BackgroundIn Yakutia, the morbidity and mortality from stroke increased in the past 2 decades. Stroke share in the total mortality structure increased significantly. According to the autopsies, haemorrhagic stroke (HS) was more common in indigenous patients.ObjectiveThe aim of the study was to examine ethnic features of stroke patients of indigenous and non-indigenous ethnicity admitted to Regional Vascular Center (RVC), Yakutsk.DesignThe study used data from a hospital stroke registry, which took into account the cases of acute stroke in 2011. Stroke type and aetiology were determined by clinical examination, computed tomography and magnetic resonance imaging studies, cerebral angiography and ultrasound of cerebral vessels.ResultsA total of 1,108 patients were hospitalized (51.4% male, n=569) in 2011. The mean age was 60.5±12.9 years, male: 59.1±12.8, female: 61.9±13.05. Five hundred and ninety-two ischemic strokes (IS; 53.4%), 236 HS (21.3%), 280 transient ischemic attacks (TIA; 25.3%) were diagnosed. Patients who had a stroke were divided into 3 groups according to their ethnicity: native (n=411; 49.6%), Russians (n=347; 41.9%) and other nationalities (n=70; 8.5%). When comparing the incidence of HS in different ethnic groups, it was found that indigenous patients had more cases of HS than Russians (38% vs. 20.2%, p<0.05; adjusted odds ratio=2.42; 95% confidence interval: 1.72–3.41). Mean age of IS and HS indigenous patients had no significant differences compared with the average age of Russian ethnicity patients (p=0.69; p=0.201, respectively).ConclusionsThe data from this study suggest that among the patients who suffered from stroke in the indigenous population, the share of a haemorrhagic form washigher than those of non-indigenous Caucasians. At the same time, the average age of patients, both having IS and HS had no significant differences by ethnicity. Further studies are needed to establish the causes of ethnic differences of stroke in Yakutia.

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Occlusion of the artery of Percheron is the cause of bilateral thalamic infarctions, sometimes involving structures of the midbrain. A clinical case of intravenous thrombolytic therapy for ischemic stroke due to the occlusion of the Percheron artery in a 72-year-old female patient who developed depression of consciousness, oculomotor disorders, dysarthria, ataxia, pyramidal disorders, and cognitive disorders is presented. Magnetic resonance imaging, which detected bilateral thalamus paramedian infarction in the acute stage, made it possible to diagnose the occlusion of the Percheron artery. Intravenous thrombolysis led to a rapid regression of symptoms; at the end of the acute period of the disease, the patient was discharged from the hospital with a slight neurological deficit and with a good functional outcome. After a one year the dynamic observation revealed persistent mild cognitive disorders; magnetic resonance imaging showed small symmetric cystic-gliosis changes in the medial parts of the thalamus on both sides. Timely diagnosis and intravenous thrombolytic therapy contribute to a good outcome of cerebral infarction due to the Percheron's artery occlusion.

Relevance. Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition. Incorrect diagnosis of aSAH in a rural medical institution can lead to a delay in surgical treatment and worse outcomes of the disease in patients with ruptured cerebral aneurysms (CA). Objective. Analysis of diagnostic algorithms and evaluation of outcomes of surgical treatment of ruptured cerebral aneurysms in a region with a vast sparsely populated territory. Materials and methods. A retrospective analysis of the results of surgical treatment of 145 patients with aSAH, hospitalized in the Regional Vascular Center (RVC) in Yakutsk city, for 2017–2018 was carried out. The subjects were divided into 3 groups: group 1 — rural residents who were diagnosed with aSAH in rural medical institutions; group 2 — rural residents who were incorrectly diagnosed in rural medical institutions; group 3 — residents of Yakutsk who were hospitalized in the RVC by emergency medical services. Results. The study included 145 patients with aSAH. All patients underwent surgical treatment. The majority of patients (91 patients, i.e. 62.8 % of the total number of patients) were brought to the RVC by air medical service from the regions of the Republic. An erroneous diagnosis at the initial health encounter was established in 12 cases (8.3 % of the total number of aSAH cases), including in 11 cases in medical institutions of small villages (91.7 %) and only in 1 case in the Central District Hospital (8.3 %). Conclusions. During the initial health encounter of patients with aSAH, incorrect diagnoses were established in 8.3 %, of which 91.7 % were established in medical institutions of small villages. Emergency hospitalization of patients with suspected aSAH in the RVC ensures correct diagnosis of the disease and timely neurosurgical treatment.

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Relevance. To provide emergency specialized neurosurgical care to patients living in rural areas, medical evacuation to a neurosurgical hospital is required. Despite the fact that medical evacuation is a necessary stage of medical care, there are not enough studies on the impact of transportation of patients with a ruptured cerebral aneurysm over long distances. There is little information about the time intervals for transportation, the timing of the start of treatment and the outcomes of the disease in patients who are at a considerable distance from the neurosurgical hospital.Aim of the study. To analyze the impact on the extensive results of surgical treatment of patients with cerebral aneurysm rupture.Material and methods. A retrospective analysis of the results of surgical treatment of 145 patients with cerebral aneurysm rupture in the acute period of hemorrhage, hospitalized in the regional vascular center of the State Budgetary Institution of the Sakha Republic (Yakutia) “Republican Hospital No. 2 — Center for Emergency Medical Aid” in the period from 01.01.2017 to 31.12.2018. Patients were divided into two groups: Group I — patients from remote areas of the Republic of Sakha (Yakutia) who underwent medical evacuation by the Disaster Medicine Service of the Sakha Republic (Yakutia); Group II — hospitalized from the territory of the city of Yakutsk and its nearest suburbs.Results. 145 patients were hospitalized at the regional vascular center in Yakutsk. Sanaviation (Sanitary Aviation) delivered 91 patients from the districts of the republic to the regional vascular center (62.8% of the total number of patients) (Group I), 54 patients (37.2%) were hospitalized from the territory of the urban district of Yakutsk (Group II). The distance of transportation by ambulance aircraft in Group I ranged from 45 to 1330 kilometers. Deterioration from admission to the local medical organization to admission to the regional vascular center was noted in 8 patients (8.8%), improvement in the condition in 25 (27.5%) patients, there were no dynamics of changes in the state of 58 (63.7%) patients. The total number of deaths in two groups of patients was 11 (12.1%) patients. Postoperative mortality had no statistically significant differences between the two study groups: in Group I — 7.7% (7 patients), in Group II — 7.4% (4 observations) (p=1,000).Conclusions. With an established system of medical evacuation, transportation over a considerable distance does not worsen the course of the disease and the results of surgical treatment of patients with cerebral aneurysm ruptures in the acute period of hemorrhage.

A study has been conducted to investigate the relationships between the risk of developing various pathogenetic subtypes of ischemic stroke (IS) and its outcomes with chronic kidney disease (CKD). A retrospective study was conducted in the group of IS patients (n=1070): with CKD (n=343) and without CKD (n=727). TOAST classification was used to determine IS subtypes. The study data showed that in patients with CKD compared to patients without CKD, TOAST2 frequency was more common in total group (p<0.0001; OR=1.878 (1.423-2.478)), among men (p<0.001; OR=2.008 (1.370-2.943)) and among women (p=0.009; OR=1.720 (1.145-2.584)); TOAST1 frequency was rare in total group (p<0.0001; OR=0.565 (0.435-0.734)), among men (p<0.0001; OR=0.502 (0.353-0.713)) and among women (p=0.042; OR=0.665 (0.448-0.487)); stroke manifestations were more severe an NIHSS scale (p=0.0001), Glasgow coma scale (p=0.002); IS mortality was higher (13.7 % versus 7.4 %; p=0.001;) in total group and TOAST2 mortality was higher (25.0 % vs.14.9 %; p=0.027; OR=1.910 (1.072-3.404) in total group and among women (29.7 % versus 11.1 %; p=0.004; )). Conclusions. IS patients with CKD are more likely to develop cardioembolic stroke (p<0.0001; OR=1.878 (1.423-2.478)), have more severe stroke manifestations (NIHSS score, p=0.0001; Glasgow score, p=0.002), have higher cardioembolic stroke mortality among women (29.7 % versus 11.1 %; p=0.004;) compared to IS patients without CKD.

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