Chronic Brain Ischemia Research Articles

CLINICAL AND NEUROLOGICAL FEATURES OF DYSCIRCULATORY ENCEPHALOPATHY COURSE IN PATIENTS WITH HYPOTHYROIDISM ACCORDING TO THE PROSPECTIVE STUDY DATA

Introduction. Chronic insufficiency of cerebral blood circulation, dyscirculatory encephalopathy, takes a prominent place among cerebrovascular pathology. Currently, along with the growth of dyscirculatory encephalopathy, there is an increase in endocrine pathology, such as hypothyroidism. Neurological disorders in hypothyroidism are a severe and widespread condition of the nervous system. Cerebral pathology, which develops as a result of metabolic and vascular disorders in patients with hypothyroidism, is a manifestation of endothelial dysfunction, such as disruption of endothelial function compensation. Aim. The aim of our study was to reveal the clinical and neurological features of dyscirculatory encephalopathy in patients with hypothyroidism according to the prospective study data. Materials and methods. The 60 patients with hypertensive dyscirculatory encephalopathy and accompanying hypothyroidism, who were under supervision for 10 years, were examined with clinical, neurological, neuropsychological, instrumental and laboratory examination. Results. According to the study results, it was proved, that the patients of the second group, i.e. those who were examined at the present time, were more likely to complain of unsteadiness while walking and general weakness. When analyzing the objective neurological symptoms among the patients included in the study, a coordination disorders were established as dominating. At the same time, the II group of patients was characterized by more frequent detection of pathological plantar reflexes, unsteadiness in the Romberg posture and walking ataxia, compared to the I group. When analyzing the objective neurological symptoms, among the patients included in the study, coordination disorders were established as dominating. Conclusions. According to the results of a prospective study, it was proved that hypothyroidism is associated with a more severe course of vestibulo-ataxic syndrome in patients with chronic brain ischemia.

Peculiarities of angiospasm and ischemic complications in ruptures of cerebral arterial aneurysms against the background of occlusive-stenotic lesions of cerebral arteries

Objective – to determine the effect of occlusive-stenotic lesions of cerebral arteries on angiospasm and ischemic complications in patients with ruptured arterial aneurysms against the background of occlusive-stenotic lesions of cerebral arteries. Materials and methods. A retrospective study of the medical histories of 1,147 patients with cerebral artery aneurysms from 2006 to 2022 was conducted. 63 patients were included in the study group because they met the following criteria: surgical treatment; rupture of saccular aneurysms (SAs); the presence of occlusive-stenotic lesions was proven using instrumental examination methods. Patients of the control group had to meet the following criteria: surgical treatment; rupture of SAs; the absence of occlusive-stenotic lesions was proven by means of instrumental examination methods; the gender and age distribution had to match the study group. Of the 126 patients included in this study, there were 76 men (60.32%) and 50 women (39.68%). The age of the patients varied from 31 to 77 years. The average age of patients- 55.9±0.76 years; men – 54.3±0.94 years, women – 58.3±1.19 years. Results. A percentage predominance of patients with high cerebral blood flow velocity (>200 cm/s, which is equal to the velocity with severe grade III vasospasm of the cerebral arteries) in the study group (32.56%) compared with the control group (24.24%) was revealed. Conclusions. The predominance of men among patients of the study group (60.32%) was established. The average age of men with occlusive-stenotic lesions was younger than that of women (men – 54.3±0.94 years, women – 58.3±1.19 years). The difference in age is the largest in the 2nd subgroup of the study group where the severity of stenosis is 50-75% (men - 48.3 years; women - 62 years). Ruptures of arterial aneurysms of the middle cerebral artery occur more often in the presence of stenoses (study group - 25.4%, control group - 12.7%). The neurological status of patients with a hemorrhagic stroke, as a result of the rupture of an arterial aneurysm, is significantly aggravated by occlusive-stenotic lesions due to the occurrence of chronic brain ischemia. The worst prognosis for life and health was in men with a ruptured arterial aneurysm against the background of a 50-75% stenotic lesion and severe vasospasm of the cerebral arteries.

Chronic insomnia and ways to overcome it

Relevance. Chronic insomnia is one of the most common forms of nighttime sleep disorders. It leads to a decrease in human performance, the development of social maladjustment, and even changes in the personal sphere. Chronic insomnia can become a trigger for decompensation of somatic, neurological and mental diseases, which determines the need to find ways to overcome it. Objective. To determine the efficacy and safety of the dietary supplement Alpha-Melatonin Relax in the treatment of chronic insomnia in patients with chronic cerebral ischemia. Materials and methods. The study involved 30 patients (18 women and 12 men) with chronic cerebral ischemia of stage I and II, the average age of which was 46.12 ± 4.98 years. The course of treatment consisted of 30 days of taking Alpha-Melatonin Relax, 1–2 tablets 30–60 minutes before bedtime. Clinical and neurological symptoms were assessed and tested using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Epworth Daytime Sleepiness Scale, and the Hospital Anxiety and Depression Scale (HADS) in dynamics. Results and their discussion. The study results showed that 30-day administration of Alpha-Melatonin Relax provided a significant p≤0.05 improvement in the subjective assessment of the quality of night sleep, a decrease in the time to fall asleep, an increase in sleep duration, a decrease in the severity of emotional disorders and daytime dysfunction. Clinical and neurological follow-up of patients during the treatment course revealed a significant reduction in the severity of chronic insomnia, asthenia, and anxiety-depressive symptoms, which allows us to recommend the use of the dietary supplement Alpha-Melatonin Relax in clinical practice. Conclusions. Based on the data of a clinical-neurological and psychodiagnostic study, the statistically significant effectiveness of the dietary supplement AlphaMelatonin Relax in correcting the symptoms of chronic insomnia in patients with the initial stages of chronic brain ischemia has been proven.

Prognostic value of blood pressure in the acute period of hemispheric ischemic stroke

Aim. To study changes in blood pressure (BP) in patients with acute hemispheric ischemic stroke (AIS), to correlate BP in patients with AIS with BP in patients with chronic brain ischemia, and to study the association of various BP indices with stroke severity and recovery.Material and methods. We included 235 patients with hemispheric AIS (age 64±11 years; women, 41,3%). BP was assessed 6 times as follows: by patient’s self-measurement during the month before the stroke onset, in the ambulance, in the admission department, in the intensive care unit using 24-hour blood pressure monitoring (BPM), in the neurologic department (BPM), and 90 days after stroke. In patients with chronic cerebral ischemia (178 patients, age 62±13 years, 46,1% women), BP was assessed 3 times: by patient’s self-measurement during the month before hospitalization, in the admission department, and in the neurologic department (BPM).Results. Patients with AIS within the month before stroke had higher systolic and pulse pressure than patients with chronic cerebral ischemia. During the acute stroke period, patients with AIS despite reaching target systolic and diastolic BP had significantly increased variability of systolic and diastolic BP compared to patients with chronic brain ischemia. Systolic BP ≥160 mm Hg recorded consecutively in ambulance, in admission department, and in intensive care unit, as well as pulse pressure ≥60 mm Hg, and systolic BP variability ≥18 mm Hg recorded on day 1-2 and day 9-10, positively correlated with National Institute of Health Stroke Scale (NIHSS) score (r≥0,37, p≤0,0017) on day 10 and with modified Rankin Scale (mRS) score (r≥0,29, p≤0,006) on day 90.Conclusion. Patients with hemispheric AIS had significantly higher systolic BP and pulse pressure within the month before stroke. During the first 10 days of AIS persistent increase in systolic, diastolic, and pulse pressure, and BP variability was associated with more severe stroke and less favorable outcome. These results should be taken into account when administering antihypertensive treatment.

Ruptures of arterial aneurysms of the brain and stenosis of the carotid basin: clinic, diagnosis

Objective – to investigate the clinical and morphological characteristics of the manifestations of the rupture of arterial aneurysms of the brain in patients with occlusive-stenotic lesions of the cerebral arteries.Materials and methods. 1147 case histories of patients with aneurysmal disease of the cerebral arteries who underwent comprehensive examination and treatment in the Department of Neurosurgical Pathology of Head and Neck Vessels with X-ray Surgical Department «Romodanov Institute of Neurosurgery NAMS of Ukraine» since 2006 until 2022. The medical histories of 126 patients who were included in this study and divided into two groups were studied in detail. The criteria for inclusion in the main group (38 men and 25 women) were: surgical treatment; rupture of arterial aneurysm the presence (proven using instrumental examination methods) of occlusive-stenotic lesions.The criteria for inclusion in the control group (38 men and 25 women) were: surgical treatment; rupture of arterial aneurysm; absence (proven by means of instrumental examination methods) of occlusive-stenotic lesions; the gender and age distribution had to match the main group.Among the patients included in this study, there were 76 men (60.32 %) and 50 women (39.68 %). The age of the patients varied from 31 to 77 years. The average age of patients ‒ 55.9 ± 0.76 years. Results. The Hunt‒Hess severity of patients was approximately the same between the main and control groups. When evaluated by the World Federation of Neurologican Surgeons (WFNS) and Glasgow Coma scale (GCS), more patients in the control group had a lighter score. Aneurysms of the anterior cerebral-anterior connecting artery complex prevailed in both groups. A higher frequency of arterial aneurysms of the middle cerebral artery was revealed among patients of the main group (main group ‒ 27.0 %, comparison group 15.8 %). The higher number of multiple aneurysms in the main group (the main group ‒ 25.4 %, the controlgroup ‒ 12.7 %) and the smaller number of miliary aneurysms and the larger number of large aneurysms in the main group may indicate the predominance of congenital etiological factors common to both pathologies in the development of the disease until the rupture of the arterial aneurysm.Conclusions. Gender differences were established with a predominance of men among patients of the main group (60.32 %). The average age of men with occlusive-stenotic lesions was lower than that of women (men – 54.3±0.94 years, women – 58.3±1.19 years). The difference in age is especially pronounced in the subgroup of the main group where the severity of stenosis is 50‒75 % (men ‒ 48.3 years; women ‒ 62.0 years).The neurological status of patients with a hemorrhagic stroke, as a result of the rupture of an arterial aneurysm, is significantly aggravated by occlusive-stenotic lesions due to the occurrence of chronic brain ischemia. The worst prognosis is in men with a ruptured arterial aneurysm and a 50‒75 % stenotic lesion.

The use of Mexidol in patients with mild (moderate) cognitive impairment: results of a meta-analysis

To conduct a meta-analysis of the effectiveness of Mexidol therapy in patients with chronic brain ischemia (CBI) and cognitive disorders (CD). This meta-analysis included the results of studies on the effectiveness of Mexidol in patients with CD measured with Montreal Cognitive Assessment Scale (MoCA). The pooled effect assessment included all publications from independent clinical trials that provided efficacy data on the MoCA scale with a level of detail sufficient for further mathematical analysis. The main result of the meta-analysis was obtained for the final values of the effectiveness indicator in the Mexidol groups compared with the basic therapy groups. Data from 10 prospective randomized trials containing information on the final scores on the MoCA scale after therapy was analyzed. The meta-analysis of ten prospective clinical studies of the effectiveness of Mexidol against the background of basic therapy in patients with CCI and CD was carried out. The total number of patients taking Mexidol was 482; the comparison group consisted of 455 patients. According to the results of a statistical model of random effects, the effect size was 2.06; 95% confidence interval for the difference in effectiveness between the groups of the study drug and the control groups [0.98; 3.14] (p=0.0002). A statistically significant and clinically significant improvement in the cognitive functions of patients with CBI, was demonstrated after treatment with Mexidol.

International multicenter randomized double-blind placebo-controlled study assessing the efficacy and safety of sequential therapy with Mexidol and Mexidol FORTE 250 in patients with chronic brain ischemia (MEMO): subanalysis in patients with arterial hypertension

International multicenter randomized double-blind placebo-controlled study assessing the efficacy and safety of sequential therapy with Mexidol and Mexidol FORTE 250 in patients with chronic brain ischemia (MEMO): subanalysis in patients with arterial hypertension

Changes in cerebral hemodynamic parameters for patients with encephalopathies of different genesis

Mental function impairment is a common sign of encephalopathies, which various factors, including neurological disorders and cerebral hemodynamics, can cause.The purpose of the study was to establish changes in cerebral hemodynamic parameters in patients with encephalopathies of various origins.Material and methods. 520 patients with chronic traumatic encephalopathy (CTE, n=145), vascular encephalopathy in chronic brain ischemia (CVE, n=145), chronic alcoholic encephalopathy (CAE, n=102) and post-infectious encephalopathy (PIE, n=128) were examined. The patients were receiving inpatient treatment on the basis of the communal non-profit enterprise "Ternopil Regional Clinical Psychoneurological Hospital" during the period of 2021-2022. The cerebral blood flow was assessed using transcranial doppler scanning of intracranial and extracranial brachiocephalic vessels on a Philips HDI device.Research results. The most frequent disorders of cerebral hemodynamics in patients with CTE are the following: insufficient blood flow (44.83%), angiospasm (44.14%) and stenosis (40.69%); in patients with CVE – stenosis (67.59%), insufficient blood flow (66.21%) and venous stasis (64.83%); in patients with CAE – insufficient blood flow (32.35%), angiospasm (31.37%) and venous stasis (30.39%); in patients with PIE - angiospasm (45.31%), blood flow insufficiency (37.50%) and vertebro-basilar insufficiency (30.47%). Comparing the parameters of cerebral hemodynamics in patients with encephalopathies of various genesis, it was established that angiospasm in patients with CVE was recorded more often (by 23.11%) than in patients with CAE. A similar trend was noted in patients with CTE and PIE relative to the CAE group. The frequency of registration of blood flow insufficiency in patients with CVE probably exceeded the data of groups of CTE, CAE, and PIE (by 21.38, 33.86, and 28.71%, respectively). At the same time, the presence of changes within two distribution zones - carotid cerebral and vertebral-basilar in patients with CVE probably exceeded the data of the CAE and PIE groups. Regarding the comparison of the characteristics of stenoses, the frequency of detection of this phenomenon in patients with CTE probably exceeded the data of the CTE, CAE, and PIE groups (by 26.90, 53.86, and 64.46%, respectively). At the same time, the proportion of patients with significant stenosis in the CTE group probably exceeded the data of the CVE, CAE and PIE groups. The highest frequency of registration of venous stasis was established in patients with CTE (64.83%), which probably exceeded the data of the CTE, CAE and PIE groups. Vertebro-basilar insufficiency was not detected in patients with CAE, and in the PIE group its frequency of registration was 14.61% higher than the data of the CVE group and 18.06% higher than the data of the CTE group.Conclusions. The obtained results indicate the heterogeneity and polymorphism of the parameters of cerebral hemodynamics in patients with encephalopathies of various genesis, which requires further research to find possible relationships between them and cognitive dysfunction.

Clinical characteristics of vertigo in elderly patients with chronic brain ischemia after SARS‑CoV‑2 coronavirus infection

Objective. To study the structure and clinical features of vertigo in elderly patients with chronic cerebral ischemia (CCI) who underwent a new SARS-CoV-2 coronavirus infection.Materials and methods. Clinical characteristics of vertigo were determined in 98 patients (48 men and 50 women aged 60–75 years) with CCI caused by arterial hypertension and its combination with atherosclerosis. The type and main characteristics of dizziness were determined using diagnostic criteria and an algorithm for examining patients. The level of anxiety was determined using the scale of Spielberger, depression – the Beck questionnaire.Results. Dizziness in elderly patients with CCI was characterized by clinical heterogeneity with a predominance of non-systemic vertigo and systemic benign paroxysmal positional vertigo in the structure of vertigo. Elderly patients with CCI who underwent a new SARS-CoV-2 coronavirus infection were more likely to have psychogenic and systemic benign paroxysmal positional vertigo, increased levels of anxiety and depression.

Features of clinical and neurological manifestations in patients suffered COVID-19

The aim of the work was to study the gender characteristics of clinical and neurological manifestations in patients with chronic brain ischemia depending on the presence of vaccination. The main neurological complaints presented by patients with chronic cerebrovascular disorders after sufferred COVID-19 were identified, which made it possible to determine the characteristics and frequency of occurrence of individual complaints in men and women. Changes in neurological status data were carefully analyzed depending on gender characteristics and the presence of vaccination. Changes in the neurological status in the group of men were detected in the study of the motor, sensitive sphere, vestibular sphere, and in women — in the study of coordination and vestibular disorders depending on the presence of vaccination, which allows us to say that the absence of vaccination leads to an increase in the expressiveness of complaints and manifestations of neurological disorders regardless of gender in different age groups of patients. Key words: COVID-19, clinical and neurological disorders, vaccination, gender characteristics

Neuroimaging aspects in encephalopathies of various genesis

This article is devoted to the analysis of the neuroimaging picture of the most common types of encephalopathies. In particular, in 2021 and 2022, we examined 520 patients with post-traumatic encephalopathy (TE) (n = 145), vascular encephalopathy (VE) in case of chronic brain ischemia (n = 145), alcoholic encephalopathy (AE) (n = 102), and post-infectious encephalopathy (PIE) (n = 128). We studied the neuroimaging characteristics of each of these subtypes, their features and frequency. Thus, we established that the most frequent expansion of the ventricles was observed in patients with VE (53.79 %), which probably exceeded the similar indicator in patients with TE (by 26.89 %), with AE (by 15.55 %) and from PIE (by 37.38 %). Expansion of the subarachnoid spaces was equally common in the groups of patients with TE (38.62 %) and VE (40.00 %), with a probable difference in relation to the group with PIE (7.81 %). Patients with AE (60.78 %) had significantly more frequent manifestations of gliosis than patients with TE (47.59 %). The highest frequency of cystic changes was observed in the group with TE (45.05 %), which significantly exceeded the indicators of other groups. The correlations between neuroimaging changes and clinical syndromes were clarified. Key words: encephalopathy, post-traumatic encephalopathy, vascular encephalopathy in case of chronic brain ischemia, alcoholic encephalopathy, post-infectious encephalopathy

Local transplantation of mesenchymal stem cells improves encephalo-myo-synangiosis-mediated collateral neovascularization in chronic brain ischemia

BackgroundTo explore whether local transplantation of mesenchymal stem cells (MSCs) in temporal muscle can promote collateral angiogenesis and to analyze its main mechanisms of promoting angiogenesis.MethodsBilateral carotid artery stenosis (BCAS) treated mice were administrated with encephalo-myo-synangiosis (EMS), and bone marrow mesenchymal stem cells (BMSCs) were transplanted into the temporal muscle near the cerebral cortex. On the 30th day after EMS, the Morris water maze, immunofluorescence, laser speckle imaging, and light sheet microscopy were performed to evaluate angiogenesis; In addition, rats with bilateral common carotid artery occlusion were also followed by EMS surgery, and BMSCs from GFP reporter rats were transplanted into the temporal muscle to observe the survival time of BMSCs. Then, the concentrated BMSC-derived conditioned medium (BMSC-CM) was used to stimulate HUVECs and BMECs for ki-67 immunocytochemistry, CCK-8, transwell and chick chorioallantoic membrane assays. Finally, the cortical tissue near the temporal muscle was extracted after EMS, and proteome profiler (angiogenesis array) as well as RT-qPCR of mRNA or miRNA was performed.ResultsThe results of the Morris water maze 30 days after BMSC transplantation in BCAS mice during the EMS operation, showed that the cognitive impairment in the BCAS + EMS + BMSC group was alleviated (P < 0.05). The results of immunofluorescence, laser speckle imaging, and light sheet microscopy showed that the number of blood vessels, blood flow and astrocytes increased in the BCAS + EMS + BMSC group (P < 0.05). The BMSCs of GFP reporter rats were applied to EMS and showed that the transplanted BMSCs could survive for up to 14 days. Then, the results of ki-67 immunocytochemistry, CCK-8 and transwell assays showed that the concentrated BMSC-CM could promote the proliferation and migration of HUVECs and BMECs (P < 0.05). Finally, the results of proteome profiler (angiogenesis array) in the cerebral cortex showed that the several pro-angiogenesis factors (such as MMP-3, MMP-9, IGFBP-2 or IGFBP-3) were notably highly expressed in MSC transplantation group compared to others.ConclusionsLocal MSCs transplantation together with EMS surgery can promote angiogenesis and cognitive behavior in chronic brain ischemia mice. Our study illustrated that MSC local transplantation can be the potential therapeutical option for improving EMS treatment efficiency which might be translated into clinical application.

COMORBIDITY AND CAUSE OF DEATH IN THE DIFFERENT VARIANTS OF SARS-COV-2 VIRUS, WITH CONTRIBUTION OF 20 AUTOPSY CASES

Analyzing the clinical and epidemiological data of COVID-19 suggests that specific comorbidities increase the risk of infection leading to worse lung injury and an even higher risk of death. The most common comorbidities reported up till now are hypertension, cardiovascular diseases, and diabetes. Aim to study: The design of the study includes comorbidity of patients and cause of death in alfa, delta, and omicron variants of SARS-CoV-2 virus, histological changes in the lungs, thrombotic complications of coronavirus infection and laboratory tests concerning thrombotic changes. Materials and Methods: We systematically evaluated 20 autopsies of patients deceased by COVID-19 infection. Collecting data was from February 28th, 2020, until June 2022. The cases were diagnosed with a PCR (Polymerase Chain Reaction) test and a rapid antigen test. 10 of the deceased patients were from the first, second, third, and fourth wave (I group) infected predominantly with the alfa and delta variants of coronavirus (from March 2020 until October 2021), and 10 patients infected after that date with predominantly the omicron variant (II group). Results: Most patients were over 50 years of age with multiple co-morbidities (28-88, average 63.9). Post-mortem case studies have shown Arterial hypertension in 80% (I/II gr), 60%/90% of patients with chronic ischemic heart disease, chronic and acute ischemic brain disease in 30%/10%, atherosclerosis, 60%/90%, diabetes mellitus 30%/40%, obesity stage III, 100%/95%). Clinical laboratory studies, in connection with thrombotic complications, revealed the increased value of creatine kinase, fibrinogen, D-dimers, and CRP. Lymphopenia was observed in 60%.All of the cases with COVID-19 viral desquamative pneumonia, at different stages, developed vascular thrombosis in medium-sized pulmonary vessels. Two patients developed pulmonary thromboembolism. We established 5 patients with generalized thrombosis. Three patients were complicated by infarcts in the brain, kidney, and spleen. Conclusion: The autopsies revealed a consistent pattern of pulmonary alveolar damage and generalized vascular/thrombotic disease in patients with frequent co-morbidities. The high frequency of generalized thrombotic complications was observed in predominant alfa and delta variants of the infection, while in the group with the omicron prevailing variant, the lung lesions were dominant, without extrapulmonary thrombotic complications, which we explain by the effective antithrombotic therapy. Major complications in these patients were secondary bacterial infection, sepsis, and respiratory distress syndrome.

A Propensity-Matched Comparison of Ischemic Brain Lesions on Postprocedural MRI in Endovascular versus Open Carotid Artery Reconstruction.

(1) Study purpose: The aim of our prospective single-center, matched case-control study was to compare the number and volume of acute ischemic brain lesions following carotid endarterectomy (CEA) versus carotid artery stenting (CAS) using a propensity-matched design. (2) Methods: Carotid bifurcation plaques were analyzed by using VascuCAP software on CT angiography (CTA) images. The number and volume of acute and chronic ischemic brain lesions were assessed on MRI scans taken 12-48 h after the procedures. Propensity score-based matching was performed at a 1:1 ratio to compare the ischemic lesions on postinterventional MR. (3) Results: A total of 107 patients (CAS, N = 33; CEA, N = 74) were included in the study. There were significant differences in smoking (p = 0.003), total calcification plaque volume (p = 0.004), and lengths of the lesion (p = 0.045) between the CAS and CEA groups. Propensity score matching resulted in 21 matched pairs of patients. Acute ischemic brain lesions were detected in ten patients (47.6%) of the matched CAS group and in three patients (14.2%) in the matched CEA group (p = 0.02). The volume of acute ischemic brain lesions was significantly larger (p = 0.04) in the CAS group than in the CEA group. New ischemic brain lesions were not associated with neurological symptoms in either group. (4) Conclusions: Procedure-related new acute ischemic brain lesions occurred significantly more frequently in the propensity-matched CAS group.

T1w/T2w ratio is associated with the brush sign and perfusion delay in watershed regions in patients with moyamoya angiopathy

BackgroundIt has been shown recently using the T1w/T2w mapping technique that white matter microstructural integrity impairments exist in watershed regions patients with moyamoya angiopathy (MMA). We hypothesized that these changes could be associated with the prominence of other neuroimaging markers of chronic brain ischemia, such as perfusion delay and the brush sign. MethodsThirteen adult patients with MMA (24 affected hemispheres) were evaluated using brain MRI and CT perfusion. The T1w/T2w signal intensity ratio, which reflects white matter integrity, was calculated in watershed regions (centrum semiovale and middle frontal gyrus). Brush sign prominence was evaluated with susceptibility-weighted MRI. Additionally, brain perfusion parameters such as cerebral blood flow (CBF), cerebral blood volume (CBF), and mean transit time (MTT) were assessed. Correlations between white matter integrity and perfusion changes in watershed regions, as well as the prominence of the brush sign, were evaluated. ResultsStatistically significant negative correlations between the prominence of the brush sign and the T1w/T2w ratio values from the centrum semiovale and middle frontal white matter were found (R = −0.62 to 0.71, adjusted p < 0.05). Furthermore, there was a positive correlation between the T1w/T2w ratio values and the MTT values from the centrum semiovale (R = 0.65, adjusted p < 0.05). ConclusionsWe revealed that T1w/T2w ratio changes are associated with the prominence of the brush sign as well as white matter hypoperfusion in watershed regions in patients with MMA. This could be explained by chronic ischemia due to venous congestion in the deep medullary vein territory.

Cognitive function restoration in rats with chronic brain ischemia using Semax and hopantenic acid comprehensive administration

The relevance and importance of treating patients with ischemic brain lesions are indisputable. Chronic ischemic processes in the brain occur much more frequently than acute cerebral circulation disorders, leading to prolonged disability and being the main contributors to a significant number of strokes. Cognitive dysfunctions prevail in the dynamics of the post-ischemic period and are often the primary determinants of the severity of residual organic and subsequent functional impairments of the brain. The aim of the study is to investigate the effectiveness of separate and combined administration of Semax and hopantenic acid in the pharmacological correction of cognitive disorders in rats with experimental chronic brain ischemia. It has been established that rats with chronic brain ischemia exhibit cognitive impairments from the 1st day, manifested in worsened learning processes, short-term and long-term memory functioning in the context of conditioned active avoidance and conditioned feeding reflexes. It has been shown that separate and combined application of Semax and hopantenic acid contributes to the restoration of the learning process and improvement of mnestic functions in rats with chronic brain ischemia. The most pronounced nootropic effect in rats with chronic brain ischemia was registered under the conditions of combined administration of Semax and hopantenic acid, starting from the 3rd day of the study. Subsequently, in terms of anti-ischemic efficacy, the effect of Semax follows, which was realized starting from the 3rd day of the study. The least pronounced neuroprotective effect belongs to hopantenic acid, starting from the 7th day of the study. The author considers the obtained data as experimental groundwork for the feasibility of clinically testing the nootropic effects of the combined administration of Semax and hopantenic acid in cases of chronic brain ischemia. The comprehensive pharmacological correction of cognitive disorders in chronic brain ischemia is pathogenetically justified and aimed at activating sanogenetic mechanisms.

Muscle activity and emotional behavior changes in rats with chronic brain ischemia via comprehensive pathogenetic correction

Cerebrovascular pathology has evolved from a medical concern to a social issue, with the efficacy of secondary neuroprotection remaining a pertinent question. While some investigations have been conducted to elucidate the effectiveness of a comprehensively grounded pharmacological correction scheme under conditions of experimentaly induced chronic brain ischemia, further refinement is necessary to understand the behavioral effects of animals, dosages, routes of administration of pharmacological agents, and analysis of obtained data. The aim of this study was to assess the effectiveness of applying Semax and hopantenic acid in the comprehensive treatment of motor disorders and established neurological impairments in rats with experimentally induced chronic brain ischemia. We determined that rats with chronic brain ischemia exhibit muscular dysfunctions and experience pronounced disturbances in emotional behavior from the first day. It has been demonstrated that the separate and combined application of Semax and hopantenic acid contributes to the restoration of muscle activity, normalization of coordination, and emotional behavior in rats with chronic brain ischemia. The most significant neuroprotective effect in rats with chronic brain ischemia was observed with the combined administration of Semax and hopantenic acid, starting from the 3rd day of the trial. The subsequent in the series of anti-ischemic effectiveness is the impact of Semax from the 3rd day of the experiment. The least pronounced neuroprotective effect was exhibited by hopantenic acid, starting from the 5th day of the experiment. We consider these findings to be an experimental foundation supporting the feasibility of clinically testing the effects of combined Semax and hopantenic acid administration, capable of restoring functional disorders caused by chronic brain ischemia. In conclusion, the observed effectiveness of the developed pathogenetically justified complex for the correction of post-ischemic muscle dysfunction and disorders indicates the development of an anti-ischemic effect, as well as the fundamental possibility of improving the treatment for patients with chronic brain ischemia through clinical intranasal administration of Semax, either alone or in combination with hopantenic acid. However, for a more comprehensive understanding of the temporal and dose-dependent effects of this complex pathogenetic correction scheme on other disorders and dysfunctions related to chronic brain ischemia and to formulate final conclusions, it is essential to conduct separate series of experimental studies.

Международное многоцентровое рандомизированное двойное слепое плацебо-контролируемое исследование оценки эффективности и безопасности последовательной терапии пациентов с хронической ишемией мозга препаратами Мексидол и Мексидол ФОРТЕ 250 (исследование МЕМО): результаты субанализа у пациентов с артериальной гипертонией

Международное многоцентровое рандомизированное двойное слепое плацебо-контролируемое исследование оценки эффективности и безопасности последовательной терапии пациентов с хронической ишемией мозга препаратами Мексидол и Мексидол ФОРТЕ 250 (исследование МЕМО): результаты субанализа у пациентов с артериальной гипертонией

VESTIBULAR DYSFUNCTIONS IN CHRONIC BRAIN ISCHEMIA IN THE POST COVID PERIOD.

The aim: The aim of the study is the clinical-pathogenetic reasoning of vestibular dysfunctions (VD) development against the background of chronic brain ischemia in the presence of degenerative changes in the cervical spine (CS) in the post COVID period. Materials and methods: 82 patients, in the conditions of the clinical base of the Odessa National Medical University in 2019-2021 were examined. Group I with VD against the background of chronic brain ischemia (CBI) at the compensated phase; Group II with VD against the background of CBI at the subcom¬pensated phase (33 men; 49 women), aged from 18 to 55 years. The control group (CG) consisted of 20 patients of the corresponding gender and age. The condition of the state of the autonomic nervous system, vestibular functions, cervical spine, cerebral arteries and emotional condition were examined. Results: Vestibulo-ataxic disorders were higher compared to CG and increased along with the degree of brain damage. An important aspect of the development of VD is autonomic dysfunction against the background of pathological autonomic characteristics with predominant parasympathetic orientation of autonomic tone, especially in the case of insufficiency of autonomic recativity (AR) and pathological autonomic support of activity. Such changes significantly increased in the presence of subcompensation of CBI. The correlation between psychoemotional disorders and changes in autonomic characteristics with VD against the background of CBI with initial regularities depending on the degree of brain damage was defined. The progression of CBI is facilitated by coronavirus infection and manifested in autonomic and psychoemotional dysfunctions. A characteristic hemodynamic feature in groups with compensated and subcompensated CBI is the presence of reduced perfusion in basilar (BA) and vertebral (VA) arteries. Changes in cerebral vascular reactivity with a decrease in cerebrovascular reactivity indicators were characteristic of the subcompensated phase of CBI. Hyperactivity to rotational functional loads in both clinical groups has a high correlation with the presence of stair descent and, to a lesser extent, isolated instability in CS. Conclusions: 1. The occurrence of VD is facilitated by the presence of autonomic dysfunction and degenerative-dystrophic changes in the CS, especially in case of subcompensation of CBI. 2. Psychoemotional changes were a characteristic feature of patients with VD against the background of CBI and had certain regularities depending on the phase of CBI. 3. Suffered coronavirus infection contributes to the progression of VD and further decompensation of CBI due to direct damage to the autonomic and vascular systems of the brain. 4. Changes in cerebral hemodynamics in the form of reduced perfusion in BA and VA, a decrease in cerebrovascular reactivity, and an increase in reactivity to rotational functional load were determined in patients with VD against the background of subcompensated CBI.

Serum brain damage biomarkers as a diagnostic and prognostic tool in ischemic stroke

To study serum quantities of neuron specific enolase (NSE), glial fibrillary acidic protein (GFAP) and NR2-antibodies (NR2-ab) in various cerebrovascular pathology and assess their value as a panel used as a diagnostic and predictive tool for stroke. NSE, GFAP and NR2-ab serum levels were measured twice for 84 patients with ischemic stroke (IS) and 8 patients with hemorrhagic stroke (HI), once for 8 patients with transient ischemic attack (TIA), 26 patients with chronic brain ischemia (CBI), 27 healthy volunteers (HV). NSE and GFAP levels were significantly higher in IS than in CBI and HV patients, and NR2-ab levels in IS were higher than in TIA and lower than in HV. In patients with more pronounced neurological deficiency and less favorable functional outcome by day 10-14 of IS, the levels of NSE, GFAP and NR2-ab were higher. Sensitivity and specificity of biomarker panel was higher than with their separate application. The NSE, GFAP and NR2-ab biomarkers have a diagnostic and predictive value for IS.