Acute Disorders Of Cerebral Circulation Research Articles

Topical issues of adequate control of dyslipidemia in the prevention of acute and recurrent cerebral circulatory disorders of ischemic type

Ischemic stroke (IS) is one of the main causes of death and permanent disability. Reducing the burden of stroke is possible if effective preventive measures are provided. The possibilities of correcting lipid metabolism as an important measure aimed at preventing IS are analyzed.

STUDY THE FUNCTIONAL ACTIVITY OF PLATELETS AGAINST THE BACKGROUND OF ANTIPLATELET THERAPY IN PATIENTS OF THE CARDIOLOGICAL HOSPITAL

Antiplatelet drugs are widely used in clinical practice to reduce the risk of adverse cardiovascular events in patients with cardiovascular diseases. It is noted that resistance to antiplatelet agents is determined in a number of patients, which may increase the risk of cardiovascular catastrophes. Given the importance of the antiplatelet component in preventive and therapeutic strategies, the inability to achieve its potential benefit in patients with atherothrombosis is an important clinical problem. Aim of the study. Studying the features of platelet aggregation in vitro in patients with coronary heart disease, acute disorders of cerebral circulation and acute coronary syndrome receiving acetylsalicylic acid or acetylsalicylic acid in combination with clopidogrel during hospital treatment. Materials and methods. The subjects were divided into 3 groups: 1 - patients of the Department of Cardiology - received acetylsalicylic acid - Cardiomagnil ® a dose of 75 mg / day; group 2 - Departments of acute coronary syndrome - took acetylsalicylic acid - Acecardol ® - 100 mg once a day in combination with clopidogrel – 75 mg per day; group 3 - patients of the Department of patients with acute disorders of cerebral circulation took Acecardol ® 100 mg once a day. Platelet aggregation activity was studied in all patients after 5 days of regular intake of antiplatelet agents. Platelet aggregation was studied by optical aggregatometry using a laser aggregometer «Biola». As agonists of aggregation were used: ADP (up to 5 mmol/L), epinephrine (10 mg/ml), collagen (1 mg/ml) and ristocetin (ristomycin) (15 mg/ml). Results and discussion. Insufficient effect on the background of taking antiplatelet agents was observed in 27.2% of cases in patients of group 1 and 8.2% in patients of group 2 (p=0.0034). In patients with acute disorders of cerebral circulation (group 3), the insufficient effect of acetylsalicylic acid was noted in 16.3% of cases, which was significantly less than in group 1 (p=0.026). Patients with acute coronary syndrome receiving double antiplatelet therapy achieved pronounced suppression of aggregation in 54% of cases, which was statistically significantly more than in group 1 - 23.3% (p=0.0004). In patients of group 3, a pronounced antiplatelet effect was observed in 41.2% of cases, which was significantly more than in patients of group 1 (p=0.0054). Thus, the use of acetylsalicylic acid in combination with clopidogrel in patients with acute coronary syndrome provided a more pronounced suppression of platelet aggregation. This is consistent with the data of other researchers who found that in 6% of patients with the use of two antiplatelet agents, the desired result was not obtained [14, 15]. It was noted that in patients with acute cerebrovascular accident who received only acetylsalicylic acid, platelet aggregation decreased to a greater extent than in patients with coronary heart disease (group 1). Perhaps this is due to the fact that patients of these groups received different medications of acetylsalicylic acid. Findings. The use of two antiplatelet agents does not always lead to optimal effect. In this regard, the expediency of aggregatometry to assess the effect of acetylsalicylic acid is obvious. Particular attention should be paid to patients receiving acetylsalicylic acid an outpatient basis, since the low effectiveness of antiplatelet therapy increases the risk of myocardial infarction, stroke.

Genotypic stratification of risk of acute cerebral circulation disorder

Genotypic stratification of risk of acute cerebral circulation disorder

EFFECT OF CORONAVIRUS DISEASE (COVID-19) ON HEMOSTASISSYSTEM IN PATIENTS WITH ACUTE CEREBROVASCULAR ACCIDENTS

Acute viral respiratory infections add to the progression risk of the already existing pathologies, including those of cardiovascular origin. Life-threatening complications emerging against SARS-CoV-2 (severe acute respiratory syndrome), which causes COVID-19 (Coronavirus disease 2019), explain the need to study the cardiovascular effects of COVID-19 in order to offer rational medical care to patients belonging to various age categories. This article presents a comprehensive assessment of changes affecting the main hemostasis parameters in patients with acute cerebral circulatory disorders against the SARS-CoV-2 virus infection. There is special attention paid to the pathophysiological features occurring against the infectious process involving the hemostasis system. Our data shows that the differences in the main hemostatic parameters in patients with acute cerebral circulatory disorders occurring against the SARS-CoV-2 virus infection are due to the degree of the body responsiveness and the severity of the comorbid pathology. Reducing the risk of adverse conditions developing in this category of patients is possible in case of responsible monitoring focusing on the main indicators of the cardiovascular system status, as well as provided there are advanced approaches introduced in order to prevent and treat thrombotic/thromboembolic complications.

Неотложные состояния при болезнях системы кровообращения взрослого населения Хабаровского края: состояние и тенденции Часть 3. Острые нарушения мозгового кровообращения

The indicators of morbidity of the adult population of the Khabarovsk Krai with diseases of the circulatory system and mortality from them in 2002–2019 have been studied. Special attention is paid to urgent pathology – acute coronary syndrome and acute disorders of cerebral circulation. It was found that acute coronary syndrome and acute disorders of cerebral circulation in the region account for about 75–85% of all newly diagnosed diseases of the circulatory system – ischemic heart disease, cerebrovascular diseases; they give up to 32% of deaths from diseases of the circulatory system

The role of neurotrophins in post-stroke rehabilitation

Annotation. Acute disorder of cerebral circulation (ADCC) occupies leading positions in mortality and disability in Ukraine, despite new treatments and modern medical care. Current data suggest that the problem of treatment and rehabilitation of patients after ADCC can be solved with the help of neurotrophins – a family of proteins that regulate the processes of plasticity in the brain. Due to the similarity of their structure, they are able to act as a holistic system, helping to repair damaged areas of the brain. Therefore, the purpose of this review was to collect information on the structure and function of neurotrophins BDNF, NGF, NT-3 and NT-4, their role in neuroplasticity after stroke in order to develop modern methods of influencing them for further implementation in practice. For this purpose, 50 sources from the main databases (Elsevier, Pubmed, Web of Science, Google Scholar) were used. The systematic review describes the structure of neurotrophins and their function, mechanisms of neuroplasticity and methods of influencing it, in particular exercise and diet. Since these methods have a general therapeutic effect and require a long time for its onset, the prospects for further development are the creation of drugs targeted to the neurotrophin system for effective rehabilitation of patients after stroke.

Analysis of the main factors influencing the development of ischemic stroke

Based on the analysis of 160 patients aged 30 to 60 years who were treated in the neurological department at the Engels City Hospital № 2 State Autonomous Health Institution with a diagnosis of acute cerebral circulation disorder of the ischemic type with damage to the vessels of the vertebro-basilar basin, an analysis of the main factors affecting the development of ischemic stroke was carried out. The study shows that the main risk factors for ischemic stroke, regardless of sex, include the presence of hypertension and is a risk factor for ischemic stroke. Moreover, the longer the duration of hypertension, the higher the risk of stroke. Moreover, the longer the duration of hypertension, the higher the risk of stroke. By analyzing the data that were obtained during the study, circumstances were established that were equally likely to affect members of both sexes. Such factors include: the presence of arterial hypertension, signs of impaired lipid metabolism, hypodynamy. In addition to common factors, those that were most common among females – the presence of signs of obesity and male – current smoking – were identified. All these circumstances can contribute to the development of acute cerebral circulation disorder of the ischemic type. Taking into account the main risk factors for ischemic stroke, we formulated the principles that underlie the prevention of the development of this complication. In this regard, it is important to identify and prescribe treatment for this pathology in a timely manner, in which periodic dispensary examinations are assigned an important role. The accuracy with which such routine work should be performed helps to timely detect signs of an increase in blood pressure in the subject. Send him in time for an examination, which will be carried out in full, which will help to make a correct diagnosis.

Неотложные состояния при болезнях системы кровообращения взрослого населения Хабаровского края: состояние и тенденции

The indicators of morbidity of the adult population of the Khabarovsk Krai with diseases of the circulatory system and mortality caused by these diseases in 2002–2019 were studied. Special attention is paid to urgent pathology - acute coronary syndrome and acute disorders of cerebral circulation. It was found that acute coronary syndrome and acute disorders of cerebral circulation in the region account for about 75–85% of all newly diagnosed diseases of the circulatory system - ischemic heart disease, cerebrovascular diseases; they result in up to 32% of deaths from diseases of the circulatory system

Clinical and neuroimaging analysis of carotid infarction in the acute ischemic stroke

Background. The assessment of clinical manifestations in patients with acute pre-circular infarction is important for verification of the lesion, the choice of the treatment program, prediction of the stroke consequences. The purpose is to investigate the clinical, neurological, and neuroimaging features of lacunar and non-lacunar carotid infarctions in acute ischemic stroke and to assess their short-term consequences. Materials and methods. There was performed a clinical and radiological analysis of carotid infarction in 540 patients with acute ischemic stroke, which were divided into two groups: 155 patients were verified for infarcts in the cortex and white matter of the brain in the vasculature of the anterior and middle cerebral artery; in 385 patients, infarct foci were found in the area of the deep hemispheres of the brain (subcortical-capsular infarcts). Results. Clinical neuroimaging analysis of patients with ischemic stroke in the vasculature of the cortical branches of the anterior and middle cerebral arteries of the anterior circulatory basin showed that acute cerebral circulatory disorders caused the development of small cortical infarctions in 89 (57.4 %) patients and 65 (41 %) — lacunar infarction, in one patient (0.7 %) with occlusion of the proximal anterior cerebral artery — total infarction. The neurological clinical picture of infarcts of varying localization, which was determined by the location and size of the lesion, was described. Conclusions. The obtained results showed that the consequences of anterior circular infarctions depended on the localization of the lesion of the arterial area, the caliber of the infarction of the dependent artery, the size of the infarct locus. For the most part, these factors determined the background severity of neurological deficit after the development of acute ischemic stroke.

Association of rs10507391 polymorphism with the development of acute cerebrovascular event

Abstract Purpose To study SNP rs10507391 association (A> T) with development of Acute Cerebrovascular Event in the patients with cardiovascular pathology and risk factors of its development who are representatives of the east Siberian population. Material and methods 260 patients with Acute Cerebrovascular Event participated in a research (age [57.0; 51.0–62.0]) and 272 patients of control group (age [55.0; 51.0–62.0].). Among the patients who transferred Acute Cerebrovascular Event, 157 men and 103 women. The control group included 170 men and 102 women. Inspection of the main group included: collecting complaints, anamnesis, clinical examination, computer tomography of a brain, electrocardiography, echo, ultrasonic of arteries, daily monitoring of arterial blood pressure and cardiac rhythm, analysis of a coagulant system of blood. Patients of the main group had the following cardiovascular pathology and risk factors: arterial hypertension, supraventricular tachycardia, dislipidemiya, atherosclerosis brachiocephalic of arteries, disturbances of a system of a hemostasis. The control group is examined within the international HAPIEE project. The molecular and genetic research was conducted by PCR method in real time. Statistical processing of material was carried out with use of set of the Statistica for Windows 7.0, Excel and SPSS 22 application programs. Results When studying SNP rs10507391 association (A> T) connection between a rare genotype of a TT and an allele of T and the increased risk of Acute Cerebrovascular Event is established with development of Acute Cerebrovascular Event in all analyzed groups and subgroups of patients. Conclusion A genotype of a TT and an allele of T of SNP rs10507391 (A> T) increases risk of development of an acute disorder of cerebral circulation in patients regardless of the previous cardiovascular pathology and risk factors, including at patients with arterial hypertension, supraventricular tachyarrhythmias, atherosclerosis the brachiocephalic of arteries, disturbance of lipidic exchange and the system of a hemostasis. Funding Acknowledgement Type of funding sources: None.

Thrombotic and hemorrhagic complications during pregnancy, delivery and the postpartum period in females with prosthetic heart valves

Abstract Background/Introduction Women with mechanical prosthetic heart valves are at greatest risk of developing complications.The main reason is that mechanical prosthetic heart valves require lifelong anticoagulation to reduce the high risk of associated thrombotic and hemorrhagic complications. Purpose The main goal of this study was to estimated risk factors and frequency of thrombotic and hemorrhagic complications during pregnancy, delivery and the postpartum period in women with prosthetic heart valves Methods According to retrospective cohort analyses in this study were included 70 patients with prosthetic heart valves who delivered in a specialized perinatal center from October 2010 to February 2020. All the patients were divided into two groups depending on prosthesis type: mechanical prostheses (44 deliveries in 44 patients), biological prostheses (22 deliveries in 19 patients). All patients were performed ECHO (Vivid 7, GE, USA). The average age were 30.7±5.2 years. The N-terminal brain natriuretic propeptide (NT-proBNP) concentration was determined by the quantitative electrochemiluminescence method using a Cobas E 411 analyzer (Roche, Switzerland). The activity of the anti –Xa factor was measured by chromogenic assays. Results In 9 (21.4%) pregnants with a mechanical valve prosthesis (MVP), prosthetic thrombosis was recorded until 2016. In 1 patient with mechanical valve prosthesis (2%) during pregnancy was complicated by an acute cerebral circulation disorder. Since 2016 there were monitored the activity of the anti –Xa factor. In 7 patients on the background of a change in anticoagulant therapy, pregnancy stopped in the early stages. Before pregnancy, 31.4% of the patients didn't have heart failure clinical manifestations, but in 12 (17.1%) patients during pregnancy had increase in NYHA Class maximum to NYHA Class III. The average NT-proBNP concentration was 912.3±1586.6 pg / ml. The frequency of the cesarean section in both groups was high: in patients with mechanical valve prosthesis in 78.5% and in the group of patients with biological valve prostheses in 68.1% of cases. There were not registered any new cases of prosthetic thrombosis after delivery, however, 9 patients had hemorrhagic complications in the early postpartum period, which required relaparotomy and blood transfusions. Regardless of frequent complications during pregnancy and in the postpartum period, no fatal outcomes have been reported. Conclusion The absence of mortality over the 9-years old observation and delivery in patients with valvular prostheses demonstrates the feasibility of monitoring and delivery of this category of patients in a specialized multidisciplinary medical center with experience in managing patients during pregnancy with valvular prostheses on anticoagulant therapy. Funding Acknowledgement Type of funding sources: None.

Dynamics of recovery of cognitive and neurological functions in patients with primary and recurrent ischemic stroke in Ulyanovsk region

According to WHO statistics repeated strokes develop during the1st year in 35% of patients and are significantly more likely to lead to disability and death. Aim: To compare degree of impairment and dynamics of cognitive and neurological functions in patients with primary ischemic stroke (IS) in VBB and patients with IS in VBB, having acute cerebral blood circulation disorders.

HEMORHEOLOGIC PROFILE AND MICROCIRCULATORY HEMOSTASIS IN PATIENTS WITH CEREBROVASCULAR DISEASE IN DIABETES MELLITUS

Diabetes mellitus is one of the most serious issues faced nowadays both by medicine and society in general, which is due to the wide spread of endocrine issues affecting nearly every country globally, the growing incidence rate, as well as the severity of complications that are hard to treat. Type 2 diabetes mellitus increases significantly the risk of developing acute cerebral blood circulation disorders, which urges further comprehensive studies focusing on the role played by the vascular-platelet relation and coagulation hemostasis in the development and progression of diabetic vascular complications. The results of our study, which involved 74 patients with acute cerebral circulation disorders against type 2 diabetes mellitus revealed alterations affecting the hemostasis system. This could be seen from activated vascular-platelet and coagulation links, decreased anticoagulant activity, and a slowdown in fibrinolysis. The severity of disorders induced by the alterations in the hemorheological profile and the microcirculatory hemostasis are associated with the duration of type 2 diabetes mellitus and the carbohydrate metabolism indicators (hyperglycemia, increased HbA1c levels and glycation end products).

Use of early puncture-dilatational tracheostomy in case of transferring patients with acute cerebral circulation disorder and new coronavirus infection COVID-19 to artificial lung ventilation

Objective. To assess the use, safety and effectiveness of puncture-dilatational tracheostomy (PDT) performed immediately after the tracheal intubation in patients with cerebrovascular accident (CVA) and new coronavirus infection (NCI).
 Materials and methods. Patients with CVA and NCI treated at ICU underwent PDT using the Ultraperc kit according to the Ciaglia technique immediately after the tracheal intubation.
 Results. The results of treatment of 12 patients with CVA and 21 patients with NCI were investigated, the safety of manipulation, treatment results, and mortality in groups were evaluated.
 Conclusions. The puncture-dilatational tracheostomy, performed as early as possible, allows improving disease outcomes in CVA, facilitating patients care, and ensuring greater safety of patients and staff.

Microscopic Examination Of Postcapillary Cerebral Venues In Hemorrhagic Stroke

Hemorrhagic stroke among acute cerebral circulatory disorders is characterized by severe neurological complications and the need to choose between surgical intervention or therapeutic therapy. According to the World Health Organization (WHO)". Globally, stroke deaths will reach 7.8 million by 2030 unless an aggressive global response to the epidemic is put in place" 1. Subarachnoid haemorrhage, which accounts for half of the non-traumatic intracerebral haemorrhage, affects the most active and able-bodied population. The most important medical and social objectives are to monitor the course of the disease from the first hours after the onset of stroke, to prescribe adequate treatment in a timely manner, and to reduce mortality and disability rates [5,9].

Pathomorphological manifestations of vascular remodeling in the perifocal areas of ischemic cerebral infarction

Abstract. Acute disorders of cerebral circulation remain one of the leading causes of death of patients throughout the world. Tissue recovery after a stroke is directly related to active revascularization, which is intensified in the peri-infarction area. Newly formed vessels contribute to the restoration of cellular metabolism in surviving neurons. The processes of vascular remodeling after stroke have been at the center of many clinical and morphological studies in recent years. The aim of the study. To study the processes of vascular remodeling and neoplasm of vessels in the perifocal areas of ischemic cerebral infarctions. Material and methods. The study researched the brain of 29 deceased patients with hemispheric infarctions with different periods of the disease: up to 3 days (n = 5), 6 days (n = 5), 9-12 (n = 10), 30 (n = 5), 45 days (n = 4). The object of the study was perifocal areas of cerebral infarction, as well as areas outside ischemic lesions. The studies were carried out using histological, morphometric and statistical techniques. Results. Studies have shown that in the perifocal areas of cerebral infarction within 3 days from the onset of the disease, the morpho-functional state of the microvasculature was characterized by circulatory and hemocoagulation disorders. Along with destructive changes in blood vessels, processes are directed to improve blood circulation in ischemic areas of the brain. Collateral blood flow increases, dilation of pial vessels is noted with a decrease in the Kernogan index. On the 6th day, the processes of angiogenesis and vasculogenesis are activated, which intensify in the subsequent stages of the disease. In the long term, the efficiency of collateral blood flow in the pial vessels decreases, reduction in the capillary network, and the lumen of large arteries is recalibrated. Conclusions. In the early stages of cerebral stroke (up to 3 days), increased blood circulation in the ischemic areas of the brain occurs due to increased collateral blood flow. From the 6th day, the processes of angiogenesis in the form of capillary budding and the processes of vasculogenesis intensify. In large arterioles, recalibration processes take place. After 30-45 days in the perifocal areas of cerebral infarction, a significant reduction of the capillary network is recorded, which is regarded as a reaction to a decrease in blood supply to the areas of organized infarction.

Evaluation of the Efficiency of the Complex of Rehabilitation Treatment for the Outcome of the Early Period after Acute Cerebral Circulation Disorders

Based on the data of neurological examination and somatic status of 200 patients with ACVA, a plan of rehabilitation measures was drawn up for each patient. In the rehabilitation department, patients received a standard course of rehabilitation treatment for 24 days, including drug therapy and non-drug drugs. Evaluation of the effectiveness of the complex of rehabilitation treatment for the outcome of the early recovery period after stroke was carried out. It was found that the outcome of the disease and the success of rehabilitation measures in the early recovery period of stroke (2-4 weeks from the onset of the disease) is determined by the presence of predictors of a positive prognosis of stroke.

Mathematical analysis of the manifestations of thrombophilia in patients with the consequences of ischemic strokes

Metabolic thrombophilia is an independent risk factor for the development of atherosclerosis in patients. The aim of the study was to improve the prediction of the severity of ischemic strokes in the modeling and analysis of neurological disorders in patients . Materials and methods . The study involved 125 patients suffering from the consequences of ischemic strokes in the vertebral-basilar and/or carotid basins. The age of the patients was 55.4 ± 11.4 years. Group 1 consisted of 61 patients with the consequences of acute cerebral circulatory disorders by the type of ischemia, by the lacunar subtype; group 2 consisted of 64 patients with the consequences of ischemic strokes by the atherothrombotic subtype. Statistical analysis of patient indicators was carried out using licensed statistical programs Excel. In the clinical picture of 43 patients of group 1, the predominant cerebral conduction disorders of the pyramidal system and sensitivity were observed. In the clinical picture, 39 patients of group 2 developed more frequent conduction disorders of the pyramidal system and sensitivity. According to the linear regression analysis, the worst prognosis for the severity of hyperfibrinogenemia and hyperhomocysteinemia were patients of groups 1 and 2 of the elderly, respectively. Conclusion . According to the results of our and other authors studies, arterial thrombosis, which causes ischemic stroke according to the atherothrombotic subtype in the presence of thrombophilia, is formed with a certain frequency in patients. Ischemic stroke is less common in young people than in the elderly, but the underlying pathogenesis and risk factors are more multifaceted. Performing all of these diagnostic tests can improve the diagnosis, primary and secondary prevention of ischemic strokes in patients.

DYNAMICS OF THE NEUROOPHTHALMIC CHARACTERISTICS OF PERINATAL ACUTE STROKE AT THE STAGES OF CHILDREN'S DEVELOPMENT

The theoretical basis of these studies is based on the dynamics of functional and adaptive relationships of important integrative departments of the Developing Child Brain. It is no coincidence that in recent years studies of the dynamics of cerebral vision disorders in children with pre-and perinatal encephalopathy have expanded in the direction of hemodynamics of Central hemodynamics, general and local cerebral circulation, as well as orbital and intraocular hemodynamics. In the last 5 years, with the help and cooperation of the children's Neurological Hospital, a diagnosis of acute cerebral circulation disorder in the neonatal period of life was detected in 1500 children from 3500 to 3 years of age. In these children, consistent between clinical and laboratory examinations, the dynamics of these indicators of homeostasis-Sommar in blood of catecholamines, their excretion in the urine, differentiated daily, the dynamics of the amount of sugar and cortisol in the blood, as well as electrolytes in plasma and erythrocytes were monitored. While evaluating the results of the additional examination methods, epicrises given to children by children's Neurological Hospital, Republican perinatal Center and research pediatric institute were used. The reaction of Pulse, arterial pressure and respiration to vegetotropic drug preparations and physical load tests was investigated in order to confirm clinical and additional correlations of electrophysiological and Clinico-laboratory results obtained in the children we examined. With known methods, atropine, adrenaline and insulin tests were carried out, the reactivity of Pulse, arterial pressure and respiration to the administration of adrenaline (0.02 mg/kg) and atropine (0.01 mg/kg) into the muscle, as well as the increase in excretion of catecholamines with urine into insulin injection (0.25 unit/kg). Thus, in the neonatal period of life of 1500 children from 3500 to 6 years of age who were involved in the examinations, acute violations of cerebral circulation were diagnosed, as a result of many years of consecutive examinations and treatments, nearly 1000 children with pre – school clinical picture were evaluated for compensation – 15%, remissions – 75%, program walk – 10%. It is proved that the solutions of recovery options depend on the direction of hypothalamic-pituitary relations and homeostatic aberrations.

Adherence to Attendance at Outpatient Clinic and Longterm Survival of Patients after Stroke in Outpatient Setting: the Data of REGION-M Registry

Aim. Assess the two-year survival rate of patients who have undergone acute cerebral circulation disorder, depending on their commitment to visiting the district polyclinic before and after discharge from the hospital.Material and methods. The outpatient part of the REGION-M register included 684 patients attached to the Moscow City Polyclinic №64, discharged from the Moscow City Clinical Hospital n.a. F.I. Inozemtsev of from 01.01.2012 to 04.30.2017 with a confirmed diagnosis of acute cerebral circulation disorder (cerebral stroke / transient ischemic attack).Results. Of the entire cohort, 83.2% of patients and 84.2% after hospital discharge attended the clinic during the year before the development of reference acute cerebral circulation disorder. Patients who attended the clinic before and after the reference stroke were older, more likely to have diabetes, comorbid disease and disability. For 22 months of follow-up, mortality was 28.8% (197 out of 684 people). Among those who applied and did not apply to the clinic before the reference acute cerebral circulation disorder, the difference in mortality tended to be reliable (27.4% versus 35.7%, p <0.1), while mortality was almost twice as low among patients who applied to the clinic at least 1 time after discharge (25.7%) than among patients who did not apply after discharge - 45.4%, p<0.0001. When adjusting for sex and age (the relative risk of death for them was 1.009, 95% confidence interval 1.005-1.01 2, p<0.0001 ), the statistical validity of reducing the risk of death was maintained when patients were committed to visiting the clinic after discharge - the relative risk of death 0.366 (95% confidence interval 0.269-0.500, p<0.0001 ).Conclusion. Lower mortality among those who visited the district polyclinic after undergoing stroke confirms the important role of medical observation in the posthospital period. At the same time, there is a reserve in improving the long-term prognosis of the lives of patients who have suffered a cerebral stroke or transient ischemic attack, due to greater coverage of patients with medical supervision in the clinic.