Vol 8, No 3 (2014)

The study is aimed at identifying various parameters of carbohydrate metabolism in acute stroke setting. We found that episodes of hyperglycemia often precede cerebrovascular events. Glycated hemoglobin levels correlate with the clinical course of stroke, including the outcome of post-stroke rehabilitation. Onset of diabetes may coincide with stroke episode.

We present results of clinical and laboratory evaluation of acute stroke patients with type 2 diabetes and metabolic syndrome (MS). Neurological deficit was assessed with NIHSS and SSS, laboratory panel included primary characteristics of hemorheology and hemostasis: platelet aggregation, beta-thromboglobulin, platelet factor 4, Von Willebrand factor, RBC aggregation and deformability. We found that disturbances of carbohydrate metabolism in patients with diabetes and MS affect all major pathways of hemorheology and hemostasis and lead to dysfunction of platelets, RBCs and endothelium. These changes along with the others metabolic abnormalities make an impact on clinical course of stroke and may significantly affect outcome due to the prolonged recovery and high rate of residual deficit.

Corticospinal tract (CST) is the major brain pathway yielding motor activity; however, functional role of the CST and other pathways in the implementation of such a socially important function as walking in patients with stroke is not completely clear. Following the CST lesion the process of recovery involves not only CST on both sides but also other pathways, including the extrapyramidal tracts: corticoreticular (CRP) and corticorubrospinal (CRSP) pathways. With the help of modern neurovisualization methods we showed that Wallerian degeneration of the CST is not the only predictor of poor recovery of motor function after stroke, whereas a compensatory increase in fiber volume of CRP on the opposite side may improve recovery of affected leg. Further studies of the functional significance of brain pathways including the CRP and CRSP in the recovery of post-stroke walking function will clarify th mechanisms of neuroplasticity and predictors of recovery to optimize the personalized approach to rehabilitation.

The Kaluga region is an area with high risk for multiple sclerosis (MS). We demonstrated the prognostic role of type of a MS debut and duration of the first remission for the clinical course of the disease. There was no association between the mean annual relapse rate and mean annual rate of MS progression. In patients with various MS variants were found decreased retinal nerve fibers layer thickness in all sectors, most prominent in the temporal sector, and the reduction of macular volume. We showed the role of optical coherent tomography and the visual evoked potentials for early diagnostics of multiple sclerosis and for monitoring of demyelination and neurodegeneration of optic nerve and in CNS in general.

Traumatic injury of frontal lobes has severe impact on social adaptation due to alterations in cognitive function and behavior. Considering the low efficacy of conventional rehabilitation methods, the development of complementary approaches is needed. Rhythmic transcranial magnetic stimulation (rTMS) is known to improve short and long-term memory, processing speed, problem solving in dementia. However, the trials show conflicting results that might be caused by lack of individualization as the target of stimulation is defined exclusively on the base of anatomy. We used fMRI-guided rTMS of the left dorsolateral prefrontal area to ameliorate consequences of traumatic injury of the frontal lobes. Case report demonstrating the efficacy of this method is presented. Significant improvement was observedafter 15 sessions of rTMS in patient with severe traumatic brain injury who gained an increase in cognitive speed, development of ability to summarize and acquire experience, improvement in planning, control and error correction.