[Cerebellum hemorrhages and infarctions: clinical computed tomography study]. / Krovoizliianiia v mozzhechok i infarkty mozzhechka: kliniko-komp'iuterno-tomograficheskoe issledovanie.

A complex examination of 46 patients with acute disturbances of cerebral circulation in the cerebellum was carried out. A new volumetric coefficient of this area lesion is proposed. The variants of the clinical course of cerebellum hemorrhage and infarctions in respect to the coefficient's value were distinguished. The course is considered favorable if the values are less than 0.08. The higher values indicate, as a rule, a progressive increase of neurological symptoms up to a lethal outcome. The results reveal that the volumetric coefficient of the cerebellum lesion is a reliable parameter both for prognosis and for quantitative evaluation of acute vascular processes in the cerebellum, allowing taking into account the potentials of reserve intracranial space of the posterior cranial focca as well as individual peculiarities of brain and cranial sizes.

[Results of open post-registration clinical trials of copaxone in patients with multiple sclerosis]. / Rezul'taty otkrytykh postregistratsionnykh klinicheskikh ispytanii preparata kopakson u bol'nykh rasseiannym sklerozom.

Results of the 2-year open postregistration study of Copaxone (glatiramer acetate), conducted in 3 Moscow leading medical centres are given. 32 MS patients with remitting-relapsing MS were investigated in accordance with international requirements (neurological scales, MRI of the brain, multimodal evoked potential). Significant reduction of annual relapse rate for 70.3%, stabilization of neurological status and benign safety profile were demonstrated during Copaxone treatment. Practical recommendations for Copaxone use are given.

Pharmacokinetics and tolerability of iopromide 240 after lumbar myelography.

OBJECTIVE: To evaluate the pharmacokinetics and tolerability of iopromide 240 mg iodine/mL after intrathecal administration. METHODS: Eleven patients with an indication for lumbar myelography received 10 mL iopromide 240 in an open, prospective, single-center study. All patients were followed 72 hours after the procedure and remained in the hospital. Urine was sampled from before the myelography up to 72 hours after the procedure in stages (range, 0-6, 6-12, 12-24, 24-48, and 48-72 hours). Iodine plasma levels were determined before and 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 9 hours, 12 hours, and 24 hours after the administration of iopromide 240. Vital signs were measured at baseline, before, and 1 and 24 hours after the procedure. Physical and neurologic examinations were performed in all patients at baseline and at the end of the study period; all adverse events were recorded. The results were subject to pharmacokinetic analysis using compartment model-independent and -dependent methods. RESULTS: Ten of 11 patients had measurable iodine plasma levels. After a lag time of approximately 0.6 hours (mean value), maximum iodine concentrations of 45% of the administered dose per total plasma volume were observed after 3.8 hours. Plasma half-lives ranged from 3.0 to 60.5 hours (model-independent methods) with a mean of 14.9 hours and a standard deviation of 17.0 hours. Using curve fitting with an open one-compartment model revealed good agreement with the model-independent methods (half-life 17.3 hours). The recovery of iodine in urine in the 72-hour period was 78%+/-15% (range, 53%-94%) as a result of an undeterminable loss of urine in some patients and prolonged half-lives in two patients. Only one patient had adverse events 24 hours after myelography. CONCLUSIONS: After lumbar myelography, iopromide 240 is almost completely excreted renally within 72 hours, with a prolonged half-life as a result of the route of administration. The kinetics of iopromide 240 after intrathecal administration are characterized by a prolonged half-life. The safety of the contrast medium was confirmed.

[In vivo diagnosis of Creutzfeldt-Jakob disease]. / Prizhiznennaia diagnostika bolezni Kreitzfel'dta-Iakoba.

The paper presents the data concerning usage of some original method of vital laboratory diagnostics of Creutzfeldt-Jacob disease that belongs to the group of prionic diseases. The method consisted in the inoculation of inoculative culture of rat Gasser ganglion's neurinoma by biologic materials investigated (serum and clot of blood) with the following passivation and investigation of the contaminated culture by means of both morphologic and electron microscopic methods. As an example of vital verificated case the wide pathomorphologic analysis of the biopsy sample of brain was presented. Besides, the efficiency of the investigation of cognitive evoked potentials (P300) together with EEG was also demonstrated as the method of objectification of the development of dementia in this disease.

[Thalamic hypertensive hemorrhage]. / Talamicheskie gipertenzivnye krovoizliianiia.

We performed statistic analysis of the results of both conservative and surgical (by means of laying on the external ventricle drain--EVD) treatment of 23 patients with thalamic (medial) hypertensive hemorrhage (THH) admitted to the hospital in the first two days of the stroke's beginning. We also investigated clinical tomographic factors which had influence either on the choice of the treatment or on the prognosis of the disease. The frequency of the lethal cases in EVD-group (6 observations) was about twice lower than in analogous group of patients treated conservatively (17 cases). In conservative treatment prognostically unfavourable factors in acute period of the stroke were the following: the awakening level lower than 10 points according to Glasgow Scale, development of acute obstructive hydrocephalus, dislocation of brain stem, break of blood into cerebral ventricles (of II-IV degree), the volume of hemorrhage more than 10 ml for thalamic and thalamo-capsular location and more than 5 ml for thalamo-mesencephalic location. Monitoring of intracranial pressure in patients with THH which had factors mentioned above revealed the development of steadfast intracranial hypertension by days 5-7 maximally. The laying on EVD was indicated in patients with unfavourable signs of THH by means of ventricle drainage. The controlled decrease of intracranial pressure increased the level of awakening, meanwhile it decreased the degree of hydrochephalus and dislocation of brain stem.

[A treatment procedure for nontraumatic cerebellar hemorrhages]. / Taktika lecheniia netravmaticheskikh mozzhechkovykh krovoizliianii.

The results of surgical treatment of 12 patients with non-traumatic intracerebellar hemorrhages are analyzed in this paper. The following parameters were assessed: clinical signs and symptoms, the level of consciousness, location and size of the lesion, the brain stem deformation, the rupture of hematoma into the adjacent ventricle, and hydrocephalus. In all patients with fulminant course as well as in the majority of patients with acute or subacute course when the brain stem compression progresses and seems to be unresponsive to medical treatment, surgery is strongly indicated. Among the surgical procedures, placement of the external ventricular drainage and extensive midline suboccipital craniectomy are curative. These procedures proved to be effective in reducing the brain stem compression. Patients with chronic intracerebral hematomas are followed conservatively.

[Lifetime diagnosis of prion transmissive encephalopathies]. / Prizhiznennaia diagnostika prionovykh transmissivnykh éntsefalopatii.

An original method for life-time diagnosis of Greutzfeldt-Jakob's disease, a neurodegenerative disease belonging to transmissive spongiform encephalopathies, is proposed. It consists in inoculation of the examined biological materials (blood serum and clot) into a continuous culture of the rat Gasser's node neurinoma, followed by passages and study of the inoculated culture by morphological methods and electron microscopy.

[A disorder of serotonin metabolism in patients in the acute period of nontraumatic intracranial hemorrhages]. / Narushenie obmena serotonina u bol'nykh v ostrom periode netravmaticheskikh vnutrimozgovykh krovoizliianii.

The indices of serotonin metabolism in cerebrospinal fluid (CSF) and blood were studied in 43 patients with nontraumatic intracerebral hemorrhage in the interval from 1 - 2 to 28 days after the onset of the disease. The considerable increase of tryptophan, serotonin and its main metabolite 5-hydroxyindoleacetic acid (5-HAA) in CSF and blood was found. The relationship between liquor and blood serum serotonin levels, hemorrhage focus size, severity and outcome of disease was also observed. There were no significant differences between serotonin, 5-HAA, free and bound serotonin levels in patients with the break of blood into different part of liquor space. The possible mechanisms of alteration of serotonin metabolism in patients with intracerebral hemorrhage were discussed.

[Hemorrhages into the cerebral hemispheres and acute obstructive hydrocephalus: new findings in their pathogenesis and the treatment procedure]. / Krovoizliianiia v polushariia mozga i ostraia obstruktivnaia gidrotsefaliia: novoe v patogeneze i taktike lecheniia.

CT study of 106 patients with non-traumatic supratentorial intracerebral hemorrhages in the acute period has found a fairly high incidence (29.3%) of the occurrence of acute obstructive hydrocephalus (AOH). It is regarded to be one of the important constituents in the process of an increase in the brain volume leading alongside with other factors to an elevation of the intracranial pressure and dislocation of the brainstem. AOH had no tendency towards the reverse development, was resistant to conservative methods of treatment and usually ended in lethal outcome. Only the differentiated surgical treatment in 250 patients with hemorrhagic stroke including that in hematomas with AOH performed predominantly by the stereotactic method as well as ventricular drainage used as an auxiliary or independent operation provided success of the treatment. In certain volumes and localizations of the hematoma the stereotactic method had an advantage over the open method, as a result of this the postoperative mortality rate decreased 2.5 times. The importance of the timely (CT) detection of AOH and the differentiated surgical treatment as the method of treating a kind of critical condition in patients with cerebral hemorrhages is emphasized.

[A method for correcting dislocation in hemorrhages into the cerebral hemispheres]. / Sposob korrektsii dislokatsii pri krovoizliianiiakh v polushariia bol'shogo mozga.

Hypertension consequent upon increasing brain edema, and intercerebral pressure gradient which is the cause of transverse dislocation diminish with the use of a method which provides for hydrodynamic equilibrium. The method consists in connecting the ventricle of the intact cerebral hemisphere to a balloon located in the cavity of the removed hematoma according to the principle of communicating vessels. The craniospinal pressure gradient is removed by additional catheterization of the spinal subarachnoid space and its connection to the ventricle and balloon according to the same principle.

[Clinical polymorphism of circumscribed intracerebral hematomas]. / Klinicheskii polimorfizm organichennykh vnutrimozgovykh gematom.

Using clinical and a series of additional methods of examination, including computer-aided tomography, the authors studied 46 cases of limited (without breakthrough of blood into the CSF) intracerebral hematomas (LIH) which constituted 22% of the total number of the examined patients with brain hemorrhages. It has been established that in the majority of the cases of LIH (87%) the diagnosis of the stroke nature was difficult to make without computer-aided tomography. It was shown that the characteristics of the clinical picture and course of LIH were determined by the absence of breakthrough of blood into the CSF system, a relatively small size of hematoma, a mild degree of dislocational manifestations and their slow evolution. Three main variants of the clinical course of LIH were identified. The course of the disorder was usually favourable; the lethal outcome occurred in only 15.2% of the cases. The authors draw attention to the expediency of conducting computerized tomography over time and to the necessity of taking into account the status of the homeostasis system in the treatment of such patients.