Chronic disorders of cerebral circulation are a common syndrome, in the pathogenesis of which the important role play structural and functional alterations in large and small arteries, autoregulation of cerebral circulation and the level of systemic arterial pressure. Drugs that increase cerebral blood flow and restore the ability to its autoregulation are used, among others, in treatment of patients with CRMC. The possibility of using nicergoline (sermion) for the treatment of patients with CRMK is considered.
The special features of the cerebral hemodynamics were studied in 138 patients with Chiari I malformation (CM) with a help of magnetic resonance angiography (MRA) and transcranial dopplerography (TCD). MRA data analysis (58) revealed the frequent presence of vertebrobasilar system (VBS) maldevelopment and embryonic type of the circle of Willis. TCD data analysis (100) discovered vertebrobasilar insufficiency and bilateral blood flow increase in the intracranial part of the internal carotid arteries giving evidence of the compensated blood flow from the carotid system to the VBS. 21,0% of patients with CM and communicating hydrocephalia had TCD signs of intracranial hypertension. The most significant changes in cerebral hemodynamics were found in patients with marked pathology and elder than 30 years old.
Цель исследования. Изучение состояния церебральной гемодинамики и тромбоцитарного гемостаза у пациентов с каротидным стенозом (КС). Материал и методы. Обследовали 123 пациентов с атеросклеротическим поражением сосудов каротидной системы. В 1-ю группу были включены 53 пациента (средний возраст 52±12,5 года), перенесшие каротидную эндартерэктомию (КЭАЭ), во 2-ю-70 больных с КС, которые лечились консервативно (средний возраст 58,5±15,9 года). Оценивали состояние кровотока по магистральным артериям головы (УЗДГ), агрегацию тромбоцитов, индуцированную адреналином, частоту острых сердечно-сосудистых событий, возникших на протяжении 12 мес. Результаты и заключение. Выраженность неврологического дефицита и когнитивных нарушений увеличивалась по мере нарастания степени КС. КЭАЭ приводит к улучшению показателей церебральной гемодинамики и стабилизации когнитивных функций. Неблагоприятное течение заболевания имело место у 23,6% больных (инсульт/инфаркт в течение года у 5,7%, прогрессирование ишемии головного мозга у 20%, рестеноз в течение 5 лет после КЭАЭ у 15%). У 53% оперированных и 60% неоперированных больных выявлены гиперагрегация тромбоцитов, индуцированная АДФ и адреналином, и сниженная агрегация тромбоцитов, индуцированная коллагеном на фоне приема АСК. Таким образом, применение комбинированной антиагрегантной терапии обеспечивает нормализацию тромбоцитарного гемостаза и снижение частоты острых сердечнососудистых событий. Ключевые слова: атеросклеротический стеноз сонных артерий, агрегация тромбоцитов, гемодинамика, каротидная эндартерэктомия, хроническая ишемия мозга, профилактика.
Ischemic stroke (IS) is one of the main causes of fatal income and disability in most developed countries. Disability due to IS is primarily caused by motor (paresis, ataxia), cognitive and emotional disorders. Post-stroke depression and dementia are associated not only with low compliance to rehabilitation measures and their low efficacy, but also with an increased risk of repeated episodes of acute brain and coronary ischemia, and mortality from cardiovascular diseases. Correction of post-stroke disorders is a complex process; its effectiveness is ensured by timely detection of disorders, early treatment onset, and combined use of medications and non-medications. The article discusses methods to the treatment of patients who have experienced IS, receiving choline alfoscerate. The results of drug administration in both acute and longterm IS were analyzed. Improvement of motor, cognitive and emotional functions was noted. Good tolerability of the drug and the possibility of its simultaneous use with other drugs were emphasized. KEYWORDS: ischemic stroke, post-stroke depression, post-stroke cognitive impairment, hemiparesis, neurometabolic drugs, choline alfoscerate, treatment, rehabilitation. FOR CITATION: Chugunov A.V., Pyshkina L.I., Osmayeva Z.Kh. Correction of post-stroke cognitive and motor disorders. Russian Medical Inquiry. 2020;4(9):584–589. DOI: 10.32364/2587-6821-2020-4-9-584-589.
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