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ECPB 2017, 79(3): 21–25
https://doi.org/10.25040/ecpb2017.03.021
Research articles

Features of the Spectrum оf Intracerebral Complications Depending on the Time of Onset of Acute Ischemic Stroke

A. VOLOSOVETS
Abstract

Abstract. Intracerebral complications after ischemic stroke significantly affect the final outcome for patients and often impede neurological healing. The most threatening complications of ischemic stroke are cerebral edema and hemorrhagic transformation.

The purpose of the work. To study the features of the intracerebral complication of ischemic stroke, depending on the time of stroke.

Materials and methods. We carried out a comprehensive clinical and instrumental examination of 300 patients who suffered an acute ischemic stroke (men - 196, women - 104) aged 42 to 84 years (average age - 65.2 ± 8.7 years) has been carried out. All patients have been divided into 3 groups according to the period of the day when an ischemic stroke has happened: group 1, patients suffering from cerebral ischemia during the day (8.00-14.59); Group 2, patients whose stroke has been observed in the evening (15.00-21.59); Group 3, patients that have had an ischemic stroke at night (22.00-7.59).

Results. Analysis of neuroimaging data combination has shown that the smallest average volume of the focal point of ischemia in patients from the 2nd group (15,9 ± 8,4 cm3) has been observed, while it has been opposite in patients from group 3, the maximum (30,8 ± 8.2 cm3), which is most likely due to prolonged necrotisation of ischemic penumbra neurons against metabolic decline during sleep without adequate reperfusion or primary neuroprotection within the «therapeutic window». The average index of ischemia in patients from group 1 was 19.3 ± 10.9 cm3. A course of the disease in patients with acute stroke that has occurred during the daytime has been mainly complicated by acute cerebral edema (n = 31, 21.2 %) and cerebral angiospazm (n = 38, 26.02 %), that could be related to pathogenetic background, characteristic for this time of stroke occurrence. Among patients from the 2nd stroke group, which arose in the evening, moderate cerebral edema occurred more often (n = 12, 11.2 %), since both the neurological deficits and the extent of the focal point of the lesion have been the smallest among these patients from 3 groups For patients with a «nocturnal» stroke, the most severe threat has been severe edema (n = 21, 44.6 %) with elements of dislocation of the brain structures (n = 14, 29.7 %) in the form of secondary stem syndrome and hemorrhagic transformation of the heart attack (n = 8, 17.02 %), which has been associated with the highest average volume of ischemic heart disease and severe initial neurological deficiency.

Conclusions. The received information allows to individualize the therapeutic approach to the correction of ischemic stroke complications and to predict the risk of their occurrence, depending on the period of cerebral ischemia onset.

Article recieved: 31.08.2017

Keywords: ischemic stroke, complications, time of occurrence

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