Vol 3, No 2 (2009)

Original articles

Endothelial vasomotor function and global arterial distensibility in ischaemic cerebrovascular diseases and arterial hypertension

Geraskina L.A., Fonyakin A.V., Suslina Z.A.

Abstract

The study of endothelial vasomotor function (EVF) and global arterial distensibility (glAD) aimed at determining their role in the development and progression of cerebral disturbances in arterial hypertension (AH) was conducted. We investigated 292 patients with different clinical forms of hypertensive cerebrovascular diseases (CVD). EVF was assessed with the use of endothelium-dependent flow-mediated vasodilatation of the brachial artery, and glAD was calculated as stroke volume (by echocardiography)/pulse pressure ratio (ml/mm Hg). Reduced EVF was revealed in patients versus controls: 7.2% (5.9; 8.2) and 10.5% (10.0; 12.9), respectively (p<0.001). EVF values were similar in patients with both early and late progressive stages of CVD. glAD was inversely correlated with the grade and duration of AH, patient age, and presence of deformations or atherosclerotic lesions of brachiocephal arteries, and it was diminished only in hypertensive encephalopathy, stage II–III [1.34 ml/mm Hg (1.11; 1.56) and 1.33 ml/mm Hg (1.13; 1.73)]. Thus, endothelial dysfunction is the earliest abnormality of vascular functional properties in AH and may be regarded as a universal factor of cerebrovascular complications. Reduced glAD reflects the loss of arteasticity and may represent a predictor of progressive course of CVD.

 
Annals of Clinical and Experimental Neurology. 2009;3(2):
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Criptogenic and symptomatic temporal epilepsies in adults

Kоtov A.S., Rudenko A.M.

Abstract

Five hundred thirty six patients with focal epilepsy, including 136 patients with temporal epilepsy (TE) aged 17–79 years were examined. In all patients specific therapy with antiepileptic drugs was initiated or corrected. The lack of pathological EEG changes was registered in 33 patients (24.3%), regional slowness in temporal zones was found in 22 (16.2%), focal epileptoform activity of the same localization – in 75 (55.1%), and diffuse epileptiform activity – in 6 (4.4%). On MRI, no changes in the brain were found in 50 patients (36.8%), non-epileptogenic changes (hydrocephaly, retrocerebellar cycts, etc.) were diagnosed in 17 (12.5%), moderately epileptogenic changes (post-stroke and posttraumatic cycts, foci of gliosis, etc.) in 42 (30.9%), and highly epileptogenic in 14 (10.3%), including hippocampal sclerosis in 8 (5.9%). The vast majority of adult TE cases were found to manifest with combination of secondarily generalized and focal (partial) seizures, the latter being predominantly automotor (32.3%) and dialeptic (27.9%). Medication remission among the patients under study was achieved in only 28.2% of cases; this confirms the opinion that TE represents not only the most frequent form of focal epilepsy in adults, but also great challenge for cure.

 
Annals of Clinical and Experimental Neurology. 2009;3(2):
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Balance of cytokines in patients with severe head injury

Shevchenko K.V., Chetvertnykh V.A., Kravtsov Y.I.

Abstract

Dynamic study of the blood levels of cytokines (interleukins IL-1β, IL-6, IL-1O and TNFalfa) was carried out in 40 patients with different outcomes of acute severe head injury. It was shown that severe head trauma resulted in the disbalance of pro- and antiinflammatory cytokines. During the first 24 hours, the direction of pathologic shifts did not differ between different patient groups and was characterized by the increase in IL-1β, IL-6 and IL-10 concentrations. By week 3, the decrease in concentrations of both pro- and anti-inflammatory cytokines was found in patients who had been discharged from the hospital for ambulant therapy. In cases of fatal outcome, deterioration of general condition of patients was combined with the decrease in IL-1β  concentration and the considerable increase in IL-6 and IL-10 concentrations, which may be regarded as one of unfavorable prognostic signs of head injury.

 
Annals of Clinical and Experimental Neurology. 2009;3(2):
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Asymptomatic stenosis of carotid arteries: novel view on the problem

Tanashyan M.M., Lagoda O.V., Klimenko I.S., Glotova N.A., Chechetkin A.O., Fonyakin A.V., Konovalov R.N.

Abstract

For the assessment of factors promoting progression of atherosclerosis of the carotid arteries (CA), we performed a detailed clinical-laboratory and instrumental comparison of the two groups of patients – with asymptomatic CA stenosis and with ischemic stroke resulted from stenosis of the CA. Progression of atherosclerotic damage of the CA was shown to be related with the following factors: а) severity of hemorheologic changes (including iatrogenic resistance to antiagregating drugs); b) presence of endothelial dysfunction; c) increase of the level of immunohistochemical markers of angiogenesis (molecules of intercellular adhesion sICAM21 and sРЕCAM21); d) the state of central hemodynamics and cerebral perfusion. The obtained data help to individualize medical and prophylactic procedures, select a group of patients with the high risk of ischemic stroke and clarify indications to reconstructive angioneurosurgical operations.

 
Annals of Clinical and Experimental Neurology. 2009;3(2):
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Osteogenetic factor in the forming of complex spondilogenic vertebralbasilar and vertebralcardial disorders

Sokov E.L., Kornilova L.E., Filimonov V.A., Klyueva V.N.

Abstract

116 patients with clinical manifestations of thoraco-cervical osteochondrosis with reflectory vertebral-basilar and vertebral-cardial disorders have been examined. 64 patients (basic group) along with traditional therapy of thoraco-cervical osteochondrosis underwent a course of intraosteal blockades, while 52 patients (comparison group) received traditional therapy with a course of paravertebral blockades. Effectiveness of treatment was assessed by the dynamics of pain syndrome parameters using Visual-Analog Pain Scale, Russian version of McGill pain questionnaire, “body scheme” questionnaire, as well as by hemodynamics parameters, cardiac rhythm variability, and examination of cognitive functions. More significant effect of intraosteal blockades in the complex treatment of the patients under study, compared to paravertebral blockades, was revealed. Clinical manifestations of both vertebral-basilar and vertebral-cardial spondilogenic disorders significantly regressed after intraosteal blockades. Osteogenetic factor can be considered as a universal mechanism of the forming of complex spondilogenic vertebal-basilar and vertebral-cardial disorders.

 
Annals of Clinical and Experimental Neurology. 2009;3(2):
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Preconditioning as a method of neuroprotection in a model of brain infarct

Khudoerkov R.M., Samojlenkova N.S., Gavrilova S.A., Pirogov Y.A., Koshelev V.B.

Abstract

Preconditioning of ischemic and hypoxic type was investigated as a method of protecting brain against acute ischemic injury. The preconditioning methods were applied to experimental rats 24 h before the time when local brain infarct was done by middle cerebral artery occlusion (MCAO). It was found that the ischemic and hypoxic preconditioning resulted in three general morphological changes: 1) the size of infarct zone was reduced by 2.2–3.8 times compared with rats that had not been treated with the preconditioning before MCAO; 2) the preconditioning treatment retained the number of living neurons in penumbra at the level of control rats, while without the preconditioning neuronal count in the penumbra after MCAO was 29% lower; 3) the number of glial cells in penumbra was increased after MCAO by 38% compared with the control level, and continued to increase under the preconditioning treatment up to 60%, that suggests an important role of neuroglia in neuroprotection. Selective blockers of ATP2dependant K+2channels (52hydroxydecanoate and glibenclamide) completely abolished the neuroprotective effects of the preconditioning.

 
Annals of Clinical and Experimental Neurology. 2009;3(2):
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Cavernous sinus syndrome in the context of differential diagnosis of disorders of the orbit and nearby anatomic structures of the cerebrum and skull

Barsukov S.F.

Abstract

Review of the literature on the problem of semiotics of pathological processes in the region of the cavernous sinus is presented. Discussed in detail are clinical picture, course, prognosis and methods of verification of the cavernous sinus syndrome, and extreme clinical heterogeneity of this condition is stressed. Main attention is focused on questions of vascular genesis in the development of this syndrome and, primarily, on aneurism of the internal carotid artery. In the review, a detailed analysis of the topic approach in differential diagnosis of the cavernous sinus syndrome with other clinically similar disorders is given.

 
Annals of Clinical and Experimental Neurology. 2009;3(2):
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Прижизненная оценка накопления β-амилоида в головном мозге человека

Власенко А.Г., Минтон М.А.

Abstract

Болезнь Альцгеймера (БА) является основной причиной первичной деменции, и необходимость в эффективной терапии БА чрезвычайно велика. Накопление β амилоида (Aβ) в мозге представляет собой хорошо известный специфический признак БА. Однако растущее число работ показывает, что патологическое накопление Aβ может иметь место задолго до клинической манифестации БА. Сегодня доступны технологии визуализации Ab, имеющие значительный потенциал с точки зрения количественной оценки патологии Aβ, ассоциированной со старением и БА. В настоящее время наиболее надежной технологией визуализации патологии Ab в мозге человека in vivo является позитронно-эмиссионная томография (ПЭТ) с радиофармпрепаратом [11C] PIB. Этот метод продемонстрировал значительное накопление Aβ у больных БА и при умеренных когнитивных расстройствах. Наиболее серьезным наблюдением стал тот факт, что некоторые пожилые лица с сохранными когнитивными функциями имеют повышенное связывание [11C] PIB, что может указывать на преклиническую стадию БА. Требуется дальнейшее накопление данных для демонстрации временнoго паттерна накопления бляшек Aβ в мозге, что должно существенно улучшить наши знания о природе БА и помочь предложить более совершенные терапевтические подходы.
Annals of Clinical and Experimental Neurology. 2009;3(2):
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Modern opportunities for surgical treatment of multiple lesions of brachiocephal arteries

Skrylev S.I., Shchipakin V.L., Koshcheev A.Y., Lobova N.M., Evdokimova T.P., Chechetkin A.O., Davydenko I.S., Fedin P.A.

Abstract

Despite the progress of angioneurology and vascular surgery, in multiple and combined lesions of the aortic arch branches the questions of indications and contraindications to surgery, surgical tactics, and types and order of operations remain disputable. In the paper we present an example of combined surgical revascularization of the brain in a patient with abnormal circulation in both carotid and vertebrobasilar systems resulted from multiple atherosclerotic lesions of the brachiocephal arteries. The expanding application to practice of non-invasive endovascular methods, used along with traditional reconstructive operations on vessels, broadens significantly the opportunities for surgical treatment in this complex group of patients.

 
Annals of Clinical and Experimental Neurology. 2009;3(2):
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