Vol 2, No 2 (2008)

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.

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.

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.

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.