[Optimization of secondary prevention in patients with high-risk atherothrombotic ischemic stroke or transient ischemic attacks]. / Optimizatsiya vtorichnoi profilaktiki serdechno-sosudistykh sobytii u patsientov s aterotromboticheskim ishemicheskim insul'tom ili tranzitornymi ishemicheskimi atakami vysokogo riska.

High and very high risk atherothrombotic ischemic stroke (ATIS) includes patients with severe extracranial atherosclerosis, any intracranial atherosclerosis, and aortic arch atheromatosis. The article discusses the most effective approaches to medical short- and long-term secondary prevention of ATIS, major vascular events and death, based on the results of modern research and current clinical guidelines. Clinical studies of recent years have proven the possibility of individualization and intensification of secondary prevention of ATIS. In the treatment of high-risk patients, it is advisable to use more widely short-term dual antiplatelet therapy (combination of ASA with clopidogrel or ticagrelor), long-term dual antithrombotic therapy (combination of ASA and rivaroxaban at a dose of 2.5 mg twice a day not earlier than 30 days from the development of stroke or TIA) to reduce the risk of recurrent stroke and death, as well as intensive lipid-lowering therapy (including the use of a combination of statins and ezetimibe or PCSK9 inhibitors).

[Vestibular vertigo in stroke and vestibular neuronitis]. / Vestibulyarnoe golovokruzhenie pri insul'te i vestibulyarnom neironite.

The article discusses two main causes of acute vestibular dizziness - vertebrobasilar ischemic stroke and vestibular neuritis. The features of acute vestibular syndrome depending on the localization of cerebral infarction - in the territory of the posterior inferior, anterior inferior and superior cerebellar arteries, as well as in the brain stem are presented. Detailed clinical characteristics of vestibular neuritis is given. The issues of differential diagnosis of diseases, including the features of nystagmus and head impulse test, are discussed. The approaches to the treatment of acute vestibular syndrome depending on its etiology are considered. The authors present a treatment and diagnostic algorithm and consider features of clinical practice in acute dizziness. Fundamental differences in the treatment of vestibular neuritis and vertebrobasilar stroke dictate the need for neurologists of vascular departments to master the skills of otoneurological examination, which is the key to differential diagnosis. When choosing a treatment method, the most individualized approach is required.

['Stroke chameleons']. / 'Insul'ty-khameleony'.

The diagnosis of acute stroke should be correct and early that allows physician planning the most effective treatment strategies (reperfusion therapy, undifferentiated (basic) treatment, early secondary prevention). However, stroke symptoms can be atypical and similar to some other (non-vascular) event. It can significantly complicate the clinical diagnosis of stroke and decrease the patient's chances for effective treatment. A stroke should be suspected in every patient with acute onset of neurological symptoms, especially when the patient has the 'vascular' risk factors. Furthermore it is important to remember that negative CT-scan data and/or MRI data do not exclude the presence of not only ischemic stroke but also hemorrhagic stroke. The article describes the main variants of strokes with atypical symptoms (strokes-chameleons), emphasizes the importance of careful clinical examination, provides supportive differential diagnostic criteria and discusses limitations of neuroimaging methods.

[Limb-shaking transitory ischaemic attack in a patient with subocclusion of the internal carotid artery]. / Tranzitornaia ishemicheskaia ataka «limb shaking¼ u bol'nogo s subokkliuziei vnutrennei sonnoi arterii.

Described in the article is a clinical case report concerning symptomatic subocclusion of the internal carotid artery in a male patient with a rare variant of recurrent limb-shaking transitory ischaemic attacks (LS-TIA). The patient presented with a three-month history of episodes of involuntary jerky movements in his left hand. These episodes occurred invariably on assuming a vertical position. The findings of duplex scanning revealed subocclusion of the right internal carotid artery. The patient was subjected to stenting with the use of the system of proximal cerebral protection. The postoperative period was complicated by the development of cerebral hyperperfusion syndrome the risk of which in patients with LS-TIA is known to be elevated. Via telephone interviewing carried out at 1, 6 and 12 months after the intervention, the patient confirmed that the episodes of hand shaking did not recur. This case report highlights the importance of accurately assessing the clinical findings while selecting patients for carotid revascularization, since such ischaemic episodes are strongly suggestive of a severe lesion of the contralateral carotid artery. Once subocclusion is revealed, it is optimal to perform stenting with the use of a system of proximal protection, as a safer and more effective method of surgical revascularization in such conditions.