EDITORIAL
Idiopathic normal pressure hydrocephalus (Hakim-Adams syndrome, iNPH) is a chronic neurodegenerative disease of elderly associated with ventricular expansion, and characterized by gait disturbance, mental deterioration, and urinary incontinence. It becomes more important with increasing of elderly part of population. Important feature of iNPH is it’s reversibility in case of early surgical treatment. One of the main problem is the differential diagnosis between iNPH and other neurodegenerative diseases and detection of patients which would be most benefit with shunting. In this purpose a number of radiological symptoms and signs have been proposed. Assessment of MR symptoms of iNPH increases the accuracy of diagnosis and allows in some cases to avoid the necessity of invasive diagnostic procedures (e.g. tap-test, infusion test, external lumbar drainage, ICP monitoring etc.) with lower risk of complications, less duration of treatment and minimizing negative personal experience. At the same time, assessing of most sensitive iNPH radiological symptoms allows to evolve candidates for shunting at prehospital stage and reduce the duration of treatment.
Background and purpose: systematization and synthesis of data on radiological symptoms of iNPH in order to identify most simple and at the same time significant diagnostic and prognostic criteria.
Matherials and methods. The search was performed in PubMed, Google Scholar and Cochrane Library by key words «normal pressure hydrocephalus», «neuroimaging», «magnetic resonance imaging», «computed tomography, radiological symptoms». In addition, data from references were used.
Results. Most specific and sensitive radiological criteria for diagnosis of iNPH are following: Evans index, DESH, temporal horns dilation, callosal angle, periventricular edema, perivascular spaces dilation and local sulci dilation. Complex assessment of this symptoms increases diagnostic accuracy and in some cases allows to avoid the necessity of invasive diagnostic procedures.
ЛЕКЦИИ,ОБЗОРЫ
ORIGINAL RESEARCH
Fim of the study. We attempted to select a complex of signs for prognosis of early post-intervention stroke in patients referred for extensive invasive cardiovascular surgery or intravascular procedures, from the data of routine MRI of the brain.
Material and methods. Basing on the histories of 540 patients underwent non-carotid cadiosurgical or invasive intravascular procedures we selected ten in whom the post-operation early stroke was diagnosed and who also underwent pre-surgically the MRI study of the brain. The control comparative group comprised twelve persons in whom no post-intervention stroke was observed and also pre-intervention MRI was present. At the admission before surgery or intervention in everybody the T2-weighted MRI has been carried out in T2-weighted and T1-weighted thin slice (1,5– 3 mm) modes with subsequent quantification of cerebral ischemic preconditioning from quantitatification of T2-w. Imaged and with measurement of cortex’thickness.
Results. In patients of both post-surgical stroke and control groups the coexistance of critical carotid stenosis or carotid occlusion with contralateral subcritical or mild/minimal contralateral carotid stenosis was detected. The post-operation ishemic stroke was detected in those persons obly, in whom pre-surgically the region of ishaemic leucodystrophy (unilateral leucoarayosis) was detected as signal-enhanced region on T2-weighted MRI scans on the side of carotid occlusion/critical stenosis, simultaneously with cortical thinning on the side. The index of physical volume of the T2-w.hyperintence region was in patients in whom post-surgically the ischemic stroke occurred as high as 18–51 сm3, whereas the volume of irreversibly damaged tissue diffusely distributed over the T2-w.hyperintensive leucoarayosis area 3,9–14,7 сm3. The ratio of volumes of irreversibly damaged tissue to the physical volume of damage was 0,17–0,29. Simultaneously in these persons in the middle cerebral artery perfusion region ipsilaterally the relative thinning of the cortex was seen with no cerebral stroke in the personal history. The cortex was in these patients on the side of ICA critical stenosis/ ICA occlusion 1,7–3,1 mm, and contralaterally 2,5–3,2 mm, with asimmetry index 0,65–0,82. This syndrome of «ischemic preconditioning of the brain» seen as combination {T2-hyperintensity & cortical dystrophy} was also detected in hree patients in whom the ishaemic stroke after cardiovascular surgery did not occur, and all these persons were treated befor the operation with high — up to 750 mg daily — doses ethylmethyl hydroxypiridine succinate (mexidol). The sensitivity of MRI syndrome {T2-hyperintensity & cortical dystrophy} in prognosis of post-operation ischemic stroke was as high as 100%, whereas specificity 75%, and diagnostic accuracy 86%.
Conclusion. Thus, the detection of extensive unilateral area of T2-hyperintensity in the internal carotid artery region (unilateral leucoarayosis) concomitant with thinning of cortex in the region, on the side of occlusion or critical stenosis of internal carotid artery can be accepted as factor of high risk of ishemic stroke early after extensive vascular surgery or intervention. It is necessary to carry out the MRI study of the brain in every patient before and after extensive cardiovascular intervention, for scoring of stroke risk early after procedure.
Aim. To evaluate the effectiveness of the mathematical model for determining the probability of osteopenic syndrome in patients with multifocal atherosclerosis.
Materials and methods. The study included 251 male patients with verified atherosclerosis of the coronary and carotid arteries. The average age of the patients was 60,56±8,7 years. All patients included in the study performed multispiral computed tomography of coronary and carotid arteries with a quantitative evaluation of calcification by the method of Agatston (calcium index and equivalent weight of calcium deposits), color duplex scanning of carotid arteries, densitometry. The obtained data were used to calculate the probability of having an osteopenic syndrome (р) using a mathematical model. Criterion for the risk of osteopenic syndrome in the patient is the value р>0,688. The results of the analysis were compared with the densitometry data chosen as the reference method.
Results. According to the quantitative assessment of coronary artery calcification in patients with osteopenia and osteoporosis, significantly higher values of the calcium index and equivalent weight of calcium deposits were observed than in patients with normal bone mineral density. Regardless of the presence of bone mineralization, more than half of the respondents (66,7% of patients with normal bone mineral density and 59,6% of patients with osteopenic syndrome) had coronary artery stenoses up to 50%. Calcification and presence of stenosis more than 30% of carotid arteries prevailed in the group of patients with osteopenic syndrome. The results of calculating the probability of having an osteopenic syndrome using a mathematical model indicate that it is highly prevalent in the sample (69,3%) and does not differ significantly from the densitometry data (70,1%). The sensitivity of the mathematical model was 89,8%, the specificity was 78,7%, the prognostic value of the positive result was 90,8%, the prognostic value of the negative result was 76,6%.
Conclusion. The mathematical model for assessing the probability of osteopenic syndrome is highly diagnostic in men with multifocal atherosclerosis.
The aim of the study. Compare the efficiency of the use of dual-energy x-ray absorptiometry (DRA) and bioimpedansometry (BIM) in the evaluation of the body composition of hemodialysis patients.
Patients and methods. 67 patients on hemodialysis, among which 23 men and 44 women aged 54±14,4 years. BIM and DRA were used to evaluate the body composition.
Results. The results of determining the total muscle mass of the body obtained by the results of DFA and BIM were compared with the use of the Bland-Altman method. The correlation coefficient between the indices was R=0,994, p<0,0001, delta (M±s) was –0,48±0,91 kg, CI 95% (–0,71)…(–0,26) kg.
Conclusion. DRA does not have significant advantages over tetrapolar multifrequency BIM when assessing the body composition in hemodialysis patients.