Acute Stroke Period Research Articles

Clinical protocol of the ischemic stroke patients treatment

Today in Ukraine there is no single standardized protocol for the treatment of patients in the acute period of ischemic stroke using modern methods of diagnosis and treatment, which include thrombolytic therapy and endovascular treatment. This protocol was created and implemented in Scientific-practical Center of endovascular neuroradiology, NAMS of Ukraine and is based on the latest recommendations of AHA/ASA and ESO, as well as registers of patients with ischemic stroke. The main purpose of this publication is the creation and implementation of «instructions» for the diagnosis and selection of objective tactics for treating patients in the acute period of ischemic stroke.

Кореляція клінічної картини з нейровізуалізаційними та допплерографічними показниками у хворих з ішемічним інсультом

В статті наведені результати клінічного, допплерографічного, нейровізуалізаційного дослідження 74 пацієнтів у гострому періоді півкульового ішемічного інсульту, які мали протипоказання до проведення тромболітичної терапії. Подана детальна характеристика гемодинамічних причин гострого порушення мозкового кровообігу з виокремленням основних типів допплерограм у хворих з атеротромботичним і кардіоемболічним підтипами інфаркту мозку. Проведено порівняння допплерограм з даними нейровізуалізаційних методів дослідження і неврологічним дефіцитом, оціненим за шкалою NIHSS на момент надходження до стаціонару, та ступенем відновлення повсякденної життєдіяльності за шкалою Ренкіна на 21-шу добу розвитку ішемічного інсульту.

Нейротрофічний фактор мозку як маркер відновлення моторних та когнітивних функцій у гострому періоді кардіоемболічного та атеротромботичного ішемічного інсульту

церебральний ішемічний інсульт - одне з найбільш поширених захворювань, що спричиняють психоемоційні, когнітивні та рухові розлади. Сучасні дослідження спрямовані на пошук біологічних маркерів ураження головного мозку при діагностиці інсультів, зокрема, фізичних, візуалізаційних, електрофізіологічних, гістологічних, генетичних та нейрональних, визначення яких може прискорити диференційну діагностику. Мета дослідження – оцінити рівень нейротрофічного фактору мозку в крові, стан моторних і когнітивних функцій в гострому періоді ішемічного інсульту на 1 та 14 добу, а також можливість використання рівня нейротрофічного фактору мозку крові в якості маркера відновлення рухової та інтелектуально-мнестичної сфери при атеротромботичному та кардіоемболічному підтипах ішемічного інсульту. У дослідження було включено 34 особи з діагнозом гострий ішемічний інсульт. Залежно від результатів клінічного обстеження пацієнтів було розподілено на 2 групи: група 1 – пацієнти, в яких ішемічний інсульт виник внаслідок атеросклеротичного ураження судин каротидної системи з розвитком оклюзії за механізмом атеротромбозу (17 осіб), група 2 – пацієнти, у яких ішемічний інсульт виник внаслідок ураження судин каротидної системи з розвитком оклюзії за кардіоемболічним механізмом (17 осіб). Для порівняння клініко-лабораторних показників додатково було виділено контрольну групу (пацієнти неврологічного відділення, які не мали ураження центральної нервової системи - 11 осіб). Обстеження пацієнтів проведено на 1 та 14 добу захворювання. Моторні функції оцінювали за ступенем повсякденної активності життя, що визначали за індексом Бартел, стан когнітивних функцій - за шкалою Mini-Mental State Examination. Індекс Бартел на 1 добу гострого періоду ішемічного інсульту перебував в межах легкої залежності для кардіоемболічного підтипу та помірної - для атеротромботичного. Протягом 14 днів у досліджуваних пацієнтів обох груп відбувалося зростання індексу до рівня повної незалежності у групі 1 та легкого ступеню залежності у групі 2. У обстежених пацієнтів із ішемічним інсультом було визначено середні значення за шкалою Mini-Mental State Examination на рівні помірного когнітивного дефіциту на 1 добу при обох підтипах ішемічного інсульту. Відновлення когнітивних функцій протягом 14 днів після ішемічного інсульту відбувалося тільки у другій групі до легких когнітивних розладів. Концентрація нейротрофічного фактору мозку на 1 добу ішемічного інсульту різко знижувалася порівняно з контрольною групою. Отримані результати дозволяють розглядати визначення мозкового нейротрофічного фактору об’єктивним біомаркером як тяжкості перебігу кардіоемболічного та атеротромботичного ішемічного інсульту, так і прогнозу відновлення моторних і когнітивних функцій.

Results of carotid endarterectomy in the acutest period of ischemic stroke

Analysis of the results of carotid endarterectomy (CEE) in the acute period of ischemic stroke (IS). This retrospective study included 128 patients (mean age 65.2±4.7 years, 84 (65.6%) men) who underwent CEE in the acute period. Inclusion criteria were: an ischemic focus in the brain with a diameter of no more than 2.5 cm according to MRI; mild neurological deficit (from 3 to 8 points on NIHSS); ≤3 points on the modified Rankin Scale (mRS); stenosis of ICA over 60%. Exclusion criteria were: severe neurological deficit; presence of decompensated comorbid dependence; contraindications to CEE. In the hospital postoperative period, 3.9% of patients were diagnosed with hemorrhagic transformation of the ischemic focus in the brain with progression of neurological deficit and level of consciousness to coma II. In 3.1% cases, a lethal outcome developed on 4-7 days after the operation. In 2.3% patients after CEE, the progression of neurological deficit was noted with the development of new ischemic foci according to postoperative neuroimaging. The probable cause of this event was a distal embolism that developed during the installation of a temporary shunt. Myocardial infarction was diagnosed in 3.9% of patients. The combined end point (death + myocardial infarction + ischemic stroke + hemorrhagic transformation) was 10.1%. CEE in the most acute period of ischemic stroke is accompanied by a high risk of hemorrhagic transformation, myocardial infarction, and death, which characterizes this revascularization option as unsafe.

A panel of serum biomarkers, including damage, apoptosis and neurotrophic markers, for the assessment of prognosis of the course of ischemic stroke

Identification of the relationship between clinical and neuroimaging data and the content of serum biomarkers (damage marker - neuron-specific enolase (NSE), apoptosis - p53 protein and neuroplasticity - brain-derived neurotrophic factor (BDNF)) in acute, early and late recovery periods of ischemic stroke. Eighty patients in the acute, early and late recovery periods of ischemic stroke, aged from 49 to 75 years, were examined. The comparison group included 20 patients with chronic cerebral ischemia, comparable to the study group. A clinical assessment was carried out on the following scales: The National Institutes of Health Stroke Scale (NIHSS), the European Stroke Scale (ESS), the modified Rankin scale, the Bartel Index and SS-QOL. In the acute, early and late recovery periods of ischemic stroke, the dynamics of biomarker levels (NSE, p53 protein, BDNF) in blood serum and brain MRI in T1, T2, FLAIR, DWI modes were quantified. In patients with a favorable course in the acute period of stroke, low values of the NSE level and a trend towards increased levels of serum BDNF by the 10th day of the disease were noted. For the first time, it was found that high NSE and stable BDNF levels or a tendency to their decrease were observed in the acute period in patients with an unfavorable course of ischemic stroke. In the early recovery period of ischemic stroke, a strong correlation was established between the degree of independence and disability of patients, and the levels of serum NSE and BDNF. A significant inverse correlation was proved between the severity of neurological deficit, assessed on the ESS, in the late recovery period of ischemic stroke (12 months) and the level of BDNF in blood serum (r=-0.464). The selected complex of biochemical methods allowed us to assess the severity of damage, the activity of apoptotic and compensatory neurotrophic capabilities of brain tissue in ischemic stroke, as well as their relationship with clinical and neuroimaging data. We have shown the prognostic significance of the selected markers, which will allow, with an integrated approach, more accurate prediction of the further course and outcome of stroke.

Clinicoradiological evaluation of oxidative stress activity in acute cerebral infarction in the first 24 h and the qualitative importance of dysfunctional HDL in stroke.

Acute cerebral infarction (ACI) occurs as a result of instant disruption of vascular flow that causes disbalance between oxidative/antioxidative activity. We examined the relationship of serum neuro-oxidative stress parameters with stroke severity and infarct volume in ACI and emphasized the qualitative importance of high-density lipoprotein (HDL) on its relationship with myeloperoxidase (MPO) and paraoxonase-1 (PON1) in the acute period of stroke. One hundred ACI patients applied within the first 24 h and 50 healthy volunteers were included. The patient group was evaluated with demographic data (including arrival serum biochemical assessment), clinical disability scores, infarct volume, serum oxidative/antioxidative parameters (lipid hydroperoxide (LOOH), MPO, PON1, MPO/PON ratio). The relevant serum parameters were compared with the control group. Dysfunctional HDL measurement was based on detecting dysfunctionality as a result of a high positive correlation between the dysfunctional feature of HDL and the MPO/PON ratio. The correlation of serum parameters, clinical disability score, and infarct volume were evaluated, and independent analyses of variability with comorbidities were performed. A negative correlation between PON1 and arrival NIH score/scale (NIHSS), LOOH and discharge modified rankin scale (mRS), triglyceride level, and infarct volume; a positive correlation between MPO\PON ratio and infarct volume was determined. Logistic regression analyses showed that hypertension, diabetes, and high HbA1C may be predictors of stroke severity, and diabetes mellitus, high HbA1C, infarct volume, and high NIHSS score may be predictors of early disability (p < 0.005). The ROC curve analysis revealed that determining the cut-off value for LOOH is of importance in determining early disability scores (7.2 and 6.2, respectively). The balance between oxidative and antioxidative stress parameters and their quantitative/qualitative changes is of importance, especially in the acute period of ACI. Dysfunctional HDL's evolution and its relationship with other oxidants are significant not only in the cardiovascular aspect but also in the clinicoradiological aspect.

Electrocardiographic predictors of the poor outcome of hemorrhagic stroke

To analyze the relationship between electrocardiogram (ECG) parameters in the acute period of hemorrhagic stroke and its poor outcome within 90 days. ECG data of 133 patients with hemorrhagic stroke recorded upon admission to the primary vascular department were analyzed. Eighteen percent out of 133 patients died within 90 days. The only ECG-predictor of the poor outcome of hemorrhagic stroke was the prolongation of corrected QT interval (QTc). The length of QTc should be taken into account while assessing patients with hemorrhagic stroke. The patients with the abnormal QTc are at higher risk of the development of cardiac complications and death.

On the Question of the Reflexotherapy Action Mechanisms in the Ischemic Stroke Acute Period (Literature Review)

A high degree of disability in stroke patients, along with severe social and economic losses, determine the enduring urgency of the problem of early rehabilitation for post-stroke patients. Despite the proven effectiveness of the various reflexotherapy techniques in rehabilitation of patients with ischemic stroke, the underlying mechanisms remain unclear. The aim of the review was to analyze the mechanisms of the acupuncture intervention effect on the main links of the ischemic stroke pathogenesis, on neurological deficit and the volume of cerebral infarction (based on publications in international databases). The use of acupuncture in the acute period of ischemic stroke can improve the ability to cerebrovascular reserve, reduce the severity of arterial stiffness and endothelial dysfunction, induce neuroprotection, inhibit cell apoptosis and stimulate neuroplasticity, alleviate the inflammatory response in acute cerebral ischemia, regulate mediators of inflammation and oxidative stress etc., thus improving cerebral blood flow. The analysis of literature data has shown that acupuncture induces multilevel regulation through complex mechanisms, and one factor may not be enough to explain the positive effect against cerebral ischemia.

Role of neuron-specific enolase, glial fibrillar acidic protein and NR2-antibodies in early diagnostic of ischemic stroke

Background. Application of a biomarker panel during the acute period of the ischemic stroke (IS) can contribute to a more accurate and prompter diagnostics and verification of the optimal approach to a patients’ management.Objective. We aimed to clarify values of neuron-specific enolase (NSE), glial fibrillar acidic protein (GFAP) and antibodies for NMDA receptor’s NR2-subunit (NR2-antibodies) in the acute period of IS, to compare with such values in patients without IS, to assess their relationship with severity of neurological deficit and short-term outcome and also to establish sensitivity and specificity of the biomarker panel.Design and methods. 63 patients with IS and 31 people (11 with chronic brain ischemia and 20 healthy individuals) as controls were included. Results. NSE and GFAP values in IS group exceeded reference values at the onset of disease, lowering significally by 10-14 day, while NR2-antibodies’ values were lower at the onset of the disease compared with controls, rising by 10-14 day. In patients with unfavourable short-term outcome higher levels of NSE, GFAP and NR2-antibodies were found. A panel of such biomarkers has higher sensitivity and specificity than each of them individually.Conclusion. Researched substances can be used in a biomarker panel for IS diagnostics, brain damage monitoring, patient’s condition evaluation and short outcome prognosing.

Prediction of unfavorable outcome in ischemic stroke patients with chronic kidney disease

Patients with chronic kidney disease (CKD) have significantly poorer functional outcomes and greater mortality after suffering a stroke. The present study aimed to identify the prognostic factors of an unfavorable outcome of the ischemic stroke in patients with CKD.&#x0D; Methods and subjects. The current study was designed retrospectively and performed with data of patients who were hospitalized due to ischemic stroke to the neurological department. A complex clinical and neuroimaging investigation was carried out in 65 patients (30 men and 35 women) aged 53 to 81 years (mean age – (67.7 ± 5.9) years) with acute stroke and CKD. Patients underwent all the necessary ancillary investigations according to guidelines. According to the clinical outcome on the 21-st day by the modified Rankin scale (mRS) all patients were divided into two groups: 1-st –favorable stroke outcome (mRS=0-3) – 34 (52.3%), 2-nd – unfavorable stroke outcome – (mRS=4-6) – 31 (47.7%).&#x0D; Results. During comparing the basic characteristics of both groups, it was revealed that patients with unfavorable functional outcomes were almost twice as likely to have diabetes mellitus (51.6% vs. 26.5%, p&lt;0.037) and atrial fibrillation (41.9% vs. 17.6%, p&lt;0.032). In age-and sex-adjusted multifactor logistic regression it was found that ischemic stroke unfavorable outcome is associated with diabetes mellitus (OR – 2.5, CI: 1.6-8.3; p=0.014), atrial fibrillation – 2.7, CI: 0.7-9.6; p=0.043), dialysis therapy (OR – 3.4, CI: 2.3-8.1; p=0.007), GFR &lt;42 ml/min/1.73 m2 (OR – 2.7, CI: 2.1-7.8; p=0.003).&#x0D; Conclusions. Determining prognostic factors of unfavorable course of the ischemic stroke in patients with CKD allows to optimize the management of such patients in the acute period of ischemic stroke and improve the prognosis.

Acute Neurological Brain Lesions in the Structure of the Clinical Picture of Severe Respiratory Syndrome-2 (SARS-CoV-2)

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 microand 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.

Сomplex rehabilitation of walking function in central paresis of the lower limb using neuroprosthetic technology

Disability after a stroke is most often associated with decreased patient activity due to walking disorder. In case of severe paresis, the function of the limb in the early stages of recovery is advisable to support with the help of partial prosthetics, using methods that provide functional stimulation. The complex treatment of central paresis includes botulinum therapy, which is due to the high incidence of spasticity.&#x0D; Aim: of the study: evaluation of the efficacy of functional electrical stimulation in a complex of multimodal effects in restoring movement in stroke patients with lower limb paresis.&#x0D; Materials and methods: Stimulation and neuroprosthetic methods (Bioness L300) were used as the main therapeutic program of rehabilitation treatment for patients with motor disorders of the lower limb after an ischemic stroke (n = 70). The median period of stroke was 21 [11; 47] days, median age 54 [42; 65] years. Scales and questionnaires were used to assess the loss of strength and volume of movement disorders, spasticity, walking speed and self-care (Medical Research Council Weakness Scale (1981, MRC), Barthel Index (1965), Modified Ashworth Scale (MAS), 10-meter test).&#x0D; Results: The effectiveness of personalized therapy with the use of a neuroprothesis (Bioness L300) in patients in the acute and early recovery period of ischemic stroke was shown. The additional use of botulinum toxin made it possible to eliminate the inhibitory effect of spasticity, which expanded the possibility of using intensive methods of physical rehabilitation. There was an increase in daily activity, walking speed, and the level of self-care of patients in 90 % of cases.&#x0D; Conclusion: The use of a complex of stimulating personalized techniques in the acute period of a stroke is justified and safe. The functional electrical stimulation helps to overcome power paresis, increases the overall level of physical activity of patients after a stroke, motivation for recovery and improves the quality of life. (1 figure, 2 tables, bibliography: 9 refs)

Emergency Carotid Endarterectomy for Internal Carotid Artery Thrombosis in the Course of COVID-19

A case of successful emergency carotid endarterectomy (CEE) in the acute period of ischemic stroke (within an hour after the onset of symptoms) in a patient with acute occlusive thrombosis of the internal carotid artery in the course of moderate-severe COVID-19 with a positive result of the polymerase chain reaction of the nasopharyngeal smear for SARS-CoV-2. The diameter of the ischemic focus in the brain according to multispiral computed tomography did not exceed 2.5 cm. The course of ischemic stroke was characterized by mild neurological deficit (score 5 according to National Institute of Health Stroke Scale). It was demonstrated that the severity of the patient’s condition was associated with bilateral, polysegmental, viral penvmonia with 65% damage to the lung tissue, a decrease in SpO2 to 93%. Laboratory noted coagulopathy with an increase in D-dimer (2837.0 ng/ml), prothrombin according to Quick (155.3%), fibrinogen (14.5 g/l) and signs of a “cytokine storm” with leukocytosis (28.4 10E9/l), an increase in C-reactive protein (183.5 mg/l), ferritin (632.8 ng/ml), interleukin-6 (176.9 pg/ml). The patient underwent glomus-sparing eversional CEE. The intervention was performed under local anesthesia due to the high risk of developing pulmonary barotrauma when using mechanical ventilation. To prevent the development of acute hematoma, a double active drainage was used into the paravasal space and subcutaneous fatty tissue (SFT). In case of thrombosis of one of the drainages, the second could serve as a spare. Also, upon receipt of hemorrhagic discharge from the drainage located in the SFT, the patient would not need to be transported to the operating room. Removal of skin sutures with revision and stitching of the bleeding source could be performed under local anesthesia in a dressing room. The postoperative period was uneventful, with complete regression of neurological symptoms. Used anticoagulant (heparin 5 thousand units 4 times a day s/c) and antiplatelet therapy (acetylsalicylic acid 125 mg at lunch). The patient was discharged from the hospital on the 12th day after CEE in satisfactory condition.

Иммунологические аспекты острого периода ишемического инсульта

Актуальность. В статье проанализирован характер изменения фенотипического состава лимфоцитов крови, содержания IgA, IgG, IgM и фракционного состава иммунных комплексов у пациентов с ишемическим инсультом и хронической ишемией мозга. Цель исследования: изучить характер нарушений клеточного и гуморального звеньев иммунитета в остром периоде ишемического инсульта. Материалы и методы. Провели сравнительное клинико-иммунологическое обследование 85 пациентов в остром периоде ишемического инсульта (основная группа) и 66 пациентов с хронической ишемией мозга (контрольная группа). Для оценки клеточного иммунитета использовали показатели иммунофенотипирования клеток крови — абсолютное и процентное содержание популяции Т- и В-лимфоцитов, их основных субпопуляций: Т-хелперов, цитотоксических Т-клеток, субпопуляции натуральных киллеров. Для оценки гуморального иммунитета исследовали содержание основных классов иммуноглобулинов (IgA, IgG, IgM) и циркулирующих иммунных комплексов. Результаты. В остром периоде инсульта наблюдали повышение количества лейкоцитов (р = 0,028) и снижение уровня лимфоцитов (р = 0,031), зрелых Т-лимфоцитов (р = 0,002), Т-хелперов (р = 0,027) и цитотоксических Т-лимфоцитов (р = 0,045). Отмечена тенденция к снижению количества натуральных киллеров (р = 0,45). В гуморальном звене иммунитета наблюдалось увеличение В-лимфоцитов (р = 0,048), дисгаммаглобулинемия за счет повышения уровня IgG (р = 0,048) и тенденции к гиперфункции IgА и IgМ (р = 0,5). Изменения показателей иммунного статуса более выражены при увеличении тяжести инсульта. Выводы. Данное исследование доказывает вовлечение иммунной системы в сложный комплекс реакций, участвующих в развитии инфарктов мозга.

Эффективность применения кверцетина у пациентов с ишемическим инсультом и коморбидной патологией

Актуальность. На сегодняшний день существует необходимость внедрения эффективного и безопасного патогенетического лечения мозгового инсульта, направленного на защиту нейронов от ишемического повреждения. Коморбидная патология у пациентов с ишемическим инсультом может оказывать существенное воздействие на течение заболевания и влиять на эффективность восстановления нарушенных функций. Целью исследования было изучение влияния кверцетина на функциональный исход острого периода ишемического инсульта, возникшего у больных на фоне соматической патологии. Материалы и методы. Представлены результаты анализа 639 случаев острого мозгового ишемического инсульта в зависимости от применявшейся схемы лечения и уровня коморбидности. Результаты. Исследуемые группы пациентов были сопоставимы по показателям исходного неврологического дефицита. 98 % из них имели коморбидную патологию с диапазоном значений от 1 до 8 баллов по шкале Чарльсона (среднее значение 3,75 ± ± 1,40 балла). Пациенты с высоким уровнем коморбидности продемонстрировали худшие показатели функционального восстановления в остром периоде ишемического инсульта по шкале инвалидизации (3,3 ± 1,6 балла) по сравнению с пациентами с низким уровнем коморбидности (2,2 ± 1,4 балла) (p &lt; 0,01, U). Изучение эффективности разных схем лечения на фоне коморбидной патологии показало достоверную эффективность назначения кверцетина у пациентов с высокой коморбидностью. Среди пациентов с низкой коморбидностью не было отмечено статистически значимых различий по показателю инвалидизации и выживаемости больных в остром периоде ишемического инсульта. Выводы. У 98 % больных с ишемическим инсультом выявляется коморбидная патология, которая негативно влияет на показатели выживания и функционального восстановления у больных в остром периоде ишемического инсульта. Худшие показатели функционального восстановления продемонстрировали пациенты с высоким уровнем коморбидности по индексу Чарльсона. Применение кверцетина в остром периоде ишемического инсульта продемонстрировало высокую эффективность у больных с высоким уровнем коморбидности, что подтвердило мультимодальный спектр его терапевтических эффектов. Индивидуальный подбор лечебных мероприятий у больных с ишемическим инсультом с учетом сопутствующей патологии повышает эффективность лечения.

Cognitive Testing During Mild Acute Ischemic Stroke Predicts Long-Term Return to Work

ObjectivesMany survivors of a mild ischemic stroke do not return to work or driving. Cognitive testing is commonly done to assess long-term cognitive impairment after stroke. Inpatient cognitive testing during the acute period of ischemic stroke may also be a predictor for workforce reengagement and functional outcome. Materials and methodsAt our comprehensive stroke center, we prospectively enrolled previously working adults < 65 years old who were diagnosed with first-ever ischemic stroke, had a prestroke modified Rankin Scale (mRS) ≤ 1 and NIHSS ≤ 3. Testing performed within 1 week of stroke included the Montreal Cognitive Assessment (MOCA), Clock Drawing Test (CDT), Trail Making Tests A and B, Backward Digit Span Test, and Hospital Anxiety and Depression Scale (HADS). Other data obtained included age, gender, years of education, occupation, stroke location, stroke laterality, and presence of white matter disease on imaging. Outcome measures assessed at 3 months, 6 months, and 12 months post-stroke included return to work, return to driving, and mRS. In a logistic regression analysis, we performed both univariate and multivariate analyses. Multivariate analysis was completed on variables with p-value ≤ 0.05 in the univariate analysis. ResultsOf 39 total stroke patients enrolled and tested (median [IQR] age 55 [46–60] years; 77.5% male; 22.5% female), 36 completed 3-month follow up, of which 58% returned to work, 78% returned to driving, and 72% had mRS of 0–1. In multivariate analysis, a single point increase in the clock drawing task score increased the odds of return to work by 3.79 (95% CI, 1.10–14.14) and return to driving by 6.74 (95% CI, 1.22–37.23) at 3 months. MOCA and HADS were both associated with mRS ≤ 1. MOCA was associated with return to work at 6 months and CDT was associated with return to work at 12 months. ConclusionCognitive testing with CDT and MOCA in the acute period after ischemic stroke may predict common patient goals post stroke, including return to work, driving, and independence. These tools can potentially be used for prognosis and identifying those who may benefit from further interventions.

Diagnostic of psychoemotional and cognitive impairments in acute ischemic stroke

Background. Early rehabilitation of patients with stroke is an important aspect of modern healthcare. The leading factor in disability is polymorphism of movement disorders, which is associated with dysfunction of various parts of the movement regulation system. Disorders of higher mental functions are another group of functional disorders widely represented among stroke patient. Aims: To assess the severity of cognitive, psychoemotional, behavioral disorders, the level of self-control and prevalence of certain coping strategies in patients with lesions of the right and left cerebral hemispheres after acute ischemic stroke. Material and methods. The study included 60 patients with a diagnosis of ischemic stroke. Depending on the location of the stroke, patients were divided into two groups: Group 1 30 patients with lesions of the right hemisphere, Group 2 30 patients with lesions of the left hemisphere. The study was conducted on the 7th day of treatment and included: assessment of the cognitive status according to the Montreal scale (with additional scales for assessing the functions of the right hemisphere); assessment of the level of distress, depression, anxiety and somatization using the Four Dimensional Symptom Questionnaire; assessment of mental and physical asthenia according to the MFI-20 scale, level of self-control using the Rotter's Locus of Control Scale and coping strategies modality using E. Heim coping questionnaire. Results. The study established the prevalence of depression, a tendency towards non-adaptive coping strategies, ideational praxis related disorders understanding of metaphors and low level of self-control in relation to health in patients with lesions of the right hemisphere. Patients with ischemic stroke localized in the left hemisphere are characterized by a high level of mental asthenia, a choice of adaptive and relatively adaptive coping strategies, and a low level of self-control in respect to interpersonal relationships. Conclusions. The results of the study show that in the acute period of stroke there are qualitative and quantitative differences in neuropsychiatric symptoms of patients with lesions of the right and left cerebral hemispheres. The predominance of depression, cognitive impairments, and non-adaptive coping strategies in patients with lesions of the right hemisphere even with minimal or moderate motor deficits justifies early examination of the patient's behavioral, neuropsychiatric, and cognitive syndromes. The results of the study indicate the need to develop individual psychological rehabilitation programs for patients with lesions of the right and left cerebral hemispheres during the acute period of stroke.

Comparative Characterization of Candidate Molecular Markers in Ischemic and Hemorrhagic Stroke

According to epidemiological studies, the leading cause of morbidity, disability and mortality are cerebrovascular diseases, in particular ischemic and hemorrhagic strokes. In recent years considerable attention has been given to the study of molecular markers of ischemic and hemorrhagic strokes. These studies are relevant because brain-specific protein biomarkers of neurons and glial cells can provide valuable and timely diagnostic information necessary for clinical decision-making.The aim of the study was to reveal the differences in the serum level of molecular markers in acute, subacute and early recovery periods of ischemic and hemorrhagic strokes.Material and methods. The study included 59 patients. Twenty patients were diagnosed with hemorrhagic stroke and 39 had ischemic stroke. The control group included 20 volunteers. Serum levels of molecular CNS markers were determined in acute, subacute, and early recovery stages of stroke. The serum levels of CNS molecular markers of patients with ischemic and hemorrhagic stroke was measured quantitatively by enzyme immunoassay. Statistical analysis was performed by nonparametric Mann-Whitney method.Results. The level of brain-derived neurotrophic factor (BDNF) in the control volunteers was 574.5 [455.5; 615] pg/ml. Significant differences were found for acute and subacute periods of hemorrhagic stroke: it was 674 [560; 749] pg/ml (P=0.003) and 664 [616; 762] pg/ml (P=0.0001).The level of neuron-specific enolase was significantly increased in all periods of the study: it was 4.15 [3.53; 4.8] ng/ml in the control group, 5.4 [4.4; 6.4] ng/ml in acute period of ischemic stroke (P&lt;0.001), 5.4 [4.4; 6.4] ng/ml in early recovery period of ischemic stroke (P=0.001), 5.1 [4.6; 6.4] ng/ml in acute period of hemorrhagic stroke (P=0.014), 664 [616; 762] ng/ml in subacute period of hemorrhagic stroke (P=0.003).In the control group, the serum S-100 protein level was 4.5 [3.8; 5.4] ng/ml. In the acute and early recovery periods of ischemic stroke, S-100 protein level has significantly fallen down to 4.1 [3.4; 4.6] ng/ml (P&lt;0.031) and 3.9 [3.4; 6] ng/ml (P=0.014), respectively. Glial-cell derived neurotrophic factor level was 1.98 [1.64; 2.1] ng/ml in the controls and increased up to 2.4 [2.2; 5] ng/ml (P=0.002) in the acute period and 2.4 [2.3; 2.6] ng/ml (P&lt;0.001) in the subacute period of hemorrhagic stroke.The vascular endothelial growth factor receptor-1 (VEGFR-1) was significantly lower in the subacute period of hemorrhagic stroke: 485 [211; 945] pg/ml in the subacute period vs 903.5 [626; 1115] pg/ml in the controls (P=0.001).Conclusion. We found differences in the serum level of molecular markers in patients with ischemic and hemorrhagic strokes. In the acute period, early recovery period of ischemic stroke, and subacute period of hemorrhagic stroke, there was an increase in the serum level of neuron-specific enolase. The level of brain-derived neurotrophic factor increased significantly in the acute and subacute periods of hemorrhagic stroke. In the acute and early recovery periods of ischemic stroke, the level of S-100 protein decreased. The level of glial cell-derived neurotrophic factor increased in the acute and subacute periods of hemorrhagic stroke. In the subacute period of hemorrhagic stroke, the level of endothelial growth factor receptor-1 significantly decreased. Moreover, there was significant difference between values of this parameter in the subacute period of hemorrhagic stroke and in the early recovery period of ischemic stroke.

Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view

The article evaluates recent perspectives about the role of oral anticoagulants in the secondary prevention of cardioembolic stroke. The timing of prescribing drugs for ischemic stroke and transient ischemic attack is discussed in accordance with current clinical guidelines and the results of clinical trials. The issues of prescribing oral anticoagulants in some problematic situations, such as the elderly and senile age, reperfusion therapy, presence of hemorrhagic transformation, combined atherosclerosis of major head and neck arteries, cerebral microangiopathy, history of intracerebral hemorrhage, cryptogenic stroke, and low patient compliance are considered. Finally, an anticoagulant therapy algorithm in the acute period of cardioembolic stroke is presented.

Ischaemic stroke and oral inflammatory diseases

The aim of this study was to establish clinical significance of oral inflammatory diseases in ischaemic stroke (IS), how aware doctors and nurses are of this problem, and the safety and possibility of performing dental hygiene in patients with acute IS.&#x0D; Materials and methods. We examined 100 patients who had suffered an ischaemic stroke in the internal carotid artery territory within 6 to 48 hours. The efficacy of dental hygiene and the risk of developing chronic oral sepsis were evaluated using the Patient Hygiene Performance Index (PHP) and Chronic Oral Sepsis Risk index (COSR). Quality of life was assessed using the short version of the Oral Health Impact Profile (OHIP-14). The sociological study included 100 patients with ischaemic stroke, 38 nurses, and 18 neurologists.&#x0D; Results. The severity of IS at study inclusion was 8 (3; 15) points on the NIHSS, while the Barthel Index score was 70 (45; 90) points. The modified Rankin Scale score was 13 points. The PHP index was 2.28 0.05 and the COSR index was 20.13 0.50. The OHIP-14 results (a total score of 28.1 6.8 points) also indicated unsatisfactory quality of dental health. The results of sociological studies revealed low level of awareness regarding dental care during acute IS among doctors. After professional oral care, treatment of oral inflammatory diseases, and removal of significantly damaged teeth, patients with IS had a decrease in the PHP index to 1.17 0.05 and the COSR index to 7.36 0.50, which corresponds to a satisfactory level of dental hygiene by the end of the acute stroke period. The impact of dental health on quality of life parameters as measured by the OHIP-14 scale (22.4 7.2 points) was satisfactory.&#x0D; Conclusion. The most important aspect of early dental care in patients with IS is increasing the quality of oral health.