Vol 9, No 1 (2015)

Original articles

Hemorheology and hemostasis in ischemic stroke patients treated with i.v. thrombolysis

Gafarova M.E., Domashenko M.A., Korobkova D.Z., Maximova M.Y., Loskutnikov M.A., Shabalina A.A., Kostyreva M.V., Konovalov R.N.

Abstract

Hemostatic and hemorheological dysregulations are the typical pathological conditions in stroke. Thorough dynamic examinations of hemostasis, platelet aggregation, kinetics of erythrocyte aggregation/disaggregation along with clinical and neuroimaging features and functional outcome were conducted in ischemic stroke patients who underwent i.v. thrombolysis or did not received rtPA. Increased strength of erythrocyte aggregates (SEA) was associated with better functional outcome, and that correlation was stronger in patients treated with i.v. thrombolysis.
Increased SEA was also associated with regression of ischemic lesion on DWI-MRI on Day 3 day in patients treated with i.v. thrombolysis.
Annals of Clinical and Experimental Neurology. 2015;9(1):
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Autonomic dysfunction in patients with cerebrovascular diseases and metabolic syndrome

Chatskaya A.V., Korepina O.S., Gnezditskiy V.V., Tanashyan M.M.

Abstract

Cerebrovascular diseases (CVD) are often associated with autonomic dysfunction. Obesity, hypertension, dyslipidemia and diabetes mellitus (or glucose intolerance) are risk factors for autonomic dysfunction. We assessed the autonomic nervous system activity (sympathetic skin response[SSR]) in patients with CVD and compared it with clinical data (body mass index, cholesterol, fasting glucose, glycated hemoglobin, blood pressure). The sympathetic skin response was evoked with electrical stimulation at rest and after cold pressor test and hyperventilation. Patients with CVD and concurrent metabolic syndrome (MetS) more often had autonomic dysfunction (namely, increased sympathetic activity and worse reaction on cold pressor test and hyperventilation) compared to patients without MetS. Increase of the amplitude of SSR correlated with high body mass index, elevated levels of total cholesterol, low-density lipoprotein, and high triglycerides, anxiety and depression. The long latency and low amplitude (autonomic neuropathy) correlated with hyperglycemia, high levels of glycated hemoglobin, and hypertriglyceridemia. Our results indicate that patients with CVD and concurrent MetS have autonomic dysfunction that is associated with obesity, dyslipidemia, anxiety and depression. The evidence of the autonomic nervous system impairment (high sympathetic activity, autonomic neuropathy) in patients with CVD may have important predictive value.

 
Annals of Clinical and Experimental Neurology. 2015;9(1):
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The antioxidant defense system at early stages of chronic cerebrovascular pathology

Gnedovskaya E.V., Logvinenko A.A., Andreeva O.S., Kravchenko M.A., Gornostaeva G.V., Fedorova T.N., Oshchepkova E.V., Varakin Y.Y.

Abstract

A total of 109 patients with initial manifestations of chronic cerebrovascular pathology (CCVP) and uncomplicated hypertension (degree 1–2) and 30 healthy individuals (control group) were examined. The patients underwent comprehensive clinical and laboratory testing. Lipid peroxidation (LPO) was assessed using chemiluminescence of LDLP induced by Fe2+ ions. Reduced antioxidant activity was revealed in 94.2% of patients with CCVP associated with hypertension as compared to healthy individuals; individual LPO components were enhanced. Dyscirculatory encephalopathy in patients with hypertension was preceded by a period of early or initial manifestations of cerebrovascular disorders with activation of free radical oxidation and depletion of the endogenous antioxidant system being comparable in terms of their severity. Enhancement of oxidation processes was observed in patients presenting with severe and frequent hypertensive urgencies, multiple microfocal cerebral lesions, dyslipoproteinemia, and increased red blood cell aggregation at the early stages of chronic cerebrovascular pathology.

 
Annals of Clinical and Experimental Neurology. 2015;9(1):
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Endoscopic removal of intracranial hemorrhage and fenestration of symptomatic arachnoid cysts in the brain

Gushcha A.O., Semenov M.S., Lepsveridze L.T., Arestov S.O.

Abstract

This article describes endoscopy as a main surgical approach in the treatment of intracranial hemorrhages and symptomatic cysts of different anatomical locations. In our paper we demonstrate that endoscopy may be used not only with video assistance but as independent surgical method. We discuss indications and contraindications of this method, technical support and surgical technique, and include clinical cases. Our neurosurgical team was the first in Russia that used method of flexible endoscopy in different ways. In our opinion, flexible intracranial endoscopy is the most effective and minimally invasive method, which should be more widely implemented in neurosurgery practice.

 
Annals of Clinical and Experimental Neurology. 2015;9(1):
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Mapping of the brain regions responsible for eating behavior regulation with functional MRI

Kremneva E.I., Suslin A.S., Govorin A.N., Krotenkova M.V., Tanashyan M.M., Piradov M.A.

Abstract

Understanding the neural mechanisms underlying the regulation of eating behavior plays the leading role in assessment of food intake in normal individuals and in patients with obesity. Modern neuroimaging methods, such as functional MRI (fMRI), may shed the light on these mechanisms. A simple and reproducible visual fMRI-paradigm was developed for the assessment of topdown executive control of eating behavior. Using this paradigm, three main components of the regulatory neural system were revealed, and the region of interest, dorsolateral prefrontal cortex, was identified.

 
Annals of Clinical and Experimental Neurology. 2015;9(1):
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Balo’s concentric sclerosis: is it pathogenic subtype of Multiple Sclerosis or distinct disorder?

Vorobyeva A.A., Konovalov R.N., Krotenkova M.V., Peresedova A.V., Zakharova M.N.

Abstract

Balo’s concentric sclerosis is a monophase demyelinating disease characterized by alternating rings of demyelinated and myelinated axons, and it is most frequently diagnosed by magnetic resonance imaging. At the present time Balo’s sclerosis is discussed in case of MRI detection of two or more concentric areas of demyelination, one or more ring of that is enhanced by the contrast. For 100-year period of the study there are 4 main theory of pathogenesis of Balo’s sclerosis: theory of concentric demyelination, theory of distal oligodendrocytopathy, colloid theory and theory of astrocytopathy. None of the theories includes all details of the disease. One of the details is concentric lesions in monophasic Balo sclerosis and in Balo-like syndromes in chronic demyelinating disorders. In case of Balo’s sclerosis and Balo-like syndromes probability of resistant to immunosuppressiv therapy is very high. So glucocorticosteroid therapy must be initiated right after concentric demyelination determination on MRI. In case of ineffectiveness of glucocorticosteroid therapy plasmapheresis and cytostatic therapy could be applied.

 
Annals of Clinical and Experimental Neurology. 2015;9(1):
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Neuroprotection in cerebrovascular diseases: is it the search for life on Mars or a promising trend of treatment? Part 1. Acute stroke

Piradov M.A., Tanashyan M.M., Domashenko M.A., Sergeev D.V., Maksimova M.Y.

Abstract

The two key strategies of specific treatment of stroke are reperfusion, aimed on the improvement of brain perfusion in the ischemic region due to the restoration of blood flow and prevention of recurrent thrombosis, and neuroprotection to maintain brain tissue metabolism and to protect it from structural damage. The evidential base of major neuroprotective drugs (nimodipine, magnesium sulfate, piracetam, ethylmethylhydroxypyridine succinate, choline alfoscerate, cerebrolysin, albumin, citicoline, edaravone) and hypothermia use in acute stroke setting is critically reviewed in the article.

 
Annals of Clinical and Experimental Neurology. 2015;9(1):
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Mechanisms of therapeutic hypothermia effect on brain damage in hypoxia and ischemia

Popugaev K.A., Hutorenko A.A.

Abstract

Ischemia and hypoxia are major factors of brain damage. Cerebral injury takes time to develop, with acute, subacute, and chronic phases specified. Reparative processes run simultaneously with damage cascades. Every phase of cerebral injury is characterized with specific pathophysiological cascades. Induced hypothermia has been implemented in neurocritical care for several decades, and its efficacy has been proved in patients after cardiac arrest and in newborns with perinatal hypoxic-ischemic encephalopathy. However, in other neurocritical care settings the efficacy of has not been demonstrated yet. On the other hand, the results of experimental studies and discovered mechanisms of hypothermia effects on pathophysiological cascades of cerebral injury and repair give hope for the hypothermia to become a valuable option for the neurocritical care. In the presented review hypothermia effects on numerous pathophysiological cascades of cerebral injury due to hypoxia and ischemia are described.

 
Annals of Clinical and Experimental Neurology. 2015;9(1):
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Distal diabetic neuropathy: review of evidence-based recommendations

Beregovsky V.B., Khramilin V.N., Demidova I.Y., Strokov I.A., Guryeva I.V.

Abstract

Distal diabetic neuropathy is the leading neurological complication of type 2 diabetes. Diabetic neuropathy is heterogeneous in its clinical entity and the pattern of peripheral neural system damage. In most cases the diagnosis is based on the typical neurological symptoms, the results of neurological examination and neurophysiological testing, where available. Medical treatment of pain in distal diabetic neuropathy includes symptomatic and pathogenetic medications. Effective control of diabetes is crucial for reduction of risk of neuropathy progression and is a predictive factor of effective symptomatic and pathogenetic treatment. The primary choice of medication is based on patient’s characteristics, diabetes control, pain severity, concomitant diseases and commercial availability of medications.

 
Annals of Clinical and Experimental Neurology. 2015;9(1):
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