Demchenko A. Chronic cerebral ischemia (aspects of pathogenesis, diagnostics and treatment)

This thesis is dedicated to the correction of chronic cerebral ischemia (CCI) pathogenesis conception, the optimization of diagnostic measures when CCI occurs on the base of analysis of the results of complex investigation of molecular and biochemical, hemodynamic, neurologic, neurovisualization and neurophysiologic data among the examined patients with CCI, the determination of predictors of its progress and optimization of treatment approach by means of pathogenous substantiation of differential usage of neuroprotective drugs and method of bioadaptive control in a complex therapy of these patients. Due to the results of investigation it was established the decrease of endogenous antioxidant system of glutathione to the extent of growing progressively worse a discirculatory encephalopathy stage in blood plasma and in hemolysate of erythrocytes against a background of activation proteins oxidative modification processes that were accompanied by the development and progress of cognitive disorders. It was revealed some changes of biomarkers contents (homocysteine, antibodies to NR2-peptide and S100B protein) among the patients due to the stage of discirculatory encephalopathy and intensity of cognitive disorders. It was established a fact that a disbalance of glutathione antioxidant system, increase of glutathione content in plasma, its decrease in hemolysate of erythrocytes and the decrease of stable NO metabolites was an important link in CCI progress associated with endothelial dysfunction. The most informative independent predictor of CCI progress among the patients with discirculatory encephalopathy was S100В protein level in a blood serum. Due to the experimental investigation it was specified the pathogenous value of oxidative and nitrosative stress in ischemic lesion of brain. It was justified the reasons for the differential prescription of neuroprotective drugs (citicoline, tiocetam, cortexin) among the patients with CCI taking into account the revealed advantages of their action on clinico-neuropsychological, biochemical and neurophysiologic parameters. It was shown the efficiency and practibility of bioadaptive control method in complex therapy among the patients with CCI.