Objective — to investigate the predictive value of serial measurements of circulating vascular endothelial growth factor-1 level in patients with essential hypertension stage III.
Methods and subjects. 102 patients with mild to moderate arterial hypertension within 3 weeks after ischemic stroke were included in the study. Follow-up was 12 months with a 3 month intervals. The circulating VEGF-1 level was assessed at baseline and after six months of baseline. Clinical interviews were conducted every 3 months for 1 year after receiving blood samples. As a clinical point we determined following cardiovascular outcomes: recurrent stroke or TIA, ischemic heart disease, sudden death, diabetes mellitus, cardiovascular events, including chronic heart failure and the need for hospitalization for these reasons.
Results. Analysis of obtained outcomes have showed that increased VEGF-1 concentration within six months after ischemic stroke is positively associated with incidence of cardiovascular events, when compared with individuals without increased circulating levels of VEGF-1. Adjusted odds ratio for the occurrence of cumulative cardiovascular events in stage III hypertension patients with VEGF-1 at baseline more 403.57 pg/ml, when compared with lower concentrations of one, was 4.11 (95  % CI  =  2.66 — 7.28; p  =  0.001), and an increased sixth month circulating VEGF-1 over 450.15 pg/ml, when compared with lower concentrations of one, was associated with adjusted odds ratio 5.46 (95  % CI  =  3.12 — 7.90; p  =  0.001).
Conclusions. Circulating vascular endothelial growth factor-1 level is an independent predictor of 1 year cumulative cardiovascular events in patients with stage III hypertension after cerebral ischemic stroke.

Keywords: vascular endothelial growth factor-1, ischemic stroke, arterial hypertension, serial measurements, clinical outcomes, predicted value.

Objective — definition of clinical diagnostic value of classical inflammation marker C-reactive protein (CRP) and tumor necrosis factor α (TNFα) and interleukin-6 (IL-6) — in patients with cognitive dysfunction in different clinical forms of atrial fibrillation (AF).
Methods and subjects. 56 people with AF were examined (the mean age of 54.2  ±  4.8 years). Three groups were organized: patients with permanent form of AF, patients with persistent (during a paroxysm) form of AF and without arrhythmia in patients with coronary heart disease. All patients were determined the content of CRP, TNFα and IL-6. By means of neuropsychological methods cognitive disorders were found in 42 patients who presented the levels of inflammatory markers and their correlation with the results of neuropsychological testing.
Results. Frequent AF paroxysms were accompanied by a significant increase in the concentration of TNFα, CRP and IL-6, compared with patients with permanent AF and patients without arrhythmia. Based on the results of the test, the Mini-Mental State Examination revealed significantly lower scores in patients with AF compared the control group. Patients in the control group had evidenced correlations between TNFα and IL-6. It was identified with the MMSE test for verbal associations, and hearing memory. Schulte punch also submit correlation between the TNFα and the MMSE. Reliable correlations also exist between the content of CRP and the results of tests Schulte and MMSE.
Conclusions. Increase of inflammatory markers is an independent рredictor of cognitive disorders in patients with AF. The reinforcement of correlation between the AF and the levels of inflammatory markers has been established.

Keywords: atrial fibrillation, cognitive disorders, cytokines, C-reactive protein.

Objective — to study the results of an initial using of deconstructive operations in patients with cerebral aneurysms (CA), identify types of deconstructions, possible complications and recurrences, to assess the patient’s quality of life.
Methods and subjects. 58 (8.2  %) deconstructive operations were performed for 706 patients with CA. Localization: 10 (3.1  %) from 323 patients with CA of anterior cerebral artery/anterior communicating artery
(ACA/ACoA), 24 (13.9  %) from 173 CA of internal carotid artery (ICA), 11 (7.4  %) from 149 MA of middle cerebral artery (MCA) and 13 (21.3  %) from 61 MA of posterior circulation basin (PCB). 26 (44.8  %) deconstructive operations were performed in acute period, 11 (10  %) — in the cool, and 21 (36.2  %) in unruptured CA. The planned deconstructions were performed for 36 (62.1  %), unplanned — 22 (37.9  %).
Results. 3 (5.15  %) deconstructions CA 0 — 3 mm were performed, CA 4  deconstractions —  5 mm — 16 (27.6  %), 6 — 10 mm — 6 (10.4  %), 11 — 15 mm — 3 (5.15  %), 16 — 20 mm — 4 (6.9  %),  >  20 mm — 19 (32.7  %) and 7 (12.1  %) in fusiform aneurysms. Analysis of compensatory blood flow in specific localizations, evaluation of complications/predictors of complications of planned and unplanned deconstructive occlusions was carried out. Main causes of unplanned deconstructions were: coils drop-out from CA in to the artery: without follow occlusion (7 cases), with the occlusion (7 cases), followed by coils migration through the vessel (8 cases). Only 3 (5.23  %) ischemic complications were observed: 2 cases with the deterioration and 1 death. The patient’s quality of life (by Rankin scale): excellent results (0 — 1 points) — 45 (77.6  %), good (2 — 3 points) — 11 (19  %), satisfactory (4 points) — 1 (1.7  %), unsatisfactory (5 — 6) — 1 (1.7  %).
Conclusions. Deconstructions is the most technically simple operation to perform and, taking into account all aspects of their design, should remain in the arsenal of endovascular neuroradiologist. In patients with large and giant CAs and fusiform aneurysms planned deconstruction is the operation of choice. The planned deconstruction is a reliable and safe method of CA occlusion, if all the requirements for preparation have been made. Unplanned deconstruction arises as a result of coil instability in aneurysm. Unplanned occlusion doesn’t often cause the deterioration or death. Stationary stable occlusion of the aneurysm with a vessel is the most radical method of treatment but requires dynamic long follow-up monitoring for any ischemic and other complications.

Keywords: cerebral aneurysm, endovascular occlusion, deconstructive operation.

Objective — to access the effectiveness of bilateral stimulation of subthalamic nuclei for the treatment of Parkinson disease (PD).
Methods and subjects. 6 patients have undergone stereotactic bilateral implantation of intracerebral electrodes for stimulation of subthalamic nucleus. Mean age of patients was 60.3  ±  12.4 years. Primary PD was diagnosed in 5 (83.3  %) cases and 1 (16.7  %) patient had secondary parkinsonism. Mean duration of PD was 9.2  ±  2.4 years, mean duration of levodopa-therapy was 6.8  ±  2.8 years. Patients were accessed before and after surgery using UPDRS II, Hent and Yahr scale, Shab and England scale. Surgery was performed with CRW Radionics stereotactic system using FraimLink, Medtronicsoftware for calculating the target. Intraoperative physiology including microelectrode recording and stimulation was carried out. All patients underwent the implantation of Medtronic Model 3389 DBS, connected to the Activa-PC Medtronic neurostimulator. Assessment of neurological status was performed in 3, 6 and 12 months after surgery.
Results. After surgery Parkinson’s tremor and rigidity disappeared in all 6 patients, significant regression of bradykinesia was observed in 5 (83.3  %) cases. Levod opa-induced dyskinesia was eliminated in 2 patients who had it before surgery. In all 3 patients «on — off» phenomenon regressed and in 3 of 5 cases was observed the regression of «wearing off» phenomenon. DBS significantly improved UPDRS II score with improvements of 74.4  % from the baseline in the period of levodop action and of 63.3  % in the period of levodop absence. DBS allows reducing daily levodopa dose on 51.1  % comparing with preoperative period.
Conclusions. DBS of subthlamic nucleus is effective and safe method of surgical treatment of PD, which improves motor symptoms, reduces the severity of dyskinesia, allows to reduce levodopa dose and improves the quality of life.

Keywords: Parkinson disease, deep brain stimulation, intracerebral electrodes, neurostimulation.

Objective — identify the correlation between clinical and laboratory/instrumental signs of multiple sclerosis activity to improve the diagnosis and optimize the prognosis of the disease.
Methods and subjects. The paper presents the data of 9-year follow-up of 72 patients (40 men and 39 women) with relapsing-remitting multiple sclerosis (RRMS). Severity of neurological symptoms was evaluated using EDSS scale. GE Signa Excite HD 1.5T MRI scanner was used to estimate the number of hyperintense lesions on T2-weighted images, including the number of lesions greater than 3 mm, the number of T1 lesions and Gd+ lesions. Study of synthesis and secretion of proinflammatory and anti-inflammatory cytokines IL-1, IL-2, IL-4, IL-6, IL-10, TNFα and IFNγ was performed in human mononuclear cell culture.
Results. Strong correlation was found between levels of proinflammatory cytokines IL-1, IFNγ, and the number of clinical relapses in a year (rs  =  0.753 and 0.7 respectively). It was found that the disability progression in patients according to EDSS is influenced by such factors as the size of T2 lesions, their localization, the presence of T1 lesions («black holes»). The Kaplan — Meier curve revealed a significant effect of the presence of more than T2 lesions larger than 3 mm on the clinical activity of the disease.
Conclusions. The correlation between the clinical and laboratory signs of MS instrumental activity contributes to further improvement of methods for monitoring the disease and improving its diagnosis.

Keywords: multiple sclerosis activity, disability progression, cytokines, demyelinating lesions.

Objective — to study comparative characteristic of 25-hydroxycholecalciferol (25(OH)D) concentration in the serum of examined adults, patients with multiple sclerosis (MS), depending on the clinical characteristics of the disease.
Methods and subjects. The study involved 68 patients with MS (Ivano-Frankivsk city and region), including 39 women and 29 men with confirmed MS diagnosis. The mean age of MS patients was 37.7  ±  9.7 years, average disease duration was 10.3  ±  6.6 years, and the average severity on the Kurtzke Expanded Disability Status Scale (EDSS) was 4.7  ±  1.3 points. The control group consisted of 10 healthy individuals (mean age — 37.3  ±  8.7 years). The content of 25(OH)D in blood serum was determined by ELISA measured.
Results. It was found that there is a statistically significant decrease in vitamin D level among patients with Secondary-Progressive Multiple Sclerosis (SPMS), compared with the group of patients with Relapsing-Remitting MS (RRMS). There is a statistically significant difference in vitamin D level between patients with an average MS severity compared with a group of MS patients, where EDSS score was the highest.
Conclusions. Our results evidenced that level of 25(OH)D in the serum of MS patients depends on the clinical characteristics of the disease. Thus, patients with the most severe type of Secondary-Progressive Multiple Sclerosis and with the highest score (6 — 9) on the Kurtzke Expanded Disability Status Scale had the lowest vitamin D level.

Keywords: multiple sclerosis, etiology, pathogenesis, vitamin D.

Objective — to study the characteristics of memory and attention in patients with lumbosacral pain syndromes and diabetes mellitus.
Methods and subjects. 142 patients (mean age  =  59  ±  0.63) with lumbosacral pain syndromes underwent a comprehensive clinical and laboratory, neuroimaging and neuropsychological examination. Women prevailed in this study. The neuropsychological testing, which was one of the fragments of the study, included the evaluation of situational and constitutive anxiety levels, the depression signs in the one- year catamnesis, the evaluation of memory (by using ten words memorizing method) and attention (by using Schulte tables).
Results. The changes in the indices of the neuropsychological status, which defined attention (focusing and fatigue) and memory (short-term and long-term) were detected both in the patients with lumbosacral pain syndromes, who had no carbohydrate metabolism derangements and in the patients with background diabetes mellitus. However, the rate and evidence of the changes were significantly higher (р  <  0.05) in the patients with diabetes mellitus.
Conclusions. The detected memory disorders in patients with lumbosacral pain syndromes against the background of diabetes mellitus and in those who had no diabetes mellitus, may be associated not only with the changes and malfunction of the amygdala and hippocampal complex, but also with the impaired focusing and the rapid attention fatigue in the patients.

Keywords: lumbosacral pain syndrome, attention focusing, attention fatigue, short-term memory, long-term memory, diabetes mellitus.

The article is focused on the empty sella syndrome. The clinic and peculiarities of diagnostics are described.

Keywords: empty sella, neuroendocrine disturbances.

Objective — to evaluate the prognosis of HIV-associated tuberculous meningoencephalitis (TM), depending on the mechanisms of its development.
Methods and subjects. 116 HIV-infected patients with TM were examined. Clinical and laboratory examination, the culture of sputum and cerebrospinal fluid drug test sensitivity MBT, determination the level of CD4-lymphocytes were cartied out. To evaluate the effectiveness of treatment the mortality rate was calculated.
Results. Of the 116 patients studied, 46.6  % had TM as the first manifestation of tuberculosis, 39.6  % of patients TM has developed against the background of anti-TB treatment for tuberculosis at other sites and in 13.8  % of TM was a manifestation of the SRIS after beginning ART. In the group of patients where the TM was the debut of tuberculosis, there was the beginning of a longer (p < 0.05), less frequently detected signs of generalization of tuberculosis (p < 0.001) and chemoresistance. SRIS TM-associated acute course was characterized by a rapid, profound immunosuppression, the most number of patients with signs of generalization of tuberculosis. Among patients with TM arising during treatment with other forms of TB, defined the largest share of patients with MRTB, established during the most unfavorable in terms of survival. Also high rates of mortality in patients with tuberculosis was caused due to the SRIS. The most favorable for survival was an option TM cord symptoms were the first manifestations of tuberculosis among these patients, mortality was lowest.
Conclusions. The most favorable prognosis had TM, which was the debut of tuberculosis. The most fatal outcome for TM developed against the background of anti-TB treatment for tuberculosis at other sites that may be linked to a large stratum of patients with MRTB. SRIS-associated TM characterized by high rates of mortality. The main event of the prevention of this variant TM is a thorough examination of patients for TB and its effective treatment before the start of ART.

Keywords: HIV, tuberculosis, meningoencephalitis, antiretroviral therapy.

Objective — investigation of zinc salts efficiency in treatment of neurologic forms of hepatocerebral degeneration (HCD).
Methods and subjects. The analysis of treatment of 82 patients (40 women and 42 men) with HCD was carried out. The age of hospitalized patients was from 5 till 55 years (mean age 27.3), age of patients with the deseases onset was from 1 till 40 years (mean age 21.3). 23 patients were treated with zinc salts only, 43 patients were treated with combination of small doses of penicillamine and zinc salts and 16 patients were treated with penicillamine only.
Results. 67.1 % patients demonstrated significant improvement of psychoneurological state: speech improvement, limbs tremor and hyperkinesia amplitude abated, muscular tonus relieved, cognitive functions improved. According to international duplex assessment scale the net index of pathology decreased by 21 %.
Conclusions. It was established: zinc salts are rather effective, low-toxical, inexpensive and can be used as choice preparation in treatment of patients on preclinical stage of disease, and also on the stage of maintenance therapy (both as monotherapy or penicillamine combination). However, zinc salts and chelator penicillamine cannot resolzve all problems of treatment and rehabilitation of patients with HCD, therefore (taking into account a clinical presentation and data of additional methods of research) it is necessary to carry out of courses of symptomatic treatment not less than 1 — 2 times a year.

Keywords: hepatocerebral degeneration, treatment, zinc salts.

Objective — to improve results of surgical treatment in patients with after-effects of peripheral nerve trauma with use of direct long-termed electrical stimulation.
Methods and subjects. 312 patients with consequences of injury of peripheral nerves underwent surgery combined with implantation of system for long-term electrical stimulation. Magnetic resonance tomography, computer tomography, ultrasound diagnostics and electroneuromiography were used as research methods.
Results. 92.2  % of positive outcomes during the follow-up period occurred: range of motion, muscle strength increased, sensitivity restored, vegetative and trophic disorders, severity of pain syndrome decreased.
Conclusions. Long-term electrical stimulation is safe and effective method of treatment of patients with consequences of injury of peripheral nerves. Chronic electrical stimulation provides maintenance of functional status of denervated muscles up to regeneration of nerve trunks, facilitates restoration of motion and sensitivity, regression of vegetative and trophic disorders, decrease of severity of pain syndrome.

Keywords: neuropathy, surgery, long-term electrical stimulation.

Objective — to find out which preventive medication can assure prolonged remission in patients with multiple sclerosis (MS).
Methods and subjects. 40 patients with MS aged 18 — 40 years were treated in the neurological department of the Transcarpathian Regional Clinical Hospital named after A. Novak during the period 2007 — 2012. The following medications: Copaxone, Betaferon, Rebif, Avoneks, Вetfer 1b, Вetfer 1a plus were prescribed.
Results. Indications and contra-indications for the preventive therapy were determined. Positive results were obtained when assigning all mentioned medications.
Conclusions. We believe that patients with multiple sclerosis should be prescribed Copaxone, Betaferon, Rebif, Avoneks, Вetfer 1b, Вetfer 1a plus as a preventive therapy. The most prolonged remission was observed in patients who took Copaxone and Avoneks.

Keywords: multiple sclerosis, preventive therapy.

Сognitive disorders are the most common and socially significant disorders of the nervous system. Cerebro­vascular pathology is one of frequent causes of cognitive deficit. In this article an evaluation of effectiveness of drug Gliatilin for elderly patients with mild cognitive impairment with discirculatory encephalopathy II stage was conducted. 15 patients with II stage. discirculatory encephalopathy and mild cognitive impairment syndrome were examined. Gliatilin was administered at a dose of 400 mg twice a day during three months. The data obtained after the treatment signified improvements of the general status of patients, their cognitive functions and were accompanied by positive dynamics of brain bioelectric activity indicators.

Keywords: mild cognitive impairment syndrome, discirculatory encephalopathy, Gliatilin.

Objective — to explore the clinical efficacy of the preparation Alora in the therapy of children with psychopathology of borderline disorders.
Methods and subjects. 66 children aged 3 to 16 years with borderline psychopathology were observed. 38 children of this group constituted the studied group They underwent Alora therapy. 28 children constituted the control group. Out of them the children aged from 3 to 12 took glycine and hydroksizin; children aged from 12 to 16 took glycine and hydazepam. All medications were administered in appropriate age dose for patients. General clinical, psychopathological, experimental and psychological examinations were carried out for all children. The degree of clinical symptoms was measured using a three-grade scale.
Results. It has been proved that preparation Alora demonstrated anxiolytic and antidepressant effect, restored distributed sleep-wake cycle, provided with a persistent reductions of the symptoms of anxiety-depressive case. The highest reduction was observed for anxious- depressive disorders (by 78  % and 70  %, respectively) and muscle tension (by 74  %) at generalized anxiety disorder during childhood age. Signs of sustained emotional background were observed by the end of the first week of the Alora therapy, reaching maximum till the beginning of the fourth week. The degree of reduction of astenic symptoms was higher than in the control group by 21 — 29  %.
Conclusions. Phytopreparation Alora has anxiolytic, sedative, antidepressant effect; it restores the disturbed sleep and has no toxic side effects compared to synthetic medication. This allows to use it in children’s psychiatric practice.

Keywords: Alora therapy, borderline psychopathology symptoms, child age.

Описан клинический случай «пустого» турецкого седла. Освещены клиническая картина, особенности этой патологии и трудности диагностики.

Keywords: «пустое» турецкое седло, нейроэндокринные нарушения.

Цель — оценить эффективность имплантации системы для двусторонней глубинной мозговой стимуляции субталамического ядра при болезни Паркинсона (БП).
Материалы и методы. Стереотаксическая двухсторонняя имплантация внутримозговых электродов для стимуляции субталамических ядер проведена 6 больным. Средний возраст больных — (60,3 ± 12,4) года. У 5 (83,3 %) больных диагностирована идиопатическая БП, у 1 (16,7 %) — вторичный паркинсонизм. Продолжи­тель­ность болезни в среднем — (9,2 ± 2,4) года, продолжительность леводопа-терапии — (6,8 ± 2,8) года. Состояние больных до и после операции оценивали по Унифицированной оценочной шкале БП (UPDRS II), шкале Хена — Яра, шкале дневной активности Шваба — Ингланда. Операции осуществляли на стереотаксической системе CRW Radionics c использованием компьютерной программы FraimLink (Medtronic). Выполняли интраоперационную микроэлектродную регистрацию электрической активности подкорковых структур. Всем больным имплантировали нейрогенератор модели Activa-PC. Регресс симптоматики оценивали через 3; 6 и 12 мес после операции.
Результаты. После операции нормализация мышечного тонуса и прекращение тремора отмечены у всех оперированных больных, значительный регресс брадикинезии — у 5 (83,3 %). Леводопа-вызванные дискинезии исчезли у 2 больных, у которых они были до операции. У 3 больных исчез феномен «включения — выключения», у 3 — регрессировал феномен «истощения дозы леводопы». Отмечено существенное улучшение по показателям шкалы UPDRS II: на 74,4 % — в период максимального действия препарата леводопы, на 63,3 % — в период отсутствия действия леводопы. После операции отмечено снижение суточной дозы леводопы в среднем на 51,1 % по сравнению с дооперационной.
Выводы. Глубинная мозговая стимуляция субталамических ядер — эффективный и безопасный метод хирургического лечения БП, способствующий значительному регрессу неврологической симптоматики, снижению дозы леводопы и улучшению качества жизни больных.

Keywords: болезнь Паркинсона, глубинная мозговая стимуляция, внутримозговые электроды, нейростимуляция.

Цель — провести ретроспективный сравнительный анализ структурно-функциональной организации дебютов рассеянного склероза (РС) с учетом прогноза заболевания при разных типах течения.
Материалы и методы. Обследованы 280 больных с разными вариантами текущего прогноза (благоприятного, неблагоприятного, неопределенного) при разных типах течения: 80 — с рецидивирующим (РТ), 140 — с вторично-прогредиентным (ВПТ), 60 — с первично-прогредиентным (ППТ). Учитывали клинические показатели: пол, возраст начала заболевания, факторы риска, предшествующие дебюту, предвестники дебюта, количество синдромов и темпы их формирования в дебюте, длительность и тяжесть дебюта, полноту и продолжительность клинических ремиссий после дебюта (при РТ и ВПТ), наличие и продолжительность этапа стабилизации (при ППТ).
Результаты. Установлено, что структура дебютов при разных вариантах прогноза для РТ и ВПТ, несмотря на ряд отличительных особенностей, не имеет существенных различий. Дебют при ППТ, особенно при неблагоприятном прогнозе, в отличие от РТ и ВПТ, носит принципиально иной характер, имеющий важное дифференциально-диагностическое значение.
Выводы. Формирование клинических синдромов дебютов происходит по разным программам, в основе которых лежат патогенетические механизмы, строго детерминированные как для типов течения РС, так и для разных вариантов прогноза.

Keywords: рассеянный склероз, типы течения, текущий прогноз, дебют.