Vol 12, No 3 (2018)

Objective: to evaluate the effectiveness of transluminal angioplasty with stenting in the treatment of atherosclerotic stenosis of the vertebral arteries (VA) proximal segment.

Materials and methods. One hundred twenty-seven patients (97 men and 30 women, mean age 60 years) with symptomatic (72% of patients) and asymptomatic (28% of patients) stenosis of the VA were examined, the degree of stenosis according to X-ray angiography was 76±11%. One hundred fifteen (91%) patients with 127 (91%) implanted stents were surveyed over time (average follow-up time 13 months).

Results. Technical success was achieved in 94% of cases. In the perioperative period, no acute cerebrovascular events, myocardial infarctions or deaths were registered. Recurrence of symptoms of vertebrobasilar insufficiency was noted in 14% initially symptomatic patients. According to ultrasound study data, restenosis ≥50% or reocclusion of the VA stent was detected in 40% cases. Damage to the integrity of the stent was diagnosed in 8% cases, which in all observations was combined with restenosis. Repeated derangement of stent patency after restenting of 11 VA in the period of 4–6 months was revealed in 60% of cases (2 reocclusions and 4 restenoses).

Conclusion. Angioplasty with stenting is a safe and clinically effective method for treating atherosclerotic stenosis of the proximal segment of VA. In a cohort of 50 patients included in the study, low quality of life was observed prior to stenting of VA. Six months after the VA stenting, the quality of life of patients increasesin both physical and psychological aspects. The main problem remains to be a high incidence of  restenosis or reocclusion of stents after primary and repeated endovascular intervention in the long-term postoperative period.

Introduction. The problem of cognitive impairment of vascular genesis takes an important place in modern angioneurology. Verification of changes occurring in the brain is carried out with the help of neuroimaging methods; and functional magnetic resonance imaging (fMRI) may reveal the main points of pharmacological activity of drugs with the declared neurometabolic effect with a greater probability.

Objective. Objectivization of the effect of basic angioneurological drugs on the cognitive sphere in patients with chronic cerebrovascular diseases.

Materials and methods. A detailed analysis of the neuropsychological sphere (cognitive tests) and neuroimaging results by studying a pharmacological fMRI of the brain with a cognitive paradigm was carried out for 154 patients with discirculatory encephalopathy.

Results. Despite similar clinical indications for the use of vinpocetine (cavinton), cortexin, cerebrolysin, and actovegin, the mechanism of their action at the cellular level, identified with fMRI, was different. The vasoactive and antiplatelet clinical effect of vinpocetine is supplemented with new data on the improvement of cerebral neuroplasticity due to the expansion of the activation zones and intensification of the signal intensity from them, as well as the emergence of new activation zones in the projection of associative fibers. Cerebrolysin and cortexin with a neurotrophic effect lead to a narrowing of the activation zones, both of the main cognitive zones and of the associative regions, which may indicate a decrease in brain energy expenditure during the cognitive loads. Given protective function of drugs appears in a positive cerebroprotective effect. During treatment with actovegin, fMRI revealed a primary increase in activation of the hippocampal brain zones responsible for improving cognitive functions, which reveals the polymodal effect of the drug, with neuroprotective action among the others.

Conclusions. The use of pharmacological fMRI together with a complex clinical and laboratory studies allows us to discover new aspects of the effect of drugs and to justify the need for a personalized approach in the treatment of cognitive impairment.

Introduction. Despite rapid development of the antiepileptic pharmaceuticals market, about 2/3 of patients suffering from epilepsy do not receive adequate treatment, which is partly due to the variety of mechanisms for the development of epileptic seizures

Objective. А comparative study of the electrophysiological mechanisms of action and effects of valproic acid (Depakin Chrono) and levetiracetam (Levetinol) under experimental focal epilepsy and status epilepticus (SE) in rats.

Materials and methods. Focal chronic epilepsy was caused by the application of cobalt to the sensorimotor cortex. On the 7th–8th day, SE was modeled by the injection of homocysteine, which provoked the development of secondary generalized tonic-clonic seizures.

Results. Levetiracetam had a suppressing effect on the paroxysmal activity of the rat brain only under conditions of a stable SE on the 5th–6th day after the application of cobalt. Its most prominant effect was seen in the hippocampus and was characterized by a significant decrease in epileptic activity (EpiA) in this structure and in the maintenance of a regular rhythm. Valproic acid significantly suppressed EpiA in the ipsilateral cortex, hippocampus and hypothalamus at a stable stage of EpiS development, with the most pronounced effect on the primary cortical focus and hypothalamus. In the model of SE caused by the injection of homocysteine, levetiracetam was ineffective, whereas valproic acid decreased the severity of paroxysmal activity in all the studied structures, especially in the cortex (ipsi- and contralateral, 33 times) and hypothalamus (28 times), which was accompanied by suppression of generalized motor manifestations and reduced number of animal deaths.

The number of surgical interventions on the lumbar spine is constantly growing due to the emergence of new surgical techniques aimed at treatment of degenerative spine pathology and a large number of patients, suffering from the back pain. Quite often, surgical intervention turns to be not effective enough and the pain syndrome persists, leading to the necessity for the repeated revision surgeries with the use of stabilizing systems. The review represents research data on the causes of recurrent-remitting course of degenerative process, problems of epidural adhesion as one of the back pain syndrome predictors, the survey of various stabilization systems and operative approaches for their implantation. The disadvantages and advantages of ventral approach with the use of interbody fusion are summarized in comparison with dorsal approach used for the installation of the transpedicular system and interbody fusion with a bone graft.

The positive features of interbody fusion from anterior retroperitoneal approach include the ability to quickly and completely remove the entire disc, decompress the dural sac without entering the vertebral canal, optimally select an implant corresponding to the size of the vertebral end plates, creation of the optimal lordosis angle, and provision of the shortest approach to the operated disk and to the place of neural structures compression.

The advantages of the dorsal approach with transpedicular system implantation and interbody fusion with a bone graft are better visualization of neural structures in comparison with discectomy from the ventral approach, the possibility of wide decompression and expansion of the extent of operation, the possibility of ablation of the facet joints by diathermocoagulation after the surgical wound was made, the reliability of posterior fixation, and familial approaches for a neurosurgeon with a lesser duration of training.

This is a description of a clinical case of levamisole-induced leukoencephalopathy. A few hours after the single intake of the immunomodulator levamisole (150 mg), the patient developed following cerebral symptoms: febrile fever, dizziness, frequent urination, impaired color vision, divergent strabismus, unsteady gait, severe weakness, increased drowsiness, retardation, delusions. The symptoms progressed towards a full clinical picture for about 2 months. The course of the disease was of a wavy nature: left-sided hemiparesis and the left facial nerve palsy were present at the beginning, with later inversion of symptoms represented by the right-sided hemiparesis and the right facial nerve palsy combined with dysarthria. Magnetic resonance imaging (MRI) revealed multiple foci of demyelination in both hemispheres of the brain that regressed after corticosteroid therapy administration. No abnormalities of the cerebrospinal fluid were detected. No pathology of the fundus was evident. The evoked potentials of the brainstem (auditory and visual) and somatosensory evoked potentials from the hands and feet were within normal limits. Plasmapheresis (3 procedures, each 2 liter, with intravenous administration of 1 g of solu-medrol after each session) was performed in the acute phase, which benefited the decrease in severity of the neurological symptoms. Vascular and metabolic therapy was performed afterwards, with the regression of the neurologic symptoms. No specific therapy was administered after the woman was discharged from the hospital. For a 10-year survey after the acute demyelinating process outbreak there’s a complete regression of neurologic symptoms and positive dynamics of the patient’s MRI. The woman is fully adapted physically, emotionally and socially.