Vol 9, No 3 (2015)

Original articles

Features of atherosclerosis of the cerebral arteries and pathomorphology of cerebral infarctions in patients with type 2 diabetes mellitus

Anufriev P.L., Tanashyan M.M., Gulevskaya T.S., Ablyakimov R.E., Gnedovskaya E.V.

Abstract

Comparison of the results of 20 autopsy cases of ischemic strokes developed during atherosclerosis with 20 autopsy cases of ischemic strokes associated with atherosclerosis in combination with type 2 diabetes mellitus (T2DM) provided data indicating a high significance of T2DM in the development of severe changes in the cerebral arteries, causing cerebral infarctions of various size and localization. A significant prevalence in the number of atherosclerotic plaques in the cerebral arteries, including those causing stenosis of the lumen by 50% or more, was found in the case of T2DM compared to cases without T2DM. Cerebral infarctions in T2DM were mostly of the multiple nature that was determined by a combination of fresh or organizing extensive, large or medium, infarction with one/several organized medium, small deep, and small surface infarctions. More severe atherosclerosis of the cerebral arteries in T2DM caused a higher rate of infarctions due to occlusive atherothrombosis, arterio-arterial embolism, and tandem atherostenosis in these patients compared to cases without T2DM. In the absence of T2DM, infarctions occurred more often due to embolism of the cerebral arteries from the heart with coronary heart disease compared to cases with T2DM.
Annals of Clinical and Experimental Neurology. 2015;9(3):
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Neuroprotection in cerebrovascular diseases: is it the search for life on Mars or a promising trend of treatment? Part 2. Chronic cerebrovascular diseases.

Piradov M.A., Tanashyan M.M., Domashenko M.A., Maksimova M.Y.

Abstract

The evidential base of major neuroprotective drugs (piracetam, cytoflavin, ethylmethylhydroxypyridine succinate, choline alphoscerate, cortexin, cerebrolysin, citicoline, actovegin) in chronic cerebral ischemia is critically reviewed in the article.
Annals of Clinical and Experimental Neurology. 2015;9(3):
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Biomarkers of cerebral atherosclerosis: the capabilities of early diagnosis and prognosis of individual risk

Tanashyan M.M., Raskurazhev A.A., Shabalina A.A., Lagoda O.V., Gnedovskaya E.V.

Abstract

The article discusses the results of a study of asymptomatic patients with a severe stenosing process in the brachiocephalic arteries (in a model of carotid atherosclerosis), with emphasis on determination of biochemical markers associated with various stages of atherogenesis. The definition of a group of proatherogenic and atheroprotective biomarkers is suggested and substantiated. Correlations among biomarkers are described. The correlations have potential etiopathogenetic nature, which necessitates further validation of these pathological changes in wider groups of patients.
Annals of Clinical and Experimental Neurology. 2015;9(3):
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Extended Doppler monitoring of cerebral blood flow in different subtypes of ischemic stroke

Polushin A.Y., Odinak M.M., Voznyuk I.A., Yanishevskiy S.N.

Abstract

The dynamics of cerebral blood flow in acute ischemic stroke was studied with allowance for a pathogenic classification of stroke. Analysis of the ultrasound parameters demonstrated that particular attention should be given to quantitative, rather than qualitative, parameters of blood flow. The dynamics of cerebral blood flow in different etiologies of cerebral stroke is reflected in specific changes in the linear velocities, which relates a stroke subtype to the factors determining the need for extended monitoring. Clinical and instrumental assessment of the development of hemodynamic disorders during reperfusion after stroke by means of Doppler ultrasound demonstrated that, depending on the etiology of ischemic stroke, recovery of the intracerebral hemodynamics parameters to normal values occurs differently and has its features that, if timely detected, may affect correction of the strategy and tactics of treatment. Based on these data, we suggest a differentiated algorithm of extended Doppler monitoring of cerebral blood flow in acute ischemic stroke.
Annals of Clinical and Experimental Neurology. 2015;9(3):
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Treatment of spondylogenic cervical myelopathy

Gushcha A.O., Dreval’ M.D., Kireeva N.S., Korepina O.S.

Abstract

The study objective was to analyze the results of cervical laminoplasty in treatment of compressive cervical myelopathy and evaluate intraoperative risks and outcomes.Experience of surgical treatment of 30 patients (mean age of 59.4 years) with cervical stenosis complicated by myelopathy was analyzed. Hirabayashi laminoplasty was performed in 26 patients, and Kurokawa laminoplasty was performed in 4 patients. All patients were diagnosed with extensive spinal stenosis at the cervical level. The diagnosis was made based on the results of complex survey, including dynamic clinical and neurological examination, X-ray, CT, MRI, somatosensory evoked potentials (SSEPs), and transcranial magnetic stimulation (TMS). The Nurick scale, Japanese Orthopaedic Association (JOA) score, and Recovery Rate scale were used to evaluate severity of myelopathy; the Visual Analog Scale was used to evaluate postoperative axial pain. The indications and contraindications for laminoplasty were determined. Early and long-term (> 3 years) outcomes of the clinical status and radiographic and neuroimaging indicators were evaluated. Laminoplasty, having a number of advantages, is the method of choice in the treatment of extensive spondylogenic cervical stenosis. Proper selection of patients based on clinical symptoms, assessment of the stenosis length, and data of neurological examination and neuroimaging enable achieving excellent outcomes of laminoplasty. The surgery is optimal for the older age group (> 60 years).
Annals of Clinical and Experimental Neurology. 2015;9(3):
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Significance of voxel-based morphometry in studying mild cognitive impairments

Damulina A.I., Konovalov R.N., Kadykov A.S.

Abstract

Cognitive impairments are an important medical and social problem associated with a high prevalence of this disease in the population. 46% of patients develop dementia within 5 years after the diagnosis of mild cognitive impairments (MCIs). Voxelbased morphometry (VBM) is a modern neuroimaging technique well-proven in studying dementia. VBM in a combination with neuropsychological examination of patients enables clarifying the genesis of mild cognitive impairments (MCIs) and predicting further development of the disease as early as the initial stage of the pathology.
Annals of Clinical and Experimental Neurology. 2015;9(3):
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Experience of experimental simulation of Huntington’s disease

Stavrovskaya A.V., Voronkov D.N., Yamshchikova N.G., Ol’shanskiy A.S., Khudoerkov R.M., Illarioshkin S.N.

Abstract

Huntington’s disease (HD) is an autosomal dominant neurodegenerative disease characterized by choreic hyperkinesia, cognitive decline, behavioral disorders, and progressive neuronal death affecting primarily the striatum. The fatal nature of HD makes searching for new effective methods of treatment topical, which requires the development of experimental models of the disease. This model can be created on the basis of 3-nitropropionic acid (3-NPA) that is a neurotoxin causing characteristic changes in motor skills and memory impairment in animals due to induction of oxidative stress, impaired glutathione defense, and destruction of striatal cells. HD in rats was simulated by chronic intraperitoneal administration of 3-NPA daily for 17 days. Systemic administration of a low dose of 3-NPA (10 mg/ kg) induced hyperactivity of the animals in the open field test (including movement redundancy as a hyperkinesia analogue) and had no effect on the behavior of the animals in the X-maze test. On the contrary, rats administered with a toxic dose of 3-NPA (20 mg/kg) demonstrated a significant decrease in the motor activity an cognitive decline in behavioral tests. Histopathological analysis revealed damage and loss of neurons and decreased expression of dopaminergic markers (tyrosine hydroxylases and plasma membrane dopamine transporter) in the striatum. Also, a gliotoxic effect of 3-NPA in the striatum was found, which was confirmed by immunohistochemical staining for astrocytic proteins: GFAP, glutamine synthetase, and aquaporin-4. This HD model may be helpful for testing new experimental therapies at various stages of neurodegeneration of the Huntington type, including those based on cell neurotransplantation.
Annals of Clinical and Experimental Neurology. 2015;9(3):
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New capabilities of laboratory diagnosis of thromboses

Shabalina A.A., Kostyreva M.V., Tanashyan M.M.

Abstract

The growing number of thromboses has been observed in various fields of medicine, which makes the issues of early diagnosis and investigation of thrombotic condition predictors more topical. Evaluation of hemostasis and investigation of risk factors of both thrombotic and hemorrhagic states is one of the most complex diagnostic problems. The objectives of laboratory diagnosis include not only studying of already known indicators of thrombovascular hemostasis and standard coagulation tests but also developing, automating, and improving of new methods for detection of biomarkers of hemostasis disturbances. According to the results of modern research, a high level of the subpopulation of procoagulant or coated platelets, known as COAT-platelets, in patient blood can be considered as this new marker for predicting thrombosis. COAT-platelets are a subpopulation of collagen and thrombin-activated platelets maintaining a high procoagulant activity of blood.

 
Annals of Clinical and Experimental Neurology. 2015;9(3):
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Monomelic amyotrophy: a rare variant of lower motor neuron disorder (2 clinical cases)

Alekseeva T.M., Demeshonok V.S., Aleksandrov N.Y., Khalikov A.D., Sokolova M.G.

Abstract

Monomelic amyotrophy (MMA) is a rare variant of lower motor neuron disease with benign progression. The disease is characterized by muscular weakness and atrophy in the hand and forearm on one side or asymmetrical lesion of both upper limbs with the presence of cold paresis, fasciculations, and fine tremor of the fingers. Sensory disorders, pyramidal symptoms, and involvement of the leg muscles are not typical of it. The final diagnosis of MMA can be made only on the basis of clinical neurological and electrophysiological tests as well as long-term follow-up of the patient. Timely recommendations for correction of the movement pattern and prevention of flexion compression may slow down the disease progression in some cases and, thereby, improve the quality of life of patients. The article describes two clinical cases with a probable diagnosis of MMA.
Annals of Clinical and Experimental Neurology. 2015;9(3):
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Сerebrotendinous xanthomatosis

Rudenskaya G.E., Zakharova E.Y.

Abstract

Cerebrotendinous xanthomatosis is a rare autosomal recessive disorder of cholesterol and bile acid metabolism associated with the sterol 27-hydroxylase gene CYP27A1. The disease is characterized by a varying age of the onset, progressive course, and wide range of the neurological and extraneural symptoms. MRI of the brain plays an important diagnostic role. Measurement of the serum cholestanol level and DNA analysis are verification methods. Timely started chenodeoxycholic acid replacement therapy enables slowing down the disease progression and, in some cases, preventing neurological disability.

References

Annals of Clinical and Experimental Neurology. 2015;9(3):
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