The aim of the study was to assess the prognostic value of the plasma neuron-specific enolase (NSE) level as a predictor of functional outcome and motor function recovery in the acute period of ischemic stroke (IS).Materials and Methods. Fifty patients with IS have been examined. On admission to the hospital and at 12-14 days after stroke onset, a clinical and neurological examination have been carried out with the supplementary quantitative assessment of neurological deficit severity according to the National Institutes of Health Stroke Scale (NIHSS), functional outcome according to the Modified Rankin Scale, and Rivermead Mobility Index. Enzyme immunoassay was used to determine NSE concentration in blood plasma in the acute period of the disease.Results. The NSE level in patients' blood plasma in the first 48 h after stroke onset positively correlates with the ischemic focus volume (r=0.49; p=0.003) and the severity of neurological symptoms (according to NIHSS) (r=0.33; p=0.02). NSE less than 2 ng/ml in the acute disease period is a predictor of good functional outcome 12-14 days after stroke onset (OR=12.4; р=0.006). The NSE level >2.6 ng/ml is associated with a high likelihood of lethal outcome.Neurological deficit below 15 according to NIHSS as well as the NSE level <2 ng/ml in the acute IS period are estimated as prognostic factors of significant recovery of motor function at 2 weeks after disease onset (OR=5.8; р=0.02).Conclusion. Determination of NSE in blood plasma makes it possible to predict functional outcome of the disease development and the recovery of motor function in patients with IS.

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The purpose of this study was to evaluate impact of cognitive impairments on the upper limb function recovery after acute lacunar stroke (LS). Material and methods. 139 patients (aged from 35 to 80 y. o.) with acute LS were examined. Along with the clinical and neurological examination, an upper limb function was evaluated by Action Research Arm Test and 9-Hole Peg Test, a study of cognitive status was made using the Montreal Cognitive Assessment (МоСа) and Frontal Assessment Battery (FAB). Results. Impaired upper limb function was revealed in 79% of patients with LS. After 2 weeks of acute period of LS, a significant improvement or the complete recovery of the upper limb function was observed in 81%. Moderate/severe executive dysfunction (FAB < 15 points) was defined in 65% of patients with LS and upper limb dysfunction. Moderate/severe cognitive impairments (МоСа < 26 points) were revealed in almost 55% of patients. In acute period of LS, the negative prognostic factor for complete recovery or significant improvement of the arm function was the presence of moderate/severe executive dysfunction (OR 3.89; 95% CI 1.07-14.19; p = 0.04) and general cognitive deficit (OR 3.27; 95% CI 1.10-9.70; p = 0.03). Conclusions. Cognitive impairments including executive disorders may affect the upper limb function recovery in acute period of LS. The data obtained can be used for the development of personalized rehabilitation programs for these patients.

The aim of the study was to analyze stroke case fatality in the regional stroke center (RSC) during the COVID-19 pandemic, in order to plan the prevention measures for reduction in mortality. A retrospective comparative analysis of the medical records of stroke patients who died in October-November 2019 and 2020, i.e. before and during the 2019 Coronavirus Disease Pandemic (COVID-19) was conducted. The age of patients, the NIHSS score and the Glasgow coma score at the admission did not differ on average in 2019 and 2020. Also, there were no differences in the incidence of ischemic and hemorrhagic stroke, the rate of early and late hospitalization, the average length of stay in the RSC prior to a lethal issue, but patients in 2020 were significantly more often diagnosed with pneumonia than in 2019. A “probable” case of COVID-19 was detected in October-November 2020 in 11 of 85 (12.9%) patients with fatal stroke before the lethal issue. In 8 of these 11 patients, laboratory confirmation of COVID-19 was obtained after the death. There was a statistically significant association between the presence of a “probable” or “confirmed” case of COVID-19 and pneumonia (Chi square 12.8, p = 0.000). According to the pathomorphological study the main cause of death in fatal stroke cases in October-November 2020 was stroke and its complications in 98% and pulmonary embolism with acute respiratory failure in 2% of cases, respectively.

A detailed analysis of the neurological disorders of «dysarthria–clumsy hand» syndrome (DCHS) is important for its earlier diagnosis. The purpose of this study was to evaluate the incidence of DCHS and the range of its clinical signs, as well as the degree of hand/arm dysfunctions and its dynamics in patients with the acute lacunar stroke (LS). Material and methods. 139 patients with acute LS were examined. Quantitative assessment of neurological deficits, such as paresis, cerebellar ataxia, and apraxia was performed using the relevant scales. The upper limb function was assessed by Action Research Arm Test and 9-Hole Peg Test. Barthel Index was used for disability evaluation. Results. DCHS was diagnosed in 17% of LS patients (group1) and other clinical variants of LS was detected in 83% of patients (group 2). The cause of «clumsiness» in the hand/arm in DCHS was ataxia (83%), mild paresis (71%) and kinesthetic apraxia (29%), which were present independently or in combination. Hand/arm dysfunction and disability, while performing daily activities, were less severe in group 1 patients compared to group 2. The complete restoration of hand/arm function was observed in 63% of the patients with DCHS in 2 weeks after the onset of LS. Conclusions. Mild paresis, cerebellar ataxia and apraxia are the main causes of «clumsiness» of the hand/arm in patients with DCHS. In general, DCHS has good functional outcomes.