Cerebral strokes are a huge problem of a modern angioneurology. They occupy leading positions among diseases with high rates of prevalence, morbidity, disability and mortality. Special interest caused by recurrent cerebral diseases, particularly, recurrent ischemic stroke, which, according to various authors, takes up from 5 to 31% of all brain vascular diseases. The peculiarities of neurological disorders, as well as data on the prevalence, structure and dynamics of cognitive impairments in patients with acute stroke are still poorly studied. Further improvement of medical and diagnostic measures in patients with a recurrent stroke is required.
This thesis is devoted to the improvement of treatment and diagnostic measures in patients with recurrent cerebral ischemic hemispheric stroke (RCIHS) by identifying clinical, paraclinical, neuropsychological features, prognosis of the outcome and optimizing the treatment of the acute period of the disease.
To achieve the goal, the following research methods were used: clinical, neurological and neuropsychological examination using international clinical scales; instrumental: computer tomography of the brain, computer electroencephalography with toposelective mapping and spectral analysis of bioelectric activity of the brain, duplex scan of extra- and intracranial vessels, laboratory and statistical.
Complex clinical-paraclinical examination of 180 patients with cerebral ischemic hemispheric stroke (CIHS) was conducted. The main observation group consisted of 136 patients with RCIHS (71 men and 65 women), age 74 (65;78) years. The comparison group included 44 patients with first-ever CHIS, among them were 27 men and 14 women, age 68 (59;75) years.
It was found that patients with RCIHS, in all control dates of the study had a more pronounced neurological deficit than patients with first-ever CHIS, that was confirmed by a significantly higher NIHSS scores at 1st -3rd day (12 (10;13) versus 7 (5;10), p <0.05) and at 10th -13th day (8 (7;11) vs. 4.5 (2.0;8.0), p <0.05). The NIHSS scores in patients with defeat of the contralateral carotid area (CCA) were significantly higher than in patients with RCIHS in the ipsilateral carotid area (ICA), particularly this difference consisted 25 % (12.0 (9.0;13.5) versus 9.0 (7.0;12;5), p, <0.05) at baseline and 27.7% (9 (7;13) to 6.5 (4.0;9.5), p <0.05) - at 10th -13th day.
Analyzing the degree of patients’ disability, it was found that patients with RCIHS in CCA had the worst prognosis for medical and social recovery and had the highest score by modified Rankin scales (mRS) which consisted 4.0 (3.5;4.0) points that was 25% higher than in patients with RCIHS in ICA (4 (3;4) points versus 3 (3;4), p <0,05).
It was found that in patients with RCIHS in the cortical - subcortical brain areas the level of neurological deficiency, which was determined by the NIHSS score at the first 72 hours from the stroke onset, correlated with the infarct volume (r = + 0.67; p <0.05) and with the mRS score (r = + 0.57; p <0.05); the volume of lesion correlated with mRS score (r = + 0.54; p <0.05) and with septum pellucidum displacement (r = + 0.50; p <0.05). Among patients with RCIHS in subcortical area in the debut of the disease, a correlation was found between the NIHSS score and the volume of lesion (r = + 0.70; p <0.05), mRS score (r = + 0.59; p <0.05), septum pellucidum displacement (r = + 0. 55, p <0.05), epiphysis displacement (r = + 0.59, p <0.05), as well as between the volume of the lesion and septum pellucidum displacement (r = + 0. 59, p <0.05), epiphysis displacement (r = + 0.52, p <0.05), mRS score (r = + 0.51, p <0.05).
