Этиология криптогенного инсульта


https://doi.org/10.23934/2223-9022-2019-8-3-302-314

Полный текст:


Аннотация

Ишемический инсульт является гетерогенным синдромом с множеством потенциально возможных этиологических факторов. Рутинная диагностика не всегда позволяет установить причину острого нарушения мозгового кровообращения (ОНМК), в таких случаях принято говорить о криптогенном ишемическом инсульте, частота которого составляет 20–40%. Категория пациентов с криптогенным инсультом впервые была охарактеризована и выделена в отдельную группу в базе данных Национального института неврологических заболеваний и инсульта США, а впоследствии в исследовании TOAST. Диагноз криптогенного инсульта, как правило, базируется на исключении хорошо известных причин ОНМК, таких как атеросклероз, нарушения ритма сердца, артериальная гипертензия. В связи со значительной вариабельностью понятия криптогенного инсульта в 2014 г. был введен термин ESUS (Embolic Stroke of Undetermined Source — эмболический инсульт с неустановленным источником) и сформулированы критерии, которые четко характеризуют таких пациентов: нелакунарный инфаркт мозга по данным компьютерной и/или магнитно-резонансной томографии, отсутствие атеросклеротического поражения, стенозирующего инсультсвязанную артерию более чем на 50%, отсутствие источников кардиоэмболии высокого риска, отсутствие других причин инсульта, таких как диссекция артерии, питающей область инфаркта мозга, мигрень, артериит. Среди потенциальных причин и источников церебральной эмболии у пациентов с криптогенным инсультом должны быть рассмотрены сердце, вены нижних конечностей и таза, нестенозирующий атеросклероз брахиоцефальных артерий, атеромы дуги аорты, парадоксальная эмболия, неатеросклеротическая васкулопатия, моногенные заболевания, гиперкоагуляционные состояния и др. Следует отметить, что в доступной нам литературе имеется большое количество исследований, посвященных описанию возможных причин криптогенного инсульта, однако единые подходы к систематизации этиологических факторов и протокола обследования пациентов отсутствуют. Высокая частота развития криптогенного инсульта, значительная гетерогенность его этиопатогенетических механизмов, необходимость дифференцированных подходов ко вторичной профилактике данного типа ОНМК обуславливают актуальность дальнейших исследований при данной патологии.


Об авторах

Г. Р. Рамазанов
ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»
Россия

Рамазанов Ганипа Рамазанович - кандидат медицинских наук, заведующий научным отделением неотложной неврологии и восстановительного лечения

129090, Москва, Б. Сухаревская пл., д. 3



Т. А. Магомедов
ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»
Россия

Магомедов Тимур Абдурахманович - врач-невролог отделения неврологии для больных с острыми нарушениями мозгового кровообращения с палатой реанимации и интенсивной терапии

Научное отделение неотложной неврологии и восстановительного лечения

129090, Москва, Б. Сухаревская пл., д. 3



Л. Т. Хамидова
ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»
Россия

Хамидова Лайла Тимарбековна - кандидат медицинских наук, заведующая научным отделением ультразвуковых и функциональных методов исследований

Научное отделение неотложной неврологии и восстановительного лечения

129090, Москва, Б. Сухаревская пл., д. 3



Н. В. Рыбалко
ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»
Россия

Рыбалко Наталья Владимировна - доктор медицинских наук, ведущий научный сотрудник научного отделения ультразвуковых и функциональных методов исследований

Научное отделение неотложной неврологии и восстановительного лечения

129090, Москва, Б. Сухаревская пл., д. 3



С. С. Петриков
ГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»
Россия

Петриков Сергей Сергеевич - доктор медицинских наук, директор

Научное отделение неотложной неврологии и восстановительного лечения

129090, Москва, Б. Сухаревская пл., д. 3



Н. А. Шамалов
ФГБУ «Федеральный центр цереброваскулярной патологии и инсульта» МЗ РФ
Россия

Шамалов Николай Анатольевич - профессор, исполняющий обязанности директора

117513, Москва, ул. Островитянова, д. 1, стр. 10



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Для цитирования: Рамазанов Г.Р., Магомедов Т.А., Хамидова Л.Т., Рыбалко Н.В., Петриков С.С., Шамалов Н.А. Этиология криптогенного инсульта. Журнал им. Н.В. Склифосовского «Неотложная медицинская помощь». 2019;8(3):302-314. https://doi.org/10.23934/2223-9022-2019-8-3-302-314

For citation: Ramazanov G.R., Magomedov T.A., Khamidova L.T., Rybalko N.V., Petrikov S.S., Shamalov N.A. Etiology of Cryptogenic Stroke. Russian Sklifosovsky Journal "Emergency Medical Care". 2019;8(3):302-314. (In Russ.) https://doi.org/10.23934/2223-9022-2019-8-3-302-314

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