r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2020-25-4-31-37r-n-j-97Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSЦеребральная амилоидная ангиопатия в сочетании с пароксизмальной формой фибрилляции предсердийCerebral Amyloid Angiopathy in Combination with Paroxysmal Atrial Fibrillationhttps://orcid.org/0000-0002-7688-3669КорниловаА. А.KornilovaA. A.

Корнилова Анастасия Александровна — аспирант, врач-невролог 1-го неврологического отделения, Москва

Moscow

kornilovaa715@gmail.comhttps://orcid.org/0000-0001-7562-4991ЛагодаО. В.LagodaO. V.

Москва

Moscow

https://orcid.org/0000-0002-5883-8119ТанашянМ. М.TanashyanM. M.

Москва

Moscow

Федеральное государственное бюджетное научное учреждение «Научный центр неврологии»РоссияResearch Center of NeurologyRussian Federation2020181020202543137Copyright © Корнилова А.А., Лагода О.В., Танашян М.М., 20202020Корнилова А.А., Лагода О.В., Танашян М.М.Kornilova A.A., Lagoda O.V., Tanashyan M.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/97

В статье на основании разбора клинического случая дается определение церебральной амилоидной ангиопатии (ЦАА) и ее симптомов, обсуждаются вопросы диагностики и лечения. Описываются методы и режимы нейровизуализации, в том числе магнитно-резонансной томографии (МРТ), верифицирующие микрокровоизлияния в веществе головного мозга. Обсуждается роль и значимость нарушений ритма сердца в генезе ишемического инсульта, приводятся шкалы для оценки риска его возникновения. Приведенное наблюдение неврологического, соматического, нейровизуализационного, нейропсихологического статуса пациента 62 лет подтверждает достаточно редко встречающееся сочетание вероятной ЦАА, пароксизмальной формы фибрилляции предсердий и повторных геморрагических нарушений мозгового кровообращения (НМК). Актуальность описываемого случая — это сложная клиническая дилемма, базируемая на фактически взаимоисключающих рекомендациях по фармакологической коррекции подобных состояний. Подчеркивается, что во многих мультицентровых клинических исследованиях об эффективности антитромботических препаратов (антиагрегантов, антикоагулянтов) в лечении и профилактике ишемических нарушений мозгового кровообращения важным критерием исключения является геморрагический инсульт в анамнезе (в связи в том числе с разнонаправленностью изменений показателей гемостаза). С учетом полученных в динамике клинических и лабораторных данных определена тактика лечения описываемого пациента. Обсуждаются результаты исследований, связанных с лечением коморбидной патологии, которая в каждом конкретном случае должна становиться предметом разработки персонифицированного алгоритма ведения пациентов.

The present article addresses the definition of cerebral amyloid angiopathy (CAA) and its symptoms based on the analysis of the medical case; the issues of diagnosis and treatment of this pathology are discussed. The Boston criteria, which became the basis for diagnosis, study of clinical manifestations and progression of CAA and approaches to its therapy, are presented. Methods and modes of neuroimaging, including magnetic resonance imaging (MRI), which verify micro cerebral haemorrhage, are described. At the same time, the role and significance of cardiac arrhythmias in the genesis of ischemic stroke are discussed, and scales for assessing the risk of its occurrence are presented. The observation of the neurological, somatic, neuroimaging, neuropsychological status of a 62-year-old patient confirms quite rare combination of probable CAA, paroxysmal atrial fibrillation and repeated hemorrhagic functional apoplexy (FA). The relevance of the case described, is a complex clinical dilemma based on mutually exclusive recommendations for the pharmacological correction of such conditions. It is emphasized that in many multicenter clinical studies on the effectiveness of antithrombotic medication (antiaggregants, anticoagulants) in the treatment and prevention of ischaemic functional apoplexy , an important exclusion criterion is a hemorrhagic stroke in past history (including the multiple changes in haemostasis indicators). Taking into account the obtained clinical and laboratory data in the dynamics, the tactics of treating the described patient were determined. The results of studies related to the treatment of comorbid pathology that should become the subject of the development of a personalized algorithm for managing patients in each specific case, are discussed.

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The authors declare that there are no conflicts of interest present.