Vol 11, No 3 (2017)
- Year: 2017
- Published: 28.09.2017
- Articles: 11
- URL: https://annaly-nevrologii.com/journal/pathID/issue/view/52
Full Issue
Original articles
Quality of life as an integral indicator for effectiveness of rehabilitation in patients with ischemic stroke
Abstract
Introduction. Neurological deficits due to ischemic stroke may cause temporary or permanent disability affecting quality of life. Thus, quality of life assessment is important for evaluation of rehabilitation outcomes and general state of the health after a vascular accident.
Objective. To evaluate quality of life in patients in the recovery period of hemispheric ischemic stroke within subsequent year after a vascular accident.
Material and methods. One hundred twenty-three patients (age ranging 40–80 years) with stroke were examined in the acute and recovery (up to 1 year) periods. In the acute period of stroke and after a rehabilitation course, patients underwent assessment with Barthel Scale, modified Rankin
Scale, NIHSS scale, and health status questionnaire SF-36.
Results. We found that within the first 3 months following acute ischemic stroke there was an improvement due to rehabilitation course in all areas which determine patients’ quality of life (including Role Emotional and Mental Health SF-36 scores). Adherence to the personalized out-patient rehabilitation program determines improvement in neurological and SF-36 outcomes as well as establishes adaptive coping strategies.
Conclusion. Within the first year after a vascular accident, patients with mild to moderate post-stroke neurological deficits showed recovery in self-care activities, functional independence, SF-36 scores for physical and mental health components along with improvement of focal neurological deficits.
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New approaches in the treatment of epilepsy
Abstract
Introduction. Despite the significant progress made in the treatment of epilepsy in recent years, no less than 30–40% of patients cannot achieve complete cessation of seizures.
Objective. To evaluate new approaches in the epilepsy treatment with nano-sized dosage forms and 3-benzylamino-metilenpirrolidin-2,4-dion (beprodone).
Materials and methods. Evaluation of the anticonvulsant activity of nano-phenazepam in comparison with bromine-dihydrochlorophenyl-benzodiazepine (phenazepam) in substances was carried out. 2-aethylium-6-methyl-3-hydroxypyridine succinate (Mexidol) encapsulated on copolymers of lactic and glycolic acids was chosen as the second medicine for evaluation. Beprodone dosed 100 mg/kg intraperitoneally was the third drug assessed in rats. Chronic cobalt-induced epileptogenic focus was chosen as an experimental model. Additional clinical study of beprodone was conducted in 75 patients with epilepsy (men and women, age ranging 18–65 years) with uncontrolled focal seizures with or without secondary generalization.
Results. In secondary generalized epilepsy model in rats, nanophenazepam significantly reduced epileptiform discharges in the cortex and hypothalamus along with hippocampus. In the chronic model of cobalt epilepsy, nanomexidol reduced the number of epileptiform discharges 3 times and also stopped the status epilepticus (reducing 7.8 times the number of secondary generalized tonic-clonic seizures). The targets for beprodon are cortical foci and, in the second stage, subcortical foci which generate epileptic activity. In 75 patients with epilepsy who had uncontrolled focal seizures with or without secondary generalization, a significant increase in days without seizures was noted on beprodon; the number of seizures decreased 2 times (p <0.01).
Conclusion. Further investigation of new targets for novel antiepileptic drugs and introduction of the latter into clinical practice can be considered as one of the ways to solve the problem of drug resistance.
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Prevention of cerebrovascular disease in patients with myeloproliferatie disorders
Abstract
Introduction. Hemorheological abnormalities in patients with Ph-negative myeloproliferative disorders (MPD) may lead to the development and/or progression ofcerebrovascular pathology. Adequate preventive therapy in such cases lowers the risk of cerebral thrombotic complications.
Objective. Evaluation of the effect of dipiridamole and acetylsalicylic acid (ASA) on platelet and erythrocyte aggregation, as well as morphofunctional properties of erythrocytes in patients with cerebrovascular disease (CVD) on the background of MPD.
Materials and methods. The study comprised 40 patients with various forms of CVD and Рh-negative MPD: 20 patients received dipyridamole, 20 – ASA for prevention of cerebral thrombotic complications. Mean study age was 44.6 years [35; 58.5]. A thorough clinical and neurological examination was performed, as well as neuroimaging studies, coagulation tests, analysis of platelet aggregation and rheological properties of erythrocytes.
Results. Within the observation period (median – 6.3 months) no acute cerebrovascular events in both groups were observed. Platelet aggregation (induced by ADP or adrenaline) was similar in both groups. Dipyridamole and ASA were also similar in their effect on functional properties of erythrocytes.
Conclusion. Our findings suggest that the therapeutic effect of dipyridamole concerning CVD is similar to that of ASA. Dipyridamole can be recommended for use in patients with Рh-negative MPD if other antiplatelet agents are contraindicated.
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The change in androgenic status in men with atherothrombotic stroke
Abstract
Introduction. Last years special attention is paid to the age-related and gender aspects of pathogenesis of cerebrovascular disease.
Objective. To investigate the androgenic status in men with atherothrombotic stroke.
Materials and methods. There were 25 man, involved in our study (mean age 53 [45; 57]) with atherothrombotic stroke in carotid system, who were observed for the initial 48 hours since the development of neurological symptoms. The laboratory study included the estimation of blood lipid profile, carbohydrate metabolism and androginic status beside the general blood analysis and clinical urine examination. The level of free testosterone was determined by the calculation method using a nomogram according to Vermeulen (normal range 225 pmol/l or more). The levels of luteinizing hormone (normal range 2,5–11,0 U/l) (for exclusion primary hypogonadizme), the levels of testosterone (normal range 11,0–33,3 nM) and estradiol (normal range 73-206 pmol/l) were determined on an automatic chemiluminescent analyzer. Hypogonadizme was diagnosed by the level of total testosterone <12 nM or the level of free testosterone <225 pmol/l. The 14 patients (mean age 55 [49; 59]) with a chronical cerebrovascular insufficiency and without laboratory signs of lipid storage disease and carbohydrate metabolism disorder or age-related hypogonadizme composed a comparison group.
Results. The laboratory signs of androgen deficiency were detected by 72% patients with atherothrombotic stroke. Correlation link was established between androgenic deficit (total testosterone not less than 12 nM), diabetes mellitus type II (r=0.514, р=0.008) and alcohol overuse (r=0.535, р=0.033). A negative correlation relationship was established between the level of free testosterone and the body-weight index (r=–0.442, р=0.022). The lowest levels of total and free testosterone, Ме 7.2 [4.2; 9.8] nM and 135 [59; 181] pmol/l respectively, were observed in a group of patients with a combination of atherothrombotic stroke and metabolic syndrome. There was no statistically significant correlation of acquired hypogonadism and blood lipid levels.
Conclusion. The laboratory signs of acquired androgenic deficit were revealed in 72% of men (mean age 53.0 [45; 57]) with atherothrombotic stroke. The lowest values of total and free testosterone were observed in patients with the syndrome of multiple metabolic disorders.
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Gender and age-related differences in morphometric characteristics of neurons in human brain substantia nigra
Abstract
Introduction. Age-related morphological changes in the brain and those taking place in Parkinson disease (PD) are similar in their nature but differ in intensity. Quantitative evaluation of the neurons’ characteristics in substantia nigra pars compacta (SNc) in men and women during aging will allow to use obtained values as a reference while studying PD.
Objective: to study gender- and age-related morphometric characteristics of neurons in SNc of the human brain.
Materials and methods. Morphometric evaluation of SNc neurons in autopsy human brain specimens (n=12) of normal aging men and women (aged 52–87 years) was performed. The sections were stained with cresyl violet and for thyrosine hydroxylase (dopamine marker). A total number of neurons and number of dopaminergic neurons in particular in ventral and dorsal regions of SNc were counted; cellular and nuclear size was also estimated.
Results. In the aging brain, the most pronounced morphological changes occur in the medial, lateral, and intermediate segments of the ventral region of SNc. In the medial segment, the overall neuronal density was decreased by 33%, while in the lateral and intermediate segments of the ventral region of SNc it was decreased by 23%. In the medial and in the lateral and intermediate segments, density of the dopaminergic neurons was decreased by 28% and 24% respectively. Survived neurons showed increased cellular size and reduced nuclear size. In women, basic morphometric characteristics of neurons in the lateral and intermediate segments of the ventral region of SNc were higher than in men.
Conclusions. In normal aging, involution of the brain structures in SNc is more pronounced in its ventral region. Interestingly, involution occurs more slowly in a female brain than in a male brain.
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Reviews
Chemical angioplasty for the treatment of cerebral vasospasm in patients with ruptured cerebral aneurysm
Abstract
Vasospasm of cerebral arteries is considered to be the main reason of unfavorable outcomes in patients in acute period of ruptured arterial aneurysms. Despite of availability of various therapeutic approaches, there is no effective way to prevent and to treat vasospasm so far. However, according to recently published works chemical angioplasty in considered as a promising technique for the treatment of vasospasm. This approach implies invasive drug administration in the narrowed segments of cerebral arteries which allows medicine to affect endothelium of cerebral arteries directly. This route of administration prevents development of systemic effects of a drug and decrease of plasma drug concentration because of its metabolism in liver. Chemical angioplasty is used not only in proximal but also in distal parts of the constricted cerebral artery. In this review, we touch upon the use of chemical angioplasty for the treatment of vasospasm in patients with subarachnoid hemorrhage due to rupture of intracranial aneurysms. The most widely used drugs for chemical angioplasty include papaverine, verapamil, nimodipinе, nicardipine, fasudil hydrochloride, and milrinone. Studies of this treatment approach show promising results confirming its efficacy in the management of vasospasm in patients with subarachnoid hemorrhage due to rupture of intracranial aneurysms.
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Neuroanatomic differences of the brain in males and females
Abstract
Gender distribution is an important factor in patient cohorts which may influence the results acquired in studies on pathogenesis and treatment of neuropsychiatric disorders. In all age groups, the mean brain volume is approximately 8–15% larger in males than in females, so the absolute volumes of almost all neuronal and white matter brain structures are larger in males. Several studies showed that body size and brain volumes may influence the results of neuroanatomical studies. In addition, brain maturation rate is faster in females than in males which should be considered as another important contributor to possible inconsistencies in the results of studies of gender effects on neuroanatomy, particularly in cohorts of young patients. Taking those circumstances into account, the most consistent findings in this field demonstrated larger amygdala volume in males in comparison with females, which was applicable to both paediatric and adult populations. Data on gender differences in neuroanatomy of visual and auditory cortical areas seem to be reasonable. Larger relative volumes of limbic and paralimbic cortex in females in comparison with males were consistently found in a range of studies as well. Overall, global and regional hemisphere asymmetry values are more pronounced in males in comparison with females.
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Technologies
Surgical treatment of the carpal tunnel syndrome using endoscopic and electrophysiological monitoring
Abstract
Introduction. Carpal tunnel syndrome (CTS) is a variant of tunnel neuropathy, which develops as a result of compression of the median nerve by a hypertrophic flexor retinaculum. Surgical treatment implies dissection of the flexor retinaculum which leads to fast pain alleviation and termination of neurologic deficit progression.
Objective. To evaluate effectiveness of the new surgical treatment of CTS using endoscopic and electrophysiological monitoring.
Materials and methods. Outcomes of the surgical treatment with the new combined technique were evaluated in a group of 72 patients. To assess effectiveness, VAS, frequency of complications and relapses, length of inpatient hospitalization, and temporary disability were assessed.
Results. We found a significant reduction in VAS pain score from 6 [3; 7] to 2 [1; 3] points within the first day following surgery along with improvement of the surface pain sensitivity from 3 [2; 4] to 2 [2; 3] points. No significant complications of relapses were found (N = 0). The average period of inpatient hospitalization was 16 [12; 24] hours and the temporary incapacity for work was 7 [5; 12] days.
Conclusions. The new surgical approach significantly reduces level of pain syndrome and sensory disturbances, allows to achieve sufficient decompression of the nerve with minimal risks of complications, and reduce duration of hospitalization and temporary disability.
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Clinical analysis
Difficulties in diagnosing primary cerebral lymphoma (clinical case)
Abstract
Primary cerebral lymphomas account for about 5% of CNS neoplasms and 1–2% of non-Hodgkin lymphomas. The article presents a clinical case of multifocal brain lesion with a long-term (more than 3 years) course of the disease, similar to the demyelinating process in the MRI picture, clinically considered as multiple sclerosis, chronic encephalitis or sarcoidosis, which ended by a lethal outcome with an immunohistochemically verified primary diffuse B-large cell lymphoma of the brain. Prolonged course of the disease and the effectiveness of glucocorticosteroids suggest the presence of isolated brain lymphomatoid granulomatosis which could develop in the background of multiple sclerosis during three years prior to malignization. Cerebral biopsy could help in the earlier diagnosis of the disease, thus it should be the diagnostic procedure of choice for verifying the pathological multifocal process in diagnostically complicated cases.
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Benign intracranial hypertension: clinical observations
Abstract
The complexity of diagnosing benign intracranial hypertension is associated with the low specificity of symptoms. For a timely diagnosis and exclusion of the secondary nature of the disease, it is sometimes necessary to conduct a broad range of additional examinations. The article describes 2 cases of benign intracranial hypertension, representing a diagnostic challenge. In the first case the disease developed in a patient with iron deficiency, hyperprolactinemia and obesity. The patient was treated with diuretics and corticosteroids, therapeutic lumbar punctures were performed. In the second case the disease developed in a patient with recent childbearing, obesity and mastitis. Due to the ineffectiveness of drug therapy surgery was carried out – ventriculoperitoneal shunting was performed with a temporary positive effect. Later breast cancer was diagnosed. The etiology, epidemiology, pathogenesis and symptoms of the disease are discussed. Particular attention is focused on the treatment of benign intracranial hypertension.
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Historical articles
History of description of Huntington disease in Russia Yury A. Seliverstov
Abstract
This paper reviews detailed historical aspects of description of Huntington’s disease (HD) in Russia. First not well-known publications reporting HD in Russia are presented. Diverse terminology which was used in the late 19th and early 20th centuries’ Russian medical literature on HD is discussed. The author touches upon a problem of using unified Russian terms in the modern scientific publications on HD.
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