[Cerebral amyloid angiopathy]. / Tserebral'naya amiloidnaya angiopatiya.

Cerebral amyloid angiopathy (CAA) is a progressive disease characterized by the deposition of ß-amyloid in the walls of blood vessels in the brain, which leads to their damage and disruption of normal blood flow. Morphologically, CAA is characterized by both isolated lesions (microhemorrhages with the appearance of cortical superficial siderosis, lacunar infarctions) and widespread changes (hyperintensity of the deep and periventricular white matter, expansion of the perivascular spaces) of cortical and subcortical localization. CAA is considered a major cause of cognitive impairment and intracerebral microbleeds, especially in patients with Alzheimer's disease. The review presents modern ideas about the etiology, pathogenesis, clinical manifestations of CAA, and also outlines the provisions of the Boston principles of CAA, revised in 2022. Understanding the features of pathogenetic methods of CAA is crucial for adjusting the accuracy of diagnosis and developing treatment methods to preserve and prolong cognitive health.

[The multidirectional effects of thrombin and the possibility of their control in neurology]. / Raznonapravlennye effekty trombina na protsessy gemokoagulyatsii i vozmozhnost' ikh kontrolya v nevrologii.

The review presents the main physiological functions of thrombin. The procoagulant and anticoagulant activities of the key serine protease are discussed in both physiological and pathological conditions of hemostasis. The involvement of thrombin in atherogenesis, as well as its role as a mediator of vascular dysfunction and inflammation in both the peripheral and central nervous system, is highlighted. A pronounced imbalance between the pro- and anticoagulant systems leads to an increase in thrombin formation and creates conditions for the development of thrombosis. Tests that allow direct or indirect assessment of thrombin's functional activity are presented. The potential applications of direct thrombin inhibitors and direct blockers of thrombin PAR receptors in vascular neurology are also considered.

[Cognitive impairment in patients with atrial fibrillation]. / Kognitivnye narusheniya u bol'nykh s fibrillyatsiei predserdii.

Atrial fibrillation (AF) is a serious medical and social problem, being a common cause of ischemic stroke (IS) and cognitive impairment (CI), often reaching the degree of dementia. The most common cause of CI in patients with AF is transferred IS or repeated IS. In a significant part of patients with AF who have undergone IS, CI is detected directly in the acute period of the disease and progresses subsequently. In addition, the risk of developing CI is increased even in patients with AF who have not experienced IS before. The review discusses the data on the relationship between CI and AF, provides information on the possible causes of the development of CI in the considered group of patients. The main difficulties of managing a patient with AF and CI are considered.

[Risk factors and adherence to treatment of patients with cerebrovascular diseases]. / Faktory riska i priverzhennost' lecheniyu patsientov s tserebrovaskulyarnymi zabolevaniyami.

OBJECTIVE: To assess the representation of risk factors and treatment adherence in patients with cerebrovascular diseases. MATERIAL AND METHODS: A single-stage cross-sectional non-comparable study was conducted, which included 492 patients, of whom 133 had an ischemic stroke/transient ischemic attack (main group, MG), 344 had chronic cerebrovascular pathology (comparison group, CG). The representation of risk factors, the state of cognitive functions, the severity of anxiety and depression were evaluated. RESULTS: MG respondents visit specialized specialists more often than CG (p<0.001), are more committed to taking antiplatelet agents (p<0.003), statins (p<0.005), antihypertensive drugs (p<0.005). Regular intake of antithrombotic drugs was associated with the history of ischemic stroke (r=0.483; p<0.01), type 2 diabetes (r=0.637; p<0.011), atrial fibrillation (r=0.481; p<0.001), living in a family (r=0.493; p<0.03). An inverse correlation was established between the systematic intake of antiplatelet drugs and the age of the respondents (r=-0.637; p<0.002), cognitive impairment (r=-0.433; p<0.05), the history of the gastrointestinal tract diseases (gastric ulcer and duodenal ulcer) (r=-0.563; p<0.001). Irregular medication intake was observed in patients aged over 60 years compared with younger (17.3% and 6.4%, respectively, p=0.001), patients living in a family compared with single (85.6% and 65.1%, p=0.032). The history of ischemic stroke or myocardial infarction is associated with increased adherence to regular medication. CONCLUSION: The study of risk factors and the assessment of treatment adherence can ensure the formation of an effective strategy for primary and secondary prevention of cerebrovascular diseases.

[Bioregulatory drug Newrexan in the treatment of anxiety and dissomnia. Resolution of the Council of Experts (June 8, 2023)]. / Bioregulyatsionnyi preparat N'yureksan v lechenii trevozhnosti i dissomnii. Rezolyutsiya Soveta ekspertov (8 iyunya 2023 g.).

Bioregulatory drug Newrexan in the treatment of anxiety and dissomnia. Resolution of the Council of Experts.

[Post-traumatic pain mononeuropathies]. / Posttravmaticheskie bolevye mononeiropatii.

Neuropathic pain syndrome (NPS) caused by peripheral nerve (PN) injury is a serious clinical problem due to its prevalence, complexity of pathogenesis, significant impact on the quality of life of patients. The issues of epidemiology, pathogenesis and treatment of patients with NBS with PN injury are considered. Modern possibilities of invasive treatment of such patients are discussed.

[Multimodal technology in the correction of post-stroke motor disorders]. / Mul'timodal'naya tekhnologiya korrektsii postinsul'tnykh dvigatel'nykh narushenii.

OBJECTIVE: To evaluate the effectiveness of a comprehensive rehabilitation program with the inclusion of programmable FES and BFB-stabilometric training in patients with post-stroke statolocomotor disorders in the late recovery period of ischemic stroke (IS). MATERIAL AND METHODS: The study included 120 patients in the late recovery period of IS, 57 women and 63 men, average age 58.4±6.4 years. The duration of the stroke was 228.59±31.9 days. The main group (MG) included 30 patients who underwent FES and BFB-stabilometric training. Comparison group 1 (CG1, n=30) received computer stabilometric training with BFB. Comparison group 2 (CG2, n=30) received FES. The control group (CG3, n=30) received a standard rehabilitation program. MR programs were carried out for all patients in the amount of 15 procedures every other day (5 weeks). RESULTS: The complex of rehabilitation measures with the inclusion of FES and BFB-stabilometric training significantly improve the function of walking in the form of restoration of the motor stereotype by the 5th week of the study, which was confirmed by neurological scales and stabilometry data. CONCLUSIONS: The inclusion of FES and BFB-stabilometric training methods in the rehabilitation process leads to earlier motor adaptation of the patient, restoration of impaired balance function and quality of life, which is associated with an increase in plastic and associative processes of the brain.

[Results of evaluation of the effectiveness of the drug Cellex in patients with small vessel disease]. / Rezul'taty otsenki effektivnosti primeneniya preparata Tselleks u patsientov s bolezn'yu melkikh sosudov.

OBJECTIVE: To study the effect of the drug Cellex on the severity of cognitive impairment in patients with small vessel disease (SVD). MATERIAL AND METHODS: A non-interventional observational controlled prospective observational study in parallel groups was conducted. 118 patients with CHEM who received unified therapy were under observation. Group 1 consisted of 40 patients who, in addition to basic therapy, received 10 injections of Cellex subcutaneously (0.2 ml 1 time/day), group 2 - 39 patients who received 2 courses of injections of Cellex subcutaneously (0.1 ml 1 time/day) with an interval of one month, patients 3-both groups (n=39) received only basic therapy. The examination included an assessment of the clinical status and neuropsychological testing (the MOS questionnaire and the clock drawing test - TRCH), analysis of the results of MRI of the brain. The blood levels of homocysteine (HC), C-reactive protein (CRP), asymmetric dimethylarginin (ADMA), and von Willebrand factor (FW) were determined in dynamics. RESULTS: A statistically significant improvement in the performance of the MoCA and TRP questionnaire tests in groups 1 and 2 was demonstrated, with a more pronounced and persistent effect in patients who received repeated courses of treatment. Clinical improvement was accompanied by normalization of the concentration of studied markers of inflammation (CRP) and endothelial dysfunction (HC, ADMA, FW) in the blood, while the dynamics was most pronounced in patients of group 2. The treatment was characterized by good tolerability, low frequency and insignificant severity of adverse events. CONCLUSION: The drug Cellex has demonstrated significant effectiveness in the treatment of patients with SVD with cognitive impairment, against the background of treatment, there was a decrease in markers of inflammation and endothelial dysfunction, therapy was characterized by good tolerability.

[Results of clinical studies of the efficacy and safety of the use of ethylmethylhydroxypyridine succinate in patients with chronic cerebral ischemia]. / Rezul'taty klinicheskikh issledovanii effektivnosti i bezopasnosti primeneniya preparatov etilmetilgidroksipiridina suktsinata u patsientov s khronicheskoi ishemiei golovnogo mozga.

Chronic cerebral ischemia (CCI) is a common syndrome that, in the absence of adequate therapy, is characterized by a progressive course, an increase in cognitive, emotional, motor and other disorders, eventually leading to persistent disability of the patient. In the treatment of patients with CCI, the use of drugs with a multimodal neuroprotective effect is indicated. The results of the analysis of a series of clinical trials of the drugs Mexidol and Mexidol FORTE in patients with CCI are presented. The effects in relation to cognitive, emotional, asthenic, vegetative and other manifestations of CCI are considered. It is concluded that it is advisable to consistently use the drugs Mexidol and Mexidol FORTE in such patients.

[Neurological manifestations of postcovid syndrome]. / Nevrologicheskie proyavleniya postkovidnogo sindroma.

The problem of postcovid syndrome (PCS) attracts great interest due to the wide prevalence and variety of clinical manifestations. The main neurological manifestations of PCS are considered. The information about the proposed mechanisms of the formation of PCS is given. The possibility of using the drug Mexidol for the treatment of patients with PCS is discussed.

[Topical therapy of acute nociceptive pain: results of an open randomized clinical trial of the domestic drug Alental cream]. / Topicheskaya terapiya ostroi notsitseptivnoi boli: rezul'taty otkrytogo randomizirovannogo klinicheskogo issledovaniya otechestvennogo preparata Alental' krem.

OBJECTIVE: Evaluation of the therapeutic efficacy, safety and tolerability of the drug Alental cream for external use (VERTEX, LLS, Russia) compared with the original drug - Aertal cream for external use (Gedeon Richter, LLS, Hungary) for local therapy of acute nociceptive pain syndrome in patients who have suffered traumatic ankle injury. MATERIAL AND METHODS: The study included 131 patients who had suffered an injury to the soft tissues of the ankle joint. The 1st comparison group received the drug Alental cream, the 2nd group - Aertal cream. The duration of therapy was 7 days. The effectiveness of the drugs was evaluated during treatment based on the dynamics of the intensity of pain syndrome and other symptoms of trauma, as well as the assessment of these changes by the doctor and the patient. The safety analysis included the registration of adverse events according to clinical and laboratory studies. RESULTS: Alental cream in terms of therapeutic efficacy was equivalent to the registered original preparation Aertal cream. The analysis of the assessment of the dynamics of clinical and laboratory parameters, the safety of treatment, including the frequency of adverse events, did not reveal significant differences between the two drugs. CONCLUSIONS: Alental cream can be used as a means for local therapy of acute nociceptive pain syndrome in traumatic soft tissue injuries.

Neurological Signs of Postcovid Syndrome.

The challenge of postcovid syndrome (PCS) is of great interest due to its wide distribution and variety of clinical signs. The main neurological signs of PCS are discussed. Data on the presumptive mechanisms forming PCS are presented. The potential for using the drug Mexidol to treat patients with PCS is addressed.

[Results of the round table: modern approaches to drug therapy of cognitive impairment in cerebrovascular pathology]. / Itogi kruglogo stola: sovremennye podkhody k medikamentoznoi terapii kognitivnykh narushenii pri tserebrovaskulyarnoi patologii.

On June 25-26, 2021, a round table was held in Kazan with the participation of leading neurologists of Russia, where the issues of treatment of patients with cognitive impairment due to cerebrovascular diseases were discussed. Cognitive disorders of vascular genesis (VCD) are widespread in the population, are a common cause of a decrease in the quality of life and restriction of daily activity. The cause of VCD is both acute and chronic cerebrovascular diseases. An effective way to prevent VCD is to control cardiovascular risk factors, ensure a sufficient level of cognitive and physical activity throughout life. The role of drug therapy, aimed, among other things, at normalizing metabolic processes in the brain, is extremely important. The data on the mechanisms of action of the new domestic drug prospecta, the results of its clinical trials in patients with VCD are presented.

[Neurogenic intermittent claudication in patients with degenerative lumbar stenosis]. / Neirogennaya peremezhayushchayasya khromota u bol'nykh s poyasnichnym degenerativnym stenozom.

OBJECTIVE: To study the clinical manifestations of neurogenic intermittent claudication (NIC) in patients with degenerative lumbar stenosis (DLS). MATERIAL AND METHODS: The neurological status, intensity and nature of pain syndrome, and pain-free walking distance were evaluated in 83 NIC patients with DPS, who underwent surgical treatment. RESULTS: The predominance of the clinical picture of sensorimotor pain (n=30; 36.1%) and isolated pain (n=31; 37.3%) forms of NIC was established. Isolated sensory (n=1; 1.2%), sensorimotor (n=3; 3.6%), and motor-pain (n=4; 4.8%) forms were significantly less common. In 6 (7.2%) patients, there was a pain-free form of NIC. In most patients, surgical treatment led to regression of neurological symptoms and an increase in the distance of pain-free walking. No relationship was found between the demographic and clinical characteristics of patients (gender, age, pain severity, pain-free walking distance), MRI results and the features of NIC clinical picture. In 4 patients, the phenomenon of pacing was revealed in the form of an increase in pain at the beginning of walking and a significant decrease or complete regression as walking continues. CONCLUSION: The clinical picture of NIC is polymorphic, its pain-free course is possible. The decision on the feasibility of surgical treatment of patients with PLS is possible taking into account the clinical picture of NIC and MRI results.

[Therapy of moderate cognitive impairment in the early recovery period of ischemic stroke]. / Terapiya umerennykh kognitivnykh rasstroistv v rannem vosstanovitel'nom periode ishemicheskogo insul'ta.

OBJECTIVE: To assess the efficacy and safety of prospecta in the treatment of moderate cognitive impairment in the early recovery period of ischemic stroke. MATERIAL AND METHODS: The study included 275 patients (mean age 64.0±8.1 years) with a history of single ischemic stroke from 3 to 6 months, with moderate cognitive impairment, and moderate activity in everyday life, who were randomized in two groups. During the screening phase, the severity of cognitive impairment was assessed with the Mini-Mental State Examination and Montreal Cognitive Assessment scales; the level of activity in everyday life was evaluated with the Barthel Scale; and quality of life was assessed with the Stroke Specific Quality of Life Scale. Patients took 2 tablets of prospecta or placebo 2 times a day for 24 weeks. The follow-up period was 4 weeks. The primary endpoint of the study was the proportion of patients with improvement in cognitive function (+1 or more on the MoCA test) after 24 weeks of treatment. The occurrence and type of adverse events (AEs), their severity, relationship to the drug, outcome, changes in vital signs, and the proportion of patients with clinically significant abnormality in laboratory tests were analyzed to assess the safety. RESULTS: A clinically significant improvement in cognitive function was obtained in 91.9% of patients in the prospecta group vs 82.,1% in the placebo group, (p=0.02). There were 57 AEs in 37 (27.4%) Prospecta group patients and 53 AEs in 39 (27.9%) Placebo group participants (p=1.00). No AEs were certainly associated with taking the medication. No clinically significant changes in vital signs or abnormal laboratory results were detected during the study. CONCLUSION: Prospecta is an effective and safe treatment option for patients with moderate cognitive impairment in the early recovery period of ischemic stroke.

[Choosing of therapy for a patient with dorsalgia].

Dorsalgia is one of the most common skeletal muscle syndromes. Dorsalgia often develops in patients of older age groups with polymorbidity that requires the appointment of a large number of medications. In these conditions, the choice of effective and safe therapy is a difficult problem. Discusses management of a patient suffering dorsalgia with comorbidities, the risks of complications of therapy, possible safety treatment, in particular, through the use of combination therapy.

[Results of endovascular treatment of acute tandem occlusion of internal carotid and middle cerebral arteries]. / Rezul'taty endovaskulyarnogo lecheniya ostroi tandemnoi okklyuzii vnutrennei sonnoi i srednei mozgovoi arterii.

OBJECTIVE: To evaluate the results of endovascular treatment of patients with ischemic stroke caused by acute tandem occlusion of the internal carotid and middle cerebral arteries (ICA and MCA). MATERIAL AND METHODS: Endovascular intervention was performed in 8 patients with tandem occlusion of ICA and MCA. The neurological deficit on admission was 17.4±5.6 NIHSS points and the average ASPECTS score was 9.5±0.8. The time from the onset of neurological symptoms to reperfusion was 224±68 min. Thrombolytic therapy was initiated before brain revascularization and continued intraoperatively in 4 out of 8 patients. ICA stenting after aspiration thrombectomy was required in 6 patients. Both antegrade (n=4) and retrograde (n=2) methods of brain revascularization were used. RESULTS: The rate of detection of tandem lesion in patients with ischemic stroke who underwent endovascular treatment was 5.4%. Technical success in restoring blood flow in the ICA basin at extra-and intra-cranial levels (mTICI 2b/3) was achieved in 7 (87.5%) patients. Intracranial hemorrhagic complications that affected the outcome of the disease were clinically significant in 25% of patients (n=2). The mortality rate was 37.5% (n=3). A satisfactory clinical result (a deficit of 0-2 mRS scores) was achieved at discharge in one of 5 surviving patients. CONCLUSION: Further studies of choosing the optimal surgical tactics for tandem occlusion of ICA and MCA, taking into account its effectiveness and safety, are need.

[Meteorological risk factors of ischemic stroke]. / Meteorologicheskie faktory riska razvitiia ishemicheskogo insul'ta.

AIM: To study an impact of climate triggers on the seasonal incidence of ischemic stroke (IS). MATERIAL AND METHODS: Case histories of 1144 patients with IS were studied. The incidence rate was distributed over months and seasons. Indicators of circannual patterns are calculated as the arithmetic average of morbidity, data on meteorological measurements of temperature, atmospheric pressure and air humidity for the corresponding seasons of the year for the city of Orel. RESULTS: There was a weak correlation between the incidence rate and some meteorological indicators. The high direct correlations were found between the incidence, temperature, humidity (first set) and the incidence, pressure and humidity (second set) (0.701 and 0.764, respectively according to Cheddok). CONCLUSION: Meteorological triggers exert the effect on the incidence of IS. The procedure for calculating correlation indicators described in the study can be used to predict the morbidity in a particular hospital during a calendar year.

[The conservative treat ment of patients with degenerative lumbar stenosis]. / Konservativnoe lechenie bol'nykh s degenerativnym liumbal'nym stenozom.

AIM: To study factors affecting the course of lumbar stenosis (LS). MATERIAL AND METHODS: In the course of a two-year prospective study, 68 patients with degenerative LS, aged from 51 to 88 years (mean age 66±15.4 years), 21 men and 47 women, were examined. The 1st group consisted of 30 patients with stenosis of the lateral pocket (lateral LS), the 2nd group included 39 patients with central LS. RESULTS AND CONCLUSION: For patients of the 1st group, significant risk factors for disease progression were spondylolisthesis, pain intensity in the lumbar region during walking, pain intensity in the leg during walking, the degree of LS, while the most significant parameter was spondylolisthesis (regression coefficient was 17.59; p=0.006). A risk factor for the lack of recovery/deterioration in the patients of the 2nd group was expressed LS, which twice worsened the prognosis of the disease (regression coefficient - 14.79; p=0.003983). The presence of spondylolisthesis in patients with central LS was a risk factor for lack of recovery, but not deterioration. The absence of therapeutic exercise was a risk factor for the progression of the disease.

[Endovascular treatment of tandem occlusion of internal carotid and middle cerebral arteries in acute ischemic stroke]. / Éndovaskuliarnoe lechenie tandemnoi ostroi okkliuzii vnutrennei sonnoi i srednei mozgovoi arterii pri ostrom ishemicheskom insul'te.

The paper presents the literature data concerning the results and surgical approaches to the treatment of tandem occlusion in the ICA system. The authors describe two clinical cases of endovascular treatment of tandem ipsilateral occlusion of ICA and middle cerebral artery (MCA). In both cases, the cause of two-level occlusion was complicated by thrombosis atherosclerotic plaque in ICA in the extracranial part with distal thromboembolism in SMA. The antegrade endovascular approach was used in both patients, when ICA was stented at the first stage, and at the second stage aspiration thrombectomy from SMA was performed. The period from the onset of symptoms to revascularization of the ICA system was 285±63 minutes. There were no fatal outcomes, patients were discharged with different neurological deficits: scores of the first patient were as following: 2 points on the NIHSS, 1 point on a Rankin scale, 13 points (initial 12 points on NIHSS) on the Rivermead mobility index and of the second patient: 14 points on the NIHSS, 5 points on a Rankin scale, 0 points (of the original 17 points on the NIHSS) on the Rivermead mobility index.