[Association of factors of vascular tone regulation with the development of hemorrhagic transformation in patients with ischemic stroke].

Concentrations of plasma vascular tone regulation markers that are indicators of endothelium dysfunction in the acute phase of ischemic stroke and their effect on the development of hemorrhagic transformation (HT) of the lesion focus have been studied. Concentrations of renin, endothelin 1-21, neuron-specific enolase, NT-proCNP, soluble adhesion molecules (sICAM) were measured in 67 patients on days 1, 3-4. Significantly higher concentrations of renin, endothelin 1-21, neuron-specific enolase were found in patients with HT in the first day compared to patients without HT. The level of NT-proCNP was lower in patients with HT; the increase in the severity of hemorrhagic component led to the elevation of neuron-specific enolase and sICAM concentrations. In conclusion, both markers of blood-brain barrier damage and regulating factors of vascular tone may play a predictive role in the development of HT in ischemic stroke.

[Computer tomographic and laboratory predictors of clinical outcomes of acute ischemic stroke patients after the systemic thrombolytic therapy].

Today the systemic thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is the most effective treatment of ischemic stroke. We included 116 patients with stroke, 82 received rt-PA, 34 were enrolled to the control group. Median NIHSS score was 16,2 +/- 5,4 in the main group and 16,2 +/- 5,4 in the control group. The trial revealed the prognostic significance of some early CT sings of ischemic brain damage for the hemorrhagic transformation and functional outcomes to the 90th day. It was shown that hyperfibrinogenemia (over 450 mg/dl) might be a risk factor of the hemorrhagic transformation. The excess of segmental leukocytes over 78% might be a predictor of the lethal outcome. The initial activity of tissue plasminogen inhibitor (first type) over 11,65 IU/L might be a risk factor of the vascular reocclusion after successful thrombolysis. The analysis of characteristic curves of leukocyte elastase revealed the informativeness of its initial values in the prognosis of reocclusion and hemorrhagic transformation.

[Passive tilting in patients in the acute period of cerebral stroke].

Passive tilt table test is one of the methods of early rehabilitation in the most acute and acute periods of stroke. We included 36 patients with stroke: 17 patients underwent passive tilting using "Lojer 1445YH" (a main group), 19 patients underwent changing position with a functional bed (a control group) on days 1, 2, 3, 5, 7, 14 and 21 after the onset of disease. Some patients were intolerant to passive tilting due to decreasing of systolic blood pressure to more than 20 mm Hg in the first 48 h after stroke. Such patients presented inadequate autonomic tests, had severe neurological deficit on the NIHSS and low heart rate variability (SDNN (standart deviation NN intervals): 19,4 +/- 4,3 ms vs 31,8 +/- 12,6 ms; TP (total power): 483,4 +/- 177,7 ms2 vs 1227,1 +/- 865,8 ms2; p< or =0,05). At the end of the first week after stroke, patients from the main group had higher indices of heart rate variability compared with the control group. Functional outcomes on the Barthel Index and the modified Rankin Scale were better in the main group as well at the 14th day, the between-group difference being the most marked at the 21st day. Passive tilting may be used as one of the methods of early rehabilitation that facilitates abilities of patients and improves functional outcomes provided a careful monitoring of health condition and blood pressure of a patient during the session.

[The prognostic significance of fibrinogen concentration in patients with ischemic stroke without thrombolytic treatment].

Recent studies showed that the increase of fibrinogen preceded not only thrombolytic events but also the development of intracerebral hemorrhage. The objective of the present study was to determine the threshold levels of fibrinogen concentration for the prognosis of ischemic stroke complications and, particularly, hemorrhagic transformation. Fibrinogen concentrations in patients with acute cerebral hemispheric stroke without thrombolytic treatment were examined. The lethal outcome and hemorrhagic transformation in patients during the hospital stay were selected as prognosis criteria. Four prognostic levels associated with the size of ischemic lesion, age and concomitant diseases were revealed. The high probability of the absence of complications regardless of the lesion size was observed when fibrinogen concentrations ranged between 200 and 350 mg/dL, the risk of hemorrhagic transformation with lethal outcome was higher in the range from 351 to 430 mg/dL and fibrinogen concentrations above 560 mg/dL predicted the high risk of lethal outcome.