Regression Of Neurological Deficit Research Articles

Spontaneous dissection of the carotid artery in a young patient with the development of ischemic stroke

Carotid artery dissection is a cerebrovascular disease, the cause of which is assumed to be connective tissue dysplasia. The provoking factors may be injury, infections, high-intensity sports. This disease can occur both asymptomatically and manifest itself with various neurological symptoms (headache, Gorner syndrome). In our clinical case, the young patient showed no signs of connective tissue dysplasia, nor provoking factors. Timely diagnosis contributed to the rapid determination of arterial dissection, and early treatment provided stabilization of the patient’s condition and regression of neurological deficit. The literature data on the diagnosis and treatment of the disease are presented.

Evaluation of the efficiency of endarterectomy from the external carotid artery in patients with internal carotid artery occlusion

Objective. To assess the effect of external carotid artery (ECA) endarterectomy on regional cerebral blood flow, cognitive function, and quality of life in patients with ICA occlusion.Materials and Methods. From 2019 to 2020 year, 14 operations were performed on patients with ICA occlusion and hemodynamically significant ECA lesion. 14 patients, 12 men (85.7 %) and 2 women (14.3 %) underwent resection of the ICA, endarterectomy of the common carotid artery (CCA), and ECA. All patients had a history of stroke of 7±5.7 months. Neurological deficit according to the Rankin scale was 2 points in 11 patients (78.6 %) and 3 points in 3 patients (21.4 %). The mean age was 62.8±11.6 years. The preoperative period included ultrasound duplex scanning and computed tomography with the contrast of the brachiocephalic arteries. Single-photon emission computed tomography was used to assess cerebral blood flow before and after surgery. Cognitive status and quality of life were assessed by questionnaire survey.Results. In the early postoperative period, there were no registered strokes. A decrease in hypoperfusion foci and an increase of cerebral blood flow by an average of 10,33 ± 6,70 ml/min/100 g were observed in 13 patients (92,8 %). The Montreal Cognitive Deficit Scale score was 3,92±3,6. Improvement of quality of life according to the Short Form-36 questionnaire was 9.27±14.75.Conclusion. Endarterectomy of the external carotid artery at the internal carotid artery occlusion leads to a significant increase of regional cerebral blood flow in symptomatic patients, which in turn correlates with the regression of neurological deficit and improvement of quality of life. Continued work in this area will be a detailed analysis of the results of the treatment of patients with occlusion of the internal carotid artery for the period from 2018 to 2022 year.

Craniocerebral hypothermia in the acute period of ischemic stroke

To determine the effect of craniocerebral hypothermia (CCH) on neurological deficit regression, hemodynamics, fever and functional outcome of therapy in patients with moderate ischemic stroke (IS). This study included 60 patients with IS (the first day). The main group consisted of 30 patients who underwent CCH, and the comparison (control) group consisted of 30 patients without CCH. The National Institutes of Health Stroke Scale (NIHSS), the Glasgow Coma Scale (GCS), the modified Rankin Scale (mRs) were used. Recorded parameters were mortality, heart rate (HR), blood pressure (BP), axial temperature, cerebral temperature of the frontal cortex. Cerebral temperature was obtained noninvasively by using a RTM-01-RES radiothermometer (Russia). CCH (for 24 hours) in the main group was implemented by ATG-01 device (Russia). Results were recorded on the day of admission, after 24 hours and at discharge. In both groups, basic neuroprotective, hypotensive, antiplatelet and antiedemic therapy was administered. No fatal outcomes were reported in both groups. Side-effects and complications of CCH were not recorded. In the main group, neurological deficit assessed by NIHSS decreased by 75% after the CCH procedure and by 93.75% at the time of discharge from the hospital. In patients of the comparison group, regression of neurological deficit was 35% on the second day and 55% at the day of discharge. The use of CCH suppressed systemic and cerebral hyperthermia. Functional outcome of therapy in the main group was higher compared to the comparison one. The dynamics in blood pressure and heart rate didn't differ in both groups. A pronounced positive effect of CCH on the course of the acute period and therapy results in patients with IS was demonstrated.

THE RESULT OF SURGICAL TREATMENT OF A LONG INTRAMEDULLARY SPINAL CORD TUMOR WITH SYRINGOMYELIA

A case of hospitalization of a 31-year-old patient due to pain in the lower back and thoracic spine, extending to the anterior surface of the thigh and accompanied by a lack of movement and sensitivity in the lower extremities, impaired pelvic organ function in the form of urinary incontinence and decreased libido is presented. Magnetic resonance imaging revealed an intradural-intramedullary long tumor at the level of VTh2-VTh3-VTh4-VTh5 vertebrae, with pronounced uneven expansion of the central canal of the spinal cord - syringomyelia throughout above and below the formation, uneven atrophy of the spinal cord substance. The patient underwent surgery to remove the tumor. Postoperative pathoanatomic examination confirmed the presumed histological diagnosis - astroependymoma. In the postoperative period, there was a partial recovery of motor and complete restoration of sensitive limb functions, regression of neurological deficit. On a repeated MRI gram 1 month after the operation, a total regression of syringomyelia above and below the levels of the removed tumor was determined.

A current view on the prospects for the pharmaceutical therapy in neurorehabilitation after stroke

Introduction. Given due regard to the urgency of the issue of pharmaceutical support in neurorehabilitation after stroke, an open multicenter study was designed and conducted.Aim. To evaluate the efficacy and safety of therapy with Brainmax®, which is an original combination of two drugs: ethylmethylhydroxypyridine succinate (EMHPS) (100 mg/ml) and meldonium dihydrate (100 mg/ml) in the form of a solution for intravenous and intramuscular injections in patients with ischemic stroke in the acute and early recovery period.Materials and methods. The study included 60 patients aged 18 to 80 years with the first ischemic stroke in the carotid or vertebrobasilar system, meeting the inclusion/exclusion criteria. The total duration of therapy was 24 days. The efficacy of therapy was assessed using the following tools: modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), Rivermead Mobility Index (RMI), Montreal Cognitive Assessment scale (MoCA).Results. All patients showed improvement of their general condition by the end of therapy. The vast majority of patients noted that they had fewer difficulties with movement, self-care and daily activities as compared to the first visit. There was also a significant improvement in the total scores on the NIHSS scale, the Rivermead Mobility Index, and the Montreal Cognitive Assessment Scale (p < 0.05) by the end of therapy. The proportion of patients with reported adverse events (AEs) accounted for 3.33%. All AEs were transient and did not require cessation of the therapy. No serious side effects were recorded in any of the groups.Conclusions. The study showed significant improvement of the key symptoms of ischemic stroke: regression of neurological deficit, functional and cognitive impairment. On top of that, it was noted that the incidence of adverse events associated with the use of Brainmax® was low, which did not lead to cessation of therapy. No serious side effects were recorded in any of the groups.

РЕКОНСТРУКТИВНЫЕ И СТАБИЛИЗИРУЮЩИЕ ВМЕШАТЕЛЬСТВА В КОМПЛЕКСНОЙ ТЕРАПИИ ПАЦИЕНТОВ С СОЛИТАРНЫМИ МЕТАСТАЗАМИ ПОЗВОНОЧНИКА

Abstract. Introduction: The problem of diagnosis and treatment of patients with oncological pathology of the spine is relevant due to treatment complexity and the increasing number of patients’ morbidity. Secondary neoplastic processes are common in spine because of its anatomy, physiological features, complex biomechanics and enhanced vascularization. The main clinical manifestations of metastatic lesions of the spine are pain and neurological deficit. The development of spinal cord compression and pain syndrome leads to a sharp deterioration in the quality of life in patients with metastatic lesions of the spine. Despite the progress made in modern surgery of patients with oncological diseases with metastasis to the spine, mortality rates after surgery reaches 6.3% and complications appear in 23% of cases. Aim: Improving the results of treatment of patients with solitary spinal metastases and spinal cord compression. Methods and materials: Between 2010 and 2018, patients with spinal neoformations (N=240) received surgical treatment at Traumatology Unit of North-Western State Medical University named after I.I. Mechnikov. All patients were put into the categories according to their sex, age, histologic type and location of tumors. We assessed patients’ pain severity (BAIII), neurologic status (Frankel scale) and life span (by Kaplan-Meier method). Results: The study presents the analysis of the results of complex therapy of 183 patients with solitary metastases of the spine, who underwent the surgical stage of treatment. For these patients the epidemiological structure and the main clinical and radiological characteristics of solitary metastatic lesions of the spine were determined, a comparative assessment of the effectiveness of various options for surgical interventions in the complex treatment was carried out. To do so, all patients of the primary cohort were divided into 2 groups depending on the volume of surgery. The first group included 54 patients who underwent a radical resection of the affected vertebra in a single block with prosthetics of the anterior support column and posterior instrumental fixation. The second group included 129 patients after palliative decompressive and stabilizing operations from the posterior approach. Conclusion: There were no statistically significant differences between the two studied methods of surgical treatment in terms of the dynamics of the level of pain syndrome, regression of neurological deficit and life expectancy. When choosing the tactics of surgical treatment of patients with solitary spinal metastases, the main method is decompressive and stabilizing interventions, which helps to reduce the risk of surgical complications, improve the quality of life of the patient and continue the complex treatment of the underlying disease.

Mine blast injury of the spine and spinal cord: a case report

Many soldiers who were wounded during the war in Ukraine with Russia increased the number of cases of spinal injury. As a result of the Russia-Ukraine war, the number of patients with spine and spinal cord injuries increased significantly. According to the literature, gunshot wounds to the spine and spinal cord accounted for 0.26% of all soldier injuries during the American Civil War, with a mortality rate of 55%. According to the U.S. military data, spinal and spinal cord injuries accounted for 1.2% of war-related deaths during the Korean War, 1.0% - during the Vietnam War and the Gulf War, 6.0% - during the US invasion of Panama, 11.1% - during the war in Afghanistan and Iraq. Disability related to spinal cord injuries (14.0%) is currently the leading cause of discharge from military service for U.S. soldiers who have been injured. Patient M., 32 years old, male sustained mine blast injury. Immediately after the injury there was tetraplegia. Surgery was performed to correct vertebrae С7–Тh1, decompression of the spinal cord at the level of vertebrae С7–Тh1. Sixteen days after surgery, the neurological deficit regressed to the Frankel C clinical group. The patient was transferred to rehabilitation treatment. A clear, consistent, rapid algorithm of action in spinal cord injuries allowed to provide highly qualified care, which allowed to achieve significant results in the regression of neurological deficits in the postoperative period.

Imaging of early vasogenic edema in hyperperfusion zones of venous ischemic stroke

Aim. The aim of the study was to investigate the features of cerebral edema in cases of venous ischemic stroke with cerebral venous sinus thrombosis.Material and Methods. The study included 33 patients with venous stroke as a result of cerebral venous sinus thrombosis. Comparison group comprised 33 patients with arterial ischemic stroke. The control group included 33 individuals. Neuroimaging included native computed tomography (CT) of the brain at admission and at days 5–7, perfusion CT (MSCT 64) within the first 40 minutes of admission to the hospital, and magnetic resonance imaging (MRI) of the brain (1.5T) within the first 24–48 hours of the disease.Results and Discussion. The relationships were found between the early intercellular edema development according to diffusion MRI and a signal inversion on diffusion-weighted imaging (DWI) (a decrease in the perifocal zone against the background of a high signal of cytotoxic edema), an increase in the signal with the average upper limit of apparent diffusion coefficient (ADC) range (0.82 ± 0.05) * 10-3 mm2 /s differing only from the central zone, and moderate plethora of perifocal zones (with an increase in rCBV and rCBF by 27–28%) according to perfusion CT. These phenomena could be unfavorable factors for the development of edema and probable hemorrhage (in 27% of cases in venous stroke versus 9% in arterial stroke), but were accompanied by a more favorable clinical outcome of venous stroke (improvement in 66% of cases with a complete regression of neurological deficit in 25% versus 57% without complete regression of symptoms in arterial) with a lower incidence of necrosis/infarction (in 50% of cases versus ¾ of cases of ischemic stroke). The presence of a significant correlation between the parameters of lesion area and the relative values of CT-based perfusion and MRI-based diffusion (r = 0.44; p < 0.05) suggested that the early vasogenic edema and hyperemia were the elements of a pathophysiological mechanism for the development of cerebral venous ischemia, which, unlike arterial ischemia, is secondary in nature, associated with mechanical arterial vasoconstriction due to intercellular edema.Conclusion. Probably, vasogenic edema in most cases of venous stroke, developing almost simultaneously with cytotoxic edema, does not reach the peak of pathological changes and stop in development at the stage of ionic edema with a functional impairment of permeability of the anatomically intact blood-brain barrier when it can reverse. The progressive development of vasogenic edema is a factor for the deepening of ischemia to necrosis/infarction and secondary hemorrhagic transformation.

Application of a combined approach in the patient treatment with aggressive hemangiomas of the spine

Aggressive hemangioma of the spine is a benign vascular tumor. Stabilization, vertebroplasty, partial resection or total corpectomy of the affected vertebra, radiation therapy are known methods of treatment. Vertebral hemangiomas are more likely to be asymptomatic. Accordind to literature review 3–5 % of hemangiomas are symptomatic (pain). In 1.0 % of cases, hemangiomas cause symptoms of compression of nerve structures, spreading epidurally around the spinal cord and / or radicular nerves. A clinical case of a 63-year-old patient who underwent surgery in 2016 at another clinic for aggressive vertebral hemangiomas Th4 was presented. Bisphosphonate treatment was performed. Despite treatment, progressive lower extremities paraparesis was observed. Spinal angiography and total embolization of hemangiomas with liquid embolizing substances were performed. Immediately after embolization, the patient noted a pain intensity decrease. Surgery was performed in 40 minutes after transarterial embolization (removal of transpedicular stabilizing metal system, laminectomy of Th4 vertebra, decompression of the spinal cord, partial removal of Th4 hemangioma biopsy). The volume of intraoperative blood loss was 200 ml. Wound suction drainage was removed on the second postoperative day. No systemic complications (deep vein thrombosis, pneumonia) were noted. The patient was verticalized on the second postoperative day. After surgery, neurological function corresponded to the preoperative level (Frankel C). Regression of neurological deficit was observed (increased strength and range of motion of the lower extremities, bladder function improvement) the 5th postoperative day (Frankel D-E), Histological examination confirmed the diagnosis of hemangiomas. The patient was discharged from hospital with neurological improvement. Radiation therapy was recommended. 3 months after surgery, neurological function was assessed as Frankel E.

THE ROLE OF ENTEROVIRUSES IN THE DEVELOPMENT OF ISCHEMIC STROKE AND ITS OUTCOMES.

The aim: To study the role of enteroviruses (EV) in the development of ischemic stroke and its outcome. Materials and methods: The main group (MG) included 72 patients with acute cerebrovascular disorders were examined using the National Institutes of Health Stroke Scale and Barthel Index. The comparison group (CG) included 35 patients without cerebrovascular disease. Viruses were isolated from patients' sera and identified in neutralization test. EV genomes were detected in polymerase chain reaction (PCR). Serological diagnosis was performed by enzyme-linked immunosorbent assay. Results: EV genomes were more frequently detected in the patients' sera in MG than in CG (23.6 ± 5.9% and 2.9 ± 2.8%, p <0.05). The greater level of neurological deficits was in patients with positive PCR test results comparatively with patients with negative PCR test results (11.76 ± 0.31 and 10.97 ± 0, 27, p = 0.040). The regression of neurological deficit during the treatment was a worse in patients with positive PCR test results and presence of specific IgG compared with patients with positive PCR test results and absence of specific IgG (11.2 ± 2.6% and 19.6 ± 2.4%, p = 0.031). Conclusions: The trigger role of EV in the development of IS is established. PCR is recommended for diagnosis of EV in patients with IS.

Endovascular treatment of cerebral venous thrombosis.

The article describes a clinical case of cerebral venous thrombosis involving the deep venous system in a 42-year-old patient suffering from acute lymphoblastic leukemia. As the patient’s condition progressively deteriorated despite anticoagulant therapy, endovascular treatment was attempted. Transvenous thrombectomy and local thrombolysis were performed, which made it possible to achieve only partial recanalization. Further prolonged administration of alteplase into the cerebral sinus through a microcatheter facilitated complete recanalization of the direct and transverse sinuses. The restoration of blood flow was accompanied by regression of neurological deficit. This case is discussed in the context of modern approaches to endovascular treatment of cerebral venous thrombosis.

Prognostic value of methylation status of MGMT gene promoter in patients with glioblastoma after combination treatment.

e14025 Background: The effectiveness of radiation therapy in the classical and stereotactic treatment regimens of the primary glioblastoma multiforme was analyzed and compared. Methods: 87 patients with primary glioblastoma multiforme were hospitalized during the study period. 17 patients of them were in the treatment group (stereotactic radiotherapy, dose per fraction 2 Gy, 60 Gy total dose, CTV 2.0 cm, PTV 0.1 cm - group 1), and 70 patients were in the control group (conventionally fractionated radiotherapy, dose per fraction 2 Gy, 60 Gy total dose, CTV 2.0 cm, PTV 0.5 cm - group 2). Patients of both groups were treated with alkylating agents as the third stage of complex treatment. MGMT methylation was evaluated by pyrosequencing. Results: The use of stereotactic radiation therapy allowed to conduct a full course of treatment without interruption, whereas in the second group, due to the development of adverse reactions, the course was interrupted for 7 patients (10%). The advantage of stereotactic radiation therapy was a less pronounced increase and rapid regression of neurological deficits during treatment, manifested by better local control for 6 months. Hypermethylation of MGMT was detected in 39% of glioblastoma cases and was not detected in non-tumor tissue. The presence of promoter methylation disrupts DNA repair and is associated with longer survival in glioblastoma patients receiving alkylating agents. Note that the median survival of patients with MGMT hypermethylation in the group 1 was 285 days (IQR = 323.75), and in the group without hypermethylation was significantly more than 338.5 days (IQR = 476) (p = 0.045). A similar trend was observed in the second group: in patients with hypermethylated MGMT, the median survival was 271 days (IQR = 337), the result is different from patients without hypermethylated MGMT – 342 days (IQR = 493) (p = 0.039). Conclusions: As a result, the application of the stereotactic approach of radiation therapy in the complex treatment of patients with glioblastoma and their classification by the MGMT methylation status with a cut-off point of 10% has the basis for improving the effectiveness and tolerability of radiation therapy and contributes to the overall survival of patients.

Udar niedokrwienny mózgu w przebiegu dziecięcego pierwotnego zapalenia naczyń ośrodkowego układu nerwowego (cPACNS) - opis przypadku i przegląd literatury

Introduction: Primary angiitis of central nervous system in childhood (cPACNS) is a rare idiopathic inflammatory disease and an increasing cause of acute ischemic stroke in children. Due to heterogenous classification and poorly understood pathomechanism there are no estimated prevalence and treatment guidelines for PACNS in pediatric population. Case report: A 6-year-old boy with symptoms of acute ischemic stroke was admitted. Neurological examination revealed left hemiparesis. After exclusion of brain hemorrhage the patient was primarily treated with anticoagulants. Brain magnetic resonance (MRI) showed reduced flow with longitudinal stenosis in right internal carotid artery and right middle cerebral artery. Numerous ischemic focuses acute and chronic were found in right cortical and subcortical regions. Hematologic disorders were excluded, as were other inflammatory disorders. Due to imaging studies and clinical features primary angiitis was suspected. Corticosteroids were administrated and regression of neurological deficits was observed. Eventually cPACNS was diagnosed. Conclusion: cPACNS should be considered after exclusion of systematic, rheumatological and secondary causes of vasculitis. Fast diagnosis and administration of therapy is absolutely essential as most of the case series carried on adult population suggest a favorable clinical outcome of cPACNS early treated with steroids.

Therapeutic effects of mirror therapy in patients after stroke

To evaluate the effect of mirror therapy on the regression of motor disorders in the paretic arm, functional and psychological disorders, the patient's functioning and quality of life, risk factors for recurrent stroke in the early recovery period of stroke. We examined 219 patients after stroke, including 154 patients after ischemic stroke (IS) and 65 patients after hemorrhagic stroke (HS) in the early recovery period (21 days to 6 months). All patients received a standard medical rehabilitation course including medications, physical rehabilitation, and physiotherapeutic treatment. Patients were divided into four groups depending on the stroke type and the medical rehabilitation course received: two study treatment groups (post-IS and post-HS groups), which consisted of patients receiving the standard medical rehabilitation course and mirror therapy, and two comparison groups (post-IS and post-HS), in which patients received only the standard medical rehabilitation course. All patients before and after the medical rehabilitation course were evaluated for neurological disorders (NIHSS, Ashworth scale of muscle spasticity, Medical Research Council (MRC) Scale and handgrip test), functional limitations (Frenchay Arm Test, Hauser Ambulation Index, Rivermead Mobility Index, Functional Independence Measure (FIM), ICF), mental status («Visual Memory» and «10 Word Memory» methods, Schulte-Platonoff tables, Lüscher color test, Hospital Anxiety and Depression Scale (HADS), Locus of Control Recovery Questionnaire), quality of life (EQ-5D), arterial hypertension (Arterial Hypertension in Adults. Clinical Guidelines, 2020). Addition of the mirror therapy to the standard course provided additional therapeutic effects: in patients with IS, the high tone of the paretic muscles of the arm significantly decreased (by 46%); the target blood pressure was achieved in 96% of patients; severe disorders of functional independence and depression regressed; significant changes of mental functions parameters (visual memory, shifting attention); improvement of activity and participation parameters (carrying in the hands, self-care, housekeeping). In patients with HS, the muscle strength of the paretic arm significantly increased (by 35%); the target blood pressure was achieved in all patients; improvement of mental functions (motivation, shifting attention, visual memory), activity and participation parameters (objects moving and manipulation, self-care), and decreased level of depression were observed. The addition of mirror therapy to the standard of care for patients after stroke resulted in regression of neurological deficit, motor disorders in the paretic arm, improvement of emotions and motivation, mitigation of recurrent stroke risk factors, as well as significant impact on the cognitive functions and enhancement of patients' capabilities of self-care.

Effect of age on outcome in patients with cerebral stroke

The aim of the studywas to assess the course and outcome of cerebral infarction, depending on the age factor and duration of stay in the neuroblock. Materials and methods: a dynamic observation of 494 patients, men and women, aged 38–84 years with acute ischemic stroke of hemispheric localization, which were divided into the three groups depending on age, was performed. Group 1 – younger than 60 years old, group 2–60–70 years old, group 3 – older than 60 years. All patients underwent standard therapy, according to the recommendations for the treatment of ischemic stroke. The patients underwent comprehensive clinical and instrumental monitoring, which included assessment of somatic and neurological status according to the NIH‑NINDS scales at 1st, 3rd, 10th days and at discharge or death; assessment of the level of social adaptation according to the Bartel scale on 1st, 3rd, 10th days and at discharge, clinical and biochemical blood tests, computed tomography of the brain. Assessment of the quality of therapy was carried out according to specially developed maps using methods of statistical correlation analysis.Results:the most pronounced positive dynamics of neurological status was in the 1st group of patients. The regression of neurological deficit in the 2nd group was worse. The minimal dynamics of neurological deficit was in the 3rd group of patients with cerebral stroke. Most often, the death of patients with cerebral stroke occurred from the development of multiple organ disorders. Conclusions: patients over 70 years of age have the greatest risk of death, due to: a decrease in the reactivity of the body, the presence of initially severe concomitant somatic pathology in patients with admission to hospital; accession of secondary somatic and purulent‑septic complications.

COMPLICATIONS OF ACUTE TRAUMATIC SPINAL INJURIES IN SAINT PETERSBURG

Almost every sailor during performing his job duties aboard receives injuries of varying severity, among which the most common are deck fractures, including compression vertebral fractures, as well as open and closed vertebral fractures with spinal cord injuries. Besides the recovery of disordered functions of the spinal cord, in cases of spinal cord injury, the fight against numerous neurological, infectious and somatic complications affecting the survival and quality of life of patients is still relevant.Objective: to study the incidence of complications of traumatic injuries of the spinal cord under initial hospitalization, their impact on the length of hospital stay, to identify and evaluate the role of risk factors in the development of complications.Materials and methods. A retrospective cohort study was conducted according to the archived case histories of patients hospitalized in neurosurgical hospitals in St. Petersburg. 311 cases of acute spinal cord injury in 2012–2016 were analyzed.Results: complications not directly related to spinal cord injury, such as bronchitis, pneumonia, bedsores, sepsis, thromboembolism, urinary tract infections, postoperative wound pyogenesis and others (damage to other organs and systems), were found in one third of patients (33,8%), in half of the cases there were multiple complications (2 or more), the most frequent — respiratory (23,5%) and pressure sores (10%). Complications significantly increased the length of hospital stay. The dependence of the frequency of complications on age, the level of spinal cord damage and the severity of the injury was revealed. Risk factors such as concomitant head injury and alcohol intoxication have been found. The revealed positive effect of corticosteroids on the regression of neurological deficit was not statistically confirmed. At the same time, there was a significant increase in the frequency of respiratory complications when using corticosteroids.Conclusion: Knowledge of the factors affecting the incidence of complications, optimization of their prevention and therapy will shorten the duration of hospitalization and improve the prognosis and quality of life of patients. The issue of use of corticosteroid therapy in the acute period of traumatic injuries of the spinal cord remains debatable. When choosing therapeutic tactics for managing patients with spinal trauma, it is necessary to take into account the risk of respiratory complications and carefully evaluate the ratio of benefits to harm.

Reperfusion therapy in ischemic stroke

Aim. To assess the main results of thrombolytic therapy (TLT) in patients with ischemic stroke (IS) in the Regional Vascular Center at the premises of Emergency Hospital in Ufa. Material and methods . A retrospective study of the TLT use was carried out in patients with acute cerebrovascular accident (CVA) who were admitted to the hospital from January 1, 2014 to December 26, 2017 The inclusion criteria were all IS cases in which patients received alteplase (actilyse) in accordance with the thrombolysis protocol. Results. There was a decrease in the number of patients with acute CVA hospitalized in the department for CVA patients. The proportion of ischemic stroke increased from 76,3% in 2014 to 79,1% in 2017 Annually, there was an increase in the number of patients with onset-to-door time <4,5 hours and reduction in door-to-needle time for thrombolysis from 1,5 hours in 2014 to 52,5 minutes in 2017 The share of TLT procedures increased from 2,4% in 2014 to 7,3% in 2017 In total, 180 (4,8%) procedures was performed. In 96% of patients there was a significant regression of neurologic deficit according to the NIH Stroke Scale after reperfusion therapy for the entire period. A complication of TLT was hemorrhagic transformation (HT), which was symptomatic in 8 (4,4%) patients. The highest 30-day mortality rate after TLT was in 2014 — 7,7%, the lowest in 2015 — 2,3%. For the entire study period, this parameter was 3,8% . Conclusion. During the study period of TLT in IS patients, there was a positive trend in the number of patients with onset-to-door time <4,5 hours and a reduction in door-to-needle time for thrombolysis. We also observed increase of total thrombolysis procedure amount, and most patients had significant neurological deficit improvement. The incidence of significant complications and mortality after TLT was lower than in the Russian Federation. The safety of TLT is based on adherence to uniform patient selection criteria and thrombolysis protocol. A personalized approach in selecting patients for TLT is a predictor of the hemorrhagic complications. The adherence to the thrombolysis algorithm and guidelines of patient management after thrombolysis contributes to the successful use of this treatment method in IS patients.

The Experience of Using the Implantable Interspinous System COFLEX in the Surgical Treatment of Compression Forms of Lumbosacral Radiculitis

The paper presents the experience of surgical treatment of 58 patients with discogenic lumbosacral radiculitis. The aim of the surgical treatment was to eliminate the compression of the spinal roots of the herniated disc with the subsequent stabilization of the spinal-motor segment with implantable interspinous system COFLEX. Indications for surgical treatment were persistent radicular pain syndrome, which was not stopped by conservative methods of treatment, and disco-radicular conflict in the area of the interested vertebral-motor segment, confirmed by radiation research methods. In the diagnosis, the following research methods were used: clinical and neurological examination, survey and functional spondylography of the lumbar spine, computed tomography with contrast myelography, morphometric and statistical methods. The effectiveness of treatment was evaluated in 49 patients (84 % of operated) one and a half years after surgery. All patients showed complete regression of neurological deficit and satisfactory standing of the implanted interstitial dynamic system COFLEX in the operated vertebral-motor segment. Thus, the use of the implantable COFLEX dynamic system for the above indications is the choice method for operating surgeons, in which it is assumed that the function of the interested vertebral-motor segment is preserved.

Combined endovascular and surgical treatment of symptomatic tandem occlusion of common carotid artery and middle cerebral artery – case report

Introduction: Cerebrovascular events are among the most common causes of invalidity or death. The aim of treatment in acute cerebral ischemia is to restore the blood flow before irreversible necrosis of brain tissue and persistent neurologic deficit occur. Pharmacological, endovascular and surgical methods are employed in the treatment of these patients. Case report: The authors present a case report of a 56-year-old woman with acute cerebral ischemia caused by tandem occlusion of the left com- mon carotid artery and the M1 segment of middle cerebral artery. In the initial phase the patient was treated by intravenous thrombolysis with minimal success. Common carotid artery was occluded and mechanical extraction of embolus was successfully performed through direct carotid bifurcation puncture. Almost complete regression of neurologic deficit occurred after the endovascular recanalization. Occluded common carotid stump and bifurcation was considered as a source of embolization and therefore, to prevent further cerebrovascular event, a subclavian-carotid bypass was performed on the 15th day after the stroke. Conclusion: In the reported patient with symptomatic tandem occlusion of common carotid artery and the M1 part of middle cerebral artery, recanalization of cerebral artery was attained by the combination of pharmacological and endovascular method. Consequent subclavian-to-carotid bypass was performed in tertiary prevention of further cerebrovascular event.

Two-stage surgical treatment of subarachnoid and paryhymatous blood effects with the use of endovascular embolization of damaged aneurysm

Introduction. Aneurysmal subarachnoid hemorrhage (SAH) is complicated by concomitant intracerebral hemorrhage (IUD) with a frequency of 4% to 42.5%. More than 80% of patients die in conservative therapy, and when removing only hematomas without occlusion of an aneurysm, the mortality rate reaches 75%. Objectives. The aim of the study was the optimization of treatment of aneurysmatic subarachnoid haemorrhage complicated by the formation of intracerebral hematoma. Materials and methods. The analysis of the results of surgical treatment of 101 patients in the acute period of cerebral aneurysm rupture was performed. The first group of observations in which the surgical treatment was limited to endovascular occlusion of cerebral aneurysms. In the second group of observations, multi-stage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of parenchymal hematoma for 24–48 hours. Results. In most cases, surgical treatment was limited to endovascular embolization of the ruptured aneurysm. In 3 observations, multistage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of intracerebral hematoma. In two cases, positive dynamics with a regression of neurological deficits in the postoperative period was noted. In one observation, partial regression of motor deficit. Conclusions. Two - stage surgical treatment of subarachnoid haemorrhage with intracerebral hematoma the use of endovascular embolization of the ruptured aneurysm and subsequent evacuation of hematoma is effective and can be used in cases where there is a technical possibility of occlusion of the aneurysm s and the compensated state of the patient.