Vol 4, No 2 (2010)

Original articles

Immediate and long-term outcome of stenting of proximal parts of aortic arch branches

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


Complex clinical-ultrasound study was carried our in 29 patients before and after stenting of 29 subclavian arteries (SA) and 2 brachiocephalic trunks (BCT). In 28 cases damage of SA/BCT was presented as stenosis and in 3 cases as SA occlusion. Сlinical picture of vertebrobasilar insufficiency and/or upper limb ischemia took place in 97% of patients. Ultrasound diagnostics of aortic arch branches showed high informativity of the method in revealing the degree of the SA/BCT damage. Technical success was achieved in 94% of cases. Twenty seven (93%) patients were examined in dynamics, with average term of observation of 16 months [12, 30]. On color-coded duplex scanning, re-stenosis was detected in 18.5% of observations (5 patients). Re-stenosis was clinical asymptomatic in 3 of 5 patients. Smoking was found to be the only significant risk factor associated with re-stenosis.

Annals of Clinical and Experimental Neurology. 2010;4(2):4-10
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Assessment of risk of cerebral intra-operative complications during reconstructive operations on brachiocephal arteries in patients with symptomatic and asymptomatic course of chronic brain ischemia

Lysichenkova O.V., Sukhanov S.G., Shestakov V.V., Kondratyev A.V.


During reconstructive operations on internal carotids and vertebral arteries, 60 patients of 42–82 years of age with asymptomatic and symptomatic course of chronic brain ischemia were examined. A method of intra-operative monitoring of somatosensory evoked potentials was applied. It was found that the risk of cerebral intra-operative complications was the lowest in patients with asymptomatic course (stage I of chronic brain ischemia). The risk of cerebral intra-operative complications raised twice in symptomatic disease, stage IV of chronic brain ischemia. For intra-operative cerebral ischemia characteristic are: decrease in amplitude of complex N20-P23 (up to zero) lasting 10 min, or repeat intra-operative episodes of decrease in amplitude of complex N20-P23 more than 50% of initial level.

Annals of Clinical and Experimental Neurology. 2010;4(2):11-14
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Dementia with Lewy bodies and autonomic regulation of cardiac functions

Tishkova I.G., Preobrazhenskaya I.S.


In dementia with Lewy bodies (DLB) neurodegenerative process affects not only central, but also peripheral nervous structures, most frequently, neurons of autonomic ganglia, which may underlay autonomic dysfunction, including peripheral autonomic failure. The purpose of this study was to analyze autonomic regulation of cardiac functions in patients with DLB with the assessment of the heart rhythm variability. Twenty three patients with probable DLB were enrolled in the study. A control group was composed of healthy individuals comparable by sex and age. In DLB peripheral autonomic failure occurred significantly more frequently. Orthostatic hypotension manifested at already early stages of the disease in half of the patients. Spectral analysis of the heart rhythm in patients with orthostatic hypotension showed relative predominance of high-frequency waves on the background of decreased power of low-frequency waves of the  spectrum, which suggests decrease of sympathic influence on the heart rhythm. Relative parasympathicotonia combined with heart rhythm abnormalities seen as supraventricular extrasystols. Analysis of the influence on the heart rhythm of drugs used for the treatment of cognitive and motor disorders showed that levodopa decreased the heart rhythm variability and parasympathic tonus because of stimulation of cardiac adrenoreceptors. Anticholinesterase medications do not influence the heart rhythm variability, but can decrease severity of orthostatic hypotension.

Annals of Clinical and Experimental Neurology. 2010;4(2):15-22
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Sleep disturbances in patients with chronic brain ischemia and metabolic syndrome

Lyubshina O.V., Maksimova M.Y.


Complains of patients with chronic brain ischemia (CBI) and metabolic syndrome (MS) on disturbed sleep do not reflect an objective picture of sleep problems, from the viewpoint of both respiratory abnormalities during sleep and changes in the sleep structure. Sleep disturbances may result from two principally different pathogenic processes: secondary sleep abnormalities due to apnea and psychophysiological insomnia on the background of severe psycho-vegetative syndrome with anxiety and depression. Polysomnographic examination should be a component of a complex of essential para-clinical investigations in patients with CBI and MS, since only this method may allow determining with certainty pathogenic character of sleep disturbances and establishing pharmaco-therapeutic strategy.

Annals of Clinical and Experimental Neurology. 2010;4(2):23-29
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Clinical assessment of the gait video-analytic profile

Likhachev S.A., Lukashevich V.A.


We propose a system for the diagnostics of postural disturbances that may be revealed in the frontal surface with an original complex of motion video-analysis, with allocation of video-analytic profile of the ankle-joints. Main group comprised 19 patients with cerebellar ataxia, and control group comprised 18 healthy individuals without coordination problems and pathology of musculo-skeletal locomotor system. In this study, we determined diagnostically significant and distinguishable video-analytic criteria of the “over the target” peak for patients suffering from cerebellar ataxia: 1) amplitude of foot raising over the surface of the “diagnostic step”; 2) time of foot placing on the surface of the “diagnostic step”; 3) speed of foot descent on the surface of the “diagnostic step”; 4) ration of time of execution of foot raising to total time of execution of the movement “Step”; 5) presence of additional peaks in the support period, which is of importance in the diagnosis of cerebellar disturbances.

Annals of Clinical and Experimental Neurology. 2010;4(2):30-34
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Memory, attention and individual profile of inter-hemispheric functional asymmetry in patients with systemic rheumatic diseases

Pizova N.V., Verbizkaya E.I., Perezhigina N.V., Pizov A.Z.


Disturbances of the central nervous system (CNS) occur rather frequently in patients with systemic rheumatic diseases (SRD). Among symptoms of the CNS dysfunction, cognitive impairment plays a very important role. We studied 96 patients with different forms of SRD. The profile of brain inter-hemispheric functional asymmetry was studied by a special standardized protocol. All the examined patients can be divided into 4 groups: right-profile subjects (44.8%), predominantly right-profile subjects (41.6%), mixed profile subjects (12.5%) and predominantly left -profile subjects (1.1%). Some specific features of memory and attention were identified depending on inter-hemispheric functional asymmetry profile.

Annals of Clinical and Experimental Neurology. 2010;4(2):35-39
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Original method of assessment of cortical aphasias and neurodinamic speech impairment using computed transformation of speech in the acute period of stroke

Prokopenko S.V., Mozheyko E.Y., Vizel T.G.


The purpose of this study was to establish objective criteria for differential diagnosis of cortical and subcortical aphasias using a method of computed transformation of tempo-rhythmic parameters of speech. Patients with cortical aphasia (40) and neurodynamicspeech disturbances (31) were examined in acute stage of stroke. The features of tempo-rhythmic structure of speech, assosiated with stability of speech syndrome, severity of aphasia and predominant defect (motor or sensory component of speech), were identified. Criteria for diagnostics of neurodynamic speech disturbances have been proposed, such as the degree of fluctuations of speech functions which were objectively registered with the help of computed transformation of speeh time parameters.

Annals of Clinical and Experimental Neurology. 2010;4(2):40-43
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New technology in experimental neurobiology: neuronal networks coupled with multielectrode array

Mukhina I.V., Khaspekov L.G.


Multielectrode arraуs (MEA) as the recording and stimulating system for self-organizing, functionally heterogeneous neuronal network formed by developing CNS cells in vitro is a new, unique technology for investigation of mechanisms of pathological neurodestructive processes and for searching the means of their pharmacological corrections. The principal advantages of the MEA are the precise noninvasive long-term network stimulation and measurement of the electric signals, pharmacological testing and drug screening, optical structural and functional imaging of metabolic ionic current into neurons and glial cells using confocal laser scanning microscopy. The brain cells and tissues coupled in vitro with MEA enables neuroprotective and/or neurotoxic drug testing in different models of the central nervous system pathological states. Data-intensive part, good reproducibility and quantitative assessment capability make it possible to relate the neuron networks cultured to the MEA with biosensors, allowing to perform effective pharmacological screening in vitro for the models of ischemia, trauma, epilepsy, Alzheimer’s disease, etc.

Annals of Clinical and Experimental Neurology. 2010;4(2):44-51
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Clinical analysis

Juvenile Huntington’s disease

Rudenskaya G.E., Savvin D.A., Fedotov V.P., Kurbatov S.A., Polyakov A.V., Galeeva N.M.


Juvenile Huntington’s disease (JHD) manifests in 1st–2nd decades of life and accounts for 2–9% of all cases of Huntington’s disease; its pathogenic mechanisms are related to genetic anticipation and imprinting. Typical features of JHD are akinesia and rigidity, and paternal inheritance and huntingtin mutations with particularly large number of CAG repeats (> 60); however, atypical cases exist, and maternal inheritance is possible. We report 6 families with 7 JHD cases confirmed by DNA testing; 4 patients, including two brothers, were clinicallyexamined. Three patients, one of the brothers among them, had an akinetic-rigid form with onset at 7–8 years; in the second brother the disease manifested at 20 years as a hyperkinetic form of the disease without dementia. This patient had mutation with 57 CAG repeats, while in the rest six patients the number ofrepeat copies varied from 63 to 81. All cases were familial, and anticipation in families was evident; in one child with JHD the disease manifested 4–5 years earlier than in the father, and in another family grandfather first noticed symptoms at 60 years, 6years after the JHD onset in his granddaughter. Such cases mask’ dominant inheritance and complicate the diagnosis. Three families showed rare maternal transmission of JHD: one of the affected mothers had JHD, and in two mothers the disease developed at 27–30 years and lasted for 3–9 years. In 4 clinically examined patients, JHD was supposed 7–18 years after its onset which shows underestimation of the disease in practice. JHD should be considered even in seemingly nonfamilial cases, and DNA testing for huntingtin mutations should be used more widely.

Annals of Clinical and Experimental Neurology. 2010;4(2):52-58
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