Saratov JOURNAL of Medical and Scientific Research

№1, 2017, volume 13

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 University n.a. N.N. Burdenko
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.

Keywords: cardioembolic stroke, direct and indirect anticoagulants, pradaxa , warfarin, xarelto

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 University n.a. N.N. Burdenko
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.

Keywords: diagnostics, etiology, hyperphagia, hypersexual behavior, recurrent hypersomnia, syndrome of Klein — Levin

Paraneoplastic neurological syndrome: focus on the involvement of the peripheral nervous system

Year: 2017, volume 13 Issue: №1 Pages: 174-180
Heading: Neurology Article type: Review
Authors: Sitkali I.V., Kolokolov O.V.
Organization: Saratov State Medical University
Summary:

The information about epidemiology, pathogenesis and clinical heterogeneity of paraneoplastic neurological syndrome is summarized and based on Russian and foreign literature. The main attention is devoted to the affection of peripheral nervous systems in patients with oncological diseases. We report the information about anti-neuronal antibodies associated with paraneoplastic syndrome. The diagnostic criteria of paraneoplastic neurological syndromes are presented.

Keywords: antineuronal antibodies, encephalitis , neurotoxicity, paraneoplastic neurological syndrome, polyneuropathy

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 University n.a. N.N. Burdenko
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.

Keywords: classification modeling, depressive disorders, prediction algorithms, risk factors, statistical analysis

Early detection of cognitive impairment in patients with multiple sclerosis

Year: 2017, volume 13 Issue: №1 Pages: 164-168
Heading: Neurology Article type: Original article
Authors: Poverennova I.E., Romanova T.V., Zakharov A.V., Khivintseva E.V.
Organization: Samara State Medical University
Summary:

The aim of the study was to examine cognitive impairment in patients with multiple sclerosis with an emphasis on the speed and efficiency of information processing. It was supposed to reveal the patterns of these disorders depending on the duration and severity of the disease. Material and methods. The study included 50 patients with established diagnosis of clinically significant multiple sclerosis, a relapsing-remitting course. The EDSS score was evaluated. Cognitive functions were assessed using SDMT and PASAT-3 tests. All patients underwent a study of cognitive evoked potential. All examined patients were divided into 2 groups depending on the duration of the disease. Results. Cognitive screening tests PASSAT and SDMT showed no correlation with the duration of the disease severity and cannot serve as a tool for screening early signs of cognitive impairment in young patients with multiple sclerosis. A significant increase in latency of the P300 potential was obtained with increasing duration and severity of the disease, which correlates with the severity of cognitive dysfunction. Conclusion. This study is the initial step in the search for a tool for screening early manifestations of cognitive impairment in patients with multiple sclerosis. In the future it is planned to expand the research with the modernization of its design.

Keywords: cognitive evoked potential, cognitive impairment, cognitive screening scales, Expanded Disability Status Scale, multiple sclerosis

The analysis of the clinical and tool parameters characterizing a cardiomyopathyat various forms of the progressing muscular dystrophies

Year: 2017, volume 13 Issue: №1 Pages: 160-164
Heading: Neurology Article type: Original article
Authors: Poverennova I.E., Zakharov A.V., Chernikova V.V.
Organization: Samara State Medical University, Samara Regional Clinical Hospital n.a. V. D. Seredavin
Summary:

Purpose: studying of clinical and tool characteristics of cardiomyopathies at various forms of the progressing muscular dystrophies. Material and methods. There had been 103 patients with hereditary forms of the progressing muscular dystrophies examined, among which 35 persons were with Duchenne muscular dystrophy, 28 with an atrophic myo-tonia, and 40 with a limb girdle dystrophy is conducted. Assessment of clinical and tool features of cardiomyopathies at these types of the hereditary progressing muscular dystrophies had been carried out. Results. In the group of patients with diffusion damage of a myocardium in the form of dystrophic violations had been revealed. Existence of a negative tooth of T in some assignments and lengthenings of an interval of QT is noted. With a dystrophic myotonia violation of a warm rhythm occurred at patients by 87 times more often than in the group of comparison. Violation of a rhythm of heart in group of patients with a limb girdle dystrophy came to light 91 times more often in reference to the group of comparison. Conclusion. Violations in a cardiovascular system at Duchenne muscular dystrophy are preferentially diffusion changes in a myocardium. At a dystrophic myotonia and a limb girdle dystrophy cardial violations concern mainly excitability and the conductivity of heart which are the main reason of developing of this disease at these patients.

Keywords: the hereditary progressing muscular dystrophies, clinical and tool indicators, cardiomyopathies

Electroneuromyographic estimation of the functional condition of the lumbar spine department

Year: 2017, volume 13 Issue: №1 Pages: 157-160
Heading: Neurology Article type: Original article
Authors: Nazarenko N.V., Remnyov A.G., Golyakhovsky A.V.
Organization: Sanatorium "Barnaulsky", Altai Regional Diagnostic Center
Summary:

Purpose: to establish the nature of the change in the F-wave parameter in patients with degenerative spondylolis-thesis of the lumbar spine, radicular syndrome. Material and methods. 20 patients with a clinical diagnosis of degenerative spondylolisthesis, 20 patients with radicular syndrome due to herniation of intervertebral disc, 20 patients of the control group were examined. Results. Decreased F-wave latency in the group of patients with degenerative spondylolisthesis, no change in F-wave latency in the group of patients with radicular syndrome. Conclusion. A screening assessment of the functional state of the lumbar spine is possible by electroneuromyography

Keywords: spondylolisthesis, spine, radicular syndrome, intervertebral foramen, electroneuromyography

Differential diagnosis of optic-spinal multiple sclerosis variant and Devic's disease among Mongoloid race representatives

Year: 2017, volume 13 Issue: №1 Pages: 155-157
Heading: Neurology Article type: Case report
Authors: Makarov N.S.
Organization: Saratov State Medical University
Summary:

The article provides an overview of the information on the racial peculiarities of some demyelinating diseases of the representatives of Asian nationalities and related methodological difficulties of differential diagnosis. Pay attention to a clinical example of a diagnostic situation.

Keywords: Devic's neuroopticomyelitis, diagnostic criteria, genetic and racial characteristics, multiple sclerosis, optic-spinal form, treatment tactics

Correlation of cardiointervalometric and somatosensory evoked potential parameters in male and female patients with epilepsy

Year: 2017, volume 13 Issue: №1 Pages: 149-154
Heading: Neurology Article type: Original article
Authors: Lesik О.О., Zhadnov V.A.
Organization: Ryazan State Medical University n.a. I.L.Pavlov
Summary:

Somatosensory evoked potentials and cardiointervalometry can be used as additional methods of examination of patients with epilepsy. Aim: determination of relationships between functional state of the brain and stress on regulatory systems, so as to assess the adaptive potential of male and female patients with epilepsy. Materials and methods. 46 male patients (group 1) and 34 female patients (group 2) diagnosed with epilepsy participated in the study. Analyzed parameters included maximum amplitude, total area of somatosensory evoked potentials and cardio-intervalometric parameters. Results. In patients with epilepsy, there is an increase in EAP indicators that suggestive of increased neu-ronal synchronization. However, with hyperventilation physiological probe, male patients demonstrated inhibition while female patients demonstrated stimulating effect of the brain. This tendency persisted in both groups of patients after hyperventilation. Cardiointervalometric findings in female patients were consistent with vagotony, indicative of normal activity of regulatory systems and the autonomous regulation of heart rhythm. Male patients with epilepsy require significant energy in order to adapt to the load, resulting to stress of regulatory systems. Conclusion. Additional methods of examination identify features of the functional state of the brain and stress on regulatory systems in male and female patients with epilepsy. Signs of disadaptation and unfavorable course ofthe disease allow timely diagnosis and improve the quality of life ofthe patient.

Keywords: adaptation, cardio-intervalometry, epilepsy, evoked potential

The modern view of the examination and treatment of patients with intracranial cystic formations

Year: 2017, volume 13 Issue: №1 Pages: 147-149
Heading: Neurology Article type: Author's opinion
Authors: Kolesov V.N., Lukina Е.М., Chekhonatsky А.А.
Organization: Saratov State Medical University
Summary:

Objective: to determine the diagnostic and treatment policy (conservative and operative) in patients with intracranial cysts of various origins. We observed 116 patients with different brain cystic formations. Diagnostic tactics and principles of treatment were refined. The evaluation of treatment results was made.

Keywords: treatment, intracranial cysts, diagnostics