Chronic Brain Ischemia Research Articles

Arterial hypertension: possible pathogenetic mechanisms for the development of chronic brain ischemia

Arterial hypertension: possible pathogenetic mechanisms for the development of chronic brain ischemia

Cholinergic profile as a target of rational therapy of central nervous system diseases and injuries

A comparative analysis of the clinical efficacy of cholinergic drugs and acetylcholinesterase inhibitors (IHE), as well as their combination, in the treatment of cerebrovascular disease and consequences of intracranial injury according to clinical, instrumental and laboratory dynamic observations. Ninety patients with cerebrovascular pathology, including 45 with chronic brain ischemia stage 2 (ICD-10 I67) and 45 with sequelae of intracranial injury (ICD-10 T90.5), were enrolled in the study. Complex treatment of patients included basic and specific therapy. The groups were divided into 3 subgroups of 15 people: the neuromidin group, the gliatilin group and the neuromidin + gliatilin group. The duration of treatment was 2 months. All patients underwent a comprehensive clinical, neurophysiological and laboratory examination prior to therapy, after 1 month and 2 month from the beginning of therapy: a study of cholinesterase activity in the blood, testing on MMSE and Hamilton scales, transcranial magnetic stimulation with determination of Central motor conduction time and somatosensory evoked potentials with calculation of Central afferent conduction time. Prior to treatment, a significant positive strong correlation was found between the age of patients and the level of CE activity in serum (Rs=0.77; p=0.0001). The treatment resulted in a significant (p<0.05) improvement of all parameters (except for MMSE that showed a trend towards improvement) in the neuromidin and the neuromidin + gliatilin subgroups of each group compared to those in the gliatilin subgroups. In addition, after 2 months from the beginning of treatment, there was a significant decrease in the activity of CE in serum in the neuromidin and the neuromidin + gliatilin subgroups. The study of deviations of the 'cholinergic profile' (the level of CE activity in the blood) in patients with cerebral pathology and the strategy using cholinergic drugs, IHE and their combination for the treatment of neuropsychiatric disorders, is one of the important directions in the optimization of combined therapy of patients of this profile.

Progression of precerebral atherosclerosis and predictors of ischemic complications in cardiac patients

To identify predictors of progression of precerebral atherosclerosis in long-term period after coronary artery bypass surgery. There were 97 procedures of carotid endarterectomy in patients after previous coronary artery bypass grafting for the period from 2006 to 2017. Inclusion criteria were previous CABG, no significant (over 60%) stenosis of internal carotid arteries at discharge after CABG. The control group included 447 patients without progression of precerebral atherosclerosis in long-term period after CABG. Careful monitoring of progression of precerebral atherosclerosis and therapeutic prevention of ischemic stroke are required in patients with mild-to-moderate ICA stenosis after CABG. The most significant predictors of progression of precerebral atherosclerosis after CABG were AF (OR=1.97, 95% CI 1.04-3.73), previous occlusion of stent (OR=7.89, 95% CI=2.3-27.0), chronic brain ischemia grade II or III (OR=22.45, 95% CI=11.9-42.3), chronic kidney disease (OR=15.8, 95% CI=5.04-49.5). It was revealed that the majority of predictors of adverse ischemic cerebral and myocardial events are indirectly associated with atrial fibrillation.

Радиологические изображения в создании гибридных интеллектуальных систем

So far, the concept of image row or tuples in the development of intelligent systems has been discussed in relation to the role of phenotypic (external) manifestations of diseases in diagnostics. This study introduces the idea of neuroimaging tuples as a tool to make a prognosis of the course of chronic cerebral ischemia. The phenomenon of leukoaraiosis is analyzed as a radiological feature of chronic brain ischemia and a predictor of stroke. Image tuples are formed from the results of computed tomography, computed tomography angiography, magnetic resonance imaging, of 85 patients with chronic cerebral ischemia. Native computed tomography images were processed with adaptive filtering methods. Computed tomography angiography results were processed through a vesselness filter that allows development of 3D reconstructions of vasculature in leukoaraiosis areas. The problem of fuzzy images, the principles of comparative analysis of images and the possibility of using confidence factors in the image tuples are discussed in the article. A scheme of a hybrid intelligent system that combines traditional logic-linguistic rules and images based on primary information and reconstruction of the original DICOM images in the knowledge base was developed. The sphere of the application is stroke risk prediction using an intelligent system.

Evaluation of heart rhythm variability in diagnosis of vegetative dysfunction in chronic cerebral ischemia

Objectives - the assessment of the possibilities of using heart rhythm variability in the diagnosis of vegetative dysfunction in chronic brain ischemia (CBI). Material and methods. Cardiointervalography was performed for 157 patients with varying intensity of CBI at rest and while performing functional tests. The resulting statistical and spectral parameters were estimated on the basis of multiple regression analysis depending on the severity of the CBI. The parameters, obtained as a result of spectral analysis of cardiointervalography, were used as the predictor data: low, high frequency end and their integrative indicators. Results. With an increase in the severity of CBI, there is a clear tendency towards an increase in heart rate variability with a predominance of autonomous regulation, against the background of its expressed decentralization during physical exercise. The obtained model describes the changes in cardiointervalography that occur with the progression of CBI. These changes can act as independent factors aggravating the course of concomitant cardiovascular pathology, or can serve as its trigger factors. Conclusion. The obtained data may indicate a decrease in the adaptive effects of suprasegmental structures of the autonomic nervous system on the cardiac cycle. Various methods of analysis of cardiointervalography make it possible to conduct a multilevel analysis of the heart rhythm, to identify not only the obvious pathology of the regulation of cardiac activity, but also the violation of its adaptive mechanisms.

CLINICAL AND IMMUNOLOGICAL ASPECTS OF CHRONIC HEADACHES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Objective: to study the clinical and immunologica features of the manifestation of chronic pain in systemic lupus erythematosus (SLE) patients with neurological symptoms.Methods. We examined 30 healthy individuals and 38 patients with SLE. Beck’s depression questionnaire was used to assess the presence of depressive symptoms. Antibodies to adenosine deaminase (anti-ADA), β2-glycoprotein-I-dependent antibodies to phospholipids of the IgG class (anti-FL) and antibodies to double-stranded DNA (anti-dsDNA) were determined in the serum of patients with SLE. Doppler sonography of the brachiocephalic arteries was performed for all patients with SLE.Results. Complaints about the presence of headaches of varying severity presented 35 people (92.1%). Migraine was recorded in 63.2% patients with SLE. Doppler ultrasound in patients with SLE with chronic headaches in 66.7% of cases showed signs of reduced blood flow in the arteries of the vertebrobasilar basin, which may indicate chronic brain ischemia. Signs of depressive disorder of varying severity were found in 36.8% of patients with SLE, and in patients with neurological disorders, moderate (p = 0.027) and severe (p = 0.041) depression were more often detected. Elevated levels of anti-ADA were found in 36.8%, and anti-FL in 44.7% of patients with SLE. It was noted that “migraine-like” manifestations of chronic pain syndrome were more common in the group of patients with SLE, who had a combined increase in anti-ADA and anti-FL (χ2 = 4.5; p = 0.024). Since a certain part of ADA is concentrated in the plasma membranes of vascular and platelet endothelium cells, it can be assumed that there is a conformational effect of anti-ADA on the β2-glycoprotein-I, leading to increased synthesis of anti-FL and undesirable activation of coagulation cascade in vessels.Conclusion. The combination of severe chronic headache with high levels of anti-ADA and anti-FL can precede the development of stroke and transient ischemic attacks, which emphasizes the need for additional immunological examination of patients with SLE with neurological symptoms.

Errors in the management of patients with Alzheimer's disease: analysis of problems and ways of their solution

Epidemiological data show that Alzheimer's disease (AD) is the most common cause of acquired cognitive impairment (CI). At the same time, according to statistics, vascular CI and vascular dementia predominate in Russia, which is mainly due to imperfect diagnosis, when any pathological condition associated with cerebral dysfunction in a patient with vascular risk factors is interpreted as dyscirculatory encephalopathy or chronic brain ischemia. However, this can be asthenoneurotic syndrome, migraine, vestibular dysfunction, and a number of neurodegenerative diseases, the most common condition of which is certainly AD. What is more, the treatment of age-related diseases, with the exception of acute vascular disease, is receiving manifestly inadequate attention. All this leads to the lack of a unified methodology for the management of these patients, to the impossibility to have adequate primary medical care, to the low detection rate of CI, to the prescription of drugs without appropriate indications, and to the denial of psychological correction methods. The review highlights the challenges facing the management of patients with AD and the possible ways of their solution.

Association between serum carbohydrate antigen 19-9 levels and leukoaraiosis in middle-aged and older adults: A cross-sectional study

Background and aimsLeukoaraiosis refers to lesions with high signal intensity on magnetic resonance imaging (MRI) in periventricular and subcortical white matter that results from chronic microvascular ischemic brain damage. Increasing evidence suggests that serum CA 19–9 is associated with non-malignant conditions including type 2 diabetes, dyslipidemia, and metabolic syndrome, which are closely related to microangiopathy. Thus, we hypothesized that serum CA 19-9 levels would be associated with cerebrovascular microangiopathy measured by leukoaraiosis among middle-aged and older adults. MethodsThis cross-sectional study included 1833 Korean adults aged ≥45 years who participated in a health examination program between 2010 and 2011. Serum CA 19-9 levels were quantified by chemiluminescence immunoassay and categorized as quartiles: Q1: ≤4.5, Q2: 4.6–7.5, Q2: 7.6–12.2, and Q4: ≥12.3 ng/mL. Odds ratios (ORs) and 95% confidence intervals (CIs) for leukoaraiosis based on brain MRI scans were calculated across serum CA19-9 quartiles using multiple logistic regression analysis. ResultsThe overall prevalence of leukoaraiosis was 4.6% and increased with serum CA 19-9 quartiles. Compared to the lowest quartile, the OR (95% CI) of the highest CA 19–9 quartile for leukoaraiosis was 2.20 (1.10–4.42) after adjusting for age, sex, BMI, regular exercise, hypertension, type 2 diabetes, dyslipidemia, smoking status, and alcohol drinking. ConclusionsSerum CA 19-9 levels were positively and independently associated with leukoaraiosis. Our findings indicate that serum CA 19-9 level might be a useful additional measure for assessing cerebrovascular microangiopathy in clinical settings.

INFLUENCE OF BLOOD PRESSURE VARIABILITY ON COGNITIVE FUNCTION IN PATIENTS WITH DYSCIRCULATORY ENCEPHALOPATHY (LITERATURE REVIEW)

Goal. To review the literature on the problem of the influence of variability of blood pressure on the cognitive function of patients with dyscirculatory encephalopathy after suffering ischemic stroke on the background of hypertension.&#x0D; Research Methods: Bibliosemantic, Comparative and Systemic Results. In the Recommendations of the European Society of Cardiologists / European Society for Hypertension (European Approach).&#x0D; Society for Cardiology / European Society of Hypertension - ESC / ESH) 2018 for the treatment of hypertension emphasized that the study of cognitive function (CF) should be mandatory in the list of methods of examination of patients to detect the damage of target organs caused by hypertension, in order refinement of stratification of risk of cardiovascular events, namely stroke (Williams B. et al., 2018). Cognitive impairment in patients with cardiovascular disease is known to be one of the earliest and most sensitive indicators of cerebral vascular injury and is a consequence of chronic cerebral ischemia and / or recurrent acute cerebral circulation disorders. It is proved that the variability of blood pressure has a negative effect on cerebral circulation, is a predictor of chronic brain ischemia, which can result in the appearance or deepening of cognitive impairment. In the ASCOT study on the prognostic significance of variability in daily monitoring of blood pressure, intracutaneous variability, and long-term variability, it was found that visit-to-visit variability is a strong predictor of stroke and coronary events, not independent of the level.&#x0D; Conclusions. Analysis of the literature on this problem has shown the negative effect of blood pressure variability on the course of chronic brain ischemia, which exacerbates cognitive and emotional-volitional disorders in patients with hypertensive dyscirculatory encephalopathy. The peculiarities of the effect of blood pressure variability on CF in patients with brain stroke are poorly understood and need further investigation.

Sirtuins and neuronal DNA damage under experimental chronic cerebral hypoperfusion

Chronic brain hypoperfusion (ChCH) is a risk factor for central nervous system (CNS) diseases, such as chronic brain ischemia, degenerative diseases, and others, in this connection, the study of its pathophysiological mechanisms is an actual problem.Objective. To investigate the relationship between SIRT1/SIRT3 expression and activity and damage of neuronal DNA in conditions of chronic cerebral hypoperfusion in mice.Маterials and methods. The experiments were carried out on male C57Bl mice (6 weeks old, weight 18–20 g), which underwent occlusion of left common carotid artery to model ChCH. On the background of ChCH nicotinamide (NAM, 200 mg/kg, 10 d, i.p.) and resveratrol (RV, 10 mg/kg, 10 d, i.p.) were used. All manipulations were carried out in anesthetized with ketamine (60 mg/kg, i.p.) mice. In 8 weeks, in mice brain tissues the features of neuronal DNA damage were studied by DNA comet assay and SIRT1/SIRT3 gene expression levels by real-time RT-PCR.Results. ChCH modeling was accompanied on the unilateral side by an increase of DNA damage (comets within classes 3 and 4) index of neurons by 6.9 times, and by a decrease of SIRT1 and SIRT3 gene expression by 9.3 and 20.2 times, respectively, compared to control (P &lt; 0.05). Using of NAM and RV treatment resulted in reduction of DNA damage index by 89.6 % and by 92.4 %, respectively, compared to control (P &lt; 0.05), and in the increase of the levels of SIRT1 by 1.7 and 3.5 times, and SIRT3 – by 2.9 and 5.2 times, respectively, in comparison with the ChCH group (P &lt; 0.05).Conclusion. Taken together, these data indicate that modification of SIRT1 activity caused positive effect on ChCH-induced brain injury by attenuating DNA breaks, which was accompanied with up-regulation of SIRT-mediated regulatory pathways.

Эффективность и фармакоэкономические аспекты лечения дисциркуляторной энцефалопатии II стадии на примере республики Коми

Эффективность и фармакоэкономические аспекты лечения дисциркуляторной энцефалопатии II стадии на примере республики Коми

Treatment of comorbid patients with chronic brain ischemia and vertebrogenic pain syndromes

Chronic brain ischemia and chronic pain both appear to be an extremely wide-spread disease. The reasons of widespread comorbidity of ischemic brain disease and chronic pain are common risk factors: old age, decrease of physical activity, syndrome of systemic inflammation and emotional disturbances. Treatment of patients with cerebrovascular diseases and chronic pain should influence common mechanisms of these disorders. Correction of microcirculatory disturbances pays particular important role, because this is the mechanism not only of chronic cerebral ischemia but compressive-ischemic radiculo- and neuropathy also.

Photomagnetic therapy and craniosacral therapy for rehabilitation patients with chronic brain ischemia at subacute phase

This is a conference abstract from the "Psychosomatic Medicine Of The XXI Century: Realities And Perspectives" Congress. It is dedicated to the photomagnetic therapy and craniosacral therapy for rehabilitation patients with chronic brain ischemia at subacute phase.

СИНДРОМ НОЧНОГО АПНОЭ У ПАЦИЕНТОВ C ВЕНОЗНОЙ ЭНЦЕФАЛОПАТИЕЙ НА ФОНЕ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХ

&#x0D; &#x0D; &#x0D; The clinical and instrumental examination and polysomnographic examination were carried out in 94 patients with chronic brain ischemia on the background of venous cerebral dysfunction with concomitant pathology-chronic obstructive pulmonary disease. 21 (22.3%) patients from the subjects had clinical manifestations of obstructive sleep apnea/hypopnea syndrome: mild – in 3, moderate – in 11, severe – in 7. A significant correlation between the body mass index, the number of episodes of apnea and the level of saturation of hemoglobin with oxygen, symptoms of venous cerebral dysfunction is shown. There was no correlation with the forced expiratory volume index for the 1st s. It should be assumed that in the pathogenesis of obstructive apnea/hypopnea syndrome in chronic obstructive pulmonary disease, the degree of obesity and venous cerebral dysfunction, rather than the severity of lower respiratory tract obstruction, are more important.&#x0D; &#x0D; &#x0D;

Оценка факторов риска развития сердечно-сосудистых заболеваний и показателей вегетативной нервной системы у пациентов с хронической ишемией мозга и хронической сердечной недостаточностью.

Оценка факторов риска развития сердечно-сосудистых заболеваний и показателей вегетативной нервной системы у пациентов с хронической ишемией мозга и хронической сердечной недостаточностью.

Chapter 20 - Vascular cognitive impairment: A preventable component of dementia

For many decades during the 20th century, the common belief was that the slow strangulation of the brains' blood supply from hardening of the brain arteries led to chronic brain ischemia and neuronal death. Not surprisingly, to counter this, vasodilators rapidly became one of the most commonly used and profitable medications worldwide; however, no clinical benefits were ever proven. In the 1970s and early 1980s cerebral blood flow studies strongly disproved the idea of brain failure due to chronic ischemia. It was also shown that infarcts and not chronic ischemia caused dementia, leading to the concept of multiinfarct dementia. In addition to infarcts, it was then realized that other vascular lesions can also cause cognitive decline. Gradually, as "atherosclerotic dementia" lost ground, Alzheimer's disease (AD) that once had been considered a presenile dementia and rare, became almost synonymous with dementia. Subsequent memory-based definitions and evaluations of dementia led to a bias in favor of diagnosing AD, overshadowing vascular contributions. The widespread use of brain imaging in the 1980s and 1990s contributed to the resurgence of evidence of cerebrovascular diseases. Moreover, it was shown that most cognitive impairment of the elderly results from mixed pathologies, emphasizing the need for a change in the traditional categorical diagnosis of dementia, e.g., AD vs vascular dementia. The alternative diagnostic method was named the vascular cognitive impairment approach, meaning identifying any impairment caused by or associated with vascular factors. The importance of this approach is that vascular lesions are currently the most important treatable and preventable components of dementia, even before any symptoms manifest, i.e., at the brain at risk stage. This chapter provides a summary of the vascular cognitive impairment approach to diagnosis, treatment, and prevention of cognitive decline.

The influence of the autonomic nervous system in the development of chronic heart failure in patients with chronic brain ischemia combined with myocardial infarction

Heart failure - severe, common clinical syndrome that is the result of many heart diseases is progressive, significantly reduces the life expectancy of patients and impairs its quality.&#x0D; Leading nosological forms the structure of coronary heart disease for many years, is a myocardial infarction. Growing proportion of elderly in most populations, increased survival after acute myocardial infarction (AMI) resulted in a significant increase in the number of patients with chronic heart failure (CHF).&#x0D; Increased tone of the sympathetic division precedes the development of chronic cerebral ischemia and, therefore, may complicate the course of disease in the presence of chronic heart failure.

Correlations between cervical spinal cord magnetic resonance diffusion tensor and diffusion kurtosis imaging metrics and motor performance in patients with chronic ischemic brain lesions of the corticospinal tract.

To investigate modifications of Magnetic Resonance Diffusion Tensor Imaging (DTI) and Diffusion Kurtosis Imaging (DKI) metrics in lateral white matter (WM) bundles of the cervical spinal cord in patients with previous stroke in the vascular territory of the middle cerebral artery (MCA). Twenty consecutive patients with a previous ischemic stroke of the MCA territory and a varying degree of upper motor impairment were enrolled. DKI was centered at the C3C4 and C5C6 intervertebral level. The fractional anisotropy (FA) values in C3C4 and C5C6 were found to be significantly lower in the lateral WM bundles contralateral to the ischemic lesion and thus, in the WM bundle including the affected corticospinal tract (CST) (p = 0.005 and p = 0.008, respectively), as well as mean kurtosis (MK) and axonal water fraction (AWF) values (p = 0.004 and p = 0.04. respectively). FA values correlated significantly with the Global Motor Index (GMI) both for C3C4 (ρ = 0.61, p = 0.004) and C5C6 (ρ = 0.69, p = 0.002). At C3C4, AWF correlated significantly with GMI (ρ = 0.54, p = 0.03). No correlations were found between lateral WM bundle volumes and GMI. A reduction of anisotropy and microstructural complexity in the affected lateral WM bundle of the cervical spinal cord was observed in patients with previous ischemic stroke involving the CST. The correlations between these metrics and motor performance were statistically significant.

ГЕНДЕРНЫЕ РАЗЛИЧИЯ КОГНИТИВНЫХ ФУНКЦИЙ ПРИ ЦЕРЕБРОВАСКУЛЯРНОЙ ПАТОЛОГИИ

&#x0D; &#x0D; &#x0D; Clinical, instrumental and neuropsychological examination was carried out in 110 patients with chronic brain ischemia of the 2nd degree on the background of hypertension of the 2nd stage. The subjects were divided into 2 groups based on gender. Signs of venous cerebral dishelie valley significantly more cases in the group of women. It is shown that the group of women with cerebral venous Disgaea more patients had cognitive impairment (MMSE scale). Also, the low rate of induced cognitive potentials in the brain (the method of cognitive evoked potentials) was more pronounced in women than in men. It should be assumed that in hypertensive disease, the presence of concomitant cerebral venous dysfunction aggravates the course of cerebral ischemia, especially in women.&#x0D; &#x0D; &#x0D;

THE PSYCHOLOGICAL ADAPTATION TO CHRONIC BRAIN ISCHEMIA IN CITIZENS OF EUROPEAN NORTH

The aim - to show the role of system psyhodiagnostics for multivariate complex study of the influence of psychological and social factors on the occurrence and during of chronic brain ischemia using the biopsychosocial approach. In particular, the mechanisms of psychological adaptation (psychological protection and coping) in persons of the organized population of Petrozavodsk with early stage of chronic brain ischemia (n = 280, average age (53.9 ± 8.1) years, gender index 1:1) have been studied. The control group included healthy individuals (n = 32, average age (52.4 ± 6.5) years, gender index 1:1, p &gt; 0.05). Methods. The following methods were used: the method «Index of life style» by R. Plutchik et al. in the modification of L. I. Wasserman; the standardized test of R. Lazarus in the modification of L.I. Wasserman. Results. It was found out that increase in the total stress index of psychological defense mechanisms in patients with early stage of chronic brain ischemia living in the European North, was typical mainly due to «denial» (63.2 ± 3.7) ‰ , «compensation» (58.9 ± 4.0) ‰ and «projection» (57.4 ± 3.9) ‰. The leading strategies of coping with stress behavior were search for social support (68.89 ± 19.45) % and acceptance of responsibility (69.64 ± 18.63) %. Conclusions. Patients with chronic brain ischemia are characterized by mosaicism of adaptive and maladaptive personality traits of protective behaviour.