Suchergebnisse

Abstract
There is insufficient information about the progress and variability of multiple sclerosis (MS). Afferent visual pathways are an appropriate MS clinical model. Optical coherence tomography (OCT) allows to perform precise measurements of axonal tissue in the retinal nerve fibre layer (RNFL). Visual evoked potentials (VEP) provide information about the functional status of visual pathways. The aim of our study was to use OCT and VEP to evaluate MS patients with and without optic neuritis (ON) history and to determine relationships between functional and structural changes. The cross-sectional study included 76 relapsing-remitting MS patients and 28 healthy controls. The lowest mean VEP N75/P100 amplitude was found in ON affected eyes (8.16 mkV, SD = 4.60). However, it was observed that the mean amplitude in patients without ON (M = 9.86; SD = 4.63) was by 4.64 mkV lower than in controls (p < 0.001). Similarly, the mean P 100 latency in ON eyes was 9.26 ms longer than in eyes of patients without ON history (p < 0.01). RNFL in the temporal segment (RNFLT) was the thinnest in ON eyes, and even in patient eyes without ON, it was thinner than in controls. We found a significant positive correlation between RNFLT and mean N75/P100 amplitude in patients without ON (rs = 0.43; p < 0.001), and after ON (rs = 0.45; p < 0.001). Both in patients without ON (rs = -0.40; p < 0.001) and in ON eyes we found a significant negative correlation (rs = -0.55; p > 0.001) between RNFLT and mean P100 latency. In summary, we found that deterioration in the visual system was not associated with the clinical ON episode. Regardless of ON symptoms in history, there exists correlation between functional and structural changes.

Abstract
Raksts sniedz īsu ieskatu akadēmiskās neiroloģijas attīstībā Latvijā dažādos laika periodos, sākot no tās pirmsākumiem neilgi pēc Latvijas Republikas dibināšanas, līdz pat šim brīdim, kā arī par izcilākajām personībām neiroloģijā, kuru devums attiecīgajā zinātnes jomā ir bijis visievērojamākais.

Abstract
Mechanical thrombectomy as an active treatment method has recently been chosen for patients with large artery occlusions and thrombolysis beyond a time window. The aim of our study was to evaluate the results of endovascular treatment in patients with proximal vessel occlusion, compare this group with the intravenous thrombolysis group, and to identify possible criteria of active treatment. The prospective study included 81 patients hospitalised in the Pauls Stradiņš Clinical University Hospital due to acute ischemic stroke; 48 of them received mechanical thrombectomy and 33 - intravenous thrombolysis. Thrombectomy (TE) was performed using Solitaire FR stent retrievers. The NIHSS score was used for evaluation of early therapy results and mRS (modified Rankin Scale) was used for late therapy results. ASPECTS was used to define the lesion size using imaging on admission and after treatment. Median NIHSS on admission was higher in the TE group - 16 (range 12 to 19) than in the TL group - 12 (range 8 to 15) (p < 0.05). Ninety days after treatment, mRS (0-2) was seen in 67% of patients in the TE group (n = 29), and 34% of patients in the TL group (n = 9) patients (p < 0.05). Median ASPECTS was lower in TE group - 5, in comparison to the TL group - 7 (p < 0.01) Mortality frequency was higher in the TL group (p > 0.05). Frequency of symptomatic intracerebral haemorrhages was similar in the groups. Mechanical thrombectomy can achieve better late functional outcome than thrombolysis in a selected patients group.

Abstract
Information about changes of health-related quality of life (HRQoL) after revascularisation as well how revascularisation procedure influences daily activities, cognitive functioning and general health is controversial. The objectives of our study were to evaluate and describe the HRQoL among patients with severe carotid artery disease; to evaluate the difference of HRQoL between symptomatic and asymptomatic carotid artery disease; and to explore the possible associations between some demographic and clinical characteristics of patients with carotid artery disease and HRQoL. The cross-sectional study included 33 patients who were referred for carotid artery endarterectomy. Data assessment was done one to three days before surgery. The HRQoL was assessed using the Medical Outcome Survey Form 36 (SF-36v2). Patients with symptomatic carotid artery disease had the lowest mean SF-36v2 scores for physical functioning, role-physical, general health and mental health. There was moderate correlation (rs = 0.441) between mean SF- 36v2 scores of mental health and Montreal Cognitive Assessment Scale (MoCA) scores. There is also indirect indication for probable correlation between MoCA test scores and mean SF-36v2 scores of social functioning, which might become statistically significant if more patients would be included. Patients with severe carotid artery disease in our study had lower mean SF-36v2 scores for role-physical, for bodily pain and for perception about their health status (general health). HRQoL in patients with severe carotid artery, stenosis was poorer in patients with symptomatic carotid artery disease and was not affected by gender and other clinical characteristics.

Abstract
The occlusion of middle cerebral artery (MCA) is the most common cause of ischemic stroke. A retrospective single centre analysis of ischemic stroke was conducted using data from the Latvian Stroke Register in the period from January 2013 till December 2014. The study included 478 patients who had confirmed MCA occlusion using computed tomography angiography (CTA). Half of the patients were males - 237 (49.6%), average age 69.51, average age of females was 74.58 years. Cardioembolic stroke was the most common cause of MCA M1 segment occlusion in 294 (61.5%) cases. Small cerebral artery occlusion was not a cause of M1 MCA occlusion. The reperfusion therapy group consisted of 209 patients and the conservative therapy group of 269 patients. Both groups presented similar neurological status when they were admitted to hospital. However, the reperfusion therapy group had better neurological status (NIHSS 6.82) than in the conservative therapy group (NIHSS 8.2) at the time period when patients were discharged from hospital (p < 0.05). There were more cases of good functional outcome (39.2%) and less of poor (34.5%) in the reperfusion group, as well as less mortality - 7.6%. Middle cerebral artery (MCA) is the most common site of stroke and the most common cause of its occlusion is cardioembolism. There is high incidence of recurrence of stroke due to M1 MCA occlusion. Both groups presented a similar neurological status on admission, but more improvement was seen in the reperfusion therapy group after discharge of patients from hospital. The functional outcome was also better in the reperfusion therapy group.

Abstract
Variable platelet response to aspirin and clopidogrel is a well-known phenomenon in patients with coronary artery disease and ischemic cerebral stroke. The objective of the present study was to evaluate the frequency and possible risk factors of antiplatelet resistance in patients with cerebrovascular and cardiovascular diseases. The VerifyNow system was used to evaluate adenosine-5-diphosphate and platelet P2YI2 receptor function in patients with cerebrovascular and cardiovascular disease, who received dual antiplatelet therapy. Aspirin resistance was defined as aspirin reaction units (ARU) ≥ 550. Clopidogrel resistance was defined as Platelet Reaction Units (PRU) > 230. In the group of cerebrovascular diseases there were 13.2% (n = 27) patients with aspirin and 24.5% (n = 50) with clopidogrel resistance. However, in the cardiovascular group there were 20% (n = 9) aspirin and 11.1% (n = 5) clopidogrel resistant patients. In the cerebrovascular group, aspirin resistant patients had a lower triglyceride level (p = 0.001, r = 0.26) than aspirin sensitive patients. Clopidogrel resistant patients had a significantly higher level of glycated haemoglobin (HbA1C) (p = 0.016, r = 023), triglycerides (p = 0.033, r = 0.16) and lower level of high-density lipoproteins (p = 0.027, r = 0.16) than clopidogrel sensitive patients. In the cardiovascular group, patients who were resistant to aspirin had a significantly higher high-density lipoprotein level (p = 0.038, r = 0.31). No other factors differed significantly between the aspirin or clopidogrel resistant and sensitive patients in the cardiovascular group. Aspirin resistance was more common in patients with cardiovascular disease, and clopidogrel resistance in patients with cerebrovascular disease, although the difference was not significant. Our findings indicate that diabetes mellitus and an elevated level of lipoproteins could be risk factors for aspirin or clopidogrel resistance in patients with cerebrovascular diseases. Further studies should be conducted using larger patient cohorts with balanced groups of patients to investigate clinical aspects of antiplatelet resistance.

Abstract
Atrial fibrillation is one of major risk factors of cerebral infarction. The use of oral anticoagulants is the only evidence-based method of reducing the risk of cardioembolic accidents. The guidelines of oral anticoagulant admission and usage have been available since 2012. The results of this study show that of 550 stroke patients that were admitted to Pauls Stradiņš Clinical University Hospital, Rīga, Latvia, from 1 January 2014 until 1 July 2014, atrial fibrillation was diagnosed in 247 (45%) cases, and of these patients, only 8.5% used oral anticoagulants before the onset of stroke. Six months after discharge of 111 (44.9%) stroke survivors, five (4.5%) used no secondary prevention medication, 27 (24.3%) used antiplatelet agents, 54 (48.6%) warfarin, and 25 (22.5%) used target specific oral anticoagulants (TSOACs). The mortality rate was significantly higher in the patient group that used no secondary prevention medication or antiplatelet agents compared to the patient group that used oral anticoagulants. The use of oral anticoagulants for primary stroke prevention in Latvia is insufficient. The mortality of cardioembolic stroke in 180 days is very high - 40.4%. Secondary prevention is essential to prevent recurrent cardioembolic accidents.

Cytomegalovirus chronic infection as a risk factor for stroke: a prospective study
Stroke is the second most common cause of death in the world and a major cause of long-term disability. Chronic infection is an independent risk factor for ischemic stroke and related forms of atherosclerotic vascular disease. The aim of our study was to compare the plasma Cytomegalovirus (CMV) immunoglobulin G antibody level in a patient and control group, and to determine the association of CMV chronic infection with ischemic stroke, and with stroke subtype. The present study does not present a cogent demonstration that cytomegalovirus chronic infection is a risk factor of stroke. Further studies are necessary to clarify the effective prophylactic measures to determine other significant risk factors for stroke.