Vol 44, No 3 (2016)

ARTICLES

BLOOD COAGULATION PROBLEMS AND THROMBOEMBOLIC COMPLICATIONS IN THE ACUTE STAGE OF STROKE

Silina E.V., Rumyantseva S.A., Kabaeva E.N., Stupin V.A.

Abstract

Background: High prevalence of stroke and constant mortality which is related to thromboembolic complications in one fourth of patients make it necessary to continue evaluation of clinically precise and technologically feasible methods of adequate control of coagulation and anticoagulation systems and predicting of venous thromboses and embolism. Aim: To improve diagnostics and treatment of patients with acute stroke of various types through assessment of haemostasis system and pathophysiological mechanisms of venous thromboembolism (VTE). Materials and methods: One hundred and forty five (145) patients with acute cerebral stroke (mean age, 69±13.2 years; 75 male and 70  female) were included into the study. All patients were admitted to the neuroresuscitation unit within 6 to 24 hours from manifestation; the diagnosis was verified by multiaxial computerized tomography. One hundred and four (104) (71.7%) of patients had ischemic stroke, 41 (28.3%) of patients had hemorrhagic stroke. At admittance, all patients had a  certain level of consciousness derangement. All patients were monitored by means of computerized tomography, general and neurological assessment, functional assessment, chest X-ray, ultrasound examination of extremities and assessment of haemostasis (screening and direct thrombodynamics test). Results: In 95%  of cases, VTE risk factors were found; VTE developed in 40  (27.6%) of patients. The most frequent complication was pulmonary embolism (90%  of all VTE and 24.8%  of 145  patients). In-hospital mortality was 44.1%  (n=64) and correlated with VTE (r=0.384; р<0.01). Outcomes of ischemic stroke depended mainly on VTE (at autopsy, they were found in 58.5%  of patients with ischemic stroke and in 26.1%  of those with hemorrhagic stroke) and other complications. Outcomes of hemorrhagic insult depended on the size of the lesion that correlated with severity of clinical symptoms. Screening coagulation parameters were not informative enough for the assessment of haemostasis. Development of VTE correlated with some hypercoagulation in the first days after stroke that were quickly transformed into hypocoagulation. This process could be reliably assessed by the thrombodynamics test. Conclusion: Taking into account high incidence of VTE in patients with severe stroke and low informative value of coagulation screening, it is reasonable to use direct methods of haemostasis assessment and individualized approached to preventive and therapeutic anticoagulation.

Almanac of Clinical Medicine. 2016;44(3):270-279
pages 270-279 views

EFFICACY OF COMPLEX NEUROREHABILITATION OF PATIENTS WITH A POST-STROKE ARM PARESIS WITH THE USE OF A BRAIN-COMPUTER INTERFACE+EXOSKELETON SYSTEM

Frolov A.A., Biryukova E.V., Bobrov P.D., Kurganskaya M.E., Pavlova O.G., Kondur A.A., Turbina L.G., Kotov S.V.

Abstract

Background: Rehabilitation of patients with poststroke motor disorders with the use of a brain-computer interface (BCI)+exoskeleton may raise the rehabilitation to a  new high-tech level and allow for an effective correction of the post-stroke dysfunction. Aim: To assess the efficacy of BCI+exoskeleton procedures for neurorehabilitation of patients with post-stroke motor dysfunction. Materials and methods: The study included 40 patients with a history of cerebral stroke (mean age 59±10.4 years, 26 male and 14 female). Thirty six of them had had an ischemic stroke and 4, a hemorrhagic stroke from 2 months to 4 years before the study entry. All patients had a various degree post-stroke hemiparesis predominantly of the arm. The main group patients (n=20), in addition to conventional therapy, had 10  sessions (3  times daily) of BCI+exoskeleton. The BCI recognized the hand ungripping imagined by the patient and, by a  feedback signal, the exoskeleton exerted the passive movement in the paretic arm. The control group patients (n=10) had 10  BCI+exoskeleton sessions without imaginary movements, and the exoskeleton functioned in a  random mode. The comparison group included 10  patients who received only standard treatment. Results: At the end of rehabilitation treatment (day 14), all study groups demonstrated an improvement in the function of the paretic extremity. There was an improvement of functioning and daily activities in the main group, compared to the control and the comparison groups: the change in the modified Rankin scale score was 0.4±0.1, 0.1±0.1  and 0±0.2 (p<0.05), in the Bartel scale score, 5.6±0.8, 2.3±0.3 and 1±0.2 (p<0.001), respectively. In the BCI+exoskeleton group the motor function of the paretic arm assessed by the ARAT scale, improved by 5.5±1.3  points (2.4±0.6  points in the control group and 1.9±0.7  in the comparison group, р<0.05), and as assessed by the Fugl-Meyer scale, by 10.8±1.5 points (3.8±1.05 points in the comparison group, p<0.001). Conclusion: Rehabilitation of patients with post-stroke paresis with the use of BCI+exoskeleton led not also to a decrease in neurological deficit and an improvement of the paretic arm motor function, but also improved parameters of daily activities. Further studies of the effects of BCI+exoskeleton rehabilitation procedures on the course of motor function restoration are planned.

Almanac of Clinical Medicine. 2016;44(3):280-286
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MODIFIABLE RISK FACTORS OF THE STROKE IN PATIENTS OF A SMALL TOWN

Kozyaykin V.V., Isakova E.V.

Abstract

Background: Evaluation of risk factor prevalence is of great practical importance. There have been few studies on modifiable and non-modifiable risk factors for stroke in Russian Federation. Impacts of individual factors and their interplay have not been assessed. Aim: To assess prevalence of modifiable

risk factors (atrial fibrillation, obesity) in stroke patients living in a small town. Materials and methods: We assessed 129 living in a  small town and admitted to a hospital due to acute stroke. Results: Fifty two (40.31%) stroke patients had heart disorders, including 27 patients (20.93%) with atrial fibrillation. The majority of patients with atrial fibrillation (n=23, 85.19%) had not taken any antithrombotic treatments before stroke or had not taken them regularly. High body mass index was found in 98 (75.97%) of patients. Mean body mass index in female patients was significantly higher than that in male patients (р=0.0002). Abdominal obesity was diagnosed in 80 (62.02%) of patients and was also more prevalent among females (p<0.0001). Conclusion: Stroke patients in a small town have a significant prevalence of such risk factors as atrial fibrillation and obesity. The control of atrial fibrillation was insufficient, if not lacking.

Almanac of Clinical Medicine. 2016;44(3):287-294
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ACUTE CEREBROVASCULAR ACCIDENTS IN PREGNANCY, LABOR AND POSTPARTUM

Arustamyan R.R., Adamyan L.V., Shifman E.M., Ovezov A.M.

Abstract

Background: Acute cerebrovascular accidents are rare and serious complication of pregnancy, labor and puerperium, leading to an increase in maternal and perinatal morbidity and mortality. More than 12% of maternal mortality is related to stroke. Aim: To assess the impact of pregnancy on the incidence of stroke, as well as the impact of cerebrovascular disorders on pregnancy, labor and puerperium. Materials and methods: We retrospectively and prospectively analyzed the course of pregnancy, labor and puerperium in 136 female patients with strokes of various etiologies. The diagnosis of stroke and cerebrovascular disorders was verified with magnetic resonance imaging, angiography, conventional and multiaxial computerized tomography, ophthalmoscopy, electroencephalography, electrocardiography and echocardiography (trans-thoracic and trans-esophageal), 24-hour blood pressure monitoring and electrocardiogram monitoring, ultrasound assessment of extra and intracranial vasculature with duplex scanning, cerebral angiography and laboratory assessments. Results: The analysis of 92 strokes that occurred during pregnancy, labor and postpartum showed that 38% of the cases (n=35) were caused by various cerebrovascular abnormalities. In 18.5% of the cases (n=17), acute cerebrovascular accidents occurred in patients with preeclampsia/eclampsia. Most often (84.8%, or 78/97 of cases) strokes or other cerebrovascular accidents developed in II and III trimesters. The most severe cases were patients with intracranial hemorrhages (n=31). In this group, there were 5  deaths of mothers, 1  antenatal and 1  neonatal fetal deaths. In 90% of these cases (28/31), intracranial hemorrhage in pregnancy was related to manifestation of intracerebral vascular abnormality (arteriovenous malformations, arterial aneurysms, cavernomas). We observed a 4-fold rate of arteriovenous malformation ruptures during pregnancy (21 cases vs. 5). The rates of arterial aneurysm and cavernoma ruptures during pregnancy and in the past history were comparable (6 and 8 cases and 4 and 6 cases, respectively). Conclusion: An acute cerebrovascular accident is a hazardous complication of pregnancy, which increases maternal and perinatal morbidity and mortality. Pregnancy increases the risk of manifestation of brain arteriovenous malformations. 

Almanac of Clinical Medicine. 2016;44(3):295-300
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ASSESSMENT OF PARAMETERS OF RENAL FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND ABDOMINAL OBESITY WITH A HISTORY OF ACUTE CEREBROVASCULAR ACCIDENT, DEPENDING ON THE TARGET LEVELS OF SYSTOLIC BLOOD PRESSURE IN THE RECOVERY PERIOD OF THE STROKE

Lopina E.A.

Abstract

Background: Essential arterial hypertension is one of the most common causes of chronic kidney disease. Timely identification of asymptomatic chronic kidney disease may help to prevent development of renal failure and maintain kidney functioning. Aim: To assess changes in renal function parameters in patients with arterial hypertension and abdominal obesity with a  history of a stroke, depending on the target levels of systolic blood pressure (SBP) during the recovery period of stroke. Materials and methods: We assessed 88 patients with arterial hypertension with a  history of an acute cerebrovascular accident within the last 1 to 6 months (mean age, 58.8±9.5 years). During 2 to 4 weeks of their hospital stay, their antihypertensive treatments were titrated to reach the chosen target levels of blood pressure. Thereafter, the patients were followed up for 8 to 12 months with baseline and follow-up measurements of their antropometric and clinical chemistry parameters including blood urea nitrogen and serum creatinine and estimated glomerular filtration rate (CKD-EPI). Chronic kidney disease was diagnosed by albumin and creatinine measurements with calculation of albumin/creatinine ratio in the morning urine portion. Results: There was a  positive correlation between office SBP and serum creatinine (r=0.5, р=0.01), serum albumin (r=0.4, р=0.003) and creatinine in the morning urine portion (r=0,5, р=0.0001). Hip circumference negatively correlated with serum creatinine and albumin/creatinine ration at the end of the follow-up (r=-0.3, р=0.04 and r=-0.3, р=0.04, respectively). Bodyweight correlated positively with the glomerular filtration rate (r=0.3, р=0.04), whereas waist to hip ration correlated with urine albumin at the end of the follow-up (r=0.3, р=0.01). Multiple regression analysis showed an association between mean office SBP and serum creatinine (β=0.43, р=0.04), urine albumin (β=0.33, р=0.02) and urine creatinine level (β=0.39, р=0.005). Conclusion: We found an association between SBP and renal function. SBP levels below 135 mm Hg are associated with an improvement of the renal function, whereas SBP levels below 124 mm Hg are associated with a significant decrease in renal function assessed by glomerular filtration rate and albumin/creatinine ratio. The efficacy of antihypertensive treatment in the recovery period after an acute cerebrovascular accident should be assessed with consideration of renal function measured by glomerular filtration rate and microalbuminuria levels. 

Almanac of Clinical Medicine. 2016;44(3):301-307
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A COMPARATIVE ANALYSIS OF EFFICACY OF INTERFERON BETA 1-B AND NATALIZUMAB TREATMENT IN PATIENTS WITH RELAPSING-REMITTING MULTIPLE SCLEROSIS

Yakushina T.I., Kotov S.V., Yakushin M.A., Belova Y.A., Kuchina N.V., Andryukhina O.M.

Abstract

Background: Disease modifying drugs for multiple sclerosis have similar indications for use and at the same time, their specifics of the effect on the pathophysiological process. This complicates the choice of an optimal therapy for a  given patient. Aim: To assess efficacy of treatment for multiple sclerosis with interferon beta-1b (IFN-β-1b) and natalizumab. Materials and methods: We performed an open label prospective study in 110  patients with multiple sclerosis who were followed up in the Moscow Regional Center of multiple sclerosis from 2012 to 2015. From those, 99  patients with relapsing-remitting multiple sclerosis (disease modifying drugs naïve) were treated with IFN-β-1b, 11 were non-responders to interferon (1 and more attacks for the previous year of therapy with IFN-β-1b) or had progressive course of multiple sclerosis (more than 2  attacks and an increase in the Expanded Disability Status Scale (EDSS) score by 1 and more within 1 year) and were treated with natalizumab. Analysis of treatment efficacy was performed with consideration of their past history, results of a  3-year neuromonitoring with Kurtzke EDSS and Functional System Scale, neuroophthalmologic testing with Farnsworth dichotomous test, and changes in optical coherent tomography parameters. Results: During 3  years of treatment with IFN-β-1b, the mean number of attacks decreased by over 70% (from 1.28±0.7 in the year before treatment to 0.35±0.09 in the 3rd year of treatment; p<0.05), whereas the degree of disability assessed by EDSS increased nonsignificantly by 0.44 (p>0.05). During the follow-up in the natalizumab group, the number of attacks decreased from 2.3±0.04 to 0.13±0.01 (p<0.05), and the degree of disability by EDSS decreased by 0.8 (p>0.05). There was a significant difference between changes in the thickness of peripapillar nervous fibers during 2  years of the follow up, this parameter decreasing by 2.5 mcm in patients treated with IFN-β-1b and by 0.1  mcm in those treated with natalizumab (p<0.01). Conclusion: Although the patients from natalizumab group had initial more severe course of multiple sclerosis, both agents were highly effective, with the most prominent clinical effect observed for natalizumab. The results obtained may serve as a  basis for recommendation of the 2nd line disease modifying drugs for patients with aggressive course of the multiple sclerosis and failure of the 1st line disease modifying drugs. Also, we were able to demonstrate the efficacy of neuroophthalmological monitoring in the assessment of disease modifying drugs efficacy. The strict safety policy is essential while using natalizumab.

Almanac of Clinical Medicine. 2016;44(3):308-316
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THE INFLUENCE OF NEUTRALIZING ANTIBODIES TO INTERFERON-BETA ON PROGRESSION OF MULTIPLE SCLEROSIS

Lizhdvoy V.Y., Ospel'nikova T.P., Kotov S.V.

Abstract

Background: Neutralizing antibodies (NAbs) affect the effectiveness of interferon therapy in patients with multiple sclerosis; however, this influence cannot be considered as unequivocal. NAbs formation is determined by several factors, such as frequency and duration of administration, interferon-β (IFN-β) formulation and the patient's genotype. It has been found that NAb titers vary over time. Aim: To assess the levels of NAbs to IFN-β in patients with multiple sclerosis and to investigate their relationship to disease progression. Materials and methods: We analyzed serum samples from 83  multiple sclerosis patients after a  long-term IFN-β-1b treatment; NAbs detection reaction was performed by assessment of their cytopathic effect. Results: NAbs were found in 63.9%  (53  of 83) of patients with dura￾tion of IFN-β-1b treatment of 33.3±17.6 months. All NAb-positive patients were treated with high￾dose IFN-β. Patients with titers>800  LU (n=28) demonstrated a  trend towards more advanced neurologic deficit on the Expanded Disability Status Scale (EDSS), compared to the patients with normal NAbs titers (0  to 20  LU, n=30) and intermediate titers (20 to 800 LU, n=25) (p>0.05). The exacerbation rate in the group with NAbs titers from 20  to 800  LU was insignificantly lower than that in the group with NAbs>800 and in the NAb-negative patients (p>0.05). Conclusion: Testing for NAbs may be a promising method for monitoring of IFN-β therapy in multiple sclerosis. There was a trend towards more pronounced neurological deficit in patients with high NAbs titers, but paradoxical data on a high rate of exacerbations in NAb-negative patients requires further study. 

Almanac of Clinical Medicine. 2016;44(3):317-323
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CHANGES IN TUMOR NECROSIS FACTOR ALFA DURING TREATMENT OF PATIENTS WITH MULTIPLE SCLEROSIS BY TRANSIMMUNIZATION METHOD

Kil'dyushevskiy A.V., Kotov S.V., Sidorova O.P., Borodin A.V.

Abstract

Background: Despite the availability of a  large number of treatments for multiple sclerosis with various targets, these treatments are not always effective. According to the literature, experimental studies have shown a  significant decrease in tumor necrosis factor alfa (TNF-α) with the use of extracorporeal photochemotherapy. Aim: To assess changes in TNF-α in patients with multiple sclerosis during treatment with transimmunization. Materials and methods: The study recruited 13 adult patients with multiple sclerosis. Serum TNF-α was measured by immunochemiluminescence analysis (IMMULITE 1000, Siemens). The patients were treated by transimmunization, i.e. a  modified photopheresis. Two hours before the procedure, Ammifurin (8-methoxypsoralene) was administered to all the patients, then their mononuclear cells were isolated under PBSC protocol with Haemonetics MCS+ cell separator. Thereafter, mononuclear cells were irradiated with ultraviolet for 90  minutes and incubated for 20 hours at 37 °С. The next day the cells were re-infused to the patients. The procedure was performed 2  times per week for 6  months, then once per 4  months. Results: Before transimmunization, mean TNF-α level in adult patients with multiple sclerosis was 9.958±0.812  pg/mL (normal, below 8.1 pg/mL). After transimmunization, its level was 6.992±0.367  pg/mL (р<0.05). Conclusion: Ultraviolet irradiation of peripheral blood monocytes with their subsequent incubation (transimmunization) led to a 30% decrease of serum TNF-α in patients with multiple sclerosis. This indicates a suppressive effect of transimmunization on TNF-α. Hence, in patients with multiple sclerosis transimmunization exerts an anti-inflammatory effect.
Almanac of Clinical Medicine. 2016;44(3):324-328
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THE РERSONALITY PROFILE OF PATIENTS WITH EARLY MANIFESTATIONS OF PARKINSON'S DISEASE

Bogdanov R.R., Borisova S.Y., Kotov S.V., Zavarzina O.O.

Abstract

Background: Mental disorders that sometimes may precede motor dysfunction have an important value in Parkinson's disease, especially at its earlier stages. Personality characteristics of patients with Parkinson's disease have not been studied enough and require a  detailed assessment, because it is a  major factor contributing to treatment efficacy. Aim: To assess personality profiles of patients with early stages of Parkinson's disease and an impact of a dopamine receptor agonist on the personality profile. Materials and methods: We assessed 33 treatment-naïve patients with early symptoms of Parkinson's disease (Hoehn-Yahr stage I and II). The following scales were used before treatment and at 1, 3 and 6 months of treatment with pramipexol: for motor disorders (UPDRS, Unified Parkinson's Disease Rating Scale), depressive disorders (MADRS, Montgomery Asberg Depression Rating Scale) and anxiety disorders (HARS, Hamilton Anxiety Rating Scale), as well as personality profile (MMPI, Minnesota Multiphasic Personality Inventory). Results: The personality profile assessed by MMPI in patients with early stage Parkinson's disease was characterized by highest T scores on scales 2 (pessimism) (74 [64; 86]), 1 (neurotic excess control) (67 [63; 74]), 3  (emotional instability) (64 [56; 70]), 7 (anxiousness) (63 [52; 70]), 8 (autism) (64 [58; 74]), 0  (introversion) (63 [59; 66]). This indicates basic pathopsychological characteristics of patients with early stages of the disease. In particular, their emotional sphere demonstrated anxiety- and depression-related affective disorders. Their personality structure was characterized by dysthymic, anxious, rigid and explosive traits, and susceptibility to hypochondriasis. With a background of a dramatic motivational conflict, frustration of high-level need in self-actualization and recognition due to a chronic disease with motor dysfunction triggered a depressive response type. Pharmacological treatment with pramipexol decreased the neurotic triad at 1 month. However, at subsequent follow-up, there was a gradual shift towards baseline parameters, in spite of a  good clinical efficacy of treatment against motor disorders that indicates a stable sensitive-anxious personality accentuation. Conclusion: Early stages of Parkinson's disease are characterized by a  sensitive-anxious personality structure that is quite stable. This should be taken into account when deciding on a treatment approach to these patients and consideration of potential psychotherapeutic support.

Almanac of Clinical Medicine. 2016;44(3):329-335
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A STUDY OF EFFICACY OF TREATMENT FOR ESSENTIAL TREMOR USING TREMOROGRAPHY

Zakharov D.V., Yarygina Y.V., Mikhaylov V.A., Bogacheva V.A., Khublarova L.A.

Abstract

Background: Essential tremor is one of the most prevalent extrapyramidal disorders, while treatment efficacy in such patients remains low. Clinical polymorphism of essential tremor requires a  differentiated treatment approach, that should be implemented with consideration of objective tremor parameters. Aim: To study efficacy of treatment of essential tremor based on tremorography. Materials and methods: We followed up 85  patients with essential tremor (mean age, 69.05±1.2  years) who were treated with anticonvulsants as monotherapy (primidone or topiramate), or with combination treatment with non-selective beta-blockers (propranolol), anxiolytics (hydroxizine, etifoxine) and aminophenylbutyric acid. During the treatment, we assessed changes in functional status by Fahn-Tolosa-Marin Tremor Severity Scale and by tremorography. Results: Under treatment with primidone, there was a decrease in global tremor assessment of postural tremor (p=0.036) and of action tremor (p=0.001). During treatment with topiramate, there was a decrease in global tremor assessment in all tests performed (p<0.0002). Non-specific treatment (anxiolytics) exerted a positive effect on the functional state of patients with essential tremor. Conclusion: Tremor amplitude and duration are the objective parameters that define its severity. The treatment guidelines for essential tremor in the elderly patients have been developed.

Almanac of Clinical Medicine. 2016;44(3):336-344
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THE STRUCTURES OF CEREBROSPINAL FLUID IN DIAGNOSTICS AND TREATMENT EFFICACY ASSESSMENT IN PATIENT WITH NEUROSYPHILIS

Shatokhina S.N., Kuznetsova N.A.

Abstract

Background: In the last years, there has been an increase in cases of latent and late neurosyphilis. Due to the wide implementation of antibiotics, there is a significant reduction in sensitivity of serological and general clinical tests used for diagnosis of this disease. The situations are not uncommon when it is not possible to exclude or confirm the invasion of Treponema pallidum into the nervous system structures. Absence of objective diagnostic criteria for neurosyphilis hints the timely administration of an adequate treatment aimed at prevention of an irreversible derangement of the nervous system and to the patient death. Aim: To search for new diagnostic symptoms of an injury to the brain structures caused by Treponema pallidum in patients with previous syphilis, based on a new technology of assessment of solid phase structures of cerebrospinal fluid. Materials and methods: One hundred and thirty one patient that had been treated for various forms of syphilis were recruited to this study. In addition to generally accepted clinical and laboratory assessments, including various serological methods, all patients underwent clinical and serological assessment of cerebrospinal fluid (CSF). According to the results of this assessment, all patients were categorized into three groups. Group 1 (n=27) consisted of patients with early asymptomatic neurosyphilis, group 2 (n=46), with late meningovascular neurosyphilis, group  3 (n=58), those without diagnosed neurosyphilis but with strong positive serum tests, negative CSF serology and negative VDRL test. An innovative method of marginal dehydration of biological fluids was used. The method is included into the Lithos-system diagnostic technology and allows for evaluation of the structures of CSF systems “lipid – water”, “lipid – protein – water” after their transition from liquid crystal phase into a  solid phase. These structures called anisomorphons are seen only at polarized microscopy. The control group comprised 24  patients from in-patient department of neurology and neurosurgery with serous meningitis (n=8), as well as with purulent meningitis and meningoencephalitis (n=16) of bacterial etiology. Results: The morphological sign of a destructive process in central nervous system of neurosyphilis patients was represented by amorphous ovals that were absent in normal CSF. In group 1 patients, the amorphous ovals were found in small numbers within basic anisomorphons  – dendrites. In group 2 patients, multiple separated amorphous ovals were detected as spheres, as well as basic anisomorphons  – dendrites, fully filled with spheres made of amorphous ovals. Based on these characteristics, in 2  patients from group  3, early asymptomatic neurosyphilis was diagnosed, and in 5  patients, late meningovascular syphilis. At follow-up of 22 patients from group 2, positive trend towards normalization of CSF anisomorphons were seen only after 6 months of additional specific treatment. Conclusion: Assessment of CSF anisomorphon contents in patients with neurosyphilis by means of marginal dehydratation may serve as an additional diagnostic criterion of an early or late phase of neurosyphilis, help decide on the sanitation of the central nervous system and assess the treatment efficacy. 

Almanac of Clinical Medicine. 2016;44(3):345-350
pages 345-350 views

THE TIME COURSE OF ABNORMALITIES IN THE BRAIN SUBCORTICAL VISUAL CENTRE FOLLOWING EARLY IMPAIRMENT OF BINOCULAR EXPERIENCE

Alekseenko S.V., Shkorbatova P.Y.

Abstract

Background: Amblyopia related to congenital strabismus belongs to neurological disorders since it is caused by structural and functional remodeling of the visual parts of the brain without any baseline retinal pathology. Although a large number of animal studies on experimentally induced strabismus, as well as clinical cases have been published, the mechanisms and time course of the processes within the brain structures are not fully understood. Aim: To study the time course of abnormalities in the dorsal lateral geniculate nucleus (LGNd) in animals with surgically induced convergent strabismus. LGNd is the structure through which the information from the retina goes to the visual cortex separately for each eye. Materials and methods: 14 strabismic and 17 intact kittens of four age groups were studied. Histochemical method was used to identify cytochrome oxidase which is a  mitochondrial respiratory chain enzyme whose activity correlates with neuronal functional activity. Optical density in eye-specific layers  A  and A1 was measured on the images of stained LGNd sections, with calculation of the contrast difference between them. Results: In strabismic kittens, there were changes in activity of A and A1 layers in the projection of the central part of visual field in LGNd of both hemispheres. At early stages of their formation, a relative decrease in activity was found in both hemispheres in the LGNd layers innervated through non-crossed pathways from both retinae. Thereafter, the time course of abnormalities in LGNd of both hemispheres was different. In the hemisphere ipsilateral to the squinting eye, the difference in layer activity was highest at the age from 3 to 5 months. However, in the opposite hemisphere the same difference indicating a decreased activity in the layer of the squinting eye were observed only at the age of 5 months. Conclusion: The process of amblyopia development during congenital convergent strabismus is characterized by abnormalities in LGNd indicating a possible shift of the visual perception strategy from alternating fixation to suppression of activity of the squinting eye. 

Almanac of Clinical Medicine. 2016;44(3):351-357
pages 351-357 views

CLINICAL CASES

AGGRESSIVE COURSE OF MULTIPLE SCLEROSIS IN AN ADOLESCENT: A CASE STUDY

Kotov A.S., Matyuk Y.V., Bunak M.S., Borisova M.N., Panteleeva M.V., Shatalin A.V.

Abstract

In the last years there has been a  tendency towards a  shift of the onset of multiple sclerosis to childhood and adolescence. According to various estimates, its incidence at the age below 18 is in the range from 2 to 10%. The most characteristic for such patients is a  relapsing remitting course with a multi symptom onset. We present a "classic" clinical case of a female patient with an aggressive course of multiple sclerosis with the onset in the adolescence, discuss its assessment and management. 

Almanac of Clinical Medicine. 2016;44(3):358-362
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STATUS EPILEPTICUS IN A PATIENT WITH RASMUSSEN’S ENCEPHALITIS

Kotov A.S. A.S., Eliseev Y.V., Semenova E.I., Tokareva Y.V., Romanova M.V., Bunak M.S., Rudakova I.G.

Abstract

We describe clinical case of Rasmussen's encephalitis in a 24-year-old woman that occurred during her hospital stay. Its clinical manifestations included a  clonic movement disorder and partial epilepsy. Brain magnetic resonance imaging study showed shrinkage of her left hemisphere with signs of inflammation and scarring. An electroencephalography showed the electrophysiological characteristics of epilepsy and slowing down of the left hemisphere activity. Brain biopsy was not provided. 

Almanac of Clinical Medicine. 2016;44(3):363-368
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AN OPTIMIZATION OF REHABILITATION PROCEDURE IN A PATIENT WITH AN ACUTE STROKE BASED ON MECHANOTHERAPY AND COGNITIVE STIMULATION WITH THE USE OF TABLET PC TECHNOLOGY

Shergeshev V.I., Plyasova Y.V., Kotov S.V., Isakova E.V., Stashuk G.A.

Abstract

The use of physical exercise and computer-based stimulation programs is considered to be a promising method for rehabilitation of cognitive dysfunction after a  stroke. The article presents the results of a  complex rehabilitation strategy in a  58-year old patient with an acute ischemic stroke with hemiparesis and moderate cognitive dysfunction. The optimized approach consisted of cyclic mechanotherapy combined with cognitive training performed by the patient himself and including the use of computer-based stimulation programs and tablet PC technology. Changes in cognitive and motor dysfunction were assessed with quantitative scales for motor functioning and neuropsychologic status. After the treatment course, there was a substantial improvement of the patient subjective well-being, as well as cognitive and motor functions on all rating scales. 

Almanac of Clinical Medicine. 2016;44(3):369-375
pages 369-375 views

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