[COVID-19 and cerebral stroke]. / COVID-19 i tserebral'nyi insul't.

OBJECTIVE: To analyze mortality rates, rehabilitation potential, and features of the course of stroke in patients with COVID-19. MATERIAL AND METHODS: The study included 50 patients in the acute period of stroke who were diagnosed with a new coronavirus infection during treatment. For comparison, we selected a group of 50 patients who had stroke during this period. RESULTS: In the study group, the virus was identified in 38 (76%) patients by polymerase chain reaction (PCR). The onset of symptoms of acute respiratory viral infection or fever was observed on average 11 days after the onset of neurological symptoms. Only in 10 (20%) patients, a PCR smear showed a positive result in the first 24 hours after the development of a stroke. In the main group, death was observed in 30% (n=15) of cases; in the comparison group - in 6% (n=3) cases. Also, in the main group of patients, a lower degree of recovery of impaired neurological functions was noted on the National Institutes of Health Stroke Scale (NIHSS). At discharge from the hospital, 33 (66%) patients had moderate and severe disabilities according to the modified Rankin scale (3-4 points). The differences were statistically significant, as in the main group there was more pronounced disability than in the control group. Lymphopenia was noted in 26 (52%) patients of the main group on admission. CONCLUSION: Increased mortality rate, decreased recovery of neurological functions and severe disabilities are observed in the group of patients with stroke who were infected by COVID-19. Lymphopenia in a patient with stroke can serve as a prognostic marker of the possible presence of COVID-19 and the degree of lung tissue damage.

[Rehabilitation of the motor function of the upper limb using 3D audio-visualization in patients with acute stroke]. / Vosstanovlenie dvigatel'noi funktsii verkhnei konechnosti s pomoshch'yu 3D-audiovizualizatsii u bol'nykh s ostrym narusheniem mozgovogo krovoobrashcheniya.

OBJECTIVE: To analyze the effectiveness of the developed technique of «3D audio-visualization¼ in restoring the motor function of the upper limb in the acute period of stroke. MATERIAL AND METHODS: The study included 20 patients in the acute period of stroke. All patients had impaired motor function of the upper limb in the form of paresis of the proximal muscle groups. The control group was enrolled according to standard methods. The treatment was well tolerated, there were no adverse effects. RESULTS: In the study group, a more complete restoration of the motor function of the upper limb is observed compared with the control group. There is also a positive effect of the proposed technique on patients in the acute period of stroke. CONCLUSION: The prospective and cost effective technique is suggested. It can be also used by the patient in the outpatient rehabilitation phase.

[Modern trends in primary disability due to cerebrovascular diseases in a large city]. / Sovremennye tendentsii pervichnoi invalidnosti vsledstvie tserebrovaskuliarnykh boleznei v megapolise.

AIM: To study the primary disability due to cerebrovascular diseases (CVD) in St.-Petersburg for 13 years (from 2004 to 2016) according to the data of the medical-social expertise institution. MATERIAL AND METHODS: Based on the official statistics, the prevalence, level and structure of primary disability due to CVD in St.-Petersburg for 13 years (from 2004 to 2016) were analyzed. RESULTS AND CONCLUSION: With the increase in overall incidence of CVD by 1.3 times during the study period and the increase in primary morbidity due to CVD by 2 times, there was a decline by 3.1 times of indicators of primary disability. The level of primary disability in people of retirement age due to this disease during the entire observation period was significantly higher than in the working age group (4.3-fold). The structure of primary disability due to CVD in people of working age is dominated by persons with disabilities of III group, whereas among the elderly, the vast majority were people with group II disability, however, the 13-year dynamics shows that their share has decreased in 1.4 times. There was a significant difference between the indicators of primary disability due to CVD in St.-Petersburg in comparison with the Russian Federation, connected, in our opinion, with the special demographic composition of the residents of the city and a predominance of people of retirement age.

[Medical-social expertise in epilepsy]. / Mediko-sotsial'naia ékspertiza pri épilepsii.

AIM: Clinical and expert analysis of the data, determining the severity of permanent disabilities in patients with epilepsy, based on the new classifications and criteria used for the implementation of medical and social examination from 2016. MATERIAL AND METHODS: Two hundred acts of examination of patients with epilepsy in medical and social examination bureaus were analyzed using statistical, clinical expertise and graphic methods. RESULTS AND CONCLUSION: A clinical expert analysis showed that the assessment of the limitations of life in epilepsy patients and people with disabilities requires an integrated approach. Not only seizures (their severity and frequency), but also gradually growing changes of the cognitive sphere and personality disorders, should be taken into account when making expert decisions. A typology of the formation of individual rehabilitation programs is presented.

[The International Classification of Functioning, Disability, and Health in the practice of a sociomedical examination service for internal diseases].

The paper gives the International Classification of Functioning, Disability, and Health (ICF), interactions between health changes, the personality and social factors of an individual with therapeutic diseases to define disability criteria and a scientific rationale for the necessity and scope of rehabilitative measures through public health and social protection organizations.

[Various indicators of serotonin metabolism in the cerebrospinal fluid of patients with neurasthenia and cerebral arachnoiditis]. / Nekotorye pokazateli obmena serotonina v likvore bol'nykh nevrasteniei i tserebral'nym arakhnoiditom.

Thirty patients with cerebral arachnoiditis and 26 with neurasthenia were found to have differences in the content of serotonin, 5-hydroxyindoleacetic++ acid and melatonin in the cerebrospinal fluid, which depended in arachnoiditis on the degree of intracranial pressure elevation. The data on serotonin metabolism can be used in objective evaluation of the organic background in neurotic patients and serve for estimating the intensity of hypertension in patients with cerebral arachnoiditis.

[Serotonin and kinins in the cerebrospinal fluid in brain tumors]. / Serotonin i kininy likvora pri opukholiakh golovnogo mozga.

Concentrations of serotonin, 5-hydroxyindoleacetic acid, melatonin and parameters of the kinin system in the cerebrospinal fluid were monitored in 109 cases of brain tumor. All the levels were increased prior to surgery but returned to normal postoperatively unless disease followed an unfavorable course. It was suggested that the above-mentioned physiologically active substances play a certain role in compensatory mechanisms assuring recovery of CNS function.

[Neuropeptide factors of pathogenesis of brain-related motor disorders]. / Neiropeptidnye faktory patogeneza tserebral'nykh dvigatel'nykh rasstroistv.

Overall 136 patients with cerebral tumors, sequels of craniocerebral injury and brain strokes with motor disorders of varying intensity were examined. Factors of the peptide nature, provoking postural asymmetry of the homolateral hind limb in an experimental animal were detected in the blood and CSF of the overwhelming majority of the patients. Provided the compensatory process runs a favorable course (recovery of motor functions), the neuropeptide factors are inactivated with inactivating substances. The data obtained attest to the advisability of further studies into the activity and nature of the factors of postural asymmetry in patients with cerebral motor disorders with a purpose of elaborating new methods of treatment and rehabilitation.

[The pseudotumorous course of ischemic myelopathies]. / Psevdotumoroznoe techenie ishemicheskikh mielopatii.

Study of 36 cases of ischemic myelopathy following a pseudotumorous course and 30 cases of spinal cord tumors revealed similarity and differences in the clinical manifestations which should be taken into account in differential diagnosis. Authentic differences in the content of serotonin and its metabolites in the cerebrospinal fluid and blood of this group of patients are pointed out.

[Serotonin and its metabolites in the cerebrospinal fluid and blood of patients with tumors of the spinal cord]. / Serotonin i ego metabolity v likvore i krovi bol'nykh s opukholiami spinnogo mozga.

Twenty-six patients with extra- and intramedullary tumors of the spinal cord had a considerably increased content of serotonin, 5-hydroxyindoleacetic acid, and melatonin in the cerebrospinal fluid (highest in patients with total blockade of the subarachnoid space) as well as of serotonin in blood platelets. The results of tests for serotonin metabolism can be used as a diagnostic test in the early stages of the tumor growth and are an additional factor in determining the indications for contrast examination of patients with a suspected spinal tumor.

[Cerebrospinal fluid and blood kinins of patients with cerebral circulatory disorders]. / Kininy likvora i krovi u bol'nykh s narusheniiami mozgovogo krovoobrashcheniia.

The kallikrein-kinin system components were examined in the cerebrospinal fluid and the blood of patients with acute cerebral circulation disorders at various intervals after the vascular episode. A considerable increase in the content of all the substances being examined in the patients' cerebrospinal fluid was shown, this increase being not dependent on the stroke character. An activation of the kallikrein-kinin system was observed in the blood plasma within the first 20 days after the vascular episode. In young patients, these changes were more pronounced. The changes in the kallikrein-kinin system components, along with those of other vasoactive substances may take a certain part in the pathogenetic mechanisms of the cerebral stroke.