Острое нарушение мозгового кровообращения по ишемическому типу в послеродовом периоде

During pregnancy and delivery, the risk of cerebrovascular disorders increases due to several physiological changes. The elevated level of estrogen stimulates the production of clotting factors, which deteriorates the risk of thromboembolism. Increased plasma volume and total blood volume lead to the risk of hypertension, and the high level of progesterone in the third trimester of pregnancy promotes the permeability of small blood vessels. The risk of developing cerebrovascular complications remains high in the postpartum period. The article describes two clinical cases of postpartum ischemic stroke as a complication after surgical delivery in young women with an aggravated somatic medical history. The treatment and follow-up of these patients during their stay in the intensive care unit included changes in management tactics, use of antiplatelet, anticoagulant, and metabolic therapy, and subsequent rehabilitation. This article describes the case-management interventions and changes in neurological symptoms of these patients, also it discusses the most likely etiological factors of cerebrovascular disorders in these casesБеременность и роды характеризуются более высоким риском цереброваскулярных нарушений, что обусловлено определенными физиологическими изменениями. Повышенный уровень эстрогена стимулирует выработку факторов свертывания крови, что увеличивает риск тромбоэмболии. Увеличение объема плазмы и общего объема крови повышает риск развития гипертензии, а повышенный уровень прогестерона в третьем триместре беременности способствует увеличению проницаемости мелких кровеносных сосудов. Риск развития цереброваскулярных осложнений остается высоким и в послеродовой период. В статье представлены два клинических наблюдения развития острого нарушения мозгового кровообращения по ишемическому типу после оперативного родоразрешения у молодых женщин с отягощенным соматическим анамнезом. Лечение и наблюдение этих пациенток во время пребывания в отделении реанимации и интенсивной терапии подразумевало изменение тактики ведения, включение антиагрегантной, антикоагулянтной, метаболической терапии и последующей реабилитации. Статья содержит описание комплексов лечебных мероприятий и динамики неврологической симптоматики этих пациенток, а также обсуждение наиболее вероятных этиологических факторов цереброваскулярных нарушений в данных случая

Comorbidity of infantile cerebral palsy and benign epileptiform EEG discharges of childhood in dizygotic twins

The article presents a clinical case of infantile cerebral palsy combined with BEDC (with no epileptic seizures) in dizygotic twins. The case supports the hypothesis of genetic nature of the BEDC patterns. The variety of EEG characteristics and clinical courses of the disease in children with cerebral palsy and BEDC are reviewed. Correct interpretation of the EEG findings provides an accurate prognosis of seizures and cognitive functions, as well as the patient management tactics. In these patients, continuous video EEG monitoring (both awake and sleeping) is recommended for a long-time follow-up

Ingrown chorionic villi of the first trimester as a result of a non-developing pregnancy in the post-cesarean scar, associated with the development of arteriovenous malformation: а clinical case

Background: Identification of residual chorionic tissue and ingrowing chorionic villi after uterine cavity curettage due to non-developing pregnancy, spontaneous abortions, and medical abortions has been a poorly studied problem. The most challenging is the differential diagnosis of this condition when the chorion grows into the scar from a caesarean section and is associated with arteriovenous malformations of the uterine wall. Nowadays, ultrasound has been recognized as the primary diagnostic method; however, the absence of specific echo-signs makes magnetic resonance imaging (MRI) and computed tomography (CT) the methods of choice and final diagnosis. Clinical case: This was a 39-year-old patient with a history of 3 caesarean sections and non-developing pregnancy and complete spontaneous miscarriage at 4 to 5 weeks of gestation in March 2021. Her final diagnosis was “growing of the chorionic villi of the first trimester of gestation into the myometrium to the entire depth of the uterine wall and up to the serous membrane without germination of the latter (placenta increta). At admission to the clinic in April 2021, she complained of pelvic pain, ongoing low intensity intermittent uterine bleeding, weakness, dizziness, and breast pain. The ultrasound revealed a mass in the uterine cavity. The MRI showed an incompetent post-cesarean uterine scar and residual chorionic tissue spreading to the uterine serosa, with peripheral arteriovenous structures of a neoangiogenous type. Multiaxial CT with angiography could not exclude an arteriovenous malformation within the uterine wall and residual chorionic tissue. During embolization, the angiograms showed the arteriovenous malformation in the projection of the uterus, with afferent vessels as bilateral uterine and cervicovaginal arteries and efferent vessels as bilateral parametric veins, internal iliac and ovarian veins. Based on the clinical and imaging pictures, embolization of the uterine arteries was performed as a first step and laparoscopic clipping of the uterine arteries and hysterectomy with fallopian tubes as a second step. Postoperatively the patient improved and beta-chorionic gonadotropin levels decreased. She was discharged home on the 5th day with no complaints. The clinical case demonstrates the important role of MRI and CT in the differential diagnosis and assessment of the zone and degree of chorionic villi ingrowth, aimed at determination of the possibility of organ-preserving treatment, or the need to perform a radical surgery should metroplasty be impossible. Conclusion: If an additional intrauterine mass is visualized by ultrasound examination after pregnancy termination, the method of choice and final diagnosis is MRI, which is performed to exclude the ingrown chorionic villi and to assess the degree of their invasion. MRI also allows for assessment of the viability of the post-cesarean scar and the presence of neoangiogenesis areas at the periphery of the ingrowth zone. CT is a method of clarifying diagnostics used to exclude vascular malformations of the uterine wall

Epilepsy combined with Wolf-Hirschhorn syndrome: a literature review and description of clinical cases

This article presents the anamnestic, clinical, electro-encephalographic and neuroimaging findings in 5 patients with epilepsy combined with Wolf-Hirschhorn syndrome (WHS). According to our data and the results of others, this combination has its specific characteristics. These include: a high incidence of epilepsy in patients with WHS (50-100% of cases), an early debut of seizures (mainly in the first year of life), fever-provoked seizures, and a variety of seizure types – focal paroxysms, bilateral tonic-clonic seizures, atypical febrile seizures, atypical absences and epileptic spasms. In addition, there may be frequent epileptic seizures tending toward status epilepticus, a slowing of the major EEG activity, a local EEG slowing (mainly in the posterior and bi-frontal areas), and regional / multiregional epileptiform activity. In more than 50% of cases, the diffuse peakwave activity is observed; the broad spectrum anti-epileptic drugs are highly efficient in 80% of cases. Based on this study, we propose recommendations for the management of patients with epilepsy combined with WHS

Small RNA MTS1338 Configures a Stress Resistance Signature in <i>Mycobacterium tuberculosis</i>

In the course of evolution, Mycobacterium tuberculosis (Mtb), the etiological agent of tuberculosis, has developed sophisticated strategies to evade host immune response, including the synthesis of small non-coding RNAs (sRNAs), which regulate post-transcriptional pathways involved in the stress adaptation of mycobacteria. sRNA MTS1338 is upregulated in Mtb during its infection of cultured macrophages and in the model of chronic tuberculosis, suggesting involvement in host–pathogen interactions. Here, we analyzed the role of MTS1338 in the Mtb response to macrophage-like stresses in vitro. The Mtb strain overexpressing MTS1338 demonstrated enhanced survival ability under low pH, nitrosative, and oxidative stress conditions simulating the antimicrobial environment inside macrophages. Transcriptomic analysis revealed that in MTS1338-overexpressing Mtb, the stress factors led to the activation of a number of transcriptional regulators, toxin–antitoxin modules, and stress chaperones, about half of which coincided with the genes induced in Mtb phagocytosed by macrophages. We determined the MTS1338 “core regulon”, consisting of 11 genes that were activated in all conditions under MTS1338 overexpression. Our findings indicate that MTS1338 is a stress-induced sRNA that promotes Mtb survival in macrophages by triggering adaptive transcriptional mechanisms in response to host antimicrobial defense reactions

Diagnostic value of neuroimaging techniques in newborn infants with malformations of internal organs

Aim of the study to determine the frequency and nature of brain lesions by the neuroimaging techniques (MRI and NSG) determining Objective: to establish the frequency and nature of brain lesions that cause CNS functional and irreversible disorders in newborn infants with malformations of internal organs in the perioperative period, by applying neuroimaging techniques.Materials and methods. 243 case histories of neonatal patients with congenital malformations of internal organs were analyzed. Their gestational age was 32 to 41 weeks (37.9±1.4 weeks). All the patients underwent neurosonography three times (within the first 24 hours after birth or in the preoperative period, in the postoperative period, and 1 week after surgery); their neurological status was evaluated. Neurological changes and structural disorders, as evidenced by neurosonography, served as an indication for brain magnetic resonance imaging (MRI) in 15 (6.2%) neonates.Results. In the perioperative period, more than 40% of children (n=102) had neurological changes as both temporary and organic hypoxic-ischemic encephalopathy, as confirmed by neuroimaging techniques. In 53 (52%) cases, pathological changes revealed by neurosonography and brain MRI were seen as an extension of the outer and inner cerebrospinal fluid spaces (n=36), cerebral cysts of various locations (n=1), intrathecal (n=3) and intraventricular (n=42) hemorrhages, and acute cerebrovascular accident (n=1).Conclusion. Newborn infants with congenital abnormalities of internal organs need a comprehensive examination aimed to timely identify risk factors for perinatal organic and transient lesions of the nervous system at the stages of the perioperative period

Clinical case of Mitochondrial DNA Depletion

The article reports clinical case of early neonatal manifestation of a rare genetic disease – mitochondrial DNA depletion syndrome, confirmed in laboratory in Russia. Mutations of FBXL4, which encodes an orphan mitochondrial F-box protein, involved in the maintenance of mitochondrial DNA (mtDNA), ultimately leading to disruption of mtDNA replication and decreased activity of mitochondrial respiratory chain complexes. It’s a reason of abnormalities in clinically affected tissues, most of all the muscular system and the brain. In our case hydronephrosis on the right, subependimal cysts of the brain, partial intestinal obstruction accompanied by polyhydramnios were diagnosed antenatal. Baby’s condition at birth was satisfactory and worsened dramatically towards the end of the first day of life. Clinical presentation includes sepsis-like symptom complex, neonatal depression, muscular hypotonia, persistent decompensated lactic acidosis, increase in the concentration of mitochondrial markers in blood plasma and urine, and changes in the basal ganglia of the brain. Imaging of the brain by magnetic resonance imaging (MRI) demonstrated global volume loss particularly the subcortical and periventricular white matter with significant abnormal signal in bilateral basal ganglia and brainstem with associated delayed myelination. Differential diagnosis was carried out with hereditary diseases that occur as a «sepsis-like» symptom complex, accompanied by lactic acidosis: a group of metabolic disorders of amino acids, organic acids, β-oxidation defects of fatty acids, respiratory mitochondrial chain disorders and glycogen storage disease. The diagnosis was confirmed after sequencing analysis of 62 mytochondrial genes by NGS (Next Generation Sequencing). Reported disease has an unfavorable prognosis, however, accurate diagnosis is very important for genetic counseling and helps prevent the re-birth of a sick child in the family

Discogenic lumbosacral radiculopathy. Recommendations of the Russian Association for the Study of Pain (RSSP)

When examining a patient with lumbosacral pain, it is necessary to rule out the specific cause of the disease. The diagnosis of discogenic lumbosacral radiculopathy (DLSR) is based on clinical examination; magnetic resonance imaging (MRI) is of informative value in excluding other causes of radiculopathy and in evaluating disk herniation. If the signs of cauda equina and spinal cord compression are absent, and no epidural glucocorticoid injection or urgent surgical treatment is scheduled, there is no reason for early (within the first 4 weeks) MRI.It is recommended to inform the patient with DLSR about the possibility of disk herniation regression and natural recovery and about the advisability of maintaining physical activity. Epidural administration of local anesthetics and glucocorticoids and use of non-steroidal anti-inflammatory drugs are advisable to relieve acute pain. Anticonvulsants (pregabalin and gabapentin), muscle relaxants, and B vitamins can be used as additional methods for acute DLSR; psychological therapies (cognitive behavioral therapy), antidepressants, therapeutic exercises (kinesiotherapy), manual therapy, and acupuncture are effective in chronic DLSR. Consultation with a neurosurgeon for possible microdiscectomy is indicated in the presence of cauda equina syndrome (urgently) and in the absence of medical therapy effects within 4–8 weeks.Therapeutic exercises (kinesitherapy) with an educational program for prevention of strenuous physical activity and static and uncomfortable positions for a long time, as well as for teaching how to lift weights properly, etc. are recommended for preventive purposes