Outpatient management after severe stroke with dementia

To render outpatient care to poststroke patients, particularly to those who have severe motor and/or speech disorders is an urgent problem in neurology. These patients have frequently cognitive and psychoemotional disorders that make rehabilitation much difficult. If there are no promises for functional restoration, these patients need care, prevention of restroke and complications associated with immobilization. Current methods for preventing restroke include modification of lifestyle, normalization of blood pressure, use of antithrombotic agents and statins (after prior ischemic stroke), treatment of cognitive and depressive disorders, pain syndromes, urination disorders, correct care, diet, passive and active exercises, positional treatment, and local domiciliary procedures. The use of up-to-date treatment options is now shown to substantially reduce the risk of restroke and to improve recovery of lost functions and quality of life in the patient

Cognitive impairments in common and rare somatic diseases

The paper gives an update on the pathogenesis, clinical presentation, and pathomorphology of cognitive impairments (CIs) in different autoimmune, endocrine, and infectious diseases, such as systemic lupus erythematosus, Sjögren's syndrome, BehНet's disease, primary angiitis of the central nervous system, polyarteritis nodosa, cryoglobulinemic vasculitis, hypothyroidism, herpetic lesion, and neurosyphilis. These patients are observed to have ischemic-hypoxic brain damage, the causes of which are free radical-induced cell injury, oxidative stress, excitation toxicity, cell necrosis and/or apoptosis, inflammation and immune disease, molecular sequestration, and cell death. There is enhanced imbalance in the pro-oxidant and antioxidant systems as cerebrovascular insufficiency progresses; as this takes place, the nerve cells are most susceptible to the induction of free radical reactions. In these cases, antioxidants that block the effects of free radicals and may potentially improve brain perfusion, by assisting the coupling of neurons and vessels, are first-choice drugs. To improve the cognitive status and to prevent the progression of CIs, it is important to build a cognitive reserve in a patient; this is largely favored by the preservation of a proactive approach to life and social bonds, as well as intellectual work

Post-stroke cognitive impairments: diagnosis and therapeutic approaches

Stroke is a leading cause of disability not only due to its impact on motor or sensory functions, but also to post-stroke cognitive impairments (CI). Within the first year after stroke, the rate of CI may be as high as 80-90% and 7-23% of patients develop dementia. The most important risk factors for CI are strokes, their extent, site, and number. Old age, low education level, severe previous pathological changes in the brain parenchyma, diabetes mellitus, atrial fibrillations, and recurrent strokes in particular, are associated with an increased risk of CI. Examining cognitive functions, monitoring the evolution of cognitive deficit, and post-stroke rehabilitation are indicated in patients who have had stroke. The main treatments in patients with CI are secondary stroke prevention, including lifestyle modification and symptomatic therapy. Sermion is one of the promising agents for the prevention and treatment of CI in these patients

Thrombolytic therapy for ischemic stroke

Systemic intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) is a proven effective treatment in a certain category of patients with ischemic stroke during the first 4.5 hours after onset of this disease. Thrombolytic therapy (TLT) promotes the achievement of reperfusion in the cerebral ischemic portion, thus improving the patient's functional state. The results of international trials of TLP are presented and therapeutic strategies considered

Your patient has lower back pain. What should be done?

Lower back pain (LBP) is a serious health problem. Its main causes are described. It is noted that acute and chronic back pain may be a manifestation of any disease. Acute LBP is more frequently nonspecific and usually caused by injury or muscle strain of the back. Chronic pain is the result of the complex interaction of biological, psychological, social, and cultural factors; it may be nociceptive, neuropathic, inflammatory, dysfunctional, or mixed. The diagnosis of LBP is based by excluding its specific cause and requires the assessment of a patient’s complaints, history data and somatic and neurologic examination. The administration of analgesics or nonsteroidal anti-inflammatory drugs and myorelaxants is the main direction of drug therapy for LBP. Cognitive and behavioral psychotherapy along with other methods is one of the effective directions for patients with chronic LBP. The application of international guidelines for the management of patients with back pain permits a positive result to be achieved in most cases

Subtypes of ischemic cerebral circulation disorders at young age: diagnosis and treatment

The paper shows that it is urgent to study stroke in young patients aged 15—45 years. In accordance with the TOAST classification, the author presents the major pathogenetic subtypes of ischemic stroke (IS): atherothromboembolic, cardioembolic, lacunar, that of other known and unknown etiology. The clinical picture and diagnostic principles of IS at young age are considered. Particular emphasis is laid on therapy for IS. It is pointed out that the leading therapy option in these patients is thrombolysis; intravenous recombinant tissue plasminogen activator is more frequently used; oral anticoagulants and antiplatelet agents are certain to prescribe

Weather risk factors for stroke in the Central Region of Russia

The weather risk factors of stroke were studied in the Central Region of Russia. Case histories of patients admitted to Yaroslavl Clinical Hospital Eight with a diagnosis of stroke from October 2002 to December 2006 were analyzed. Among 3243 patients, there were 1607 men and 1636 women (mean age 62.45±12.19years. Ischemic and hemorrhagic strokes were identified in 61.1 and 19.0% of cases, respectively. The risk factors of stroke were found to be essential hypertension (70.4%), cerebral atherosclerosis (35.2%), and coronary heart disease (17.4%). A significant role is played in the occurrence of the disease by weather factors, such as wind speed (contribution factor, 32.1%), average daily air temperature (contribution factor, 17.9%), and atmospheric pressure (contribution factor, 17.1%)