Vol 14, No 3 (2020)

Сurrent strategies of primary stroke and cardiovascular disease prevention are aimed at addressing the main risk factors primarily in patients with higher cardiovascular disease risk. Since the number of people with incident stroke and ischaemic heart disease cases is rapidly growing across all countries of the world, this preventive strategy appears to be not sufficiently effective. World Stroke Organization recently (2020) endorsed a different concept of stroke and dementia prevention based on a population-wide approach to dealing with risk factors, which involves all individuals regardless of their cardiovascular disease risk level. This article describes four main primary prevention strategies suggested by the World Stroke Organization to effectively reduce stroke and dementia incidence by 50% and 30% respectively. These strategies include (1) population-wide prevention; (2) polypill therapy; (3) free e-Health application “Stroke Riskometer”; and active engagement of community health workers.

Introduction. The thalamus is a 'transmitting organ' that is involved in a wide range of neurological functions. Its functional uniqueness and high sensitivity to damage during the earliest stages of multiple sclerosis (MS) make the thalamus a kind of barometer of diffuse brain damage in MS.

The aim of the study was to examine the structural and functional changes in the thalamus and its subregions using magnetic resonance morphometry and to determine their clinical significance in different types of MS.

Materials and methods. We examined 68 patients with relapsing-remitting (n = 40) and secondary progressive (n = 28) MS. The control group consisted of 10 healthy people matched for age and gender. The Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Severity Score (MSSS) were used to assess the patients' neurological status. The cognitive and mental domains were tested using the MMSE, FAB, MoCA, SDMT, Beck's test, and HADS. All patients underwent a brain MRI and morphometric evaluation of the obtained data using the FreeSurfer 6.0 software.

Results. The size of the thalamic pulvinar in relapsing-remitting MS was reduced on the left (M (anterior : posterior) = 186.6 : 149.4 mm3) compared with the controls (229.5 : 187.5 mm3) and on the right (219.5 : 187.1 mm3) compared with the controls (261.6 : 240.5 mm3; p < 0.05). The size of the left thalamic nuclei was significantly reduced in secondary progressive MS when compared with relapsing-remitting MS and the controls. EDSS was correlated with a decrease in the dimensions of the geniculate nucleus on the left (r = –0.48) and the pulvinar nuclei on the left (r = 0.46–0.54). Standard neuropsychological scales correlated with the size of the medial dorsal nucleus (r (MMSE:FAB:MoCA) = 0.51; 0.45; 0.59). The greatest correlation was between the SDMT test (written section) and the left ventral anterior nucleus (r = 0.71).

Conclusion. The obtained data indicate that thalamic nuclei atrophy plays a significant role in the progression of disability and cognitive disorders in MS. Mag- netic resonance morphometry of the thalamic nuclei can be considered an important marker and predictor of MS progression.

Progressive ischaemic stroke is a clinical form of unfavourable progression of an acute cerebrovascular accident, found in around 20% of cases during the acute period. The strategy and approach to managing patients with an apparent deterioration during the acute period of stroke have not been fully established. Various types of antithrombotic therapy are discussed in the literature, with the use of antiplatelet drugs considered the most promising.

The authors analyse all types of antithrombotic therapy for progressive ischaemic stroke and examine in detail the only known case of late thrombolysis, which was performed in 1968.

Introduction. The article discusses the search for new and highly effective drugs for the prevention and treatment of cerebrovascular disease. The aim was to examine the effect of the acyl hydrazone tropane derivative on individual platelet aggregation (PA) sensitivity in in vitro studies.

Results. We present the results of a pilot study on the effect of a new acyl hydrazone tropane derivative — acyl hydrazone (2,3,4-trimethoxy-N'-(8-methyl-8-azabicyclo [3.2.1.] octane-3-ylidene) benzohydrazide hydrochloride on PA properties in vitro in healthy volunteers and in patients with chronic cerebrovascular disease.

Conclusion. The studied compound has a pronounced ability to suppress PA when administered intravenously in vivo in two concentrations, equivalent to doses of 10 and 100 mg/kg, and its effect is superior to the comparator acetylsalicylic acid, which is used in clinical practice as an antiplatelet drug.

This review deals with research on the effect of board games on the prevention of cognitive disorders in the older population. It is known that activities using board games significantly enhance educational and intellectual abilities in children. However, data on the effect of such interventions in older patients (including those at risk for developing dementia) are few and equivocal. In the Bronx Aging Study, reading, board games, playing musical instruments, and dancing were associated with a reduced risk of cognitive disorders. The MoVIES study assessed the cognitive status of 942 participants aged 65 years and older, and a lower risk of dementia was found in those who devoted more than 1 hour per day to 'recreational activities'. The French study of the PAQUID cohort showed that those who regularly played board games had a 15% lower risk of developing dementia than those who did not.

This review attempts to systematize the known data (including functional MRI data) on how playing board games influences changes in cognitive function. The article covers memory mechanisms that are necessary components of cognitive health. Structures that are directly involved in long-term memory formation, especially explicit memory, including the hippocampus, parahippocampal gyrus, and entorhinal cortex, are described.

The article includes studies covering not only geographical, economic and social status, age, gender, and level of cognitive load, but also the different assessments measuring the effect board games have on the brain. Different assessment methods and functional MRI data have demonstrated the potential effectiveness of using board games in the prevention of both age-related and pathological intellectual ageing.

Introduction. The frequency of adverse outcomes in patients with severe traumatic brain injury (TBI) exceeds 25%. Epileptic seizures and vasospasm, in the absence of pathogenetic treatment, cause irreversible brain damage and thus complicate the course of severe TBI. Bedside electroencephalography (EEG) is traditionally used to diagnose these conditions. However, its low spatial resolution when recording from the scalp and a large number of artefacts that make it challenging to analyse the data.

Materials and methods. Electrocorticography (ECoG) monitoring was performed using subdural electrodes implanted in the traumatic brain lesion during TBI surgery in 11 patients during the acute period of severe TBI. All patients were concurrently monitored using scalp EEG with subdermal needle electrodes.

Results. Analysis of scalp recordings showed frequency disturbances and oscillation asymmetry in all patients, while sporadic epileptiform activity and rhythmic and periodic patterns were detected in 18% and 64% of subjects, respectively. Analysis of invasive EEG showed sporadic epileptiform activity in 27% of patients, while rhythmic and periodic patterns were present in 91%. Moreover, epileptiform activity was registered only by the subdural leads in 3 patients. The total percentage of subjects in whom we registered clinical and electrographic signs of convulsive and non-convulsive status epilepticus using EEG and ECoG was 55%. We found indirect EEG signs of slow-spreading cortical depolarization in one patient whose level of consciousness was coma, followed by an electrographic pattern of status epilepticus on ECoG.

Conclusion. ECoG recording, while patients with severe TBI are in the intensive care unit, increases the diagnostic capabilities of this method, allowing electrographic seizures to be recorded more often and more accurately, but also to detect indirect signs of slow-spreading cortical depolarization using standard EEG amplifiers. Electrode implantation during TBI surgery is safe and does not significantly change the surgical approach.

Hypertrophic olivary degeneration (HOD) is a rare variant of transsynaptic degeneration in the inferior olivary nuclei due to a lesion within the dentato-rubro- olivary pathway, also known as the Guillain–Mollaret triangle. Bilateral HOD can be identified on MRI in patients with not only acquired but also genetic neurological disorders. The article describes patients with both common and rare genetic causes of the bilateral HOD. The pathophysiology of HOD is also briefly reviewed.