Tactics of a general practitioner in case of suspected acute cerebrovascular accident and measures to prevent it

Author(s):  
Dmitriy Sergeevich Kovalev

Acute cerebrovascular accident (stroke) is a fairly common severe pathology, which is one of the main causes of death in most countries. Every year in the world, a stroke occurs in 15 million people, of whom about 5 million die, and the same number become disabled. The disease is based on a sudden sharp failure of the normal blood supply to the brain substance due to a rupture or blockage of a blood vessel. Mortality in the first weeks after a stroke can reach 30-35%. Depending on the pathogenesis of the lesion, stroke can be ischemic and hemorrhagic (ischemic occurs about 6 times more often); clinical symptoms will depend on which area of the brain is involved in the pathological process. Predisposing factors include heredity, gender (more often observed in men), age (in elderly age, the risk of stroke increases every year), arterial hypertension, diabetes mellitus, obesity, hypodynamia. Since in 80% of cases after a stroke people become disabled, often unable to take care of themselves, the problem of acute cerebrovascular accident has long passed from the category of purely medical issues to the category of socio-economic ones. The tasks of the general practitioner include the timely identification of factors predisposing to the development of a stroke and minimization of the possible risks of this formidable condition, and in the case of a stroke, active participation in the patient's rehabilitation process.

2002 ◽  
Vol 1 (2) ◽  
pp. 77-82
Author(s):  
T. A. Valikova ◽  
V. M. Alifirova ◽  
I. M. Fyodorova ◽  
N. Yu. Paimursina

Nervous system syphilis — neurosyphilis (NS) belongs to rather rare diseases. According to the different authors data available it comes to about 1% of the nervous system organic disturbances and develops by 5—10% syphilous patients not having been treated in the acute stage of the pathological process. The syphilitic disturbance of the nervous system is a chronic progressive disease caused by the pale spirochaeta. The nervous system disturbance occurs basically in two ways: secondary one, because of brain shells, vessels, gummatous manifestations involving in the pathologic process; or primary one, when the causative agent affects directly the brain substance. In the first case syphilis is called rnesodermic or early one; in the second case — parenchymatous or late, primary one. In the article the analysis of two clinical cases of mesenchyme neurosyphilis is carried out: latent neurosyphilis and syphilitic meningomyelitis. Neurosyphilis classification is applied to clinical manifestatons of syphilitic arachnoiditis and vasculitis are described. The methods of specific and nonspecific therapy of mesenchyme syphilis are stated in detail.


2020 ◽  
Vol 18 (5) ◽  
pp. 99-104
Author(s):  
S. K. PERMINOVA ◽  
◽  
A. A. YAKUPOVA ◽  
A. Ya. NAZIPOVA ◽  
R. T. GAYFUTDINOV ◽  
...  

The purpose — to evaluate the Willis circle pathology in patients with acute cerebral circulatory disorders using the National Institutes of Health Stroke Scale, to assess the degree of functional disorders and the long-term perspective. Material and methods. Data from magnetic resonance imaging of the brain and magnetic resonance angiography of the brain were analyzed in 47 patients with acute cerebrovascular accident. The study included 21 (44,6%) men and 26 (55,4%) women, with an average age of 67,08 ± 16,03. All patients underwent neurological examination using the National Institutes of Health Stroke Scale, assessment of functional disorders using the Rivermead scale, and assessment of long-term perspective using the Rankin scale before and after treatment. Results. Patients with the absence of one posterior connective artery showed a significant stroke severity according to the National Institutes of Health Stroke Scale. The largest subgroup with the absence of both posterior connective arteries was identified, having the best indicators on the Rivermead scale before treatment and a good recovery for neurological deficit after treatment. Significant positive results by the Rivermead scale after treatment were shown in the subgroup with the absence of all connecting arteries. Conclusion. The variant of the Willis circle structure in the form of the absence of both posterior connective arteries in patients with acute cerebrovascular accident is most often found with a good recovery of neurological deficit.


2020 ◽  
Vol 3-4 (213-214) ◽  
pp. 64-73
Author(s):  
Nazira Zharkinbekov ◽  

Chronic сеrebral ischemia is one of the leading causes of morbidity, mortality and disability in the Republic of Kazakhstan. According to the data from Ministry of Healthcare of the Republic of Kazakhstan, the overall morbidity of the country’s population due to diseases of the circulatory system registered in health care organizations has increased almost three times from 1998 to 2017 over the past 20 years. According to world publications, on average, the incidence of Chronic сеrebral ischemia in the world is relatively high among the elderly, occurring in two-thirds of people over 65 years of age. It is also observed in 50% of people aged 50 to 65 years and in 25% of people aged 45 to 50 years. Purpose. To review of epidemiological data, risk factors, causes, pathogenetic mechanisms, diagnostic algorithms and principles of treatment of Chronic сеrebral ischemia. Material and methods. The literature review on Chronic сеrebral ischemia data was conducted using the Pubmed search engine in Medline electronic databases from 2009 to 2019. Results and discussion. A total of 45 research papers were included. This review examines epidemiological data, risk factors, causes, pathogenetic mechanisms, diagnostic algorithms and principles of therapy for Chronic сеrebral ischemia disease. In the etiopathogenesis of Chronic сеrebral ischemia, a significant part is played by the combination of risk factors known as vascular comorbidity and being the main cause of deaths. Vascular comorbidity is characterized by the involvement into a single pathological process of all risk factors that form Chronic сеrebral ischemia, which lead to a change in cerebral circulation with hypoxia of the brain substance and a cascade of biochemical changes, and subsequently results in diffuse, multi-focal changes in the brain substance. In a case of comorbidity of the atherosclerotic process with dyslipidemia, narrowing of the lumen of the arteries with an increase in the permeability of their wall membranes can be observed, with further damage to the endothelium, activation of synthesis by leukocytes, platelets, endotheliocytes of chemotaxis factors, kinins, growth factors, with the accumulation of active oxygen, peroxidation with the formation of oxidative stress. Chronic сеrebral ischemia therapy with vascular comorbidity, in which all risk factors are В тексте переправлены стилистические и ортографические ошибки. involved in a single pathological process, provides the prevention of polypragmasia, and the assignment of certain pathogenetic drugs aimed at the same pathogenesis that leads to the formation of Chronic сеrebral ischemia. Conclusion. It is most rational to use an antioxidant/antihypoxant in therapy. Such pathogenetic drugs include antioxidant therapy. Among other antioxidants/antihypoxants used in routine practice, Mexidol (ethylmethylhydroxypyridine succinate) is characterized with the strongest evidence base. Keyword: chronic brain ischemia, chronic cerebral circulatory insufficiency, vascular comorbidity, ethylmethylhydroxypyridine succinate, Mexidol.


Pharmacia ◽  
2021 ◽  
Vol 68 (3) ◽  
pp. 665-670
Author(s):  
Bogdan S. Burlaka ◽  
Igor F. Belenichev ◽  
Olga I. Ryzhenko ◽  
Victor P. Ryzhenko ◽  
Olena G. Aliyeva ◽  
...  

Introduction: This study was designed to evaluate the effect activity of RAIL-gel in comparison with Citicoline on nitroxydergic system during acute cerebrovascular accident. Methods: In this study, 80 white nonlinear rats were randomly assigned to 4 groups (20 rats in each): 1) intact; 2) control - untreated with acute cerebrovascular accident (ACVA), examined on the 4th day; 3) animals with ACVA, receiving RAIL, examined on the 18th day; 4) animals with ACVA, treated with Citicoline, examined on the 4th day. The expression of inducible NOS was determined by Western blotting. The nitrosative stress marker, nitrotyrosine, was determined using the ELISE kit NITROTYROSINE (kit no. HK501-02, series 12825k1212-k). To assess the state of iNOS mRNA expression, we used the method of polymerase chain reaction with reverse transcription in real time (RT-PCR). Results: Our research demonstrated that course administration of the RAIL and Citicoline to animals with ACVA for 4 days leads to the stabilization of the parameters of the brain nitroxydergic system. However, Citicoline does not provide a full effect on the shifts of the NO system in the brain. It does not have the proper effect on such an important link in the pathogenesis of ischemic brain damage as nitrosative stress. RAIL leads to a significant decrease in NOS activity due to its inducible form (decrease in the expression of iNOS and iNOS mRNA) and a decrease in NO metabolits, and inhibition of nitrosative stress (decrease in nitrotyrosine). Conclusion: IL-1b antagonist RAIL (Intranal Gel) significantly exceeds Citicoline in terms of the severity of the effect on the nitroxydergic system indicators.


2020 ◽  
Vol 101 (1) ◽  
pp. 124-131
Author(s):  
K G Valeeva ◽  
S K Perminova ◽  
A Ya Nazipova ◽  
S V Kurochkin ◽  
A A Yakupova

Aim. Assessment of cerebral blood flow in various vascular beds in patients with an acute cerebrovascular accident in the acute period by perfusion computed tomography in combination with transcranial Doppler ultrasonography of cerebral vessels. Methods. Data was analyzed from perfusion computed tomography of the brain and transcranial Doppler ultrasonography in 35 patients with an acute cerebrovascular accident, based at the vascular centre of the City Clinical Hospital No. 7 of Kazan. The study included 18 (51.4%) women and 17 (48.6%) men who had arrived in the first hours after a vascular accident. When analyzing the stroke subtype, atherothrombotic subtype was determined in 27 (77.1%) patients, cardioembolic subtype in 5 (14.3%) patients, and 3 (8.6%) patients had had a transient ischemic attack. Results. Perfusion computed tomography is a method that allowed evaluation of the structure of the brain, and blood supply to the anterior cerebral (in 2.9% of the studied patients), middle cerebral (in 62.9% of the studied patients), posterior cerebral (in 11.4% of the studied patients) and vertebral (in 14.2% of the studied patients) arteries of patients with a stroke. The method revealed a zone of critical perfusion (ischemic penumbra) by quantitatively processing perfusion indicators in the anterior cerebral blood flow system (decrease in rate and increase in average volume of cerebral blood flow and average transit time) and in the posterior cerebral circulation system (decrease in blood flow and prolongation of transit time) in the bed of the right vertebral artery). The method also aided the construction of perfusion maps. Transcranial Doppler ultrasonography of cerebral vessels revealed breaches in the cerebral circulation: a decrease in the linear velocity of blood flow in the right middle cerebral arterial bed and in the posterior circulatory system of blood flow in the brain, and an increase in the pulsatility index in all the studied vascular beds. Conclusion. Perfusion computed tomography of the brain in combination with transcranial Doppler ultrasonography is applicable to patients with stroke in various vascular beds, followed by determination of indications for thrombolytic therapy and thrombectomy.


2020 ◽  
Vol 99 (1) ◽  
pp. 232-236
Author(s):  
P.V. Shumilov ◽  
◽  
A.Ya. Ilyina ◽  
A.L. Mishchenko ◽  
A.S. Barinova ◽  
...  

2020 ◽  
Vol 3 (1) ◽  
pp. 51-53
Author(s):  
Rano Azizova ◽  
◽  
Umida Shamsiyeva ◽  
Mirzohid Turabbayev ◽  
Begzod Jorayev ◽  
...  

Traumatic brain disease (TBHD) is a pathological process triggered by the damaging effect of mechanical energy on the brain and is characterized — with a variety of clinical forms — by the unity of etiology, pathogenetic and sanogenetic mechanisms of development and outcomes.


2020 ◽  
Vol 25 (3) ◽  
pp. 17-25 ◽  
Author(s):  
G. R. Ramazanov ◽  
L. B. Zavaliy ◽  
L. L. Semenov ◽  
S. A. Abudeev ◽  
A. O. Ptitsyn ◽  
...  

Abstract. Early rehabilitation (ER) of patients with acute cerebrovascular accident (ACA) is one of the priority tasks of the vascular centers; the issue of increasing the volume of rehabilitation measures in the resuscitation and intensive care units (ICU) is relevant. Objective. To evaluate the safety and effectiveness of the progressive ER program in patients with ACA. Material and research methods. The study included 129 patients with ACA in ICU. Each patient of the main group (MGr, n = 61) underwent progressive ER: at least 4–5 vertical adjustments per day, passive mode Kinesiotherapy 49 ± 9.3 minutes, a double load of physiotherapy exercises, preventive physiotherapy; the total time of classes reached 240 minutes per day. In the comparison group (СGr, n = 68), standard ER was performed no more than 120 minutes per day. The groups are comparable by sex, age, severity of the disease and comorbidity. The severity of ACA, the gravity gradient, patient mobility, functional status, degree of dependence, and the presence of complications were evaluated. Results. During a month of work with the MGr, 102 ICU bed-days, 94 days of the artificial lung ventilation use, p < 0.05 were saved. Mortality in MGr decreased -— 8 patients (13.1%) versus 14 (20.6%) in CGr (p < 0.05). In patients within CGr, pulmonary thromboembolism developed in 8.8%, in MGr – in 3.3%. The severity of the apoplectic attack decreased ( by 28% in MGr, and by 20% in CGr ), mobility increased. Comparing the modalities of post resuscitationsyndrome in MGr, it was noted that the score decreased by 2 times from 6 [5; 6] to 3 [2.3; 3.3], but it has not changed in the CGr. Patients in the MGr were 2-–3 days earlier adapted to the vertical adjustment. Conclusions. The progressive ER program in ICU is safe, effective, realisable, and allows reducing the number of bed-days in ICU, the number of days of the artificial lung ventilation use, complications, and mortality in comparison with standard medical care.


Vestnik ◽  
2021 ◽  
pp. 51-56
Author(s):  
Д.А. Митрохин ◽  
Ж.Б. Дюсембаева ◽  
М.М. Ибрагимов ◽  
А.А. Оспанов ◽  
А.Н. Сембинова ◽  
...  

В данной статье, представлены результаты обследования 17 женщин, перенесших острое нарушение мозгового кровообращения в послеродовом периоде, с 2017 по 2021 годы, в возрасте от 19 до 39 лет. Показано, что у женщин в послеродовом периоде, перенесших острое нарушение мозгового кровообращения, выявлено преобладание ишемического инсульта над геморрагическим, что составило 64,7% и 35,3% соответственно. Неврологические признаки церебрального инсульта в послеродовом периоде характеризуются двигательными, речевыми расстройствами, нарушением чувствительности, а также часто психоэмоциональными проявлениями. Генерализованные тонико-клонические приступы чаще наблюдались у пациенток с геморрагическим инсультом (33,3%), в сравнении с ишемическим инсультом (9,1%). У женщин в послеродовом периоде, перенесших острое нарушение мозгового кровообращения, наиболее значимыми факторами риска являются: наличие хронических заболеваний, в том числе отягощенный акушерско-гинекологический анамнез, прием пероральных контрацептивов, а также курение. Биоэлектрическая активность головного мозга характеризовалась выраженной дельта и тета активностью, эпилептиформными разрядами в виде острых волн, спайков и комплексов «пик-волна», с преобладанием у пациенток с геморрагическим инсультом. Более значительное повышение индекса когерентности в дельта и тета диапазонах у пациентов, перенесших геморрагический инсульт, может указывать на более грубые межполушарные нарушения, в сравнении с ишемическим инсультом. Отмечено повышение интегрального индекса диапазона медленно-волновой активности и преобладание процентного отношения спектральных мощностей медленных волн (дельта, тета) к быстрым волнам (альфа, бета), особенно выраженное у больных с геморрагическим инсультом (р < 0,05), в сравнении с ишемическим инсультом. Наиболее тяжелое течение послеродового периода наблюдалось у пациенток с геморрагическим инсультом, именно в этом случае было 2 летальных исхода. This article presents the results of a survey of 17 women with acute cerebrovascular accident in the postpartum period, from 2017 to 2021, aged 19 to 39 years. It is shown that the period in women in the postpartum period, who underwent acute cerebrovascular accident, revealed the prevalence of ischemic stroke over hemorrhagic, which amounted to 64,7% and 35,3%, respectively. Neurological signs of cerebral stroke in the postpartum period are characterized by movement, speech disorders, impaired sensitivity, and often psychoemotional manifestations. Generalized tonic-clonic seizures were more often observed in patients with hemorrhagic stroke (33,3%) in comparison with ischemic stroke (9,1%). In postpartum women who have suffered acute cerebrovascular accident, the most significant risk factors are: the presence of chronic diseases, including a burdened obstetric and gynecological history, taking oral contraceptives, as well as smoking. The bioelectrical activity of the brain was characterized by pronounced delta and theta activity, epileptiform discharges in the form of sharp waves, spikes and peak-wave complexes, with a predominance in patients with hemorrhagic stroke. A more significant increase in the coherence index in the delta and theta ranges in patients after hemorrhagic stroke may indicate more severe interhemispheric disorders in comparison with ischemic stroke. An increase in the integral index of the range of slow-wave activity and a predominance of the percentage of the spectral powers of slow waves (delta, theta) to fast waves (alpha, beta), especially pronounced in patients with hemorrhagic stroke (p <0,05), in comparison with ischemic stroke. The most severe postpartum period was observed in patients with hemorrhagic stroke, in this case there were 2 deaths.


2021 ◽  
Vol 22 (1) ◽  
pp. 83-86
Author(s):  
O. A. Kicherova ◽  
◽  
L. I. Reikhert ◽  
O. N. Bovt ◽  
◽  
...  

In recent years, cerebral vascular diseases have been increasingly detected in young patients. It is due not only to better physicians’ knowledge about this pathology, but also to the improvement of its diagnosis methods. Modern neuroimaging techniques allow us to clarify the nature of hemorrhage, to determine the volume and location of intracerebral hematoma, and to establish the degree of concomitant edema and dislocation of the brain. However, despite the high accuracy of the research, it is not always possible to establish the cause that led to a brain accident, which greatly affects the tactics of management and outcomes in this category of patients. A special feature of the structure of cerebrovascular diseases of young people is the high proportion of hemorrhagic stroke, the causes of which are most often arterio-venous malformations. Meanwhile, there are a number of other causes that can lead to hemorrhage into the brain substance. These include disorders of blood clotting, and various vasculitis, and exposure to toxic substances and drugs, and tumor formations (primary and secondary). All these pathological factors outline the range of diagnostic search in young patients who underwent hemorrhagic stroke. Diagnosis of these pathological conditions with the help of modern visualization techniques is considered to be easy, but this is not always the case. In this article, the authors give their own clinical observation of a hemorrhagic stroke in a young patient, which demonstrates the complexity of the diagnostic search in patients with this pathology.


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