Vol 2, No 2 (2008)

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Original articles

Intravenous thrombolysis in acute ischemic stroke

Domashenko M.A., Maksimova M.Y., Kistenev B.А., Loskutnikov M.A., Konovalov R.N., Bryukhov V.V., Krotenkova M.V., Suslina Z.A.


Strategic trend in the treatment of acute stroke resulted from thrombosis or embolization of intracerebral arteries is reperfusion of the blood flow in the ischemic area – thrombolysis. The modern methods of neuroimaging (CT and MR-angiography, diffusion and perfusion-weighted MRI, CT perfusion) play an important role in the thrombolysis decision making, as they allow to visualize the occlusion of the artery causing acute stroke, recanalization of the artery due to thrombolytic therapy, as well as the dynamics of the blood flow and metabolism in the respective brain regions. The presented clinical examples demonstrate the high efficacy of the thrombolytic treatment in acute ischemic stroke under the condition of absolute compliance with the inclusion and exclusion criteria to this therapy. The treatment of patients with acute stroke should be guided by the principles of evidence-based medicine and rely on adequate diagnostic algorithm of neuroimaging methods.

Annals of Clinical and Experimental Neurology. 2008;2(2):5-12
pages 5-12 views

Hyperhomocysteinemia in Parkinson’s disease – new variant of complications of ongoing therapy or specific biochemical marker of the disease?

Litvinenko I.V., Odinak M.M., Sologub O.S., Mogilnaya V.I., Schmeleva V.M., Saharovskaya A.A.


Homocysteine is an amino acid with excitotoxic effect on the nervous system, and its elevated level is an independent risk factor for cerebrovascular disease and dementia. In order to evaluate pathogenic role of hyperhomocysteinemia in Parkinson’s disease (PD) we examined 102 patients and 50 control subjects by analyzing motor and cognitive functions in their relationships with the total plasma level of homocysteine. Among the examined patients, dementia was diagnosed in 58 persons. Mean homocysteine level in the demented PD patients significantly differed from that in PD patients without dementia (23.5±6.7 µmol/l vs. 12.9±2.8 µmol/l, respectively, p<0.05). Multivariate regression analysis showed strong positive correlation between homocysteine level and duration of the disease (r=0.63, p<0.001) and of levodopa therapy (r=0.71, p<0.001). We found strong inverse correlation between hyperhomocysteinemia and neuropsychological scores by MMSE (r=–0.64, p<0.001), FAB (r=–0.59, p<0.001) and clock drawing test (r=–0.35, p<0.001). At the same time, no correlation was found between daily L-dopa dose and plasma homocysteine level. Our study showed that hyperhomocysteinemia may contribute to the formation of cognitive decline in PD.

Annals of Clinical and Experimental Neurology. 2008;2(2):13-17
pages 13-17 views

Сlinical-epidemiological study of stroke in the city of Yakutsk

Tretyakova N.N., Varakin Y.Y., Kuzmina Z.M., Chuprova N.G., Gogolev M.P.


The study of epidemiological characteristics of stroke in Yakutsk was carried out within the population register (2002–2004). 1495 patients with acute stroke have been verified. Among them, 81.5% patients were hospitalized, and CT/MRI was performed in 73.2% of patients. Such high percentage of the CT/MRI exams was a prominent feature of this register; this allowed to verify surely the diagnosis of stroke and to define its character and pathogenic subtype. It was shown that the use of neuroimaging methods in the diagnostics of stroke character led to a twofold increase in percentage of patients with cerebral hemorrhages (CH) – 38% vs. 18% initial frequency of CH (i.e. first diagnosed only by clinical data). Large cerebral infarctions in the population were found in 32.8% of cases and, clinically, they could be similar to CH. Thus, on clinical definition of stroke character, in 1/3 of cases there might be some diagnostic difficulties. Lacunar infarctions were found in 16.3% of patients. Severe conditions, such as brainstem and cerebellar hemorrhages, were shown to occur in the population with equal frequency (5.6%); ventricular hemorrhage was also frequent (35.7%). The frequency of CH in natives and non-natives was identical (0.74 and 0.79 per 1000 inhabitants in a year, correspondingly). The frequency of ischemic stroke in the non-native population was significantly higher compared to natives (1.96 and 1.12, correspondingly), which results from lower severity of atherosclerosis in Yakuts.

Annals of Clinical and Experimental Neurology. 2008;2(2):18-22
pages 18-22 views

Effects of pharmacological drugs on synaptic activity of hippocampus

Skrebitsky V.G., Kapay N.A., Derevyagin V.I., Kondratenko R.V.


The search for physiologically active drugs with precognitive action and the study of mechanisms of their influence on the brain represent important tasks of neurobiology and neuropharmacology. The paper considers methodical and scientific approaches to the study of effects of different memoryenhancing drugs on synaptic activity of area CA1 of hippocampus. Special attention was paid to the modulation of longtermpotentiation, previously disturbed by hypoxia or alcohol perfusion, by peptide analogues of piracetam. It was demonstrated using patch clamp technique that one of these peptides, Noopept, increases inhibitory synaptic transmission, probably due to blockade of potassium channels in the terminals of inhibitory interneurons.

Annals of Clinical and Experimental Neurology. 2008;2(2):23-27
pages 23-27 views


Cortical reorganization in multiple sclerosis

Zavalishin I.A., Peresedova A.V., Krotenkova M.V., Pugacheva O.V., Trifonova O.V.


Functional MRI (fMRI) is a new method promoting the study of brain functions and relationships between physiological activity and anatomical location. At present cortical reorganization is regarded as one of possible factors of recovery or maintenance of function in the presence of irreversible brain damage in multiple sclerosis (MS). Functional cortical changes have been demonstrated in all MS phenotypes using different fMRI paradigms, but the majority of studies were focused on the motor system. It was shown variability of functional reorganization of the motor cortex in MS depending on the stage of the disease. Cortical reorganization plays a role in limiting the impact of structural damage in MS; conversely, failure of these plastic mechanisms may cause irreversible disability upon the disease progression. Future dynamic fMRI studies will allow to access changes of functional brain activity in different disease severity and different extent of regress of MS symptoms. The improvement of cortical adaptive plasticity represents a potentially significant direction of rehabilitation in MS patients.

Annals of Clinical and Experimental Neurology. 2008;2(2):28-34
pages 28-34 views


Perspectives of nanotechnologies in clinical neurology

Seifulla R.D., Suslina Z.A., Kulykova E.V., Kim E.K., Timofeev A.B., Illarioshkin S.N., Rozhkova E.A.


Nanotechnologies is a new and rapidly developing field of science and engineering related to targeted manipulation of objects sized within the nano-diapason (10–9–10–12 m); this means principally new characteristics and qualities of the respective systems to be constructed. In the paper, problems of nanotechnology applications in clinical neurology are considered, namely, possibilities and prospects of the use, in diagnostic and medicinal purposes, of biochips, nanosensors, bioreactors, immunonanoparticles, biodegradable polymers, convectionenhanced drug delivery, etc. in various diseases of the nervous system. Special attention is paid to the development of pharmacotherapeutic applications, including drug transport systems and targeted nanotherapy, which outlines modern nanomedicine. Different medicinal nanoformulations are discussed, including polymeric nanoparticles, fullerenes, dendrimers, liposomes, nanotubes, etc. The authors’ experience in the study of stable glycosphyngolipid nanotubes and nanoliposomes as the drug delivery system is presented. For this purpose, the model of skin vasomotor reaction stimulation by cutaneous nitroglycerin application was used: the effect of nitroglycerin was shown to rise 1.5 times with nanotubes as carriers, and 2.5 times with nanoliposomes.

Annals of Clinical and Experimental Neurology. 2008;2(2):35-44
pages 35-44 views

Clinical analysis

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL): first description of a Russian family with the identified mutation in the Notch3 gene

Illarioshkin S.N., Slominsky P.A., Shadrina M.I., Partola M.V., Kandyba D.V., Zhulev N.M.


Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a recently described familial form of ischemic stroke caused by mutations in the Notch3 gene on chromosome 19q12. Clinically, CADASIL develops as a cerebrovascular ‘small vessel disease’: against a background of repeated lacunar strokes, progressing are subcortical, pseudobulbar and cerebellar syndromes and cognitive decline. Neuroimaging methods (CT, MRI) reveal combination of small lacunar infarcts of variable location with diffuse white matter changes (leucoaraosis). In this paper we present the first description of a Russian family with the verified mutation in the Notch3 gene, nucleotide change 832G>A in exon 5 leading to substitution of valine to methionine (Val252Met) at protein codon 252. This missense mutation is novel and has not been reported before in other families with CADASIL syndrome. The observation presented confirms that CADASIL syndrome should be suspected in all cases of white matter disease of unknown origin.

Annals of Clinical and Experimental Neurology. 2008;2(2):45-50
pages 45-50 views

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