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Many studies have reported the effects of constraint-induced movement therapy (CIMT) with an orthosis on the residual function of the impaired side of post-stroke patients. We encountered a case with left hemiparesis whose functioning of the impaired hand improved by CIMT with an orthosis not to assist as in the past but to restrict the residual function of the paralyzed fingers. The patient was a 46-year-old woman with left hemiparesis due to cerebral infarction 18 months ago. The patient had resumed work but would easily tire while typing the keyboard. We found that the extrinsic hand muscles were more engaged in compensatory movements than the intrinsic muscles. Therefore, we designed an orthosis that would extend and fixation the distal interphalangeal joint and proximal interphalangeal joint muscles to promote the engagement of the intrinsic muscles and restrict the compensatory movements of the extrinsic muscles. The orthosis was used for 8 h/day for 2 weeks; CIMT were performed. Left hemiplegia improved from CIMT and the patient was able to handle the same amount of work as that before onset. Restrictive orthosis on the paralyzed hand in combination with CIMT was found to be a beneficial rehabilitation approach. This case suggests that not assistive but suppressive orthosis with constraint-induced movement therapy can be effective in strengthening the intrinsic muscles of the hand and restricting compensatory movements by the extrinsic muscles in hemiplegic patients. Treating the paralyzed side with a suppressive orthosis may be an effective novel approach for improving the physical function of the paralyzed hand in post-stroke patients. [ABSTRACT FROM AUTHOR]

Objective: to study the level of inflammatory biomarkers and growth factors in the peripheral blood of patients with chronic cerebrovascular disease (CCVD) and anamnesis of coronavirus infection COVID-19.Material and methods. The study included patients with CCVD (n=41), 26 of them had a documented anamnesis of coronavirus infection within 4 months before inclusion in the study, 15 people did not have COVID-19. The control group consisted of 20 apparently healthy individuals of the same age. Neuroimaging was performed using a Philips Achieva 1.5 T device. Pro-inflammatory cytokines were determined in blood serum – tumor necrosis factor α (TNF α ), interleukin 6 (IL6), IL18, interferon γ (IFN γ ); chemokines – monocytic chemoattractant protein 1 (MCP-1), IL8; growth factors – vascular endothelial growth factor type A (VEGF-A), transforming growth factor β 1 (TGF β 1).Results. In patients with CCVD, compared with the control group, an increase in the level of proinflammatory cytokines (TNF α , IL6, IL18), chemokines (MCP1 and IL8), a decrease in the concentration of IFN γ , and divergent changes in the content of growth factors (VEGF-A and TGF β 1) were noted. Patients who recovered from COVID-19 showed an increase in the level of IL6 and a decrease in the level of IFN γ compared with those who had not been ill, which indicates a persistently high activity of immunoinflammatory processes and an insufficient humoral immune response.Conclusion. Postponed coronavirus infection COVID-19 aggravates the existing endothelial dysfunction and intravascular inflammation in patients with CCVD, which may probably require changes in their treatment and prevention strategies in the future.

Treatment of esophageal cancer is based on tumor-node-metastasis (TNM) classification, and surgical treatment is chosen based on the patient's ability to tolerate surgery. Surgical endurance partly depends on activity status, with performance status (PS) generally used as an indicator. This report describes a 72-year-old man with lower esophageal cancer and an 8-year history of severe left hemiplegia. He had sequelae of cerebral infarction and a TNM classification of T3, N1, and M0, and was judged ineligible for surgery because his PS was grade three; he underwent preoperative rehabilitation with hospitalization for 3 weeks. He had been able to walk with a cane in the past, but once he was diagnosed with esophageal cancer, he began using a wheelchair and was dependent on assistance from his family in his daily life. Rehabilitation consisted of strength training, aerobic exercise, gait training, and activities of daily living (ADL) training for 5 h a day, according to the patient's condition. After 3 weeks of rehabilitation, his ADL ability and PS improved sufficiently for surgical indication. No complications occurred postoperatively, and he was discharged when his ADL ability was higher than that before preoperative rehabilitation. This case provides valuable information for the rehabilitation of patients with inactive esophageal cancer. [ABSTRACT FROM AUTHOR]

Objective: to study the clinical efficacy and tolerability of omberacetam in comparison with piracetam/cinnarizine and aminophenylbutyric acid in non-demented patients with vascular cognitive impairment (VCI).Patients and methods. The study included 150 patients with VCI that does not meet dementia, randomized into three groups of 50 patients. In addition to the basis therapy, patients of the 1st group recieved omberacetam 10 mg 2 times per day, the 2nd group – piracetam/cinnarizine 400/25 mg (1 tablet) 3 times per day, the 3rd group – aminophenylbutyric acid 250 mg 3 times per day. The duration of the treatment course was 45 days. In 50 patients of the 1st group and another 50 patients with VCI from other groups, the duration of the nootropic effect of omberacetam was evaluated 3.5 months after the end of follow-up. Cognitive functions and emotional state of patients were assessed using: 1) Montreal Cognitive Assessment (MoCA); 2) Hamilton Anxiety Rating Scale (HAM-A); 3) Subjective assessment of asthenia scale; 4) Modified subjective sleep characteristics scale. Evaluation of treatment effectiveness and tolerability was carried out.Results and discussion. During omberacetam treatment a significant improvement in well-being and regression of patient complaints were observed. After 45 days of therapy an increase in the mean MoCA score from 19.8 to 23.3 points (p≥0.001) was observed in the omberacetam group. In other groups, an increase in the mean MoCA score was also noted, but it was less significant. A decrease in asthenic symptoms, anxiety, and dissomnic disorders was present in all studied groups. Anxiety level, assessed by the HAM-A, decreased by 16.9; 19.9 and 20.0 points (p≥0.001) in groups 1, 2 and 3, respectively. Sleep characteristics, assessed by the subjective sleep characteristics scale, improved by 4.6; 5.0 and 5.3 points (p≥0.001), respectively. 4.5 months after the completion of the omberacetam treatment course, the mean MoCA score was 0.8 points higher compared to baseline (p=0.061).Conclusion. The results showed high efficacy and safety of omberacetam in patients with VCI. A long-term positive effect of omberacetam was observed.

Introduction. Chronic cerebrovascular disease (CeVD) is usually accompanied by a decrease in the quality of life (QoL). A possible cause of decreased QoL is sleep-disordered breathing. Aim: to assess the frequency of sleep-related breathing disorders and QoL in patients with chronic CeVD. Materials and methods. The study included 100 patients (50 men and 50 women), with an average age of 65 (58; 74.5) years. Cognitive (MoCA-test) and affective disturbances (HADS), severity of daytime sleepiness and fatigue (the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome) were assessed. QoL was evaluated using the SF-36 health survey. Sleep-disordered breathing (SDB) was verified using cardiorespiratory monitoring. The apnoea/hypopnoea index was also calculated. Results. On average, the cognitive impairment score was 25 (23, 27) points; the anxiety level was 6 (4; 9), depression level was 6 (3.5; 8), daytime sleepiness and fatigue were 4 (1.5; 7). QoL was reduced in the majority of patients. SDB was registered in 82% of patients. Multiple comparisons found no differences in QoL scores depending on the presence and severity of sleep-related breathing disorders. Patients with a history of stroke had higher scores for general health (p = 0.06), mental health (p = 0.01), and overall psychological health (p = 0.04). The stroke patients were younger (p = 0.02) and experienced less daytime sleepiness and fatigue (p = 0.007). Women had lower QoL scores compared to men. At the same time, the women were older than the men (p = 0.006) and had higher levels of anxiety (p = 0.0008). Statistically significant correlations were found between the various QoL components and age, anxiety and depression levels, severity of daytime sleepiness and fatigue, and cognitive dysfunction, but not the apnoea/hypopnoea index. Conclusion. Patients with chronic ischaemic CeVD and SDB had reduced QoL; however, the mental health component remained slightly higher than the physical component. The main factors associated with a decrease in QoL were age, female gender, anxiety and depression levels, and excessive daytime sleepiness/fatigueo.

Vascular cognitive impairment (VCI) is the main manifestation of dyscirculatory encephalopathy (DEP). According to the severity of cognitive impairment, Stage I DEP corresponds to mild (subjective) cognitive impairment; stage II DEP to moderate cognitive impairment; stage III DEP to severe cognitive impairment or vascular dementia. VCI is diagnosed on the basis of cognitive impairment, the clinical and neuroimaging findings confirming the presence of cerebrovascular disease, and the neuropsychological study results indicating a cognitive defect.Citicoline is one of the most widely used nootropic drugs for cerebrovascular pathology. The treatment of VCI involves the prevention of stroke and progressive chronic cerebrovascular disease (CCVD) and the use of drugs improving cognitive functions.Citicoline is one of the most widely used nootropic drugs for cerebrovascular disease. This drug was synthesized in Japan to treat stroke, then it became widely used in different countries in patients with CCVD and VCI. The data of clinical trials and a Cochrane systematic review prove the efficacy and safety of citicoline in the elderly and senile patients.

Cognitive impairment (CI) associated with brain aging is a consequence of disorders varying in etiology and pathogenesis, which often coexist in elderly patients and can have a mutual impact on the clinical manifestation, severity, and rate of progression of CI. Alzheimer's disease (AD) and vascular CI are the most common forms of dementia in the elderly. In recent decades, there has been increasing evidence that there is a close relationship between these forms due to a substantial overlap of their risk factors, clinical manifestations, neuromorphological changes, as well as genetic and neuroimaging biomarkers. The complex multicomponent relationship of these disorders also makes it difficult to elaborate effective preventive and therapeutic approaches in these patients.

Objective:We assessed the safety and clinical effectiveness of intranasal therapy with M2 macrophage-derived soluble products (M2-SPs) for treating patients with cerebrovascular disease (CVD).Materials and methods:The protocol of the study was registered at www.ClinicalTrails.gov (NCT02957123). The study group comprised 30 patients with chronic CVD. Neurological status was examined before therapy and at 1- and 6-month follow–up. Concentrations of 32 cytokines in the blood serum were evaluated before and 1 month after therapy onset. Neurological assessment was conducted with the following scales: Subjective Assessment of Clinical (neurological) Symptoms (SACS), Hospital Anxiety and Depression Scale (HADS), Functional Mobility Assessment in Eldery Patients (FMA), and Montreal Cognitive Assessment (MoCa).Results:M2-SPs treatment (once daily for 28~30 days) was found to be safe and well tolerated. Neuropsychological improvements showed the amelioration of neurological symptoms, reduction in anxiety and depression levels, improvement in balance and gait ability as well as cognitive functions. Clinical effects could be detected at the end of treatment course and was stable during 6-month follow-up. Blood serum cytokine evaluation demonstrated diminished baseline levels of many cytokines including those with neurotrophic activity (brain-derived neurotrophic factor, BDNF; hepatocyte growth factor, HGF; migration inhibitory factor, MIF). Upon treatment, most pronounced clinical responses were observed in patients with most severe cytokine deficiency and post-therapy normalization of MIF and HGF levels.Conclusion:Intranasal therapy with M2-SPs is safe and according to preliminary data reduces neuropsychological deficit in patients with chronic CVD. The positive effect of M2-SPs treatment seems to be HGF- and MIF-dependent.

The article presents a modern view of the pathogenic mechanisms of cerebrovascular diseases was Observed that currently available data indicate the existence of different variants of ischemic lesions of the brain and their clinical manifestations. Based on the available data and the results of our own studies, it is concluded that therapeutic strategies in patients with CVD should take into account the variety of clinical manifestations, the existence of various options for ischemic lesions of the brain substance, especially the course of the disease, heterogeneity of pathogenetic mechanisms and risk factors, as well as multi-morbidity of patients. Discusses the use of the drug Vazobral in CVD.

We conducted an epidemiological study of an open population(aged 4059 yrs) restricted to the two therapeutic clusters of aregional out-patient clinic, Ulyanovsk city. A total of 500 peoplewere examined, including 157 men and 343 women. The meanage was 51.16.8 yrs. Arterial hypertension was diagnosed in46.8% of the population. The prevalence of definite casesof cerebrovascular disease (CVD) was 25.4%, including:hypertensive cerebral crises (HCC) 3.6%, transient ischemicattacks 0.6%, stroke 3.6%, initial stages of cerebrovasculardisease (ISCVD) 7.0%, and chronic cerebrovascular disease(CCD) 10.6%. The prevalence of all types of CVD wassimilar among both sexes, with the exception of HCCoccurring much more frequently in women. Two types of CVDdominated in the structure of CVD, CCI and ISCVD (68.8%of all registered cases of CVD). A significant prevalence(52%) of initial-stage cases of CVD, ISCVD and CCI-stage I,underlines the need for active preventive measures of acuteand severe chronic forms of CVD.

Chronic cerebrovascular disease (CCVD) is one of the most common iagnoses in Russian neurology, by which is meant vascular cognitive impairment (VCI) in modern foreign literature. There are data available in the literature on the diagnosis and treatment of CCVD (VCI). Theresults of the author’s studies show that CCVD often masks other diseases (anxiety and depressive disorders, primary headache, peripheral vestibulopathy, and Alzheimer's disease) that are unfortunately poorly diagnosed in our country, so patients do not receive effective treatment. To modify risk factors for stroke (smoking and alcohol cessation, sufficient exercise), to normalize blood pressure (the use of antihypertensivemedications), to reduce blood cholesterol levels (statins), to perform antithrombotic therapy (antiplatelet agents and anticoagulants), and to use cognitive enhancers are of key importance when treating patients with CCVD (VCI). There are data on the use of pentoxifylline in patients with CCVD, vascular dementia.

An analysis of data of carotid angiographies was made in 146 patients with chronic cerebrovascular disease. Combined lesions of the common and internal carotid artery with clinical signs were revealed in 2 (1,4%) patients. A crossed extraanatomic bypass from the left common carotid artery to the right internal carotid artery was performed in one patient. The orthotopic common-internal autovenous bypass on the right side was carried out for another patient. According to obtained results, the authors suggested that the orthotopic or extraanatomic common-internal carotid artery bypasses could be applied in case of impossibility of endovascular intervention, when patients had the combined atherosclerotic lesions of common carotid and internal carotid artery.

Objective: to investigate the specific features of epilepsy that manifests itself in the presence of chronic cerebrovascular disease.Patients and methods. A total of 304 patients (a study group of 174 patients with new-onset seizures developing in the presence of cerebrovascular disease and a control group of 130 patients with cerebrovascular disease and no seizures) were examined. They underwent clinical neurological examination, electroencephalography (EEG), ultrasonic duplex scanning of extra- and intracranial arteries with functional tests, and visualization of brain structures.Results. Focal seizures were prevalent in the patients with cerebrovascular disease and epilepsy. It was found that there was a preponderance of left-sided localization of EEG foci of abnormal activity and a tendency to more commonly detect subcritical and critical stenoses in the left carotid bed in the patients with epileptic seizures. Diminished perfusion reserves in the posterior circulation system were more frequently observed in the patients with seizures in the presence of cardiovascular diseases. Moreover, the patients with seizures displayed a more profound degree of brain ischemia with the frequent cortical and subcortical localization of dyscirculatory foci. Thus, a study of perfusion reserves, localization of vascular foci, and degree of occlusive changes in the wall of brachiocephalic vessels allows identification of risk factors for epilepsy in the patients with cerebrovascular disease and promotes the prediction of the course of the disease.

Aim. To study the sleep structure and sleep disturbances in obese (O) patients with arterial hypertension (AH). Material and methods. Group I included 62 patients (30 women and 32 men) with chronic cerebrovascular disease (CerVD) and arterial hypertension (AH), aged 53,4±7,4 years. Group II included 42 patients (27 women and 15 men) with increased body mass index (BMI), over 30 kg/m2 (mean BMI 33,5±2,6 kg/m2 ), aged 49,3±7,3 years. In all participants, Stage I-II discirculatory encephalopathy was diagnosed. The control group (CG) included 24 healthy volunteers (14 women and 10 men), aged 49,3±8,2 years. Sleep disturbances were evaluated with the questionnaire on subjective assessment of sleep disturbances, as well as with an objective method of polysomnography. Results. Subjective complaints of sleep disturbances were reported by 87% of AH patients. All elements of sleep structure were disturbed: comparing to the CG, falling-asleep time was significantly increased (31,5±9,8 minutes), as well as the prevalence of within-sleep wakefulness (21,1±7,9%; р

Aim. To evaluate the effectiveness and safety of zopiclone in apnoea-free sleep disorders among patients with metabolic syndrome (MS). Material and methods. The study included 60 patients with chronic cerebrovascular disease (CerVD) and MS (mean age 53,3±11,2 years). Zopiclone was administered in the dose of 7,5 mg once a day, 30 minutes before going to bed, for 21 days. Therapy effectiveness was evaluated by various subjective and objective sleep assessment methods. Results. After a zopiclone treatment course, all patients reported substantial improvement of sleep quality. These beneficial effects were explained by changing sleep architecture — the duration of sleep phases and stages (%). In particular, Stage 1 of slow sleep phase, the most affected at the pre-treatment level, was significantly reduced by 20 %, while Stage 2 of slow sleep phase increased by 14 % (p

Immune cells (IC) play a crucial role in murine stroke pathophysiology. However, data are limited on the role of these cells in ischemic stroke in humans. We therefore aimed to characterize and compare peripheral IC subsets in patients with acute ischemic stroke/transient ischemic attack (AIS/TIA), chronic cerebrovascular disease (CCD) and healthy volunteers (HV). We conducted a case-control study of patients with AIS/TIA (n = 116) or CCD (n = 117), and HV (n = 104) who were enrolled at the University Hospital Würzburg from 2010 to 2013. We determined the expression and quantity of IC subsets in the three study groups and performed correlation analyses with demographic and clinical parameters. The quantity of several IC subsets differed between the AIS/TIA, CCD, and HV groups. Several clinical and demographic variables independently predicted the quantity of IC subsets in patients with AIS/TIA. No significant changes in the quantity of IC subsets occurred within the first three days after AIS/TIA. Overall, these findings strengthen the evidence for a pathophysiologic role of IC in human ischemic stroke and the potential use of IC-based biomarkers for the prediction of stroke risk. A comprehensive description of IC kinetics is crucial to enable the design of targeted treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Animal models have implicated an integral role for coagulation factors XI (FXI) and XII (FXII) in thrombus formation and propagation of ischemic stroke (IS). However, it is unknown if these molecules contribute to IS pathophysiology in humans, and might be of use as biomarkers for IS risk and severity. This study aimed to identify predictors of altered FXI and FXII levels and to determine whether there are differences in the levels of these coagulation factors between acute cerebrovascular events and chronic cerebrovascular disease (CCD). Methods: In this case-control study, 116 patients with acute ischemic stroke (AIS) or transitory ischemic attack (TIA), 117 patients with CCD, and 104 healthy volunteers (HVs) were enrolled between 2010 and 2013 at our University hospital. Blood sampling was undertaken once in the CCD and HV groups and on days 0, 1, and 3 after stroke onset in patients with AIS or TIA. Correlations between serum FXI and FXII levels and demographic and clinical parameters were tested by linear regression and analysis of variance. Results: The mean age of AIS/TIA patients was 70 ± 12. Baseline clinical severity measured with NIHSS and Barthel Index was 4.8 ± 6.0 and 74 ± 30, respectively. More than half of the patients had an AIS (58%). FXI levels were significantly correlated with different leukocyte subsets (p < 0.05). In contrast, FXII serum levels showed no significant correlation (p > 0.1). Neither FXI nor FXII levels correlated with CRP (p > 0.2). FXII levels were significantly higher in patients with CCD compared with those with AIS/TIA (mean ± SD 106 ± 26% vs. 97 ± 24%; univariate analysis: p < 0.05); these differences did not reach significance in multivariate analysis adjusted for sex and age. FXI levels did not differ significantly between study groups. Sex and age were significantly associated with FXI and/or FXII levels in patients with AIS/TIA (p < 0.05). In contrast, no statistical significant influence was found for treatment modality (thrombolysis or not), pre-treatment with platelet inhibitors, and severity of stroke. Conclusions: In this study, there was no differential regulation of FXI and FXII levels between disease subtypes but biomarker levels were associated with patient and clinical characteristics. FXI and FXII levels might be no valid biomarker for predicting stroke risk. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim of this study was to clarify whether decreases in baseline regional cerebral blood flow (rCBF) and in residual cerebral vasoreactivity (CVR), assessed by the acetazolamide (ACZ) challenge, can detect misery perfusion in patients with chronic cerebrovascular disease (CVD). Oxygen extraction fraction (OEF) and other haemodynamic parameters were measured in 115 patients (64±9 years old) with unilateral cerebrovascular steno-occlusive disease (>70% stenosis) using 15O-gas and water PET. A significant elevation of OEF, by greater than the mean+2SD compared with healthy controls, was defined as misery perfusion. CBF, CVR determined by percent change in CBF after ACZ administration, OEF and other haemodynamic parameters in the territories of the bilateral middle cerebral arteries were analysed. Diagnostic accuracy for the detection of misery perfusion using the criteria determined by baseline CBF and CVR was evaluated in all patients and in only those patients with occlusive lesions. Ten of 24 patients with misery perfusion showed a significant reduction in CVR. Using criteria determined by significant decreases in CVR and baseline CBF, misery perfusion was detected with a sensitivity of 42% and a specificity of 95% in all patients. In patients with occlusive lesions ( n=50), sensitivity was higher but specificity was slightly lower. The diagnostic accuracy of the threshold determined by baseline CBF alone was similar in all patients and in only those patients with occlusive lesions, and was higher than that achieved using the asymmetry index of OEF. Reductions in CVR and baseline CBF in the ACZ challenge for CVD would detect misery perfusion with high specificity. Reduction in baseline rCBF is more accurate than reduction in CVR alone for the detection of misery perfusion. [ABSTRACT FROM AUTHOR]

Objective: To study the efficacy and safety of sequential MexidoL therapy, administered intravenously (500 mg once a day) for 14 days, followed by taking the oral form Mexidol FORTE 250 at a dose of 250 mg (1 tablet) 3 times a day for 60 days in elderly patients with chronic cerebral ischemia (CCI) on the background of arterial hypertension and atherosclerosis., Material and Methods: An open prospective observational study included 60 patients with an established diagnosis (CCI), confirmed by the results of neuroimaging. All patients were examined with an assessment of neuropsychological status (MoCA test), severity of asthenia (scale MFI-20), emotional state (Hamilton anxiety and depression scale), motor functions (formalized clinical scale for assessing motor activity of elderly Tinetti). The effectiveness of the therapy was evaluated according to the quality of life questionnaire (SF-36)., Results: The results of the study showed the high efficiency and safety of sequential therapy with Mexidol in relation to the relief of asthenic and emotional disorders, improving the state of cognitive functions, improving the quality of life of patients. The maximum effect occurred after the end of the full course of therapy. High adherence of patients to the therapy, low frequency of adverse events are shown., Conclusion: Sequential use of intravenous administration of Mexidol followed by oral administration of Mexidol FORTE 250 is an effective and safe way to treat patients with CCI.

Objective: To estimate the frequency of long-COVID in patients with chronic cerebrovascular disease, to identify the risk factors for the development of this condition and to analyze effectiveness and tolerability of Vinpocetine and Aertal in treatment of this disease., Material and Methods: The study included 97 patients (64.5±5.2 years), among which 42 were diagnosed with long-COVID. The effectiveness of treatment was analyzed with NRS-P, Post-COVID-19 Functional Status (PCFS), Global Rating of Change Scale (GROC)., Results: Predictors of long-COVID was female gender ( p =0.022), severe COVID-19 ( p =0.035), comorbidities: cardiovascular diseases ( p =0.032), endocrinopathies ( p =0.041), affective disorders ( p =0.021). Significant changes in the functional status of patients were recorded after 20 days of treatment (PCFS), in pain after 10 days (NRS-P). The most pronounced clinical effect (PCFS) was obtained after 1 mth of therapy with vinpocetine and 20 days with aceclofenac (NRS-P). After 30 days 25/59.5% of patients noted a «pronounced» improvement in their own well-being (GROC) without the development of significant side effects., Conclusions: 43.3% of patients with chronic cerebrovascular disease and certain predictors develop long-COVID. Aceclofenac and vinpocetine are effective in relieving a number of symptoms of long-COVID, which requires further study.

Aim: To study the efficacy and safety of mexidol dripped intravenously (500 mg once a day) in the form of infusions for 14 days, followed by oral administration of mexidol FORTE 250 at a dose of 250 mg (1 tablet) 3 times a day for 60 days, in treatment of chronic brain ischemia in patients with hypertension and atherosclerosis., Material and Methods: The open observation program included 60 patients with an established diagnosis of chronic brain ischemia confirmed by neuroimaging methods., Results and Conclusion: The results of the study show the high efficacy and safety of sequential therapy (injections followed by tablets of mexidol FORTE 250). The treatment improves emotional and cognitive status, decreases motor disorders and severity of subjective manifestations. High adherence of patients to the therapy is shown.

Introduction: The role of circulating immune cells in the pathophysiology of cerebrovascular accidents is currently under debate. The aim of this study was to characterize peripheral immune cell subsets in patients undergoing carotid endarterectomy (CEA)., Material and Methods: We conducted a prospective observational study in a group of 124 patients with significant carotid stenosis undergoing carotid endarterectomy, both symptomatic and asymptomatic. We compared the percentages of circulating immune cells: B lymphocytes, T lymphocytes, T helper, cytotoxic T, CD4+/CD8+ ratio, T regulatory, monocytes and NK cells before CEA and 6 h after the procedure., Results: Total lymphocyte count and cytotoxic T lymphocyte count decreased 6 h after CEA in both subgroups. The NK cell level decrease was statistically significant only in the symptomatic subgroup (19.41 ±9.30 before CEA and 16.52 ±9.37 after CEA; p = 0.0044), but not in the asymptomatic subgroup (17.88 ±9.14 before CEA and 15.91 ±9.51 after CEA; p = 0.0886). The T lymphocyte level showed a statistically significant increase only in symptomatic patients (69.74 ±10.16 before CEA vs. 71.45 ±9.77 after CEA; p = 0.0462), and not in the asymptomatic subgroup (70.08 ±11.19 prior to CEA and 70.21 ±12.35; p = 0.9048). B lymphocyte, helper T lymphocyte and regulatory T (Treg) lymphocyte (CD4+/CD25+) levels showed a significant increase after CEA., Conclusions: This is the first study to compare circulating immune cells in patients undergoing carotid endarterectomy. Only the symptomatic subgroup experienced a significant decrease in the NK cell level and an increase in the T lymphocyte count after CEA. This study enriches our understanding of immune cell kinetics during carotid endarterectomy., Competing Interests: The authors declare no conflict of interest.

Abstract: Among the patients with cognitive vascular impairment, a particular group is represented by those who have concomitant cerebrovascular and coronary heart disease (CHD). The clinical evolution of some of these patients is dominated apparently by the progressive cognitive impairment and sometimes psychotic episodes and not by evident clinical stroke and/or symptoms of their heart disease, so that they receive the diagnosis of Alzheimer''s disease or of a psychiatric disease. Most of these patients have a severe evolution, particularly if their cardiovascular disease is not recognized and die unexpectedly. In the author''s clinical experience, the systematic cardiovascular examination in all patients hospitalized with the diagnosis of dementia or cognitive impairment, even if they did not have previously been diagnosed with cerebrovascular and/or coronary heart disease, disclosed in many instances the presence of severe but apparently silent cardiovascular disorders characterized always by concomitant severe CHD and significant large vessel disease of the brain. It is important to emphasize the particular situation in which the progressive cognitive impairment associated or not with psychiatric manifestations could mask severe cardio- and cerebrovascular disorders, which could further be worsened by symptomatic psychiatric treatment, and which evolution is to “unexpected” cardiovascular death. [Copyright &y& Elsevier]

Disturbances of gait and postural stability are characteristic of the chronic progressive vascular lesion of the brain observed in moderate to severe stages of cerebrovascular disease. Disconnections between the prefrontal cortex, basal ganglia and cerebellum due to the damage of the white matter (vascular leukoencephalopathy) underlie disturbances of gait and postural stability (shorter stride length, wider gait). There are difficulties in starting with possible stoppings during the walking, waiting in front of small barriers as well as difficulties in concentration (e.g., talk during walking worsen the gait). In contrast to Parkinson's disease, associated movements of hands are observed. The severity of gait disturbances is usually correlated with the severity of vascular cognitive impairment unified by the common underlying substrate - the dysfunction of the frontal brain lobes. Approaches to treatment of patients with vascular movement disorders are discussed.