Volume 03 Issue 12-2023
7
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
12
P
AGES
:
7-12
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
In our studies, the predominance of the proportion of chronic vertebral-basilar insufficiency in women was found.
Men were significantly more likely to have acute brain disorder in the vertebral-basilar sistem. In persons younger than
50 years, no ischemic strokes were detected in 87% of cases, this indicator decreased by half at the age of 50 to 60
years and remained in persons older than 60 years. Thus, the most vulnerable age period in relation to the
development of stroke is the age over 52.6 years. According to WHO statistics, more than 15 million cases of stroke
are registered annually in the world, of which more than 30% die within a year, more than 80% become disabled.
KEYWORDS
Chronic cerebral ischemia, vertebrobasilar insufficiency, violations of static-locomotor functions, morphological
aspects.
INTRODUCTION
Vascular diseases of the brain are an urgent medical
and social problem. They occupy a leading place in the
structure of morbidity and mortality in economically
developed countries. Mortality from cerebrovascular
diseases in economically developed countries is 11-12%
and is second only to mortality from heart diseases and
tumors of all localizations. Today, 9 million people in
the world suffer from cerebrovascular diseases. [2].
The problem of chronic cerebral ischemia would not
receive so much attention if this disease were not one
Research Article
MORPHOLOGICAL ASPECTS OF STATIC-LOCOMOTOR FUNCTION
DISORDERS IN CHRONIC CEREBRAL ISCHEMIA
Submission Date:
December 01, 2023,
Accepted Date:
December 05, 2023,
Published Date:
December 10, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue12-02
Yo’ldosheva Naima Qudratovna
Assistant Of The Department Of Osta In Bukhara State Medical Institute, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 12-2023
8
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
12
P
AGES
:
7-12
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
of the most common causes leading to stroke,
dementia and disability. The epidemiology of chronic
forms of cerebrovascular diseases has not been
sufficiently studied, while the trend towards an aging
population leads to an increase in their prevalence,
especially in primary health care. To some extent, it is
possible to judge the frequency of epidemiological
forms of cerebrovascular disease (CVD) based on
epidemiological indicators, the prevalence of stroke,
since acute cerebrovascular accident, as a rule,
develops on the prepared chronic ischemia and this
process continues to increase in the post-stroke
period. When the initial symptoms of cerebral
circulatory insufficiency appear, the patient usually
turns to a local therapist (general practitioner, family
doctor) and only with pronounced signs to a
neurologist. The rate of development of the disease,
prevention of stroke and dementia largely depends on
the development of a unified approach and algorithm
for the diagnosis and treatment of the initial forms of
chronic cerebrovascular disease. Early detection and
treatment of chronic forms of cerebrovascular
diseases is important to prevent their progression and
take measures to prevent stroke.
The purpose of the study is to study clinical and
instrumental criteria diagnosis of chronic cerebral
ischemia.
MATERIALS AND METHODS
The material of this study was patients with vertebral
basilar insufficiency (186 people) aged 45-75 years (on
average 59.7+12.6 years), of whom 71 were men and 115
women. The criteria for inclusion in the study were the
presence of documented vascular disease, a
combination
of
subjective
and
objective
manifestations of vascular brain damage, progressive
course of chronic vascular brain damage or episodes of
acute cerebral ischemia in the form of TIA or strokes
with complete regression of neurological deficit. The
comparison group consisted of 73 patients comparable
to the main group in age, gender, and severity of
concomitant somatic diseases who had suffered an
ischemic stroke in the vertebral-basilar system (0.5 to 2
years old). The control group consisted of 60
volunteers of comparable age without signs of
vascular lesion. Most often, circulatory insufficiency of
the brain is combined with an increase in blood
pressure. This fact is observed in both compared
groups (140-155 / 90-105, p<0.05).
Based on the leading clinical syndrome and the results
of an instrumental examination, two groups of
patients were identified. The first group included 58
patients who had a progressive course of the disease,
a predominance of subjective disorders was observed,
and there were no episodes of acute cerebral ischemia.
Volume 03 Issue 12-2023
9
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
12
P
AGES
:
7-12
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
The second group consisted of 55 patients whose
clinical picture was characterized by the presence of
small-focal neurological symptoms, previous TIA or
minor strokes. Clinical manifestations at the time of the
study consisted in a combination of a conductive
motor or sensory neurological deficit and damage to
cranial nerves of a predominantly alternating nature.
The results of the study. When analyzing the gender
characteristics of cerebrovascular pathology in the
examined patients, it turned out that there were 65
women in the main clinical group. In the comparison
group, ONMC in IBS developed in 16 women, and in 10
women - ONMC in the carotid system. There were 48
men with vertebral-basilar insufficiency, while there
were 41 male patients with stroke in the IBS, and 6 men
with ONMC in the carotid system. Thus, in our studies,
ONMC was less common in women, respectively, the
proportion of chronic vascular insufficiency of the
brain was observed more often in them. In men, the
proportion of cancer was higher, with predominant
localization in the IBS (p<0.05)
In order to analyze the clinical material, the main
criteria for the formation of clinical groups were
determined - the presence of a history of ONMC in the
vertebral-basilar system was encoded by the first digit
(0 - no, 1 - is), the presence of focal neurological deficit
- by the second digit (0 - no, 1 - is). Pyramidal
insufficiency syndrome, which is characterized by
certain neurophysiological correlates in the study of
SBS reflex activity, was considered as an important
objective criterion for ischemic damage to cerebral
structures. Thus, the subgroup (0;0) was characterized
by the absence of ONMC in the anamnesis, the absence
of focal neurological deficit. The leading clinical
manifestation is vestibular atactic syndrome with a
predominance of dizziness, ataxia and instability when
walking. The subgroup (0;1) was characterized by the
absence of ONMC in the anamnesis and the presence
of a focal neurological deficit (within the framework of
a chronic vascular process) - DE N-Sh degree. For
patients of subgroup (1;0), the presence of a history of
ONMC and the absence of focal neurological
deficiency, in particular, pyramidal insufficiency, was
typical, and subgroup (1;1) - a combination of ONMC
and pyramidal insufficiency.
When analyzing the results of an MRI study in clinical
groups, it turned out that in the subgroup (0;0), foci of
ischemia in the trunk were detected in 27% of cases,
hemispheric localization of the lesion was present in 7%
of cases, foci were absent in 67% of cases. In the
subgroup (0;1), in 29% of cases, the lesion had a stem
localization, in 10% the lesion was localized in the
carotid system, the absence of the lesion was observed
in 61% of cases. In the subgroup (1;0) - in 1 patient
(100%), the lesion was localized in the trunk. In the
subgroup (1;1), in 43% of cases the lesion was localized
in the trunk, in 9% of cases the lesion was determined
outside the trunk, the absence of pathological changes
Volume 03 Issue 12-2023
10
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
12
P
AGES
:
7-12
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
on MRI was observed in 48% of cases. The absence of
ONMC in the anamnesis was associated with the
absence of ischemic foci during neuroimaging in 63% of
studies, in 29% the focus was located in the brain stem,
in 9% the focus was localized in carotid structures. In
patients with a clinical picture of ONMC in the brain
stem, during MRI, the lesion was not detected in 47% of
cases, whereas it was detected in the brain stem in 44%
or in the carotid artery system in 9%. With a history of
ONMC in the carotid system, an ischemic focus was not
detected only in 19%, while a focus of stem localization
was detected in 50% of cases, carotid localization in 31%
of cases.
Thus, the detection of an ischemic lesion in the brain
stem in the absence of indications of a history of stroke
occurs in 1/3 of cases. In ischemic stroke of stem
localization, focal changes were absent in half of the
cases during MRI of the brain. In case of ONMC, there
were no additional foci of carotid localization in the
IBS, and ischemic stroke of carotid localization in half
of the cases was associated with identified foci in the
trunk. Vascular studies have also been standardized in
the established clinical groups. In the subgroup (0;0) -
the absence of vascular lesions of IBS according to the
USDG was observed in 20% of cases, pathological right-
sided changes in IBS were observed in 47%, left-sided in
33%. In the subgroup (0;1), the absence of pathological
signals of vascular changes in IBS was noted in 42% of
cases, 29% of the changes were noted on the right and
left. In the subgroup (1;0), the absence of vascular
changes was noted in 50% of cases, and left-sided
vascular lesion of the air force was also noted in one
patient. In the subgroup (1;1), the absence of vascular
changes in the air force was in 36% of cases, right-sided
vascular damage in this basin was noted in 42% of cases
and in 21% of cases vascular changes were left-sided.
The structure of patient complaints at all stages of the
disease was dominated by headaches CCI I-32 (63%),
CCI II-44 (95%), CCI III-15 (88%); control - 10 (33%), fatigue
CCI I-18 (36%), CHIM II- 44 (95%), CHIM III - 15 (88%);
control - 5 (16%), sleep disorders CHIM I - 19 (38%), CHIM
II-35 (68%), CHIM III - 11 (66%); control - 4 (13%); There
were also very characteristic complaints of memory
and attention loss CHIMI-18 (36%), CHIMII-40 (85%),
CHIM III- 14 (83%); control - 3 (10%). Complaints of
dizziness, a feeling of noise in the head, and "shakiness
of the ground underfoot" were recorded somewhat
less frequently, while it should be noted that these
subjective manifestations practically did not occur in
the control group. The intensity of headache,
according to VAS, was most pronounced at stages I
and II of CCI, respectively 7.4±0.2 and 7.1±0.4; at the
same time, the severity of cephalgic syndrome in
patients with stages II and III of CCI was combined with
a high level of depression. Depending on the etiology
of CCI, the greater severity of cephalgia was
characteristic of CCI of mixed etiology - 6.3±0.3
compared with CCI-G - 3.8± 0.2, CCI-A - 2.4±0.5. The
Volume 03 Issue 12-2023
11
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
12
P
AGES
:
7-12
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
nature of cephalgia more often corresponded to the
criteria of tension headache.
Disseminated microorganic symptoms were noted in
the neurological status of patients with stage I CRF. In
stage II CRF, two or more distinct neurological
syndromes were identified in the clinical picture:
pyramidal -42 (93%), vestibulo-atactic -32 (25%),
amyostatic -17 (38%), pseudobulbar in combination
with moderate cognitive symptoms - 42 (93%). Several
neurological syndromes were also identified in
patients with stage III CRF: pyramidal - 17 (100%),
vestibulo-atactic - 13 (77%), amyostatic - 14 (88%),
pseudobulbar with pronounced cognitive symptoms of
pre-dementia and dementia type - 8 (55%).
Thus, hemodynamic changes according to the USDG
data were observed in a group of patients with initial
manifestations of vertebral-basilar insufficiency in the
absence of objective neurological symptoms. The
number of hemodynamically significant changes in the
main arteries was significantly higher in the second
clinical group.
CONCLUSION
In our studies, a predominance of the proportion of
chronic vertebral-basilar insufficiency in women was
found. Men were significantly more likely to have
ONMC in the vertebral-basilar basin. In persons under
50 years of age, no ischemic strokes were detected in
87% of cases, this indicator halved between the ages of
50 and 60 years and persisted in persons over 60 years
of age. Thus, the most vulnerable age period in relation
to the development of stroke is the age over 52.6
years.
Chronic cerebral ischemia may be asymptomatic for a
long period of time. Clinical and instrumental
examination provides an opportunity for early
diagnosis of chronic cerebral ischemia. The clinical
picture of brain stem damage is observed in more than
half of patients with chronic cerebral ischemia.
REFERENCES
1.
Т.ф.д. Ходжиева Д.Т., Йўлдошева Н.
Қ
“
Specificity of cognitive impairment in chronic
cerebral ischemia
”
. International scientific and
practical Conference: Modern views and
research
–
2021, July, 2021: Egham, London.
Independent Publishing Network Ltd
–
52 p.
(page 23-24)
2.
PhD, доцент Ахророва Ш.Б., Йўлдошева Н.
Қ
.
“Особенности
когнитивных
и
эмоционалных
расстройств
при
хронической
ишемии
мозга”
.
Journal
of
neurology
and
neurosurgery research volume 2, issue 3
–
2021
(стр. 50
-53)
3.
5. Йўлдошева Н.
Қ
.
“
Cognitive disorders in
patients with chronic brain ischemia
”
Volume 03 Issue 12-2023
12
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
12
P
AGES
:
7-12
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
4.
Amaliy va Tibbiyot fanlari ilmiy jurnali
“Ekologiya va ekologik ta’lim muammolari”
maxsus son
–
2022. (323-326 bet)
5.
Камчатнов
П.Р.
Дисциркуляторная
энцефалопатия –
некоторые вопросы киники
и терапии. Русский медицинский журнал–
2004.
–Т.12.–№24.–С.1414–
1417
6.
Манвелов
Л.
С.,
Кадыков
А.С.
Дисциркуляторная
энцефалопатия.
Клиническая геронтология.–
2000.
–Т.6.–№9–
10.
–С.21–
27.
7.
Robertson CS, Contant CF, Gokaslan ZL, et al:
Cerebral blood flow, arteriovenous oxygen
difference, and outcome in head injured
patients. J Neurol Neurosurg Psychiatry 55:
594-603, 2002,26.
8.
Sheinberg M, Kanter MJ, Robertson CS, et al:
Continuous monitoring of jugular venous
oxygen saturation in head-injured patients. J
Neurosurg 76: 212-217, 2002. 11.
9.
7. Яхно Н.Н., Захаров В. В., Локшина А. Б.
Нарушения памяти и внимания в пожилом
возрасте.
//
Журнал
неврологии
и
психиатрии –
2006.
–Т.106.–№2.–
С.58–
62.
