Vol 4, No 2 (2010)

Complex clinical-ultrasound study was carried our in 29 patients before and after stenting of 29 subclavian arteries (SA) and 2 brachiocephalic trunks (BCT). In 28 cases damage of SA/BCT was presented as stenosis and in 3 cases as SA occlusion. Сlinical picture of vertebrobasilar insufficiency and/or upper limb ischemia took place in 97% of patients. Ultrasound diagnostics of aortic arch branches showed high informativity of the method in revealing the degree of the SA/BCT damage. Technical success was achieved in 94% of cases. Twenty seven (93%) patients were examined in dynamics, with average term of observation of 16 months [12, 30]. On color-coded duplex scanning, re-stenosis was detected in 18.5% of observations (5 patients). Re-stenosis was clinical asymptomatic in 3 of 5 patients. Smoking was found to be the only significant risk factor associated with re-stenosis.

In dementia with Lewy bodies (DLB) neurodegenerative process affects not only central, but also peripheral nervous structures, most frequently, neurons of autonomic ganglia, which may underlay autonomic dysfunction, including peripheral autonomic failure. The purpose of this study was to analyze autonomic regulation of cardiac functions in patients with DLB with the assessment of the heart rhythm variability. Twenty three patients with probable DLB were enrolled in the study. A control group was composed of healthy individuals comparable by sex and age. In DLB peripheral autonomic failure occurred significantly more frequently. Orthostatic hypotension manifested at already early stages of the disease in half of the patients. Spectral analysis of the heart rhythm in patients with orthostatic hypotension showed relative predominance of high-frequency waves on the background of decreased power of low-frequency waves of the  spectrum, which suggests decrease of sympathic influence on the heart rhythm. Relative parasympathicotonia combined with heart rhythm abnormalities seen as supraventricular extrasystols. Analysis of the influence on the heart rhythm of drugs used for the treatment of cognitive and motor disorders showed that levodopa decreased the heart rhythm variability and parasympathic tonus because of stimulation of cardiac adrenoreceptors. Anticholinesterase medications do not influence the heart rhythm variability, but can decrease severity of orthostatic hypotension.

We propose a system for the diagnostics of postural disturbances that may be revealed in the frontal surface with an original complex of motion video-analysis, with allocation of video-analytic profile of the ankle-joints. Main group comprised 19 patients with cerebellar ataxia, and control group comprised 18 healthy individuals without coordination problems and pathology of musculo-skeletal locomotor system. In this study, we determined diagnostically significant and distinguishable video-analytic criteria of the “over the target” peak for patients suffering from cerebellar ataxia: 1) amplitude of foot raising over the surface of the “diagnostic step”; 2) time of foot placing on the surface of the “diagnostic step”; 3) speed of foot descent on the surface of the “diagnostic step”; 4) ration of time of execution of foot raising to total time of execution of the movement “Step”; 5) presence of additional peaks in the support period, which is of importance in the diagnosis of cerebellar disturbances.

The purpose of this study was to establish objective criteria for differential diagnosis of cortical and subcortical aphasias using a method of computed transformation of tempo-rhythmic parameters of speech. Patients with cortical aphasia (40) and neurodynamicspeech disturbances (31) were examined in acute stage of stroke. The features of tempo-rhythmic structure of speech, assosiated with stability of speech syndrome, severity of aphasia and predominant defect (motor or sensory component of speech), were identified. Criteria for diagnostics of neurodynamic speech disturbances have been proposed, such as the degree of fluctuations of speech functions which were objectively registered with the help of computed transformation of speeh time parameters.

Juvenile Huntington’s disease (JHD) manifests in 1st–2nd decades of life and accounts for 2–9% of all cases of Huntington’s disease; its pathogenic mechanisms are related to genetic anticipation and imprinting. Typical features of JHD are akinesia and rigidity, and paternal inheritance and huntingtin mutations with particularly large number of CAG repeats (> 60); however, atypical cases exist, and maternal inheritance is possible. We report 6 families with 7 JHD cases confirmed by DNA testing; 4 patients, including two brothers, were clinicallyexamined. Three patients, one of the brothers among them, had an akinetic-rigid form with onset at 7–8 years; in the second brother the disease manifested at 20 years as a hyperkinetic form of the disease without dementia. This patient had mutation with 57 CAG repeats, while in the rest six patients the number ofrepeat copies varied from 63 to 81. All cases were familial, and anticipation in families was evident; in one child with JHD the disease manifested 4–5 years earlier than in the father, and in another family grandfather first noticed symptoms at 60 years, 6years after the JHD onset in his granddaughter. Such cases mask’ dominant inheritance and complicate the diagnosis. Three families showed rare maternal transmission of JHD: one of the affected mothers had JHD, and in two mothers the disease developed at 27–30 years and lasted for 3–9 years. In 4 clinically examined patients, JHD was supposed 7–18 years after its onset which shows underestimation of the disease in practice. JHD should be considered even in seemingly nonfamilial cases, and DNA testing for huntingtin mutations should be used more widely.