[Ischemic stroke associated with patent foramen ovale: hospital database analysis]. / Ishemicheskii insul't, assotsiirovannyi s otkrytym oval'nym oknom: analiz dannykh gospital'nykh registrov.

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) №4 group. At the same time, there were twice as many patients with aneurysm of the interatrial septum in the CCH №4 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.

[Noninvasive brain stimulation in the rehabilitation of patients with post-stroke aphasia]. / Neinvazivnaia stimuliatsiia mozga v reabilitatsii patsientov s postinsul'tnoi afaziei.

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.

[The study of diagnostic capabilities of somatosensory evoked potentials in patients with neurogenic urinary retention]. / Diagnosticheskie vozmozhnosti issledovaniia somatosensornykh vyzvannykh potentsialov u bol'nykh s neirogennoi zaderzhkoi mochi.

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.

[Current pharmacotherapy of overactive bladder in neurological patients].

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).

[Neurourological signs of chronic cerebral vascular diseases].

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.

[Experience with application of trospium chloride in patients with neurogenic detrusor overactivity].

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.

[Spontaneous dissection (intramural hematoma) in vertebrobasilar artery and ischemic stroke].

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.

[A comparative assessment of the results of surgical and conservative treatments in parkinsonism]. / Sravnitel'naia otsenka rezul'tatov khrirugicheskogo i konservativnogo lecheniia parkinsonizma.

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%).

[Progressive aphasia without dementia--the onset of an atrophic process of the brain]. / Progressiruiushchaia afaziia bez dementsii--debiut atroficheskogo protsessa golovnogo mozga.

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.

[Prevention of contractures in post-stroke arthropathies]. / Profilaktika kontraktur pri postinsu'ltnykh artropatiiakh.

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.

[Experience using selective monoamine oxidase inhibitors in treating parkinsonism patients]. / Opyt primeneniia selektivnykh ingibitorov monoaminoksidazy pri lechenii bol'nykh parkinsonizmom.

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.

[Dynamics of the recovery of motor functions after the stereotaxic removal of intracerebral hematomas (clinical computed tomographic study)]. / Dinamika vosstanovleniia dvigatel'nykh funktsii posle stereotaksicheskogo udaleniia vnutrimozgovykh gematom (kliniko-komp'iuterno-tomograficheskoe issledovanie).

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.

[Experience with the use of parlodel in the treatment of Parkinson patients]. / Opyt primeneniia parlodela pri lechenii bol'nykh parkinsonizmom.

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.

[Relation between features of the recovery of motor functions in patients with ischemic strokes and the site and extent of lesion focus]. / Osobennosti vosstanovleniia dvigatel'nykh funktsii u bol'nykh s ishemicheskim insul'tom v zavisimosti ot lokalizatsii i razmerov ochaga porazheniia.

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.