LECTURES
ORIGINAL INVESTIGATIONS
Patients and methods. Thirty-two patients with prior hemispheric stroke and evolving spastic paresis were examined. Neurophysiological studies of upper and lower motor neuron functions and morphological, histochemical, and immunohistochemical studies of soleus muscle biopsy specimens were conducted.
Results. There was diminished excitability of cortical neurons, impaired conduction along the pyramidal tracts, and hyperexcitability of the segmental apparatus of the spinal cord. The muscle exhibited myosin phenotype transformation with a preponderance of fast type II fibers, as well as a higher fiber diameter variability and a lower muscle tissue capillarization. The late periods of spasticity were marked by better conduction along the pyramidal tract, at the same time structural changes tended to increase in skeletal muscle tissue. The time course of the changes suggests that there is partial reversibility in the central nervous system and skeletal muscle, which allows elaboration of approaches to differentiated therapy for the above conditions.
Patients and methods. Prior to and following CE, 97 patients underwent neurological examination, neuropsychological syndrome analysis described by A.R. Luria, evaluation using the Wexler verbal working memory scale, Stroop word-digital test, and Schulte test. BCA ultrasound duplex scanning and cerebral perfusion were made over time.
Results. Preoperative neuropsychological study revealed abnormalities in 98% of the patients. There was most common bilateral frontal dysfunction and deep structural pathology, which were more pronounced in persons above 50 years of age and in the presence of mixed BCA stenosis. Stenosis-associated unilateral parietal and temporal dysfunctions were more frequently registered. Within 30 days after CE, the maximum HMF changes were found in patients having unilateral stenosis. There was ameliorated dysfunction of the structures blood is supplied to which by an operated vessel and the vertebrobasilar system. Poststroke patients were found to have a significant intraoperative HMF reduction in the early rehabilitation period of stroke. The syndromes having common and local mechanisms of development and different topic sites were identified among the short-term and reversible HMF impairments.
Conclusion. Despite heterodirectional HMF changes in the early period after BCA reconstructive operations, the positive cognitive functional changes in all the patients at 30 days of CE confirm the rationale for and efficiency of surgical intervention.
Objective: to analyze the association of fatigability with the duration of PD and the degree of movement and neuropsychic (depression, nocturnal sleep disorders, daytime sleepiness) disorders; to evaluate changes in the manifestations of fatigability during therapy with the dopamine receptor agonist pramipexole (Mirapex).
Patients and methods. Sixty patients with PD (disease duration 6.02±3.47 years; stage 2.68±0.62) without dementia were examined using the PD fatigue scale (PFS-16), unified PD rating scale (Part 2), the Beck depression inventory, the PD sleep scale, and the Epworth sleeping scale.
Results. 66% of the patients were found to consider fatigability to be one of the three most daily life-limiting manifestations of the disease. The integrated rating of fatigability significantly correlated with total depression scores and sleep scores. During pramipexole therapy, there were statistically significant positive changes in fatigability, which did not correlate with those in motor functions, depression, and sleep problems.
It is concluded that fatigability substantially impairs the daily activities of patients with PD and is associated with neuropsychic symptoms to a greater extent than with the degree of movement disorders in PD. This may be due to both the common pathophysiological mechanisms of these abnormalities and their comorbidity in PD. The fact that there is no significant association of the time course of changes in fatigability with alterations in the parameters of other neuropsychic functions during therapy conceivably indicated the independent genesis of this symptom.
Patients and methods. The study enrolled 63 patients (29 women and 34 men aged 41—85 years) in the acutest period of middle cerebral artery (MCA) basin infarct with evolving hemiplegia. In the first 5 days after stroke, TMS was performed in the projection of the motor cortex of the involved hemisphere, by recording a motor evoked response (MER) from m. tibialis anterior and m. pollicis brevis in hemiplegia; and SSEPs were recorded when stimulating n. medianus and n. tibialis in hemiplegia. The outcomes were assessed a year after stroke: muscle strength on a scale from 0 to 5 e and the Rivermead mobility index were studied.
Results. A year later, there was either partial or full recovery of active lower and upper limb movements in 73.3 and 58.2%, respectively. With good and poor motor outcomes, the parameters of MCA rather than SSEPs differed significantly. The optimal threshold amplitude for MER from the lower and upper limbs was 0.25 and 0.3 mW, respectively; the time of central motor conduction was 22 and 19 msec for the lower and upper limbs, respectively. At the same time, TMS findings were insufficient for predicting a patient's mobility. The prognosis was determined by the data of TMS and the results of SSEPs: the best outcomes in movement recovery were noted when the prognosis was positive according to the data of TMS in combination with the preserved parameters of SSEPs in the study of cortical projections of the lower limb.
Conclusion. It is expedient to perform TMS to estimate the probability of muscle strength recovery. The SSEPs method cannot determine the prognosis of muscle strength recovery; however, its results are of importance for estimating the promises of recovering a patient's mobility. Therefore, comprehensive neurophysiological examination is warranted.
Patients and methods. The clinical features were analyzed in 25 patients with systematic vertigo and 25 patients with psychogenic vertigo. Their psychoemotional sphere was studied using the Beck depression inventory, the Spielberger—Khanin personality- and situation-related anxiety inventory, and the vestibular inventory.
Results. There were statistically significant clinical differences and a higher degree of anxiety-depressive disorders in the patients with psychogenic vertigo. Drug therapy in combination with stabilometric platform exercises based on the biological feedback principle was stated to be effective in patients with different types of vertigo, in those with psychogenic dizziness in particular.
Objective: to evaluate the cerebral circulation in idiopathic arterial hypotension (IAH) in relation to neurological and neuropsychological disorders.
Patients and methods. Sixty-five patients (mean age 40.2 [8, 14] years) with prolonged IAH were examined. Neuropsychological examination was made using the procedure adapted by A.R. Luria; different psychic functions (memory, speech, gnosis, praxis, thinking, attention, counting, writing, and reading) were studied. Cerebral hemodynamics was investigated using duplex scanning of the brachiocephalic arteries (BCA), middle cerebral arteries (MCA), internal jugular (IJV) and vertebral veins (VV). The patients were assigned to 2 groups: 1) 19 (29%) patients with somatoform disorders, 2) 46 (71%) patients with signs of the initial manifestations of chronic cerebrovascular insufficiency. Group 2 patients were older and had a longer history of IAH.
Results. In all the patients, cerebral blood supply in the carotid system showed moderately lower arterial blood inflow with a compensatory vascular resistance decrease and balanced venous outflow reduction with increased vascular resistance. Group 2 patients had a substantial (to the lower normal range) blood flow decline in the vertebral artery along with increased peripheral resistance in the VV. The degree of neuropsychological derangement was inversely proportional to blood flow velocity in BCA and MCA and to blood outflow in IJV and VV.
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ISSN 2310-1342 (Online)