nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2013-2355nnp-206Research ArticleArticlesСтатьиManagement of a post-stroke patientВедение больного, перенесшего инсультParfenovVladimir AnatolyevichParfenovVladimir Anatolyevichvladimirparfenov@mail.ruVerbitskayaS VVerbitskayaS Vvladimirparfenov@mail.ruКафедра нервных болезней ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова», Минздрава РоссииРоссияDepartment of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian Federation20130811201352SSpecial issue "Stroke"2327Copyright © Parfenov V.A., Verbitskaya S.V., 20132013Parfenov V.A., Verbitskaya S.V.Parfenov V.A., Verbitskaya S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/206

The management of a post-stroke patient represents is a challenge to modern neurology. Complete recovery of all functions requires only recurrent stroke prevention. If the patient continues to have motor, speech, and/or other disorders that are promising to recover function, there is a need for rehabilitation. Patient care and prevention of recurrent stroke and akinesia-associated complications are required if there are no promises for functional recovery. The paper describes the current methods for the prevention of recurrent stroke, which include lifestyle modification, blood pressure normalization, and the use of surgical procedures (in some patients), antithrombotic agents, and statins (after ischemic stroke). It analyzes the possibilities and methods of treatment in lost motor and speech functions, neuropsychic (cognitive and depressive) disorders, and urination disorders. It is noted that the application of current treatment options makes it possible to substantially reduce the risk of recurrent stroke and to improve recovery of lost functions and quality of life in the patient.

Ведение больного, перенесшего инсульт, представляет собой актуальную проблему современной неврологии. При полном восстановлении всех функций требуется только профилактика повторного инсульта. Если у больного сохраняются двигательные, речевые и/или другие расстройства, перспективные в отношении восстановления функции, необходима реабилитация. При отсутствии перспектив восстановления функций требуются уход за больным и профилактика повторного инсульта и осложнений, связанных с обездвиженностью. Представлены современные методы профилактики повторного инсульта, которые включают модификацию образа жизни, нормализацию артериального давления, применение хирургических методов (у части больных), антитромботических средств и статинов (после перенесенного ишемического инсульта). Анализируются возможности и методы лечения при утраченных двигательных и речевых функциях, нервно-психических (когнитивных и депрессивных) расстройствах, нарушениях мочеиспускания. Отмечено, что использование современных методов лечения позволяет существенно снизить риск повторного инсульта, улучшить восстановление утраченных функций и качество жизни больного.

последствия инсультапрофилактика повторного инсультареабилитация после инсультапостинсультные когнитивные нарушенияпостинсультная депрессияпостинсультное недержание мочиstroke sequelsrecurrent stroke preventionpost-stroke rehabilitationpost-stroke cognitive impairmentspost-stroke depressionpost-stroke urinary incontinenceReferences<div><p>Дамулин ИВ, Парфенов ВА, Скоромец АА, Яхно НН. Нарушения кровообращения в головном и спинном мозге. В кн.: Болезни нервной системы. Руководство для врачей. Под ред. Яхно НН. Москва: Медицина; 2005;(1):232–303. [Damulin IV, Parfenov VA, Skoromets AA, Yakhno NN. Narusheniya krovoobrashcheniya v golovnom i spinnom mozge. In the book: Bolezni nervnoy sistemy. Rukovodstvo dlya vrachey. Under edition of Yakhno NN. Moscow: Meditsina; 2005;(1):232–303.]</p><p>Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 с. [Parfenov VA, Khasanova DR. Ishemicheskiy insul't. Moscow: MIA; 2012. 288 р.]</p><p>European Stroke Organization (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis. 2008;(25):457–507.</p><p>Sacco RL, Adams R, Albers G. et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack. Stroke. 2006;(37):577–617. DOI: http://dx.doi.org/10.1161%2F01.STR.0000199147.30016.74.</p><p>Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomized tri-als of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Br Med J. 2002;(324):71–86.</p><p>Van de Port I, Wood-Dauphinee S, Lindeman E, Kwakkel G. Effects of exercise training programs on walking competency after stroke: a systematic review. Am J Phys Med Rehabil. 2007;(86):935–51. DOI: http://dx.doi.org/10.1097%2FPHM.0b013e31802ee464.</p><p>Carter AR, Connor LT, Dromerick AW. Rehabilitation After Stroke: Current State of the Science. Curr Neurol Neurosci Rep. 2010;(10):158–66. DOI: http://dx.doi.org/10.1007%2Fs11910-010-0091-9.</p><p>Manheim LM, Halper AS, Cherney L. Patient-reported changes in communication after computerbased script training for aphasia. Arch Phys Med Rehabil. 2009;(90):623–7.</p><p>Cerebrovascular disease, cognitive impairment and dementia. In: Cerebrovascular disease and dementia. 2nded. O'Brien J, Ames D, Gustafson L et al, editors. London: Martin Dunitz; 2004;135–52.</p><p>Henon H, Pasquie F, Leys D. Poststroke Dementia. Cerebrovasc Dis. 2006;(22):61–70. DOI: http://dx.doi.org/10.1212%2FWNL.57.7.1216.</p><p>Вахнина НВ., Никитина ЛЮ., Парфенов ВА., Яхно НН. Постинсультные когнитивные нарушения. Журнал неврологии и психиатрии им. С.С. Корсакова. 2008;108(S22):16–21. [Vakhnina NV, Nikfflna LYu, Parfyonov VA, Yakhno NN. Post-stroke cognitive disturbances. Neuroscience and Behavioral Physiology. 2008;108(S22):16–21.]</p><p>Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol. 2009;8(11):1006–18. DOI: http://dx.doi.org/10.1016%2FS1474-4422%2809%2970236-4.</p><p>Kavirajan H, Schneider LS. Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomized controlled trials. Lancet Neurol. 2007;6(9):782–92.</p><p>Hackett ML, Anderson CS, House AO et al. Interventions for Treating Depression After Stroke. Stroke. 2009;(40):487–8. DOI: http://dx.doi.org/10.1161%2FSTROKEAHA.109.547059.</p><p>Gaete JM, Bogousslavsky J. Post-stroke depression. Expert Rev Neurother. 2008;(8):75–92. DOI: http://dx.doi.org/10.1586%2F14737175.8.1.75.</p><p>Berg A, Psych L, Lonnqvist J et al. Assessment of Depression After Stroke. A Comparison of Different Screening Instruments. Stroke. 2009;(40):523–9. DOI: http://dx.doi.org/10.1161%2FSTROKEAHA.108.527705.</p><p>Mitchell PH, Veith RC, Becker KJ. Brief Psychosocial-Behavioral Intervention With Antidepressant Reduces Poststroke Depression Significantly More Than Usual Care With Antidepressant. Stroke. 2009;(40):3073–8. DOI: http://dx.doi.org/10.1161%2FSTROKEAHA.109.549808.</p><p>Williams MP, Srikanth V, Bird M, Thrift AG. Urinary symptoms and natural history of urinary continence after first-ever stroke – a longitudinal population-based study. Age Ageing. 2012;(41):371–6. DOI: http://dx.doi.org/10.1093%2Fageing%2Fafs00.</p><p>McKenzie P, Badlani GH. The incidence and etiology of overactive bladder in patients after cerebrovascular accident. Curr Urol Rep. 2012;(13):402–6. DOI: http://dx.doi.org/10.1007%2Fs11934-012-0269-6.</p><p>Itoh Y, Yamada S, Konoeda F et al. Burden of overactive bladder symptom on quality of life in stroke patients. Neurourol Urodyn. 2012;32(5):428–34. DOI: 10.1002/nau.22336. Epub 2012 Nov 5.</p><p>Воробьев ПА, Краснова ЛС, Шустов АГ и др. Клинико-экономический анализ эффективности использования подгузников MoliCare®Premium extra soft (Моликар Премиум экстра софт) для профилактики развития дерматита и пролежней у неподвижных больных с недержанием мочи. В кн.: Пролежни. Экономика и профилактика. Под ред. Воробьева ПА, Красновой ЛС. Москва: Ньюдиамед; 2012. C. 34–99. [Vorob'ev PA, Krasnova LS, Shustov AG i dr. Kliniko-ekonomicheskiy analiz effektivnosti ispol'zovaniya podguznikov MoliCare®Premium extra soft (Molikar Premium ekstrasoft) dlya profilaktiki razvitiya dermatita i prolezhney u nepodvizhnykh bol'nykh s nederzhaniem mochi. In the book: Prolezhni. Ekonomika i profilaktika. Under edition Vorob'eva PA, Krasnovoy LS. Moscow: N'yudiamed; 2012. P. 34–99.]</p></div><br /><div><p>Дамулин ИВ, Парфенов ВА, Скоромец АА, Яхно НН. Нарушения кровообращения в головном и спинном мозге. В кн.: Болезни нервной системы. Руководство для врачей. Под ред. Яхно НН. Москва: Медицина; 2005;(1):232–303. [Damulin IV, Parfenov VA, Skoromets AA, Yakhno NN. Narusheniya krovoobrashcheniya v golovnom i spinnom mozge. In the book: Bolezni nervnoy sistemy. Rukovodstvo dlya vrachey. Under edition of Yakhno NN. Moscow: Meditsina; 2005;(1):232–303.]</p><p>Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 с. [Parfenov VA, Khasanova DR. Ishemicheskiy insul't. Moscow: MIA; 2012. 288 р.]</p><p>European Stroke Organization (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis. 2008;(25):457–507.</p><p>Sacco RL, Adams R, Albers G. et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack. Stroke. 2006;(37):577–617. DOI: http://dx.doi.org/10.1161%2F01.STR.0000199147.30016.74.</p><p>Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomized tri-als of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Br Med J. 2002;(324):71–86.</p><p>Van de Port I, Wood-Dauphinee S, Lindeman E, Kwakkel G. Effects of exercise training programs on walking competency after stroke: a systematic review. Am J Phys Med Rehabil. 2007;(86):935–51. DOI: http://dx.doi.org/10.1097%2FPHM.0b013e31802ee464.</p><p>Carter AR, Connor LT, Dromerick AW. Rehabilitation After Stroke: Current State of the Science. Curr Neurol Neurosci Rep. 2010;(10):158–66. DOI: http://dx.doi.org/10.1007%2Fs11910-010-0091-9.</p><p>Manheim LM, Halper AS, Cherney L. Patient-reported changes in communication after computerbased script training for aphasia. Arch Phys Med Rehabil. 2009;(90):623–7.</p><p>Cerebrovascular disease, cognitive impairment and dementia. In: Cerebrovascular disease and dementia. 2nded. O'Brien J, Ames D, Gustafson L et al, editors. London: Martin Dunitz; 2004;135–52.</p><p>Henon H, Pasquie F, Leys D. Poststroke Dementia. Cerebrovasc Dis. 2006;(22):61–70. DOI: http://dx.doi.org/10.1212%2FWNL.57.7.1216.</p><p>Вахнина НВ., Никитина ЛЮ., Парфенов ВА., Яхно НН. Постинсультные когнитивные нарушения. Журнал неврологии и психиатрии им. С.С. Корсакова. 2008;108(S22):16–21. [Vakhnina NV, Nikfflna LYu, Parfyonov VA, Yakhno NN. Post-stroke cognitive disturbances. Neuroscience and Behavioral Physiology. 2008;108(S22):16–21.]</p><p>Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol. 2009;8(11):1006–18. DOI: http://dx.doi.org/10.1016%2FS1474-4422%2809%2970236-4.</p><p>Kavirajan H, Schneider LS. Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomized controlled trials. Lancet Neurol. 2007;6(9):782–92.</p><p>Hackett ML, Anderson CS, House AO et al. Interventions for Treating Depression After Stroke. Stroke. 2009;(40):487–8. DOI: http://dx.doi.org/10.1161%2FSTROKEAHA.109.547059.</p><p>Gaete JM, Bogousslavsky J. Post-stroke depression. Expert Rev Neurother. 2008;(8):75–92. DOI: http://dx.doi.org/10.1586%2F14737175.8.1.75.</p><p>Berg A, Psych L, Lonnqvist J et al. Assessment of Depression After Stroke. A Comparison of Different Screening Instruments. Stroke. 2009;(40):523–9. DOI: http://dx.doi.org/10.1161%2FSTROKEAHA.108.527705.</p><p>Mitchell PH, Veith RC, Becker KJ. Brief Psychosocial-Behavioral Intervention With Antidepressant Reduces Poststroke Depression Significantly More Than Usual Care With Antidepressant. Stroke. 2009;(40):3073–8. DOI: http://dx.doi.org/10.1161%2FSTROKEAHA.109.549808.</p><p>Williams MP, Srikanth V, Bird M, Thrift AG. Urinary symptoms and natural history of urinary continence after first-ever stroke – a longitudinal population-based study. Age Ageing. 2012;(41):371–6. DOI: http://dx.doi.org/10.1093%2Fageing%2Fafs00.</p><p>McKenzie P, Badlani GH. The incidence and etiology of overactive bladder in patients after cerebrovascular accident. Curr Urol Rep. 2012;(13):402–6. DOI: http://dx.doi.org/10.1007%2Fs11934-012-0269-6.</p><p>Itoh Y, Yamada S, Konoeda F et al. Burden of overactive bladder symptom on quality of life in stroke patients. Neurourol Urodyn. 2012;32(5):428–34. DOI: 10.1002/nau.22336. Epub 2012 Nov 5.</p><p>Воробьев ПА, Краснова ЛС, Шустов АГ и др. Клинико-экономический анализ эффективности использования подгузников MoliCare®Premium extra soft (Моликар Премиум экстра софт) для профилактики развития дерматита и пролежней у неподвижных больных с недержанием мочи. В кн.: Пролежни. Экономика и профилактика. Под ред. Воробьева ПА, Красновой ЛС. Москва: Ньюдиамед; 2012. C. 34–99. [Vorob'ev PA, Krasnova LS, Shustov AG i dr. Kliniko-ekonomicheskiy analiz effektivnosti ispol'zovaniya podguznikov MoliCare®Premium extra soft (Molikar Premium ekstrasoft) dlya profilaktiki razvitiya dermatita i prolezhney u nepodvizhnykh bol'nykh s nederzhaniem mochi. In the book: Prolezhni. Ekonomika i profilaktika. Under edition Vorob'eva PA, Krasnovoy LS. Moscow: N'yudiamed; 2012. P. 34–99.]</p></div><br />

The authors declare that there are no conflicts of interest present.