[Clinical and pathologic aspects of the impairment of cerebral blood flow in atherosclerotic carotid stenosis]. / Kliniko-patogeneticheskie aspekty rannikh narushenii mozgovogo krovoobrashcheniia pri stenoze sonnykh arterii ateroskleroticheskogo geneza.

Based on clinical and neurophysiological investigations, triplex scanning of the carotid arteries the authors make a conclusion that early clinical forms of the ischemic diseases of the brain (IDB) in hemodynamically significant atherostenosis of the carotid arteries are characterized by certain neuropsychological and neurological complexes of symptoms dependent on the impairments of blood flow at the main and regional levels. The leading role of hypoperfusion was shown in the development of early forms of the cerebral blood flow impairments in patients with IDB. A significantly increased number of atherosclerotic plaques was shown with the increasing degree of carotid artery stenosis. Specific alterations of the central hemodynamics were determined in early impairments of the cerebral circulation against the background of atherosclerotic stenosing lesion of BCA. A complex comparative investigation of these parameters at the pre- and postoperative stages (after carotid endarterectomy) has shown a practically complete regress of hemodynamic impairments and clinical manifestations of ischemia of brain structures. According to the investigations performed, the timely correction of hemodynamically significant atherostenoses of carotid arteries during revascularization of the brain in such patients allows to carry out primary prophylactics of acute impairments of cerebral blood flow and to increase effectiveness of the treatment.

[Dynamics of higher mental functions in surgical therapy of internal carotid artery stenosis]. / Dinamika vysshikh psikhicheskikh funktsii pri khirurgicheskom lecheniia stenoza vnutrennei sonnoi arterii.

To reveal typical changes of higher mental functions in patients with atherosclerotic lesion of internal carotid artery and to estimate influence of operative and non-operative treatment of carotid stenosis upon cognitive function. 42 patients who had undergone carotid endarterectomy (CEA) due to high grade carotid stenosis, and 31 patients treated conservatively were examined. A battery of neuropsychological tests was used to evaluate a state of higher mental functions. The neuropsychological syndrome in patients with carotid stenosis manifests with impairment of verbal and visuospatial memory, attention, disorders of impressive speech and constructive praxis. The degree of cognitive impairment was most severe in patients with bilateral stenosis. CEA performed at early stages of cerebral ischaemia has beneficial effect on cognitive functions. Non-operative treatment and late CEA do not prevent further cognitive decline in patients with carotid stenosis.