Acute Disturbance Of Cerebral Circulation Research Articles

Vascular cognitive impairment: issues of diagnosis and treatment

Vascular brain diseases are one of the leading causes of death and disability in developed countries. Along with acute disturbance of cerebral circulation, chronic cerebrovascular diseases, which manifest as vascular cognitive impairment (VCI), are of great medical and social importance. VCIs include a wide range of cognitive impairments (CI) ranging from subjective CI to vascular and mixed dementia. The article discusses pathogenetic and clinical variants, approaches to the diagnosis of VCIs, and provides their modern classification. The features of CI, typical for chronic cerebrovascular insufficiency, are described, such as a slowdown in the rate of mental activity and disorders of frontal executive functions in combination with behavioral and emotional disorders. The issues of treatment of VCI are discussed, which should be comprehensive and include correction of the underlying vascular disease, non-drug (regular physical activity, smoking cessation, cognitive training) and drug treatments aimed at improving cognitive functions. The possibilities of modern neuroprotective and symptomatic therapy of CI, including the use of Cellex®, are shown.

Changes in kinesiostabilogram parameters and movement speed of stroke patients while increasing their physical activity due to the use of biofeedback method

Balance disorders are complications of stroke survivors. Aim of this study was the establish effectiveness of the biofeedback approach. In this intervention study 245 patients with early diagnosis of acute disturbance of cerebral circulation (ADCC) were examined. Patients able to move independently were treated by standard conservative ADCC therapy on an outpatient approach, but they continued to have problems with coordination of movement in upright position. Then they were submitted to an increasing physical activity based on five sessions of biofeedback, i.e., a complex rehabilitation of patients with motor pathology "Trust-M" according to TU 9442-001-63704475-2010. Mobility rates were assessed using a web camera. Patients' quality of life was evaluated by SF-36 questionnaire and the Hospital Anxiety and Depression Scale (HADS). All parameters were recorded before and after 5 sessions of biofeedback. After treatment, the stability indicators improved and all patients showed a significant increase in motion rate and quality of life. At the same time, the severity of pain and of depression and anxiety decreased. Negative correlations of average strength between the quadrant and patient HADS scaling rates were obtained. In conclusion, our work shows effectiveness of the biofeedback technique for correcting coordination in stroke survivors.

USE OF THERAPEUTIC EXERCISES FOR POST-STROKE CORRECTION OF SWALLOWING

Dysphagia (Greek. Dys + phagein ­­– eat, swallow) ­– is a violation of swallowing, in which there is a feeling of discomfort or difficulty in transporting the food bolus from the mouth to the stomach. Because the disorder of the act of swallowing in stroke is usually of neurogenic origin and is defined by a number of neurologic disturbances and dysfunctions, it is better to use the term "neurogenic dysphagia" for patients with acute disturbance of cerebral circulation. The urgency of this problem is especially emphasized in the development of a set of therapeutic exercises for such socially important disease as acute cerebrovascular accident. One of the formidable complications of stroke is a violation of the act of swallowing. This leads to a significant reduction in quality of life increasing the risk of secondary complications, which, in turn, significantly increases the likelihood of death. Violation of the act of swallowing is observed in 26–45% of patients due to acute ischemic stroke. Dysphagia leads to the development of life-threatening complications such as aspiration pneumonia, dehydration, and significantly reduces the quality of life of such patients. Thus, the correction of the act of swallowing by means of physical rehabilitation after brain injury is a very important task of the rehabilitologist. For a long time, speech therapy was the only method of rehabilitation of dysphagia; now we can widely use therapeutic exercises to restore the functions of facial muscles and masticatory muscles. Screening for swallowing disorders allows us to assess the function of the masticatory muscles in five stages, which makes it possible to develop a more individual and thorough set of therapeutic exercises after each stage of the screening study. Depending on the phase of swallowing in which disorders are observed, we have developed an individual set of therapeutic exercises that will be performed by the patient in each of the five stages of the screening study, if the patient could not overcome this stage.

CLINICAL ANAMNESTIC CHARACTERISTICS AND MUSCLE STRENGTH IN MIDDLE-AGED MEN WITH ISCHEMIC HEART DISEASE IN THE PRESENCE OF MYOCARDIAL INFARCTION

Introduction. Evaluation of muscle strength of wrist flexors in patients with coronary heart disease can act as a predictor of total muscle strength and influence the prognosis for patients after a previous myocardial infarction, taking into account the rehabilitation program. The purpose of the study is comparison of clinical anamnestic characteristics of middle-aged men with coronary heart disease with comparable social status, physical activity and body mass index (BMI), depending on the presence of myocardial infarction as well as an assessment of muscle strength of the wrist flexors, bioelectrical impedance analysis and testosterone level. Material and Methods. The study included men at the age of 58.09±6.85 on average; living in rural areas who were clinically monitored by a cardiologist at the central district hospital: the main group included men 3 months after the first myocardial infarction, the comparison group — patients with stable coronary heart disease. Clinical anamnestic status of all patients was assessed; evaluation of muscle strength of wrist flexors by means of dynamometry, bioelectrical impedance analysis, testosterone test and SF-36 Survey were also carried out. Results. Middle-aged men (58.09±6.85 years old) living in rural areas who had a similar physical activity, a long anamnesis of hypertension 180 (72; 228) months, coronary heart disease (49.28±12.47 months), anamnesis of coronary artery bypass surgery — CABG (1.2±0.03 years) were more likely to have hereditary cardiovascular diseases (38 vs. 12% , p=0.05) and anamnesis of previous acute disturbance of cerebral circulation (16 vs. 2%, p=0.04) than patients after the first myocardial infarction. The 6-minute walk test was greater in men after the first myocardial infarction (457.07±46.44 vs. 416.64±51.58, р<0.05), they had higher indexes of physical — 70 (55; 80) scale against to 55 scale (25; 65, р<0.02) and social functioning — 75 (62.5; 100) vs. 62.5 (50; 75, p<0.05), energy level was 55 (50; 75) scale to 50 (45; 60) scale (p<0.05) and mental health 62 (52; 77) to 52 (52; 60) scale with (p<0.01). Regardless of the duration of IHD or the presence of the first myocardial infarction, middle-aged men with overweight who had the same correlation of muscle and adipose tissue and testosterone level showed comparable strength of wrist flexors, measured by means of a dynamometer.

VEGETATIVE RELATIONS IN PATIENTS WITH DIFFERENT FORMS OF DISTURBANCES OF CEREBRAL CIRCULATIONIN THE MOST ACUTE PERIOD

Objective: to determine the distinguishing features of the ANS state as the first link of the stress-realizing system in patients with various forms of acute disturbances of cerebral circulation (passing infringements of cerebral circulation and stroke) in the most acute period. Methods . 51 patients with transient ischemic attack (TIA), 25 with cerebral hypertensive crisis (CHC), 71 with lacunar stroke (LS), and 10 volunteers were examined. Besides the standard examinations, the heart rate variability (HRV) parameters, including the standard deviation of consecutive RR intervals (SDNN), percentage of the number of pairs of consecutive RR-intervals differing by more than 50 ms during the recording period (pNN50), mode of intervals RR (Mo), amplitude of the mode (AMO) were tested in all the patients. On the basis of the above parameters the stress index, the reactivity coefficient, the vegetative equilibrium index (IER) and the vegetative index of the rhythm (VIR) were calculated. The correlation, linear, and nonlinear regression analysis of the HRV parameters was performed. Results. A negative effect of the sympathetic tone (AMO, r=0.42, p=0.006) and a favorable effect of the parasympathetic tone of the ANS on severity of clinical manifestations in TIA (ΔX, r=0.66, p=0.026) were determined. The patients with CHC found an inverse relation: (AMo; r=-0.48; p=0.026) and (r=0.55, p=0.009). The group with stroke revealed a negative effect of growing parasympathycotonya after the end of the first decade (pNN50, r=-0.72, p=0.028). In the group of patients with rapid recovery of the neurological deficit (CHC, TIA, LI) there was a negative AMO / Mo dependence. The patients with all variants of stroke detected a positive relation of ΔX / Mo. In the isolation of a group of young patients with stroke, certain patterns were confirmed, and the positive ratio (ΔX / Mo) at the end of the treatment preserved only in patients with a large site of stroke affection. Conclusion. The key difference of the vegetative status of the patients with TIA from the stroke group is predominance of activity of the sympathetic ANS segment with an increase of parasympathycotonya in exercise. The stroke patients irrespective of the size showed an increase in activity of the parasympathetic link of the ANS in response to an increase in the humoral effect.

The experience of using thrombolysis in patients with acute disturbances of cerebral circulation: efficacy, safety, predictors of outcome and hemorrhagic transformation

To evaluate neurological and functional outcomes of early stage of ischemic stroke, their determining factors and predictors of hemorrhagic transformation in patients who received thrombolysis. A retrospective analysis of 147 patients, who underwent thrombolysis, and 127 patients, matched for basic parameters, who did not receive thrombolysis, was performed. Anamnesis, results of clinical examination, a spectrum of laboratory-instrumental parameters were evaluated. Functional status was assessed at discharge from the hospital using the Rivermead mobility index and the modified Rankin scale. Along with standard computed tomography (CT) at admission and after 24h, 73 patients receiving thrombolysis underwent CT-perfusion examination. The insufficient number of patients (37%) are admitted to a hospital in the first 2 h after stroke. The high prevalence of cardioembolic stroke and aphasia disorders in patients treated with thrombolysis was identified compared to the control group. CT revealed acute cerebral infarction in 14% of patients admitted within 2h. CT-perfusion examination determined brain ischemia only in half of patients. There was a low prevalence of symptom hemorrhagic transformation (0.7%). Thrombolysis was correlated with the higher rate of good functional outcomes of acute stroke, reduced neurological deficit, better mobility at discharge and shorter duration of the first rehabilitation period. Age, smoking, Rankin scale score at baseline, acute infarction on the primary CT, pathogenetic variant of stroke, myocardial hypertrophy, atherosclerosis of carotid arteries and volume of MRI lesions were the main factors associated with the efficacy of thrombolysis. The main predictors of hemorrhagic transformation were the severity of stroke, glomerular filtration rate, atrial fibrillation, treatment with antiaggregants before admission and hemispheric stroke. The analysis has demonstrated the safety and efficacy of thrombolysis in ischemic stroke in real clinical practice of a regional Vascular center.

Relationship of Remodeling of Carotid Arteries and Left Ventricular Geometry in Patients With Chronic Glomerulonephritis.

to study clinical-functional features of remodeling of carotid arteries and its relation to restructuring of the left ventricle (LV) in patients with chronic glomerulonephritis at pre-dialysis stage. We examined 269 patients (189 men, 80 women) with chronic glomerulonephritis (CGN) aged 17-71 years, at pre-dialysis stages of the disease. We analyzed biochemical parameters of peripheral blood with the determination of daily proteinuria and glomerular filtration rate (GFR). For identification of structural changes of carotid arteries (CA) and LV we used Doppler ultrasound and echocardiography. Atherosclerotic changes of CA were found in 79 patients (29.3%). Four patients (1.4%) had history of acute disturbance of cerebral circulation. Concentric type of left ventricular hypertrophy (LVH) was significantly more prevalent among patients with CA remodeling compared with those without (37.84 vs. 18.75%; p=0.006). Eccentric variant of LVH was significantly more prevalent among patients without atherosclerotic lesions in CA compared with those with CA remodeling (81.25% vs. 62.16%; p=0.001). Increased CA intima media thickness positively correlated with body mass index (r=0.273; p=0.014) and negatively - with GFR (r= -0.222; p=0.048). Statistically significant relationships were also found between the presence of carotid atherosclerosis and structural rearrangements of the heart. We demonstrated a clear relationship between GFR, restructuring of CA and concentric type of change of LV geometry, regardless of the presence of traditional risk factors.

Нейропсихологические изменения у пациентов с острым нарушением мозгового кровообращения

The work is devoted to the study of cognitive and emotional disorders in patients with acute impairment of cerebral circulation. The research was based on the assumption that memory and attention are most severely disturbed in the structure of neuropsychological pattern with acute cerebrovascular accident developing by the ischemic type. According to numerous studies, patients with acute stroke also suffer from depressive and anxiety disorders. Cognitive and emotional disorders in many ways determine the outcome of rehabilitation activities and the quality of life of the patients, it seemed important to assess the cognitive and emotional state in patients with acute cerebrovascular accident, as well as rehabilitation goals and tasks. The degree of disorder of cognitive functions, in particular, mnestic, praxis, attentive, was examined, also the emotional status was investigated. The classification of the leading disorders of cognitive functions in patients with different types of acute stroke was presented. A scheme of neuropsychological examination and a program of short-term rehabilitation in a hospital for patients who had acute cerebrovascular accident with attentively-mnestic disorders were developed. The directions of psychological support and early neuropsychological correction of patients after acute disturbance of cerebral circulation are identified.

THE DISTANT OUTCOMES OF SURGICAL TREATMENT FOR STENOSING AFFECTION OF BRACHIOCEPHALIC ARTERIES

Acute disturbed cerebral circulation is the second leading cause of death around the world. Carotid stenosis is a cause of acute disturbed cerebral circulation in approximately 25 % of cases. At present, carotid endarterectomy is one of the most frequently performed vascular reconstructions. This is due to the high efficiency of the surgery in the correction of cerebral circulation and prevention of acute disturbances of cerebral circulation. The problem of the further disease progression still remains topical despite the method of intervention and plastic material applied, as restenosis is diagnosed in approximately 10-15 % of the cases. The work studies and analyzes the distant results of various surgical techniques used in carotid reconstructions. It gives a comparative analysis of the plastic materials used in carotid endarterectomy. The analysis of the results showed that there is no optimal technique of surgical correction and plastic material in atherosclerotic lesion of brachiocefal arteries that can help avoid restenosis. This proves a necessity for further investigation and search for a method of surgical correction and alternative tissue for internal carotid reconstruction.

State of the Rheological Properties of Blood in the Dynamics of Development of Acute Disturbances of Cerebral Circulation in Atherosclerosis Patients

The data on the state of the rheological properties of blood and the thrombocytic‐vascular chain of hemostasis in the dynamics of development of transitional ischemic attacks and acute ischemic insult are presented and compared to the indices of healthy persons and patients with chronic cerebrovascular pathology. Throughout the period of observation, in the patients of all the groups examined we established changes in the increase in the blood viscosity, the aggregation of erythrocytes, and the content of fibrinogen (with decrease in the deformability of erythrocytes) and an increase in the activation of the function of thrombocytes against the background of the changed athrombogenic properties of the vascular system. It has been revealed that there is a close connection between the hemorheological disturbances and the heaviness of atherosclerotic affection of the main arteries of the heart.

Dynamic study of autoantibodies to glutamate receptors of NMDA-type in blood of patients with acute ischemic and hemorrhagic insult

Results of dynamic study of level of antibodies to NMDA- receptors in blood serum of patients at different moments of acute period of disturbance of cerebral circulation of ischemic and hemorrhagic tipe are generalized in the given work. A total of 48 patients of 3266 years of age with acute disturbance of cerebral circulation, 29 of which with acute cerebral ischemic and 19 with acute hemorrhage has been examined. The trends has been identified in changes of the level of antibodies to receptors at different phases of acute period of ischemic insult and acute cerebral hemorrhage. The results can be used for diagnosis and prognosis of the course of different types of acute disturbance of cerebral circulation.

Bilateral disturbances of perception function of the brain in patients with unilateral disorders as a result of acute disturbances of cerebral circulation.

Bilateral disturbances of perception function of the brain in patients with unilateral disorders as a result of acute disturbances of cerebral circulation.