Vol 4, No 3 (2010)

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Original articles

Poststroke cognitive impairment in patients with deep hemispheric lesions

Shakhparonova N.V., Kashina E.M., Kadykov A.S.


The status of cognitive functions in 129 patients after stroke with deep hemispheric lesions was investigated. In the vast majority of patients abnormalities (predominantly mild or moderate) of the auditory-speech (95%) and the visual (83%) memory were observed. Mild and moderate abnormalities of the direct auditory-speech memory were predominant (85.6%), and delayed reproduction was mostly affected in severe disturbances. Moderate-to-severe abnormalities of attention and moderate abnormalities of the dynamics of mental processes prevailed in patients with right hemispheric lesions. As the result of complex therapy, memory mprovement was observed in 65% of patients, improvement in the attention focusing in 72%, and improvement in the dynamics of mental processes in 55% of patients.

Annals of Clinical and Experimental Neurology. 2010;4(3):4-9
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Epilepsy in women of reproductive age

Kotov A.S.


Four hundred fourty seven women with epilepsy aged 18–55 years were examineds, and catamenial epilepsy (CE) and/or reproductive dysfunction was diagnosed in 64 cases. Methods of investigation included clinical and neurological examination, routine EEG and/or video-EEG-monitoring, brain MRI, and laboratory tests. In the examined patients, antiepileptic drugs (AED) were prescribed for the first time or current therapy was corrected. CE was diagnosed in 30 cases: a perimenstrual form of CE was revealed in 24 cases, a luteal phase form in 5, and an ovulation form in one. Idiopathic generalized epilepsy (IGE) was diagnosed in 2 cases, temporal lobe epilepsy in 20, frontal epilepsy in 6, and non-localized focal epilepsy in 2. High frequency of seizures correlated with inefficacy of treatment (r = 0.3; p <0.05). Menstrual cycle (MC) dysfunction was diagnosed in 25 cases: dysmenorrhea in 21 and amenorrhea in 4. MC dysfunction was associated with excess weight in 44% of cases, and with ovarian cysts or polycystic ovary syndrome in 20%. After correction of the treatment, normalization of MC was achieved in 48% of cases. In this group, remission was observed in 57.1% of cases, improvement in 14.3%, and the lack of effect in 28.6%. Some correlations of the AED efficiency with positive dynamics of MC were shown.

Annals of Clinical and Experimental Neurology. 2010;4(3):10-13
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Correlation ties in cerebral atherosclerosis: results of ultrasound assessment of arterial morphological changes

Novikova L.B., Averzev G.N.


For revealing correlations between cerebral atherosclerosis and different forms of concomitant pathology, the following groups of patients were examined: arterial hypertension (n = 80), disorders of the autonomous nervous system (n = 212), endocrine pathology (n = 453), chronic liver diseases (n = 45), obesity (n = 35), syringomyelia (n = 97), cerebral atherosclerosis without comcomitant pathology (n = 51), persons with status dysraphicus (n = 35), and healthy controls (n = 50). Duplex scanning of the brachiocephal arteries was used. The initial atherosclerotic lesions were revealed in 32,7% of cases, stenosis <50% in 33,9%, and stenosis 50% in 18,2%. We found significant reverse relationships between age at onset of cerebral atherosclerosis and arterial hypertension (ρ = –0.73), obesity (ρ = –0.70), syringomyelia (ρ = – 0.90), status dysraphicus (ρ = –0.72), and liver disorders (ρ = –0.67). Correlations were revealed between atheroma evolution rate and presence of endocrine pathology (hormone levels in hypothyreosis), combination of cataract and diabetes, severity of arterial hypertension, combination of arterial hypertension and obstructive sleep apnea, severity of status dysraphicus and trophic disturbances in syringomyelia. In patients with anatomic disconnection of the Willis circle, blood flow deficiency at the extracranial stenosis level occurred in the case of 40–50% stenosis, while in patients with normal collateral flows it occurred only in the case of 60–70% stenosis.

Annals of Clinical and Experimental Neurology. 2010;4(3):14-19
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Results of the study of avonex efficiency in multiple sclerosis

Peresedova A.V., Stoida N.I., Askarova L.S., Zakharova M.N., Adarcheva L.S., Niyazbekova A.S., Trifonova O.V., Rebrova O.Y., Zavalishin I.A.


Results of the two-year treatment with avonex of 34 patients with relapsing remitting multiple sclerosis are summarized. This study provides evidence for the significant decrease in activity of the pathological process in patients treated with avonex, which is confirmed by the reduction of the relapse rate and the increase of the
proportion of patients remaining exacerbation-free. The decrease of the EDSS score has also been shown. In general, avonex was tolerated well in patients under study.

Annals of Clinical and Experimental Neurology. 2010;4(3):20-24
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Neurophysiological characteristics of supra-segmental structures in patients with arterial hypertension and chronic headaches

Kuznetsova E.A., Yakupov E.Z.


Neurophysiological characteristics of chronic headaches in patients with arterial hypertension were studied using brainstem auditory evoked potentials, visual evoked potentials and blink reflex. In patients with arterial hypertension suffering from chronic headaches, signs of brainstem dysfunction were revealed, which was accompanied by impairments of ascending afferent input and dysfunction of upper structures (thalamus and cortex), including impairment of functioning of the antinociceptive system of supraspinal level. These abnormalities result in the formation of a specific clinical pattern in the studied group of patients.

Annals of Clinical and Experimental Neurology. 2010;4(3):25-28
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Endogenous neuroprotection during focal brain ischemia in rats: erythropoietin, ischemic pre- and postconditioning

Shmonin A.A., Panov I.Y., Simanenkova A.V., Prosvirnina M.S., Chekanov S.S., Melnikova E.V., Vlasov T.D.


The aim of the present study was to investigate neuroprotective effects of erythropoietin (EPO), and ischemic pre- and postconditioning in a rat model of focal cerebral ischemia. Adult male Wistar rats were subjected to a 40-min bilateral common carotid artery (CCA) occlusion and permanent ligation of the cortical branch of the middle cerebral artery (MCA). Preconditioning protocol consisted of either one or two episodes of 5-min CCA occlusion with 5-min reperfusion prior to test ischemia (PreCon 1 and PreCon 2). Postconditioning (PostCon) protocol comprised 10 episodes of 10-s CCA occlusion followed by 10-s reperfusion intervals. After modelling of ischemia, brain infarct occurred predominantly in the left temporal cortex. EPO administration at doses of 2500 and 5000 U/kg 30 minutes prior to ischemia, PreCon 1 and PostCon reduced significantly the infarct size (p <0.05) compared to controls. EPO at dose of 5000 U/kg reduced the severity of neurological deficit (p<0.05). EPO at both doses, PreCon 1 and PreCon 2 were shown to ameliorate postischemic cerebral blood flow. Brain edema was significantly smaller in the EPO arm at dose of 5000 U/kg, and in PreCon 2 and PostCon groups. Thus, PreCon and PostCon, as well as prior administration of EPO result in neuroprotective effect in focal cerebral ischemia, and EPO has a dose-dependent protective effect. EPO and PreCon reduce the severity of postischemic hypoperfusion.

Annals of Clinical and Experimental Neurology. 2010;4(3):29-35
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Neurotransmitter structure and functional role of cerebellum

Barkhatova V.P.


The review summarizes modern concepts concerning functional role and neurotransmitter organization of the cerebellum. The results of recent studies demonstrated that the cerebellum might be involved not only in motor control, but also in regulation of cognitive functions, affective and behaviour reactions, development of emotional-personality and mental disturbances, as well as in modulation of cerebral blood flow and metabolism. Futher studies of the functional role of different cerebellar neurotransmitter systems and their mechanisms of interaction are very important for understanding the pathogenesis and for the development of approaches to the treatment and prevention of the cerebellum-related motor and non-motor disorders.

Annals of Clinical and Experimental Neurology. 2010;4(3):44-49
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Neuromonitoring in intracranial hemorrhage

Petrikov S.S., Krylov V.V.



Annals of Clinical and Experimental Neurology. 2010;4(3):36-43
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Clinical analysis

Stroke-like episodes in mitochondrial encephalomyopathy with lactic acidosis

Kalashnikova L.A., Dobrynina L.A., Sakharova A.V., Chaykovskaya R.P., Mir-Kasimov M.F., Konovalov R.N., Shabalina А.A., Kostyreva M.M., Gnezditsky V.V., Protsky S.V.


We described two patients (female, 47 years and male, 42 years) with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS). Diagnosis was confirmed by genetic study (A3243G mitochondrial DNA mutation was found), muscle biopsy and elevated lactate level in the blood. Clinical picture of stroke-like episodes was presented by symptoms of mainly involvement of the posterior brain area (fluent and amnestic aphasia, hemianopia, paresis, ataxia), as well as by headache and epileptic seizures. In the first patient stroke-like episodes recurred but their symptoms almost completely regressed with time. The second patient had severe residual neurological deficit. Other clinical manifestations included hearing loss, memory deterioration, cardiomyopathy, fatigue and type 1 diabetes mellitus. MRI in acute period of stroke-like episodes found cortical lesions mainly in the posterior parts of the brain. They completely disappeared in the first case, but persisted in the second patient. The differential diagnosis of stroke-like episodes and ischemic stroke and approaches to treatment are discussed.

Annals of Clinical and Experimental Neurology. 2010;4(3):50-58
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