Vol 15, No 1 (2021)

We aimed to evaluate the treatment results in patients with internal carotid artery (ICA) and vertebral artery (VA) dissection.

Materials and methods. We examined 285 patients (122 men and 163 women, mean age 37.7 ± 8.1 years) with ICA dissection (n = 147), VA dissection (n = 122), or a combination of both (n = 16). The dissection presented as ischemic stroke in 175 patients and with local symptoms in the others. Out of 173 patients, 156 were managed conservatively. Efficacy of the conservative treatment in first 3 months was assessed in 143 patients who received anticoagulants (AC; n = 38), antiplatelets (AP; n = 42), both (n = 45) or no antithrombotic therapy (n = 18).

Results. Good functional recovery (0–2 points on the modified Rankin Scale) after 3 months was noted in 70% of patients, with no statistically significant differences between the different treatment types. There were 3 (2%) deaths in patients with severe stroke receiving AC. Recurrent ischemic stroke occurred in 10% of patients most often (86%) occurring in the first 3 weeks and triggered by head movement, straining, or fluctuating blood pressure. No statistically significant differences were found between different conservative treatments. However, there was a tendency towards increased frequency of recurrent stroke in patients without antithrombotic therapy (22%), as compared with patients receiving AC (4%) or AP (12%). There were no strokes in 110 patients with local symptoms due to ICA/VA dissection during the observation period.

Conclusion. There were no statistically significant differences in AC and AP efficacy in patients with ICA or VA dissection. A neck brace to prevent head movement and control of blood pressure are advisable alongside pharmacological therapy.

Introduction. Systemic thrombolytic therapy (STT) is an effective and accessible method of reperfusion treatment for ischaemic stroke. However, it is not yet evident how the risk factors preceding ischaemic stroke affect disease progression and outcome, as well as the efficacy of STT.

The study aimed to examine the results of STT in stroke patients, depending on their risk factors, severity of those risk factors, and the success in managing them at the prehospital stage.

Materials and methods. We examined 229 patients who underwent SST, of whom 201 survived and 28 died. The presence of hypertension, type 2 diabetes mellitus, atrial fibrillation, or metabolic syndrome, as well as blood sugar level, lipid panel results, and body mass index were assessed.

Results. Ischaemic stroke subtype, the length of time from symptom onset to start of STT, or the presence of hypertension did not have a statistically significant effect on 28-day mortality. Patient age, NIHSS score, presence/absence of type 2 diabetes mellitus and atrial fibrillation, modified Rankin Scale score, blood sugar level, body mass index, and the presence of metabolic syndrome had a statistically significant influence on 28-day mortality. Data from the survived 201 patients were used to analyze the correlation between risk factors and functional recovery after ischaemic stroke. For patients with moderate and mild ischaemic stroke, statistically significant inverse correlations were found for age, blood sugar level, and body mass index.

Conclusion. An inverse correlation was found between 28-day mortality and age, severity of neurological impairment, blood sugar level at onset, body mass index, and the presence of the metabolic syndrome. The ‘obesity paradox’ was not identified in regard to survival, but patients with hypercholesterolemia had more significant regression of neurological symptoms and better functional recovery. Receiving statins and having a target cholesterol level were not found to have a positive effect on patient recovery in the first 28 days after disease onset, likely because of greater severity of the overall vascular disease.

Introduction. Early diagnosis of amyotrophic lateral sclerosis (ALS) is difficult because of the low sensitivity of clinical criteria at the early stages of the disease and the lack of reliable laboratory biomarkers. Neuron destruction leads to the release of excessively accumulated phosphorylated neurofilament heavy chains (pNFH) in the cerebrospinal fluid (CSF) and may potentially be used for early diagnosis of ALS. In addition, pNFH may have predictive significance.

Aim. To investigate the clinical significance of elevated neurofilament heavy chain levels in the CSF in ALS.

Materials and methods. The study included 33 patients with ALS diagnosed using the El Escorial criteria, 30 patients in the control group (post phlebectomy), as well as 28 patients in the comparison group: 16 patients with multiple sclerosis, 5 with autoimmune encephalitis, 1 with tick-borne encephalitis, 2 with primary lateral sclerosis, 1 with progressive muscle atrophy and 3 with other conditions (restless leg syndrome, compressive myelopathy and paraneoplastic cerebellar degeneration). All patients underwent a lumbar puncture, with pNFH levels measured using ELISA.

Results. A statistically significant difference in pNFH concentration was found between ALS patients and patients in the comparison group (p < 0.0001). At a threshold pNFH level, which was taken to be 0.785 ng/ml, the test sensitivity and specificity were 94% and 86%, respectively. Elevated pNFH levels in the CSF of patients with confirmed ALS were found in 94% of cases, compared with only 14% of patients in the comparison group. A statistically significant difference in pNFH concentration was found between the group with ALS and the control group (p < 0.0001). A negative correlation was found between pNFH level in the CSF and disease duration (r = –0.5172; p = 0.0029). A positive correlation was also found between the speed of disease progression and pNFH concentration (r = 0.5480; p = 0.001).

Conclusion. The results of this study demonstrate the high clinical significance of pNFH in the CSF in ALS.

The aim of this study was to examine the cytoarchitecture of area 10 in the frontal lobe of I.P. Pavlov, an outstanding scientist, physiologist, and Nobel Prize winner.

Materials and methods. We studied the cortical cytoarchitecture of area 10 in the brain's frontal region belonging to the scientist and physiologist I. P. Pavlov (aged 86 years), compared with similar brain cortices of 4 elderly males (75–90 years). Modern morphometric methods were used, on the basal surface of each cerebral hemisphere, to study the cortical thickness of area 10, thickness of the associated layer III, area of the specialized neural field in this layer, the number density of contained neurons, total glial cells, satellite glial cells, and the neurons surrounded by them.

Results. It was found that area 10 of the cerebral cortex of I.P. Pavlov is characterized by good preservation, pronounced radial striation, and significant asymmetry of the macroscopic and cytoarchitectural structure. Compared with ordinary men, area 10 of I.P. Pavlov’s brain has a significantly thicker cortex and associative layer III, as well as a higher proportion of large neurons, number density of neurons, total glial cells, satellite glial cells, and neurons surrounded by them.

Hemorrhagic stroke is a medical and social problem, with an incidence of 15–35 per 100 000 people per year. It is characterized by high patient mortality (up to 53% in the first year) and disability, with most of the surviving patients having persistent neurological deficits and about 20% of them requiring continuous assistance.

The advantages of surgical or conservative treatment of patients with supratentorial hypertensive intracerebral hemorrhage (ICH) are still under discussion. This literature review is based on 12 open-source articles on prospective randomized trials comparing conservative and surgical treatment results in patients with supratentorial ICH, which demonstrate contradictory results.

Based on an analysis of all the works, we can conclude that surgical treatment has an advantage when performed early (within 12–72 hours) in patients whose level of consciousness is 9–12 points on the Glasgow Coma Scale. Needle aspiration and local fibrinolysis are effective for basal ganglia ICH, while open surgery and endoscopic aspiration are effective in subcortical ICH. For subcortical ICHs that are 20–80 cm³ in size, surgical treatment improved functional outcomes, while in ICHs larger than 50 cm³, it helped to reduce mortality.

Introduction. Endovascular thrombectomy with stent retrievers (SR) is effectively used to treat patients with ischaemic stroke due to thrombotic occlusion of large intracerebral arteries.

The aim of the study was to evaluate the ability of popular SR made overseas to grab the blood clot in vitro compared with the first Russian SR (Grasper, Angioline), as well as to analyze the first use of this SR in clinical practice.

Materials and methods. A comparative assessment of different SR: Trevo ProVue (Stryker), Penumbra (Penumbra Inc.), Solitaire (Medtronic), and Grasper (Angioline) and their ability to capture a blood clot in vitro was performed. A clinical evaluation of the safety and efficacy of the Grasper SR in patients with ischaemic stroke was conducted.

Results. No difference was found in the ability of the test devices to pass through torturous areas, and all devices successfully reached the target implantation zone without difficulty. The clot could be removed entirely in all cases, with no evidence of fragmentation during removal. Clinical testing of the Grasper SR demonstrated that its performance was comparable to the Solitaire SR in restoring intracerebral blood flow.

Conclusion. The obtained results from the in vitro study demonstrate comparable effectiveness of the Russian SR to its counterparts. The clinical study results show that the Grasper SR can effectively and safely remove blood clots in clinical settings but requires further study on a larger number of subjects.

Introduction. Neuropathic pain in trigeminal neuralgia (TN) is one of the most common and debilitating symptoms in patients with multiple sclerosis (MS). This condition in MS is due to the demyelination of pontine afferent fibers in the sensory root of the trigeminal nerve. The area of demyelination is usually located in the ventrolateral pons between the exit of the trigeminal nerve root and the trigeminal nucleus, which is confirmed on MRI. In some cases, neurovascular compression also plays a role in afferent fiber injury, leading to the so-called double crush effect. Conservative therapy for TN in patients with MS is often insufficiently effective, thus increasing the pertinence of surgical treatment.

Materials and methods. The article reviews current pharmacological and surgical approaches to treating TN, findings from the literature, and our data on the safety and efficacy of percutaneous radiofrequency rhizotomy (PRR) for TN, based on the surgical treatment of 52 patients with MS at the Research Center of Neurology.

Results. PRR works by interrupting the connection between peripheral receptor zones and the hyperactive trigeminal structures in the brainstem. All patients were discharged from the hospital on day 2–3 after surgery, with complete pain resolution. There were early and late relapses in some instances, which required a repeated PRR.

Conclusion. PRR is a symptomatic surgical method that is safe, repeatable, and effective for treating TN in patients with MS, in whom pharmacological therapy has been ineffective or who could not tolerate it.