Lateralization of cardiovascular autonomic functions in hemispheric ischemic stroke

Violations of cardiovascular and other autonomous functions are common in cerebrovascular disease. Various cortical and subcortical anatomical regions of the brain are involved in autonomic regulation, as cortex insularis has the most important role crust. Stimulation of the right cortex insularis increases sympathetic cardio-vascular tone, whereas the parasympathetic activity increased more frequently in stimulation of the left cortex insularis. The evidence regarding the impact of lateralization of stroke for cardiovascular risk are contradictory. Most authors demonstrated that patients with stroke affecting the right cortex insularis are more likely to develop cardiovascular autonomic dysfunction leading to reduced heart rate variability, cerebrogenic arrhythmias and an increased incidence of cardiac mortality

Sympathetic skin response - correlation with the severity of cardiovascular autonomic dysfunction in patients with ischemic cerebral stroke

The sympathetic skin response (SSR) is a polysynaptic somatosympathetic multiaxonal reflex with a spinal, bulbar and suprabulbar component. From a pathogenetic point of view it is considered that the SSR changes are a result of an interruption of the efferent sympathetic pathways. The study of the correlation between the SSR parameters and the severity of the cardiovascular autonomic dysfunction in patients with acute ischemic stroke is a matter of interest. The data from our research showed that the patients with severe autonomic dysfunction had a significantly more expressed SSR parameter disorders than the deviations in patients with milder autonomic dysfunctions

Stroke - disturbance of intestinal mucosal barrier function

Честотата на внезапна смърт след инсулт варира от 2% до 6%, като двете водещи не-неврологични причини са нарушенията в сърдечната функция и инфекциите. Острата мозъчна увреда предизвиква различни автономни, нервно-ендокринни и инфламаторни промени, които се манифестират в някои органи в тялото, водещи до имуносупресия и развитие на възпалителни усложнения.Интестиналната микрофлора играе ключова роля в поддържането на хомеостазата, като нарушенията в регулацията й може да доведе до тежки възпалителни заболявания. Имунната депресия след инсулт засяга лигавицата на червата и води до нарушаване на нейната бариерна функция, което може да доведе до увеличаване на бактериалната транслокация, септицемия и системни инфекции. Смята се, че цитокин-медиираният антивъзпалителен отговор е патогенетичен фактор в развитието на инфекциите след инсулт. Нивата на Peptococcaceae при мозъчен инсулт се увеличават над 3 пъти. Тези промени в дебелочревната микрофлора са свързани с повишаване на нивата на норадреналин и норадренергичната инервация.The incidence of sudden death after stroke varies from 2% to 6%, and two leading non-neurological causes are heart function disorders and infections. Acute brain injury induces various autonomic, neuro-endocrine and inflammatory changes which are manifested in certain organs in the body, leading to immunosuppression and development of inflammatory complications.The intestinal microbiota plays a key role in the maintenance of homeostasis, such as distortions in its regulation may result in severe inflammatory diseases. Immune depression following stroke, affects the intestinal mucosa and lead to distortion of its barrier function, which can lead to increased bacterial translocation, septicemia and systemic infections. It is believed to be a cytokine-mediated anti-inflammatory response to pathogenic factor in the development of infections after stroke. Peptococcaceae levels in stroke, increasing more than three times. These changes in colonic microflora associated with increased levels of norepinephrine and noradrenergic innervation

Micturition disorders after stroke

Пикочният мехур получава както соматомоторна, така и висцеромоторна парасимпатикова инервация. Инконтиненцията на урина, както и други нарушения в уринарната функция, са чести усложнения при пациенти с мозъчно-съдова болест. Значителните нарушения в уринирането повлияват качеството на живот на пациента, както и неговата смъртност. Разпространението на уринарната инконтиненция рано след инсулт варира значително от 41% до 83%. Освен това не съществува еднаквост по отношение на типа функционално нарушение.По-голяма част от преживелите мозъчен инсулт имат дисфункция на детрузорния мускул (хиперрефлексия или хипорефлексия), като никтурията е сред най-често съобщаваните нарушения след инсулт. По-голямата възраст, женският пол, наличието на инконтиненция преди настъпването на инсулта, както и по-голямата тежест на инсулта се асоциират с по-висока честота на инконтиненция на урина.The bladder gets as somatomotor and vistseromotorna parasympathetic innervation. Urinary incontinence, and other disorders of urination function are common complications in patients with cerebrovascular disease. Significant urination disorders affect the quality of life of the patient, and its mortality. The prevalence of urinary incontinence early after stroke varies znachiterlno from 41% to 83%. Furthermore, there is no uniformity in terms of the type of functional impairment. The majority of surviving a stroke have a dysfunction of the detrusor muscle (hyperreflexia or hyporeflexia) as nocturia is among the most commonly reported disorders after stroke. Older age, female sex, the presence of incontinence before the onset of the stroke, and the greater severity of the stroke, are associated higher incidence of urinary incontinence

Investigation of cardiovascular autonomic function - Ewing`s battery

Използването на различни автономни тестове допълва клиничната оценка при нарушение на автономните функции. Автономното тестуване има ясен фокус върху сърдечно-съдовата система (ССС) и взаимодействието й с дихателната система. Ewing и Clarke предлагат изпълнението на пет автономни теста (три предимно парасимпатикови и два предимно симпатикови), включени в т.нар. „стандартна батерия` (Ewing`s battery). Нито един тест самостоятелно не може да даде обща оценка на автономната функция. Нормативните стойности на тестовете зависят от много фактори. Ewing и Clarke въвеждат променливите - абнормни, гранични и нормални за всеки един от тестовете.The use of different autonomous tests complement clinical assessment in violation of autonomous functions. Autonomous testing has a clear focus on the cardiovascular system and its interaction with the respiratory system. Ewing and Clarke propose the implementation of the five autonomous tests (three primarily parasympathetic and sympathetic mostly two) included in the so called „Standard battery` („Ewing‘s battery). Not one test alone can not provide an overall assessment of autonomic function. Normative values of tests depend on many factors. Ewing and Clarke introduced variable - abnormal, border and normal limit for each of the tests

Frequency and characteristics of seizures in the acute stage of stroke

Мозъчно-съдовите заболявания са важна причина за поява на епилептични пристъпи при болни на средна възраст. Ранните и късни пристъпи са по-често срещани след хеморагичен мозъчен инсулт, отколкото след мозъчни инфаркти, с изключение при тотален инфаркт в предна мозъчна циркулация, които показват по-голям риск за развитие на слединсултна епилепсия от хеморагичните инсулти. Честотата на субарахноидална хеморагия (САХ) е по-ниска в сравнение с другите подтипове инсулт, в резултат на което честотата на епилептичните пристъпи след САХ е по-ниска, но при САХ се наблюдава значителен риск за развитие на СИЕ. Като предиктори за поява на епилептични пристъпи след инсулт се смятат тежестта на инсулта, наличие на кортикални симптоми, хеморагичен мозъчен инсулт, тотален инфаркт в предна циркулация, инсулт в млада възраст и появата на ранни епилептични пристъпиCerebrovascular diseases are the major causes of seizures in patients of middle age. Early and late seizures are more common after hemorrhagic stroke than after brain infarcts, except for total infarct in the anterior cerebral circulation that indicate a higher risk for developing post-stroke epilepsy than hemorrhagic stroke. The incidence of subarachnoid hemorrhage (SAH) is lower. Compared to the other subtypes of stroke, with the result that the frequency of epileptic seizures after SAH is lower, but SAH is a significant risk for the development of poststroke epilepsy. As predictors for the occurrence of seizures after stroke are considered, the severity of the stroke, the presence of cortical symptoms, hemorrhagic stroke, total infarction in anterior circulation stroke at an early age and onset of early epileptic seizure

Thermoregulatory dysfunction in stroke

Едни от най-важните автономни наруше- ния след мозъчен инсулт са кардиоваскуларните и терморегулаторните усложнения. Асиметри- ята в кожната температура и потната секре- ция отразяват вазомоторната автономна ди- срегулация и повлиява качеството на живот на пациентите с инсулт. По-голяма част от болни- те описват „чувство на студенина` в паретич- ните крайници. При хемисферен инсулт често се наблюдава хиперхидроза на паретичната стра- на на тялото, най-силно изразено в острата фаза на инсулт.One of the most important autonomous disorders after stroke are cardiovascular and thermoregulato- ry complications. The asymmetry in skin temperature and sweat glands, autonomic dysregulation reflect va- somotor and affects the quality of life of patients with stroke. The majority of the patients describe a ` feeling of coldness` in paretic limbs. In hemispheric stroke is often observed hyperhidrosis of paretic side of the body most pronounced in the acute phase of stroke

Approaches for optimizing medical aid in acute ischemic stroke patients, hospitalized in UMHAT „Saint Marina` - Varna

In Bulgaria generally, treatment of acute ischemic strokes is done at the neurology wards and in smaller hospitals - in internal diseases wards, at intensive care wards in state regional hospitals; at ischemic stroke units and intensive care wards for treatment of neurological diseases at university hospitals. Between 2009 and 2013 in Varna, at the Neurology Clinic of UMHAT- St. Marina, a prospective research was carried out in view of optimizing the treatment of acute ischemic stroke (AIS) patients hospitalized at the clinic. After a stage-by-stage introduction into everyday clinical practice of innovative treatment methods, including intravenous thrombolysis and endovascular therapy of AIS patients, as well as organizational restructuring in view of optimizing the care for such patients, improvement in some of the quality indicators was observed

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