Vol 23, No 2 (2021)


Strategies to enhance the treatment of lacunar stroke

Maksimova M.Y., Airapetova A.S.


Lacunar stroke (LS) is caused mainly by pathological changes in the small intracerebral (perforating) arteries, which are typical for arterial hypertension primarily. The current review highlights actual treatment strategies to LS. The management of patients with LS is carried out in accordance with the general approaches for ischemic stroke treatment and includes acute reperfusion and prevention of recurrent stroke. The choice of antithrombotic therapy in patients with LS is based on assessment of intracerebral hemorrhage and systemic bleeding risks. Dual antiplatelet therapy in patients with LS is not provide a significant benefit beyond aspirin monotherapy, increasing intracerebral hemorrhage risk.
Consilium Medicum. 2021;23(2):115-121
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Traditional and rare causes of ischemic stroke in 18 to 50-year old persons

Pizov N.A., Skachkova O.A., Pizova N.V., Baranova N.S.


The article discusses the epidemiological data on the incidence of ischemic stroke (IS) in persons aged 18-50 years, the frequency of various subtypes of IS, depending on the region according to the TOAST classification. Based on recent studies, the frequency of the main traditional risk factors for IS in young people is given, as well as our own data on the frequency of detection of various subtypes of IS on admission and the main risk factors in 145 people aged 18-45 years. The article describes other, moderate causes of stroke at a young age, taking into account modern diagnostic capabilities.
Consilium Medicum. 2021;23(2):122-126
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Study of the efficacy and safety of dimethyloxobutylphosphonyldimethylate in complex therapy of patients with the consequences of ischemic stroke

Belova Y.A., Kotov S.V.


According to the instructions, Dimethyloxobutylphosphonyldimethylate stabilizes cell membranes, restoring the reactivity of cerebral vessels, improving the functions of the large hemispheres and the brain stem. Aim. To assess the effectiveness and tolerability of the preparation Dimephosphone in complex therapy in patients with the consequences of ischemic stroke, with chronic cerebrovascular insufficiency due to atherosclerosis and/or hypertension compared to traditional therapy in patients. Materials and methods. The study included patients of both sexes aged 35 to 80 years who had an ischemic stroke. The main criteria for clinical effectiveness were the assessment of cognitive functions by MoCA scales, FAB, Modified Strup Test. Secondary indicators confirming the effectiveness of therapy were the assessment of the dynamics of cytochemical study data (indicators of mitochondrial activity of enzymes in peripheral blood lymphocytes). Results. Dimephosphone had a positive impact on cognitive functions, improved indicators of flexibility/rigidity of control, automation of cognitive functions. Indicators of mitochondrial activity of enzymes require further study. Conclusion. Dimephosphone has proved to be an effective and well tolerated drug.
Consilium Medicum. 2021;23(2):127-130
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Cerebral edema: from the origins of the description to the modern understanding of the process

Gudkova V.V., Kimelfeld E.I., Belov S.E., Koltsova E.A., Stakhovskaya L.V.


He article, which is a review-lecture, reflects the historical milestones in the description and study of cerebral edema (CE) from ancient times to the present. Great attention is paid to the Monroe-Kellie doctrine, without which it is impossible to understand the mechanism of development of a vitally significant complication of CE - intracranial hypertension. The importance of the Monroe-Kellie doctrine in substantiating the symptomatic treatment of increased intracranial pressure is emphasized. The possible involvement of the glymphatic system in both the decrease and the increase in increased intracranial pressure is discussed. The modern ideas about the blood-brain barrier (BBB), its role in the development of CE and an increase in intracranial volume are analyzed. With the study of the molecular mechanisms of BBB damage and the development of targeted therapy, the researchers associate future advances in the treatment of CE. The great interest of modern authors in the state of the BBB in various diseases, as well as in the violation of its integrity in COVID-19 is reflected. It is noted that the main and only, today, method for diagnosing CE is neuroimaging. Development has begun on the isolation of potential biochemical markers of CE from blood.
Consilium Medicum. 2021;23(2):131-135
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A medical speech therapist in a multidisciplinary rehabilitation team. Practical experience of the Clinic of the Brain Institute

Belkin A.A., Belkina Y.B., Prudnikova S.S., Skripai E.Y., Ermakova E.V., Lakimova A.S., Baryshnikova Y.S., Ladeishchikova Y.A., Nikitenko T.V., Pinchuk E.A., Safonova T.Y.


Aim. To analyze our own experience in organizing the work of the speech therapy service of the regional neurorehabilitation Center. Materials and methods. We conducted a retrospective analysis of the activities of the division of MST of the interterritorial Center for Neurorehabilitation “Clinic of the Brain Institute" (CBI) for the period 2015-2019. In the structure of the CBI, there is a 24-hour hospital with 45 beds, including a 9-bed intensive care unit, an 8-bed day hospital, a polyclinic with 50 visits per shift, and a telemedicine center. The speech therapy team of the MDRT consists of 8 specialists with higher education in the specialty "speech pathologist-defectologist". Speech therapy examination consists of key blocks of clinical diagnosis of speech therapy syndromes: dysphagia, dysarthria, aphasia and prosoparesis. Each block represents a complex of a basic score scale and additional instrumental, including neurophysiological methods. The basis of speech therapy is voice training, articulation and probe massage and other standard procedures, combined in the concept of "basic techniques” for speech therapy syndromes. Drug and non-drug modulations are used to enhance the basic techniques. Results. In the period from 2015 to 2019, 5243 patients were treated in CBI after acute cerebral circulatory disorders and traumatic brain injuries, of which 4273 (81%) needed the help of clinical speech therapists. The most common problem was dysarthria - 55%. Speech breakdown in the framework of aphasia syndrome was noted in 26% of all hospitalized patients. Dysphagia was diagnosed in 30% of all hospitalized patients. During the hospitalization period of 14 days, each patient receives at least 45 minutes of daily individual training with a specialist and group articulation exercises, including weekends. The lesson is preceded by a modulating drug or non-drug procedure. For 5 years, 4273 patients were treated with speech therapy team. In 154 (11.6%) patients, speech therapy syndromes completely regressed, in 28% the severity of their manifestations decreased by 1-2 levels. Conclusion. At the early stage of rehabilitation, the speech therapist is called upon to solve priority tasks: achieving the maximum possible level of independence of the patient, at least staying at home with a minimum level of dependence on the help of a guardian. This is a prerequisite for the implementation of an individual comprehensive rehabilitation program. Despite many methodological and organizational problems, the MST is a key member of the MDRT, without which an effective rehabilitation process is impossible.
Consilium Medicum. 2021;23(2):136-143
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Refeeding syndrome and its prevention in patients with anorexia

Luft V.M., Tyavokina E.l., Sergeeva A.M., Lapitsky A.V.


Aim. To study the condition of the problem, the prevalence and severity of dyselectrolytemia, as a possible manifestation of the syndrome of renewal of nutrition (refeeding syndrome) in patients with anorexia nervosa (AN). Materials and methods. We studied somatometric indicators and the prevalence of electrolyte disturbances of 81 women aged from 18 to 55 years, who were treated in the somato-psychiatric department of the Dzhanelidze Saint Petersburg Research Institute of Emergency Medicine. Results. Hypotrophy predominates as marasmus (95.2%) in the early stages of AN. At the later stages of development of AN, the frequency of mixed hypotrophy by the type of marasmatic kwashiorkor increases significantly (up to 63.2%), which is manifested by a decrease not only in somatometric indices, but also in depletion of the visceral protein pool. When studying the frequency of electrolyte disturbances, hypokalemia was most often observed in patients with NA in the initial period of realimentation (14.8%). At the same time, its moderately expressed degree prevailed. Moderate hypophosphatemia (not less than 0.6 mmol/L), which may indicate a latent manifestation of refeeding syndrome, was relatively often (21.1%) observed in patients with severe malnutrition (body mass index less 12.5 kg/m2). Hypomagnesemia for the entire period of observation of patients with various stages of the disease were not detected. Conclusion. Diselectrolytemia is often observed in patients with AN during their refeeding, which requires regular dynamic monitoring of serum potassium, magnesium and phosphate levels and timely correction of their deficiency.
Consilium Medicum. 2021;23(2):144-147
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Practical use of non-steroidal anti-inflammatory drugs in relieving recurrent headaches

Tabeeva G.R., Kiryanova E.A.


The main burden of headache in the world falls on primary cephalalgia (tension headache, migraine). However, there is often a need to rule out a secondary cause of the headache. This review presents the main options for the differential diagnosis of cephalgias, taking into account the patient's age, headache characteristics, and anamnestic information. The role of non-steroidal anti-inflammatory drugs in headache treatment, the safety of its long-term use and prevention of medication overuse headache are discussed.
Consilium Medicum. 2021;23(2):148-153
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Paradigms of modern epileptology

Badalian O.L., Burd S.G., Lebedeva A.V., Avakian G.G., Oleinikova O.M., Savenkov A.A.


The article is devoted to modern problems of epilepsy, discusses the perspectives on the etiology, pathogenesis, definition, epidemiology, modern classification, discusses the diagnosis and prediction of disease and treatment strategy.
Consilium Medicum. 2021;23(2):154-160
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The study of the efficiency of robotic mechanotherapy with the use of an exoskeleton for the lower extremities in patients with multiple sclerosis with impaired walking function

Gevorkyan A.A., Kotov S.V., Lizhdvoy V.Y., Baryshev A.M.


Aim. To study the efficiency of robotic mechanotherapy using the exoskeleton ExoAtlet on the functional state of patients with multiple sclerosis with impaired walking function. Materials and methods. This is a prospective, open, single-center study. The study included 53 patients with remitting course in remission and secondary progressive course, who had a neurological deficit level of 3 to 7 on the disability status scale (EDSS). To assess the severity of neurological deficits and functional state, we used the extended EDSS. Also we used the multiple sclerosis functional composite (MSFC) test, including the assessment of walking - Timed 25-Footwalk, the assessment of upper limb functions - 9-HolePegTest (9-HPT), the assessment of mental abilities - Symbol Digit Modalities Test (SDMT). Additionally, the preservation of cognitive functions was assessed by the Montreal Cognitive Assessment Scale (MoCA). Results. When assessing the level of disability on the EDSS scale, patients showed a statistically significant (p<0.02) decrease in this indicator by 0.22 points (4%). When studying the degree of impairment of the pyramidal function in patients, there was a decrease in indicator by 0.21 points (7%); p<0.01. The study of the SDMT subtest showed a statistically significant (p<0.02) improvement, the increase in the indicator was 2.3 points (4.3%). When evaluating other MSFC subtests, there was a statistically significant improvement in Timed 25-Footwalk subtest (p<0.001), 9-HPT on dominant (p<0.02) and non-dominant (p<0.02) hands. The improvement in Timed 25-Footwalk subtest score was 3.3 s (18.6%), in the 9-hole test on the dominant hand -1.7 s (5.6%), on the non-dominant hand - 2.3 s (6.7%). When studying MoCa test, a statistically significant (p<0.001) improvement in cognitive functions after a course of rehabilitation was noted with a high degree of confidence, the improvement was 1.5 points (5.7%). Assessment of affective disorders in patients with multiple sclerosis showed a statistically significant decrease in the level of depression (p<0.02) on the HADS scale by 0.9 points (16.4%), and the level of anxiety (p<0.001) by 1.2 points (21.4%). Conclusion. During the study, data were obtained that showed the efficiency of robotic mechanotherapy using the exoskeleton for the lower extremities as a method of rehabilitation and the prospects for further study of this direction for restoring walking function in patients with MS in the presence of a motor deficit in the lower extremities.
Consilium Medicum. 2021;23(2):161-164
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Vitamin D and multiple sclerosis

Cheredanova V.R., Chabin I.A., Bembeeva R.T.


Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system and is a major cause of disability in able-bodied young people. Recently, the question of the effect of vitamin D on the risk of occurrence and clinical course of MS has been widely discussed. The review presents pathogenesis of this disease and estimated mechanisms of the effect of cholecalciferol on it, current data on the effect of vitamin D levels on the risk of MS, the course and outcome of this disease.
Consilium Medicum. 2021;23(2):165-169
pages 165-169 views

Risk factors for fractures in patients with cerebrovascular disease

Shishkova V.N., Kosmatova O.V., Skripnikova I.A., Drapkina O.M.


Aim. To study the link between various risk factors and an occurrence of osteoporotic fractures (OPF) in women who have had a first ischemic stroke (IS). Materials and methods. The study included 170 women 45 to 80 years of age who have had the first IS and received neurorehabilitation treatment for post-stroke speech disorders in the Center for Speech Pathology and Neurorehabilitation in Moscow in 2011-2013. For all women, the ten-year absolute risk of major OPF and hip fractures (HF) was retrospectively analyzed using the FRAX algorithm, excluding the data on bone mineral density. The risk of OPF was assessed according to the treatment intervention threshold proposed by the Russian Osteoporosis Association in 2012. In January 2021, a telephone survey was conducted to register the fractures that occurred over the past period of time. The SPSS Version 20 was used for statistical analysis of the results. Results. During the study period, fractures with a minimal level of trauma occurred in 34 (20%) women (fractures of fingers, toes, and skull bones were excluded). The absolute risk of OPF and HF in women with a low-traumatic fracture was higher than in patients without it (р<0.001), but did not reach the treatment intervention threshold proposed by the Russian Osteoporosis Association in 2012. Correlation analysis demonstrated the association between the occurrence of low-traumatic fractures in patients who had the first non-cardioembolic IS and the following parameters: age (rd=0.277; р<0.001), weight (r6=-0.368; р<0.001), body mass index (r6=-0.378; р<0.001), total cholesterol concentration (r6=0.189; р=0.014), type 2 diabetes mellitus (ф=0.225; р=0.003), HF in parents (ф=0.375; р<0.001). Conclusion. The results of this study demonstrate the presence of an association between the occurrence of low-traumatic fractures in patients with prior non-cardioembolic IS and traditional risk factors included in the FRAX algorithm, as well as with type 2 diabetes mellitus.
Consilium Medicum. 2021;23(2):170-174
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Clinical pharmacological particular qualities of original ibuprofen different forms in treatment of diseases manifesting by pain

Pchelintsev M.V.


In the present article, the role of non-steroidal anti-inflammatory drugs in treatment of different diseases manifesting by nociceptive pain is viewed. Special consideration is given to Ibuprofen, which is very often used as a non-prescription analgesic and/or anti-pyretic agent. Using the examples of randomized clinical trials and meta-analyzes carried on their basis, a high comparative analgesic efficacy and safety of use of original ibuprofen, Nurofen®, in different pharmaceutical forms in particular in a form of rapidly absorbed tablets and in combination with paracetamol.
Consilium Medicum. 2021;23(2):175-180
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Distal arthrogryposis type 5 - arthrogryposis with ophthalmoplegia, polyneuropathy. Case Report

Sidorova O.P., Kotov S.V., Demikova N.S., Borodataya E.V., Vasilenko I.A.


A clinical case of a 27-year-old patient with distal arthrogryposis of the 5th type - arthrogryposis with ophthalmoplegia, which was combined in a patient with polyneuropathy is presented. To assess tissue respiration (mitochondrial respiratory chain) and other types of metabolism in mitochondria, cytochemical analysis of lymphocytes in peripheral blood was carried out according to A. Pearse's method modified by R.P. Narcissov. The activity of four mitochondrial enzymes involved in carbohydrate metabolism (lactate dehydrogenase), amino acid metabolism (glutamate dehydrogenase), fatty acid metabolism (а-glyce-rophosphate dehydrogenase) and the second complex of the mitochondrial respiratory chain (succinate dehydrogenase) was assessed. A slight decrease in the activity of the enzyme succinate dehydrogenase, which is part of the second complex of the mitochondrial respiratory chain, was determined. The activity of the enzyme а-glycerophosphate dehydrogenase was more significantly reduced, an increase in the activity of lactate dehydrogenase was noted. In the presented observation, along with the typical manifestations of the disease (contractures of the hands and feet, ophthalmoplegia, ptosis of the eyelids, visual impairment), polyneuropathy with impaired sensitivity of the polyneuritic type was revealed. Thus, a patient with polyneuropathy had a hereditary type 5 arthrogryposis disease. Along with the typical manifestations of the disease, polyneuropathy with hyporeflexia and impaired sensitivity of the polyneuritic type was revealed. Secondary mitochondrial disorders were identified, which was the basis for the appointment of energotropic therapy.
Consilium Medicum. 2021;23(2):181-183
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The ARISTOTLE trial celebrates 10 years

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Consilium Medicum. 2021;23(2):184-185
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Pamyati Lyudmily Vital'evny Stakhovskoy

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Consilium Medicum. 2021;23(2):188
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