[Variants of the clinical course of the acute period of ischemic stroke in young and middle-aged patients].

Abstract

Objective: To identify and study variants of the clinical course of the acute period of ischemic stroke (IS) in young and middle-aged patients, to establish their dependence on the presence of the main risk factors for cardiovascular diseases.

Material and methods: The study included 145 patients (111 men and 34 women) with IS in its acute period, including 22 young (15.2%) and 123 middle-aged people (84.8%). The main risk factors of cardiovascular diseases were analyzed. Five variants of the clinical course of the acute period of IS were identified: regredient, regredient with residual mild focal neurological symptoms, stable, slowly progressive, and rapidly progressive. The regredient course and the regredient course with residual mild focal neurological symptoms are attributed to the favorable course of the acute period of IS; stable, progressive, and rapidly progressive predicted unfavorable course.

Results: Regredient course was observed in 43 (29.7%) patients; regredient with residual mild focal neurological symptoms in 78 (53.8%) patients; stable course was established in 4 (2.8%) patients; slow progressive course in 15 (10.3%) patients and fast progressive course in 5 (3.4%) patients. The following risk factors significantly contributed to the favorable course: less pronounced motor, sensory and speech disorders at the time of admission of the patient to the hospital and at the end of the acute period of IS, timely hospitalization in the neurological department for the treatment of patients with acute disorders of cerebral circulation within the «therapeutic» window, intravenous thrombolytic therapy, mild severity of IS on the NIHSS, a lesion of the vertebral-basilar brain basin, absence of overweight and ischemic heart disease in the patient's anamnesis (p<0.05).

Conclusion: Determining the clinical course of the acute period of IS in young and middle-aged patients will make it possible to predict the rehabilitation potential of a particular patient and increase the effectiveness of individual neurorehabilitation measures at the stages of early and late rehabilitation treatment.