The aim of the work was to increase the effectiveness of diagnosis, predict the development of acute visual impairment due to hypertension and the development of transient ischemic events by revealing the clinical and paraclinical, neuropsychological features and improve the assessment of optic nerve disorders criteria in such conditions. The objectives of the study were to determine the clinical (neurological, neuroophthalmological) features of the condition in patients with hypertension and TIA with impaired vision and optic nerve functions, to identify the structure and nature of morphological disorders of the brain, to reveal the impact of functional and structural impairments of the optic nerve by the method of visual evoked potentials (VEP), assessment of the structure of neurophysiological disorders, the characters of microcirculatory pathology, structural disorders of MAH and functional state of cerebral hemodynamics. On the basis of correlation analysis and buildings of the model of forecasting it was necessary to allocate factors of pathology, to establish conditions of restoration of function of an optic nerve at ischemic damage, to compare diagnostic efficiency of VEP at similarly pathologies and to estimate efficiency of such a diagnostic method in dynamics of therapy. The efficacy and safety of the pharmacological substance DHK as an additional component of therapy in the restoration of visual function in TIA with TVD were also evaluated.
To perform these tasks were examined 104 patients (56; 53,85%) men and 48 (46,15%) women (mean age - 62,1 ±3,56 years) with hypertension, who had TIA with TPD, 36 (34, 6%) – second time, 68 (35,3%) for the first time. The control group consisted of 26 men and 20 women (46 persons) of comparable age (n = 46; mean age 62,43 years) without persistent hypertension of 2 st. (according to the new classification, 2020) and who previously didn’t suffer by ischemic events with visual impairment. All cases of TIA with the maximum probability were not be caused by other proven factors than cerebral circulatory disorders. At the age of 25 - 44 years there were 9 patients (8,65% ± 2,76), including 5 men (Me 42 (Q141; Q2 44)) and 4 women (Me 41 (Q1 39; Q2 42)). At the age of 45-59 years there were 42 (40.38% ± 4,81) patients, including 21 men and 21 women, at the age of 60-75 years there were 53 (50.1% ± 4,9) patients, including 30 men and 23 women. The number of patients aged 25-44 years was smaller (p <0,001).
At patients aged 25-44 years, hypertension 2st was at level 85,6% combined with signs of MSP of the brain. In the age groups 45-59 and 60-74, the degree of MAH stenosis didn’t affect the distribution of TIA events frequencies in the different basins. In the control group, signs of intima thickening were determined in 32 (69,57% ± 6,78) and structural changes in MAG up to 30% in 8 (17,39% ± 5,59). At the age of 45-58 years and 60-74 years, the number of cases of TIA in the pool of MBA - a.ophthalmica with structural pathology of MAH was significantly higher (3,77-4,76% of patients with TIA and thickening of the intima of vessels, 16-24 % with stenosis up to 30% and 52-58% with MAH stenosis more than 30%, but statistical criteria outlined only the tendency of reliability. Disorders of the structure of MAH in any form were present in all patients with TIA and were a lot less typical in the control group. Structural pathology (SP) MAH was detected without a significant difference in frequencies in the groups 45-59 years and 60-74 years in the absence of significant SP MAH in group aged 25-44 years, what can provide arguments to link TIA not so much with age as with SP MAH (there were determined in 12 or 26% with qualitative difference to main group). There were not significant differences between the frequencies of detection of retinopathy (RP) 3st. and 1st and 2nd st. at the age of both 45-59 years (18; 42,86% ± 7,64 against 16,67 1st and 28,57 2nd st.) and at the age of 60-74 years (45,28% ± 6,06) 3st. vs 15,09 ± 4,92 1st. Dependences of TIA localization on the level of structural disorders of MAH and the stage of retinopathy were not found in all age groups.
When building a model of correlation-regression analysis and performing its procedures, it was clearly found that the only reliable factor, independently combined with the development of TIA - is the presence of AH. In age groups (45-74 years) frequency of hospital visits due to the development of TIA was significantly higher (compared with the group of 25-44 years), but as a separate factor, age did not show in this study a significant effect on the prognosis of ischemic events, which is highly likely to be predicted with age only on condition of presence of other factors such as hypertension, angiopathy, structural disorders MAH and changes in cerebral circulation
