nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2014-2-62-69nnp-397Research ArticleREVIEWSОБЗОРЫHeart diseases and strokes in young peopleЗаболевания сердца и инсульты у лиц молодого возрастаПизоваН.В.PizovaN.V.

Кафедра неврологии и медицинской генетики с курсом нейрохирургии

Department of Neurology and Medical Genetics with Course of Neurosurgery

pizova@yandex.ruГБОУ ВПО «Ярославская государственная медицинская академия» Минздрава России, ЯрославльРоссияYaroslavl State Medical Academy, Ministry of Health of Russia, YaroslavlRussian Federation201420062014626269Copyright © Pizova N., 20142014Пизова Н.Pizova N.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/397

The paper shows the relevance of the problem associated with the diagnosis and treatment of stroke in young patients aged 15-45 years. It considers the major causes of acute cerebrovascular accidents in young people, including pregnant women. Diseases, such patent foramen ovale, mitral valve prolapse, infective endocarditis, and postpartum cardiomyopathy, are described in detail. The basic principles of the diagnosis and therapy of ischemic stroke at a young age are given. The mainstay of therapy for acute ischemic stroke is stated to include two procedures: reperfusion and neuronal protection.

Показана актуальность проблемы диагностики и лечения инсульта у пациентов молодого возраста (15–45 лет). Рассмотрены кардиальные причины развития острых нарушений мозгового кровообращения в молодом возрасте, в том числе у беременных. Подробно описаны такие заболевания, как открытое овальное окно, пролапс митрального клапана, инфекционный эндокардит и послеродовая кардиомиопатия. Представлены основные принципы диагностики и терапии ишемического инсульта в молодом возрасте. Указано, что основой терапии острого ишемического инсульта являются два направления: реперфузия и нейрональная протекция.

ишемический инсультмолодой возрасткардиальная патологияischemic strokeyoung agecardiac pathologyReferencesПизова НВ. Подтипы ишемических нарушений мозгового кровообращения в молодом возрасте: диагностика и лечение. Неврология, нейропсихиатрия, психосоматика. 2012;(4):34–8. [Pizova NV. Subtypes of ischemic cerebral circulation disorders at young age: diagnosis and treatment. Nevrologiya,neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;(4):34–8. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2012-418.Пизова НВ. Подтипы ишемических нарушений мозгового кровообращения в молодом возрасте: диагностика и лечение. Неврология, нейропсихиатрия, психосоматика. 2012;(4):34–8. [Pizova NV. Subtypes of ischemic cerebral circulation disorders at young age: diagnosis and treatment. Nevrologiya,neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;(4):34–8. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2012-418.Haapaniemi H, Hillbom M, Juvela S.Lifestyle-associated risk factors for acute brain infarction among persons of working age. Stroke. 1997;28(1):26–30. DOI: http://dx.doi.org/10.1161/01.STR.28.1.26.Haapaniemi H, Hillbom M, Juvela S.Lifestyle-associated risk factors for acute brain infarction among persons of working age. Stroke. 1997;28(1):26–30. DOI: http://dx.doi.org/10.1161/01.STR.28.1.26.Kittner SJ, McCarter RJ, Sherwin RW, et al. Black-white differences in stroke risk among young adults. Stroke. 1993;24(12 Suppl):I13–5.Kittner SJ, McCarter RJ, Sherwin RW, et al. Black-white differences in stroke risk among young adults. Stroke. 1993;24(12 Suppl):I13–5.Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 Consecutive Patients Aged 15 to 49 With First-Ever Ischemic Stroke. The Helsinki Young Stroke Registry. Stroke. 2009;40(4):1195–203. DOI: 10.1161/STROKEAHA.108.529883. Epub 2009 Feb 26.Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 Consecutive Patients Aged 15 to 49 With First-Ever Ischemic Stroke. The Helsinki Young Stroke Registry. Stroke. 2009;40(4):1195–203. DOI: 10.1161/STROKEAHA.108.529883. Epub 2009 Feb 26.Фонякин АВ, Суслина ЗА, Гераскина ЛА.Кардиологическая диагностика при ишемическом инсульте. Санкт-Петербург:ИНКАРТ; 2005. 224 c. [Fonyakin AV, Suslina ZA, Geraskina LA. Kardiologicheskaya diagnostika pri ishemicheskom insul'te [Cardiological diagnostics at an ischemic stroke]. St-Petersburg: INKART; 2005. 224 p.]Фонякин АВ, Суслина ЗА, Гераскина ЛА.Кардиологическая диагностика при ишемическом инсульте. Санкт-Петербург:ИНКАРТ; 2005. 224 c. [Fonyakin AV, Suslina ZA, Geraskina LA. Kardiologicheskaya diagnostika pri ishemicheskom insul'te [Cardiological diagnostics at an ischemic stroke]. St-Petersburg: INKART; 2005. 224 p.]Cujec B, Manira R, Johnson DH. Prevention of recurrent cerebral ischemic events in patients with patent foramen ovale and cryptogenic strokes or transient ischemic attacks. Can J Cardiol. 1999;15(1):57–64.Cujec B, Manira R, Johnson DH. Prevention of recurrent cerebral ischemic events in patients with patent foramen ovale and cryptogenic strokes or transient ischemic attacks. Can J Cardiol. 1999;15(1):57–64.Hagan PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Prac.1984;59(1):17–20. DOI: http://dx.doi.org/10.1016/S0025-6196(12)60336-X.Hagan PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Prac.1984;59(1):17–20. DOI: http://dx.doi.org/10.1016/S0025-6196(12)60336-X.Overell JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology. 2000;55(8):1172–9. DOI: http://dx.doi.org/10.1212/WNL.55.8.1172.Overell JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology. 2000;55(8):1172–9. DOI: http://dx.doi.org/10.1212/WNL.55.8.1172.Lechat P, Mas JL, Lascault G, et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988;318(18):1148–52. DOI: http://dx.doi.org/10.1056/NEJM198805053181802.Lechat P, Mas JL, Lascault G, et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988;318(18):1148–52. DOI: http://dx.doi.org/10.1056/NEJM198805053181802.Berthet K, Lavergne T, Cohen A, et al. Significant association of atrial vulnerability with atrial septal abnormalities in young patients with ischemic stroke of unknown cause. Stroke. 2000;31(2):398–403. DOI: http://dx.doi.org/10.1161/01.STR.31.2.398.Berthet K, Lavergne T, Cohen A, et al. Significant association of atrial vulnerability with atrial septal abnormalities in young patients with ischemic stroke of unknown cause. Stroke. 2000;31(2):398–403. DOI: http://dx.doi.org/10.1161/01.STR.31.2.398.Homma S, Sacco RL, Di Tullio MR, et al. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Stroke. 2002;105(22):2625–31.Homma S, Sacco RL, Di Tullio MR, et al. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Stroke. 2002;105(22):2625–31.Bogousslavsky J, Garazi S, Jeanrenaud X, et al. Stroke recurrence in patients with patent foramen ovalethe Lausanne Study. Lausanne Stroke with Paradoxal Embolism Study Group. Neurology. 1996;46(5):1301–5. DOI: http://dx.doi.org/10.1212/WNL.46.5.1301.Bogousslavsky J, Garazi S, Jeanrenaud X, et al. Stroke recurrence in patients with patent foramen ovalethe Lausanne Study. Lausanne Stroke with Paradoxal Embolism Study Group. Neurology. 1996;46(5):1301–5. DOI: http://dx.doi.org/10.1212/WNL.46.5.1301.Nedeltchev K, Arnold M, Wahl A, et al. Outcome of patients with cryptogenic stroke and patent foramen ovale. J Neurol Neurosurg Psychiatry. 2002;72(3):347–50. DOI: http://dx.doi.org/10.1136/jnnp.72.3.347.Nedeltchev K, Arnold M, Wahl A, et al. Outcome of patients with cryptogenic stroke and patent foramen ovale. J Neurol Neurosurg Psychiatry. 2002;72(3):347–50. DOI: http://dx.doi.org/10.1136/jnnp.72.3.347.Rosenberg RD, Aird WC. Vascular-bed-specific hemostasis and hypercoagulable states. N Engl J Med. 1999;340(20):1555–64. DOI: http://dx.doi.org/10.1056/NEJM199905203402007.Rosenberg RD, Aird WC. Vascular-bed-specific hemostasis and hypercoagulable states. N Engl J Med. 1999;340(20):1555–64. DOI: http://dx.doi.org/10.1056/NEJM199905203402007.Kistler JP, Furie KL. Patent foramen ovale diameter and embolic stroke: a part of the puzzle? Am J Med. 2000;109(6):506–7. DOI: http://dx.doi.org/10.1016/S0002-9343(00)00599-4.Kistler JP, Furie KL. Patent foramen ovale diameter and embolic stroke: a part of the puzzle? Am J Med. 2000;109(6):506–7. DOI: http://dx.doi.org/10.1016/S0002-9343(00)00599-4.Giberti L, Bino G, Tanganelli P. Pregnancy, patent foramen ovale and stroke: a case of pseudoperipheral facial palsy. Neurol Sci. 2005;26(1):43–5. DOI: http://dx.doi.org/10.1007/s10072-005-0381-1.Giberti L, Bino G, Tanganelli P. Pregnancy, patent foramen ovale and stroke: a case of pseudoperipheral facial palsy. Neurol Sci. 2005;26(1):43–5. DOI: http://dx.doi.org/10.1007/s10072-005-0381-1.Daehnert I, Ewert P, Berger F, Lange PE. Echocardiographically guided closure of patent foramen ovale during pregnancy after recurrent strokes. J Interv Cardiol. 2001;14(2):191–2. DOI: http://dx.doi.org/10.1111/j.1540-8183.2001.tb00733.x.Daehnert I, Ewert P, Berger F, Lange PE. Echocardiographically guided closure of patent foramen ovale during pregnancy after recurrent strokes. J Interv Cardiol. 2001;14(2):191–2. DOI: http://dx.doi.org/10.1111/j.1540-8183.2001.tb00733.x.Lui CY, Marcus FI, Sobonya RE. Arrhythmogenic right ventricular dysplasia masquerading as peripartum cardiomyopathy with atrial flutter, advanced atrioventricular block and embolic stroke. Cardiology. 2002;97(1):49–50. DOI: http://dx.doi.org/10.1159/000047419.Lui CY, Marcus FI, Sobonya RE. Arrhythmogenic right ventricular dysplasia masquerading as peripartum cardiomyopathy with atrial flutter, advanced atrioventricular block and embolic stroke. Cardiology. 2002;97(1):49–50. DOI: http://dx.doi.org/10.1159/000047419.Crawford TC, Smith WT 4th, Velazquez EJ, et al. Prognostic usefulness of left ventricular thrombus by echocardiography in dilated cardiomyopathy in predicting stroke, transient ischaemic attack, and death. Am J Cardiol. 2004;93(4):500–3. DOI: http://dx.doi.org/10.1016/j.amjcard.2003.10.056.Crawford TC, Smith WT 4th, Velazquez EJ, et al. Prognostic usefulness of left ventricular thrombus by echocardiography in dilated cardiomyopathy in predicting stroke, transient ischaemic attack, and death. Am J Cardiol. 2004;93(4):500–3. DOI: http://dx.doi.org/10.1016/j.amjcard.2003.10.056.Demakis JG, Rahimtoola SH, Sutton GC, et al. Natural course of peripartum cardiomyopathy. Circulation. 1971;44(6):1053–61. DOI: http://dx.doi.org/10.1161/01.CIR.44.6.1053.Demakis JG, Rahimtoola SH, Sutton GC, et al. Natural course of peripartum cardiomyopathy. Circulation. 1971;44(6):1053–61. DOI: http://dx.doi.org/10.1161/01.CIR.44.6.1053.Baughman KL. Peripartum cardiomyopathy. Curr Treat Options Cardiovasc Med. 2001;3(6):469–80. DOI: http://dx.doi.org/10.1007/s11936-001-0021-x.Baughman KL. Peripartum cardiomyopathy. Curr Treat Options Cardiovasc Med. 2001;3(6):469–80. DOI: http://dx.doi.org/10.1007/s11936-001-0021-x.Sliwa K, Skudicky D, Bergemann A, et al. Peripartum cardiomyopathy: analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO-1. J Am Coll Cardiol. 2000;35(3):701–5. DOI: http://dx.doi.org/10.1016/S0735-1097(99)00624-5.Sliwa K, Skudicky D, Bergemann A, et al. Peripartum cardiomyopathy: analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO-1. J Am Coll Cardiol. 2000;35(3):701–5. DOI: http://dx.doi.org/10.1016/S0735-1097(99)00624-5.Sharshar T, Lamy C, Mas JL. Incidence and causes of strokes associated with pregnancy and puerperium. A study in public hospitals of lle de France. Stroke in Pregnancy Study Group. Stroke. 1995;26(6):930–6. DOI: http://dx.doi.org/10.1161/01.STR.26.6.930.Sharshar T, Lamy C, Mas JL. Incidence and causes of strokes associated with pregnancy and puerperium. A study in public hospitals of lle de France. Stroke in Pregnancy Study Group. Stroke. 1995;26(6):930–6. DOI: http://dx.doi.org/10.1161/01.STR.26.6.930.Dyken ME, Biller J. Peripartum cardiomyopathy and stroke. Cerebrovasc Dis. 1994;4:325–8. DOI: http://dx.doi.org/10.1159/000108502.Dyken ME, Biller J. Peripartum cardiomyopathy and stroke. Cerebrovasc Dis. 1994;4:325–8. DOI: http://dx.doi.org/10.1159/000108502.Lanska DJ, Kryscio RJ. Risk Factors for Peripartum and Postpartum Stroke and Intracranial Venous Thrombosis. Stroke. 2000;31(6):1274–82. DOI: http://dx.doi.org/10.1161/01.STR.31.6.1274.Lanska DJ, Kryscio RJ. Risk Factors for Peripartum and Postpartum Stroke and Intracranial Venous Thrombosis. Stroke. 2000;31(6):1274–82. DOI: http://dx.doi.org/10.1161/01.STR.31.6.1274.Лунев ДК, Глазунова ТИ. О роли пролапса митрального клапана в патогенезе инфаркта мозга. Клиническая медицина. 1985;(9):1292–6. [Lunev DK, Glazunova TI. About a role of a prolapse of the mitralny valve in патогенезе a brain heart attack. Klinicheskaya meditsina. 1985;(9):1292–6. (In Russ.)].Лунев ДК, Глазунова ТИ. О роли пролапса митрального клапана в патогенезе инфаркта мозга. Клиническая медицина. 1985;(9):1292–6. [Lunev DK, Glazunova TI. About a role of a prolapse of the mitralny valve in патогенезе a brain heart attack. Klinicheskaya meditsina. 1985;(9):1292–6. (In Russ.)].Adams HP, Butler MJ, Biller J, Toffol GJ. Nonhemorrhagic cerebral infarction in young adults. Arch Neurol. 1986;43(8):793–6. DOI: http://dx.doi.org/10.1001/archneur.1986.00520080041017.Adams HP, Butler MJ, Biller J, Toffol GJ. Nonhemorrhagic cerebral infarction in young adults. Arch Neurol. 1986;43(8):793–6. DOI: http://dx.doi.org/10.1001/archneur.1986.00520080041017.Banet GA. Stroke in young adults: a retrospective analysis. J Vasc Nurs. 1994;12(4):101–5.Banet GA. Stroke in young adults: a retrospective analysis. J Vasc Nurs. 1994;12(4):101–5.Barletta GA, Gagliardi R, Benvenuti L, Fantini F. Cerebral ischemic attaks as a complication of aortic and mitral valve prolapse. Stroke. 1985;16(2):219–23. DOI: http://dx.doi.org/10.1161/01.STR.16.2.219.Barletta GA, Gagliardi R, Benvenuti L, Fantini F. Cerebral ischemic attaks as a complication of aortic and mitral valve prolapse. Stroke. 1985;16(2):219–23. DOI: http://dx.doi.org/10.1161/01.STR.16.2.219.Ковальчук ВВ, Скоромец АА. Этиология и патогенез, диагностика и лечение инсультов у женщин. Журнал невропатологии иКовальчук ВВ, Скоромец АА. Этиология и патогенез, диагностика и лечение инсультов у женщин. Журнал невропатологии ипсихиатрии им. С.С. Корсакова. 2006;106(Приложение Инсульт):10–7. [Koval'chuk VV, Skoromets AA. Etiology and patogenez, diagnostics and treatment of strokes at women. Zhurnal nevropatologii i psikhiatrii im. S.S. Korsakova. 2006;106(Suppl Stroke):10–7. (In Russ.)].психиатрии им. С.С. Корсакова. 2006;106(Приложение Инсульт):10–7. [Koval'chuk VV, Skoromets AA. Etiology and patogenez, diagnostics and treatment of strokes at women. Zhurnal nevropatologii i psikhiatrii im. S.S. Korsakova. 2006;106(Suppl Stroke):10–7. (In Russ.)].Шевченко ЮЛ, Одинак ММ, Кузнецов АН и др. Кардиогенный и ангиогенный церебральный эмболический инсульт. Москва; 2006. С. 130–1. [Shevchenko YuL, Odinak MM, Kuznetsov AN, et al. Kardiogennyi i angiogennyi tserebral'nyi embolicheskii insul't [Cardiogenic and angiogenny cerebral embolichesky stroke]. Moscow; 2006. P. 130–1.] 32. Gerhard L, Schmitz-Bauer G. Hinbasiarterinveranderungen bei Marfan-syndrom und idiopathischer media-nekrose. Acta Neuropathol (Berl). 1973;26(2):179–84. DOI: http://dx.doi.org/10.1007/BF00697753.Шевченко ЮЛ, Одинак ММ, Кузнецов АН и др. Кардиогенный и ангиогенный церебральный эмболический инсульт. Москва; 2006. С. 130–1. [Shevchenko YuL, Odinak MM, Kuznetsov AN, et al. Kardiogennyi i angiogennyi tserebral'nyi embolicheskii insul't [Cardiogenic and angiogenny cerebral embolichesky stroke]. Moscow; 2006. P. 130–1.] 32. Gerhard L, Schmitz-Bauer G. Hinbasiarterinveranderungen bei Marfan-syndrom und idiopathischer media-nekrose. Acta Neuropathol (Berl). 1973;26(2):179–84. DOI: http://dx.doi.org/10.1007/BF00697753.Строжаков ГИ, Верещагина ГС, Малышева НВ. Стратификация риска и выбор клинической тактики у пациентов с пролапсом митрального клапана. Журнал сердечная недостаточность. 2001;2(6):3–11.[Strozhakov GI, Vereshchagina GS, Malysheva NV. Stratification of risk and choice of clinical tactics at patients with a prolapse of the mitralny valve. Zhurnal serdechnaya nedostatochnost'. 2001;2(6):3–11. (In Russ.)].Строжаков ГИ, Верещагина ГС, Малышева НВ. Стратификация риска и выбор клинической тактики у пациентов с пролапсом митрального клапана. Журнал сердечная недостаточность. 2001;2(6):3–11.[Strozhakov GI, Vereshchagina GS, Malysheva NV. Stratification of risk and choice of clinical tactics at patients with a prolapse of the mitralny valve. Zhurnal serdechnaya nedostatochnost'. 2001;2(6):3–11. (In Russ.)].Jones HR Jr, Siekert RG, Geraci JE. Neurologic manifestations of bacterial endocarditis. Ann Intern Med. 1969;71(1):21–8. DOI: http://dx.doi.org/10.7326/0003-4819-71-1-21.Jones HR Jr, Siekert RG, Geraci JE. Neurologic manifestations of bacterial endocarditis. Ann Intern Med. 1969;71(1):21–8. DOI: http://dx.doi.org/10.7326/0003-4819-71-1-21.Pruitt AA, Rubin RH, Karchmer AW, Duncan GW. Neurologic complications of bacterial endocarditis. Medicine. 1978;57(4):329–43. DOI: http://dx.doi.org/10.1097/00005792-197807000-00004.Pruitt AA, Rubin RH, Karchmer AW, Duncan GW. Neurologic complications of bacterial endocarditis. Medicine. 1978;57(4):329–43. DOI: http://dx.doi.org/10.1097/00005792-197807000-00004.Lopez JA, Ross RS, Fishbein MC, Siegel RJ. Nonbacterial thrombotic endocarditis: a review. Am Heart J. 1987;113(3):773–84. DOI: http://dx.doi.org/10.1016/0002-8703(87)90719-8.Lopez JA, Ross RS, Fishbein MC, Siegel RJ. Nonbacterial thrombotic endocarditis: a review. Am Heart J. 1987;113(3):773–84. DOI: http://dx.doi.org/10.1016/0002-8703(87)90719-8.Hart RG, Foster JW, Luther MF, Kanter MC. Stroke in infective endocarditis. Stroke. 1990;21(5):695–700. DOI: http://dx.doi.org/10.1161/01.STR.21.5.695.Hart RG, Foster JW, Luther MF, Kanter MC. Stroke in infective endocarditis. Stroke. 1990;21(5):695–700. DOI: http://dx.doi.org/10.1161/01.STR.21.5.695.Heiro M, Nikoskelainen J, Engblom E, et al. Neurologic manifestations of infective endocarditis. Arch Intern Med. 2000;160(18):2781–7. DOI: http://dx.doi.org/10.1001/archinte.160.18.2781.Heiro M, Nikoskelainen J, Engblom E, et al. Neurologic manifestations of infective endocarditis. Arch Intern Med. 2000;160(18):2781–7. DOI: http://dx.doi.org/10.1001/archinte.160.18.2781.Kanter MC, Hart RG. Neurologic complications of infective endocarditis. Neurology. 1991;41(7):1015–20. DOI: http://dx.doi.org/10.1212/WNL.41.7.1015.Kanter MC, Hart RG. Neurologic complications of infective endocarditis. Neurology. 1991;41(7):1015–20. DOI: http://dx.doi.org/10.1212/WNL.41.7.1015.Lunardi W, Grinberg M, Scaff M, et al. Neurological events in infective endocarditis. Arq Bras Cardiol. 1993;61(6):349–55.Lunardi W, Grinberg M, Scaff M, et al. Neurological events in infective endocarditis. Arq Bras Cardiol. 1993;61(6):349–55.Horstkotte D, Piper C, Wiemer M, et al. Emergency heart valve replacement after acute cerebral embolism during florid endocarditis. Med Klin (Munich). 1998;93(5):284–93. DOI: http://dx.doi.org/10.1007/BF03044863.Horstkotte D, Piper C, Wiemer M, et al. Emergency heart valve replacement after acute cerebral embolism during florid endocarditis. Med Klin (Munich). 1998;93(5):284–93. DOI: http://dx.doi.org/10.1007/BF03044863.Kim SJ, Lee JY, Kim TH, et al. Imaging of the neurological complications of infective endocarditis. Neuroradiology. 1998;40(2):109–13. DOI: http://dx.doi.org/10.1007/s002340050549.Kim SJ, Lee JY, Kim TH, et al. Imaging of the neurological complications of infective endocarditis. Neuroradiology. 1998;40(2):109–13. DOI: http://dx.doi.org/10.1007/s002340050549.Bakshi R, Wright PD, Kinkel PR, et al. Cranial magnetic resonance imaging findings in bacterial endocarditis: the neuroimaging spectrum of septic brain embolization demonstrated in twelve patients. J Neuroimaging. 1999;9(2):78–84.Bakshi R, Wright PD, Kinkel PR, et al. Cranial magnetic resonance imaging findings in bacterial endocarditis: the neuroimaging spectrum of septic brain embolization demonstrated in twelve patients. J Neuroimaging. 1999;9(2):78–84.Lai SM, Perera S, Duncan PW, Bode R. Physical and social functioning after stroke: comparison of the stroke impact scale and short form-36. Stroke. 2003;34(2):488–93. DOI: http://dx.doi.org/10.1161/01.STR.0000054162.94998.C0.Lai SM, Perera S, Duncan PW, Bode R. Physical and social functioning after stroke: comparison of the stroke impact scale and short form-36. Stroke. 2003;34(2):488–93. DOI: http://dx.doi.org/10.1161/01.STR.0000054162.94998.C0.Zisbrod Z, Jacobowitz IJ, Kramer M, et al. Results of open heart surgery in patients with recent cardiogenic embolic stroke and central nervous system dysfunction. Circulation. 1987;76(5 Pt 2):109–12.Zisbrod Z, Jacobowitz IJ, Kramer M, et al. Results of open heart surgery in patients with recent cardiogenic embolic stroke and central nervous system dysfunction. Circulation. 1987;76(5 Pt 2):109–12.European Stroke Organization (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attacks 2008. Cerebrovasc Dis. 2008;25(5):457–507. DOI: 10.1159/000131083. Epub 2008 May 6.European Stroke Organization (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attacks 2008. Cerebrovasc Dis. 2008;25(5):457–507. DOI: 10.1159/000131083. Epub 2008 May 6.Суслина ЗА, Танашян ММ. Антитромботическая терапия в ангионеврологии. Москва: Медицинская книга; 2004. [Suslina ZA, Tanashyan MM. Antitromboticheskaya terapiya vangionevrologii [Antitrombotichesky therapy in an angionevrologiya]. Moscow: Meditsinskaya kniga; 2004.]Суслина ЗА, Танашян ММ. Антитромботическая терапия в ангионеврологии. Москва: Медицинская книга; 2004. [Suslina ZA, Tanashyan MM. Antitromboticheskaya terapiya vangionevrologii [Antitrombotichesky therapy in an angionevrologiya]. Moscow: Meditsinskaya kniga; 2004.]Alberts MJ. Secondary prevention of stroke and the expanding role of the neurologist. Cererovasc Dis. 2002;13 Suppl 1:12–6. DOI: http://dx.doi.org/10.1159/000047784.Alberts MJ. Secondary prevention of stroke and the expanding role of the neurologist. Cererovasc Dis. 2002;13 Suppl 1:12–6. DOI: http://dx.doi.org/10.1159/000047784.Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7330):71–86. DOI: http://dx.doi.org/10.1136/bmj.324.7329.71.Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7330):71–86. DOI: http://dx.doi.org/10.1136/bmj.324.7329.71.Hart RG, Pearce LA, McBride R, et al. Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I–III clinical trials. The Stroke Prevention in Atrial Fibrillation (SPAF) Investigators. Stroke. 1999;30(6):1223–9. DOI:http://dx.doi.org/10.1161/01.STR.30.6.1223.Hart RG, Pearce LA, McBride R, et al. Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I–III clinical trials. The Stroke Prevention in Atrial Fibrillation (SPAF) Investigators. Stroke. 1999;30(6):1223–9. DOI:http://dx.doi.org/10.1161/01.STR.30.6.1223.Salem DN, OХGara PT, Madias C, et al. Valvular and structural heart disease: American College of Chest Physicians Evidence–Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):593S–629S. DOI: 10.1378/chest.08-0724.Salem DN, OХGara PT, Madias C, et al. Valvular and structural heart disease: American College of Chest Physicians Evidence–Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):593S–629S. DOI: 10.1378/chest.08-0724.Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2006;48(3):e1–148.Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2006;48(3):e1–148.Vahanian A1, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. European Heart J. 2007;28(2):230–68. Epub 2007 Jan 26.Vahanian A1, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. European Heart J. 2007;28(2):230–68. Epub 2007 Jan 26.Парфенов ВА. Цитиколин при ишемическом инсульте: исследование ICTUS. Неврология, нейропсихиатрия, психосоматика. 2012;(4):71–6. [Parfenov VA. Citicoline for ischemic stroke: ICTUS trial. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;(4):71–6.(In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2012-426.Парфенов ВА. Цитиколин при ишемическом инсульте: исследование ICTUS. Неврология, нейропсихиатрия, психосоматика. 2012;(4):71–6. [Parfenov VA. Citicoline for ischemic stroke: ICTUS trial. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;(4):71–6.(In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2012-426.Парфенов ВА. Цитиколин в лечении инсульта и сосудистых когнитивных нарушений. Неврология, нейропсихиатрия, психосоматика. 2009;(3–4):69–74. [Parfenov VA. Citicolin in the treatment of stroke and vascular cognitive disorders. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology,Neuropsychiatry, Psychosomatics. 2009;(3–4):69–74. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2009-59.Парфенов ВА. Цитиколин в лечении инсульта и сосудистых когнитивных нарушений. Неврология, нейропсихиатрия, психосоматика. 2009;(3–4):69–74. [Parfenov VA. Citicolin in the treatment of stroke and vascular cognitive disorders. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology,Neuropsychiatry, Psychosomatics. 2009;(3–4):69–74. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2009-59.Tazaki Y, Sakai F, Otomo E, et al. Treatment of acute cerebral infarction with a choline precursor in a multicenter double-blind placebo-controlled study. Stroke. 1988;19(2):211–6. DOI: http://dx.doi.org/10.1161/01.STR.19.2.211.Tazaki Y, Sakai F, Otomo E, et al. Treatment of acute cerebral infarction with a choline precursor in a multicenter double-blind placebo-controlled study. Stroke. 1988;19(2):211–6. DOI: http://dx.doi.org/10.1161/01.STR.19.2.211.Saver JL, Wilterdink J. Choline precursors in acute and subacute human stroke: a metaanalysis. Stroke. 2002;(33):353.Saver JL, Wilterdink J. Choline precursors in acute and subacute human stroke: a metaanalysis. Stroke. 2002;(33):353.Davalos A, Alvarez-Sabin J, Castillo J, et al. Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). Lancet. 2012;380(9839):349–57. DOI: http://dx.doi.org/10.1016/S0140-6736(12)60813-7.Davalos A, Alvarez-Sabin J, Castillo J, et al. Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). Lancet. 2012;380(9839):349–57. DOI: http://dx.doi.org/10.1016/S0140-6736(12)60813-7.Мартынов МЮ, Бойко АН, Камчатнов ПР и др. Нейропротективная терапия цитиколином (Цераксон) у больных с ишемическим инсультом. Журнал неврологии и психиатрии им. С.С. Корсакова. 2012;112(3–2):21–6. [Martynov MIu, Bo_ko AN, Kamchatnov PR, et al. Neuroprotective treatment with citicoline (ceraxon) in patients with ischemic stroke. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2012;112(3–2):21–6. (In Russ.)]Мартынов МЮ, Бойко АН, Камчатнов ПР и др. Нейропротективная терапия цитиколином (Цераксон) у больных с ишемическим инсультом. Журнал неврологии и психиатрии им. С.С. Корсакова. 2012;112(3–2):21–6. [Martynov MIu, Bo_ko AN, Kamchatnov PR, et al. Neuroprotective treatment with citicoline (ceraxon) in patients with ischemic stroke. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2012;112(3–2):21–6. (In Russ.)]Парфенов ВА, Фатеева ТГ,Косивцова ОВ. Клинический опыт применения Цераксона при ишемическом инсульте. Неврология, нейропсихиатрия, психосоматика. 2010;(3):67–70. [Parfenov VA, Fateyeva TG, Kosivtsova OV. Clinical experience with ceraxon used in ischemic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2010;(3):67–70. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2010-104.Парфенов ВА, Фатеева ТГ,Косивцова ОВ. Клинический опыт применения Цераксона при ишемическом инсульте. Неврология, нейропсихиатрия, психосоматика. 2010;(3):67–70. [Parfenov VA, Fateyeva TG, Kosivtsova OV. Clinical experience with ceraxon used in ischemic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2010;(3):67–70. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2010-104.Пирадов МА, Сергеев ДВ, Кротенкова МВ. Применение Цераксона в остром периоде полушарного ишемического инсульта: клиническая и КТ-перфузионная оценка. Анналы клинической и экспериментальной неврологии. 2012;6(3):31–7.[Piradov MA, Sergeev DV, Krotenkova MV. Ceraxon's application in the sharp period of a polusharny ischemic stroke: clinical and KTperfuzionnaya assessment. Annaly klinicheskoi I eksperimental'noi nevrologii. 2012;6(3):31–7.(In Russ.)]Пирадов МА, Сергеев ДВ, Кротенкова МВ. Применение Цераксона в остром периоде полушарного ишемического инсульта: клиническая и КТ-перфузионная оценка. Анналы клинической и экспериментальной неврологии. 2012;6(3):31–7.[Piradov MA, Sergeev DV, Krotenkova MV. Ceraxon's application in the sharp period of a polusharny ischemic stroke: clinical and KTperfuzionnaya assessment. Annaly klinicheskoi I eksperimental'noi nevrologii. 2012;6(3):31–7.(In Russ.)]Гусев ЕИ, Скворцова ВИ, Платонова ИА. Терапия ишемического инсульта. Сonsilium medicum. Спец. выпуск. 2003;18–25. [Gusev EI, Skvortsova VI, Platonova IA. Therapy of an ischemic stroke. Сonsilium medicum. Special Issue. 2003;18–25. (In Russ.)]Гусев ЕИ, Скворцова ВИ, Платонова ИА. Терапия ишемического инсульта. Сonsilium medicum. Спец. выпуск. 2003;18–25. [Gusev EI, Skvortsova VI, Platonova IA. Therapy of an ischemic stroke. Сonsilium medicum. Special Issue. 2003;18–25. (In Russ.)]Федин АИ, Румянцева СА. Избранные вопросы базисной интенсивной терапии нарушений мозгового кровообращения. Методические указания. Москва: Интермедика; 2002. 256 c. [Fedin AI, Rumyantseva SA. Chosen questions of basic intensive therapy of violations of brain blood circulation. Metodicheskie ukazaniya [Methodical instructions]. Moscow: Intermedica; 2002. 256 p.]Федин АИ, Румянцева СА. Избранные вопросы базисной интенсивной терапии нарушений мозгового кровообращения. Методические указания. Москва: Интермедика; 2002. 256 c. [Fedin AI, Rumyantseva SA. Chosen questions of basic intensive therapy of violations of brain blood circulation. Metodicheskie ukazaniya [Methodical instructions]. Moscow: Intermedica; 2002. 256 p.]Любшина ОВ, Талибов ОБ, Верткин АЛ. Алгоритм диагностики инсульта на догоспитальном этапе. Сonsilium medicum. 2004;6(8):606–9. [Lyubshina OV, Talibov OB, Vertkin AL. Algorithm of stroke diagnostics at a pre-hospital stage. Сonsilium medicum. 2004;6(8):606–9. (In Russ.)]Любшина ОВ, Талибов ОБ, Верткин АЛ. Алгоритм диагностики инсульта на догоспитальном этапе. Сonsilium medicum. 2004;6(8):606–9. [Lyubshina OV, Talibov OB, Vertkin AL. Algorithm of stroke diagnostics at a pre-hospital stage. Сonsilium medicum. 2004;6(8):606–9. (In Russ.)]Чуканова ЕИ. Актовегин в лечении больных с дисциркуляторной энцефалопатией. Фарматека. 2005;(17):71–6.[Chukanova EI. Aktovegin in treatment of patients with distsirkulyatorny encephalopathy. Farmateka. 2005;(17):71–6. (In Russ.)]Чуканова ЕИ. Актовегин в лечении больных с дисциркуляторной энцефалопатией. Фарматека. 2005;(17):71–6.[Chukanova EI. Aktovegin in treatment of patients with distsirkulyatorny encephalopathy. Farmateka. 2005;(17):71–6. (In Russ.)]Kuninaka T, Senga Y, Senga H, Weiner M. Nature of enhanced mitochondrial oxidative metabolism by a calf blood extract. J Cell Physiol. 1991;146(1):148–55.Kuninaka T, Senga Y, Senga H, Weiner M. Nature of enhanced mitochondrial oxidative metabolism by a calf blood extract. J Cell Physiol. 1991;146(1):148–55.Obermaier-Kusser B, Muhlbacher Ch, Mushack J, et al. Further evidence for a twostep model of glucose-transport regulation. Inositol phosphate-oligosaccharides regulate glucose-carrier activity. Biochem J.1989;261:699–705.Obermaier-Kusser B, Muhlbacher Ch, Mushack J, et al. Further evidence for a twostep model of glucose-transport regulation. Inositol phosphate-oligosaccharides regulate glucose-carrier activity. Biochem J.1989;261:699–705.Румянцева СА. Актовегин в комплексной терапии критических состояний неврологического генеза. Неотложные состояния в неврологии. Орел; 2002. C. 376–83. [Rumyantseva SA. Aktovegin in complex therapy of critical conditions of neurologic genesis. Neotlozhnye sostoyaniya v nevrologii [Medical emergencies in neurology]. Orel; 2002. P. 376–83.]Румянцева СА. Актовегин в комплексной терапии критических состояний неврологического генеза. Неотложные состояния в неврологии. Орел; 2002. C. 376–83. [Rumyantseva SA. Aktovegin in complex therapy of critical conditions of neurologic genesis. Neotlozhnye sostoyaniya v nevrologii [Medical emergencies in neurology]. Orel; 2002. P. 376–83.]Hoyer S, Betz K. Elimination of the delayed postischemic energy deficit in cerebral cortex and hippocampus of aged rats with a dried, deproteinized blood extract (Actovegin). Arch Gerontol Geriatr. 1989;9(2):181–92.Hoyer S, Betz K. Elimination of the delayed postischemic energy deficit in cerebral cortex and hippocampus of aged rats with a dried, deproteinized blood extract (Actovegin). Arch Gerontol Geriatr. 1989;9(2):181–92.Стаховская ЛВ, Квасова ОВ, Гудкова ВВ и др. Применение Актовегина на разных этапах лечения больных с ишемическим инсультом. Consilium medicum. 2007;9(8):22–5. [Stakhovskaya LV, Kvasova OV, Gudkova VV, et al. Aktovegin's application at different stages of treatment of patients with an ischemic stroke. Consilium medicum. 2007;9(8):22–5. (In Russ.)].Стаховская ЛВ, Квасова ОВ, Гудкова ВВ и др. Применение Актовегина на разных этапах лечения больных с ишемическим инсультом. Consilium medicum. 2007;9(8):22–5. [Stakhovskaya LV, Kvasova OV, Gudkova VV, et al. Aktovegin's application at different stages of treatment of patients with an ischemic stroke. Consilium medicum. 2007;9(8):22–5. (In Russ.)].Федин АИ, Румянцева СА. Принципы антигипоксической терапии у больных с инсультом. Интенсивная терапия ишемического инсульта. Руководство для врачей. Москва; 2004. С. 251–60. [Fedin AI, Rumyantseva SA. The principles of anti-hypoxemic therapy at patients with a stroke. Intensive therapy of an ischemic stroke. Rukovodstvo dlya vrachei [Guide for doctors. Moscow; 2004.P. 251–60.]Федин АИ, Румянцева СА. Принципы антигипоксической терапии у больных с инсультом. Интенсивная терапия ишемического инсульта. Руководство для врачей. Москва; 2004. С. 251–60. [Fedin AI, Rumyantseva SA. The principles of anti-hypoxemic therapy at patients with a stroke. Intensive therapy of an ischemic stroke. Rukovodstvo dlya vrachei [Guide for doctors. Moscow; 2004.P. 251–60.]Стаховская ЛВ, Ефремова НМ, Шамалов НА и др. Исследование безопасности и эффективности комбинированной терапии цитиколином и актовегином больных в остром периоде ишемического инсульта. Журнал неврологии и психиатрии им. С.С. Корсакова. 2010;Приложение Инсульт:13–7. [Stakhovskaya LV, Efremova NM, Shamalov NA, et al. Research of safety and efficiency of the combined therapy tsitikoliny and aktoveginy patients in the sharp period of an ischemic stroke. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2010;Issue Stroke:13–7. (In Russ.)]_Стаховская ЛВ, Ефремова НМ, Шамалов НА и др. Исследование безопасности и эффективности комбинированной терапии цитиколином и актовегином больных в остром периоде ишемического инсульта. Журнал неврологии и психиатрии им. С.С. Корсакова. 2010;Приложение Инсульт:13–7. [Stakhovskaya LV, Efremova NM, Shamalov NA, et al. Research of safety and efficiency of the combined therapy tsitikoliny and aktoveginy patients in the sharp period of an ischemic stroke. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2010;Issue Stroke:13–7. (In Russ.)]_

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