CC BY
12UDC: 616.127-005.3+616.831- 616-005.6 NEW METHODS TO STUDY THE CAUSES OF CARDIOEMBOLIC
STROKE
KHODZHAEVA DILBAR TAJIEVNA
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 NUROVA ZARNIGOR KHIKMATOVNA Assistant of the Department of Neurology, Psychiatry, Narcology, Medical Genetics and Medical Psychology of the Bukhara State Medical Institute. City of Bukhara of the Republic of Uzbekistan.
ORCID ID 0000-0002-2434-2887 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.
НОВЫЕ МЕТОДЫ ИЗУЧЕНИЯ ПРИЧИН КАРДИОЭМБОЛИЧЕСКОГО ИНСУЛЬТА
ХОДЖАЕВА ДИЛБАР ТАДЖИЕВНА
доктор медицинских наук, профессор, заведующая кафедрой неврологии, психиатрии, наркологии, медицинской генетики и медицинской психологии Бухарского Государственного медицинского института. Бухара. Республика Узбекистан.
ОНОЮ Ю 0000-0002-5883-9533 НУРОВА ЗАРНИГОРХИКМАТОВНА ассистент кафедры неврологии, психиатрии, наркологии, медицинской генетики и медицинской психологии Бухарского Государственного медицинского института. Город Бухара Республики Узбекистан. ОНОЮ Ю 0000-0002-2434-2887
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 ИНСУЛЬТНИНГ САБАБЛАРИНИ УРГАНИШНИНГ ЯНГИ УСУЛЛАРИ
ХОДЖАЕВА ДИЛБАР ТАДЖИЕВНА
Т.ф.д., профессор, Неврология кафедраси мудири, Бухоро давлат тиббиёт институти, Бухоро ш., Узбекистон Республикаси. ОНОЮ Ю 0000-0002-5883-9533 НУРОВА ЗАРНИГОРХИКМАТОВНА
Неврология кафедраси мустацил изланувчиси, Бухоро давлат тиббиёт институти, Бухоро ш., Узбекистон Республикаси.
ОНОЮ Ю 0000-0002-2434-2887 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, хавф омиллари, цилпилловчи аритмия.
The relevance of the problem.
Cardioembolic stroke (CS) is one of the most frequent and severe forms of ischemic stroke (IS) - [1, 2, 5]. The problem of cerebral stroke remains extremely relevant at the present time, which is determined by the significant frequency of its development, a high percentage of disability and mortality of patients - [4, 6, 10]. The development of cardioembolic stroke is the most formidable complication of cerebral ischemia - [7, 8].
Stroke is a qualitatively special condition, being an integrated expression of a complex of complex metabolic, hemodynamic changes occurring in the brain at a certain stage of insufficient blood supply - [7, 9]. Patients were evaluated according to the Glasgow Coma Scale (GSC) to assess the degree of unconsciousness - [3, 4]. The study is based on the data obtained from 142 patients treated in treatment facilities in the city of Bukhara - [9]. The research was conducted based on laboratory, instrumental and general clinical examination data - [10].
Materials and methods of research.
The study is based on the data obtained from 142 patients treated in treatment facilities in the city of Bukhara. The research was conducted based on laboratory, instrumental and general clinical examination data.
The diagnosis of the disease was made according to the results of clinical examination, CT (computed tomography) or MRI (magnetic resonance imaging) examination of the brain, DS (duplex scan), laboratory analysis (D-dimer, S-reactive protein, coagulogram).
This study is based on the analysis of the results of a comprehensive clinical examination of 142 patients. Selection criteria were as follows: 1) patients with KEI combined with palpable arrhythmia (main group - МG); 2) Patients with KES without palpable arrhythmia (control group - СG).
Of the 142 people examined, 97 patients had type II and ventricular arrhythmias, with a mean age of 72.3 ± 5.66 years. NG was 40 patients with non-KEI II, the average age of which was 70.8 ± 6.42 years.
Criteria for inclusion in СG: 1) patients without ventricular arrhythmias; 2) different subgroups of II - according to the МG diagnostic series; 3) Patients over 60 years old - corresponds to the average age of patients in МG.
82 women and 60 men participated in the survey. There were 58 females (56.86%) and 44 males (43.14%) in the MG. The average age of men was 64.8 ± 4.57 years, and that of women was 75.8 ± 5.36 years.
The mean age of men and women in MG and CG was compared: 64.7 ± 5.32 years for men and 72.3 ± 5.24 years for women in CG, respectively.
There was no significant difference in stroke lateralization in patients with II: 47.06% in the left hemisphere, 45.1% in the right hemisphere.
IS localization in MG and CG patients
Group Number of cases
Left hemisphere Right hemisphere Vertebro basilar vein
Abs. % Abs. % Abs. %
MG(n = 102) 48 47,06 46 45,10 8 7,84%
CG (n = 40) 19 47,50 18 45,00 3 7,50
Neurological, laboratory, ultrasound and neurovisualization methods were used for complex clinical examinations, where patient complaints were described using data formatting, anamnestic data were collected, objective and subjective symptoms of the disease were collected, paraclinical examination results were studied.
Considered IS ADCC (acute disturbance of cerebral circulation) it is characterized by sudden onset of convulsive symptoms (movement, speech, sensation, coordination disorders) and/or general brain disturbances lasting 24 hours or more and having a cerebrovascular cause.
Patients were evaluated according to the Glasgow Coma Scale (GSC) to assess the degree of unconsciousness. Based on this scale, three indicators were evaluated - evaluation of speech, reaction to pain and eye opening. Evaluation of each indicator was carried out independently of others. The sum of the three responses determined the severity of unconsciousness. The level of coma according to the Glasgow scale had the following indicators: 15 - conscious; 13-14 - numbness; 9-
12 - sopor; 4-8 - coma; (8 - light level, 7-6 - medium, 4-6 - severe); 3 -brain death.
Conclusion.
1. Clinical characteristics of cardioembolic stroke are the presence of focal and generalized symptoms: loss of consciousness, hemiplegia, aphasia, visual paresis, anosognosia, psychomotor agitation, severe complications, high mortality rates. Severe cardioembolic stroke occurs in two-thirds of patients, with more severe ischemic stroke in women.
2. When cardioembolic type of ischemic stroke and myocardial infarction occur together, signs of inflammation are clearly observed (neutrophil leukocytosis, shift of the leukocyte formula to the left, increased erythrocyte sedimentation rate), in addition, a significant appearance of hyperfermentemia is detected (a clear increase in the amount of CK, AST, LDG), which in turn, it is a non-specific manifestation of tissue necrosis.
3. The characteristic feature of central and cerebral blood circulation in patients with ischemic stroke and ventricular arrhythmia is that the ejection fraction decreases and the blood flow rate in the internal carotid arteries decreases, which is evidence of the hemodynamic component underlying the development of the stroke. Sleep and spine the presence of deformations in the form of curvature of the arteries and the increase in the thickness of the intima media complex can cause the development of myocardial infarction along with ischemic stroke in many patients.
4. Identification of high-risk patients who are ill with atrial fibrillation may develop cardioembolic stroke based on these anamnestic and clinical factors will determine the correct approach to the prevention of these diseases in patients with vascular changes.
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