[Characteristics and peculiarities of the course of encephalopathy in diabetes mellitus].

A complex neurological and neuropsychological study of clinical signs of encephalopathy in patients with diabetes mellitus type I (DM I) was carried out. One hundred and twelve patients with different severity and compensation state of DM were examined. A comparison group included 40 patients with discirculatory encephalopathy. Clinical symptoms of encephalopathy were significantly more frequent in patients with DM I, with the presence of frequent hypoglycemias (more than once a week during the last year). The higher level of glycolized hemoglobin (by more than 6.9%) and longer duration of the disease (more than 5 years) were found in the group of patients with encephalopathy. Ultrasonic dopplerography of head and neck vessels and transcranial dopplerography support the involvement of complex vascular factors in the development of encephalopathy in DM I. The special attention is drawn to the changes in microcirculation channel that contribute to the development of encephalopathy in DM I and determine the characteristics of its clinical presentations and course compared to discirculatory encephalopathy.

[Medical service to patients with stroke at the prehospital stage in different cities of the Russian Federation].

We have conducted a comparative analysis of medical service quality to stroke patients at the pre-hospital stage in Yuzhno-Sakhalinsk and Irkutsk. Periods of hospitalization, including periods of referral of patients (or their relatives) for medical care, arrival of ambulance personnel (AP), time spent by AP on the primary medical care and transportation of patients have been analyzed. We have analyzed periods of referral of people for medical care and assessed the volume and quality of pre-hospital therapy. The high percentage of hospitalization during the period of "therapeutic window" has been found in both cities with the significant prevalence in Irkutsk. The delay in hospitalization was caused by late referral of patients, low level of population awareness on importance of referral for urgent medical care besides the referral to AP. The number of patients transported to a hospital during the time interval (30-40 min) recommended by the WHO did not exceed 30-40% in both cities. Although the volume of medical care at the pre-hospital stage was larger in Yuzhno-Sakhalinsk, the quality of pharmacotherapy used by AP in Irkutsk was more in line with modern standards.

[Oxidative stress and oxygen status in ischemic stroke].

A dynamic assessment of oxygen status of the arterial blood, activity of antioxidant system enzymes (AOS), succinatedehydrogenase (SDG), mitochondrial alpha-glycero-phosphate-dehydrogenase (alpha-GPDH) and alkaline phosphatase (AP) as well as concentrations of reduced glutathione (GSH) and secondary products of lipid peroxidation reacting with thiobarbituric acid (PLPRTA) has been carried out in patients at the acute stage of ischemic stroke of hemispheric location. Relative hyperoxia as a result of the hyperventilation syndrome was mostly pronounced on day 1 and 3. At the same time, a reduced activity of AOS system and an increase of PLPRTA concentration have been observed from the 1st day after stroke. There were also a decrease of the SDG activity and a marked (2,8 fold) increase of the alpha-GPDH activity as compared to the controls. A decrease of the AP leukocyte activity in the peripheral blood to day 7 after stroke makes possible a prognosis of good functional rehabilitation to the 21st day of the disease. Therefore, the results of the study suggest that the development of oxidative stress in patients with ischemic stroke is caused by tprimary disruption of bioenergetic processes during the reduction of AOS activity.

[Systemic thrombolysis in ischemic stroke].

Intravenous recombinant tissue plasminogen activator (rt-PA) is an approved and effective treatment for acute ischemic stroke within 3 hours of symptoms onset. The results of the first-ever implementation of the thrombolysis in the Russian Federation are presented. Fourteen stroke patients received rt-PA in dose of 0.9 mg/kg (10% as a bolus during 1 minute followed by infusion), the mean "door-to-needle" time was 50 +/- 23.6 min. The thrombolysis resulted in the clinical improvement by the end of the first day after stroke onset in 9 (64.2%) patients, with a dramatic regress of neurological deficit (the decrease of the NIHSS scores = 4) in 3 (21.4%) of them. Hemorrhagic transformation was observed in 6 (42.8%) patients, however in 5 cases it was asymptomatic and was found only in the repeated CT study to the end of the first day. Three months after stroke onset, 7 (50%) patients scored 0-1 on the modified Rankin scale, 1 patient had 4 scores and 1 patient died. Thus the thrombolysis can change the stroke management and significantly improves the outcome.

[Free radicals in cerebral ischemia]. / Svobodnye radikaly pri ishemii golovnogo mozga.

The review considers an involvement of active oxygen forms, nitric oxide (NO) and its active forms in accumulation of low molecular weight cytotoxic compounds that lead directly to cell death. A dual role of free radicals in cerebral ischemia, free radical function as secondary messengers are analysed.

[Change of bioelectric brain activity registered at the distance from the focus of cerebral tissue injury]. / Izmeneniia bioélektricheskoi aktivnosti mozga, registriruemye na rasstoianii ot ochaga porazheniia tserebral'noi tkani.

The focal delta-waves and the remote influences of the stroke in the form of the sinusoidal flashes of delta-waves with a maximal amplitude exceeding an amplitude of the focal delta-waves (frontal flashes--FF) in frontal-polar leads were investigated in 51 patients (22 men, 29 women) by means of mapping, dipole location (BrainLoc) and LORETA methods. The patients were examined in dynamics during the acute period of hemispheric stroke on days 1-3, 14 and 21 after the onset of the disease. The usage of the modern computer methods of EEG analysis permits to consider FF as an independent electrophysiological phenomenon and to localize a zone of the sources of such flashes, which does not coincide with the zone of generation of the focal delta-activity that corresponds to the perifocal zone of the stroke. According to the data of the three-dimensional location a probable zone of FF generation corresponds to the frontal pole and medial-basal areas of the frontal lobe. Comparison with the MRI data leads to the conclusion that a damage of anterior white substance was the most frequent cause of FF development, probably by deafferentation mechanism. FF may be an electrophysiological manifestation of the influence of the damage of the different brain structures on the frontal lobes according to diaschisis mechanism.