Vol 17, No 9 (2015)

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.

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.

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.

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.

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.

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.

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.

Eagle syndrome mimics tregiminal neuralgia, which requires a multidisciplinary approach to diagnosis and treatment of chronic pain in the facial area.

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.

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.

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.

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.

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.

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.