Vol 9, No 1 (2015)

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.

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.

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.

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.

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.