[Clinico-pathogenetic evaluation of the headache syndrome in cerebral stroke].
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Biomedical subjects
Publications and source records attributed to B G Gafurov.
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30 women aged 30-45 years with the diagnosis "initial manifestations of insufficiency of cerebral circulation" were examined. These disorders were observed on the background of the syndrome of autonomic dysfunction. Correlative analysis was performed by means of methods which permitted quantitative estimations on the basis of investigation of the severity of the syndrome, peculiarities of the patients' mental state and cerebral hemodynamics. Pronounced correlation was found between hemodynamic indices and the degree of anxieties. Anxiety plays an inducing role in the development of either autonomic dysfunction or the main vascular disorders. The syndrome of autonomic disfunction was considered as the realising factor.
The results of psychological and vegetative investigations in 142 patients with bronchial asthma (BA) demonstrated that BA gives rise to psychovegetative syndrome resultant from parasympathetic orientation of the vegetative tone and reactivity, weak vegetative support of muscular and mental activity. These vegetative shifts occur in line with enhanced ascending nonspecific activation and anxious-hypochondriac traits of personality.
The authors analyze some pathophysiologic mechanisms underlying the relationships between the vegetative dystonia syndrome running in the presence of the climacteric syndrome, on the one hand, and cerebrovascular insufficiency, on the other. A total of 82 women were examined, 62 of these with the climacteric syndrome and 20 with the normal climacteric (reference group). Among women with the climacteric syndrome patients with signs of cerebrovascular insufficiency (initial signs of cerebral circulation insufficiency and Stage I dyscirculatory encephalopathy) predominated. The severity of cerebrovascular insufficiency was higher in patients with the climacteric syndrome. The sympathetic tone of the autonomic nervous system clearly prevailed in the test group, and signs of inadequate autonomic supply were present. Electropolygraphic registration of the function of the nonspecific systems of the brain has shown marked signs of increased level of the ascending nonspecific activation of the brain in the main group as against the reference one. Basing on these findings, the authors analyze the specific features of the psychovegetative syndrome, conducive to the development of cerebrovascular dystonia in women with the pathologic course of the climacteric.
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Function of the nonspecific brain structures (NBS) was examined in 49 patients distributed into two groups: with initial manifestations of brain blood supply insufficiency (IMBBSI) (n = 28) and atherosclerotic encephalopathy (n = 21). Use was made of an approach with the use of autonomic and psychological techniques as well as of a polygraphic recording of the electrophysiological parameters of nocturnal sleep. It has been established that both groups patients manifest NBS dysfunction. However, its qualitative characteristics were found to differ noticeably in IMBBSI and AE. The patients with DE demonstrate more remarkable inhibition of the synchronous mechanisms that regulate both phases of nocturnal sleep and reciprocal enhancement of the activity of the systems of the ascending nonspecific brain activation. The autonomic and psychological data agree with the electrophysiological data obtained. The conclusion is drawn that in patients with cerebrovascular insufficiency, the NBS systems are first of all involved in the pathological process. This is of importance for both the diagnosis and further studies into the pathogenesis of different forms of cerebrovascular insufficiency.
In trained cats, unilateral extirpation of the sigmoid gyri's cortex disinhibited the unreinforced runs while preserving the positive conditioned reflexes associated with differentiation of different salt food reinforcement. The bilateral extirpation induced a disorder of differentiated inhibition while preserving the conditioned runs reinforced with the highly salted food. The unilateral extirpation did not affect the food-motor conditioning against the background of the salt diet. The bilateral extirpation delayed the differentiation inhibition and facilitated the positive conditioning.
The problem of the role of the autonomic nervous system (ANS) in the mechanism of symptom formation and in the pathogenesis of acute disturbances of cerebral circulation (ADCC) has not been studied well. Bearing this in mind, the authors examined 78 patients who suffered ADCC. The patients were divided into 2 groups. The first group was made up of 50 patients who suffered ischemic brain stroke with a stable neurological defect (SSD), the second one comprised 28 patients who suffered brain stroke with a reversible neurological defect (SRD). It has been established as a result that the initial level of sympatheticotonia and the intensity of the signs of vegetodystonia was higher in patients with SSD. Electrophysiological studies have demonstrated that in SRD, the level of ascending nonspecific brain activation prevailed according to the responsiveness of the reference alpha-rhythm as compared with the first group patients and the control group. The data obtained are discussed from the standpoint of the compensatory role played by the autonomic nervous system in the pathogenesis and course of the clinical forms of ADCC differing in the gravity and prognosis.
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Under condition of normal temperature the conditioned reflectory runnings of rats on the audible irritants were developed more quickly during dry food than damp one. Daily influence of high temperature during two hours and partially water deprivation resulted in reduction of the conditioned reflex which had been developed before during dry food. The reproduction of the conditioned reflexes during dry food failed. The essential changings in the conditioned reflexes during damp and dry food were not found when animals had become overheating without restriction of water consumption. During daily heat affecting at the end of the second week animals adapted to high temperature. This statement is confirmed by lowering the rectal temperature, decrease of the breath rate, daily water consumption and restoration of the activity of conditioned reflexes.
The increase of excitement of lateral and supraoptic nuclei of hypothalamus in cats on the background of thirsty rate has been established to appear under the influence of shifts in blood physical and chemical properties and via irritation of specific visceral receptors reflectively as well.
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In cats kept on the salt diet, spontaneous cortical EEG and electrohypothalamogram were recorded in stimulation of the tongue, stomach and intestine receptors with salt solutions. Longlasting bursts of hypersynchronized activity (HA) were recorded in the lateral and supraoptic nuclei of the hypothalamus, the bursts spreading over to the brain cortex in longer salt diets. The HA also were evoked with light and sound stimuli and disappeared after intracavital administration of water or after i.v. administration of saline. A primary focus of stationary excitation possessing some features of a dominanta in formation of the thirst motivation, seems to appear in the hypothalamus.
A comprehensive clinico-physiological investigation involved 23 patients of whom 13 had had a "diurnal" and 10 a "nocturnal" cerebral stroke. The structure of the nocturnal sleep was studied by polygraphic recording; the authors also studied the circadian rhythm of the clotting properties of blood, pulse blood filling of the cerebral vessels and arterial pressure. It was found that the structure of dream in patients with a history of a "nocturnal" stroke was characterized by an increase in the activity of the mechanisms responsible for the phase of rapid sleep. Characteristic features of the circadian dynamics of the hemostatic system and hemodynamic parameters in patients with a history of a "diurnal" and "nocturnal" stroke were identified. A conclusion is drawn that the circadian distribution of acute disturbances of the cerebral blood circulation is determined by individual characteristics of some circadian rhythms of the patients' bodies.
The results of polygraphic examination of night sleep in 40 post-stroke patients are presented. In 22 of these patients, the focus was localized in the left, and in 18, in the right hemisphere. The pattern of sleep was found to vary with the hemispherical lateralization of the pathological process. Patients with damage to the left hemisphere and aphasia exhibited differences in the phase of rapid sleep and the time-course of the activation phenomena on the EEG during sleep related to the degree of speech disturbances. When the right hemisphere was impared, the most marked disturbances of the sleep pattern were elicited in patients with prominent manifestations of anosognosia. The data obtained are considered as features characteristic of the dysfunction of the cerebral nonspecific systems associated with hemispherical damage.
Forty-two epileptic patients with distinct localization of the focus in the left (22 patients) and the right (20 subjects) hemispheres of the brain were subjected to a combined electrophysiological examination including electroencephalography at rest and under intellectual exertion and also polygraphic recording of the night dream pattern. On the basis of the data obtained the authors analyze the function of the cerebral nonspecific activating and deactivating systems in relation to the localization of the focus. The differences detected are suggestive of the functional insufficiency of the activating mechanisms in the left lateral localization of the focus as compared with the right lateral one. The feasibility of utilizing the findings obtained in the differential management of epilepsy (with the lateralization of the epileptic focus taken into account) is discussed.
In 25 patients with acute myocardial infarction objective signs of sleep disorders and the restoration trends of its separate phases and stages after the infarction are described. The data obtained can be used for adequate qualitative and quantitative correction of sleep disorders in acute myocardial infarction at different stages of the disease.
The paper deals with a polygraphic study of night sleep in 44 patients who had cerebral strokes with a different localization of the focus, in 10 patients with atherosclerosis and hypertensive disease (the control group). The structure of sleep following strokes was seriously imparied. Besides general traits, the changes were specific depending upon the focus of lesion. Differences were also displayed in patients with lesions of either the right or left hemisphere and their relationship with the opposition. The author stresses the importance of studying the interrelationship of sleep structure. It is assumed that disturbances in the sleep structure of the patients who have suffered from strokes are of importance in the rehabilitative period.