Monitoring of acute stroke patients with suppressed consciousness by using transcranial Doppler sonography

Introduction: Dynamic monitoring of the patients presenting with suppressed consciousness during the acute stage of stroke plays an important role in the diagnostic and therapeutic process as a whole.  Aim: The objective of the present study was to analyze the initial results from the twofold transcranial Doppler sonography application in acute stroke patients with suppressed consciousness aiming at optimizing their timely treatment.Materials and Methods: The histories of 46 patients, 21 males and 25 females, at a mean age of 75 years with acute stroke and a different degree of suppressed consciousness hospitalized during the period from January 1, 2018 to January 31, 2019 were analyzed. All the patients were examined by means of transcranial Doppler sonography. The degree of suppressed consciousness was evaluated by means of Glasgow-Liége Coma Scale.Results: Thirty-four patients presented with acute ischemic stroke and 12 ones with acute hemorrhagic one. Several accompanying cardiovascular diseases that aggravated the course of the acute cerebrovascular accident were diagnosed. Considerable differences in terms of the mean values according to the Glasgow-Liége Coma Scale were observed. The intervals of the maximal, minimal and average sonographic parameters of four cerebral arteries such as left and right middle cerebral artery and left and right vertebral artery varied within broad limits, too.   Conclusion: The application of a constellation of various neuroimaging methods in the patients with acute cerebrovascular diseases could identify essential relationships between the parameters analyzed and risk factors as well as to give assistance to the individualized therapeutic approach

FEELING OF HAPPINESS IN PATIENTS WITH MULTIPLE SCLEROSIS AND COMORBIDITY

Purpose: As the feeling of happiness in multiple sclerosis (MS) is not investigated in Bulgaria yet, we decided to reveal some essential features of this non-motor symptom in multiple sclerosis patients with and without comorbidity. Material/Methods: We examined 80 MS patients, 56 females and 24 males, at a mean age of 49 years. Forty of them presented with multiple sclerosis alone, and 40 did with multiple sclerosis and accompanying diseases. Health-related quality of life was assessed by means of Short Form-36 questionnaire and Multiple Sclerosis Quality of Life Questionnaire with 54 items. Results: We established a lower frequency of feeling of happiness reported in MS patients with comorbidity. There were statistically significant positive correlations between the health status self-assessment and MS influence upon the feeling of happiness (R=0.428; p<0.01) as well as between MS influence upon social activities and the feeling of happiness (R=0.539; p<0.01). There were statistically reliable negative correlations between depression and feeling of happiness (R=-0.591; p<0.01) as well as between health-related quality of life scores and feeling of happiness in MS patients (R=-0,565; p<0,01). There was a statistically significant difference concerning the feeling of happiness (p<0.001) between the patients with MS only and those with MS and comorbidity. Conclusion: Multiple sclerosis alone and with comorbidity exerts an unfavourable influence on individual patient’s feeling of happiness. The presence of this common non-motor symptom in MS patients needs more comprehensive research

Impact of diabetes mellitus and admission hyperglycemia on outcomes after intravenous thrombolysis in acute ischemic stroke patients

Diabetes mellitus (DM) is a major risk factor for stroke, which is associated with unfavorable outcomeafter acute ischemic stroke (AIS) and disability. The potential harmful effect of DM, and the role and importance of blood glucose(BG) at admission are currently unclear for clinical outcome after АIS. Aim of this study is to look for correlations between the presence of DM and theinitial level of BG and the clinical outcome after an intravenous thrombolysis (IVT) in patients with acute AIS.Material and methods. IVT with Astylise has been conducted to 170 patients with AIS for the period 09.2011- 09.2015, from which 20% (n = 34) are with DM, 80% without DM (n = 136). According to the values of the BG at admission they have been divided into three groups: I group- (n = 34) 8,1 mmol/l.Results With mRs (0-2) at 3 months are 60.2% of patients without DM and 40% respectively, p= 0,05(OR-1,5, 95% CI 0,91-2,49). With mRs (0-1) are 35% and 24% respectively (p= 0.196). The probability of this outcome is 1.47 times higher in those without DM (OR 1,47, 95% CI: 0,7-3,09). Mortality about the third month is 20% in patients with DM and 8.8% in those without DM, p 0.05); With mRs (0-1) are respectively 38.2%, 32.3% and 30.8% (p> 0.05). Mortality is 15.4% in the III group compared to 9.2% in the II and 8.8% in the I (p> 0.05). With mRs(3-5) are 38.4% of the III group and 26.5% in the I (p> 0.05).Conclusion. Patients with DM have significantly higher mortality and lack of favorable functional outcome at third monthcompared to those without DM, which can not be explained by the presence of ICH. The initial HG not significantly associated with unfavorable clinical outcome, but she quickly identify patients with an increased risk of such an outcome in which blood sugar levels should be closely monitored

Sexual Disturbances in Patients with Multiple sclerosis

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that is accompanied by different concomitant diseases. We have investigated the frequency of sexual disorders as an element of individual quality of life with a questionnaire (MSQOL-54) in 80 MS patients at an average age of 42.95 ± 10.39 for the period between 2002 and 2015. Forty of them had between one and seven accompanying diseases. There were problems in both group of patients concerning specific indicators of sexual function expressed to varying degrees. Sexual disturbances further aggravate the vitality not only of MS patients, but also of those with MS and concomitant diseases and require timely diagnosis and treatment

Arterial blood pressure and heart rate response in patients with acute ischemic stroke - Correlation with the severity of cardiovascular autonomic dysfunction

Background and purpose:Despite numerous studies, the mechanisms of blood pressure and heart rate regulation in cerebrovascular diseases remain not completely understood. The aim of the study was to determine the changes in blood pressure (BP) and heart rate (HR) in patients with an acute hemispheric ischemic stroke and to seek a relation to the severity of the cardiovascular autonomic dysfunction.Methods:20 healthy volunteers and 50 patients with an acute hemispheric ischemic stroke participated in the study. The values of BP and HR were registered. Cardiovascular autonomous disorders were examined with "Ewing battery" tests. Patients were divided into two groups according to the severity of the autonomous disorders.Results:Elevated BP values at admission were observed in 56% of our patients, and significantly higher values of systolic blood pressure (SBP) (p <0,001), diastolic blood pressure (DBP) (p = 0,001), and mean arterial pressure (p <0,001), as well as of the heart rate (p = 0,027) were found, compared to the control group. The most significantly increased values of the indicators were reported in patients with a stroke in the territory of the right middle cerebral artery with an involvement of the insular cortex. The results of the t-test performed, showed correlation only between the systolic blood pressure and the severity of the autonomic dysfunction, the values being significantly higher in patients with severe autonomic disorders (t = -2,14; p = 0.036).Conclusion:A variability in BP and HR with a tendency to increase was observed in patients with an acute hemispheric ischemic stroke (ICS) compared to controls, with the highest values reported in patients with ICS in the territory of right middle cerebral artery (TRMCA) with the involvement of the insular cortex (IC). A positive correlation was found between the values of systolic blood pressure (SBP) and the severity of autonomic dysfunction (AD)

Some Aspects Of The Feeling Of Happiness In Patients With Multiple Sclerosis

Happiness is an emotional state that reflects the positive feelings and satisfaction of life. We examined the subjective feeling of happiness with a questionnaire (MSQOL-54) including a self-assessment of happiness in 80 MS patients with and without accompanying diseases at an average age of 42.95 ± 10.39 years between 2002 and 2015. The results were processed statistically by correlation analysis. There were statistically significant positive correlations between both the self-assessments of the health status and the sense of happiness of MS patients, as well as between the impact on public activities and the sense of happiness of these patients. There were also statistically significant negative correlations between depression and the sense of hap-piness in MS patients as well as between health-related quality of life assessments and the feeling of happi-ness of these patients

Comorbidity of Structural Epilepsy and Multiple Sclerosis: MRI, 18FFDG PET/CT and EEG Investigations

There is accumulating evidence of a mutual relationship between multiple sclerosis and structural epilepsy. Comorbidity of these severe neurological disorders is reported in numerous recent publications in the available foreign literature. Modern diagnostic tools include comprehensive neurological examinations as well as computed tomography, electroencephalography and 18FFDG positron emission tomography. In this paper we report the case of a female patient with multiple sclerosis and structural epilepsy

Continuous Multimodal Monitoring of Acute Stroke in Patients with Suppressed Consciousness // Продължително мултимодално мониториране на острия мозъчен инсулт при пациенти с потиснато съзнание

A comparative investigation of the influence on disease prognosis of continuous multimodal monitoring by means of transcranial Doppler sonography, electroencephalography, visual and acoustic evoked potentials in patients with acute ischemic and haemorrhagic stroke and suppressed consciousness was carried out. During the period between January 1, 2018 and February 28, 2019, 63 patients, 25 males and 38 females, with acute stroke and a different degree of suppressed consciousness were examined. In 42 patients, an ischemic stroke while in 21 patients, a haemorrhagic stroke was diagnosed. There were several significant correlation dependences between the maximal Doppler sonographic values of the main cerebral vessels as the middle and posterior cerebral arteries are represented in both types of stroke between the first and third day after admission. The low-voltage bioelectrical activity and diffusely scattered sharp and theta waves represented the main pathological electroencephalographic findings. The prolonged latent time of P100 waves with reduced amplitude and the reduced amplitude of the visual evoked potentials prevailed, while the pathological alterations of the third and fifth wave of the acoustic evoked potentials were the most common. The number and relative share of the acute stroke patients with a medium severe degree of suppressed consciousness according to Glasgow-Liège coma scale were statistically significantly greater on the first than on the third day. Arterial hypertension was the most common accompanying disease. The severe degree of suppressed consciousness unfavourably influences on the prognosis of acute stroke patients. Their multimodal monitoring possessed a greater prognostication value in comparison with the independent application of the transcranial Doppler sonography, electroencephalography, and examinations of the evoked potentials alone.Проведено е сравнително проучване на влиянието на продължителното мултимодално мониториране с помощта на транскраниална Доплер сонография, електроенцефалография, зрителни и слухови евокирани потенциали при болни с остър исхемичен и хеморагичен мозъчен инсулт и потиснато съзнание върху прогнозата на заболяването. За периода 1.I.2018 г. и 28.II.2019 г. са изследвани 63 болни, 25 мъже и 38 жени, с остър мозъчен инсулт и различна степен на потиснато съзнание. При 42 болни е диагностициран исхемичен, а при 21 болни - хеморагичен мозъчен инсулт. Налице са редица значими корелационни зависимости между максималните Доплер сонографски стойности на магистрални мозъчни съдове като са представени средна и задна мозъчни артерии при двата вида мозъчен инсулт между първия и третия ден след хоспитализацията. Нисковолтажната биоелектрическа активност и дифузно пръснатите остри и тета вълни са основните патологични електроенцефалографски находки. Преобладават удълженото латентно време на Р100 вълна при нормална амплитуда, удълженото латентно време на Р100 вълна при снижена амплитуда и снижената амплитуда на зрителните евокирани потенциали, а най-чести са патологичните изменения в третата и петата вълна на слуховите евокирани потенциали. Броят и относителният дял на болните с остър мозъчен инсулт със средно тежка степен на потиснато съзнание по скалата за комата от Glasgow-Liège са статистически достоверно по-големи на първия, отколкото на третия ден. Най-честото придружаващо заболяване е хипертоничната болест. Тежката степен на потиснатост на съзнанието влияе неблагоприятно върху прогнозата на болните с остър мозъчен инсулт. Мултимодалното им мониториране притежава по-голяма прогностична стойност в сравнение със самостоятелното използване на транскраниалната Доплер сонография, електроенцефалографията и изследването на евокираните потенциали поотделно

Neuropsychological effects of comorbidity in multiple sclerosis patients

Introduction: Multiple sclerosis (MS) is a progressive demyelinating and degenerative neurological disease. The degree of disability increases along with pathological damage, especially in cases with comorbidity. Methodology: The objective of this study was to analyze the influence of MS alone and with comorbidity on some neuropsychological patterns. Individual quality of life of 80 MS patients at a mean age of 49 years, 56 females and 24 males, was examined by means of Multiple Sclerosis Quality of Life-54 Questionnaire (MSQOL-54) in 2002-2015. Forty patients presented with MS alone and 40 with MS and comorbidity. The frequency of troubles of mental concentration/thinking, fixation of attention, and memory as well as of difficulty at work and other activities were examined. Results: Statistically significant differences were observed between patients with MS alone and those with MS and comorbidity concerning troubles of mental concentration/thinking (t=4.822; p<0.0001), and of memory (t=4.020; p<0.0001). Gender correlated negatively with troubles of memory (R=-0.343; r<0.05), while EDSS scores did with troubles of memory (R=-0.346; p<0.05) and with troubles of attention (R=-0.330; p<0.05). The accompanying diseases additionally worsened the components of health-related quality of life. Conclusions: Common comorbidity in MS patients requires careful clinical examinations and proper management in order to reduce the neuropsychological burden and assure a better individual quality of life for the patient

Health-related quality of life in multiple sclerosis patients with accompanying diseases

Introduction: Multiple sclerosis (MS) is a progressive demyelinating neurologic disease characterized by a different extent of comorbidity. Everydaily life is challenging for these patients because of physical and psychological impairments. The purpose of this study was to comparatively analyze the relationships between several health-related quality of life aspects of MS patients` in case of accompanying diseases.Material and methods: Health-related uality of life of 80 MS patients, 56 females and 24 males, at a mean age of 49 years, was examined by means of Short Form-36 questionnaire. Forty patients presented with at least one accompanying chronic disease.Results: These patients presented with similar Expanded Disability Status Scale scores of 2.0 or 2.5. Most questionnaire scores differed between MS patients without and with comorbidity. Usually, comorbidity additionally worsened patients` quality of life. There were statistically significant differences between the patients with MS alone and those with MS and comorbidity concerning the depression (t=5.877; p<0.0001); the troubles with concentration/thinking (t=4.822; p<0.0001); the troubles with memory (t=4.020; p<0.0001); the feeling of fatigue (t=4.148; p<0.0001), and the feeling of happiness (t=-3.399; p<0.001).Conclusion: The hot topic of the health-related quality of life of the patients with MS and comorbidities necessitates further interdisciplinary research. Correct treatment and follow-up of MS patients and particularly of those with common accompanying cardiovascular and other neurological diseases could contribute to long-lasting preservation of acceptable individual quality of life