[The experience of using thrombolysis in patients with acute disturbances of cerebral circulation: efficacy, safety, predictors of outcome and hemorrhagic transformation]. / Opyt provedeniia tromboliticheskoi terapii u bol'nykh s ostrymi narusheniiami mozgovogo krovoobrashcheniia: éffektivnost', bezopasnost', prediktory iskhoda i gemorragicheskoi transformatsii.

AIM: To evaluate neurological and functional outcomes of early stage of ischemic stroke, their determining factors and predictors of hemorrhagic transformation in patients who received thrombolysis. MATERIAL AND METHODS: A retrospective analysis of 147 patients, who underwent thrombolysis, and 127 patients, matched for basic parameters, who did not receive thrombolysis, was performed. Anamnesis, results of clinical examination, a spectrum of laboratory-instrumental parameters were evaluated. Functional status was assessed at discharge from the hospital using the Rivermead mobility index and the modified Rankin scale. Along with standard computed tomography (CT) at admission and after 24h, 73 patients receiving thrombolysis underwent CT-perfusion examination. RESULTS: The insufficient number of patients (37%) are admitted to a hospital in the first 2 h after stroke. The high prevalence of cardioembolic stroke and aphasia disorders in patients treated with thrombolysis was identified compared to the control group. CT revealed acute cerebral infarction in 14% of patients admitted within 2h. CT-perfusion examination determined brain ischemia only in half of patients. There was a low prevalence of symptom hemorrhagic transformation (0.7%). Thrombolysis was correlated with the higher rate of good functional outcomes of acute stroke, reduced neurological deficit, better mobility at discharge and shorter duration of the first rehabilitation period. Age, smoking, Rankin scale score at baseline, acute infarction on the primary CT, pathogenetic variant of stroke, myocardial hypertrophy, atherosclerosis of carotid arteries and volume of MRI lesions were the main factors associated with the efficacy of thrombolysis. The main predictors of hemorrhagic transformation were the severity of stroke, glomerular filtration rate, atrial fibrillation, treatment with antiaggregants before admission and hemispheric stroke. CONCLUSION: The analysis has demonstrated the safety and efficacy of thrombolysis in ischemic stroke in real clinical practice of a regional Vascular center.

[Post-stroke cognitive impairment and the possibility of treatment with cellex].

OBJECTIVE: To present neuropsychological characteristics of post-stroke cognitive impairment (PSCI) in acute ischemic stroke (IS) and to assess the efficacy of the drug cellex. MATERIAL AND METHODS: A comprehensive neuropsychological testing battery was administered to 288 patients with acute IS. In addition to basic therapy, 30 patients received cellexin the dosage of 0.1 mg (1 ml) subcutaneously for 10 days, treatment was started in the acute phase. RESULTS AND CONCLUSION: Multifunctional PSCI were revealed in 87% of patients with acute IS. Impairments of attention, regulatory functions, speech and memory were identified in the majority of patients. More than a third of patients had multifunctional nonamnestic PSCI. Monofunctionalnonamnestic PSCI were found in 5.5% of patients. Isolated deficit of memory was observed in 2% of patients. PSCI with the predominance of mixed character were found mostly in elderly patients. In the group of young and middle-aged patients,there was a decrease in isolated speed reduction or regulation of cognitive activity, combined cognitive impairment was detected in every fourth patient. There was a trend towards an increase in the age of patients withPSCI of the mixed character. An analysis of the efficacy of cellex in acute IS has shown that the drug improves cognitive status as well as the state of neurodynamic, regulatory and visuospatial functions. Therefore, cellex is effective in treatment of PSCI in acute IS.

[Neuroinflammatory, Neurodegenerative and Structural Brain Biomarkers of the Main Types of Post-Stroke Cognitive Impairment in Acute Period of Ischemic Stroke].

Background: Post-stroke cognitive impairment is a clinically heterogeneous condition, some types of which cannot be fully differentiated neuropsychologically that necessitates the active search for biomarkers. Aims: Analyze parameters of neuroinflammation and neurodegeneration in combination with neuroimaging markers in patients with different types of post-stroke cognitive impairment in acute ischemic stroke. Materials and Methods: In 72 patients we performed the assessment of cognitive status and distinguished 3 types: normal cognition, dysexecutive, and mixed cognitive impairment. In each group we determined the concentration of cytokines (IL-1ß, IL-6, TNFα, IL-10) in liquor and serum, ß-amyloid 1−40 in liquor and a number of MRI morphometric parameters and fractional anisotropy. Results: In all groups of patients we detected higher level of IL-10 in serum compared with the control. Patients with dysexecutive cognitive impairment had higher concentration of IL-1ß, IL-10 in liquor, IL-6 level in serum, lower fractional anisotropy of ipsilateral thalamus compared with patients with normal cognition and largest size of infarct. Patients with dysexecutive and mixed cognitive impairment had the higher area of leukoareosis and ventricular volume, reduced fractional anisotropy of contralateral cingulum compared with patients with normal cognition. Patients with mixed cognitive impairment characterized by lower fractional anisotropy of contralateral fronto-occipital fasciculus compared with patients with dysexecutive cognitive deficit. Conclusions: Serum and cerebrospinal fluid concentrations of cytokines studied in combination with MRI parameters particularly fractional anisotropy seems to be informative biomarkers of pathogenic types of PSCI.

[The role of melatonin in the development of post-stroke cognitive impairment in elderly patients in comparison with middle-aged patients].

In the acute phase of ischemic stroke 73 patients aged from 61 to 86 years and 47 patients aged 36 to 60 years underwent a comprehensive neuropsychological testing, evaluation of the concentration of 6-sulfatoximelatonin 6-sulfatoximelatonin in the night urine and brain MRI morphometry in some patients. The control group consisted of 14 persons without cerebrovascular disease. Younger and middle-aged patients had higher levels of 6-sulfatoximelatonin compared to both controls and elderly patients. The level of the metabolite in patients older than 60 years and the control group did not differ. In the group of patients older than 60 years we revealed a direct correlation with the severity of the stroke and concentration of 6-sulfatoximelatonin. Metabolite concentration was inversely correlated with the results of the Mini Mental State Examination, Frontal Assessment Battery, verbal fluency, clock drawing test and directly - with the Shulte tables result. High concentrations of 6-sulfatoximelatonin was also associated with a large size of acute ischemic lesion and hippocampal volume. The highest concentration of the metabolite was observed in patients with dysexecutive cognitive impairment and the lowest in patients with normal cognitive status and amnestic deficit. Thus, in elderly patients a high concentration of 6-6-sulfatoximelatonin is a marker "pure" post-stroke cognitive impairment, whereas a low concentration of metabolite in the presence of cognitive deficits may be indicative of its mixed, that is, in part, of hippocampal type.

[THE RELATIONSHIP BETWEEN SERUM AND LIQUOR IL-1ß, IL-6, TNFα, IL-10 LEVELS AND CLINICAL, COGNITIVE AND FUNCTIONAL CHARACTERISTICS IN ACUTE ISCHEMIC STROKE].

Introduction: Inflammation is probably the main process that links cardiovascular risk factors with damage to blood vessels and neurons. Elucidation of mechanisms of this relationship is an important issue. Materials and methods: 70 acute stroke patients were studied to assess their neuropsychological (MMSE, MoCA, FAB, Clock Drawing Test, Shulte Tables and Verbal Fluency) and functional status (mRS, Rivermead Mobility Index). The serum and liquor IL-1ß, IL-6, TNFa and IL-10 levels were analyzed. Control group included subjects without cerebrovascular diseases. Results: Stroke patients had higher IL-10 serum concentration than controls. No difference was found for other cytokines. There was correlation between serum and liquor cytokines levels. We found positive correlation between IL-1ß, IL-6 and IL-10 levels. High IL-1ß concentration was associated with vascular risk factors, cardio embolic stroke, enhanced severity of cerebral stroke, low processing speed, impaired executive and visual-spatial functions and higher grade of mRS on discharge. The same pattern was revealed for IL-6 and IL-10. IL-6 level was related to mRS without relation to NIHSS on admission. High TNFa concentration was linked with vascular risk factors, low MMSE score and processing speed. Discussion: Despite the antagonistic effects of IL-1ß, IL-6 and IL-10 on inflammation, associations of these cytokines with anamnestic, clinical, neuropsychological and functional characteristics were similar in acute ischemic stroke. Probably, this fact indicates that during the acute ischemic brain damage process the immune response develops at the same time in pro- and anti-inflammatory directions. Its magnitude correlates with the damage severity and is associated with the effects of vascular risk factors before stroke.

[Characteristics of ischemic stroke according to hospital register data: a role of neuroreparative therapy].

AIM: To study characteristics of the acute stage of ischemic stroke (IS) basing on the data of a hospital register of the Perm Regional vascular center and to assess the efficacy and safety of the drug cellex in patients with IS. MATERIAL AND METHODS: Authors have analyzed the group of 128 patients with MRI-confirmed acute ischemic lesion. The subgroup of 40 patients, which beside the basic therapy received cellex in dose of 0.1 mg during 10 days, was randomized. RESULTS: The following data were analyzed: gender and age, prevalence of risk factors, primary prevention, time before admission, clinical presentations, results of instrumental diagnostic methods, pathogenic structure of stroke, use of intravenous thrombolysis, regimens of secondary prevention, functional outcome and its predictors. CONCLUSION: The group of patients was characterized by the high prevalence of risk factors, insufficient primary prevention, prolonged time before the admission, low rate of thrombolysis use and significant prevalence of large artery disease associated with stroke. The main independent predictors of low mobility level at discharge were severe neurological deficit on admission, cognitive impairment and age. Patients treated with cellex were characterized by the lower level of neurologic deficit, higher mobility and better global cognitive status in comparison with controls.

[Frontotemporal degeneration: a clinical case and experience of using of diffusion tensor magnetic-resonance imaging tractography].

Frontotemporal degeneration is a frequent cause of presenile dementia that makes up from 5 to 17% of autopsy-confirmed cases developed at the age of 70 years. Authors report a case of this disease, discuss the possible causes of its development and present the results of diffusion tensor magnetic resonance tractography. Clinical features of this case are practically isolated speech disturbance with the most likely domination of a semantic variant of primary progressive aphasia. Magnetic-resonance imaging has an important practical significance for this pathology due to the possibility of assessing atrophic zones. The use of DTI-tractography allows to extend diagnostic possibilities.

[Poststroke cognitive, emotional impairment and sleep quality: efficience of treatment with melaxen].

OBJECTIVE: To study melatonin secretion and its correlations with poststroke cognitive, emotional impairment and sleep quality in the acute period of stroke and to assess treatment efficacy of melaxen. MATERIAL AND METHODS: We studied 96 patients with acute stroke. A battery of tests and scales for assessment of neurological deficit, neuropsychological status and emotional impairment was used. The night urinary level of 6-sulfatoxymelatonin was assessed. The relationship between 6-sulfatoxymelatonin and cognitive, emotional status and sleep parameters was analyzed. RESULTS: The level of 6-sulfatoxymelatonin was decreased in the night urine. Patients with dysexecutive poststroke cognitive impairment had higher level of 6-sulfatoxymelatonin and patients with dysmnestic and mixed cognitive impairment had lower level of 6-sulfatoxymelatonin in comparison with patients with normal cognitive functions. Melaxen improved cognitive function and sleep parameters, reduced the level of anxiety in the early recovery period of stroke. CONCLUSION: A role of chronobiological processes in the development of clinical signs of stroke in the aspect of cognitive impairment is discussed.

[Chronobiological characteristics of stroke and poststroke cognitive impairment].

OBJECTIVE: To study chronobiological characteristics of ischemic stroke (II) and post stroke cognitive impairment (CI). MATERIAL AND METHODS: We examined 80 patients with acute ischemic stroke. The cognitive status, sleep quality, chronobiological parameters and night urinary level of 6-sulfatoxymelatonin were assessed. The clinical observation of the efficacy of melaxen treatment in intensive care unit was performed. RESULTS: The results of the study indicate the significance of social and environmental factors which determine the sleep-wake behavior in the development of pineal dysfunction. The pineal dysfunction probably underlies the development of stroke and accompanied neurodegenerative process. CONCLUSION: The use of melaxen in hyperacute stroke was associated with better recovery of circadian rhythms and rehabilitation results.

[Chronobiological parameters, cognitive emotional status and sleep quality in acute stroke].

The night urinary level of 6-sulfatoxymelatonin was assessed in 57 patients in acute ischemic stroke and subarachnoid hemorrhage. The relationship between 6-sulfatoxymelatonin (6-SOMT) and chronobiological parameters, cognitive and emotional status and sleep quality was analyzed. The low levels of 6-SOMT in night urine was revealed and more pronounced in ischemic stroke. The association between low levels of 6-SOMT and domen-specific cognitive impairment, high level of trait anxiety and low sleep quality was found. The deficiency of chronotropic and neuroprotective activity of melatonin may be regarded as a key factor in the development of these pathological phenomena.

[Secretion of melatonin and serum cholinesterase activity as biological markers of cognitive disorders in the acute stage of ischemic stroke].

The content of 6-sulfatoximelatonin in daily urine and butyrylcholinesterase in blood serum was determined in the acute stage of ischemic stroke in 25 and 40 men, respectively. Correlations between these parameters and the cognitive state of patients were analyzed. The decrease in the 6-sulfatoximelatonin excretion and butyrylcholinesterase activity was identified. The level of 6-sulfatoximelatonin in daily urine lower than 4.0 ng/ml may be considered as a biological marker of cognitive impairment with marked memory impairment. The level of butyrylcholinesterase lower than 7.0 nmol/L may be a biochemical marker of multifunctional cognitive impairment.

[Heterogeneity of cognitive disorders in the acute stage of the first ischemic carotid stroke].

We studied 116 patients in the acute stage of the first ischemic carotid stroke. The patients had no cognitive disorders before the disease. All patients underwent a neuropsychological examination in 3-4th week after stroke. The severity of neurological deficit was evaluated with the NIHSS in 4-7th day. To study cognitive disturbances in depth, we divided the neuropsychological tests into 5 integral characteristics in accordance with the cognitive domains: attention, executive functioning, memory, speech, visual-spatial functions. Most of patients performed best on the memory index and worst on the attention index. Four groups of cognitive disturbances were singled out: "typical" that was characterized by the combination of intact memory with impaired attention (31% of patients); "atypical" with the prevalence of memory disturbances (19%); "typical transitive" (42%) and "atypical transitive" (8%). The greater severity of stroke as assessed by the NIHSS was associated with the "typical" variant of cognitive disturbances. Therefore, the neurodynamic disturbances represent basic neurological deficit in stroke but every fifth patient demonstrates the amnestic profile of cognitive disturbances that suggests the presence of the concomitant neurodegenerative process.

[Clinical efficacy of cytoflavin in the combined treatment of patients during acute phase of ischemic stroke].

This study investigated efficiency of cytoflavin in combined treatment of acute hemisphere or stem stroke. It included 35 patients aged 40-70 years with the newly diagnosed mild and moderate stroke. The main group comprised 29 patients treated with cytoflavin (10 ml twice daily by i/v drop infusion for 10 days) in addition to basal therapy. Controls (n=15) were given basal therapy alone. All patients were examined on days 1 and 15 for the evaluation of their neurological status, neuropsychological testing, assessment of cognitive function (from the ability to remember 10 words), everyday activities, and quality of life (based on the QOL scale). Evaluation of the neurological status by the NIHSS scale on day 15 after the onset of therapy revealed its positive dynamics. Indicators of functional normalization in groups 1 and 2 were significantly different. Analysis of social and functional activities on day 15 demonstrated a higher Bartel index in patients given cytoflavin. Moreover these patients showed significant improvement of short- and long-term memory as well as the highest health index. The MMSE test did not reveal significant difference between the two groups on day 15 (p > 0.05). It is concluded that cytoflavin therapy significantly improved the health status of the patients. It proved efficacious as regards correction of motor and non-motor symptoms in patients having acute ischemic stroke.

[Clinical features of migraine and parameters of trigeminal somatosensory evoked potentials in patients with different levels of thyroid-stimulating hormone].

UNLABELLED: Levels of thyroid-stimulating hormone (TSH), trigeminal somatosensory evoked potentials (TSEPs) and quality of life (QoL) were studied in 50 migraine patients and 10 healthy subjects. The latency of P1 as well as the asymmetry of P1 latency and N1P1 amplitude were enlarged in migraine patients. Lower levels of TSH were correlated with more pronounced asymmetries in TSEPs. QoL in migraine was inversely correlated with TSH levels, pain intensity, MIDAS score, passive strategies preference, levels of anxiety and depression. IN CONCLUSION: TSH levels may modulate the function of trigeminal system in migraine.

[The alterations of lipid spectrum in patients with migraine]. / Izmeneniia lipidnogo spektra u bol'nykh migren'iu.

The paper presents lipid spectrum in 40 patients aged 19-50 years with migraine. Migraine is one of the possible causes of stroke development at young age. There were found significant atherogenic changes of blood serum lipid spectrum, which didn't depend on clinical peculiarities of the disease, but became more pronounced as far as the level of the situational anxiety (according to Spilberger's questionnaire) increased. It is suggested that the changes in lipid spectrum may be some components in complex alterations of the functions of structures of limbic-reticular complex and humoral-endocrine homeostasis which are both genetically determined and acquired. These changes are quite important in pathogenesis of migraine and may be considered as the risk-factors of the development of cerebral stroke at young age.

[Migraine and epilepsy: clinical comparisons and the characteristics of the cerebral blood circulation]. / Migren' i épilepsiia: klinicheskie sopostavleniia i osobennosti mozgovoi gemotsirkuliatsii.

Clinical, electroencephalographic, rheoencephalographic and linear cerebral circulation findings were compared for 71 epileptics (group 1), 62 migraine patients (group 2) and 6 patients with epilepsy which had developed in the presence of severe migraine with aura (group 3). One-third of migraine patients, mostly of young age, suffering from migraine with aura and basilar migraine had such consciousness disorders as stupefaction and syncopes. EEG changes in migraine patients were considered nonspecific, paroxysmal spike activity arose only in addition of epileptic seizures. Cerebral blood flow measured by radionuclide tracing in migraine-free interval tended to speeding up, while in groups 1 and 3 hemocirculation was slow. Epileptogenic provocation in group 1 patients accelerated cerebral blood flow on the side of the focus, but decelerated it in group 3. The authors hold that the nature of migraine and epilepsy is different. By disintegration of cerebrovascular regulation and vascular supply of the neuron, migraine may promote secondary epileptogenesis.

[Complications of surgery on the pancreas]. / Oslozhneninia operatsii na podzheludochnoi zheleze.

The authors carried out 198 various operations for chronic pancreatitis and carcinoma of the pancreas. Postoperative complications occurred in 105 (53%) patients. Twenty-four (12%) patients died. Right resections of the pancreas were complicated by incompetence of the stump sutures when the remaining part of the gland was large and its tissue changed mildly. In left resection the stump of the gland was sutured completely after wirsungography and complete assurance that the pancreatic duct was not obstructed. In impaired patency of the duct pancreato-digestive anastomoses were established. Tampons and tubes were left in the abdominal cavity in 95-97% of pancreatic resections. Healing occurred through the formation of pancreatic fistulas which closed under the effect of nonoperative treatment.

[Characteristics of cerebrovascular circulation and its regulation in early stages of cerebrovascular disorders]. / Osobennosti mozgovogo krovoobrashcheniia i ego reguliatsii v nachal'nykh stadiiakh tserebrovaskuliarnykh zabolevanii.

Cerebral circulation studied in 121 patients with early signs of cerebrovascular insufficiency exhibited typical asymmetric slowing down which started in distal compartments of the cerebral vascular bed and advanced to predominance in the vertebrobasilar circulation. Autoregulation of the circulation was preserved though hemodynamic requirements of emotional, mental and physical activity were not met completely. Initial discirculatory encephalopathy involves generalization of dysgemic shifts with progressive circulatory slowing down along the internal carotid arteries. In this case autoregulation gets disturbed in inhibited cerebrovascular reactivity.

[Changes in cerebral blood circulation and their correction in the interparoxysmal period of epilepsy]. / Izmeneniia tserebral'noi gemotsirkuliatsii i ikh korrektsiia v mezhparoksizmal'nom periode épilepsii.

The linear cerebral blood flow (LCBF) was explored in 75 patients with epilepsy according to 131I-albumin transition. LCBF acceleration on the side of the focus, during which the attacks occur rarely and the background EEG remains unchanged is regarded as the most adequate LCBF. The grave course of epilepsy is associated with a decrease of the LCBF on the side of the focus. The pattern of LCBF alterations depends as well on the form of epilepsy. Subclinical activation of the epileptic focus by corasole or hyperventilation gives rise to an increase of the LCBF on its side in patients with generalized secondary epilepsy, to a lowering in temporal epilepsy, and the lack of dynamics in the precentral disease pattern. Correction of the hemodynamic disorders can be attained with the aid of combining phenobarbital and caffeine or papaverine. The pathogenetic importance of the hemodynamic disorders is discussed in connection with functional hypoxia of neurons.