Vol 18, No 9 (2016)

Introduction. Repeated strokes are the actual problem of modern neurology in mind the severity of clinical symptoms and high mortality. The aims and objectives of the study: The study of epidemiological indicators of recurrent stroke in the Russian regions. Materials and methods. A study of recurrent stroke carried out in the framework of a multi-center study of the epidemiology of stroke in 17 regions of the Russian Federation by the territorial and population registra.Since 2009 to 2014 in the study population reported 36,283 cases of stroke, including recurrent stroke was 8144 cases. It concerned the case of recurrent stroke for stroke, if from the beginning of any previous stroke has been more than 28 types of stroke dney. Diagnostics corresponded with International Classification of Diseases revision 10. After the incidence analysis, mortality, mortality from stroke recurrence. Recurrent stroke prevalence was studied in young age (25-44 years), medium (45-59 years old), the elderly (60-74 years) and old (75 and older), and depending on the type of stroke. In processing the data used statistical software package SAS 8,0. To calculate incidence and smertnostiispolzovalsya method of direct standardization. For standard assumed distribution of the number of men and women by age group for each study area in a year. Changing trends index is determined using the approximation method. Results. The incidence of recurrent stroke in 2009 was 1.09 cases per 1 000 population in 2014 - 0.79 per 1000 population. During the study period there were significant fluctuations in the indicator. Deaths from stroke recurrence showed a decline for the period 2009-2012 gg (0.32; 0.24; 0.20; 0.15 cases per 1,000 population, respectively). The slight increase in the rate recorded in 2013 (0.16) with a decrease in 2014 (0.12), which did not change the trend of decreasing trends. The proportion of ischemic stroke among recurrent stroke was 87.5%, intracerebral hemorrhage - 7.1%, 0.9% subarachnoid hemorrhage, stroke unspecified etiology 4.6%. Prevalence of recurrent stroke among all stroke was 25.5% in 2009. From the period of the study, there were changes in the rate does not exceed 2009. The incidence of recurrent stroke at a young age was 13.2% of cases, on average - 19.1%, in older age - 24.1%, in old - 23.3%. Mortality after repeated insults made; in ischemic insulte - 18.2%, intracerebral hemorrhage - 41.7%, subarachnoid hemorrhage - 34.7%, stroke unspecified etiology - 43.4%. Conclusions. During the period of the study there were changes in the main epidemiological indicators of recurrent stroke in the Russian regions. Despite the emerging positive changes, the problem of recurrent stroke remains relevant.

Bilateral internal carotid artery occlusion is a relatively rare condition which is generally characterized with a poor prognosis. Each new case is of particular interest in relation to the activation of the compensatory mechanisms of cerebral blood flow. This article presents a case of bilateral internal carotid artery occlusion, accompanied by developing collaterals between the internal and external carotid arteries. The pathological processes leading to bilateral occlusion of the internal carotid arteries are discussed and the main ways of collateral circulation between the internal and external carotid arteries are described.

The study included 60 patients with acute hemispheric ischemic stroke. In addition to standard rehabilitation methods 40 patients underwent additional lateralized therapy aimed at enhancing lesions (20 patients) or the intact hemisphere (20 patients). The control group consisted of 20 patients who had more lateralized therapy has not been evaluated. The results showed that the additional activation of the left hemisphere is dominant in significant positive changes, especially in the case of lesions of the left hemisphere homolateral. Additional activation of the right hemisphere in the event of the defeat of the left can have a negative impact. With the defeat of the right hemisphere, the left-sided and right-sided activation can be positive.

The article summarizes the modern principles of management of patients with atherosclerosis of the cerebral arteries. The article presents methods of diagnostics of atherosclerotic stenosis of extra - and intracranial cerebral arteries. Special attention is paid to methods of assessing individual risk of vascular complications. The article covers in detail current strategies of antiplatelet therapy in patients with high risk of ischemic stroke.

The purpose of research - to study efficiency of correction of sleep disorders by Melaxen® taking into account the level of secretion of melatonin (6-SOMT) at patients with stroke. Materials and methods. The study included 141 patients with CVD. Examination of patients included assessment of neurological status, psychometric scales, the definition of circadian rhythm of the heart and blood pressure, determination of 6-SOMT in urine. Results. It was found that pathological changes in circadian rhythms affect sleep disturbances, emotional and cognitive disorders and are associated with a reduction in the level of 6-SOMT in the urine. These changes are most pronounced in patients with stroke. The efficiency of inclusion in a comprehensive rehabilitation regimen Melaxen® in respect of sleep disorders. Conclusion. The data obtained allow us to consider Melaxen® as an effective tool in the complex rehabilitation of patients with cerebrovascular diseases.

The paper deals with the rehabilitation of patients with type 2 diabetes, stroke, having a changing transcapillary cerebral metabolism and movement disorders. The treatment of these patients has been used complex, including drug therapy and multi-bipolar electrical pulse currents, which led to a marked clinical benefit, as well as accompanied by the restoration of motor activity of patients with the improvement transcapillary sharing and normalization of inter-hemispheric asymmetry.

Cerebrovascular diseases are one of the most maladaptive disorders in both men and women. Meanwhile, in the female population when compared to men, strokes occur much later. Strokes in women have a higher frequency of traditional risk factors such as hypertension, atrial fibrillation, as well as the presence of specific factors, such as the use of oral contraceptives and during pregnancy. In addition, in women compared with men more than the proportion of severe stroke, the higher the frequency of hospital medical complications and deaths, as well as the number of cases of severe disability after stroke. In the formation of sex differences in the pathophysiology of stroke participate as hormonal mechanisms, and other factors not related to the influence of reproductive hormones. Understanding these laws is important in order to develop a stratified approach to the management of female patients with cerebrovascular disease.

The analysis of the cerebral arteries and cerebral blood flow shows the importance of vascular pathogenetic mechanisms in the formation of autonomic disorders, headaches at young patients being treated with various forms of astheno-neurotic depressive disorders. The results of applying the method oftranscranial Doppler in complex clinical and instrumental monitoring has shown that the inclusion of this method in the diagnostic system contributes to thesolution of diagnostic, prognostic and tactical tasks. Combined therapy of these disorders includes short courses of Diacarb, Sermion, Aescusan, Semax under the control of ultrasound diagnostic techniques.

Neuropathy is a serious complication of diabetes mellitus, where treatment involves glycemic control, pathogenic agents and symptomatic agents (analgesics), if necessary. This review shows the efficacy and safety of α-lipoic acid (ALA) in pathogenetic therapy of diabetic neuropathy. Mechanisms of action of ALA include the reduction of oxidative stress while improving endoneuronal blood flow, increase in nerve fibers conduction velocity, as well as the improvement of a number of other nerve functions. There is enough clinical trials, corresponding to modern requirements of evidence-based medicine, evidence that ALA is an effective and safe drug. As analgesic effectiveness of ALA is inferior central analgesics, but it is better tolerated, it has a more rapid onset of action, and in addition to analgesia facilitates paresthesia, numbness, reduces / eliminates muscle and sensory deficits. Therefore, ALA is a drug of choice for patients with early symptoms of neuropathic deficits, with the autonomic neuropathy of the cardiovascular system and for patients with co-morbidities to reduce the risk of polypharmacy.

Current article is devoted to diagnosis and treatment of nociceptive and neuropathic pain syndromes in neck and head. From the up-to-date points of view on anatomo-physiological interactions of neck and head structures place and role of pathogenic mechanisms in formulating syndromes of cervico-cranialgia, occipital neuralgia, cervicogenic headache, tension headache, migrane are discussed. Modern diagnostic criteria of the current conditions are given. Local and systematic pharmacotherapy of skeleto-muscular and neuropathic pain in neck and head are also examined.

Lumbar pain is a common clinical syndrome characterized by a high risk of recurrence. Relief of intense prolonged pain, recurrent complications of therapy is often associated with increased drug load on the body and an increased risk of unwanted side effects. The correct choice of drug, that can provide maximum efficiency at low risk of drug complications is an important component of a successful individualized therapy. The possibilities of use of nimesulide in patients with low back pain, taking into account features of the pharmacological profile of the drug, are discussed below.

This article describes the characteristics of pain in diseases of the musculoskeletal system, its pathogenesis and treatment principles; Traumeel is examined as the drug used in the treatment of this group of diseases; its mechanism of action is understood via compiled data from clinical trials efficacy and safety of different forms of Traumeel S.

The paper discusses the results of the use of anxiolytic Aphobazolum in patients with arterial hypertension (AH) associated with neurotic, stress-related disorders, among which a special place is occupied by anxiety disorders. Aphobazolum therapy was used in 31 patient cases with hypertension stage I-II has been included in the scheme of complex treatment of antihypertensive drugs of different classes, appointed in the form of mono - or combination therapy in adequate doses, depending on the degree of hypertension (blood pressure level achieved) and cardiovascular risk complications. Aphobazolum was administered at a dose of 30 mg/day for 4 weeks with the assessment of the effectiveness against the main points of its applications - alarm, gipotimii, asthenia. The anxiolytic activity of the drug manifested in the reduction of anxiety disorders, ranging from 3-5-day admission, during the 1st week of its application, which allowed to use antihypertensive therapy more efficiently. in combination with antihypertensive therapy aphobazolum treatment is not accompanied by any side effects are marked with good compatibility and portability of antihypertensive drugs and Afobazol

The article deals with aging in general and the effects of aging in women, particularly menopausal symptoms. Presents modern views on the basic therapy of age-related diseases in postmenopausal women, including cognitive impairment. The possibility of effective use of the drug in women Cerebrolysin.

The most common cause "pain in the elbow" is epicondylitis. Epicondylitis of the elbow area are common, having a characteristic diagnostic signs and reacting positively to treatment form periarticular pathology. The presence in the arsenal of the first contact doctor various forms of homeopathic medication Traumeel S expands its therapeutic potential and to improve health care quality and efficiency for patients in primary health care.