Vol 18, No 9 (2016)
Articles
Analysis of epidemiological indicators of recurrent stroke in regions of Russian Federation (On the basis of territorial and population registry 2009-2014)
Abstract
Introduction. Repeated strokes are the actual problem of modern neurology in mind the severity of clinical symptoms and high mortality. The aims and objectives of the study: The study of epidemiological indicators of recurrent stroke in the Russian regions. Materials and methods. A study of recurrent stroke carried out in the framework of a multi-center study of the epidemiology of stroke in 17 regions of the Russian Federation by the territorial and population registra.Since 2009 to 2014 in the study population reported 36,283 cases of stroke, including recurrent stroke was 8144 cases. It concerned the case of recurrent stroke for stroke, if from the beginning of any previous stroke has been more than 28 types of stroke dney. Diagnostics corresponded with International Classification of Diseases revision 10. After the incidence analysis, mortality, mortality from stroke recurrence. Recurrent stroke prevalence was studied in young age (25-44 years), medium (45-59 years old), the elderly (60-74 years) and old (75 and older), and depending on the type of stroke. In processing the data used statistical software package SAS 8,0. To calculate incidence and smertnostiispolzovalsya method of direct standardization. For standard assumed distribution of the number of men and women by age group for each study area in a year. Changing trends index is determined using the approximation method. Results. The incidence of recurrent stroke in 2009 was 1.09 cases per 1 000 population in 2014 - 0.79 per 1000 population. During the study period there were significant fluctuations in the indicator. Deaths from stroke recurrence showed a decline for the period 2009-2012 gg (0.32; 0.24; 0.20; 0.15 cases per 1,000 population, respectively). The slight increase in the rate recorded in 2013 (0.16) with a decrease in 2014 (0.12), which did not change the trend of decreasing trends. The proportion of ischemic stroke among recurrent stroke was 87.5%, intracerebral hemorrhage - 7.1%, 0.9% subarachnoid hemorrhage, stroke unspecified etiology 4.6%. Prevalence of recurrent stroke among all stroke was 25.5% in 2009. From the period of the study, there were changes in the rate does not exceed 2009. The incidence of recurrent stroke at a young age was 13.2% of cases, on average - 19.1%, in older age - 24.1%, in old - 23.3%. Mortality after repeated insults made; in ischemic insulte - 18.2%, intracerebral hemorrhage - 41.7%, subarachnoid hemorrhage - 34.7%, stroke unspecified etiology - 43.4%. Conclusions. During the period of the study there were changes in the main epidemiological indicators of recurrent stroke in the Russian regions. Despite the emerging positive changes, the problem of recurrent stroke remains relevant.
Consilium Medicum. 2016;18(9):8-11
8-11
The origins of "right-hemispheric" neuropsychological symptoms after left middle cerebral artery stroke
Abstract
The article discusses the problem of features of neuropsychological syndromes in vascular pathology of the brain, particularly in stroke in the basin of the left middle cerebral artery. Raises issues related to the explanation of the appearance of symptoms of neuropsychological dysfunction right hemisphere in lesions of the left hemisphere of the brain.
Consilium Medicum. 2016;18(9):12-16
12-16
Bilateral internal carotid artery occlusion: case report
Abstract
Bilateral internal carotid artery occlusion is a relatively rare condition which is generally characterized with a poor prognosis. Each new case is of particular interest in relation to the activation of the compensatory mechanisms of cerebral blood flow. This article presents a case of bilateral internal carotid artery occlusion, accompanied by developing collaterals between the internal and external carotid arteries. The pathological processes leading to bilateral occlusion of the internal carotid arteries are discussed and the main ways of collateral circulation between the internal and external carotid arteries are described.
Consilium Medicum. 2016;18(9):17-20
17-20
Guidelines for intensive care in non-traumatic subarachnoid haemorrhage cases (review)
Abstract
Subarachnoid hemorrhage (SAH) is an urgent condition with a high risk of adverse outcomes. Patients with SAH require a multidisciplinary approach to solving problems of diagnosis, tactics, timing and methods of occlusion of the aneurysm, which involves treatment in a specialized neurosurgical centers with extensive experience in the treatment of patients with SAH. The main tasks of intensive care in patients with SAH are prevention and treatment of secondary ischemic brain injuries, which are caused by the development of cerebral vasospasm, and whose success depends on the skillful use of integrated monitoring and control of perfusion-metabolic coupling. In the present literature review outlines the main therapeutic strategy for intensive care of the emergency condition.
Consilium Medicum. 2016;18(9):22-26
22-26
Restoration of higher mental functions in more lateralized therapy in patients with acute ischemic stroke
Abstract
The study included 60 patients with acute hemispheric ischemic stroke. In addition to standard rehabilitation methods 40 patients underwent additional lateralized therapy aimed at enhancing lesions (20 patients) or the intact hemisphere (20 patients). The control group consisted of 20 patients who had more lateralized therapy has not been evaluated. The results showed that the additional activation of the left hemisphere is dominant in significant positive changes, especially in the case of lesions of the left hemisphere homolateral. Additional activation of the right hemisphere in the event of the defeat of the left can have a negative impact. With the defeat of the right hemisphere, the left-sided and right-sided activation can be positive.
Consilium Medicum. 2016;18(9):27-31
27-31
Transluminal balloon angioplasty with stenting of vertebral arteries: clinical and neurophysiological aspects
Abstract
Transluminal balloon angioplasty with stenting of vertebral arteries (VA) is an effective endovascular technique for improving cerebral blood flow with a low complication rate and good long-term results. The aim of this study was to assessment of quality of life and brainstem disfunction in patients after transluminal balloon angioplasty with stenting of VA. Study group included 50 patients (mean age, 64±6 years) with hemodynamically significant of extracranial VA stenosis. In a cohort of the patients included in research low indicators of life quality were observed before stenting of VA. Patients with hemodynamically significant of extracranial VA stenosis had brainstem auditory evoked potentials abnormalities including elongation of interpeak intervals I-V and V peak latency, reducing I peak amplitude. After transluminal balloon angioplasty with stenting of VA revealed a shortening V peak the latency (compared to preoperative period), reflecting the improved of the brainstem conductive functions. In 6 months after stenting of vertebral arteries indicators of life quality are raised in physical and psychological spheres.
Consilium Medicum. 2016;18(9):32-36
32-36
Stenosing atherosclerosis of cerebral arteries: modern strategies for diagnosis and treatment of patients
Abstract
The article summarizes the modern principles of management of patients with atherosclerosis of the cerebral arteries. The article presents methods of diagnostics of atherosclerotic stenosis of extra - and intracranial cerebral arteries. Special attention is paid to methods of assessing individual risk of vascular complications. The article covers in detail current strategies of antiplatelet therapy in patients with high risk of ischemic stroke.
Consilium Medicum. 2016;18(9):37-44
37-44
Prospective experimental and clinical trends of neuroprotection in ischemic stroke
Abstract
The review is devoted to modern trends of neuroprotection in ischemic stroke. At this time the new rules were developed for the conducting of such studies, they are conducted on the basis of the knowledge of the ischemic cascade and the neurovascular unit. The results of experimental and clinical studies of drugs with neuroprotective effect are discussed. Special attention is paid to growth factors and similar substances.
Consilium Medicum. 2016;18(9):45-48
45-48
Influence of correction of sleep disorders on the effectiveness of rehabilitation in patients after stroke
Abstract
The purpose of research - to study efficiency of correction of sleep disorders by Melaxen® taking into account the level of secretion of melatonin (6-SOMT) at patients with stroke. Materials and methods. The study included 141 patients with CVD. Examination of patients included assessment of neurological status, psychometric scales, the definition of circadian rhythm of the heart and blood pressure, determination of 6-SOMT in urine. Results. It was found that pathological changes in circadian rhythms affect sleep disturbances, emotional and cognitive disorders and are associated with a reduction in the level of 6-SOMT in the urine. These changes are most pronounced in patients with stroke. The efficiency of inclusion in a comprehensive rehabilitation regimen Melaxen® in respect of sleep disorders. Conclusion. The data obtained allow us to consider Melaxen® as an effective tool in the complex rehabilitation of patients with cerebrovascular diseases.
Consilium Medicum. 2016;18(9):49-55
49-55
Canis-therapy second stage of rehabilitation of patients after an ischemic stroke
Abstract
Reduced motor activity and motor disorders that develop as a result of a stroke, leads to a decrease in motivation for the movement and the development of depressive disorders. These factors cause the communicative deficits, fear of activity, enhance motor deficit, reduce the motivation for rehabilitation. Complementing rehabilitation сanis-therapy can reduce the activity of the fear, stress and severity of depressive disorders, stimulate locomotor activity and communication, motivation for rehabilitation. As a result of the inclusion in the program of rehabilitation сanis-therapy patients significantly reduced the severity of depression HADS, improved mobility index Rivermid improved state of the modified scale of outcomes of rehabilitation and functional independence Rankin.
Consilium Medicum. 2016;18(9):56-58
56-58
Angioprotective effect of pulsed currentsin patients with diabetes, stroke
Abstract
The paper deals with the rehabilitation of patients with type 2 diabetes, stroke, having a changing transcapillary cerebral metabolism and movement disorders. The treatment of these patients has been used complex, including drug therapy and multi-bipolar electrical pulse currents, which led to a marked clinical benefit, as well as accompanied by the restoration of motor activity of patients with the improvement transcapillary sharing and normalization of inter-hemispheric asymmetry.
Consilium Medicum. 2016;18(9):59-61
59-61
Function recovery of the shoulder joint of patients in the acute stroke
Abstract
Introduction. Impaired function of the shoulder joint is one of the most common medical conditions that significantly limit the ability of the patient to self-service as a result of stroke. Organization of the study. The study involved three groups: 20 healthy, 50 patients with cerebral stroke with hemiparesis of the upper extremity, of which 25 got standard treatment and 25 had additional course of training with biofeedback for movement in the shoulder joint. A study of the kinematics of movements in the shoulder joints in combination with electromyography (EMG) recording were made on the 3-4th day and 21-th day. Results and conclusion. It was found that both groups of patients have a decrease in range of motion in the shoulder joint paretic hand, and support normal cyclical movement of time. A part of patients shown reduced range of motion not only on affected, but also on the healthy side. In contrast to the kinematics basic acting muscles on the affected side are characterized not only a decrease in EMG-amplitude, but also the later peak activity. Parts of patient were shown the phenomenon of anomalous, two-phase activity of muscles on the side of paresis. After treatment, ranges of motion in the affected shoulder joint are increasing, but remain significantly lower than those in normal. The magnitude of the EMG-activity of the maximum delay is reduced. The numbers of abnormal variants of EMG-activity were coming to be less after treatment. The group receiving biofeedback training demonstrated better functional result. The proposed method of investigation function of the shoulder joint is more sensitive compare to clinical scales to determine quantitatively and qualitatively the functional dynamics.
Consilium Medicum. 2016;18(9):62-67
62-67
Cerebrovascular disorders in women in perimenopausal period
Abstract
Cerebrovascular diseases are one of the most maladaptive disorders in both men and women. Meanwhile, in the female population when compared to men, strokes occur much later. Strokes in women have a higher frequency of traditional risk factors such as hypertension, atrial fibrillation, as well as the presence of specific factors, such as the use of oral contraceptives and during pregnancy. In addition, in women compared with men more than the proportion of severe stroke, the higher the frequency of hospital medical complications and deaths, as well as the number of cases of severe disability after stroke. In the formation of sex differences in the pathophysiology of stroke participate as hormonal mechanisms, and other factors not related to the influence of reproductive hormones. Understanding these laws is important in order to develop a stratified approach to the management of female patients with cerebrovascular disease.
Consilium Medicum. 2016;18(9):68-72
68-72
Clinical features of cerebral venous hemodynamics disorders in children: treatment options under the control of ultrasound diagnostics
Abstract
In the genesis of chronic cerebrovascular disease, often clinically manifested encephalopathy, great value (sometimes determining) have impaired cerebral venous circulation, and research, interpretation of results and even the terminology of this component of the overall hemodynamics neglected. Clinical and ultrasound examinations carried out more than 6 thousand children (from 1 year to 18 years). Identified and determined the severity of cerebral venous disorders. Schemes of complex treatment of these disorders: Diacarb (acetazolamide) - short courses, nootropic (Semax) and vasoactive (Aescusan) drugs under the supervision of an ultrasonic diagnostic methods.
Consilium Medicum. 2016;18(9):73-79
73-79
Questions and answers in ultrasonic therapy of disturbances of cerebral hemodynamics in young patients with venous encephalopathy
Abstract
The analysis of the cerebral arteries and cerebral blood flow shows the importance of vascular pathogenetic mechanisms in the formation of autonomic disorders, headaches at young patients being treated with various forms of astheno-neurotic depressive disorders. The results of applying the method oftranscranial Doppler in complex clinical and instrumental monitoring has shown that the inclusion of this method in the diagnostic system contributes to thesolution of diagnostic, prognostic and tactical tasks. Combined therapy of these disorders includes short courses of Diacarb, Sermion, Aescusan, Semax under the control of ultrasound diagnostic techniques.
Consilium Medicum. 2016;18(9):80-86
80-86
Axonal degeneration and secondary demyelization in the central and peripheral nervous system
Abstract
Introduction. It is known that during Wallerian degeneration, regeneration of axons after injury, secondary demyelination, as well as speed and quality recovery after nerve fiber damage are different in the central and peripheral nervous system. Objective - comparative assessment of the severity of axonopathy and secondary demyelination in patients with myelopathy, and diseases of the peripheral nervous system. Methods. The study involved 115 patients with myelopathy of different genesis and the statute of limitations (main study group), 70 patients with diabetic peripheral sensorimotor polyneuropathy (comparison group 1) and 90 patients with amyotrophic lateral sclerosis (comparison group 2). Segmental (all groups) and suprasegmental (Group principal and comparisons 2) engine research conducted electroneuromyography methods and transcranial magnetic stimulation. The disease was assessed by the specialized quantitative scales with the follow-up 3 months after the initial evaluation (FIM - the main group, NDS - group comparison 1, ALSFRS-R - in the comparison group 2). Results for: change of segmental demyelinating motor conduction were significantly (p<0,05) were more pronounced in the two comparison groups with a more aggressive course of the disease - in a subgroup of patients with diabetic polyneuropathy with an increase in magnitude on the NDS, and in the subgroup of patients with amyotrophic lateral sclerosis with rapid progression rate on a scale ALSFRS-R. In patients with a primary lesion of segmental conductors - with myelopathy - a single neurophysiological examination is not allowed to judge the future course of the disease. Conclusion. The findings demonstrate the importance of considering the state of myelin in assessing the dynamics of the flow diseases of the central and peripheral nervous system.
Consilium Medicum. 2016;18(9):87-91
87-91
Lipoic acid in pathogenetic therapy of diabetic polyneuropathy
Abstract
Neuropathy is a serious complication of diabetes mellitus, where treatment involves glycemic control, pathogenic agents and symptomatic agents (analgesics), if necessary. This review shows the efficacy and safety of α-lipoic acid (ALA) in pathogenetic therapy of diabetic neuropathy. Mechanisms of action of ALA include the reduction of oxidative stress while improving endoneuronal blood flow, increase in nerve fibers conduction velocity, as well as the improvement of a number of other nerve functions. There is enough clinical trials, corresponding to modern requirements of evidence-based medicine, evidence that ALA is an effective and safe drug. As analgesic effectiveness of ALA is inferior central analgesics, but it is better tolerated, it has a more rapid onset of action, and in addition to analgesia facilitates paresthesia, numbness, reduces / eliminates muscle and sensory deficits. Therefore, ALA is a drug of choice for patients with early symptoms of neuropathic deficits, with the autonomic neuropathy of the cardiovascular system and for patients with co-morbidities to reduce the risk of polypharmacy.
Consilium Medicum. 2016;18(9):92-97
92-97
Autonomic heart neuropathy and its correction in type 2 diabetic patients
Abstract
Diabetic autonomic neuropathy of the heart develops during 3-5 years of diabetes, leads to myocardial contractility decreasing, causes cardiac arrhythmia and increases the incidence of latent ischemia and myocardial infarction. The aim of this study was to determine the effect of Cocarnit in heart autonomic neuropathy symptoms in patients with diabetes. Material and methods. The study involved 50 patients with type 2 diabetes. All patients received Cocarnit (lyophilisates for solution for intramuscular injection, administered one time per day intramuscularly at a dose of 2 ml per day for 9 days, then 3 more injections of 2 ml every other day). The main criteria for the effectiveness of the study was the dynamics of the symptoms on 5 standard tests D.Ewing and changes in heart rate variability parameters. Results and conclusions. Application of Cocarnit safe, no side effects, and improves the overall clinical impression of the patients on a scale of GCIC. Its use has a beneficial effect on the cardio-vascular autonomic nervous system, which manifests in improving the results of tests D. Ewing. Cocarnit therapy increases heart rate variability, which manifests an increase in its temporal and spectral parameters according to Holter monitoring. Cocarnit intramuscular injection once a day at a dose of 2 ml per day for 9 days, then 3 more injections of 2 ml every other day can be recommended to patients for treatment of the manifestations of heart.diabetic autonomic neuropathy.
Consilium Medicum. 2016;18(9):98-102
98-102
Neck and headache
Abstract
Current article is devoted to diagnosis and treatment of nociceptive and neuropathic pain syndromes in neck and head. From the up-to-date points of view on anatomo-physiological interactions of neck and head structures place and role of pathogenic mechanisms in formulating syndromes of cervico-cranialgia, occipital neuralgia, cervicogenic headache, tension headache, migrane are discussed. Modern diagnostic criteria of the current conditions are given. Local and systematic pharmacotherapy of skeleto-muscular and neuropathic pain in neck and head are also examined.
Consilium Medicum. 2016;18(9):103-109
103-109
110-115
Efficacy and safety of nimesulide for the treatment of patients with dorsopathy
Abstract
Lumbar pain is a common clinical syndrome characterized by a high risk of recurrence. Relief of intense prolonged pain, recurrent complications of therapy is often associated with increased drug load on the body and an increased risk of unwanted side effects. The correct choice of drug, that can provide maximum efficiency at low risk of drug complications is an important component of a successful individualized therapy. The possibilities of use of nimesulide in patients with low back pain, taking into account features of the pharmacological profile of the drug, are discussed below.
Consilium Medicum. 2016;18(9):116-121
116-121
Acute pain in the lower back and neck
Abstract
Acute pain in the lower back and the neck is a common reason for medical care. The costs associated with this disease, pose a serious financial burden on society in the developed countries. spine stability is ensured by ligaments and muscles of the back and abdomen. Some authors identify the so-called mechanical pain in the lower back, which is associated with the violation of the biomechanics of the spine, it is a musculoskeletal pain and is not associated with nerve compression or serious spine disease. The prevalence of such pain is higher in young and active adults. The most common type of neck pain is non-specific ("mechanical", axial) pain. Often the exact cause or origin of it can not be evaluated. For relief of acute pain in the back and neck most widely used non-steroidal anti-inflammatory drugs. From this group of drugs ketorolac (Ketorol) is often selected, with its analgesic effect at a dose of 30 mg, to be administered intramuscularly, is comparable to the effect of 10-12 mg of morphine or 50 mg of meperidine. Limiting the duration of treatment is able to reliably increase the safety of ketorolac therapy.
Consilium Medicum. 2016;18(9):122-127
122-127
Chronic pain in diseases of the musculoskeletal system: the use of antihomotoxic medications
Abstract
This article describes the characteristics of pain in diseases of the musculoskeletal system, its pathogenesis and treatment principles; Traumeel is examined as the drug used in the treatment of this group of diseases; its mechanism of action is understood via compiled data from clinical trials efficacy and safety of different forms of Traumeel S.
Consilium Medicum. 2016;18(9):128-132
128-132
Neurologic manifestations of alcoholic disease: the role of vitamin B in the treatment
Abstract
Chronic alcohol intoxication leads to the development of specific somatic and neuropsychiatric disorders, united by the term of alcoholic disease. The article deals with the clinical picture and leading pathogenetic mechanisms of neurological manifestations of alcoholism, which include shortage of B vitamins, especially thiamine. The role of the complex neurotropic vitamins in the treatment of lesions of the central and peripheral nervous system caused by alcohol abuse is also discussed therein.
Consilium Medicum. 2016;18(9):133-138
133-138
Psychopharmacological support in a situation to cope with stress in hypertensive patients with anxiety disorders
Abstract
The paper discusses the results of the use of anxiolytic Aphobazolum in patients with arterial hypertension (AH) associated with neurotic, stress-related disorders, among which a special place is occupied by anxiety disorders. Aphobazolum therapy was used in 31 patient cases with hypertension stage I-II has been included in the scheme of complex treatment of antihypertensive drugs of different classes, appointed in the form of mono - or combination therapy in adequate doses, depending on the degree of hypertension (blood pressure level achieved) and cardiovascular risk complications. Aphobazolum was administered at a dose of 30 mg/day for 4 weeks with the assessment of the effectiveness against the main points of its applications - alarm, gipotimii, asthenia. The anxiolytic activity of the drug manifested in the reduction of anxiety disorders, ranging from 3-5-day admission, during the 1st week of its application, which allowed to use antihypertensive therapy more efficiently. in combination with antihypertensive therapy aphobazolum treatment is not accompanied by any side effects are marked with good compatibility and portability of antihypertensive drugs and Afobazol
Consilium Medicum. 2016;18(9):139-146
139-146
Optimizing adherence to therapy in patients with non-specific back pain
Abstract
Back pain is a common complaint among people of working age. To solve this problem, a comprehensive treatment is necessary. For the purpose of pain relief nonsteroidal anti-inflammatory drugs, muscle relaxants, vitamins of group B are usually appointed. The drugs of choice are non-steroidal anti-inflammatory drugs. Their application is limited due to the risk of adverse symptoms that occur in average 20-25% of cases, particularly in individuals with comorbid pathology. Often, because of the high risk of complications, patients stop taking their self-inflammatory drugs that reduces the effectiveness of treatment, leads to chronic disease. Strict compliance with all recommendations of the doctor, or patient compliance - a difficult task. The complexity of the implementation of all provisions of the doctor due to many factors. The aim of study was to investigate its own compliance in patients with non-specific back pain, determining factors to optimize adherence to therapy with nonsteroidal anti-inflammatory drugs.
Consilium Medicum. 2016;18(9):147-150
147-150
The main problems of aging and the limited capacity of hormone replacement therapy in women
Abstract
The article deals with aging in general and the effects of aging in women, particularly menopausal symptoms. Presents modern views on the basic therapy of age-related diseases in postmenopausal women, including cognitive impairment. The possibility of effective use of the drug in women Cerebrolysin.
Consilium Medicum. 2016;18(9):151-158
151-158
159-163
Epicondylitis: current issues of diagnosis and treatment in phase of rendering primary health care
Abstract
The most common cause "pain in the elbow" is epicondylitis. Epicondylitis of the elbow area are common, having a characteristic diagnostic signs and reacting positively to treatment form periarticular pathology. The presence in the arsenal of the first contact doctor various forms of homeopathic medication Traumeel S expands its therapeutic potential and to improve health care quality and efficiency for patients in primary health care.
Consilium Medicum. 2016;18(9):164-169
164-169