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Introduction : The clinical picture of acute disseminated encephalomyelitis is characterized not only by a variety of neurological signs, but also by disorders of higher cortical functi ons. Disorders of higher cognitive functions often remain undetected during routine examination of patients and the use of specialized neuropsychological tests enables timely diagnosis of cognitive disorders. Methods: The assessment of cognitive impairment was carried out in 67 patients with ADEM (28 male and 39 female, aged 16 – 50, mean age - 31.6 ± 2.3). All the patients were being treated at the Kiev city centre of multiple sclerosis (Ukraine). The diagnosis of ADEM was based on neurological examination, MRI of the brain and CSF analysis. The cognitive impairment in patients with ADEM was assessed during the first three days after the onset of the disease. The neurological status was assessed by Kurtzke an Expanded Disability Status Scale (EDSS) and Functi onal Systems Scores (FSS). Patients performed neuropsychological tests that enabled evaluation of short - term and long term visual and auditory memory, various parameters of attention as well as ability to concentrate, orientation in time and space. Result s: The assessment of cognitive functions in patients with ADEM demonstrated impaired short - term and long - term memory indices according to “memorizing 10 words” test (34.6 ± 1.5 words compared with control 42.7±1 words, P

Introduction: Appropriate dosing of anticoagulation during carotid angioplasty and stenting remains unstudied. Although 70 units /kg is a commonly used dose, in patients with acute stroke, this dose may increase the risk of hemorrhagic transformation. We report safety of a novel low fixed-dose protocol in patients treated with CAS after recent ischemic event. Methods: All patients who underwent carotid angioplasty and stenting after or during a recent admission with acute ischemic stroke, at a tertiary care hospital, from Jun 2012 to August 2015 were retrospectively identified from a prospectively maintained database. A dose of 25 u/kg was used if patient had a recent infarct on imaging, or in case imaging cannot rule out an acute infarct, a recent clinical stroke. In other patients a dose of 50 u/kg was used. Activated clotting time (ACT) was checked in all patients at the time of stent deployment. Results: CAS was performed in 59 patients (mean age 71.3+/-13.3, 68% men) as per fixed-dose heparin protocol. Procedure was performed within 48 hours, 48 hours to 7 days, and after 7 days of the event in 18, 15 and 26 patients, respectively. Clinical characteristics of patients in three groups are shown in table. Only 2 patients suffered transient ischemic event and 1 patient suffered minor stroke during hospitalization. No patients suffered any hemorrhagic complication or death. Conclusion: A fixed low dose heparin protocol during carotid angioplasty and stenting ay be safe and effective, especially in patients with recent ischemic stroke.

Prediction of transformation of acute disseminated encephalomyelitis (ADEM) into multiple sclerosis is of great clinical importance, as it enables timely determination of the tactics for treatment of a patient as well as volume of respective therapeutic interventions.This work is aimed at ascertainingthe prognostic factors that determine the risk of transformation of acute disseminatedencephalomyelitis into multiple sclerosis. We have examined 101 patients with the diagnosis ADEM, namely: 28 men and 73 women in the age from 17 up to 53 years (average value31.7 ± 1.01years). To ascertain the prognostic meaning of clinic-paraclinic indices corresponding to patients with ADEM, we estimated the cumulative part of absence of relapses in the group of patients by using the Kaplan-Meyer method with estimating the Fisher criterion and using the most important clinic-paraclinic data. Development of transformation of ADEM into multiple sclerosis is reliably related to the following prognostic signs: degree of disability in accord with the EDSS scale and sizes of demyelination focuses determined using MRT. Criteria for congenial prediction in disease development with delayed appearance of transformation of ADEM into multiple sclerosis are as follows: slight degree (in EDSS scale) of disability and large sizes of demyelination focuses (MRT data).Our analysis of the main clinic-paraclinic indexes obtained using the Kaplan-Meyer method indicates reliability of results and enables us to find a number of important prognostic criteria for development of transformation of ADEM into multiple sclerosis.

Prediction of development of the multi-phase alternative for the course inherent to acute disseminated encephalomyelitis (ADEM) is of great clinical importance, as it enables timely determination of the treatment tactics as well as volume of respective therapeutic interventions. This work is aimed at ascertaining the prognostic factors that determine the risk of development of the multi-phase course in disseminated encephalomyelitis. We have examined 101 patients with the diagnosis ADEM, namely: 28 men and 73 women in the age from 17 up to 53 years (average value 31.7 ± 1.01 years). To ascertain the prognostic meaning of clinic-paraclinic indices corresponding to patients with ADEM, we estimated the cumulative part of absence of relapses in the group of patients by using the Kaplan-Meyer method with estimating the Fisher criterion and using the most important clinic-paraclinic data. Development of the multiphase course in ADEM is reliably related to the following prognostic signs: changes in the neurologic status of patients with ADEM, degree of disability in accord with the EDSS scale as well as sizes of demyelination focuses determined using MRT. Criteria for congenial prediction in disease development with delayed appearance of ADEM relapses in the form of the multi-phase course are as follows: domination of motor impairments over coordinative impairments in neurological status, slight degree (in EDSS scale) of disability and small sizes (up to 4 mm) of demyelination focuses (MRT data). Our analysis of the main clinic-paraclinic indices obtained using the Kaplan-Meyer method indicates reliability of results and enables us to find a number of important prognostic criteria for appearance of the multiphase course in ADEM.

Hypertension is very common among the adult population in the United States of America (29.0%), especially among individuals aged greater than 60 years (64.9%). The optimal blood pressure (BP) goal during treatment of hypertension has been controversial. Assessment of patient-reported outcomes (PRO), such as the health status, excellence of the life, and satisfaction with care, has important implications for BP guidelines in population. The previously published results of the Systolic Blood Pressure Intervention Trial (SPRINT) showed that among participants with hypertension and an increased cardiovascular risk, but without diabetes, the rates of cardiovascular events were lower among those who were assigned to a target systolic BP of less than 120 mmHg (intensive treatment) than among those who were assigned to a target of less than 140 mmHg (standard treatment). In addition, PRO among participants who received intensive treatment were similar to those among participants who received standard treatment, including among participants with decreased physical or cognitive function. The new recommendations modified the target goal BP for those with diabetes mellitus or renal diseases to

Background: It remains unclear whether certain thrombus characteristics in patients with acute ischemic stroke result in lack of lysis with IV rt-PA. We performed this study to evaluate the histopathological characteristics of in vivo thrombi retrieved from acute ischemic stroke patients resistant to IV rt-PA prior to endovascular treatment. Methods: The thrombus was removed from the device or retrieval catheter by gentle disassociation and processed for paraffin section preparation and hematoxylin and eosin (H&E) staining. Each slide was reviewed by an independent pathologist and classified as RBC dominant, fibrin dominant, and mixed based on the content. The characteristics were compared with thrombi retrieved from IV rt-PA naïve patients. Results: Thrombi were retrieved from a total of 19 patients (mean age±SD; 73.4 ±14.8 years) who underwent mechanical thrombectomy. IV rt-PA resistant thrombi were retrieved in 9 of 19 patients with a time interval (min±SD) between IV rt-PA initiation and thrombus retrieval of 174±48 mins. The IV rt-PA resistant thrombi were characterized as: RBC dominant (n=4), fibrin dominant (n=2), and mixed (n=3). The proportion of mixed thrombi were lower in those who did and who did not receive IV rt-PA prior to endovascular treatment (3 of 9 versus 5 of 10, p=0.2). The rates of partial or complete recanalization were similar between RBC dominant (8 of 9), fibrin dominant (2 of 2), and mixed thrombi (8 of 8, p=0.5). The time interval between symptom onset and thrombus retrieval was 349±98 min±SD for RBC dominant, 242±15 (min±SD) for fibrin dominant, and 456±313 (min±SD) for mixed thrombi (p=0.3). Conclusions: In our preliminary observations, we did not find any differences in histomorphology of IV rt-PA resistant and naïve thrombi in acute ischemic stroke patients.

We performed the current study to test the hypothesis that the aggregation of cardiovascular risk factors in patients with Alzheimer's disease (AD) was associated with a higher rate of volume loss in the hippocampus and progression of cognitive deficits.A total of 103 persons with AD were included (65 men and 38 women, average age of 74.5 ± 0.8 years). All participants underwent 1.5 T structural magnetic resonance imaging (MRI), at specified intervals (6 or 12 months) for 2-3 years. We determined the rates of hippocampus, whole brain, ventricle, middle temporal lobe, fusiform, and entorhinal volume loss (in cubic millimeter/year) for all patients with AD, separately for 0-6 months, 6-12 months and 0-12, 12-18 and 18-24 months scan intervals.There were significant differences in Mini-Mental State Examination (MMSE) (p = 0.001) and Alzheimer's disease Assessment Scale (ADAS) (p = 0.01) scale scores between persons with and without hypertension and in MMSE (p = 0.04) and Clinical Dementia Rating (CDR) (p = 0.008) scale scores between persons with and without hyperlipidemia. There were no significant differences in MMSE, ADAS, and CDR scales scores between persons with and without diabetes mellitus and cigarette smoking. There were no significant differences in regional brain volume loss in those with or without cardiovascular risk factors.Cardiovascular risk factors have a significant influence on the progression of cognitive deficits in patients with AD. The progression of cognitive deficits in patients with AD is not mediated by progressive hippocampal volume loss.

Individuals who develop Parkinson's disease are confronted not only with the physical manifestations of the disorder, but also with the psychosocial issues that impact on quality of life. The aim of the current work was to assess the level of psychosocial and physical functioning impairment in 95 patients with Parkinson’s disease (48 men and 47 women aged 65–79, average age 70.3±0.5, stages of Parkinson’s disease acсording to Hoehn and Yahr scale - 2–2.5). This research was carried out with the help of “Functional Limitation Profile” and “Sickness Impact Profile – 68” tests.According to the “Functional Limitation Profile” test, the patients with a diagnosis of Parkinson’s disease most commonly showed functional condition impairment in 3 categories: “walk” (92% of cases), “social interaction” (85% of cases) and “clarity of mind” (79% of cases). Less frequent condition impairments were changes in the categories “body care and motion” (72% of cases), “emotions” (65% of cases) and “work” (56% of cases). The least impaired were the categories “communication” (22% of cases), “leisure and entertainment” (24% of cases) and “food” (19% of cases). According to the “Sickness Impact Profile – 68” test, patients with Parkinson’s disease showed functional condition impairment most often in the categories “mobility control”, “social behavior” and “degree of mobility”. Patients showed impairment less frequently in the categories “somatic autonomy”, “psychic autonomy and communication”. The least impaired category was “emotional stability”. The highest percent in relation to the maximum possible point was shown in the category “mobility control”, and the lowest in the category “emotional stability”.Thus, this study demonstrates significant impact of the disease on the functional condition of these patients. Functional limits, connected with the disease appearance, are most often present in the motion and social sphere of patients’ life and less frequently in the emotional sphere.