The main tasks of prehospital medical care are to make a correct diagnosis of stroke and to minimize patient transportation delays. Stroke is a medical emergency so all patients with suspected stroke must be admitted by a first arrived ambulance team to a specialized neurology unit for stroke patients. Most rapidly transporting the patient to hospital, as well as reducing the time of examination to verify the pattern of stroke are a guarantee of successful thrombolytic therapy that is the most effective treatment for ischemic stroke. Substantially reducing the time of in-hospital transfers (the so-called door-to-needle time) allows stroke patients to be directly admitted to the around the clock computed tomography room, without being sent to the admission unit. Prehospital stroke treatment policy (basic therapy) is to correct the body’s vital functions and to maintain respiration, hemodynamics, and water-electrolyte balance and it can be performed without neuroimaging verification of the pattern of stroke. The application of current organizational, methodical, and educational approaches is useful in improving the quality of medical care for stroke patients, in enhancing the continuity between prehospital and hospital cares, and in promoting new effective technologies in stroke therapy.

Clinical, neuropsychological, and neuroimaging examinations were made in 65 patients (52 men and 13 women) aged 65.6±10.1 years who had experienced ischemic stroke. Cognitive impairments (CI) were heterogeneous; regulatory functions, attention, and counting were most significantly affected in moderate CI. In mild dementia, mainly poor attention and regulatory dysfunctions were added by clearly-cut impairments of memory, orientation, and visual-spatial function. Brain atrophy, white matter changes, and small focal gray matter damages along with focal post-stroke changes were revealed by neuroimaging in most patients. It was found that besides the volume and location of a damage focus, the signs of impaired integrated mental activity of the brain, regulatory dysfunctions in particular, should be a necessary condition for the verification of post-stroke CI.

The purpose of the study was to comparatively analyze the rate of post-stroke depression and cognitive impairments in escitalopram (cipralex)-treated and untreated (control) patients. Emotional and affective cognitive symptoms, neurological deficit, and day-to-day activity were evaluated over time 1, 3, and 6 months after treatment. The results of the study indicated that escitalopram used to prevent depression in the acute phase of stroke provided a good effect. This drug caused a prompter recovery of cognitive impairments and reduced the pace of development of neurodegenerative disorders underlying the post-stroke 2D (depression and dementia) syndrome. The study group was recorded to have more favorable functional outcomes of stroke and patient mobility indicators associated with lower disability rates.

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.

The rate of cardiogenic embolism among all ischemic strokes is as high as 38%. Cardioembolic strokes are characterized by the higher magnitude of neurological deficit, the high risk of recurrent acute stroke, and a lethal outcome. This review deals with the etiopathogenesis of thrombus formation in the heart chambers, with current criteria for the verification of cardioembolic strokes, with the results of trials of new oral anticoagulants, and latest guidelines for antithrombotic therapy to prevent stroke. Special focus is given to secondary stroke prevention in patients with nonvalvular atrial fibrillation since it is atrial fibrillation that is the most common cause of cardioembolic stroke.

The paper gives the data available in the literature and the author’s results of an examination of almost 140 patients with dissection of the internal carotid and vertebral arteries (ICA and VA). Dissection is blood penetration through an intimal tear from the lumen of an artery into its wall to develop intramural hematoma (IMH). The cause of dissection is the weakness of the arterial wall presumably due to mitochondrial cytopathy. IMH narrows/occludes the arterial lumen or is a source of arterioarterial embolism, which in turn leads to ischemic stroke. Stroke as a result of dissection generally develops in young patients, who are not prone to traditional vascular risk factors, frequently after the influence of provocative factors (mild head/neck injury, head jerks, physical strain, contraceptives, etc.). The characteristics of stroke are head/neck pain on the side of dissection that appears a few days prior to stroke or simultaneously with the latter; quite often a good recovery of impaired functions; and low recurrence rates. Another major manifestation, isolated cervicocephalic pain, is encountered in PA dissection more frequently (in almost a third of cases) and in ICA dissection less frequently (about 5%). Magnetic resonance (MR) angiography and fat-saturated T1-weighted MR imaging play a leading role in the verification of dissection. Dissection should be treated with anticoagulants/antiaggregants in its acute phase, as well as with trophic drugs, primarily actovegin, in both acute and chronic phases.

Dementia occurs in 10-20% of cases and substantially hampers the rehabilitation of patients who have had stroke. Management of patients with post-stroke dementia is based on the prevention of recurrent stroke, cognitive stimulation, and the use of drugs improving cognitive functions. The paper gives the data available in the literature on the results of randomized placebo-controlled trials evaluating the efficacy of central acetylcholinesterase inhibitors and the NMDA receptor antagonist akatinol memantine in vascular dementia, as well as the author’s positive experience with akatinol memantine used in 20 patients.

The paper summarizes an update on the morbidity, mortality, and a risk for recurrence of stroke occurring in babies. It shows a variety of conditions and syndromes which may be responsible for stroke in infancy. Babies with the signs of intrauterine infection and congenital heart disease, the carriers of major thrombophilia gene mutations, may be regarded as a risk group.

Stroke is a leading cause of disability not only due to its impact on motor or sensory functions, but also to post-stroke cognitive impairments (CI). Within the first year after stroke, the rate of CI may be as high as 80-90% and 7-23% of patients develop dementia. The most important risk factors for CI are strokes, their extent, site, and number. Old age, low education level, severe previous pathological changes in the brain parenchyma, diabetes mellitus, atrial fibrillations, and recurrent strokes in particular, are associated with an increased risk of CI. Examining cognitive functions, monitoring the evolution of cognitive deficit, and post-stroke rehabilitation are indicated in patients who have had stroke. The main treatments in patients with CI are secondary stroke prevention, including lifestyle modification and symptomatic therapy. Sermion is one of the promising agents for the prevention and treatment of CI in these patients.