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Clinical and doppler sonography comparisons in patients with migraine
Список литературы:
1. Адриановская, Н. В. Отдаленные результаты хирургического лечения и их прогнозирование у больных диффузным токсическим зобом//- 14.00.27 - Пермь, 2007.
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Kalashnikov Valeriy Iosifovich, Kharkiv Medical Academy of Postgraduate Education,
Kharkiv, Ukraine E-mail: val_kalash@mail.ru
Clinical and doppler sonography comparisons in patients with migraine
Abstract: We performed clinical and Doppler sonography examinations of104 patients with migraine aged 16 to 45 years. According to the Doppler examination, in patients with migraine without aura, vasospastic reactions in middle cerebral artery predominated; patients with migraine with aura more often have difficulties with perfusion in middle cerebral and vertebral arteries. Patients in both
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Section 1. Clinical medicine
groups had excessive blood supply in external carotid arteries, superior ophthalmic veins, basal veins of Rosenthal and direct sinus.
Keywords: Doppler, transcranial duplex scanning, cerebral hemodynamics, migraine
Migraine is one of the best-known and most common neurological diseases occurring in the adult population with an average incidence of 12% [1, 638-645]. Migraine is one of the most common forms of headaches, and significantly reduces the quality of life of patients. Headache is the initial symptom of the majority ofvascular diseases of the brain; hence, diagnosis of the causes of headache becomes essential for preventing the development ofvascular disease [2, 493-494]. Migraine attack begins with the so-called cortical spreading depression of Leao. The phenomenon of cortical depression is triggered by various stimuli and occurs in the occipital cortex, where a focus of neuronal depolarization is formed that progressively spreads across the surface of the frontal lobe of the cortex. The change in cerebral blood flow during a migraine attack is similar to the stages of spreading depression. It is believed that the root cause of the attack is neurogenic due to changes in the metabolism and function of the cortex [3, 318-320]. Released from thrombocyte(s), serotonin causes narrowing of large arteries, veins, expanding at the same time the small vessels of the brain [4, 187]. Actual in the modern conditions is the question of studying cerebral hemodynamics in patients with migraine. The results of the studies are contradictory. In paper [5, 141-147], the ultrasound examination revealed an increase in blood flow indices in the ophthalmic artery and the external carotid artery. In this study, no significant differences were detected in patients with migraine with and without aura. In study [6, 680-685], patients with migraine without aura showed an increase in blood flow velocity parameters and decrease in the index of pulsation in the arteries of the base of the brain, and in the group with migraine with aura - reduced speed performance and increased indices of peripheral resistance. Some authors have not noted changes in the indices of cerebral blood flow at the time of the attack [7, 37-40]. The available published data contain no results of a comprehensive study of the arterial and venous hemodynamics in patients with different types of migraine paroxysms (migraine wi-
thout aura and migraine with aura). All mentioned above makes our research actual.
Purpose of the study
To study cerebral hemodynamics using transcranial duplex scanning in patients with different types of migraine paroxysms.
Design of the study
Complex examination of 104 patients aged 16 to 45 years (41 men and 63 women). Criteria for inclusion of patients in the study were: migraine without aura (group 1-59 patients), migraine with aura (group 2-45 patients), in accordance with the criteria of the international classification of headaches. All patients underwent clinical neurological examination. The intensity of cephalic syndrome was assessed using a visual analog scale and a headache diary filled out by the patient himself. To determine the severity of the condition at the time of attack we used the MIDAS scale that describes the degree of decrease in the functional activity of the patient with migraine. Hemodynamics in extra- and intracranial arteries and veins was studied using an ultrasonic device «Ultima PA» (^ADMIR, Ukraine) and transcranial Doppler device “Angiodin” (BIOSS, Russia). We investigated the performance of the linear blood flow velocity (BFV), resistance index (RI) in the internal carotid arteries (ICA), middle cerebral (MCA), external carotid (ECA), vertebral artery (VA) and systolic blood flow velocity (SBFV) in superior ophthalmic veins (SOV), vertebral veins (VV), Rosenthal basal veins (BV) and straight sinus (SS). The study results were processed by variation statistics with the calculation of arithmetical mean values: M m, sigma, using spreadsheets «Exel-5”.
Results and discussion
Characteristics ofpain in the period offit in patients with migraine has the following features. In both groups dominated the orbitofrontal-temporal localization of pain (92.6% in group 1, 97.4% in group 2). The pulsating type of pain was observed in 78.9% of patients in group 1 and 85.4% of patients in group 2, bursting - in 5.6% and 3.4%, their combination - in 15.5% and 11.3 % (p <0.001). Predominantly
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Clinical and doppler sonography comparisons in patients with migraine
left-sided localization of the pain attack occurs in 38.4% of patients in group 1 and 29.6% of patients in group 2, mainly right-sided - respectively in 31.2% and 43.7%, alternating sides - 10.4 % and 6.7% (p <0.001). Attacks on awakening occurred in 46.9% of patients in group 1 and 31.2% ofpatients in group 2, the daily attacks - respectively, 40.6% and 53.4%, in the night - 12.5% and 15.4% (p <0.001). Associated symptoms of migraine attack were presented in the form of photophobia (81.3% and 88.4%), phono-phobia (77.2 and 80.8%), the feeling of pulsation in the head (56,3 and 49,7%), nausea and vomiting (48.9% and 57.4%), dizziness and instability when walking (45.2% and 40.6%), senestopathic syndrome (28.7% and 34.4%), vegetative disorders (27.1% and 23.8%) (p <0.001). The attacks were stopped after administering combinations of analgesics and antimigraine drugs of triptane series (44.9% and 48.6%), spontaneous arresting of the attack during sleep was observed not so often (31.8 and 38.6).
Patients with migraine in the interictal period in addition to the basic complaints presented the following types of claims: dizziness, insomnia, decreased performance, increased fatigue, emotional instability, pain in the heart. Dizziness, as a rule, of non-systemic nature, was occasionally observed in 30.2% of patients of group 1 and 41.8% of patients in group 2, and in a number of cases was accompanied by impaired coordination. Unstable noise in the head bothered respectively 21.4% and 19.2% of patients, in rare cases the noise appeared with increasing blood pressure. Sleep disorders in the form of difficulty in falling asleep, restless, intermittent, superficial sleep occurred in 15.2% of patients in group 1 and 16.8% of patients in group 2.
Fatigue, weakness, decreased performance harassed 42.8% of patients in group 1 and 50.3% of patients in group 2, emotional instability, irritability, tearfulness - respectively, 39.7% and 40.4% of patients. Complaints about the confusion, memory and attention loss was presented 12.4% of patients in group 1 and 11.6% of patients in group 2.
The neurological status of patients of groups 1 and 2 revealed: the revival of tendon reflexes - respectively, 58.7% and 68.1% of cases, vegetative stigma - in 54.6% and 49.2%, staggering in Romberg
- 23.4% and 18.1%, light oculomotor disturbances
- in 16.2% and 15.7%, light asymmetry of facial muscles - in 12.5% and 9.6% of patients.
A study of BFV performance in cerebral arteries revealed the following patterns. In the patients of both groups the values of BFV and RI in ICA did not differ from the normal values; also did not differ from the normal the values of RI in VA in both groups; in the 1st group the values of blood flow in MCA somewhat exceeded those in the control group, the values of RI thereat were below standard. Patients in group 2 showed a decrease in the speed values in MCA, VA, with an increase in this group of RI values in MCA; also in this group, most patients (58.9%) had asymmetry of the flow rate (25-30%) in MCA and VA. Speed and performance parameters of RI in ECA were reduced in both groups, which is probably due to their extension in the time of attack.
Cerebral venous hemodynamics in the studied groups was characterized by increased outflow in superior ophthalmic veins, mainly in patients with migraine with aura, as well as the basal veins of Rosenthal and direct sinus; to a greater extent in patients with migraine without aura. The values of venous outflow in the vertebral veins did not differ from the standard.
Conclusions:
1. Patients with migraine with aura expressed to a greater extent than patients with migraine without aura the following symptoms of migraine attack: the presence of a provoking factor, nausea and vomiting, phonophobia and photophobia.
2. Cerebral hemodynamics in the middle cerebral artery in the migraine attack is characterized by a pattern of vasospasm in migraine without aura and hampered perfusion pattern in migraine with aura.
3. Specific feature of hemodynamics in migraine attacks is an excessive blood supply in external carotid arteries.
4. Patients in both clinical groups manifested excessive perfusion in supra ophthalmic veins, basal veins of Rosenthal and direct sinus.
5. A comprehensive study of arterial and venous hemodynamics in patients with migraine helps to clarify pathogenic mechanisms in different types of migraine attack.
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Section 1. Clinical medicine
References:
1. Lipton R.B., Diamond S., Reed M., et al. Migraine diagnosis and treatment: results from the American Migraine Study II. Headache. 2001;41:638-645.
2. Lipton R.B., Pan J. Is migraine a progressive brain disease? (editorial). JAMA. 2004;291:493-494.
3. Olesen J. Cerebral blood flow in migraine with aura // Pathol. Biol. - 1992; 40 (4): 318-324.
4. Dimitriadou V. Ultrastructural evidence for permeability and neuroinflammatory changes within the dura mater and tongue after trigeminal sensory fiber stimulation // Neurosci. - 1992; 48: 187.
5. De Benedttis G., Ferrari Da Passano C., Granata G., Lorenzetti A. CBF chandes during headache-free periods and spontaneous-induced attacks in migraine with and without aura: a TCD and SPECT com-prasion study. J.Neurosurg.Sci. 1999. V. 43 (2). P. 141-147.
6. Zanette E.M., Agnoli A., Roberti C., Chiarotti F., Cerbo R., Fieschi C. Transcranial Doppler in spontaneous attack of migraine Stroke. 1992. V.23 (5). P. 680-685.
7. Silverstrini M., Matteis M., Troisi E., Cupini L.M., Bernardi G. Cerebrovascular react. in migraine with and without aura. Headache. 1996. V. 36 (1). P. 37-40.
Zubritskiy Vladislav Feliksovich, Moscow Medical Institute of Postgraduate Medical, Head of the Department of Surgery, professor E-mail: kdortt@gmail.com Koltovich Alexei Petrovich, MD, chief of coloproctological department FKUZ “Main Military Clinical Hospital of the Russian Interior Troops”
Nikolaev Konstantin Nikolaevich, MD, a senior surgeon FKUZ “3 Military Clinical Hospital
of the Russian Interior Troops” Kapustin Sergej Igorevich, Doctor of Biological Sciences, Head of the Laboratory FGBI “Russian Research Institute of Hematology and Blood
Transfusion FMBA of Russia “ Vardanjan Arshak Vardanovich, MD, Professor of Surgery, Russian Medical Academy
of Postgraduate Education Borodin Igor Anatolevich, Head of the branch clinic “Gazprom”
Prevention of venous thromboembolic events in wounded from firearms-governmental vertebral fractures
Abstract: The analysis of the results of modern methods of prevention of venous thromboembolic events (VTEC) in 47 wounded with gunshot fractures of the spine, obtained during the conduct of hostilities in different stages of their treatment. Comprehensive prevention VTEC for the duration of the treatment phases evacuation reduced the incidence of venous thrombosis by 16.9%. In 55.6% of wounded with venous thrombosis identified genetic defects of the hemostatic system.
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