[Modern pathogenetic aspects of development of cerebral chronic ischemia]

[Cerebrovascular disease with neurocognitive impairment]

In the International Classification of Diseases 11th revision in the section «Diseases of the nervous system», it is proposed to distinguish «Cerebrovascular disorder with neurocognitive impairment», which corresponds to both discirculatory encephalopathy (DEP) or chronic cerebral ischemia (CCI) accepted in our country, and also vascular cognitive impairments. The terminology, prevalence, risk factors and pathological basis of the disease are discussed, in particular multiple infarctions, strategic infarctions, cerebral small vessel disease, specific microangiopathies, intracerebral hemorrhage and global hypoperfusion. Post-stroke cognitive impairments are discussed in detail. The article presents relevant data on the pathogenesis of the disease, highlights the issues of clinical and neuroimaging diagnostics. Based on the data presented in the article, we can conclude that the diagnosis of DEP, CCI should be based on the presence of cerebrovascular disease with neurocognitive impairment, which implies the verification of vascular cognitive impairments and reliable neuroimaging signs of cerebrovascular pathology while excluding other causes. Early diagnosis and effective treatment of cerebrovascular disease with neurocognitive impairment (DEP, CCI) is becoming increasingly important, since treatment can slow the progression of the disease and lead to a decrease in the incidence of stroke and dementia.

[Correlations between parameters of central hemodynamics and cytokine profile in chronic kidney disease in combination with cerebrovascular diseases]

AIM

To study the relationship between central hemodynamics and arterial stiffness indicators with cystatin C, tumor necrosis factor-alpha (TNF-alpha) and interleukin-(IL)-10 in patients with chronic kidney disease (CKD) in combination with cerebrovascular diseases (CEV).

MATERIAL AND METHODS

One hundred and twenty patients, aged from 19 to 81 years, with signs of chronic renal dysfunction, including 73 with CKD (1st group) and 47 with CKD in combination with CEH (group 2), were examined. 'AngioScan' (Russia) was used to study indices of arterial rigidity. Blood plasma concentrations of TNF-alpha, IL-10 and cystatin C were determined by the enzyme immunoassay.

RESULTS

There is a significant increase (p<0.05) in the systolic, diastolic, central levels of arterial pressure, augmentation index, the index of increase at a pulse rate of 75 per min, the age index, the age of the vascular system and cystatin C content in the patients with CKD in combination with CEV compared to the patients with CKD without accompanying CEH. In the group of patients with CKD in combination with CEV, a correlation was found between the level of TNF-alpha and arterial stiffness index on one side (r=0.318; p<0.05) and the augmentation index on the other (r=0.299; p<0.05).

CONCLUSION

The results confirm the fact that there is a significant increase in the level of plasma cystatin C and a decrease in GFR in patients with CKD in combination with CEV. Correlations were found between the level of TNF-alpha, augmentation index and deterioration of parameters of central hemodynamics and arterial stiffness in CKD in combination with CEH.

Vascular cognitive impairment and chronic cerebral ischemia (dyscirculatory encephalopathy)

The paper reviews the literature on vascular cognitive impairment (VCI), the diagnosis widely used in foreign neurological practice, as well as chronic cerebral ischemia (CCI) and dyscirculatory encephalopathy (DEP), the common diagnoses in Russian neurological practice. According to the etiology, risk factors, and manifestations, Stages I and II DEP largely corresponds to moderate VCI; Stage III DEP does to severe VCI. The results of the author’s studies show that a considerable proportion of patients followed up with a diagnosis of CCI, DEP, have no signs of chronic cerebrovascular disease (CVD), but suffer from primary or secondary headache, vertigo of various origins, emotional disorders, and other diseases. The diagnosis of CCI, DEP should be based on the presence of CCI, the reliable neuroimaging signs of chronic CVD, and the ruling out of other diseases. When treating and preventing VCI, CCI, and DEP, a premium is placed upon both non-drug (regular physical activity, smoking cessation, rational nutrition) and drug therapy aimed at normalizing blood pressure and blood lipid spectrum, preventing blood clots, and improving cognitive functions.

[The experimental strategies in the study of ischemic stroke]

Literature data and own experience in the studies of experimental stroke methodology are reviewed. Advantages and disadvantages of the common models of focal ischemia used in the laboratory practice are discussed in details. The advantages of the filament occlusion of the middle cerebral artery in rats as the most adequate model of human stroke are substantiated. The authors suggest a modification of this variant using an additional coagulation of the pterygopalatine artery that allows the exclusion of the retrograde and collateral blood flow into the inner carotid artery after ligation of the common and external carotid arteries.

[Pathogenetic aspects of the development of acute focal cerebral ischemia]

Current concepts on the main mechanisms of brain damage in ischemic stroke are considered. Chemical regulation of physiological and pathological processes of maintaining cellular pool is supported by a multistep system that included compounds of different structure and complexity. A complex assessment and comparison of the processes taking place during the development of acute local cerebral ischemia (necrosis, apoptosis, autoimmune inflammatory reaction, neuroplasticity) can help in the objectification and prognosis of individual characteristics of the course and outcome of ischemic stroke. Understanding of the cascade of events that occur during the acute ischemic damage is critical for determining current and future diagnostic and therapeutic approaches.

[Angiogenesis mechanisms in the formation of structural changes of brain tissue in patients with progressive cerebrovascular disease]

AIM

To study the correlation between expressiveness of focal changes of brain tissue and VEGF and MCP-1 levels in plasma and blood serum of patients with chronic cerebral ischemia (CCI).

MATERIAL AND METHODS

Markers of inflammation (MCP-1, CRP) and angiogenesis (VEGF) in serum and blood plasma of 35 patients with CCI depending on expressiveness of structural changes of brain substance according to MRI were investigated.

RESULTS

The increase in MCP-1 and CRP content in blood serum and simultaneous decrease in VEGF level in serum and blood plasma were correlated with the increase in the number of focal changes of substance of the brain in patients with CCI.

[Tthe efficacy and safety of drug therapy divaza in patients with chronic cerebral ischemia]

AIM

To evaluate the efficacy and safety of divazа in the treatment of cognitive and emotional disorders in patients with chronic cerebral ischemia (CCI) based on clinical findings and laboratory markers of endothelial dysfunction.

MATERIAL AND METHODS

Thirty patients with CCI, aged 40 to 70 years, were examined. All patients were treated with divazа (2 tablets 3 times a day) for 12 weeks. Cognitive functions and markers of endothelial dysfunction (the activity of endothelial NO-synthase (eNOS), the number of circulating desquamated endothelial cells in blood plasma) were measured at baseline and after treatment.

RESULTS

Divazа significantly reduced the severity of clinical symptoms and had a positive effect on endothelial dysfunction normalizing the tone of cerebral vessels and preventing deendotheliazation.

CONCLUSION

The use of divazа resulted in clinical improvement and normalization of markers of endothelial dysfunction as well.

[Mechanisms of development of chronic cerebral ischemia in arterial hypertension]

AIM

To study a relationship of arterial hypertension (AH) severity with the cerebral blood flow and structural changes in the brain matter, processes of lipid peroxidation and antioxidant defense, parameters of homeostasis, indicators of endothelial dysfunction and apoptosis.

MATERIAL AND METHODS

A complex study of 84 patients with AH, aged from 43 to 64 years, was carried out.

RESULTS AND CONCLUSION

The severity of atherosclerotic damage increased with the increasing of the AH degree. There were the sings of cerebral atrophy, changes in the white matter of brain hemispheres accompanied by the increase of oxidative stress and insufficient antioxidant activity, appearance of procoagulation shifts in the homeostasis system, along with the moderate activity of fibrinolysis, increase in the level of proinflammatory cytokines and markers of apoptosis, endothelin-1, decrease in nitrogen oxide concentration.