Acute Stroke Period Research Articles

Application of exoskeleton with functional electrostimulation for rebalancing of patients in acute and early recovery periods of ischemic stroke

To study impact of robotic mechanotherapy with functional electrostimulation (FES) on rebalancing in patients in acute and early recovery periods of ischemic stroke. The number of patients equal 60, divided into 2 groups, were examined. Study group included 30 patients, who were treated in an exoskeleton with FES; control group consisted of 30 patients, whose walking and balance recovering was carried out with exercise therapy. The study group showed a more pronounced improvement of balance indicators by Tinetti scale compared to the control group (11 [8; 13] against 8 [6; 12]; p=0.0281) at the end of treatment. Patients of study group demonstrated significantly better results both by Tinetti scale and stabilometrical parameters in acute period of stroke compared to the control group. Application of exoskeleton with FES in patients in acute and early periods of ischemic stroke contributes (to a better balance recovery), which may be achieved by long-lasting verticalization and large repetition of the correct walking pattern during rehabilitative trainings.

Relevance of admission hyperglycaemia and diabetes mellitus to efficacy and safety of mechanical thrombectomy in stroke patients.

The relevance of diabetes mellitus (DM) to the efficacy of mechanical thrombectomy (MT) has been the subject of few studies and with only inconclusive results. This study aimed to evaluate the effect of DM and admission hyperglycaemia on the efficacy and safety of MT in stroke patients. This retrospective study analysis focused on the relevance of admission hyperglyacemia and DM to the functional status of patients treated with MT at the Upper Silesian Medical Centre of the Silesian Medical University in Katowice, Poland. 417 stroke patients (median age 70 years) were qualified for the study. There were 103 patients (24.70%) with DM. Admission hyperglycaemia ≥ 140 mg% was found in 91 patients (21.82%), of whom 69 were diagnosed with DM before or during hospitalisation. The parameters with the strongest effect on the functional status on days 7, 90 and 365 were: age, and neurological status according to the National Institutes of Health Stroke Scale (NIHSS) on the first day of ischaemic stroke before MT. The angiographic effect indirect after MT and patient functional status on days 7, 90 and 365 were comparable between the groups, regardless of the DM burden. The frequency of symptomatic intracranial bleeding 24 hours after MT was comparable between patients with and patients without DM (p = 0.092). Model based on parameters were age, NIHSS on the first day of ischaemic stroke, an when score in Thrombolysis In Cerebral Infarct (TICI) showed good predictive attributes for the functional status of patients in the acute period (day 7). Age, a lack of admission hyperglycaemia, and the neurological state on day 1 of ischaemic stroke (before MT) were the key parameters for a favourable outcome (≤ 2 points on the modified Rankin Scale, mRS) on day 90. Admission hyperglycaemia ≥ 140 mg/dL, regardless of the presence or absence of DM, had a negative effect on achieving a good functional status one week after stroke onset. Diabetes mellitus has a neutral effect on the angiographic and clinical outcomes of mechanical thrombectomy in stroke patients. It does not increase the risk of intracranial haemorrhage after instrumental therapy. It is admission hyperglycaemia, rather than diabetes mellitus, that is a predictor of poor functional status in patients treated with thrombectomy. According to our results, the patient's neurological status, age, and the outcome of thrombectomy are relevant to the functional status in the acute ischaemic stroke period.

Evaluation of the outcome in ischemic stroke acute period

Introduction. As a major cause of both temporary and permanent disability, ischemic stroke is the most common type of cerebrovascular accident (CVA).
 Objective. To assess fatal outcome probability in the acute period of ischemic stroke.
 Materials and methods. We performed post-hoc analysis of the fatal outcome probability in the patients with acute ischemic stroke at the Neurology Department of the Ufa Emergency Hospital, the Republic of Bashkortostan, Russian Federation. The analysis included data from the randomly selected medical records of 31 patients with fatal outcomes and 55 patients discharged with favorable outcomes.
 Results. The patients with fatal outcomes were significantly (p 0.001) older, with more severe strokes and a higher prevalence of disorders of consciousness, medical co-morbidities, and recurrent strokes as compared to the group of patients with favorable outcomes. Regression coefficients showed that brain herniation, kidney and liver disease, post-infarction cardiosclerosis, diabetes mellitus, and atrial fibrillation were associated with a higher probability of the fatal outcome. Increased severity of disorders of consciousness, NIHSS and mRS scores, specific blood tests values, age, and heart rate were associated with a more probable fatal outcome, while elevated hemoglobin, total protein, red blood cells, and lymphocytes, a higher GCS score, and a history of hypotensive drug therapy were associated with a less probable fatal outcome.
 Multivariate analysis showed that the stroke fatal outcome was related with the age, a NIHSS score, and elevated creatinine and total bilirubin levels.
 Conclusion. The detected predictors of the stroke fatal outcome can be used as reference points to choose management strategy for patients in the acute period of ischemic stroke.

Carotid endarterectomy in Russia. What if current guidelines do not answer difficult questions?

This literature review covers the publications of Russian vascular surgeons in recent years and deals with debatable issues of carotid surgery, including: 1. What is the best technique for carotid endarterectomy (CEA)? 2. Why does restenosis of the internal carotid artery (ICA) develop and how to eliminate it? 3. How to operate on bilateral ICA stenosis? 4. Should carotid glomus be preserved? 5. Is CEA safe in the acute phase of cerebrovascular accident (CVA)? 6. Is CEA safe in elderly patients? 7. How to operate on patients with combined internal carotid and coronary artery involvement? The evidence presented in this publication makes it possible to draw the following conclusions: 1. When choosing a CEA technique, the classical technique with patch angioplasty should be avoided due to the high risk of ICA restenosis. 2. To eliminate ICA restenosis, carotid angioplasty with stenting (CAS) should be used. When performing primary CEA with ICA transposition over the hypoglossal nerve, reCEA can be used 3. In the absence of contraindications, bilateral ICA stenosis can be operated at the same time using CEA. 4. CEA with carotid glomus preservation is the operation of choice in the treatment of patients with hemodynamically significant ICA stenosis due to the elimination of the risks of postoperative hypertension and the formation of hemorrhagic transformation. 5. If there are indications for cerebral revascularization in the most acute period of stroke, CEA should be abandoned in favor of CAS. 6. In old age, CAS is the safest treatment strategy. 7. In the presence of a combined ICA and coronary involvement, the choice of treatment tactics should be carried out only by a multidisciplinary commission, taking into account the risk stratification of adverse cardiovascular events.

Predictors of thrombosis development in the acute period of stroke

Introduction. According to foreign studies, the frequency of asymptomatic deep vein thrombosis (DVT) in the acute period of stroke varies from 10 to 75%, clinically obvious — from 2 to 10%. DVT is a life-threatening complication as it can lead to the development of pulmonary embolism (PE).Purpose of the study: to identify predictors of DVT development in the lower extremities in patients with stroke according to the registry of the Regional Vascular Center (RVC).Materials and methods. 100 patients with stroke who were admitted to the wards/intensive care unit of the RVC from November to December 2021 were examined. In addition to the standard examination, all patients underwent duplex scanning of the veins of the lower extremities upon admission and on the 7th day of inpatient treatment.Results. The incidence of DVT was 13%. Compared with patients without DVT, patients with thrombosis were characterized by higher median values of age (77 vs 67 years, p = 0.015), time from stroke to hospital admission (24 vs 5 hours, p = 0.026), stroke severity by NIHSS score at admission (16 vs 5 points, p = 0.006) and completion of the first stage of treatment (10 vs 3 points, p = 0.010), movement disorders in the leg according to the Medical Research Council scale (4 vs 1 points, p = 0.011) and IMPROVE-VTE scales (4 vs 2 points, p < 0.001). In half of patients with DVT, thrombosis occurred already at admission to the hospital, in the rest it occurred during treatment. In a quarter of patients, thrombosis involved the proximal veins and was complicated by the development of PE in one patient, the rest had distal DVT. In all cases, DVT developed in the paretic limb. In all patients, thrombosis was initially regarded as asymptomatic and was diagnosed only by duplex scanning of the veins. The most significant risk factors for developing DVT in the acute period of stroke were age 64 years and over (OR = 8.1), stroke severity on the NIHSS scale at admission of 6 points and above (OR = 5.6), time to admission from 10 hours or more (OR = 3.8), leg strength not more than 3 points (OR = 4.5) and an IMPROVE-VTE score of 3 points or more (OR = 9.5). When building a logistic regression model using the identified risk factors, accuracy values were obtained equal to 83% and 85% for the training and test samples, respectively.Conclusion. DVT is observed in 13% of patients in the acute period of stroke and is associated with the age of patients, the severity of stroke and movement disorders, the time from the development of symptoms to hospital admission, and the risk of venous thromboembolic complications according to the IMPROVE-VTE scale.

Impairment of social cognitive functions in the patients with acute ischemic stroke

BACKGROUND. Cognitive impairment is common after a stroke. However, the condition of social cognitive functions, in particular theory of mind, in this group of patients has been studied insufficiently.
 AIM. To study the frequency and predictors of the development of the social cognitive disorders based on theory of mind impairment in patients with acute ischemic stroke.
 MATERIAL AND METHODS. Theory of mind impairment was assessed using Reading the Mind in the Eyes test in the acute period of ischemic stroke. National Institutes of Health Stroke scale was used to assess the severity of neurological deficit, modified Rankin scale the degree of disability, Delirium Severity Rating Scale the symptoms of delirium, Buss Perry aggressiveness scale severity of aggressive behavior, Montreal Cognitive Assessment Scale cognitive deficit. The severity of cortical atrophy was evaluated by computed tomography of the brain. The study included 86 patients, 53 males and 33 females. The average age of patients was 64 years. Statistical analysis was performed using the IBM SPSS Statistics 21 software package. Nonparametric statistics methods were used. Binary data were compared using the chi-square parameter, categorical data were compared using the MannWhitney test.
 RESULTS. Seventy percent of patients suffered from the impairment of social cognitive functions. Independent predictors of the impairment of theory of mind according to linear regression analysis were cognitive dysfunction according to the Montreal Cognitive Assessment Scale (p=0.0001) and the severity of cortical atrophy on computed tomography of the brain (p=0.001).
 CONCLUSION. Social cognitive impairment is registered in a substantial number of patients in acute period of stroke; its predictors include general cognitive impairment and cortical atrophy of the brain.

Evaluation of hemostasis clinical and laboratory indicators of patients with stroke and coronavirus infection (COVID-19) on the basis of a multidisciplinary hospital in the period of its conversion to an infectious diseases hospital

Introduction. The COVID-19 impact on hemostasis of stroke survivors with community-acquired pneumonia is an urgent problem. The aim of the study is to analyze the features of clinical and laboratory parameters in cerebral stroke combined with community-acquired pneumonia caused by the SARS-Co-V-2 virus. Materials and methods. The instrumental and laboratory examination results of 88 patients aged 73.0 (12.3) years in the acute period of stroke with community-acquired viral pneumonia symptoms were analyzed. The present study included 39.8 % (n=53) male and 60.2 % female (n=35) with duration of diagnosed infectious disease less than 7 days. The symptoms of cerebral stroke were compared with the results of laboratory testing of the hemostasis system, lipid metabolism, and the activity of the systemic inflammatory response. The severity of lung tissue damage and the outcomes of the diagnosed changes were assessed. Results. All patients had mild or moderate COVID-19. In 87.5 % (n=77) cases unspecified (40.2 %, n=31), cardioembolic (36.4 %, n=28), lacunar (3.9 %, n=3) and atherothrombotic (19.5 %, n=15) ischemic stroke subtype was diagnosed. Focal ischemia lesion in the left middle cerebral artery (LMCA) territory was detected in 45.6 % (n=35), in the right middle cerebral artery (RMCA) territory in 41.6 % (n=32). Manifestations of hemorrhagic stroke were noted in 12.5 % (n=11) with signs of parenchymal hemorrhage in 54.5 % (n=6), ventricular hemorrhage in 27.3 % (n=3), subarachnoid hemorrhages were noted in 18.2 % (n=2). The indicators of the coagulation system in terms of the number of platelets corresponded to 251.3 (90.7); the APTT value was in the range of 29.2 (26.7 33.0) (s); the INR parameter was 1.16 (1.05 1.25); the value of prothrombin ( %) corresponded to the value of 85.9(23.4). Conclusion. We do not observe the great disorders of haemostasis in the most acute period of the stroke. When combined with COVID-19 the most common stroke is ischemic stroke. The stroke survivors with the community-acquired pneumonia caused by SARS-CoV-2 laboratory tests show that increase of inflammatory markers are above the reference range.

Chuanzhitongluo regulates microglia polarization and inflammatory response in acute ischemic stroke

Background and purposeChuanzhitongluo (CZTL), a traditional Chinese medicine mixture, is used in the recovery period of acute ischemic stroke (AIS), and effectively improves the prognosis of AIS patients. This study aims to evaluate whether CZTL regulates microglia polarization and inflammatory response to reduce brain damage in the acute phase of AIS. MethodsA mouse model of AIS was prepared by the photochemical method. Cerebral infarct volume was detected by 2,3,5-Triphenyltetrazolium chloride (TTC) staining. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay was used to assess neuronal apoptosis. Gene expression profile change was explored by Gene chip. Inflammatory factors were analyzed by Protein microarray. The Immunofluorescence double-labeling assay was executed to elucidate the effects of CD16+ / Iba-1+ and CD206+ / Iba-1+ in the peripheral area of cerebral ischemia. ResultsResults revealed that CZTL treatment alleviated the neurological impairment, reduced cerebral infarct volume, and inhibited neuronal apoptosis. CZTL altered gene expression profiles, which indicate that CZTL may be involved in regulating neuroinflammation. CZTL restrained inflammatory responses by down-regulated pro-inflammatory cytokines expression and enhanced anti-inflammatory cytokines level. Further experiments demonstrated that CZTL inhibited the activation of NLRP3 inflammasome, which decreasing the inflammatory response. In addition, CZTL promoted the transformation of microglia from M1 to M2 phenotype. ConclusionsThese results indicate that CZTL alleviates neuroinflammation and brain damage after AIS in mice, which may be mediated by modulating microglia polarization.

Biochemical markers of thrombotic complications in the acute period of ischemic stroke

To study the profile of biochemical markers of the hemostasis system, to clarify their role and relationships in the pathogenesis of the development of thrombotic complications (TC) of ischemic stroke (IS) and the associated assessment of the possibilities of their diagnostic application. The study group included 302 patients (164 men, 138 women) who were admitted to the hospital with a diagnosis of IS within 24 hours of the onset of the disease. The diagnosis was confirmed by computed tomography. The average age of patients was 69 (5088) years. Blood was taken from all patients on the 1st day of the disease to determine the profile of analytes presumably associated with the pathogenesis of TC. Levels of homocysteine, protein C inhibitor, thrombomodulin, plasminogen, tissue plasminogen activator, urokinase, plasminogen activator type 1 inhibitor, t-PA/PAI-1 complex, vitronectin, plasmin-2-antiplasmin complex, D-dimer, fibronectin were determined in blood serum by ELISA. TC in the acute period of IS (up to 21 days) were recorded in 32 (10.6%, 95% CI 7.3714.3) patients, of which pulmonary embolism was observed in 27 (8.94%, 95% CI 5.9812.4) patients, deep vein thrombosis in 5 (1.66%, 95% CI 0.473.47) patients. The results of the study of a panel of specific proteins involved in pathogenetic processes accompanying necrosis of brain tissue in IS demonstrated that of the entire list of markers of the hemostasis system activation selected for the study, the most significant are: the concentration of fibronectin in the prognosis of the absence of TC with a threshold value of more than 61 mkg/ml and OR 4.4 (95% CI 1.512.9, p=0.011), and the concentration of the t-PA/PAI-1 complex in the prognosis of the development of TC with a threshold value of more than 14 ng/ml and OR 11.3 (95% CI 1.18109.3, p=0.03). The significance of the t-PA/PAI-1 complex and fibronectin as markers of TC in IS may be due to a violation of the activation processes of the fibrinolytic link of hemostasis and the accumulation of non-deposited compounds that damage the vascular wall.

Anamnestic, clinical and laboratory features of the acute period of ischemic stroke in young patients

Objective: to study the anamnestic, clinical and laboratory features of the acute period of ischemic stroke (IS) and to determine the risk factors for its development in young patients.Patients and methods. Clinical and statistical processing of data of 256 patients aged 18 to 44 years included, who had IS, confirmed by computed and/or magnetic resonance imaging of the brain in the acute period, was carried out. Furthermore, in 154 patients and in 117 healthy participants, who made up the control group, eight polymorphisms of the thrombophilic spectrum genes were determined – FGB: -455G>A, F2: 20210G>A, F5: 1691G>A, F7: 10976G>A, F13: 103 G>T, ITGA2: 807C>T, ITGB3: 1565 T>C, PAI-1: -675 5G>4G.Results and discussion. 154 (60.15%) patients demonstrated good recovery (achievement of a level of ≤2 points on the Rankin scale by the patient). None of the patients died during their hospitalization. In the evaluated group of patients, we identified allelic variants of the thrombophilic spectrum genes and gene-gene combinations, the carriage of which increased the likelihood of IS development at the young age by 1.74 and 2.19 times, respectively. Taking into consideration additional examination methods, the pathogenetic variant of IS according to the TOAST classification was verified in 226 (88%) patients.Conclusion. In IS at a young age a detailed assessment of risk factors is required, including an analysis of carrier variants and combinations of procoagulant and prothrombotic spectrum gene polymorphisms.

The role of the venous system in the maintenance of cerebral perfusion pressure in acute ischemic stroke

The article analyzes the state of cerebral venous hemodynamics in the acute period of ischemic stroke based on the results of clinical neurological, Dopplerographic, neuroimaging and cerebrospinal fluid examination of patients with different amounts of brain matter damage. Factors for predicting the development of moderate or severe cerebral venous dyscirculation have been identified. Attention is paid to the importance of a comprehensive examination of patients with assessment of cerebral venous blood flow in the acute period of ischemic stroke.

The results of treatment of patients with tandem occlusions in the acute period of ischemic stroke

Objective – to evaluate the efficacy and safety of endovascular treatment in patients with acute ischemic stroke due to tandem occlusions.Materials and methods. The results of the examination and treatment of 237 patients with acute ischemic stroke due to large vessel occlusion who underwent endovascular reperfusion were analyzed. Tandem occlusions (internal carotid ‒ middle cerebral artery) were diagnosed in 65 (27.4 %) cases. Patient age ranged from 29 to 84 years (mean age ‒ 64.8 years). Men predominated among the patients (46 (70.8 %)). Among patients with ischemic stroke due to tandem occlusion, 29 (44.6 %) were diagnosed with atherothrombotic stroke subtype, 27 (41.5 %) had cardioembolic. In 9 (13.9 %) cases the cause of thrombosis was spontaneous dissection of the wall of the internal carotid artery. To assess collateral blood flow, the ACG scale proposed by the American Society for Interventional and Therapeutic Radiology was used. The quality of reperfusion was assessed using the eTICI scale. Analysis of the functional results of patients after 90 days from the onset of the disease was carried out according to the modified Rankine scale (mSR).Results. According to our study, a good angiographic result (eTICI 2b-3) was achieved in 54 (83.1 %) patients. Intraoperative complications were registered in 8 (12.3 %) cases. An analysis of the dependence of the quality of reperfusion on the severity of collateral compensation of a thrombosed artery showed that in patients with developed (ACG 3-4) collaterals (35 (53.8 %)) good reperfusion was achieved in 33 (94.3 %) cases, in patients with mild (ACG 0-2) collateral compensation (30 (46.2 %)) the quality of eTICI 2b-3 reperfusion was achieved only in 21 (70.0 %) cases. It was found that out of 40 (61.5 %) patients with tandem occlusion, in whom arterial puncture was performed within 6 hours after the onset of neurological symptoms, 15 (37.5 %) had 0-2 points for mSR after 90 days. When puncturing the artery later than 6 hours (25 (38.5 %) cases), a good result after 90 days was registered only in 7 (28.0 %) patients. Analysis of the influence of collaterals on the dynamics of changes according to multislice computed tomography revealed that patients with well-defined collaterals (35 (53.8 %) cases) during the control examination had ASPECTS scores from 1 to 9 points (average ‒ 5.3 points). Patients with mild collaterals (30 (46.2 %) observations)) on the ASPECTS scale during the control examination had from 0 to 6 points (average ‒ 2.2 points). During the first day or at the time of discharge, a statistically significant decrease in neurological deficit was observed in the group with successful restoration of cerebral blood flow findings.Conclusions. Many factors influence the clinical efficacy of endovascular reperfusion techniques: hypoperfusion area and area of brain damage according to computed tomography during hospitalization, quality of endovascular reperfusion, time from the onset of the disease, collateral compensation of the thrombosed artery basin, complications during surgery. Well-defined collaterals are a predictor of positive dynamics after successful endovascular reperfusion.

Managing high blood pressure in hypertensive patients with an acute ischemic stroke

IntroductionArterial hypertension (AH) is one of the key risk factors and triggers for the development of acute cerebrovascular accident. The purpose of the study is to investigate the peculiarities and rates of blood pressure reduction in AH patients during the acute period of ischemic stroke depending on the patients’ sex, age, medical history, and clinical characteristics. Material and methodsThe study involved 120 patients aged 41–77 years, of whom there were 47 (39.2%) men and 73 (60.8%) women. All enrolled patients had established diagnoses of AH and acute ischemic cerebrovascular accident (acute ischemic stroke, AIS), with the latter diagnosed within the first 24h from onset. The follow-up period was 14 days. ResultsAn increase in diastolic blood pressure was associated with higher scores on the National Institutes of Health Stroke Scale (NIHSS, r=0.301, p=0.026) and Rankin scale (r=0.225, p=0.030), as well as a worse health status at the time of discharge from hospital (r=0.318, p=0.021). ConclusionDiastolic blood pressure can be considered a marker of the severity of neurological disorders in AIS, which should be considered when monitoring such patients.

Proinflammatory laboratory predictors of pneumonia in ischemic stroke patients: prospective study

Bacterial pneumonia is a frequent complication of ischemic stroke at the hospital stage. The search for prognostic laboratory markers of pneumonia remains an urgent task, as it will allow to individualize the approach to the treatment and rehabilitation of such patients. To investigate the prognostic significance of proteins of the acute phase of inflammation, as well as to evaluate them as early predictors of the development of pneumonia in patients with ischemic stroke. The study included 302 patients in the acute period of ischemic stroke. C-reactive protein (CRP), tumor necrosis factor , interleukin-6 (IL-6), neutrophil elastase, neopterin, serum amyloid A (SAA), secreted phospholipase type 2 (sPLA2) were determined in all patients on the first day by enzyme immunoassay. Statistical data processing was carried out using SPSS and Microsoft Excel software (USA). At the hospital stage, pneumonia developed in 82/302 patients (27.2%; 95% confidence interval 22.332.3%). The levels of CRP, IL-6, sPLA2, SAA and neopterin significantly differed in the presence and absence of pneumonia. Step-by-step logistic regression analysis revealed the significance of IL-6 and CRP concentrations in the prognosis of pneumonia. The threshold value of IL-6 concentration was 3.45 pg/ml (sensitivity 82.4%, specificity 66.7%). The prognostic value of a positive result (PPR) in the prognosis of pneumonia was 40%, a negative result (PNR) 92%. The threshold value of CRP was 1640 mg/l with a sensitivity of 65.8% and a specificity of 74.8%. The PPR of the threshold value of the concentration of CRP was 45%, PNR 80%. The measurement of the concentration of IL-6 and CRP on the first day of ischemic stroke makes it possible to identify patients with the greatest risk of pneumonia at the hospital stage. The results of the work indicate the necessity to include CRP and IL-6 in the list of mandatory laboratory tests that should be carried out for each patient with ischemic stroke on the first day from the onset of the disease.

Effect of Heart Rate on 1-Year Outcome for Patients With Acute Ischemic Stroke.

BackgroundPrevious literature about the effect of heart rate on poststroke outcomes is limited. We attempted to elucidate (1) whether heart rate during the acute period of ischemic stroke predicts subsequent major clinical events, (2) which heart rate parameter is best for prediction, and (3) what is the estimated heart rate cutoff point for the primary outcome.Methods and ResultsEight thousand thirty‐one patients with acute ischemic stroke who were hospitalized within 48 hours of onset were analyzed retrospectively. Heart rates between the 4th and 7th day after onset were collected and heart rate parameters including mean, time‐weighted average, maximum, and minimum heart rate were evaluated. The primary outcome was the composite of recurrent stroke, myocardial infarction, and mortality up to 1 year after stroke onset. All heart rate parameters were associated with the primary outcome (P’s<0.001). Maximum heart rate had the highest predictive power. The estimated cutoff point for the primary outcome was 81 beats per minute for mean heart rate and 100 beats per minute for maximum heart rate. Patients with heart rates above these cutoff points had a higher risk of the primary outcome (adjusted hazard ratio, 1.80 [95% CI, 1.57–2.06] for maximum heart rate and 1.65 [95% CI, 1.45–1.89] for mean heart rate). The associations were replicated in a separate validation dataset (N=10 000).ConclusionsThese findings suggest that heart rate during the acute period of ischemic stroke is a predictor of major clinical events, and optimal heart rate control might be a target for preventing subsequent cardiovascular events.

Evaluation of the Efficacy of Neoadjuvant Radiation Twice a Day Fractionation Therapy in Patients with Resectable Pancreatic Head Cancer

The coronavirus of severe acute respiratory syndrome-2 (SARS-CoV-2) and the coronavirus infection caused by it, along with damage to the respiratory system, can lead to disorders of the central and peripheral nervous system. The article presents literature data and own observations of neurological disorders in patients with coronavirus disease in the superacute period. Pronounced neurological disorders are mainly observed in severe coronavirus disease and include acute ischemic stroke, subcortical micro- and macro— bleeding, acute necrotizing encephalopathy, Guillain-Barre syndrome. Factors potentially complicating the course of coronavirus disease and contributing to the development of neurological complications are hypertension, diabetes mellitus, chronic diseases of the heart and respiratory system. Based on existing publications and our own observations, we have systematized information about the relationship between coronavirus disease and neurological disorders, about possible factors contributing to the occurrence of stroke. The possibilities of using chest MSCT as the only method of radiation diagnostics for the early detection of viral pneumonia in patients receiving emergency and emergency care at the regional vascular center of BUZOO «GC BSMP No. 1» are considered. The use of this method, in the ultra-acute period of acute ischemic stroke, during the first 40 minutes from the moment of admission, can significantly reduce the time of diagnosis and mortality in patients with acute ischemic stroke and viral pneumonia.

Assessment of the dynamics of autophagy and apoptosis biomarkers in the acute period of ischemic stroke using flow cytometry

The objective was to conduct a comparative analysis of the dynamics of biomarkers of apoptosis and autophagy in the eripheral blood of patients in the acute period of ischemic stroke (IS) and compare it with the dynamics of the severity of neurological deficit according to the NIHSS (National Institutes of Health Stroke Scale) and the volume of the brain lesion according to the results of magnetic resonance imaging (MRI). To assess the role of the studied parameters in the prognosis of the outcome of the acute period of the disease.Methods and material. We examined 56 patients in the acute period of newly developed atherothrombotic IS. The control group consisted of 29 healthy donors. Patients underwent a dynamic clinical and neurological examination on the 1st, 7th and 14th days from the onset of the disease. At the same time intervals, the dynamics of the expression of biomarkers of apoptosis and autophagy in peripheral blood was evaluated by flow cytometry and compared with neurological status indicators on the 1st, 7th, and 14th days, respectively, using correlation analysis.Results. A statistically significant increase in the expression of annexin V and caspase-3 compared with the control group was observed throughout the study in all populations of leukocytes with a maximum increase in the first 24 hours. Increased expression levels of annexin V and caspase-3 positively correlated with the severity of neurological deficit and the amount of brain damage on the 1st and 7th days. A direct correlation was found between increased values of autophagy biomarkers LC3, Cyto-ID, the amount of brain damage, and the severity of neurological deficit on the 7th day.Conclusion. A statistically significant increase in biomarkers of apoptosis and autophagy in the peripheral blood in the acute period of IS correlates with the severity of clinical and neurological parameters. The role of a significant increase in caspase-3 as a predictor of adverse disease outcome requires further study.

Structural epilepsy in children who have suffered a hemorrhagic stroke

The relevance of studying the consequences of hemorrhagic strokes in young children is due to the frequency of cerebrovascular pathology, the formation of persistent neurological deficits, including post-stroke epilepsy, and high mortality. It is known that hemorrhages are diagnosed in the first 28 days of life in 6-7 out of 100,000 infants, in children from the 28th day of life to 18 years of age from 0.7 to 5.1 cases per 100 thousand children. Mortality in hemorrhagic and ischemic strokes in children ranges from 7 to 28%. Epileptic seizures of the acute and acute period of stroke are prognostically unfavorable factors of the course of the disease. The article presents brief literature data on the etiology and localization of hemorrhagic strokes, their role in the formation of pharmacoresistant epilepsy. Special attention is paid to the role of late hemorrhagic disease of newborns, accompanied by intracranial hemorrhages, in the formation of structural epilepsy in the future. The paper describes own clinical observations of 25 patients suffering from epilepsy after a hemorrhagic stroke with a description of the clinical picture, features of paroxysmal states and their therapy, neuroimaging data, electroencephalographic phenomena. A clinical example is presented in which the clinical, anamnestic, electrophysiological data of a patient with pharmacoresistant epilepsy developed as a result of a hemorrhagic stroke on the background of late hemorrhagic disease of newborns are considered.&#x0D; Structural epilepsy in children, formed after a hemorrhagic stroke, is accompanied by significant multi-regional damage, pronounced neurological deficit and is characterized by a pharmacoresistant course.

Dopplerographic features of venous cerebral blood flow disorders in acute period of ischemic stroke

The article analyzes results of a Doppler study of brachiocephalic vessels in the acute period of ischemic stroke. The role of the venous link of blood flow in maintaining the intracerebral constant in the acute period of ischemic stroke was revealed. The features of the reactivity of cerebral venous hemodynamics in patients with different volumes of brain damage during the formation of ischemic foci of various localization are shown. Attention is paid to the importance of a comprehensive assessment of cerebral venous circulation in the acute period of ischemic stroke. It was shown that in patients with ischemic stroke involving one or two lobes of one hemisphere of the brain, there was a significant increase in the size of the areas and a significant decrease in the speed indicators in the internal jugular and vertebral veins, respectively, the localization of the ischemic focus. It was found that in hemispheric ischemic strokes with signs of cerebral edema, cerebral blood flow disturbances were maximal and were accompanied by a paradoxical reaction of hemodynamic compensatory mechanisms, but no lateralization of dysgemia was observed according to the focus of ischemia.

Dysphagia in patients in acute period of ischemic stroke: What is the relationship of dysphagia with infarct localization, cognition, malnutrition, and independence level?

Background and Objective: Swallowing and nutritional disorders can occur for many different reasons after stroke. This study aimed to evaluate dysphagia, malnutrition, and independence in patients with an acute period of ischemic stroke, and to examine the relationship between dysphagia and lesion location, cognition, malnutrition, and dependence. Methods: Ischemic stroke patients (n: 109, mean age: 72.91 ± 11.78 year) were evaluated within the first 5 days after stroke. Standardized Mini-Mental State Examination (SMMSE), Combining pulse oximetry with a 10 milliliter (ml) Bedside Water Drinking Test (CPOBWDT), Mini Nutritional Assessment (MNA), and Barthel Index (BI) were performed. Results: Dysphagia was detected in 57.8% of the patients; malnutrition was present in 19.27% and 55.96% were at risk of malnutrition. In patients with dysphagia, it was observed that the most common site of infarct involved the superior cortical division of the middle cerebral artery. SMME (p&lt;0.001) and BI (p=0.001) were significantly worse in patients with dysphagia than patients without dysphagia. Conclusion: This study showed that more than half of the ischemic stroke patients are at risk of dysphagia and malnutrition in the acute period after stroke. The localization of the infarct and a decrease in the cognitive level are among the factors that are associated with dysphagia. Dysphagia is associated with increased dependence for functional activities. Therefore, in patients with ischemic stroke, swallowing and malnutrition should be evaluated during the acute phase.