Vol 3, No 1 (2009)

Original articles

Neuroprotection in cardiosurgery

Suslina Z.A., Bokeria L.A., Piradov M.A., Malashenkov A.I., Akhmadzhonuva N.A., Fedin P.A., Rodionova Y.V., Rebrova O.Y., Krotenkova M.V., Lagutin A.V., Klochkov A.S.

Abstract

Acute stroke is one of the most important complications of corоnary artery bypass grafting surgery (CABG) and valve replacement in the setting of assisted circulation. Therefore the cerebral protection becomes the crucial part of preoperative care. We performed prospective randomized controlled trial to estimate the efficacy of cytoflavin in 103 patients (94 men, 9 women) with ischemic heart disease (ICD) and acquired valve disease who undergone CABG and valve replacement surgery. The patients were divided into 4 groups. Group 1 (main) consisted of 32 patients with ICD (mean age 55.7±7.9 years) who underwent CABG and received 20 ml of cytoflavin i.v. in 3 consecutive days before and 3 days after surgery. Group 2 (control) included 40 patients with ICD (mean age 48.2±12.6 years) and CABG without cytoflavin. Thirteen patients with valve disease (mean age 53.1±8.4 years) were randomized in Group 3 (main); they underwent valve replacement and were treated with cytoflavin using the same regimen (20 ml i.v. in 3 days before and 3 days after surgery). Group 4 (control) was comprised of 18 patients with valve disease (mean age 48.2±12.0 years) and surgery without cerebral protection with cytoflavin. One month after the intervention significant improvement (p<0.05) was observed in Group 1 vs. Group 2 in the dynamic modality of cognitive performance, recent memory and long-term memory, and clear trend to improvement in the same variables in Group 3 vs. Group 4. Moreover, in Group 2 (CABG without treatment) significant deterioration was observed in long-term memory (p=0.028), along with the distinct trend towards worsening in Group 4 in recent and long-term memory. As an effective antioxidant, cytoflavin renders reliable neuroprotective effect in patients whо underwent CABG in the setting of assisted circulation and improves cognitive functioning and emotional well-being. Cytoflavin ameliorates absolute characteristics of long-term and recent memory in patients after valve replacement surgery. Cytoflavin improves absolute parameters of cognitive evoked potentials (P300) decreasing the latency and increasing the amplitude in patients after CABG and valve replacement. Cytoflavin is recommended for use in patients with ICD and acquired valve disease who underwent CABG and valve replacement in the setting of assisted circulation.

 
Annals of Clinical and Experimental Neurology. 2009;3(1):
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Cerebral hemodynamics in vertebrobasilar pathology, as for the issue of vertebrobasilar insufficiency

Barkhatov D.Y.

Abstract

A study of the functional state of cerebral hemodynamics (blood flow velocity and hemodynamic reserve in the basilar artery) using transcranial Doppler with nitroglycerine test has been carried out in 18 patients with ischemic stroke in vertebrobasilar circulation and 20 patients with and/or symptoms suggestive of posterior circulation disease. Significant decrease of the parameters of cerebral hemodynamic reserve was shown in patients with a history of ischemic stroke and also in patients with atherosclerotic obstructive lesions of the vertebral arteries. On the other hand in patients with the anomalies of the vertebral arteries (kinking, hypoplasia) blood flow in vertebrobasilar circulation was normal. Therefore these patients need not of the surgical preventive treatment

 
Annals of Clinical and Experimental Neurology. 2009;3(1):
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The problem of stroke in Seversk, Tomsk region

Alifirova V.M., Antukhova O.M.

Abstract

In the study “Register of Stroke”, which was hold on in Seversk (Tomsk region) with the population of 111 500 residents, the age-standardized stroke incidence was 3.99 cases in 2002 and 3.76 cases in 2003 per 1000 persons, and the lethality was 1.03 and 1.02, respectively (European population was used as a standard). Lethality in all types of stroke was 25.9%, that was lower compared to other regions of Russia. In multiple regression analysis arterial hypertension, heart diseases and smoking were the main risk factors of stroke in Seversk. 94.5% of patients were treated in specialized neurological clinics. Clinical predictors of fatal outcome (death) were detected.

 
Annals of Clinical and Experimental Neurology. 2009;3(1):
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Ischemic stroke in young age due to dissection of intracranial carotid artery and its branches (clinical and morphological study)

Kalashnikova L.A., Gulevskaya T.S., Anufriev P.L., Gnedovskaya E.V., Konovalov R.N., Piradov M.A.

Abstract

We present clinical and morphological study of intracranial dissection of carotid artery and its branches led to massive brain infarct in practically health 23-year old female patient. Clinical picture was presented with sudden development of right sided hemiplegia, aphasia and left sided headache. Magnetic resonance image and ultrasound study showed increasing occlusion of the left intracranial internal carotid artery (ICA), middle (MCA) and anterior cerebral artery (ACA). On 11 day of disease lethal exit occurred. Autopsy study showed that the lumen of ICA, ACA and MCA was filled with a dense dark-red mass suggested to be intra-arterial thrombi. However microscopic study demonstrated that this mass was the hemorrhage in the arterial wall (intramural hematoma) which completely occluded its lumen. At the different levels of extraand intracranial arteries microscopy revealed pronounced dysplastic changes in the arterial wall (fibromuscular dysplasia), which were the main cause predisposed to arterial wall dissection and development of intramural hematoma. Presented observation demonstrates that dissection with intramural hematoma formation may be the cause of intracranial occlusion. On differential diagnosis with thrombosis one should take into consideration the absence of clinical and laboratory thrombophylic manifestations as well as atherosclerotic changes in cerebral arteries in patient with artery dissec- tion.

 
Annals of Clinical and Experimental Neurology. 2009;3(1):
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Modern technology in long-term EEG monitoring (EEG-Holter) in neurology practice

Gnezditsky V.V., Zakharov S.M., Korepina O.S., Koshurnikova E.E.

Abstract

The work is devoted to application of ambulatory monitoring EEG (AMEEG) in neurological practice, its opportunities and restrictions are shown. The experience of AMEEG 87 patients with duration of recording from 3 till 24 hours in natural conditions of behaviors of the man in time of vigilance and sleep is generalized. The researches were carried out as is out-patient (48), on the house at the patient, and in patients: in wards of clinic (19), ICU (20). AMEEG was carried out on compact EEG system at small dimensions and weight (of the whole device 400 g.) “Encephalan-19/26” of firm Medicom-MTD (Taganrog), which allows to carry out simultaneous monitoring EEG of the data on 20 channels, and also on 6 additional channels monitoring ECG, breath, EMG, EOG, and special sensor of body position. At 36 patients surveyed for diagnostics epilepsy , the diagnosis epilepsy in 19 cases (53%) is confirmed, though on short registration of routine EEG were not the indications on presence epileptifom activity. In 16 cases (44%) was not of the indications on epileptyform activity and in 1 case there were marks, which were doubtful, and the further supervision and investigation was required. At two patients with syncope the condition show them cardiac nature and only in one case at AMEEG have revealed epileptic genesis of attacks. At inspection on a subject with insomnia and night nightmares in one case it were real parasomnia, in the other – the nature these paroxysm is shown the epileptiform nature, that has appeared obvious at long monitoring EEG, including and polysomnography. At ward monitoring at 5 of 8 patients the nature available paroxysms confirmed epilepsy. Monitoring EEG and polygraphic indications in ICU gives the important estimation of a condition and forecast of the patients who are taking place in areactive condition.
AMEEG considerably expands opportunities routine EEG and allows to receive the new information on a condition of the brain, helps to decide differential diagnostic tasks at paroxysm displays, gives opportunities monitoring of the patients who are taking place in areactive critical condition. AMEEG of sleep allows easily enough to carry out polysomnography investigation in a place of a presence of the patient, not resorting to bulky systems.
Annals of Clinical and Experimental Neurology. 2009;3(1):
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Neurosarcoidosis

Maksimova M.Y.

Abstract

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Annals of Clinical and Experimental Neurology. 2009;3(1):
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Multiple sclerosis: current state

Peresedova A.V., Zavalishin I.A.

Abstract

Etiology of multiple sclerosis has both genetic and environmental components. The current conception is that multiple sclerosis pathogenesis comprises an initial inflammatory phase, followed by a phase of demyelination and last, a neurodegenerative phase. The mechanisms of inflammatory reactions, axonal loss and reparative changes have been discussed. There are two schemes of treatments: the escalating approach and the induction therapy. One of the main principles of disease modifying therapy of MS is treat-early approach. Results of interferon’s-b and glatiramer acetate comparison as first-line MS therapy have been described. The use immunosuppressive agents and future developments of MS therapy have been discussed.

 
Annals of Clinical and Experimental Neurology. 2009;3(1):
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