This article defines vertebra-related causes of vertebrobasilar insufficiency in patients with the signs of tortuosity of segment VI of the VA. The aim of this study is to present the results of diagnostics of discirculatory phenomena in the vertebrobasilar system and to show their importance for differentiated surgical treatment of stenotic lesions of segment V1 of VA in pathological disorders of cerebral circulation in the VBS caused by osteochondrosis of the cervical spine. The following traditional methods are used in diagnostics: Doppler ultrasonography, multispiral computed tomography with contrast enhancement. Also using developed by the author method for determining VA reactivity and circulatory insufficiency in the vertebrobasilar system (VBS). Based on our methodology and criteria, patients were selected for different types of surgical treatment with clinical outcome prediction following interventions on the arteries of the VBS. To determine the pathologies of the intracranial segments of the vertebral and basilar arteries, taking into account the pathways of collateral compensation in the VBS, cerebral angiography is recommended before surgery on the arteries of the VBS. Reconstructive techniques used on segment VI of the VA will predictably show the best long-term clinical results. The excision of a tortuous segment VI of the VA may be effective in obtaining reliable results of successful interventions in the early postoperative period. The conservative treatment of the patients with multiple VBD lesions is possible. early outcomes of their use are satisfactory.
Epithelioid hemangioendothelioma (EHE) is one of the rarest vascular tumor found in the brain. In the pediatric group of patients, the proportion of EHE is only 0.02% of all brain neoplasms, and therefore oncogenesis and the causes are currently not well understood. Intracranial localization of EHE is extremely rare, nevertheless, this type of neoplasm should be included in the differential diagnostic series when multiple small intracerebral masses with hypointense MR signal in T2 mode are detected on magnetic resonance imaging. No specific therapy is currently developed for this disease, the optimal treatment is surgical removal of the volumetric mass if this type of treatment is possible. This article presents a clinical case of a primary multiple CNS lesion in a 14-year-old child with a long history of epilepsy. According to our data, the presented clinical case is the only one registered in the world, with primary multiple CNS EHE of the brain in the pediatric population
The most severe course of COVID-19 is observed in patients with vascular comorbidity (more than 3 cardiovascular diseases). At the same time, a large number of complications from various organs and systems are recorded in this group of patients, with acute stroke being one of the most severe. Stroke in patients with COVID-19 is characterized by a severe clinical course, with a high rate of deaths and poor rehabilitation prognosis in the early and late recovery period. The cohort combined retrospective-prospective study included 80 patients. All subjects were divided into groups: 1) patients with stroke and COVID-19; 2) stroke patients without COVID-19; 3) COVID-19 patients without stroke. All patients underwent complex clinical and laboratory monitoring, including general and biochemical blood tests, assessment of hemostasis and the level of pro-inflammatory cytokines, and MSCT of the brain and lungs. As a result of the study, it was found that patients with stroke and COVID-19 have a more severe course of the disease with a high incidence of multiple organ dysfunction syndrome (MODS) and deaths at the hospital stage.
The paper considers a case of surgical treatment of a patient with a completed stroke in the brain stem in anamnesis and with a clinical picture of chronic vertebrobasilar insufficiency caused by combined occlusion of the right vertebral artery (VA), hypoplasia of the left VA, and pathological tortuosity of the right internal carotid artery (ICA). The patient underwent extra-anatomical reconstructive surgery: simultaneous lowering of the loop of the right ICA and its resection in the middle third with redressement and reimplantation in the proximal third of the ICA with the formation of the ICA-ICA end-to-side anastomosis and the subsequent creation of an end-to-side anastomosis between the free end of the resected ICA and the V3 segment of the right VA. In addition, a case of surgical treatment of isolated bifurcation of the common carotid artery (CCA) that occurs when the proximal CCA is occluded and the blood flow is maintained in the external carotid artery (ECA) and ICA is considered. These reconstructive surgical interventions for combined lesions of the main arteries of the head are safe and reliable methods for the treatment of chronic cerebral ischemia and effective prevention of recurrent ischemic strokes.
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