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A modern approach to migraine diagnosis 偏头痛诊断的现代方法
T. V. Sorokovikova, A. M. Morozov, A. N. Kryukova, S. A. Naumova
Headache is currently one of the most common disorders of the nervous system, and such type of headache as migraine significantly reduces the quality of life and working capacity of the population, which affects healthcare, economy, and social sphere of the country. A competent approach to the diagnosis of migraine implements further timely therapeutic and preventive measures. For an integrated approach to diagnosis, it is necessary to resort to international standards and criteria, which are explained in this review. It is important to note that migraine can be mistaken for other conditions and cephalgic syndromes with similar clinical manifestations. The doctor's attention should first of all be aimed at a clinical study, according to the results of which it is already possible to make a diagnosis. Neuroimaging methods should not be used routinely in all patients, but only if there are indications. Based on the analysis of the literature, we have identified the key signs of migraine with and without aura, chronic migraine, as well as provided the information necessary for differential diagnosis with other pathologies.
头痛是目前最常见的神经系统疾病之一,偏头痛等类型的头痛严重降低了人们的生活质量和工作能力,影响了国家的医疗保健、经济和社会领域。一个称职的方法来诊断偏头痛实施进一步及时的治疗和预防措施。为了综合诊断,有必要采用国际标准和标准,本文对此进行了解释。值得注意的是,偏头痛可能被误认为其他条件和头痛综合征具有类似的临床表现。医生的注意力首先应该集中在临床研究上,根据临床研究的结果,已经有可能做出诊断。神经影像学方法不应常规应用于所有患者,但只有当有指征。在文献分析的基础上,我们确定了有先兆和无先兆偏头痛、慢性偏头痛的关键体征,并提供了与其他病理鉴别诊断所必需的信息。
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引用次数: 0
Pharmacological correction of neurological disorders in the relief of alcohol withdrawal syndrome 酒精戒断综合征缓解中神经障碍的药理学矫正
B. S. Litvintsev, D. P. Konstantinov, V. L. Reinuk, M. V. Ardashev, A. V. Belskaya
Among the existing addictions, the greatest medical and social problems are created by chemical dependencies associated with the use of alcohol, narcotic drugs and psychotropic substances. Neurological disorders in alcoholism are distinguished by the multifactorial nature of their genesis. Pharmacological correction of potential neurological disorders in alcohol users should be considered from the perspective of prescribing drugs with polymodal effects, which justifies the search for the most promising and effective means of pharmacological correction of mental and somatoneurological consequences of alcoholism. The aim of the study was to analyze the dynamics of neurological symptoms under the control of laboratory indicators of toxic liver damage to assess the effectiveness of complex pharmacotherapy of alcohol withdrawal syndrome. 40 patients (average age 43.2±7.2 years) who are being treated for alcohol withdrawal syndrome were examined. A neurological examination and a study of blood biochemical parameters were carried out to assess the functional state of the liver. Neurological organic symptom complex was detected in all observed patients and was a diffuse focal symptomatology associated with cerebral and polyneuritic disorders. Laboratory indicators of the functional state of the liver in patients taking morpholinium- methyl-triazolyl-thioacetate orally showed a statistically significant difference before and after therapy, in the absolute majority of cases positive hemodynamic dynamics and regression of neurological symptoms were observed. Morpholinium-methyl-triazolyl-thioacetate has polymodal effects and can be used not only for alcoholic hepatitis, but also for the correction of cardiological and neurological disorders associated with alcoholic liver damage. It is advisable to consider Thiotriazoline® as a means of choice in the complex therapy of alcoholic liver damage in the outpatient unit.
在现有的成瘾问题中,最大的医疗和社会问题是与使用酒精、麻醉药品和精神药物有关的化学依赖。酒精中毒引起的神经紊乱的特点是其发病的多因素性质。对酒精使用者潜在神经障碍的药理学纠正应从处方具有多模效应的药物的角度考虑,这证明了寻找最有希望和最有效的方法来药理学纠正酒精中毒的精神和躯体神经后果。本研究的目的是分析在毒性肝损害实验室指标控制下神经系统症状的动态变化,以评估酒精戒断综合征综合药物治疗的有效性。对40例正在接受酒精戒断综合征治疗的患者(平均年龄43.2±7.2岁)进行调查。进行了神经学检查和血液生化参数研究,以评估肝脏的功能状态。在所有观察到的患者中都检测到神经系统器质性症状复合物,并且是与大脑和多神经性疾病相关的弥漫性局灶性症状。口服吗啡啉甲基三唑硫乙酸酯患者肝脏功能状态实验室指标治疗前后差异有统计学意义,绝大多数患者血流动力学阳性,神经系统症状消退。morpholium -methyl- triazyl - thiioacetate具有多模态效应,不仅可用于酒精性肝炎,还可用于纠正与酒精性肝损伤相关的心脏病和神经系统疾病。建议考虑将硫代三唑啉®作为门诊酒精性肝损伤综合治疗的一种选择。
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引用次数: 0
Social factors and their effect on clinical manifestations of depressive disorders 社会因素及其对抑郁症临床表现的影响
A. V. Kuchaeva, M. L. Maksimov, E. B. Mikhailova
The dependence of clinical manifestations of non-psychotic depressive disorders on social factors has been studied. In the treatment of patients with non-psychotic depression, it is necessary to take into account the degree of violation of social symptomatically significant components for rational pharmacotherapy.
研究了非精神病性抑郁症临床表现对社会因素的依赖性。在非精神病性抑郁症患者的治疗中,有必要考虑到社会症状显著成分的违反程度,进行合理的药物治疗。
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引用次数: 0
Experience in surgical treatment of extra-intracranial tandem ICA stenosis at the National Medical Research Center for High Medical Technologies named after A. A. Vishnevsky of the Ministry of Defense of the Russian Federation 在以俄罗斯联邦国防部A. A. Vishnevsky命名的国家高医疗技术医学研究中心进行颅内外串联ICA狭窄手术治疗的经验
A.V. Fedyanin, G.I. Antonov, E.G. Chmutin, G.E. Chmutin, E.R. Miklashevich, S.Yu. Gladyshev, I.I. Shumakov, S.V. Melnichuk, M.M. Muminzhonova
To date, the effectiveness and safety of reconstructive surgery for steno-occlusive lesions of the internal carotid artery (ICA) have been proven by multicenter cooperative studies Despite this, the indications and tactics of surgical treatment of patients with extra-intracranial tandem stenotic lesions of the ICA remain controversial. In the period 2010-2020, 32 patients with symptomatic (15 cases) and asymptomatic tandem ICA lesions were hospitalized for surgical treatment. The distribution of tandem lesions was as follows: 10 patients had bicarotid hemodynamically significant stenotic and occlusive lesions of the ICA ostium in combination with stenosis of more than 50% of the petrous (4 cases), cavernous (8 cases), and clinoid segments (5 cases), of these, four had bilateral intracranial stenosis; 22 patients with hemodynamically significant lesions of the ICA and vertebral artery (VA) in combination with stenosis of more than 50% of the petrous (10 cases), foramen lacerum (2 cases), cavernous (16 cases), clinoid (14 cases), and ophthalmic segments (1 cases), of these, six had bilateral intracranial stenosis of the ICA. All patients underwent staged surgical interventions on the arteries of the carotid and vertebrobasilar systems. In the postoperative period, there was one case of repeated ischemic stroke in the territory of the reconstructed artery after the application of extra-intracranial microanastomosis (EICMA). There were no relapses of restenosis or acute cerebrovascular accident (CVA) in the follow-up. Staged reconstructive and revascularization treatment is safe and effective for tandem extra-intracranial lesions of the ICA. It is necessaryto continue further study of this issue in order to develop unified tactics and methods of surgical treatment.
迄今为止,多中心合作研究已证实颈内动脉(ICA)狭窄闭塞病变重建手术的有效性和安全性。尽管如此,颅内外颈内动脉连续狭窄病变患者的手术治疗指征和策略仍存在争议。2010-2020年期间,32例有症状(15例)和无症状的串联ICA病变住院接受手术治疗。继发性病变的分布如下:10例患者存在颈动脉血流动力学显著的ICA口狭窄闭塞病变,合并岩状节段(4例)、海绵状节段(8例)、斜状节段(5例)的狭窄超过50%,其中4例为双侧颅内狭窄;22例颈内动脉及椎动脉(VA)血流动力学显著病变合并岩状(10例)、撕裂孔(2例)、海绵状(16例)、斜状(14例)、眼段(1例)狭窄超过50%,其中6例颈内动脉双侧颅内狭窄。所有患者都接受了分阶段的颈动脉和椎基底动脉系统的手术干预。术后应用颅内外微吻合术(EICMA)后,重建动脉区域发生反复缺血性脑卒中1例。随访无再狭窄复发及急性脑血管意外(CVA)。分阶段重建和血运重建术治疗颈内动脉颅内多发病变是安全有效的。为了制定统一的手术治疗策略和方法,有必要继续深入研究这一问题。
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引用次数: 0
On temporary clipping in cerebral aneurysm surgery (literature review). 脑动脉瘤手术中的临时夹持(文献复习)。
P. G. Shnyakin, A. V. Botov, A. S. Loseva
Temporary clipping (TC) of the parent artery is a standard procedure in cerebral aneurysm surgery. According to a number of studies, TC lasting up to 5 minutes is safe in terms of the development of ischemic complications. In cases where a longer TC is required, it is recommended to alternate vessel shutdown with periods of reperfusion, which allows the procedure to be repeated many times without the risk of ischemia. The article presents a review of current scientific publications on TC in cerebral aneurysm surgery, showing that this is a very unpredictable procedure in terms of the development of complications, even when performed within the recommended time parameters. There are cases of ischemia with TC lasting less than 5 minutes and the opposite situation, when TC lasting more than 10–20 minutes does not lead to the development of complications. The review also presents current ideas on how to improve the safety of TC, including the use of intraoperative neurophysiological monitoring.
临时夹闭(TC)的母动脉是一个标准的程序在脑动脉瘤手术。根据多项研究,就缺血性并发症的发生而言,持续5分钟的TC是安全的。在需要更长的TC的情况下,建议将血管关闭与再灌注交替进行,这使得该过程可以重复多次而不会有缺血的风险。本文回顾了目前关于脑动脉瘤手术中TC的科学出版物,表明即使在推荐的时间参数内进行TC手术,其并发症的发展也是非常不可预测的。有缺血时TC持续时间小于5分钟的病例,也有相反情况,TC持续时间大于10-20分钟时不发生并发症。这篇综述还介绍了目前关于如何提高TC安全性的想法,包括术中神经生理监测的使用。
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引用次数: 0
The prevalence of laxative and diuretic abuse in patients with anorexia nervosa and bulimia nervosa 神经性厌食症和神经性贪食症患者滥用泻药和利尿剂的发生率
E. I. Batyrev, A. E. Bryukhin, M. B. Sologub, K. S. Shikhgafizova
The article is devoted to the study of laxative and diuretic abuse among patients with anorexia nervosa (AN) and bulimia nervosa (BN). The medical records of 152 patients with AN and NB, who were hospitalized in a specialized clinic for the treatment of eating disorders, were studied. Of 152 patients, 52 % (N=79) had restricting anorexia nervosa, 29.6 % (N=45) had purgative anorexia nervosa, and 18.4 % (N=28) had bulimia nervosa. The number of people abusing laxatives and diuretics in the groups with AN purgative type and BN did not differ significantly. Laxative abuse accounted for 42.2 % (N=19) and 42.9 % (N=12) in AN purgative type and BN, respectively. Diuretics abuse accounted for 20 % (N=9) and 17.9 % (N=5) in AN purgative type and BN, accordingly. The total number of laxative and diuretic abusers among the patients with eating disorders was 20.4 % (N=31) and 9.2 % (N=14), respectively.
本文旨在研究神经性厌食症(AN)和神经性贪食症(BN)患者滥用泻药和利尿剂的情况。研究了152名在一家专门诊所治疗饮食失调的AN和NB患者的医疗记录。152例患者中,限制性神经性厌食症占52% (N=79),泻性神经性厌食症占29.6% (N=45),神经性贪食症占18.4% (N=28)。AN型和BN型患者滥用泻药和利尿剂的人数差异无统计学意义。AN型和BN型患者滥用泻药的比例分别为42.2% (N=19)和42.9% (N=12)。AN型和BN型患者滥用利尿剂的比例分别为20% (N=9)和17.9% (N=5)。饮食失调患者中滥用泻药和利尿剂的比例分别为20.4% (N=31)和9.2% (N=14)。
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引用次数: 0
Results of treatment of patients with degenerative lumbar stenosis using spinal epidural neurostimulation 脊髓硬膜外神经刺激治疗退行性腰椎管狭窄症的疗效观察
A.S. Nikitin, R.M. Nanaev, O.V. Levchenko
The article provides the results of treatment of patients with degenerative lumbar stenosis; a detailed analysis of the main components of pain syndrome, neurogenic intermittent claudication, and factors of patient disability has been carried out. The efficacy of volley and tonic neurostimulation has been compared, factors of the effectiveness of neurostimulation have been identified, and an algorithm for managing patients with degenerative lumbar stenosis with severe concomitant diseases that prevent decompressive surgery has been developed.
本文提供退行性腰椎管狭窄症患者的治疗结果;详细分析了疼痛综合征的主要组成部分,神经源性间歇性跛行,以及患者残疾的因素。我们比较了齐射和强直神经刺激的疗效,确定了影响神经刺激效果的因素,并开发了一种算法,用于管理伴有严重伴发疾病的退行性腰椎管狭窄症患者,从而防止进行减压手术。
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引用次数: 0
Study of some predictors of delinquent disorders in patients with organic personality disorder 器质性人格障碍患者犯罪障碍预测因素的研究
Yu. S. Khudina, N. V. Tkachenko, V. G. Zaika
The problem of antisocial (delinquent) human behavior has existed since ancient times. According to literary sources, adolescents are the most susceptible to this form of behavior, however, this does not always reflect the reality. In psychiatry, it is customary to pay attention not only to age, gender, or nosological aspects, but also to personal characteristics when behavioral disorders occur. This article analyzes predictors of delinquent disorders in patients with organic personality disorder. The age parameters of the disorders presented in the sample are considered: behavioral deviations characteristic of childhood and adolescence, as well as of adults, are described. In addition, personal characteristics influencing the occurrence of delinquent behavior have been studied. It is proposed to introduce a new parameter — locus of control, which allows for a comprehensive assessment of the condition of subjects in different spheres of life.
人类反社会(犯罪)行为问题自古以来就存在。根据文献资料,青少年最容易受到这种行为形式的影响,然而,这并不总是反映现实。在精神病学中,习惯上不仅要注意年龄、性别或疾病方面,而且要注意行为障碍发生时的个人特征。本文分析器质性人格障碍患者不良行为障碍的预测因素。考虑了样本中出现的疾病的年龄参数:描述了儿童和青少年以及成年人的行为偏差特征。此外,还研究了影响犯罪行为发生的个人特征。本文建议引入一个新的参数——控制点,以便对受试者在不同生活领域的状况进行综合评估。
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引用次数: 0
Psychosomatic causes of the gastrointestinal tract functional disorders: historical aspects and modern assessment 胃肠道功能障碍的心身原因:历史方面和现代评估
Zh. R. Gardanova, V. I. Esaulov, V. A. Sotnikov, M. Yu. Kazaryan, D. N. Chernov, A. A. Gavisova, K. A. Uporov, V. V. Novikov, A. K. Gardanov, V. I. Ilgov, D. Kh. Gubaidullin, D. A. Nakhapetyan, K. A. Mikirtumova
Psychosomatic disorders are becoming increasingly common among neurotic disorders in the practice of doctors of various profiles. The history of studying psychosomatic disorders goes back to the past, and even in ancient times, doctors paid attention to a special group of diseases, the cause of which was related to the mental state of the patient, while complaints were in the nature of somatic diseases. At the present stage, psychosomatic disorders prevail in the practice of internists, as well as obstetricians and gynecologists. Irritable bowel syndrome, as one of the psychosomatic disorders, currently attracts the attention of many researchers. The article presents the results of a study of pregnant women with irritable bowel syndrome and the peculiarities of their emotional response. The aim of the study was to identify the level of anxiety in pregnant women with IBS, depending on the IBS clinical form. The feeling of anxiety was revealed at an equally high level in all subjects in the experimental and control groups. Tension was more pronounced in the patients with diarrhea predominant irritable bowel syndrome, while depressive states were more often detected in the patients with IBS-D and less pronounced in the subjects with abdominal pain.
心身疾病在各种医生的实践中越来越普遍。研究心身疾病的历史可以追溯到过去,甚至在古代,医生就关注一类特殊的疾病,其病因与患者的精神状态有关,而主诉则属于躯体疾病的性质。在目前阶段,心身疾病在内科医生以及妇产科医生的实践中普遍存在。肠易激综合征作为心身疾病的一种,目前引起了许多研究者的关注。这篇文章介绍了一项研究的结果与肠易激综合征孕妇和他们的情绪反应的特点。该研究的目的是根据肠易激综合征的临床形式,确定患有肠易激综合征的孕妇的焦虑水平。焦虑感在实验组和对照组的所有受试者中都表现出同样高的水平。在腹泻为主的肠易激综合征患者中,紧张状态更为明显,而在IBS-D患者中,抑郁状态更常被发现,而在腹痛患者中则不太明显。
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引用次数: 0
Impact of sleep-disordered breathing on the dynamics of cognitive dysfunction in patients after ischemic stroke 睡眠呼吸障碍对缺血性脑卒中患者认知功能障碍动态的影响
V. V. Amelina, L. S. Korostovtseva, M. V. Bochkarev, I. V. Sakovskiy, M. S. Golovkova-Kucheryavaya, Yu. V. Sviryaev, A. N. Alekhin
Ischemic stroke is a crucial medical and social issue, and the study of factors influencing the development and prognosis of rehabilitation of motor, cognitive, and emotional disorders is of great importance. The presence of concomitant diseases is among these factors. This study examined the impact of sleep-disordered breathing, common in patients after acute cerebrovascular accident, on the prognosis of rehabilitation of cognitive dysfunctions in the early recovery period. The duration of hypoxemia has been found to act as a key factor determining the severity of cognitive impairment. NIHSS stroke severity was a predictor of poor prognosis and can be considered as a general nonspecific marker of decompensation.In addition, it has been found that increasing age, cerebral atherosclerosis, and coronary heart disease, as well as the night time of stroke development are associated with an unfavorable prognosis for the development of cognitive dysfunction in patients after stroke.
缺血性脑卒中是一个重要的医学和社会问题,研究影响运动、认知和情绪障碍患者康复发展和预后的因素具有重要意义。伴随疾病的存在是这些因素之一。本研究探讨急性脑血管事故后常见的睡眠呼吸障碍对认知功能障碍患者早期康复预后的影响。低氧血症的持续时间已被发现是决定认知障碍严重程度的关键因素。NIHSS卒中严重程度是不良预后的预测因子,可视为失代偿的一般非特异性标志物。此外,已有研究发现,年龄增长、脑动脉粥样硬化、冠心病以及卒中发生的夜间时间与卒中后患者认知功能障碍的发展预后不利相关。
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引用次数: 0
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