[A case of COVID-associated encephalopathy in a patient with multiple sclerosis]. / Klinicheskii sluchai COVID-assotsiirovannoi entsefalopatii u patsienta s rasseyannym sklerozom.

A case of acute encephalopathy manifested with impaired consciousness, hemichorrhea, speech and cognitive impairment in a female patient with COVID-19 and multiple sclerosis is presented. In the literature, there are isolated reports of such a combination of diseases, and therefore difficulties arise in carrying out differential diagnosis and prescribing therapy. Given the limited knowledge about the long-term consequences of COVID-19, systematic analysis of such cases and follow-up of such patients is necessary.

[CT-predictors of unfavorable outcome in hemorrhagic stroke]. / KT-prediktory neblagopriyatnogo iskhoda gemorragicheskogo insul'ta.

OBJECTIVE: To analyze the relationship between the changes on non-contrast CT of the head in patients with acute hemorrhagic stroke and its unfavorable outcome within 90 days. MATERIAL AND METHODS: The retrospective analysis of the clinical, demographic parameters and results of CT of the head of all patients admitted to the stroke unit of the district hospital between January 2015 and December 2021 was performed. The data of 131 patients were included in the work (52% males), average age was 65.75±14.1. RESULTS: Fatal outcomes were recorded in 13.7% of cases. The age of the patient, severity of neurological deficit and CT-signs predicting hematoma expansion were independent predictors of unfavorable outcomes of hemorrhagic stroke within 90 days. CONCLUSION: Detection of the sings predicting hematoma enlargement on CT scans improves prognostication of the outcomes of hemorrhagic stroke.

[Digital technologies in the assessment of neurological status]. / Tsifrovye tekhnologii v otsenke nevrologicheskogo statusa.

Digital technologies (DT) can be used at all stages of the neurologist's work with the patient. The medical professional can obtain online information on the patient's complaints and history. DT may help to assess cognitive functions, muscular power, details of the movements including gate. The methods of the assessment of sensory functions are being currently developed. The methods of the assessment of the olfaction, vision, oculomotor function, pupillary reactions, mimic muscles, hearing and balance are also developed, however the methods of assessment of the function of trigeminal nerve, movement of the head, neck and tongue using DT are not available. The assessment of the reflexes using DT is not developed yet. The use of DT is possible in telemedicine, in long-term monitoring of the neurological status of the patient, as well as in the clinical exam in order to obtain additional, more detailed data.

[An analysis of clinical and laboratory characteristics of patients with ischemic stroke and COVID-19]. / Analiz kliniko-laboratornykh kharakteristik patsientov s ishemicheskim insul'tom, assotsiirovannym s COVID-19.

OBJECTIVE: To analyze clinical and laboratory characteristics of patients with ischemic stroke associated with COVID-19. MATERIAL AND METHODS: A retrospective analysis of all cases of COVID-19, including those complicated with ischemic stroke, admitted to the multispecialty infectious hospital in Ufa (Russia) in 2020, was performed. Multivariate analysis was used to identify the independent predictors of the development of ischemic stroke in patients with COVID-19. RESULTS: Eleven thousand forty hundred and thirty-two patients were admitted to the multidisciplinary infectious hospital during 2020, 1226 of them also suffered from ischemic stroke. Independent predictors of ischemic stroke in COVID-19 included age and laboratory parameters: increase in number of leucocytes, erythrocytes and platelets, increase of the level of creatinine, glucose, total bilirubin and decrease of the level of total protein, and activated partial thromboplastin time. CONCLUSION: Elderly people, patients with prominent systemic inflammatory response, which presented with leukocytosis, hypercoagulation, multiorgan failure of different severity and hypoproteinemia, were at higher risk of the development of ischemic stroke in COVID-19.

[Electrocardiographic predictors of the poor outcome of hemorrhagic stroke]. / Elektrokardiograficheskie prediktory neblagopriyatnogo iskhoda gemorragicheskogo insul'ta.

OBJECTIVE: To analyze the relationship between electrocardiogram (ECG) parameters in the acute period of hemorrhagic stroke and its poor outcome within 90 days. MATERIAL AND METHODS: ECG data of 133 patients with hemorrhagic stroke recorded upon admission to the primary vascular department were analyzed. RESULTS: Eighteen percent out of 133 patients died within 90 days. The only ECG-predictor of the poor outcome of hemorrhagic stroke was the prolongation of corrected QT interval (QTc). CONCLUSION: The length of QTc should be taken into account while assessing patients with hemorrhagic stroke. The patients with the abnormal QTc are at higher risk of the development of cardiac complications and death.

[Clinical and laboratory predictors of unfavorable outcome in hemorrhagic stroke]. / Kliniko-laboratornye prediktory neblagopriyatnogo iskhoda gemorragicheskogo insul'ta.

OBJECTIVE: The study was to analyze the relationship laboratory parameters of the blood in acute phase of hemorrhagic stroke and its unfavorable outcomes within 90 days. MATERIAL AND METHODS: We performed retrospective analysis of 122 patients with hemorrhagic stroke from Dyurtyuli district hospital between 2015 and 2020. The laboratory parameters in patients with favorable and unfavorable outcomes were compared. Multivariate analysis was performed to identify the independent predictors of death after hemorrhagic stroke. RESULTS: Death within 90 days after hemorrhagic stroke was registered in 16 cases (13%). In this group of patients the count of RBC, lymphocytes, prothrombin index, hemoglobin level were lower, count of WBC, neutrophil-lymphocyte ratio (NLR) and INR were higher (p<0.05). Patients' age, stroke severity according to NIHSS, hemoglobin level, NLR were the independent predictors of death in patients with hemorrhagic stroke according to multivariate analysis. CONCLUSION: Standard laboratory analyses can predict the outcome of hemorrhagic stroke.

[Socioeconomic factors and stroke]. / Sotsial'no-ekonomicheskie faktory i tserebral'nyi insul't.

Low socioeconomic status increases the risk of development of stroke by 67%, it also has negative influence on its severity and outcomes. The mortality among stroke survivors with low socioeconomic status is higher by 39% in comparison to those with high socioeconomic status. The link between socioeconomic status and increased risk of stroke and its poor outcomes could be explained by higher frequency of vascular risk factors, lower compliance, late presentation to hospital after a stroke onset and lower access to high-quality specialized medical care in some countries. Socioeconomic factors should be taken into account while planning stroke prevention measures.

[Clinical manifestations of COVID-19 in children]. / Nevrologicheskie proyavleniya COVID-19 u detei.

The neurological symptoms of COVID-19 in children (in Dyurtyuli area, Republic of Bashkortostan) are analyzed and brief review of the literature is undertaken in the paper. 137 children underwent swab test for COVID-19. The disease was diagnosed in 9 of them. Only respiratory symptoms were observed in 3 children, a combination of respiratory with anosmia or/and headache - in 3, asymptomatic form - in another 3. A case of a 7-years old girl suffering from COVID-19 with respiratory symptoms as well as anosmia and headache is presented. According to the review of the literature, COVID - 19 in children is usually milder than in adults, but in some cases may lead to neurological consequences. Multisystem inflammatory syndrome may lead to the development symptoms of encephalopathy (altered mental status, headache) and stroke. Autoimmune complications such as Gillian-Barre syndrome develop simultaneously or after resolving of the infectious process. The development of viral meningoencephalitis in COVID-19 is questionable.

[The impairment of bone-mineral metabolism in the development of benign paroxysmal positional vertigo]. / Narusheniia kostno-mineral'nogo obmena v razvitii dobrokachestvennogo pozitsionnogo paroksizmal'nogo golovokruzheniia.

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of systemic vertigo in clinical practice. The results of recent research demonstrated the decrease of bone mineral density, level of vitamin D and estrogen in blood serum in patients with BPPV. In summary these data points at the relationship between osteoporosis/osteopenia and BPPV. This association is most obvious in menopausal women and in those with recurrent BPPV. Patients with recurrent BPPV should undergo investigation for osteoporosis/osteopenia. Treatment of bone-mineral metabolism allows decreasing the frequency of BPPV recurrence, however more research is needed in this area.

[Autonomic dysfunction in patients with multiple sclerosis]. / Vegetativnaia disfunktsiia u patsientov s rasseiannym sklerozom.

AIM: To optimize the early diagnosis of the autonomic dysfunction in patients with MS. MATERIAL AND METHODS: The main group consisted of 46 patients: 15 men and 31 women with MS (McDonald, 2005), the average age was 33.35±9.9 years, the average score of the Expanded disability scale (EDSS) was 2.8±1.17 points. The control group consisted of 24 healthy subjects matched by age and sex with the main group. A study of the autonomic nervous system was carried out using the Scheme for detection of signs of autonomic disorders (A.M. Vein, 1998) and analysis of heart rate variability (HRV) at rest and after active orthostatic test (AOT). RESULTS: Autonomic dysfunction was found in 73% of the patients. The overall score of the Scheme was significantly higher in MS patients (31.32±9.43 points) compared to the comparison group (2.36±4.39 points, p<0.05). According to HRV, the contribution of brainstem autonomic centers in the regulation of stress-response during AOP was significantly reduced (p<0.05) and was characterized by the lack of activation of the sympathetic division of the ANS. In patients with MS, cerebral influences were dominating on HRV baseline records, evaluated by the domination of the VLF component in the spectrum. During AOP, VLF was almost leveled in both groups, and the VLF changes in patients before and after the AOP reached statistical significance (p<0.05). CONCLUSION: The use of the Scheme is preferable in outpatient clinics to screen the large numbers of patients with MS, and then selected patients could be referred to the instrumental methods of investigation.

[Smoking as a risk factor of development and progression of multiple sclerosis (a review and experimental data)].

Epidemiological data on smoking influence on the development and course of multiple sclerosis (MS) are presented. The relative risk (RR) of MS for smokers was calculated as 1.3-1.8 in various cohort studies. Smoking was positively correlated with MS progression. The RR of the transition of remitting-relapsing MS to secondary progressive MS was in the range of 2.5-3.6. The RR of the transition to clinically isolated syndrome authentic MS was 1.8. Results of the MRI study of 239 MS patients (102 smokers and 137 non-smokers) revealed the higher level of disability on EDSS, higher rate of disease progression and lesser cases with remitting course in the group of smokers. The primary progressive MS course was more often observed in the group of smoking patients. The more favorable prognosis in terms of sensitivity and visual symptoms of disease onset were found in nonsmokers.Forms with a late onset prevailed in smokers.