[Optimization of secondary prevention in patients with high-risk atherothrombotic ischemic stroke or transient ischemic attacks]. / Optimizatsiya vtorichnoi profilaktiki serdechno-sosudistykh sobytii u patsientov s aterotromboticheskim ishemicheskim insul'tom ili tranzitornymi ishemicheskimi atakami vysokogo riska.

High and very high risk atherothrombotic ischemic stroke (ATIS) includes patients with severe extracranial atherosclerosis, any intracranial atherosclerosis, and aortic arch atheromatosis. The article discusses the most effective approaches to medical short- and long-term secondary prevention of ATIS, major vascular events and death, based on the results of modern research and current clinical guidelines. Clinical studies of recent years have proven the possibility of individualization and intensification of secondary prevention of ATIS. In the treatment of high-risk patients, it is advisable to use more widely short-term dual antiplatelet therapy (combination of ASA with clopidogrel or ticagrelor), long-term dual antithrombotic therapy (combination of ASA and rivaroxaban at a dose of 2.5 mg twice a day not earlier than 30 days from the development of stroke or TIA) to reduce the risk of recurrent stroke and death, as well as intensive lipid-lowering therapy (including the use of a combination of statins and ezetimibe or PCSK9 inhibitors).

[Vestibular vertigo in stroke and vestibular neuronitis]. / Vestibulyarnoe golovokruzhenie pri insul'te i vestibulyarnom neironite.

The article discusses two main causes of acute vestibular dizziness - vertebrobasilar ischemic stroke and vestibular neuritis. The features of acute vestibular syndrome depending on the localization of cerebral infarction - in the territory of the posterior inferior, anterior inferior and superior cerebellar arteries, as well as in the brain stem are presented. Detailed clinical characteristics of vestibular neuritis is given. The issues of differential diagnosis of diseases, including the features of nystagmus and head impulse test, are discussed. The approaches to the treatment of acute vestibular syndrome depending on its etiology are considered. The authors present a treatment and diagnostic algorithm and consider features of clinical practice in acute dizziness. Fundamental differences in the treatment of vestibular neuritis and vertebrobasilar stroke dictate the need for neurologists of vascular departments to master the skills of otoneurological examination, which is the key to differential diagnosis. When choosing a treatment method, the most individualized approach is required.

[Embolic stroke of undetermined source]. / Embolicheskii insul't iz neustanovlennogo istochnika.

About 20-40% of ischemic stroke survivors cannot be attributed to a particular pathogenetic subtype despite a thorough diagnostic evaluation (cryptogenic stroke). Most cryptogenic strokes are likely embolic. This understanding is captured by a related concept, termed embolic stroke of undetermined source (ESUS), which is defined as a nonlacunar brain infarct without proximal arterial stenosis or cardioembolic sources. These patients are generally younger, has less disabilities and more favourable prognosis. It is assumed that in this group of patients, anticoagulants may have an advantage over antiplatelet drugs as a means of secondary prevention. Specific methods of treatment and secondary prevention of ESUS has not yet been developed.

[Changes in cerebral perfusion in patients undergoing revascularization of carotid artery stenosis]. / Izmeneniia tserebral'noi perfuzii u patsientov, podvergshikhsia revaskuliariziruiushchim operatsiiam na sonnykh arteriiakh.

Ischemic stroke is caused by atherosclerotic lesions in extra- and intracranial arteries in about 25% of cases. Revascularization surgery has been long and widely used for secondary prevention of ischemic stroke in patients with atherosclerotic lesions of the carotid arteries. However, currently the changes in cerebral perfusion in patients with atherosclerotic lesions of brachiocephalic arteries, who underwent surgical revascularization, are still not fully understood. This article highlights the issues of changes of cerebral hemodynamics in patients undergoing surgery on the carotid arteries.

[Assessing the impact of citicoline on the efficiency of rehabilitation measures in patients with ischemic stroke].

OBJECTIVE: To evaluate the effect of citicoline on the efficacy of rehabilitation measures in patients with ischemic stroke (IS). MATERIAL AND METHODS: Sixty patients were examined in the acute period of hemispheric IS. All patients underwent routine comprehensive treatment. The study group included 30 patients who received citicoline within the first 24 hours after IS onset. The control group consisted of 30 patients who were not treated with citicoline. The examination of patients included the assessment of neurological deficit, cognitive functions, P300 evoked potentials, head single photon emission computed tomography. RESULTS: Six months after the onset of disease, there was a significant improvement in cognitive functions as assessed with the MMSE and MoСa scale, and P300 latency in the main group. There was a trend towards the improvement in the activities of daily living (Barthel index) in patients of the main group compared to the control group. SPECT results showed the improvement in cerebral perfusion in an affected hemisphere: in Broca's area, the rear sections of the upper and middle frontal gyrus, the parietal lobe (p <0,05). CONCLUSION: Citicoline significantly improves cognitive function, which in turn has a positive effect on the efficacy of remediation and indirectly improves cerebral perfusion in patients with hemispheric IS.

[Melatonin in the correction of sleep in post-stroke patients].

AIM: To assess an effect of melatonin on quality of life and effectiveness of rehabilitation in patients with ischemic stroke (IS) suffered from insomnia due to sleep initiation disturbance. MATERIAL AND METHODS: Sixty post-stroke patients with insomnia were stratified into two groups matched for characteristics assessed in the study. Patients of the main group received melatonin during 21 days. In the first three days after admission and 21 days after the first examination, we administered the MMSE, the Rankin scale, FOSQ, NIHSS, EuroQol, the Epworth sleepiness scale (ESS) and used instrumental methods of examination (computed and magnetic-resonance tomography, electroencephalography, polysomnography). RESULTS: After 3 weeks, there was a reduction (p<0.05) in ESS scores in the main group compared to the control group (5.7 and 10 scores, respectively). Significant between-group differences were identified for polysomnographic parameters: latency to sleep was 17.8 min in the main group and 20.5 min in the control group (p<0.05), the number of microactivations was 15 and 18, respectively (p<0.05). There was a trend towards more rapid recovery in the main group (on average 8.4 days) compared to the control group (10.2 days), but the differences did not reach the level of statistical significance p<0.05. CONCLUSION: Melatonin reduced sleepiness (measured with the ESS), latency to sleep and number of wakings (microactivations) and was likely to promote the recovery in IS patients with insomnia due to sleep initiation disturbance.

[Insomnia and sleep-related breathing disturbances are the new risk factors for ischemic stroke]. / Insomniia i rasstroistva dykhaniia vo sne: novye faktory riska ishemicheskogo insul'ta.

Sleep disorders have an extremely negative impact on human vital functioning, encompassing both mental and somatic sphere. A large number of clinical trials have shown an increased risk of cardiovascular diseases and their complications, including the risk of ischemic stroke, in patients suffering from insomnia or sleep-related breathing disturbances. These types of sleep disorders are the most common in the structure of all violations of sleep. Obstructive sleep apnea syndrome is the most clinically significant type of sleep-related breathing disturbances. A number of pathophysiological mechanisms that may be responsible for the negative impact of sleep disorders was identified. In order to treat insomnia, behavioral techniques, including the normalization of sleep hygiene, behavioral and cognitive therapy, medication treatment, are used. Continuous Positive Airway Pressure (CPAP) therapy is currently the method of choice in the treatment of obstructive sleep apnea syndrome of any etiology.

[Treatment of sleep disorders in patients with mild cranial-brain injury in the early rehabilitation period].

OBJECTIVE: To study the effect of melatonin (melaxen) on sleep disorders in patients with mild cranial-brain injury (CBI) in the early rehabilitation period. MATERIAL AND METHODS: Sixty patients were randomized to equal groups treated or not treated with melaxen. Along with neurological and somatic examination, polysomnography and scales for measurement depression and quality of life ( ESS, BDI, EuroQol etc) were used. RESULTS AND CONCLUSION: Melatonin improved sleep (sleep latency, number of wakings per night etc) and decreased the severity of depression in the early rehabilitation period after mild CBI. Further research is needed to fully understand the effect of melatonin on sleep disorders in CBI, in particular in its later stages.