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CARDIOEMBOLIC STROKE: DIAGNOSIS AND TREATMENT
NUROVA ZARNIGOR KHIKMATOVNA
Scientific applicant of the Department of Neurology, Bukhara State Medical Institute. City of Bukhara of the Republic of Uzbekistan.
ORCID ID 0000-0002-2434-2887 KHODZHAEVA DILBAR TADJIEVNA Doctor of Medical Sciences, Professor, Head of the Department of Neurology, Psychiatry, Narcology, Medical Genetics and Medical Psychology of the Bukhara State Medical Institute. Bukhara. Republic of
Uzbekistan. ORCID ID 0000-0002-5883-9533 ANNOTATION
Globally, studies are being conducted to study the risk factors and clinical-functional characteristics of cardioembolic stroke in order to develop an algorithm for comparative diagnosis and pre-clinical prediction of patients in the acute period of the disease. The complexity of the diagnosis in the case of a combination of atrial fibrillation and stroke is often associated with a more obvious manifestation of brain symptoms, in this case, success in preventing complications from the heart and brain depends on the timely and correct identification of risk factors with the rational use of modern diagnostic methods. It is important to study the risk factors for the combination of atrial fibrillation and stroke, which in turn indicates the need for further research.
Keywords: cardioembolic stroke, brain symptoms, risk factors, atrial fibrillation.
КАРДИОЭМБОЛИЧЕСКИЙ ИНСУЛЬТ: ДИАГНОСТИКА И ЛЕЧЕНИЕ
НУРОВА ЗАРНИГОРХИКМАТОВНА
Научный соискатель кафедры неврологии Бухарского государственный медицинский институт. Город Бухара Республики Узбекистан. ORCID Ю 0000-0002-2434-2887
ХОДЖАЕВА ДИЛБАР ТАДЖИЕВНА доктор медицинских наук, профессор, заведующая кафедрой неврологии, психиатрии, наркологии, медицинской генетики и медицинской психологии Бухарского государственного медицинского института. Бухара. Республика Узбекистан.
ОИОЮ Ю 0000-0002-5883-9533 АННОТАЦИЯ
Во всем мире проводятся исследования по изучению факторов риска и клинико-функциональных характеристик кардиоэмболического инсульта с целью разработки алгоритма сравнительной диагностики и доклинического прогнозирования пациентов в остром периоде заболевания. Сложность диагностики в случае сочетания мерцательной аритмии и инсульта часто связана с более очевидным проявлением симптомов головного мозга, в этом случае успех в профилактике осложнений со стороны сердца и мозга зависит от своевременного и правильного выявления факторов риска при рациональном использовании современных методов диагностики. Важно изучить факторы риска сочетания мерцательной аритмии и инсульта, что в свою очередь говорит о необходимости дальнейших исследований.
Ключевые слова: кардиоэмболический инсульт, симптомы головного мозга, факторы риска, мерцательная аритмия.
КАРДИОЭМБОЛИК ИНСУЛЬТ: ТАШХИС ВА ДАВОЛАШ
НУРОВА ЗАРНИГОРХИКМАТОВНА
Неврология кафедраси мустацил изланувчиси, Бухоро давлат тиббиёт институти, Бухоро ш., Узбекистон Республикаси.
ORCID ID 0000-0002-2434-2887 ХОДЖАЕВА ДИЛБАР ТАДЖИЕВНА Т.ф.д., профессор, Неврология кафедраси мудири, Бухоро давлат тиббиёт институти, Бухоро ш., Узбекистон Республикаси. ORCID ID 0000-0002-5883-9533 АННОТАЦИЯ
Бутун дунёда кардиоэмболик инсультни уткир даврда циёсий ташхислаш ва клиник башорат цилиш учун алгоритмларни яратишда уни келтириб чицарувчи хавф омиллари ва клиник функционал характеристикаларини урганиш муцим саналади. Xилпилловчи аритмия ва инсульт биргаликда келганда ташхис цуйишнинг цийинлиги мия билан боглиц симптомларнинг устунлик цилиши цисобланади. Xилпилловчи аритмия ва инсультнинг барча цавф омилларини урганиб чициш зарур, бу эса кейинги тадцицотларни талаб цилади.
Калит сузлар: кардиоэмболик инсульт, бош мия симптомлари головного мозга, хавф омиллари, цилпилловчи аритмия.
The relevance of the problem.
In recent years, the quality of medical care for the population has improved in our country, targeted, large-scale measures have been taken for the effective treatment of diseases, and modern technologies have been introduced, which made it possible to achieve significant positive results. In the diagnosis and treatment of ischemic stroke with atrial fibrillation, a wide range of program measures have been implemented, as a result of which the diagnostic criteria that are important for evaluating
the outcome of the disease have been determined. Currently, it is planned to further improve the provision of medical assistance to the population of the country, including assistance to people with ischemic stroke in old age, in accordance with the Action Strategy on five priority areas of development of the Republic of Uzbekistan in 2017-2022.
Materials and methods of research.
The study was conducted at the Bukhara Multidisciplinary Medical Center in the Department of Neurology. We examined and treated 160 patients aged 26 to 75 years with ischemic stroke who were admitted to the intensive care unit through the emergency medical care channel. In the NRO, the Hunt -Hess scale and the Glasgow coma scale were used to objectify the severity of the patients ' condition and the severity of neurological deficits. The intensity of the pain syndrome was carried out according to a ten-point visual analog pain scale. The diagnosis of Cardioembolic stroke was established on the basis of complaints, clinical criteria (neurological examination with the assessment of the severity of cerebral, meningeal, focal symptoms), palpation and auscultation of the study available sections of the carotid arteries in the neck, the data of additional research methods (laboratory blood tests, EKG, Echo-EG, Doppler ultrasound, TCD, skull x-ray, CT scan of the brain).The study was based on 160 patients with CEI. Of these, 95 women(63.6 %),65 men (36.4%). The study was conducted at the Bukhara Multidisciplinary Medical Center in the Department of Neurology. All patients underwent a course of treatment for the purpose of neuroprotective therapy: cytoflavin 10 ml (on 5% glucose intravenously drip 1 time a day, gliatilin 1000 mg intravenously drip on saline solution 1 time a day. Cytoflavin and gliatilin were introduced in the first half of the day. From day 16 until discharge, patients continued to receive cytoflavin. They also received basic therapy at the same time. Basic therapy of cardioembolic stroke included correction of blood pressure,
maintenance of normovolemia, use of anticoagulants and antiplatelet agents.
Results and discussions. The study was based on data from a prospective analysis of the clinical examination and treatment of 160 patients with CEI. By simple randomization, patients will be divided into the main and control groups that received different treatment regimens. The criteria for inclusion of patients in the study were AI, acute and acute periods, the ability to perform locomotor functions and psychoneurological tests. All patients were conscious at the time of the examination and were available for verbal contact. The study was conducted with the consent of patients and did not contradict generally accepted ethical standards.85 patients of the main group received basic and combined neuroprotective therapy. Basic therapy of ischemic stroke included correction of blood pressure, maintenance of normovolemia, control of glycemia and body temperature, according to indications, treatment of brain edema and nutritional support, use of anticoagulants and antiplatelet agents. Combined neuroprotective therapy consisted of the use of 10 ml of cytoflavin (succinic acid 1000 mg, inosine 200 mg, nicotinamide 100 mg, riboflavin mononucleotide sodium 20 mg) on 5% glucose intravenously drip 1 time per day; gliatilin 1000 mg intravenously drip on saline solution 1 time per day; actovegin 200 mg intravenously jet 1 time per day.
Cytoflavin and gliatilin were administered in the first half of the day, actovegin-in the second. From day 16 until discharge, patients continued to receive cytoflavin.75 patients of the control group received standard treatment, which included a similarbasic therapy to the main group, and throughout the inpatient period neuroprotective therapy with ethylmethylhydroxypyridine succinate (mexidol) or cytoflavin. Indications for combined neuroprotective therapy CEI in the acute period were developed based on the analysis of its effectiveness.
Conclusion. Thus, the use of neuroprotective therapy in the acute period of cardioembolic stroke led to a decrease in disability and mortality of patients. As a result of the study, on the basis of a comprehensive systemapproach, the concept of the acute period of CEI as a complex system consisting of a complex of synergistic elements that allows predicting the course, complications and outcomes of the disease, including in the conditions of optimizing neuroprotective therapy, was developed.
Distribution of patients by age and gender.
13+heart pathologies BIS
Clinical studies have shown that rapid screening and immediate therapy can improve clinical outcomes in stroke patients. Early detection of stroke and the use of neuroprotective treatments have improved patients ' lives. Cognitive impairment in the acute period of primary ischemic stroke was present in 70.1% of patients, while in 33.0% of cases they had mild cognitive disorders, in 56.4% -moderate and in 10.6% -severe. In 73.4% of patients with ischemic stroke with cognitive impairment, hemispheric localization of brain infarction was observed. By the end of the follow-up year, cognitive deficits persisted in 70.2% of patients with ischemic stroke.Patients in the early recovery period of the first hemispheric ischemic stroke are characterized by cognitive disorders
of varying severity. At the same time, their main clinical features are a disorder of regulatory and neurodynamic processes, as well as a violation of visual-spatial functions, short-term memory and speech fluency. Primary mnestic disorders occur in some patients and may be caused by a concomitant neurodegenerative process. Recovery of cognitive functions under the influence of therapy is more favorable in patients with a mild degree of neurological deficit, with right-sidedlocalization of the focus of stroke, moderate severity of cognitive disorders, the absence of primary mnestic disorders, at the age of 60 years.In the early recovery period of ischemic stroke in the central leads increased relative to the age norm, whichis associated with a decrease in cognitive functions of patients. An increase in the central leads is an unfavorable prognostic sign of the restoration of regulatory and neurodynamic processes. The use of cytoflavin in the early recovery period of ischemic stroke leads to improvement and normalization of cognitive processes, including regulatory and visual-spatial functions, short-term memory, semantic verbal fluency and contributes to social readaptation of patients.The use of the drug ipidacrinin in theearly recovery period of ischemic stroke has a pronounced positive effect on cognitive functions, including regulatory, neurodynamic, mnestic processes, which is combined with a decrease in latency in the central leads, and also leads to an increase in daily activity and independence of patients. Thus, the treatment of CEI should be comprehensive and include measures aimed at maintaining vital functions, adequate management of existing cardiovascular and other somatic diseases, restoration of cerebral blood flow and neuroprotection. An important role in the treatment of CEI is played by antiplatelet drugs, which should be prescribed already in the first hours after the onset of symptoms of AI. The use of thrombolysis and the latest recanalization methods improve the prognosis of CEI. And such minimally invasive interventions as percutaneous transcatheter occlusion
of the auricle of the left atrium and percutaneous transcatheter closure of the oval opening will reduce the number of repeated CEI.
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