Журнал неврологии и нейрохирургических исследований / Journal of Neurology and Neurosurgical Research Volume 6 Issue 6 (2025)
CLINICAL AND BIOCHEMICAL CHANGES AFTER STROKE AT THE OUTPATIENT STAGE
Саломова Нилуфар Каххаровна, Жамолов Шариф Шухратович
Abstract
Ischemic stroke remains one of the leading causes of disability and mortality. In a study of 287 patients, it was shown that functional recovery depends not only on clinical but also on social factors. In the early stages, pronounced neurological deficits and multifunctional cognitive impairments predominated. Changes in hemostasis, elevated inflammatory markers (sICAM-1, MPO, sE-selectin), and increased platelet adhesion were noted, which raised the risk of recurrence. The combination of ASA and clopidogrel reduced the risk of recurrent stroke, while the addition of TMS and choline alfoscerate increased rehabilitation effectiveness by 1.5 times. Secondary prevention includes risk factor management and lifestyle modification. Objective. Optimization of rehabilitation measures through the assessment of clinical and biochemical changes at different stages of ischemic stroke in outpatient settings, including rheological properties of blood. Materials and Methods. The study was conducted in 216 patients during the recovery period after atherothrombotic and lacunar stroke of mild and moderate severity. To assess inflammatory processes associated with endothelial dysfunction, levels of MPO, sICAM-1, and sE-selectin were measured. Rehabilitation included individualized application of TMS and alfoscerate to correct cognitive impairments and prevent recurrence. Results. Neurological deficits were assessed using the NIHSS scale, and adaptation was evaluated using the Barthel Index, where the 3rd subgroup showed 1.5-fold higher scores (p<0.01). Cognitive impairments predominated: in young patients, ACE-R scores increased (81.3→90.9), in middle-aged patients scores decreased (79.6→72.3), and in elderly patients the decline was more pronounced (70.7→67.1). A unilateral increase in MCA blood flow was observed. In the 3rd subgroup, sICAM-1, MPO, and sE-selectin levels initially decreased, but in the decompensation phase increased: in the 1st group by 1.5 times, in the 3rd group by 2.3 times (p<0.001). The highest sICAM-1 values were recorded in the comparative group. Conclusions. In both early and late recovery periods, functional recovery was 1.5 times higher (p<0.05), although no association with hemostasis was found. The main risk factors for recurrent stroke were type 2 diabetes mellitus, grade 3 arterial hypertension, metabolic syndrome, endothelial dysfunction, and increased platelet adhesion. In 32.1% of patients, platelet activity persisted despite ASA, while combination with clopidogrel reduced the risk by 1.5 times (p<0.05). Platelet adhesion was elevated in 66% in the early phase, 56% in the late phase, and 71% in recurrent stroke, requiring individualized antiplatelet therapy. TMS and choline alfoscerate increased rehabilitation effectiveness by 1.5 times, while prevention included risk factor correction and lifestyle modification.
МРО, sICAM-1 и sE-селектина, ТМС, инсультMPO, sICAM-1, sE-selectin, TMS, strokeMPO, sICAM-1, sE-selectin, ТМС, инсульт
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