Vol 12, No 1 (2018)

Introduction. Biologically determined differences between males and females and different levels of sex hormones determine some specific features of their ischemic stroke (IS). Clinical studies aimed at identifying risk factors for the development of IS in persons of different sexes are considered to be necessary for elaborating strategies to increase life expectancy and to improve quality of life.

Objective: to study risk factors for the development of IS in the arteries of the carotid system in males and females.

Materials and methods. Risk factors for the development of IS in the arteries of the carotid system were analyzed in 268 patients for the period from 2010 to 2017. Among the patients, there were 148 (55%) men and 120 (45%) women aged from 47 to 79 years. MRI of the brain, duplex scanning of the cerebral arteries, and transthoracic and transesophageal echocardiography were used to establish the diagnosis of the stroke subtype.

Results. In the age group 47-79 years, females had more often cardioembolic and lacunar stroke, while males had predominantly atherothrombotic  stroke  and stroke with competing causes. Atrial fibrillation, diabetes mellitus, atherosclerotic cardiosclerosis, chronic heart failure, thyroid disease and excess body weight were also more common in females. In contrast, there were significantly more smokers and over-consumption of alcohol among males, and the same was true for small heart attacks and transient symptoms in the past history. Atherosclerosis of the extracranial part of the internal carotid artery (ICA) of high degree was found more often in males, while females with atherothrombotic stroke had significantly higher blood cholesterol level. The study of arterial hypertension (AH) revealed the following differences between groups: AH III degree (180/110 mm Hg or higher) was more often in females, and AH I degree (140-159 / 90-99 mm Hg) in males, while  the proportion of patients with grade II AH (160-179 / 100-109 mm Hg) and patients without AH  was approximately equal in the two groups.

Conclusions. The risk factors for the development of IS in the arteries of the carotid system in men are atherosclerotic carotid stenosis, smoking and excessive alcohol consumption. Development of stroke in men is preceded by small infarcts with transient symptoms. The risk factors for the development of IS in the arteries of the carotid system in women are atrial fibrillation, diabetes mellitus, atherosclerotic cardiosclerosis, chronic heart failure, thyroid disease, and excess body weight. As in men, despite of significantly higher cholesterol levels, there are more pronounced atherosclerotic carotid stenosis and more frequent ISs, one may suggest the existence of an additional factor leading to stroke (alternatively, women may have some gender-specific protective factor).

Introduction. The occurrence of hemorrhagic stroke (HS) is about 1/5 of that of ischemic stroke, but HS represents an important problem of neurology because of high mortality and disability rates. HS can manifest as spontaneous subarachnoid hemorrhage (SAH), intracerebral hematoma (ICH), spontaneous (non-traumatic) extradural and subdural hematomas, or as a combination of these conditions. HS is characterized by a high percentage of complications, most severe of which is intraventricular hemorrhage (IVH).

Objective. To analyze the structure of HS, its complications and various methods of neurosurgical treatment.

Materials and methods. We studied medical histories of 84 patients with HS were who were treated in the Neurosurgical Department of GBUZ RB Hospital ambulance Ufa for the 6-month period in 2016. All patients underwent neurological, instrumental and laboratory examination, CT scan and CT angiography, brain MRI and, if necessary, cerebral angiography (CAG). To assess the severity and outcome of IVH, we used the Graeb criteria of the ventricular system involvement and the Hounsfieid characteristics of the ventricular clot density.

Results. The main causes of HS were arterial hypertension (54,7%) and aneurysmal disease of the brain (44%). Most of patients (63,8%) had putaminal ICH. Rupture of the aneurysm was the cause of SAH in 24 (28.6%) of patients. Aneurysms were located mostly in the basin of the middle cerebral artery. Surgical treatment was undertaken in 76 patients (90.4%t). IVH as a complication occurred in 21.4% of patients, main cause of this complication was massive SAH.

Discussion. In most of our cases of HS, the clinical picture of SAH was seen – 59.5% of patients. Among all methods of neurosurgical treatment of ICH, we predominantly used minimally invasive high-tech techniques proven to be most effective: needle aspiration, endoscopic removal of hematomas under the control of neuronavigation, and fibrinolysis; these technologies were used in 52.5% of patients. 

Abstract

Introduction. In the treatment of patients with cerebrovascular disorders, pharmacological correction of cerebral circulation largely depends on the character and the state of the pathological process. This determines the need to study the pharmacological regulation of the cerebral blood supply in various pathological conditions.

Objective. To study the effects of oxymethylethylpiridine succinate, nicotinoyl gamma-aminobutiric acid, nimodipine, amlodipine besylate and S-amlodipin nicotinate on the cerebral circulation of intact and ischemic rats, and to assess the effects of oxymethylethylpiridine succinate and nimodipine in experimental myocardial infarction and combined vascular pathology of the brain and heart.

Materials and methods. The cerebral circulation was evaluated using the laser Doppler flowmetry technique. Global transient ischemia was caused by occlusion of both common carotid arteries with simultaneous decrease in arterial pressure by bleeding and subsequent reinfusion. Experimental myocardial infarction was modeled by occlusion of the left coronary artery.

Results. Oxymethylethylpiridine succinate significantly increases blood supply to the brain in rats under conditions of global transient ischemia of the brain and combined vascular pathology of the brain and heart, in contrast with intact animals and animals with experimental myocardial infarction. Nicotinoyl gamma-aminobutiric acid equally increased blood circulation of the intact and the ischemic brain. Nimodipine equally increased cerebral blood flow in intact rats and in rats underwent brain ischemia, whereas this effect was significantly weakened in experimental myocardial infarction and disappeared in combined vascular pathology. S-amlodipin nicotinate and, to a lesser extent, amlodipine bisilate increased blood supply to the ischemic brain. The vasodilating effects of oxymethylethylpiridine succinate, nicotinoyl gamma-aminobutiric acid and S-amlodipin nicotinate, but not of nimodipine, were eliminated by GABA_A receptor blockers.

Conclusions. The dependence of the vasodilating effect of the studied drugs on the initial state of the organism was revealed. This phenomenon should be taken into account in prescribing target pathogenetic therapy of ischemic stroke.

Abstract                                   

Cerebral small vessel disease (cSVD) is a leading cause of vascular cognitive impairment and dementia, cerebral hemorrhages, and lacunar strokes. It is considered to be the most common clinically silent vascular brain disorder. Major forms of cSVD are age- and hypertension-associated arteriolosclerosis and cerebral amyloid angiopathy. For most types of cSVD causes and mechanisms of disease development and progression remain unknown. Detailed research of cSVD is hindered by lack of technical approaches to an in vivo assessment of microvasculature. MRI equivalents of pathological changes in cSVD might serve as surrogate markers of vascular damage and might be associated with clinical signs and symptoms. We review studies that demonstrated clinical significance of the primary MR signs of cSVD, i.e. white matter hyperintensity (formerly known as leukoareosis), lacunes, enlarged perivascular spaces and cerebral microbleeds, as well as their role in the disease progression. Recently introduced STRIVE standards established MRI changes as diagnostic criteria for cSVD. These standards may significantly improve our understanding of the role of various factors in the development of cSVD and its heterogeneity. However, individual prognostication and assessment of short-term and long-term treatment efficacy is still lacking. The use of diffusion-weighted MRI techniques for the assessment of microstructural changes of visually normal bran tissue might be helpful. Strong association between microstructural changes and clinical manifestation of cSVD supports the need for multimodal MRI studies for the assessment of pathophysiological mechanisms of the disease progression even on preclinical stages.

Abstract

Studying the brain structure and function in health and disease is one of the most important and intensively developing fields of neuroscience in the new century. Nowdays, in vivo studies of brain structure, metabolism, blood flow and function are mostly performed using safe imaging technologies not requiring ionizing radiation and based on magnetic resonance imaging (MRI). In this review, the detailed description of the principles of commonly used techniques that provide high-quality information about the brain, such as functional MRI (fMRI) and magnetic resonance spectroscopy (MRS), is presented. The potential and advantages of these methods including their use in combination with other imaging techniques (MR-tractography etc.) are outlined. The authors believe that combining all MRI options in one study may produce a complex approach for exploring physical-chemical mechanisms underlying brain function which may be of value for basic and applied research.

In this paper, we present some typical problems of managing patients with hepatolenticular degeneration (HLD), a severe hereditary disorder of cupper metabolism requiring permanent cupper-eliminating therapy. Special attention should be paid the following questions: choice of combined treatment with D-penicillamine (D-PAM) and zinc vs. monotherapy with either of these medications; the possibility of temporary worsening of neurologic symptoms induced by massive increase in free copper level in the blood following therapy with D-PAM; the need for special psychological support of patients and their relatives; strict adherence to a regimen prohibiting physical exercises and the need for following a special diet. Two clinical cases have been described: a fatal case of many-year compensated HLD after a physical load during a travel to the seaside, and a case of an infected foot wound in a HLD patient with the development of septicopyaemia (lower leg phlegmon and osteomyelitis of the lumbar vertebrae) following a physical activity and violation of the dietary pattern.