The modern understanding of the prevalence, pathogenetic heterogeneity of post-stroke pain syndrome have been shown. Its main clinical variants were described. Principles of diagnostics and differential diagnostics of post-stroke pain were presented. The absence of conventional agreement on the definition of central post-stroke pain and specialized assessment scale was indicated. We presented the modern approaches to the treatment of post-stroke pain.

Keywords: central post-stroke pain, nociceptive pain, gabapentin, pregabalin.

Multiple sclerosis is a chronic progressive autoimmune disease of the nervous system that occurs more frequently in the second and third decade of life, 2 times more often affects women than men. Thus, the problems associated with family planning and childbirth are particularly relevant to women. Most of them concern issues of pregnancy, childbirth and the postpartum period. In general, pregnancy has a protective effect during the course of multiple sclerosis, especially in the third trimester. The influence of pregnancy at the frequency of relapses exceeds the effect of all presently known immunomodulating drugs.

Keywords: multiple sclerosis, pregnancy, pathogenetic treatment.

The notifications about modern state of blood-brain barrier as a part of neuro-immune-endocrine network in the world neurological practice are given and discussed at the article. The basic relationships between major adaptive systems of the body — the nervous, immune and endocrine have been described. Based on literature data and own research authors highlight the important issues management capabilities of neuro-immune-endocrine system affecting the blood-brain barrier.

Keywords: cerebrospinal fluid, homeostasis, macrophages, cytokines, neuropeptides.

Objective — to study the peripheral nerves functional state and clinical-laboratory findings in patients with non-insulin-dependent diabetes mellitus (DM), type II, depending on polymorphism of endothelial NO-synthase (eNOS) G894T gene.

Methods and subjects. Genetic typing of 110 patients with DM type II, complicated with distal symmetrical polyneuropathy, and 80 practically healthy individuals has been performed to detect allelic polymorphism of eNOS G894T gene. All the patients were examined by means of Neuropathy Symptomatic Scale (NSS) score, modified Neuropathy Dysfunctional Scale (NDS) score, electroneuromyographic testing of the peripheral nerves of the lower limbs, and the values of carbohydrate metabolism were detected.

Results. Association of homozygotic TT genotype by the unique polymorphism allele of eNOS G 894T gene with higher values of NSS-score, increasing of glycated hemoglobin level (p   <  0.05) and a reliable decrease of motor response amplitudes detected by electroneuromyographic testing of the peripheral nerves has been found.

Conclusions. Homozygosis by a minor allele increases a probable development of distal symmetrical polyneuropathy against the ground of DM type II. At the same time, according to the findings of our research heterozygosis possesses the lowest risk of development of severe complications due to diabetic polyneuropathy.

Keywords: non-insulin-dependent diabetes mellitus, type II, distal symmetrical polyneuropathy, electroneuromyographic values, carbohydrate metabolism, G894T gene polymorphism, endothelial NO-synthase.

Objective — to examine the effectiveness of different neuroprotective drugs on the course of ischemic stroke in posterior circulation (PC) compared with anterior circulation (AC).

Methods and subjects. The clinical and neurological examinations of 104 patients with acute infarct in PC aged 32 to 82 years (mean age — (58.5  ±  11.3) years) and 50 patients with acute infarct in AC aged 48 to 84 years (mean age — (64.4  ±  10.4) years) were carried out. Patients were divided into 6 groups depending on the applied therapy. It was evaluated the dynamics of patients’ subjective data and their neurological status using scales NIHSS, B. Hoffen-berth et al., modified Rankin scale, index Bartel and Global test within 90 days of the disease.

Results. Neurological state dynamics, disability level and functional sufficiency evidenced the neuroprotective therapy efficacy for patients with ischemic stroke in the PC and AC. Patients with ischemic stroke in PC, who were treated with antioxidant and antyhipoxant drugs, were characterized by more rapid recovery of the neurological deficit and improvement of functional outcome. In 3 months complete recovery was recorded in 41.4  % patients, treated with antioxidant drugs, 30  % patients, treated with drugs, which possess mainly neurotransmitter or neurotrophic action, and in 23.3  % patients treated with standard therapy.

Conclusions. Antioxidant and antihypoxant drugs are more effective in nonlacunar brainstem and cerebellar strokes. Usage of neuroprotective drugs is more justified in ischemic AC strokes. Localization of ischemic lesion should be always taken into account when carrying out large-scale studies to determine the effectiveness of neuroprotective therapy for acute ischemic strokes.

Keywords: acute ischemic stroke, posterior circulation, neuroprotective therapy.

Objective — to evaluate brain functional activity changes in patients with cerebral vasospasm (CVS) of different levels of severity caused by aneurismal subarachnoid haemorrhage (SAH), and their role in complex diagnosis and prognosis of delayed ischemic complications.

Methods and subjects. Comparison of clinical and instrumental examination data of 52 patients with acute SAH by means of computer encephalography (EEG), ultrasonography (US), duplex scanning of main arteries of the head and neck, multispiral CT (SCT) of the brain were performed.

Results. It was established that brain bioelectric activity in SAH acute period was characterized by general brain changes, presence of polymorphous bilateral synchronic activity of different intensity in most of patients. The frequency of pathological slow-wave activity detection was increased from 42.8  % in moderate degree of CVS to 68.4  % in marked CVS. EEG changes in patients with marked CVS was characterized by the decrease of the amplitude, disorganized a-rhythm, rough polymorphous character of q- and d-activity. The distribution of EEG classification types for SAH acute period differed depending on CVS severity: in marked degree of the spasm, III and IV EEG types were registered in 73.6  %, in moderate degree, II and III EEG types were detected in 90.4  %. A positive correlation was established between the detection of type IV EEG and the development of focal neurological disorders, formation of ischemia foci according to brain SCT.

Conclusions. It is expedient to include type IV EEG changes into the complex of prognostic factors of delayed ischemic disorders development in patients with aneurismal SAH complicated by CVS.

Keywords: subarachnoid haemorrhage, cerebral vasospasm, delayed cerebral ischemia, brain bioelectric activity.

Objective — to elucidate role of modifiable risk factors in the development of mild cognitive impairment in patients with chronic cerebrovascular insufficiency (CCI) and metabolic syndrome (MS) of different age groups and establish changes of their cognitive functions in three years.

Methods and subjects. There were 269 patients with CCI aged from 45 till 74 years (mean age 64.4  ±  9.8) years) enrolled into the study. MS was diagnosed according to criteria of 2009 year. Diagnostic evaluation included clinical examination with determination of the blood pressure and body mass index (BMI), magnetic resonance imaging of the brain. Cognitive assessment consisted of Mini-Mental State Examination (MMSE).

Results. Presence of MS significantly increased the frequency of vascular risk factors in patients with mild cognitive impairment of all age groups. MS contributed to significant deterioration of patients cognitive functions in three years, especially in those of older age.

Conclusions. Early detection and correction of cardiovascular risk factors, such as hypertension, hypercholesterolemia, diabetes mellitus or smoking will improve cognitive functions of patients and prevent dementia.

Keywords: mild cognitive impairment, metabolic syndrome, risk factors.

Objective — study of peculiarities of circadian profile of blood pressure (BP) in patients with cognitive disorders with atrial fibrillation (AF), combined with arterial hypertension, as well as determining the relationship of characteristics curve of daily BP with indicators of autonomic regulation of the cardiovascular system.

Methods and subjects. 62 patients (the average age of 64.2   ±   4.8 years) with AF, which developed on the background of coronary heart disease combined with arterial hypertension were examined. To examine the status of cognitive functions two groups were formed: 62 patients with atrial fibrillation were the core group, 18 patients with coronary heart disease and arterial hypertension without associated arrhythmias formed a control group. The patients of both groups underwent daily monitoring AD with the assessment of variability of BP and heart rate.

Results. By means of neuropsychological methods cognitive disorders were defined in 47 patients who subsequently made the core group for the study of circadian profile of BP and the characteristics of its vegetative regulation. 72.8  % of patients had an insufficient reduction of night systolic and diastolic BP and dates to day (non-dippers); in 11.4  % of patients the night BP exceeded pressure in the daytime hours (night-peakers). In patients with cognitive disorders significantly higher values of standard deviation and the coefficient of variability of systolic and diastolic BP during the day were observed, as well as in the daytime and at night, indicating high variability of both systolic and diastolic BP at specified time periods. The direct correlation of a daily average systolic and diastolic BP and amplitude of fashion, which shows an increase in the severity of sympathicotonia, was revealed.

Conclusions. Circadian profile BP in patients with cognitive dysfunction with AF is closely intertwined with heart rate variability that characterize the activity of the autonomic nervous system. An increased level of functional activity of the sympathetic nervous system against the background of reduced function of the parasympathetic nervous system in patients with cognitive dysfunction with AF increases the average daily values of systolic and diastolic BP, increases variability and the speed of the morning raising BP.

Keywords: atrial fibrillation, cognitive disorders, variability of blood pressure, daily monitoring of blood pressure.

Objective — to optimize the treatment of progredient forms of multiple sclerosis (MS) using the method of intrathecal glucocorticoids injection and to evaluate its efficiency.

Methods and subjects. The results of treatment of 76 patients with poor curable progressive courses of MS by intrathecal introduction of glucocorticoids (dexasone) are presented in the study. The advantages of method, methodic of introduction, the patient`s selection parameters were given. The efficiency criterions of intrathecal introduction of glucocorticoids were defined, including the neurological deficiency regress, stabilization and the delay of MS progressing. Integral assessment of efficiency was made as on 4 gradations: «good», «moderate», «low» and «absence of effect».

Results. The positive dynamics of neurological state was registered predominantly on spastic-paretic syndrome with presence of several active spinal foci on MRI with contrast enhancement. The sphincter infringements and brain stem symptomatic were observed as rarely reversible, extremely rarely — cerebellar symptom complex. As the results of the treatment (the term of the observation — 6 months and more) 80.2 % of MS patients marked the efficiency as «good» and «moderate».

Conclusions. The obtained data indicated the reasonability of the proposed method of treatment introduction for patients with severe progressive courses of MS, occurring mainly with spinal symptomatic.

Keywords: multiple sclerosis, progressive courses, intrathecal introduction of glucocorticoids, efficiency.

Objective — to reveal the frequency of sexual dysfunctions (SD) in patients with multiple sclerosis (MS) and their relation to demographic and clinical characteristics.

Methods and subjects. 70 patients (36 women and 34 men) with MS have been examined. Average age of patients was 32.8  ±  6.5, mean duration of disease — 6.2  ±  4.9 years, degree of disability by EDSS scale — 3.3  ±  1.5 points. Patients have undergone complex clinical and neurological investigation, anonymous testing by questionnaires MFSQ, IIEF, SEAR.

Results. We haven’t determined any statistically significant difference of SD changes depending on the level of disability and duration of disease in women. We have found out the dependence of sexual dysfunction level on the neurological status in men and worsening of partners’ relationship in more expressed disability of patients with MS. In men with the duration of disease 6 — 10 years, we have found out the significant decline of sexual functions. We have revealed the statistically significant difference in worsening of relations between partners in patients with the duration of disease not more than 5 years and 6 — 10 years.

Conclusions. We haven’t determined any profound SD in women. SD is more expressed in men with more progressive neurological deficit and duration of disease 6 — 10 years in comparison to other subgroups. Partners’ relation worsening is also marked during the first 10 years of the disease.

Keywords: multiple sclerosis, sexual function.

Objective — to evaluate the activity of the enzyme lactate dehydrogenase (LDH) in serum and cerebrospinal fluid of patients with amyotrophic lateral sclerosis (ALS) as a diagnostic test to assess the severity of tissue hypoxia in ALS.

Methods and subjects. In a group of ALS there were included patients, who had ALS as defined by revised El Escorial diagnostic criteria and underwent inpatient treatment in the department of neural infections and multiple sclerosis of SI INPN NAMSU in 2012 — 2013. The object of the study was 45 serum samples and 35 samples of cerebrospinal fluid of ALS patients. Determination of the LDH level was held by kinetic spectrophotometric method. LDH levels in serum and cerebrospinal fluid of patients with different forms of ALS were considered by gender, ALSFRS-R (Functional Rating Scale ALS, Revised) score and duration of the disease.

Results. Analysis of the data showed that among patients who had elevated levels of LDH in the blood serum, 59  % had elevated levels of LDH in the cerebrospinal fluid. The source of LDH in the cerebrospinal fluid may also be blood plasma, as the ALS patients LDH level in the blood is most pronounced increases with the development of amyotrophy on the stage of generalization of the disease.

Conclusions. We think, the increase in LDH activity in the serum and cerebrospinal fluid observed in 40  % of patients most expressed at the stage of generalization of the disease and is associated with a dysfunction of the mitochondrial respiratory chain leading to cells «hypoxia», activation of anaerobic glycolysis leading to lactic acidosis, and the content of this enzyme can indirectly conclude the severity of the process.

Keywords: amyotrophic lateral sclerosis, lactate dehydrogenase, lactic acidosis, tissue hypoxia.

Spasticity, as one of the central motoneuron damage syndrome component, often occurs in post-stroke patients and affects their everyday activity. Without treatment spasticity can cause significant discomfort and immobility. The main medical tactics approaches include team work and objectives setting. Spasticity preventive measures are key factors of medical tactics: patient’s body right positioning at rest and early introduction of complex physical rehabilitation. The combination of drug-induced and not drug-induced therapy is applied. The injection of botulin toxin into overactive muscles is widely used for focal spasticity which affects movements, is accompanied with pain or complicates care. Treatment experience of patients with post-stroke spasticity evidences the efficacy of interdisciplinary rehabilitation approach.

Keywords: stroke, spasticity, physical rehabilitation, interdisciplinary approach, botulin toxin.

Objective — improved diagnosis and results of surgical treatment of patients with stenotic lesions of the proximal internal carotid artery.

Methods and subjects. The analysis of surgical treatment of 124 patients with stenotic lesions of the proximal internal carotid artery was carried out. Patients were divided into two main groups according to the method of treatment. 31 operation were performed for 30 patients with carotid endarterectomy (CЕА), 104 operations with cerebral patronage were performed for 94 patients in the group of carotid angioplasty with stenting (CAS). For the diagnosis of lesions of the brachiocephalic arteries the main diagnostic methods such as ultrasound dopplerography (ultrasonography) with duplex scanning and cerebral angiography were used.

Results. The results obtained in our study data show the same effectiveness of preventive and curative methods of carotid endarterectomy and carotid stenting in patients with carotid stenosis in the long term with a term up to 36 months of observation.

Conclusions. In patients with 60 — 99 % stenosis who underwent surgery after a stroke, CEA and CAS improves neurological status, quality of life and cognitive function.

Keywords: carotid endarterectomy, carotid angioplasty and stenting.

The problem of cerebrovascular pathology is presented in the article. Pathogenetic mechanisms of development and description of clinical presentation of venous encephalopathy against the background the chronic obstructive pulmonary disease (COPD) are described, also the results of the clinic-neurologic observation of patients with different stages of COPD are considered.

Keywords: venous encephalopathy, chronic obstructive pulmonary disease, pathogenesis, clinical manifestations.

Objective — to study the effectiveness of donepezil hydrochloride for elderly patients with Alzheimer’s and vascular dementia types depending on the apoE genotype.

Methods and subjects. The 3-month clinical study included 38 elderly patients (mean age — 71.03   ±  1.20 years) with dementia. All patients underwent clinical, neurological, laboratory, instrumental (electrocardiography, CT/MRI brain), neuropsychological examinations, apoE genotype determination

Results. Certain characteristics of response to treatment with donepezil hydrochloride (acetylcholinesterase inhibitor) with dementia according to apoE genotype were determined. The effectiveness of donepezil hydrochloride was more pronounced in e4 allele carriers patients compared with e3/e3 group according to the results of the scale parameter ADAScog, describing episodic memory and complex types of praxis.

Conclusions. The effectiveness of donepezil hydrochloride therapy for elderly patients with dementia is largely associated with apoE genotype that evidences worthwhile determination apoE 2, 3, 4 allele in patients with cognitive deficits before introducing pharmacotherapy.

Keywords: dementia, age, treatment, donepezil hydrochloride, apoE genotype.

Цель — изучить особенности суточного профиля артериального давления (АД) у пациентов с когнитивными расстройствами на фоне фибрилляции предсердий в сочетании с артериальной гипертензией, а также установить взаимосвязь характеристик суточной кривой АД с показателями вегетативной регуляции сердечно-сосудистой системы.

Материалы и методы. Обследовано 62 пациента (средний возраст (64,2  ±  4,8) года) с фибрилляцией предсердий, которая развилась на фоне ишемической болезни сердца в сочетании с артериальной гипертензией (основная группа). 18 пациентов с ишемической болезнью сердца и артериальной гипертензией без сопутствующих аритмий составили контрольную группу. Пациентов с фибрилляцией предсердий в зависимости от наличия или отсутствия когнитивной дисфункции распределили на две группы для исследования особенностей суточного профиля АД и особенностей его вегетативной регуляции. Пациентам обеих групп проводили суточный мониторинг АД с оценкой вариабельности АД и сердечного ритма.

Результаты. С помощью нейропсихологических методик выявлены когнитивные расстройства у 47 пациентов с фибрилляцией предсердий. 72,8 % пациентов имели недостаточную степень снижения ночного систолического (САД) и диастолического АД (ДАД) по отношению к дневному, у 11,4 % больных ночное АД превышало давление в дневные часы. У больных с когнитивными расстройствами отмечены достоверно более высокие значения среднеквадратичного отклонения и коэффициентов вариабельности САД и ДАД в течение суток и в дневные и ночные часы, что свидетельствовало о повышенной вариабельности САД и ДАД в указанные периоды, а также достоверно более высокая величина и скорость их утреннего подъема. Установлена прямая корреляционная связь среднесуточных показателей САД и ДАД и амплитуды моды, что свидетельствует об увеличении выраженности симпатикотонии.

Выводы. Показатели суточного профиля АД у пациентов с когнитивной дисфункцией на фоне фибрилляции предсердий тесно взаимосвязаны с показателями вариабельности сердечного ритма, характеризующими активность вегетативной нервной системы. Повышенный уровень функциональной активности симпатической нервной системы на фоне снижения функции парасимпатической нервной системы у данной группы больных способствует увеличению среднесуточных значений САД и ДАД, повышению вариабельности и скорости утреннего подъема АД.

Keywords: фибрилляция предсердий, когнитивные расстройства, вариабельность артериального давления, суточное мониторирование артериального давления.