Clinical application of perfusion computed tomography in the early diagnosis of acute ischemic stroke and hemorrhagic transformation prediction

Department of Radiology and Neuroimaging, Department of Neurology Institute of Neurology and Neurosurgery, Chisinau, the Republic of Moldova, Department of Molecular Biology and Human Genetics, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Our study was designed to evaluate the efficacy of perfusion computed tomography (PCT) in patients with acute phase of stroke for the early diagnosis of this pathology and prediction of hemorrhagic transformation in the ischemic area. Material and methods: We studied the functional PCT maps obtained at admission from 23 patients with acute ischemic stroke, compared to follow-up computer tomography or magnetic resonance imaging. Results: Mean Transit Time(MTT) map showed that the highest sensitivity (80.3%) and parameters of relative Cerebral Blood Flow (rCBF) and Cerebral Blood Volume (rCBV) were the most specific (95.0% and 96.9%, respectively) in the early diagnosis of ischemic stroke. Automatic technique “Tissue Classification” showed the highest value of the overall accuracy (91.7%), a significant correlation with the final stroke extension and differentiation of potentially salvageable regions from the irreversibly damaged, which plays an important role in the treatment management. Evaluation of permeability function of the blood-brain barrier with a Permeability Surface area product (PS) showed high values of specificity, sensitivity and overall accuracy (89.5%, 75.0% and 87.0%) in the prediction ability of hemorrhagic transformation. Conclusions: Quantitative analysis of functional parameters of dynamic cerebral perfusion computed tomography has significant efficacy in emergency diagnosis of acute ischemic stroke and hemorrhagic transformation prediction in tissue exposed to ischemia

Simptomele clinice şi neurofiziologice ale meningiomului spinal

Department of Neurology, State Medical and Pharmaceutical University “N. Testemitanu” Institute of Neurology and NeurosurgeryWe present the longitudinal clinical and electrophysiological study of 27 patients with spinal meningioma. All cases were confirmed by MRI and histological examinations. Electrophysiological examination included needle electromyography of muscles: paravertebralis,vastus lateralis, biceps femoris, tibialis anterior and gastrocnemius medialis. Clinical and electrophysiological findings were assessed in each case together with the level of spinal lesion. Electrophysiological abnormalities were founded in 100% of cases. Based on statistical analysis of the results, electrodiagnostic criteria were elaborated for the discrimination of each clinical syndrome of spinal meningioma. In addition to this data were founded that compressive damage of spinal cord tissue causes the morphofunctional reorganization of motor units and segmentar neuro-muscular apparatus. Moreover, as a result of neuronal plasticity at this level of nervous system news programs of motor function are established. The general conclusion of this study is that multimodal electrophysiological investigation as a consciously extension of clinical examination is very important in the positive and differential diagnosis of spinal meningioma. An electrophysiological examination is also useful for the prognosis of tumoral spinal cord process and for the control of neurosurgical treatment efficacy. Simptomele clinice şi neurofiziologice ale meningiomului spinal Studiul clinic şi electrifiziologic s-a bazat pe investigaţie a 27 de pacienţi cu meningiom spinal. Toate cazurile au fost confirmate prin RMN şi examenul histologic. Examenul electrofiziologic a constatat din EMG cu ac-electrod al muşchilor: paravertebralis, vastus lateralis, biceps femoris, tibialis anterior and gastrocnemius medialis. Rezultatele examenului electrofiziologic şi clinic în fiecare caz au fost correlate cu nivelul de leziune spinală. Dereglările electrofiziologice au fost detectate în 100% de cazuri. Basându-se pe analiza statistică, criteriile electrofiziologice au fost elaborate pentru a determina fiecare sindrom al meningiomului spinal. Adăugător acestor rezultate au fost stabilite: dereglări compresive ale cordului spinal, reorganizarea morfofuncţională a unităţilor motorii şi aparatului segmentar neuro-muscular. Ca rezultatul plasticităţii neuronale la acest nivel al sistemului nervos au fost stabilite programe noi de conductabilitate motorie. Concluzia generală acestui studiu este că examinarea electrofiziologică multimodală în contuitatea examenului clinic neurologic este foarte importantă în diagnosticul pozitiv şi diferenţial al meningiomului spinal. Studiul electrofiziologic este foarte util şi în prognozarea procesului tumoral spinal şi pentru controlul eficacităţii tratamentului neurochirurgical

Hemorrhagic transformation of ischemic stroke – prediction and evaluation with different computed tomography modalities

Department of Radiology and Neuroimaging, Department of Neurology Institute of Neurology and Neurosurgery, Chisinau, the Republic of MoldovaBackground: Hemorrhagic transformation (HT) of ischemic stroke is a complex and heterogeneous phenomenon, which involves numerous parameters whose knowledge remains partial. Large HT is often associated with poorer outcome and higher mortality, especially parenchymal hematoma type 2, that’s why the search of strong HT predictors is very important and can improve management of ischemic stroke patients. Our aim was to review the literature regarding computed tomography (CT) imaging predictors of HT and possible input of different computed tomography modalities in diagnosis and evaluation of HT following acute ischemic stroke. The contribution of non-contrast computed tomography, computed tomography angiography (CTA) and dynamic Perfusion CT (PCT) investigation in the prediction of the hemorrhagic transformation risk were studied. Multiple multicentre studies revealed useful information on different CT patterns predictors of symptomatic intracerebral hemorrhage after stroke, which is the most important type of hemorrhagic transformation from a clinician’s point of view. Conclusions: Data from the multiple studies and trials revealed that different CT modalities show high potency in HT prediction and evaluation. Non-contrast CT standard investigation showed high accuracy in HT prediction by assessment of early ischemic signs, quantification of the Alberta Stroke Program Early CT Score (ASPECTS), grading of leukoaraiosis severity. CTA is useful in HT prediction by the assessment of collateral vessels; intra-arterial occlusion and ASPECTS score calculated from the CTA source images. PCT showed the best predictive values by the measurement of blood-brain barrier permeability

Периферическая невропатия при рассеянном склерозе. Клинические и электрофизиологические аспекты

Nicolae Testemitanu State Medical and Pharmaceutical University, Institute of Neurology and Neurosurgery, Medical and Sanitary Department of the Information and Security ServiceLa un lot de 50 de pacienţi, cu scleroză multiplă clinic şi imagistic definită, au fost studiate manifestările clinice şi electrofiziologice de afectare a fibrelor nervilor periferici. Deşi semnele clinice de neuropatie la aceşti pacienţi se determină doar ocazional, examenul de stimulodetecţie frecvent (în 28% din cazuri) pune în evidenţă existenţa subclinică a unei neuropatii periferice, manifestate prin diminuarea vitezei de conducere, majorarea latenţei distale şi latenţei răspunsurilor tardive (undei-F). Procesul patologic în cadrul sclerozei multiple nu se limitează la demielinizarea fibrelor sistemului nervos central, dar se extinde şi la radiculele nervoase, fibrele motorii şi sensorii ale nervilor periferici.В группе из 50 больных рассеянным склерозом были исследованы клинические и электрофизиологические проявления поражения волокон периферических нервов. Несмотря на то, что у этих больных клинические признаки невропатии определяются лищь изредка, при исследовании проведения нервных импульсов выявлено частое (в 28% случаях) доклиническое проявление периферической невропатии, проявляющейся снижением скорости проведения, увеличением дистальной латентности и латентности поздних ответов (F-волны). Патологический процесс при рассеянном склерозе не ограничивается демиелинизацией волокон центральной нервной системы, он распространяется и на нервные корешки спинного мозга и на двигательные и чувствительные волокна периферических нервов

Сравнительная оценка структуры заболеваемости студентов I курса Государственного Медицинского и Фармацевтического Университета им. Н. A. Тестемицану

Department of Family Medicine and Laboratory of Genetics, Nicolae Testemiţanu State Medical and Pharmaceutical University, Chisinau, Republic of Moldova, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe purpose of this work was to comparatively evaluate the morbidity spectrum of the first year students of the SMPhU ”Nicolae Testemiţanu” enrolled in 2002-2004 and 2010-2011. Materials and methods: the data of medical examination performed at the University Clinic of Primary Care were analyzed in order to estimate the morbidity spectra. Results: the comparative analysis of the health status of students revealed an increase of students being “sick” from 24.0% in 2002-2004 to 35.0% in 2010-2011. The comparative analysis of morbidity spectra denotes a significant increase in proportions of eye pathology, pathologies of urinary and digestive tracts and endocrine system in the morbidity structure during 2002-2011 period. Conclusions: our data support the need of medical examination of first-year students in order to identify the existing chronic pathologies, proper treatment, and monitoring their diseases during the academic years.Целью настоящей работы была сравнительная оценка структуры заболеваемости студентов первого курса Государственного Медицинского и Фармацевтического Университета имени „Николая Тестемицану”, поступивших на учебу в 2002-2004 и 2010-2011 годы. Материал и методы: результаты медицинского осмотра студентов первого курса 2002-2004 и 2010-2011 годов поступления, для определения спектра заболеваемости. Результаты: сравнительный анализ состояния здоровья студентов показал увеличение группы студентов «больных» от 24,0% в 2002-2004 гг. до 35,0% в 2010-2011 гг. В структуре заболеваемости за период 2002-2011 годы произошло значительное увеличение доли глазной патологии, патологии мочеполового, пищеварительного трактов и эндокринной системы. Выводы: Для выявления существующих хронических заболеваний, своевременного их лечения и мониторинга динамики состояния здоровья студентов во время учебы, необходимо проведение медицинского осмотра студентов на первом курсе

Minimally-invasive surgical treatment of myastenia gravis

IMSP SCR, Secţia Chirurgie Toracică, RM, Chişinău, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere. Miastenia gravis (MG) este o patologie autoimună în care dereglările neuromusculare sunt induse de anticorpii circulanți contra receptorilor acetilcolinici (nAChR) localizați la nivelul postsinaptic al joncțiunii neuromusculare. Abordarea terapeutică a MG presupune un tratament gradual care cuprinde inhibitori de colinesterază pentru simptomatologie minoră şi avansează la medicaţie imunomodulatoare sau plasmafereza pentru situatiile de o gravitate crescută. Timectomia are un rol important în tratamentul complex al MG. Scopul lucrării. Analiza rezultatele postoperatorii ale tratamentului chirurgical videoasistat al miasteniei gravis. Materiale şi metode. În grupul de studiu au fost incluşi 63 pacienți cu MG fără timom observați postoperator mai mult de 12 luni. Repartizarea după sex a fost - 11 bărbați (17,7 %) şi 52 femei (82,5 %), cu vârsta între 18 şi 62 ani. Durata medie a afecțiunii a fost de 21,2 luni, variind mult în cadrul grupului dar fără diferență semnificativă legată de sex. Conform clasificării clinice MGFA pacienți au fost repartizaţi în următoarele stadii : I- 4 (6,3 %) , IIa - 12 (19,04 %), IIb - 17 (26,98 %), III - 13 (20,63 %), IIIb - 12 (19,04 %), IV - 5 (7,94%). Diagnosticul de MG a fost bazat pe examenul clinic neurologic, răspunsul pozitiv la testul cu prozerină sau tensilon, rezultatele tipice electromiografice şi în unele cazuri prin demonstrarea prezenței anticorpilor contra aAChR. Rezultate. Ameliorarea generală a stării pacienților (RCS + AS) a fost demonstrată la 95,23 % pacienți. Ameliorarea stării a fost înregistrată la 42 (66,67 %) pacienți. La 2 pacienți (3,17 %) conform criteriilor noastre (micşorarea scorului QMG ≥ 4 puncte) starea nu s-a modificat după timectomie şi la un pacient (1,59 %) a fost constatată agravarea simptomelor MG în perioada postintervenție. Concluzii. 1. Timectomia toracoscopica este o tehnică avansată de chirurgie miniminvazivă şi este rezervată centrelor cu experienţă atât în chirurgia toracoscopică cât şi în abilitatea de a trata bolnavul miastenic. 2. Factorii de prognostic favorabil depistati în urma analizei multivariate sunt debutul la o vârsta mai tânără a afecţiunii şi intrevenţia chirurgicală precoce faţă de momentul de debut al afecţiunii.Introduction. Myasthenia gravis (MG) is an autoimmune pathology in which neuromuscular disorders are caused by circulating antibodies against acetylcholine receptor (nAChR) located at the postsinaptic level of the neuromuscular junction. Management of MG involves a gradual treatment including cholinesterase inhibitors for minor symptoms and advances to immunomodulating medications or plasmapheresis for high gravity situations. Thymectomy has an important role in the complex treatment of MG. Goal of the study. Analysis of postoperative results of minimally-invasive surgical treatment of myasthenia gravis. Materials and methods. In the study group were included 63 patients with MG without thymoma observed more than 12 months postoperatively. Distribution by sex was - 11 men (17.7%) and 52 women (82.5%), aged between 18 and 62 years. The average duration of disease was 21.2 months, ranging a lot in the group but with no significant differences related to sex. According to clinical classification MGFA patients were divided into the following stages: I-4 (6.3%), IIa - 12 (19.04%), IIb - 17 (26.98%), III - 13 (20.63% ), IIIb - 12 (19.04%), IV - 5 (7.94%). The diagnosis of MG was based on neurological clinical examination, positive response to prozerin or tensilon test, typical electromyographic results and in some cases by demonstrating the presence of antibodies against aAChR. Results. General improvement in the patient’s condition (RCS + AS) has been demonstrated in 95.23% patients. State improvement was recorded in 42 (66.67%) patients. In 2 patients (3.17%) according to our criteria (QMG score decrease ≥ 4 points) status has not changed after thymectomy and in one patient (1.59%) was observed during postoperative period worsening of MG symptoms. Conclusions. 1. Thoracoscopic thymectomy is an advanced technique of minimally-invasive surgery and is reserved to centers with experience in both thoracoscopic surgery and the ability to treat myasthenic patients. 2. Favorable prognostic factors found in multivariate analysis are the onset of disease at a younger age and early surgical treatment from time of onset

Lack of Accredited Clinical Training in Movement Disorders in Europe, Egypt, and Tunisia

Background: Little information is available on the official postgraduate and subspecialty training programs in movement disorders (MD) in Europe and North Africa. Objective: To survey the accessible MD clinical training in these regions. Methods: We designed a survey on clinical training in MD in different medical fields, at postgraduate and specialized levels. We assessed the characteristics of the participants and the facilities for MD care in their respective countries. We examined whether there are structured, or even accredited postgraduate, or subspecialty MD training programs in neurology, neurosurgery, internal medicine, geriatrics, neuroradiology, neuropediatrics, and general practice. Participants also shared their suggestions and needs. Results: The survey was completed in 31/49 countries. Structured postgraduate MD programs in neurology exist in 20 countries; structured neurology subspecialty training exists in 14 countries and is being developed in two additional countries. Certified neurology subspecialty training was reported to exist in 7 countries. Recommended reading lists, printed books, and other materials are the most popular educational tools, while courses, lectures, webinars, and case presentations are the most popular learning formats. Mandatory activities and skills to be certified were not defined in 15/31 countries. Most participants expressed their need for a mandatory postgraduate MD program and for certified MD sub-specialization programs in neurology. Conclusion: Certified postgraduate and subspecialty training exists only in a minority of European countries and was not found in the surveyed Egypt and Tunisia. MD training should be improved in many countries.Peer reviewe

Нейромидин в лечении поражений периферической нервной системы и при постинсультных парезах

The purpose of this study was to evaluate the efficiency of Neiromidin (Ipidacrine) in the treatment of ischemic stroke patients and patients with pathology of peripheral nervous system (polyneuropathies, mononeuropathies, radiculopathies) by clinical and electrophysiological examinations. In order to enhance the accuracy of the study patients were randomized in 4 groups. All patients were examined clinically using special scales (Barthel index of daily living, polyneuropathic scale), as well they underwent electrophysiological exams (neurography, needle EMG, Somatosensorial Evoked Potentials). All patients were examined twice: one time at the beginning of the treatment and a second time three months later. Results of repeated clinical examination revealed a significant increase in the functional independency in patients treated with Neiromidin. Electrophysiological exam showed faster improvements of electrophysiological parameters in Neiromidin treated patients.Целью данного исследования является клиническая и нейрофизиологическая оценка эффективности Нейромидина в реабилитации пациентов с поражением центральной нервной системы (при ишемическом инсульте) и периферической нервной системы (полиневриты, мононевриты, радикулиты). Для обьективизации результатов исследования, пациенты, включённые в данное исследование, были распределены на четыре группы. Клинические шкалы обследования (Barthel index, полиневропатическая шкала), были дополнены комплексным электрофизиологическим исследованием посредством нейрографии, игольчатой электромиографии, Н волны (H wave), вызванные соматосенсорные потенциалы (PESS). Мониторинг данных клинического и электрофизиологического обследования был осуществлён до начала исследования и через 3 месяца после первого исследования. Результаты данного динамического исследования продемонстрировали значительное увеличение функциональной независимости пациентов, в схеме лечения которых был использован Нейромидин. Также и результаты электрофизиологического обследования зарегистрировали положительные изменения после лечения Нейромидином