Vol 8, No 2 (2014)

Original articles

Drug-Eluting stents in the treatment of proximal vertebral artery stenosis

Chechetkin A.O., Skrylev S.I., Koshcheev A.Y., Shchipakin V.L., Krasnikov A.V., Suslina Z.A.


The objective of the study was to assess the efficacy of endovascular revascularization with drug-eluting stents in patients with proximal atherosclerotic stenosis of the vertebral arteries. We studied 32 subjects (61±10 years) who underwent 35 interventions of sirolimus- or tacrolimus-coated stent placement (3 patients were operated on both vertebral arteries). Twentyseven (84%) patients were symptomatic. All patients received double antiplatelet therapy after the intervention. The intervention was technically successful in 89% cases. No cases of acute stroke, myocardial infarction or death were seen in the perioperative period. Ultrasound scanning showed that stents remained completely patent. Twenty-nine (91%) subjects with 32 stents were followed-up for a mean period of 9.5 months. No acute strokes in the vertebral basin were reported, although recurrent symptoms were noted in 3 patients. In-stent restenosis was found in 16 (50%) vertebral arteries in 15 patients, and it was asymptomatic in 12 (80%) cases. Restenosis ≥50% (n=13) and re-occlusion (n=3) were seen more often in the tacrolimuseluting stents compared to the sirolimus-eluting stents (10 out of 14 cases [71%] vs. 6 out of 18 cases [33%], р=0.1794). Stent damage followed by restenosis was reported in 2 arteries (6%). Recurrent stenosis was seen more often in men (р=0.0173). To conclude, stenting of the extracranial portion of the vertebral artery is safe and clinically effective. Usage of drug-eluting stents cannot help solving the problem of reducing the high risk of restenosis in the late postoperative period.

Annals of Clinical and Experimental Neurology. 2014;8(2):5-11
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Objectivization of equilibrium and stability changes in patients with stroke in the early restorative period

Romanova M.V., Kubryak O.V., Isakova E.V., Grochovsky S.S., Kotov S.V.


In 40 patients with ischemic stroke in the vertebrobasilar basin, complex assessment of disturbances of patient’s equilibrium and steadiness was carried out in the early restorative period, including respective clinical scales and stabilometry. Compared with commonly used in clinical practice non-instrumental assessment, the introduction of stabilometric criteria helps to improve the diagnostics of equilibrium/stability changes and allows controlling objectively the patient’s condition on treatment and further follow-up, thus increasing the efficiency of rehabilitation procedures.

Annals of Clinical and Experimental Neurology. 2014;8(2):12-15
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Clinical and pathogenetic aspects of hypertensive crises in patients with early signs of chronic cerebrovascular diseases

Varakin Y.Y., Gnedovskaya E.V., Andreeva O.S., Gornostaeva G.V., Prokopovich M.E., Oshchepkova E.V., Lazareva N.V., Kravchenko M.A., Suslina Z.A.


The aim of the present retrospective study was the analysis of characteristics of early signs of chronic cerebrovascular diseases in patients with hypertension of grades 1 or 2 suffering from hypertensive crises of various severity. We developed uniform diagnostic criteria for hypertensive crises that allowed to identify them and to assess their rate and severity. We studied 109 men and women (age 50–69) with hypertension, who were divided into 2 groups: patients who suffered from hypertensive crises (n=65) and patients with no crises (n=44). Complex assessment included 24-hour blood pressure monitoring, echocardiography, duplex scan of carotid, vertebral and cerebral arteries, and MRI of the head. Clinical and pathogenetic features of the development and progression of chronic cerebrovascular diseases in patients with hypertension were disclosed, and profile characteristics of such a type of patients with hypertensive crisis were described. We plan to continue the prospective follow-up and to assess the efficacy of antihypertensive treatment for the prevention of recurrent crises.

Annals of Clinical and Experimental Neurology. 2014;8(2):16-21
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Demyelinating optical neuritis: correlation of data of optical coherence tomography and multifocal electroretinography

Neroev V.V., Eliseeva E.K., Zueva M.V., Lysenko V.S., Zakharova M.N., Tsapenko I.V., Semenova N.A., Simaniv T.O.


The analysis of optical coherence tomography and multifocal electroretinography (mfERG) at 61 hexagons data is presented in three groups of patients: (1) with multiple sclerosis (MS) and optical neuritis (ON) (14 patients), (2) with ON of unknown etiology (19 patients), and (3) with ON of infectious etiology (12 patients). In patients with MS, the correlation of the P1 component latency of mfERG in the perifovea with retinal thickness in the central zone in all quadrants of fundus (except superior), as well as with the total macular volume was revealed, that allows using this mfERG parameter as a marker of MS progressing. The results of our study showed that the calculation of the ratio in the density of P1 R1/Rx may be recommended as an additional marker of acute process in functional diagnosis. Patients with ON of infectious etiology were characterized by the decrease in the retinal thickness in a perifoveal zone of temporal and inferior quadrants and the reduction in the density and the amplitude of P1 in all rings.

Annals of Clinical and Experimental Neurology. 2014;8(2):22-26
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Antiamnestic effect of dicholine succinate on models of amnesia caused by using scopolamine or electric irritation

Sariev A.K., Rychikhin V.M., Abaimov D.A.


We studied antiamnestic properties of dicholine succinate on models of amnesia caused by using scopolamine or electric irritation in the test of conditional reflex of passive avoidance. The experiments were carried out on outbreed male rats. It was shown that sub-chronic introduction of dicholine succinate in the dose of 25 mg/kg per day was characterized by a significant antiamnestic effect. The effect of dicholine succinate in amnesia caused by electric irritation was greater compared to that in the amnesia model caused by scopolamine.

Annals of Clinical and Experimental Neurology. 2014;8(2):27-30
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Myeloproliferative diseases and ischemic stroke

Tanashyan M.M., Kuznetsova P.I., Lagoda O.V., Shabalina A.A., Subortseva I.N., Melikyan A.L.


Myeloproliferative diseases (MPD) comprise a group of clonal pathology resulting from genetic alterations at a stem cell level. WHO (2008) divides MPD into several “classical” forms – polycythemia vera, essential thrombocytemia, and primary myelofibrosis. Haemorheologic and haemostatic disturbances have been widely accepted as a significant (in some cases – primary) cause of acute and/or chronic cerebrovascular disease. A pre-existing MPD may potentiate and accelerate the development of circulatory alterations, including those occurring in the brain tissue, leading to ischemic stroke. The present article comprises a literature review on this uncommon pathology, as well as a clinical presentation of a stroke case in a patient with underlying MPD (Vaquez’ disease).

Annals of Clinical and Experimental Neurology. 2014;8(2):41-45
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Reproductive health of women with multiple sclerosis

Tikhonovskaya O.A., Pinchuk A.Y., Alifirova V.M., Musina N.F.


Organic diseases of the central nervous system (CNS) are of utmost importance in the formation of gynecological pathology. Multiple sclerosis (MS) and mmunomodifying therapy which is in use in patients with this disease have a significant effect on menstrual and reproductive functions, pregnancy and delivery in women with MS. Infertility in patients with MS is due, on the one hand, to psychological and sexual problems and, on the other hand, to the secondary gonadal failure. Obstetric outcomes in women with MS do not differ significantly from those in the general population, but some specific characteristics of the course of  pregnancy and delivery need attention and multidisciplinary approach.

Annals of Clinical and Experimental Neurology. 2014;8(2):46-50
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D-amino acids in the pathogenesis of neurodegenerative diseases and in normal ageing

Chervyakov A.V., Zakharova M.N., Pestov N.B.


Recent studies have shown that D-amino acids (DAA) are widely represented in tissues of higher organisms, including man. Specific functions of particular DAA in a healthy body are determined: for instance, D-serine plays an important role in neuroplasticity, memory and learning, while D-aspartate is involved in the development processes and endocrine functions. Pathogenicity of DAA is associated with over-activation of NMDA glutamate receptors, conformational changes of normal protein molecules upon incorporation in the polypeptide chain, and increase inconcentration of reactive oxygen species during oxidase metabolism of DAA. Assessment of the levels of DAA in biological fluids, as well as detection of enzyme activity and mutations of the respective genes may serve as diagnostic markersin a number of the diseases of the central nervous system (Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, etc). Practical interest to the content and the functions of DAA is also related to perspectives of elaborating novel therapeutic strategies aimed at correcting the synthesis/degradation of DAA and modulation of activity of the their receptors.

Annals of Clinical and Experimental Neurology. 2014;8(2):51-58
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New method of examination of kinesthetic sensitivity in neurology

Gordeev S.A., Voronin S.G.


We present a new electrophysiological method of registration of kinesthetic evoked potentials (KEP) to passive radiocarpal articulation flexion for 50° with angular acceleration of 350 rad/s2, which is aimed at testing kinesthetic sensitivity in neurological patients. KEP changes in the kinesthetic system lesions of various types, levels, localizations and degrees are characterized by certain specificity and reproducibility; therefore, this method may be used as a valuable additional diagnostic tool. The potential of the KEP method in early diagnostics of the proprioceptive sensitivity disturbances is showed. The KEP method may be useful in fine studies of neurophysiological mechanisms underlying the diseases with abnormal proprioceptive sensitivity and motors functions.

Annals of Clinical and Experimental Neurology. 2014;8(2):31-36
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Clinical analysis

Neurological debut of non-Hodgkin’s lymphoma: the complexity of diagnosis

Magzhanov R.V., Bakhtiyarova K.Z., Tunik V.F., Dolganyuk V.K., Galliamova N.A., Zakirova E.N., Pervushina E.V.


A rare case of system non-Hodgkin’s lymphoma manifested with oculomotor abnormalities is presented in the paper. In the patient examined, initial symptoms were diplopia and restriction of the lateral eye movements; these symptoms appeared on the background of the intense headaches. The death resulted from the acute cardio-pulmonary failure. On postmortem study, B-cell lymphoma of multiple localizations, including the central nervous system, heart, lymph nodes, spleen and liver, was found.

Annals of Clinical and Experimental Neurology. 2014;8(2):37-40
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