CLINICAL СASE: 41-YEAR MAN WITH NEUROLOGICAL SIGNS AND BACK PAIN AFTER PHYSICAL EXERCISES AND UNUSUAL IMAGING APPEARANCES.

The aim was to describe the uncommon cause of back pain with successful treatment, precise diagnostic and good outcome. Lower back pain is prevalent among all the age groups and can derive from many potential anatomic sources. Here is presented the case of atypical course of back pain and neurological signs with point on importance of astute visualizations technics. This clinical case of 41-year old male patient who got back pain and neurological signs after intensive physical exercises and had no adequate response for anti-inflammatory and analgesic drugs demonstrated the importance of appropriate visualization and considering non-standard causes of these symptoms. This allowed to prescribe effective treatment with good outcome during follow-up period. This could be the supporting evidence for including such additional visualization in protocols for non-typical back pain after strenuous physical activity. Back pain is common condition with a variety of causes. It is important to consider them in case of inadequate results of treatment and use non-conventional investigation if appropriate, which improves the outcome. This could be the supporting evidence for including such additional visualization in protocols for non-typical back pain after strenuous physical activity.

The Co-Pilot Project: An International Neurosurgical Collaboration in Ukraine.

OBJECTIVE: We aim to provide a thorough description of the efforts and outcomes of the Co-Pilot Project in Ukraine, which facilitates neurosurgical collaboration between American and Ukrainian physicians. METHODS: The Co-Pilot Project, which operates under its parent nonprofit organization, Razom, organized multiple trips for American physicians to Ukraine. Activities included consulting in clinic, assisting with neurosurgical operations, and providing didactic lectures. Further efforts have included coordinating training opportunities for Ukrainian surgeons. We retrospectively reviewed all operations performed by Ukrainian partner physicians alongside American co-pilot physicians across Ukraine since August 2016. RESULTS: Teams of Ukrainian and American physicians operated on 78 patients (24 children and 54 adults) for a total of 84 procedures in 5 different cities (Kyiv, Lutsk, Lviv, Odessa, and Stryi) of Ukraine. Operations were classified into the following categories: adult brain tumors (n = 39), adult spine tumors (n = 1), epilepsy (n = 9), pain (n = 2), pediatric brain tumors (n = 11), vascular/endovascular (n = 10), and miscellaneous (n = 12). Four illustrative cases are described in detail. Of the patients with brain tumors, 43.5% (20/46) had giant tumors, and gross total resection or near-total resection was achieved in 78.3% (36/46). CONCLUSIONS: Profound disparities in neurosurgical care exist globally, which has led to the formation of collaborative relationships between physicians from various countries. We hope that the work of the Co-Pilot Project in Ukraine can serve as a template for effective international neurosurgical collaboration in other low-to-middle-income countries.

Stroke in the artery of percheron territory: the two edges of one diagnosis.

Occlusion of artery of Percheron is a rare condition caused by a peculiar anatomic variation in cerebral blood supply, leading to a bilateral thalamic infarction. Strokes in artery of Percheron account for 0.1% to 2% of all cerebral infarctions. Thalamic area is supplied by the arteries arising directly from the P1 segment of the posterior cerebral artery. However, in 1/3 of cases the supply is provided by a single trunk referred to as artery of Percheron (AOP). Early diagnosis of stroke in AOP can be very challenging due to an ambiguous clinical presentation and the absence of neurovisualization findings. This article presents two clinical cases of stroke in artery of Percheron observed at Lviv Emergency Hospital. Different clinical progression of a cerebrovascular accident contrasted with a similar neurovisualization pattern was a distinctive feature in these patients. Taking into consideration the rarity of this condition and a characteristic clinical presentation, these clinical cases were retrospectively analyzed and compared. A stroke in AOP should be suspected in all patients with symptoms of interrupted blood supply in the vertebrobasilar territory. The diagnosis primarily depends on clinical features; patients with paramedian bilateral thalamic lesions may develop sudden problems with consciousness, vertical gaze palsy and memory disorders. Early diagnosis of this condition allows for more effective therapeutic interventions and improves patient prognosis.

The significance of νо gas transmitter and nucleases in shaping the sequelae of traumatic brain injury

Introduction: Traumatic brain injuries are at present remaining an important worldwide medical problem due to substantial percentages of incapacitation and lethality, especially among people of working age. All therapeutic interventions in TBI and their timeliness and efficacy depend on timely and quality diagnosis of patient's condition, including laboratory parameters of blood and urine. The aim: To assess for peculiar patterns in changes of NO gas transmitter levels in patients with severe traumatic brain injury during the treatment period and to investigate into its relationship with nuclease enzymes in the context of various treatment outcomes. Material and methods: This research work has used clinical data, history and diagnostic tests obtained in 72 patients with severe traumatic brain injury, age 18 to 76 years (mean age 42.26±15.02 years), who six months later have been divided into the following four groups according to Glasgow outcome scale: "Death", "Severe disability", "Moderate disability" and "Recovery". Results: Biochemical assessments in patients with severe traumatic brain injury have shown supranormal levels of urinary nitric oxide and serum DNAses. Going forward, nitric oxide levels significantly decreased over the time of treatment in subjects with favorable outcomes ("Moderate disability" and "Recovery" groups) and increased with treatment time in subjects with unfavorable outcomes ("Severe disability" and "Death" groups). The diagnostic markers of further unfavorable survival outcomes may be present at the onset of treatment (Day 1) and may include urinary levels of nitric oxide below 1.1 µmol/L and DNAse levels below 26 µU/mL. A positive diagnostic sign of favorable survival and health outcomes may include DNAse І levels over 30.0 µU/mL from Day 7 of treatment. Conclusions: The findings of this work can be used when making a diagnosis/selecting an optimal treatment schedule and predicting the sequelae of traumatic brain injury in a patient, which may cumulatively minimize the impact of the injury.

Changes of nitric oxide synthase and hydrogen sulfide in blood lymphocytes in the acute period of polytrauma

Introduction: Polytrauma patients have high risk of shock, septic complications and death during few years of follow-up. In recent years a lot of attention is paid to gaseous transmitters, among which are nitrogen oxide (NO) and hydrogen sulfide (H2S). It is known that the rise of NO and its metabolites levels occurs during the acute period of polytrauma. Nitric oxide and hydrogen sulfide are produced in different cell types, among which are lymphocytes. The aim: To investigate the levels of NO, NOS, iNOS, еNOS, H2S in lymphocytes lysate in patients at the moment of hospitalization and 24 hours after trauma. Materal and methods: We investigated the levels of NO, NO-synthase, inducible NO-synthase, endothelial NO-synthase, H2S in lymphocytes lysate in patients at the moment of hospitalization and 24 hours after trauma. Results: The study included 20 patients with polytrauma who were treated in the intensive care unit (ICU) of the Lviv Emergency Hospital. Tissue injury was associated with an increased production of NO, NOS, iNOS, еNOS during the acute period of polytrauma. At the same time, the level of H2S decreased by the end of the first day of traumatic injury. Conclusions: In acute period of polytrauma, significant increasing of iNOS and eNOS occurs with percentage prevalence of iNOS over eNOS on the background of H2S decreasing.