The aim of the study was to Doppler sonography study of the structural and functional state of head magistral arteries (HMA) and cerebral arteries in the patients with various forms of migraine. Materials and methods: We conducted the clinical Doppler examination of 124 young patients (18-45 years old), including 55 men and 69 women in the conditions of the clinical base of the Kharkiv Medical Academy of Postgraduate Education in 2017-2019. The criteria for involvement of patients in the study were: migraine without aura (group 1 – 63 patients), migraine with aura (group 2 – 61 patients) The control group consisted of 45 patients of the corresponding gender and age. The condition of HMA and cerebral arteries was studied using the ultrasound device. Results: The presence of extravasal compressions of vertebral arteries (VA) is typical for the patients with migraine, as well as for some cases of the hypoplasia of the VA in the group of the patients with migraine with aura. In the patients with migraine with aura, there was a decrease in the velocity values in the extracranial VA segments. The velocity values in the external carotid arteries (ECA) were slightly reduced in both groups. The most significant were the changes in the hemodynamics in the middle cerebral arteries (MCA), which were manifested by the pattern of the excessive perfusion in the patients of the migraine without aura and the pattern of the hampered perfusion in the MCA in the patients of the migraine with aura. Conclusions: 1. In the patients with migraine with aura, a decrease in the velocity values in the extracranial segments of the VA was observed, in some cases combined with the hypoplasia of the vertebral artery, the hampered perfusion in middle cerebral arteries. 2. The excessive perfusion in middle cerebral arteries is the most critical hemodynamic pattern in the patients with migraine without aura. 3. The extravasal compression of vertebral arteries, combined with the hyperperfusion in posterior cerebral arteries, is a typical hemodynamic pattern both in the group of the patients with migraine with aura, and in the group of the patients with migraine without aura.
The aim of the study was to Doppler sonography study of cerebrovascular reactivity in young patients with migraine and comparison of autoregulation patterns between groups of migraine patients with aura and migraine without aura. Materials and methods: We conducted the clinical Doppler examination of 124 young patients (18-45 years old), including 55 men and 69 women in the conditions of the clinical base of the Kharkiv Medical Academy of Postgraduate Education in 2017-2019. The criteria for involvement of patients in the study were: migraine without aura (group 1-63 patients), migraine with aura (group 2-61 patients) The control group consisted of 45 patients of the corresponding gender and age. The indicators of CVR were studied using the ultrasound device. Results: A hyperreactive response to tests with CO2 and photoreactivity were more pronounced in the patients with migraine without aura. The patients with migraine with aura showed hyperreactivity in the test with O2, which was an indicator of the tendency to hyperconstriction. The hyperreactivity in the functional nitroglycerin test and the carotid compression test shows the state of the myogenic mechanism of changes in vascular tone. Insignificant hyperreactivity to orthostatic load detected in both groups shows the interest of the neurogenic regulatory link. Conclusions: 1. The most important hemodynamic patterns in the patients with migraine are excessive perfusion with migraine without aura and difficult perfusion with migraine with aura. 2. For the patients with migraine without aura, a characteristic criterion for autoregulation is the pattern of hyperreactivity hypercapnic load and photostimulation. 3. The most important difference in the autoregulatory response in the patients with migraine with aura compared with migraine without aura is the hyperresponse to hyperventilation load, compression carotid and nitroglycerin tests.
The aim: A comprehensive assessment of the state of the autonomic nervous system and cerebrovascular reactivity of the cerebral blood flow in the patients with the headache accompanied by arterial hypertension (AH) and somatoform autonomic dysfunction (SAD). Materials and methods: We conducted the clinical, autonomic regulation and Doppler sonography examination of 124 young patients (18-45 years old), including 51 men and 73 women in the conditions of the clinical base of the Kharkiv Medical Academy of Postgraduate Education in 2018-2021. All patients with cephalgias were divided into three groups: with AH stage II (Group I - 41 patients), AH stage I (Group II - 40 patients), SAD (Group III - 43 patients). The control group consisted of 50 patients of the corresponding gender and age Results: The intensity of cephalalgia in patients with SAD was maximum. The autonomic tone (AT) was changed in 68.5%examined patients. It had a pronounced shift towards sympathicotonia. According to the visual analogue scale the maximum intensity of cephalgias was against the sympathicotonia. In the groups with organic lesions of the cerebral vessels the latent period delay was registered with the progression of the organic pathology. The regularity was revealed - the shortening of the evoked skin sympathetic potentials latency with the severity of cephalalgia, which can be interpreted as an increase in ergotropic effects with the realisation of the pain syndrome. The obtained data on the state of the AT indicate the depletion of the ergotropic processes with the progression of cerebral ischemia with a known increase in parasympathicotonia. In the patients of SAD group the CrCO2 and KrFNTvalues were significantly increased, in AH stage I group they slightly exceeded the standard values , in AH stage II group they were reduced. The reactivity to the orthostatic loads and functional metabolic test in all groups exceeded the control values. Conclusions: 1. The cephalgic syndrome is one of the main symptoms of the autonomic dysfunction and arterial hypertension; the frequency and intensity of the headache increases with the hyperreactivity of the sympathetic system. 2. The SSP data indicate that the sympathetic activity triggers and maintains the pain syndrome, and can also be realized in the form of arterial hypertension. 3. The dysfunction of the central link of the GSR indicates the instability of the autonomous regulation, the work of the limbic-reticular complex, which is clinically manifested by the changes in the cerebral vascular tone. 4. The cerebrovascular hyperreactivity as a sign of the search for the optimal sanogenetic variant of the cerebral hemodynamics in patients with SAD and AH stage I occurs predominantly due to the vasodilatory component. 5. In the patients with AH stage II the vasoconstrictor reactions are observed with the depletion of the vasodilation reserves, which is a marker of the autoregulation failure.
The aim: The aim of the study is the clinical-pathogenetic reasoning of vestibular dysfunctions (VD) development against the background of chronic brain ischemia in the presence of degenerative changes in the cervical spine (CS) in the post COVID period. Materials and methods: 82 patients, in the conditions of the clinical base of the Odessa National Medical University in 2019-2021 were examined. Group I with VD against the background of chronic brain ischemia (CBI) at the compensated phase; Group II with VD against the background of CBI at the subcom¬pensated phase (33 men; 49 women), aged from 18 to 55 years. The control group (CG) consisted of 20 patients of the corresponding gender and age. The condition of the state of the autonomic nervous system, vestibular functions, cervical spine, cerebral arteries and emotional condition were examined. Results: Vestibulo-ataxic disorders were higher compared to CG and increased along with the degree of brain damage. An important aspect of the development of VD is autonomic dysfunction against the background of pathological autonomic characteristics with predominant parasympathetic orientation of autonomic tone, especially in the case of insufficiency of autonomic recativity (AR) and pathological autonomic support of activity. Such changes significantly increased in the presence of subcompensation of CBI. The correlation between psychoemotional disorders and changes in autonomic characteristics with VD against the background of CBI with initial regularities depending on the degree of brain damage was defined. The progression of CBI is facilitated by coronavirus infection and manifested in autonomic and psychoemotional dysfunctions. A characteristic hemodynamic feature in groups with compensated and subcompensated CBI is the presence of reduced perfusion in basilar (BA) and vertebral (VA) arteries. Changes in cerebral vascular reactivity with a decrease in cerebrovascular reactivity indicators were characteristic of the subcompensated phase of CBI. Hyperactivity to rotational functional loads in both clinical groups has a high correlation with the presence of stair descent and, to a lesser extent, isolated instability in CS. Conclusions: 1. The occurrence of VD is facilitated by the presence of autonomic dysfunction and degenerative-dystrophic changes in the CS, especially in case of subcompensation of CBI. 2. Psychoemotional changes were a characteristic feature of patients with VD against the background of CBI and had certain regularities depending on the phase of CBI. 3. Suffered coronavirus infection contributes to the progression of VD and further decompensation of CBI due to direct damage to the autonomic and vascular systems of the brain. 4. Changes in cerebral hemodynamics in the form of reduced perfusion in BA and VA, a decrease in cerebrovascular reactivity, and an increase in reactivity to rotational functional load were determined in patients with VD against the background of subcompensated CBI.
Introduction: Tension-type headache (TTH) is very common, with a lifetime prevalence in the general population ranging in different studies between 30% and 78%. TTH, divided into episodic and chronic types, introduced in the manual "International Classification of Headache Disorders"(ICHD-I), is of practical importance. Infrequent episodic headaches (no more than once a month) may not require drug therapy, but, on the contrary, frequent forms may require expensive treatment. Objective: To study the state of cerebral hemodynamics and cerebrovascular reactivity in patients with Tension-type headache and evaluate the efficacy of treatment with Phenibite using Doppler ultrasound. Materials and Methods: A retrospective analysis of the results of ultrasound dopplerography of the anterior, middle and posterior cerebral arteries (ACA, MCA and PCA), Vertebral and Basal (VA, BA) arteries was performed in 188 patients with TTH. Among them are infrequent episodic TTH - 68 (36,2%) patients, frequent episodic TTH - 64 (34,0%) patients, chronic TTH - 56 (29,8%) patients. The age of the subjects was 18-45 years, among them 85 (45.2%) men and 103 (54.8%) women. The maximum systolic velocity (Vs), the end diastolic velocity (Vd), the resistance and pulsativity indexes (RI, PI) in all vessels were determined. Patients were given consent to participate in the study. Results: Infrequent episodic (IFE) TTH were recorded in 86.4% of cases, frequent episodic (FE) — in 88.9%, and chronic (Ch) TTH — in 81.6% of cases. Bilateral TTH was noted in 39.2%, frontal localization - in 35.6%, in the occipital region - in 25–7% of cases. The asymmetry of the maximum systolic blood flow velocity (Vs) in the paired arteries within 20-30% was considered a violation of cerebral hemodynamics, which was detected in 38.7% of patients. An increase in Vs was noted in all cerebral vessels, especially in patients with FE TTH and chronic Ch TTH compared with the control group. In patients with IFE TTH the average value of RcFMt was 1.24±0.03, in patients with FE TTH - 1.25±0.02, in patients with Ch TTH - 1.27±0.03. In patients with TTH, hyper-responsiveness to hypercapnic test was detected: RcCO2 was 1.43±0.05 in the group with FE TTH; 1.39±0.07 in the group of Ch TTH and 1.37±0.04 in the group of IFE TTH, which indicates a tendency for the tension of the vasodilator regulation mechanism even in clinically insignificant forms of TTH. In the study of reactivity to the O2-test, a hyporeactive response was observed in the groups with FE TTH and Ch TTH (0.38±0.04 and 0.35±0.05, respectively. The treatment with Phenibut carried out in a step-by-step manner - during the first week the drug was applied at a dose of 250 mg 2 times a day, over the next 6 weeks the dose increased to 500 mg 2 times a day, then the dose was reduced back to 250 mg 2 times a day. Among patients with FE TTH, the frequency of headache decreased from 5.7±2.3 to 3.6±2.1 days/month, and in patients with Ch TTH - from 22.8±1.7 to 17.7±1,3 days/month (P<0,05). Influence of the drug was manifested at the initially increased RcFMt and RcCO2. A decrease in initially elevated RcCO2 was noted in all (FE TTH, ChTTH, IFETTH) clinical groups. However, this decrease was not statistically significant. Conclusion: In patients with TTH, an increase in the Vs is more often recorded, their asymmetry in the middle cerebral artery. Hyperreactivity on CO2-load is typical for patients with chronic TTH, and reflects the mobilization of metabolic regulation of cerebral blood flow. Conducting FMt was the most informative method for detecting autoregulatory disorders mainly in patients with IFE TTH. FE TTH in patients is characterized by the presence of a hyperactive reaction to hypercapnic and orthostatic tests, probably due to mobilization of humoral-metabolic and neurogenic links of regulation. In the group of patients with chronic TTH prevails hyporeactivity for hyperventilation test, reflecting the depletion of vasoconstriction reserve. The use of Phenibut(Noophen® (JSC Olainfarm Latvia in the treatment of TTH is accompanied by a decrease in the frequency of pain, and of pericranial muscle tone, most pronounced in patients with FE TTH. It's effectiveness is evident in the normalization of the coefficients of cerebrovascular reactivity in a patients with chronic TTH. The minimal statistical significance was observed on the dynamics of blood flow only in the VA.
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