Vol 5, No 2 (2011)

Original articles

Idiopathic arterial hypotension: neurological abnormalities and cerebral and central hemodynamics

Atayan A.S., Fonyakin A.V., Mashin V.V.

Abstract

To study abnormalities of central and cerebral hemodynamics in chronic cerebrovascular pathology, 65 patients were examined with long-term stable idiopathic arterial hypotension (IAH), mean age of 40.2 (8.1) years. According to neurologic examination, all patients were distributed into two groups. The first group comprised 19 (29%) patients with somatoform disturbances, and the second group comprised 46 (71%) patients with cerebrovascular pathology: early signs of cerebral blood supply impairment and dyscirculatory encephalopathy, stage I. Patients from the second group were older and had longer hypotension anamnesis. Cerebral and central hemodynamics was examined with duplex ultrasonography of internal carotid arteries (ICA), vertebral arteries (VA) and medial cerebral arteries and with transthoracic echocardiography. In all patients ICA ultrasound showed moderate slowness of blood velocity and compensatory reduction of vascular resistance. There was no compensatory vasodilatation in VA, which resulted in considerable blood flow reduction, most expressed in the second group. The cardiac index was increased in both groups: in the first group due to increase in the left ventricular contractility and in the second group due to increase in the cardiac rate. Cerebrovascular disorders in patients with IAH are associated with age, duration of arterial hypotension, predominant deterioration of blood supply in the vertebral-basilar system and hyperkinetic state of central hemodynamics.

 
Annals of Clinical and Experimental Neurology. 2011;5(2):
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Regulatory T-cells CD4+CD25+Foxр3+ in patients with remitting multiple sclerosis

Eliseeva D.D., Zavalishin I.A., Bykovskaya S.N., Fedorova T.N., Karandashov E.N., Trunova O.A.

Abstract

In the maintenance of immunological tolerance a recently discovered population of regulatory T-cells CD4+CD25+Foxp3+ (Treg) plays an important role. These cells have potential in suppressing pathologic immune response observed in various autoimmune diseases, including multiple sclerosis. In the present work, we showed reduction in the number and functional activity of Treg in peripheral blood of patients with multiple sclerosis in the acute stage, as well as increase in Treg content in the disease remission and relation of the Treg content with duration of the autoimmune process and the degree of disability of patients.

 
Annals of Clinical and Experimental Neurology. 2011;5(2):
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Diagnostics of dysfunction of the autonomic nervous system with the use of computer finger tremorography

Prokopenko S.V., Shanina E.G.

Abstract

Clinical assessment of the autonomic status in healthy individuals and patients with autonomic dysfunction was carried out. On examination, the authors used an original method of computer finger tremorography. Significant differences of tremor characteristics were observed between healthy controls and patients with autonomic dysfunction. Possibilities for application of the computer finger tremorography method as an additional criterion in the diagnostics of autonomic dysfunction are shown.

 
Annals of Clinical and Experimental Neurology. 2011;5(2):
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Parkinsonism in in the Yaroslavl region: clinico-epidemiological aspects and a working experience of a specialized center

Pizova N.V., Bykanova M.A., Kurapin E.V., Kоvalchuk A.Y.

Abstract

The objective: to explore clinico-epidemiological aspects of parkinsonism in the Yaroslavl region. One thousand patients were examined in the movement disorders outpatient clinics in 2007–2010. We used standard criteria for the diagnostics of extrapyramidal disorders and the following scales: UPDRS, Hoehn–Yahr and Schwab–England. On observation, 53% of patients were from Yaroslavl and 37% from the Yaroslavl region. 474 (47%) patients were diagnosed with Parkinson disease, 62 (6.2%) with vascular parkinsonism, 17 (1.7%) with parkinsonism-plus, 8 (0.8%) with neuroleptic parkinsonism, 1 (0.1%) with post-encephalitic parkinsonism and 1 (0.1%) with parkinsonism caused by brain tumor. Women prevailed among Parkinson’s disease patients (1 : 1.5). Most patients (71%) were from 60 to 75 years of age. 18% of patients had stage 5 of PD, 50% had stage 2, 27% had stage 3 and 5% had stage 4. A mixed form of the disease prevailed (71%); an akinetic-rigid form (23%) and a trembling form (5%) occurred more rarely. In 58% of patients an intermediate rate of progression was observed, in 22% of patients progression was rapid and in 20% of patients it was slow. In general, our results correspond to international findings. Activity of a specialized movement disorders center improve diagnostics, treatment and quality of life of patients with Parkinson’s disease.

 
Annals of Clinical and Experimental Neurology. 2011;5(2):
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Quantitative characteristics of EEG in Alzheimer’s disease during cognitive tasks

Sergeev A.V., Medvedeva A.V., Voznesenskaya T.G.

Abstract

In Alzheimer’s disease (AD) the EEG changes are rather diffuse and most expressed in moderate and severe cognitive disorders. Pathological changes of spectral power and EEG coherence are assumed to be related with the degree of cognitive deficit. The aim of this study: comparative analysis of spectral power and EEG coherence and their reactivity during functional tasks in AD patients with mild and moderate dementia and in agematched healthy control subjects. Twenty two AD patients with mild-to-moderate dementia and 25 controls were examined. All patients underwent EEG recordings with analysis of spectral power of the main rhythms, as well as with analysis of intra- and inter-hemispheric coherence and their dynamics during functional tasks. We found an increase in slow-wave activity (delta and theta rhythms) and a decrease in alpha activity in frontal, parietal and temporal regions of the brain. Intra- and interhemispheric coherence was significantly lower in frontal, parietal and temporal regions in AD patients compared to controls. EEG pattern was more obvious after functional tests. One may conclude that changes of spectral power and EEG coherence seem to be a sensitive indicator of cognitive decline at very early stages of neurodegenerative process.

 
Annals of Clinical and Experimental Neurology. 2011;5(2):
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Effects of paradoxical sleep deprivation on behavioral reactions and ultrastructure of the brain neurons in rats

Abushov B.M.

Abstract

The aim of this work was morpho-functional analysis of the effect of paradoxical sleep deprivation of different duration on ultrastructure of the brain neurons, as well as on rearing, grooming, sexual activity and food and water consumption. It was revealed that, in early terms (36–48 hours) of the paradoxical sleep deprivation, the neuronal reparative changes were accompanied by intensification of all behavioral reactions. Under 60- hours paradoxical sleep deprivation, reparative processes in neurons were slightly reduced, while dystrophic changes covered a large number of neurons, which was accompanied by decrease in the number of main behavioral reactions.

 
Annals of Clinical and Experimental Neurology. 2011;5(2):
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Modern technologies of the diagnostics of vestibular dysfunction in neurological practice

Likhachev S.A., Alenikova O.A.

Abstract

Assessment of vestibular dysfunction is a fine criterion of the functional state of brain systems responsible for spatial comfort. Long-term studies of oculomotor reactions in neurological and otological practice clearly showed nystagmus as an important sign of the CNS disorder. Being an objective, temporal clinical phenomenon, nystagmus is seen visually, it can be easily registered and assessed quantitatively. Most difficult is to detect latent vestibular dysfunction, i.e. cases when nystagmus cannot be observed on routine neurological examination. The use of special
equipment allows to evaluate quantitative and qualitative parameters of nystagmus, especially those not seen visually (dysrhythmia) or hardly registered (amplitude irregularity, nystagmus changes after different functional tests, etc.). Potential and clinical evaluation of modern technologies of the diagnostics of vestibular dysfunction are presented on a number of clinical cases.
Annals of Clinical and Experimental Neurology. 2011;5(2):
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Electroneuromyography in the diagnosis of carpal tunnel syndrome

Savitskaya N.G., Pavlov E.V., Shcherbakova N.I., Yankevich D.S.

Abstract

The review is devoted to modern methods of electrophysiological evaluation of median nerve damage in the carpal tunnel (the so-called carpal tunnel syndrome, CTS) which is the most frequently diagnosed form of compression neuropathy of the upper extremities. Specificity and sensitivity of different methods of electromyography (EMG) in diagnostics of the disease, as well as in determining subclinical patterns of nerve involvement and indications for optimal treatment choice are demonstrated. EMG criteria of the CTS severity are provided. A protocol of EMG evaluation of patients suspected for CTS, based on most sensitive methods, is presented. The need of comprehensive electrophysiological evaluation of patients with median nerve lesions is shown, with special attention to exclusion of hereditary neuropathy. Problems of differential and false-positive diagnosis of CTS are considered.

 
Annals of Clinical and Experimental Neurology. 2011;5(2):
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Clinical presentations of trigeminal neuralgia in patients with dolichoectasia of the basilar artery

Balyazina E.V.

Abstract

Described are clinical presentations of trigeminal neuralgia (TN) in 3 cases verified as pathogenetically related to neurovascular conflict of the two arteries, basilar and anterior inferior cerebellar. Neurological symptoms in these patients included a number of symptoms characteristic of classical neuralgia: transient paroxysmal pain in the trigeminal nerve innervation zones, predominantly corresponded to branches 2 and 3 and lasting for seconds to minutes; algetic attacks provoked by non-pain stimulation of the trigger zone or by oral toileting, speech, shaving, making up, etc; long duration of the disease with periods of remission; efficacy of carbamazepine at early stages of the disease. These features combined with symptoms of the trigeminal root involvement, but without any signs of spread of the process to nearby brain anatomic structures, the latter being characteristic of symptomatic (secondary) TN. Unlike classical TN, pain paroxysms occurred also at night. In the interictal period dull pain remained, in contrast to a pain-free refractory period characteristic of classical TN. The above clinical symptoms allowed us to suspect, already at the clinical stage of examination, a neurovascular conflict with the dolichoectatic basilar artery, with the corresponding recommendation to undergo multispiral CT angiography that confirmed our diagnosis.

 
Annals of Clinical and Experimental Neurology. 2011;5(2):
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