The Pathophysiological Aspects of Cerebral Diseases

Introduction. Cerebrovascular disorders are the main causes of heavy burden health worldwide, also, it is critical to understand the pathophysiological mechanism and then trying to prevent the neurological sequels. Objective. To discuss the inflammatory and oxidative stress aspects associated to the cerebrovascular diseases, focusing on biomarkers, also the role of omega oils, and the intracellular molecular network associated to the tissue burden on those conditions. Results. One of the most promising biomarkers it is Neuron-Specific Enolase (NSE). Serum NSE levels were elevated in stroke-patients compared to the non-stroke controls. Also, studies have demonstrated that in specific ratio omega oils 3, 6 and 9 can ameliorate the inflammatory and oxidative stress in nervous tissue and could be useful to the inflammatory and oxidative stress negative effects of cerebrovascular diseases. In addition, the study of the molecular mechanisms is essential to understand which molecules could be addressed in cascade of events preventing the permanent damage on the nervous tissue. Final considerations. The studies on cerebrovascular disorders must precisely identify the mechanisms and key molecules involved and improve the time of diagnostics and prognostics reducing the negative impacts of those conditions.

Acupuncture Effects on Cerebral Blood Flow during Normoxia and Normobaric Hypoxia: Results from a Prospective Crossover Pilot Study

Cerebral blood flow (CBF) is significantly influenced by exposure to hypoxia, both hypobaric and normobaric. Alterations in cerebral blood flow can play a crucial role in the pathogenesis of acute mountain sickness (AMS) and its symptoms, especially headache, dizziness, and nausea. Acupuncture has been proven to be effective in treating some cerebrovascular disorders and PC6 Nei Guan stimulation seems to enhance cerebral blood flow. Therefore, we have hypothesized that PC6 Nei Guan stimulation could affect CBF in acute hypoxia and could be used to contrast AMS symptoms. We evaluated blood flow in the middle cerebral artery (MCA) in normoxia, after 15 min in normobaric hypoxia (fraction of inspired oxygen (FiO2) 14%, corresponding to 3600 m a.s.l.) in basal conditions, and after PC6 Nei Guan stimulation, both by needle and by pressure. No comparisons with other acupuncture points and sham acupuncture were done. PC6 stimulation seemed to counteract the effects of acute normobaric hypoxia on end-diastolic velocity (EDV) in MCA, especially after acupuncture, and significantly reduced systolic and diastolic blood pressure. A rebalance of CBF could control some AMS symptoms, but further studies are necessary.

Recurrent Strokes as the First Presentation of Occult Pancreatic Cancer; Trousseau Syndrome: A Case Report

Cerebrovascular disorders (CVDs) are widespread in cancer patients, exacerbating their condition and lowering their prognosis. Approximately 15% of cancer patients have a coexisting CVD. Stroke may occur after the initial cancer diagnosis or before the diagnosis of malignant disease. The underlying causes of stroke in cancer patients are distinct from those in noncancer patients and are related to both cancer itself and the type of treatment. Cardio-embolism, large vessel atherosclerosis, and small vessel occlusion have all been identified as important causes of ischemic stroke, but nonbacterial thrombotic endocarditis has been documented only infrequently. We present a case of a 64-year-old female with recurrent ischemic stroke of unknown cause and involving different arterial territories, who was discovered to have metastatic pancreatic cancer. The initial workup with brain imaging revealed multiple acute/subacute ischemic strokes and a negative cardiac assessment. Accordingly, she underwent a whole-body positron emission tomography-computed tomography which revealed a hypermetabolic mass lesion in the pancreaticoduodenal area. Our case indicates that cancer-associated stroke should be seriously evaluated. It demonstrates the critical nature of contemplating hidden cancer in survivors of ischemic stroke and identifies factors that may necessitate further investigation as part of a comprehensive approach to ischemic stroke, especially embolic stroke of unknown sources.

The effect of mesenchymal stromal cells of various origins on mortality and neurologic deficit in acute ischemia-reperfusion in rats

Stroke is a global epidemic issue and the second leading cause of death in the world and in Ukraine. According to official statistics, every year 100-110 thousand Ukrainians suffer acute cerebrovascular disorders. One third of such patients are of working age, up to 50 % will have a disability, and only one in ten will fully return to full life. So far, promising experimental data on the treatment of neurological dysfunction using mesenchymal stromal cells (MSCs) have been obtained. The aim of study is to compare the effect of MSCs of different origins on mortality and neurologic deficit in rats with acute cerebral ischemia-reperfusion injury (CIRI). Materials and methods. Transient bilateral 20-minute occlusion of internal carotid arteries was modeled in male Wistar rats aged 4 months and animals were injected intravenously with MSCs derived from human umbilical cord Wharton's-jelly (hWJ-MSC), human and rat adipose tissue. Other groups of experimental animals were injected intravenously with rat fetal fibroblasts and cell lysate from hWJ-MSC. The last group of rats received Citicoline at a dose of 250 mg/kg as a reference drug. Control animals were injected intravenously with normal saline. The cerebroprotective effect of therapy was assessed by mortality and neurologic deficit in rats on the McGraw's stroke index score. Results. After 12 hours of observation in the crucial period in the development of experimental acute cerebrovascular disorders with the administration of hWJ-MSC, mortality was only 10 % against 45 % of animals in the control group. The use of rat fetal fibroblasts reduced the mortality of animals compare to the control group by an average of 25 %. CIRI in rats caused severe neurologic deficits: paralysis, paresis, ptosis, circling behavior. On the 7th day of observation in the control group of animals, the mean score on the McGrow's stroke index indicated severe neurological disorders. On the 14th day of observation in this group of animals there was no complete recovery of lost central nervous system functions. Compared with the control group of animals, all the treatment agents for acute CIRI (MSCs of various origins, MSC's lysate and Citicoline) contributed to a significant regression of neurologic deficit. Conclusions. Thus, transplantation of human Wharton's jelly-derived MSCs and rat fetal fibroblasts reduced mortality and alleviated neurological symptoms in rats with experimental ischemic stroke. hWJ-MSC, rat fetal fibroblasts, and rat adipose-derived MSCs reduced the incidence of neurological disorders better than Citicoline, which was accompanied by a regression of neurologic deficit dynamics on the 14th day of follow-up. The ability of stem cells of different origins to reduce neurologic deficit indicates the feasibility of their use in experimental acute cerebral ischemia.

Structure and nature of hypertensive intracerebral hemorrhages of supratentorial localization

Objective ‒ to analyze data of patients with hypertensive supratentorial hemorrhages who were hospitalized in Kyiv Emergency Hospital in 2019‒2020.Materials and methods. We analyzed data of 232 patients who were treated for hypertensive intracerebral hemorrhage at the Kyiv Emergency Hospital in 2019‒2020. Patients were included regardless of admission status and chosen treatment tactics (surgical, medical). The study did not include patients with subtentorial hemorrhage, patients with tumor hemorrhage, arteriovenous malformations, aneurysms, angiomas, ischemic and mixed strokes.Results. Among patients males are predominated (149 (64 %)). The average age of patients was 60 years (group of men ‒ 56 years, group of women ‒ 69 years). 77 (33 %) patients were delivered in a comatose state (GCS ≤8 points), 36 (16 %) were in a coma (GCS 9‒12 points), 81 patients were in a state of stupor (GCS 13‒14 points), in a clear mind ‒ 31 (13 %). In 7 (3 %) cases it is impossible to determine the level of consciousness (in patients with seizures or after the introduction of sedative drugs before admission to hospital). 85 patients were operated (surgical activity ‒37 %), who underwent 97 surgical interventions. The overall mortality was 42 %, postoperative mortality ‒ 43 %. Patients who had a compression-dislocation syndrome were operated on. Mortality in the group of patients admitted in a coma mortality was 85 % regardless of the method of treatment.Conclusions. Hemorrhagic strokes predominate in men, due to lifestyle and uncontrolled hypertension in patients. The results of treatment of patients with hypertensive intracerebral hemorrhage indicate the need for early hospitalization, early CT, differentiated approache to surgical removal of hematomas (lobar, lateral with dislocation syndrome), intensive care in patients in a comatose state, even with massive hemorrhages. The results of hypertensive intracerebral hemorrhage depend on the location of the hemorrhage, the severity of the patient’s condition, the timing of hospitalization in specialized stroke departments, the dynamics of cerebrovascular disorders (completed stroke and stroke in development).

Clinical and pathogenetic approaches to early rehabilitation of ischaemic stroke patients

Stroke is the most important medical and social problem, both worldwide and in Uzbekistan, owing to its high morbidity, mortality and disability rates. Uzbekistan's official statistical authorities consider cerebrovascular disease (CVD) to be a single nosological form, without distinguishing it from stroke. Given that the structure of CVDs includes both acute cerebrovascular disorders (ACS) (various types and subtypes of ischemic and hemorrhagic stroke) and chronic CVDs (various forms of so-called dyscirculatory encephalopathy), reliable epidemiological data on stroke prevalence in Uzbekistan are not available. According to the Ministry of Health of the Republic of Uzbekistan, there were 62876 cases of stroke in Uzbekistan in 2019. 15% were fatal, 10-15% relapsed and 55-70% became disabled.

Neurogenic pulmonary edema in subarachnoid hemorrhage: relevant clinical concepts

Background Subarachnoid hemorrhage (SAH) continues to be a condition that carries high rates of morbidity, mortality, and disability around the world. One of its complications is neurogenic pulmonary edema (NPE), which is mainly caused by sympathetic hyperactivity. Due to the complexity of the pathophysiological process and the unspecificity of the clinical presentation, it is little known by general practitioners, medical students and other health care workers not directly related to the neurological part, making the management of this chaotic condition difficult. This review aims to present recent evidence on clinical concepts relevant to the identification and management of NPE secondary to SAH. Main body of the abstract NPE is defined as a syndrome of acute onset following significant central nervous system (CNS) injury. Its etiology has been proposed to stem from the release of catecholamines that produce cardiopulmonary dysfunction, with this syndrome being associated with spinal cord injury, cerebrovascular disorders, traumatic brain injury, status epilepticus, and meningitis. NPE has long been considered a rare event; but it may occur more frequently, mainly in patients with SAH. There are two clinical presentations of NPE: the early form develops in the first hours/minutes after injury, while the late form presents 12–24 h after neurological injury. Clinical manifestations consist of non-specific signs of respiratory distress: dyspnea, tachypnea, hypoxia, pink expectoration, crackles on auscultation, which usually resolve within 24–48 h in 50% of patients. Unfortunately, there are no tools to make the specific diagnosis, so the diagnosis is by exclusion. The therapeutic approach consists of two interventions: treatment of the underlying neurological injury to reduce intracranial pressure and control sympathetic hyperactivity related to the lung injury, and supportive treatment for pulmonary edema. Short conclusion SAH is a severe condition that represents a risk to the life of the affected patient due to the possible complications that may develop. NPE is one of these complications, which due to the common manifestation of a respiratory syndrome, does not allow early and accurate diagnosis, being a diagnosis of exclusion. Therefore, in any case of CNS lesion with pulmonary involvement, NPE should be suspected immediately.

Immunopathogenesis and immunotherapeutic approaches of neurodegenerative and cerebrovascular diseases with cognitive impairment. The current state of the problem and prospects

Cognitive impairments (CI) are a serious problem in modern society, because they significantly reduce patients’ quality of life and tend to progress. Age-related diseases such as neurodegenerative — first of all Alzheimer’s disease (AD) and cerebrovascular disorders are key causes leading to CI. At present, approaches to treating these diseases have limited effectiveness in restoring cognitive functions, and do not change disease course, although they can slow cognitive decline.Understanding the immunopathogenesis of neurodegenerative and cerebrovascular diseases defines new targets and approaches to their treatment. In addition, suppression of neuroinflammation is advisable in the cases of early nonclarified cognitive decline, when information from routine medical, laboratory and instrumental examination of patients is insufficient to identify the causes of CI.This article summarizes current understanding of the immunopathogenesis of AD and chronic cerebral ischemia. The mechanism of neuroinflammation is presented as a cascade of sequential events that are closed in a self-perpetuating inflammatory response in the end. So called damage-associated molecular patterns, specific receptors that can bind them (pattern recognition receptors), intracellular signal transduction in microglia, cytokines and adhesion molecules are considered as potential points of application of immunomodulatory therapy. The review provides information on the current level of development of immunotherapy of AD, chronic cerebral ischemia and offers the prospect of its application.

Increased Prevalence of Neuropsychiatric Disorders during COVID-19 Pandemic in People Needing a Non-Deferrable Neurological Evaluation

Background: The novel coronavirus disease of 2019 (COVID-19) outbreak provoked a profound healthcare system reorganization. This study aimed to compare the reasons for requesting a non-deferrable neurological evaluation before the COVID-19 pandemic and during the lockdown. Methods: Retrospective observational study including non-deferrable neurological outpatients before the pandemic (pre-COVID-19 group, n = 223) and during the Italian second wave of the COVID-19 pandemic (LOCKDOWN group, n = 318). Results: The number of patients sent for cerebrovascular disorders, headache, and vertigo significantly dropped between the pre-COVID-19 era and the lockdown period. While in the pre-COVID-19 group, the most frequent diagnosis was cerebrovascular disorder; neuropsychiatric disorders ranked first in the LOCKDOWN group. Moreover, the percentage of appropriate non-deferrable neurological evaluations significantly increased in the LOCKDOWN group compared with the pre-COVID-19 group. Discussion: Our study shows a significant increase of neuropsychiatric disorders in non-deferrable neurologic evaluations during the Italian second wave of the COVID-19. Overall, cases were more severe and required a more complex management during the lockdown compared with the pre-COVID era. These findings confirm that a careful approach to prevent the psychological consequences of the pandemic is needed, and long-term rearrangements of the healthcare system are desirable to guarantee appropriate management.

Ultrasound in the Diagnosis of Perinatal Ischemic Strokes (Literature Review with Their Own Clinical Observations)

The issues of early diagnosis of perinatal arterial stroke (PAII) continue to be discussed in the domestic and foreign literature. Along with MRI, the ultrasound method allows to identify foci of ischemia of different localization and sizes in newborns. During ultrasound, we identified 29 cases of PAIA of different localization in children of different gestational and postnatal age. Analysis of our own and published data showed that up to 32 weeks of gestational development, AII develops in the lenticular-striar basin, and later in the cortical-subcortical region. Diagnostic capabilities of ultrasound in PAII can be significantly expanded by using ultrasound duplex scanning of brain vessels. Our observations showed that the nature of changes in Doppler parameters depends on the localization of the affected vascular basin and on the duration of cerebrovascular disorders