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Neuropsychological and electroencephalographic correlates of damaged and intact hemisphere in left hemisphere insult
Draws attention to the identification in 18 (60,00 ± 8,94%) of the main group of pregnant women to increase vascular resistance in umbilical artery. At the same time an increase in vascular resistance in fruit-placental link to the UA (umbilical artery) was characterized by ADR greater than 3.0, RI — more than 0.67, more than 0.90 UA (umbilical artery).
Patients of the main group there was a significant change in the ADR 3,27 ± 0,20), RI (0,73 ± 0,03) and PI (1,05 ± 0,05). In the comparison group these indicators were: ADR (2,20 ± 0,11), RI (0,53 ± 0,02) and PI (0,75 ± 0,04), (p <0.001).
Analysis of the research showed that when evaluating CSC in fetal umbilical artery in the main group of the most characteristic of all the increase in vascular resistance index.
The increase in RI in the umbilical artery, exceeds the norm, a sign of violations of fruit-placental blood flow dopplerograms. In the comparison group violation fruit-placental blood flow was observed in 10% of cases, while in both cases there was a questionable biophysical profile of the fetus. In 90% of the violations were found (p <0.001).
Comparative analysis of vascular resistance in the UA there is an increase it by 6 times in the intervention group relative to the
comparison group. It should be stressed that this reveals within the placenta combined disturbance of blood flow.
Thus, with prolonged pregnancy fruit hemodynamic changes consistently. Initially, when the fruit unchanged hemodynamic disturbances observed within the placenta blood flow due to the fruit unit (umbilical artery). To further develop the mechanism of centralization of blood circulation: the compensatory decreases resistance in the blood vessels of the brain, there is an isolated change in blood flow in the middle cerebral artery [4, 1-2].
In general, as shown by our study, in the study group increased frequency of adverse perinatal outcomes, which are further compounded by the detection of changes in the Doppler hemodynamics fruit [2, 3-4].
Conclusions: 1. Pregnant with gestational age over 40 weeks, it is necessary to carry out Doppler study of fruit-placental blood flow and the study parameters BFF (biophysical profile of the fetus) for more accurate assessment of the state of the fetus and compensatory possibilities.
2. Timely identify disorders of fetus in prolonged pregnancy will predict the deterioration of the fetus during labor and violation during the neonatal period.
References:
1. Attila C Stepankovo EA Sichinava LG Doppler study of uterine blood flow in the diagnosis of postpartum endometritis//Questions of gynecology, obstetrics and perinatology. - 2002. № 2. - S. 32-35.
2. Bolshakov EE Predicting perinatal outcomes and obstetric tactics in prolonged pregnancy: Author. ... Cand. honey. Sciences: 14.00.01. -M., 1998. - 23 p.
3. Reznichenko GI Differential diagnosis, tactics and prediction of the outcome of labor in post-term and prolonged pregnancy: Author. .Cand. honey. Sciences: 14.00.01. - Kyiv, 1999. - 21 p.
4. Timokhina TF, OR Baev Prolonged pregnancy: diagnosis, tactics and methods of delivery//Questions of gynecology, obstetrics and perinatology. - 2003. - T. 2, № 2. - S. 37-43.
Mamadaliev Akmal,
Department of Neural Diseases of the Andijan medical institute
E-mail: [email protected]
Neuropsychological and electroencephalographic correlates of damaged and intact hemisphere in left hemisphere insult
Abstract: We studied neuropsychological and electroencephalographic correlates of the damaged and intact hemisphere of brain in ishemic insult cases. In dynamics we studied the structure of neuropsychological symptoms of hemispheric insult taking into account the lateralization of the damage focus. We revealed an interrelation between highest cerebral functional disorders and EEG alterations in the damaged and intact hemispheres, we studied inter hemispheric mechanisms of restoration of the damaged cerebral functions.
Keywords: hemispheric insult, neuropsychological syndromes, electroencephalography, hemispheric interrelation, vicari-ate mechanism
The problem of cerebral ischemic insult is one of the actual ones due to the high prevalence, invalidation, and lethality rates. Post insult neuropsychological impairments also serve to be one of the main reasons of invalidation, as the tempus of functional recovery mostly depends on the presence of the last [1, 4, 6]. In case of cerebral insult with hemispheric location there is inter hemispheric reconstruction of the highest cerebral functions (HCF), switching the plasticity mechanism on, accompanied by regress of several neuropsychological impairments [1; 2; 4; 7]. Though, the process of cerebral functions restoration in cerebral insult depends both on the lateralization of the focus, and individual profile of the asymmetry [3].
EEG studies in hemispheric insults performed taking into account hemispheric interrelation provided the chance of a more detailed study of brain intact hemisphere functional status, approach to vicariate mechanism [4-8]. It is necessary to study intact hemisphere dysfunction more thoroughly in hemispheric insults using EEG maping for revealing the vicariate mechanisms and definition of insult rehabilitation prognosis.
Objective of this work is study of neurophysiological and encephalography correlations of the damaged and intact hemispheres of brain in ischemic insults.
Materials and methods of the research. We examined 86 patients with hemispheric ischemic insult along the medial cerebral
Section 6. Medical science
artery. Among them 44 had left hemispheric insult (LHI), 42 with right hemispheric insult (RHI). Among them there were 46 men, and 40 women. The average age was 56±4.1 years old. The study was performed in two stages: the first stage — at the 3-5 days from the start of the disease, and the second one — at the 30-35th days. The cohort included patients with clear consciousness, and all checked patients with right profile of asymmetry. Neuropsychological study was performed in compliance with A. R. Lurya's method (1973). We studied verbal, gnostic, mnestic, and intellectual functions. We performed qualitative and quantitative analysis of the obtained data. Expression degree of neuropsychological impairments was assessed according to L. I. Wasserman's scale (1987). We calculated a mean summary point (MSP) of the damaged and intact hemispheres both for LHI and for RHI.
EEG maping was performed using "Neuron-spectrum-2" en-cephalograph. Electrodes were set in compliance with the international scheme 10-20 from 16 leads. The EEG record was done after liquidation of clinical symptoms of brain edema. In the analysis of EEG spectral components we paid attention to summary power of EEG spectrum, symmetrical frequency-energetic distribution ofpow-er of normal (a and p) and pathologic (8 and 0) waves, frequent-amplitude values ofEEG spectrum of the damaged and intact hemispheres. For the study of the functional activity of damaged and intact hemispheres of brain, patients were given verbal and non-verbal stimuli.
Statistical analysis of the results was performed with the help of Statistica 6.0 software.
The results of the research. As shown by neuripsychological studies during the initial weeks of insult all patients had disorders of HCF: in left hemispheric insult the symptoms of verbal-thinking operation disorders, and in right hemispheric one — disorders of optic -space gnosis. In LHI various forms of aphasia were observed in 97.7% of the patients, among them 44.1% sensory-motor, 23.25% — motor, and 32.65% sensory aphasia. At the same time there were impairments of hearing-verbal memory (68.2%), impairments of various forms of praxis (72.7%), and somato-sensory gnosis (81.28%).
In RHI optic-space impairments were noticed in 92.8% patients, versus 47.7% (p<0.001) in LHI. API were characterized by the presence of anosognosis and auto topognosis (82%), ignoring phenomenon (59%), disorder of right-left orientation (46.1%), space apraxis (83%), disorder of optic gnosis (33.3%), disorder of hearing-verbal memory (23%), and disorder of tactile gnosis (56.4%).
During initial weeks of insult MSP of neuropsychological symp-tomd in LHI was equal to 28.1, and in RHI 16.2 (p<0.05). In both cases in intact hemisphere we revealed disorders of HCF. Thus, MSP of neuropsychological symptoms of the intact hemisphere in LHI was equal to 19.2, and for RHI to 9.7 (p<0.05). The obtained data testify that the damage of one hemisphere leads to dysfunction of the opposite one, accompanied by appearance of several neuropsychological symptoms. Though, it should be noted that there was a reliable prevailing of the left hemispheric neuropsychological symptoms both in case of damage and intact status. We also revealed correlation link between the disorders of HCF of the damaged and intact hemispheres both in LHI and RHI: the greater and the more explicit was the neuropsychological symptoms' complex of the damaged hemisphere, the more expressed neuropsychological symptoms were observed in the intact hemisphere. Degree of HCF recovery depended on the lateralization
ofthe focus of damage, i. e. left hemisphere functions recovered faster than right hemispheric ones, proving high degree plasticity of that hemisphere and possible participation ofvicariate mechanism.
Electroencephalographic maping within initial weeks of insult showed more explicit alterations in LHI in comparison with the RHI. We revealed a reliable (p<0.01) decrease of alfa-rhythm power index in the left hemisphere of brain in comparison with the right one, accompanied by a reliable rise of asymmetry coefficient of the main EEG components. In comparative analysis of intact hemispheres EEG results we also determined that the more explicit alterations were noted in the left hemisphere. Consequently, the dysfunction of the left hemisphere was accompanied by more expressed alterations on EEG pattern, than the right one.
We studied the correlation link between neuropsychologi-cal impairments and the values of EEG main components. MSP of neuropsychological syndromes of the damaged hemisphere in LHI had a strong correlation with the alfa-rhythm power index (r = — 0.71 with p<0.001), at the same time all these values in RHI had weak correlation with each other (r= - 0.29 with p<0.05). Correlation between MSP of neuropsychological syndromes of the intact (left) hemisphere in RHI also showed a strong correlation link with the alfa-rhythm power index (r= — 0.68 with p<0.001), while in LHI neuropsychological syndromes of the intact (right) hemisphere had weak correlation with EEG values (r = - 0.25 with p<0.05). So, both in case of damaged and intact right hemisphere electroencephalographs impairments weakly correlate with neuropsychological ones, what is quite opposite for the left hemisphere of brain.
In our opinion, after development of insult vicariate mechanism is performed by means of inter system and intra system reconstruction of functional systems, inclusion of new parts, activation of associate centers of both damaged and intact hemispheres of brain. In case of right hemisphere damage optic-space afferentations are more activated, and in cases of the left hemisphere damage — verbal-thinking operations. Especially those cerebral functions, which are responsible for both hemispheres of brain, undergo functional reconstructions more effectively. And the role of preserved analy-zator systems is important. Projection and projection-associative centers in acute vascular damages have little inter systemic and intra systemic reconstruction of functional systems.
Conclusions:
1. With similar explicit acute ischemic insults the more expressed EEG alterations and neuropsychological impairments were observed in left hemispheric location of the focus. Left hemispheric insult leads to more expressed dysfunction of the right hemisphere, while the right hemispheric insult has less effect on the function of the left hemisphere.
2. Neuropsychological syndromes of the intact hemisphere develop independently from the lateralization of the focus of damage, but these are more expressed in left hemispheric location of the focus of damage. Alfa-rhythm power index has direct correlation with the severity of neuropsychological impairments of both damaged and intact hemisphere.
3. In case of ischemic insult of hemispheric location regression of neuropsychological impairments depends on the lateralization of the focus of damage and occurs faster in left hemispheric location of the insult. Consequently, vicariate mechanism works better in case of damage of the left hemisphere, rather than right one.
References:
1. Gusev E. I., Kamchatnov P. R. Plasticity of nerve system//Neurology and psychiatry journal under the name of S. S. Korsakov. - 2004. -№ 3 - P. 75-76.
Characteristics of multi spiral angiography in patients with multi focal atherosclerosis
2. Ibadullayev Z. R. Inter hemispheric functional asymmetry and neuropsychological syndromes in cerebral insults and the ways of its correction. Doct. dissert. Tashkent., 2005. P. 274.
3. Ibadullayev Z. R. Brain lateral organization profile and EEG values of inter hemispheric functional asymmetry in the acute stage of hemispheric ischemic insult. Throret. and clin. medicine journ. № 1, 2004. P. 10-13.
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5. Cuspineda E., Machado C., Calan L. et al. QEEG prognostic value in acute stroke.//Clin EEG Neurosci. - 2007. V. 38 (3). - P. 155-160.
6. De Vos C. C., Van Maarseveen S. M., Brouwers P. J. et al. Continuous EEG monitoring during trombolysis in acute hemisphere stroke patients using the brain symmetry index.//J Clin Neurophysiol/2008. - V. 25 (2). - P. 77-82.
7. Ferree T. C., Hwa R. C. Electrophysiological measures of acute cerebral ischaemia.//Physics in Medicine and Biology. 2005. - V. 50. -P. 3927-3939.
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9. Gerloff C., Bushara K., Sailer A. et al. Multimodal imaging of brain reorganization in motor areas of the contralesional hemisphere of well recovered patient after capsular stroke.//J. Brain. 2006. - V. 129 (3). - P. 791-808.
Zufarov Mirjamol Mirumarovich, MD, PhD, FACC. Deputy Director of High Technology Head of the department of Interventional Cardiology and Cardiac Arrhythmias' The Joint Stock Company «Republican Specialized Center of Surgery named after academician V. Vakhidov, department of Interventional Cardiology
and Cardiac Arrhythmias'» Makhkamov Najmiddin Kozimivich, MD., Intervention Cardiologist The Joint Stock Company «Republican Specialized Center of Surgery named after academician V. Vakhidov, department of Interventional
Cardiology and Cardiac Arrhythmias'» Babadjanov Sandjar Abdumurodovich, MD., Intervention Cardiologist The Joint Stock Company «Republican Specialized Center of Surgery named after academician V. Vakhidov, department of Interventional
Cardiology and Cardiac Arrhythmias'» E-mail: [email protected]
Characteristics of multi spiral angiography in patients with multi focal atherosclerosis
Abstract: Development and improvement of diagnostic methods provide definition of location and expression degree of atherosclerotic lesion in cases of multi focal atherosclerosis with greater accuracy. As a result of the study we noted a great prevalence of calcinosis of vascular lumen in patients with MFA, especially in the elder age group. Keywords: multi focal atherosclerosis, diagnostics, vascular calcinosis.
Ischemic heart disease (IHD) and brain insult were and still tion of a plaque. Oppositely in case of vast calcification of vascular are the main reason of population lethality and invalidization [1]. lumen there is high possibility of presence of unstable plaques Playing a leading role in the pathogenesis of these diseases, in the tend for rapture [5].
majority of cases atherosclerosis causes lesion of several vascular Many authors think that calcinosis of carotid arteries indi-
lumens [2], and that demands a complex assessment of altera- cates stability of a plaque and it is linked with presence of clinical tions in vascular lumen, definition of the tactics and strategy of symptoms of ischemic lesion of brain [9]. In other studies there revascularization. Traditionally the methods used for that are was no data about the link of carotid plaques' calcification with fo-radiological diagnostic ones (ultra sound, x-ray selective angiog- cal alterations of the cerebral white matter [7]. Besides the qualita-raphy, computer tomography, magnetic resonance imaging) [3]. tive analysis of the structure of non-coronary plaques there is also Taking into account the variability of morphology for roent- quantitative assessment of calcinosis by means of MSCT method genologic visualization methods the most available ones are cal- analogic to coronary arteries [8].
cinated atherosclerotic plaques due to high roentgen density. It is Aim: to assess the character of MSCT-angiography peculiari-
calcinosis that serves to be a marker of not only terminal but also ties in patients with MFA.
early stages of atherosclerosis; and MSCT method is the best for Materials and methods: The work was based on the study
quantitative assessment of vascular lumen calcinosis from the of the check up and endovascular therapy results in 47 patients point of view of validation and verification, reflecting the prog- with multi focal lesion of coronary and extra cranial arteries. In the nosis of the lesion of cardiac vascular system [4, 6]. At the same definition of the indications to stenting of inner carotid arteries we time we cannot state that expressed calcinosis indicates stabiliza- took into account the following: clinical manifestations ofvascular-
