The pathophysiological mechanisms of the perihematomal area edema development are reviewed. The perihematomal area edema is the important marker of the brain tissue perifocal damage after intracerebral hemorrhage.

The model of the perihematomal tissue edema forming is described, where pathological changes of neurons and neuroglia cells have arisen. The critical assessment of current approach for treatment of brain edema as complication of intracerebral hemorrhage is given.

Keywords: intracerebral hemorrhage, brain edema, therapy.

The aim – to review the causes of ophthalmopathy and the results of treatment of patients with oculomotor disorders.

Methods and subjects. 430 patients with oculomotor disorders have been examined. Comprehensive clinical, neurological and neuroophthalmological examinations, neurovisual methods (magnetic resonance, computer tomography of the brain) were carried out.

Results. Neurogenic ophthalmopathies were diagnosed in 382 (88.8 %) patients, miogenic – in 48 (11.2 %).

Neurogenic ophthalmopathy was detected in patients with vascular pathology, brain injury, brain tumors, inflammatory lesions of the nervous system, diabetes mellitus. Myogenic – was observed in case of lesions of the eye muscles of patients in the orbit (inflammation, autoimmune processes, trauma, endocrinological pathology). Results of rehabilitation treatment of oculomotor disorders were analyzed in the early post surgery period for patients with vascular pathology, brain injury, brain tumors.

Conclusions. The ophthalmopathies are observed in patients with diseases and injuries of the central nervous system, and common diseases of the organism. Complex rehabilitation treatment using pharmacotherapy and physiotherapy methods contributes complete or partial recovery of the damaged III, IV, VI nerves and regresses oculomotor disorders.

Keywords: oculomotor disorders, neurogenic ophthalmopathies, myogenic ophthalmopathies, rehabilitation treatment.

Цель — анализ причин возникновения офтальмопатий и результатов проведенного лечения пациентов с глазодвигательными нарушениями.

Материалы и методы. Обследовано 430 больных с глазодвигательными нарушениями. Проведено комплексное клинико-неврологическое и нейроофтальмологическое обследование с использованием нейровизуальных методов (магнитно-резонансной, компьютерной томографии головного мозга).

Результаты. Неврогенные офтальмопатии диагностированы у 382 (88,8 %) больных с сосудистой патологией, черепно-мозговой травмой, опухолями головного мозга, воспалительными поражениями нервной системы, сахарным диабетом. Миогенные — у 48 (11,2 %) пациентов с поражением мышц глаза в орбите (воспалительные, аутоиммунные процессы, травмы, эдокринная патология). Проведен анализ результатов восстановительного лечения глазодвигательных нарушений в ранний послеоперационный период у больных с сосудистой патологией, черепно-мозговыми травмами, опухолями мозга.

Выводы. Офтальмопатии наблюдаются у пациентов с заболеваниями и травмами центральной нервной системы, а также с общими заболеваниями организма. Комплексное восстановительное лечение с использованием медикаментозной терапии и физиотерапевтических методов способствует полному или частичному восстановлению функции III, IV, VI нервов и регрессу глазодвигательных нарушений.

Keywords: глазодвигательные нарушения, неврогенные офтальмопатии, миогенные офтальмопатии, восстановительное лечение.

The aim – study clinical and neurophysiological correlations in syndromology of tic hyperkinetic disorders for the purpose of pathogenetical mosaic structure classification, differential diagnosis optimization and therapy functional tics.

Methods and subjects. 77 patients with tics were under examination, during which, apart from somatic and neurological study, there was conducted research of brain bioelectrogenesis with the help of electroencephalogram (EEG), the state of brain ventricular system and intracranial pressure with the help of echo encephalogram (EchoEG) as well as cerebral haemodynamics using the method of transcranial Doppler ultrasonography (TCD).

Results. Complex examination which was carried out has allowed to conclude that 93.51 % of patients had primary tics, including classic Tourrete’s syndrome at 10.39 %, neurotic tics at 15.59 %, and at the overwhelming majority of 67.53 % there were pseudoneurotic or «neurosis-like» tics developing against prenosological premorbid procedural or residual lesions of different aetiology in cerebral structures, striatum system first of all, that were witnessed by considerable lesions in bioelectrogenesis, brain ventricular system and in a number of cases in cerebral haemodynamics that were detected during this research.

Conclusions. Recommended complex examination of all patients with tics, including EEG, the Echo EG and TCD will allow to optimize differential diagnostics and consequently therapy of the given contingent of patients.

Keywords: tic hyperkinetic disorders, clinical picture, electroencephalography, еchoencephalogram, tran

The aim – to improve the results of the operative treatment of patients with degenerative lumbar spinal stenosis on the base of the optimized approach to the surgery taking into account medico-social criteria.

Methods and subjects. 48 patients with lumbar spinal stenosis were operated at the A.P. Romodanov Institute of Neurosurgery over the period from 2008 to 2010. The patients were from 39 to 72 years old. According to the MRI, CT and X-ray central stenosis was found in 26, lateral – in 15, combined – in 7 cases. 12 patients had a single-level stenosis, 26 patients had lumbar stenosis at 2 levels, and multilevel stenosis was diagnosted in 10 patients. Herniated discs were found in 16, and spondilolisthesis – in 4 cases. 43 patients presented with neurogenic claudication, 42 і 34 – with lumbalgia and lumboischialgia, respectively. 23 patients had motor weakness and 19 – sensory abnormalities. Impaired sphincter functions were found in 5 patients. Extended laminectomy was performed in 9 (18.8 %) cases, bilateral microsurgical fenestration – in 20 (41.9 %), hemilaminectomy – in 7 (14.6 %) and interlaminectomy – in 12 (25 %) patients. 16 and 4 patients required disc removal and transpedicular stabilization, respectively.

Results. At the moment of discharge 39 (81.2 %) patients demonstrated good postoperative status, 7 (14.6 %) showed satisfactory results.

Conclusions. A rational approach to the choice of proper method and extent of surgical intervention for lumbar spinal stenosis is the prerequisite for optimal decompression of neurovascular elements and preservation of spinal stability.

Keywords: lumbar stenosis, neurogenic claudication, laminectomy, microsurgical fenestration.

Цель — улучшить результаты оперативного лечения больных со стенозом поясничного отдела позвоночника на основе использования оптимизированного подхода к выбору метода оперативного вмешательства с учетом медико-социальных критериев.

Материалы и методы. Проанализированы результаты оперативных вмешательств у 48 больных со стенозом поясничного отдела позвоночника, находившихся на лечении в Институте нейрохирургии им. А.П. Ромоданова АМН Украины в период с 2008 по 2010 г. Возраст больных составлял от 39 до 72 лет. По данным МРТ, КТ и спондилографии, центральный стеноз обнаружен у 26 пациентов, латеральный — у 15, сочетанный — у 7, стеноз на уровне 1 сегмента — у 12, на уровне 2 сегментов — у 26, 3 и больше сегментов — у 10, грыжи межпозвоночных дисков — у 16, спондилолистез — у 4. Каудогенная перемежающаяся хромота отмечена у 43 больных, люмбалгия и люмбоишиалгия — у 42 и 34 соответственно, двигательные расстройства — у 23, нарушения чувствительности — у 19, дисфункция тазовых органов — у 5 пациентов. Ламинэктомию выполнено 9 (18,8 %) больным, билатеральную микрохирургическую фенестрацию — 20 (41,9 %), гемиламинэктомию — 7 (14,6 %), интерламинэктомию — 12 (25 %), дискэктомию и транспедикулярную стабилизацию — соответственно 16 и 4 больным.

Результаты. На момент выписки из стационара результаты лечения были оценены как хорошие у 39 (81,2 %), как удовлетворительные — у 7 (14,6 %) больных.

Выводы. Рациональный подход к выбору метода и объема хирургического вмешательства при поясничном стенозе позволяет провести полноценную декомпрессию нервно-сосудистых структур при сохранении стабильности позвоночника.

Keywords: поясничный стеноз, нейрогенная перемежающаяся хромота, ламинэктомия, микрохирургическая фенестрация.

The aim – to study changes of cerebrovascular reactivity in an acute period of cerebral infarction according to findings of metabolic and myogenous mechanisms of cerebral blood flow autoregulation.

Methods and subjects. Compex clinical and neurological examination of 47 patients in an acute period of cerebral infarction (19 male and 28 female, average age (67.1 ± 1.9)) was carried out. The examination included only those patients who experienced blood flow impairments for the first time. Patients were divided into two groups: 1st group included 27 patients with cerebral infarction of hemospheric localization, 2nd group included 20 patients with infarction in vertebrobasilar basin vessels. Control group included 10 people without acute cerebral blood flow impairment, average age – (65.7 ± 1.7). Cerebrovascular reactivity was tested by means of transcranial dopplerography with the application of functional tests with load, which activated metabolic and myogenous mechanisms of cerebral blood flow autoregulation.

Results. Patients of the 1st hroup demonstrated decompensated cerebral hemodynamic type, also there was marked deminishing of reactivity index on hypercapnic test with the breath arrest in comparing with the control group (1.09 ± and 1.39 ± 0.04 accordingly, p < 0.005. This is evidence of cerebral reactivity vasodilate component depletion.

Pateints of the 2nd group also demonstrated marked deminishing of reactivity index on hypercapnic test with the breath arrest in comparing with the control group (1.07 ± 0.06 and 1.28 ± 0.06 accordingly, p < 0.005). Orthostatic instability was marked during the orthostatic load, that is caused by myogenous mechanisms of cerebral blood flow dysfunction (diminishing of reactivity index on orthostatic load in comparing with the contropl group (0.71 ± 0.04 and 0.96 ± 0.07 accordingly p < 0.005). Revealed changes are conditioned by stem structures dysfunction which should provide with central cerebral blood flow regulation.

Conclusions. Patients with hemospheric cerebral infaction localization demonstrate impairments of metabolic mechanisms of cerebral blood flow autoregulation; patients with stem cerebral infarction demonstrate myogenous mechanisms of cerebral blood flow autoregulation impairments such as cerebral blood flow orthostatic instability caused by stem structures dysfunction.

Keywords: cerebral infarction, cerebrovascular reactivity, transcranial dopplerography.

The aim – to study changes of cerebrovascular reactivity in an acute period of cerebral infarction according to findings of metabolic and myogenous mechanisms of cerebral blood flow autoregulation.

Methods and subjects. Compex clinical and neurological examination of 47 patients in an acute period of cerebral infarction (19 male and 28 female, average age (67.1 ± 1.9)) was carried out. The examination included only those patients who experienced blood flow impairments for the first time. Patients were divided into two groups: 1st group included 27 patients with cerebral infarction of hemospheric localization, 2nd group included 20 patients with infarction in vertebrobasilar basin vessels. Control group included 10 people without acute cerebral blood flow impairment, average age – (65.7 ± 1.7). Cerebrovascular reactivity was tested by means of transcranial dopplerography with the application of functional tests with load, which activated metabolic and myogenous mechanisms of cerebral blood flow autoregulation.

Results. Patients of the 1st hroup demonstrated decompensated cerebral hemodynamic type, also there was marked deminishing of reactivity index on hypercapnic test with the breath arrest in comparing with the control group (1.09 ± and 1.39 ± 0.04 accordingly, p < 0.005. This is evidence of cerebral reactivity vasodilate component depletion.

Pateints of the 2nd group also demonstrated marked deminishing of reactivity index on hypercapnic test with the breath arrest in comparing with the control group (1.07 ± 0.06 and 1.28 ± 0.06 accordingly, p < 0.005). Orthostatic instability was marked during the orthostatic load, that is caused by myogenous mechanisms of cerebral blood flow dysfunction (diminishing of reactivity index on orthostatic load in comparing with the contropl group (0.71 ± 0.04 and 0.96 ± 0.07 accordingly p < 0.005). Revealed changes are conditioned by stem structures dysfunction which should provide with central cerebral blood flow regulation.

Conclusions. Patients with hemospheric cerebral infaction localization demonstrate impairments of metabolic mechanisms of cerebral blood flow autoregulation; patients with stem cerebral infarction demonstrate myogenous mechanisms of cerebral blood flow autoregulation impairments such as cerebral blood flow orthostatic instability caused by stem structures dysfunction.

Keywords: cerebral infarction, cerebrovascular reactivity, transcranial dopplerography.

The aim – to study сognitive and еmotional impairments in patients with the acute period of stroke.

Methods and subjects. Іn order to study cognitive impairments cognitive functions were studyed in 71 patients with the acute period of brain infarction (average age 50.39 ± 0.89 years) using the Mini-Mental State Examination scale (MMSE), screening battery to identify the frontal lobe dysfunction and clock drawing test. Control group included 20 cases with dyscirculatory encephalopathy of vascular genesis (І–ІІ stage) without acute stroke who had agerelated cognitive dysfunction (average age 49.1 ± 2.46 years).

Results. It was defined that within the first 3 days of brain infarction, cognitive impairments developed in 64.78 % of patients according to the MMSE scale. Depression and anxiety level was elevated in patients during an acute infarction period comparing to control group.

Conclusions. According to the test results, cognitive impairments have been associated with the symptom of «splitting» that comes from the disturbances between the cortical and subcortical structures.

Keywords: stroke, cognitive, emotional impairments.

Цель — изучить особенности когнитивных и эмоциональных нарушений у больных в острый период инфаркта мозга.

Материалы и методы. У 71 больного в острый период инфаркта мозга (средний возраст — (50,39 ± 0,89) года) были исследованы когнитивные функции по шкале Mini-Mental State Examination (MMSE), батарее тестов для оценки лобной дисфункции, тесту рисования часов, шкале Бека, шкале Спилбергера—Ханина. Групу контроля составили 20 человек с дисциркуляторной энцефалопатией сосудистого генеза (І—ІІ стадии) без острого нарушения мозгового кровообращения в анамнезе, которые имели возрастные нарушения когнитивных функций (средний возраст — (49,1 ± 2,46) года).

Результаты. Установлено, что в первые 3 дня острого периода инсульта когнитивные нарушения по шкале MMSE имели место у 64,78 % больных. Уровень депресии и тревожности был выше у больных в острый период инфаркта мозга по сравнению с группой контроля.

Выводы. Результаты исследования показали, что когнитивные нарушения обусловлены синдромом «разобщения», в основе которого лежат нарушения связей между корковыми и подкорковыми образованиями головного мозга.

Keywords: инфаркт мозга, когнитивные нарушения, эмоциональные нарушения.

The aim – to study the cerebrolysin`s influence on cerebral circulation and bioenergetics in patients with ischemic stroke.

Methods and subjects. It was conducting the complex examination of 26 elderly patients (average age 62 ± 2.2 years) who had atherothrombotic ischemic stroke before and after administration of 10.0 ml Cerebrolysin i/v dropwise for 10 days. This examination included clinical and neurological examination, assessment of the daily activity level (Barthel's scale), the state of memory function (MMSE), ultrasound dopplerography of head and neck vessels (EN VISOR (Philips)), the EEG analysis (Neurofax EEG-1100 Nihon Kohden).

Results. Course of cerebrolysin improves cognitive function, increases social activity and provides reorganization of cerebral bioelectrical activity in patient with ischemic stroke. Cerebrolysin harmonizes the structure of cerebral bioelectrical activity in patients with ischemic stroke in left hemisphere comparing with patient with ischemic stroke in right hemisphere. The influence of cerebrolysin includes the improving of cerebral hemodynamic. This fact confirms the increasing of LBFV and decreasing indexes of peripheral resistance in several carotid vessels and vertebrobasilar vessels.

Conclusions. All these results are basis for including cerebrolysin to complex rehabilitation system for elder patient with ischemic stroke.

Keywords: ischemic stroke, rehabilitation, cerebrolysin, cerebral bioelectrical activity, cerebral hemodynamics.

The aim – to find out the possibility of using the data about state of chromatin in nuclei of buccal epithelium as a marker of presence – absence of multiple sclerosis (MS).

Methods and subjects. 63 patients with MS (the basic group) and 164 practically healthy people (control group) were examined. It was estimated chronological age and contents of heterochromatin granules (CHG) in nucleus of cells of buccal epithelium (by Yu.G. Shkorbatov), as a marker of biological age. Besides the functional condition of patients with MS by Kurtzke scale (EDSS) was estimated. Processing of the received data was carried out by methods of mathematical statistics.

Results. It is established, that parameter CHG in patients with MS is much higher, than in practically healthy people. Hence the processes of heterochromatization and reducing of functional activity of nuclei’s chromatin were passing at higher rate than at healthy people and their biological age forestalls their chronological one.

Conclusions. Patients with MS have the accelerated ageing of cells which reflected in values of CHG which can be used as a marker of presence – absence of MS.

Keywords: multiple sclerosis, biological age, chromatin in nuclei of buccal epithelium, diagnosis.

The aim – to elevate the efficacy of diagnostics of brainstem structures organic and functional impairments in patients with multiple sclerosis by means of application of registration methods of evoked motor potentials in response to magnetic stimulation.

Methods and subjects. 40 patients with SD (onset progressive stage) were examined. The diagnosis was set on the basis of clinical and instrumental (brain and spinal cord MRI), immunological and electrophysiological findings. The NPh diagnostic complex included: registration of blink (BR) and mandibular reflexes (MR), auditory (AVP), somatosensory (SSVP) evoked potentials, MEP in resoponse to transcranial (TMS) magnetic stimulation.

Results. 55 % of patients with SD clinical signs of brainstem demonstrated the presence of brainstem structures impairments, but NPh signs – in 80 %. On basis of analysis of the frequency of registration of NPh abnormalities of conduction along pyramidal tract, spinal and brainstem afferents ways, brainstem reflexes comparing to clinical manifestations, the pathological procces distention criteria, brainstem caudal structures involvement, impairment manifestations stage, objective evaluation of the conduction deceleration along demyelinated zones in CNS were defined.

Conclusions. The appropriateness of NPh methods extension has been proved. NPh findings provide with opportunities to define the brainstem function impairments even under the clinical manifestations absence. Application of NPh diagnostic complex makes it possible to improve the effectiveness of SD diagnosics as compared to selective application of one NPh method, promotes treatment efficacy evaluation objectification.

Keywords: multiple sclerosis, diagnosis, transcranial magnetic stimulation, brainstem reflexes

The aim – studying tensiometric and rheological characteristics of a cerebro-spinal liquid (CSL) at patients with nervous system organic defeats.

Methods and subjects. 148 patients with nervous system organic defeat (a multiple sclerosis, consequence encephalomyelitis, virus encephalomyelitis, an ischemic stroke, brain tumours, neyrosifilis) were examined. The dynamic interphase tensiometrywas performed using methods МРТ and АDSA for defining neurolymph concentration of surface-active substances (SAS), their viscosity, adsorption and relaxation.

Results. The influence of high viscidelastic indicators was established at patients with multiple sclerosis, virus encephalomyelitis and brain tumours on a superficial tension of low- and high-molecular SAS. It is revealed that the lowest indicators of adsorption of highly active components were marked at neyrosifilis.

Conclusions. The TSL dynamic interphase tensiometry research is an informative method of diagnostics of the basic neurologic diseases.

Keywords: cerebro-spinal liquid, a superficial tension, surface-active substances.

The aim – determination of plasmapheresis efficacy in treatment of patients with demyelinating diseases of central and peripheral nervous system.

Methods and subjects. 21 patients with demyelinating diseases of central and peripheral nervous system were examined. The antibodies for myelin-associated glycoprotein level was measured before the treatment and after the third plasmapheresis session. Plasmapheresis efficacy was evaluated according to neurological scales EDSS and NRS.

Results. The elevated level of antibodies for myelin-associated glycoprotein was marked in 13 patients. The decreasing of the level was noted in 9 patients. It correlated with their state changes according to neurological scales EDSS and NRS.

Conclusions. Presence of antibodies for myelin-associated glycoprotein can be the indication for plasma-pheresis application in complex therapy of demyelinating diseases of central and peripheral nervous system.

Keywords: plasmapheresis, demyelinating diseases, myelin-associated glycoprotein.

The aim – an estimation of life’s quality (LQ) parameters change at patients suffer from diabetes mellitus (DM) with a diabetic encephalopathy (DE).

Methods and subjects. 113 patients with DM were examined: 27 patients with a syndrome of a vegetative dystonia (SVD) – 1 group; 48 – with a diabetic encephalopathy of I stage (DE I) – 2 group; 38 – with DE II stage – 3 group.

Neuropsychological examination was carried out for all patients. Parameters of LQ were estimated according to SF-36 Health Status Survey questionnaire.

Results. Correlation relations between life’s quality and a level glycosilirative hemoglobin (HbA1c), severity and frequencies of hyperglycemia with parameters of scales «Ability to physical activities», «Influence of a physical condition on role functioning», «Influence of an emotional condition on role functioning» have been revealed.

Deterioration of LQ is interconnected with a level of depression at patients with DE and with levels of situational and personal anxiety.

Conclusions. The estimation of LQ parameters allows to receive the qualitative and quantitative characteristic of combined (somatic, neurologic and mental) disturbances at patients with DE. The characteristic of subjective satisfaction with the functioning level should be included into the estimation of a patients condition with DE alongside with other methods of patients’ conditions examnation. This information provides with new opportunities in overcoming patients of undesirable experiences, development of the positive attitude to treatment, preventive maintenance of possible complications from nervous system.

Keywords: diabetes mellitus, diabetic encephalopathy, life’s quality.

Motor impairments are common stroke sequalae that cause significant functional limitations. Although optimal care is not established, starting treatment in the acute stroke is thought to be important. Spasticity may play a key role in poststroke motor dysfunction. Local injections of botilinum toxin A proved to be safe and effective treatment for post stroke spasticity which results in decrease in muscle tone as well as active and passive movements facilitation. There is insufficient evidence suggesting positive influence of botilinum toxin A treatment on activities of daily living, thus goals set for the treatment should be realistic. Recovery of complex movements after stroke is more important, than improvement in single motor impairments such as muscle weakness or spasticity. Effect of any intervention aimed at motor recovery and treatment of spasticity after stroke will be unsatisfactory if it is not included in comprehensive rehabilitation program.

Keywords: stroke, motor impairment, spasticity, botulinum toxin A.

Motor impairments are common stroke sequalae that cause significant functional limitations. Although optimal care is not established, starting treatment in the acute stroke is thought to be important. Spasticity may play a key role in poststroke motor dysfunction. Local injections of botilinum toxin A proved to be safe and effective treatment for post stroke spasticity which results in decrease in muscle tone as well as active and passive movements facilitation. There is insufficient evidence suggesting positive influence of botilinum toxin A treatment on activities of daily living, thus goals set for the treatment should be realistic. Recovery of complex movements after stroke is more important, than improvement in single motor impairments such as muscle weakness or spasticity. Effect of any intervention aimed at motor recovery and treatment of spasticity after stroke will be unsatisfactory if it is not included in comprehensive rehabilitation program.

Keywords: stroke, motor impairment, spasticity, botulinum toxin A.

The aim – to determine the term of cholinergic differentiation beginning in the human central nerve system.

Methods and subjects. We have examined the expression of genes, associated with cholinergic type of differentiation – cholineacethyltransferase, acethylcholinesterase, and vesicular acethylcholinetransporter (VAChT) by the RT-PCR method. The brain tissue of human embryos 6–12 weeks of gestation was used.

Results. Cholineacethyltransferase and vesicular acethylcholinetransporter VAChT mRNA were detected at the samples of 9–10 weeks and more later terms. At the same time the transcription of acethylcholinesterase gene was at the same level in all samples.

Conclusions. The cell population from embryos 9–10 weeks of gestation demonsrate the greatest potential for cell culture reproduction of brain holinergic neurons.

Keywords: сholinergic neurons, cholineacethyltransferase, acethylcholinesterase, vesicular acethylcholinetransporter, embryonal nerve cells.

The aim – Solkoseryl neuroprotective effects investigation under the experimental brain stroke

Methods and subjects. The experiments were performed using Wistar rats under chronic experiment on the models of experimental brain stroke with the strong accordance to the basic standard and ethical requirements to carrying out of laboratory and other experiences with participation of different kinds of experimental animal. 3 groups of animals were selected: the group of comparison, rats with brain stroke without treatment (control group) and rats with brain stroke treated with solkoseryl. Brain tissue histological examination was performed 4, 7, 10 and 14 days after brain stroke induction.

Results. Macro- and micro-cellular impairments were shown to develop mainly in the cortical and hippocampal level. The neurons content with elevated functional activity decreased. Solkoseryl resulted in animal’s brain morphological structure normalization. These pathomorphological changes were marked on the 14th day after ischemic stroke induction.

Conclusions. The data obtained are the experimental background of solkoseryl reasonability to include into stroke patients complex treatment as neuroprotective compound for the secondary neuroprotection.

Keywords: solkoseryl, neuroprotection, ischemic stroke

Цель — исследование нейропротективных эффектов Солкосерила в условиях экспериментального инсульта мозга.

Материалы и методы. Иccледoвания прoведены в ycлoвиях хрoничеcкoгo экcперимента на крыcах линии Виcтар. Животных распределили на три группы: группа сравнения, животные с инсультом без лечения (контроль) и животные с инсультом, которым вводили Солкосерил. Через 4, 7 и 14 дней после воспроизведения инсульта проводили гистологическое исследование ткани мозга животных.

Результаты. Показано, что у крыс в данных модельных условиях развивались макро- и микроскопические клеточные нарушения преимущественно в участках коры мозга и гиппокампа, снижалось количество нейронов с повышенной функциональной активностью. Солкосерил способствовал нормализации морфологической структуры мозга животных. При этом патоморфологические изменения отмечены на 14-е сутки с момента воспроизведения ишемического инсульта.

Выводы. Полученные данные являются экспериментальным обоснованием целесообразности включения Солкосерила в комплексное лечение больных с ишемическим инсультом для обеспечения вторичной нейропротекции.

Keywords: ишемический инсульт, нейропротекция, Солкосерил.

There is an improvement of the brain functional activity due to the usage of preparation Giloba with phytosomes in complex pathogenetic therapy of Parkinson’s disease owing to its neurometabolic, vasoprotective and antioxidant action. The effectiveness of Giloba with phytosomes was evaluated in the group of 29 patients, aged 45 to 74 years, with Parkinson’s disease (1.5–3.0 scores by the UPDRS) before and after 3-months course treatment with 120 mg daily dosage. The obtained results pointing to positive dynamics of clinical symptomatic, improved general motorics, and normalized brain bioelectric activity, cerebral blood flow, lipogenesis condition and nitrogen oxide activity allow us to recommend the preparation Giloba with phytosomes in complex pathogenetic therapy of the Parkinson’s disease.

Keywords: Parkinson’s disease, Ginkgo biloba, brain functional activity.

Применение препарата Гилоба с фитосомами в комплексной патогенетической терапии болезни Паркинсона (БП) способствует улучшению функциональной активности головного мозга, церебральной гемодинамики за счет нейрометаболического, вазопротекторного и антиоксидантного действия. Оценка эффективности Гилоба с фитосомами проведена у 29 больных БП в возрасте 45—74 года со стадией заболевания 1,5—3,0 до и после 3-месячного курса лечения при суточной дозе препарата 120 мг. Положительная динамика клинической симптоматики на фоне лечения, улучшение общей моторики, нормализация биоэлектрической активности головного мозга, мозгового кровотока, состояния липогенеза и активности оксида азота позволяют рекомендовать применение Гилоба с фитосомами в комплексной патогенетической терапии при БП.

Keywords: болезнь Паркинсона, Гинкго билоба, функциональная активность головного мозга.

The aim – to study clinical and pathobiocinematic peculiarities of the combined vertebro-visceral syndromes (CVVS) for the optimization of the treatment and diagnostic activity.

Methods and subjects. 139 patients with CVVS were examined. The rates of vertebrodynamics, degree of pain and muscle hypertone manifestation were evaluated. By means of manipulative-muscle testing (MMT) the types of pathobiocinematic disorders and levels of functional blocking of vertebro-motional segments (VMS) and also blocking of additional joints (costosternal and costovertebral) were determined.

Results. Clinical peculiarities of combined vertebro-visceral syndromes were determined. The differential diagnostic criteria of vertebrogenic and viscerogenic toracalgies were determined. The peculiarities of pathobiocinematic disorders at various CVVS were revealed and their essential influence on forming of clinical presentation and clinical course was proved, which is necessary to consider on the diagnostics stage and also for prescription of pathogenetically grounded complex therapy.

Conclusions. Diagnostics of the combined vertebro-visceral syndromes shall be complex with application of neurological and manipulative examination which allows to reveal their clinical and pathobiocinematic peculiarities and influence all pathogenerics links of process.

Keywords: the combined vertebro-visceral syndromes, clinical and pathobiocinematic peculiarities.

Цель — изучить клинические и патобиокинематические особенности комбинированных вертебровисцеральных синдромов (КВВС) для оптимизации лечебно-диагностических мероприятий.

Материалы и методы. Обследовано 139 больных с КВВС. Оценивали показатели вертебродинамики, степень выраженности боли и гипертонуса мышц. С помощью мануально-мышечного тестирования определяли тип патобиокинематических расстройств и уровень функционального блокирования позвоночно-двигательных сегментов, а также блокирование дополнительных сочленений (реберно-грудинных и реберно-позвоночных).

Результаты. Выявлены клинические особенности КВВС. Определены дифференциально-диагностические критерии вертеброгенных и висцерогенных торакалгий. Выявлены особенности патобиокинематических расстройств при различных КВВС и доказано их существенное влияние на формирование клинической картины и течение процесса, что необходимо учитывать на этапе диагностики, а также для назначения патогенетически обоснованной комплексной терапии.

Выводы. Диагностика КВВС должна быть комплексной, с использованием неврологического и мануального обследования, что позволяет выявить их клинические и патобиокинематические особенности и воздействовать на все патогенетические звенья процесса.

Keywords: комбинированные вертебровисцеральные синдромы, клинические и патобиокинематические особенности.

The aim – Solkoseryl neuroprotective effects investigation under the experimental brain stroke

Methods and subjects. The experiments were performed using Wistar rats under chronic experiment on the models of experimental brain stroke with the strong accordance to the basic standard and ethical requirements to carrying out of laboratory and other experiences with participation of different kinds of experimental animal. 3 groups of animals were selected: the group of comparison, rats with brain stroke without treatment (control group) and rats with brain stroke treated with solkoseryl. Brain tissue histological examination was performed 4, 7, 10 and 14 days after brain stroke induction.

Results. Macro- and micro-cellular impairments were shown to develop mainly in the cortical and hippocampal level. The neurons content with elevated functional activity decreased. Solkoseryl resulted in animal’s brain morphological structure normalization. These pathomorphological changes were marked on the 14th day after ischemic stroke induction.

Conclusions. The data obtained are the experimental background of solkoseryl reasonability to include into stroke patients complex treatment as neuroprotective compound for the secondary neuroprotection.

Keywords: solkoseryl, neuroprotection, ischemic stroke

Цель — определить срок начала дифференцирования нейронов по холинергическому типу в центральной нервной системе человека.

Материалы и методы. С помощью метода полимеразной цепной реакции с обратной транскрипцией анализировали экспрессию генов, ассоциированных с холинергическим типом дифференцирования, — холинацетилтрансферазы, ацетилхолинэстеразы, транспортного белка везикул ацетилхолина (VAChT). Для исследования использовали ткань головного мозга эмбрионов человека 6—12 недель гестации.

Результаты. Матричная РНК холинацетилтрансферазы и VAChT определялась в образцах 9—10 недель гестации и более поздних сроков, тогда как транскрипция гена ацетилхолинэстеразы, сохранялась на том же уровне во всех исследованных образцах.

Выводы. Наибольшим потенциалом для размножения в культуре холинергических нейронов головного мозга обладают клеточные популяции от эмбрионов 9—10 недель гестации.

Keywords: холинергические нейроны, холинацетилтрансфераза, ацетилхолинэстераза, транспортный белок везикул ацетилхолина, эмбриональные нервные клетки.

The aim – to determine the term of cholinergic differentiation beginning in the human central nerve system.

Methods and subjects. We have examined the expression of genes, associated with cholinergic type of differentiation – cholineacethyltransferase, acethylcholinesterase, and vesicular acethylcholinetransporter (VAChT) by the RT-PCR method. The brain tissue of human embryos 6–12 weeks of gestation was used.

Results. Cholineacethyltransferase and vesicular acethylcholinetransporter VAChT mRNA were detected at the samples of 9–10 weeks and more later terms. At the same time the transcription of acethylcholinesterase gene was at the same level in all samples.

Conclusions. The cell population from embryos 9–10 weeks of gestation demonsrate the greatest potential for cell culture reproduction of brain holinergic neurons.

Keywords: сholinergic neurons, cholineacethyltransferase, acethylcholinesterase, vesicular acethylcholinetransporter, embryonal nerve cells.

Двигательные нарушения часто встречаются после инсульта и существенно ограничивают функциональные возможности больных. Хотя оптимальная организация помощи пока не определена, считается важным начинать лечение в острый период инсульта. Спастичность мышц может играть ключевую роль в нарушениях двигательных функций после инсульта. Местные инъекции ботулотоксина А являются безопасным и эффективным

способом лечения постинсультной спастичности, позволяющим как снизить тонус мышц, так и облегчить активные и пассивные движения. Доказательств положительного влияния лечения ботулотоксином А на повседневную жизнедеятельность пока недостаточно, в связи с этим следует выбирать реалистичные цели лечения. Комплексное восстановление движений после инсульта имеет большее значение, чем устранение отдельных двигательных расстройств, таких как слабость мышц или спастичность. Эффективность любого лечебного вмешательства, направленного на двигательное восстановление и лечение спастичности после инсульта, окажется недостаточной, если это лечение не является частью комплексной программы реабилитации.

Keywords: инсульт, двигательные нарушения, спастичность, ботулотоксин А.

The aim – an estimation of life’s quality (LQ) parameters change at patients suffer from diabetes mellitus (DM) with a diabetic encephalopathy (DE).

Methods and subjects. 113 patients with DM were examined: 27 patients with a syndrome of a vegetative dystonia (SVD) – 1 group; 48 – with a diabetic encephalopathy of I stage (DE I) – 2 group; 38 – with DE II stage – 3 group.

Neuropsychological examination was carried out for all patients. Parameters of LQ were estimated according to SF-36 Health Status Survey questionnaire.

Results. Correlation relations between life’s quality and a level glycosilirative hemoglobin (HbA1c), severity and frequencies of hyperglycemia with parameters of scales «Ability to physical activities», «Influence of a physical condition on role functioning», «Influence of an emotional condition on role functioning» have been revealed.

Deterioration of LQ is interconnected with a level of depression at patients with DE and with levels of situational and personal anxiety.

Conclusions. The estimation of LQ parameters allows to receive the qualitative and quantitative characteristic of combined (somatic, neurologic and mental) disturbances at patients with DE. The characteristic of subjective satisfaction with the functioning level should be included into the estimation of a patients condition with DE alongside with other methods of patients’ conditions examnation. This information provides with new opportunities in overcoming patients of undesirable experiences, development of the positive attitude to treatment, preventive maintenance of possible complications from nervous system.

Keywords: diabetes mellitus, diabetic encephalopathy, life’s quality.

The aim – an estimation of life’s quality (LQ) parameters change at patients suffer from diabetes mellitus (DM) with a diabetic encephalopathy (DE).

Methods and subjects. 113 patients with DM were examined: 27 patients with a syndrome of a vegetative dystonia (SVD) – 1 group; 48 – with a diabetic encephalopathy of I stage (DE I) – 2 group; 38 – with DE II stage – 3 group.

Neuropsychological examination was carried out for all patients. Parameters of LQ were estimated according to SF-36 Health Status Survey questionnaire.

Results. Correlation relations between life’s quality and a level glycosilirative hemoglobin (HbA1c), severity and frequencies of hyperglycemia with parameters of scales «Ability to physical activities», «Influence of a physical condition on role functioning», «Influence of an emotional condition on role functioning» have been revealed.

Deterioration of LQ is interconnected with a level of depression at patients with DE and with levels of situational and personal anxiety.

Conclusions. The estimation of LQ parameters allows to receive the qualitative and quantitative characteristic of combined (somatic, neurologic and mental) disturbances at patients with DE. The characteristic of subjective satisfaction with the functioning level should be included into the estimation of a patients condition with DE alongside with other methods of patients’ conditions examnation. This information provides with new opportunities in overcoming patients of undesirable experiences, development of the positive attitude to treatment, preventive maintenance of possible complications from nervous system.

Keywords: diabetes mellitus, diabetic encephalopathy, life’s quality.

The aim – determination of plasmapheresis efficacy in treatment of patients with demyelinating diseases of central and peripheral nervous system.

Methods and subjects. 21 patients with demyelinating diseases of central and peripheral nervous system were examined. The antibodies for myelin-associated glycoprotein level was measured before the treatment and after the third plasmapheresis session. Plasmapheresis efficacy was evaluated according to neurological scales EDSS and NRS.

Results. The elevated level of antibodies for myelin-associated glycoprotein was marked in 13 patients. The decreasing of the level was noted in 9 patients. It correlated with their state changes according to neurological scales EDSS and NRS.

Conclusions. Presence of antibodies for myelin-associated glycoprotein can be the indication for plasma-pheresis application in complex therapy of demyelinating diseases of central and peripheral nervous system.

Keywords: plasmapheresis, demyelinating diseases, myelin-associated glycoprotein.

The aim – studying tensiometric and rheological characteristics of a cerebro-spinal liquid (CSL) at patients with nervous system organic defeats.

Methods and subjects. 148 patients with nervous system organic defeat (a multiple sclerosis, consequence encephalomyelitis, virus encephalomyelitis, an ischemic stroke, brain tumours, neyrosifilis) were examined. The dynamic interphase tensiometrywas performed using methods МРТ and АDSA for defining neurolymph concentration of surface-active substances (SAS), their viscosity, adsorption and relaxation.

Results. The influence of high viscidelastic indicators was established at patients with multiple sclerosis, virus encephalomyelitis and brain tumours on a superficial tension of low- and high-molecular SAS. It is revealed that the lowest indicators of adsorption of highly active components were marked at neyrosifilis.

Conclusions. The TSL dynamic interphase tensiometry research is an informative method of diagnostics of the basic neurologic diseases.

Keywords: cerebro-spinal liquid, a superficial tension, surface-active substances.

The aim – an estimation of life’s quality (LQ) parameters change at patients suffer from diabetes mellitus (DM) with a diabetic encephalopathy (DE).

Methods and subjects. 113 patients with DM were examined: 27 patients with a syndrome of a vegetative dystonia (SVD) – 1 group; 48 – with a diabetic encephalopathy of I stage (DE I) – 2 group; 38 – with DE II stage – 3 group.

Neuropsychological examination was carried out for all patients. Parameters of LQ were estimated according to SF-36 Health Status Survey questionnaire.

Results. Correlation relations between life’s quality and a level glycosilirative hemoglobin (HbA1c), severity and frequencies of hyperglycemia with parameters of scales «Ability to physical activities», «Influence of a physical condition on role functioning», «Influence of an emotional condition on role functioning» have been revealed.

Deterioration of LQ is interconnected with a level of depression at patients with DE and with levels of situational and personal anxiety.

Conclusions. The estimation of LQ parameters allows to receive the qualitative and quantitative characteristic of combined (somatic, neurologic and mental) disturbances at patients with DE. The characteristic of subjective satisfaction with the functioning level should be included into the estimation of a patients condition with DE alongside with other methods of patients’ conditions examnation. This information provides with new opportunities in overcoming patients of undesirable experiences, development of the positive attitude to treatment, preventive maintenance of possible complications from nervous system.

Keywords: diabetes mellitus, diabetic encephalopathy, life’s quality.

The aim – determination of plasmapheresis efficacy in treatment of patients with demyelinating diseases of central and peripheral nervous system.

Methods and subjects. 21 patients with demyelinating diseases of central and peripheral nervous system were examined. The antibodies for myelin-associated glycoprotein level was measured before the treatment and after the third plasmapheresis session. Plasmapheresis efficacy was evaluated according to neurological scales EDSS and NRS.

Results. The elevated level of antibodies for myelin-associated glycoprotein was marked in 13 patients. The decreasing of the level was noted in 9 patients. It correlated with their state changes according to neurological scales EDSS and NRS.

Conclusions. Presence of antibodies for myelin-associated glycoprotein can be the indication for plasma-pheresis application in complex therapy of demyelinating diseases of central and peripheral nervous system.

Keywords: plasmapheresis, demyelinating diseases, myelin-associated glycoprotein.

The aim – determination of plasmapheresis efficacy in treatment of patients with demyelinating diseases of central and peripheral nervous system.

Methods and subjects. 21 patients with demyelinating diseases of central and peripheral nervous system were examined. The antibodies for myelin-associated glycoprotein level was measured before the treatment and after the third plasmapheresis session. Plasmapheresis efficacy was evaluated according to neurological scales EDSS and NRS.

Results. The elevated level of antibodies for myelin-associated glycoprotein was marked in 13 patients. The decreasing of the level was noted in 9 patients. It correlated with their state changes according to neurological scales EDSS and NRS.

Conclusions. Presence of antibodies for myelin-associated glycoprotein can be the indication for plasma-pheresis application in complex therapy of demyelinating diseases of central and peripheral nervous system.

Keywords: plasmapheresis, demyelinating diseases, myelin-associated glycoprotein.

The aim – studying tensiometric and rheological characteristics of a cerebro-spinal liquid (CSL) at patients with nervous system organic defeats.

Methods and subjects. 148 patients with nervous system organic defeat (a multiple sclerosis, consequence encephalomyelitis, virus encephalomyelitis, an ischemic stroke, brain tumours, neyrosifilis) were examined. The dynamic interphase tensiometrywas performed using methods МРТ and АDSA for defining neurolymph concentration of surface-active substances (SAS), their viscosity, adsorption and relaxation.

Results. The influence of high viscidelastic indicators was established at patients with multiple sclerosis, virus encephalomyelitis and brain tumours on a superficial tension of low- and high-molecular SAS. It is revealed that the lowest indicators of adsorption of highly active components were marked at neyrosifilis.

Conclusions. The TSL dynamic interphase tensiometry research is an informative method of diagnostics of the basic neurologic diseases.

Keywords: cerebro-spinal liquid, a superficial tension, surface-active substances.

The aim – studying tensiometric and rheological characteristics of a cerebro-spinal liquid (CSL) at patients with nervous system organic defeats.

Methods and subjects. 148 patients with nervous system organic defeat (a multiple sclerosis, consequence encephalomyelitis, virus encephalomyelitis, an ischemic stroke, brain tumours, neyrosifilis) were examined. The dynamic interphase tensiometrywas performed using methods МРТ and АDSA for defining neurolymph concentration of surface-active substances (SAS), their viscosity, adsorption and relaxation.

Results. The influence of high viscidelastic indicators was established at patients with multiple sclerosis, virus encephalomyelitis and brain tumours on a superficial tension of low- and high-molecular SAS. It is revealed that the lowest indicators of adsorption of highly active components were marked at neyrosifilis.

Conclusions. The TSL dynamic interphase tensiometry research is an informative method of diagnostics of the basic neurologic diseases.

Keywords: cerebro-spinal liquid, a superficial tension, surface-active substances.

The aim – to elevate the efficacy of diagnostics of brainstem structures organic and functional impairments in patients with multiple sclerosis by means of application of registration methods of evoked motor potentials in response to magnetic stimulation.

Methods and subjects. 40 patients with SD (onset progressive stage) were examined. The diagnosis was set on the basis of clinical and instrumental (brain and spinal cord MRI), immunological and electrophysiological findings. The NPh diagnostic complex included: registration of blink (BR) and mandibular reflexes (MR), auditory (AVP), somatosensory (SSVP) evoked potentials, MEP in resoponse to transcranial (TMS) magnetic stimulation.

Results. 55 % of patients with SD clinical signs of brainstem demonstrated the presence of brainstem structures impairments, but NPh signs – in 80 %. On basis of analysis of the frequency of registration of NPh abnormalities of conduction along pyramidal tract, spinal and brainstem afferents ways, brainstem reflexes comparing to clinical manifestations, the pathological procces distention criteria, brainstem caudal structures involvement, impairment manifestations stage, objective evaluation of the conduction deceleration along demyelinated zones in CNS were defined.

Conclusions. The appropriateness of NPh methods extension has been proved. NPh findings provide with opportunities to define the brainstem function impairments even under the clinical manifestations absence. Application of NPh diagnostic complex makes it possible to improve the effectiveness of SD diagnosics as compared to selective application of one NPh method, promotes treatment efficacy evaluation objectification.

Keywords: multiple sclerosis, diagnosis, transcranial magnetic stimulation, brainstem reflexes

Цель — повысить эффективность диагностики органических и функциональных нарушений структур ствола головного мозга у больных рассеянным склерозом (РС) путем применения методов регистрации вызванных моторных ответов на магнитную стимуляцию и стволовых рефлексов.

Материалы и методы. Исследования проведены у 40 больных с церебральной формой РС (первично-прогрессирующее течение). Диагноз установлен на основании данных клинико-инструментальных (магнитно-резонансная томография головного и спинного мозга), иммунологических, электрофизиологических исследований. У всех больных проведены клинико-нейрофизиологические исследования с регистрацией мигательного

и мандибулярного рефлексов, вызванных слуховых и соматосенсорных потенциалов; вызванных моторных ответов на транскраниальную магнитную стимуляцию.

Результаты. У 55 % пациентов с РС выявлены клинические признаки нарушения функции структур ствола мозга, почти у 80 % — отклонения от нормы нейрофизиологических показателей. На основании анализа частоты регистрации нейрофизиологических признаков нарушения проведения по пирамидному тракту, афферентным путям спинного мозга и ствола головного мозга в сопоставлении с клиническими симптомами определены критерии распространенности патологического процесса, вовлечения каудальных структур ствола мозга, степени выраженности нарушений, объективной оценки замедления проведения через зоны демиелинизации в ЦНС.

Выводы. Доказана целесообразность расширения диапазона нейрофизиологических методов в диагностике РС. Нейрофизиологическое тестирование позволяет выявить нарушения функции структур ствола головного мозга и при отсутствии клинических признаков. Применение комплекса нейрофизиологических тестов для выявления дисфункции стволовых структур при РС повышает эффективность диагностики по сравнению с избирательным использованием одного диагностического метода, способствует объективизации оценки эффективности лечения.

Keywords: рассеянный склероз, диагностика, транскраниальная магнитная стимуляция, стволовые рефлексы.

Цель — изучение возможности использования состояния хроматина в ядрах клеток буккального эпителия как маркера наличия/отсутствия у больных рассеянного склероза (РС).

Материалы и методы. Обследовано 63 больных РС (основная группа) и 164 практически здоровых лиц (контрольная группа). Оценивали: хронологический возраст обследованных и содержание гетерохроматиновых гранул (СГГ) в ядрах клеток буккального эпителия (по Ю.Г. Шкорбатову) как маркер биологического возраста, а также функциональное состояние больных РС по шкале Kurtzke (EDSS).

Результаты. Установлено, что показатель СГГ у больных РС существенно выше, чем у практически здоровых. Следовательно, процессы гетерохроматизации и снижение функциональной активности хроматина ядер клеток у больных РС происходят быстрее, чем у здоровых людей, и их биологический возраст опережает хронологический.

Выводы. У больных РС происходит ускоренное старение клеток, о чем свидетельствует СГГ, которое может быть использовано как маркер наличия/отсутствия РС.

Keywords: рассеянный склероз, биологический возраст, хроматин ядер клеток, диагноз.

The aim – to find out the possibility of using the data about state of chromatin in nuclei of buccal epithelium as a marker of presence – absence of multiple sclerosis (MS).

Methods and subjects. 63 patients with MS (the basic group) and 164 practically healthy people (control group) were examined. It was estimated chronological age and contents of heterochromatin granules (CHG) in nucleus of cells of buccal epithelium (by Yu.G. Shkorbatov), as a marker of biological age. Besides the functional condition of patients with MS by Kurtzke scale (EDSS) was estimated. Processing of the received data was carried out by methods of mathematical statistics.

Results. It is established, that parameter CHG in patients with MS is much higher, than in practically healthy people. Hence the processes of heterochromatization and reducing of functional activity of nuclei’s chromatin were passing at higher rate than at healthy people and their biological age forestalls their chronological one.

Conclusions. Patients with MS have the accelerated ageing of cells which reflected in values of CHG which can be used as a marker of presence – absence of MS.

Keywords: multiple sclerosis, biological age, chromatin in nuclei of buccal epithelium, diagnosis.

The aim – to study the cerebrolysin`s influence on cerebral circulation and bioenergetics in patients with ischemic stroke.

Methods and subjects. It was conducting the complex examination of 26 elderly patients (average age 62 ± 2.2 years) who had atherothrombotic ischemic stroke before and after administration of 10.0 ml Cerebrolysin i/v dropwise for 10 days. This examination included clinical and neurological examination, assessment of the daily activity level (Barthel's scale), the state of memory function (MMSE), ultrasound dopplerography of head and neck vessels (EN VISOR (Philips)), the EEG analysis (Neurofax EEG-1100 Nihon Kohden).

Results. Course of cerebrolysin improves cognitive function, increases social activity and provides reorganization of cerebral bioelectrical activity in patient with ischemic stroke. Cerebrolysin harmonizes the structure of cerebral bioelectrical activity in patients with ischemic stroke in left hemisphere comparing with patient with ischemic stroke in right hemisphere. The influence of cerebrolysin includes the improving of cerebral hemodynamic. This fact confirms the increasing of LBFV and decreasing indexes of peripheral resistance in several carotid vessels and vertebrobasilar vessels.

Conclusions. All these results are basis for including cerebrolysin to complex rehabilitation system for elder patient with ischemic stroke.

Keywords: ischemic stroke, rehabilitation, cerebrolysin, cerebral bioelectrical activity, cerebral hemodynamics.

Цель — изучить влияние церебролизина на церебральное кровообращение и биоэнергетику мозга у больных, перенесших ишемический инсульт.

Материалы и методы. Проведено комплексное обследование 26 больных пожилого возраста (средний возраст — (62 ± 2,2) года), перенесших атеротромботический ишемический инсульт, до и после введения 10,0 мл церебролизина внутривенно капельно на 100,0 мл физиологического раствора в течение 10 дней, которое включало клинико-неврологический осмотр, оценку уровня повседневной активности по шкале Бартела, состояния мнестических функций по шкале MMSE, ультразвуковую допплерографию сосудов головы и шеи (EN VISOR (Philips)), анализ ЭЭГ (16-канальный электроэнцефалограф Neurofax EEG-1100 Nihon Kohden).

Результаты. У больных, перенесших ишемический инсульт, под влиянием курсового лечения церебролизином улучшаются мнестические функции, повышается социально-бытовая активность, происходит реорганизация биоэлектрической активности головного мозга. У больных с левополушарным инсультом церебролизин оказывает более гармонизирующее влияние на структуру биоэлектрической активности головного мозга, чем у больных с локализацией инсульта в правом полушарии. Под влиянием курсового лечения церебролизином у больных улучшается церебральная гемодинамика, о чем свидетельствует увеличение линейной систолической скорости кровотока и уменьшение периферического сопротивления в отдельных сосудах каротидного и вертебробазилярного бассейнов.

Выводы. Влияние церебролизина на мозговое кровообращение и биоэнергетику мозга больных пожилого возраста, перенесших ишемический инсульт, позволяет рекомендовать включение этого препарата в комплексную систему реабилитации данной категории больных.

Keywords: ишемический инсульт, реабилитация, церебролизин, биоэлектрическая активность головного мозга, церебральная гемодинамика.

The aim – to study сognitive and еmotional impairments in patients with the acute period of stroke.

Methods and subjects. Іn order to study cognitive impairments cognitive functions were studyed in 71 patients with the acute period of brain infarction (average age 50.39 ± 0.89 years) using the Mini-Mental State Examination scale (MMSE), screening battery to identify the frontal lobe dysfunction and clock drawing test. Control group included 20 cases with dyscirculatory encephalopathy of vascular genesis (І–ІІ stage) without acute stroke who had agerelated cognitive dysfunction (average age 49.1 ± 2.46 years).

Results. It was defined that within the first 3 days of brain infarction, cognitive impairments developed in 64.78 % of patients according to the MMSE scale. Depression and anxiety level was elevated in patients during an acute infarction period comparing to control group.

Conclusions. According to the test results, cognitive impairments have been associated with the symptom of «splitting» that comes from the disturbances between the cortical and subcortical structures.

Keywords: stroke, cognitive, emotional impairments.

Цель — изучить особенности изменений цереброваскулярной реактивности в острый период инфаркта мозга по результатам исследования метаболического и миогенного механизмов авторегуляции мозгового кровотока.

Материалы и методы. Проведено комплексное клинико-неврологическое обследование 47 пациентов (19 мужчин и 28 женщин, средний возраст — (67,1 ± 1,9) года) в острый период инфаркта мозга. В исследование включали лишь пациентов, которые впервые перенесли острые нарушения мозгового кровообращения. Больных распределили на две группы: 1<я группа — 27 пациентов с инфарктом мозга полушарной локализации, 2-я — 20 пациентов с инфарктом в сосудах вертебробазилярного бассейна. Контрольная группа состояла из 10 лиц без острого нарушения мозгового кровообращения в анамнезе, средний возраст — (65,7 ± 1,7) года. Цереброваскулярную реактивность исследовали методом транскраниальной допплерографии с использованием функциональных проб с нагрузкой, которые последовательно активировали метаболический и миогенный механизмы авторегуляции мозгового кровообращения.

Результаты. У пациентов 1-й группы преобладал декомпенсированный тип мозговой гемодинамики, а также зарегистрировано достоверное снижение индекса реактивности на гиперкапническую пробу с задержкой дыхания по сравнению с группой контроля (1,09 ± 0,06 и 1,39 ± 0,04 соответственно, p < 0,005), что свидетельствует об истощении вазодилататорного компонента цереброваскулярной реактивности. У больных 2-й группы также зарегистрировали достоверное снижение индекса реактивности на гиперкапническую пробу с задержкой дыхания по сравнению с группой контроля (1,07 ± 0,06 и 1,28 ± 0,06 соответственно, p < 0,005). Во время проведения ортостатической нагрузки зарегистрировано преобладание ортостатической неустойчивости, обусловленной дисфункцией миогенного компонента регуляции мозгового кровотока (снижение величины индекса реактивности на ортостатическую нагрузку по сравнению с группой контроля (0,71 ± 0,04 и 0,96 ± 0,07 соответственно, p < 0,005). Выявленные изменения, по нашему мнению, обусловлены дисфункцией стволовых структур, которые обеспечивают центральную регуляцию мозгового кровотока.

Выводы. У пациентов с полушарной локализацией инфаркта мозга преобладают нарушения метаболического вазодилататорного механизма авторегуляции мозгового кровотока; у больных со стволовым инфарктом мозга дополнительно регистрируются нарушения миогенного механизма авторегуляции, а именно, ортостатическая неустойчивость мозгового кровотока, обусловленная дисфункцией стволовых структур.

Keywords: инфаркт мозга, цереброваскулярная реактивность, транскраниальная допплерография.

The aim – to improve the results of the operative treatment of patients with degenerative lumbar spinal stenosis on the base of the optimized approach to the surgery taking into account medico-social criteria.

Methods and subjects. 48 patients with lumbar spinal stenosis were operated at the A.P. Romodanov Institute of Neurosurgery over the period from 2008 to 2010. The patients were from 39 to 72 years old. According to the MRI, CT and X-ray central stenosis was found in 26, lateral – in 15, combined – in 7 cases. 12 patients had a single-level stenosis, 26 patients had lumbar stenosis at 2 levels, and multilevel stenosis was diagnosted in 10 patients. Herniated discs were found in 16, and spondilolisthesis – in 4 cases. 43 patients presented with neurogenic claudication, 42 і 34 – with lumbalgia and lumboischialgia, respectively. 23 patients had motor weakness and 19 – sensory abnormalities. Impaired sphincter functions were found in 5 patients. Extended laminectomy was performed in 9 (18.8 %) cases, bilateral microsurgical fenestration – in 20 (41.9 %), hemilaminectomy – in 7 (14.6 %) and interlaminectomy – in 12 (25 %) patients. 16 and 4 patients required disc removal and transpedicular stabilization, respectively.

Results. At the moment of discharge 39 (81.2 %) patients demonstrated good postoperative status, 7 (14.6 %) showed satisfactory results.

Conclusions. A rational approach to the choice of proper method and extent of surgical intervention for lumbar spinal stenosis is the prerequisite for optimal decompression of neurovascular elements and preservation of spinal stability.

Keywords: lumbar stenosis, neurogenic claudication, laminectomy, microsurgical fenestration.

The aim – study clinical and neurophysiological correlations in syndromology of tic hyperkinetic disorders for the purpose of pathogenetical mosaic structure classification, differential diagnosis optimization and therapy functional tics.

Methods and subjects. 77 patients with tics were under examination, during which, apart from somatic and neurological study, there was conducted research of brain bioelectrogenesis with the help of electroencephalogram (EEG), the state of brain ventricular system and intracranial pressure with the help of echo encephalogram (EchoEG) as well as cerebral haemodynamics using the method of transcranial Doppler ultrasonography (TCD).

Results. Complex examination which was carried out has allowed to conclude that 93.51 % of patients had primary tics, including classic Tourrete’s syndrome at 10.39 %, neurotic tics at 15.59 %, and at the overwhelming majority of 67.53 % there were pseudoneurotic or «neurosis-like» tics developing against prenosological premorbid procedural or residual lesions of different aetiology in cerebral structures, striatum system first of all, that were witnessed by considerable lesions in bioelectrogenesis, brain ventricular system and in a number of cases in cerebral haemodynamics that were detected during this research.

Conclusions. Recommended complex examination of all patients with tics, including EEG, the Echo EG and TCD will allow to optimize differential diagnostics and consequently therapy of the given contingent of patients.

Keywords: tic hyperkinetic disorders, clinical picture, electroencephalography, еchoencephalogram, tran

The aim – study clinical and neurophysiological correlations in syndromology of tic hyperkinetic disorders for the purpose of pathogenetical mosaic structure classification, differential diagnosis optimization and therapy functional tics.

Methods and subjects. 77 patients with tics were under examination, during which, apart from somatic and neurological study, there was conducted research of brain bioelectrogenesis with the help of electroencephalogram (EEG), the state of brain ventricular system and intracranial pressure with the help of echo encephalogram (EchoEG) as well as cerebral haemodynamics using the method of transcranial Doppler ultrasonography (TCD).

Results. Complex examination which was carried out has allowed to conclude that 93.51 % of patients had primary tics, including classic Tourrete’s syndrome at 10.39 %, neurotic tics at 15.59 %, and at the overwhelming majority of 67.53 % there were pseudoneurotic or «neurosis-like» tics developing against prenosological premorbid procedural or residual lesions of different aetiology in cerebral structures, striatum system first of all, that were witnessed by considerable lesions in bioelectrogenesis, brain ventricular system and in a number of cases in cerebral haemodynamics that were detected during this research.

Conclusions. Recommended complex examination of all patients with tics, including EEG, the Echo EG and TCD will allow to optimize differential diagnostics and consequently therapy of the given contingent of patients.

Keywords: tic hyperkinetic disorders, clinical picture, electroencephalography, еchoencephalogram, tran

The aim – to review the causes of ophthalmopathy and the results of treatment of patients with oculomotor disorders.

Methods and subjects. 430 patients with oculomotor disorders have been examined. Comprehensive clinical, neurological and neuroophthalmological examinations, neurovisual methods (magnetic resonance, computer tomography of the brain) were carried out.

Results. Neurogenic ophthalmopathies were diagnosed in 382 (88.8 %) patients, miogenic – in 48 (11.2 %).

Neurogenic ophthalmopathy was detected in patients with vascular pathology, brain injury, brain tumors, inflammatory lesions of the nervous system, diabetes mellitus. Myogenic – was observed in case of lesions of the eye muscles of patients in the orbit (inflammation, autoimmune processes, trauma, endocrinological pathology). Results of rehabilitation treatment of oculomotor disorders were analyzed in the early post surgery period for patients with vascular pathology, brain injury, brain tumors.

Conclusions. The ophthalmopathies are observed in patients with diseases and injuries of the central nervous system, and common diseases of the organism. Complex rehabilitation treatment using pharmacotherapy and physiotherapy methods contributes complete or partial recovery of the damaged III, IV, VI nerves and regresses oculomotor disorders.

Keywords: oculomotor disorders, neurogenic ophthalmopathies, myogenic ophthalmopathies, rehabilitation treatment.

The pathophysiological mechanisms of the perihematomal area edema development are reviewed. The perihematomal area edema is the important marker of the brain tissue perifocal damage after intracerebral hemorrhage.

The model of the perihematomal tissue edema forming is described, where pathological changes of neurons and neuroglia cells have arisen. The critical assessment of current approach for treatment of brain edema as complication of intracerebral hemorrhage is given.

Keywords: intracerebral hemorrhage, brain edema, therapy.

Рассмотрены патофизиологические механизмы развития отека перигематомной области – важного маркера периочагового повреждения ткани головного мозга после острого внутримозгового кровоизлияния. Представлена модель формирования отека ткани перигематомы, в зоне которой возникают патологические изменения нейронов и клеток нейроглии. Дана критическая оценка современным подходам к лечению отека головного мозга, осложняющего внутримозговое кровоизлияние.

Keywords: внутримозговое кровоизлияние, отек мозга, терапия.

Цель – изучить клинико-нейрофизиологические соотношения в синдромологии тикозных гиперкинезов для уточнения структуры их патогенетической мозаики, оптимизации дифференциальной диагностики и терапии функциональных тиков.

Материалы и методы. Под наблюдением находились 77 пациентов с тиками, которым, помимо соматоневрологического, проведено исследование биоэлектрогенеза головного мозга с помощью электроэнцефалографии (ЭЭГ), изучение состояния желудочковой системы головного мозга и внутричерепного давления с применением эхоэнцефалоскопии (ЭхоЭС) и церебральной гемодинамики методом транскраниальной допплеросонографии (ТКДСГ).

Результаты. Проведенное комплексное обследование показало, что у 93,51 % пациентов были первичные тики, в том числе классический синдром Туретта – у 10,39 %, невротические тики – у 15,59 %, а у подавляющего большинства (67,53 %) – «псевдоневротические», или «неврозоподобные» тики, развивающиеся на фоне донозологического преморбидного процессуального либо резидуального поражения церебральных структур, в первую очередь, стриарной системы, различной этиологии, о чем свидетельствуют выявленные у этих больных существенные нарушения биоэлектрогенеза, состояния желудочковой системы головного мозга и, в ряде случаев, церебральной гемодинамики.

Выводы. Проведение комплексного обследования, включающего ЭЭГ, ЭхоЭС и ТКДСГ, всех пациентов с тиками позволит оптимизировать дифференциальную диагностику, а следовательно, и терапию данного контингента больных.

Keywords: тикозые гиперкинезы, клиническая картина, электроэнцефалография, эхоэнцефало-скопия, транскраниальная допплеросонография, дифференциальная диагностика.

Цель — изучение тензиометрических и реологических характеристик цереброспинальной жидкости у больных с органическими поражениями нервной системы.

Материалы и методы. Обследовано 148 больных с органическими поражениями нервной системы (рассеянным склерозом, последствиями энцефаломиелита, вирусным энцефаломиелитом, ишемическим инсультом, опухолями головного мозга, нейросифилисом). Всем пациентам проведена динамическая межфазная тензиометрия методами МРТ и АDSА, позволяющая определить концентрацию поверхностно-активных веществ ликвора, их вязкость, адсорбцию и релаксацию.

Результаты. Установлено влияние высоких показателей вязкоэластичности у пациентов с рассеянным склерозом, вирусным энцефаломиелитом и опухолями головного мозга на поверхностное натяжение низко- и высокомолекулярных поверхностно-активных веществ. Самые низкие показатели адсорбции высокоактивных компонентов выявлены при нейросифилисе.

Выводы. Исследование динамической межфазной тензиометрии церебральной жидкости является информативным методом диагностики основных неврологических заболеваний.

Keywords: цереброспинальная жидкость, поверхностное натяжение, поверхностно-активные вещества.

Цель — определение маркеров эффективности плазмафереза у пациентов с аутоиммунными демиелинизирующими заболеваниями центральной и периферической нервной системы.

Материалы и методы. Обследован 21 пациент с аутоиммунными демиелинизирующими заболеваниями центральной и периферической нервной системы. У всех пациентов определяли уровень антител к миелин-ассоциированному гликопротеину до лечения и после третьего сеанса плазмафереза. Эффективность лечения оценивали при помощи неврологических шкал EDSS и NRS.

Результаты. У 13 пациентов выявлен повышенный уровень антител к миелин-ассоциированному гликопротеину. Снижение титра антител произошло у 9 пациентов и коррелировало с изменением их состояния по неврологическим шкалам.

Выводы. Наличие антител к миелин-ассоциированному гликопротеину может служить показанием к применению плазмафереза в комплексной терапии аутоиммунных демиелинизирующих заболеваний нервной системы.

Keywords: плазмаферез, демиелинизирующие заболевания, миелин-ассоциированный глико-протеин.

Цель — оценить изменения показателей качества жизни (КЖ) у больных сахарным диабетом (СД) и диабетической энцефалопатией (ДЭ).

Материалы и методы. Обследовано 113 больных СД: 27 — с синдромом вегетативной дистонии, 48 — с ДЭ I стадии, 38 — с ДЭ II стадии. Всем больным проведено нейропсихологическое исследование. Показатели КЖ оценены с помощью опросника SF-36 Health Status Survey.

Результаты. Выявлены корреляционные связи между КЖ и уровнем гликозилированного гемоглобина, а также между тяжестью и частотой гипергликемии и показателями шкал «Способность к физическим нагрузкам», «Влияние физического состояния на ролевое функционирование», «Влияние эмоционального состояния на ролевое функционирование». Ухудшение КЖ взаимосвязано с уровнем депрессии у больных ДЭ и с уровнями ситуационной и личностной тревожности.

Выводы. Оценка параметров КЖ позволяет получить качественную и количественную характеристику комбинированных (соматических, неврологических и психических) расстройств у больных ДЭ. Характеристику субъективной удовлетворенности уровнем своего функционирования целесообразно включить в оценку состояния больных с ДЭ, наряду с другими методами объективизации состояния больных.

Keywords: сахарный диабет, диабетическая энцефалопатия, качество жизни.