[Pulmonary alveolar proteinosis associated with persistence of SARS-CoV2 virus]. / Legochnyi al'veolyarnyi proteinoz, assotsiirovannyi s persistentsiei virusa SARS-CoV2.

Alveolar proteinosis is a rare lung disease characterized by the accumulation of protein-lipid complexes in the alveoli due to impaired surfactant utilization by alveolar macrophages. The frequency is from 2 to 4 cases per 1 million adult population. We present an observation of pulmonary alveolar proteinosis in a patient with a history of coronavirus pneumonia.

[Modern issues of improving the prognosis in patients with atrial fibrillation after ischemic stroke].

The anticoagulant therapy with a priority of direct oral anticoagulants is an approach to the prevention of recurrent stroke in patients with atrial fibrillation (AF) that has presently proved its efficacy and is stated in international clinical guidelines. An extensive evidence-based database demonstrates advantages of rivaroxaban over other drugs of this class in secondary prevention of stroke in AF. Furthermore, these advantages are combined with the optimal safety profile. The rivaroxaban treatment may provide the most favorable prognosis due to the prevention of recurrent stroke in AF, reducing the rate of kidney disease progression, and slowing vascular atherosclerosis. An important beneficial feature of rivaroxaban is once-a-day intake, which is important in the context of a high incidence of cognitive disorders in this patient category, and may improve their compliance and, thus, help achieving the expected profile of treatment efficacy. Thus, rivaroxaban can be regarded as a drug of choice for secondary prevention of stroke in AF.

[60 years towards definition of dyscirculatory (vascular) encephalopathy: can we put new wine into old wineskins?] / 60 let kontseptsii distsirkuliatornoi éntsefalopatii - mozhno li v starye mekhi nalit' molodoe vino?

The term 'dyscirculatory encephalopathy' (DEP) was proposed in 1958 by Garun Maksudov and Vladimir Kogan for the definition of gradually progressive diffuse brain changes with slowly worsening of cerebral circulation ('dyscirculation') in vascular disorders. The article presents current data on the etiology and pathogenesis of DEP, with the emphasis on its syndromal status, clinical/pathogenetic types of DEP, neuropsychological and neuroimaging signs, which provide a causal relationship to avoid hyperdiagnosis of DEP. In addition, possible methods of treatment and prevention of DEP are considered.

[Neuroimaging and molecular biomarkers of dementia]. / Neirovizualizatsionnye i molekuliarnye biomarkery dementsii.

Development of laboratory diagnosis and neuroimaging revealed a number of biomarkers for in vivo diagnosis of the most common forms of dementia (Alzheimer's disease, Lewy body dementia and vascular dementia). Currently, the highest diagnostic sensitivity and specificity of molecular biomarkers in the cerebrospinal fluid are detected for Alzheimer's disease. At the same time, the changes according to the magnetic resonance imaging are more prognostically significant for future cognitive decline than cerebrospinal fluid biomarkers. Cerebral microbleeds are an available adjuvant diagnostic marker, which increases the diagnostic value of leukoaraiosis that suggests the development of cerebral amyloid angiopathy or hypertensive microangiopathy, especially in cases of mixed pathology and severe cognitive deficits.

[Do cerebral microbleeds increase the risk of hemorrhagic complications of thrombolytic therapy?] / Povyshayut li tserebral'nye mikrokrovoizliyaniya risk gemorragicheskikh oslozhnenii tromboliticheskoi terapii?

The role of the cerebral microbleeds (CMB) as a potential predictor of hemorrhagic complications of thrombolytic therapy is discussed. CMB are small perivascular hemosiderin deposits in the brain detected by magnetic resonance imaging in gradient echo T2* or SWI sequences. They are associated (along with leukoaraiosis or lacunes) with cerebral microangiopathies. Most often CMB are associated with hypertensive arteriopathy (the main cause of CMB localization) or cerebral amyloid angiopathy (the main cause of cerebral CMB). Despite the controversies of recent data, most of researchers agree that thrombolytic therapy in patients with multiple CMB increases the risk of hemorrhagic complications. Neuroimaging diagnosis of CMB may be important in making decision for thrombolytic therapy.

[Clinical and neuropsychological features of Alzheimer's disease in the combination with cerebrovascular disease]. / Kliniko-neiropsikhologicheskie osobennosti bolezni Al'tsgeimera pri ee sochetanii s tserebrovaskulyarnym zabolevaniem.

AIM: To study clinical/neuropsychological and neuroimaging characteristics of Alzheimer's disease in the combination with cerebrovascular disease (CVD). MATERIAL AND METHODS: Ninety patients with dementia, including 35 patients with AD, 35 patients with mixed dementia (MD) and 20 patients with vascular dementia, were examined. The character of dementia was established according to NINCDS-ADRDA and NINDS-AIREN criteria. The neuropsychological battery included Addenbrooke's Cognitive Examination (ACE-R), Montreal Cognitive Assessment scale (MoCA), fluency test and the visual memory test (SCT). Affective and behavioral disorders were assessed with the Cornell Depression Scale in patients with dementia and a short version of NPI-4 in AD patients. Focal and diffuse changes were assessed with MRI. RESULTS AND CONCLUSION: Patients with MD were older, had more often pseudobulbar syndrome (74%), postural instability (66%), frontal gait disorders (57%), Neuropsychological profile of patients with MD had mixed amnestic-dysexecutive character and, depending on the severity of vascular pathology, was closer to AD or to vascular dementia. Neuroimaging changes of patients with MD were correlated with clinical manifestations. The authors propose the approaches to the differential diagnosis of MD that allow to determine the main directions of treatment more precisely and to predict disease course.