[Cognitive impairment in multiple system atrophy - exclusion criteria or an integral part of the clinical picture?] / Kognitivnye narusheniya pri mul'tisistemnoi atrofii ­ kriterii isklyucheniya ili neot"emlemaya chast' klinicheskoi kartiny?

Multiple system atrophy (MSA) is a severe, orphan disease characterized by a steady increase in symptoms of parkinsonism, cerebellar disorders, and autonomic failure. In addition to autonomic failure, which is considered the defining symptom of this type of atypical parkinsonism, there are a range of other non-motor clinical manifestations, such as sleep disorders, pain syndrome, anxiety-depressive disorders, cognitive impairment (CI). CI, especially severe CI, has long been considered as a distinctive feature of MCA. Recently, there have been many clinical studies with pathomorphological or neuroimaging confirmation, indicating a high prevalence of cognitive disorders in MCA. In this article, we discuss the pathogenetic mechanisms of the development of MCA and CI in MCA, as well as the range of clinical manifestations of cognitive dysfunction.

[Neurological disorders in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)]. / Nevrologicheskie rasstroistva pri éozinofil'nom granulematoze s poliangiitom (sindrom Cherdzha-Strossa).

Eosinophilic granulomatosis with polyangiitis - EGPA (Churg-Strauss syndrome) is a rare autoimmune disorder. The pathogenesis of the disease includes production of anti-neutrophil cytoplasmic antibodies directed against myeloperoxidase with the development of small-vessel necrotizing vasculitis and eosinophilic infiltration of organs. The involvement of peripheral and central nervous system is observed in more than 3/4 of cases. The authors describe three patients with EGPA. In a 53-year-old male patient, EGPA manifested with multiple neuropathies, which regressed after treatment with corticosteroids and cytostatics. In a 34-year-old woman, cerebral sinus thrombosis and cerebral infarction developed in the non-active period of long-term EGPA. The patient was treated with anticoagulants. A 77-year-old woman with a newly diagnosed EGPA, confirmed by bone marrow examination for eosinophilia, developed ischemic stroke and polyneuropathy. The causes and mechanisms of development as well as dynamics and outcomes of neurological disorders, differential diagnosis, treatment and prognosis of eosinophilic granulomatosis with polyangiitis are discussed.

[Natural neurotrophic IgG autoantibodies in the blood serum of patients with different clinical outcomes after ischemic stroke].

Recent studies revealed a role of natural neurotrophic IgG autoantibodies (NNAA) in the trophic supply of nervous tissue and modification ability of neuronal networks. Changes of the NNAA level likely may reflect direction (compensation, decompensation) of cytochemical and morphologic alterations of nervous tissue in acute focal ischemia, thus, having certain prognostic value. To assess the dynamics of NNAA in the blood serum on 3, 7, 14 and 21 days after ischemic stroke and 3 months after the disease, 84 patients (mean age 68+/-10 years) with first-ever stroke in the system of internal carotid artery were studied. NNAA immunoreactivity to four nervous tissue proteins, S100b, GRAP, MP-65, NGF, was conducted using ELIZA method. Patients' outcomes were assessed with the Barthel Index and NIH on the 3rd month of the disease. In the acute period of stroke, the changes of immunoreactivity, comparing to controls, were found in 95% o cases (p<0,01), the level of NNAA pathologically increased or decreased. The increase of NNAA level was revealed in 45 patients (56% cases) with satisfactory clinical rehabilitation on 7-14 days (p<0,0001) with the following normalization of these parameters to the 21st day. In case of unfavorable outcomes, the prolonged increase of the NNAA level or decrease of immunoreactivity (p<0,0001) was found in 44% of cases. The changes of NNAA level were observed in 60 patients on the 3rd month of the disease, i.e. the protracted decrease of immunoreactivity was found in 42 patients and increase - in 18 cases (p<0,01). The quantitative changes of NNAA likely indicate the adaptive-compensative reaction of the immune system. The character of immunoreactivity changes is related to reparative neuroplasticity and may be of prognostic value.

[A differentiated approach to Parkinson's disease treatment in early stage of the disease]. / Differentsirovannyi podkhod k lecheniiu patsientov s bolezn'iu Parkinsona v rannem periode.

A conception of the approach to Parkinson's disease treatment at early stage, which could be realized in practice is suggested. The conception is based on the results of dopaminergic drugs treatment of 149 patients, aged 33-87 years. The patient's state was assessed by neurological examination and clinical scales with regard to different disease types, tremor and rigid, and levodopa doses--from moderate (up to 500 mg) to high (above 500 mg). A general treatment policy, including therapy directed to activation of regulatory and compensatory influences and differentiated usage of levodopa and combined therapy with levodopa and dopamine agonists, is presented.

[Prognosis of the course of acute cerebrovascular pathology]. / Prognozirovanie kharaktera ostroi tserebrovaskuliarnoi patologii.

The authors used numerical methods to comparative characterization of patients with TIAs- and offered 10 prognostic criteria to predict the course of the disease for nearest 6 to 12 h.