[Diagnosis of isolated angiitis of the central nervous system].

We have analyzed clinical presentations, neuroimaging data, blood and cerebrospinal fluid diagnostic tests in isolated angiitis of the central nervous system on the basis of data of recent publications and 22 our own cases. Due to the insufficient diagnostic value of invasive methods including biopsy of leptomeningeal and intracerebral vessels, we considered practical approaches to the diagnosis of cerebral vasculitis and ways of its optimization. We suggested the stratification of clinical, neuroimaging and laboratory criteria for the evaluation of their sensitivity and specificity and for the development of diagnostic algorithms.

[Current possibilities of the comprehensive diagnostic assessment in the differential diagnosis of inflammation and tumors of the spine cord].

The article discusses the differential diagnosis of transverse myelitis. An algorithm for the assessment of patients was given. The authors present two clinical examples demonstrating the role of the integrated neuroradiological approach in the differential diagnosis of difficult cases.

[Multiple sclerosis in children and adolescents: history and current experience of immunomodulating treatment]. / Rasseiannyi skleroz u detei i podrostkov: istoriia izucheniia problemy i sovremennyi opyt immunomoduliruiushchego lecheniia.

An agreement accepted worldwide for treatment of multiple sclerosis (MS) in adult patients has not been achieved so far for children and adolescents, mostly due to the insufficient information on the features of MS with early age-at-onset. New methods of immunomodifying treatment and the conception of early MS treatment have changed the attitude to prognosis of MS with early onset. In such cases, a course of the disease is less aggressive and characterized by more intensive remyelination as well as brain plasticity and less neurological deficit that may predict highest efficacy of the disease modifying treatment timely started in these patients. Such drugs, as beta-interferons, glatiramer acetate and high-dosage intravenous immunoglobulines G, which are able to decrease MS relapse frequency and disability progression in adult patients, are poorly studied in children and adolescents. Preliminary positive results of international and Russian investigations on the efficacy and tolerability of immunomodulating therapy of MS with early age-at-onset require further investigations in this field.

[Multiple sclerosis with childhood onset]. / Rasseiannyi skleroz s debiutom v detskom vozraste.

The clinical manifestations, magnetic resonance imaging (MRI) data, blood and cerebrospinal fluid (CSF) tests were analyzed in 19 patients with early-onset (before the age of 17 years) multiple sclerosis (MS) and in 100 patients with the definite diagnosis of MS with adult onset. Between group differences in sex ratio and initial neurological symptoms, with the prevalence of acute brainstem dysfunction (37%) and optic neuritis (37%) in the patients with early onset MS, were revealed. In childhood, the disease course was poorer with early disablement on the background of attendant unfavorable conditions. A sensitivity of various MRI parameters was analyzed and the essential proportion of the tumor-like acute inflammatory lesions was shown in early onset MS (29%). Immunological tests (albumin coefficient evaluation) revealed that in early onset MS hematoencephalic barrier dysfunction was registered more often, comparing to adult onset MS (100% vs 50%). The peculiarities of biases in concentrations of kappa-free and lambda-free light immunoglobulin chains in blood and CSF were detected. Higher levels of the kappa-free light chains concentrations in CSF were mostly found in the patients both with early and adult onset MS (86% and 99%, respectively) that confirmed the diagnostic value of this index. The results obtained may improve MS diagnosis in children.

[UV irradiation of the cerebrospinal fluid in the treatment of patients with disseminated sclerosis]. / UF-obluchenie tserebrospinal'noi zhidkosti v lechenii bol'nykh rasseiannym sklerozom.

Cerebrospinal fluid (SF) in the quantity 5-7 ml from 26 multiple sclerosis patients was exposed to UV radiation with subsequent reinfusion. The assessment of clinical symptoms and immunological indices 7 days later showed that positive results (6 scores by Sipe scale) were achieved in 14 patients with cell abundance in the SF. The improvement was indicated by positive trends in pelvic functions, sensory and coordination disorders, normalization of the blood immunological picture. The responders exhibited elevated SF levels of B-lymphocytes, phagocytosing cells and IgM concentrations. High levels of IgG registered in 58% of the patients did not change. The only side effect was represented by short-term postpuncture syndrome in 4 patients with arterial hypotension. In 12 patients with progressive sclerosis the treatment was ineffective.

[Efferent methods of the treatment of cerebrospinal fluid hypertension in exacerbation of multiple sclerosis]. / Efferentnye metody lecheniia likvornoi gipertenzii pri ékzatserbatsii rasseiannogo skleroza.

Analysis is made of the efficacy of the treatment of CSF hypertension in 40 patients in the phase of exacerbation of multiple sclerosis. Use was made of sorption detoxication methods: hemoperfusion (the author's certificate No.1466754) and enterosorption (the priority certificate No.4465054/14 (115542) dated July 22, 1988). SKH-IK and SKH-2K sorbents were employed as hemoperfusion, using the venovenous scheme of perfusion, the volumetric rate of the blood flow being 100-120 ml/min during 2-3 hours. Altogether 2-3 sessions were carried out, with an interval of 5 to 7 days. For enterosorption, use was made of a crumbled up filamentous carbonic sorbent in a dose of 50-60 mg per kg bw 3 times a day for 20 days in 2 hourly intervals between food intake. Regression of the neurological symptoms began 2-3 hours after the first session of hemoperfusion and 5-6 days after the beginning of the intake of the filamentous carbonic sorbent, increasing throughout the whole treatment course. That coincided with the disappearance of CSF hypertension and normalization of the immunological spectrum of the blood serum. Sorption detoxication brought about no complications and is a method of choice in the treatment of CSF hypertension in patients in the phase of multiple sclerosis exacerbation.