Acute Stroke Period Research Articles

Adhesion molecules in patients with severe atherothrombotic stroke

Abstract Introduction . Atherothrombotic stroke represents 34% of stroke cases among all the subtypes of ischemic stroke. Adhesion molecules are proteins associated with the basal membrane. They contribute to the intensification of adhesion processes, hyperaggregation of blood cells and microcirculation disorders. Objective. To investigate the blood levels of adhesion molecules in patients with severe atherothrombotic stroke. Materials and methods. For the study, we recruited 21 patients (mean age, 67 [61; 73] years) with atherothrombotic stroke in the carotid system who were observed for the initial 48 hours since the development of neurological symptoms. The patients were categorized as severe stroke based on the total NIHSS score (Me 15 [14; 18]) at the time of admission. The spectrum of soluble cellular adhesion molecules as immunological markers of endothelial dysfunction was studied. Results. Increased levels of sICAM-1, sPECAM-1, sР-selectin, sЕ-selectin and sVCAM-1 were revealed at the beginning of the acute period of atherothrombotic stroke. By the day 21, a decrease of sPselectin, sE-selectin and sVCAM-1 was seen, and this phenomenon was probably caused by effects of blood antiplatelet therapy and statins on cellular adhesion. Positive correlation was established between the VCAM-1 during the first 48 hours of atherothrombotic stroke and the severity of neurologic deficit by the day 21. In the subgroup of patients with lethal outcomes, sICAM-1 and sVCAM-1 levels were higher in comparison with patients with severe disability. Conclusion. Elevated expression of sVCAM-1 in the first 48 hours of atherothrombotic stroke is associated with severe neurologic deficit by the day 21 of stroke. The high levels of sICAM-1 and sVCAM-1 upon admission may be regarded as risk factors for lethal outcomes.

EFFICACY OF USING VIRTUAL REALITY IN POST-STROKE UPPER LIMB PARESIS

Aim. To estimate the efficacy of using training by means of virtual reality in restoration of the upper limb function in patients during the acute period of stroke. Materials and methods. 48 patients in the acute period of stroke (average time from the onset of stroke 4.5 ± 1.3 days, mean age 67 (45; 72.1) years were randomized into 2 groups: the main group (standard therapy + virtual reality) and the control (standard therapy alone). Patients of the main group underwent a course of virtual reality training, lasting for 15 minutes, twice a day for 10 days. The functional status before the onset of training course and after it was evaluated using Fugl-Meyer Assessment Scores (FMA), Motor Assessment Scale (MAS), Ashworth Scale, Modified Barthel Index Score (MBI), Action Research Arm Test (ARAT), 9-Hole Peg Test, Rankin Scale, Function Independence Measure (FIM) and dynamometry. Results. When assessing FMA of “upper limb” ( p = 0.029), “wrist” ( p = 0.04), “hand speed” ( p = 0.02); MAS ( p = 0.042), 9-Hole Peg Test ( p = 0.028), paretic hand dynamometry ( p = 0.03) and FIM ( p = 0.045), patients of the main group demonstrated statistically significant improvement versus the control group. Conclusions. The results detected that inclusion of a short training course, using virtual reality, improves the upper limb function in patients during the acute period of stroke.

Abstract WP146: Predictors of Recovery From Acute Aphasia

Introduction: Making accurate predictions about a stroke patient’s language/speech-motor outcome and recovery potential is a challenge. We previously showed that a combined variable of lesion site and size pertinent to relevant white matter language structures, the Arcuate Fasciculus lesion load (AF-LL), correlated highly with measures of speech fluency in chronic aphasic patients (Marchina et al., 2011; Wang et al., 2013). However, studies in motor recovery and other domains have shown that behavioral measures in the acute stroke phase might be equal or better predictors of recovery compared to lesion measures. Whether or not any of these measures follow a proportional recovery rule, has not been established. Hypothesis: To evaluate whether acute aphasia measures (overall WAB score) and/or acute lesion measures (e.g., AF-Lesion Load) predict recovery from aphasia. Methods: Over a period of several years, patients presenting with acute aphasia were evaluated using a bedside version of the Western Aphasia Battery complemented by picture naming tests, automatic speech measures, and custom-made word/phrase spoken and sung test. A total of 100 acute patients were assessed of which 56 followed up at 3 months. Lesion maps drawn on diffusion-weighted images were used to calculate lesion loads of a probabilistic Arcuate Fasciculus (AF) tract derived from matched elderly healthy control subjects. Analyses included correlations between recovery potential and actual recovery and other predictors of 3 months outcome. AF-LL was regressed with the overall WAB score, measures of speech fluency and naming ability (using the Boston Naming Test). Results: The overall bedside WAB score in the acute stroke period was the best predictor of the overall WAB score at 3 months (R2=0.60). This predictor was slightly improved when a measure of speaking-singing dissociation was added to the model. Lesion-load of the AF was also a good predictor of WAB score at 3 months (R2=0.48), but did not improve outcome predictions of the WAB score by itself. Overall acute aphasic patients followed a proportional recovery rule, but only recovered about 56% of what was theoretically possible. Conclusion: Language and Speech-Motor Outcome after stroke can be predicted best by a bedside WAB score.

Efficacy of Korteksin in acute period of hemispheric ischemic stroke

To study the efficacy and prolonged effect of repeated treatment with low-doses of the neuroprotection drug cortexin (30 mg, (10+10+10, morning, noon, day), daily) in patients in the acute period of hemispheric ischemic stroke. One hundred and twenty-two patients with hemispheric ischemic stroke were studied. Patients of the first group (n=30) received cortexin in a dose of 20 mg (10+10) intramuscularly along with basic therapy, patients of the second group (n=30) received two courses of cortexin in the same dose for 10 days each with a break of 10 days in-between, patients of the third group (n=30) received only basic therapy, patients of the fourth group (n=32) received cortexin in a dose of 30 mg (10+10+10), two courses for 10 days each with a break of 10 days in-between. NIHSS, modified Rankin scale, Barthel index, Rivermead mobility index, MMSE, MOCA-test were used to evaluate the severity of the condition. The most complete regression of neurological deficit during the acute period of ischemic stroke was observed in the fourth group of patients (30 mg (10+10+10) of cortexin, two courses) compared to the 1-3 groups.

The restoration of the shoulder joint function in the patients presenting with hemiparesis during the acute phase of hemispheric stroke

The objective of the present study was to obtain a deeper insight into the process of recovery of the movements in the shoulder joint of the patients presenting with hemiparesis during the acute period of hemispheric stroke based on the results of the analysis of the biomechanical data and the targeted training with biofeedback (BFB). The study included three groups comprised of 25 subjects each. One (control) group included the subjects having neither neurological nor orthopedic pathology. The second group consisted of the patients receiving the conventional treatment in the combination with therapeutic physical exercises (TPE). Group 3 was composed of the patients given the standard course of conventional and physical (TPE) therapy complemented by biofeedback training (the TPE/BFB group). The study included clinical investigations and biomechanical registration of the movements of the shoulder joints and trunk. The results of the study gave evidence that the patients presenting with hemiparesis during the acute period of hemispheric ischemic stroke including those treated with the application of the active means and methods of rehabilitation, such as BFB training, showed no appreciable dynamics of the parameters being evaluated with the use of the relevant clinical scales. The biomechanical study has demonstrated that the movements in the shoulder joints (in a single plain) of the patients comprising the control group are characterized by the presence of the main component with a maximum amplitude in the plane of this movement and additional components (in other planes with a significantly lower amplitude); they are accompanied by the ancillary movements of the trunk. Functionally, the condition of paresis at the level of the shoulder joint is characterized by a decrease in the amplitude of the primary movement and the increase of one of the additional amplitudes, with the growing amplitude of the auxiliary movements of the trunk. The biomechanical methods for the objective assessment have revealed the following functional changes in the shoulder joints: the 6% improvement of flexion in the group of the patients treated with the use of therapeutic physical exercises and the 10% improvement in those treated with the combination of TPE and BFB. Moreover, abduction in the patients of these two groups improved by 4% and 9% respectively. The method for the study of kinematics of the movements in the shoulder joints appears to be most sensitive and informative for the purpose of diagnostics of disorders of the motor function and assessment of the process of its restoration in the patients presenting with hemiparesis during the acute period of hemispheric stroke.

Early carotid endarterectomy in patients with symptomatic carotid stenosis in the acute period of ischemic stroke

To identify the optimal timing of CEA in patients with hemodynamic significant stenosis of carotid arteries in the acute period of ischemic stroke (IS). Five samples (n=30 911) based on the search results from January 2008 to April 2016 in Russian and English-language scientific databases were analyzed. The main endpoints of the studies in both groups (repeated stroke, death, cardiac complications, frequency of restenosis) were studied depending on the timing of operative intervention and preoperative selection criteria. Perioperative morbidity and mortality were analyzed within 30 days after disease onset. There are heterogeneous and contradictory information on the safety of CEA in patients with symptomatic carotid stenosis in acute period of IS. Fundamentally, a new individual approach is required to select best candidates for timed surgery after disease onset, taking into account the severity of the condition, risk factors, comorbidity and surgical techniques.

The use of cytoflavin in the acute period of hemorrhagic stroke

To evaluate the efficacy of cytoflavin in the dose of 10 ml/day in the complex therapy in acute period of hemorrhagic stroke. Sixty patients were examined in the acute period of hemorrhagic stroke (HS). The NIHSS, the Rivermead Mobility Index, the Rankin scale and the Barthel Index of Activities of Daily Living were used. Patients were divided into 2 groups: the main group included 30 patients who received cytoflavin in addition to basic therapy. The control group included 30 patients who received basic therapy. In the main group, there were a significant decrease in the severity of neurological symptoms assessed with the NIHSS in the 10th day of treatment and a more pronounced improvement in the indicators of functional activity on the Rankin scale and daily life on the Barthel index to the level of 'moderate dependence', while the level of 'pronounced dependence' remained in the control group. Thus, the probability of favorable outcome was higher in the main group. Inclusion of cytoflavin in the therapy scheme of patients in the acute period of HS increased the efficacy of treatment.

The dynamics of markers of apoptosis in the acute period of ischemic stroke

To study the dynamics of markers of apoptosis (Bcl-2, p53) in serum in the acute period of ischemic stroke (IS) in comparison to the severity of the neurological condition and the volume of infarct. Fifty-one patients (mean age 60.5±2.2 years) with the first ever carotid IS were examined within the first 24 hours. The comparison group consisted of 20 patients (mean age 58.7±2.1 years) with chronic cerebral insufficiency. Clinical and neurological dynamic examinations with assessment of neurological deficit using (NIHSS), CT/MRI of the brain; ELISA immunoassay of p53 and Bcl-2 in blood serum were carried out. Significantly higher levels of p53 and of Bcl-2 were shown on the 3rd and 10th days in patients with IS compared to the control group (p<0.05). An increase in the content of p53 was positively correlated with the severity of neurological deficit (NIHSS≥10) on the first and third days of acute IS and with larger amounts of damage to the brain parenchyma according to the MRI study from the first day of IS and all subsequent days. High levels of Bcl-2 were positively correlated with the large volume of brain damage only on the 10th day of IS (p<0.045). The results confirm the active involvement of pro- and antiapoptotic processes in the formation of delayed neuronal death in the brain, which are important components of damaged brain tissue in IS.

Эффективность когнитивных тренировок у пациентов с острым нарушением мозгового кровообращения в остром периоде: пилотное исследование

The comparative results of a pilot study in 2 groups of patients who are hospitalized in the acute period of stroke are presented. The results obtained clearly represent the effectiveness of cognitive training compared to the control group, in which the improvement in cognitive performance remains minimal, which allows us to recommend correction of higher mental functions as a necessary link in the rehabilitation of an acute period of stroke.

In-hospital outcomes of carotid endarterectomy in acute period of ischemic stroke: single-center register data

In-hospital outcomes of carotid endarterectomy in acute period of ischemic stroke: single-center register data

Stenting of precerebral arteries in acute period of ischemic stroke

OBJECTIVE. The study aimed to raise an efficacy of motor functions after stenting of precerebral arteries in acute period of ischemic stroke in patients of elderly and senile age. MATERIAL AND METHODS. Treatment efficacy was assessed according to dynamics of neurological status, data of duplex scanning of brachiocephalic vessels, index of mobility «Rivermed», scale «Bartel» in 30 patients. RESULTS. Stenting of precerebral arteries in acute period of ischemic stroke facilitated to regress of motor disorders and normalized cerebral hemodynamics. CONCLUSIONS. Stenting is an alternative method to carotid endarterectomy. This approach should be applied in patients with expressed carotid stenosis in combination with accompanied diseases and high surgical risk.

ВОЗМОЖНОСТИ НЕМЕДИКАМЕНТОЗНОЙ КОРРЕКЦИИ ИММУНОЛОГИЧЕСКИХ НАРУШЕНИЙ В ОСТРОМ ПЕРИОДЕ ИШЕМИЧЕСКОГО ИНСУЛЬТА

In order to study the effectiveness of reflexotherapy in correction of immunological disorders in an acute period of ischemic stroke, 45 patients were clinical and immunological examined (on the 2nd day of patients’s stay in hospital and 15 days after the beginning of the course of early rehabilitation). In the main group of patients (30 people), whose basic complex of rehabilitation measures was optimized by the inclusion of reflexotherapy, there was a significant improvement in a number of indicators of cellular and humoral immunity: reduction of leukocytes in peripheral blood (p˂0.05), an increase in lymphocyte count (p˂0.05), relative and absolute values of T-lymphocytes (CD3+) content (p˂0.01 and p˂0.05, respectively), immunoregulatory cells of T-helpers (CD4+) (p˂0.05), decrease in the number of B-lymphocytes to normal values (p˂0.01), and an increase in IgG level (p˂0.05). In the control group (15 people), where standard treatment was conducted, there was no pronounced dynamics of the indices. Thus, a comprehensive clinical and immunological study of the effectiveness of non-drug correction of immunological disorders in the acute period of ischemic stroke demonstrated high efficiency of acupuncture, with relative simplicity and safety of its application.

Holter Monitorisation Results in Early Period of Acute Ischemic Stroke.

Paroxysmal atrial fibrillation (PAF) has a similar risk with persistent AF for ischemic stroke. Holter monitorization (HM) and other long-term monitorization methods increased the detection of PAF and short-lasting runs of tachyarrhythmias. Their classification as PAF and roles in the etiology of ischemic stroke is controversial. In this study, we aimed to investigate the frequency of any duration of PAF and clinical characteristics of the patients with acute ischemic stroke who have undergone 24-hrs HM. Patients with acute ischemic stroke and transient ischemic attack (TIA) hospitalized in the Neurology ward and undergone 24-hrs of HM during their hospital stay were included in the study. HM reports, clinical, and laboratory characteristics were analyzed, retrospectively. Patients were grouped into three based on HM: 1st group, without PAF; 2nd group, PAF >30 seconds (s) and 3rd group, PAF<30s. PAF of any duration was detected in 18.8% (n=49) of 261 patients. The duration of PAF was <30s in 16.1% (n=42) and >30s in 2.7% (n=7) of the patients. The mean age, left atrium diameter and CHA2DS2-VASc scores of the second group were significantly higher than the first group (p<0.001, p<0.001 and p=0.007; respectively). The mean age, left atrium diameter, modified Rankin Scores (mRS), and CHA2DS2-VASc scores of the third group were significantly higher than the first group (p<0.001; for all). There was no difference between the second and the third groups in means of mean age, left atrial diameter, MRS, and CHA2DS2-VASc scores (p<0.017, for all). In this study, 24-hrs HM in the early period of acute ischemic stroke results yielded a high frequency of PAF<30s and predictive features were in parallel with the literature.

Predictive Value of Pulse Pressure in Acute Ischemic Stroke for Future Major Vascular Events

This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of ischemic stroke can be used as a predictor for future major vascular events. Using a multicenter prospective stroke registry database, patients who were hospitalized for ischemic stroke within 48 hours of onset were enrolled in this study. We analyzed blood pressure (BP) data measured during the first 3 days from onset. Primary and secondary outcomes were time to a composite of stroke recurrence, myocardial infarction, all-cause death, and time to stroke recurrence, respectively. Of 9840 patients, 4.3% experienced stroke recurrence, 0.2% myocardial infarction, and 7.3% death during a 1-year follow-up period. In Cox proportional hazards models including both linear and quadratic terms of PP, PP had a nonlinear J-shaped relationship with primary (for a quadratic term of PP, P=0.004) and secondary (P<0.001) outcomes. The overall effects of PP and other BP parameters on primary and secondary outcomes were also significant (P<0.05). When predictive power of BP parameters was compared using a statistic of -2 log-likelihood differences, PP was a stronger predictor than systolic BP (8.49 versus 5.91; 6.32 versus 4.56), diastolic BP (11.42 versus 11.05; 10.07 versus 4.56), and mean atrial pressure (8.75 versus 5.91; 7.03 versus 4.56) for the primary and secondary outcomes, respectively. Our study shows that PP when measured in the acute period of ischemic stroke has nonlinear J-shaped relationships with major vascular events and stroke recurrence, and may have a stronger predictive power than other commonly used BP parameters.

INFLUENCE OF ARTERIAL HYPERTENSION WITH DIFFERENT DURATION ON NEUROLOGICAL AND FUNCTIONAL OUTCOME OF ISCHEMIC STROKE

Relevance. The outcome of acute ischemic stroke depends on the complex interaction of many factors, such as those that are not controllable, and those that can be affected. An important prognostic value of blood pressure level during the first day after a stroke has been proven. At the same time, the relationship between the primary ischemic stroke outcome and various characteristics of arterial hypertension (duration, severity of pre-existing arterial hypertension, its course) continues to be studied.&#x0D; Objective: to study the relationship between the degree of neurological recovery and functional dependence in patients after ischemic stroke within 1 year, depending on the duration of arterial hypertension in the pre-stroke period.&#x0D; Materials and methods. The study included 156 patients, 6 patients were excluded because of the loss of communication with them and refusal to participate in the study. 150 patients, 74 (49,3 %) women and 76 (50,7 %) men aged 43 to 80 years (mean age 67.4±0,71 years) with a history of ischemic stroke and the presence of arterial hypertension were examined during the year, on 1, 21 days, after 6 and 12 months. The stroke severity was evaluated by NIHSS, functional dependence – by the Barthel Index. The diagnosis of arterial hypertension, its severity, duration was based on data from clinical, instrumental examination and medical documentation.&#x0D; Results. The severity of ischemic stroke by NIHSS at the time of admission was 9,5±0,35 points; the average degree of neurological disorders severity was determined in 57,4 % of patients. The arterial hypertension duration in the history of examined patients varied from 2 to 45 years, the average 12,3±0,64 years. The most commonly reported was the arterial hypertension with its duration 6-10 years (46 %). In the case of arterial hypertension duration up to 5 years, the ischemic stroke has developed in 18,7 % of patients. The duration of arterial hypertension in anamnesis significantly correlated with the severity of the neurological deficiency at the time of admission and at the end of the acute period (r=0,65; r=0,66, respectively). The degree of functional dependence in patients with arterial hypertension duration over 10 years was worse comparatively with patients that had arterial hypertension duration up to 5 years and even with patients with a duration from 6 to 10 years after 6 and 12 months period (61,7±2,1; 90,9±1.1; 82,8±1,4 and 64,9±2,7; 93,2±0,9; 85,7±1,3, correspondingly, all p &lt;0,05).&#x0D; Conclusions. The reliable direct relationship between the arterial hypertension duration and the degree of neurological disorders in the acute period of ischemic stroke and the reverse relationship between the duration of arterial hypertension and the degree of functional recovery in all periods of the study were found. The most patients with moderate and severe functional dependence in a year have arterial hypertension duration more than 10 years.

Post-Stroke Cognitive Impairments and the Potential for Treatment with Cellex

Objective. To assess the neuropsychological characteristics of post-stroke cognitive impairments (PSCI) in the acute period of ischemic stroke (IS) and to evaluate the efficacy of Cellex. Materials and methods. Complex neuropsychological testing was performed in 288 patients in the acute period of IS. Cellex was used in addition to basal treatment in 30 patients at a dose of 0.1 mg (1 ml) s.c. for 10 days, with treatment being initiated in the hyperacute period. Results and discussion. Multifunctional PSCI was detected in 87% of the patients in the acute period of IS. Most patients showed impairments to attention, regulatory functions, speech, and memory. More than a third of patients showed multifunctional non-amnestic cognitive impairments. Monofunctional nonamnestic PSCI was encountered in 5.5% of cases. Isolated memory deficit was found in 2% of patients. Most elderly patients displayed PSCI, mostly the mixed variant. Isolated decreases in the rate or regulation of cognitive activity dominated among young and middle-aged patients, with one in four patients showing mixed cognitive impairments. A tendency to greater age was seen in patients with mixed-type PSCI. Analysis of the efficacy of Cellex in the acute period of IS showed that use was linked with improvements in cognitive status and the state of neurodynamic, regulatory, and visuospatial functions. The neurotrophic agent Cellex was effective in correcting PSCI in the acute period of IS.

Cognitive Impairments in Stroke: Potential for Medication-Based Correction

Objective. To assess the efficacy and safety of Cellex for the correction of cognitive disorders in the acute period of ischemic stroke (IS). Materials and methods. The study included 246 patients in the acute period of IS. Patients were divided by random selection into two groups given Cellex or placebo for 10 days on the background of standard basal treatment. Patients were assessed dynamically in terms of neuropsychological status. Results and conclusions. This study showed that in patients with IS, mild and moderate cognitive impairments underwent faster and more marked regression when Cellex was prescribed (p < 0.05).

The brain functional activity - bioelectrical marker of the effectiveness of carotid endarterectomy performed in the acute period of ischemic stroke

Bioelectrical activity is a universal characteristic of functional state of the brain at a normal level of blood flow and under hypoperfusion. This parameter can be used to assess the effectiveness of the operation before and after endarterectomy. In this study we analyzed spectral characteristics of EEG in 106 patients who underwent endarterectomy in the acute period of stroke before and after two weeks from the onset of the disease. Was studied the dynamics of the power spectra of the EEG evoked potentials and clinical data before and after surgery. It is revealed that the nature of the change in the spectral power of alpha and beta activity of the EEG in the affected and in the intact hemisphere in acute ischaemic stroke can affect the timing of carotid endarterectomy and are important for the prediction of functional outcome after surgery. Inhibition of alpha- and beta-activity in both hemispheres in the preoperative period is an unfavorable factor for surgical intervention, as this will not lead to restoration of disturbed functions irrespective of stroke severity.

Quality of life as an integral indicator for effectiveness of rehabilitation in patients with ischemic stroke

Introduction. Neurological deficits due to ischemic stroke may cause temporary or permanent disability affecting quality of life. Thus, quality of life assessment is important for evaluation of rehabilitation outcomes and general state of the health after a vascular accident. Objective. To evaluate quality of life in patients in the recovery period of hemispheric ischemic stroke within subsequent year after a vascular accident. Material and methods. One hundred twenty-three patients (age ranging 40–80 years) with stroke were examined in the acute and recovery (up to 1 year) periods. In the acute period of stroke and after a rehabilitation course, patients underwent assessment with Barthel Scale, modified Rankin Scale, NIHSS scale, and health status questionnaire SF-36. Results. We found that within the first 3 months following acute ischemic stroke there was an improvement due to rehabilitation course in all areas which determine patients’ quality of life (including Role Emotional and Mental Health SF-36 scores). Adherence to the personalized out-patient rehabilitation program determines improvement in neurological and SF-36 outcomes as well as establishes adaptive coping strategies. Conclusion. Within the first year after a vascular accident, patients with mild to moderate post-stroke neurological deficits showed recovery in self-care activities, functional independence, SF-36 scores for physical and mental health components along with improvement of focal neurological deficits.

ОСОБЕННОСТИ ИММУННОГО СТАТУСА У ПАЦИЕНТОВ В ОСТРОМ ПЕРИОДЕ ИШЕМИЧЕСКОГО ИНСУЛЬТА

To study the immune status of patients in an acute period of ischemic stroke, a clinical and immunological observation of 45 patients was performed. At the 2nd day after the onset of the disease, an increase in the leukocyte count (p˂0.01) and a decrease in lymphocytes (p˂0.05), T-lymphocytes (CD3+) (p&lt;0.01), T-helpers (CD4+) (p˂0.01) and cytotoxic T-lymphocytes (CD8+) (p˂0.05) were observed. There was also a tendency to decrease the content of natural killers (NK cells, CD16+) and cells that express the receptors for IL-2 (CD25+) (p˃0.05). In the humoral immunity an increase in the number of B-lymphocytes (CD20+) (p˂0.05) and dysgammaglobulinaemia due to the tendency to hyperfunction IgA and IgM (p˃0.05) and an increase in IgG (p˂0.05) was observed. Deviation of the immune status of normal values was more pronounced with increasing severity of neurological symptoms and infarct size. With a moderate and severe stroke on the NIHSS scale and the infarct size of more than 15 mm, more pronounced lymphopenia (p˂0.05) was noted with a significant decrease in the T-lymphocyte (CD3+) (p˂0.05), T-lymphocyte subpopulations (CD4+; p˂0.05) and CD8+; p&lt;0.005), as well as NK cells (CD16+) and cells expressing receptors for IL-2 (CD25+) (p˃0.05). Thus, these studies demonstrate the involvement of the immune system in a complex set of reactions involved in the development of cerebral accidents and suggest an increased susceptibility of these patients to the development of infectious complications. The lack of immune status changes against standard therapy requires an immune-corrective therapy (in case of violations of basic parameters of the immune system).