Acute Period Of Ischemic Stroke Research Articles

Risk factors for carotid endarterectomy in the early period of stroke

The OBJECTIVE was to identify significant risk factors of complications after carotid endarterectomy in the acute period of ischemic stroke, thus improving the outcomes of surgical treatment of symptomatic internal carotid artery stenosis.METHODS AND MATERIALS. The results of treatment of 776 patients after carotid endarterectomy in the acute period of stroke operated in the State Budgetary Institution of Tuberculosis «Regional Clinical Hospital № 2» were subjected to the factor analysis. catamnesis of the disease was traced for at least one year from the surgical intervention.RESULTS. Repeated ispilatory stroke occurred in 13 patients. Significant factors were tortuosity of the target artery (OR, 6.94; 95 % cI=2.21–21.86; p=0.003), aneurysm in the tortuosity zone (OR, 138.5; 95 % cI=11.6–1643.1; p=0.001), the presence of an electric cardiac pacemaker in the patient (OR, 31.71; 95 % cI=2.69–373.84; p=0.05), and need for IcA resection (OR, 6.83; 95 % cI=2.1–21.48; p=0.004). The risk factor for contralateral stroke in the early postoperative period was the use of a temporary intraluminal shunt (OR – 35.86; 95 % cI=2.17–592.92; p=0.05). Tortuosity of the target artery (OR – 4.6; 95 % cI=1.1–18.3; p=0.017), the need for IcA resection and in the presence of complicated atherosclerotic plaque in the reconstruction area (OR – 6.84; 95 % cI=1.89–24.85; p=0.01) turned out to be the sig nificant risk of death in the immediate postoperative period.CONCLUSIONS. Significant risk factors for recurrent stroke and death after carotid endarterectomy performed in the acute period of stroke were the tortuosity of the target artery, an aneurysm in the tortuosity zone, the presence of an electric cardiac pacemaker in the patient and the need for IcA resection in the presence of complicated atherosclerotic plaque in the reconstruction zone. The only risk factor for contralateral stroke in the early postoperative period was the use of a temporary intraluminal shunt. Further large trials are needed to clarify the obtained results.

MULTIDIMENSIONAL WEIGHTED ASSESSMENT IN THE ANALYSIS OF THE COURSE OF ISCHEMIC STROKE DUE TO CAROTID STENOSIS
 OF VARIABLE DEGREES OF EXPRESSION

Aim: to develop a multidimensional weighted assessment of the influence of risk factors for stroke on the course of ischemic stroke that developed against the background of carotid stenosis of varying severity.Material and methods. We studied 606 patients who were in the department for patients with stroke in the acute period of ischemic stroke, who were divided into three groups according to the severity of carotid stenosis according to NASCET. In all patients, risk factors for the development of stroke were identified, the size of the ischemic focus was determined using a CT scan of the brain, and the patient’s condition and its changes were assessed using the NIHSS, Rankin, and Rivermead scales.Results. Estimated indicators are represented by different measurement scales, so there is a need to bring them to the same basis. The methodology for constructing a weighted assessment involves the formation of weighting coefficients for each component of the new index. A multidimensional weighted assessment was modeled in order to identify the main factors influencing its variation. A selection of risk factors for stroke in the studied patients was carried out, regression models were built, their statistical analysis was performed and their quality was assessed. Conclusion. Regression models allow you to cover a wide range of factors and mathematically express their relationship with performance indicators. The developed logistic models show the degree of positive or negative influence of various risk factors on the course of ischemic stroke in the studied groups of patients.

Personalized approach to assessing the functional result of acute ischemic stroke

BACKGROUND: The main reason for the poor prognostic outcome in stroke patients is the polymorphism of cognitive and motor impairments.
 AIM: The purpose of this study is to evaluate the impact of clinical and paraclinical factors on the functional outcome of the patient in the acute period of ischemic stroke based on statistical methodology.
 MATERIALS AND METHODS: 160 patients of the primary vascular center with a diagnosis of “Ischemic stroke” were examined. Functional outcome parameters were designated as absolute values and were calculated as the difference between Montreal Cognitive Assessment (MoCA), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Modified Rankin (mRS) scale scores before and after treatment. The following criteria were considered as factors influencing the prognosis of the functional result of acute stroke: demographic characteristics, parameters of cognitive function, stroke characteristics (localization, lateralization, subtype). Mathematical statistics was performed using the Python programming language and the Pandas and SciPy libraries.
 RESULTS: The mathematical model developed in this study made it possible to identify the main neuropsychological and clinical indicators that negatively and positively affect the functional result of acute stroke. As the main factors influencing the functional result in relation to MoCA, impairments in the areas of attention, speech and executive function, age, indicators on the IQCODE and ASPECTS scales were identified. Apraxia, agnosia, executive dysfunction, sex, age, lesion side, IQCODE parameters influenced the prognosis of the degree of patient’s daily activity according to IB. Regression of neurological symptoms according to NIHSS depended on indicators in the field of perception, praxis, speech, IQCODE and ASPECTS values. Semantic aphasia, mnestic and executive dysfunction, apraxia, and IQCODE scores were important for the prognosis of disability degree according to mRS.
 CONCLUSION: The use of discriminant analysis to predict the functional result will allow to create personalized diagnostic and therapeutic strategies for managing patients in the acute period of ischemic stroke. The predictive value of clinical and paraclinical markers in relation to the recovery of motor and cognitive function of patients may be useful in the further management of ischemic stroke.

СТРУКТУРА РАННИХ ПОСТИНСУЛЬТНЫХ КОГНИТИВНЫХ НАРУШЕНИЙ У ПАЦИЕНТОВ. С ПОРАЖЕНИЕМ ПРАВОГО И ЛЕВОГО ПОЛУШАРИЙ ГОЛОВНОГО МОЗГА: КОГОРТНОЕ ИССЛЕДОВАНИЕ

AIM. To identify the most informative indicators of functional-cognitive status, allowing for a differentiated approach to the diagnosis of cognitive impairment in patients with damage to the right and left hemispheres in the acute period of ischemic stroke. MATERIAL AND METHODS. 240 patients diagnosed with ischemic stroke in the carotid region were examined. Depending on the location, the patients were divided into two groups: Group 1 — 122 patients with damage to the left hemisphere of the brain;Group 2 — 118 patients with damage to the right hemisphere. The following scales were used to assess parameters of cognitivefunctional status: Montreal Cognitive Assessment Scale (MoCA), National Institutes of Health Scale (NIHSS), Barthel Index (BI), Questionnaire for Cognitive Decline in the Elderly (IQCODE), additional scales for assessing praxis, semantic aphasia, perceptual and executive function, Hospital Anxiety and Depression Scale (HADS), MFI-20 and Apathy Scale (AES). The latency and amplitude of acoustic endogenous evoked potential, P300, was used as neurophysiological markers. Statistical analysis was performed using the SPSS 23 software package. RESULTS AND DISSCUSION. The main relevant indicators of cognitive dysfunction in both groups were declines in the areas of memory, perception and executive function, which prevailed in patients of the 1st group. The disorder of visual perception, understanding of complex grammatical structures, a predominance of decreased motivation and mental fatigue were identified in patients of the 1st group; impaired recognition of emotions and understanding of idioms, the presence of general fatigue and depression — in patients of the 2nd group. Statistically significant neurophysiological indicators were an increase in P300 latency in the frontal and central leads in patients of the 2nd group. CONCLUSION. The study identified relevant indicators of cognitive and psychoemotional status depending on the lateralization of the lesion in patients in the acute period of ischemic stroke. The P300 evoked potential method can be used to objectify cognitive dysfunction and evaluate the effectiveness of therapy for cognitive disorders. The results prove the feasibility of a comprehensive examination of cognitive deficits with the inclusion of additional scales and tests to assess perception, executive and mnestic functions, fatigue, affective and personality disorders. This will allow us to develop more effective individual rehabilitation programs aimed at restoring the cognitive and emotional resources of patients. KEYWORDS: ischemic stroke, cognitive function, affective disorders, fatigue, evoked potentials, Р300

Linking Immunological Parameters and Recovery of Patient’s Motor and Cognitive Functions In The Acute Period of Ischemic Stroke

Objective. To evaluate the relationship between immunological parameters and functional outcome in patients with varying severity of ischemic stroke based on statistical methodology.Materials and methods. The prospective study included 78 patients diagnosed with ischemic stroke, who were distributed into two groups: group 1 — 38 mild stroke patients, NIHSS score < 5, group 2 — 40 moderate stroke patients, NIHSS score 5–15. Signs of stroke severity, degree of disability, cognitive decline, and activities of daily living were chosen as criteria to estimate the functional outcome by calculating the difference between the NIHSS, mRS, MoCA, and BI scales at the time of admission and on Day 12 of hospital stay. Lab tests included assessment of plasma concentrations of CXC and CC subfamilies of cytokines, interleukins and TNF-a on Day 2 of hospital stay. Machine learning algorithms, the Python programming language, the Pandas and SciPy libraries, and discriminant analysis were used for statistical processing.Results. The following parameters were found as significant: concentrations of IL-1b and MPIF-1/CCL23 for — for group 1, and concentrations of IL-16, MPIF-1/CCL23, Eotaxin-2/CCL24, Gro-a/CXCL1 and IL-8/CXCL8 for group 2 patients. Positive correlation was established between NIHSS dynamics and concentrations of TNF-a (R=0.227, P=0.001), MPIF-1/CCL23 (R=0.380, P=0.00061) and Gro-a/CXCL1 (R=0.211, P=0.00001), and between changes in mRS and concentrations of MPIF-1/CCL23 (R=0.277, P=0.00006), Gro-a/CXCL1 (R=0.211, P=0.0075) and IL-16 (R=0, 211, P=0.00001). There was a significant negative correlation between cognitive dysfunction and concentrations of Eotaxin-2/CCL24 (R=–0.378, P=0.00075), Gro-a/CXCL1 (R=–0.313, P=0.0035), and IP-10/CXCL1 (R=–0.214, P=0.00023), and between limited activities of daily living (IB) and concentrations of MPIF-1/CCL23 (R=–0.345, P=0.0024) and Gro-a/CXCL1 (R=–0.210, P=0.00001).Conclusion. Chemokines form the CC family — MPIF-1/CCL23 and Eotaxin-2/CCL24, and the CXC-Gro-a/CXCL1 and IL-16 clusters are the principal cytokines associated with the dynamics of patient’s motor and cognitive functions recovery in the acute period of ischemic stroke. Although obtained results demonstrate negative effect of increased MPIF-1/CCL23, Gro-a/CXCL1, IL-16 and Eotaxin-2/CCL24 concentrations on the improvement of motor and cognitive impairments, further studies are needed to verify the CXC and CC subfamilies chemokines as prognostic markers of patient’s functional outcome in the acute period of ischemic stroke.

Relationship between biomarkers of autophagy and inflammation in acute period of ischemic stroke

Postischemic neuroinflammation is a critical pathophysiological process within the entire pattern of cerebral ischemia, spanning early injury and tissue repair. According to recent experimental data, autophagy is involved in the regulation of neuroinflammation, influencing the outcome of the acute period of ischemic stroke (IS).Objective. To evaluate the relationship between autophagy biomarkers and inflammation indicators in the dynamics of the acute period of atherothrombotic IS.Materials and methods. 112 patients in the acute period of newly developed atherothrombotic IS and 56 donors (control group) were examined. Patients underwent dynamic clinical and neurological examination on the 1st, 7th and 14th days from the onset of the disease (magnetic resonance imaging, testing using the NIHSS scale, modified Rankin scale). At the same time intervals, blood was drawn for testing. The number of active autophagosomes in peripheral blood was assessed by flow cytometry using a specific Cyto-ID dye. The serum concentrations of proinflammatory cytokines IL‑1β, IL‑8, IL‑18 (interleukins‑1β, -8, -18), TNFα (tumor necrosis factor-α), autophagy biomarkers Beclin‑1, LC 3 and p62 were determined by enzyme-linked immunosorbent assay analysis. C-reactive protein was assessed by a highly sensitive immunoturbidimetric method.Results. A statistically significant increase in the studied parameters was revealed compared to the control group. The maximum increase in inflammation biomarkers was observed on the 1st day, and the maximum increase in key indicators of autophagy (LC 3, Beclin‑1, Cyto-ID) – on the 7th day after the development of ischemia. A direct relationship was established between the level of autophagy and the concentration of inflammatory biomarkers (CRP, IL‑1β, IL‑18, TNF-α) on the 1st and 7th days of acute IS.Conclusions. The identified correlations indicate the participation of activated autophagy in the regulation of post-ischemic neuroinflammation and its involvement in ischemic brain damage in the early stages of the acute period of IS (days 1–7). The results obtained confirm the literature data on the influence of autophagy on the outcome of the acute period of the disease.

Modern approaches to perioperative management of patients undergoing carotid endarterectomy in acute period of ischemic stroke

This article presents the Moscow Botkin Hospital experience of using combination of general and superficial cervical plexus regional anesthesia during carotid endarterectomy performed in patients in the acute period of atherothrombotic genesis ischemic stroke. The result of reliable antinociceptive protection of the body from the activation of the sympatho-adrenal system against the background of surgical manipulations was the prevention of episodes of critical hypertension and ensuring normalization of systemic hemodynamics. By reducing the need for opioids, patients’ awakening is accelerated, and their time in the operating room is minimized. In addition, the time of necessary observation in the intensive care unit and the need for anesthesia at the immediate postoperative period, is also reduced. The above factors, as well as a multidisciplinary approach to the patient, allowed not only to provide reliable prevention of recurrent vascular incidents in the acute period of ischemic stroke, but also to improve the neurological outcomes.

Medical and social consequences of confusion syndrome that developed in the acute period of ischemic stroke

AIM: To assess the dynamics of cognitive functions in patients in whom the acute period of ischemic stroke was accompanied by the confusion syndrome, in comparison with patients in whom the acute period of stroke was not accompanied by the development of confusion. To assess the impact of clinical features of confusion syndrome on the development of post-stroke cognitive impairment, mortality, and patient care burden.
 MATERIALS AND METHODS: The study involved 99 patients, 55 of whom developed severe confusion during the acute period of stroke, and 44 patients whose ischemic stroke was not complicated by the development of confusion syndrome. The groups were homogeneous in terms of the main etiological factors: age, degree of pre-stroke cognitive impairment. The study assessed the impact of the development of confusional syndrome on the outcome.
 RESULTS: Confusion syndrome that develops in the acute period of ischemic stroke significantly increases the risk of developing or worsening existing cognitive impairment, mortality, dependence on care, and the burden on caregivers.
 CONCLUSION: Being a serious complication, confusion syndrome requires monitoring of qualitative and quantitative indicators of consciousness in the acute period of ischemic stroke, prevention and, if detected, immediate correction of confusion syndrome.

Perforative duodenal ulcer in a patient in the acute period of ischemic stroke. Case report

Perforated duodenal ulcer is a common pathology with fairly high postoperative mortality, especially in late diagnosis. In some cases, timely diagnosis of a perforative ulcer may be difficult and the results of the survey may be contradictory. The classical triad of clinical signs of perforative ulcers is not always observed in patients, sometimes the clinical picture is so unclear that the final diagnosis can only be made intraoperative. The article presents an analysis of the clinical case of difficult diagnosis and treatment of perforative duodenal ulcer in a patient in an acute period of ischemic stroke. In addition, the patient had severe concomitant somatic pathology with a high risk of systemic thromboembolism and at the same time a high risk of bleeding.

Emergency Stenting of Tandem Stenoses of the Internal Carotid Artery Using Proximal Protection Against Distal Embolism “MoMa”

Man, 61 years old. Admitted with complaints of severe weakness in the right limbs, which developed about 4 hours ago. Multispiral computed tomography with cerebral angiography: signs of ischemic stroke in the basin of the left middle cerebral artery. Angiography of the brachiocephalic arteries (BCA) was performed: angiographic signs of damage to the BCA: the left internal carotid artery (ICA) of the C2–C3 segments up to subocclusion, up to 75% in the mouth and right third. The circle of Willis is closed.A multidisciplinary council made a decision on emergency stenting of tandem ICA stenoses using proximal protection against distal embolism “MoMa”. The course of the operation: after angiography, the sheath introducer was replaced by a guidewire sheath with a 9F introducer. A proximal protection system “MoMa” was installed along the diagnostic conductor 260 cm at the mouth of the left external carotid artery (ECA) and the middle third of the left common carotid artery (OCA). Baloons in the ECA and OCA were inflated. The Promus element 4.0x12 mm (DES) ICA was brought into the affected area of C2–C3 segments, positioned and opened at a pressure of up to 14 atm. The balloon catheter has been removed. Aspiration from the ICA. On check angiography, residual stenosis of the ICA stenting zone was 0%. On the test angiography intracranial arteries without signs of embolism. A Protege (7x10x40) mm stent was placed, positioned and deployed in the affected area of the orifice and the right third of the ICA. The delivery system has been removed. Aspiration from the ICA. On the test angiography, the residual stenosis of the ICA stenting zone was up to 0%. The distal embolism protection system has been removed. On the control angiography intracranial arteries without signs of embolism.The postoperative period was uneventful. On the 10th day after stenting, the neurological deficit regressed completely, the patient was discharged for outpatient observation in a satisfactory condition.CONCLUSIONS When performing brain revascularization in the most acute period of ischemic stroke, it is necessary to take into account the recommendations of multicenter studies that report such conditions for a successful outcome of the operation as: the diameter of the ischemic focus in the brain, not exceeding 2.5 cm and the absence of severe neurological deficit (more than the Rankin scale score 2). Within the framework of this clinical example, these recommendations were taken into account, which, among other things, contributed to the optimal outcome of urgent revascularization. Emergency stenting of tandem stenosis of the internal carotid artery using the device for proximal protection “MoMa” is effective in the presence of a closed structure of the circle of Willis. The technical complexity of the operation is associated with the installation of a catheter guide and its diameter of 9 Fr (catheters up to 7 Fr are usually used), which requires additional manual skills.

Low-flow extra-intracranial bypass in acute carotid and vertebrobasilar ischemic stroke (literature review)

Introduction. The effectiveness of the method of revascularization of the brain using extra‑intracranial bypass in chronic insufficiency of blood supply to the brain has been studied in several randomized multicenter studies. The analysis of available publications devoted to this technique for 10 years with acute strokes in the carotid basin and for 20 years with ischemic strokes in the vertebrobasilar basin was carried out.Aim. To improve the results of treatment of ischemic strokes with the help of emergency extra‑intracranial low‑flow bypasses in the acute and acute period. In 12 publications over the past 10 years, selected from the PubMed search engine, 194 cases of the use of emergency extra‑intracranial microbypasses in the acute and acute period of ischemic stroke in the carotid basin were identified, 127 cases of emergency extra‑intracranial bypass were found in 6 articles during the last 20 years in the acute phase of vertebra‑basilar area stroke. Middle patient age in carotid group was 61.9 years, and 65 years in vertebral patient’s group. The male / female ratio was 3 / 1. The main indications for the bypass creation were: worsening of neurologic deficit from 4 and more according to the Stroke Severity Scale of the US National Institutes of Health, mini mal or not significant computed tomography (CT) or diffusion‑weighted magnetic resonance imaging (DW‑MRI) ischemia brain changes (not lower than 8 points on the scale of assessment of initial changes in the computed tomographic (CT) examination for stroke Alberta Stroke Program Early CT Score, ASPECTS), signs of significant brachiocephalic arteries atherosclerotic stenosis. In 83 carotid group cases perfusion‑diffusion mismatch was distinguished before bypass creation. In 111 carotid cases and in priority of vertebra‑basilar cases clinic‑diffusion mismatch was the only indication for emergency extra‑intracranial bypass creation. During the first 24 hours 65 % of carotid group bypass were performed, in other 35 % of cases bypasses were performed during 1 week after the stroke onset. There were 78 % of good results (<2 on the Rankin outcome scale, mRS) and 22 % of poor (mRS >2) in carotid stroke group. Mortality was 3 %. In vertebral group, coma was not contraindication for emergence extra‑intracranial bypass creation. In most cases, 70 % of bypass were performed between superficial temporal artery and superior cerebellar artery. Mortality in vertebral stroke group was 5 %, mostly because of somatic pathology worsening. Good results were achieved in76 % of cases.Conclusion. In some cases of atherosclerotic carotid and vertebrobasilar ischemic stroke, results of recovery can be approved greatly with use of emergency low‑flow extra‑intracranial bypass, if intravenous thrombolysis and endovascular tromboextraction were failed.

Prediction of restoration of swallowing function in patients with ischemic stroke and neurogenic dysphagia

Objective: to determine prognostic characteristics of the restoration of swallowing function in patients with ischemic stroke (IS) of various pathogenetic subtypes.Material and methods. The study included 110 patients (64 men and 46 women aged 44–89 years) with dysphagia in the acute period of IS. The SSS-TOAST criteria were used to diagnose the pathogenetic subtype, and the MASA scale was used to determine the presence and severity of dysphagia. To predict the probability of switching to self-feeding depending on the severity of dysphagia, a non-linear regression method was used using the least squares method.Results. Patients with cardioembolic stroke subtype were initially characterized by a greater degree of dysphagia in comparison with patients with atherothrombotic stroke subtype in groups comparable in severity (p<0.05). In the cardioembolic subtype of IS, the probability of switching patients to self-feeding on the 21st day in groups with dysphagia severity from 105 to 135 points on the MASA scale was lower than in the atherothrombotic subtype of IS (p<0.05).Conclusion. Patients with cardioembolic strokes are characterized by more severe initial dysphagia and a worse prognosis for recovery of swallowing function compared to patients with atherothrombotic strokes.

CLINICAL AND PSYCHOSOCIAL FACTORS DETERMINING THE QUALITY OF LIFE IN PATIENTS WITH ISCHEMIC STROKE

Acute cerebrovascular pathology, including common clinical forms such as ischemic stroke, remains the most important medical and socio-economic challenge, due to the severe consequences of the post-stroke period. Cognitive impairments are the most socially significant ones.
 The aim of the study is to assess the influence of psychosocial and clinical factors on the quality of life of patients with ischemic stroke.
 Materials and Methods. The authors examined 100 patients with ischemic stroke (54 men, 46 women). The age of patients ranged from 35–85; the average age of men was 59.6±11.0 years, the average age of women – 60.7±10.4 years. The authors interviewed the patients, conducted neurological examination, and neuropsychological testing using the HADS, MMSE scales, Personality Questionnaire of the Bekhterev Institute, SCL-90-R, and the SAGE test. Statistical processing was carried out using non-parametric (Mann–Whitney U test) and parametric (Student’s t-test) criteria.
 Results. The study establishes the main clinical and psychosocial factors of the acute period of ischemic stroke, which have the most significant impact on the patients’ quality of life. The most important are cognitive impairments associated with disorders of psycho-emotional background and autonomic regulation. They greatly reduce the adaptive abilities of a person. Despite neuropsychological and cognitive impairments, the motivation level for recovery remains high in all patients with ischemic stroke.
 Conclusions. While developing personalized rehabilitation programs, it is necessary to take into account personal characteristics of patients and to focus on the active restoration of their adaptive-compensatory capabilities.

Hypoxia-induced factor-1α and markers of inflammation in patients with ischemic stroke

Ischemic stroke (IS) occurs as a result of local disturbance of hemocirculation and hypoxia in the brain tissue. Hypoxia-inducible factor-1α (HIF-1α), which is involved in the regulation of tissue oxygen levels, plays an important role in the pathophysiology of stroke, including neuronal survival, neuroinflammation, angiogenesis, glucose metabolism, blood-brain barrier permeability, and is important in IS outcomes. The purpose of the study was to determine the relationship between blood levels of HIF-1α and the degree of neurological deficit in the acute period of IS and the outcome of the disease. We examined 58 people with IS aged 73 (67-81) years. Patients were divided into two groups – discharged and dead. The severity of stroke (NIHSS), neurological deficit, comorbidity index, blood levels of HIF-1α, p53 protein, interleukin-6, cystatin C, CRP, creatinine, hematological parameters were determined at admission, on days 3 and 10 of the disease. At admission the blood levels of HIF-1α was lower than in the comparison group and remained reduced until the 10th day. On day 10 the association of HIF-1α with neurological deficit, comorbidity index and disease outcome was determined. We observed a feedback of HIF-1α with the content of erythrocytes, hemoglobin and hematocrit, which can be regarded as a reflection of the hemic component of mixed hypoxia. In dead patients, an increased blood level of cystatin C was detected, which was associated with HIF-1α concentrations. In all periods of observation of IS, a correlation between cystatin C and creatinine and CRP levels was noted. These results may indicate dysfunction of endotheliocytes, inflammation associated with hypoxia in IS. The prognostic significance of the blood level of HIF-1α on the 10th day for the outcome of IS was AUC = 0.900. Blood levels of HIF-1α in the acute period was associated with the severity of IS and the outcome of the disease.

The Relationship of focal neurologic symptoms and emotional neuro-psychological disorders in patients in the acute period of ischemic stroke in the basin of the middle cerebral artery.

The Relationship of focal neurologic symptoms and emotional neuro-psychological disorders in patients in the acute period of ischemic stroke in the basin of the middle cerebral artery.

Antioxidant therapy in the complex treatment of patients with ischemic stroke in the acute and recovery period

Improvement of therapy of patients with ischemic stroke (IS) remains a relevant problem, despite the widespread use of drug and mechanical revascularization methods during recent years. One of the pathogenetic mechanisms of IS is oxidative stress as one of the components of brain tissue damage in the acute period and a factor that prevents the processes of repair and neuroplasticity in the recovery period. This is the rationale for the use of antioxidant drugs in the acute and recovery periods of stroke. Data from clinical studies on the use of antioxidants in the treatment of patients with IS are presented. We describe the use of the domestic drug dimephosphone (dimethyloxobutylphosphonyl dimethylate), a synthetic non-anticholinesterase organophosphorus compound, which has a wide range of effects: antioxidant, antacidotic, vasodilating, membrane stabilizing, anti-inflammatory, etc. Data are given on the use of dimephosphone in the acute period of IS in patients with no indications for thrombolytic therapy, there was a decrease in neurological deficit and a decrease in disability. The positive results of the use of dimephosphone in the recovery period of IS and in chronic cerebrovascular insufficiency are described. The data of our own study on the use of dimephosphone in the complex therapy of cognitive rehabilitation of patients in the recovery period of IS are presented. A statistically significant recovery of cognitive functions was registered according to the Montreal Cognitive Scale (MoCA), and an increase in the MoCA score by 2 points or more in 59.6% of patients. An improvement in executive functions, an increase in the flexibility of cognitive control of cognitive processes, and the predominance of verbal thinking over sensory-perceptual were noted.

The effect of acupuncture on the correction of post-stroke dysphagia compared to methods of physical influence

Background. Dysphagia is a problematic field in the clinical work of neurologists, resuscitation experts and therapists due to the high percentage of secondary complications caused by aspiration pneumonia, nutritional deficiency, which affect the recovery process. This ultimately affects the main socio-medical indicators such as mortality, lethality, disability in structure of cerebrovascular diseases. Neurogenic dysphagia occurs in 25–65 % of patients with stroke, while mortality among patients with post-stroke dysphagia receiving tube feeding varies from 20 to 24 %.The aim. To evaluate the impact of reflexology in the treatment of post-stroke dysphagia in comparison with the methods of physical impact. Materials and methods. An open clinical comparative study was conducted in two clinical bases: Republican Hospital named after N.A. Semashko (Ulan-Ude) and Bokhan District Hospital.In this clinical trial, 53 patients with swallowing disorders during the acute period of ischemic stroke were tested. When diagnosing dysphagia, a point scale of the Clinic of the Institute of the Brain was used, which assesses the degree of swallowing disorders before and after treatment. The comparative group receiving standard therapy in combination with physiotherapy (VOCASTIM) included 27 patients, the study group was comprised of 26 patients, who underwent basic therapy in combination with acupuncture (1 course – 10 sessions). In the course of the comparative clinical trial, statistical data were obtained that indicate the positive role of acupuncture in restoring the function of swallowing in patients with acute impairment of cerebral circulation.Results. During the current clinical study, on the background of a 10-day course of reflexology with an exposure of 10–15 minutes and VOCASTIM physiotherapy for 10–15 minutes, the majority of patients experienced regression of post-stroke dysphagia.Conclusion. According to the results of this study, the method of reflexology as a result of physiotherapy showed a faster recovery of swallowing function in the correction of neurogenic swallowing diseases, which causes cerebral infarction.

The results of systemic thrombolytic therapy for acute ischemic stroke in women and men depending on the stroke risk factors

Background: Systemic thrombolytic therapy (STLT) with alteplase is the method of choice in all patients with acute ischemic stroke (IS) within the first 4.5 hours after the symptom onset. There is a noticeable difference between men and women in the clinical characteristics and results of stroke treatment; however, results of studies have been contradictory.
 Aim: To evaluate the efficacy of STLT with alteplase in women compared to men, depending on the presence of some risk factors for stroke.
 Materials and methods: This open-label prospective observational non-interventional cohort study of STLT in IS included 209 patients (102 women, the main group, and 107 men, or the comparison group) aged 32 to 86 years. All patients received STLT with alteplase within 4.5 hours from the onset of IS symptoms. The primary endpoint of the study was 28-day survival, and the secondary endpoint was the achievement of mobility independence (0 to 2 points by the modified Rankin Scale (mRS)).
 Results: The demographic and clinical patient characteristics of both groups were comparable, but women were on average 5 years older than men (p = 0.003). The index IS was not the first one in 31.4% of women and 23.4% of men (p 0.05). There were no significant differences in the severity of stroke and the timing of STLT. Men had a high mortality rate in the acute period of IS, but the difference was non-significant. PST-STLT hemorrhagic transformation was more common in men, with the difference being non-significant (2 0.743, p = 0.389). Women were more likely to have type 2 diabetes mellitus (DM2) (37.3% and 20.6%, respectively, 2 7.111, p = 0.008). In women, there was a trend towards better symptom regression by about 1 point (p = 0.129). The women with DM2 had a 13% higher survival than men (p = 0.038). The numbers of patients achieving independence (02 points on the mRS scale) by Day 28 was not different (56 women and 52 men). No between-groups differences were found in the numbers of patients with arterial hypertension and atrial fibrillation. Only 13 women (12.75%) and 21 men (20%) had a normal body mass index, while 56.3% of women and 46.7% of men had obesity 2 or 3 grades, with the gender differences being non-significant.
 Conclusion: In women, who have received STLT in the acute period of IS, the death rates and the functional outcomes were non-inferior to those in men, despite their older age, hyperglycemia in the acute period and past history of DM2. The risk factors for stroke in women, compared to men, could be the potential cause of more frequent IS recurrence (every third case in women and every fourth in men was recurrent). Despite a number of negative factors (age, obesity, metabolic syndrome, hyperglycemia, DM2, atrial fibrillation), there was a trend towards better outcomes of STLT in women.

Microwave Radiothermometry in Evaluating Brain Temperature Changes (Review)

Aim. This review aims to inform physicians of different specialties (anesthesiologists, intensivists, neurologists, neurosurgeons, oncologists) about the diagnostic capabilities of microwave radiothermometry, which enables to identify and analyze features of alterations of cerebral temperature in brain damage.The review displays a critical analysis of 80 recent Russian and foreign open access publications found by keywords.The review presents major clinical features and pathophysiological mechanisms of cerebral thermal balance disruptions in brain lesions. Slow responsiveness and vulnerability of cerebral thermal homeostasis regulation mechanisms that underlie development of different temperature heterogeneity levels in the cerebral cortex in healthy brain and brain lesions are highlighted. The authors postulate their concept about the critical role of hyperthermia in the pathogenesis of brain damage and disruption of interconnections in the global central regulation system. A body of evidence explaining direct association between the depth of consciousness impairment and degree of cerebral cortex temperature heterogeneity manifestation is presented. It is emphasized that a significant increase in temperature heterogeneity with areas of focal hyperthermia accompanies an acute period of ischemic stroke, while in post-comatose state usually associated with prolonged impairment of consciousness, the temperature heterogeneity significantly subsides. It has been suggested that lowering of an increased and rising of the reduced temperature heterogeneity, for example by using temperature exposure, can improve altered level of consciousness in patients with brain damage. The diagnostic capabilities of various technologies used for cerebral temperature measurement, including microwave radiothermometry (MWR), are evaluated. Data on high accuracy of MWR in measurement of the cerebral cortex temperature in comparison with invasive methods are presented.Conclusion. In healthy individuals MWR revealed a distinct daily rhythmic changes of the cerebral cortex temperature, and badly violated circadian rhythms in patients with brain lesions. Since MWR is an easy-toperform, non-invasive and objective diagnostic tool, it is feasible to use this technology to detect latent cerebral hyperthermia and assess the level of temperature heterogeneity disruption, as well as to study the circadian rhythm of temperature changes.

Nutritional support as part of the basic therapy of a patient in the acute period of ischemic stroke in the intensive care unit

Ischemic stroke remains the predominant cause of disability in the population (3.2 per 1000 population). Only 8% of ischemic stroke survivors can return to their previous work. Nutritional support is an integral part of the multidisciplinary approach to the treatment of ischemic stroke in the intensive care unit during the acute and rehabilitation phases. Brain damage always has metabolic consequences on the patients body, and premorbid malnutrition and stroke-stroke malnutrition significantly affect disease outcomes. The incidence of malnutrition in patients with ischemic stroke varies widely, ranging from 6.1% to 62%, depending on the method for determining protein-energy malnutrition. Despite the relevance of the problem of nutritional support in patients with ischemic stroke, only a few specific recommendations are available in the literature for this category of patients. This review focuses on nutritional support for patients who require mechanical ventilation or admission in the intensive care unit for 48 h.