[Stroke: current state of the problem].

Abstract

We review the current and emerging topics in ischemic stroke (IS) and intracerebral hemorrhage (ICH). We discuss the association of genetic predisposition and healthy lifestyle, ambient particulate air pollution, weather parameters, variations in the anatomy of cerebral blood vessels, psychological stress, depression, insonmia with the development of IS or ICH. Also, the role of oral anticoagulants (AC) as a new risk factor for ICH is presented. The issues of pathophysiology of IS and ICH are considered, in particular, the discrepancy between blood flow and metabolism and penumbra stability in IS and changes in perfusion and cerebral blood flow (CBF) in stroke, autoimmune mechanisms of brain damage. Widening of therapeutic window, introduction of new generation of thrombolytic medications, tele-thrombolysis and thrombolysis in mobile stroke units are discussed. In patients taking AC, the tactics of prescribing IIa and Xa factor blockers during telethrombolysis and thrombolysis are discussed. The issues of urgent correction of hemostasis in the development of ICH while taking AC, as well as the resumption of their use in the future, are considered. The issues of neuroprotection, including the combination of neuroprotection and telethrombolysis and thrombolysis, and the translation of experimental studies into clinical practice, as well as the implementation of immunomodulatory therapy are discussed.