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Blood test.

Name - XXXXX.
Age - XXXX.
Date of blood sampling - XXXXX
Date of examination - XXXXX

Triglycerides 1.44 mmol/l
Cholesterol 5.29 mmol/l
HDL Cholesterol 1.85 mmol/l
LDL Cholesterol (Frivald probe) 2.79 mmol/l Atherogenic index 1.9*
Potassium 4.4 mmol/l Sodium 138 mmol/l Chlorine 107 mmol/l Magnesium 0.79 mmol/l T3 free 4.3 picomol/l
T4 free12.3 picomol/l
TSH 3.82 mU/l
Anti-thyroglobulin autoantibodies 3.2 U/ml Thyroid peroxidase autoantibodies 378.5* U/ml ACTH <5.00 pg/ml
STH 0.7 mIU/l

Cortisol 431 nmol/l
Fraction Cholesterol VLDL 0.64 mmol/l Apolipoprotein А1 2.11 g/l
Apolipoprotein В 0.90 g/l
Apo В/Apo А1 0.4
Lipoprotein (а) 0.74* g/l

CENTRAL CLINICAL HOSPITAL OF CIVIL AVIATION. THE CARDIOLOGY DEPARTMENT.

Medical discharge report XXXXX
The name of the patient XXXXX
Date of birth XXXXX
Age XXXXX
Home address XXXXX
Date of admission - XXXXX
Date of discharge - XXXXX

Diagnosis:

Hypertensive disease III degree. The risk of developing cardiovascular complications 4. "Hypertensive heart". Paroxysmal form of atrial fibrillation. Ventricular premature beats. Circulatory failure 2A. Chronic heart failure 2nd functional class. Peptic ulcer of the duodenum.

Exogenous alimentary obesity 2nd degree. Dyslipidemia. Gout. Varicose veins of the extremities. Adenoma of the prostate. Adenocarcinoma, resection of sigmoid colon and rectum in 2012. Postoperative ventral hernia, surgical treatment in 2013.

Complaints:

interruptions in heart rhythm, shortness of breath when walking, increased blood pressure, recurrent pain in the left side of the chest.

Medical history: patient notes the increase of blood pressure for a long time. Maximum blood pressure was 260/100 mmHg. In 2010 patient was examined in the central clinical hospital of the President Administration of the Russian Federation and diagnosed hypertrophic cardiomyopathy. Diagnose based on ECG changes (formerly ECG changes were regarded as myocardial infarction).

In 201З year for the first time revealed the paroxysm of atrial fibrillation, a rhythm was restored after counter-shock therapy. The patient constantly took pradaxa 110g 2 times per day, lozap 50 mg twice a day, cordarone 200 mg 1 per day, amlodipine 2.5 mg, 20 mg Liprimar, akatinol 20 mg morning and evening.

The patient noted feeling unwell during 10 days, when the renewed rise of blood pressure up to 150/100 mmHg. Then the patient independently increased the dose of cordarone to 400 mg, once took propanorm 150 mg. After frequent interruptions in the heart rhythm 06.04.2016 the patient applied to the emergency department of CENTRAL CLINICAL HOSPITAL OF CIVIL AVIATION and was hospitalized in the intensive care unit. The therapy was carried out until the return of sinus rhythm on the EKG. After the patient was transferred to the cardiology unit for further evaluation and treatment.

Condition:

satisfactory condition of patient. The skin - normal color and clean. Pasty legs. Auscultation of the lungs: breathing is hard, without wheezing. The number of respiratory movements 16 times per minute. Heart tones are muted, with regular rhythm. Heart tones are muted, with regular rhythm. Heart murmurs are not auscultated. Heart rate is 60 per minute. Blood pressure is 150/100 mmHg. The abdomen is usual form and involved in the act of respiration. Auscultated peristalsis. On the midline of the abdomen is postoperative scar. During palpation abdomen is soft, painless. A liver on edge of a rib arch. Pasternatskiy-sign is negative.

Findings:

ECG: sinus Rhythm with heart rate of 54 beats/min (sinus bradycardia). Electric axis of the heart rejected the left. Slowing of atrioventricular conduction. Disturbance of intraventricular conduction. Changes of left ventricular myocardium in the apical-lateral, anterior-basal region of the left ventricle.

The echo-KG: the Aorta (N - 4-cm): 4.0 cm, thickened, sclerotic (fibrous).
The ascending aorta is 4.5 cm.
The divergence of the folds (N > 14 mm): 20mm, edge hardening.
Maximum pressure gradient on aortic valve (N up to 10 mm Hg): N. Regurgitation is not detected.
The left atrium (N-4.0 cm): 4.7 x 6.2 cm the Volume of the left atrium (N to 65 ml): 95 ml
Mitral valve: the seal of the fibrous annulus. Small calcification is in the grounds of the valves. Regurgitation: 1 degree.
Left ventricle: end-diastolic dimension (N to 5.7 cm) - 5.6 cm, end-systolic dimension (N to 4,0sm) - 3,5 cm, Ejection Fraction - 67%, myocardial contractile function is satisfactory.
Diastolic function: broken 1 type.
Ventricular septum (N to 1,2sm) - 1,7cm.
Left Ventricular Mass - 272 gr. The structure of the myocardium with increased echogenicity.

The right ventricle (N to 3.6 cm): 3.2 cm wall (N 0.5 cm) 0.3 Pulmonary artery (N up to 2.8 cm): N. Regurgitation: 0-1 degree. The pressure in the LA (N up to 30-36 mm Hg. calendar): N.
The right atrium (N 3.8x4.6 cm): 4.3 x 5.8 cm Tricuspid valve:
seal of the annulus. Regurgitation: 1 degree. Inferior Vena cava (N 2.5-2.7 cm): N

Conclusion:

Atherosclerosis of the aorta. Expansion of the ascending aorta. Dilatation of the left atrium and the right atrium. Myocardium hypertrophy of the left ventricle. Violation of diastolic function of the left ventricular myocardium - 1 type.

Daily monitoring of ECG:

Sinus rhythm with among heart rate 57 beats/min (minimum heart rate of 40 beats/min during sleep; maximum heart rate 107 beats/min). Recorded ventricular (3024 e/s/day, 1-436 e/s/h, including 12/323 e/s type bi/trigeminy) arrythmia (33 er/s/day,0-5 e/s/h), unstable inverted teeth T in l, aVL, V4-6.
Pathological displacement of ST segment is not registered.

Daily monitoring of blood pressure:
During the day was 42 check blood pressure. During wakefulness fluctuation ns blood pressure ranged from 129/62 mmHg to 176/88 mmHg. The maximum blood pressure amounted to 193/90 mmHg. Average blood pressure war 147/74 mmHg, heart rate war 58 beats/min. Hypertensive load of systolic blood pressure - 60%.
Night decrease of arterial pressure at 13-8%. The average blood pressure of 128/68 mmHg, Heart rate 54 beats/min. Hypertensive load 68-55%. Conclusion: Daily blood pressure profile corresponds to a soft arterial systolic hypertension.

Clinical [common] blood analysis

The white blood cells.

The red blood cells.

Hemoglobin.

Hematocrit.

Platelets.

8,2

4,14

129

36,9

187

Biochemical blood test:

glucose - 4.9mmol/l, creatinine.- 123umol/l, urea. 4.7mmol/l, uric acid 4,7mmol/l, alanine aminotransferase-26.1 iu/l, aspartate aminotransferase - 28.3 iu/l, lactate dehydrogenase 255u/l, Сreatine phosphokinase-57 iu/l and
Сreatine phosphokinase МВ 13, triglycerides.- mmol/l, cholesterol.-3,83 mmol/l, potassium 4.12mmol/l

Urinalysis: specific gravity-1020, protein - not identified sugar-not identified, leukocytes - 1-23 in the field of view, erythrocytes were not identified

Сoagulogram - Activated partial thromboplastin time 48,5s, INR - 1,8% Quick-46,5% fibrinogen - 3,878 g/l.

HBsAg, aHCV - negative
Syphilis - negative
HIV - negative

Treatment:
pradaxa - 110 mg twice per day, losartan 50 mg twice per day, amlodipin 5 mg in the middle day, simvastatin 20 mg in the evening, bisoprolol 2,5 mg in the morgen.

Examination and treatment carried out in accordance with the standard of care for patients with hypertensive disease with heart failure code ICD 11.0 i, code of standard 69.080

Epicrisis:

The reason for hospitalization was increased blood pressure, increased shortness of breath and arrhythmias. On the background correction regimens achieved an optimal reduction of blood pressure during daily ECG monitoring was 3024 ventricular extrasystoles, but paroxysms of atrial fibrillation were not. In connection with the poor tolerability of the arrhythmia was recommended to cancel cordaron, but assigned to bisoprolol 2.5 mg with subsequent change of antiarrhythmic therapy (b-blocker in combination with carbamazepine 100-200 mg/day) in 3 weeks.

The patient's condition before discharge improved. Decreased symptoms of heart failure such as shortness of breath, swelling, and blood pressure level is 130/80 mmHg. There are no negative dynamics on EKG. There was no complications associated with therapy and the survey.

Recommendations:

1. The supervision of a cardiologist.
2. Diet with limit animal fats and foods containing cholesterol, reducing the use of salt and liquid.
3. Control of blood pressure.
4. To continue taking: pradaxa 110 mg x 2 p\q, losartan 50 mg x 2 p/d, amlodipine 5 mg in the middle of the day, simvastatin 20 mg evening, bisoprolol 2.5 mg in the morning.


Date XXXXX
Head of cardiology unit XXXXX
Doctor XXXXX

Neurologist consultation.

Name - XXXXX.
Age - XXXXX.
Date of examination - XXXXX.

Patient complaints are parasomnia (superficial sleep with frequent awakening), throbbing headaches with temporal and occipital lobe localization, high diastolic blood pressure.
For sleep take the pill Melaxen, Cyrkadin without positive e ect. Atarax helps some, but short.

Clinically patient has mixed type of headache. Drug [medicamentous] migraine. Chronic tension-type headache. Patient takes vascular-metabolic therapy. For headaches she takes Zomig, but without positive e ect.

Magnetic resonance angiography (XXXXX):
Conclusion. Hypoplasia of the left vertebral artery at the level of the intracranial segment. The reduced blood flow is on segments of anterior cerebral arteries.
Patient has hypothyroidism and takes Eutirox.

Neurological status: meningeal and cerebral syndromes are not identified. Cranial nerves are intact. Paresis's are not identified. Deep reflexes of average vivacity, distal hyperhidrosis. Painful palpation is of the forearm.
Conclusion: mixed type of headache. Drug [medicamentous] migraine. Chronic tension-type headache. Cervicogenic headache. Hypertensive microangiopathy. Anxious disorder.

Recomendation:
1) alternating douche, swimming, spa services.
2) acupuncture.
3) consultation of psychotherapy.
4) cinnarizin 0,25 - 1 pill 3 times a day. 5) Imigran, Relpax (headache). 6) Teralidjen 5 1 pill take in evening. Every day take 1 pill extra up to 2 pill 3 times a day (2 mouth). 7) repeated consultation of the neurologist.
PhD XXXXX

Moskauer Medizinischen Akademie namens Sechenov

Universitätsklinikum N1
Radiologische Abteilung
Adresse: Moskau, Pirogovskajastrasse 6
Patient: XXXXX
Alter: XXXXX
Untersuchungsdatum: XXXXX
Schnittebenen: axial, frontal, sagittal
Schichtdicke -4 mm
Ohne KM

MRT des Schädels vom XXXXX

Technik:

MRT des Schädels. T1 und T2gewichtet in verschiedenen Ebenen , FLAIR, DWI-Wichtung. Die Mittellinienstruktur nicht verlagert. Normale Weite und Größe von Ventrikeln. Keine Erweiterung von Subarachnoidalraum. Regelrechte Differenzierung der weißen und grauen Hirnsubstanz. In der weißen Hirnsubstanz, sowie in paraventrikulären und konvexen Regionen zeigen sich einige Herde im Durchmesser 2-3 mm, a.e perinataler oder vaskulärer Genese, andere Diagnose (demyelinisierende Erkrankung- unwahrscheinlich). Unspezifisches Signal von subkortikalen Kernen. Sellaregion unauffällig. Keine Vergrößerung von Hypophyse. Hirnstamm und Kleinhirn sind regelrecht entwickelt. Kleinhirnbrückenwinkel bds und kraniozervikaler Übergang unauffällig. In der Mastoidzelle links sind Zeichen entweder des chronischen oder entzündlichen Prozesses nachweisbar. In anderen Regionen ist regelrechte Darstellung der NNH und der Mastoidzellen. Orbitainhalt unauffällig.

Schlussbeurteilung:

In der weißen Hirnsubstanz zeigen sich einige Herde, a.e perinataler oder vaskulärer Genese, andere Diagnose -demyelinisierende Erkrankung- unwahrscheinlich.
Empfohlen:
Neurologische Untersuchung. Dynamische MRT des Schädels
Arzt XXXXX
Arzt XXXXX

Das städtische Krankenhaus № XXXXX der Stadt XXXXX Kernspintomographie des Gehirns.

Name: XXXXX.
Geburtsjahr: XXXXX
Datum der Forschung: XXXXX
Kontrastmittel: Gadowist 7.5 ml
Schichtdicke: 2,5 mm
Schritt: 2-5 mm

DAS PROTOKOLL DER FORSCHUNG:

Auf einer Reihe von MRT-Bildern sind T1, T2, FLAIR, DWI-Bildern des Gehirns. Ein Tumor bestimmt in der Projektion der Boden des IV Hirnventrikels (Größe 19,7x12x14,2mm). Diese Tumor ist heterogene Struktur mit kleine Verkalkungen. Dieser Tumor ist geringfügig Kontrast sammelt.
Die Hypophyse liegt intrasellar und nicht erhöht. Chiasma opticum ist nicht verformt.
Das Kleinhirnmandel befindet oberhalb der Linie Chamberlain.
Die Medialen Strukturen ist nicht verschoben.
Die Ventrikel sind nicht erweitert, normale Konfigurationen und Formen.
Die Subarachnoidale Raum ist nicht erweitert.
Die Nasennebenhöhlen sind ohne Eigenschaften.

Der Abschluss.
MR-Anzeichen - Tumor in der Projektion der Boden des IV Hirnventrikels.

DIE EMPFEHLUNG: die Konsultation des Neurochirurgen
DER ARZT: XXXXX

Ladies and gentlemen.

I need advice with recommendations of the relevant specialist for my kinswoman (46 years old) in conformity with the following set of her complaints (if necessary with participation of an appropriate specialist on the profile of concomitant diseases endocrinology) and her general condition.
Also, I need advice with therapy strategy of her arterial hypertension (as for a course of treatment, and cupping condition associated with increased blood pressure) and if it possibly changes the drug-strategy for the treatment of concurrent conditions (it could be one of the reasons for the ineffective treatment of arterial hypertension permanent taking the drug EUTIROX). Frequent and long time increased blood pressure in the last year. Diastolic pressure rises faster than the systolic and can go up to 100 mmHg. She perceived this condition hardly, because condition are often associated with severe headaches with temporal and occipital lobe localization. Her headaches are without aura, but with nausea. The pressure was stopped by MOXONIDINE in a dose of 200 mg. At the same time she took a NUROFEN or another anti-migraine drug, such as AMIGA. After taking these medications headache was stopped, but not for long. When the pressure was increased to 140/95, MOXONIDINE have not helped and she was taking CAPOTEN, which helped to reduce the pressure, but the headache was even stronger. She took courses at different times such drugs as ANAPRILIN, ARIFON, ATAKAND, but without significant improvement.

She took the prescribed her a sedative, antidepressant and nootropic drugs (SEMAX, ATARAX, MEXIDOL ACTOVEGIN, NERVOHEL), and she has also taken drugs which regulated the sleep (MEL AKSEN, then CIRCADIN, which was been a positive effect for a short period). I recommended the drug, based on the principles of TENS Belgian drug CEFALY (http:// www.cefalytechnology.com/) and the German drug MAXALT (lingual form), as an experienced patient who suffers from migraine attacks.
These two drugs were able to reduce the quantity, tolerability, severity of headaches, but 100% result failed to be achieved.

2. Related disease: HYPOTHYROIDISM, for the treatment which takes EUTIROX in a dosage of 100 mcg.

Attached copies of the surveys with the results and findings lately:

1) Echocardiography.
2) Blood test.
3) Nevrologist Consultation.
4) Oculist Consultation.
5) Protocol of stress EKG test - Treadmill.
6) Duplex ultrasound.
7) Kidney ultrasound.

Nach-, Vor- und Vatersname - XXXXX
Geschlecht des Patienten - XXXXX
Lebensalter - XXXX
Datum Forschung - XXXXX

Die Magnetresonanztomographie (MRT) des Schädels.
Magnetresonanztomographie - Technik
MRT ohne Kontrastmittel. Die Dicke war 4 mm.
Die Orientierung: Sagittal-, Frontal- und Axial-ebene.

In der FLAIR-, DWI-, T1- und T2-Reihe erhielt das Gehirn Bilder von subtentorial und supratentoriellen Strukturen.

Die Mittellinienstruktur sind nicht verschoben.
Die Hirnventrikel sind die normale Forme und die normale Größe.
Der Subarachnoidalraum nicht erweitert.

Die Differenzierung zwischen der weiße Substanz und der graue Substanz ist normal. In der weißen Substanz des Gehirns, in paraventricular Gegend und convexital Gegend visualisiert die wenigen Herde mit eine Durchmesser von 2 bis 3 Millimetern. Wahrscheinlich diese pathologischen Herde sind perinatalen oder vaskulären Sachen. Weniger wahrscheinlicher ist es, dass diese Herde die Demyelinisierungherde sind.
Das MR-Signal von subkortikalen Kerne ist nicht geändert. Der Bereich der Sella turcica ist nicht geändert. Die Abmessungen der Hypophyse ist in Ordnung.
Die Struktur des Stammhirn und die Struktur des Kleinhirn sind normal. Die Kleinhirnbrückenwinkel sind ohne Pathologie. Der Kraniovertebralteil ist nicht geändert.
In die Projektion der linken Mastoidzellen visualisiert die Anzeichen des chronischen Entzündung. Die übrigen Abteilungen der Nasennebenhöhlen und anderen der Mastoidzellen sind luftig. Die Augenhöhlen sind in Ordnung.

Das Ergebnis:

Das visualisiert die wenigen Herde in der weißen Substanz des Gehirns. Wahrscheinlich diese pathologischen Herde sind perinatalen oder vaskulären Sachen. Weniger wahrscheinlicher ist es, dass diese Herde die Demyelinisierungherde sind.

Die Empfehlung:

1) Die Konsultation des Nervenarztes.
2) Verwirklicht die Magnetresonanztomographie (MRT) des Schädels in der Dynamik.

Duplex ultrasonography.

Distal brachiocephalic trunk and proximal right subclavian artery, common, internal and external carotid arteries, vertebral arteries are defined on both sides. In a typical evaluation sections of the common carotid artery intima- media thickness is not thickened (0.6-0.7 mm), at all evaluated areas preserved layer differentiation.
In the bifurcations of both common carotid arteries indicated the areas of improving the echogenicity of the intima with the loss of layer differentiation and a thickening of the intima-media thickness up to 1.3 mm. Areas of increasing echogenicity of the intima with the loss of layer differentiation and a thickening of the intima-media thickness up to 1.3 mm are marked at the bifurcations of both common carotid arteries.
Intraluminal mass, causing reduction of the lumen more than 20%, are not detected. The geometry of the right subclavian, common arteries tract is normal. The right internal carotid artery has a corner bend before entering the cranium, the left internal carotid artery has an S-shaped deformity of the distal aspect. Deformation increasing the flow rate is not fixed.
The diameter of the right vertebral artery is 2 mm, the left vertebral artery is 3.8 mm. Groove for vertebral artery is with vascular permeability (in the b- mode rendered at high quality). The track of both vertebral arteries in the transverse processes channels of the cervical vertebrae and over the grooves are irregular.
The flow velocity in the vertebral artery is at a sufficient level (asymmetry measure time-averaged maximum flow velocity does not exceed 40%), peripheral vascular resistance is normal. In V4 intracranial segments the blood flow velocity is with the same asymmetry, as in extracranial departments.

Intracranial:

The quality of transtemporal imaging is satisfactory. Revealed fragments of both distal ICA, A1 segments of both anterior cerebral arteries, M1-M2 segments of both middle cerebral arteries, P1-P2 segments of both posterior cerebral arteries. The direction of blood flow in these arteries in the base of the brain normal, signs of collateralization are not revealed. Blood flow velocity and peripheral resistance in the arteries of the base of the brain are symmetrical on the sides (In the MCA of 120 cm/s, in PMA - 95 cm/s, in PCA - 55 cm/s). Blood flow velocity and peripheral resistance level of the basilar artery are normal.

Conclusion:

Echosonographic signs of atherosclerosis with localization in the extracranial part brachiocephalic arteries and signs of deformation of both the ICA (presumably as a manifestation of the emerging hypertensive polymacroangiopathy). Variant of the development with a small diameter right vertebral artery, hemodynamic predominance of the left vertebral artery. The deficit of cerebral blood flow in the vertebrobasilar system is not revealed.

Ultrasonography of Kydney.

Kidneys are usually located, symmetrical in size. Right kidney 104х48х45 mm, left kidney 100х48х43 mm). The thickness of parenchyma is 15-17 mm. Cortico-medullary differentiation is expressed. Accessory mass are not revealed. Pyelocaliceal system and ureters are not dilated. Accessory mass are not revealed in paranephral cellular tissue and in the projection of the typical anatomical location of the adrenal glands.

Protocol of stress EKG test - Treadmill.

Name -XXXXX.
Age - XXXXX.
Date of examination - XXXXX.

Protocol - BRUCE.

Cause of ending examination - attaining necessary heart rate. Positive signs of myocardial ischemia is not found.
Irregular heartbeat and asequence is not found.
Patient is not complained.
Exercise tolerance is high.
Normotonic type of blood pressure is responded for stress.
Other specifics of test: functional power is high, high (7,0-10,0 METS). Heartbeat stress response is adequate. Arterial pressure stress response is adequate. During test warn’t angina pectoris, irregular heartbeat and changes of ST-segment. Rest EKG is normal.
Conclusion:
Test is negative. Physical stress tolerance is high. Heartbeat and arterial pressure stress response is adequate.
Examined by XXXXX

Oculist Consultation.

Name - XXXXX.
Age - XXX.
Date of examination - XXXXX.

Patient complaints are headaches and low distance vision.

Anamnesis:
patient hasn’t traumas, operations and inflammatory diseases of eye. Lately patient wears glasses (OU sph +1,0), which are satisfactory to the patient. Patient has high diastolic blood pressure.

Patient examination:
Vis OD =1,2
Vis OS=1,2 Binocular 1,2
In patient reading glasses - 1,0 / 0,8
Intraocular pressure. OD = 10 mm Hg.
OS = 11 mm Hg.


Biomicroscopy of eyes.
OU Conjunctiva is pale-pink and quiet. The cornea is transparent. Front camera is of medium depth. Moisture is transparent. The iris is structural. Pigment border is saved. The pupil in the center, the light reacts adequately. The lens and vitreous body are transparent.

Fundus of eyes:
OU disk of optic nerve is pale-pink, borders is clear. Veins are plethoric, arteries are narrowed. Foveal and foveolar reflexes are normal.

Diagnosis.
OU presbyopia. Hypertensive type of retina angiopathy.

Recommendation:
hypotensive terapie.
MD XXXXX

Duplex ultrasonography.

Distal brachiocephalic trunk and proximal right subclavian artery, common, internal and external carotid arteries, vertebral arteries are defined on both sides. In a typical evaluation sections of the common carotid artery intima- media thickness is not thickened (0.6-0.7 mm), at all evaluated areas preserved layer differentiation.
In the bifurcations of both common carotid arteries indicated the areas of improving the echogenicity of the intima with the loss of layer differentiation and a thickening of the intima-media thickness up to 1.3 mm. Areas of increasing echogenicity of the intima with the loss of layer differentiation and a thickening of the intima-media thickness up to 1.3 mm are marked at the bifurcations of both common carotid arteries.
Intraluminal mass, causing reduction of the lumen more than 20%, are not detected. The geometry of the right subclavian, common arteries tract is normal. The right internal carotid artery has a corner bend before entering the cranium, the left internal carotid artery has an S-shaped deformity of the distal aspect. Deformation increasing the flow rate is not fixed.
The diameter of the right vertebral artery is 2 mm, the left vertebral artery is 3.8 mm. Groove for vertebral artery is with vascular permeability (in the b- mode rendered at high quality). The track of both vertebral arteries in the transverse processes channels of the cervical vertebrae and over the grooves are irregular.
The flow velocity in the vertebral artery is at a sufficient level (asymmetry measure time-averaged maximum flow velocity does not exceed 40%), peripheral vascular resistance is normal. In V4 intracranial segments the blood flow velocity is with the same asymmetry, as in extracranial departments.

Intracranial:

The quality of transtemporal imaging is satisfactory. Revealed fragments of both distal ICA, A1 segments of both anterior cerebral arteries, M1-M2 segments of both middle cerebral arteries, P1-P2 segments of both posterior cerebral arteries. The direction of blood flow in these arteries in the base of the brain normal, signs of collateralization are not revealed. Blood flow velocity and peripheral resistance in the arteries of the base of the brain are symmetrical on the sides (In the MCA of 120 cm/s, in PMA - 95 cm/s, in PCA - 55 cm/s). Blood flow velocity and peripheral resistance level of the basilar artery are normal.

Conclusion:

Echosonographic signs of atherosclerosis with localization in the extracranial part brachiocephalic arteries and signs of deformation of both the ICA (presumably as a manifestation of the emerging hypertensive polymacroangiopathy). Variant of the development with a small diameter right vertebral artery, hemodynamic predominance of the left vertebral artery. The deficit of cerebral blood flow in the vertebrobasilar system is not revealed.

Ultrasonography of Kydney.

Kidneys are usually located, symmetrical in size. Right kidney 104х48х45 mm, left kidney 100х48х43 mm). The thickness of parenchyma is 15-17 mm. Cortico-medullary differentiation is expressed. Accessory mass are not revealed. Pyelocaliceal system and ureters are not dilated. Accessory mass are not revealed in paranephral cellular tissue and in the projection of the typical anatomical location of the adrenal glands.

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