[Features of the patient management with traumatic brain injury]. / Osobennosti vedeniya patsientov s cherepno-mozgovoi travmoi.

The aim of our study was to consider features of pathogenesis, diagnosis and therapy of traumatic brain injury (TBI) from the viewpoint of neurologist. The mechanisms of emerging injury of the central nervous system, including neuro-inflammation and oxidative stress in patients with TBI, and correlations between clinical manifestations and severity of TBI are discussed. Special attention is paid to the description of certain TBI consequences, e.g. structural drug-resistant epilepsy and post-traumatic stress disorder. We provide evidence for difficulties and lesser availability of rehabilitation programs to patients with TBI during COVID-19 pandemics. One should mention a need for administration of Mexidol as the antioxidant/antihypoxant drug into complex therapy of TBI in such patients. In the period of COVID-19 pandemics, the role of neurologist in management of TBI patients still increases, especially, at the outpatient treatment stage, and when carrying out therapy and medical rehabilitation programs.

[Specifics of diagnosis and treatment of diabetic polyneuropathy in elderly patients]. / Osobennosti diagnostiki i lecheniia diabeticheskoi polineiropatii u patsientov starshikh vozrastnykh grupp.

AIM: To study the specifics of diagnosis and treatment of diabetic polyneuropathy in elderly patients. MATERIAL AND METHODS: Forty-two patients (22 men and 20 women, aged from 65 to 75 years) with diabetes mellitus type 2 and diabetic polyneuropathy were studied using the following psychometric scales: the Michigan Neuropathy Screening Instrument (MNSI), Neurological symptoms scale (NSS), Neuropathy Disability Score (NDS), the Numerical Rating Scale (NRS), Kaplan-Feinstein index (KFI), the Covi Anxiety Scale (COVI), the Recovery Locus of Control Scale (RLOC). Patients were divided into group 1 (n=24) treated with neuromultivit injections, along with standard treatment, and group 2 (n=18), which received standard treatment only. Patients were examined at baseline and one month after treatment. RESULTS: In elderly patients, diabetic distal symmetric sensorimotor polyneuropathy of moderate severity was comorbid mostly with cardio-vascular disease. Pain syndrome was associated with anxiety and significant direct correlation between anxiety and pain intensity was found. The level of motivation towards recovery was significantly lower and correlated with COVI scores. CONCLUSION: Injections of neuromultivit decrease the intensity of pain, improve the emotional state and increase the level of motivation towards recovery.

[Assessment of clinical manifestations and treatment of post-stroke depression in young patients with ischemic stroke]. / Otsenka klinicheskikh proiavlenii i lecheniia postinsul'tnoi depressii u patsientov molodogo vozrasta, perenesshikh ishemicheskii insul't.

AIM: To consider clinical manifestations and treatment of post-stroke depression in young patients with carotid ischemic stroke. MATERIAL AND METHODS: Forty patients, 24 women and 16 men, aged from 18 to 45 years old, diagnosed with ICD-10 post-stroke depression were examined. All patients underwent neurological examination, brain MRI and MR-angiography of cerebral vessels. The following psychometric tests were used: MMSE, Hamilton depression scale, CES-D depression scale, a questionnaire on nocturnal sleep assessment, and Epworth Sleepiness Scale. The Recovery Locus of Control Questionnaire was administered to evaluate motivation level for the post-stroke recovery. Patients were divided into two groups: group 1 (n=22) received basic treatment including milnacipran hydrochloride (ixel) in dose 1 capsule twice a day during 3 months, group 2 received only basic treatment. Psychometric testing was performed 2 month after stroke before the treatment and 3 month after the end of treatment. RESULTS AND CONCLUSION: Patients demonstrated positive (melancholy, anxiety, intellectual and motor inhibition) and negative affectation (apathy, dysphoria) accompanied by somatic/autonomic disorders, in particular, sleep deficiency. A marked therapeutic effect of ixel was shown in group 1. The number of patients with depression decreased significantly after treatment compared to group 2. Sleep improvement and increased motivation levels for recovery were observed as well.

[Diagnosis and treatment of dorsopathy in patients with connective tissue dysplasia]. / Osobennosti diagnostiki i lecheniia dorsopatii u patsientov s displaziei soedinitel'noi tkani.

AIM: To study the pathogenesis, clinical manifestations and treatment of dorsopathy in patients with connective tissue dysplasia. MATERIAL AND METHODS: Thirty-six patients, aged from 18 to 45 years, with lumbar-sacral radiculopathies associated with connective tissue dysplasia were examined. Detailed neurological examination, X-ray visualization and MRI of lumbosacral spine section, electromyographic assessment were performed. A five-point scale of neuro-vertebrological symptoms, the Numerical Rating Scale (NRS) and the Roland-Morris Low Back Pain and Disability Questionnaire were used. RESULTS AND CONCLUSION: The results contained own data on the pathogenesis, clinical manifestations and treatment of dorsopathies in connective tissue dysplasias. Inclusion of long-acting pentoxifylline (vasonite) in the combined therapy in patients with dorsopathy associated with connective tissue dysplasia had a positive effect on disease course, decreased pain intensity and improved life activities.

[Ischemic cerebral stroke in the young].

The authors of the review discuss etiological factors, pathogenesis, and diagnostic peculiarities of ischemic stroke in young patients (less than 45). Special attention is paid to the role of arterial hypertension, heart diseases, and blood pathology in ischemic stroke pathogenesis. The frequency of brain infarction grows due to meningovascular syphilis and drug abuse. Genetic aspects of ischemic stroke are discussed in detail. Brain infarction diagnostics is shown to require interdisciplinary approach, which provides early diagnosis, timely and appropriate therapy, favorable outcome, and prevention of recurrent ischemic strokes in young patients.