358
Жамият
ва
инновациялар
–
Общество
и
инновации
–
Society and innovations
Journal home page:
https://inscience.uz/index.php/socinov/index
Peculiarities of the clinical course of stroke in the vertebro-
basillar system
Munisa BAHADIROVA
1
, Elbek MIRDJURAEV
2
, Djahangir AKILOV
3
Tashkent Institute for Advanced Training of Doctors
ARTICLE INFO
ABSTRACT
Article history:
Received September 2020
Received in revised form
15 November 2020
Accepted 20 November 2020
Available online
15 December 2020
The relevance of CVD (Cerebrovascular Diseases), in
particular strokes, is due to the high prevalence, disability and
mortality.
The degree of medical, social, psychological rehabilitation of
patients after Ischemic Stroke depends on the regression of the
clinical picture and cerebral disintegration.
Objectives of the study: detection of the entire spectrum of
clinical manifestations from examined patients, corresponding
to damage to the structures of the brain supplied by the vessels
of the Vertebrobasilar basin, the relationship with regression of
the primary focus and the subtype of Ischemic Stroke, and
determination of the presence of a statistically significant
dependence of clinical manifestations on COPD.
To achieve the goal and solve the set tasks, 126 patients, 60
men and 66 women were examined in the recovery period of
stroke in the in the vertebro-basillar system, at the age of 50-80.
The Blindemark scale was used to assess the neurological status.
To assess neuropsychological status, the Montreal Cognitive
Assessment Scale, the Hospital Anxiety and Depression Scale, the
Rankin scale were used, as well as for objectification of MRI data
and Dopplerography.
Results of the study: In patients with Ischemic Stroke in the
vertebro-basillar system, paresis and paralysis prevailed in the
structure of clinical manifestations, 68 patients had them, which
is 54%, 43.7% of patients had dysarthria, coordination disorders
were observed in 48.4% of patients, 26.2% had vertigo, 24.6%
had sensory impairments and 5.6% had neglect.
In patients with Ischemic Stroke in the vertebro-basillar
system, a correlation was found between the scores of Renkin
Keywords:
Stroke
Rehabilitation
Clinic changes
MRI
COPD
1
Candidate of Medical Sciences, Associate Professor, Tashkent Institute for Advanced Training of Doctors,
Tashkent, Uzbekistan
2
Doctor of Medical Sciences, Professor, Tashkent Institute for Advanced Training of Doctors, Tashkent, Uzbekistan
3
Candidate of Medical Sciences, Assistant, Tashkent Institute for Advanced Training of Doctors, Tashkent,
Uzbekistan
359
scale. Various pathogenetic subtypes of ischemic stroke in
vertebro-basillar system were analyzed. They have a significant
correlation between NIHSS scores at the time of hospitalization
and at the end of rehabilitation. In patients with AT Ischemic
Stroke in the vertebro-basillar system the incidence of
oculomotor disorders is significantly lower. Based on the above
mentioned, the following conclusions can be drawn:
1. A certain localization of the focus of ischemic stroke in the
vertebra-basilar system is more likely to be characteristic of the
corresponding stroke subtype.
2. The rate of reduction and reorganization of the focus does
not depend on the stroke subtype, localization of the hearth,
comorbidphone, rehabilitation methods and is proportional to
the initial size of the heart attack site.
3. The degree of severity of COPD has a correlation with the
blood flow indices of posterior cerebral arteries and vertebral
arteries, as well as the asymmetry coefficient.
2181-
1415/© 2020 in Science
LLC.
This is an open access article under the Attribution 4.0 International
(CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/deed.ru)
Особенности клинического течения инсульта в вертебро
-
базиллярной системе
АННОТАЦИЯ
Ключевые слова:
Инсульт
Реабилитация
Клинические проявления
МРТ
ХОБЛ;
Актуальность цереброваскулярных заболеваний, в
частности
инсультов,
обусловлена
высокой
распространенностью, инвалидностью и смертностью.
Степень
медико
-
социальной,
психологической
реабилитации пациентов после ишемического инсульта
зависит от регресса клинической картины и церебральной
дезинтеграции.
Задачи
исследования:
выявление
всего
спектра
клинических проявлений у обследованных пациентов,
соответствующих повреждению структур головного мозга,
снабжаемых сосудами вертебробазилярного бассейна,
взаимосвязи с регрессом первичного очага и подтипа
ишемического
инсульта.
и
определение
наличия
статистически
значимой
зависимости
клинических
проявлений от ХОБЛ.
Для достижения цели и решения поставленных задач
обследовано 126 пациентов, 60 мужчин и 66 женщин в
восстановительном периоде инсульта в позвоночно
-
базиллярной системе
в возрасте 50
-
80 лет. Для оценки
неврологического статуса использовали шкалу Blindemark.
Для
оценки
нейропсихологического
статуса
использовались Монреальская шкала когнитивной оценки,
Госпитальная шкала тревожности и депрессии, шкала
Рэнкина, а также для объективизации данных МРТ и
допплерографии.
360
Результаты исследования: У больных с ишемическим
инсультом в вертебро
-
базиллярной системе в структуре
клинических проявлений преобладали парез и паралич, их
имели 68 пациентов, что составляет 54%, у 43,7% пациентов
наблюдалась
дизартрия,
нарушения
координации
наблюдались
в
48,4%
пациентов,
26,2%
имели
головокружение, 24,6% имели сенсорные нарушения и 5,6%
имели пренебрежение.
У пациентов с ишемическим инсультом в вертебро
-
базиллярной системе обнаружена корреляция между
баллами по шкале Ренкина. Проанализированы различные
патогенетические подтипы ишемического инсульта в
вертебро
-
базиллярной системе. У них есть значительная
корреляция
между
оценками
NIHSS
на
момент
госпитализации и в конце реабилитации. У пациентов с
AT
ишемическим инсультом в вертебро
-
базиллярной системе
частота глазодвигательных нарушений значительно ниже.
На основании вышеизложенного можно сделать следующие
выводы:
1. Определенная локализация очага ишемического
инсульта в позвоночно
-
базилярной системе, скорее,
характерна для соответствующего подтипа инсульта.
2. Скорость уменьшения и перестройки очага не зависит
от подтипа инсульта, локализации очага, сопутствующих
заболеваний, методов реабилитации и пропорциональна
исходному размеру очага инфаркта.
3. Степень тяжести ХОБЛ коррелирует с показателями
кровотока задних мозговых артерий и позвоночных
артерий, а также с коэффициентом асимметрии.
The problem of cerebrovascular diseases of the brain is still relevant, despite
notable advances in understanding the pathogenesis, diagnosis and treatment [1, p.
1305-1315]. This is due to a number of reasons, and above all, the high prevalence of
this pathology [2, p. 259-274].Worldwide, about 20 million strokes are recorded every
year, within a year after IS - 33% die, 37% of patients become addicted and 9% suffer a
second stroke [3, P. 122-126].
Both from the point of view of maintaining the quality of life and the cost of
patients’
treatment that underwent cerebral infarction, prevention of relapses are an
important task [4, P.43-53].
Actually, all over the world, cerebral infarction is the first leading cause of
neurological disorders. Despite the fact that in everyday speech a stroke is often called
a cerebral hemorrhage, in reality, hemorrhages - the hemorrhagic type of stroke -
account for only 20-25% of cases. IS account for 70-85% of cases, non-traumatic
subarachnoid hemorrhages - 5% of cases [5, 11-20.].
One of the important aspects of this pathology is a high rate of disability and
mortality from cerebrovascular diseases. In economically developed countries of
Europe, IS ranks third among the causes of mortality after cardiovascular and cancer
diseases. Annual mortality rates vary from 63 cases per 100,000 in Sweden to 274 per
100,000 in Russia [6, pp. 55-61.].
361
In Russia, the incidence and mortality from stroke remain among the highestone
in the world, and a steady increase in CVD is observed [7, pp. 8-18]. More than 400,000
cases are registered annually in Russia [8, 397 p.].
In the acute and restorative stages, the clinical picture of the disease is determined
by a combination of movement disorder, sensory, coordination disorders, disorders of
higher cerebral and mental functions. These syndromes are manifestations of cerebral
disintegration.The degree of medical, social and, often, psychological rehabilitation of
patients who have undergone IS depends on its regression [9, pp. 3-18.].
Most of the mentioned syndromes are disorders of the sensorimotor complex.
These are gross speech disorders in the syndromes of expressive and impressive
aphasia, the destruction of a full-fledged movement stereotype in the syndromes of
central paresis or Parkinsonism, and coordination disorders in ataxia [10, P.22-33].
In all these cases, there is a disorder of both the sensory and movement
components of the functional system that provides voluntary movements. This functional
system has a cortical representation, a complex system of afferentation with various types
of sensitivity (musculo-articular, visual, auditory), multiple systems of effector
connections - pyramidal, extra pyramidal, cerebellar, cortico-reticular [11, pp. 4-6.].
The clinical manifestations of VertebrobasilarIschemia cannot always be
adequately interpreted by the patients themselves and / or their relatives and medical
staff. According to the Stroke Registry of the city of Perugia, Italy, within the first 6 hours
after the onset of the disease, 60.8% of all patients with stroke were hospitalized in
specialized centers for the treatment of stroke and only 35.5% of patients with
vertebrobasilar vascular syndromes [12, P. 405- 411].
Ischemia in the vertebrobasilar basin can be clinically manifested by a wide range
of symptoms, depending on the lesion of certain brain structures. According to the New
England Medical Center Posterior Circulation Registry (NEMC-PCR), USA, which
includes 407 patients with IS in VI (63% of men and 37% of women, average age 60.5
years old ), most often patients complained of dizziness (47% of cases), unilateral
weakness of limbs (41% of cases), dysarthria (31% of cases), headache (28% of cases),
nausea and vomiting (27% of cases) [13, P. 389-398.].The most frequently detected
signs in these patients during clinical examination were unilateral limb weakness (38%
of cases), walking ataxia (31% of cases), unilateral limb ataxia (30% of cases),
dysarthria (28% of cases), and nystagmus (24%). cases). Impairment of consciousness
was observed in 5% of cases [14, P. 346-351.].
According to Ischemic posterior circulation stroke in the state of Qatar registry
(IPCSQ), including 116 patients with IS in VI (85% men and 15% women, average age
53 years old), dizziness occurred in 75% of patients with IS in VI, ataxia in 65% of
patients, dysarthria in 64% of patients, nausea and vomiting in 60% of patients,
unilateral limb weakness in 49% of patients, nystagmus in 48% of patients, and
conscious disturbances in 18% of patients [15, P]. 1004-1009.]. It should be noted that
most of the symptoms described above are non-specific for ischemia in VI, especially if
they occur in isolation [16, P. 45-53]. The severity of the neurological deficit in a patient
with acute ischemia in VI cannot always be fully reflected using generally accepted
stroke scales. According to Inoa and coauthors out of 372 patients with strokes in VI,
71% had 4 or less points on the NIHSS scale (National Institutes of Health Stroke Scale),
which is a contraindication to thrombolytic therapy during the therapy window [17, P.
251- 255.].
362
Research by P.C. Chung and coauthors revealed that in patients with heart attacks
in the VIat admission, the average score on the NIHSS scale was 5.8. At the same time, it
was shown that if patients with IS in VI have more than 9 points on the NIHSS scale at
admission, the odds ratio (OR) of an unfavorable functional outcome (5 or 6 points on
the Rankin scale) by the end of treatment is 19.65 (95%
ДИ
from 9.43 to 40.94), after 3
months - 13.52 (95%
ДИ
from 6.34 to 28.86) [18, P. 510-517.].
The use of the Barthel Index (a score for daily activities and the ability to care for
oneself) also does not always give a correct assessment. According to the Kansas City
Stroke Study, the Barthel Index scale has a "ceiling effect" in patients with minimal
consequences of stroke (most patients receive high scores) and in mild strokes the scale
is not sensitive enough [19, P. 1840-1843].
In spite of the large amount of descriptive data on clinical manifestations of acute
ischemia in the VI, classical clinical syndromes corresponding to circulatory disorders
in certain vessels are rarely encountered in routine practice [20, P. 989-998; 21;22, P.
72-76].
Usually, patients have a combination of symptoms, some of which are non-
specific [23, P. 80-87;24, P. 45-53].
The aim of the research was to study the clinical manifestations of patients with
syndrome-stroke in the invertebral-basillary system.
To achieve the goal of the study and solve the set tasks for the period 2017
–
2020,
126 patients (60 men and 66 women) were examined in the rehabilitation period of
cerebral IS in VI at the age of 50-
80 years old (61.2 ± 6.2).
Distribution of patients by gender and age groups
Groups
Group I
Group II
Total
Number
of
Patients
62 (49,2%)
64 (50,8%)
126 (100%)
Average age
59,8±5,8
62,4±5,4
61,2±6,2
Sex
М
F
М
F
М
F
Number
of
Patients
29
(46,8%)
33
(53,2%)
31
(48,4%)
33
(51,6%)
60
(47,6%)
66
(52,4%)
Average age
57,9±4,7
61,1±4,1
61,2±3,7
63,6±3,9
59,6±5,6
62,8±7,1
For assessment of neurological status in the early and late rehabilitation periods
we used the V. Lindmark scale (score evaluation of movement disorders (active and
passive), muscle tone, sensitivity, walking, balance, social skills).
The Lindmark scale includes 7 subscales that characterize various parameters of
the movement system, sensitivity and coordination: subscale A - performance of active
movements in the arm and leg, B - performance of fast variable movements, C - general
mobility of the patient, D - balance parameters, E - state superficial and deep sensitivity,
F - the strength of pain in the joints and G - mobility in them.
Each dimension is scored and has a different maximum for each dimension. The
score is maximum in case of normal function (a healthy subject can score a maximum of
446 points) and is equal to zero in the case of the greatest severity of impairments. The
degree of decrease in the integral indicator correlates with the severity of the functional
consequences of AICC (Acute Impairment of Cerebral Circulation [25, P. 1-40]
(Appendix 3).
363
To assess the neuropsychological status of patients, we used the following scales
in the early and late rehabilitation periods: the Montreal Cognitive Assessment Scale
(MoCA) and the Hospital Anxiety and Depression Scale (HADS).
The time for MoCA was about 10 minutes for each patient. The maximum points
- 30, 26 points and more were considered a normal indicator (Appendix 4).
The time for self-filling the form of the HADS scale by the patient, after instructing,
was also about 5-10 minutes. The classic form of the HADS scale for cognitively safe
patients includes odd-numbered anxiety subscale questions, even-numbered
depression subscale questions, odd and even-numbered scores were calculated
separately, giving two scores for each subscale.Each patient was asked separately to
prevent data corruption. The point score was interpreted according to the following
criteria: 0-7 points "normal" (no reliably expressed symptoms of anxiety and
depression), 8-10 points, "sub clinically expressed anxiety / depression", 11 points and
higher "clinically expressed anxiety / depression". [26, p. 91].
Regardless of the time spent on hospitalization, the number of NIHSS points on
admission (mean score 6.8 ± 2.3)
was significantly higher in patients who were
admitted to the clinic directly via the EMS (average score 4.8 ± 1.8; p = 0.029). However,
the NIHSS level at discharge in these patients (average score 2.8 ± 2.4 for patients
admitted to the emergency room an
d 2.4 ± 2.1 for patients admitted to self
-referral) did
not differ significantly (p = 0.52). Comparison of the above-mentionedpatients in terms
of the number of points on the Rankin scale at admission (average score 3.8 ± 1.1 for
patients hospitalized via
the EMS and 3.4 ± 0.9 for patients hospitalized by self
-referral)
and at discharge (2.2 ± 1.4 and 1.8 ± 1.1 points, respectively) did not show significant
differences (p> 0.11).
All 126 patients underwent brain MRI image to confirm the diagnosis. According
to the data of neuroimaging (MRI) methods, in the analyzed sample, infarctions in the
occipital lobes were detected in 51 patients (40.5% of the total number of patients),
infarctions in the cerebellar hemispheres in 37 patients (29.4%), in the pons of the brain
in 32 patients (25.4%), in the thalamus in 22 patients (17.5%), in the mediobasal
regions of the temporal lobes in 13 patients (10.3%), 9 patients (7.1% each) had heart
attacks in the lower medial regions parietal lobes, cerebellar vermis and medulla
oblongata, 7 people in the midbrain (5.6%). At the same time, in some patients,
involvement of two or more structures of the brain supplied from the vertebrobasilar
basin was observed (Table 3.3).
Among men, infarctions in the occipital lobes were detected in 26 patients (43.3%
of all men), in the cerebellar hemispheres in 23 patients (38.3%), in the pons of the brain
in 14 patients (23.3%), in the thalamus in 7 patients (11.7%), in the mediobasal parts
of the temporal lobes in 8 patients (13.3%), in the lower medial parts of the parietal
lobes in 5 patients (8.3%), in the cerebellar vermis in 4 patients (6.7%) ), in the medulla
oblongata in 5 patients (8.3%), in the midbrain in 4 patients (6.7%).
Among women, infarctions in the occipital lobes were detected in 23 patients
(34.8% of all women), in the cerebellar hemispheres in 10 patients (15.2%), in the pons
of the brain in 18 patients (27.3%), in the thalamus in 17 patients (25.8%), in the
mediobasal parts of the temporal lobes in 5 patients (7.6%), in the cerebellar vermis in
4 patients (6.1%), 2 patients (3%) each had infarctions in the lower medial parts of the
parietal lobes, in the medulla oblongata and midbrain (table 3.3).
364
In the studied patients, only in 42 cases (33.3%) it was possible to reveal
complete or partial classical clinical syndromes corresponding to circulatory disorders
in certain vessels of the vertebrobasilar basin (VBB)
At the same time, paramedian pontine syndrome occurred in 9 cases (23.7%),
ventral pontine syndrome - in 8 cases (21.1%), lateral thalamic (thalamogeniculatory)
syndrome - in 8 cases (21.1%), posterior lower cerebellar artery (lateral medullary
syndrome) - in 5 cases (13.2%), anterior inferior cerebellar artery syndrome - in 4 cases
(10.5%), superior cerebellar artery syndrome - in 4 cases (10.5%), lateral pontine
syndrome - in 2 cases (5.3%) and anterolateral thalamic (tuber thalamic) syndrome - in
2 cases (5.3%).
Figure 3.8. Involvement of brain structures in patients with IS in
VBB with their division into groups
Based on the above mentioned, an important task was to identify in the studied
patients the entire spectrum of clinical manifestations corresponding to the lesion of the
brain structures supplied by the blood vessels of VBB and to determine the presence of
a statistically significant dependence of clinical manifestations on COPD.
In one patient, as a rule, several clinical symptoms of stroke were determined,
both subjective, found during the consideration of complaints and interviewing the
patient, and objective, identified by a doctor during a clinical neurological
examination.At the same time, certain subjective sensations of patients could not always
be objectified during functional tests (for example, a patient complaining of dizziness or
feeling unsteadiness, unsteadiness when walking, could stand satisfactorily in the
complicated Romberg test and, conversely, was detected in the patient in tests ataxia
was not always associated with complaints of impaired coordination).
It was important for us to identify the widest and most complete list of both
subjective and objective clinical manifestations of stroke in VBB that were present in the
studied patients and to determine their dependence on COPD.
11
19
23
18
2
2
5
2
6
9
17
21
15
4
2
6
1
5
0
5
10
15
20
25
Group I (n=62)
Group II (n=64)
Column 1
365
In the studied patients with IS in VBB, paresis and paralysis of the limbs
(hemiparesis and hemiplegia, tetra paresis, monoparesis) prevailed in the structure of
clinical manifestations, 68 patients had them, which amounted to 54% of all cases, 55
patients (43.7%) had dysarthria. When conducting coordination tests, ataxia was
detected in 61 patients (48.4%), including hemiataxy - in 27 patients (22.2%).45 people
(35.7%) complained of a subjective feeling of unsteadiness, instability in an upright
position, imbalance, 33 people (26.2%) - a feeling of rotational dizziness (vertigo), 2
people (1.6%) - a feeling no rotational dizziness. Nystagmus was detected in 45 patients
(35.7%), in 38 patients (30.2%) - depression of consciousness of one degree or another
(from stunning to coma), in 31 patients (24.6%) - sensory disturbances (hypesthesia,
paresthesia, dysesthesia).There were 26 cases (20.6% each) of hemianopsia and paresis
of the oculomotor muscles. 19 people (15.1%) complained of diplopia, 17 patients
(13.5%) had autonomic disorders (nausea, vomiting, sweating, palpitations), 14
patients (11.1%) complained of headache.
In 12 cases (9.5% each) there was confusion, dysphagia and visual agnosy, in 7
cases (5.6% each) - aphasia, dysphonia and ignoring syndrome (neglect), in 4 cases
(3.2% each) - amnesia, respiratory disorders and syncope episodes.There were also 2
cases (1.6% each) of epic attacks in the disease's debut, visual hallucinations,
nonspecific binocular vision disorders, positive visual phenomena (photopsies), and a
feeling of marked generalized (general) weakness (Fig. 3.9).
In patients of group I, among the clinical manifestations of IS in VBB, ataxia
prevailed, which occurred in 35 patients (56.5%), including hemi ataxia, which occurred
in 20 patients (31.3%). Paresis and paralysis of the limbs were detected in 31 patients
(50%).
Complaints about a subjective feeling of unsteadiness, instability in an upright
position, and imbalance occurred in 25 patients (40.3%). Dysarthria also occurred in 25
cases (40.3%). Nystagmus was detected in 22 cases (35.5%), rotational dizziness
(vertigo) - in 20 cases (32.3%), depression of consciousness - in 21 cases (33.9%).
Symptoms such as hemianopsia and ophthalmoparesis occurred each in 14 cases
(22.6%).Sensory disorders were detected in 12 patients (19.4%), autonomic disorders
- in 8 patients (12.9%), diplopia - in 8 patients (12.9%), dysphagia - in 7 patients
(11.3%) , aphasia and headache - 6 patients each (9.7% each), dysphonia - 7 patients
(11.3%), confusion and visual agnosia - 4 patients each (6.5% each), respiratory failure
- 3 patients (4.8%). There were also 2 cases (3.2% each) of amnesia, ignorance
syndrome (neglect) and a feeling of generalized weakness (Figure 3.9).
The paresis and paralysis of the limbs prevailed among the patients of the group
II; they were detected in 37 patients (57.9%). Dysarthria occurred in 30 cases (47%),
nystagmus - in 23 cases (35.9%), sensitive disorders - in 19 cases (29.6%). Ataxia was
detected in 26 patients (40.6%), including hemi ataxia - in 7 patients
(10.9%).Complaints about a subjective feeling of unsteadiness, instability in an upright
position, and imbalance occurred in 20 patients (31.2%). The depression of
consciousness was also detected in 17 cases (26.6%). Rotational dizziness (vertigo) was
detected in 13 cases (20.3%), diplopia - in 11 patients (17.2%).
Symptoms such as ophthalmoparesis and hemianopsia occurred each in 12 cases
(18.7% each), confusion - in 8 cases (12.4% each), autonomic disorders - in 9 patients
(14.1%), visual agnosia and headache - in 8 cases (12.5% each), neglect syndrome and
dysphagia - in 5 patients (7.8% each). An episode of syncope, like amnesia, occurred in
366
2 patients (3.2% each), epileptic seizures at the onset of the disease occurred in 1 case
(1.6%).And, finally, symptoms such as dysphonia, non-rotational dizziness, positive
visual phenomena, nonspecific binocular visual impairment, visual hallucinations and
feelings of generalized weakness did not occur in this group of patients. (Figure 3.9).
The Mann-Whitney test did not reveal significant differences in the clinical
manifestations of IS in VBB in both groups (p> 0.05). According to the correlation
analysis, the age of patients with IS in VBB does not have significant relationships with
the incidence of clinical manifestations (-0.3 <r <0.3).
In patients with IS in VBB, a significant (p <0.05) average strength direct
relationship was detected between NIHSS scores at the time of hospitalization and the
frequency of the following clinical manifestations: paresis and paralysis of the limbs (r
= 0.61), dysarthria (r = 0.57), depression of consciousness (r = 0.58), respiratory
failure (r = 0.68). At the same time, a significant (p <0.05) inverse relationship was
revealed between the NIHSS scores at the time of hospitalization and the frequency of
occurrence of a feeling of unsteadiness, instability in the upright position, imbalance (r
= 0.31), vertigo (r = 0, 41), ataxia (r = 0.44).
This is probably due to the insufficient reflection of ischemic symptoms in the
VBB in the NIHSS scale. A significant (p <0.05) average direct relationship between the
NIHSS scores at the end of treatment and the frequency of depression of consciousness
(r = 0.56) was found in patients with IS in the VBB.
367
Figure 3.9. Clinical manifestations of the disease in patients with IS in VBB in %
54
43,
7
48,
4
35,
7
26,
2
35,
7
30,
2
24,
6
20,
6
20,
6
15,
1
13,
5
11,
1
9,
5
9,
5
9,
5
5,
6
5,
6
5,
6
3,
2
3,
2
3,
2
1,
6
1,
6
1,
6
1,
6
1,
6
50
40,
3
56,
5
40,
3
32,
3
35,
5
33,
9
19,
4
22,
6
22,
6
12,
9
12,
9
9,
7
6,
5
11,
3
6,
5
9,
7
11,
3
3,
2
3,
2
4,
8
3,
2
3,
2
1,
6
3,
2
3,
2
3,
2
57,
9
47,
0
40,
6
31,
2
20,
3
35,
9
26,
6
29,
6
18,
7
18,
7
17,
2
14,
1
12,
5
12,
5
7,
8
12,
5
1,
6
0,
0
7,
8
3,
1
1,
6
3,
1
0
1,
6
0
0
0
0
10
20
30
40
50
60
All patients
Group I
Group II
365
In patients with IS in the VBB, a significant (p <0.05) moderate direct relationship
was detected between the Rankin scores at the time of hospitalization and the incidence of
depression of consciousness (r = 0.60). In patients with IS in the VBB, a significant (p
<0.05) moderate direct relationship was detected between the Rankin scores at the end
of treatment and the incidence of respiratory failure (r = 0.34).
In patients with IS in VBB, a significant (p <0.05) strong direct relationship between
the time from the moment of symptom detection to hospitalization and the incidence of
sensory disorders (r = 0.89) was revealed.
Clinical manifestations were analyzed in patients with different pathogenetic
subtypes of IS in VBB (Table 3.3). In patients with LA subtype of IS in VBB, the incidence
of paresis and paralysis of the limbs is significantly higher than in patients with strokes of
unspecified etiology (p = 0.045).
The incidence of ataxia is significantly higher in patients with IS in the VBB HD
etiology than in patients with the EC subtype (p = 0.003), the AT subtype (p = 0.017) and
patients with the LA subtype (p = 0.009).
In patients with AT subtype of IS in VBB, the frequency of occurrence of a feeling of
unsteadiness, instability in the upright position, and imbalance is significantly higher than
in patients with LA subtype of IS (p = 0.038). In patients with EC subtype IS in VBB, the
incidence of a feeling of unsteadiness, unsteadiness in the upright position, and imbalance
is significantly lower than in patients with HD etiology strokes (p = 0.019).
Table 3.
Clinical manifestations in patients with different
pathogenetic subtypes of IS in VBB
Clinical manifestations
АТ (n=55)
EC (n=39)
L
А (n=14)
HD (n=18)
Abs %
Abs %
Abs %
Abs %
Paresis and paralysis of the limbs 26
47,3
26
66,7
12
85,7
5
27,8
Ataxia
26
47,3
13
33,3
4
28,6
16
88,9
Hemiataxia
17
30,9
8
20,5
--
--
5
27,8
Dysarthria
22
40,0
15
38,5
6
42,9
15
83,3
Feelings
of
unsteadiness,
unsteadiness
in
the
upright
position, imbalance
24
43,6
8
20,5
--
--
13
72,2
Vertigo
14
25,5
5
12,8
2
14,3
10
55,6
Non-rotational vertigo
3
5,5
--
--
--
--
--
--
Nystagmus
19
34,5
13
33,3
--
--
13
72,2
Depression of consciousness
15
27,3
16
41,0
2
14,3
5
27,8
Sensitive disorders
14
25,5
8
20,5
8
57,1
--
--
Hemianopsia
10
18,2
13
33,3
2
14,3
--
--
Paresis of the oculomotor muscles 5
9,1
8
20,5
--
--
8
44,4
Diplopia
7
12,7
5
12,8
--
--
8
44,4
Vegetative disorders
5
9,1
5
12,8
--
--
8
44,4
Headache
6
10,9
5
12,8
2
14,3
--
--
Confusion
4
7,3
8
20,5
--
--
--
--
Dysphagia
5
9,1
5
12,8
--
--
3
16,7
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Visual agnosia
2
3,6
10
25,6
--
--
--
--
Aphasia
3
5,5
3
7,7
--
--
--
--
Dysphonia
2
3,6
2
5,1
2
14,3
--
--
Neglect Syndrome
--
--
8
20,5
--
--
--
--
Amnesia
4
7,3
--
--
--
--
--
--
Breathing disorder
--
--
5
12,8
--
--
--
--
Syncope
--
--
1
2,6
--
--
--
--
Epi attacks
--
--
1
2,6
--
--
--
--
Visual hallucinations
--
--
1
2,6
--
--
--
--
Binocular visual impairment
--
--
1
2,6
--
--
--
--
Feeling of generalized (general)
weakness
--
--
--
--
--
--
2
11,1
In patients with strokes in VBB HD etiology, the incidence of a feeling of
unsteadiness, instability in the upright position, and imbalance is significantly higher than
in patients with LA subtype (p = 0.009). In patients with EC subtype of IS in VBB, the
incidence of vertigo is significantly lower than in patients with HD strokes (p = 0.028). In
patients with HD of IS in VBB, the incidence of nystagmus is significantly higher than in
patients with LA subtype (p = 0.013). In patients with LA subtype of IS in VBB, the
incidence of sensory disorders is significantly higher than in patients with HD strokes (p
= 0.031).
In patients with AT of IS in VBB, the incidence of paresis of the oculomotor muscles
is significantly lower than in patients with HD strokes (p = 0.035). In patients with AT of
IS in VBB, the incidence of autonomic disorders is significantly lower than in patients with
HD strokes (p = 0.028). In patients with AT of IS in VBB, the incidence of the syndrome of
neglect is significantly lower than in patients with the EC subtype (p = 0.029).
In patients with IS in VBB, the frequency of the incidence of hemianopsia, hemi
ataxia, diplopia, dysarthria, non-rotational dizziness, depression of consciousness,
episodes of syncope, confusion, amnesia, positive visual phenomena, nonspecific binocular
visual impairment, feelings of generalized weakness, dysphagia, aphasia pain, visual
hallucinations, epileptic seizures, dysphonia, respiratory failure does not depend on the
subtype of stroke (p> 0.05).
In the group of patients with AT of IS, a significant (p <0.05) moderate direct
correlation was detected between the number of points on the NIHSS scale at the time of
hospitalization and the incidence of paresis and paralysis of the limbs (r = 0.53),
dysarthria (r = 0.54 ), depression of consciousness (r = 0.61); significant (p <0.05)
average inverse correlation between the number of points on the NIHSS scale at the time
of hospitalization and the incidence of vertigo (r = -0.54). In the group of patients with AT
of IS, a significant (p <0.05) moderate inverse correlation was recorded between the
number of points on the NIHSS scale at the end of treatment and the incidence of vertigo
(r = -0.41).
In the same group of patients with AT of IS, a significant (p <0.05) moderate direct
correlation was detected between the number of points on the Rankin scale at the time of
hospitalization and the incidence of dysarthria (r = 0.48), depression of consciousness (r
= 0.51).
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In the group of patients with EC of IS, a significant (p <0.05) moderate direct
correlation was detected between the number of points on the NIHSS scale at the time of
hospitalization and the incidence of paresis and paralysis of the limbs (r = 0.55),
dysarthria (r = 0.58), depression of consciousness (r = 0.57).There was also a significant
(p <0.05) moderate direct correlation between the number of points on the NIHSS scale
at the end of treatment and the incidence of dysarthria (r = 0.67).There was also a
moderate direct correlation between the number of points on the Rankin scale at the time
of hospitalization and the incidence of dysarthria (r = 0.64), depression of consciousness
(r = 0.62); significant (p <0.05) average strength inverse correlation between the number
of points on the Rankin scale at the time of hospitalization and the incidence of hemiataxia
(r = -0.5), significant (p <0.05) average strength direct correlation between the number
of points according to the Rankin scale at the end of treatment and the incidence of paresis
and paralysis of the limbs (r = 0.60);significant (p <0.05) average strength inverse
correlation between the number of points on the Rankin scale at the time of hospitalization
and the incidence of hemiataxia (r = -0.5), revealed significant (p <0.05) average strength
direct correlation between the number of points according to the Rankin scale at the end
of treatment and the incidence of paresis and paralysis of the limbs (r = 0.60); significant
(p <0.05) mean inverse correlation between the number of points on the Rankin scale at
the end of treatment and the incidence of ataxia (r = -0.62), hemiataxia (r = -0.64), vertigo
(r = - 0.52).
In the group of patients with HD strokes, there was a significant (p <0.05) strong
direct correlation between age and the incidence of depression of consciousness (r =
0.81), a significant (p <0.05) strong inverse correlation betweenBMI (Body Mass Index)
and the incidence of sensation instability, unsteadiness, imbalance (r = -0.82) and diplopia
(r = -0.84). In this group of patients with HD strokes, there was also a significant (p <0.05)
strong direct correlation between the number of points on the NIHSS scale at the time of
hospitalization and the incidence of paresis and paralysis of the limbs (r = 0.84).
Based on the above, the following conclusions can be drawn:
1.In the acute and rehabilitation stages, the clinical picture of the disease is
determined by a combination of movement, sensory, coordination disorders, disorders of
higher cerebral and mental functions. These syndromes are manifestations of cerebral
disintegration. The degree of medical, social and, often, psychological rehabilitation of
patients who have undergone IS depends on its regression.
2. In patients with IS in VBB, a significant (p <0.05) average strength direct
relationship was detected between NIHSS scores at the time of hospitalization and the
frequency of the following clinical manifestations: paresis and paralysis of the limbs (r =
0.61), dysarthria (r = 0.57), depression of consciousness (r = 0.58), respiratory failure (r
= 0.68).At the same time, a significant (p <0.05) inverse relationship was revealed
between the NIHSS scores at the time of hospitalization and the frequency of occurrence
of a feeling of unsteadiness, instability in the upright position, imbalance (r = 0.31), vertigo
(r = 0, 41), ataxia (r = 0.44). This is probably due to the insufficient reflection of ischemic
symptoms in the VBB in the NIHSS scale. A significant (p <0.05) average direct relationship
between the NIHSS scores at the end of treatment and the frequency of depression of
consciousness (r = 0.56) was detected in patients with IS in the VBB.
3. In patients with AT of IS in VBB, the incidence of paresis of the oculomotor
muscles is significantly lower than in patients with HD strokes (p = 0.035).
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4.In the group of patients with EC of IS, a significant (p <0.05) moderate direct
correlation was detected between the number of points on the NIHSS scale at the time of
hospitalization and the incidence of paresis and paralysis of the limbs (r = 0.55),
dysarthria (r = 0.58), depression of consciousness (r = 0.57). There was also a significant
(p <0.05) moderate direct correlation between the number of points on the NIHSS scale
at the end of treatment and the incidence of dysarthria (r = 0.67).
5.In the group of patients with EC of IS, a significant (p <0.05) moderate direct
correlation was detected between the number of points on the NIHSS scale at the time of
hospitalization and the incidence of paresis and paralysis of the limbs (r = 0.55),
dysarthria (r = 0.58), depression of consciousness (r = 0.57). There was also a significant
(p <0.05) moderate direct correlation between the number of points on the NIHSS scale
at the end of treatment and the incidence of dysarthria (r = 0.67).
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