[Poststroke cognitive impairment and the possibility of its nonpharmacological treatment with vestibular stimulation based on biological feedback to supporting reaction]

[The relationship between the development of post-stroke cognitive impairment and changes in the coagulation component of hemostasis]

OBJECTIVE

To evaluate the relationship between the severity of post-stroke cognitive impairment (PSCI) and coagulation parameters assessed using the dynamic thrombophotometry.

MATERIAL AND METHODS

Thirty-five patients with hemispheric ischemic stroke (IS) with moderate neurological deficit at admission were included. All patients underwent a comprehensive clinical and instrumental assessment according to the current guidelines. On days 10-14, the cognitive status of patients was assessed using the Montreal Cognitive Assessment (MoCA). Coagulation parameters were assessed using the dynamic thrombophotometry at admission, on 6-8th days and 13-15th days from the onset of the disease. A database of laboratory studies of 30 apparently healthy volunteers was used as a comparison group.

RESULTS

Data analysis revealed that a number of spatial and temporal parameters were within the reference values, and there were no significant changes over time. Nevertheless, though the optical density of the fibrin clot (D) was within the reference values, it showed a steady increase from the admission by the end of the 1st week of the disease (p=0.007) and by 13-15th days (p=0.009). Correlation and multivariate linear regression, including baseline stroke symptom severity, showed significant associations (p<0.01 in all tests) between the higher optical density of the fibrin clot (D) on days 6-8 and 13-15 and lower MoCA score, confirming the negative effect of altered hemostatic parameters on cognitive function in IS patients.

CONCLUSION

The increase of optical density of the fibrin clot (D) by 6-8th and 13-15th days is a potential prognostic biomarker for the early development of PSCI.

The experience of comprehensive rehabilitation of a patient after a stroke with moya-moya disease. Case report

The article describes a clinical case of neurorehabilitation with a multimodal approach of a young patient with repeated ischemic strokes against the background of a rare chronic progressive cerebrovascular disease moya-moya disease. The multimodal approach consisted in the use of high-tech complexes with biofeedback, such as a stabilometric platform for visual and support reactions, cognitive training using computer technologies, as well as mirror therapy, physiotherapy procedures and physical therapy, including physiotherapy exercises and individual targeted training with paretic limbs. In accordance with the clinical scales used, convincing data were obtained on the effectiveness of the selected complex of rehabilitation measures.