Objective
Glutathione (GSH) is a major intracellular thiol-containing antioxidant. We tried to determine whether blood plasma GSH level is a marker for the severity of the two subtypes of acute stroke (large-artery atherosclerosis, LA and cardioembolic, CE). Forty-three patients with LA and 36 patients with CE aged 65 (47–82) years were included in the study. Thirty-one patients with cerebral microangiopathy were included for comparison. Total (t) and reduced (r) GSH levels were determined at admission. Neurological deficit was assessed by the National Institutes of Health Stroke Scale (NIHSS) on the first day, functional outcome and independence were assessed by the modified Rankin scale (mRs) and Bartel index (BI), respectively, after 21 days.
Results
The tGSH and rGSH levels in acute stroke were significantly lower than cerebral microangiopathy patients. Low tGSH (≤ 1.45 μM) and rGSH (≤ 30 nM) levels were risk markers for stroke severity at admission (NIHSS > 10) in patients with LA: age and gender adjusted odds ratio (AOR) was 4.95, 95% coincidence interval (CI) 1.31–18.7, AOR = 9.141, CI 1.84–45.3 for t- and rGSH, respectively. A low level of rGSH (≤ 30 nM) was found as risk marker for functional independence (BI ≤ 60: AOR = 15.9, CI 2.22–114.2) in patients with LA. Low tGSH level (≤ 1.1 μM) was associated with the reduction of poor outcome risk (mRs > 2: AOR = 0.154, CI 0.029–0.809) in CE group.
Conclusions
Low t- and rGSH levels may be considered potential risk markers for severity and insufficient functional independence in LA. Conversely, low tGSH level reduce the risk of poor stroke outcome only for CE.
Objective: Acute brain ischemia is accompanied by a disruption of low-molecular-weight aminothiols (LMWTs) homeostasis, such as homocysteine (Hcy), cysteine (Cys), and glutathione (GSH). We investigated the redox balance of LMWTs in blood plasma and its influence on ischemic stroke severity and the functional outcome in patients with an acute period. Patients and methods: A total of 177 patients were examined. Total and reduced forms of LMWTs were determined in the first 10-24 h. Stroke severity and functional state were estimated using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRs) at admission and after 21 days. Results: Patients with high levels of total Hcy (> 19 μM) showed significantly reduced redox statuses of all LMWTs. Patients with low total GSH levels (≤ 1.07 μM) were at an increased risk of higher stroke severity (NIHSS > 10) compared to patients with a total GSH level > 2.64 μM (age/gender-adjusted odds ratio: 4.69, 95% CI: 1.43-15.4). Discussion: (1) low total GSH level can be considered as a novel risk marker for the severity of acute stroke in conditions of low redox status of LMWTs and (2) high Hcy levels associated with low redox status of LMWTs.
Poststroke depression (PD) is considered as a common medical and social problem. Depression is estimated to occur in 30-35% of the patients during the first year after stroke. Despite the high level of comorbidity, PD is frequently undetectedand and untreated. Psychological impairment from stroke has a negative effect on functional outcome, rehabilitation and quality of live. On the basis of literature review present prevalence, etiology, pathogenesis,diagnosis of PD and summarize current recommendations for therapeutic intervention. A rational approach to the treatment and prevention of PD is proposed.
Представлен обзор литературы по исследованию невралгической головной боли с вегетативными проявлениями. Невралгическая головная боль с вегетативными проявлениями является первичной головной болью с фенотипом тригеминальной боли, сопровождающейся слезотечением, ринореей, покраснением конъюнктивы. Рассматриваются вопросы классификации, патогенеза, клинической картины, диагностики и лечения этой формы головной боли. Особое внимание уделено кластерной головной боли, пароксизмальной гемикрании, SUNCT-синдрому, постоянной гемикрании.
Ключевые слова: невралгическая головная боль с вегетативными проявлениями, кластерная головная боль, пароксизмаль-ная гемикрания, SUNCT-синдром, постоянная гемикрания.Rewiew of literature on the trigeminal autonomic cephalgias are presented. Trigeminal autonomic cephalgias are primary headaches with phenotype consisting of trigeminal pain with autonomic signs including lacrimation, rhinorrhoea and miosis. Discussed are issues of classification, pathogenesis, clinical picture, diagnosis, differential diagnosis and treatment of this headache. Special attention is paid to cluster headache, paroxysmal hemicrania, SUNCT syndrome, hemicrania continua.
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