Цель. Изучение особенностей оксигенации тканей и роли нитроксидэргических реакций кровообращения при ишемическом инсульте на фоне артериальной гипертонии. Материал и методы. Проведено исследование 62 пациентов мужского и жен-ского пола с диагнозом ишемический инсульт. Всем пациентам проводилась компьютерная или магнитно-резонансная томография головного мозга, цере-бральный кровоток исследовался с помощью экстра-и транскраниальной уль-тразвуковой допплерографии, центральная гемодинамика оценивалась с помо-щью эхокардиографии, проводились общеклинические методы исследования, неврологическое и нейроофтальмологическое обследование. Изучение транс-порта кислорода на микроциркуляторном уровне осуществлялось полярографи-ческим способом путем транскутанного определения напряжения кислорода в тканях. Газовый состав крови оценивался на анализаторе газов крови Easy Stat "Medica Corporation" (США). Для оценки уровня оксида азота (NO) использовали метод определения в сыворотке крови его стабильных метаболитов -нитритов и нитратов. Неврологический статус оценивался по шкале NIHSS (Шкала инсульта Национального Института Здоровья США (T. Brot, H. P. Adams, 1989). Все исследо-ванные пациенты были разделены на 3 группы по степени тяжести неврологиче-ского дефицита. Обработка полученных данных проводилась с помощью про-граммы "Statistica 6.0" с использованием непараметрического критерия Манна-Уитни. Статистически значимыми считали различия при p<0,05. Результаты. У пациентов с ишемическим инсультом наблюдались нарушения в нитроксидэргических механизмах регуляции сосудов. Снижение уровня стой-ких метаболитов оксида азота и нарушение оксигенации тканей было взаимосвя-зано с тяжестью заболевания и выраженностью неврологического дефицита. Заключение. При ишемическом инсульте происходят структурные и функциональ-ные изменения в церебральных сосудах, которые усугубляются расстройством сис-темного кровообращения, повышением артериального давления, что приводит к развитию гипоксии тканей и прогрессированию неврологического дефицита. THE INFLUENCE OF ENDOTHELIUM-DEPENDENT MECHANISMS OF VESSEL TONE REGULATION ON THE TISSUE OXYGENATION PARAMETERS IN PATIENTS WITH ISCHEMIC STROKE AT THE BACKGROUND OF ARTERIAL HYPERTENSION SYNDROMERyabchenko A. Yu., Dolgov A. M., Denisov E. N., Gumanova N. G.Aim. To study properties of tissue oxygenation and role of nitricoxyde-ergic reactions of circulation in ischemic stroke at the background of arterial hypertension. Material and methods. Totally 62 men and women included with the diagnosis of ischemic stroke. All patients underwent CT and MRI of the brain; cerebral flow was studied by extraand transcranial ultrasound dopplerography, central hemodynamics was assessed by echocardiography, the basic clinical tests performed, and neurological and neuroophthalmological examination. Study of oxygen transport on the microcirculatory level was performed by polarographic method by transcutaneous measurement of oxygen pressure in tissues. Gases of the blood were measured on the analyzer Easy Stat "Medica Corporatio...
Aim. To study features of tissue oxygenation and changes in nitroxidergic and endothelinergic mechanisms of circulation regulation in ischemic stroke and hypoxia modeling. Methods. 74 men and women with ischemic stroke were examined and experimental study on 30 outbred white male rats was conducted. All patients underwent computed tomography of the brain, neurological status was assessed and general clinical examination was performed. Tissue oxygen tension was measured percutaneuosly using polarographic method. Chronic hypoxic hypoxia was simulated in animals by daily 40-50 minutes inhalation of 10% oxygen mixture for 4 weeks. Blood oxygen tension was evaluated in patients and laboratory animals. Nitric oxide level of was assessed by determining its stable metabolites. Endothelin-1 level was determined by ELISA. Data was analyzed using «Statistica 8.0» software using non-parametric tests. Differences were considered as statistically significant at p
Н.В. Аптикеева, А.М. Долгов ГБОУ ВПО «Оренбургская государственная медицинская академия» Минздрава РоссииПациентов с вестибулярным головокружением (ВГ) часто направляют в больницу по неотложным показаниям, что делает актуальным экстренное установление причины ВГ. Обследовано 198 пациентов (86 мужчин, средний возраст -55,6±13,7 года и 112 женщин, средний возраст -69,1±9,2 года) с ВГ, поступивших в стационар с подозрением на инсульт. Ишемический инсульт в вертебрально-базилярной системе (ВБС) диагностирован только у 28 (32,5%) мужчин и 22 (19,6%) женщин, транзиторная ишемическая атака в ВБС -у 10 (12,2%) мужчин и 6 (5,6%) женщин, в остальных случаях установлены другие заболевания. Отмечается гипердиагностика инсульта в ВБС у пациентов с ВГ, обсуждается целесообразность стандартизированного подхода к проблеме головокружения и неустойчивости равновесия, привлечения мультидисциплинарной бригады к обследованию пациентов в многопрофильной больнице на этапе приемного отделения. Ключевые слова: головокружение; мозжечковый инсульт; задняя черепная ямка; тромбоз основной и позвоночной артерий; отек мозга. Контакты: Наталья Владимировна Аптикеева naptikeeva@yandex.ru Для ссылки: Аптикеева НВ, Долгов АМ. Вестибулярное головокружение и атаксия в неотложной неврологии. Неврология, нейропсихиатрия, психосоматика. 2013;(4):34-8. Vestibular vertigo and ataxia in emergency neurology N.V. Aptikeeva, A.M. Dolgov Orenburg State Medical Academy, Ministry of Health of RussiaPatients with vestibular vertigo (VV) are commonly referred to hospital, as emergently indicated, which makes the urgent establishment of the cause of VV relevant. One hundred and ninety-eight patients (86 men; mean age, 55.6±13.7 years and 112 women; mean age, 69.1±9.2 years) with VV who had been admitted to hospital for suspected stroke were examined. Ischemic stroke in the vertebrobasilar system (VBS) was diagnosed in only 28 (32.5%) men and 22 (19.6%) women; transient ischemic attack in VBS was seen in 10 (12.2%) men and 6 (5.6%) women; other diseases were identified in the remaining cases. VBS stroke was noted to be hyperdiagnosed in the patients with VV; whether it is expedient to apply a standardized approach to the problem of vertigo and unstable equilibrium and to attract a multidisciplinary team to examine patients in the admission room of a multidisciplinary hospital is discussed.
Introduction. Transient global amnesia (TGA) is a clinical syndrome, the main clinical manifestation of which is sudden development of anterograde and retrograde amnesia, lasting not more than 24 hours, without other general cerebral or focal neurological symptoms.The aim of the work was to reveal the peculiarities of clinical manifestations and data of additional methods of examination of patients with TGA syndrome referred to the primary vascular department with suspected acute cerebral circulation disorder (ACCD).Materials and methods. The study included 16 patients with transient global amnesia diagnosed according to the diagnostic criteria of Hodges and Warlow (1990). All patients underwent a detailed neurological and general medical examination. Electrocardiography, multispiral computer tomography of the head, echocardiography, ultrasound duplex scanning of the main arteries of the head and neck, laboratory examination (lipid spectrum) were performed. The Brief Mental Status Rating Scale was used to assess cognitive impairment.Results. The majority of patients had elevated blood pressure (BP). The leading trigger factor of transient global amnesia was stress. The duration of amnesia ranged from 1.5 to 5 hours. There was a significant impairment of short-term memory. On the first and second days of hospitalization, 50% of patients had normal cognitive functions on a brief mental status assessment scale, but by the 5th−7th day only 12.5 % of patients had abnormalities. Ultrasound markers of atherosclerosis in the form of intima-media complex thickening and dyslipidemia were found in 6 patients. Signs of left ventricular hypertrophy were found in the majority of patients. Discussion TGA is a relatively rare condition and an understudied syndrome. Due to its suddenness of clinical manifestation, TGA requires differential diagnostics with acute cerebral circulatory disorders, epilepsy, acute hypertensive encephalopathy and psychogenic amnesia.Conclusion. The clinical features of TGA identified in the patients were a history of arterial hypertension, elevated BP during an episode of TGA. The leading provoking factor was stress. TGA episode occurred predominantly in the first half of the day. The majority of patients had complaints of headache on admission. Cognitive disorders detected in patients on the first and second days of the disease quickly regressed to normal. Left ventricular hypertrophy was detected in most patients.
Aim. To study the role of nitroxidergic reactions of the circulatory system in the development of ischemic stroke. Methods. 51 patients (both males and females) with the diagnosis of ischemic stroke were examined. All patients were distributed to 3 groups according to the severity of neurological deficit. All patients underwent brain computed tomography or magnetic resonance imaging. Cerebral blood flow was examined by extra and transcranial ultrasonic dopplerography. Central hemodynamics was evaluated by echocardiography. General clinical examination, neurological and neuroophthalmological examinations were also performed. Vasomotor endothelial function was assessed using a 7 MHz linear transducer on the ultrasound unit «Medison SonoAce X8». The level of nitric oxide was assessed using its stable metabolites, nitrite and nitrate definition in serum. Neurological status was assessed according to the USA National Institutes of Health Stroke Scale. Results. Disorders of nitroxidergic mechanisms of blood vessels regulation were observed in patients with ischemic stroke. Endothelium-dependent brachial artery dilation disorders and nitric oxide persistent metabolites level decrease were related to the severity of the disease and the neurological deficit degree. Conclusion. The study of endothelium-dependent vascular tone regulation mechanisms revealed that these mechanisms are involved in the pathogenesis of ischemic stroke; the study of these mechanisms can be used to clarify the severity of neurological deficit, and possible prognosis.
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