Dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke in the recovering period of the disease

Abstract

The aim of our study was the investigation of the dynamics of clinical-neurological indicators of patients with hemorrhagic hemispheric stroke (HHS) in the recovering period of the disease by comprehensive neurological, medical and social research. Materials and methods. 90 patients in the age from 38 to 70 years were studied, 58 men – 64.4 % and 32 women – 35.6 %. The condition of the patients was evaluated by NIHSS, mRS, BI and MSA on the 30th, 180th, 360th day of HHS. Depending on their self-care recovering level the patients were divided in two groups for analysis: the first one was formed with the patients whose self-care level completely was restored on the 360th day (ВІ = 100), and the second one was formed with the patients with BI 95 and less on the 360th day. Results. Structure of indicators according to NIHSS, mRS, ВІ and MSA on the 30th day of disease in these groups was analyzed during rehabilitation, as well as distribution of the patients based on their gender and process lateralization. Analyzing the data of the dynamics of the recovery period of HHS depending on the lateralization of the process and the sex of patients, we can notice that there was no significant difference during the recovery period of HHS depending of the lateralization of the process, for example, in patients with the damaged dominant hemisphere median score of BI was 70 points on the 30th day, patients with the lesion of subdominant hemisphere – 65, and on the 360th days in both groups it was 95 points. There was also no significant difference in the dynamics of neurological deficit and recovery of functional activity depending on the gender of patients. On the 30th day of the disease in the group of patients who fully restored their daily activity on the 360th day of HHS a significantly higher score for BI was determined than in the group with incomplete recovery (80 (70; 85) points against 55 (45; 65) points (P ˂ 0.05)). Although a significantly greater regression of functional disorders was found in the second group of patients (P ˂ 0.05). An analysis of the impact of spasticity on the recovery of self-care level showed a significant negative impact of increased muscle tone on the recovery of self-care (P ˂ 0.05) and reduction of the probability of complete recovery of independence in everyday life with increasing degree of spasticity (P ˂ 0.05). At the same time, no significant factors (sex, age, side of the lesion, etc.) were identified that would affect the development of spasticity in patients with HHS, except for the level of neurological deficit according to NIHSS. When we analyzed the distribution of patients in these two groups by sex, it was revealed that the groups didn't have any significant difference. There was also no significant difference in the study's groups depending of the lateralization of the stroke. Conclusions. It was found that on the 30th day of the disease in 35.6 % of patients the total score on NIHSS ranged from 2 to 6 points, 55.6 % of patients had mRS of 3 points and 48.9 % of patients had severe dependent of outside help in daily life by BI. Significant positive dynamics of recovery on NIHSS, mRS, BI scales on the 180th and 360th day of the disease (P ˂ 0.05) was revealed. The dependence of the indicators of the level of self-care on the 360th day of HHS, on the severity of stroke on the 30th day of the disease (P ˂ 0.01) and on the presence of manifestations of increased muscle tone was established. It was found that patients who had manifestations of spasticity on the 360th day of the disease had a significantly higher score for NIHSS at the onset of the disease, on the 30th day of the disease and on the 360th day of the disease than patients without manifestations of increased muscle tone (P ˂ 0.05). However, no interconnection was found between the indicators of the level of self-care on the 360th day of HHS and the lateralization of the process as well as the sex of patients.