RU2314030C1 - Method for differential diagnostics of initial chronic cerebrovascular diseases - Google Patents

Abstract

FIELD: medicine, neurology.

SUBSTANCE: one should study neurological state and values of rheoencephalography (REG) and ultrasound dopplerography (USDG). Moreover, it is necessary to analyze the following diagnostic criteria: disorder of cognitive functions, autonomic symptomocomplex, the degree of neurological focal symptoms, the degree of arterial hypertension, hyperlipoproteinemia, the presence of regional morphological dysplasias (RMD), type of REG disorders, asymmetry of circulation according to REG data, type of USDG disorders, asymmetry of circulation in cerebral vessels according to USDG data, alteration of fundus oculi vessels according to ophthalmoscopic data to evaluate the degree of such disorders by a 4-point scale, where 0 points - the norm; 1 point - light degree; 2 points - average degree; 3 points - severe degree. It is important to plot a diagram, its vectors being the degree of diagnostic criteria and at prevailing the vectors that correspond to: affected cognitive functions, the degree of focal neurological symptoms, RMD, REG disorders, asymmetry of circulation according to REG, USDG disorders, asymmetry of circulation according to USDG one should diagnose DE stage I. The innovation widens the quantity of means for predicting initial chronic cerebrovascular diseases.

EFFECT: higher accuracy of diagnostics.

3 dwg, 2 ex, 4 tbl

Description

The invention relates to medicine, namely to neurology.

According to the classification of vascular lesions of the brain and spinal cord adopted in Russia, the initial manifestations of cerebrovascular accident (NSCM) and discirculatory encephalopathy (DE) are divided by the nature of cerebrovascular accident (Schmidt EV "Classification of vascular lesions of the brain and spinal cord." // Journal Neuropathol. Psychiatrist. - 1985.- T.85, N.9). Currently, the diagnosis of "NPNMK" and "DE stage I" is made on the basis of a set of rather subjective signs of the disease (Kanareikin KF, Manvelov L.S., Bahur V.T. Clinic and diagnosis of the initial manifestations of insufficient blood supply to the brain // Clinical medicine. 1991. No. 2; Manvelov LS Initial manifestations of insufficient blood supply to the brain (etiology, pathogenesis, clinical features and diagnosis) // Journal of the attending physician. - 1999. - No. 5; Damulin IV, Zakharov V.V. Discirculatory encephalopathy, Methodical recommendations / Edited by NN Yakhno. - M .: MMA, 2000).

The closest in technical essence are the developed criteria for the early stages of cerebrovascular insufficiency (Martynov Yu.S., Girich T.N., Kuntsevich G.I., and others // Journal of Neurovol. And Psychiatrist. - 1998. - No. 8 - S.14-18), according to which the authors differentiate the subclinical form of circulatory insufficiency of the brain, the initial manifestations of circulatory failure and the initial circulatory failure of the brain - DE I Art., Using complaints, neurostatus, rheological blood tests, microscopy of the bulbar conjunctiva, indicators of rheoencephalography (REG), ultrasound dopplerography (UZDG), electroencephalography (EEG). In particular:

- Subclinical form of circulatory failure of the brain.

There are no complaints. With physical and emotional stress, incoming symptoms occur in the form of irritability, tremor of the eyelids, extremities, emotional lability. In neurological status without focal symptoms. The earliest manifestations at the microcirculatory level: biomicroscopy of the bulbar conjunctiva - uneven caliber and tortuous vessels, spastic tone, on REG - increased blood supply to the internal carotid and vertebral arteries. In isolated cases - a decrease in blood supply in the same pool. Doppler ultrasound of the intra- and extracranial arteries - there is no pathology, EEG - in some patients, slight diffuse changes in bioelectric activity.

- Initial manifestations of circulatory failure of the brain.

Complaints of dizziness, headache, memory impairment, noise in the head, ears, decreased performance. In neurological status without pathology. The bulbar conjunctiva is narrow arteries, the blood flow is slowed down, on REG - pulse blood supply is increased, the tone is increased, venous dysfunction. On the coagulogram - hypercoagulation, increased levels of thromboplastin and fibrinogen. UZDG - without pathology. EEG - irrigation of nonspecific brain systems.

- Initial circulatory failure - DE I Art.

The increase in the severity of clinical symptoms. The complaints are the same, but in the neurostatus - hyperreflexia, asymmetry of tendon reflexes, oculomotor disorders. Bulbar conjunctiva - swelling or turbidity of the background, uneven caliber and tortuous vessels, slowing blood flow. On REG - arterial blood supply is reduced, often difficulty in venous outflow. Doppler ultrasound - a decrease in blood flow velocity in the suprablock and anterior cerebral arteries.

However, in this diagnostic method there is no criterion for cognitive, autonomic disorders, lipid metabolism, blood pressure, and an assessment of the constitutional risk factor for predisposition to cerebrovascular pathology. In addition, there is no holistic view of the pathological process, there is no analysis of the combination of diagnostic criteria for the initial forms of cerebrovascular insufficiency.

The task of maximizing the objectification of the differential diagnostic features of NPNMK and DE I Art.

The essence of the method consists in presenting each diagnostic parameter on a four-point scale of severity, where 0 points is the norm, 1 point is a light degree of severity, 2 points is a medium degree, 3 points is a heavy degree, and a visual representation of the results graphically in the form of a kind of coordinate system , the vectors of which are the investigated diagnostic parameters: 1 - cognitive impairment, 2 - vegetative symptom complex, 3 - severity of neurological focal symptoms, 4 - severity hypertension, 5 - hyperlipoproteinemia, 6 - the presence of regional morphological dysplasia (RMD), 7 - type of REG-disturbances, 8 - asymmetry of blood flow according to REG, 9 - type of ultrasound-related disorders, 10 - asymmetry of blood flow according to ultrasound of brain vessels, 11 - change in the vessels of the fundus with ophthalmoscopy.

The method is as follows.

On an outpatient or inpatient basis, a patient is examined with a suspicion of a chronic cerebrovascular disease (CEH) according to eleven diagnostic criteria: initial cognitive impairment, severity of the autonomic symptom complex, neurological focal symptoms, arterial hypertension, hyperlipoproteinemia, assessment of regional morphological dysplasias of REG and RG and the severity of the asymmetry of blood flow according to the REG and ultrasound of the brain vessels, changes in the fundus vessels with almoscopy. Each diagnostic parameter is evaluated on a four-point scale of severity, where 0 points is normal, 1 point is mild, 2 points is moderate, 3 points is severe.

Each vector (diagnostic parameter) is examined separately:

1) cognitive impairment

The main evaluation criteria are the presence or absence of cognitive impairment according to neuropsychological testing. A study is being made of the ability of verbal associations, semantic coding, regulation of voluntary activity, switching and perseveration (sample “fence”), auditory memory (according to A.R. Luria), visual memory (reproduction of drawings), testing: “establishing patterns”, visually - spatial function (“cube”, “clock” samples), semantic mediation and generalization (“fifth extra” sample). A four-point system evaluates cognitive impairment: 0 points - cognitive impairment was not detected, 1 - decrease in the level of attention, auditory memory, 2 - decrease in the level of attention, difficulty in semantic coding, auditory and visual memory, 3 - decrease in the level of attention, semantic coding, auditory and visual memory, difficulty verbal associations, regulation of voluntary activity, switching and perseveration, violation of semantic mediation and generalization;

2) autonomic symptom complex

the main evaluation criteria are the severity and nature of the autonomic dysfunction (in points): 0 - there are no autonomic disturbances, 1 - autonomic disturbances appear only in special conditions (heat, cold, physical and emotional overstrain), mainly subjective pathological sensations, invisible to others, without signs of disability, 2 - autonomic disorders can occur under normal conditions, acquire objective signs of damage to specific departments (sympathetic or parasympathetic) autonomic system, noticeable to others, with reduced ability to work, 3 - autonomic disorders are generalized, occur for no apparent reason, acquire a paroxysmal course, are combined with a wide range of neurotic and neurosis-like disorders, vivid behavioral reactions, with significant temporary inconvenience;

3) the severity of neurological symptoms

the main evaluation criteria are the severity and prevalence of focal neurological manifestations (in points): 0 - neurological focal symptoms are not detected, 1 - the presence of focal symptoms from one of the cerebral systems (pyramidal, sensitive, oculomotor, coordinator, etc.), 2 - focal signs of insufficiency of two or three functional systems of the brain, 3 - focal neurological symptoms are detected in four or more functional systems of the brain, are distinct;

4) severity of arterial hypertension (AH)

main assessment criteria: AH level (in points) - 0 - optimal or normal blood pressure, 1 - high normal blood pressure, 2 - first degree hypertension, 3 - second and third degree AT. See table 1.

Table 1.
The ratio of the level and degree of hypertension Points Hypertension Systolic A / D, mmHg Diastolic A / D, mmHg 0 optimal or normal blood pressure 120-130 80-85 one high normal blood pressure 130-139 85-89 2 AH I degree 140-159 90-99 3 AH II, III degree 160-179 and> 180, respectively 100-109 and> 110, respectively

5) hyperlipoproteinemia

the main evaluation criteria are the severity of violations in the lipid profile (in points): 0 - normal lipid metabolism, 1 - mild hypercholesterolemia, 2 - moderate hypercholesterolemia, 3 - severe hypercholesterolemia. See table 2.

Table 2.
Evaluation of Hypercholesterolemia Points Changes in the lipid profile Cholesterol, mmol / L HDL, mol / l Atherogenic coefficient 0 normal rates 4,5-5,0 > 1 <3 one mild hypercholesterolemia 5.2-6.5 0.9-1.0 3.1-4.0 2 moderate hypercholesterolemia 6.7-7.8 0.5-0.9 4.1-5.0 3 severe hypercholesterolemia > 7.8 > 0.5 > 5.0

6) the presence of RMD

the main evaluation criteria are the qualitatively-quantitative composition of RMD (in points): 0 - up to 4 RMD, while there should be less than 3 groups of RMD of different localization and disharmonious regional dysplasias of less than 3; 1 - 5-7 RMD or 3 groups of signs of different localization, or 3 disharmonious dysplasias, 2 - 7-9 RMD or 4-5 groups of signs of different localization, or 3-5 disharmonious dysplasias, 3 - over 9 RMD or more than 5 groups of signs , or over 5 disharmonious regional morphological dysplasias;

7) type of REG-violations

main assessment criteria: the nature of REG-disorders (in points) - 0 - there are no changes in blood supply, tone, venous outflow, peripheral resistance; 1 - dystonic type of REG with normal blood filling, a slight change in peripheral resistance, venous outflow, reversible changes in REG during functional tests; 2 - moderate hyperconstrictor type of changes in REG with a change in blood supply, a moderate increase in arterial tone, difficulty in venous outflow in one of the blood flow pools (carotid - frontastomoidal abduction of REG, vertebrobasilar - occipitomastoid abduction of REG), functional tests without significant changes; 3 - pronounced hyperconstrictor type of changes in REG with changes in blood supply, a significant increase in arterial tone, difficulty in venous outflow. Blood flow disorders are detected in both REG leads. Functional tests do not alter the organic constrictor state of blood flow;

8) REG asymmetry of blood flow

the main evaluation criteria are the degree of severity of the asymmetry of the blood flow by the asymmetry coefficient (KA) (in points): 0 - interhemispheric asymmetry is not detected or is within the functional norm, 1 - moderate interhemispheric asymmetry of blood flow in one of the two leads. 2 - pronounced interhemispheric asymmetry of blood flow in one of the two leads, 3 - roughly pronounced interhemispheric asymmetry in one of the two leads or pronounced asymmetry in both leads. See table 3.

Table 3.
Blood flow asymmetry according to REG Points Severity of asymmetry KA,% 0 within normal limits to 10 one moderate 10-30 2 pronounced 30-50 3 roughly expressed > 50

9) type of ultrasound disorders

main assessment criteria - the nature of blood flow disorders (in points): 0 - there is no change in blood flow velocity, circulatory and peripheral resistance, vascular tone, 1 - signs of cerebral angioedema, 2 - signs of decreased elasticity of the brain arteries in the carotid or vertebral pool, 3 - signs organic circulatory failure in both vascular pools;

10) asymmetry of blood flow by ultrasound

the main evaluation criteria are the degree of severity of the asymmetry of blood flow velocity along the spacecraft (in points): 0 - asymmetry within normal limits, 1 - slight asymmetry, 2 - moderate asymmetry, 3 - pronounced asymmetry. See table 4.

Table 4.
Doppler blood flow asymmetry points severity of asymmetry KA,% 0 within normal limits <10 one light 10-30 2 moderate 30-50 3 pronounced > 50

11) changes in the vessels of the fundus with ophthalmoscopy

the main evaluation criteria are the severity of retinal angiopathy (in points): 0 - no changes in the fundus, 1 - functional changes in the retinal vessels (angiospasm), 2 - retinal angiopathy, 3 - retinal angiosclerosis.

A comprehensive examination of 200 patients from 2001 to 2005, comprising three groups of patients, was carried out. The first main group included patients with NPNMK - 80 people (Fig. 1), the second main group - patients with DE I st. - 70 people (figure 2), in the third (comparative) - patients with arterial hypertension (AH) and dyslipidemia, without cerebral complaints and without signs of CEH-50 people (figure 3). A comparative statistical analysis for quantitative indicators determined the average values, as well as the standard error of the mean. The significance of differences between the values was estimated by the parametric method using Student's criterion.

The combination of diagnostic parameters in the structure of a multi-vector clinical and neurological analysis, characteristic of NPNMK, stage I of DE and in patients with systemic vascular pathology without CVH, is clearly demonstrated in the constructed diagrams of figure 1, figure 2, figure 3, where the vectors: 1 - disorder cognitive functions, 2 - vegetative symptom complex, 3 - severity of neurological focal symptoms, 4 - severity of hypertension, 5 - main indicators of lipid metabolism, 6 - qualitative and quantitative characteristic of RDM, 7 - type of REG, 8 - asymmetry of blood flow REG, 9 - type of ultrasound scan of cerebrovascular disorders, 10 - asymmetry of blood flow by ultrasound scan, 11 - changes in the fundus vessels with ophthalmoscopy.

The vector of initial cognitive impairment 1 significantly prevailed in the group with DE (Fig. 2) - 2.3 ± 0.2 points, which is 2.9 and 4.6 times higher than in patients with NPNMK (Fig. 1) - 0.8 ± 0.1 points and the comparative group (figure 3) - 0.5 ± 0.06 points, respectively. Statistically, differences according to the reliability criterion are significant, p <0.05. Vegetative vector 2 was more pronounced in the first group (Fig. 1) - 2.2 ± 0.3 points, which is 1.2 and 1.6 times higher than in the second (Fig. 2) - 1.8 ± 0.2 points and the third (figure 3) - 1.4 ± 0.1 points in groups, p> 0.05. Neurological status (vector 3) in the form of micro-focal cerebral symptoms was noted to a greater extent in the second group (figure 2) - 1.9 ± 0.7 points than in the first (figure 1) - 0.5 ± 0.2 points and the third (figure 3) - 0.2 ± 0.06 groups, p <0.05. The vectors of hypertension 4 and lipid disorders 5 prevailed in the comparative group (figure 3) - 2.4 ± 0.3 points and 2.6 ± 0.3 points, respectively, over the change in these parameters in the first (figure 1) - 1 , 3 ± 0.1 points and 1.4 ± 0.1 points and the second (figure 2) main groups - 1.6 ± 0.1 points and 1.8 ± 0.2 points, respectively, p> 0, 05. The vector estimate of RMD (vector 6) in the second group (figure 2) - 2.2 ± 0.2 points was 1.3 and 2 times higher than in the first (figure 1) - 1.9 ± 0.2 point and the third (figure 3) groups - 1.2 ± 0.1 points, p> 0.05. The total vector of REG-violations 7, in the second group (figure 2) -2.1 ± 0.2 points prevailed 1.2 and 1.4 times over the indicators in the first (figure 1) - 1.7 ± 0, 2 points and the third (Fig. 3) groups - 1.5 ± 0.1 points, p> 0.05. The degree of severity of the asymmetry of the blood flow of the brain according to the REG (vector 8) in the second group (figure 2) did not exceed 1.9 ± 0.2 points, the asymmetry in the first (figure 1) slightly increased - 1.6 ± 0.1 points and the third (Fig. 3) groups - 1.5 ± 0.1, p> 0.05. The total vector of UZDG 9 in the second group (figure 2) corresponded to 2.2 ± 0.3 points, which is almost 1.6 and 2.8 times higher than in the first (figure 1) - 1.4 ± 0, 1 point (p> 0.05) and in the third (Fig. 3) group, 0.8 ± 0.09 points, p <0.05. Blood flow asymmetry according to Dopplerography of cerebral vessels (vector 10) retains a tendency similar to REG data, i.e. exceeds in the group of patients with DE (figure 2) - 2.1 ± 0.7 points in 1.5 and 3 times the asymmetry in patients with NPNMK (figure 1) - 1.4 ± 0.4 points and in the comparative group (Fig. cumulative graphic 3) - 0.7 ± 0.3 points, respectively, p <0.05. According to ophthalmoscopy (vector 11) in all patients (figures 1, 2, 3), signs of angiospasm and angiopathy were found almost equally on the fundus.

According to multivariate clinical and neurological analysis, visualization of the results of the study confirms the severity and predominance of brain pathology in patients with stage I DE over NPNMK and both over the comparative group (without signs of CVH). The use of a combination of diagnostic parameters in the structure of a multi-vector clinical and neurological analysis significantly increases the accuracy of the differential diagnosis of NPNMK, stage I of DE and the likelihood of predicting the formation of a clinical picture of the initial chronic CEH in specific individuals under conditions of mass and rapid examinations of subpopulations.

Observation 1.

Patient A., 46 years old. I was observed in June 2001 by a neurologist at the Municipal Clinic No. 2 in Stavropol with complaints of dizziness, headache, memory impairment, noise in the head, ears, decreased performance, fatigue, irritability, sleep disturbance, paroxysmal deterioration with a feeling of lack air, palpitations, a feeling of heat, sweating throughout the body, expressed anxiety.

A history of about 5 years of hypertension with an increase in A / D to 140 / 90-150 / 100 mm Hg, irregular intake of antihypertensive drugs. The deterioration over the past 2 years has been associated with emotional stress in the family. My father had hypertension of the III degree. He suffered an acute myocardial infarction in 2000. Objectively: the condition is satisfactory, the consciousness is clear, adequate, oriented. Integuments of usual coloring, humidity. Heart sounds are rhythmic, muffled with a slight accent of the II tone above the aorta. ES 76 in 1, satisfactory properties. A / D 140/90 mm Hg Vesicular breathing over the lungs, no wheezing. The abdomen is soft, painless. The symptom of striking is negative. In a neurostatus: weak convergence, lively CXR, without distinct anisoreflexia, tremor of the hands, eyelids, staggering in a sensitized Romberg pose. From morphodysplasias: asymmetry of the palpebral fissures, hyperplasia of the zygomatic bones, dysentery, diastema, hypertrophy of the urine, posterior ear cutting. Neuropsychological testing was carried out, an angioprogram examination was performed: REG, ultrasound of the brain vessels, lipid profile, examined by an ophthalmologist. With the data obtained, a multivariate (multi-vector) analysis was carried out according to eleven diagnostic criteria:

1) cognitive impairment - 1 point (decrease in the level of attention, auditory memory);

2) the severity of the autonomic symptom complex - 2-3 points (autonomic disorders can occur under normal conditions, acquire objective signs of damage to the autonomic system, are noticeable to others, with reduced ability to work, are generalized, arise for no apparent reason, occasionally acquire a paroxysmal course);

3) neurological focal symptoms - 1 point (the presence of micro-focal symptoms from one of the cerebral systems);

4) the severity of arterial hypertension - 2 points (first degree hypertension);

5) hyperlipoproteinemia - 1 point (mild hypercholesterolemia);

6) an assessment of regional morphological dysplasias - 1 point (6 RMD, of which 3 groups of signs of different localization);

7) type of REG-disorders - 1 point (dystonic type of REG with normal blood supply, a slight change in peripheral resistance, venous outflow, reversible changes in REG during functional tests);

8) the severity of the asymmetry of blood flow according to REG - 0-1 points (asymmetry of 15%);

9) type of ultrasound disorders - 1 point (signs of cerebral angioedema);

10) the severity of the asymmetry of blood flow according to the ultrasound scan of cerebral vessels - 0-1 points (asymmetry up to 20%);

11) a change in the vessels of the fundus with ophthalmoscopy - 1 point (angiospasm of the vessels of the retina).

Compiled a multi-vector chart (Patient An, June 2001), corresponding to the magnitude and shape of the chart with NPNMK (figure 1).

The patient was examined 3 years later, after several courses of conservative therapy under the program of chronic cerebrovascular disease in August 2004, presenting previous complaints of episodic dizziness, headache, memory impairment, noise in the head, ears, decreased working capacity, fatigue, irritability, sleep disturbance . Despite the subjective lack of improvement in the patient’s condition, paroxysmal autonomic disturbances and stabilization of A / D at 130 / 90-140 / 95 mm Hg are somewhat less common. A dynamic examination was conducted as part of a multidimensional clinical and neurological analysis. A diagnostic chart was obtained (Patient An, August 2004), corresponding to the diagnosis chart "NPNMK" (Fig. 1) with some positive dynamics in the form of less pronounced vectors of autonomic disorders and arterial hypertension.

Observation 2.

Patient Pa, 38 years old. I was treated from 03.17.02 to 03.28.02 in the neurological department of the Municipal Clinical Hospital No. 3 of the city of Stavropol with complaints of dizziness, noise in the head, headache, memory loss, irritability, sleep disturbance, fatigue, decrease working capacity, increase A / D to 150/90 mm Hg

In the history of about 3 years, hypertension with an increase in A / D to 150/100 mm Hg, regularly takes a stareum of 4 mg / day. Sick about 1 year, associates with overwork at work (accountant). Heredity is burdened by the father for hypertension. Objectively: the condition is satisfactory, the consciousness is clear, adequate, oriented. Integuments of usual coloring, humidity. Heart tones are rhythmic, muffled. ES 72 in 1, satisfactory properties. A / D 140/90 mm Hg Vesicular breathing over the lungs, no wheezing. The abdomen is soft, painless. The symptom of striking is negative. In the neurostatus, weakness of convergence, CXR with anisoreflexia (D> S), teetering in the Romberg position, mild intentional tremor with PUP. From morphodysplasia: epicantum on the left, half-leukemia on the left, asymmetry of the palpebral fissures, asymmetry of the face, wide, flat palate, direct bite, Darwin's tubercle on both sides, hyperextension of the thumb, many nevi on the face.

Neuropsychological testing was carried out, an angioprogram examination was performed: REG, ultrasound of the brain vessels, ophthalmoscopy. A multivector analysis was carried out according to eleven diagnostic criteria:

1) cognitive impairment - 2-3 points (decrease in the level of attention, difficulties in semantic coding, auditory and visual memory);

2) the severity of the autonomic symptom complex - 1-2 points (autonomic disorders are manifested both in special conditions (heat, cold, physical and emotional overstrain), and under ordinary circumstances, are mostly subjective pathological sensations, invisible to others, without signs of disability) ;

3) neurological focal symptoms - 2 points (focal signs of failure of the three functional systems of the brain);

4) the severity of arterial hypertension - 2 points (first degree hypertension);

5) hyperlipoproteinemia - 2 points (moderate hypercholesterolemia);

6) assessment of regional morphological dysplasias - 2-3 points (9 RMD, of which 6 disharmonious regional morphological dysplasias);

7) type of REG-disturbances - 2 points (hyperconstrictor moderate type of REG changes with a change in blood supply, a moderate increase in arterial tone, difficulty in venous outflow in the vertebral pool);

8) the severity of the asymmetry of blood flow according to REG - 2 points (asymmetry up to 50%);

9) type of ultrasound disorders - 2 points (signs of decreased elasticity of the arteries of the brain in the carotid pool);

10) the severity of the asymmetry of blood flow according to the ultrasound scan of cerebral vessels - 2 points (asymmetry up to 45%);

11) a change in the vessels of the fundus with ophthalmoscopy - 2 points (retinal angiopathy).

Compiled a multi-vector chart (Patient P-a, March 2002), the point value and its shape corresponding to the diagnosis chart "DE" (figure 2).

The patient was examined after 2 years, in May 2005, presenting previous complaints. Despite conducting 2 outpatient courses of conservative therapy under the program of chronic cerebrovascular disease, the patient does not notice any improvement. A dynamic examination was conducted as part of a multidimensional clinical and neurological analysis. A diagnostic chart was obtained (Patient P-a, May 2005), corresponding to the diagnosis chart "DE" (Fig.2) with some negative dynamics in the form of a greater severity of the vectors of cognitive disorders, REG, ultrasound disorders.

These examples demonstrate the possibility of objective differential diagnosis of a slightly progreduated form of initial cerebrovascular accident from progressive DE with a similar clinical picture of the disease with the likelihood of initial prediction of an adverse course of chronic CEH.

The method of multi-vector (multivariate) clinical and neurological analysis of the differential diagnosis of NPNMK and stage I of DE allows you to visually objectify the results of screening clinical examinations, which is especially important for people who are highly likely to develop chronic CEH. It can be used by neurologists as a diagnostic procedure and to objectify the degree of effectiveness of the applied or developed medical technologies in angioneurology.

Claims (1)

A method for differential diagnosis of the initial manifestations of cerebrovascular accidents (NPNMK) and stage 1 of discirculatory encephalopathy (stage 1 DE), including the study of neurological status, rheoencephalography (REG) and ultrasound dopplerography (USG), characterized in that they analyze diagnostic criteria: cognitive function disorder , vegetative symptom complex, severity of neurological focal symptoms, severity of arterial hypertension, hyperlipoproteinemia, the presence of regional morphological dysplasia (RMD), type of REG disturbances, asymmetry of blood flow according to REG, type of ultrasound disturbances, asymmetry of blood vessels in the brain according to ultrasound, changes in the vessels of the fundus according to ophthalmoscopy, evaluated on a four-point scale of severity of disorders, where 0 points are norm, 1 point - mild degree, 2 points - medium degree, 3 points - severe severity; a diagram is constructed, the vectors of which are the severity of diagnostic criteria - and with the prevalence of vectors corresponding to: cognitive impairment, severity of focal neurological symptoms, RDM, REG disturbances, asymmetry of blood flow by REG, UZD disturbances, asymmetry of blood flow by ultrasound diagnostics, stage 1 DE is diagnosed.

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