Cerebral Blood Flow Disorders Research Articles

The role of citicoline in the correction of cerebral blood flow disorders in patients with coronary artery disease in combination with COVID-19

OBJECTIVE. To evaluate the effect of citicoline on cerebral blood flow and microembolic signals (MES) after 6 months of treatment in patients with coronary artery disease combined with coronavirus disease (COVID-19). MATERIALS AND METHODS. A prospective study of 68 patients with coronary artery disease with confirmed COVID-19 by PCR was conducted. Group I (n=35) included patients with coronary artery disease in combination with COVID-19, who, in addition to standard therapy of cerebrovascular disease, received citicoline (500 mg twice daily) for 6 months after discharge from the hospital. The comparison group (group II; n=33) consisted of patients who did not receive citicoline. Cerebral blood flow, peak systolic velocity in extracranial and intracranial vessels were determined, and 1-hour transcranial monitoring to detect MES were performed. Patients were re-examined in 6 months. RESULTS. At the initial examination of patients, cerebral blood flow and the number of MES did not differ significantly. After 6 months, there was an increase in cerebral blood flow in the cerebral arteries, as well as a decrease in MES in patients taking citicoline, whereas in group II there was no positive dynamics of this ratio. A direct correlation between plasma C-reactive protein, D-dimer and MES was found in patients of both groups. After 6 months of treatment, C-reactive protein and D-dimer decreased in both groups equally. CONCLUSIONS. The obtained results of improvement of cerebral perfusion, blood rheology, due to the anti-inflammatory effect, stabilising function of citicoline on phospholipid membranes of cerebral vascular endothelium, neurons and glial elements allow the use of citicoline in patients with coronary artery disease in combination with COVID-19 to reduce the negative impact of COVID-19 on the central nervous system.

Possibility of correction of cerebral blood flow disorders and central nervous system damage with citicoline in patients with coronary artery disease in combination with COVID-19

ABSTRACT. The review describes some pathogenetic mechanisms of central nervous system lesions in patients with coronary artery disease in combination with coronavirus disease (COVID-19) and presents the current possibilities of their pharmacotherapy. The analysis of experimental and clinical trials has shown that the multifactorial effect of citicoline on the main pathogenic links of brain damage in COVID-19 and numerous positive clinical effects make it a promising drug in the treatment of patients with coronary artery disease in combination with COVID-19 and post-COVID syndrome.

Perbandingan Efektifitas Latihan Rom Aktif Dan Akupresur Terhadap Kekuatan Otot Ekstremitas Atas Pada Pasien Stroke Non Hemoragik Di Ruang Rawat Inap Rsud Dr. Haryoto Lumajang

Stroke is a clinical syndrome that begins suddenly, progressively, in the form of focal or global neurological deficits that lasts 24 hours or more and can cause death. This is caused by nontraumatic cerebral blood flow disorders. The purpose of this study was to compare the effectiveness of active ROM and acupressure exercises on upper limb muscle strength in non-hemorrhagic stroke patients in the inpatient room of RSUD Dr. Haryoto Lumajang.
 The research method used was a pre-experimental design with the type of pre-test and post-test one group design. With a sample of 36 respondents with the Accidental Sampling technique and the test used was the Wilcoxon test.
 From the results before being given the ROM treatment, 11 respondents (61.1%) had poor muscle tone and before being given the acupressure treatment, 15 respondents (83.3%) had poor muscle tone. From the results after being given ROM treatment, 13 respondents (72.2%) had moderately good muscle tone and after being given the acupressure treatment, 14 respondents (77.8%) had poor muscle tone. The results of the Mann-Whitney analysis test obtained α = 0.003, which means that there is a comparison of the effectiveness of active ROM exercises and acupressure on upper limb muscle strength in non-hemorrhagic stroke patients.
 It is expected that patients with stroke will always try to practice ROM independently which has been taught by health workers, for the patient's family to participate and motivate patients to do ROM exercises to accelerate the healing of stroke patients.
 
 Keywords: Active ROM Exercises, Acupressure, Upper Extremity Muscle Strength, Non Hemorrhagic Stroke

Study of the relationship between hemostasis and vascular endothelium in hypoxic lesions of the nervous system in newborns

The study of the statement of the hemostatic system and vascular endothelium was made in newborns with hypoxic lesions of the nervous system. Some indicators of hemostasis (PTT, APTT, TT and fibrinogen) were determined in cord blood, as well as endothelial dysfunction marker Endothelin-1. In newborns who underwent a chronic hypoxia, a statistically significant increase of the fibrinogen level and endothelin-1 were revealed in the umbilical cord blood. During hypoxic lesions of the nervous system in newborns the vascular endothelium primarily reacts, causing activation of hemostasis and cerebral blood flow disorders.

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.

VERTEBROBASILAR BLOOD FLOW IN GERIATRIC PATIENTS WITH HIP FRACTURES

Background: Falls constitute a problem especially in individuals aged above 70 years in terms of fracture formation. Considering the etiology of falling, insufficiency of the blood flow which feeds the balance center in the brain may cause postural hypotension and vertigo and may lead to falling. Objective: In this study, we emphasized the importance of evaluating vertebrobasilar blood flow in the etiology of fractures in the elderly. Methods: This study was executed on 48 patients aged 70 years and older (28 females, 20 males, mean age 80.45), who were presented to the emergency department of Dumlupınar University Evliya Çelebi Training and Research Hospital with hip fractures resulting from a simple fall around where they live, diagnosed with hip fractures and treated via joint prostheses or different internal and external fixation methods. After the stabilization of the patients' postoperative fractures, the carotid artery lumen and blood flow, vertebral arterial lumen, diameter and blood flow were examined via doppler ultrasonography. The control group was comprised of 48 patients aged 70 years and older (26 females, 22 males, mean age 75.52 years) who were presented to the Polyclinic of Neurology for routine examination and had no falling and fracture history, and the carotid artery and vertebral artery examination of this group was also performed by the same radiologist via doppler ultrasonography Results: In individuals aged above 70 years, temporary cerebral blood flow disorders are more severe in those with vertebrobasilar insufficiency. This study was conducted between 2015-2016 on 48 patients aged 70 years and older (28 females and 20 males), who were presented to the emergency department of Dumlupınar University Faculty of Medicine Training and Research Hospital and hospitalized due to hip fractures; the control group was comprised of 48 patients within the same age group, who were presented to the Polyclinic of Neurology with different complaints (26 females and 22 males).The vertebral arterial diameters and flow velocities of the patients were assessed via Doppler USG. Conclusion: The vertebral arterial diameters and flow velocities were found statistically lower in the patient group with fracture formation resulting from falling.We recommend taking precautions against the risk of falling in patients aged above 70 years who are found to have a flow decrease through carotid artery doppler USG at certain intervals.

Relationship between homocysteine level and prognosis of elderly patients with acute ischemic stroke treated by thrombolysis with recombinant tissue plasminogen activator.

BACKGROUNDAcute ischemic stroke (AIS) is mainly caused by cerebral blood flow disorders, which further leads to ischemic brain necrosis or encephalomalacia. The role of homocysteine (Hcy), an independent risk factor for cardiovascular disease, in the development of atherosclerosis is gradually revealed. However, studies are still rare and little is known about the relationship of Hcy level with the prognosis.AIMTo explore the relationship between Hcy level and prognosis in elderly patients with AIS after thrombolytic therapy with recombinant tissue plasminogen activator (rtPA).METHODSA total of 120 patients with acute ischemic stroke who were admitted to Jingzhou Central Hospital and underwent recombinant tissue plasminogen activator treatment were randomly selected from January 2017 to December 2018. They were divided into two groups according to the level of Hcy, with 60 patients in each group. Patients with Hcy ≥ 18.54 umol/L were included into a high-level group and those with Hcy < 18.54 umol/L were included into a low-level group. The outcomes were analyzed in the two groups after the treatment.RESULTSThe National institute of Health Stroke Scale (NIHSS) scores were significantly higher in the high-level group than in the low-level group before and 1 h after the treatment (P < 0.05). There was no significant difference in NIHSS scores between the two groups at 12 and 24 h after the treatment (P > 0.05). The Modified Rankin scale (MRS) scores were significantly higher in the high-level group than in the low-level group before and 1 h after the treatment (P < 0.05). There was no significant difference in MRS scores between the two groups at 12 and 24 h after the treatment (P > 0.05). NIHSS and MRS scores were positively correlated with the prognosis after thrombolytic therapy (P < 0.05).CONCLUSIONThe level of Hcy is closely related to the prognosis of elderly patients with acute ischemic stroke, and after rtPA treatment, the prognosis of elderly patients is improved significantly.

Etiopathogenetic risk factors for stroke in pregnant women

Stroke is a severe thrombotic condition that can occur in women of reproductive age during their pregnancy. Physiological changes that occur during gestation, childbirth and the postpartum period predispose a woman to the development of thrombotic complications. However, the true causes of cerebrovascular accidents are not fully understood. More than 50 % of strokes occur in the absence of obvious risk factors. The article reviews etiological and pathogenetic mechanisms of cerebral blood flow disorders and factors contributing to this condition in pregnant women.

Synthesis, physical and chemical properties, antihypoxic activity of some 5-[((5-(adamantane-1-yl)-4-R-4H-1,2,4-triazole-3-yl)thio)methyl]-N-R1-1,3,4-thiadiazole-2-amines and 5-[((5-(adamantane-1-yl)-4-R-4H-1,2,4-triazole-3-yl)thio)methyl]-4-R1-4H-1,2,4-t

Today, an increase of natural and technogenic situations leads to the disorders of the central nervous system, functional-metabolic processes, vascular diseases, in particular, acute cerebral blood flow disorders. In addition, the changes occurring on the molecular and cellular levels are in the basis of the functional violations of individual systems and the organism as a whole. Hypoxia not only complicates the disease course, but in most cases, determines its outcome. The important role in the fight against hypoxia belongs to antioxidants, which improve the circulating oxygen utilization by the body, reduce its need for the organs and tissues, which is not only expedient but necessary for the treatment of many acute and chronic pathological processes. So, the frequency of the hypoxic states and a wide range of factors causing them determine the relevance of new ways and methods finding to overcome the oxygen deficiency.The aim of this work is the purposeful search of some 5-[((5-(adamantane-1-yl)-4-R-4H-1,2,4-triazole-3-yl)thio)methyl]-N-R1-1,3,4-thiadiazole-2-amines and 5-[((5-(adamantane-1-yl)-4-R-4H-1,2,4-triazole-3-yl)thio)methyl]-4-R1-4H-1,2,4-triazole-3-thiols, the study of their physical and chemical properties and pharmacological screening of the antihypoxic activity of the obtained compounds.Materials and methods. The study of physical and chemical properties was conducted on certified and licensed modern equipment. Antihypoxic activity was studied during the modeling process of hypoxia with hypercapnia. Mexidol was used as a comparison drug in studies at a dose of 100 mg/kg.Results. As the result of the study, it was found that the synthesized compounds and the comparison drug influenced on rats’ life span differently. Compounds, the antihypoxic activity of which exceeded control have been discovered, and others’ were at the level of Mexidol. A number of compounds showed a somewhat less activity in comparison with control, and two compounds, among the investigated ones were weaker then comparison drug action, but they did not reduce the life expectancy of the investigated groups in comparison with control. The effect of the remaining compounds on the lifetime of the investigated group was at the level of control group that received the physiological solution.Conclusions. A series of new compounds of derivatives among 5-[((5-(adamantane-1-yl)-4-R-4H-1,2,4-triazol-3-yl)thio)methyl]-N-R1-1,3,4-thiadiazole-2-amines and 5-(5-(adamantane-1-yl)-4-R-4H-1,2,4-triazole-3-yl)thio)methyl)-4-R1-4H-1,2,4-triazole-3-thiols have been synthesized, the structure of which has been confirmed with the help of modern physical and chemical methods of analysis. The most active compounds among the studied ones were 3a and 2a, their antihypoxic activity exceeds control on 37.86 % and 36.30 % and Mexidol is on 7.35 % and 5.79 % respectively.

Potential Use of Transspinal Direct Current Stimulation For Cerebral Circulation Correction

Research objective: to prove the potential use of Trans spinal direct current stimulation for treatment of brain systems functioning disturbance attached with regulation of vasal tonus. Identify the most effective localizations and exposure regimens, so that in the future they can be used purposefully, for the treatment of cerebral blood flow disorders.&#x0D; Materials and methods. 38 children aged 4-12 years were examined who were treated with TSDCS and who had EEG at the beginning of the course of treatment – signs of hemolytic dysfunction with ICD-10 diagnoses as mental retardation (F70-F79), disorders of psychological development (F80-F89) or as behavioural and emotional disorders with onset usually occurring in childhood and adolescence (F90-F98). The following examinations were performed: an electroencephalogram, a neurological examination. The trans spinal direct current stimulation was carried out by a constant current of 100-200 μA, during 30-40 min. At the same time, the cathode was located lateral from the spinous process of the seventh cervical vertebra C7, and the anode counterlaterally to the cathode in the lumbosacral region at the level of the spinous processes L5-S1. A total of 3 to 5 sessions of TSDCS were conducted. A repeat EEG examination with the determination of Hemolucleodynamics Coefficient (HC) was performed 7-10 days after the last TSMP session.&#x0D; Result. After the course of TSDCS, all patients significantly decreased the HC score. In 27 patients (71%) patients, HC decreased to the norm value (≤1,2). In 23 patients (29%), HC values corresponded to the first degree of hemolytic dysfunction.

EXPRESSION OF SERINE RACEMASE IN THE HIPPOCAMPUS OF RATS IN THE MODEL OF CHRONIC CEREBRAL BLOOD-FLOW DISORDERS

The results of a qualitative and quantitative analysis of serine racemase expression in the hippocampus of rats in chronic cerebral blood-flow disorders modeled by hypergravity in the caudo-cranial vector are presented in this article. A significant increase in the number of defective neurons showing the signs of damage, a decline in the relative density of pyramidal cells in all zones of the hippocampus combined with expressed pericellular and perivasculare dema were revealed. The immunohistochemical study demonstrated intensified serine racemase expression in CA1 as well as translocation of immunoreactive material to the dendrites of pyramidal neurons. The tendency to a decrease in serine racemase expression in CA3 and CA4 was registered.

CURRENT POSSIBILITIES OF USING RADIOPHARMACEUTICALS TO EVALUATE CEREBRAL BLOOD FLOW

A comparison of the possibilities of using various neurotropic radiopharmaceuticals for scintigraphic evaluation of cerebral perfusion. In the whole range of radiopharmaceuticals used to diagnose cerebral blood flow disorders, there are Ceretec (99mTc-hexamethylpropyleneamine) and Neurolite (N,N-1,2-ethylenediylbis-L-cysteine-diethyl ether), which are the most optimal agents. Due to their high cost and related radiation exposure, the radiopharmaceuticals 123І-IMP (123I-isopropyl-iodoamphetamine) and 201Tl-DDC (diethyldithiocarbamate) labeled with thallium-201 virtually minimize the possibilities of being used in daily clinical practice. Fixation of 99mTc-DDC in the brain proves to be short-term, which is insufficient for tomoscintigraphy studies. Literature has been sought in the Scopus, Web of Scince, Pubmed, EMBASE, and Russian Science Citation Index databases.

КЛІНІКО-БІОХІМІЧНІ ПОКАЗНИКИ ОБМІНУ БІЛКІВ ТА ВМІСТ ЕЛЕКТРОЛІТІВ У КРОВІ ПАЦІЄНТІВ ЗА УМОВ ІШЕМІЧНОГО ІНСУЛЬТУ, УСКЛАДНЕНОГО ЦУКРОВИМ ДІАБЕТОМ ДРУГОГО ТИПУ

Diabetes is one of the generally accepted factors of acute cerebral blood flow disorders. Numerous studies have shown the involvement of many factors in the pathogenesis of diabetic cerebral disorders, the most important of which are the metabolic changes. The aim of this study was to determine the transaminase activities, the urea and creatinine, the levels of K +, Na + and Cl - ions, the total protein and albumin contents in the serum of patients with ischemic stroke and patients with stroke complicated by type 2 diabetes. Also the average age of the patients, body mass index (BMI) and blood glucose level were determined. The investigation has shown that patients with ischemic stroke, particularly complicated by insulin independent diabetes, were characterized by hypoproteinemia with the absence of marked changes of albumin content, transaminase activities and the concentrations of end-products of protein metabolism (urea and creatinine) in the serum of both groups patients. The results also have revealed the significant differences of BMI in patients with ischemic stroke accompanied by type 2 diabetes.

ПОКАЗНИКИ ЕНДОТОКСЕМІЇ ПАЦІЄНТІВ ІЗ ІШЕМІЧНИМ ІНСУЛЬТОМ ТА ЦУКРОВИМ ДІАБЕТОМ ДРУГОГО ТИПУ

Diabetes is one of the generally accepted factors of acute cerebral blood flow disorders. Numerous studies have shown involvement of many factors in the pathogenesis of diabetic cerebral disorders, the most important of which are the metabolic changes, including endotoxication. The aim of this study was to measure the endotoxication parameters and total protein and albumin contents in the blood of patients with ischemic stroke and patients with stroke complicated by type 2 diabetes. Also the average sex, age of the patients, body mass index (BMI) and blood glucose and lipoproteins levels, different disease complication presents and NIH Stroke Scale with Barthel index were determined. The investigation had shown that patients with ischemic stroke, including complicated by insulin independent diabetes, were characterized by hypoproteinemia with the absence of marked changes of albumin content. The middle mass molecule (MSM) and oligopeptide contents revealed the presence of endogenous intoxication. These parameters, exceeding the control by 1.5 times, were high independently of hyperglycemia presence. The results also allowed to establish differences in BMI, hyperlipoproteinemia and increasing of NIHSS in patients with ischemic stroke and diabetes mellitus type 2 comparing with stroke alone. Thus, the development of ischemic stroke separately and under conditions of type II diabetes was characterized by increasing rates of endotoxication (middle mass molecule and oligopeptides contents) in the blood of patients, that with hypoproteinemia and hyperlipidemia may cause the secondary pathobiochemical changes in the head brain cells and mediate the negative effects of acute disorders of cerebral blood circulation.

THE COURSE OF CEREBRAL VASCULAR INSUFFICIENCY IN PATHOLOGIC TORTUOSITY OF CAROTID ARTERIES, ITS ROLE IN INDICATIONS FOR SURGICAL TREATMENT

The article describes the effect of pathologic tortuosity of carotid arteries on cerebral circulation, variants of the course of vascular cerebral insufficiency and clinical manifestations, their role in indication for surgical treatment. The pathologic tortuosity of carotid arteries is revealed by the clinical picture of vascular cerebral insufficiency in carotid and/or vertebrobasilar basins. The work assesses the role of spiral computed tomography with contrasting and magnetic resonance imaging in the verification of signs of episodes of focal neurologic deficiency in patients with the tortuosity of carotid arteries and the potential for application of transcranial Doppler for evaluation of cerebral blood flow disorders in different variants of cerebral vascular insufficiency. The article covers the problems of analysis of the received data for indication for surgical treatment for the tortuous internal carotid artery and presents the long-term results of the surgical treatment of the patients with tortuosity of carotid artery (dynamics of neurological symptoms and the absence of cerebral infarction on the area of the surgery).

Radiography and complex ultrasound scanning: optimal screening methods in diagnosis of vertebrogenic changes in vertebral arteries at cerebrovascular blood flow disorders

Introduction. Number of causes of cerebral vascular pathology justifies the necessity for a balanced application of modern instrumental complex in patients with cerebral blood flow disorders. However, more frequently practitioners exclude radiography and complex ultrasound scanning – methods of primary screening of high informativity, and begin the study with expensive methods such as MRI and SCT.Methods. The results of complex survey of 103 patients with ischemic circulation disorders in posterior basin due to vertebrogenic stenosis of vertebral artery were analyzed. We studied the results of cervical radiography and complex ultrasound scanning in the diagnosis of blood flow pathology.Results. According to data of radiography of cervical spine we found no difference between clinical diagnosis and results of radiography. Complex ultrasound scanning of vessels of cervical spine showed its high informativity in diagnosis of extravasal compression of vertebral artery, which allowed us not only to define the strategy of further diagnosis with additional neurovizualizing techniques, but also to treat stenosis of vertebral artery.Conclusions. Radiography and complex ultrasound scanning is the optimal method of high informativity for screening of vertebrogenic changes of vertebral arteries, cerebrovascular blood flow disorders. The data obtained, allowed us to define precise indications for MRI, SCT scanning, provided proper information for further treatment.

STRESS-INDUCED BRAIN DAMAGES

The review represents recent data devoted to pathogenesis of the brain ischemia and pharmacological ways to correct metabolic shifts in the cerebral blood flow disorders.

Early Brain Spect in Patients after Minor Craniocerebral Trauma

A prospective study made 57 measurements of cerebral blood flow (CBF) by Single Photon Emission Computed Tomography (SPECT) in post-traumatic patients. The aim of the investigation was to evaluate CBF in patients after minor craniocerebral trauma (mCCT) to ascertain the clinicotopographic correlation of the CBF changes, and to study SPECT in comparison with computed tomography (CT) findings. In addition, evaluation of the usefulness of SPECT for forensic medicine, assessment of secondary brain injury by SPECT and the predictive value of hypofrontalism were performed. A direct correlation was shown between mCCT and the observed CBF disorders, and between the CBF disorders and clinical symptoms as well as better SPECT sensitivity in comparison with CT. The usefulness of SPECT for forensic medicine purposes was also shown. Secondary brain injuries were disclose and the predictive value of hypofrontalism was confirmed. No correlation between GCS and CBF changes was found.

461 Computer control of brain functions in cerebral blood flow disorders

461 Computer control of brain functions in cerebral blood flow disorders

The state of the microcircular bed in patients with severe traumatic brain damage

The course and outcome of severe traumatic brain injury (TBI) is more influenced by the degree and nature of cerebral blood flow disorders. Changes in blood circulation, in turn, depend on the state of the microvasculature, which ensures the transcapillary metabolism between blood and tissues. The most convenient object in the study of the microcirculatory network of the brain in patients is the vessels of the bulbar conjunctiva. This is due, on the one hand, to the fact that the vascular network of the outer and inner shell of the eyeball belongs to those few structures of the body that can be directly observed and photographed, on the other hand, the vessels of the bulboconjunctiva have the same source of blood circulation and innervation as the head brain.