[Factors of intercellular interaction in acute ischemic stroke].

29 patients with acute carotid and vertebrobasilar stroke caused by combination of atherosclerosis and arterial hypertension were examined, of them 8 patients were diagnosed as having type II diabetes mellitus. Clinical manifestations and blood serum levels of adhesion molecules (АМ) in dynamics (48 h and 21st-day) of acute ischemic stroke (IS) were estimated. Soluble AM levels were significantly elevated in patients with acute IS compared with controls. The highest levels of AM were found in IS predominantly on the 1-2 days. Levels of AM were significantly higher in patients with severe stroke. Diabetes mellitus promotes the hyperproduction of adhesion molecules. Given the role of AM in endothelian disfunction genesis and tissue damage associated with IS, they could constitute a therapeutic target for prevention of the progression neurological deficit.

[Neyromidin in the treatment of stage I hypertensive dyscirculatory encephalopathy].

AIM: To evaluate the efficacy and safety of neyromidin in the treatment of Stage I hypertensive dyscirculatory encephalopathy (HDE) and to analyze long-term treatment results. SUBJECTS AND METHODS: Fifty-seven with Stage I dyscirculatory encephalopathy in the presence of grades 1-2 arterial hypertension were examined. Clinical, psychological, and electrophysiological studies were performed and the efficacy of neyromidin was evaluated using the SANDOS geriatric scale. Neyromidin as monotherapy was used as one tablet (20 mg) b.i.d. during a meal. The duration of course treatment was 3 months. RESULTS: Positive changes in the early manifestations of HDE were observed just on day 45 of therapy. The therapeutic effect of the drug manifested as a reduction in the degree of clinical symptoms. There were positive changes in attention, memory, kinetics, verbal associations, counting. The most noticeable improvement was seen in the values of memory and intellectual processes, suggesting higher working capacity, reduced fatigability, and eliminated sluggishness of intellectual processes. EEG displayed a higher amplitude level, a better response to rhythmic photostimulation, and a total power rise in a- and 8-ranges, which was indicative of the activated effect of neyromidin on the functional state of brain structures. CONCLUSION: Neyromidin (20 mg b.i.d. for 3 months) was shown to be effective and well tolerated. The drug reduced the magnitude of clinical manifestations and improved psychological functions and electrophysiological parameters.

[Mildronate in the treatment of transitory ischemic attacks].

An aim of the present study was to evaluate the treatment efficacy of the antioxidant mildronate in patients with transitory ischemic attacks. We studied the dynamics of clinical status, psychometric data and indices of free-radical lipid oxidation in 40 patients. The improvement in the subjective state, memory and attention was seen in 24 patients.

[Neyromidin in ischemic stroke].

An aim of the study was to evaluate the therapeutic effect of neyromidin in patients with ischemic stroke. Forty patients with acute carotid artery stroke were enrolled into the study. The diagnosis was made on the basis of general clinical methods as well as the neurological examination, CT or MRI scans of the head, investigation of hemodynamic parameters, ECG, ultrasound dopplerography of major brain arteries. Neurological deficit was measured using the Scandinavian Scale. According to the TOAST classification, 14 (35%) of the patients suffered from large vessel disease, 16 (40%) patients were diagnosed with cardioembolic disease and 10 (25%) with the small vessel disease. Patients were randomized to the study and control groups (n=20 patients). All patients received standard treatment. Patients of the study group were treated with neyromidin. The study duration was 80 days. Clinical examinations were performed in the acute phase, on 21st and 80th days after stroke. Better recovery of neurological functions was identified in patients treated with neyromidin compared to control patients. No side-effects of neyromidin was found. Neyromidin is recommended for complex treatment of patients in the acute stage of ischemic stroke of carotid origin.

[Neuromidin in the restoration of motor functions after ischemic stroke].

The efficacy of neyromidin in the treatment of motor disturbances after ischemic stroke (IS) was studied. The study included 60 patients with left middle cerebral artery stroke. The diagnosis was made on the basis of general clinical methods as well as the neurological examination, computed tomography (CT) scan of the head, investigation of hemodinamic parameters, ECG, ultrasound dopplerography of main head arteries, biochemical blood tests. Patients were divided into two equal groups: patients in the acute phase of stroke (main group) and patients in the early rehabilitation phase (comparison group). The groups were matched for sex, age, clinical features of the disease. Neyromidin was administered for 60 days. After the completion of the treatment with neyromidin, an improvement of the neurological status as well as an enhancement of motor functions in patients with moderate and severe paresis of the leg were observed in 30 patients with acute ischemic stroke.

[Neuroimaging of the penumbra in ischemic stroke].

Brain ischemia has been recently a central problem in basic and applied studies in angioneurology. The latest investigations that give an insight into a relationship between metabolic changes and cerebral blood flow and make it possible to study ischemia at the molecular level and its changes over time have promoted the accumulation of fundamentally new facts and some reappraisal of existing ideas. Ischemic semishadow or penumbra is one of the most important presently studied phenomena. Detection of penumbra signs suggests that it is expedient to evaluate cerebral blood flow and metabolism when planning treatment (thrombolysis or neuroprotective therapy) and that it is important to predict the severity of ischemic stroke. Positron emission tomography (PET) is the reference method for detecting the penumbra; however, its application is limited in clinical practice. Computed tomography (CT) perfusion and perfusion MRI, a combination of diffusion-weighted and perfusion MRI, single-photon emission CT, and xenon-enhanced CT are most frequently used to evaluate a cerebral ischemia area and its blood flow. However, there are no standardized approaches to quantifying the thresholds for cerebral blood flow or unified algorithms for penumbra verification, which calls for further investigations.

[Lower limb vein thrombosis in dynamics of acute impairments of cerebral circulation].

The present work was aimed at studying the state of the inferior vena cava system according to the findings of duplex scanning in dynamics of acute cerebral circulation impairments (ACCI). Amongst 100 patients with ACCI, lower limb vein deep thrombosis (LLVDT) was revealed in 57% of cases. The incidence of LLVDT in patients with intracerebral haemorrhage was higher than in those with ischaemic stroke, however there were no statistically significant differences between the type of ACCI (p=0.06) and subtypes of ischaemic stroke (atherothrombotic, ceardioembolic) (p = 0.68). The main risk factors for LLVDT are the presence of pronounced motion deficit in the extremities, induced by the underlying disease (p=0.02) and immobilization. In the overwhelming majority of patients (81%) thrombosis localized isolatedly in the crural veins. Ascending thrombosis and the development of a floating thrombus were represented mainly on the side of motility deficit in the extremities. We have confirmed a strong association between positive dynamics in the neurological status of patients and frequency of recanalization of thrombi (p=0.043). Ultrasonographic examination of lower limb veins in dynamics of ACCI is an important component of preventive and therapeutic process.

[Changes of haemostatic parameters in patients with acute cardioembolic stroke].

Haemostatic parameters: platelet aggregation, hematocrit, fibrinogen, antithrombin III, fibrinolytic activity and euglobulin lysis time, plasminogen, plasminogen activator and anti-activator activity, thrombin- antithrombin and plasmin-antiplasmin complexes and serum von Willebrand factor were studied at the most acute stage of cardioembolic stroke (1-7 days after development of neurological symptoms). State of the vascular wall was assessed using the "cuff"-test. The activation of hemostasis in patients with cardioembolic stroke was characterized by the hypercoagulation and decrease of fibrinolysis and athrombogenic potential of vessel wall properties (antiaggregation, fibrinolytic and anticoagulative). In conclusion, haemostatic disbalance and decreasing of athrombotic potential of the vessel wall may be the indicator of embolism in patients with cardioembolic stroke.

[The use of neuromidin in patients with minor ischemic stroke].

Efficacy of neuromidin was studied in 62 patients with a small ischemic stroke and cognitive disorders. Patients of the main group received neuromidin as an add-on to basic treatment and patients of the comparison group received only basic treatment (antiaggregant, antihypertensive, cardiac and antidiabetic drugs with the exclusion of nootropic and psychotropic medications). The decrease of subjective complaints, improvement of memory, attention, abstract and practical reasoning assessed by neuropsychological tests were seen in 32 patients of the main group after the end of treatment course. Neuromidin did not cause side-effects and was well tolerated. The long use of this led to the reduction of cognitive impairment, a predictor of vascular dementia.

[Effectiveness of cerebrolysin in hypertensive supratentorial intracranial hemorrhages: results of a randomized triple blind placebo-controled study].

Cerebrolysin was administered to 38 patients with small hypertensive supratentorial intracranial hemorrhages. Cerebrolysin was used intravenous in drops in dosage of 30 ml during 14 days. High effectiveness and good tolerability of the treatment was shown. In the end of treatment, groups receiving cerebrolysin or placebo were statistically significant differed by the total NIHSS score, Bartel index and the Rankin's modified scale. Moreover, a trend to the decrease of intracranial hemorrhage volume was observed in patients treated with cerebrolysin.

[Hemorheology and homeostasis in the most acute stage of lacunar stroke].

Eighty patients were studied at the first day of the development of lacunar stroke, the main attention being focused on the particular form of focal pathology--a small deep (lacunar) stroke (SDS). Patients with arterial hypertension and complication free course had higher hemorheologic parameters (blood viscosity, erythrocytes aggregation) and a shift of prostacyclin-thromboxane balance towards preaggregation and decrease of fibrinolysis. These disturbances strengthened during the development of SDS. The endothelium dysfunction, alterations of blood rheologic characteristics due to the formation of aggregants of erythrocytes, decrease of erythrocytes deformation and activation of cell homeostasis play a central role in the development of intracranial arterial occlusion resulted in the SDS development. At the same time, fibrinolysis remains relatively stable.

[Diagnosis of sarcoidosis of the brain].

Based on 15 years' their own experience and clinical observations of 65 patients with sarcoidosis of the brain, the authors have formulated diagnostic algorithms and a battery of studies that can suspect this disease. Since the clinical manifestations of sarcoidosis of the brain are non-specific, particularly at the early stages of its development, the condition of its recognition is the application of all required high-informative diagnostic neuroimaging techniques that are available to a neurological clinic. Nevertheless, sarcoidosis cannot be timely and correctly recognized in all cases. Diagnostic errors in its recognition are caused by the fact that X-ray computed tomography and/or magnetic resonance imaging is untimely made, tomographic changes are erroneously interpreted, and the studies are conducted improperly.

[Arterial hypertension and cerebrovascular pathology. Current status of the problem]. / Arterial'naia gipertoniia i tserebrovaskuliarnaia patologiia: sovremennyi vzgliad na problemu.

In the process of development and progression of arterial hypertension hypertensive cerebral angiopathy is formed - that is a complex of intricate primarily destructive (acute and recurring) and secondary reparative changes and adaptive processes occurring on all structural and functional levels of cerebral vascular system. Arterial hypertension in patients with cerebrovascular diseases should be treated. Because of heterogeneity of etiology and pathogenetic mechanisms of stroke detailed assessment of the state of cerebral vessels, blood flow, circulatory and metabolic cerebral reserve is a prerequisite of effective and safe antihypertensive therapy, prevention of stroke and other complications. This excludes generalized (leveling-off) approach to treatment and prevention of various types and subtypes of stroke. A notion that hypertension is a most important, independent controllable risk factor of cerebrovascular diseases remains definitely valid. However it is far from being a single cause of stroke.

[The neural network algorithm for diagnosis of ischemic stroke pathogenetic subtypes]. / Neirosetovoi algoritm diagnostiki patogeneticheskikh podtipov ishemicheskogo insul'ta.

The pathogenetic subtype of ischemic stroke (IS) in 204 cases of acute ischemic stroke was based on the results of clinical estimation, computer tomography, duplex scanning of brain vessels, electrocardiography, echocardiography and Holter monitoring. Initially, experts assigned a diagnosis of large-artery atherosclerosis to 59 (29%) patients, cardio embolic subtype to 51 (25%), small-vessel occlusion to 43 (21%), stroke of other etiology to 10 (5%), stroke of unclear etiology to 41 (20%). The TOAST computerized algorithm has been used for stroke subtypes diagnosis but it failed in 73% of the cases. Basing on artificial neural network, the authors developed the algorithm for determination of stroke subtypes by estimating probabilities for 3 IS subtypes: atherothrombotic, cardio embolic and lacunar. Its efficacy was proved by high diagnostic sensitivity of 97% (95% CI, 93% to 99%); positive predictive value--98% ((95% CI, 94% to 99%) and index of agreement with expert (K=0.955; 95% CI, 0.911 to 0.998).

[Antioxidant activity of mildronate and L-carnitine in the treatment of patients with cerebrovascular diseases]. / Antioksidantnoe deistvie mildronata i L-karnitina pri lechenii bol'nykh s sosudistymi zabolevaniiami golovnogo mozga.

The antioxidant properties of mildronate and a structurally close compound L-carnitine were studied under clinical conditions during the therapy of patients with acute lacunar stroke and discirculatory encephalopathy (DEP) on the background of diabetes mellitus, respectively. Administered in addition to the base course of therapy, both mildronate (in a daily dose of 500 mg) and L-carnitine (2 mg) increased the resistance of blood serum lipoproteins with respect to peroxidation. It was concluded that the drugs possess antioxidant activity and offer protection against lipid peroxidation. L-carnitine acute produced a significant hypoglycemic action and made possible an almost twofold (42%) decrease in the dose of hypoglycemic drugs. The administration of L-carnitine also improved both abstract and concrete thinking and memory function in DEP patients. The results allowed mildronate and L-carnitine to be included in the complex therapy of patients with cerebrovascular diseases.

[Personality traits in depressive adolescents (diagnosis and prognosis]. / Lichnostnye osobennosti bol'nykh depressiiami iunosheskogo vozrasta (diagnosticheskoe i prognosticheskoe znachenie).

The youthful depressions without psychotic symptoms are very similar in respect to syndrome appearance that makes it difficult to elucidate their nosologic origin and prognosis. To differentiate a diagnosis, psychodiagnostic methods--Cloninger personality inventory (TCI-125) and Raine Schizotypic Personality Questionnaire (SPQ-74)--were administered, along with clinico-psychopathological approach, in 144 patients with depression, aged 16-25 years. The data obtained allowed to detect statistically significant personality traits corresponding to 3 nosologic groups: slow progressive schizophrenia (schizotypic disorder), psychopathy (personality disorder) on the formation stage, adolescence cyclothymia. According to constitutional personality peculiarities, passive and mosaic schizoids predominated in schizophrenia, emotionally unstable, hysteric sensitive and hysteric psychasthenics--in psychopathia and sensitive schizoids and psychostenic type persons--in adolescence cyclotihymia. Correlations between TCI-125 and SPQ-74 scales and data obtained using clinico-psychopathological evaluation were found that indicated higher significance of combined psychological and clinical approach.

[Treatment and prevention of cognitive dysfunction in patients with arterial hypertension and atherosclerosis: results of a randomized double-blind placebo-controlled trial of cerebrolysin]. / Lechenie i preduprezhdenie rasstroistv poznavatel'noi funktsii u bol'nykh arterial'noi gipertoniei i aterosklerozom: rezul'taty randomizirovannogo dvoinogo slepogo platsebo-kontroliruemogo issledovaniia tserebrolizina.

AIM: To assess therapeutic and prophylactic effect of large-dose cerebrolysin (15 ml/day for 28 days) in hypertensive and atherosclerotic patients with cognitive disorders. MATERIAL AND METHODS: Cerebrolysin was given annually (15 ml/day for 28 days) for 2 years to 42 patients in a randomized double-blind placebo-controlled study. The effect was stated by clinical status, neuropsychological and neurophysiological data. RESULTS: In mild disturbances of cognitive functions in patients with arterial hypertension and atherosclerosis courses of cerebrolysin with one-year interval produce stable improvement of subjective status, productivity of memory, attention and thinking which persist for at least a year after the course. The clinical data agree with positive trend in neurophysiological parameters of cognitive component of the response of evoked potentials P-300. CONCLUSION: A course of 28-day annual treatment with cerebrolysin (15 ml/day) of patients with mild defects of cognitive functions stabilizes the process, leads to regression of cognitive disorders predicting vascular dementia.

[Antioxidant therapy in ischemic stroke]. / Antioksidantnaia terapiia pri ishemicheskom insul'te.

The paper presents the results of investigation of emoxipin, an antioxidant synthetic drug, for treatment of patients with ischemic disorders of cerebral circulation. The drug produced a beneficial clinical effect in patients with lacunar and cardioembolic strokes of moderate severity. Therapy with emoxipin increased endogenic antioxidant activity and improved a clinical status of the patients. The protective effect of carnosine was demonstrated in experimental acute hypobaric hypoxia and cerebral ischemia in rats. The results obtained permit to recommend an inclusion of both emoxipin and carnosine in a combined treatment of ischemic disorders of cerebral circulation.

[The dynamics of lipid peroxidation in patients with acute disorders of the cerebral circulation of an ischemic nature]. / Dinamika perekisnogo okisleniia lipidov u bol'nykh s ostrymi narusheniiami mozgovogo krovoobrashcheniia ishemicheskogo kharaktera.

Lipid peroxidation (LP) was analysed in the blood and atherogenic lipoproteins of 36 patients with ischemic stroke in the internal carotid arteries at the acute stage (1, 7 and 21 days). During 1-7 days 22 patients (group 1) were treated with haemocorrecting drugs (rheopolyglucin, euphyllin, aspirin, curantyl, trental) and 14 patients (group 2) were treated with vasoactive and metabolic drugs (cavinton, complamin, actovegin). On days 8-21 all the patients received the same treatment: pyracetam and essential. Before the treatment both activation of LP and exhaustion of endogenic antioxidant background were observed in blood samples of all the patients. Significant changes of LP parameters were observed in group 1 up to day 7, but they reached the basic level on the 21 day. No significant changes were observed in group 2. Thus, haemocorrecting drugs had some antioxidant effects, but to provide a steady antioxidant effect it is necessary to use special antioxidants.