CHARACTERISTICS OF CLINICAL AND PATHOMORPHOLOGICAL COURSE OF CARDIOEMBOLIC STROKE
Keywords:
cardioembolic stroke, ischemic infarcts, carotid system, vertebral basilary system, myocardial infarction, atrial fibrillation, autopsyAbstract
Cerebrovascular diseases (CVD) have remained an urgent medical and social problem of modern society over the past decades. One of the main pathogenetic subtype of ischemic stroke is cardioembolic stroke (CES), which accounts for 22-39% of all stroke subtypes. CES is characterized by the rapid development of neurological symptoms (80% of cases) with its maximum severity in the first 5 minutes (47-74%) and large and medium-sized ischemic infarcts, which in 85% of cases are located in the carotid artery system, more often in the left middle cerebral artery (MCA).
The aim of the study: In this study, pathomorphological and clinical features of cardioembolic stroke, such as neurological signs, cerebral and myocardial infarcts in each sectional case, macroscopic and microscopic examinations were conducted and analyzed.
Materials and methods: This study is based on the analysis of the results of a comprehensive clinical and pathomorphological examination. The patients were selected for 1 year. Clinical observations were carried out at the first clinic of the Tashkent Medical Academy in the Department of Intensive Neurology. The selection criteria were: 1) patients with ischemic stroke (IS) in combination with acute myocardial infarction and atrial fibrillation (main group); 2) persons with ischemic stroke (IS) without cardiac etiology (control group). Exclusion criteria: oncological and hematological diseases, severe renal and hepatic insufficiency. The analysis of 138 sectional cases with ischemic stroke and myocardial infarctions with atherostenosis of cerebral and coronary arteries were carried out. Autopsies of all deceased patients were performed in the laboratory of the Republican Center of Pathological Anatomy. Macroscopic examination of the brain in all 138 cases determined the type, magnitude, localization, degree of organization of each cerebral infarction and the number of cerebral infarctions in each sectional case. In each case, microscopic examination of the brain and cerebral arteries with atherosclerotic changes were also performed. For microscopic examination, preparations were cut from the area of cerebral infarction, as well as from the borderline zone with infarction. Areas of the brain were poured into paraffin wax, preparations with 5-7 microns thick were prepared into the blocks, which were stained with hematoxylin and eosin, cresyl violet according to the modified Nissl method, according to the methods of Wangizon, Weigert, as well as laxol blue durable.
Results: Patients with IS and cardiac pathology – 120 people (group I) – 65 men and 55 women aged 48 to 77 years (62.6±5.8 years).
Patients with IS without cardiac pathology – 160 people (group II). Of these, 83 men and 77 women aged 56 to 81 years (68.4±5.4 years). Among the deceased were 93 men and 45 women aged 45 to 93 years (average age 69 ± 11 years). The average age of men was 60 years, of women - 69 years. In 113 cases (82%), an autopsy revealed a combination of atherosclerosis with arterial hypertension, in 9 (6.5%) - atherosclerosis with diabetes mellitus. The cause of death in 64 patients (47%) was pronounced edema of the brain with dislocation and insertion of brain stem and parts of the cerebellum into the large occipital foramen due to infarction of the brain. All cases are divided into 3 groups: Group 1 includes cases with infarcts localized in the carotid system (68 cases), group 2 - cases with infarcts localized in the vertebrobasilar system (36 cases), group 3 - cases with infarcts localized in the arteries of both systems (34 cases).
Conclusion: Brain infarctions in AS are characterized by great diversity regarding their localization; degree of organization, quantity; type; as well as: the main factors of their occurrence. The most numerous were medium infarcts and small deep infarcts, extensive, large infarcts and small superficial infarcts were less common. In our study, multiple atherosclerotic plaques, narrowing the lumen of the arteries by 30-80%, were found in 46% of cases. Moreover, in 28% of cases, plaques were located in different parts of the ICA - in the cerebral arteries of the MCA.
References
Ablyakimov R. E., Anufriev P. L., Tanashyan M. M. Pathogenetic subtypes of stroke and criteria for their diagnosis in patients with ischemic heart disease and cerebral atherosclerosis (clinical and morphological research). – 2016. – T. 10. – №. 4. P. 5-10.
Ablyakimov R. E., Tanashyan M. M., Anufriev P. L. [Possibilities of differential diagnosis of cardiogenic embolic and hemodynamic strokes in patients with ischemic heart disease and cerebral atherosclerosis]. – 2016. – №. 9-2. P. 330-332.
Anufriev P. L., Tanashyan M. M., Guleskaya T. S., et al. Features of atherosclerosis of cerebral arteries and pathomorphology of cerebral infarction in diabetes mellitus of the 2nd type // Annals of clinical and experimental neurology -2015, - T. 9. №3. -pp. 4-9.
Akhatova Z. A. et al. What Influences the Detectable Ischemic Stroke in Neuroimaging? Medical Council. – 2022. – T. 16. – №. 14. P. 32-37.
Babkina A. S., Golubev A. M., Ostrov I. V., et al. [Morphological changes of the brain in Covid-19]. 2021; 17(3);4-15.
Baturova M. A. Fibrillation of atria in patients with ischemic stroke. – 2014. – №. 76. P. 51-56.
Brizhaneva A. S. Cardioembolic Stroke: Risk Factors, Prognosis, Prevention // World Science: Problems and Innovations. – 2018. P. 205-208.
Bursa Y. A., Timchenko L. V., Kolodina M. V. clinical case of ischemic stroke in young patients with genetically conditioned thrombophilic predisposition. – 2018. – №. 4 (12). P. 39-43.
Vlasov T. D., Petrishchev N. N., Lazovskaya O. A. Endothelial dysfunction. Do we understand this term correctly? Bulletin of Anesthesiology and Resuscitation. 2020. T17, No2. pp. 76-84.
Vorob'eva O. V., Gromova D. N. Multifocal ischemic lesion of the back brain-variant "top basilar syndrome"]. – 2014. – №. 1. P. 45-51.
Vorozhtsova I. N. et al. Comparative analysis of risk factors for the development of embolic stroke]. – 2018. – №. 1 (109). P. 49-53.
Geletka A. A. Determination of the number of circulating endotheliocytes and their morphological characteristics in patients who have suffered a hemisphere ischemic stroke depending on the degree of severity. 19-21 December 2014, Uzhhorod5
Gerasimova Y. A. Clinical and functional characteristics of ischemic stroke in combination with myocardial infarction. Ivanovo State Medical Academy, 2015.
Zhang L. et al. Characteristics of non-stenotic carotid plaque in embolic stroke of undetermined source compared with cardiogenic embolism: a retrospective cross-sectional observational study //BMC neurology. – 2022. – Т. 22. – №. 1. – p. 1-8.
Toledo M. E. G. et al. Atrial fibrillation detected after acute ischemic stroke: evidence supporting the neurogenic hypothesis //Journal of Stroke and Cerebrovascular Diseases. – 2013. – Т. 22. – №. 8. – p. e486-e491.
Ning Y. et al. Atrial cardiomyopathy: an emerging cause of the embolic stroke of undetermined source //Frontiers in cardiovascular medicine. – 2021. – Т. 8. – p. 674-612.
Min J. et al. Neurogenic cardiac outcome in patients after acute ischemic stroke: The brain and heart connection //Journal of Stroke and Cerebrovascular Diseases. – 2022. – Т. 31. – №. 12. – p. 106-859.
Manea M. M. et al. Cardiac changes in acute ischemic stroke //Romanian Journal of Neurology. – 2017. – Т. 16. – №. 1. – С. 15.
Mebazaa A. et al. Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance //Intensive care medicine. – 2016. – Т. 42. – p. 147-163.
Jensen M., Thomalla G. Causes and secondary prevention of acute ischemic stroke in adults //Hämostaseologie. – 2020. – Т. 40. – №. 01. – p. 022-030.
