Неврология, нейропсихиатрия, психосоматика

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Том 1, № 1 (2009)


5-12 603
Updates of the diagnosis and treatment of ischemic stroke are given. The diagnosis of ischemic stroke is stated to be based on the risk factors of its development, the rapid progression of focal neurological deficits (neurovascular syndrome) and brain computed or magnetic resonance imaging. Arterial studies of the brain (ultrasound studies, angiography) and heart (EchoCG, and others), and blood analyses are performed to establish the causes of stroke. Treatment for ischemic stroke is noted to be most effective in a specialized unit, which substantially reduces mortality and disability. The intravenous injection of tissue plasminogen activator is stated to be the method of choice in treating ischemic stroke in the first 3-4,5 hours after its development. The value of anticoagulants, antithrombocytic, neuroprotective, and other drugs and the monitoring of blood glucose, blood pressure, and other vital functions are also of importance. The important role of early activation of a patient and his/her rehabilitation is noted.
14-18 546
The authors consider the cardinal causes of vestibular vertigo, a benign paroxysmal positional vertigo, Meniere's disease, vestibular neuroni-tis, vestibular migraine, cerebrovascular diseases. It gives brief data on the etiology, pathogenesis, clinical manifestations, and treatment of these diseases. The diagnosis of the latter is largely based on a patientХs complaints and medical history data and frequently requires no additional instrumental study. The currently available treatments for various diseases manifesting as vestibular vertigo are analyzed. Vestibular exercises and rehabilitation maneuvers that are effective in benign positional vertigo are noted to play an important role. In addition, methods for drug stimulation of vestibular compensation in central and peripheral vestibulopathies are described.
19-22 443
Low back pain is stated to be of muscular origin, it is somewhat less frequently associated with osteochondrosis or/and spondyloarthrosis. While examining a patient with back pain, it is necessary to exclude rare causes (fractures, neoplasms, etc.) that require special management. The diagnosis is established on the basis of physical, neurological, manual, and orthopedic studies. The presence of herniated disks, particularly those of small sizes detectable by computed tomography or magnetic resonance imaging, does not rule out any other cause of back pain. Musculoskeletal pain management is noted to relieve the pain, by returning the patient to an active life as soon as possible. Nonsteroidal anti-inflammatory drugs and myorelaxants are beneficial for pain relief. In chronic back pain, antidepressants are effective in case of depression; the occupational, social, and everyday rehabilitations are of great value.
23-28 392
Based on the current data available in the literature and the results of his studies, the author characterizes the implication of cardiac diseases in the pathogenesis of cardioembolic and hemodynamic insults. Cardiogenic insults are demonstrated to account for as high as 40% of all the causes of ischemic insult. The leading causes of cardioembolic stroke are considered to be nonrheumatic atrial fibrillation, postinfarct changes, and rheumatic heart disease. The pathogenesis of hemodynamic insult (HDI) may be also caused by cardiac pathology that can singly affect blood pressure levels via cardiac output variations. Silent myocardial ischemia, atrial fibrillation, and sick sinus syndrome are regarded as the most common cardiogenic causes of HDI. The importance of a target cardiological study of patients with ischemic insult is accentuated for the effective secondary prevention of cardiogenic insults.
30-34 352
The author reviews the meta-analyses of recent large studies of the primary prevention of stroke with antithrombotic drugs. It is stated that acetylsalicylic acid and clopidogrel are antithrombotic agents of proven clinical efficacy in patients with stroke risk factors (coronary heart disease, clinical signs of lower extremity vascular atherosclerosis obliterans, etc.) that have no potential source of cerebral arterial embolization.
35-38 549
The author discusses the results of clinicopathopsychological, psychometric, and gastroenterological studies in 103 patients treated at the gastroenterology clinic (Clinic of Faculty Therapy, I.M. Sechenov Moscow Medical Academy). Functional dyspepsia is held to be obligate psychosomatic syndrome with comorbidity mental (depressive, personality, and hypochondriac) disorders and its diagnosis and treatment require an interdisciplinary approach.
38-40 321
The paper describes the procedure of cognitive therapy for panic disorder, which is based on the explanation of the nature of physical and psychopathological symptoms of anxiety.
41-44 305
Objective: to study the clinical efficacy and tolerability of tenoten versus cavinton in patients with organic central nervous system pathology. Subjects and methods. The study was conducted by the neurology and therapeutics clinics, Russian Gerontology Research and Clinical Center, and included 50 patients (42 females and 8 males; mean age 75,5±1,8 years) diagnosed as having dyscirculatory encephalopathy in the presence of cerebrovascular atherosclerosis, sequels of prior acute ischemic attacks, and posttraumatic encephalopathy. The patients were divided into 2 matched groups. The study group comprised 30 patients; the control consisted of 20 patients. During 28 days, the study group patients received tenoten as a tablet thrice daily and basic therapy (antiaggregatory, antihypertensive, sugar-reducing drugs, etc.); the control group had cavinton as a tablet (5 mg) thrice daily and a basic therapy. Results. Depressed mood, headache, dizziness, tinnitus cerebri, and sleep disorders were found to be alleviated in the tenoten-treated patients by day 28 of therapy. The results of Schulte's test suggested that tenoten exerted the same positive effect on cognitive functions as cavinton. With tenoten, attention concentration was also improved. There was a significant reduction in the symptoms of anxiety, as shown by the Hamilton anxiety rating scale. The serial counting and word-memorization tests showed positive changes in the all indices under study during tenoten treatment. Conclusion. The findings suggest that tenoten is effective in elderly patients with cerebrovascular diseases.
46-50 327
A female patient with chronic sarcoidosis involving the nervous system and heart is described. The first manifestations of sarcodoisis were the neurological disorders indicative of a focal lesion of the brain. During 6 years, these disorders were the only manifestations of sarcoidosis, which resulted in its diagnostic errors. It is noted that neurosarcoidosis may mimic various neurological diseases (stroke, tumor, or multiple sclerosis) and this should be borne in mind in its differential diagnosis.
51-53 309
The pathogenetic aspects of a concomitance of infantile autism and epilepsy are considered. Data on the implication of genetic and organic disorders and epileptiform activity in the origin of these disorders are given. A case of congenital malformation (schizencephalia) with the symptomatic partial seizures occurring in the presence of autistic disorder is described.
54-58 284
Moscow State Medical University of Dentistry The authors consider the specific features of epilepsy in middle-aged and elderly patients: a preponderance of focal symptomatic and cryptogenic epilepsies, a frequent combination with concomitant mental and somatic diseases, and a relative efficacy of small-dose antiepileptic drugs (AED). Choice of therapy is noted to depend on the form of epilepsy/type of seizures, comorbidity and used medicines. A major focus is on the use of basic AEDs Р carbamazepine and valproates. Data on the promise for using depakine chronosphere in middle-aged and elderly patients are given.
58-62 350
The pathogenesis, diagnosis, and clinical signs of somatic and autonomic diabetic neuropathy (DN) are discussed. Based on the present views of the pathogenetic mechanisms of peripheral DN, the author provides evidence for the expedient use of р-lipoic acid preparations (Espa-lipon) in the therapy of this complication of diabetes mellitus. Treatment regimens are given depending on the stage of DN.
63-67 363
Impairments in redox processes, metabolism, and energy provision are observed at the cellular level in many diseases of the central and peripheral nervous system. The use of Actovegin is of great interest to clinical neurological practice, including therapy for the diseases, the pathogenesis of which involves the mechanisms of hypoxia, ischemia, and oxidative stress.
67-73 381
The paper describes the therapeutic properties of nonsteroidal anti-inflammatory drugs (NSAID), among them there is etoricoxib, the most selective current COX-2 inhibitor that may be successfully used for both acute analgesia and the treatment of chronic pain in patients with dorsopathies. The important advantages of the drug are its easiness-to-use (once-daily dosing), a wide range of effective doses (from 30 to 120 mg/day), lower risk of gastrointestinal events, liver damage, and skin and respiratory reactions as compared with nonselective NSAIDs, which make etoricoxib an appropriate treatment option if relevant risk factors are present.
74-75 302
The paper discusses the topical problem how to organize health care to patients with cerebrovascular diseases (nursing, social adaptation, rehabilitation) with the direct participation of their relatives. For this, in 2006 the All-Russian Public Organization ТSociety of Relatives of Stroke PatientsУ (SRSP) was set up under the aegis of the National Stroke Control Association, which involves schools for the relatives of stroke patients. The major aspects and lines of SRSP activities are described in this paper.

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)