The aim was to analyze the contemporary scientific literature on Devic’s opticomyelitis and to present a case report from our clinical practice. Based on the patient’s complaints, case history and features of clinical course, objective neurological status, clinical laboratory and additional examination methods, characteristic MR-patterns, consultations of related specialists and differential diagnostics, we made the clinical diagnosis according to ICD-10: G36.0 Devic’s opticomyelitis, exacerbation, with a sustained bilateral lesion of the optic nerves in the form of retrobulbar neuritis with the development of partial atrophy of the optic nerves in both eyes, spinal cord lesions with common cystic, cicatrical and atrophic alterations at C1-Th8 level with moderate lower paraparesis, expressed by sensory ataxia, sensory disturbances by the descending conductive type from Th10, impaired function of pelvic organs by the type of acute urinary retention, asthenic and neurotic syndrome. Widespread cases of demyelinating pathology in medical practice and complexity of differential diagnostics determine the need for a specific diagnostic algorithm. This algorithm should consider anamnestic data along with the course of the disease, clinical, laboratory and instrumental examination, including neuroimaging, analysis of CSF for oligoclonal bands, analysis for IgG antibodies to AQP4, which will allow to carry out diagnostics and to decide on tactics for further management of patients of this cohort. Further research is needed to conduct additional studies for optimization of tactics for dynamics monitoring and improvement of diagnostic, treatment and rehabilitation measures in patients with Devic’s opticomyelitis, including appropriate immunological control, given the complexity of differential diagnostics and the affinity of this pathology to multiple sclerosis.
The aim: Was to evaluate the impact of active rehabilitation treatment in the scheme of comprehensive therapy of patients with cerebral hemispheric ischemic stroke on the dynamics of recovery of cognitive and psychoemotional disorders, as well as to study their correlations. Materials and methods: The study involved 138 patients: 30 apparently healthy individuals (control group, CG, n = 30) without acute cerebrovascular disorders (anamnestic and neuroimaging), of whom 53.33% were men (n = 16) and 46.67% women (n = 14), the average age of patients in the group was 57.9 ± 1.45 years; 108 people diagnosed with cerebral hemispheric ischemic stroke (n = 108), of whom 62.96% were men (n = 68) and 37.04% women (n = 40), the average age of patients in the group was 58.4 ± 0.76 years. The neurocognitive assessment was performed using the international standardized scales: MMSE, MoCa were used to assess the cognitive sphere, and BDI, STAI (STAI SA, STAI TA) were used to assess psychoemotional disorders. Results: Patients in the comprehensive treatment scheme were additionally prescribed and given two courses of rehabilitation treatment using active rehabilitation methods after the first and third examinations, recovery of cognitive and psychoemotional disorders was significantly faster and better than in group 1, where “classical” measures were applied with the predominance of medicinal therapy. Thus, the average score on the MoCa scale during examination on days 3-7 after cerebral hemispheric ischemic stroke in group 1 was 19.71 ± 0.62 points, in group 2 – 19.17 ± 0.54 points, and during evaluation after 6 months in group 2 – 24.72 ± 0.26 points against 22.19 ± 0.41 points (p <0.0001) in group 1. According to the MMSE scale during examination on days 3-7 after cerebral hemispheric ischemic stroke, the average indicator in group 1 was 22.56 ± 0.43 points, in group 2 – 22.47 ± 0.37 points, and when evaluated after 6 months in group 2 – 25.83 ± 0.23 points against 24.35 ± 0.27 points (p = 0.0001) in group 1. Conclusions: The use of methods for active rehabilitation in the treatment of patients in acute and recovery periods of cerebral hemispheric ischemic stroke significantly contributes to the acceleration and enhancement of the recuperation of cognitive and psychoemotional functions after the acute cerebral accident. The obtained results can find practical application in improving the effectiveness of therapeutic and rehabilitation programs in patients with cerebral hemispheric ischemic stroke to reduce their post-stroke deficit.
The aim – to consider the etiopathogenesis, the main clinical manifestations, diagnostic criteria of NF1, and present a clinical case from their practice. The paper analyzes the research findings in recent publications, focused on the studied issue using the methods of continuous sampling, synthesis and generalization, bibliosemantic evaluation and content analysis. In order to attract the attention of family physicians, neurologists, dermatologists, ophthalmologists, surgeons and other specialists, we present our own clinical observation of NF1. The patient was examined using the methods of neurological examination, as well as other laboratory and instrumental methods of research. Early diagnosis and medical examination of patients with NF1 is crucial for predicting and improving the quality of life of patients. NF1 is a complex disease where the cooperation of doctors of different specialties is important. A favorable prognosis for patients is associated with the possibility of early diagnosis of malignant transformation and timely treatment.
The article considers the influence of α-glycerylphosphorylcholine in the scheme of comprehensive therapy on the dynamics of functional recovery in patients with cerebral hemispheric ischemic stroke. Against the background of the progressive growth of acute cerebral infarction, the problem of timely care is relevant. Timely treatment of stroke, based on evidence-based medicine, along with early activation and rehabilitation of patients is designed to reduce mortality and subsequent disability of patients. Given that cholinergic insufficiency and structural and functional damage of neurons play an important role in the pathogenesis of post-stroke disorders, the use of medicines for their correction, in particular α-glycerylphosphorylcholine, is justified. Choline alfoscerate, a precursor of acetylcholine and phosphatidylcholine, is broken down by enzymes into choline and glycerophosphate when ingested, and the choline thus obtained is able to improve neuronal functionality in patients with neurodegenerative and vascular diseases. The study revealed a significantly better recovery of impaired motor and cognitive functions after cerebral hemispheric stroke under the influence of comprehensive therapeutic and rehabilitation measures using active rehabilitation methods in conjunction with α-glycerylphosphorylcholine. The results obtained during the study allow us to report the advantage of a combination of methods of active rehabilitation and the use of the pharmacological agent α-glycerylphosphorylcholine. The feasibility and efficacy of α-glycerylphosphorylcholine are related to its ability to reduce motor and cognitive deficits after ischemic stroke. The scheme of comprehensive treatment of patients in acute and restorative periods of cerebral hemispheric ischemic stroke with the use of α-glycerylphosphorylcholine helps to increase the effectiveness of functional recovery after an acute cerebral accident, and can be used in the use of therapeutic and rehabilitation programs for patients after cerebral hemispheric ischemic stroke to reduce the post-stroke deficit.
Cerebral stroke is one of the most common causes of death; in most countries it is ranking the third position by the incidence rate. The prevalence of strokes in Ukraine is one of the highest in Europe. In recent years, there has been an increase in the prevalence of post-stroke cognitive and anxiety-depressive disorders. The aim of the study is to identify and analyze the features of correlations between cognitive and psycho-emotional disorders in people in the acute period of cerebral ischemic stroke of different hemispheric localization. Materials and methods. The study included 43 post-stroke patients, average age 59.81±1.28 years. The dextrocerebral ischemic stroke was diagnosed in 20 patients (46.5%, group 1; average age 61.25±1.98 years), sinistrocerebral ischemic stroke was detected in 23 patients (53.5%, group 2; average age 58.57±1.67 years). The control group consisted of 16 healthy individuals (10 men and 6 women, the average age 59.5±1.74 years). All patients underwent comprehensive neuropsychological testing. The examination was carried out on the 3rd - 7th days following the cerebrovascular event. Assessment of neurocognitive status was performed by using the Mini-Mental State Examination, the Montreal Cognitive Assessment Scoring, Beck’s Depression Scale, and the Spielberger-Khanin Reactive and Personal Anxiety Questionnaire. The analysis of the results obtained showed that the patients with sinistrocerebral ischemic stroke have a positive correlation between post-stroke cognitive impairment (total score Mini-Mental State Examination = 21.3±0.61, Montreal Cognitive Assessment Scoring = 18.22±0.9) and indicators of language, speech and memory dysfunctions as compared to the individuals with ischemic stroke in the right carotid pool, who have positive correlations between indicators of post-stroke cognitive impairment (total score Mini-Mental State Examination = 24.05±0.52, Montreal Cognitive Assessment Scoring = 21.35±0.84) and indicators of attention and abstract thinking dysfunction. Indicators of depressive disorders positively correlate with indicators of post-stroke cognitive dysfunction only in the group of sinistrocerebral ischemic stroke, while the degree and frequency of depressive disorders are significantly more often observed when ischemic focus is localized in the right hemisphere, and their indicators have direct correlations in both groups of patients. The features of correlations between psychodiagnostic indicators taking into account lateralization of the ischemic centre, investigated in the study, can serve as a ground for applying separate subtest-blocks of the specified psychodiagnostic scales for patients with hemispheric ischemic stroke. This approach is time-saving, and can make the scale more widely available and accelerate the screening of neurocognitive status in order to optimize therapeutic and rehabilitation interventions.
Cerebral stroke is a «global epidemic», which occupies the leading place in the structure of the causes of disability of the adult population in most countries, having great medical, social, and economic significance. Therefore, this problem is urgent worldwide, being a priority area of the research, which is constantly explored. The earliest possible start of rehabilitation measures improves functional output and reduces the risk of recurrent stroke. Activation and rehabilitation of patients with stroke should begin from the first days of the patient’s stay at the stroke department, immediately after stabilization of the basic vital functions (breath and hemodynamics). The use of international standardized scales is recommended to assess the functional status of the patient, screening, and dynamic diagnosis of motor disorders. The purpose of the study was to evaluate the impact of active rehabilitation treatment in the scheme of comprehensive therapy of patients with cerebral hemispheric ischemic stroke on the dynamics of recovery of motor disorders, and to study their correlations. Materials and methods. The study enrolled 138 patients: 30 healthy individuals (n = 30) and 108 people with cerebral hemispheric ischemic stroke (n = 108), who were divided into two groups: the first group (n = 48), whose treatment generally followed the «classical» measures with the use of medicinal therapy in accordance with the current clinical protocol of medical care for patients with ischemic stroke and the second group (n = 60), in which patients were additionally prescribed and given two courses of rehabilitation using active rehabilitation methods after the first and the third examinations. Results and discussion. The screening was performed using standardized diagnostic scales to determine: stroke severity (National Institutes of Health Stroke Scale), post-stroke functional capacity (Modified Rankin Scale), index of daily activity and self-care ability (Barthel Activities of Daily Living Index), balance impairment (Berg Balance Scale), clinical assessment of spasticity (Modified Ashworth Scale) after acute ischemic cerebrovascular accident. Verification of indicators was performed on days 3-7, day 30, day 90, day 180 after cerebral hemispheric ischemic stroke. In the course of the research, we used modern statistical methods and analyzed the structure of motor disorders before and after treatment, determined the reliability of changes in indicators that demonstrate the dynamics of functional recovery under the influence of active rehabilitation, examined the correlations of motor disorders in the study groups. Conclusion. The obtained results show that the use of active rehabilitation methods in the scheme of comprehensive treatment of patients in acute and recovery periods of cerebral hemispheric ischemic stroke significantly increases the efficiency of recovery of motor functions after the acute cerebral accident
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