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Objective – to investigate the clinical and morphological characteristics of the manifestations of the rupture of arterial aneurysms of the brain in patients with occlusive-stenotic lesions of the cerebral arteries. Materials and methods. 1147 case histories of patients with aneurysmal disease of the cerebral arteries who underwent comprehensive examination and treatment in the Department of Neurosurgical Pathology of Head and Neck Vessels with X-ray Surgical Department «Romodanov Institute of Neurosurgery NAMS of Ukraine» since 2006 until 2022. The medical histories of 126 patients who were included in this study and divided into two groups were studied in detail. The criteria for inclusion in the main group (38 men and 25 women) were: surgical treatment; rupture of arterial aneurysm the presence (proven using instrumental examination methods) of occlusive-stenotic lesions.The criteria for inclusion in the control group (38 men and 25 women) were: surgical treatment; rupture of arterial aneurysm; absence (proven by means of instrumental examination methods) of occlusive-stenotic lesions; the gender and age distribution had to match the main group.Among the patients included in this study, there were 76 men (60.32 %) and 50 women (39.68 %). The age of the patients varied from 31 to 77 years. The average age of patients ‒ 55.9 ± 0.76 years. Results. The Hunt‒Hess severity of patients was approximately the same between the main and control groups. When evaluated by the World Federation of Neurologican Surgeons (WFNS) and Glasgow Coma scale (GCS), more patients in the control group had a lighter score. Aneurysms of the anterior cerebral-anterior connecting artery complex prevailed in both groups. A higher frequency of arterial aneurysms of the middle cerebral artery was revealed among patients of the main group (main group ‒ 27.0 %, comparison group 15.8 %). The higher number of multiple aneurysms in the main group (the main group ‒ 25.4 %, the controlgroup ‒ 12.7 %) and the smaller number of miliary aneurysms and the larger number of large aneurysms in the main group may indicate the predominance of congenital etiological factors common to both pathologies in the development of the disease until the rupture of the arterial aneurysm. Conclusions. Gender differences were established with a predominance of men among patients of the main group (60.32 %). The average age of men with occlusive-stenotic lesions was lower than that of women (men – 54.3±0.94 years, women – 58.3±1.19 years). The difference in age is especially pronounced in the subgroup of the main group where the severity of stenosis is 50‒75 % (men ‒ 48.3 years; women ‒ 62.0 years).The neurological status of patients with a hemorrhagic stroke, as a result of the rupture of an arterial aneurysm, is significantly aggravated by occlusive-stenotic lesions due to the occurrence of chronic brain ischemia. The worst prognosis is in men with a ruptured arterial aneurysm and a 50‒75 % stenotic lesion.

The search for the optimal approach in the treatment of brachiocephalic arteriovenous fistulas is one of the current problems of neurosurgery and vascular surgery. It is important to note that the best prognosis requires timely diagnosis and the earliest possible dissection of the fistula. Also, the method of treatment should have the least negative consequences and a good clinical effect. Previously, surgeons used open surgical vessel ligation with great technical difficulties due to anatomical difficulties of access as well as bleeding. In recent decades, the endovascular approach to treatment has demonstrated advantages over open interventions. Despite the low traumaticity, there is a risk of complications such as untargeted vascular embolization, perioperative stroke, etc. In this article we demonstrate the experience of arterio-venous vertebral artery fistula dissection using an occluder.

Objective: to comparatively analyze the patterns of functional hemispheric specialization in patients with local brain tumor lesions and in healthy participants.Patients and methods. 40 patients (20 men and 20 women) with local unilateral brain tumor lesions (astrocytomas, gliomas, metastases) aged 19–60 years (mean age, 33±9.2 years) were examined for functional hemispheric specialization for verbal and visual perceptual functions when performing cognitive tasks by functional transcranial Doppler ultrasonography. The findings were compared with those in 57 healthy individuals (mean age, 28±5.1 years). All the participants were right-handed.Results. There was a more pronounced increase in blood flow velocity (BFV) while performing verbal cognitive tasks in the vessels of the left hemisphere (LH) and a more marked rise in that when fulfilling non-verbal cognitive tasks in the vessels of the right hemisphere (RH). The trends in the ratio of LH/RH BFV amplification when performing cognitive tasks were observed to be the same as previously observed in the healthy participants.

Cerebral persistent primitive arteries are uncommon and associated with cerebrovascular diseases, like cerebral aneurysms. They can cause vertebrobasilar ischemia and neuropathy of the cranial nerves. The authors present a patient with trigeminal artery associated with giant partially thrombosed cavernous internal cerebral artery aneurysm.

The paper provides a review of the works in which functional transcranial Doppler ultrasound is used in different areas of neurocognitive studies. It discusses the advantages and disadvantages of the technique in solving theoretical and practical problems and prospects of its use.

Abstract Today diseases of the cardiovascular system are called the problem number 1in the world, including Ukraine. Every year more than 500 thousand Ukrainians dye from CVDs, i.e. 1370 people on average dye every day. Smoking is one of the most serious threats to health, especially with regard to cardiovascular disease. Every year, smoking kills more than 1.2 million people in Europe (of which 450 thousand - due to cardiovascular diseases) and about 650 thousand people of the EU countries (including from cardiovascular problems - 185 thousand). Analysis of the literature suggests paucity and contradictory information about changes in the functional status of the various systems of the body while smoking. The aim of the work was to study the peculiarities of cerebral hemodynamics in patients with hypertension stage II depending on smoking status. Material and methods. We examined 100 patients with essential hypertension stage II low additional cardiovascular risk, 53 men and 47 women. Depending on the smoking status (at least 10 years), all patients were divided into 2 groups: a group of smokers included 30 patients, in the group of non-smokers there were 70 patients. To assess cerebral hemodynamic Doppler ultrasound and duplex scanning methods were used. Statistical processing of the material was performed using the software package Statistica 6.0 («Statsoft», USA, № license AXXR712D833214FAN5). Results and discussion. Analysis of the data shows the predominance of authentic vascular resistance index in the right CCA by 3.3% (p = 0.033), in the right MCA by 8.5% (p = 0.05), in the left MCA by 7.1% (p = 0.042) in hypertensive patients with smoking status, compared with non-smoking hypertensive patients. In smokers with hypertension statistically significant increasing of the indicator "reserve vasoconstriction" by 4.63 times (p = 0.029) in the left ICA and by 3.01 times (p = 0.031) in the right ICA was also found compared with data rates in nonsmokers hypertensive patients. The results of our studies in hypertensive patients revealed the following gender differences. Significant predominance of resistance index in the right ICA by 10.8%, the maximum linear velocity of blood flow in the left ICA by 22.0% was obtained in female smokers compared with male smokers. At the same time, in women-smokers lower values of systolic and diastolic index in the right CCA by 8.7% and resistance index in the left MCA by 4.9% than in male smokers were observed. Conclusions: Disorders of cerebral blood flow in hypertensive patients with smoking status compared with hypertensive nonsmokers were characterized by more pronounced carotid artery spasm. In hypertensive patients with smoking status most sensitive Doppler indicators of the great neck and head arteries are Pourcel resistance indices in the common carotid and middle cerebral arteries, as well as indicators of cerebrovascular reactivity in the internal carotid artery. Gender differences of Doppler indices of the great neck and head arteries in hypertensive patients with smoking status were characterized by: higher vascular resistance in the common and internal carotid arteries in women and in the middle cerebral arteries in men, possibly due to spasm of the arteries under the influence of tobacco smoke.

Objective — to evaluate the efficacy of endovascular techniques in the treatment of occlusion and stenotic lesions of the brachiocephalic and cerebral arteries, to define the ways of complications prevention. Materials and methods. 594 patients with occlusion and stenotic lesions of the brachiocephalic and cerebral arteries were operated by endovascular methods in endovascular center of Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov. 688 endovascular operations were carried out. Most part of the operations are carotid stenting (423 operations). All of these operations were carried out with the usage of different types of antiembolic protection systems: distal, proximal or their combination. Intracranial segments of cerebral arteries were operated in 43 cases. 169 operations of stenting of vertebral arteries in extracranial segments were performed. Subclavian arteries and brachiocephal truncus were operated in 53 cases. Results. Total removal of stenosis was achieved in 588 cases (98.99%). 509 patients (85.69% of cases) had improvement in neurological status (on a scale NIHHS, Mrs., MoCA). 77 (12.96%) patients had no deterioration of neurological status. Postoperative mortality was 1.01%. Common level of other complications was 4.3 %: cerebral complications - 2.7%. Discussion. The results of the endovascular treatment of occlusion and stenotic lesions of the cerebral arteries show high efficacy and low complication level. The ways of reduction complications level are identified. They are in a differentiated selection of antiembolic protection method, endovascular treatment planning, based on monitoring of changes in the brain hemoperfusion, the emphasis is on the use of the special neurologic devices. Conclusions. Endovascular treatment of occlusion and stenotic lesions of the cerebral arteries is effective with a small risk of complications. Risk can be reduced further by the differential choice of antiembolic protection methods, with the help of wide use of special cerebral balloon-catheters and stents for the treatment of stenotic pathology of intracranial arteries, by planning stages of endovascular treatment, based on the clinical data, data of cerebral hemoperfusion in various areas of the brain, and cerebral angiography. [ABSTRACT FROM AUTHOR]

Dissection of cerebral arteries is a rare cause of stroke in the general population. The article describes 5 clinical cases of patients with ischemic stroke after dissection, discusses the issues of etiology, diagnosis and treatment tactics. The possibility of using high-tech methods of treatment for this subtype of stroke is emphasized. The diagnostic method of choice is neuroimaging, including cerebral angiography.

Postmortem studies are of great importance in evaluating the effectiveness of clinical, diagnostic, therapeutic, and preventive measures aimed at combating a social disease, such as dyscirculatory encephalopathy, the leading causes of which are hypertension and atherosclerosis. The complexity of these studies is largely determined by a variety of brain changes with the frequent concurrence of hypertension and severe cerebral atherosclerosis and, at the same time, the similarity of some changes, for example, the localization and size of hypertensive and atherosclerotic lacunar infarcts. The paper describes a case of dyscirculatory encephalopathy with multiple small focal cerebral ischemic changes caused by both hypertension and athero-stenosis of several arteries in both the brain carotid systems and the vertebrobasilar system, namely tandem stenoses. It has been established that small infarcts in tandem stenosis can result from adaptive processes in the intracranial arteries. These infarcts have some features of localization, such as the areas of adjacent blood supply to the cerebral hemispheres and cerebellum, as well as the deep regions of the brainstem. It is shown that arterial pathological changes in the ischemic zones permit one to make a differential diagnosis of hypertensive lacunar infarcts and the same infarcts arising in tandem stenoses. In addition, among the typological signs of hypertensive lacunar infarcts, there are enlarged perivascular spaces in the peri-infarct region and ischemic destruction of myelin in the periventricular regions of the brain.

This article describes a rare clinical and diagnostic case report regarding a female patient presenting with frequent transitory attacks in the basin of both middle cerebral arteries. Based on the findings of duplex scanning of the cervical arteries we revealed floating structures with the presence of pronounced slow turbulent blood flow. After excluding all known causes of cerebral artery microembolism, associated with heart pathology or with the presence of unstable atherosclerotic plaques, the leading hypothesis of transitory ischaemic attacks in the woman concerned was the formation of microthrombi in the zone of motility of the structures revealed. The results of bitemporal transcranial Doppler monitoring carried out during 30 minutes detected more than 10 microembolic signals in the middle cerebral artery, thus confirming the embolic nature of transitory ischaemic attacks.

This review is devoted to moyamoya disease. It is a rare chronic steno-occlusive cerebrovascular disease. However, moyamoya disease is increasingly diagnosed by neurosurgeons in our country. Unlike atherosclerotic lesions of cerebral arteries, pathogenesis and course of this disease are much more complex and variable. Therefore, specialists often have certain difficulties in diagnosis, management and treatment of these patients. To date, a large number of surgical interventions have been proposed for the treatment of moyamoya disease. Revascularization approaches include direct procedures (extra-intracranial microanastomoses), indirect methods (synangioses) and combined revascularization. The purpose of the review is to systematize current literature data on the pathogenesis, diagnosis, clinical patterns and surgical treatment of patients with moyamoya disease. results Outcomes of surgical revascularization and the role of its various components in combined approach are under particular attention.

Aim: To study the frequency and characteristics of headache which is in the past history (HPH) of patients with cervical artery dissection (CeAD) and evaluate with the help of EEG and visual evoked potentials (VEP) the role of central mechanisms in its development., Material and Methods: Two hundred and twenty-seven patients with CeAD verified by neuroimaging were studied. All patients were interviewed about the presence of a headache in the past history and its features. The comparison group comprised 35 patients (mean age - 32,3±8,9 years, 77% female) with migraine. Thirty-five patients with HPH and 35 patients of the comparison group underwent EEG and VEP., Results: HPH was found in 101 patients (average age of 38.5±8.5 years, 70% female) (44.5%) out of 227 patients. In 35 patients (15.4%), HPH met the International Criteria for migraine (with aura - 3.1%, without aura - 12.3%) and in 66 patients (29.1%) did not (non-migraine headache). The latter started at the age of 24.5±10.2 years, had mild/ moderate intensity (95%), diffuse localization (68%), dull/pressing/squeezing character (53%), never accompanied by vomiting and rarely by nausea (8%), photo- phonophobia (11%). HPH, which met the migraine criteria unlike migraine in the comparison group began at a later age (19.9±9.6 vs 16.2±4.4 years, p<0.03), more frequently did not have aura (80% vs 48%, p<0.003), less often was unilateral (31% vs 71%, p<0,004) and had less intensity. The visual EEG analysis less often found rhythmic disorganization in CeAD patients with HPH than in comparison group with migraine. The hyperventilation caused a slight increase in the spectral power of Teta, Delta waves in HPH patients and significant enhancement in comparison group with migraine (p<0.05). Pattern reversal VEP in patients with HPH had a greater latency and smaller amplitude of cortical responses than in comparison group with migraine (p=0.028 and =0.037, respectively). The flash VEP amplitude was lower in HPH patients than in migraine (p=0.01)., Conclusion: HPH in patients with CeAD meets criteria of migraine in 15.4% (with aura - 3.1%, without aura - 12.3%), 29.1% patients have nonmigraine HPH. Central mechanisms, namely, the hypersensitivity of the cerebral cortex playing the main role in migraine pathogenesis, are not significant in HPH genesis. The main role appears to have peripheral mechanisms - dysplastic changes in the wall of extra- and intracranial arteries that predispose both to headache and dissection.

Aim: To find clinical criteria applied in the first hours of disease for the identification of severe ischemic stroke caused by an occlusion of proximal major arteries., Material and Methods: The authors have analyzed 133 medical histories of patients with the diagnosis of acute cerebral blood circulation disorder admitted in the first 6 h from onset. All patients underwent CT-angiography or digital subtraction angiography. Occlusion of the inner carotid artery, occlusion of M1-segment of the middle cerebral artery and occlusion of a major artery were considered as proximal occlusion of major cerebral arteries. Neurological status was assessed by the signs of proximal arterial occlusion (PAO)., Results and Conclusion: Checking of 5 PAO symptoms allows the prediction of occlusion location in approximately 80% of cases. Presence of ≥3 out of 5 symptoms is characterized by 70% sensitivity and 90% specificity with regard to the occlusion of the inner carotid artery, M1-segment of the middle cerebral artery and/or a major artery. Predictive value of this model should be verified in a prospective study.

Epidemiologic, etiologic and pathogenetic aspects of chronic brain ischemia are reviewed. Based on the modern conception of neuroplasticity, neuroprotection and neurogenesis, the authors substantiate the lines of pharmacotherapy. The results of the clinical study of photochromotherapy in the restorative treatment of chronic brain ischemia are presented.

On the model of acute blood-brain barrier injury in rats after a short-term hyperperfusion of one brain hemisphere with blood, the injection of exogenic superoxide dismutase (SOD) was accompanied by pronounced increase in the activity of SOD in the damaged brain tissue. This fact and other data of the authors on this model confirm the penetration of SOD over the microvessel endothelium into the extracellular space of the same damaged brain areas that are permeable for plasma albumin.

Phonoangiography was conducted in 113 patients with various diseases of the brain. From comparison of the findings of clinical and angiographic examination the authors defined typical phonoangiographic criteria for the diagnosis of arterial and arteriovenous aneurysms of the brain which can be used in out- and inpatient practice.

A clinical analysis of focal epileptic attacks in 18 patients with ischemic disturbances of blood circulation in the zone of mixed blood supply by the frontal and median cerebral arteries was carried out. The epileptic attacks observed were found to be due to irritation of the frontal adversive and pre-moter fields. Focal clonic convulsions in the foot due to irritation of the brain paracentral lobule were also observed. The versatility of the clinical forms of the epileptic attacks was determined mainly by the involvement of particular cytoarchitectonic fields of the frontal lobe of the brain (8th, 6th, 4th) belonging to the zone of mixed blood supply by the frontal and median cerebral arteries and provided with blood by different cortical branches of those arteries. Clinico-angiographic and clinico-morphological comparisons showed that in most patients with focal epileptic attacks there was combined involvement of the internal carotid arteries.

The authors have studied the mechanisms of action and the results of the use of ethylcloride block (ECB) in 467 hypertensive patients with headaches before and after ECB. A marked analgetic effect was observed in 93.8% of the patients. A myogenic component of pain in the occipital area was verified electromyographically. It has been established that ECB of the sinocarotid zone significantly decreases both regional and total blood pressure.

On the basis of a special study (diencephalic tests and the EEG) carried out in 48 patients with verified intracranial aneurysms the character of the diencephalic disturbances in the acute period of aneurysm rupture was specified. Two forms of the disturbances, i. e. the clinical (in 94% of the patients) and the latent (in 6%) ones, as well as variants of the diencephalic syndrome (vasomotor, catabolic, neurodystrophic and mixed) were differentiated. It is suggested that the development of the diencephalic disturbances in the acute period of rupture of arterial aneurysms is of a stage character.

The paper is concerned with analysis of angiographic findings on 62 patients with arteriovenous aneurysms (AVA) of the cerebral vessels who received proton beam stereotactic therapy in the period of 1978-1986 depending on an absorbed dose value of an irradiated volume. Proton stereotactic therapy (PST) of brain AVA located deep in the functionally important regions, can be used as an independent radical therapeutic method in such cases including inoperable ones. Complete AVA elimination from the blood flow or considerable reduction of the AVA volume was achieved in 68% of the patients after delivering a dose of approximately 40 Gy, the AVA volume being approximately 30%. Significant (p less than 0.05) correlation of PST results, a dose of irradiation and a value of the AVA irradiated volume was established in the groups with positive results and in the nonresponding groups.

Use was made for the first time of the ultrasonic dopplerography method for diagnosing occlusions of the brain base arteries in patients with cerebrovascular diseases. For this purpose a functional-compression examination technique was developed that enabled one to evaluate indirectly the patency of the intracranial arteries. Dopplerographic criteria of occlusions of individual arteries were determined. A comparison of the diagnosis made with the use of the ultrasonic dopplerography with the data of subsequent cerebral angiography showed that the results coincided in 83.3% of occlusions in the basilar arteries; 90% of occlusions in the terminal parts of the vertebral arteries: 90% of occlusions in the anterior and posterior communicating arteries; 86% of occlusions of internal carotid arteries in the siphon region, and 80% of occlusion of the median cerebral arteries. The results obtained give one grounds to recommend the ultrasonic dopplerography for practical use as a simple and sufficiently reliable method for diagnosing occlusions of the brain basin arteries.

Neuropsychological symptoms of "robbing" the anterior, median, and posterior cerebral arteries due to the ischemia caused within their basins by arteriovenous aneurisms were studied. The disappearance of the "robbing" symptoms after occluding the influx vessels of the aneurism by a separable balloon-catheter (62 observations), or after radical excision of the arteriovenous aneurism (81 observations) was taken for the control. The dynamics of the "robbing" symptoms in the process of the endovascular operations was followed. The importance of the "robbing" and the local symptoms associated with the localization of the vascular conglomerate for the clinic of arteriovenous aneurisms is demonstrated. A high sensitivity of the neuropsychological tests to changes of the cerebral hemodynamics is noted.

Under study there were 12 cases of total infarction within the median cerebral artery system. The resemblance of this disease with cerebral hemorrhage consists not only in the similarity of the neurological symptoms, but also frequently in analogous shifts on the part of peripheral blood and metabolic processes. For diagnostic differentiation dynamic examinations of cerebrospinal liquor can be used. If the absence of erythrocytes in the liquor is confirmed repeatedly, or they appear later and in an insignificant quantity, the diagnosis of the total infarction becomes almost absolitely correct. If, however, the blood appears in the liquor in a greater amount, an extremely thorough analysis of the clinical course of the disease in comparison with the liquor dynamics is necessary, so as to give a correct interpretation of a particular case of the disease.

The pathology of the motor analyser, originating in connection with local lesions of the brain may be studied by means of sensorimotor tracing method. By this parameter, localizations of the lesion produce dissimilar disturbances of the percentive-motor activity. Disorders in movement control were revealed in the case of disturbance of interhemispheric relations resulting from a lesion of the dominant hemisphere; as a result of disfunction of the frontal lobes, which led to disturbance of prognostication; due to disturbance of the "body scheme" and proprioreception disturbances.

The authors convened a clinico-physiological study of the interaction of the visual and skin temperature analyzers in patients with disturbed circulation in the deep branches of the posterior cerebral artery (the first group) and in patients with disturbed circulation in the vertebro-basillar system (the second group). Inasmuch as in the first group there was an involvement of thalamic structures, the significant disorders connected with disturbances of reflectory interaction in the visual and skin-temperature analyzers are presumably related to these structures. An insignificant change in the continuing of the visual and skin temperature analyzers in disturbances of the brain stem indicate to the limited importance of nonspecific structures of this area in the reflectory interaction of these analyzers.

The distribution of the parameter of asymmetry of the wave fronts in EEG on the convexital surface of the cortex during instenon administration is significantly changed in time and becomes normal after 3 hours of observation. This may point to an improvement of the functional state of the brain under the influence of the drug. The most distinct positive dynamics in such conditions were marked in patients with general brain symptoms and transient disorders in the vertebro-basillar system. A transition of desynchronized EEG to hypersynchronized with a subsequent normalization of the structure is apparently conditioned by the central influence of the preparation on the synchronizing areas of the brain reticular formation.

In studying the content of lactic and pyruvic acids in the cerebrospinal fluid of 31 patients during operation for intracranial aneurysms under halothane anesthesia, the authors established that the performance of these operations under protection of deep (40 mm Hg) and prolonged (up to 2 hrs 25 min) artificial arterial hypotension in an uncomplicated course of the surgical intervention was not attended with hypoxic damage of the brain. The danger of hypoxia developing became greater when acute disturbances of blood flow in the cerebral arteries (clipping of a vessel, spasm) occurred in the period of hypotension.

The authors studied clinical and psychological features in disorders of memory due to vascular brain lesions. With the aid of pyktograms the character of activities of the examinees during the process of perception and differences in disorders of moderation in patients with lesions of the frontal and occipital parts of the brain were demonstrated. It is established that in the initial stages of the mnestic process the leading role is played by frontal lobes, while in latent reproductivity the significance of occipital brain areas increases.