The article deals with the topical neurological problem-meningitis. The approaches to classification, epidemiology, and pathogenesis are outlined. Main clinical manifestations of the disease rare forms are described. The acquirement of meningitis rare forms allows the doctor to diagnose the diseases promptly and to ensure the necessary treatment.

Keywords: meningitis, rare forms, primary, secondary impairments of arachnoid membrane.

The article reviews the problem of cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL). The current data of prevalence and etiopathogenesis of the disease are presented.
Variable clinical features of CADASIL have been summarized according to their diagnostic value. In the article aspects of clinic-neuroimaging comparison have been interpreted, available diagnostic methods and treatment approaches of this pathology have been analyzed.

Keywords: CADASIL, hereditary cerebral angiopathy, cerebral autosomal dominant arteriopathy.

Objective – improvement of diagnostic methods for the purpose of identification of main characteristics of nervous system impairments in young and middle age patients with chronic hepatitis and liver cirrhosis.
Methods and subjects.We examined 123 young and middle age patients with chronic hepatitis and liver cirrhosis. Complex study included: detailed questioning with analysis of refined complaints, general examination and standard laboratory tests, refined neurological state study, complex neuropsychological testing (using MMSE scale, frontal assessment battery, clock drawing test), rheoencephalographic and rheohepatographic studies were provided.
Results. The main neurological complaints and symptoms were analyzed and their frequency in chronic hepatitis and liver cirrhosis were studied. Cognitive dysfunction was found in patients with chronic hepatitis as well as in patients with liver cirrhosis. According to the rheoencephalographic and rheohepatographic data, impairment of arterial as well as venous part of brain and liver blood circulation was detected.
Conclusions. Impairment of central as well as peripheral nervous system occurs in chronic hepatitis and liver cirrhosis. Semiology of nervous system impairments in chronic hepatitis is similar to liver cirrhosis but some differences in frequency and intensity of certain neurological state and para-clinical method characteristics are present. It is advisable to include neurological and neuropsychological examinations into the complex diagnostic plan of the patients with chronic hepatitis and liver cirrhosis.

Keywords: nervous system, somatoneurology, hepatitis, cirrhosis, neuropsychological tests, rheoencephalography, reohepatography.

Objective – to determine the frequency, spectrum and severity of cognitive disorders in acute period of ischemic posterior circulation stroke (PCS).
Methods and subjects. A complex clinical neurological examination was carried out in 97 patients (54 men and 43 women) aged 31 to 77 years in acute period of ischemic PCS. Assessment of the cognitive functions was performed in patients at 18–21 days of disease by the use of MMSE scale, MoCA scale, frontal assessment battery, study of verbal memory with the test of «10 words» O.R. Luria, attention and speed of sensor and motor reactions by the Schulte tables.
Beck’s depression scale was used for detection of post-stroke depression.
Results. At 18–21 days of the disease cognitive impairments were observed in 45.3 % patients with ischemic strokes in the PC; 6.1 % patients were presented with mild or moderate severe dementia. Disorders of executive functions in cerebellar infarcts compared with lesions of the brainstem are more evident (p < 0.05). 31 % patients demonstrated post-stroke depression, that affected cognitive functions.
Conclusions. Combined ischemic PC strokes with lesions of various anatomical structures in comparison with isolated strokes are characterized by the lowest rates of cognitive functions. Among isolated infarcts the most evident cognitive disorders are observed in cerebellar and pontine ischemic strokes. Identified cognitive disorders in patients with acute PC strokes depend on the age of patients, level of education, localization of ischemia and do not depend on gender.

Keywords: ischemic stroke, posterior circulation, cognitive disorders.

Objective – to study the ipidacrine effect on the cerebral and vascular reactivity in acute period of ischemic stroke.
Methods and subjects. Complex clinical and neurological examination was carried out in 45 patients (22 male and 23 female)in acute period of cerebral stroke of hemispheric localization. The mean age of patients was 66.7 ± 1.4 years. Patients were distributed into two groups: main group numbered 30 patients (mean age 66.8 ± 1.3) who underwent traditional therapy accompanied with 0.5 % Neuromedin administration 1.0 intramuscular once a day during 1–5 days, from 6 to 10 days they were given 1.5 % Neuromedin 1.0 intramuscular once a day and from 11 to 40 days they were given pills of Neuromedin 20 gr three times a day. Control group comprised 15 patients who were compared with the patients from the main group by demographic criteria and received the traditional therapy for ischemic stroke. To assess cerebral vascular reaction the following test was performed: transcranial dopplerography with functional tests with stress which was sequentially activated by metabolic and myogenous mechanisms of cerebral circulation autoregulation.
Results. Patients of both groups evidenced decrease (р < 0.05) of maximal and average blood flow velocity in the medial cerebral artery in the ischemia area comparing with similar indexes of not affected hemisphere. Reactivity index for hypercapnic sample with breath)holding in the affected area was also reduced comparing with not affected area. It evidences the emaciation of cerebral vascular reactivity of vasodilator component and comparative vasoconstrictive component preservation in acute ischemia period. The re-examination on the 14-th day demonstrated that patients of the main group had better indexes of vasoconstrictive and vasodilating components of cerebral vascular reactivity in both basins. Although patients of control group had insufficiency of vasoconstrictive and vasodilating components (р < 0.05).
Conclusions. Ipidacrine administration in complex treatment of patients with acute ischemic stroke allows to improve cerebral vascular reactivity indexes and it promotes better restoration of lost neurological functions.

Keywords: ischemic stroke, cerebral vascular reactivity, transcranial dopplerography, ipidacrine.

Objective – to conduct the comparative evaluation of early administration of antidepressants and combinations of antidepressants with сortexin for treatment of post-stroke depressive disorder (DD) in patients with primary ischemic stroke (IS).
Methods and subjects. 68 patients with primary cerebral IS in acute (3 and 14 days) and early recovery period (3 months) were examined. According to the treatment strategy, patients were divided into 4 groups: control group and three main groups, depending on the combination of designated compared drugs (cortexin, paroxetine, or combination of paroxetine and cortexin). Assessment of the level of DD was performed with the Hamilton Depression Scale at 3; 14 days and 3 months after IS onset. Laboratory tests included determination of IL-6 and CRP concentrations in serum at similar terms.
Results. Patients with DD in acute and early post-stroke periods of the primary IS demonstrated increasing of IL-6 and CRP concentrations in serum. Cortexin administration in acute and early post-stroke periods of the primary IS decreases inflammation humoral factors level with evidenced lower indexes at 3 and 14 days. The reduction of DD cases 3 moths following IS was observed in patients with paroxetine administration. Moreover patients, who were given additional cortexin administration, demonstrated significantly lower DD level (p < 0.05).
Conclusions. A combination of a cortexin and paroxetine in patients with post-stroke DD while compared with standard therapy and monotherapy with paroxetine effectively reduces depression according to the Hamilton scale score and reduces level of serum markers of inflammation.

Keywords: ischemic stroke, depression, inflammation, paroxetine, cortexin.

Objective – to investigate the relationship between hemispheric stroke localization in different brain structures and type and gravity of swallowing disorders at patients with acute supratentorial cerebral stroke and to assess restoration of their swallowing function in recovery period.
Methods and subjects. A clinical neurological and magnetic resonance tomographic examination was performed at 105 patients aged from 46 to 84 years (mean age – 66,3 ± 10,5 years) with acute cerebral stroke of supratentorial localization with disorders of swallowing after stroke. We used clinical neurological methods and structured scales for assessing neurological and swallowing status. The diagnosis of stroke and stroke localization was specified by using clinical methods and techniques of neuroimaging.
Results. The most evident swallowing disorders were detected in case of bilateral hemispheric stroke, witch was manifested in disruption of oral and / or pharyngeal stage of swallowing act; strokes with lesions in the parietal lobe of the right hemisphere of the brain caused difficulty in initiation the act of swallowing, adversely affect the swallowing process in general and its recovery; damage the lower parts of the parietal lobe of the left hemisphere resulted in dysfunction of the oral stage of swallowing. Hemispheric localization of stroke had influence not only on the stage of neurogenic dysphagia, but also on the degree of restoration of swallowing function. Bilateral hemispheric lesions of brain tissue had lower percentage for the full recovery of swallowing function than in cases unilateral localization of stroke (50.0 % and 67.5 % respectively).
Conclusions. The results of the examination of patients with acute cerebral stroke of supratentorial localization with disorders of swallowing demonstrated that the localization and nature of the lesions affected the nature and severity of the act of swallowing violation, and the speed regression swallowing deficits.

Keywords: neurogenic dysphagia, stroke, supratentorial localisation, neurological deficit.

Results of literatures review are generalized on questions of epidemiology, pathogenesis, clinical diagnostic features of basilar migraine. Differentiation of migraine of basilar type from temporal and cervical epilepsy is outlined. The clinical criteria of migraine-induced cerebral stroke are grounded. Information value of neuroimaging diagnostics of migraine is appraised. Own clinical supervision of patient is presented and analyzed. The patient suffered from migraine with an aura during all her life, the case was with the variant of ophthalmic aura transformation in basilar and complication – migraine-induced stroke.

Keywords: basilar migraine, diagnostics, differential diagnostics.

Objective – to increase the efficacy of restorative surgical treatment of ulnar nerve injury consequences combined with prolonged electrical stimulation.
Methods and subjects. During 2008–2012 years 15 patients with injury of ulnar nerve underwent surgery, at which the system for direct and prolonged electrical stimulation was implanted. We performed neurolysis and decompression of ulnar nerve (in two cases system the prolonged electrical stimulation was implanted after the suturing of ulnar nerve). Following the debriding the ulnar nerve of scar tissue the implantation of system for prolonged electrical stimulation НейСі 3М (Ukraine) was preformed. This individual system allows one to perform electrical stimulation several times a day during a long period of time, this approach significantly increases the efficacy of treatment.
Results. 12 (80 %)patients demonstrated positive result and significantly improved functional recovery of ulnar nerve: range of motion, muscle strength and sensitivity improved, pain syndrome decreased or even reduced, vegetative)trophic changes were also reduced.
Conclusions. The application of prolonged electrical stimulation is safe and effective method of influence on functional status of neuromuscular apparatus of upper extremity after the injury of ulnar nerve. Prolonged electrical stimulation showed its efficacy even in patients with history of disease more then 2 years. The application of prolonged electrical stimulation allowed us to accelerate and to obtain significant restoration of lost function in patients who underwent traditional surgeries which included neurolysis and decompression of ulnar nerve without further implantation of system for prolonged electrical stimulation.

Keywords: ulnar nerve injury, prolonged electrical stimulation, surgical treatment.

Objective – to investigate the features of the borreliosis clinical manifestations (Lyme disease (LD), to estimate the importance of Borrelia antibodies (IgM and G) in the diagnostics of borreliosis to develop proposals of the treatment LD quality improving.
Methods and subjects. 36 patients with systemic tick borreliosis were examined. Clinical manifestations, changes in laboratory parameters, including the determination of antibodies to borrelia (IgM and IgG) at different times, were defined. Instrumental methods (ECG, ultrasound)were applied to examine different organs, that are targets for LD. Antibacterial therapy effectiveness was considered. The case of the acute meningitis during systemic borreliosis was analyzed.
Results. The incidence of Lyme disease in 2012 has doubled compared with 2011 year in City Clinical Hospital № 4, Kyiv (36 and 19 cases respectively). The erythema migrants match with the localization of tick bite in 100 % cases.
All patients had general symptoms of intoxication. 13 patients underwent the test for the detection of IgM and IgG tо Borrelia burgdorferi. While determining IgM and IgG to Borrelia 8 patients (61 %) (the analysis was conducted on 9, 10,
11, 14, 22, 30, 36, 37 day after the first symptoms of the disease) and 6 patients (46 %) had positive IgG test (the analysis was conducted on 7, 10, 14, 22, 30, 37 day after first symptoms). 5 patients (38 %) had positive results of IgG and IgM tests (on 10, 14, 22, 36, 37 days). One patient demonstrated ambiguous results for IgG and IgM tests (on 14 day).
Negative results of IgG and IgM tests were determined in 1 patients on 33 day since first symptoms. 4 patients (30 %) didn’t have analysis on IgG and IgM on 7, 9, 17, 33 day after erythema appeared. Negative IgG analysis were in 53 %
cases (7 patients) (on 9,10,14 (2 patients), 17, 33, 39 days). 38 % patients had enlarged liver from 1 to 3,5 cm, diffuse changes in the liver; 11 % (4 patients) patients had increased level of AlAT, 3 % (1 patient) had increased level of AsAT.
All patients underwent the course of treatment with ceftriaxone at a dose 1 g 2 times a day intramuscular injections.
The course of treatment was about 14 days. The favorable outcome was in 100 % cases.
Conclusions. LD morbidity has significantly increased during the past 6 years (6 times compared to 2007) in City Clinical Hospital № 4, Kyiv. LD has specific phases. Phases alternation in anamnesis helps in the diagnostics of LD. It is important to consider the presence or absence of IgM and G to Borrelia burgdorferi. However, PCR is the determining method of the LD diagnostics. The main direction of the LD treatment is antibiotic therapy: ceftriaxone, cefotaxime, doxycycline.

Keywords: systemic borreliosis, neuroborreliosis, Lyme disease, erythema migrant, meningitis.

The most frequent complication of diabetes mellitus of both types is diabetic polyneuropathy (DPN). The administration of vitamins group B for DPN is pathogenetically reasonable due to its specific neurotropic action. Our research evidenced the improvement of all peripheral fibers sensitivity after the treatment with vitamins B complex. The decreasing of indexes according to neurological impairments scales NSS and NDS was observed. The improvement of mild neuropathy diagnostics was also noticed. The administration of Neurorubin significantly increases myelinated (Aβ and Аδ) as well as nonmedullated (С) nerve fibers sensitivity.

Keywords: diabetes mellitus, diabetic polyneuropathy, neurometry, the perception current threshold, vitamins group B.

Problem of insomnia is one of the most actual problems of modern medicine and connected with its high frequency, and medical and social burden. In the present paper the modern approaches to pharmacotherapy of insomnia, criteria of an optimal hypnotic drug and disadvantages of modern hypnotics have been outlined.
Possibilities and advantages of combined phytodrugs with hypnotic and sedative action have been suggested. A main attention is paid to the analysis of the mechanisms of action and clinical use of new combined valerian- and mint-containing drug – Menovalen. Expediency of Menovalen application in treatment of insomnia of different genesis as an effective and safe alternative of hypnotics of chemical nature has been grounded.

Keywords: insomnia, hypnotic drugs, valerian-containing drugs.

The article deals with the analysis of bioequivalence and relevance of ginkgo biloba remedies. The data about chemical constituents and pharmacological activity of different ginkgo biloba drugs have been summarized. It is found that the obligatory presence of extract EGb 761® is necessary for claims of clinical trials of the standard extract regarding human health can be fulfilled.

Keywords: ginkgo biloba, standard extract EGb 761®, Тanakan®.

We have studied the drug choline alfoscerate (Gliatilin) effectiveness in 58 patients. As a result of the research we have obtained a significant improvement of the objective neurological status of patients who received Gliatilin at a dose of 800 mg/day, in the form of leveling the static-locomotor functions, sensitive violations regress, the reduction of pyramidal failure. We also evidenced significant decrease of subjective complaints of patients for headache, dizziness, irritability, fatigue and significant improvement of cognitive functions, which was manifested by the better fluency of speech, praxis, auditory and visual memory, reduction of anxiety and depressive manifestations. Received data allow to recommend the choline alfoscerate (Gliatilin) for the treatment of hepatic encephalopathy.

Keywords: hepatic encephalopathy, encephalopathy, cognitive impairments, choline alfoscerate, Gliatilin.

The article reviews the role and place of antithrombotic drugs in both primary and secondary prevention of cerebrovascular events. The data of most important randomized clinical trials are considered. The character of the influence of antiaggregant, anticoagulants and antithrombotic drugs on the probability of death incidences according to pretreatment, timely withdrawal in case of need and the resumption of therapy in patients with high scores on CHADS2 and CHA2DS2VASc scales are discussed.

Keywords: stroke, prognosis, prevention, treatment, antithrombotic drugs.

В обзоре рассмотрены роль и место антитромботических лекарственных средств в программах первичной и вторичной профилактики цереброваскулярных событий. Приведены результаты наиболее важных рандомизированных клинических исследований, посвященных этому вопросу. Обсуждается характер влияния антиагрегантов, антикоагулянтов и антитромботических лекарственных средств на вероятность смертельного исхо
да в зависимости от предшествовавшего лечения, своевременности отмены в случае необходимости и возобновления терапии у пациентов с высокими баллами по шкалам CHADS2 и CHA2DS2VASc.

Keywords: мозговой инсульт, прогноз, профилактика, лечение, антитромботические лекарственные средства.

The article reviews the problem of cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL). The current data of prevalence and etiopathogenesis of the disease are presented.
Variable clinical features of CADASIL have been summarized according to their diagnostic value. In the article aspects of clinic-neuroimaging comparison have been interpreted, available diagnostic methods and treatment approaches of this pathology have been analyzed.

Keywords: CADASIL, hereditary cerebral angiopathy, cerebral autosomal dominant arteriopathy.

Results of literatures review are generalized on questions of epidemiology, pathogenesis, clinical diagnostic features of basilar migraine. Differentiation of migraine of basilar type from temporal and cervical epilepsy is outlined. The clinical criteria of migraine-induced cerebral stroke are grounded. Information value of neuroimaging diagnostics of migraine is appraised. Own clinical supervision of patient is presented and analyzed. The patient suffered from migraine with an aura during all her life, the case was with the variant of ophthalmic aura transformation in basilar and complication – migraine-induced stroke.

Keywords: basilar migraine, diagnostics, differential diagnostics.

We have studied the drug choline alfoscerate (Gliatilin) effectiveness in 58 patients. As a result of the research we have obtained a significant improvement of the objective neurological status of patients who received Gliatilin at a dose of 800 mg/day, in the form of leveling the static-locomotor functions, sensitive violations regress, the reduction of pyramidal failure. We also evidenced significant decrease of subjective complaints of patients for headache, dizziness, irritability, fatigue and significant improvement of cognitive functions, which was manifested by the better fluency of speech, praxis, auditory and visual memory, reduction of anxiety and depressive manifestations. Received data allow to recommend the choline alfoscerate (Gliatilin) for the treatment of hepatic encephalopathy.

Keywords: hepatic encephalopathy, encephalopathy, cognitive impairments, choline alfoscerate, Gliatilin.

Статья посвящена анализу проблемы эквивалентности и взаимозаменяемости лекарственных средств на основе гинкго билоба. Проведено обобщение данных относительно идентичности химического состава и фармакологической активности разных гинкгосодержащих препаратов. Сделан вывод о том, что наличие экстракта EGb 761® является гарантией соответствия эффектов препарата результатам клинических испытаний этого стандартизированного экстракта.

Keywords: гинкго билоба, стандартизированный экстракт EGb 761®, Танакан®.

Problem of insomnia is one of the most actual problems of modern medicine and connected with its high frequency, and medical and social burden. In the present paper the modern approaches to pharmacotherapy of insomnia, criteria of an optimal hypnotic drug and disadvantages of modern hypnotics have been outlined.
Possibilities and advantages of combined phytodrugs with hypnotic and sedative action have been suggested. A main attention is paid to the analysis of the mechanisms of action and clinical use of new combined valerian- and mint-containing drug – Menovalen. Expediency of Menovalen application in treatment of insomnia of different genesis as an effective and safe alternative of hypnotics of chemical nature has been grounded.

Keywords: insomnia, hypnotic drugs, valerian-containing drugs.

Наиболее частое осложнение сахарного диабета обоих типов — диабетическая полинейропатия (ДПНП). В лечении ДПНП патогенетически обосновано использование витаминов группы В благодаря их специфическому нейротропному действию. Наше исследование доказало, что после полного курса лечения препаратами комплекса витаминов группы В достоверно улучшилась чувствительность всех исследуемых периферических волокон. Также отмечено снижение количества баллов по шкалам неврологических нарушений NSS и NDS и соответствующее увеличение диагностированной нейропатии легкой степени. Можно утверждать, что использование препарата Нейрорубин значительно повышает чувствительность нервных волокон, как миелинизированных (Aβ и Аδ), так и немиелинизированных (С).

Keywords: сахарный диабет, диабетическая полинейропатия, нейрометрия, порог восприятия тока, витамины группы В.

Objective – to investigate the features of the borreliosis clinical manifestations (Lyme disease (LD), to estimate the importance of Borrelia antibodies (IgM and G) in the diagnostics of borreliosis to develop proposals of the treatment LD quality improving.
Methods and subjects. 36 patients with systemic tick borreliosis were examined. Clinical manifestations, changes in laboratory parameters, including the determination of antibodies to borrelia (IgM and IgG) at different times, were defined. Instrumental methods (ECG, ultrasound)were applied to examine different organs, that are targets for LD. Antibacterial therapy effectiveness was considered. The case of the acute meningitis during systemic borreliosis was analyzed.
Results. The incidence of Lyme disease in 2012 has doubled compared with 2011 year in City Clinical Hospital № 4, Kyiv (36 and 19 cases respectively). The erythema migrants match with the localization of tick bite in 100 % cases.
All patients had general symptoms of intoxication. 13 patients underwent the test for the detection of IgM and IgG tо Borrelia burgdorferi. While determining IgM and IgG to Borrelia 8 patients (61 %) (the analysis was conducted on 9, 10,
11, 14, 22, 30, 36, 37 day after the first symptoms of the disease) and 6 patients (46 %) had positive IgG test (the analysis was conducted on 7, 10, 14, 22, 30, 37 day after first symptoms). 5 patients (38 %) had positive results of IgG and IgM tests (on 10, 14, 22, 36, 37 days). One patient demonstrated ambiguous results for IgG and IgM tests (on 14 day).
Negative results of IgG and IgM tests were determined in 1 patients on 33 day since first symptoms. 4 patients (30 %) didn’t have analysis on IgG and IgM on 7, 9, 17, 33 day after erythema appeared. Negative IgG analysis were in 53 %
cases (7 patients) (on 9,10,14 (2 patients), 17, 33, 39 days). 38 % patients had enlarged liver from 1 to 3,5 cm, diffuse changes in the liver; 11 % (4 patients) patients had increased level of AlAT, 3 % (1 patient) had increased level of AsAT.
All patients underwent the course of treatment with ceftriaxone at a dose 1 g 2 times a day intramuscular injections.
The course of treatment was about 14 days. The favorable outcome was in 100 % cases.
Conclusions. LD morbidity has significantly increased during the past 6 years (6 times compared to 2007) in City Clinical Hospital № 4, Kyiv. LD has specific phases. Phases alternation in anamnesis helps in the diagnostics of LD. It is important to consider the presence or absence of IgM and G to Borrelia burgdorferi. However, PCR is the determining method of the LD diagnostics. The main direction of the LD treatment is antibiotic therapy: ceftriaxone, cefotaxime, doxycycline.

Keywords: systemic borreliosis, neuroborreliosis, Lyme disease, erythema migrant, meningitis.

Objective – to increase the efficacy of restorative surgical treatment of ulnar nerve injury consequences combined with prolonged electrical stimulation.
Methods and subjects. During 2008–2012 years 15 patients with injury of ulnar nerve underwent surgery, at which the system for direct and prolonged electrical stimulation was implanted. We performed neurolysis and decompression of ulnar nerve (in two cases system the prolonged electrical stimulation was implanted after the suturing of ulnar nerve). Following the debriding the ulnar nerve of scar tissue the implantation of system for prolonged electrical stimulation НейСі 3М (Ukraine) was preformed. This individual system allows one to perform electrical stimulation several times a day during a long period of time, this approach significantly increases the efficacy of treatment.
Results. 12 (80 %)patients demonstrated positive result and significantly improved functional recovery of ulnar nerve: range of motion, muscle strength and sensitivity improved, pain syndrome decreased or even reduced, vegetative)trophic changes were also reduced.
Conclusions. The application of prolonged electrical stimulation is safe and effective method of influence on functional status of neuromuscular apparatus of upper extremity after the injury of ulnar nerve. Prolonged electrical stimulation showed its efficacy even in patients with history of disease more then 2 years. The application of prolonged electrical stimulation allowed us to accelerate and to obtain significant restoration of lost function in patients who underwent traditional surgeries which included neurolysis and decompression of ulnar nerve without further implantation of system for prolonged electrical stimulation.

Keywords: ulnar nerve injury, prolonged electrical stimulation, surgical treatment.

Results of literatures review are generalized on questions of epidemiology, pathogenesis, clinical diagnostic features of basilar migraine. Differentiation of migraine of basilar type from temporal and cervical epilepsy is outlined. The clinical criteria of migraine-induced cerebral stroke are grounded. Information value of neuroimaging diagnostics of migraine is appraised. Own clinical supervision of patient is presented and analyzed. The patient suffered from migraine with an aura during all her life, the case was with the variant of ophthalmic aura transformation in basilar and complication – migraine-induced stroke.

Keywords: basilar migraine, diagnostics, differential diagnostics.

Objective – to investigate the relationship between hemispheric stroke localization in different brain structures and type and gravity of swallowing disorders at patients with acute supratentorial cerebral stroke and to assess restoration of their swallowing function in recovery period.
Methods and subjects. A clinical neurological and magnetic resonance tomographic examination was performed at 105 patients aged from 46 to 84 years (mean age – 66,3 ± 10,5 years) with acute cerebral stroke of supratentorial localization with disorders of swallowing after stroke. We used clinical neurological methods and structured scales for assessing neurological and swallowing status. The diagnosis of stroke and stroke localization was specified by using clinical methods and techniques of neuroimaging.
Results. The most evident swallowing disorders were detected in case of bilateral hemispheric stroke, witch was manifested in disruption of oral and / or pharyngeal stage of swallowing act; strokes with lesions in the parietal lobe of the right hemisphere of the brain caused difficulty in initiation the act of swallowing, adversely affect the swallowing process in general and its recovery; damage the lower parts of the parietal lobe of the left hemisphere resulted in dysfunction of the oral stage of swallowing. Hemispheric localization of stroke had influence not only on the stage of neurogenic dysphagia, but also on the degree of restoration of swallowing function. Bilateral hemispheric lesions of brain tissue had lower percentage for the full recovery of swallowing function than in cases unilateral localization of stroke (50.0 % and 67.5 % respectively).
Conclusions. The results of the examination of patients with acute cerebral stroke of supratentorial localization with disorders of swallowing demonstrated that the localization and nature of the lesions affected the nature and severity of the act of swallowing violation, and the speed regression swallowing deficits.

Keywords: neurogenic dysphagia, stroke, supratentorial localisation, neurological deficit.

Objective – to conduct the comparative evaluation of early administration of antidepressants and combinations of antidepressants with сortexin for treatment of post-stroke depressive disorder (DD) in patients with primary ischemic stroke (IS).
Methods and subjects. 68 patients with primary cerebral IS in acute (3 and 14 days) and early recovery period (3 months) were examined. According to the treatment strategy, patients were divided into 4 groups: control group and three main groups, depending on the combination of designated compared drugs (cortexin, paroxetine, or combination of paroxetine and cortexin). Assessment of the level of DD was performed with the Hamilton Depression Scale at 3; 14 days and 3 months after IS onset. Laboratory tests included determination of IL-6 and CRP concentrations in serum at similar terms.
Results. Patients with DD in acute and early post-stroke periods of the primary IS demonstrated increasing of IL-6 and CRP concentrations in serum. Cortexin administration in acute and early post-stroke periods of the primary IS decreases inflammation humoral factors level with evidenced lower indexes at 3 and 14 days. The reduction of DD cases 3 moths following IS was observed in patients with paroxetine administration. Moreover patients, who were given additional cortexin administration, demonstrated significantly lower DD level (p < 0.05).
Conclusions. A combination of a cortexin and paroxetine in patients with post-stroke DD while compared with standard therapy and monotherapy with paroxetine effectively reduces depression according to the Hamilton scale score and reduces level of serum markers of inflammation.

Keywords: ischemic stroke, depression, inflammation, paroxetine, cortexin.

Objective – to study the ipidacrine effect on the cerebral and vascular reactivity in acute period of ischemic stroke.
Methods and subjects. Complex clinical and neurological examination was carried out in 45 patients (22 male and 23 female)in acute period of cerebral stroke of hemispheric localization. The mean age of patients was 66.7 ± 1.4 years. Patients were distributed into two groups: main group numbered 30 patients (mean age 66.8 ± 1.3) who underwent traditional therapy accompanied with 0.5 % Neuromedin administration 1.0 intramuscular once a day during 1–5 days, from 6 to 10 days they were given 1.5 % Neuromedin 1.0 intramuscular once a day and from 11 to 40 days they were given pills of Neuromedin 20 gr three times a day. Control group comprised 15 patients who were compared with the patients from the main group by demographic criteria and received the traditional therapy for ischemic stroke. To assess cerebral vascular reaction the following test was performed: transcranial dopplerography with functional tests with stress which was sequentially activated by metabolic and myogenous mechanisms of cerebral circulation autoregulation.
Results. Patients of both groups evidenced decrease (р < 0.05) of maximal and average blood flow velocity in the medial cerebral artery in the ischemia area comparing with similar indexes of not affected hemisphere. Reactivity index for hypercapnic sample with breath)holding in the affected area was also reduced comparing with not affected area. It evidences the emaciation of cerebral vascular reactivity of vasodilator component and comparative vasoconstrictive component preservation in acute ischemia period. The re-examination on the 14-th day demonstrated that patients of the main group had better indexes of vasoconstrictive and vasodilating components of cerebral vascular reactivity in both basins. Although patients of control group had insufficiency of vasoconstrictive and vasodilating components (р < 0.05).
Conclusions. Ipidacrine administration in complex treatment of patients with acute ischemic stroke allows to improve cerebral vascular reactivity indexes and it promotes better restoration of lost neurological functions.

Keywords: ischemic stroke, cerebral vascular reactivity, transcranial dopplerography, ipidacrine.

Objective – to study the ipidacrine effect on the cerebral and vascular reactivity in acute period of ischemic stroke.
Methods and subjects. Complex clinical and neurological examination was carried out in 45 patients (22 male and 23 female)in acute period of cerebral stroke of hemispheric localization. The mean age of patients was 66.7 ± 1.4 years. Patients were distributed into two groups: main group numbered 30 patients (mean age 66.8 ± 1.3) who underwent traditional therapy accompanied with 0.5 % Neuromedin administration 1.0 intramuscular once a day during 1–5 days, from 6 to 10 days they were given 1.5 % Neuromedin 1.0 intramuscular once a day and from 11 to 40 days they were given pills of Neuromedin 20 gr three times a day. Control group comprised 15 patients who were compared with the patients from the main group by demographic criteria and received the traditional therapy for ischemic stroke. To assess cerebral vascular reaction the following test was performed: transcranial dopplerography with functional tests with stress which was sequentially activated by metabolic and myogenous mechanisms of cerebral circulation autoregulation.
Results. Patients of both groups evidenced decrease (р < 0.05) of maximal and average blood flow velocity in the medial cerebral artery in the ischemia area comparing with similar indexes of not affected hemisphere. Reactivity index for hypercapnic sample with breath)holding in the affected area was also reduced comparing with not affected area. It evidences the emaciation of cerebral vascular reactivity of vasodilator component and comparative vasoconstrictive component preservation in acute ischemia period. The re-examination on the 14-th day demonstrated that patients of the main group had better indexes of vasoconstrictive and vasodilating components of cerebral vascular reactivity in both basins. Although patients of control group had insufficiency of vasoconstrictive and vasodilating components (р < 0.05).
Conclusions. Ipidacrine administration in complex treatment of patients with acute ischemic stroke allows to improve cerebral vascular reactivity indexes and it promotes better restoration of lost neurological functions.

Keywords: ischemic stroke, cerebral vascular reactivity, transcranial dopplerography, ipidacrine.

Objective – to determine the frequency, spectrum and severity of cognitive disorders in acute period of ischemic posterior circulation stroke (PCS).
Methods and subjects. A complex clinical neurological examination was carried out in 97 patients (54 men and 43 women) aged 31 to 77 years in acute period of ischemic PCS. Assessment of the cognitive functions was performed in patients at 18–21 days of disease by the use of MMSE scale, MoCA scale, frontal assessment battery, study of verbal memory with the test of «10 words» O.R. Luria, attention and speed of sensor and motor reactions by the Schulte tables.
Beck’s depression scale was used for detection of post-stroke depression.
Results. At 18–21 days of the disease cognitive impairments were observed in 45.3 % patients with ischemic strokes in the PC; 6.1 % patients were presented with mild or moderate severe dementia. Disorders of executive functions in cerebellar infarcts compared with lesions of the brainstem are more evident (p < 0.05). 31 % patients demonstrated post-stroke depression, that affected cognitive functions.
Conclusions. Combined ischemic PC strokes with lesions of various anatomical structures in comparison with isolated strokes are characterized by the lowest rates of cognitive functions. Among isolated infarcts the most evident cognitive disorders are observed in cerebellar and pontine ischemic strokes. Identified cognitive disorders in patients with acute PC strokes depend on the age of patients, level of education, localization of ischemia and do not depend on gender.

Keywords: ischemic stroke, posterior circulation, cognitive disorders.

Objective – to determine the frequency, spectrum and severity of cognitive disorders in acute period of ischemic posterior circulation stroke (PCS).
Methods and subjects. A complex clinical neurological examination was carried out in 97 patients (54 men and 43 women) aged 31 to 77 years in acute period of ischemic PCS. Assessment of the cognitive functions was performed in patients at 18–21 days of disease by the use of MMSE scale, MoCA scale, frontal assessment battery, study of verbal memory with the test of «10 words» O.R. Luria, attention and speed of sensor and motor reactions by the Schulte tables.
Beck’s depression scale was used for detection of post-stroke depression.
Results. At 18–21 days of the disease cognitive impairments were observed in 45.3 % patients with ischemic strokes in the PC; 6.1 % patients were presented with mild or moderate severe dementia. Disorders of executive functions in cerebellar infarcts compared with lesions of the brainstem are more evident (p < 0.05). 31 % patients demonstrated post-stroke depression, that affected cognitive functions.
Conclusions. Combined ischemic PC strokes with lesions of various anatomical structures in comparison with isolated strokes are characterized by the lowest rates of cognitive functions. Among isolated infarcts the most evident cognitive disorders are observed in cerebellar and pontine ischemic strokes. Identified cognitive disorders in patients with acute PC strokes depend on the age of patients, level of education, localization of ischemia and do not depend on gender.

Keywords: ischemic stroke, posterior circulation, cognitive disorders.

Objective – improvement of diagnostic methods for the purpose of identification of main characteristics of nervous system impairments in young and middle age patients with chronic hepatitis and liver cirrhosis.
Methods and subjects.We examined 123 young and middle age patients with chronic hepatitis and liver cirrhosis. Complex study included: detailed questioning with analysis of refined complaints, general examination and standard laboratory tests, refined neurological state study, complex neuropsychological testing (using MMSE scale, frontal assessment battery, clock drawing test), rheoencephalographic and rheohepatographic studies were provided.
Results. The main neurological complaints and symptoms were analyzed and their frequency in chronic hepatitis and liver cirrhosis were studied. Cognitive dysfunction was found in patients with chronic hepatitis as well as in patients with liver cirrhosis. According to the rheoencephalographic and rheohepatographic data, impairment of arterial as well as venous part of brain and liver blood circulation was detected.
Conclusions. Impairment of central as well as peripheral nervous system occurs in chronic hepatitis and liver cirrhosis. Semiology of nervous system impairments in chronic hepatitis is similar to liver cirrhosis but some differences in frequency and intensity of certain neurological state and para-clinical method characteristics are present. It is advisable to include neurological and neuropsychological examinations into the complex diagnostic plan of the patients with chronic hepatitis and liver cirrhosis.

Keywords: nervous system, somatoneurology, hepatitis, cirrhosis, neuropsychological tests, rheoencephalography, reohepatography.

Обзор литературы посвящен проблеме церебральной аутосомно-доминантной артериопатии с субкортикальными инфарктами и лейкоэнцефалопатией (CADASIL). Представлены современные данные относительно распространенности, этиопатогенеза заболевания. Проведено обобщение различных проявлений болезни с точки зрения их диагностической ценности. В статье освещены аспекты клинико-нейровизуализационного сопоставления, подан анализ известных методов диагностики и подходов к лечению в условиях развития данной патологии.

Keywords: CADASIL, наследственная церебральная ангиопатия, аутосомно-доминантная артериопатия мозга.

Лекция посвящена актуальной проблеме неврологии — менингиту. Приведены подходы к классификации, эпидемиологии, патогенезу. Освещены основные клинические проявления редких форм этого заболевания. Знание редких форм менингита поможет врачу своевременно его диагностировать и обеспечить необходимую врачебную помощь.

Keywords: менингит, редкие формы, первичные, вторичные поражения оболочек головного мозга.

Objective – improvement of diagnostic methods for the purpose of identification of main characteristics of nervous system impairments in young and middle age patients with chronic hepatitis and liver cirrhosis.
Methods and subjects.We examined 123 young and middle age patients with chronic hepatitis and liver cirrhosis. Complex study included: detailed questioning with analysis of refined complaints, general examination and standard laboratory tests, refined neurological state study, complex neuropsychological testing (using MMSE scale, frontal assessment battery, clock drawing test), rheoencephalographic and rheohepatographic studies were provided.
Results. The main neurological complaints and symptoms were analyzed and their frequency in chronic hepatitis and liver cirrhosis were studied. Cognitive dysfunction was found in patients with chronic hepatitis as well as in patients with liver cirrhosis. According to the rheoencephalographic and rheohepatographic data, impairment of arterial as well as venous part of brain and liver blood circulation was detected.
Conclusions. Impairment of central as well as peripheral nervous system occurs in chronic hepatitis and liver cirrhosis. Semiology of nervous system impairments in chronic hepatitis is similar to liver cirrhosis but some differences in frequency and intensity of certain neurological state and para-clinical method characteristics are present. It is advisable to include neurological and neuropsychological examinations into the complex diagnostic plan of the patients with chronic hepatitis and liver cirrhosis.

Keywords: nervous system, somatoneurology, hepatitis, cirrhosis, neuropsychological tests, rheoencephalography, reohepatography.

Цель — усовершенствовать диагностические подходы к определению основных характеристик поражения нервной системы у лиц молодого и среднего возраста с хроническим гепатитом (ХГ) и циррозом печени (ЦП).
Материалы и методы. Обследовано 123 пациента молодого и среднего возраста с установленным диагнозом ХГ и ЦП. Комплексное обследование включало: опрос с анализом детализированных жалоб, общесоматическое и стандартное лабораторное обследование, исследование неврологического статуса и комплексное нейропсихологическое тестирование (шкала MMSE, батарея тестов на лобную дисфункцию, тест рисования часов), реоэнцефалографию, реогепатографию.
Результаты. Проанализированы основные жалобы со стороны нервной системы, неврологические симптомы и исследована их частота при ХГ и ЦП. Как у пациентов с ЦП, так и у пациентов с ХГ, встречалась когнитивная дисфункция. По данным реоэнцефалографического и реогепатографического исследования выявлены нарушения как в артериальном, так и в венозном звене кровотока, в головном мозге и печени.
Выводы. При ХГ и ЦП наблюдают поражение как центральной, так и периферической нервной системы. Семиология поражений нервной системы при ХГ и ЦП похожа, однако отмечены отличия по частоте и выраженности отдельных показателей неврологического статуса и параклинических методов. Целесообразным является включение неврологического и нейропсихологического исследования в комплексный план обследования пациентов с ХГ и ЦП.

Keywords: нервная система, соматоневрология, гепатит, цирроз, нейропсихологические тесты, реоэнцефалография, реогепатография.

Objective – to determine the frequency, spectrum and severity of cognitive disorders in acute period of ischemic posterior circulation stroke (PCS).
Methods and subjects. A complex clinical neurological examination was carried out in 97 patients (54 men and 43 women) aged 31 to 77 years in acute period of ischemic PCS. Assessment of the cognitive functions was performed in patients at 18–21 days of disease by the use of MMSE scale, MoCA scale, frontal assessment battery, study of verbal memory with the test of «10 words» O.R. Luria, attention and speed of sensor and motor reactions by the Schulte tables.
Beck’s depression scale was used for detection of post-stroke depression.
Results. At 18–21 days of the disease cognitive impairments were observed in 45.3 % patients with ischemic strokes in the PC; 6.1 % patients were presented with mild or moderate severe dementia. Disorders of executive functions in cerebellar infarcts compared with lesions of the brainstem are more evident (p < 0.05). 31 % patients demonstrated post-stroke depression, that affected cognitive functions.
Conclusions. Combined ischemic PC strokes with lesions of various anatomical structures in comparison with isolated strokes are characterized by the lowest rates of cognitive functions. Among isolated infarcts the most evident cognitive disorders are observed in cerebellar and pontine ischemic strokes. Identified cognitive disorders in patients with acute PC strokes depend on the age of patients, level of education, localization of ischemia and do not depend on gender.

Keywords: ischemic stroke, posterior circulation, cognitive disorders.

Цель — определить частоту, спектр и выраженность когнитивных расстройств в острый период ишемического инсульта в сосудах вертебрально-базилярного бассейна (ВББ).
Материалы и методы. Проведено комплексное клинико-неврологическое обследование 97 пациентов (54 мужчин и 43 женщин) в возрасте от 31 года до 77 лет в острый период инфаркта головного мозга в сосудах заднециркулярного бассейна. Исследование когнитивных функций проводили больным на 18—21-е сутки заболевания с помощью шкалы MMSE, MоCA, батареи тестов на лобную дисфункцию, исследования вербальной памяти с помощью теста «10 слов» А.Р. Лурии, внимания и скорости сенсомоторных реакций с использованием таблиц Шульте. Для выявления постинсультной депрессии использовали шкалу депрессии Бека.
Результаты. На 18—21-е сутки заболевания снижение когнитивных функций зарегистрировано у 45,3 % пациентов с ишемическими инсультами в сосудах ВББ, которое у 6,1 % больных с сочетанными заднециркулярными инфарктами достигало степени легкой или умеренно выраженной деменции. При мозжечковых инфарктах по сравнению с поражением ствола головного мозга наблюдали более выраженные расстройства исполнительных функций (р < 0,05). У 31 % пациентов зарегистрирована постинсультная депрессия, которая негативно влияет на когнитивные функции.
Выводы. Сочетанные ишемические инсульты заднециркулярного бассейна с поражением различных анатомических структур ВББ по сравнению с изолированными характеризовались самыми низкими показателями когнитивных функций. В группе изолированных ишемических инсультов ВББ более выраженные когнитивные расстройства наблюдали у больных с мозжечковыми и понтинными инфарктами головного мозга. На когнитивные расстройства у больных с острым инфарктом заднециркулярного бассейна влияли возраст больных, уровень образования, локализация очага ишемии и не влиял пол.

Keywords: ишемический инсульт, вертебрально-базилярный бассейн, когнитивные нарушения.

Цель — изучить влияние ипидакрина на состояние цереброваскулярной реактивности в острый период ишемического инсульта.
Материалы и методы. Проведено комплексное клинико-неврологическое обследование 45 пациентов (22 мужчин и 23 женщины) в острый период инфаркта мозга полушарной локализации. Средний возраст больных — (66,7 ± 1,4) года. Пациентов распределили на две группы: основную — 30 больных (средний возраст — (66,8 ± 1,3) года), которые на фоне традиционной терапии получали в течение 1—5 суток 0,5 % Нейромидин 1,0 мл внутримышечно один раз в сутки, с 6-х по 10-е сутки — 1,5 % Нейромидин 1,0 мл внутримышечно один раз в сутки и с 11-х по 40-е сутки — таблетки Нейромидина 20 мг трижды в сутки. Контрольная группа состояла из 15 больных, которые по демографическим показателям были сопоставимы с пациентами основной группы и получали традиционную терапию ишемического инсульта. Для оценки цереброваскулярной реактивности проводили транскраниальную допплерографию с функциональными пробами с нагрузками, которые последовательно активировали метаболический и миогенные механизмы авторегуляции мозгового кровообращения.
Результаты. У пациентов обеих групп зарегистрировано достоверное (р < 0,05) снижение максимальной и средней скорости кровотока по средней мозговой артерии (СМА) в участке ишемии по сравнению с аналогичными показателями в СМА непораженного полушария мозга. Достоверное снижение у пациентов обеих групп индекса реактивности на гиперкапническую пробу с задержкой дыхания в пораженной СМА по сравнению с непораженным бассейном свидетельствует об истощении вазодилататорного компонента цереброваскулярной реактивности и относительном сохранении вазоконстрикторного компонента в острый период ишемического инсульта. Проведенное на 14-е сутки заболевания повторное исследование выявило, что у пациентов основной группы показатели вазоконстрикторного и вазодилататорного компонентов цереброваскулярной реактивности улучшились в обоих бассейнах, тогда как у пациентов группы контроля сохранялась недостаточность вазодилататорного компонента в пораженном бассейне (р < 0,05).
Выводы. Использование ипидакрина в комплексном лечении больных острым ишемическим инсультом способствует нормализации показателей цереброваскулярной реактивности, что создает условия для лучшего восстановления утраченных неврологических функций.

Keywords: ишемический инсульт, цереброваскулярная реактивность, транскраниальная допплерография, ипидакрин.

Цель — провести сравнительную оценку влияния раннего назначения антидепрессантов и комбинации антидепрессантов с курсовым лечением кортексином на динамику депрессивных расстройств (ДР) у пациентов, перенесших первичный ишемический инсульт (ИИ).
Материалы и методы. Обследовано 68 пациентов с первичным церебральным ИИ в острый (на 3-и и 14-е сутки) и ранний восстановительный (через 3 мес) период. В зависимости от лечебной тактики пациентов распределили на четыре группы: группу сравнения и три основные группы (монотерапия кортексином, моноте) рапия пароксетином, комбинированная терапия пароксетином и кортексином). Оценку уровня ДР проводили с использованием шкалы Гамильтона на 3-и, 14-е сутки и через 3 мес от начала заболевания. Определяли уровни ИЛ-6 и С-реактивного белка (С-РБ) в сыворотке крови в те же сроки.
Результаты. У пациентов с ДР в острый и ранний восстановительный период первичного ИИ наблюдается повышение сывороточных концентраций ИЛ-6 и С-РБ. Назначение кортексина в острый и ранний восстановительный период ИИ снижает уровень гуморальных факторов воспаления с достоверно более низкими значениями на 14-е сутки и через 3 мес. Уменьшение ДР через 3 мес после ИИ наблюдали в группах пациентов, принимавших пароксетин, причем в группе пациентов, дополнительно получавших повторные курсы кортексина, уровень ДР был достоверно ниже (p < 0,05).
Выводы. Назначение комбинации курса кортексина и пароксетина у больных с постинсультными ДР по сравнению со стандартной терапией и монотерапией пароксетином снижает уровень депрессии по шкале Гамильтона и содержание серологических маркеров воспаления.

Keywords: ишемический инсульт, депрессивные расстройства, воспаление, пароксетин, кортексин.

Objective – to investigate the relationship between hemispheric stroke localization in different brain structures and type and gravity of swallowing disorders at patients with acute supratentorial cerebral stroke and to assess restoration of their swallowing function in recovery period.
Methods and subjects. A clinical neurological and magnetic resonance tomographic examination was performed at 105 patients aged from 46 to 84 years (mean age – 66,3 ± 10,5 years) with acute cerebral stroke of supratentorial localization with disorders of swallowing after stroke. We used clinical neurological methods and structured scales for assessing neurological and swallowing status. The diagnosis of stroke and stroke localization was specified by using clinical methods and techniques of neuroimaging.
Results. The most evident swallowing disorders were detected in case of bilateral hemispheric stroke, witch was manifested in disruption of oral and / or pharyngeal stage of swallowing act; strokes with lesions in the parietal lobe of the right hemisphere of the brain caused difficulty in initiation the act of swallowing, adversely affect the swallowing process in general and its recovery; damage the lower parts of the parietal lobe of the left hemisphere resulted in dysfunction of the oral stage of swallowing. Hemispheric localization of stroke had influence not only on the stage of neurogenic dysphagia, but also on the degree of restoration of swallowing function. Bilateral hemispheric lesions of brain tissue had lower percentage for the full recovery of swallowing function than in cases unilateral localization of stroke (50.0 % and 67.5 % respectively).
Conclusions. The results of the examination of patients with acute cerebral stroke of supratentorial localization with disorders of swallowing demonstrated that the localization and nature of the lesions affected the nature and severity of the act of swallowing violation, and the speed regression swallowing deficits.

Keywords: neurogenic dysphagia, stroke, supratentorial localisation, neurological deficit.

Цель — исследовать взаимосвязь между полушарной локализацией инсультного очага в различных структурах головного мозга и стадией нарушения акта глотания у больных с острым супратенториальным мозговым инсультом, установить у них особенности восстановления функции глотания.
Материалы и методы. Проведено клинико-неврологическое и магнитно-резонансно-томографическое обследование 105 больных в возрасте от 46 до 84 лет (средний возраст — (66,3 ± 10,5) года) с острым мозговым инсультом супратенториальной локализации и нарушением акта глотания после перенесенного мозгового инсульта. При обследовании больных применяли клинико-неврологические методы и структурированные шкалы для оценки неврологического и глотательного статуса. Установление диагноза мозгового инсульта и определение локализации инсультного очага проводили с помощью клинических методов и методов нейровизуализации.
Результаты. Наиболее выраженные дисфагические расстройства выявляли при двустороннем полушарном инсульте — нарушение оральной и/или глоточной стадии акта глотания. Инсульты с поражением теменной доли правого полушария головного мозга вызывали затруднение инициации акта глотания, негативно влияли на глотательный процесс в целом и на его восстановление. Поражение нижних отделов теменной доли левого полушария приводило к дисфункции оральной стадии глотания. Полушарная локализация очага инсульта влияла не только на стадию нейрогенной дисфагии, но и на степень восстановления глотательной функции. Двустороннее полушарное поражение ткани мозга ассоциировалось с меньшей частотой полного восстановления функции глотания, чем в случае унилатеральной локализации очага инсульта (50,0 и 67,5 % соответственно).
Выводы. Полученные результаты свидетельствуют о том, что локализация и характер очага поражения при супратенториальном мозговом инсульте в значительной степени влияли на характер и степень тяжести нарушения акта глотания, а также на скорость регресса глотательного дефицита.

Keywords: нейрогенная дисфагия, мозговой инсульт, супратенториальная локализация очага, неврологический дефицит.

Обобщены данные литературы об эпидемиологии, патогенезе, клинико-диагностических особенностях базилярной мигрени. Рассмотрена дифференциация мигрени базилярного типа с височной и затылочной эпилепсией. Обоснованы клинические критерии мигрень-индуцированного мозгового инсульта. Оценена информативность нейровизуализационной диагностики мигрени. Представлено и проанализировано собственное клиническое наблюдение пациентки, страдающей на протяжении всей жизни мигренью с аурой, с вариантом трансформации офтальмической ауры в базилярную и осложнением — мигрень-индуцированным инсультом.

Keywords: базилярная мигрень, диагностика, дифференциальная диагностика.

Objective – to increase the efficacy of restorative surgical treatment of ulnar nerve injury consequences combined with prolonged electrical stimulation.
Methods and subjects. During 2008–2012 years 15 patients with injury of ulnar nerve underwent surgery, at which the system for direct and prolonged electrical stimulation was implanted. We performed neurolysis and decompression of ulnar nerve (in two cases system the prolonged electrical stimulation was implanted after the suturing of ulnar nerve). Following the debriding the ulnar nerve of scar tissue the implantation of system for prolonged electrical stimulation НейСі 3М (Ukraine) was preformed. This individual system allows one to perform electrical stimulation several times a day during a long period of time, this approach significantly increases the efficacy of treatment.
Results. 12 (80 %)patients demonstrated positive result and significantly improved functional recovery of ulnar nerve: range of motion, muscle strength and sensitivity improved, pain syndrome decreased or even reduced, vegetative)trophic changes were also reduced.
Conclusions. The application of prolonged electrical stimulation is safe and effective method of influence on functional status of neuromuscular apparatus of upper extremity after the injury of ulnar nerve. Prolonged electrical stimulation showed its efficacy even in patients with history of disease more then 2 years. The application of prolonged electrical stimulation allowed us to accelerate and to obtain significant restoration of lost function in patients who underwent traditional surgeries which included neurolysis and decompression of ulnar nerve without further implantation of system for prolonged electrical stimulation.

Keywords: ulnar nerve injury, prolonged electrical stimulation, surgical treatment.

Цель — улучшить результаты восстановительного лечения больных с повреждением локтевого нерва с помощью длительной электростимуляции.
Материалы и методы. В клинике восстановительной нейрохирургии в период с 2008 по 2012 г. прооперировано 15 больных с повреждением локтевого нерва с использованием методики прямой длительной электростимуляции. Всем больным выполнены невролиз и декомпрессия локтевого нерва (у 2 больных электростимуляционную систему установили после нейрорафии). После освобождения локтевого нерва от окружающих рубцово)измененных тканей проводили имплантацию электростимуляционной системы «НейСи-3М» (Украина). Эта система имеет преимущества над кратковременной электростимуляцией, так как не требует посещения больными физиотерапевтического отделения. Это индивидуальная система, которая позволяет осуществлять стимуляцию в домашних условиях несколько раз в сутки в течение длительного времени, что значительно повышает эффективность лечения.
Результаты. У 12 (80 %) больных получены позитивные результаты восстановления функции локтевого нерва (улучшение движений правой кисти и чувствительности, уменьшение или исчезновение болевого синдрома, регресс вегетативно-трофических нарушений).
Выводы. Использование длительной электростимуляции — эффективный и безопасный метод влияния на функциональное состояние нервно-мышечного аппарата конечности при повреждениях локтевого нерва. Электростимуляция эффективна также у больных с давностью заболевания свыше два года. Ее использование дает возможность достичь более полноценного и быстрого возобновления потерянной функции в сравнении с больными, которым проводили невролиз и декомпрессию без электростимуляции.

Keywords: повреждение локтевого нерва, длительная электростимуляция, хирургическое лечение.

Objective – to investigate the features of the borreliosis clinical manifestations (Lyme disease (LD), to estimate the importance of Borrelia antibodies (IgM and G) in the diagnostics of borreliosis to develop proposals of the treatment LD quality improving.
Methods and subjects. 36 patients with systemic tick borreliosis were examined. Clinical manifestations, changes in laboratory parameters, including the determination of antibodies to borrelia (IgM and IgG) at different times, were defined. Instrumental methods (ECG, ultrasound)were applied to examine different organs, that are targets for LD. Antibacterial therapy effectiveness was considered. The case of the acute meningitis during systemic borreliosis was analyzed.
Results. The incidence of Lyme disease in 2012 has doubled compared with 2011 year in City Clinical Hospital № 4, Kyiv (36 and 19 cases respectively). The erythema migrants match with the localization of tick bite in 100 % cases.
All patients had general symptoms of intoxication. 13 patients underwent the test for the detection of IgM and IgG tо Borrelia burgdorferi. While determining IgM and IgG to Borrelia 8 patients (61 %) (the analysis was conducted on 9, 10,
11, 14, 22, 30, 36, 37 day after the first symptoms of the disease) and 6 patients (46 %) had positive IgG test (the analysis was conducted on 7, 10, 14, 22, 30, 37 day after first symptoms). 5 patients (38 %) had positive results of IgG and IgM tests (on 10, 14, 22, 36, 37 days). One patient demonstrated ambiguous results for IgG and IgM tests (on 14 day).
Negative results of IgG and IgM tests were determined in 1 patients on 33 day since first symptoms. 4 patients (30 %) didn’t have analysis on IgG and IgM on 7, 9, 17, 33 day after erythema appeared. Negative IgG analysis were in 53 %
cases (7 patients) (on 9,10,14 (2 patients), 17, 33, 39 days). 38 % patients had enlarged liver from 1 to 3,5 cm, diffuse changes in the liver; 11 % (4 patients) patients had increased level of AlAT, 3 % (1 patient) had increased level of AsAT.
All patients underwent the course of treatment with ceftriaxone at a dose 1 g 2 times a day intramuscular injections.
The course of treatment was about 14 days. The favorable outcome was in 100 % cases.
Conclusions. LD morbidity has significantly increased during the past 6 years (6 times compared to 2007) in City Clinical Hospital № 4, Kyiv. LD has specific phases. Phases alternation in anamnesis helps in the diagnostics of LD. It is important to consider the presence or absence of IgM and G to Borrelia burgdorferi. However, PCR is the determining method of the LD diagnostics. The main direction of the LD treatment is antibiotic therapy: ceftriaxone, cefotaxime, doxycycline.

Keywords: systemic borreliosis, neuroborreliosis, Lyme disease, erythema migrant, meningitis.

Objective – to investigate the features of the borreliosis clinical manifestations (Lyme disease (LD), to estimate the importance of Borrelia antibodies (IgM and G) in the diagnostics of borreliosis to develop proposals of the treatment LD quality improving.
Methods and subjects. 36 patients with systemic tick borreliosis were examined. Clinical manifestations, changes in laboratory parameters, including the determination of antibodies to borrelia (IgM and IgG) at different times, were defined. Instrumental methods (ECG, ultrasound)were applied to examine different organs, that are targets for LD. Antibacterial therapy effectiveness was considered. The case of the acute meningitis during systemic borreliosis was analyzed.
Results. The incidence of Lyme disease in 2012 has doubled compared with 2011 year in City Clinical Hospital № 4, Kyiv (36 and 19 cases respectively). The erythema migrants match with the localization of tick bite in 100 % cases.
All patients had general symptoms of intoxication. 13 patients underwent the test for the detection of IgM and IgG tо Borrelia burgdorferi. While determining IgM and IgG to Borrelia 8 patients (61 %) (the analysis was conducted on 9, 10,
11, 14, 22, 30, 36, 37 day after the first symptoms of the disease) and 6 patients (46 %) had positive IgG test (the analysis was conducted on 7, 10, 14, 22, 30, 37 day after first symptoms). 5 patients (38 %) had positive results of IgG and IgM tests (on 10, 14, 22, 36, 37 days). One patient demonstrated ambiguous results for IgG and IgM tests (on 14 day).
Negative results of IgG and IgM tests were determined in 1 patients on 33 day since first symptoms. 4 patients (30 %) didn’t have analysis on IgG and IgM on 7, 9, 17, 33 day after erythema appeared. Negative IgG analysis were in 53 %
cases (7 patients) (on 9,10,14 (2 patients), 17, 33, 39 days). 38 % patients had enlarged liver from 1 to 3,5 cm, diffuse changes in the liver; 11 % (4 patients) patients had increased level of AlAT, 3 % (1 patient) had increased level of AsAT.
All patients underwent the course of treatment with ceftriaxone at a dose 1 g 2 times a day intramuscular injections.
The course of treatment was about 14 days. The favorable outcome was in 100 % cases.
Conclusions. LD morbidity has significantly increased during the past 6 years (6 times compared to 2007) in City Clinical Hospital № 4, Kyiv. LD has specific phases. Phases alternation in anamnesis helps in the diagnostics of LD. It is important to consider the presence or absence of IgM and G to Borrelia burgdorferi. However, PCR is the determining method of the LD diagnostics. The main direction of the LD treatment is antibiotic therapy: ceftriaxone, cefotaxime, doxycycline.

Keywords: systemic borreliosis, neuroborreliosis, Lyme disease, erythema migrant, meningitis.

Цель — исследовать особенности клинических проявлений при боррелиозе (болезни Лайма (БЛ)); оценить роль антител к боррелиям (IgM и IgG) в диагностике БЛ для разработки предложений по повышению качества лечения БЛ.
Материалы и методы. Обследовано 36 пациентов с системным клещевым боррелиозом. Проанализированы клинические проявления, изменения лабораторных показателей. Определено наличие антител к боррелиям (IgM и IgG) в разные сроки. С помощью инструментальных методов (ЭКГ, УЗИ) исследованы органы-мишени при БЛ. Изучена эффективность антибактериальной терапии. Проанализирован случай острого менингита в рамках системного боррелиоза.
Результаты. Заболеваемость БЛ в КГКБ № 4 в 2012 г. была почти в 2 раза выше по сравнению с 2011 годом (36 и 19 случаев соответственно). В 100 % случаев локализация мигрирующей эритемы совпадала с местом укуса клеща. Все пациенты жаловались на сопутствующие общеинтоксикационные симптомы. 13 пациентам проведено определение IgM и IgG к Borrelia burgdorferi. У 8 (61 %) из них выявлен IgM (на 9, 10, 11, 14, 22, 30, 36, 37-е сутки после появления первых симптомов заболевания), у 6 (46 %) — IgG (на 7, 10, 14, 22, 30, 37-е сутки). У 5 (38 %) пациентов были положительными результаты теста на наличие одновременно IgM и IgG (на 10, 14, 22, 36, 37-е сутки). У одного пациента при определении IgM и IgG результат был сомнительным (на 14-е сутки). Отрицательными результаты теста на наличие IgM и IgG были у одного больного на 33-и сутки от появления первых симптомов.
У 4 (30 %) пациентов IgM на 7, 9, 17, 33-и сутки после появления эритемы не определялись. Отрицательными результаты теста на наличие IgG были у 7 (53 %) пациентов (на 9, 10, 14 (2 пациента), 17, 33, 39-е сутки). 38 % пациентов, по данным УЗИ брюшной полости, имели увеличенную печень (от 1,0 до 3,5 см), диффузные изменения. Повышение уровня АЛТ отмечено у 11 % пациентов, АСТ — у 3 %. Все пациенты прошли курс лечения цефтриаксоном в дозе 1 г 2 раза в сутки внутримышечно. Длительность лечения в среднем составила 14 дней. Во всех случаях исход был благоприятным.
Выводы. Заболеваемость БЛ по КГКБ № 4 значительно возросла за последние 6 лет (в 6 раз по сравнению с 2007 г.). Наличие в анамнезе чередования фаз помогает в диагностике БЛ. Важно учитывать наличие/отсутствие IgM и IgG к Borrelia burgdorferi. Основной метод диагностики БЛ — полимеразная цепная реакция.
Главным направлением в лечении БЛ является антибактериальная терапия (цефтриаксон, цефотаксим, доксициклин).

Keywords: системный боррелиоз, нейроборрелиоз, болезнь Лайма, мигрирующая эритема, менингит.

Рассмотрены современные подходы к фармакотерапии инсомний, требования к оптимальному снотворному средству и недостатки имеющихся препаратов-гипнотиков. Освещены возможности и преимущества лекарственных средств растительного происхождения с сочетанием снотворного и седативного действия.
Особое внимание уделено анализу механизмов действия и сфере клинического применения нового комбинированного препарата на основе экстрактов валерианы и мяты — Меновалена. Обоснована целесообразность применения препарата при нарушениях сна различного генеза как эффективной и безопасной альтернативы снотворным средствам химической природы.

Keywords: нарушения сна, снотворные средства, препараты валерианы.

Изучена эффективность препарата холина альфосцерата (Глиатилин) у 58 пациентов. Установлено достоверное улучшение объективного неврологического статуса пациентов, получавших препарат в дозе 800 мг/сут, а именно: нивелирование статико-локомоторной функции, регресс чувствительных нарушений, снижение пирамидной недостаточности. Отмечено достоверное уменьшение субъективных жалоб больных на головную боль, головокружение, раздражительность, утомляемость и достоверное улучшение когнитивных функций, о чем свидетельствовало улучшение беглости речи, праксиса, слуховой и зрительной памяти, снижение тревожности и депрессивных проявлений. Полученные данные позволяют рекомендовать холина альфосцерат (Глиатилин) для лечения печеночной энцефалопатии.

Keywords: печеночная энцефалопатия, энцефалопатия, когнитивные нарушения, холина альфосцерат, Глиатилин.