Salii M. Optimization of diagnostics of lacunar stroke with consideration of hemodynamic, neuroimaging and neuropsychological characteristics

The thesis work is devoted to determination of characteristics of the acute period of lacunar stroke on the grounds of study of clinical, neuropsychological, laboratory and neuroimaging parameters for improvement of diagnostic tactics in patients with LS. As a result of a comprehensive examination of 120 patients with ischemic lacunar stroke, the presence of cognitive disorders of different severity and the peculiarities of changes of cognitive and emotional-volitional sphere, depending on age, sex, education level, history of arterial hypertension, type of lacunar syndrome and neuroimaging characteristics of the brain was confirmed. In 72 % of patients, LS developed on the background of brain atrophy (internal, external and mixed). It is proved that the presence of morphometric signs of internal or mixed cerebral atrophy is a predicative of progression of cognitive deficits. The role of male sex and changes in emotional and volitional sphere as additional factors in the formation of cognitive deficits was proved. Dominance of a stagnant type of microcirculation and morphometric features of the microcirculatory bloodstream in case of presence of atrophic process of the brain was found. Silent lacunar lesions were twice as often found in patients with large type microangioarchitectonics. Violations of synthetic activity of endothelium in acute LS is confirmed and significantly lower indexes of stable metabolite of NO and ET-1 in patients with repeated LS and the presence of multiple lacunar lesions were showed