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«NEVROLOGIYA»—2(82), 2020
ВОПРОСЫ КЛИНИКИ, ДИАГНОСТИКИ И ЛЕЧЕНИЯ НЕРВНЫХ БОЛЕЗНЕЙ
пой пациентов со значительно-выраженными когнитивными
нарушениями.
Литературы.
1. Васильев И.А., Ступак В.В., Черных В.А., Половников
Е.В., Черных Е.Р., Шевела Е.Я., Дергилев А.П. Патогенетиче-
ские аспекты нарушения венозного кровообращения голов-
ного мозга. Международный журнал прикладных и фунда-
ментальных исследований. -2014.-С.23-26.
2. Боголепова А.Н. Когнитивные нарушения у больных с
цереброваскулярнойпатологией // Лечение нервных болез-
ней. – 2011. – № 3(8). – С. 16–21.
3. Jason D. Yeatman, Brian A. Wandell, Aviv A. Mezer. Lifes-
pan maturation and degeneration of human brain white matter. //
Nature Communications, 2014. –Vol.5. -P.49-32.
C
erebrovascular diseases (CVDs) are the most important
medical and social problem of modern neurology,
as they provide the highest rates of morbidity, mortality and
disability in almost all countries of the world. According to the
conducted research, about 5 million people die every year from
cerebrovascular diseases [4].
In Uzbekistan, more than 60 thousand cases of stroke (acute
cerebrovascular accident) are registered annually. At the same
time, disability after a stroke is 83.8%, and the percentage of
hospital fatality is 17.3%.
The modern concept of risk factors for disease development
includes a combination of various biochemical, clinical, behavioral
and other properties that are characteristic of a particular person
or a particular population. In addition, risk factors also include
external influences-indicators indicating an increased risk of
developing specific pathologies [1-3].
The etiology of CVD is extremely complex and involves a
complex interaction between numerous factors. According to
who, there are more than 300 risk factors associated with stroke,
which are grouped into four categories:
• the main modifiable risk factors (high blood pressure,
atherosclerosis, Smoking, physical inactivity, obesity, unhealthy
diet, diabetes);
• other modifiable factors (social status, mental disorders,
emotional stress, alcohol abuse, certain medications);
* unmodified risk factors (age, heredity, nationality, gender);
• “new” risk factors (hyperhomocysteinemia, inflammation,
abnormal blood clotting).
A characteristic feature today is a significant “ rejuvenation” of
arterial hypertension (AH) and atherosclerosis. The manifestation
of atherosclerotic diseases has become common even at the age
of 30-40 years [5]. The state of chronic psychoemotional stress
characteristic of significant categories of the population has
SCREENING OF CEREBROVASCULAR DISEASES AND
STROKE AMONG DOCTORS ON THE EVALUATION OF
RISK FACTORS OF THEIR DEVELOPMENT
1
Sharipov F.R.,
2
Majidova Y.N.,
1
Yusupaliev B.K.,
2
Nasirova I.R.,
3
Turaboev O.O.,
2
Mukhammadsolikh Sh.B.
1
Ministry
of health of the Republic of Uzbekistan,
2
Tashkent Pediatric Medical Institute,
3
Kitab District Medical Association
Key words:
CVD,
stroke, risk factors, screening.
СКРИНИНГ ЦЕРЕБРОВАСКУЛЯРНЫХ ЗАБОЛЕВАНИЙ И ИНСУЛЬТА СРЕДИ ВРАЧЕЙ ПО ДАННЫМ
ОЦЕНКИ ФАКТОРОВ РИСКА ИХ РАЗВИТИЯ
Шарипов
Ф.Р., Маджидова Ё.Н., Юсупалиев Б.К., Насырова И.Р., Турабоев О.О., Мухаммадсолих
Ключевые слова: ЦВЗ, инсульт, факторы риска, скрининг.
Ш.Б.
Представлены результаты проведенного скрининга по изучению факторов риска развития цереброваскулярных заболе-
ваний и инсульта. При выявлении степени риска развития использовали специальный опросник в которую входили амбула-
торная шкала Федина, тест Мини КОГ, а также учитывались показатели холестерина и сахара в крови, артериальное давле-
ние, индекс массы тела, и аускультация сонной артерии. Низкий риск развития ЦВЗ и инсульта выявлен у 45 %, средний - у
33%, высокий - у 22 % обследованных.
ШИФОКОРЛАР ОРАСИДА ЦЕРЕБРОВАСКУЛЯР КАСАЛЛИКЛАР ВА ИНСУЛЬТГА ОЛИБ КЕЛУВЧИ ХАВФ ОМИЛЛАРИ
РИВОЖЛАНИШИНИ БАҲОЛАШ СКРИНИНГИ
Шарипов
Ф.Р., Маджидова Ё.Н., Юсупалиев Б.К., Насырова И.Р., Турабоев О.О., Муҳаммадсолиҳ Ш.Б.
Калит сўзлар: ЦВК, инсульт, хавф омиллари, скрининг.
Цереброваскуляр касалликлар ва инсульт учун хавф омиллар бўйича скрининг ўтказиш натижалари тақдим этилади.
Ривожланиш хавфи даражасини аниқлашда Фединнинг амбулатор шкаласи, Мини-КОГ тести, шунингдек холестерин ва
қондаги қанд миқдори, қон босими, тана массаси индекси ва каротид артерия аускультацияси кўрсаткичлари киритилган мах-
сус сўровнома ишлатилган. ЦВК ва инсульт паст хавф 45 %, 33% ўртача хавф даражаси аниқланиб, шифокорларнинг 22%да
юқори хавф топилди.
no less pathogenetic significance, which, in combination with
eating disorders and a disorderly lifestyle, as well as adverse
environmental factors, leads to the early development of changes
typical of brain aging (weakening of protein biosynthesis in brain
neurons, violation of cell membrane permeability, destabilization
of neurotransmitter systems, etc.) [6]. It is difficult to overestimate
the importance of identifying and correcting modifiable risk
factors. Information about unmodified factors is also extremely
important, since it allows identifying individuals with an increased
probability of cerebrovascular diseases in the population and
directing efforts to their active prevention.
Purpose of research. Study of risk factors for CVD and stroke
among doctors using screening.
Research material and methods. A single-stage
epidemiological study was Conducted-a continuous screening
among doctors (men and women aged 40-80 years). As a result
of screening, a cohort of 52 people was formed, including 16
men (31%) and 36 women (69%). By age decade (40-49, 50-
59,60-69,70-79,80 men and women surveyed were distributed
relatively evenly (table 1). The identification of FR was carried out
in the course of screening populations with the use of a special
questionnaire. During the examination, in addition to General
clinical and neurological methods for assessing the condition
of patients, the outpatient scale of A. I. Fedin CHEMICAL was
used. The outpatient scale of the A. I. Fedin CHEMICAL Institute
(2016) is divided into subscales: “General cerebral and asthenic
syndromes”, “cranial nerves”, “motor system (in the absence of
limb paresis)”, “speech and other cognitive functions”, “affective
disorders”, which allows us to evaluate each of these syndromes
in points and conduct a General assessment of the severity of
neurological disorders.
The Mini-COG test (a screening questionnaire for
determining cognitive impairment) was used for screening
UDC: 616.831-005-056.4
«NEVROLOGIYA»—2(82), 2020
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ВОПРОСЫ КЛИНИКИ, ДИАГНОСТИКИ И ЛЕЧЕНИЯ НЕРВНЫХ БОЛЕЗНЕЙ
assessment of the level of cognitive functions. It consists of
memorizing 3 items and a clock drawing test. If you score less
than 3 points, this is a reason to assume dementia. However,
many patients with clinically significant cognitive disorders score
more than two points. Therefore, for greater sensitivity of the
test, it is recommended to consider a result of less than 4 points
as evidence of the need for a deeper examination [7].
Statistical data analysis was performed using the
STATISTICA 8.0 software. data were Analyzed in the General
cohort (from 29-80 years old) and in groups divided by age (40-
49, 50-59, 60-69, 70-79, 80 and older) and gender. Arithmetic
mean and standard square deviations were used to describe
the age of the population and the number of risk factors in the
groups. The differences were considered significant at p<0.05.
Results and discussion. The average age of the subjects
was 50.5±8.9 years. Thus, this population sample was mainly
represented by working people.
Table 1. Distribution of patients according to sex and age.
Age, years
All patients (%)
Men(%)
Women (%)
40-49 years old
20 (38,5)
7 (13,5)
13 (25)
50-59 years old
25 (48,1)
8 (15,4)
17 (32,7)
60-69 years old
3 (5,8)
1 (2)
2 (3,8)
70-79 years old
3 (5,8)
-
3 (5,8)
Over 80 years old 1 (2)
-
1 (2)
Total
52 (100)
16 (31)
36 (69)
Screening provides, based on the results obtained, the
determination of the risk of developing CVD (table 2).
Table 2. Determination of the risk of developing CVD.
Examination method
Low
Average
Tall
1
Study of patients '
complaints on the
outpatient scale Fedina
A. I..
Less
than 10
points(mild
symptoms)
10-20 points.
(Moderately-
severe
symptoms).
More than 20
points.(Pronounced
symptoms.)
2
Study of cognitive functions
on the Mini COG test
3 points
(1 point)
Norm.
2 points (2
points)Moderate
cognitive
decline.
0-1 point (3 points)
Marked cognitive
decline.
3
Auscultation of the carotid
artery in the area of its
bifurcation on the neck.
1 point
Ripple
reduction is
insignificant
2 points A
moderate
decrease in the
ripple
3 points Marked
decrease in pulsation
4
Determination of cholesterol
in the blood by Express
method.
5.2-5.5 (1
point)
5,5-7 (2 point)
Above 7 (3 point)
5
Determination of blood
sugar by Express method.
5-6 (1 point)
6-7 (2 point)
Above 7 (3 point)
6
Blood pressure
measurement.
130-140 (1
point)
140-160 (2
point)
160 and higher (3
point)
7
Measurement of div mass
index. (BMI)
25-29 (1
point)
30-35 (2 point)
35-40 (3 point)
8
The elimination of
the risk of developing
Cerebrovascular diseases.
16 point
22-32 point
38 point
1. Low risk assessment criteria.
1. The presence of mild symptoms of cerebral complaints
on the outpatient Fedin scale. 2. Weakly expressed (or their
absence) cognitive functions according to the Mini-COG test.
3. Slight pulsation of the carotid artery. 4. Slightly elevated
cholesterol levels in the blood. 5. Slightly elevated blood sugar.
6. Slight increase in blood pressure. 7. Slight change in div
weight.
2. Criteria for assessing the average risk.
1. The presence of moderate symptoms of cerebral
complaints according to the outpatient Fedin scale. 2. Moderate
cognitive function according to the Mini-COG test. 3. Moderate
decrease in carotid artery pulsation. 4. Moderately elevated
cholesterol levels in the blood. 5. Moderately elevated blood
sugar. 6. Moderate increase in blood pressure. 7. Moderate
change in div weight.
3. High risk criteria.
1. The presence of severe symptoms of cerebral complaints
according to the outpatient Fedin scale. 2. Expressed cognitive
functions on the Mini-COG test. 3. Marked decrease in carotid
artery pulsation. 4. High cholesterol in the blood. 5. Increased
blood sugar. 6. Marked increase in blood pressure. 7. Marked
change in div weight.
The results of the risk factor assessment, taking into account
gender differences, are shown in table 3.
Table 3. Assessment of risk factors for CVD among doctors.
Evaluation criterion
All patients
Male
Famale
1
Study of patients ' complaints on the
outpatient scale Fedina A. I..
7,8±5,6
6,6±4,8
8,2±5,9
2
Study of cognitive functions on the
Mini COG test
1,6±0,7
1,6±0,6
1,6±0,7
3
Auscultation of the carotid artery in
the area of its bifurcation on the neck.
1,1±0,9
1,2±1
1,1±0,8
4
Determination of cholesterol in the
blood by Express method.
1,4±0,7
1,2±0,7
1,5±0,7
5
Determination of blood sugar by
Express method.
1,4±0,8
2±0,9
1,2±0,6
6
Blood pressure measurement.
1,1±0,7
1,1±0,7
1,1±0,7
7
Measurement of div mass index.
(BMI)
1,3±0,6
1,4±0,7
1,2±0,5
From the data shown in table 3, it can be seen that changes
in indicators of the outpatient Fedin scale differed significantly
among men and women. Among men, this indicator was equal to
6.6±4.8, and among women-8.2±5.9. the Average score for the
Mini COG test among men was 1.2±1, and among women it was
1.6±0.7 points. Auscultation of the carotid artery in the area of
its bifurcation on the neck among men was 1.2±1 points, among
women 1.1±0.8 points. Blood cholesterol in both gender groups
was 5.5±0.9 which was 1.4±0.7 points. Blood sugar in men and
women averaged 5.6±1 which was 1.4±0.8 points. According to
the results of blood pressure measurement in men and women,
it was 1.1±0.7 points. The BMI index for men was 1.4±0.7 points,
and for women 1.2±0.5 points.
It should be noted that the screening conducted among
doctors showed that the risk of cerebrovascular diseases is high
among doctors, that is, the part of the population that belongs
to a healthy contingent. The results of screening among doctors
were as follows: low risk in 45% of those present, average - in
33%, high-in 22 % of those examined.
Thus, people with a high risk of CVD will be sent for further
examination: ultrasound dopplerography, Echocardiography, a
consultation with a vascular surgeon, an angioneurologist, with
an assessment of the possibility of performing surgery.
Conclusions. Thus, despite the active work of medical
and social services, the problem of cerebrovascular diseases
remains relevant both in our country and abroad. The working-
age population aged 39-59 years had a wide prevalence of risk
factors for cardiovascular and cerebrovascular diseases. Among
men and women, differences in the values on the HIM Fedin
scale were statistically significant. The dynamics of cognitive
tests did not reveal any significant differences between these
groups (p>0.05).
It should be noted that the screening conducted among
doctors showed that a low risk was detected in 45% of those
present, an average risk - in 33%, and a high risk - in 22% of
those examined. The data obtained indicate the need to continue
constant active information and educational work among the
entire population and improve the system of identification and
medical monitoring of persons with risk factors. At the same
time, special attention should be paid to the category of middle
working age, in which the first significant jump in the increase
in the prevalence of risk factors for CVD occurs when passing
the 50-year mark. To solve these tasks, the use of a special
questionnaire is optimal, since it has a number of undoubted
advantages in comparison with other modern scales.
Literature.
1. Vibers, D. O. Stroke: klinich. guide / D. O. Vibers, V. L.
Feigin, R. D. brown; TRANS. with English and ed. V. L. Feigin,
2nd ed., ISPR. and add. –SPb.: Dialect, 2005. -607 p.
2. Suslina, Z. A. Vascular diseases of the brain. Epidemiology.
Foundation for the prevention / Z. A. Suslina, Y. Y. Varakin, N. In.
Vereschagin. –M: HONEY press-inform, 2009. -254 C.
3. Risk factors for the development of cerebrovascular
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«NEVROLOGIYA»—2(82), 2020
ВОПРОСЫ КЛИНИКИ, ДИАГНОСТИКИ И ЛЕЧЕНИЯ НЕРВНЫХ БОЛЕЗНЕЙ
diseases according to the screening of the middle-aged
population of Ulyanovsk/ V. V. Mashin I [I 101dr.] / / Annals of
clinical and experimental neurology. -2014. - No1(vol. 8) - P. 4-9.
4. Dolgova I. N., Kopenko T. A., Matevosyan M. A. risk
Factors for cerebrovascular diseases depending on gender //
International student scientific Bulletin, 2016, no. 4-1.;
5. Meseguer E, Lavallee PC, Mazighi M, et al. Yield of
systematic transcranial Doppler in patients with transient
ischemic attack. Ann Neurol 2010;68:9–17.
6.Derdeyn CP. Mechanisms of ischemic stroke secondary
to large artery atherosclerotic disease. Neuroimaging Clin N Am
2007; 17:303–11.
7. Zakharov V. V. Cognitive disorders in neurological
practice. Difficult patient. 2005;3(5):4–9. [Zakharov VV. Cognitive
disorders in neurological practice. Trudny patsient = Difficult
Patient. 2005;3(5):4–9 (In Russ.)]
Р
аспространенность невропатии тройничного не-
рва (НТН) достаточно велика и составляет до 30-50
больных на 100 000 населения, а заболеваемость по данным
ВОЗ находится в пределах 2-4 человек на 100 000 населе-
ния. Заболевание чаще возникает после 40 лет и преоблада-
ет у женщин[1-3]. Предполагается, что причиной невропатии
тройничного нерва могут быть недостаточность кровоснаб-
жения тройничного узла, чрезвычайно чувствительного к
ишемии, или вовлечение в патологический сосудистый про-
цесс стволовых или корково-подкорковых образований си-
стемы тройничного нерва. Существенное значение для
нормального функционирования тройничного нерва имеет
состояние вегетативной иннервации сосудистого русла, при-
нимающего участие в кровоснабжении тройничного нерва
и органические изменения сосудистых стенок. С возрастом
происходят склеротические изменения мелких артерий и де-
формация капилляров, в которых снижается скорость крово-
тока, расширяются и деформируются венулы. Сосуды пере-
полняются кровью. Формируются выраженные застойные
явления во внутриневральных сосудах. Факторами наруше-
ния кровоснабжения нервных стволов многие авторы объяс-
няют увеличение частоты НТН у лиц пожилого возраста.Так-
же возникновение заболевания преимущественно у пожилых
людей, возможно, связано с тем, что к 65 годам возрастная
дегенерация этого вида волокон составляет около 30 %. По-
скольку одним из признанных ведущих этиологических при-
знаков невропатии тройничного нерва является нарушение
мозгового кровообращения, приводящее к нарушению кро-
воснабжения нервных стволов, исследование церебраль-
ной гемодинамики у больных с НТН представляет научный и
практический интерес.
Цель исследования
. Изучить клинико-гемодинамиче-
ские особенности невропатии тройничного нерва.
Материалы и методы исследования.
Нами проанали-
зированы результаты наблюдений 40 пациентов с невропа-
тией тройничного нерва. Анализ распределения пациентов
по возрастампоказал, что среди пациентов преобладали
УДК 616.833.15-009.7:616-073
КЛИНИКО-ГЕМОДИНАМИЧЕСКИЕ ОСОБЕННОСТИ
НЕВРОПАТИИ ТРОЙНИЧНОГО НЕРВА
Иноятова С.О., Маджидова Ё.Н.,
Мухаммадсолих Ш.Б.
Консультативная поликлиника при многопрофильной Клинике Ташкентской медицинской академии
Ташкентский педиатрический медицинский институт
Ключевые слова: невропатия тройничного нерва, церебральная гемодинамика, ультразвуковая доплерография, стеноз
сонных артерий
УЧ ШОХЛИ НЕРВ НЕВРОПАТИЯСИ КЛИНИК ВА ГЕМОДИНАМИК ХУСУСИЯТЛАРИ
Иноятова С.О., Маджидова Ё.Н., Мухаммадсолих Ш.Б.
Калит сузлар: уч шохли нерв невропатияси, церебрал гемодинамика, ультратовуш доплерография, уйку артерия стенози.
Уч шохли нерв невропатияси купинча ёши катталарда учрайди. 43% холатда огрик уч шохли нервни иккинчи ва учинчи
шох иннервация чегарасида жойлашган, 22% холатда иккинчи шох иннервация чегарасида жойлашган. Стеноз мавжудлиги
ва йуқлигига караб хама беморлар икки гурухга ажратилган. Ушбу маколада ультратовуш доплерография асосида церебрал
гемодинамика хусусиятлари батафсил келтирилган.
CLINICAL AND HEMODYNAMIC FEATURES OF TRIGEMINAL NEUROPATHY
InoyatovaS.O., Madjidova Y.N.,, Mukhammadsolikh Sh.B.
Key words:trigeminal neuropathy, cerebral hemodynamics, ultrasound dopplerography, stenosis of the carotid arteries
Trigeminal neuropathy is more common in the elderly. In 43% of cases, the pain is localized in the innervation zone of the second
and third branch of the trigeminal nerve, in 22% of cases the innervation zone of the second branch is involved. Depending on the
presence or absence of stenosis, all patients were divided into 2 groups. The article details the features of cerebral hemodynamics
in trigeminal neuropathy.
женщины - 24 (60%), мужчин было 16 (40%), что в 1,5 раза
больше, чем мужчин. Большинство пациентов 28(70%) со-
ставили старшего среднего и пожилого возраста (средний
воз раст 50±19 лет). Длянаглядности приводим рис.1, на кото-
ром отражено распределениюпациентов по возрасту в обеих
группах.
Рис.1. Распределение пациентов по возрасту в обеих
группах.
По частоте поражения ветвей тройничного нерва паци-
ентыраспределились следующим образом. У 19 (47%) паци-
ентов отмечаласьНТН справа, у 21 (53%) больных - слева.
У исследуемых пациентов чаще поражалась вторая +третья
ветви (43%), вторая (22%) и третья ветвь (20%) и, как отмеча-
лось выше, в большинстве случаев отмеченалевосторонняя
невропатия. Нами для удобства анализа пациенты с невро-
патией тройничного нерва распределены на группы по рас-
положению пораженных ветвей (рис.2).
Рис.2. Частота поражения ветвей тройничного нерва.
