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Assessment of patients with intracranial aneurysms in the late postoperative period consists of both determining structural changes in computed tomography (CT) and the neurological and cognitive status of the patient. Meantime, the topic of the relationship between structural pathology in CT and cognitive impairment has not been suffi ciently disclosed.Objective: to determine CT, functional and cognitive outcomes in the long-term period of surgical treatment of cerebral aneurysms.Material and methods. The data of CT angiography of 49 patients operated on for intracranial aneurysms were analyzed. 39 patients were examined neurologically for 2.3 years using a range of rating scales.Results. The residual part of the aneurysm after surgery was found in 50% of patients with complex aneurysms, more often in patients with PMA-PSA aneurysms. The connection between the method of surgery and the preserved cervical part with structural changes in the brain and the development of cognitive impairment in the late postoperative period has not been proven.Conclusion. CT angiography preoperatively makes it possible to identify a group of complex aneurysms with a high risk of preservation of the cervical part and the development of brain structural changes. The predictors of the development of ischemic changes in the brain, hydrocephalus, and cognitive dysfunctions was the advanced age of patients, the duration of the operation, and a history of hypertension.

There is no unified management of patients with the consequences of subarachnoid hemorrhage in the long term.Purpose of the study. To study the nature and severity of SAH, the clinical manifestation of hemorrhage, the choice of the intervention technique in the acute period of the disease for the long-term results of the treatment of aneurysms.Materials and methods. In the long-term period, at an average time of 3.5 years after aneurysmal subarachnoid hemorrhage, 100 patients were examined who underwent microsurgical intervention (n = 48), endovascular exclusion of the aneurysm from the bloodstream (n = 14), simultaneous intervention, including microsurgical intervention and extra-intracranial vascular bypass (n = 23), as well as microsurgical intervention followed by the introduction of a fibrinolytic agent into the subarachnoid space (n = 15).Results. Risk factors for unfavorable clinical recovery of patients, as well as the development of cognitive and mental disorders, were: intracerebral hematoma, dislocation syndrome, duration of temporary clipping more than 7 minutes, the volume of intraoperative blood loss of more than 300 ml. The best functional recovery in the long-term period was noted in patients who underwent microsurgical clipping of the aneurysm, supplemented by surgical revascularization (p = 0.003).Conclusion. The results of our study demonstrated the persistence of the consequences of surgical intervention for the rupture of cerebral aneurysms for a long time, which necessitates long-term observation of patients, the development of individual programs of physical and psychological rehabilitation, and clinical examination of persons at high risk.

Study objective. To determine the role of transcranial duplex sonography measurements in prognosing the risk of adverse outcome in patients with nontraumatic subarachnoid haemorrhage.Materials and Methods. In 2010–2020 413 patients admitted to N. V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department with aneurysmatic subarachnoid haemorrhage were enrolled into the study, including 201 males (48.7 %) and 212 females (51.3 %). Mean age was 51 ± 12 years. All patients were treated surgically (aneurysm clipping). Patients’ status on admission and before surgery was evaluated according to Hunt and Hess scoring system. Transcranial duplex sonography was conducted in all patients on admission, before surgical treatment and on a daily basis after aneurysm clipping (up to the 10th day after aneurysm rupture, 2,612 examinations in total). The degree of angiospasm in middle cerebral artery, Lindegaard ratio and the presence of diffuse angiospasm in all arteries of Willis circle were assessed according to a previously described classification system. Brain computed tomography scans were used to determine the extent of subarachnoid haemorrhage according to C. M. Fisher scale and volume of ischemic lesions in areas supplied by middle cerebral artery. Outcomes were rated according to Glasgow Outcome Scale. Study sample was divided into two groups according to outcome. Group 1: adverse outcome (Glasgow Outcome Scale 1–3). Group 2: favorable outcome (Glasgow Outcome Scale 4–5). Binary logistic regression was applied to reveal risk factors for adverse outcome. To define long-term treatment outcome 104 patients (68 females, 36 males) were examined using neurologic scoring systems: Modified Rankin Scale, Barthel Index, Mini-Mental State Exam, Hospital Anxiety and Depression Scale.Results. Favorable outcome (group 2) was ascertained in 221 (53.5 %), unfavorable outcome (group 1) – in 192 (46.5 %) patients. The following independent risk factors for unfavorable outcome were detected: angiospasm in middle cerebral artery before surgery, severe angiospasm in middle cerebral artery and diffuse angiospasm. According to univariate analysis, daily increase in middle cerebral artery peak systolic velocity by 51.6 cm / s was associated with adverse outcome either. Binary logistic regression model was able to predict unfavorable outcome with sensitivity 88.5 %, specificity 76.0 %. Daily increase in middle cerebral artery peak systolic velocity by 58.7 cm / s was associated with Modified Rankin Scale increase by 1 point. Angiospasm proved to be strongly connected with cognitive and self-care ability impairment on follow-up.Conclusion. Ultrasonic signs of angiospasm in patients with aneurysmatic subarachnoid haemorrhage are independent predictors of adverse outcome and long-term results worsening.

The study objective is an assessment of long-term results of cerebral revascularization performed in the acute period of subarachnoid hemorrhage due to rupture of cerebral aneurysms.Materials and methods. This cross-sectional study includes 74 patients, operated in N.V. Sklifosovsky Research Institute for Emergency Medicine in the acute period of aneurysmal subarachnoid hemorrhage. Patients were divided into two groups. The first group contained patients with EC—IC bypass performed in the acute period of aneurysmal subarachnoid hemorrhage. The Control group contained patients without bypass. In the long-term period, 11 patients were examined. Computed tomography of cerebral vessels, duplex ultrasound examination of the aortic arch, brachiocephalic arteries and intracranial vessels, transcranial Doppler ultrasonography with a breathing function test, single-photon emission computed tomography of the brain followed by stress test with acetazolamide, Modified Renkin Scale, Mini-Mental State Examination, Montreal Cognitive Assessment, Index Bartel, The Hospital Anxiety and Depression Scale, Holms-Rahe were performed. For descriptive results, a mathematical model was used.Results. The best treatment outcomes in severe patients with subarachnoid hemorrhage and cerebral ischemia were observed when performing simultaneous clipping of the aneurysm and EC-IC bypass (57.1 % versus 41.0 %) there was no statistically significant difference in outcomes. EC-IC bypass functioned in 37.5 % of cases. The rate and acceleration of the fall in volumetric blood flow and the passage of blood from the aortic bulb to the cerebral arterioles affect the perfusion values in the region of the brain concerned. Evaluation of long-term results of simultaneous interventions revealed persistent disturbances in the regulation of cerebral blood flow at the microcirculatory level. Patients with EC-IC bypass had a higher level of cognitive function and stress potential.Conclusion. The results of this study showed us the necessity for a comprehensive exploration of cerebral blood flow.

Objective: to study cognitive functions in patients in the long-term period of microsurgical treatment of cerebral aneurysms. Materials methods: on the basis of the University Clinic of the Moscow State Medical University. A.I. Evdokimov and the Department of Emergency Neurosurgery of the N.V. Sklifosovsky Research Institute for Emergency Medicine, an analysis of cognitive functions was carried out in 212 patients operated on by a microsurgical method since 2013. Results: in the long-term period of surgical treatment of cerebral aneurysms, cognitive impairments of varying severity were detected in 78 patients (37 %). The main factors negatively affecting cognitive functions were the severity of the patient’s condition before surgery, corresponding to Hunt-Kosnik III–V, the age of patients over 60 years old, body mass index over 30, localization of the aneurysm in the basin of the anterior cerebral artery and vertebrobasilar basin, patients’ condition discharge according to the Glasgow Grade IV–III Outcome Scale. No significant dependence of cognitive impairment on the severity of subarachnoid hemorrhage and the gender of patients was found. On the contrary, the severity of anxiety and depression, which was assessed on the HADS scale, was twice as likely to be observed in female patients as compared with male patients. Conclusion: it is obvious that the persistence of cognitive deficit and mental disorders, in the form of anxiety and depression, in the long-term period of surgical treatment of cerebral aneurysms dictates the need for long-term dispensary observation and correction of the revealed disorders.

The article covers the current concepts of cerebral edema development, the mechanisms of cerebral oxygenation and perfusion impairments, as well as delayed morphological and cognitive disorders in non-traumatic subarachnoid hemorrhage due to the rupture of intracranial aneurysms.

Concentrations of plasma vascular tone regulation markers that are indicators of endothelium dysfunction in the acute phase of ischemic stroke and their effect on the development of hemorrhagic transformation (HT) of the lesion focus have been studied. Concentrations of renin, endothelin 1-21, neuron-specific enolase, NT-proCNP, soluble adhesion molecules (sICAM) were measured in 67 patients on days 1, 3-4. Significantly higher concentrations of renin, endothelin 1-21, neuron-specific enolase were found in patients with HT in the first day compared to patients without HT. The level of NT-proCNP was lower in patients with HT; the increase in the severity of hemorrhagic component led to the elevation of neuron-specific enolase and sICAM concentrations. In conclusion, both markers of blood-brain barrier damage and regulating factors of vascular tone may play a predictive role in the development of HT in ischemic stroke.

Perfusion computed tomography (CT) allows to evaluate brain perfusion and provides additional information about local cerebral hemodynamics in stroke patients. Twenty-seven patients underwent CT-perfusion in the early acute phase of ischemic stroke. Significant differences between ischemic lesion and contralateral hemisphere on CBF and MTT scans during the first 3 hours after stroke were revealed. In the following 24 h, the differences were seen in all perfusion parameters. CT-perfusion allows to reveal perfusion parameters associated with stroke severity and outcome that is relevant for prescription of reperfusion treatment beyond the boundaries of 3-4.5h "therapeutic window".

A neuropsychological and neurophysiological study using computed EEG was carried out in 31 stroke patients who did not have a cognitive impairment according to MMSE. Thirty age-matched patients with the same risk factors without a history of stroke were included into the control group. The examination of the control group was performed only once. The examination of stroke patients was performed on days 1, 7 and 21. It was shown that cognitive neurodynamic disturbances (memory disorders and the visual memory decrease) and bioelectrical brain activity disturbances (the decrease in a- and beta band activities and the increase of theta-band power) occurred from the first day and lasted during the acute stroke period even after the improvement of neurological status.

Data on the mechanism of action of the neuroprotector citicoline, its effectiveness in the experimental models of cerebral ischemia and in patients with ischemic and hemorrhagic stroke are reviewed. Citicoline is a unique drug with neuroprotective properties that demonstrated the positive results in patients with stroke. The effectiveness of the combined thrombolytic and citicoline therapy was demonstrated in the experimental model of ischemic stroke.

Clinic-experimental complex investigation and ELISA determination of protein HLDF as also primary antibodies (Abs) to HLDF values in blood and cerebro-spinal fluid (CSF) of patients with hypertensive crises and acute aterotrombotic ischemic stroke were performed. Statistically improved difference in serum HLDF and Abs content in examined patients in comparison with age-matched controls as also significant intergroup's differences in protein and Abs dynamic content were determined. Correlation between content and dynamics of investigated factors in CSF and blood serum with determined clinical and instrumental parameters was revealed. Pathogenetic and prognostic significance of revealed changes in molecular factors was viewed.