Neurology, Neuropsychiatry, Psychosomatics

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Vol 5, No 4 (2013)


4-9 1695

Stroke patients among all patients with somatic diseases are at one of the highest risks for venous thromboembolism (VTE). The proven risk factors for venous thrombosis in stroke are prolonged immobilization, elderly age, obesity, diabetes mellitus, and inherited coagulopathies. If no drug prevention is done, the course of stroke is complicated by deep vein thrombosis (DVT) in 75% of the immobilized patients and pulmonary thromboembolism develops in 20%. At present there are mechanical, pharmacological, and combined DVT prevention strategies that may considerably lower the rate of pulmonary embolism. In stroke patients, the use of low-molecular-weight heparins (LMWH) reduces the
risk of DVT, without increasing the risk of hemorrhagic complications. Novel oral anticoagulants used to treat venous thrombosis and VTE in stroke patients are an equivalent alternative to LMWH therapy. Treatment with novel oral anticoagulants to prevent recurrent VTE is effective and safe and may be continued up to 1–2 years.

10-20 935

The paper discusses the general problems of the pathogenesis of tunnel neuropathies of the lower extremities with the endogenous and exogenous etiological factors being indicated. The clinical manifestations of tunnel neuropathies at this site are considered in detail. Various leg tunnel syndromes are characterized. Diagnostic and treatment methods for the above syndromes are considered.

21-27 723

The article presents data on different forms of moderate cognitive impairments (MCI) and the specific features of their transformation to dementia. Cerebrospinal fluid (CSF) was investigated in 60 patients with the amnestic and neurodynamic types of MCI, in 15 patients with vascular dementia (VD), 50 patients with Alzheimer’s disease (AD), and 23 patients with mixed vascular and neurodegenerative dementia (MVND). The specific features of β-amyloid and τ-protein concentrations were established in the preclinical stages of dementia, which reflects the main components of the pathogenesis of neurodegeneration. In the amnestic form of MCI and AD, there was drastically decreased Aβ-42 and increased τ-protein levels in SCF. As cognitive impairments progressed, there was a rise in the concentration of τ-protein; its level correlated with the severity of dementia. In MND, the level of Aβ-42 was significantly reduced while the concentration of τ-protein was much increased; moreover, to a greater extent than in AD and VD. Cerebrovascular damage and neurodegeneration were related to each other and mutually worsened clinical and pathogenic effects.

28-33 1101

The paper analyzes the results of treatment in 373 patients included in the Samara Region’s register of myasthenia gravis. The average disease duration was 9.7±7.6 years. Treatment encompassed symptom control with acetylcholinesterase inhibitors and immunosuppressive therapy. To achieve remission and good compensation, most cases needed the combined use of anticholinesterase inhibitors and immunosuppression with glucocorticoids and/or cytostatics. The efficiency of glucocorticoid and cytostatic therapies did not differ essentially. The adverse reactions of the treatment were evaluated. Therapy could achieve stabilization and improvement in 88.2% of cases.

34-38 1180

Patients with vestibular vertigo (VV) are commonly referred to hospital, as emergently indicated, which makes the urgent establishment of the cause of VV relevant. One hundred and ninety-eight patients (86 men; mean age, 55.6±13.7 years and 112 women; mean age, 69.1±9.2 years) with VV who had been admitted to hospital for suspected stroke were examined. Ischemic stroke in the vertebrobasilar system (VBS) was diagnosed in only 28 (32.5%) men and 22 (19.6%) women; transient ischemic attack in VBS was seen in 10 (12.2%) men and 6 (5.6%) women; other diseases were identified in the remaining cases. VBS stroke was noted to be hyperdiagnosed in the patients with VV; whether it
is expedient to apply a standardized approach to the problem of vertigo and unstable equilibrium and to attract a multidisciplinary team to examine patients in the admission room of a multidisciplinary hospital is discussed.

39-42 1272

Referred pain is a painful sensation in the peripheral regions during pathological processes in deep tissues or viscera. There are two types of referred pain: 1) somatic referred pain (from spinal structures to adjacent areas); 2) visceral referred pain (from pelvic and abdominal viscera).
Patients and methods. The investigation enrolled 80 patients with nonspecific chronic and subacute lumbosacral spine pain. All the patients underwent standard neurological examination. Pain intensity was determined on a visual analog scale (VAS) using the DN4, PainDETECT, and short-form McGill questionnaires; the wind-up phenomenon was evaluated; the degree of muscular tonic syndrome was estimated applying the Khabirov questionnaire. The health-activity-mood (HAM), SF-36, and Roland-Morris questionnaires were used to assess quality of life.
Results. Somatic referred pain was found in 62% of the examinees. In these patients, the clinical picture showed a set of characteristics for neuropathic (allodynia (31%), hyperesthesia (12%), and nociceptive (grades 1 and 2 muscular tonic syndrome 41 and 59%, respectively) pain; a high wind-up index was noted in 89% of the patients.

43-48 858

The paper describes a clinical case of a 27-year-old female patient with Niemann – Pick disease type C (NPC), a rare inherited orphan disease, belonging to a group of lipid storage diseases. It gives an update on the etiology and pathogenesis of this type of glycosphingolipidosis and on established gene mutations. The clinical polymorphism of NPC and the trends in the development of somatic, mental, and neurological disorders are highlighted in relation to the onset age of the disease. The problem of differential diagnosis is discussed. The diagnostic NPC probability index in scores and the latest methods for laboratory diagnostic verification, including molecular genetic testing, are presented.
Information is given on specific substrate reduction therapy with miglustat for NPC.

49-53 764

The review of literature considers the possible mechanisms responsible for the development of sleep disorders in patients with varying degrees of cognitive impairments. It assesses the association of the severity of cognitive impairments (CI) with the degree of sleep disorders. The treatment of sleep disorders in patients with cognitive disorders, the benefits and risks of current hypnotic drugs are discussed in detail. Recommendations are given to manage patients with sleep disorders concurrent with cognitive dysfunctions. Melatonin preparations are noted to be effective in treating insomnia in patients with CI.

54-59 773

The review of literature gives current views on the role of antiplatelet therapy in the treatment and secondary prevention of ischemic stroke. Relying on the data of evidence-based medicine, the author provides analytical characteristics of all platelet antiaggregants that have been put through worldwide clinical trials. The benefits and risks of each agent are shown in both monotherapy and combination therapy. The basic principles of choice of antiplatelet drugs for patients with acute stroke and postischemic stroke are outlined.

60-65 898

Based on the data available in the literature and the results of their investigations, the authors give the present-day views of the role and place of cardiac diseases in the pathogenesis of cardioembolic stroke (CES). Among all causes of ischemic strokes, cardiogenic strokes are demonstrated to account for as high as 40%. Nonrheumatic atrial fibrillation, postinfarction changes, and rheumatic heart diseases are considered to be the leading causes of CES. Current recommendations for CES prevention are presented; the specific features of antithrombotic therapy are analyzed in detail.

66-70 977

Cognitive impairments in epilepsy are a current problem in neurology. The basis of the idea on the pathogenesis of higher nervous system dysfunctions is the interaction of a few factors that include the form and duration of the disease, gender differences, and the impact of antiepileptic therapy. The role of interattack epileptiform changes in the development of cognitive deficit in adults and epileptic encephalopathies in children is discussed. Up-to-date neurophysiological and neuroimaging diagnostic methods allow the detection of new features in the course and progression of higher nervous system dysfunctions in epilepsy.

71-77 1127

The review of literature discusses in detail the clinical signs of non-dementia cognitive impairments (CIs) and differences between subclinical, mild, and moderate CIs. It considers in detail the manifestations of dementia, the typical clinical picture of the most common forms of dementia, such as Alzheimer’s disease, Lewy body dementia, and vascular dementia. The paper outlines basic approaches to the pathogenetic therapy for dementia and the efficiency and safety of using NMDA receptor antagonists in patients with this pathology.

78-83 881

To render outpatient care to poststroke patients, particularly to those who have severe motor and/or speech disorders is an urgent problem in neurology. These patients have frequently cognitive and psychoemotional disorders that make rehabilitation much difficult. If there are no promises for functional restoration, these patients need care, prevention of restroke and complications associated with immobilization. Current methods for preventing restroke include modification of lifestyle, normalization of blood pressure, use of antithrombotic agents and statins (after prior ischemic stroke), treatment of cognitive and depressive disorders, pain syndromes, urination disorders, correct care, diet, passive and active exercises, positional treatment, and local domiciliary procedures. The use of up-to-date treatment options is now shown to substantially reduce the risk of restroke and to improve recovery of lost functions and quality of life in the patient.

84-87 821

The paper gives information on multidisciplinary treatment programs for chronic back pain. It discusses whether it is expedient and effective to use these programs. The structure and sequence, volume and methods used in the programs for secondary and tertiary health care are considered. The examples of substantiated treatment for back pain during primary health care are given, which promote the prevention of its chronization.

88-93 1251

The paper gives the data of Russian and foreign authors and the results of this paper authors’ investigation of higher cerebral functions in patients who have sustained brain injury (BI). It shows their high prevalence, the predominance of cognitive impairments (CI) over neurological disorders in patients with mild and moderate injury, presents their quantitative and qualitative features (a preponderance of focal symptoms in severe injury and neurodynamic disorders in mild injury), describes the predictors of their course and prognosis (the degree of injury is one of the most important predictors), and discusses current trends in the medical correction of detected abnormalities.

94-96 659

The paper reviews the proceedings of the 22ndWorld Congress on Psychosomatic Medicine, held in Lisbon, Portugal, on September 12–14, 2013. Investigations of psychosomatic disorders and diseases are indicated to preserve traditional areas (psychocardiology, psycho-oncology, psychoendocrinology, etc.) and to direct relatively new trends (to establish correlations between psychopathological and/or pathocharacterological disorders and maxillofacial pathology, as well individual pain symptom complexes).

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