Dmitry A. Demin’s scientific contributions

Ischemic stroke caused by the obstruction of the artery of Percheron is a rare type of ischemic stroke, in which one arterial branch supplying blood to both thalamuses and the middle brain is occluded, which leads to the depression of consciousness, paresis of vertical vision, and cognitive impairment. Due to the atypical symptoms ("stroke-chameleon"), the diagnosis is often not verified in time, which deprives the patient of the most effective treatment – thrombolytic therapy. The review aims to increase clinicians' awareness of this subtype of stroke.

Wallenberg–Zakharchenko syndrome associated with lateral medullary infarction has been known to neurologists since the end of the 19th century. However, to this day, its diagnosis is challenging due to the polymorphic, atypical, and rapidly changing clinical manifestations. Timely verification of the syndrome provides essential information regarding its etiology and also prevents serious complications. The paper presents clinical and anatomical correlates of lateral medullary infarction, its etiology, features of the clinical presentation, complications, and prognosis. In conclusion, a diagnostic algorithm that can be used in everyday practice is given.

Background. Ischemic stroke (IS) and cerebral microbleeds (CMB) are the most common types of neurological complications of infective endocarditis (IE), while their combination is poorly understood. Aim. To evaluate the pattern of combination of cortical-subcortical infarction with lobar CMB or subarachnoid hemorrhage (SAH) in patients with left-sided IE. Materials and methods. A retrospective case-control study was conducted, including patients with IE who received cardiac surgery at the Federal Center for Cardiovascular Surgery. Inclusion criteria: age of patients 18 years; definite or possible (Duke criteria) IE of the left heart (aortic and/or mitral valves). The control group included patients without IE, with non-lacunar (likely embolic) IS. In both groups, the pattern of combination of cortical-subcortical infarction with lobar CMB or SAH was assessed. Differences between groups of patients were assessed using the 2 test, Fisher's exact test and the MannWhitney test. Additionally, odds ratios for binary features were calculated. To assess the information content of the studied pattern, classical classification quality metrics were calculated: accuracy, sensitivity, and specificity. Results. In patients with IS, infarcts corresponded to the main characteristics of cardioembolism: involvement of multiple cerebral arterial territories (84%), multiple infarcts (88%), cortical-subcortical localization (100%), and a high incidence of hemorrhagic transformation (44%). CMB was detected in 64% of cases (in 93.8%, CMB localization was lobar), SAH in 28% of patients (with CMB in 6 out of 7 cases). The pattern of combination of cortical-subcortical infarction with lobar CMB or SAH was observed in 64% in the IE group (in the control group in 12%). Odds ratio for the presence of IE was 13.0 (95% confidence interval 3.0455.9; p0.001). The accuracy of the sign was 76%, specificity 71%, sensitivity 84%. Conclusion. The combination of cortical-subcortical infarcts with lobar CMB or SAH may be a sign characteristic of IE-associated stroke.