[Clinical and Pathophysiological Correlations in Acute Stroke, CT Visualized at Different Times].

Two hundred twenty one patients aged 32-93 years with brain infarction, admitted to a Vascular Neurology Center in the first 3-48 hours (mean 6 hours) after the onset of the symptoms of stroke with computed tomography (CT) verified diagnosis were enrolled in the study. According to the timing of the CT-verification the patients were divided into 2 groups: "early" visualization (EV 50.2%) and "late" visualization (LV, 49.8%). In the EV group the lesion was visualized by CT on the admission (3-6 hours after the admission), in the LV group it was visualized only when CT was repeated 2-3 days after the admission. The patients in the LV group demonstrated increased severity of the underlying pathology, increased mortality and unfavourable functional outcomes correlating with the stroke lesion volume vs. the EV group. There was observed pathophysiological correlation of the blood enzymatic spectrum and acid-base balance parameters, explaining the late lesion visualization by delayed and more pronounced intracellular energy synthesis stabilization mechanisms failure in the aerobic and anaerobic glycolysis cycles.

[Efficacy of antioxidant energocorreсtion in brain infarction (results of a multicenter randomized trial)].

OBJECTIVE: To determine the optimal duration of energy corrective treatment of ischemic stroke (II) with cytoflavin or ascorbic acid. MATERIAL AND METHODS: A multicenter randomized clinical trial included 185 patients, aged 40-75 years. Patients were randomized into 3 groups: the control group (n=64) received ascorbic acid; cytoflavin group 1 (n=72) was treated for 10 days and cytoflavin group 2 (n=49) for 20 days. In all groups, mean NIHSS score was 13, 42.2% of patients scored ≥14 and on admission, 42.2% of patients had consciousness impairment of different severity. RESULTS: Cytoflavin treatment was more efficient than ascorbic acid that can be explained by different pharmacologic mechanisms. Treatment with cytoflavin for 10 days resulted in a significant decrease of ischemia zone volume by 25.2%, treatment with cytoflavin for 20 days - by 29.0%, which was associated with better outcomes in neurologic and functional status. Ascorbic acid demonstrated no effect on morphologic parameters. Prolonged treatment with cytoflavin in critically ill patients led to significant improvement in clinical and morphologic variables compared to the 10-day course. In patients with less severe condition comparable results were obtained. CONCLUSION: Our data justify the need for personalized integrated antioxidant and energy correction therapy.

[Medical and organizational issues of pre- and post-stroke disablement].

Authors examined 400 patients in the acute stage of ischemic and hemorrhagic stroke, including 140 patients who were followed-up for 6 months after the discharge. The dynamics of neurological and functional status, degree of disability and 6 month mortality were evaluated. It was shown that before hospitalization, 45.3% patients had disability pensions group I (14 or 7.7%), group II (136 or 75.1%) and group III (31 or 17.1%). The proportion of disabled people among able-bodied citizens younger than 60 years was 17.5% and it was 77.4% among those older than 80 years. Disability was caused by the cardiovascular pathology (48.1%), previous stroke (30.9%), diabetes mellitus type 2 and its complications (21%). The group of disability assigned before stroke, degree of comorbidity and severity of main disease were positively correlated with the severity of patient's condition on admission to and at discharge from the hospital. During 6 months after discharge, 15.7% of patients died, the rate of mortality was higher by a factor of 1.5 (21.4%) for secondary stroke compared to the first one. The rate of disability increased during 6 months. A number of people with disability group I increased by 12%, group II - by 20% , group III - by 5% and was estimated as 15, 55.7 and 15%, respectively.

[Energokorrektion of hemorrhagic stroke in the elderly].

The study included 102 elderly patients with hemorrhagic stroke of different size, location, and severity; the treatment was conservative. The results of the study demonstrate the important pathogenetic significance of free radical processes for hemorrhagic stroke. Severity of oxidative stress being a direct reflection of the energy deficiency correlates with the severity of the patients, with the volume of intracerebral hematoma, hyperglycemia, and determines the outcome. Assignment Cytoflavin leads to the elimination of free radical imbalance, a more rapid recovery of the impaired consciousness and focal neurological deficiency with the improvement of the functional outcome of the disease, and disability also decreased.