Vol 22, No 9 (2020)

Aim. To study the quality of care for stroke patients in the Moscow region in 2005, 2015 and 2019. Materials and methods. Annual reports, medical documents of 5 vascular centers, the Moscow regional medical information and analytical center were studied. Results. In 2005-2019, the incidence of acute cerebrovascular accident was at the level of 3.7-4.4 per 1 thousand population per year, the number of patients increased from 28.5 to 33.7 thousand, and the mortality rate decreased from 27.1 to 21.1%. In 2019, 38 vascular centers were functioning, and the profile hospitalization rate was 82.1%. The required volume of studies in 2005 was conducted in 5-51%, in 2015 - in 45-95%, in 2019 - in all patients, the number of systemic thrombolysis increased from 3 in 2015 to 10% in 2019. The subtype Determination by TOAST in 2015 was performed in 35, in 2019 - 47%. The number of patients prescribed secondary prevention increased from 40 to 87% (p<0.05). A decrease in the rating on the Rankin scale of at least 1 point was observed in 65, 80 and 97% of patients, respectively. Conclusion. There was an increase in the proportion of profile hospitalization of patients from 5.1% to 82.1%, but in the first 4.5 hours - less than a third, which limits the possibility of thrombolysis. There is an insufficient number of patients who have a subtype defined by TOAST, which leads to omissions in treatment tactics and a decrease in the effectiveness of secondary prevention. We believe it is important that the secondary prevention program be included in the discharge papers.

Background. During the study of cognitive functions in patients with post-traumatic epilepsy, in most cases moderate cognitive impairments are noted. With the repetition of epileptic seizures up to 3-5 times a week, more pronounced cognitive decline is determined. Cognitive deficit in such patients increases due to long use of anticonvulsants. In the pathogenesis of cognitive impairment in post-traumatic epilepsy further processes are important: local cerebral vasospasm, metabolic disturbances at the cellular and molecular levels in the brain matter and shifts in the functioning of mediator systems in brain's cortical-subcortical departments. In this regard, important directions of pathogenetic therapy of the indicated contingent of patients are: correction of intracerebral hemodynamics and angioprotection, normalization of neurometabolism, correction of cortical-subcortical interhemispheric interconnections, achievement of a balance of epileptic and antiepileptic systems. Aim. To analyze the effectiveness of the treatment of cognitive and psycho-emotional disorders in post-traumatic epilepsy in patients, who have had a mild traumatic brain injury, while taking anticonvulsants, in particular topamax, by including a drug of cortexin multimodal action in the treatment scheme, based on the results of a neuropsychological examination. Materials and methods. The indicated treatment was carried out to 71 patients of the main group, in combination with traditional therapy (dehydrating, vasoactive, metabolic drugs, vitamin therapy). The control group consisted of 30 patients with the consequences of a mild traumatic brain injury in the form of an epileptic syndrome, who took only traditional therapy, including anticonvulsants. The effectiveness of the recommended therapy was judged on the basis of changes in neuropsychological parameters and sensorimotor functions. Results. When analyzing the state of cognitive functions during treatment with cortexin, a significant improvement in neuropsychological tests execution was revealed. Significant recovery of autonomic disorders has also been observed. In addition, the results obtained indicate a beneficial effect of the drug on motor functions and balance, in particular on postural instability. Conclusions. Thus, the early use of cortexin is an effective direction in the prevention and treatment of cognitive impairment in post-traumatic epilepsy.

The article is devoted to the problem of post-stroke apathy, which is recognized as an important neuropsychiatric syndrome, which is associated with its impact on the effectiveness of rehabilitation, social adaptation of the patient, and return to work activity. The paper presents literature data on the prevalence, clinical manifestations, and diagnostic criteria of post-stroke apathy, its Association with age, gender, depression, and cognitive dysfunction. The article deals with the pathogenesis of post-stroke apathy, the relationship with the localization of the brain lesion, the severity of stroke, the directions of treatment and prognosis.

The article presents a review of the literature on the goals and possibilities of statin and nonstatin hypolipidemic therapy, as well as their combination in cerebrovascular diseases associated with dyslipidemia. The issues of safety of the combined lipid-lowering strategy on the possibility of primary and secondary prevention of cerebrovascular accidents (ischemic and hemorrhagic strokes, as well as transient ischemic attack) are discussed.

The article is devoted to the diagnosis and treatment of the most prevalent form of cephalalgia - tension headache (TH) in the outpatient practice of a general practitioner. The information presented is in accordance with the Resolution of the council of Russian experts on the diagnosis and treatment of patients with headache at the primary care stage. Along with the diagnostic criteria of the latest International Classification of Headache (3rd Edition, 2018) and an example of an effective clinical interview, it provides a list of "danger signals", a detailed diagnostic algorithm, common diagnostic errors, indications for additional examinations and patient referral to a neurologist and cephalgologist. Clinical manifestations, provocateurs, risk factors for the onset and chronicity of TH are provided. The article also describes basic mechanisms of TH pathophysiology, including the role of pericranial muscle dysfunction in the development of pain syndrome. Evidence-based approaches to the therapy of TH are presented - behavioral therapy, relief of seizures, preventive pharmacological and non-drug treatment. Special attention is paid to the advantages of Ketoprofen in the relief of painful episodes and the muscle relaxant Tizanidine in the treatment of pericranial muscle tension.

Tension headache (TH) is a neurological disorder characterized by attacks of mild to moderate headache with few associated symptoms. According to the data of 5 population studies, TH lifetime prevalence in adults is 46% (range 12-78%). The underlying cause of TH is unknown. Diagnosis is based on history and examination. Many patients self-manage their acute attacks and seek medical care when attacks become frequent or chronic. Behavioral therapy, relief of pain episodes and preventive treatment are recommended for HT treatment. Acute attacks of TH are usually treated with simple analgesics (paracetamol, acetylsalicylic acid) or non-steroidal anti-inflammatory drugs [ibuprofen, ketoprofen, naproxen]. The situation with pain relief in TH has changed with the emergence of fastacting forms of non-steroidal anti-inflammatory drugs, in particular ibuprofen, since rapidly absorbing salts of ibuprofen act significantly faster, have a more pronounced and prolonged analgesic effect.

Osteoarthritis (OA) is a chronic, progressive disease that usually affects the hands, knee and hip joints, causing severe pain and significantly reducing the quality of life of patients. Topical non-steroidal anti-inflammatory drugs (NSAIDs) are widely represented in international guidelines as the first step of anti-inflammatory therapy for OA. Thus, the American College of Rheumatology (ACR) strongly recommends topical NSAIDs for patients with knee OA and conventionally for patients with hand OA. In accordance with the principle that drugs with the least systemic effect are preferred, topical NSAIDs are the first step in anti-inflammatory therapy for OA of these localizations. In addition, ACR recommends that people age 75 and older use topical rather than oral NSAIDs; elderly patients often have comorbidities and/or an increased risk for cardiovascular, gastrointestinal, or renal complications. The Osteoarthritis Research Society International (OARSI) classifies the use of topical NSAIDs as a recommendation of the highest level (1A). This method is strongly recommended for patients with knee OA without concomitant diseases and with concomitant diseases of the gastrointestinal tract or cardiovascular system. Topical NSAIDs are recommended more strongly than all oral analgesics due to their favorable balance of efficacy and tolerability.

Posttraumatic progressive cystic myelopathy is a rare condition that occurs after a spinal cord injury, leading to an increase in neurological deficit and aggravation of disability. In the pathogenesis lies the formation of a single large cyst, multiple small cysts or softening of the spinal cord (myelomalacia). The article describes a clinical case of progressive ascending posttraumatic syringomyelia. Questions of the clinical picture, the course of condition, the features of diagnosis and the results of treatment are discussed.