RESUMEN
OBJECTIVE: To analyze clinical and instrumental characteristics of patients with ischemic stroke (IS) due to paradoxical embolism according to the data of hospital registers of Moscow and Perm. MATERIAL AND METHODS: A comprehensive study of 114 patients, aged 18 to 55 years, with IS by the mechanism of paradoxical embolism was carried out. All patients underwent clarification of the cause of IS (electrocardiography, ultrasound scanning of the brachiocephalic arteries, CT or MRI of the brain, CT or MR angiography, transthoracic and/or transesophageal echocardiography). The presence of right-left shunt blood flow (RLS) was confirmed by transcranial dopplerography with a bubble test. The clinical significance of patent foramen ovale (PFO) was assessed according to The PFO-Associated Stroke Causal Likelihood Classification System (PASCAL). RESULTS: Clinical and instrumental characteristics of patients with IS due to paradoxical embolism were obtained from two hospital registries. In both groups, the leading trigger for the development of IS was the Valsalva phenomen (>20%), the share of other provoking factors did not exceed 10%. Significant differences between the analyzed groups related to the ultrasonic characteristics of RLS/PFO: patients with a grade 4 shunt predominated in the Research Center of Neurology (RCN) population, while patients with a grade 3 shunt predominated in the City Clinical Hospital (CCH) â4 group. At the same time, there were twice as many patients with aneurysm of the interatrial septum in the CCH â4 group. In accordance with the PASCAL classification, in 93% of RCN patients, PFO can be considered as a probable cause of IS, while in the CCH No. 4 group, a probable causal relationship was traced only in 51% of cases, in 18% of patients, the role of an anomaly in the development of stroke was unlikely. CONCLUSION: The analysis showed that the primary screening of RLS in a regional vascular center allows classifying PFO as a probable cause of IS in only half of the patients. For a more accurate selection of patients for whom endovascular occlusion of the PFO will be most effective, an in-depth examination in a specialized hospital is recommended.
Asunto(s)
Embolia Paradójica , Foramen Oval Permeable , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/epidemiología , Accidente Cerebrovascular Isquémico/complicaciones , Embolia Paradójica/complicaciones , Embolia Paradójica/diagnóstico por imagen , Embolia Paradójica/epidemiología , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Ecocardiografía Transesofágica/efectos adversosRESUMEN
Over the past decade, non-invasive brain stimulation, in particular transcranial stimulation by direct electric current (TES), has been increasingly included in the array of methods used for rehabilitation of patients with post-stroke impairments (motor, speech, cognitive). Development of stimulation protocols with determination of the zones of exposure, as well as better understanding of the patterns of restoration of functional systems, became possible due to basic research using functional MRI paradigm. However, the complexity of the organization of the speech system, the variety of forms of aphasia that occur when it is damaged, the individual variability of neuroplastic processes, motivated a search for optimal stimulation protocols that contribute to the personification of the rehabilitation process. Portability, low cost of equipment, a good safety and tolerance profile, as well as a proven effect on neuroplasticity processes, are the undoubted advantages of TES-therapy. There is reason to believe that further study and clinical testing of this technique will turn it into the promising tool for enhancing the effectiveness of classical speech therapy approaches in patients with post-stroke aphasia.
Asunto(s)
Afasia/complicaciones , Afasia/terapia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/complicaciones , Estimulación Transcraneal de Corriente Directa , Estimulación Magnética Transcraneal , Encéfalo/fisiología , Encéfalo/fisiopatología , Humanos , Accidente Cerebrovascular/terapiaRESUMEN
OBJECTIVE: To study diagnostic capabilities of somatosensory evoked potentials (SSEP) in clarifying the mechanisms of formation of urinary disorders. MATERIAL AND METHODS: The authors studied the characteristics of nerve impulses during stimulation of the pudendal and tibial nerves in patients with neurogenic urinary retention and cerebral ischemic stroke in the parietal lobes (4 patients), spinal ischemic stroke (10 patients), myelitis at the level of thoracic segments (7 patients), spinal cord cauda equina tumors (3 patients). RESULTS AND CONCLUSION: The study of SSEPs made it possible to determine the localization and nature of damage to the structures of the central nervous system and to establish the neurogenic cause of urinary disorders.
Asunto(s)
Potenciales Evocados Somatosensoriales , Retención Urinaria , Estimulación Eléctrica , Humanos , Neurogénesis , Nervio Tibial , Retención Urinaria/fisiopatologíaRESUMEN
The literature data on the urgent neurological problem - overactive bladder (OAB) are summarized. The OAB prevalence, current conceptions on the physiology and pathophysiology of urination and pathogenetic mechanisms of OAB development are presented. Main groups of pharmacological agents used in OAB treatment are described. Special attention is drawn to rationale of using anticholinergic (antimuscarinic) drugs. The authors present the results of their own comparative analysis on the efficacy and tolerability of these drugs in treatment of patients with cerebral vascular diseases including the use of solifenacin succinate (VESIcare).
Asunto(s)
Antagonistas Muscarínicos/uso terapéutico , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Agentes Urológicos/uso terapéutico , Humanos , Quinuclidinas/uso terapéutico , Succinato de Solifenacina , Tetrahidroisoquinolinas/uso terapéutico , Vejiga Urinaria Hiperactiva/etiología , Vejiga Urinaria Hiperactiva/fisiopatología , MicciónRESUMEN
Disorders of urination, along with motor and cognitive disorders, are characteristic of different forms of chronic cerebral vascular diseases (CCVD). Irritation symptoms are more frequent in subcortical arteriosclerotic encephalopathy (SAE) and multi infarct hypertonic encephalopathy (MIHE). Overactive urine bladder syndrome (OUBS) caused by neurogenic detrusive hyperactivity manifests itself in frequent urination, nocturia and imperative enuresis and thus decreases quality of life and results in disability of patents with CCVD. At the same time, the character of symptoms points indirectly to the localization of lacunar infarction or the extent of severity of leukoareosis. It is the most frequent form of disorders of urination in the first years of disease that significantly aggravates its course and needs timed diagnosis and pharmacological treatment. Competitive antagonists of muscarinic receptors M2, M3 subtypes are the most effective drugs for treatment of OUBS comorbid to CCVD.
Asunto(s)
Trastornos Cerebrovasculares/complicaciones , Antagonistas Muscarínicos/uso terapéutico , Vejiga Urinaria Hiperactiva/etiología , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/fisiopatología , Enfermedad Crónica , Humanos , Pronóstico , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Vejiga Urinaria Hiperactiva/fisiopatología , MicciónRESUMEN
Overactive bladder (OAB) is observed in such brain diseases as stroke, hypoxic ischemic encephalopathy, Parkinson's disease (PD), multiple sclerosis (MS). Trospium chloride (spasmex) was used in OAB patients with MS (n = 87), stroke (n = 83), encephalopathy (n = 47) and PD (n = 36) in doses from 15 to 45 mg/day in 2 to 36 month courses. The response with minimal side effects was achieved in 94% patients. In addition to basic effects, trospium chloride relieved spastic constipation in patients with stroke, hypersalivation in PD and anal incontinence in MS.
Asunto(s)
Nortropanos/administración & dosificación , Parasimpatolíticos/administración & dosificación , Vejiga Urinaria Neurogénica/tratamiento farmacológico , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Adulto , Anciano , Bencilatos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nortropanos/efectos adversos , Parasimpatolíticos/efectos adversos , Vejiga Urinaria Neurogénica/etiología , Vejiga Urinaria Hiperactiva/etiologíaRESUMEN
Twelve patients (mean age 36,0+/-10,4 years) with a vertebral artery dissection (VAD) were followed-up during 2,5 months - 5 years. All patients underwent magnetic resonance (MR) imaging of the head, MR-angiography (11 patients - repeated studies), 5 patients - conventional cerebral angiography. VAD was located on extracranial (7), intracranial (1), extra-intracranial levels (4), the extension of dissection to the basilar artery was found in 2 patients. Dissection involving both vertebral arteries was observed in 6 patients, recurrent VAD after 4-15 months - in 3 patients. A total number of VAD was 22, a total number of cerebrovascular events - 15. The latter included ischemic strokes (13), transient ischemic attacks (1) and isolated headache (1). Ischemic cerebrovascular events were characterized by the combination of cerebral ischemic symptoms with occipital headache and/or posterior neck pain (79%) which usually preceded ischemic cerebral symptoms by the interval of several hours - 3 weeks as well as a goof recovery of neurological deficit (92%). In a half of patients, cerebral ischemic symptoms developed after neck movements or manual therapy. Angiography revealed the stenosis of vertebral arteries, usually elongated, irregular or tapered (64%), more often located at the level of V3-V4 segments, vertebral artery occlusion (36%) and pseudoaneurisms (19%). The repeated angiography performed in 2-3 months or more showed positive changes in 82%, the complete (86%) or partial (14%) resolution of all stenoses and the complete or partial recanalization of the half of vertebral artery occlusions, the regress of all pseudoaneurisms. An intramural hematoma on MR imaging (the axial plane) was found in 85% dissections analyzed, the increased vertebral artery outer diameter - in 69%. Atherosclerotic plaques were absent in all cases. VAD is one of unknown causes of ischemic stroke in vertebrobasilar circulation. Diagnosis is based on characteristic clinical and angiography data.
Asunto(s)
Isquemia Encefálica/epidemiología , Hematoma/epidemiología , Insuficiencia Vertebrobasilar/epidemiología , Adulto , Encéfalo/irrigación sanguínea , Isquemia Encefálica/diagnóstico , Circulación Cerebrovascular/fisiología , Femenino , Cefalea/diagnóstico , Cefalea/epidemiología , Hematoma/diagnóstico , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Disección de la Arteria Vertebral/diagnóstico , Disección de la Arteria Vertebral/epidemiología , Insuficiencia Vertebrobasilar/diagnósticoAsunto(s)
Anticuerpos Anticardiolipina/inmunología , Neurosífilis/diagnóstico , Neurosífilis/inmunología , Adulto , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Progresión de la Enfermedad , Humanos , Masculino , Pruebas Neuropsicológicas , Neurosífilis/complicaciones , Índice de Severidad de la EnfermedadRESUMEN
Late outcomes of surgical and medical treatment of parkinsonism were studied in 582 (including 321 medical and 261 surgical) patients. The follow-up ranged from 6 to 30 years. Three hundred and fifty eight surgeries were performed. In immediate postoperative period, the following results were observed: significant (64%), moderate (20.3%) improvements, no changes (8%), deterioration (3.1%). Late outcomes were as follows: significant (34.9%), moderate (20.3%) improvements, no changes (28.7%), deterioration (16.1%). In surgical patients the complication rate was 14.8%, mortality 0.8%. Analysis of outcomes of surgical and medical treatment showed a statistically significant predominance of good outcomes in surgical patients (34%) as compared with medical ones (14%).
Asunto(s)
Enfermedad de Parkinson/tratamiento farmacológico , Enfermedad de Parkinson/cirugía , Enfermedad Crónica , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Enfermedad de Parkinson/clasificación , Complicaciones Posoperatorias/epidemiología , Inducción de Remisión , Técnicas Estereotáxicas , Factores de Tiempo , Resultado del TratamientoRESUMEN
Three cases of progressive aphasia were analyzed. Moderate motor aphasia without any cognitive disturbances was observed at an early stage of the disease. Subsequently gradual development of severe motor aphasia, agraphia, alexia, as well as of speech comprehension disorder, intellectual retardation, aspontaneity, and apraxia was observed in such patients. Computer tomography revealed brain fronto-temporal local atrophy which was growing progressively as far as the disease developed. Any cerebrovascular diseases were absent. The conclusion was made that progressive isolated aphasia was the debut of cerebral cortex atrophy.
Asunto(s)
Afasia Progresiva Primaria/diagnóstico , Encéfalo/patología , Demencia , Anciano , Anciano de 80 o más Años , Afasia Progresiva Primaria/psicología , Atrofia/diagnóstico , Atrofia/psicología , Progresión de la Enfermedad , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Arthropathies develop in 15-20% of post-stroke paresis patients. A complex of rehabilitative measures including physical therapy (transcutaneous stimulation analgesia, heating etc.), kinesitherapy and anabolic hormones can prevent contractures if applied at the early rehabilitative stage.
Asunto(s)
Brazo , Trastornos Cerebrovasculares/complicaciones , Contractura/prevención & control , Hemiplejía/rehabilitación , Pierna , Modalidades de Fisioterapia , Distrofia Simpática Refleja/rehabilitación , Adulto , Anciano , Terapia Combinada , Hemiplejía/etiología , Humanos , Persona de Mediana Edad , Distrofia Simpática Refleja/etiologíaRESUMEN
MAO B selective inhibitor was given to parkinsonism patients for several months. Positive effect was found in half of the patients irrespective of their age, time of the disease onset and its severity. The drug proved most effective in bradykinesia. Its use is most expedient in combination with L-DOPA-containing drugs which prolong the effect and reduced diurnal shifts in the patients' conditions. Side effects are seldom observed and usually weak.
Asunto(s)
Antiparkinsonianos/uso terapéutico , Inhibidores de la Monoaminooxidasa/uso terapéutico , Enfermedad de Parkinson/tratamiento farmacológico , Adulto , Antiparkinsonianos/efectos adversos , Evaluación de Medicamentos , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de la Monoaminooxidasa/efectos adversos , Selegilina/efectos adversos , Selegilina/uso terapéuticoRESUMEN
The recovery of impaired motor functions in patients with intracerebral haemorrhages depends on many factors. It has been proved that surgical removal of intracerebral hematomas improves the survival rate. Yet, the results of recovery primarily depend on the type of surgery. A new method of stereotaxic removal of intracerebral hematomas has a number of advantages over the open method, primarily low traumatism. The prognosis of the recovery of motor ability is determined by not only the type of surgery but by a number of other factors as well, namely, the volume and localization of the hematoma, the degree of deformation of the brain stem and the timing of surgical intervention. The results of clinical employment of the new method in 51 patients should be considered encouraging while the operation of stereotaxic removal of intracerebral hematomas appears rather promising.
Asunto(s)
Hemorragia Cerebral/diagnóstico por imagen , Hematoma/diagnóstico por imagen , Actividad Motora/fisiología , Tomografía Computarizada por Rayos X , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/cirugía , Hemorragia Cerebral/fisiopatología , Hemorragia Cerebral/cirugía , Femenino , Marcha , Hematoma/fisiopatología , Hematoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Pronóstico , Técnicas Estereotáxicas , Factores de TiempoRESUMEN
The dopamine agonist parlodel was given to 42 patients with parkinsonism for several months. The drug proved effective in more than one-third of the patients. Different side-effects were observed in almost half of the patients. Parlodel may be used alone in mild cases but generally it is used as an adjunct to L-DOPA therapy. The optimum dose of parlodel is individual and varies within a wide range.
Asunto(s)
Bromocriptina/uso terapéutico , Enfermedad de Parkinson/tratamiento farmacológico , Adulto , Anciano , Bromocriptina/administración & dosificación , Bromocriptina/efectos adversos , Quimioterapia Combinada , Femenino , Humanos , Hipoxia Encefálica/complicaciones , Levodopa/administración & dosificación , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson Posencefalítica/tratamiento farmacológico , Enfermedad de Parkinson Secundaria/tratamiento farmacológicoRESUMEN
The nature and degree of motor disorders, the degree and rate of recovery were shown to be more dependent on the localization than on the size of the cerebral infarction specified by computer-aided tomography of the drain. Localization of infarct in the posterior femur of the internal capsule proved the least favourable with regard to the recovery of motor functions.