ABSTRACT. This article discusses the clinical cases of rare and difficult to diagnose brain damage — osmotic demyelinating syndrome (ODS). ODS is a lifethreatening condition, manifested by acute demyelination of the headbrain on the background of water-electrolyte disturbances,usually associated with fast management of hyponatremia. Within the framework of ODS, central pontine myelinolysis (CPM) and extra-pontine myelinolysis (EPM) are observed, which are accompanied by acute demyelination in the pons and white matter of the cerebral hemispheres, respectively. In 60%, CPM combine with EPM. The main reason for the development of ODS is a violation of water-electrolyte metabolism associated with alcohol abuse, chronic hepatic and/or renal failure, diabetes mellitus, Sheehan syndrome, polydipsia, condition after the removal of pituitary adenoma, bulimia, immunodeficiency syndrome. Today, the diagnosis of ODS is based on magnetic resonance imaging of the brain. The article indicates the main causes of the disease, clinical features, methods of diagnosis and treatment, as well as the outcomes of the disease.
The modern integrated approach to the treatment of ischemic stroke (IS), in addition to pharmacotherapy, provides for the impact of physical factors. Among them is injectable carboxytherapy (ICBT). Objective. The aim of the study was to evaluate the effi cacy and safety of using ICBT in combination with a standard treatment program in patients with acute ischemic stroke. Material and methods. The main group (MG) included 39 patients with acute IS, the comparison group (GC) — 31 patients. On the second day of hospitalization, patients with MG underwent ICBT on the background of standard therapy, and GC — procedures that mimic ICBT. Clinical, laboratory and instrumental data, IS outcomes, complications, timing were assessed.Results. There were no statistically signifi cant diff erences in physiological parameters (heart rate, blood pressure, SpO2) between MG and GC during and after the course of treatment. Positive dynamics of the neurological status was observed in both groups in the form of a decrease in the NIHSS score — in the MG from 6 to 4 (p = 0.047), in the GC — also from 6 to 4 (p = 0.25). In patients with MG, trophic disorders were less likely to develop in comparison with GC — 1 (2.6%) versus 6 (19.4%), p = 0.039. ICBT did not aff ect the duration of hospitalization of patients, the duration of treatment in the intensive care unit and carrying of resuscitation and also did not contribute to reducing mortality. Changes in the indicators of the acid-base state of the blood were compensatory in nature and did not lead to changes in the pH of the blood. The decrease in pH from 7.5 to 7.4 in 30–90 minutes after the procedures was a physiological reaction of the body to the introduction of CO2 and was not accompanied by negative consequences. Conclusions. ICBT is a safe method, does not aff ect the duration of hospital stay and mortality, help lower the likelihood of complications.
Неврологическое отделение для больных с острыми нарушениями мозгового кровообращения с палатой реанимации и интенсивной терапии ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ» Российская Федерация, 129090, Москва, Б. Сухаревская пл., д. 3 * Контактная информация: Шевченко Евгений Владимирович, заведующий неврологическим отделением для больных с острыми нарушениями мозгового кровообращения с палатой реанимации и интенсивной терапии ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ».
This article will discuss the causes of Wernicke encephalopathy, diagnosis, treatment and clinical examples of this disease.
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