URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720.

The aim of the research was to study the effect of the inclusion in the scheme cytoflavin patient care during the recovery period of ischemic stroke in the neuropsychological changes in the status and content of neurotrophins in serum. For this purpose we surveyed 52 patients who underwent a first ischemic stroke (29 women and 23 men) aged 52-74 years. Patients were divided into 2 groups: primary (25 patients) received in addition to basic therapy cytoflavin: intravenously at 20 ml per 400 ml of 5% glucose solution, 1 time a day for 10 days, then into 2 tablets 2 times a day for half an hour before food for a month, and the comparison group (27 patients) who received standard treatment. The control group consisted of 12 healthy people. In addition to standard clinical and laboratory tests were carried out a comprehensive neuropsychological study and evaluation of the data on the scale NIHSS, Bartell, Beck, Spielberger-Hanin, test «frontal dysfunction of the battery» and the Mini-Mental State Examination. Furthermore, determination carried neurotrophic factors: nerve growth factor (NGF) and brain-derived neurotrophic factor brain (BDNF). The study was conducted in the dynamics: before treatment and 2 months after treatment. Patients in the recovery period of the first ischemic stroke revealed moderate manifestations of neuropsychological disorders status and reduction of neurotrophic factors. Inclusion in cytoflavin scheme increased the efficiency of the treatment, which was manifested in a more pronounced when compared with the results of basic therapy, positive dynamics of neurological symptoms and improved cognitive function, accompanied by an increase in BDNF levels. The data on the efficacy and safety allow us to recommend its inclusion in the scheme of treatment of patients in the recovery period after the first carotid ischemic stroke.

No abstract

No abstract

Открытое овальное окно (ООО) является важной причиной эмболического криптогенного инсульта (ЭКИ) у молодых пациентов. Главным механизмом при этом служит парадоксальная эмболия (ПЭ), в основе которой лежит праволевый шунт (ПЛ-шунт). Цель исследования-сравнительная характеристика пациентов, перенесших ЭКИ, с наличием и отсутствием ПЛ-шунта по данным транскраниальной допплерографии с пузырьковой пробой (ТКДГ-ПП). Пациенты и методы. У 40 пациентов с эмболическим криптогенным острым нарушением мозгового кровообращения проводился поиск ПЛ-шунта с помощью ТКДГ-ПП с последующей чреспищеводной эхокардиографией (ЧПЭхоКГ). Дополнительно вычисляли индекс объема левого предсердия (ИОЛП). Поражение головного мозга проанализировано методом вероятностного картирования очагов по данным магнитно-резонансной томографии.

Порфирия относится к редким генетически детерминированным заболеваниям, средняя распространенность в странах Западной Европы составляет 1-10 на 100 000 населения [1, 2]. Одной из самых тяжелых форм порфирии с поражением нервной системы считается острая перемежающаяся порфирия (ОПП) [3, 4]. Количество выявленных больных напрямую зависит от настороженности врачей в отношении острой порфирии и знания клинических симптомов заболевания. Химической основой порфиринов является тетрапиррольное кольцо, главная функция которого состоит в захвате ионов металлов с образованием хелатных со единений. Встраивание ионов железа приводит к образованию гема, входящего в состав гемоглобина, миоглобина, системы цитохром Р-450, ряда ферментов. Синтез гема-многоступенчатый процесс, ключевым ферментом является синтетаза δ-аминолевулиновой кислоты (δ-АЛК). Нарушение регуляции синтетазы δ-АЛК приводит к гиперпродукции и накоплению δ-АЛК и порфобилиногена (ПБГ) [5]. Основными провоцирующими факторами атак обычно являются употребление определенных лекарств, алкоголя, инфекции, колебания гормонального фона, т.е. все то, что стимулирует синтез гема [4]. Клинически ОПП проявляется симптомами поражения центральной, периферической нервной системы, болями в животе и стойким повы

Timely evaluation of cardioembolic stroke (CES) caused by atrial fibrillation is critical from the point of view of the possibility of prescribing effective secondary prevention with oral anticoagulants. Insular lesion is considered as a promising neuroimaging marker of CES.Objective: to analyze the role of insular cortex lesions using magnetic resonance imaging (MRI) of the brain as a potential neuroimaging marker of the pathogenetic subtype of ischemic stroke (IS).Patients and methods. 225 patients in the acute period of IS were examined. Depending on the stroke etiology, patients were divided into three groups: cryptogenic stroke (CS; n=99), CES (n=45), and non-CES (n=81). All patients underwent an MRI of the brain to analyze the insular cortex lesions. In 57 patients, foci of cerebral infarction were additionally marked manually on axial slices of diffusion-weighted MRI using the Anatomist software. The calculated MRI characteristics of foci for CES and non-CES groups were used to construct a decision tree in the WEKA 3.6 package. Echocardiographic markers of atrial cardiopathy were assessed in all patients – the left atrium (LA) emptying fraction and LA function index; in 68 patients, the concentration of serum NT-proBNP was also assessed.Results and discussion. The insula was affected in 12% of patients: most often in CES (33%), significantly less often in CS and non-CES (6 and 7.4%, respectively), without significant differences between the latter groups. The presence of insula lesion in relation to CES has a sensitivity of 33% and a specificity of 93% (p=0.002); odds ratio 6.25; 95% confidence interval 2.22–17.63. In most patients, the posterior insular cortex was involved in the pathological process. Isolated insular infarction occurred in only one patient with CES, while the involvement of the insula and adjacent zone, and the combination of insular infarction with territorial infarction, were observed more often. The group of patients with insular lesions was distinguished by the predominance of women, greater severity of stroke at admission, less deficit at discharge, larger LA diameter, lower LA emptying fraction, and functional index. CES was four times more common in the insular lesion group, while CS was two times more common in those without insular lesions. Insula involvement identifies three out of five CES patients according to the decision tree. Further analysis of the total lesion volume can locate almost all remaining patients with CES: they are characterized by the indicator >12 sm3.Conclusion. Insular lesions allow reliable differentiation of patients with CES and non-CES and can be considered a potential marker of the cardioembolic subtype of IS, which requires further investigation.

The authors of the article describe a case of the damage to the central nervous system by fungi of the genus Cryptococcus in a HIV-infected patient. The features of clinical manifestations and laboratory diagnostics are characterized. Special attention is paid to the discrepancy between the sharply changed appearance of the cerebrospinal fluid obtained during lumbar puncture and the clinical picture of the disease as well as the data of laboratory analysis of cerebrospinal fluid.