Zh Nevrol Psikhiatr
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Moyamoya syndrome is a rare chronic progressive disease of brain vessels in which certain arteries in the brain are constricted. During the disease a collateral circulation develops around the blocked vessels to compensate for the blockage, and on angiography these collateral vessels have the appearance of a "puff of smoke". ⋯ The clinical features are an acute stroke in the right middle cerebral artery with dysarthria and paralysis of VII and XII cranial nerves. The diagnosis of moyamoya is suggested by MRI-angiogram results in accordance to the diagnostic criteria.
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The literature on methods of invasive local treatment of chronic pain was analyzed. We reviewed 14 publications including meta-analyses and systematic reviews. The use of regional anesthesia conducted by anesthesiologists in pain clinics demonstrated the evidence based efficacy of different types of peridural injections of local anesthetics with steroids in patients with root pain syndromes at cervical and lumbar levels. ⋯ There are clear indications of the efficacy of local injections in primary chronic cephalgia (migraine and headache of tension). The possibility of the abortion of the pain information flow in peripheral nociceptive pathways and, as a consequence, breaking the vicious circle is emphasized. Issues on the efficacy of local injections at trigger points in the treatment of chronic pain are highlighted.
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Zh Nevrol Psikhiatr · Jan 2014
[Innovation in differential diagnosis and monitoring of rational therapy in patients with lumbosacral radiculopathies].
Unfortunately, nowadays there are no reliable ways to predict the outcomes of the conservative treatment in patients with dorsopathies. Otherwise, we could identify patients that demand intensive treatment including therapeutic blockades. We approbated and modified a method for assessment of radicular latency duration in patients with lumbosacral radiculopathies to evaluate its diagnostic value and the possibility of using in monitoring of effectiveness of conservative treatment. ⋯ There was a definite resistance to treatment in patients with FBSS. The complex management of patients, including neuromidin and epidural glucocorticoid blockades, demonstrated the greater effectiveness. The evaluation of radicular latency duration with neuromidin test turned out to have important predictive value which could be used to stratify treatment of patients with dorsopathies.
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Zh Nevrol Psikhiatr · Jan 2014
[Transcranial dopplerography in the combination with echopulsography in the assessment of intracranial and cerebral perfusion pressure in patients with intracranial hemorrhages].
To study the possibilities of common ultrasound diagnostic methods in the evaluation of intracranial pressure (ICP) and central perfusion pressure (CPP) and to search for the ways of increasing the accuracy of these methods. ⋯ The complex use of noninvasive ultrasound methods allow in most cases to measure with acceptable accuracy and assess the degree of intensity of ICP and CPP changes at the acute stage of intracranial hemorrhages.
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Treatment of neuropathic pain (NP) is a serious medical problem. Antiepileptic drugs and antidepressants, used to relief pain, act on the central pain mechanisms and cause several side-effects, thus substantially restricting possibilities of their clinical application. At the same time, NP often has a peripheral component. ⋯ Recently it has been shown that the local use of single high doses of capsaicin during 30-60 min causes a marked stable(> 12 weeks) effect. The decrease in NP (>50%) is seen in about half of patients. Current studies will allow to single out groups of patients with the maximal treatment effect of capsaicin.