to rats.Materials and methods. A study was conducted of the effect of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietan-3-yl)-1H-1,2,4-triazol-4-bromide on the hemostasis system during intravenous and intragastric administration to healthy white non-linear sexually mature male rats (n = 160). Thromboelastography was performed on a TEG 5000 device, activated with a 0.2 M solution of calcium chloride, Born aggregometry and standard clotting tests to assess the coagulation component of hemostasis.Result and discussion. The findings show that 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4-th bromide with peroral administration exceeded acetylsalicylic acid by 2.8 times in terms of ED50, and by 1.8 times with intravenous way of administration accordingly. A similar effect of pentoxifylline in the intravenous route of administration was recorded at a concentration of 27.8 mg/kg versus 12.4 mg/kg of compound I. The results of a complex method to assess the state of the hemostasis system indicate a more pronounced antiaggregational effect of compound I compared with pentoxifylline and acetylsalicylic acid.Conclusion. Preclinical studies of 4-(2-(4-nitrophenyl)-2-oxoethyl)-1-(thietane-3-yl)-1H-1,2,4-triazole-4 bromide, was demonstrated that a combination of antidepressant and antiplatelet activity, which can serve as a basis for further drug development.

Personalized approach to the logopedic rehabilitation of neurogenic dysphagia patients

Aim. To determine the role of personalized approaches in the rehabilitation of patients with neurogenic dysphagia after acute disorders of cerebral circulation (ADCC) in the early recovery period.Materials and methods. The study included 97 patients (53 men and 44 women with the mean age of 69.5) in the early recovery period after ADСС. All the patients were at the second stage of medical rehabilitation. The treatment program included the following methods of logopedic rehabilitation: disinhibition of the act of swallowing; stimulation of the sensitivity of the mucous membranes of the oral cavity; recovery of respiratory and speech functions; selection of the consistency of liquid and solid foods to ensure the safety of swallowing during feeding; selection of the feeding method and appropriate portions to facilitate the patient’s eating.Results. When developing a personalized program of logopedic rehabilitation, the following aspects were considered: the severity of swallowing dysfunctions; the primary speech defect; patient compliance; the degree of cognitive dysfunctions; motivation for recovery.Conclusion. The application of logopedic rehabilitation methods in combination with specialized multidisciplinary care based on personalized approaches can significantly improve patients’ quality of life and reduce the risk of undesired complications.

Correlation analysis of clinical and laboratory markers in COVID-19 and acute cerebrovascular accident

Coagulopathies developing with COVID-19 are a serious problem. Increased fibrinogen levels, activation of coagulation, a direct damaging effect of the virus on the endothelium, and increased interaction of the platelet with the vascular endothelium play an important role in the development of thrombotic complications and the occurrence of acute cerebral circulatory disorders. Case histories of COVID-19 patients and those with secondary CHF were analysed. Among the biochemical blood parameters in COVID-19, an increased level of D-dimer, which reflects the severity of the course of coronavirus infection, as well as CRP and ferritin were revealed more frequently.
 Results: Among biochemical blood parameters in COVID-19, an increase in D-dimer level, which reflects the severity of the course of coronavirus infection, as well as CRP and ferritin, is more frequently detected. In correlation analysis, a positive correlation was observed between the level of ferritin, CRP and stage of CT as well as between the level of D-dimer and the number of platelets

Таксономическая характеристика бактериальной ДНК, выделенной из тромбов пациентов с ишемическим инсультом

There is evidence of the role of microorganisms in endothelial damage and, as a consequence of activation of blood coagulation pathways, thrombosis, which in turn is one of the risk factors for the development of acute cerebrovascular accidents (ACVA). Objective. To analyze the microbiological profile of DNA isolated from thrombus of patients with ACVA. Materials and methods. Fifty-seven thrombus samples obtained lifetime from the vessels of patients with ischemic-type ACVA during thrombectomy and thrombaspiration were selected for the study. All patients with ACVA were in the period of coronavirus infection reconvalescence. Twelve blood samples from patients without infectious diseases were used for comparison. Amplification of DNA isolated from biological material was performed using primers specific to the 16S rRNA gene fragment. The obtained PCR products were sequenced by Sanger sequencing method, with subsequent processing of chromatograms in the BCV package. RDP Classifier was used to determine the taxonomic affiliation of DNA sequences. Statistical analysis was performed in the R environment using Pearson's and Fisher's χ2 criteria. Test results were considered significant at p < 0.05. Results. Using the RDP Classifier, the taxonomic affiliation of 16S rRNA gene fragment amplification products were determined for 43 blood and clot samples. DNA of Actinobacteria and Firmicutes taxa were most represented in the clot samples of patients with ACVA. Of the Firmicutes and Proteobacteria taxa, Firmicutes predominated in thrombi, whereas Proteobacteria predominated in blood. The obtained data are consistent with the data on the key role of systemic intestinal inflammation in the pathogenesis of ACVA. Conclusion. DNA fragments of Actinomycetales, Bacillales, and Clostridiales bacteria found in thrombi of patients with ACVA indicate that they can penetrate the damaged epithelial barrier and promote platelet aggregation and thrombus formation, increasing the risk of ischemic stroke. Key words: ischemic stroke, acute cerebral circulatory disorders, bacterial infection, RDP Classifier

High-intensity training as a tool of physical therapy in acute cerebral blood circulation disorders

High-intensity training as a tool of physical therapy in acute cerebral blood circulation disorders

TOWARDS PSYCHOLOGICAL SUPPORT IN INTERACTIVE STROKE REHABILITATION THERAPY (EEG-FMRI STUDY)

HighlightsInteractive therapy (stimulation) of the brain has a significant potential, especially if it includes not only medical, but neurophysiological and psychological modalities. An integrated approach is required to provide complete readaptation to new life conditions and to decrease the percentage of disabilities in post-stroke patients. Abstract:Aim. The article is devoted to the psychological support in neurorehabilitation of patients with acute disorders of cerebral circulation. Interactive therapy (stimulation) of the brain is a new generation of neurofeedback characterized by a radical change in the “targets” of cognitive (adaptive, volitional) influence. These targets are specific cerebral structures and neural networks, the reconstruction of which leads to the restoration of physiological functions and behavioral (psychological) metamorphoses.Methods. The study involved 18 patients diagnosed with ischemic stroke with hemiparesis of 2 points in the hand (early recovery period). All patients received rehabilitation treatment at the clinic of the Federal Research Center for Fundamental and Translational Medicine. The rehabilitation program for patients from the main group (n = 11) was supplemented with a course of interactive brain stimulation in an MRI scanner. Functional magnetic resonance imaging (fMRI) in the biofeedback contour uses a natural intravascular tracer, a blood oxygen level dependent (BOLD) signal, as feedback. Thus, the subject included into an “interactive brain” circuit is learning to modulate and modify his cerebral networks creating the new ones, or “awakening” pre-existing ones in order to improve (or reform) his mental, sensory and/or motor functions. The subject being placed in a tomograph for a long time to learn new reparative skills is in a significant need of constant (sustainable) psychological support at all stages of the neurorehabilitation.Results. A course of interactive therapy contributed to a radical improvement in motor functions, confidence in movements, and an increase in working capacity. The analysis of fMRI data over time showed that activation of the accessory motor cortex and cerebellum on the ipsilateral side at the beginning is replaced by bilateral expansion of activity zones in the cerebellum and premotor cortex by the end of the course of interactive therapy. It also was established that the result of a stroke is a deep transformation of the intrapersonal relationships of patients. At the same time, rehabilitation has significant potential, especially if it includes not only medical, but also neurophysiological and psychological modalities. The dynamics of learning in terms of fMRI mapping should be successfully synchronized with the kinetics of psychological metrics and success scales, the influence of which, as a rule, remains beyond the scope of clinical studies.Conclusion. This study was carried out in line with the search for a self-referential psychological accompaniment that optimizes the recovery, the study of temporal and spatial correspondence between the interactive dynamics of fMRI and specific clinical symptoms.

Thrombotic and hemorrhagic complications in COVID-19.

Background. In some cases, a new coronavirus infection demonstrates non-standard clinical manifestations, an integral characteristic of which is a tendency to thrombotic and hemorrhagic complication.Objective. To study the predisposing factors for the development of thrombotic and hemorrhagic complications in patients with COVID-19.Design and methods. The work was based on observations of 403 patients who were hospitalized for pneumonia of viral etiology (COVID-19). The features of comorbid pathology, markers of inflammation and coagulation, characteristics of the identified complications in the main group (75 people who had thrombotic and hemorrhagic complications) were prospectively collected in comparison with the control (328 patients), where no such consequences were detected.Results. There were no significant differences between the groups in terms of age and gender. In the main group, a large number of overweight patients were registered in comparison with the control. The levels of CRP, ferritin, and D-dimer in patients with complications significantly exceeded the reference values more often. Among the complications, spontaneous hematomas, gastrointestinal bleeding, acute cerebral circulatory disorders, acute myocardial infarction and venous thromboembolic complications were recorded.Conclusion. In patients with thrombotic and hemorrhagic complications of COVID-19, the level of markers of the inflammatory process (CRP, ferritin) increases. These negative consequences are most characteristic for patients with chronic kidney disease, severe hypertension, COPD and generalized atherosclerotic process (myocardial infarction, stroke).