'Stroke chameleons'

Demin, D. A.; Белопасов, В. В.; Asfandiiarova, E. V.; Zhuravleva, E. N.; Mintulaev, I. S.; Nikolaeva, E. V.

doi:10.17116/jnevro201911904172

Z. nevrol. psikhiatr. im. S.S. Korsakova

2019

DOI: 10.17116/jnevro201911904172

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'Stroke chameleons'

D. A. Demin¹,

В. В. Белопасов²,

E. V. Asfandiiarova³

et al.

Abstract: Проблема инсульта отражается в официальных данных ВОЗ: 15 млн новых случаев в год, из которых 5 млн инсультов фатальны, а 5 млн оставляют пациентов стойко инвалидизированными [1]. Это диктует острую необходимость повышения качества оказания медицинской помощи на всех этапах ведения пациента. При этом терапия инсульта и планирование мер вторичной профилактики возможны только в случае верной и своевременной диагностики ишемического/геморрагического события. Острый инсульт (ОИ) или транзиторную ишемическую атаку … Show more

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Cited by 2 publications

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Intravenous thrombolysis in ischemic stroke: 10 rules for the practical neurologist

Кулеш

Demin

2022

Medicinskij sovet

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Intravenous thrombolysis (IT) with recombinant tissue plasminogen activator has remained the main method of reperfusion therapy in ischaemic stroke for a quarter of a century. The main trends in the use of IT in recent years are the expansion of the therapeutic window using additional methods of neuroimaging, reducing the number of contraindications and introduction into clinical practice of bolus forms of drugs. Providing IT to the largest number of patients should be considered a major challenge for the primary vascular department. This article presents 10 clinical rules for extending IT in stroke while ensuring its efficacy and safety: 1) conduct IT in suspected stroke; 2) conduct IT in patients over 80 (and even 90) years of age; 3) conduct IT in minor but disabling stroke; 4) conduct IT in minor vertebrobasilar stroke and central acute vestibular syndrome; 5) perform IT in cases of large artery occlusion; 6) perform IT in suspected lacunar stroke and chronic neuroimaging changes (lacunas, white matter hyperintensity, atrophy); 7) reduce door-to-needle time, use thrombolytics with bolus administration; 8) use neuroimaging options (CT perfusion, MR perfusion, MR DWI/FLAIR) to expand the therapeutic window; 9) ensure the safety of IT; 10) be prepared for complications. Increasing the frequency of IT should not be seen as a goal, but intensifying the use of this method of treatment is associated with the improvement of all areas of the diagnostic and treatment process in the clinic and the improvement of stroke outcomes.

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Intravenous thrombolysis in ischemic stroke: 10 rules for the practical neurologist

Кулеш

Demin

2022

Medicinskij sovet

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Lacunary stroke. Clinical cases

Захарычева

Shirokova

Polyakov

et al. 2022

Regional blood circulation and microcirculation

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Introduction. Cerebral microangiopathy is the leading cause of vascular cognitive disorders accompined by dementia in the final stages of the disease. Purpose – to study the spectrum of lacunar syndromes in patients with acute cerebrovascular accidents based on our own observations and provide a description of rare clinical variants of the didorders. Materials and methods. We examined 18 patients (10 men and 8 women) aged 33 to 66 years (mean age 52.33 years) in the acute period of lacunar strokes (LS). We studied the neurological status, the data of laboratory-instrumental, speech therapy and neuropsychological testing. The diagnosis of LS was verified using magnetic resonance imaging. Results. Lacunar strokes were more common in patients of mature age (72.22 %) suffering from arterial hypertension (88.89 %) in combination with obesity (44.44 %); patients with atherosclerosis of the coronary and cerebral arteries (27.78 %), type 2 diabetes mellitus (22.22 %) found to have lacunar stroke less often. The sensorimotor hemisyndrome was found to be prevailed (44.44 %). Other classical lacunar syndromes were detected less frequently: with the same frequency (16.67 %) – isolated hemihypesthesia and «hemiballism / hemichorea», as well as «dysarthria – clumsy hand» (11.11 %). The predominant localization of the lesion is the right hemisphere (88.89 %), the internal capsule (66.67 %), rarely the thalamus (27.78 %). Multiple LS were registered in 27.78 % of cases, including the patients with tandem atherostenosis of the cerebral arteries. Descriptions of two clinical cases of LS are presented. Conclusion. Sensorimotor hemisyndrome dominated in clinical scenario. We also observed more rare disorders – bulbar syndrome with anarthria with bilateral damage to the knee of the internal capsule and hyperkinetic syndrome with myoclonus of the respiratory, vocal and articular apparatus. The right-hemispheric lesion predominated with the localization of foci in the internal capsule, the thalamus suffered rarely. Multiple LS were registered in 27.78 % of cases. LSs have unfavorable prognosis for patients with uncontrolled arterial hypertension combined with tandem stenoses of extra- and intracerebral arteries with cognitive disorders that made it difficult to manage patients. The relevance of LS neuroimaging in overweight patients was noted.

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'Stroke chameleons'

Cited by 2 publications

References 62 publications

Intravenous thrombolysis in ischemic stroke: 10 rules for the practical neurologist

Intravenous thrombolysis in ischemic stroke: 10 rules for the practical neurologist

Lacunary stroke. Clinical cases

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