Recovery Period Of Ischemic Stroke Research Articles

Brain-Derived Neurotrophic Factor in the Acute and Early Recovery Period of Ischemic Stroke: The Role of Nocturnal Hypoxemia

Brain-Derived Neurotrophic Factor in the Acute and Early Recovery Period of Ischemic Stroke: The Role of Nocturnal Hypoxemia

Therapeutic potential of mesenchymal stromal cells on morphological parameters in the hippocampus of rats with brain ischemia-reperfusion modeling

Ischemic stroke is an extremely important pathology with high mortality, in which more than 50 % of patients with occlusion of the main vessels remain disabled, despite early reperfusion therapy by thrombolysis or thrombectomy. As part of the regenerative strategy, stem cell transplantation in ischemic stroke became a new impetus. Cell therapy with the use of mesenchymal stromal cells demonstrated encouraging results regarding endogenous mechanisms of neuroregeneration in response to ischemic damage to brain structures. The aim of the research is to study the influence of mesenchymal stromal cells of various genesis, lysate of mesenchymal stromal cells obtained from Wharton’s jelly umbilical cord and citicoline on the dynamics of morphological changes in the hippocampal CA1 region of rats with acute cerebral ischemia-reperfusion according to light microscopy and micromorphometry data. The experiment was carried out using 200 male Wistar rats, which were subjected to ischemia-reperfusion by reversible 20-minute bilateral occlusion of the internal carotid arteries. Animals with modeled pathology were intravenously transplanted with mesenchymal stromal cells of various genesis (from Wharton’s jelly of the human umbilical cord, human and rat adipose tissue), and rat embryonic fibroblasts, lysate of mesenchymal stromal cells and citicoline were injected. Histological analysis of rat brain sections was performed on the 7th and 14th day of the experiment. Statistical analysis was performed using “Statistica 6.0” (StatSoft® Snc, USA). The significance of differences was assessed using the Student’s t-test and the nonparametric Mann-Whitney U test. During the study, it was found that modeled ischemia-reperfusion in rats caused almost complete degeneration of the structure of the pyramidal layer of hippocampal CA1 region, gave uniformity to the structure of the radiant layer, infiltration of microglia, contributed to the disruption of the arrangement of apical dendrite bundles and narrowing of blood vessels as a result of perivascular edema. Also, the modeled pathology reduced the total number of neuronal nuclei in the hippocampal CA1 area, the overwhelming majority of which had signs of pathological changes. Transplantation of mesenchymal stromal cells of various origins, lysate of mesenchymal stromal cells and citicoline contributed to a significant increase in the number of neuronal nuclei in the hippocampal CA1 zone and nuclei that did not undergo pathological changes. The most positive effect was found in the transplantation of mesenchymal stromal cells from human Wharton’s jelly-derived cells. Thus, both in the subacute and recovery periods of ischemic stroke in rats, the transplantation of human Wharton’s jelly-derived mesenchymal stromal cells was significantly surpassed the reference drug citicoline in its ability to reduce the number of pathologically changed nuclei by 1.5 times (p<0.05). At the same time, the number of pathologically unchanged nuclei significantly exceeded the number of nuclei with signs of karyorrhexis and karyopyknosis, so it would be advisable to use mesenchymal stromal cells of various genesis, lysate or citicoline in conditions of acute cerebral ischemia-reperfusion, taking into account their ability to reduce the volume of the infarct. In the future, an injectable drug will be created from the most effective culture of mesenchymal stromal cells in terms of cerebroprotective properties for cell therapy of patients with acute ischemic stroke.

Blood indices reflecting infl ammatory changes in patients undergoing rehabilitation in the early recovery period of ischemic stroke

Blood indices reflecting infl ammatory changes in patients undergoing rehabilitation in the early recovery period of ischemic stroke

Brain-derived neurotrophic factor in the acute and early recovery period of ischemic stroke: the role of nocturnal hypoxemia

To study the relationship between brain-derived neurotrophic factor (BDNF) and the severity of nocturnal hypoxemia in patients in the acute and early recovery period of ischemic stroke (IS). We enrolled 44 patients (27 men, 17 women), aged 18-85 years, in the acute phase of IS. At 3-month follow-up, 35 people were examined (21 men and 14 women). In the acute period, in addition to routine diagnostic procedures, respiratory monitoring was carried out, and the serum level of BDNF was measured by enzyme-linked immunosorbent assay. BDNF level was also evaluated at 3-month follow-up visit. Neurological status and its dynamics in the acute period of stroke were assessed as part of the clinical routine according to the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge. We found a direct correlation between the duration of hypoxemia with SpO2 less than 90% (r=0.327, p=0.035) and less than 85% (r=0.461, p=0.003) and BDNF level in the acute phase of IS. BDNF level in the acute period of IS was negatively correlated with the minimum saturation value (r=-0.328, p=0.034). There was a direct relationship between BDNF level in the early recovery period and the duration of hypoxemia with SpO2 less than 85% (r=-0.389, p=0.028). A regression model showed that BDNF level was associated with the minimum SpO2 level. No significant associations were found with indicators of sleep-disordered breathing severity, such as the apnea-hypopnea index and the oxygen desaturation index. The severity of nocturnal hypoxemia is associated with the increase in BDNF levels both in the acute and recovery periods of IS, regardless of the presence of concomitant breathing disorders during sleep.

Sensorimotor Rehabilitation and Psychotherapeutic Techniques Effect on the Psychoemotional State in the Stroke Recovery Period

INTRODUCTION. Stroke is the leading cause of disability of the population. In addition to motor disorders, cognitive and affective disorders contribute to the development of disability. The development of effective neurorehabilitation programs aimed not only at reducing the severity of motor deficits, but also at timely correction of psychoemotional disorders in stroke patients is very relevant for restorative medicine. In view of the proven positive therapeutic effect of physical exercises on anxiety and depression, their protective effect on cognitive functions, it is of interest to study the effect of motor rehabilitation on psychoemotional disorders in stroke patients.
 AIM. To study the effect of sensorimotor rehabilitation on affective and cognitive disorders in patients in the recovery period of stroke in comparison with a complex psychotherapeutic technique.
 MATERIALS AND METHODS. The study examined 2 groups of patients in the recovery period of ischemic stroke (up to 2 years) with the presence of anxiety and/or depressive disorders, comparable in gender, age, duration and focus of stroke localization, severity of neurological deficit. The 1st group — 24 patients — received a course of sensorimotor rehabilitation without targeted impact on affective disorders; the 2nd group — 25 patients — a course of complex medical and psychological adaptation lasting 18 days. The effectiveness of rehabilitation was assessed using validated scales and questionnaires (Rivermead Mobility Index, 6-point muscle strength assessment scale, modified Ashfort spasticity scale; Berg balance scales, Beck depression, Spielberger-Khanin anxiety, MMSE, MoCA; Schulte Table Methodology, SS-QOL Stroke Quality of Life Assessment Scale). Statistical analysis was carried out using the StatTech v. 2.8.8 program (developed by Stattech LLC, Russia).
 RESULTS AND DISCUSSION. The preliminary assessment carried out in both groups showed a twofold predominance of anxiety states over depressive ones, concomitant cognitive impairments were detected in 88 % of patients, among whom attention disorders were most often recorded (there was no intergroup difference in these indicators). After completing the course of both sensorimotor and medico-psychological rehabilitation, both groups showed a significant decrease in the level of situational and personal anxiety on the Spielberger-Khanin scale, positive dynamics on the MoСа scale, the SS-QOL questionnaire, while a significant decrease in the level of depression on the Beck scale was registered only in patients of the 2nd group on against the background of the use of specialized psychotherapeutic techniques.
 CONCLUSION. Motor rehabilitation is positively comparable with complex medical and psychological adaptation, it affects anxiety and cognitive functions in patients with ischemic stroke, it can be considered as one of the effective ways to correct anxiety states and prevent cognitive impairment in these patients, while in the treatment of depression the priority is should be given to specialized medical and psychological intervention.

The Results of Targeted Training in the Rehabilitation of Patients with a Combination of Motor and Speech Disorders

AIM. To evaluate the effectiveness of using a rehabilitation glove in patients with central paresis of the arm and motor aphasia due to ischemic stroke, and also to study the rate of motor production in the upper limb in these patients.
 MATERIALS AND METHODS. We examined 49 patients with hemiparesis and motor aphasia in the early recovery period of ischemic stroke in the left middle cerebral artery. Depending on the fact of conducting training with the use of a rehabilitation glove, patients were randomly distributed into two groups (1, where this training option was implemented, and 2 — without it), comparable in the severity of motor and speech disorders. Within each of them, patients were additionally divided into subgroups, depending on the degree of paresis in the distal part of the affected upper limb: L-mild (in group 1L — 18 people, 2L — 16) and U-moderate (in group 1U — 8, and 2U — 7 patients). On days 1 and 10 of training, all patients underwent functional testing. Treatment and rehabilitation were carried out according to the order of care. Patients of groups 1L and 1U additionally received a course of 10 sessions, including 2 exercises of 15 minutes each for a paretic arm 5 times a week.
 RESULTS. Patients of groups 1L and 1U demonstrated statistically significant improvements in the Medical Research Committee Scale, the ARAT Arm Motor Activity Test, the Wasserman Speech Impairment Rating Scale, and the Montreal Cognitive Function Rating Scale. According to amplitude indicators, there was a tendency towards their increase in all groups. A decrease in the number of errors and an increase in the percentage of correct task completion accompanied the development of a motor act. They stabilized in patients with mild paresis of the hand by 5–6 sessions and in patients with moderate paresis by 6–7 sessions.
 CONCLUSION. In patients with mild to moderate paresis of the right hand in combination with motor aphasia in the early recovery period of ischemic stroke, when using a rehabilitation glove, there was an improvement in the strength and motor activity of the paretic hand, cognitive functions and speech. Stabilization of task performance indicators should be taken into account when determining the duration of training and timely correction of the motor rehabilitation program.

Validation of the Performance Oriented Mobility Assessment (Tinetti Test) Scale in Russia for Stroke Patients

INTRODUCTION. Balance disturbances are frequent syndromes after a cerebral stroke (CS). The availability of a validated tool for balance and walking functions comprehensive assessments is very important part of real clinical practice, for rehabilitation diagnosis and individual medical rehabilitation plan.
 AIM. To determine the psychometric properties of the Motor Activity Performance Assessment Scale (Tinetti Test, TT) for measuring balance and walking in patients with ischemic stroke (IS).
 MATERIALS AND METHODS. 200 patients were included, 100 in the early (ERP) and 100 in the late (LRP) recovery periods of IS. The average age of patients was 55 [51; 57] years. The average of IS-duration were 99.3 ± 30.9 days (ERP) and 267.7 ± 27.8 days (LRP). Clinical and demographic characteristics of patients in two groups were comparable. The median and interquartile interval of TT were 20 [14; 24] points out of 28 possible. Content validity and intra-rater reliability were assessed by 10 clinicians. The test-retesting method was used to determine the intra-rater reliability. The Berg Balance Scale (BBS), the Stand Up and Go for Time (TUG), and the 10-meter walk test (10MWT) were used for concurrent validation.
 RESULTS. Two-stage linguistic and cultural adaptation made it possible to construct a Russian-language version of TT that was tested in a pilot study of 30 patients. The subsequent study of the psychometric properties of TT demonstrated high level of content validity and internal consistency of TT (α-Kronbach: 0.74 for TT-Balance and 0.72 for TT-Gait). BBS data significantly correlated with TT-Balance scores (r = 0.73, p = 0.001), TUG showed a negative correlation with TT-Gait (r = −0.69, p = 0.02). Retest reliability ranged from 0.72 to 0.86. The Bland-Altman plot showed the loss of one data point for TT-total beyond 95 % CI.
 DISCUSSION. The Tinetti test indicates high substantive validity and internal consistency of the scales (the α-Kronbach for the balance and walking sections are 0.74 and 0.72, respectively), which is consistent with the data of foreign authors.
 CONCLUSION. The linguistic and cultural adaptation and psychometric testing of the Russian version of the Motor Activity Performance Assessment Scale demonstrated the validity and reliability of this test as a tool for balance and walking assessment in patients with IS.

Overcoming Unilateral Spatial Agnosia in the Late Recovery Period of Ischemic Stroke: A Case Report

INTRODUCTION. Unilateral spatial agnosia (neglect syndrome), is one of the most common disorders resulting from damage in right hemisphere, which is difficult to reverse dynamics, especially in the late recovery period.
 CASE PRESENTATION. A 58 year old man with sequelae of cerebral infarction (I69.3 ICD-10) which had a stroke in right hemisphere was admitted for rehabilitation. The results of neuropsychology diagnostic have shown disorders of optical-spatial synthesis, neglect syndrome, cognitive disorder, frontal cortex dysfunction. To restore impaired functions, along with methods aimed at eliminating motor deficits, classical (sensorimotor and cognitive levels) modernized (computer cognitive therapy) methods of neurorehabilitation were purposefully used. As a result, positive dynamics was noted in the form of a significant decrease in the severity of unilateral spatial agnosia, an improvement in the emotional background and the course of cognitive activity.
 CONCLUSION. This clinical observation is of interest to neuropsychologists, neurologists, clinical psychologists, physical and rehabilitation medicine physicians. It shows that purposeful efforts to overcome neglect syndrome even in the late recovery period of stroke can have a pronounced positive effect, making a significant contribution to the entire rehabilitation process.

Diagnosis and Prevention of Scabies in Low Mobility Patients with Cognitive Impairment

Scabies is an infectious skin disease caused by the human-specific ectoparasite Sarcoptes scabiei var. hominis. Despite the comprehensive study of scabies, the problem of its timely diagnosis in low-mobility patients with neurological and cognitive impairments remains relevant all over the world. Simultaneous administration of a large number of medications to patients with limited mobility may mask the clinical manifestations of scabies and mistakenly attribute itching to manifestations of skin allergic reactions or other dermatoses. The authors observed patient K., who was admitted in FCBRN of FMBA of Russia from 14.11.2022 to 15.11.2022. Clinical diagnosis upon admission: I69.3. The consequences of a stroke. Early recovery period of ischemic stroke in the basin of the left middle cerebral artery from 09.08.2022, atherothrombotic subtype according to TOAST criteria. Right-sided hemiparesis. Gross aphasia. Violation of the pelvic organs function. RMS 5. Comorbid diseases: arterial hypertension, controlled, the risk of CVE 4 (very high). The target blood pressure is less than 135/85 mmHg. Occlusion of the left anterior cerebral artery, middle cerebral artery. Toxic-allergic dermatitis (medicinal) in the acute phase. Based on a set of clinical data and laboratory detection of the pathogen, patient K. was diagnosed with B86 — scabies. Even though the patient was under medical supervision at the ambulatory step, scabies was not diagnosed timely. Late diagnosis of scabies leads to the spread of the disease and an unfavorable epidemiological situation.

Mailuoning oral liquid attenuates convalescent cerebral ischemia by inhibiting AMPK/mTOR-associated apoptosis and promoting CREB/BDNF-mediated neuroprotection

Ethnopharmacological relevanceIschemic stroke is divided into acute, subacute and convalescent phases according to the time of onset. Clinically, Mailuoning oral liquid (MLN O) is a traditional Chinese patent medicine for treating ischemic stroke. Previous studies have shown that MLN O could prevent acute cerebral ischemia-reperfusion. However, its underlying mechanism remains unclear. Aim of the studyTo investigate the relationship between neuroprotection and apoptosis for clarifying MLN O mechanism in the recovery phase of ischemic stroke. Materials and methodsWe imitated stroke using middle cerebral artery occlusion/reperfusion (MCAO/R) in vivo and oxygen-glucose deprivation/reoxygenation (OGD/R) in vitro models. The infarct volume, neurological deficit scores, HE staining, Nissl staining, TUNEL staining, immunohistochemistry, and Western blot were correspondingly performed to find pathological changes and detect neuronal apoptosis in rat cerebral cortex. The contents of LDH, Cyt-c, c-AMP and BDNF in rat plasma and cerebral cortex were detected by ELISA. Cell viability was measured by CCK8 assay. Cell morphology, Hoechst 33342 staining and Annexin-V-Alexa Fluor 647/PI staining were performed to assess neuronal apoptosis. The expression levels of proteins were evaluated by western blotting. ResultsMLN O obviously reduced brain infarct volume and neurological deficit scores in MCAO rats. MLN O inhibited inflammatory cell infiltration and neuronal apoptosis, but promoted gliosis, neuronal survival, and neuroprotection in the cortical region of MCAO rats. Additionally, MLN O decreased the amount of LDH and cytochrome c, while increasing the expression of c-AMP in the plasma and ischemic cerebral cortex of MCAO rats, and promoting the expression of BDNF in the cortical tissue of MCAO rats. Besides, MLN O improved cell viability, restored cell morphology, while attenuating cell damage, inhibiting neuronal apoptosis following OGD/R in PC-12 cells. Moreover, MLN O inhibited apoptosis by suppressing the expression of pro-apoptotic-associated proteins, including Bax, cytochrome c, Cleaved caspase 3 and HIF-1α, whereas accelerating the expression of Bcl-2 in vivo and in vitro. Furthermore, MLN O inhibited the activity of AMP-activated protein kinase (AMPK)/mechanistic target of rapamycin (mTOR), but activated the signaling pathway of cAMP-response element binding protein (CREB)/brain-derived neurotrophic factor (BDNF) in MCAO rats and OGD/R-stimulated PC-12 cells. ConclusionsThese results demonstrated that MLN O inhibited AMPK/mTOR to affect apoptosis associated with mitochondria, leading to improve CREB/BDNF-mediated neuroprotection in the recovery period of ischemic stroke in vivo and in vitro.

Antioxidant therapy in the complex treatment of patients with ischemic stroke in the acute and recovery period

Improvement of therapy of patients with ischemic stroke (IS) remains a relevant problem, despite the widespread use of drug and mechanical revascularization methods during recent years. One of the pathogenetic mechanisms of IS is oxidative stress as one of the components of brain tissue damage in the acute period and a factor that prevents the processes of repair and neuroplasticity in the recovery period. This is the rationale for the use of antioxidant drugs in the acute and recovery periods of stroke. Data from clinical studies on the use of antioxidants in the treatment of patients with IS are presented. We describe the use of the domestic drug dimephosphone (dimethyloxobutylphosphonyl dimethylate), a synthetic non-anticholinesterase organophosphorus compound, which has a wide range of effects: antioxidant, antacidotic, vasodilating, membrane stabilizing, anti-inflammatory, etc. Data are given on the use of dimephosphone in the acute period of IS in patients with no indications for thrombolytic therapy, there was a decrease in neurological deficit and a decrease in disability. The positive results of the use of dimephosphone in the recovery period of IS and in chronic cerebrovascular insufficiency are described. The data of our own study on the use of dimephosphone in the complex therapy of cognitive rehabilitation of patients in the recovery period of IS are presented. A statistically significant recovery of cognitive functions was registered according to the Montreal Cognitive Scale (MoCA), and an increase in the MoCA score by 2 points or more in 59.6% of patients. An improvement in executive functions, an increase in the flexibility of cognitive control of cognitive processes, and the predominance of verbal thinking over sensory-perceptual were noted.

Potential circulating biomarkers of atherosclerotic plaque vulnerability in patients in the early recovery period of atherothrombotic stroke

Despite the informative value of ultrasound examination of atherosclerotic vascular lesions, predicting­ the plaque vulnerabili­ty remains difficult. Circulating blood biomarkers could provide additional criteria that would allow better determination of the risk of recurrent stroke. The aim of our study was to estimate the level of C-reactive protein (CRP), low-density lipoproteins (LDL) and lipoprotein-associated phospholipase A2 (Lp-PLA2) in the blood of patients in the early recovery period of atherothrombotic stroke depending on the density of atherosclerotic plaque according to duplex scanning of cerebral vessels. Clinical and laboratory analysis of 69 men and 61 women aged (60.42 ± 7.40) years in the early recovery period of atherothrombotic stroke was conducted. Depending on the structure of the atherosclerotic plaque the examinees were divided into two groups with stable (n = 80) and unstable (n = 50) atherosclerotic layers. The blood lipid spectrum was examined on a biochemical analyzer Screen master, the level of CRP was determined with a diagnostic kit and that of Lp-PLA2 by ELISA. Significantly higher levels of LDL, CRP and Lp-PLA2 were observed in patients with unstable atherosclerotic plaque compared to patients with stable atherosclerotic plaque in the early recovery period of atherothrombotic stroke. The increased level of LDL, CRP, and Lp-PLA2 in patients with cerebral atherosclerosis can be considered as an indicator of the vulnerability of atherosclerotic plaques, prone to rupture, and as a prognostic marker of repeated acute ischemic events. Keywords: atherosclerotic plaque, C-reactive protein, lipoprotein-associated phospholipase A2, low density lipoproteins, recovery period of ischemic stroke

Clinical Significance of the Characteristics of Microembolic Signals Recorded in the Recovery Period of Ischemic Stroke, a Cross-Sectional Observational Study

Background. Microembols detected during transcranial Doppler monitoring with microembolodetection (TCDM with MED) are different in nature and, accordingly, in structure, as well as in size and consequences of their impact on the cerebral vessels. The following biophysical characteristics of microembolic signals (MES) can be assessed during TCDM with MED: frequency, which indirectly reflects the structure of the microembolus, duration, which indirectly reflects the size of the microembolus, and power, which is an integral characteristic. The issues of the relationship between characteristics of MES and clinical indicators have been little studied according to literature.
 Aims study of the biophysical characteristics of microembolic signals recorded in patients with ischemic stroke, as well as the factors affecting these characteristics, the clinical and prognostic significance of microembolism.
 Methods. This is a cross-sectional observational study that is part of a prospective cohort study. Data on 28 patients in the recovery period of ischemic stroke are included, in whom the biophysical characteristics of MES were analyzed (the total number of cases in the cohort study was 1600), and who underwent: duplex scanning of the brachiocephalic arteries, transcranial duplex scanning, TCDM with MED, transthoracic echocardiography, magnetic-resonance tomography of the brain, electrocardiography. Study enrollment was carried out in the period from 2019 to 2021. The MES characteristics included frequency, duration, power, energy index (the product of power and duration), of which the MES power was the main one.
 Results. MES characteristics correlated with anthropometric parameters: average duration - with the patients age (r = 0.421; p = 0.029); average frequency with body surface area (r = 0.624; p = 0.010). The average power, duration and energy index of MES were significantly higher in persons with intraluminal masses in the carotid arteries (p 0.05). Correlations of biophysical characteristics of MES with blood flow velocities in brain vessels (inverse correlation between the duration of the MES and the value of the peak systolic velocity in the M2 segment of the right MCA r = 0.529, p = 0.02; correlations between the power of MES, as well as the duration of MES with peak systolic and end-diastolic velocities in the V4 segment of the right VA r = 0.4810.572, p = 0.0270.007), as well as with signs of atrophy of the temporal and occipital lobes of the brain were identified (inverse correlation between MES frequency and regional atrophy in the right temporal lobe r = 0.434, p = 0.038; inverse correlation between MES frequency and regional atrophy in the left temporal lobe r = 0.422, p = 0.045; inverse correlation between MES frequency and regional atrophy in the left occipital lobe r = 0.465, p = 0.025). Significant differences were found in the number of MES and their average power, duration, energy index in the presence and absence of atrial fibrillation (p 0.05).
 Conclusions. Age and, apparently, weight, as well as signs of atherosclerosis of the brachiocephalic arteries, influence the development of microembolism. In the presence of atrial fibrillation, material microembolism is observed predominantly, and the number of MES and their characteristics which reflect the size of microemboli are significantly higher. The relationship between the duration of MES and the characteristics reflecting the blood supply in the basin of the middle cerebral artery, as well as between the frequency of MES and the presence of regional atrophy in the temporal and occipital lobes of the brain according to magnetic resonance imaging was revealed.

Patterns and features of the course of the early and late stages recovery period after ischemic stroke associated with COVID-19

Introduction. COVID-19 increases the risk of ischemic stroke (IS), but the impact of COVID-19 on the recovery period of IS remains poorly understood.The aim of the study – to identify patterns and features of the course and manifestations of the early and late stages of the recovery period after ischemic stroke associated with COVID-19.Materials and methods. The combined retro-prospective study included 81 patients. Patients were divided into three groups: 1) development of stroke followed by outcome in ischemic stroke (IS) associated with COVID-19 (n = 21); 2) COVID-19 infection without stroke (n = 40); 3) development of stroke without COVID-19 (n = 20). All subjects were interviewed by telephone within 12 months from the date of discharge from the hospital. In patients with stroke, the severity of stroke (NIHSS scale), functional status (Rankine scale), and daily activity level (Bartel scale) were studied. All subjects were interviewed by telephone within 12 months from the moment of discharge from the hospital, the following were assessed: complaints, general condition of patients, the patient’s level of activity and ability to self-care, emotional status and the presence of anxiety and depressive disorders. The following were retrospectively assessed: stroke severity, functional status, volume of lung lesions according to MSCT, the presence of cardiovascular diseases, indicators of general and biochemical blood tests, changes in blood levels of cytokines IL-6, IL-8, IL-10, TNF-α.Results. The highest mortality at the post-hospital stage (only 67 and 47% of the total number of deaths) was in patients who had an ischemic stroke associated with COVID-19; half of them were registered in the first 3 months; by the end of the 6th month, this figure was 79%. Deaths in patients with IS due to COVID-19 occur 6 months earlier than in the group of patients with stroke without COVID-19. The leading causes of fatal outcomes in patients with IS due to COVID-19 in the first 3 months were acute myocardial infarction and repeated strokes. A high frequency of unfavorable rehabilitation prognoses and deaths both in the acute period of the disease and at the post-hospital stage was observed in patients with high comorbidity with forms of pathology of the circulatory system.Conclusion. Patients who have had an ischemic stroke associated with COVID-19, in the first 3 months of the post-hospital period, are at an increased risk of developing thrombotic complications and death and require special attention of outpatient doctors in this period after discharge from the hospital.

Динамика когнитивных и психоэмоциональных нарушений в раннем восстановительном периоде ишемического инсульта при проведении реабилитационных мероприятий с применением стабилотренинга

Objective: to analyze post-stroke cognitive and psycho-emotional disorders in patients in the early recovery period of ischemic stroke, to assess the dynamics of these disorders during rehabilitation measures using stabilometric training. Materials and methods. The study involved 58 patients aged 35-75 years; the average age was 60.6 years. The study was conducted on the basis of Bryansk City Hospital No. 1 in the Department of Medical Rehabilitation. Stabilometric training was carried out on a computerized stabiloanalyzer with biofeedback "Stabilan-01-2" (Taganrog). The course included 7-10 sessions of stabilotherapy. The Montreal Cognitive Scale and the Hospital Anxiety and Depression Scale were used to assess cognitive and psychoemotional status before and after rehabilitation activities. Statistical analysis of the obtained data was carried out on a personal computer using MS EXCEL and IBM Statistica 12.0 application packages. The significance of differences between the studied groups was assessed using the nonparametric Mann-Whitney test. The dynamics in each group before and after treatment was assessed using the Wilcoxon test. Results. According to the results of the study, a significant improvement in the memory indicators of patients was revealed along with a decrease in the level of anxiety and depression. Conclusion. The positive effect of the use of a stabilometric training on the intellectual-mnestic and psycho-emotional functions of patients in the early recovery period of ischemic stroke revealed during the study allows us to recommend this method not only for motor rehabilitation, also to use it as a cognitive and psycho-corrective training.

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

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

Multimodal technology in the correction of post-stroke motor disorders

To evaluate the effectiveness of a comprehensive rehabilitation program with the inclusion of programmable FES and BFB-stabilometric training in patients with post-stroke statolocomotor disorders in the late recovery period of ischemic stroke (IS). The study included 120 patients in the late recovery period of IS, 57 women and 63 men, average age 58.4±6.4 years. The duration of the stroke was 228.59±31.9 days. The main group (MG) included 30 patients who underwent FES and BFB-stabilometric training. Comparison group 1 (CG1, n=30) received computer stabilometric training with BFB. Comparison group 2 (CG2, n=30) received FES. The control group (CG3, n=30) received a standard rehabilitation program. MR programs were carried out for all patients in the amount of 15 procedures every other day (5 weeks). The complex of rehabilitation measures with the inclusion of FES and BFB-stabilometric training significantly improve the function of walking in the form of restoration of the motor stereotype by the 5th week of the study, which was confirmed by neurological scales and stabilometry data. The inclusion of FES and BFB-stabilometric training methods in the rehabilitation process leads to earlier motor adaptation of the patient, restoration of impaired balance function and quality of life, which is associated with an increase in plastic and associative processes of the brain.

ТЕСТИРОВАНИЕ НЕЙРОПСИХОЛОГИЧЕСКОГО СТАТУСА У ПОСТИНСУЛЬТНЫХ БОЛЬНЫХ С РАЗЛИЧНОЙ ЛОКАЛИЗАЦИЕЙ ПОЛУШАРНОГО ОЧАГА

32 patients in the early recovery period of ischemic stroke in the right and left hemispheres of the brain were examined in order to assess the level and characteristics of cognitive functions and anxiety-depressive disorders for planning personalized rehabilitation treatment. Pre-dementia was detected in 42.1% of patients according to the results of the Short Mental Status Assessment Scale (MMSE), which is more common in patients with left-hemisphere stroke. Clinical depression, as well as subclinical and clinical anxiety are detected more often in left-hemisphere stroke. The inverse correlation of the cognitive function index on the MMSE scale and the level of anxiety and depression on the hospital anxiety and depression scale (HADS) was revealed. All patients who have suffered a hemispheric stroke should undergo early cognitive and psychological rehabilitation, especially patients with lesions of the left hemisphere.

Clinical characteristics and metabolic therapy of fatigue in the acute and early recovery periods of ischemic stroke

To reveal clinical characteristics of asthenic syndrome with subsequent estimation of Meldonium therapy efficacy in patients in acute and early recovery periods of ischemic stroke. The study included 94 patients diagnosed with ischemic stroke, mean age being 65.6±9.5 years. Psychoemotional status was assessed on the 10th day of hospitalization with the use of the Asthenic Disorders Inventory (MFI-20), Hospital Anxiety and Depression Scale (HADS), Apathy Evaluation Scale (AES). Patients with verified asthenic syndrome were added Mildronate in a daily dose of 1000 mg (500 mg 2 times a day) for one month to baseline therapy in a real outpatient setting, followed by an assessment of treatment efficacy. The presence of asthenic syndrome in patients in the acute period of ischemic stroke was detected on all subscales of MFI-20. A high level of general and physical asthenia was found in patients with subcortical localization stroke, with decreased motivation corresponding to lesions in the frontotemporal and decreased activity in the parieto-occipital lobes. Close correlations between the MFI-20 parameters and the level of depression, anxiety, apathy, and the degree of neurological deficit were found. The dynamic evaluation of the severity of main manifestations of psychoemotional dysfunction during treatment with Mildronate showed a decrease in the level of depression, general and mental asthenia, and decreased activity during the period of observation. The high prevalence and multifactorial character of asthenia in early ischemic stroke make it urgent to optimize the early treatment of asthenic syndrome. The results of assessment of Mildronate application in a daily dose of 1000mg for a month have shown therapy efficacy concerning affective and asthenic disorders, which allows recommending its inclusion in the complex therapy of ischemic stroke.

Risk factors for unfavorable clinical course of the early recovery period of ischemic stroke in young and middle-aged patients

Background. This study was carried out due to persistent increase in the incidence of ischemic stroke in people of working age and insufficient knowledge of risk factors affecting its clinical course in the early recovery period in young and middle-aged patients.The aim. To identify and to study variants of the clinical course of the early recovery period of ischemic stroke in young and middle-aged patients; to determine the risk factors for its unfavorable course.Materials and methods. We carried out a longitudinal prospective study, which involved 145 patients with ischemic stroke in its early recovery period. The main risk factors for cardiovascular diseases were analyzed. Dynamic observation of these patients allowed us to determine five variants of the clinical course of the ischemic stroke early recovery period – regressive, regressive with residual mild focal neurological symptoms, stable, slowly progressive and rapidly progressive.Results. Regressive course was observed in 58 (40 %) patients; regressive course with residual mild focal neurological symptoms – in 66 (45.5 %) patients; stable course – in 9 (6.2 %) patients; slowly progressive course – in 8 (5.5 %) patients, rapidly progressive course – in 4 (2.8 %) patients. The following risk factors had statistically significant affect on the unfavorable course of the disease: more pronounced motor, sensory and speech disorders at the time of patient’s admission to the hospital and at the end of the ischemic stroke early recovery period; severity of ischemic stroke according to the National Institutes of Health Stroke Scale (NIHSS); damage to the carotid basin of the brain; ischemic heart disease; irregular intake or patient’s refuse of taking prescribed antiplatelet, lipid-lowering, antihypertensive therapy (p < 0.05).Conclusions. Defining the variant of the clinical course of the ischemic stroke early recovery period in young and middle-aged patients and risk factors for its unfavorable course is important in determining tactics and further neurorehabilitation measures.