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Mathematical modeling of ischemic stroke

https://doi.org/10.14412/2074-2711-2019-4-38-43

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Abstract

Objective: to determine the prognostic value of the indicators of fluid and electrolyte balance in the acutest period of severe ischemic stroke (IS).
Patients and methods. A total of 150 patients with severe IS of various locations and pathogenetic subtypes were examined. The impact of plasma osmolarity or sodium levels on the course and prognosis of IS was studied on day 1 of the disease.
Results and discussion. It has been established that in patients with severe IS, the most common type of fluid and electrolyte imbalance is hyperosmolar hypernatremic syndrome that develops at the onset of severe IS, serves as a factor for poor outcome, and is accompanied by high mortality. The rate of fatal outcomes in hypoosmolar syndromes is higher than that in normal plasma osmolarity, but significantly lower than that in hyperosmolar syndromes. Cerebral salt wasting (CSW) is associated with a higher mortality rate than syndrome of inappropriate antidiuretic hormone secretion (SIADH), which confirms a worse prognostic value in hypovolemia than in normo- and hypervolemia. The development of diabetes insipidus at the onset of IS reflects the degree of brainstem structural destruction and, accordingly, is associated with the highest rate of fatal outcomes. The cardioembolic pathogenetic subtype of IS is characterized by a more severe course and a higher probable mortality rate in both hypoosmolar and normosmolar conditions.

Conclusion. Impaired fluid and electrolyte homeostasis is of significant prognostic value for the outcome of IS. In this case, the leading role is played by the hyperosmolar hypernatremic syndrome, in which the probability of a fatal outcome is highest and there is a need for continuous patient health monitoring and high-speed decision-making aimed to correct this condition. Therapeutic policy for diabetes insipidus depends on the duration of IS. The risk for fatal outcome in the cardioembolic pathogenetic subtype of IS is higher than that in atherothrombotic stroke, at any plasma osmolarity and sodium levels.

About the Authors

V. I. Ershov
Orenburg State Medical University, Ministry of Health of Russia; University Research and Clinical Center for Neurology, Neurosurgery, and Neurointensve Care, N.I. Pirogov City Clinical Hospital
Russian Federation

6, Sovetskaya St., Orenburg 460000;

140B, Pobeda Prospect, Orenburg 460000



A. N. Chirkov
Orenburg State Medical University, Ministry of Health of Russia; Orenburg Regional Clinical Hospital
Russian Federation

6, Sovetskaya St., Orenburg 460000;

23, Aksakov St., Orenburg 460018



A. P. Gonchar-Zaykin
Orenburg State Medical University, Ministry of Health of Russia
Russian Federation

6, Sovetskaya St., Orenburg 460000



S. N. Lyashchenko
Orenburg State Medical University, Ministry of Health of Russia
Russian Federation

6, Sovetskaya St., Orenburg 460000



T. Yu. Lozinskaya
Orenburg State Medical University, Ministry of Health of Russia
Russian Federation
6, Sovetskaya St., Orenburg 460000


N. V. Gumalatova
Orenburg State Medical University, Ministry of Health of Russia; University Research and Clinical Center for Neurology, Neurosurgery, and Neurointensve Care, N.I. Pirogov City Clinical Hospital
Russian Federation

6, Sovetskaya St., Orenburg 460000;

140B, Pobeda Prospect, Orenburg 460000



G. E. Kuznetsov
Orenburg State Medical University, Ministry of Health of Russia; University Research and Clinical Center for Neurology, Neurosurgery, and Neurointensve Care, N.I. Pirogov City Clinical Hospital
Russian Federation

6, Sovetskaya St., Orenburg 460000;

140B, Pobeda Prospect, Orenburg 460000



L. R. Tenchurina
Orenburg State Medical University, Ministry of Health of Russia; University Research and Clinical Center for Neurology, Neurosurgery, and Neurointensve Care, N.I. Pirogov City Clinical Hospital
Russian Federation

6, Sovetskaya St., Orenburg 460000;

140B, Pobeda Prospect, Orenburg 460000



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For citation:


Ershov V.I., Chirkov A.N., Gonchar-Zaykin A.P., Lyashchenko S.N., Lozinskaya T.Y., Gumalatova N.V., Kuznetsov G.E., Tenchurina L.R. Mathematical modeling of ischemic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(4):38-43. (In Russ.) https://doi.org/10.14412/2074-2711-2019-4-38-43

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