[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.

[Polyneuropathies during COVID-19 epidemics]. / Polineiropatii v usloviyakh pandemii COVID-19.

Our review article aimed for analysis of pathogenesis, diagnostyics and treatment of polyneuropathies manifesting in the course of COVID-19. The reasons for hyposmia and taste disturbances are considered in the subjects with this coronavirus infection as well as relationship between these clinical manifestations and severity of the viral infection. Special attention is given to description of autoimmune mechanisms of Guillain-Barré syndrome and polyneuropathies of critical conditions associated with COVID-19. Some data report about clinical deterioration of diabetic and alcoholic neuropathy during the SARS-CoV-2 infection. Inclusion of group B vitamins, together with C and D vitamins, is recommended to the schedules of combined treatment for polyneuropathies in these patients. Early diagnostics of polyneuropathies, especially, Guillain-Barré syndrome, is required during COVID-19 pandemics, thus helping to administer rational therapy and promoting better quality of life in the patients.

[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.

[Cognitive impairments in psychoactive drug addicts].

This short literature review addresses common features of the pathogenesis and treatment of cognitive impairment in people with drug addiction (cocaine, opioids, hashish, amphetamine, benzodiazepines). A role of cholinergic deficit in the development of cognitive impairment and possibilities of its treatment with acetylcholineesterase inhibitions are analyzed.

[Pathogenetic mechanisms of dementia in the older patients with Parkinson's diseases].

The review covers the current literature on the pathogenetic mechanisms of dementia in older patients with Parkinson's disease(PD). The author emphasizes that, along with the degeneration of brain structures, there are vascular changes that promote the development of mixed dementia. Neurodegenerative process and cerebrovascular pathology are in reciprocal relationship and their combination enhances the development of cognitive impairment. The cholinergic deficit is one of the key patterns of pathogenesis of dementia in PD. In this connection, the efficacy of acetylcholinesterase inhibitors: galantamine (reminil),neuromidin, rivastigmine in the treatment of PD patients with dementia is discussed. It is concluded, that correction of vascular risk factors should be administered to older PD patients with mixed dementia. A multidimensional approach with the close relationship between neurologists, psychiatrists and therapists is needed.

[Environmental factors and parkinsonian syndrome].

Particular emphasis has been in recent years placed on the study of an integrating role of medicine in the prevention, early diagnosis, and treatment of diseases associated with the influence of environmental factors. Among nervous system diseases associated with the adverse influence of environmental factors, the parkinsonian syndrome has been the particular concern, which is due to its higher incidence rates and early disability in able-bodied persons. In this connection, the purpose of the study was to review the data available in the literature on the neurotoxicity of heavy metals and other environmental factors causing toxic parkinsonism. The mechanisms of development and the clinical manifestations of the parkinsonian syndrome were considered in occupational manganese poisonings, magnesium deficiency, and carbon monoxide intoxication. Profound assessment of the influence of environmental factors on certain population groups is possible only when hygienists, toxicologists, biochemists, immunologists, molecular geneticists, and clinicians combine their efforts.

Raised prolactin levels in myasthenia gravis: two case reports and a study of two patient populations.

OBJECTIVES: To describe two patients with myasthenia gravis (MG) and prolactinoma and analyze the associations between MG and prolactin (PRL) levels. DESIGN: Two case reports and a case-control study of PRL levels in 192 patients with MG. PARTICIPANTS: The Immunological Research Laboratory, Center for Molecular Medicine, Department of Medicine and the Department of Neurology, Karolinska Institutet, Stockholm, Sweden; St Petersburg Medical Academy for Postgraduate Studies, and St Petersburg State Medical Pediatric Academy, Russia. RESULTS: Two women with MG and thymic hyperplasia accompanied by prolactinomas are described. The levels of plasma PRL were raised in 101 women with MG, but not in 91 men. There was an association between high PRL levels and high levels of autoantibodies against the acetylcholine receptor. CONCLUSIONS: There is an association of MG with raised levels of PRL in women. PRL has stimulating effects on immune activation and the increased levels might thus be implied in the pathophysiology of MG.

[Forensic medical differential diagnosis of craniocerebral trauma in children].

It is emphasized that history, complaints, a comprehensive neurological examination, craniography are not often sufficient for differentiation between brain concussion and mild brain contusion in children because of specific characteristics of craniocerebral trauma (CCT) in such patients. To make an adequate forensic medical diagnosis of CCT in children, it is necessary to take into consideration anatomophysiological peculiarities of a child, biomechanical conditions of the brain injury, to apply modern methods of neurovisualization (ultrasonography, computed and MR imaging), to follow up brain function with quantitative electroencephalography. Improvement of differential forensic-medical assessment of CCT severity in childhood should be made according to the principles of evidence-based medicine.

[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.

[Peculiarities of the forensic medical expertise of the head trauma in children]. / Osobennosti sudebno-meditsinskoi ékspertizy pri travme golovy u detei.

One hundred and forty (140) medicolegal reports were analyzed in cases of non-lethal trauma of the head in children and teenagers. The specificity of the clinical pattern related with the anatomic-and-physiological peculiarities of child's body was defined. The forensic-medical expertise in such damages needs an elaboration of diagnostic criteria (e.g. an interim stage in craniocerebral trauma) that would be valuable both for medico-legal experts and for neurologists; besides, there is also a need in using the modern methods of neuro-visualization.

[Specific features of pathogenesis and diagnosis of hemorrhagic stroke in young patients]. / Osobennosti patogeneza i diagnostiki gemorragicheskogo insul'ta u lits molodogo vozrasta.

The paper deals with hemorrhagic stroke (HS) pathogenesis and diagnosis in young people. Among cerebrovascular diseases in the young acute hemorrhagic strokes take noticeable place. Arterial hypertension, diabetes mellitus, smoking, alcoholism are among risk factors of subarachnoidal hemorrhage (SAH). Massive hemorrhages occur in the rupture of arterial aneurysms and arteriovenous malformations. HS in the young may be caused by blood diseases, i.e. leukemias, hemophilias, idiopathic thrombocytopenic purpura, coagulopathies; vasculitis in diffuse diseases of the connective tissue; non-inflammatory arteriopathies; drug addiction. Genetic predisposition to HS development is discussed with focus to such diseases as a family form of moya-moya disease, glucocorticoid-depressed hyperaldosteronism, elastic pseudoxanthoma, Marfan's syndrome, renal olycystosis, Sturge-Veber syndrome. It is recommended to use wider updated methods of neurovisualization (CT, MRT, angiography) in diagnosis of HS. The conclusion is made that HS diagnosis, especially in the young, needs a multidisciplinary approach with active participation of neurologist, neurosurgeon, therapist, endocrinologist, hematologist.