Saratov JOURNAL of Medical and Scientific Research

Kutashov V.A.

Voronezh State Medical University n.a. N.N. Burdenko, Department of Psychiatry and Neurology IDPO, Professor, Doctor of Medical Sciences

On the clinical picture and diagnosis of rare neurological diseases

Year: 2018, volume 14 Issue: №1 Pages: 174-177
Heading: Neurology Article type: Case report
Authors: Ulyanova O.V., Kutashov V.A., Brezhneva N.V.
Organization: Regional Children's Clinical Hospital No. 1 (Voronezh), Voronezh State Medical Academy
Summary:

 The article presents clinical observation of patient H, 2007 year of birth., with X-linked adrenoleukodystrophy (X-ALD). This is a rare hereditary metabolic disease, not only in Russia but also worldwide. It belongs to the group of peroxisomal diseases, is associated with the accumulation of fatty acids with a very long chain and is characterized by a combined lesion of the nervous system and adrenal glands. X-ALD in neurology and Pediatrics require a targeted individual approach to each patient, genetic tests in relatives and prenatal diagnosis among patients at risk.

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Features of the medical and social characteristics and anxiodepressive disorders in patients with little brain insult in the early recovery period

Year: 2018, volume 14 Issue: №1 Pages: 141-144
Heading: Neurology Article type: Original article
Authors: Kutashov V.A., Ulyanova O.V., Zakharov O.P.
Organization: Voronezh State Medical Academy
Summary:

The aim of the study was to study medical and social and anxiodepressive disorders (ADR) in patients with little brain insult (LBI) in the early recovery period. Materials and Methods. 140 patients were examined, the mean age of which was 57.2±2.2 years. The patients were examined in the early recovery period. Among the 140 patients with LBI, 62% were men and 38% women. The level of anxiety and depression was assessed using the Hamilton psychometric scales (HPMS). Results. In 6% of patients there are relatives who have undergone an acute cerebrovascular acident. 50% of patients live with their families, 27.2% lived with relatives and 22.8% lived alone. Only 25.5% of patients had a daily monitor blood pressure (BP), 17.8% of patients — several times a week and 17.8% of people — several times a month. In addition, 16.4% of patients are forced to measure BP in the health facility, since they do not have a personal tonometer. 26.4% of patients did not measure their BP. 16.4% measure blood pressure once a year. A high level of depression occurred in 3.57% of patients, an average level in 27.86% of patients, mild depression in 33.57% of patients and absence of depressive symptoms in 35% of patients. A high level of anxiety was found in 17.50% of patients with Ml, moderate anxiety level in47.86% of patients, low anxiety level in 45.00%, no anxiety in 1.43% of patients. Conclusion. In patients with LBI in the early recovery period a rather high level of ADR severity was revealed. That causes as early as possible the identification and administration of specific therapy for ADR with LBI.

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Cardioembolic stroke: risk factors, forecast, secondary prevention

Year: 2017, volume 13 Issue: №1 Pages: 187-192
Heading: Neurology Article type: Original article
Authors: Khakhanova O.N., Skorokhodov А.Р., Kutashov V.A., Ulyanova O.V.
Organization: Voronezh Emergency City Hospital №1, Voronezh State Medical Academy
Summary:

The goal of the study is to evaluate the effectiveness of warfarin and the new direct anticoagulants (xarelto and pradaxa) in the secondary prevention of re-occurrence of cardioembolic stroke (CES). Material and methods. Inclusion criteria of patients in the study: migrated CES, confirmed the presence of a pathology of heart; reception of indirect anticoagulant (warfarin) or direct inhibitors of factor Xa (xarelto, pradaxa) to prevent re-CES. Exclusion criteria from the study: patients with other subtypes of ischemic stroke (IS), hemorrhagic stroke (HS), patients receiving aspirin, diseased patients with CES. The severity of neurological deficit was assessed according to the NIHSS, Rivermead, Rankine and Barthel scales. Results. By the end of the second year of monitoring after suffering CES number of patients with full recovery a self-service increased by 3% and decreased by the same number of patients with moderate and severe dependence on assistance in everyday life. More efficient and faster neurological function was restored in patients taking warfarin is worse in the group of patients receiving pradaxa. However, a second stroke in the first year after suffering several CES were more frequent in the group of patients receiving pradaxa, and usually fatal. Conclusion. Change of medications in the group of patients receiving xarelto and warfarin, other anticoagulants have not led to the emergence of recurrent stroke.

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Revisiting of etiology, clinical picture and diagnosis of the Kleine-Levin syndrome.

Year: 2017, volume 13 Issue: №1 Pages: 181-187
Heading: Neurology Article type: Case report
Authors: Ulyanova О.V., Kutashov V.A.
Organization: Voronezh State Medical Academy
Summary:

Objective: to draw the attention to the Kleine - Levin syndrome (SKL), a rare, poorly understood disease, not only in Russia but throughout the world. We analyzed the case of the 23-year old patient M, with the Kleine — Levin syndrome. SKL belongs to the group of recurrent hypersomnia and is characterized by long bouts of sleep lasting an average of 10-14 days, beginning with the imperative and difficulty awakening. During bouts of sleep observed unusual behavior of patients: hyperphagia; hypersexuality in males; irritability, restlessness, impaired mental activity; aggression; feeling of unreality of it all; confusion, hallucinatory episodes and depression in females. During wakefulness, marked dyspho-ria, emotional stupefaction, loss of memory. The syndrome develops in 4 times more often in men than in women, aged 12-25 years. Etiological factors: brain tumor, head trauma, metabolic disorders, acute infectious diseases with fever. Often the development of the syndrome is preceded by hyperemia and hypothalamic-pituitary dysfunction. The article discussed the etiology, diagnosis, and possible combinations of clinical manifestations in SKL.

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Applying of classification and predictive modeling to predict individual risk factors for depressive disorders

Year: 2017, volume 13 Issue: №1 Pages: 168-174
Heading: Neurology Article type: Original article
Authors: Samsonov A.S., Kutashov V.A.
Organization: Voronezh State Medical Academy
Summary:

Purpose: the formation of mathematical models and algorithms for predicting the development of depressive disorders in patients based on their individual medical and social characteristics. Material and methods. The substantiation of the urgency of the problem is given. The methods and the course of the research are described. Results and conclusions. On the basis of the data obtained, a set of the most significant medical and social characteristics of patients was formed, an integral indicator for assessing the degree of risk of depressive disorders was developed, a computer program was created to predict the probability of development of affective pathology. Appropriate conclusions had been made.

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Neurological presentations of a secondary antiphospholipid syndrome

Year: 2017, volume 13 Issue: №1 Pages: 139-143
Heading: Neurology Article type: Case report
Authors: Yesaulenko I.E., Kutashov V.A., Ulyanova O.V.
Organization: Voronezh State Medical Academy
Summary:

The aim of the study is to turn the attention of specialists to antiphospholipid syndrome (APS), which is of interest to physicians of many specialties. The observation of the patient W., 32 years, with secondary APS was analyzed. Poor prognostic factors in CFA are the high frequency of thrombotic complications and thrombocytopenia, and laboratory markers — the presence of lupus anticoagulant. All patients with APS should be under medical supervision, whose main task is to assess the risk of recurrence of venous or arterial thrombosis and its prevention.

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The issue of neuropsychiatric disorders in patients with hypothyroidism

Year: 2016, volume 12 Issue: №3 Pages: 375-378
Heading: Neurology Article type: Original article
Authors: Kutashov V.A., Budnevsky A.V., Ulyanova O.V., Priputnevich D.N.
Organization: Voronezh State Medical Academy
Summary:

The aim of the study was assessment of thyroid function in patients with psychiatric and psychological assistance; to study the structure of AR in patients with hypothyroidism, to reveal alexithymical identifying of personality characteristics of patients with hypothyroidism and AP Materials and Methods. 406 patients with AR at the age of 51.3±4.7 years. To verify the useofTSH hypothyroidism rate and to assess depressive disorder — Hamilton Scale and the Montgomery— Asberg; with clinical and psychopathological study: 1) the scale of self-BH alarm Spielberger (Y. L. Hanin), 2) questionnaire G. Shmisheka 3) Toronto alexithymia scale. Results. Hypothyroidism is set at 116 (28.6%) of 406 patients suffering from RA. Among the 374 patients with depressive disorders hypothyroidism was observed in 116: subclinical — in 76 patients (65.5%), symptomatic — in 40 (34.5%). The first group consisted of 258 patients with the presence of depressive disorders and without hypothyroidism; second — 116 patients with the presence of depression and hypothyroidism. TSH in patients suffering AR, without thyroid dysfunction was 5.2 times lower than in patients with the presence of hypothyroidism. Among AP comorbid with hypothyroidism, are predominant depressive with a predominance of mild and moderate forms. Dominating are anxious-depressive, dysphoric, adynamic, sad, depressive disorders. Conclusion. In patients with AR and hypothyroidism predominant types of personality accentuation are dysthymic, anxious, demonstrative and meticulous.

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Cognitive impairment in multiple sclerosis

Year: 2016, volume 12 Issue: №2 Pages: 267-270
Heading: Neurology Article type: Original article
Authors: Kutashov V.A., Ulyanova O.V., Khabarova T.Y., Budnevsky A.V.
Organization: Voronezh State Medical Academy
Summary:

Aim: to identify the degree of cognitive impairment (CN) and to optimize the treatment of patients with multiple sclerosis (MS). Material and methods. A total of 695 patients (278 men and 417 women) were ranged from 18 to 63 years. The mean age was 30.2±0.7 years: women (417) 28.5±0.5 years, while for men (278) 31.8±0.7 years. Relaps-ing-remitting type (RT) of MS was established in 520 patients (74.8%), secondary progressive type (VPT MS) in 132 patients (18.9%) and primary progressive type (PPT MS) in 10 patients (1.5%). Clinically isolated syndrome (CIS) was detected in 33 patients (4.8%). The diagnosis of MS 662 patients according to the criteria McDonald etal. (2005). Score of neurologic deficit was carried out on an extended scale of disability (Expanded Disability Status Scale — EDSS). CN were evaluated by conventional tests. To estimate the orientation in time, assessment of short-term and long-term memory, attention and concentration, as well as executive functions, memory, language, evaluation of optical-spatial activities, conceptual thinking, the account used by the Montreal Cognitive Assessment Scale (MoCA). For the screening of dementia with a primary lesion of the frontal lobes and subcortical cerebral structures used battery frontal test to assess frontal dysfunction. Results. The ratio of male (265) and female (397) was 1:1.5. The severity of the condition patients EDSS scale ranged from 1.5 to 8.0 points, and the average score was 3.5±1.2. In the group of patients with RT RS average score EDSS was more than a half (2.5±1.1), than in the group of patients with MS VAC (5.5±1.2) and POS PC (6.5±1.2). In the study of history, it was found that the development of the RS (662 patients) was preceded by the following conditions: a viral infection in 277 patients (41.84%); fatigue in 147 patients (22.21%); transferred psycho-emotional load from 218 (32.93%); after pregnancy and childbirth in 20 patients (3.02%). Conclusion. Among the patients with MS often met type remitting course of the disease. CN were diagnosed in 82.93% of patients. Some patients KN come to the fore in the onset of the disease, with minimal neurologic deficit, which significantly complicates the treatment and impairs the subsequent social adaptation of this group of patients. In the patients with a VPT MS KH level was statistically significantly lower than in patients with RT RS.

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