[The biomarkers of cerebral ischemia as a new method for the validation of the efficacy of cytoprotective therapy]. / Biomarkery ishemii golovnogo mozga kak novyi metod dokazatel'stva éffektivnosti neirotsitoprotektorov.

AIM: To study blood plasma concentrations of NR2-peptide in patients with ischemic stroke (IS) to assess its diagnostic value as a biomarker of cerebral ischemia and determine the dynamics of the biomarker during treatment with cortexin. MATERIAL AND METHODS: One hundred and twenty patients, aged from 18 to 70 years, including 36 with transient ischemic attack (TIA) and 84 with IS in the carotid territory (n=70) and vertebral/basilar territory with the Wallenberg-Zakharchenko syndrome (n=14), were enrolled. The National Institute of Health Stroke scale (NIHSS) was used to assess neurological status. Blood plasma concentration of NR2-peptide was measured in all patients at admission and after treatment. All laboratory results were compared with neuroimaging (MRI, CT) data. RESULTS: Concentrations of NR2-peptide detected in all patients were higher than in controls (>1.5 ng/ml), p<0.0001. The direct correlation between NR2-peptide (from 3.38 ng/ml to 15.6 ng/ml) and ischemic lesion (from few to 80 mm) was observed. A decrease in NR2-peptide concentration (from 8.5 to 5,.9 ng/ml, p<0.0001) was noted in patients treated with cortexin after 10-day treatment course. CONCLUSION: NR2-peptide blood assay is a reliable hemotest of brain ischemia. Cortexin has a sufficient therapeutic efficacy.

[On possibility of partial restore integrative brain activity in patients with vegetative state].

A combined approach to neuroreconstructive effects on pathogenesis mechanisms of vegetative state that develops as a result of severe traumatic brain injury (TBI). It is shown that under the influence of chemical transtimpanal vestibular dereception and transcranial micropolarization (TDCS) accelerated and more pronounced therapeutic effect than conventional therapy. Neurophysiological in-depth examination of the dynamics shows that over time in patients in a vegetative state, picking up the intensity, "tension" and "rigidity" of inter-regional cortical interactions in the organization that are beginning to dominate the area TPO cortex of both hemispheres. It is suggested that in the dislocation of the brain stem in severe TBI is vestibulotalamic tract, thanks to its anatomical location, is the least vulnerable. As a result, the prevailing afferentation forming inter-regional cortical interactions is vestibular afferent impulses. On its basis the pathological functional system, blocking the work of other functional systems of the damaged brain. Suggested treatments significantly reduce the amount of vestibular afferent flow and open up the possibility of recovery of more effective interafferential interactions. This greatly facilitates the work of the brain as a multimodal analyzer.

[Role and place of biochemical markers in diagnosis of cerebral ischemic stroke].

In recent years neurologists pay special attention to biochemical markers of instrumental diagnosis of brain ischemia in its acute phase. Determination of specific biomarkers in the blood of patients at early stages of cerebral blood circulation disorders may be helpful in screening patients at high risk of stroke in the short-term period. We present a review of literature and an analysis of own data (over 200 patients) with chronic and acute cerebral blood circulation disorders on the possibility of using brain biomarkers in clinical practice. The diagnostic value of NR2-antibodies in stroke with ischemic volume 5-70 cm3 is approximately 95,9% and in transitory ischemic attacks--98%.

[Clinical and neurophysiological manifestations of cerebral asymmetry in cervical dystonia].

Based on the analysis of clinical and neurophysiological data with the use of up-to-date methods of EEG processing, the authors discuss a role of cerebral asymmetry (CA) in the pathogenesis of cervical dystonia (CD). Sixty-seven patients (31 male and 36 female) with CD have been studied. The pathological turn of the head to the right side (RT) was observed in 34 patients, to the left side (LT) - in 33 patients. The uni- or bilateral generalization of dystonic symptoms (Meig's syndrome, laterocollis) was found only in one-third of RT patients. The visual analysis of EEG of RT patients revealed the high level of EEG synchronization with signs of cortical irritation, with the prevalence in the left hemisphere, and the presence of focal epileptiform appearances in the temporal leads of the left or both hemispheres with the left-side prevalence. In LT patients, the EEG presentation was similar to normal but more often represented the variants of <> EEG-pattern. In these cases, the apparent manifestations of CA were not found. The coherent analysis revealed the formation of the network of <> coherent links, with bilateral spread, in RT patients. This may suggest the functional inequivalence of the peripersonal space of right and left hand and the dominate significance of striopallidar and thalamic structures of the left hemisphere for the total brain activity.

[Influence of smoking on the cerebral hemodynamics and biochemical blood indices in chronic insufficiency of brain circulation]. / Vliianie kureniia na tserebral'nuiu gemodinamiku i biokhimicheskie pokazateli krovi pri khronicheskoi nedostatochnosti mozgovogo krovoobrashcheniia.

The influence of smoking on cerebral hemodynamics and biochemical blood indices has been studied in 50 male patients with chronic insufficiency of brain circulation (CIBC), aged 40-50 years, divided into 2 groups: smoking (n=26) and nonsmoking (n=24). Smoking was shown to play a substantial role in the development of discirculatory encephalopathy with atrophic brain changes, causing metabolic disturbances (a shift of acid-basic balance towards acidosis) and microcirculation disorders due to altered cerebrovascular reactivity. These alterations develop previously to hemodynamically significant atherosclerotic arteries lesion and emerge irrespective of the presence of atherosclerotic vascular changes, atherogenic shifts of lipid metabolism, disturbances of free-radical processes and platelet aggregation.

[Efficacy of cytoflavin in spondylogenic radiculomyeloischemia]. / Effektivnost' tsitoflavina pri spondilogennykh radikulomieloishemiiakh.

The efficacy of cytoflavin in the treatment of 60 patients (39 women, 21 men, age 32-64 year) with spondylogenic cervical and lumbosacral radiculomyeloischemia due to degenerative dystrophic spinal lesions was studied in a randomized double-blind placebo controlled study according to GCP rules. During 10 days 40 patients received intravenous cytoflavin dropper injections once daily; 20 patients (control group) received 5% glucose solution as a placebo. Considerable improvement was observed in 70% patients with radiculomyeloischemia of cervical localization and in 65%--with radiculomyeloischemia of lumbosacral segments. In the control group, positive dynamics of neurologic symptoms was 25-30% lower. Cytoflavin significantly reduced cognitive disturbances, improved reparative processes both in the central and peripheral neurons, and may be recommended in ischemic neuronal spinal lesions.