SU1507322A1 - Method of differential diagnosis of atherosclerotic and hypertonic encephalopathy - Google Patents

Abstract

The invention relates to medicine, namely to neurology. The goal is to improve the accuracy of differential diagnosis. For this purpose, after conducting a clinical examination, reoencephalography is performed. Then, the subject is assigned a functional load. After that, the size of the venous and arterial components is determined, and their ratio is determined. The duration of the pulse wave and the duration of the arterial component are determined, and their ratio is found. Then, the ratio of the obtained indices is determined, and if it is more than 5.0, hypertensive is diagnosed, and if it is 5.0 or less, atherosclerotic encephalopathy is diagnosed. The application of the method allows to increase the accuracy of differential diagnosis of atherosclerotic and hypertensive encephalopathy by 42.7% compared with the prototype.

Description

The invention relates to medicine, namely to neurology.

The purpose of the invention is to increase the differential diagnosis.

The method is carried out as follows.

After clinical diagnosis of dyscirculatory encephalopathy, rheoencephalogram recordings are performed in the fronto-mastoid and occipital-mastoid leads using functional loads (head turning to the side, nitroglycerine test) and blood pressure measurement. A further analysis of the rheoencephalogram is carried out using a well-known method for isolating the arterial, otic and venous components.

Cup-shaped electrodes with a diameter of 15 mm are fixed on the head with rubber bands in standard leads (fronto-mastoid and occipito-mastoid). The skin under the electrodes is wiped with an alcohol-based solution and moistened with an electrically conductive paste. The patient is placed on a couch and the rheoencephalogram is recorded according to the listed leads before and after exercise. The values of the venous and arterial components in ohms are determined, their ratio is found, then the duration of the pulse wave and the duration of the arterial component are determined and their ratio is determined. After that, the ratio of the obtained indicators is determined. In the case of

about

00

to to

In addition, if this ratio is greater than 5.0, hypertensive is diagnosed, and if 5.0 or less, atherosclerotic encephalopathy is diagnosed.

Example 1. SICK L, 51 years old. Complaints of severe speech impairment and reduction of force in the right extremities. The patient during the last year had a double stroke (with left-sided and right-sided hemiparesis) and stenosis of the left common carotid artery (rheoencephalography and Doppler ultrasound) was revealed.

Objectively. Heart sounds are deaf, rhythmic. Blood pressure fluctuates within 130/80 - 180/110 mm Hg, the person is amimically, emotionally labile, criticism is reduced, interests are narrowed, memory weakening, speech disorder (motor aphasi). Anizokori convergence and accommodation weakened. The right nasolabial fold is flattened, the tongue deviation is left. Subcortical reflexes are expressed (proboscide, nazolabial symptom of Marionsko-Radovici on both sides). Central tetraparesis, more to the right.

Right-sided hemihypesthesia. Prior to treatment of the patient, reoencephalography was performed. Cup-shaped electrodes with a diameter of 15 mm are fixed with rubber bands in the fronto-mastoid and occipital-mastoid leads on the skin of the patient's head and connected to a rheograph. The skin under the electrodes is treated with an alcohol-based solution and an electrically conductive paste. Background rheoencephalograms (in a bipolar manner) are recorded in the patient's supine position alternately from the carotid (right and left) and vertebrobasal basins. Use functional loads: turning the head to the side (right, left) and nitroglycerin test. Blood pressure is measured at 150/80 mm Hg.

With the help of an analyzer or calculator, the analysis of rheoencephalograms is carried out, based on the isolation of the arterial and venous components.

To differentiate the forms of ocular phalopathy, the following parameters are determined: the amplitude of the arterial component (A) is equal to 0.078 Ω, the ratio of the maximum systolic value

the venous component to the arterial amplitude (VA) is 114%, the duration of the arterial component (o () is 0.22 s. the duration of the entire pulse wave (T) is 0.70 s. The indicated values correspond to the right carotid artery after the nitroglycerin test.

If the analysis is carried out automatically using an analyzer, then the described parameters in each vascular pool are determined on both sides before and after the loading tests with the calculation of the average differentiation coefficient,

The coefficient of differentiation (KD) is calculated by the formula

VA

 7 d а7т 0,22, 70

114 „, -, ЗГ 3,67

The differentiation coefficient of 3.67 indicates the predominance of the atherosclerotic process.

Conclusion The intensity of pulse blood filling in the brain is sharply reduced, especially in the left carotid region. Vascular tone is increased mainly in arteries of large and medium caliber, decrease in arterial elasticity, more to the left. Periodic hypotonia of the veins, more to the right. When the head turns to the sides, the asymmetry of blood filling in the carotid pool (S; D) increases, especially when the head is turned to the right, apparently due to stenosis of the left common carotid artery. Phenomena of discirculation in the vertebrobasil basin of vertebrogenic origin. The reaction to nitroglycerin is virtually absent. Atherosclerotic encephalopathy has been diagnosed.

Occlusion of the left common carotid artery (as revealed by dopplerosonography), retinal vascular sclerosis, hyperbetalipoprotidemia (64 units) in the blood confirm the diagnosis of atherosclerotic dyscirculatory encephalopathy.

Example 2: Patient S., 50 years old, was admitted to the hospital with complaints of weakness in extremities, speech and walking disorders. Six months ago, suffered a stroke. A month ago, weakness in the legs increased, and precariousness in walking appeared.

Objectively. Heart sounds are rhythmic, somewhat muffled. Arterial

pressure ranges from 130/80 to 200/100 mm Hg. Pronounced decrease in memory, tearfulness, criticism reduced, emotionally labile, halfway to the right, restriction of movements of the right eye block upwards. The right nasolabial fold is flattened, hearing is reduced to high tones on the right. The soft sky is sedentary. The pharyngeal reflex is absent. Speech is guttural, dizarthric. Pronounced reflexes of oral automatism. Central tetraparesis, more to the right. Mild coordination disorders, more left.

The registration and analysis of rheoencephalogram. Blood pressure 150/80 mm Hg

The amplitude of the arterial component is 0.055 ohms. The ratio of the maximum systolic value of the venous component to the arterial amplitude is 170%.

The duration of the arterial component (a) is 0.23 s, the duration of the entire pulse wave (T) is 0.84 s. Differential factor after nitroglycerin test

CD

170 170 о723 Г 0.84 27

6.2.

Conclusion The intensity of pulse blood volume is reduced in all vascular basins of the brain, but to the left. Povpen tone of arteries of small and medium caliber. Vessel elasticity is reduced. Venous outflow without features. When turning the head to the side, there are observed the appearance of dystonia in the vertebrobasil basin, apparently of vertebrogenic origin.

Q 5

0

five

0

five

0

The nitroglycerin reaction is practically absent. The coefficient of differential is 6.2. Hypertensive dyscirculatory encephalopathy diagnosed.

Retinal hypertonic angiopathy, deviation of the electrical axis and hypertrophy of the left myocardial stomach for ECG, an increase in the size of the heart on fluoroscopy and the absence of obstructions to the blood flow in the cerebral arteries with ultrasound dopplerosonography confirm the diagnosis of hypertonic circulatory encephalopathy.

Claims (1)

The proposed method allows to increase the accuracy of differential diagnosis of atherosclerotic and hypertensive encephalopathy by 42.7% compared with the prototype. Invention Formula The method of differential diagnosis of atherosclerotic and hypertensive encephalopathy by means of rheoencephalography, characterized in that, in order to improve the accuracy of diagnosis, the subject is given a functional load, the pulse wave duration and duration are determined on the rheoencephalogram. arterial components, their ratio is found, then the ratio of the first indicator to the second is determined and, if its level exceeds 5.0 diagrams ostiruyut hypertonic, and at the level of 5.0 or less - ateroskle- rhotic encephalopathy.