The aim of the study was to assess the prognostic value of the plasma neuron-specific enolase (NSE) level as a predictor of functional outcome and motor function recovery in the acute period of ischemic stroke (IS).Materials and Methods. Fifty patients with IS have been examined. On admission to the hospital and at 12-14 days after stroke onset, a clinical and neurological examination have been carried out with the supplementary quantitative assessment of neurological deficit severity according to the National Institutes of Health Stroke Scale (NIHSS), functional outcome according to the Modified Rankin Scale, and Rivermead Mobility Index. Enzyme immunoassay was used to determine NSE concentration in blood plasma in the acute period of the disease.Results. The NSE level in patients' blood plasma in the first 48 h after stroke onset positively correlates with the ischemic focus volume (r=0.49; p=0.003) and the severity of neurological symptoms (according to NIHSS) (r=0.33; p=0.02). NSE less than 2 ng/ml in the acute disease period is a predictor of good functional outcome 12-14 days after stroke onset (OR=12.4; р=0.006). The NSE level >2.6 ng/ml is associated with a high likelihood of lethal outcome.Neurological deficit below 15 according to NIHSS as well as the NSE level <2 ng/ml in the acute IS period are estimated as prognostic factors of significant recovery of motor function at 2 weeks after disease onset (OR=5.8; р=0.02).Conclusion. Determination of NSE in blood plasma makes it possible to predict functional outcome of the disease development and the recovery of motor function in patients with IS.
The purpose of this study was to evaluate impact of cognitive impairments on the upper limb function recovery after acute lacunar stroke (LS). Material and methods. 139 patients (aged from 35 to 80 y. o.) with acute LS were examined. Along with the clinical and neurological examination, an upper limb function was evaluated by Action Research Arm Test and 9-Hole Peg Test, a study of cognitive status was made using the Montreal Cognitive Assessment (МоСа) and Frontal Assessment Battery (FAB). Results. Impaired upper limb function was revealed in 79% of patients with LS. After 2 weeks of acute period of LS, a significant improvement or the complete recovery of the upper limb function was observed in 81%. Moderate/severe executive dysfunction (FAB < 15 points) was defined in 65% of patients with LS and upper limb dysfunction. Moderate/severe cognitive impairments (МоСа < 26 points) were revealed in almost 55% of patients. In acute period of LS, the negative prognostic factor for complete recovery or significant improvement of the arm function was the presence of moderate/severe executive dysfunction (OR 3.89; 95% CI 1.07-14.19; p = 0.04) and general cognitive deficit (OR 3.27; 95% CI 1.10-9.70; p = 0.03). Conclusions. Cognitive impairments including executive disorders may affect the upper limb function recovery in acute period of LS. The data obtained can be used for the development of personalized rehabilitation programs for these patients.
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