Vol 17, No 9 (2015)


Characteristics of the main types of stroke in Russia (according to the population-based stroke register 2009-2013)

Stakhovskaya L.V., Klochikhina O.A.


The aim of the study had been to investigate the characteristics of the main types of stroke in Russia. The data collected in different regions of Russia by the population-based stroke register. We presented epidemiological types of stroke indicators: prevalence, incidence and fatality rate among people older than 25 years in 2009-2013. Most of all strokes had got an ischemic origin. Moreover, the prevalence of ischemic stroke type had increased by decreased unknown etiology stroke cases. The prevalence of intracerebral (IH) and subarachnoid hemorrhage (SH) had remained unchanged. The incidence rate of IH was 0.38; SH - 0.08; ischemic stroke (IS) - 2.76; stroke of unknown etiology - 0.06 percents. There was a downward trend in the IS’ fatality rate.
Consilium Medicum. 2015;17(9):8-11
pages 8-11 views

The main approaches to primary prevention of stroke

Martsevich S.Y., Kutishenko N.P., Suvorov A.Y.


The paper estimated the importance of stroke, are major risk factors for the disease, as well as the estimated basic approaches to its primary drug prevention from the standpoint of evidence-based medicine.
Consilium Medicum. 2015;17(9):12-15
pages 12-15 views

Atrial fibrillation as a risk factor for ischemic stroke

Gilyarov M.Y., Konstantinova E.V.


Atrial fibrillation (AF) is a common arrhythmia affecting more than 1-2% of the population increases the risk of stroke 5-7-fold. There is no significant difference in the risk of ischemic stroke among patients with the three types of AF (paroxysmal, persistent, and permanent). Oral anticoagulation clearly prevents ischemic strokes in AF patients. Warfarin, a vitamin K antagonist, was until recently the only available oral anticoagulant for stroke prevention in AF. Warfarin has limitations that have motivated development of several novel oral anticoagulants (NOACs), including apixaban, dabigatran, rivaroxaban, and edoxaban. Clinical trials demonstrate that the NOACs at least as efficacious as warfarin and were associated with lower rates of intracranial bleeding in patients with nonvalvular AF. Choosing antithrombotic treatment involves assessing the benefits of therapy versus its risks. Risk indexes, including CHA2DS2-VASc, and HAS-BLED can help determine how to treat patients with AF. Russian and European Guidelines suggest using of NOACs as an alternative to warfarin in patients with nonvalvular AF. Left atrial appendage closure device should be considered only for individuals with a high risk of stroke and a high risk of bleeding while on anticoagulant therapy. Analysis of clinical trial data and recommendations for the management of patients with AF allows to make the decision on the appointment is effective, safe and cost-effective therapy for each patient.
Consilium Medicum. 2015;17(9):16-20
pages 16-20 views

Ischemic stroke at a young age and thrombophilia caused by deficiency or abnormality of physiological anticoagulants

Pizova N.V.


Arterial and venous thrombosis, primarily acute ischemic stroke is one of the urgent problems of modern neurology. Clinical and pathological analysis revealed heterogeneity of ischemic strokes. At the young age of causes of stroke was significantly different from the causes of stroke in elderly and senile age. In young adults about 1/3 of affiliation to determine the etiologic stroke is not possible. The article focuses on the violations in the system of blood coagulation due to deficiency or abnormality of physiological anticoagulants. We present the clinical features of genetically determinate thrombophilia caused by a deficiency or abnormality of antithrombin III, heparin cofactor II, protein C, protein S, protein Z, and thrombomodulin. It is shown that the incidence of these conditions in the general population and in patients with arterial and venous thrombosis. We present diagnostic techniques.
Consilium Medicum. 2015;17(9):21-26
pages 21-26 views

Stroke patients with diabetes as a multidisciplinary problem

Gudkova V.V., Stakhovskaya L.V., Meshkova K.S., Shanina T.V.


The paper shows the complex interactions of pathological processes developing in stroke in patients with diabetes are reflected peculiarities of stroke and recovery of disturbed functions in these patients. We consider the tactical nuances of the appointment of basic therapy of stroke in people with diabetes.
Consilium Medicum. 2015;17(9):27-31
pages 27-31 views

Cognitive impairment of vascular genesis: the value of the defeat of the frontal lobes and their connections

Damulin I.V.


The article deals with vascular cognitive impairment. Particular attention is paid to the defeat of the frontal lobes in this pathology. It is stressed that memory disorders are rarely dominant in the clinical picture of the disease, often leading value is "frontal" syndrome. We consider the relation of the front of the brain with other structures of the central nervous system. Analyzes the importance of fluctuations in blood pressure when cognitive disorders of vascular origin. It stresses the importance of neuroplastic processes in vascular dementia.
Consilium Medicum. 2015;17(9):32-36
pages 32-36 views

The clinical picture of anxiety disorders in patients with stroke

Petrova E.A., Koltsova E.A., Savina M.A.


198 patients with first-ever cerebral stroke were studied. Affective disorders included depressions, generalized anxiety disorder, phobias were exposed in 71.2% of patients. Our study demonstrated that post-stroke anxiety disorders have different risk and pathogenetic factors. Anxiety disorders are associated with young age, phobias associated with women sex and inherited predisposition.
Consilium Medicum. 2015;17(9):37-41
pages 37-41 views

Managing the cerebral insult patients on the prehospital stage

Shamalov N.A., Sidorov A.M.


Prehospital stage is the first link in the system of care for patients with acute cerebrovascular accident (CVA). All patients with suspected stroke should be hospitalized first brigade arrived on a call to a specialized neurological department for the treatment of patients with CVA. Base tasks of prehospital medical care are accurate diagnosis and differential diagnosis of stroke stroke with other emergency conditions, and minimizing delays in transportation. When using a formalized algorithm telephone survey frequency coincidence reason to call the brigade arrived and the diagnosis can be up to 61.2%. Maximally fast transportation of the patient directly to the office round the clock computer tomography, bypassing receiving department also reduces the time the survey takes to verify the nature of the stroke are the key to the success of thrombolytic therapy in patients with ischemic stroke. Important for improving the quality of care for patients with stroke in the prehospital phase has a professional development of ambulance employees.
Consilium Medicum. 2015;17(9):42-45
pages 42-45 views

Reperfusion therapy in ischemic stroke

Shamalov N.A., Kholopov M.A.


Modern technologies of treatment of ischemic stroke (IS) include the use in the first 4.5 hours of the disease highly effective methods of reperfusion of the brain (thrombolytic therapy - TLT) to restore blood flow in the affected vessels. Once you have created in our country in regional vascular centers and vascular compartments of primary units for the treatment of patients with acute cerebrovascular accident (CVA) there was a significant increase in the number of procedures TLB system. In recent years there has been a clear positive trend to increase (more than 10 times) the number of patients with IS, which was carried out systemic thrombolysis. The further increase in the number of procedures of reperfusion in patients with IS prevents delays in seeking medical help for stroke due to low health literacy, delays and problems in the pre-hospital phase, the lack of organization in the admission of patients to the hospital. The main factors affecting the "door to needle" indicator: the time from admission to examination neurologist, the execution and the results of neuroimaging, the study required in laboratory parameters, the time from admission to transfer to an intensive care unit after the computer tomography . In terms of process quality indicators (implementation of the necessary diagnostic, therapeutic and other interventions) can be distinguished, affecting the safety and efficacy of thrombolytic therapy: error in determining contraindications to reperfusion, thrombolysis protocol non-compliance and follow-up monitoring of the patient. In view of the existing potential created stroke units operating under a uniform procedure and standards of care, it is absolutely real and necessary to increase the number of procedures TLT through active public information campaigns in order to maximize the early hospitalization of patients with stroke in specialized departments, as well as further organizational improving the system of care for patients with stroke in all phases of its provision.
Consilium Medicum. 2015;17(9):46-49
pages 46-49 views

Management of patients with neurogenic dysphagia in acute stroke (multidisciplinary approach)

Norvils S.N., Tsareva I.V., Staritsyn A.N., Yaroslavcev A.V., Anoufriev V.A., Anufrieva T.V.


The purpose of this article is to show an important role of a multidisciplinary approach in the management of patients with neurogenic dysphagia, early detection of swallowing dysfunction, adequacy purpose way of feeding, the importance of rehabilitation treatments. The description of a clinical case is based on data from a medical record of the patient who was treated in primary vascular department in acute brainstem stroke. The estimation of an multidisciplinary team coordinated action in the framework of rehabilitation measures, resulting in avoided mortality and discharge the patient from the hospital in a stable state, with oral feeding.
Consilium Medicum. 2015;17(9):50-54
pages 50-54 views

Vascular cognitive impairment: diagnosis and treatment

Kadykov A.S., Shakhparonova N.V., Kashina E.M.


One of the most common consequences of cerebral circulatory disorders are cognitive disorders of varying severity. The article discusses the diagnosis and treatment of vascular cognitive disorders using antagonists of N-methyl-D-aspartate receptors.
Consilium Medicum. 2015;17(9):55-58
pages 55-58 views

Diagnosis and treatment of disorders of urination after cerebrovascular accidents

Krivoborodov G.G., Efremov N.S., Tur E.I.


It is now well known that acute cerebrovascular accident (CVA) is often accompanied by the development of lower urinary tract symptoms (UT) as a function of the type of violation of emptying the bladder, and the type of storage dysfunction. That is why the question remains timely and correct identification of the type of violation of the lower UT at this category of patients. Today experts have a wide arsenal of methods for the determination of such violations, ranging from voiding diary and questionnaire International Prostate Symptom Score (IPSS) and ending with the execution of complex urodynamic studies. It does not set any clear pattern between the type and location of stroke and the degree of expression or form of violation of the act of urination. Certainly, the presence in patients after stroke, symptoms of lower UT requires selection of adequate and effective method of treatment. In the acute phase of stroke is not uncommon acute urinary retention. In a subsequent independent urination restored in most patients. Unfortunately, at present there is no any effective medication to restore the contractility of the bladder, thus contributing to the elimination of urinary retention. That is why periodic catheterization is the method of choice for an adequate emptying of the bladder in this category of patients individuals with impaired accumulation of urine in the bladder for a broader range of therapeutic measures. Thus, in case of failure of behavioral therapy successfully applied therapy anticholinergics and vnutridetruzornye injection of botulinum toxin type A.
Consilium Medicum. 2015;17(9):59-62
pages 59-62 views

Influence of informing patients with stroke of environment during hospitalization for the disease post-stroke depression

Maltseva M.N., Melnikova E.V., Shmonin A.A., Sudnikova I.A., Ivanova A.B.


Post-stroke depression complicates the treatment and rehabilitation after stroke. The patient is experiencing stress from lack of information about the environment surrounding after hospitalization, with total dependence on it can be a factor that exacerbates depression and provoking risk of its development. Timely information about planned manipulation of the patient and allowing him to follow the course of time reduce the risk of post-stroke depression.
Consilium Medicum. 2015;17(9):63-65
pages 63-65 views

Continuous-stage medical rehabilitation of acute violation of cerebral circulation and craniocerebral trauma: the legal framework

Repyev A.P., Ivanova G.E., Stakhovskaya L.V.


One of the main issues of the Russian HC system is how should be medical rehabilitation provided for the stroke patients according the current Russian legislation. The comprehensive analysis of the current Russian legislation has been provided by the authors of the article in terms of healthcare regulations in medical rehabilitation for defined groups of patients. Particularly the status of medical rehabilitation as a part of the specialized medical care has been disclosed. Sources of budgeting and necessary conditions for the medical rehabilitation providing was determined. Brief analysis of the Russian Ministry of Healthcare order “On the organization of the medical rehabilitation” N 1705n has been provided. Some gaps in the systems of legal, HR and finance support of HC and medical rehabilitation system was highlighted. Some assumptions were made on the possible way of some problems mitigation.
Consilium Medicum. 2015;17(9):66-69
pages 66-69 views

Chronic facial pain: clinical case

Fokina N.M., Dudnik E.N.


Eagle syndrome mimics tregiminal neuralgia, which requires a multidisciplinary approach to diagnosis and treatment of chronic pain in the facial area.
Consilium Medicum. 2015;17(9):70-73
pages 70-73 views

Vertebrogenic thoracalgy in an intern physician practice

Shostak N.A., Pravdyuk N.G.


The article describes the basics of clinical and instrumental diagnosis of vertebral thoracalgia from the perspective of a General practitioner. The greatest importance is given rheumatologic aspects of lesions of the thoracic spine. The approach to the treatment of the pain syndrome in thoracalgia.
Consilium Medicum. 2015;17(9):74-77
pages 74-77 views

New perspectives for the treatment of tension-type headache

Amelin A.V., Babayan L.E., Myatleva M.I., Tarasova S.V., Tumelevich B.C.


In the pathogenesis of acute and chronic tension-type headache (TTH) both peripheral and central mechanismsare of key importance. An important role is played by the peculiarities of personality development, a special type of nervous system response to stress, the rapid formation of a "pain behaviour". Preventive pharmacotherapy is individually applied in frequent attacks and chronic TTH cases. Antinociceptive effect of antidepressants appears no earlier than in 2 weeks, and at the same time, often there has been increasing concern. The aim of our study was to examine the effectiveness of flupirtine (Katadolon®) in combination with an antidepressant escitalopram in patients with frequent episodic and chronic TTH. The use of flupirtine for 2 weeks in patients with TTH is accompanied by a decrease in the frequency and intensity of headaches, as well as reducing the number of additional used cupping analgesics. The combination of flupirtine and escitalopram was effective and safe in patients with chronic TTH. Flupirtine significantly increases the threshold of pain sensitivity in patients with TTH.
Consilium Medicum. 2015;17(9):78-81
pages 78-81 views

Dorsalgia: topical aspects of treatment at stages of primary health care

Trukhan D.I., Davydov E.L.


The varied scope of medical diagnostic procedures and the expansion of the volume of medical care, including pain in the back provided by a doctor at the stage of primary health care, intended to include in the arsenal used analgesics meloxicam and complex B vitamins.
Consilium Medicum. 2015;17(9):82-87
pages 82-87 views

Ostheoarthritis in common practice: pain or disease treatment?

Vovk E.I.


The increase of ostheoarthritis (OA) circulation is a modern challenge. OA causes the deterioration of life quality, and is the cause of disabilities in all ages, as it leads to vast material expenses for treatment, especially due to the difficulties imposed by non-steroid antiflammatory drugs (NSAIDs) and creates a significant burden to the healthcare system. In the meantime, an uncertainty in therapy strategy choice when treating the OA patients in different stages of the diseases, takes place in the medical and scientific societies. The keys to improving the medical aid for OA patients are: 1) the optimal regimen choice complacent to the clinical phenotype and comorbid weight of the patient; 2) the early onset appointment of a background symptom - and structure-modificating therapy based on chondroitine and glucosamine, allowing to decrease the need in NSAIDs use.
Consilium Medicum. 2015;17(9):88-96
pages 88-96 views

Age aspects of dorsopathies

Khitrov N.A.


This paper considers different variants of dorsopathies in age aspect: connective tissue dysplasia, scoliosis, spondylolisthesis, spondyloarthritis, myofascial pain syndrome, osteoarthritis of the facet joints, spondylosis, vertebral disc herniation, diffuse idiopathic skeletal hyperostosis, osteoporosis, metastasis. The treatment of dorsopathies with Amelotex and KompligamB reduced pain, increased the mobility of the spine, had good tolerability.
Consilium Medicum. 2015;17(9):97-102
pages 97-102 views

Cardiovascular security as selection criteria for nonsteroidal anti-inflammatory drugs in the treatment of pain syndromes

Shirokov V.A.


The problem of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with the development of complications of the cardiovascular system and gastrointestinal tract. The review presents the results of clinical and epidemiological studies on the efficacy and safety of naproxen, demonstrating the lowest among all NSAIDs the risk of developing complications of the cardiovascular system.
Consilium Medicum. 2015;17(9):103-107
pages 103-107 views

The use of diclofenac with vitamins of V group in patients with low back pain

Kamchatnov P.R., Chugunov A.V., Umarova K.Y.


Lumbar pain is one of the most common forms of musculoskeletal disorders, characterized by a tendency to chronicity and recurrence. Treatment of analgesic and anti-inflammatory drugs, usually has a significant positive effect, however, it is associated with a number of physical complications. The simultaneous use of B vitamins can reduce the terms of therapy, to improve its efficiency, reduce the risk of complications. The article analyzes the results of Neyrodiklovit, Neyromultivit in patients with low back pain.
Consilium Medicum. 2015;17(9):108-112
pages 108-112 views

Vestibular rehabilitation: substantiation, indications, application

Palchun V.T., Guseva A.L., Chistov S.D.


Vestibular rehabilitation therapy is effective and inexpensive management of patients with dizziness and balance disorders. Here the authors discuss vestibular rehabilitation for patients with benign paroxysmal positional vertigo, unilateral vestibular loss or hypofunction, bilateral vestibular loss/hypofunction and central vestibular disorders. They describe different mechanisms of vestibular compensation, exercises that are used, repositioning maneuvers, principles of conducting a vestibular rehabilitation program and drug therapy.
Consilium Medicum. 2015;17(9):113-120
pages 113-120 views

Cognitive impairments in some deficit and dismetabolic states

Pizova N.V.


Cognitive impairments (CI) as one of the symptoms of the nervous system are often found in various states of deficit and dismetabolism. There is good evidence that CI is one of the main manifestations of developing encephalopathy in chronic liver disease, kidney disease, diabetes. At deficiency of cyanocobalamin (vitamin B12) and folic acid, hyperhomocysteinemia is observed in cognitive decline up to the development of dementia. The features of the CI in alcoholic lesion of the central nervous system are also discussed. The possible mechanisms of neuronal damage in the brain and dismetabolic of deficit states. The results of randomized clinical studies examining the efficacy of vitamins in patients with CI. Special attention is given to Berocca vitamins and minerals.
Consilium Medicum. 2015;17(9):121-127
pages 121-127 views

Treatment with artrofoon - modifying symptoms, clinical course and prognosis of osteoarthritis

Badokin V.V.


The article discusses the importance of inflammation in the pathogenesis of osteoarthritis, which determines not only the lot of its clinical manifestations, but is crucial in the progress of its structural changes. In the development of osteoarthritis participate pro-inflammatory cytokines, including interleukin occupy a prominent place 1 and tumor necrosis factor-a. Treatment with artrofoon regulates the balance of pro - and anti-inflammatory cytokines, especially tumor necrosis factor-a, and from these positions should be considered as anti-cytokine immunotropic preparation or as a modulator of biological action. The article presents data on short-term and long-term treatment of osteoarthritis treatment with artrofoon showing its reliable analgesic and anti-inflammatory activity. The most pronounced and stable effect of therapy occurs in a continuous 3-6 months of taking the drug. A positive feature of treatment with Artrofoon is its good tolerability and high safety that allows you to safely use this medication for the treatment and prevention of exacerbations of chronic diseases of joints and spine.
Consilium Medicum. 2015;17(9):128-132
pages 128-132 views

Place of ketoprofen in clinical practice

Chichasova N.V., Imametdinova G.R.


The use of various forms of ketoprofen achieves pronounced analgesic and anti-inflammatory effect in a large number of patients and chronic arthritis and osteoarthritis. The drug was well tolerated, the new form - Ketonal Duo was approved by patients in 10 regions of the Russian Federation as an effective and easy to use.
Consilium Medicum. 2015;17(9):133-138
pages 133-138 views

The role of the active metabolite of vitamin D (alfacalcidol) in the treatment of deficiency states and functional disorders

Dydykina I.S., Dydykina P.S., Kovalenko A.A.


Deficiency of vitamin D proceeds, reduction of its synthesis, metabolism disorders in the liver or kidney accompanied by the appearance of a number of functional disorders, abnormal conditions and diseases, including osteoporosis and its complications - fractures which are used for the prevention and treatment of these pathological processes and are now widely applied as the native vitamin D, and its active metabolites (calcitriol and alphacalcidol) consisting of mono - or combination therapy. Wide range of individual doses of Alpha D3-Teva (alfacalcidol) minimize the risk of side effects.
Consilium Medicum. 2015;17(9):140-143
pages 140-143 views

The efficacy of αa-lipoic acid in diabetic polyneuropathy

Khramilin V.N., Andreeva V.A.


Diabetic polyneuropathy (DN) is a serious complication of diabetes. The aim of this review is to assess the efficacy and safety of α-lipoic acid (ALA, thioctic acid) in treatment of DN. ALA is an effective and safe treatment of DN, associated with strong and rapid antinociceptive action with delayed pathogenetic effects. In clinical practice, ALA can be used as a treatment of choice in patients with semeiotic DN associated with light and moderate sensorial deficit, as well as in case of combination of DN and the autonomic nervous system disorders.
Consilium Medicum. 2015;17(9):144-148
pages 144-148 views

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