Comparative Character of Diabetic Encephalopathy and Encephalopathy on the Background of Arterial Hypertension.
Djurabekova Aziza Taxirovna
Doctor of Medical Sciences, Prof. Head of the Department of Neurology and Neurosurgery, Samarkand State Medical Institute,Uzbekistan
GaybievAkmalAxmatjonovich
PhD assistant at the Department of Neurology and Neurosurgery Samarkand State Medical Institute,Uzbekistan
BaxronovaBaxoraXabibullaevna
Master student at the Department of Neurology and Neurosurgery Samarkand State Medical Institute,Uzbekistan
The number of patients with diabetes mellitus (DM) is increasing every year. So, at the beginning of 2020, according to the WHO and the International Diabetes Federation ( IDF ), 470 million people. Among people over 60 years old, there are 136 million people ( 1, 3, 6 ). Diabetes mellitus is a disease associated with impaired glucose uptake and the development of insulin deficiency, which leads to large-scale metabolic disorders. A lot of research work is devoted to the mechanism of formation of brain lesions in diabetic patients, but so far to whether or cal pathogenesis of central nervous system (CNS) in diabetes remains controversial. The main point, Kotor s noted in the literature, this is a very slow formation of diabetic encephalopathy , mainly in the form of cognitive impairment. At the same time, cognitive deficits reach dementia ( 2, 4, 7 ). In addition, it has been proven that the presence of cognitive impairment in patients with diabetes increases the risk of death by up to 25%. Characteristic is the fact that pronounced diabetic polyneuropathy does not affect the level of diabetic encephalopathy . Little attention has been paid to identifying the initial stages of diabetic encephalopathy (DE). The initial stages of cerebral blood flow may occur for a long time latent, at the same time, it is in this t period important preventive measures. Both types of diabetes are associated with an increased risk of micro - and macrovascular complications, some of the mechanisms of hyperglycemia or giperinsul and n e mia , but it is difficult to determine. Recent experimental data in this direction have shown that a lack of insulin and C- peptide plays a role in the development of DE. Diagnostic measures study do not differ much from the research dyscirculatory encephalopathy on the background of arterial hypertension and atherosclerosis, it is ultra sound doppler , brain imaging , angiography, neuropsychological testing ( 5, 8 ) . Determination of the correlation of ultrasound data of central hemodynamics, with neuropsychological data and data from the clinic of patients with diabetes mellitus of various types, seems relevant as an early prognostic indicator.
Purpose. To study the clinical and diagnostic indicators of patients with diabetic encephalopathy depending on the type of diabetes mellitus.
Material and research methods. Subject to examination, patients with diabetic encephalopathy and HNMK who are hospitalized in the Department of Neurology Clinic
1 summit for the period 2019-2021 gg . ; the age ranged from 30 to 60 years. The patients were divided into groups according to the diagnosis. Group I - patients with diabetic encephalopathy (DE), Group II - patients with chronic cerebrovascular accidents (CCI) against the background of arterial hypertension, atherosclerosis. The gender division of patients in groups was almost equal to half. Study e included collection analysis (with a detailed history of symptoms of diabetes patients), clinical neurological examination. Central hemodynamics was assessed by ultrasound Doppler imaging of the blachnocephalic arteries , and in addition , the patients were examined for hemodynamic status on the basis of transcranial Doppler sonography . The study of neuropsychological testing was carried out in several complex procedures and tables (a technique for detecting memory: shaped, operational, Table III in lte ). The exclusion criterion was the factors of arterial hypertension in patients with diabetes mellitus, severe nephropathy in patients with diabetes mellitus, vision loss above 40%. The statistical data of the research results were processed on an individual computer with an assessment of the Student's criteria .
Research result. Clinical symptoms of patients I group nN non-specifically , the main complaints of the patients was demonstrated in weakness and fatigue, periodic headaches, reduction of attention and with Mr. livost. When viewed from patients gross disturbances of the central nervous system is not clear portions s symptom s: violation of convergence in 90% of cases, unsteadiness in walking and intermittent th dizziness, as signs of attacks with nical symptom in the examinees were observed in 37%; rare symptom as an LP Caria with difference diameters of p achkov , only two patients; pyramidal insufficiency, given the length of the disease and the type of diabetes is different, mainly weakness in the limbs, symptoms of diabetic for l inevr of patii . In the II group ne races with troystvo also have a subjective character, complaints of headache, weakness and fatigue, decreased alertness, ataxia symptoms as dizziness and instability when walking. As can be seen, if not uch and t s Vat factor elevated blood glucose level in the I group n, and the factor of high blood pressure in the II group ne, clinical symptoms are difficult to distinguish . In accordance with the set goal, patients of both groups underwent a neuroimaging study, MR T of the brain. In the I group ne - in patients with experience of m disease 2-3 years, no significant changes are close to normal, in patients with diabetes experienced more than 5-6 years revealed nonspecific and e small foci s e diffusely s e organic changes, degenerative and atrophic nature , that coincides with the literature data foreign and Russian authors, r d e diabetic patients showed signs of atrophy predominantly gray matter of the brain, on the background of chronic hyperglycemia (Fig . 1 ).
Fig. 1 . MRI of the brain of patient S., 3-2 years old, group I
For patients of group II, MRI data are diverse, in the form of multiple or single foci with different blurred contours. The location of the foci, in the basal nuclei, in the white matter of the brain or cerebellum - this is 41% of patients, in 12% of cases there were rough extensive zones of softening of density, surrounded by the lateral ventricles, in 100% of cases the expansion of the ventricular system and the groove of the hemisphere was revealed (in some sources, this feature is considered indirect). ESTATE t ki density associated with the presence of varnish University ary heart attack, against a background of prolonged hypertension. In older patients with existing atherosclerotic disorder in 5 patients, marked local lesions in the cerebral cortex, which determines the criteria for the differential diagnosis of these encephalopathy th or HNMK. The most valuable information can give research vessels method dy p le to meat scanning (DS) and t p and nskranialnoe (TCD).
Comparative th evaluations in cerebrovascular reactivity resulted in both groups. Thus, the indicator of vasomotor reactivity in both groups is below normal (consistent with age). Taking into account the unreliability of the difference, the index of the vasomotor reactivity index (IVR) was calculated . Moreover, in patients of group II, the index (IVR) exceeded the indices of patients in group I (Fig. 2 ). Method of TCD evaluated background brain blood flow ( Table . 1 ). According to research revealed severity of vasospasm higher in Group I than in Group II, that is, indicators of background blood flow in patients with diabetic encephalopathy worse due to increased concentration of her blood glucose levels, etc. , and leading to the destruction of the vessels of balance and as a result, the destruction of nerve cells.
Fig. 2. The nature of IVR in patients of both groups
Table 1
LBFV level in patients with CIU and diabetic encephalopathy (%)
Patient groups Total LSK changes
Signs
of SMA vasospasm
Decreased PA blood flow
Acceleration of blood flow by PA
The number of
concomitant pathologies of MCA and PA
Group I DE 80 60 42 27 40 Group
II KhNMK 78 55 47 nineteen 32
Comparative analysis of indicators for assessing neuropsychological disorders in terms of attention and memory (using the above described methods), in patients with diabetes mellitus, the level was much lower ( Fig. 4 ). The results in Table III at the l t e , where studied the level of resistance and attention, again figures in the I group ne significantly lower (Fig. 5).
Fig. 4. The attention and memory in patients 1- II group nN
Fig. 5. exhaustion (fatigue s ) for tables e Schulte patients 1 and II groups nN
Neuropsychological indicators in the surveyed groups showed a slowing down of psychological disorders, cognitive disorders . The severity and differences as well between the indices in both groups, prevailed in patient s with diabetic th encephalopathy , which is based on the violation of regulatory, metabolic and of neural functions and defeat subkartikalno-frontal connections.
OUTPUT
1. Diabetic Single encephalopathy and HNMK
( discirkulatornaya Single encephalopathy caused by the presence of hypertension or atherosclerosis) in their clinical and neuropsychological diseases are common characteristics that differ little by neurological symptom and m.
2. The result of assessing the nature of cerebrovascular reserve and background blood flow showed the worst results in patients with diabetic encephalopathy , which is an early sign of the threat of cerebral catastrophe .
3. Neuropsychological testing has confirmed significant cognitive decline in patients with diabetes mellitus , with evidence of information content and method. The impact on the cause of the disease will undoubtedly slow down the progression of diabetic encephalopathy, thereby improving the quality of life of patients.
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