Vol 2, No 1 (2008)

There are different pathogenetic mechanisms underlying the polimorphism of the ischemic stroke (atherothrombosis, cardiocerebral emboly, small vessels changes in arterial hypertension). Among these mechanisms one of the key places belongs to the disturbances of the endothelial function and haemostatic system. Today, endothelial dysfunction is believed to be a crucial step in the pathogenesis of arterial hypertension and atherosclerosis, as well as of their complications, such as ischemic stroke. The aim of this study was to evaluate the endothelial function in patients with acute ischemic stroke using biochemical (level of antithrombin III, von Willebrand factor) and ultrasound (test on endothelial derived vasodilatation of the brachial artery) methods. It was shown that ischemic stroke occurs in the case of dysbalance of endothelial production of substances with procoagulant activity (increase in level of the von Willebrand factor) and anticoagulant activity (decrease in the antithrombin III level), i.e. they occur in the situation of endothelial dysfunction. The ultrasound markers of endothelial dysfunction were also demonstrated in patients with ischemic stroke. The endothelial dysfunction is maximal in acute phase of ischemic stroke, it takes place in all stroke subtypes and is correlated with the degree of neurological deficit.

We describe a 53 year old patient with the left internal carotid artery (ICA) dissection, which developed after the resection of tortuous part of ICA. The first clinical manifestations of dissection were the left lower cranial nerve palsies (dysphagia, dysphonia, disorder of tongue movement), in two days left frontotemporal headache appeared and in two weeks patient developed ischemic stroke in the territory of the left middle cerebral artery. Diagnosis of ICA dissection was confirmed by CT-angiography and duplex ultrasound. Morphological study of resected ICA found two small arteries beginning from ICA, small aneurismatic dilatation of the ICA wall and evidence of fibromuscular dysplasia. In two months, swallowing significantly improved and right hemiparesis partly regressed. Clinical and morphological data suggest that fibromuscular dysplasia was the cause of dissection and ischemia of the lower cranial nerves was the cause of their palsies. Blood supply of the lower cranial nerves was not from the external carotid artery, as usually, but from the ICA. Its dissection led to the interruption of the nutrient arteries and as the result – to nerve ischemia.

Hereditary factor increases the risk of migraine and underlies in many respects the development of symptoms and the disease course. Last years, basic genetic studies in migraine resulted in impressive achievements, which gave the key to understanding pathophysiological processes in this disease. At the same time, many questions remain unanswered. Most interesting is the search for genetic markers of migraine and their phenotypical correlates. From practical viewpoint, equally promising in migraine heredity studies are pharmacogenetic aspects, namely, identification of genetic predictors of the efficacy of particular medications. In this review, modern approaches to genetic studies in migraine are discussed, and presently known genetic biomarkers and their possible role in the disease development are presented.

The purpose of this work was to present the advanced imaging tools using diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) for yielding structural and functional information about white matter (WM) pathways in the brain. A brief review of the basic principles underlying DTI and examples of clinical  applications  of  DTI  and  DTT  in  neurosurgery  for patients with brain tumors is presented. Knowledge of DTT patterns, when a cerebral neoplasms involves the WM tracts, becomes critically important when neurosurgeons use DTI in evaluation of the topography of WM and tumor for planning tumor resection.

We present the first case report of licorice overdose in Russian literature. 28-year-old man had severe untreatable arterial hypertension, hypokaliemia, quadriparesis and pain in the calf after acute respiratory disease. Additional laboratory tests disю covered metabolic alkalosis, breath dysfunction, myoglobinuria and very high level of creatine phosphokinase in serum. It was discovered that this man was a codeineюabuser and took combined medicine containing codeine and licorice («Codelac») which is free for sale without prescription in pharmacies in Russia. The dose of licorice was up to 12 g per day in the course of half a year (up to 60 pills per day). The prescription of aldosterone antagonist was successful, and after 3 weeks of taking spironolactone the patient’s condition and all laboratory tests became normal. Licorice inhibits 11-beta-hydroxisteroid dehyю drogenase type 2 and leads to symptomatology of secondary hyperaldosteronism. There are many case reports of licorice overdose by old people with chronic obstructive syndromes in the medical literature. Some cases result to lethal outcome due to breath dysfunction with apnoea. We consider that codeineю abusers who are taking free for sale medicines containing codeine and licorice are in the risk group for licorice overdose.