Objective: to determine the prognostic value of the indicators of fluid and electrolyte balance in the acutest period of severe ischemic stroke (IS). Patients and methods. A total of 150 patients with severe IS of various locations and pathogenetic subtypes were examined. The impact of plasma osmolarity or sodium levels on the course and prognosis of IS was studied on day 1 of the disease. Results and discussion. It has been established that in patients with severe IS, the most common type of fluid and electrolyte imbalance is hyperosmolar hypernatremic syndrome that develops at the onset of severe IS, serves as a factor for poor outcome, and is accompanied by high mortality. The rate of fatal outcomes in hypoosmolar syndromes is higher than that in normal plasma osmolarity, but significantly lower than that in hyperosmolar syndromes. Cerebral salt wasting (CSW) is associated with a higher mortality rate than syndrome of inappropriate antidiuretic hormone secretion (SIADH), which confirms a worse prognostic value in hypovolemia than in normo- and hypervolemia. The development of diabetes insipidus at the onset of IS reflects the degree of brainstem structural destruction and, accordingly, is associated with the highest rate of fatal outcomes. The cardioembolic pathogenetic subtype of IS is characterized by a more severe course and a higher probable mortality rate in both hypoosmolar and normosmolar conditions.Conclusion. Impaired fluid and electrolyte homeostasis is of significant prognostic value for the outcome of IS. In this case, the leading role is played by the hyperosmolar hypernatremic syndrome, in which the probability of a fatal outcome is highest and there is a need for continuous patient health monitoring and high-speed decision-making aimed to correct this condition. Therapeutic policy for diabetes insipidus depends on the duration of IS. The risk for fatal outcome in the cardioembolic pathogenetic subtype of IS is higher than that in atherothrombotic stroke, at any plasma osmolarity and sodium levels.

Objective: to evaluate the efficiency of a training method using special infant formulas as part of combined rehabilitation for patients with ischemic stroke and neurogenic dysphagia.Patients and methods. The investigation enrolled 55 patients (30 men and 25 women) aged 45–80 years with dysphagia during the acute period of ischemic stroke. Thirty patients used special astringent formulas as part of combined therapy and 25 patients did not. The investigators studied the time of course of changes in the restoration of swallowing function, by using the Penetration-Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), as well as the transition from probe feeding to independent one.Results and discussion. The best restoration of swallowing function was shown to be achieved through training using formulas with different astringency. Stronger astringent formulas, like solid foods, stimulate better the pharyngeal receptor apparatus; the most active restoration of a dynamic swallowing stereotype occurs. The gradual transition to a milder astringent formula allows restoration of the skill to swallow thinner liquid foods. It takes 10 days to achieve a significant clinical effect in most patients, mainly in those with pseudobulbar disorders. Training may be prolonged to 2 weeks or more in severe cases, in bulbar dysfunctions.Conclusion. The training rehabilitation method using special infant formulas in combination with electrical stimulation in patients with ischemic stroke and neurogenic dysphagia allows achieving the significantly better indicators of restoration of swallowing function in accordance with the PAS scale. The application of the method contributes to the significantly better transition from probe feeding to independent one.

Objective: to identify the prognostic aspects of the ischemic stroke (IS) focus characteristics according to the data of computed tomography of the brain.Patients and methods. We examined 80 patients with hemispheric IS up to 1-day old (50 patients for constructing mathematical models of disease outcomes and 30 patients for subsequent testing of the obtained models) aged 30-84 years.Results and discussion. The analysis of the association between mortality probability and brain midline shift size shown that a brain midline shift of 4.5-5 mm did not increase mortality probability much, which indicates the synergistic stability of this system. System destabilization began after an increase of the brain midline shift for more than 5-5.5 mm. After a mild change in the initial indicator (6-8 mm), mortality probability increased from 25% to 90% and higher. When the brain midline shift was more than 8.5 mm, the system, from the synergistic viewpoint, became stable again but with an unfavorable prognosis. This analysis helps to identify the critical decision-making point when analyzing the IS focus neuroimaging characteristics. Thus, the point for the focus volume is 145 cm3, and for the brain midline shift - 5.0 mm.Conclusion. The results of our study about the prognostic value of the IS focus characteristics according to CT data may have additional value for decision-making in the management of patients with a poor prognosis.