The observations of immune neuropathies such as chronic inflammatory demyelinating neuropathy, multifocal motor neuropathy, neuropathy associated with IgM monoclonal gammopathy and neuropathy associatted with IgG/A monoclonal gammopathy are presented in this article. Their diagnostic criteria and the cterismodern methods of treatment based on evidenced based medicine are outlined. Clinical characteristics of the diseases and their serologic diagnosis are emphasized.

Keywords: chronic inflammatory demyelinating neuropathy, multifocal motor neuropathy, gammapathies, immunoglobulin, antibodies.

Objective — to examine the clinical and neurological features and dynamics of cognitive impairment in patients with acute recurrent ischemic supratentorial stroke (RISS)
Methods and subjects. 103 patients were examined. The study of stroke severity and its dynamics were estimated using NIHSS — (National Institutes of Health Stroke Scale) on the 1, 3, 5, 10 and 15 days of the acute period of disease, and the clinical and social outcome of the acute period of the stroke was estimated by the modified Rankin scale at the end of the observation period (21 days). Neuropsychological examination included verification of cognitive impairment using scales: Mini-Menthal State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and the Frontal Assessment Battery (FAB).
Results. Recurrent RISS in the contra lateral carotid hemisphere localization were characterized by more severe course and worse health and social outcomes of the acute period of the disease. Cognitive deficits that formed in patients with recurrent RISS was more pronounced by scales: MMSE, MoCA and FAB in all periods of observation in comparison with the primary RISS, which disorders of perceptual-gnostic activities were transient.
Conclusions. It was found that patients with recurrent RISS had more severe cognitive and focal neurological deficits and worse health and social outcomes of the acute period of the disease.

Keywords: recurrent supratentorial hemispheric stroke, acute phase, ipsilateral carotid territory, contra lateral carotid territory, cognitive impairment.

Objective — to set up the frequency of allelic variant of genes factors (20210 G/A) and factor V (Arg506Gln, 1691 G/A) (Leiden mutation, rs6025)) of blood coagulation in patients with ischemic stroke.
Methods and subjects. Complex clinical and neurological examination was carried out for 116 patients with acute ischemic stroke (59 (50.9 %) female and 57 (49.1 %) male; mean age — (73.0 ± 8.8) years). Genetic typing for G20210A gene FII and G1691A gene FV was conducted by means of allelic specific polymerase chain reaction. Control group comprised 40 people of appropriate age and gender.
Results. No significant difference was determined while comparing the gene factor II and V of blood coagulation in patients with IS and people from control group: unfavorable genotypes G/A factor II frequency constituted 5.2 %, factor V — 2.6 %, frequency of both variants in control group was 2.5 %. Heterozygote type G/A factor II was evidenced more often in patients with atherothrombotic subtype than with cardioembolic (8.8 and 1.7 % accordingly, χ2 =  2.960, р = 0.095), and heterozygote variant G/A/ factor V was only in patients with cardioembolic subtype (χ2 = 2.975, р = 0.085).
Conclusions. It is evidenced that allelic polymorphism factors II and V of blood coagulation frequency in patient with IS does not differentiate from average population data. Heterozygote variant G/A factor II of blood coagulation is associated with the development of IS atherothrombotic subtype but heterozygote type of variant G/A factor V of blood coagulation is associated with the development of cardioembolic subtype.

Keywords: ischemic stroke, allelic polymorphism genes factors II (20210 G/A) and V (Arg506Gln, 1691 G/A) blood coagulation.

Objective — to identify the impact of the day period of occurrence of ischemic stroke on patient’s regression of neurological deficit.
Methods and subjects. In this study we have examined 120 patients with ischemic stroke (men — 66, women  — 54) aged 42 to 84 years (mean age — 65.2 ± 9.7 years).  Depending on the period of stroke patients were divided into two groups. The first group was assigned 97 patients whose stroke occurred during daily activity. The second group consisted of 23 patients with ischemic stroke that emerged during sleep or immediately after it. For examination of these patients we have used clinical and neurological methods with structured scales for the assessment of neurological status. The diagnosis of stroke and determination of stroke localization was performed out using clinical methods and neuroimaging techniques.
Results. Analysis of regression of disability on a scale NIHSS showed that a significant reduction in the average points neurological deficit compared to benchmarks in group 1 was seen at 14 days of onset (9.6 ± 2.4 points), while patients of the 2nd groups such regression occurred only after 21 days (9.4 ± 3.8 points). Comparison of functional recovery by IB for 21 days observation also showed higher rates among patients with stroke during the daytime (86.1 ± 4.3 points) compared with patients whose symptoms arose during sleep at night during the day (74.1 ± 7.1 points).
Conclusions. The results of this study showed that among patients who had acute ischemic stroke originated during night time or during sleep, there is a worse regression of disability than among patients who had cerebrovascular accident occurred in day time. Thus, time of the occurrence of ischemic stroke manifestations has a significant impact on the nature and severity of the disease and to a large extent determines the prognosis of patients on recovery and restoration of full neurological function.

Keywords: ischemic stroke, time of occurrence, neurological deficit.

Objective — Identification of risk factors for post-stroke depression (PSD) during the 3-month poststroke period.
Methods and subjects. Cohort clinical study of 116 patients during the acute and early recovery periods of ischemic stroke was performed by means of NIHSS scale, Bartel index, modified Renkin scale, DASS, MMSE scale, and SF-36 life quality survey. The statistical analysis was performed by means of Spearman’s rank correlation coefficient, χ2  criterion, Cruskell — Walles criteria, multiple regression analysis, and methods of observational statistics.
Results. We have identified risk factors for depression in the early recovery period of ischemic stroke and found a strong correlation between the likelihood of PSD and decreased quality of life. PSD is more likely to develop in older patients, females, and single patients. Multiple risk factors for PSD development were identified: severity of stroke, significant functional impairment, high level of disability, decreased cognitive abilities, and poor quality of life. PSD severity is strongly linked to the degree of functional dependence and level of cognitive ability.
Conclusions. PSD leads to more impaired functional and cognitive status in patients, increases their dependency on outside assistance, and significantly decreases quality of life. The likelihood of PSD development is correlated with higher levels of functional dependency and decreased cognitive status. Managing these risk-factors can prevent the development of PSD and help treat it efficiently.

Keywords: ischemic stroke, post-stroke depression, quality of life.

Objective — to study the characteristics of cognitive and emotional disorders in patients with the sick sinus syndrome without permanent pacemaker and patients with the sick sinus syndrome with implanted permanent pacemaker, and to clarify the relationship of these disorders with some indicators of cerebral hemodynamics and neuroimaging changes of the brain.
Methods and subjects.The study involved 48 patients (mean age 66.8 ± 3.2 years) with symptoms of weakness sinus node. Two groups were formed: 1st group — 30 patients with the sick sinus syndrome without permanent pacemaker and 2nd group — 18 patients with the syndrome sick sinus with permanent pacemaker, which was implanted not less than 6 months before the study. A comparative analysis of neuropsychological, ultrasonographic and neuroimaging characteristics of the patients in both groups was carried out.
Results. Mild cognitive disorders prevailed in patients of the 1st group (70.0 % at 44.4 % in the 2nd group), and minor in patients of the 2nd group (40.0 % with 16.7 % in the 1st group, p < 0.05). Emotional disorders were more frequently found in patients of the 1st group: anxiety disorders were at 46.7 % (1st group) and 27.8 % (2nd group) (p < 0.05), depression, respectively at 50.0 % and 27.8 % (p < 0.01).Insomnia by criteria ICDS-2 was recorded in 63.3 % of the patients of the 1st group and in 44.4 % of patients of the 2nd group. In the study of intracranial venous blood flow it was revealed that the average linear flow velocity in the middle segment of the basal vein and direct sinus in patients of the 2nd group were statistically significantly higher than that in patients of the 1st group. CT brain demonstrated that patients of the 1st group differed from the patients of the 2nd group by a greater severity of periventricular leukoaraiosis all locations (p < 0.05) and the symmetry of atrophic changes in the brain, as well as greater severity of asymmetric internal cerebral atrophy with predominant involvement of the left hemisphere; high representation of multiple ischemic lesions > 5 mm in the brain substance, especially in the deeper sections of the white matter of the frontal lobes, the head of the caudate nucleus, thalamus and the bridge of the brain.
Conclusions.  In patients with sick sinus syndrome without permanent pacemaker, compared with patients with the syndrome sick sinus with implanted permanent pacemaker, showed more pronounced disorders of cognitive functions with the prevalence of disorders of attention and verbal memory, as well as the emotional and insomniaque disorders. Stronger correlation between the average linear velocity of blood flow in the basal vienna, the average score of leukoaraiosis and the level of depression in patients with syndrome sick sinus without pacemaker was established. Characteristics of cognitive and emotional disorders, hemodynamic and neuroimaging characteristics of patients with the sick sinus syndrome should be taken into account during the examination and treatment planning of this pathology.

Keywords: cognitive disorders, emotional impairments, sick sinus syndrome, pacemaker.

Objective — to investigate the relation between insufficient dietary intake of vitamin D during childhood and adolescence and a risk of multiple sclerosis (MS) with adult onset in the population of Vinnytsya region.
Methods and subjects. We conducted a population-based case control study in Vinnytsya region. We collected surveys from 109 MS patients (mean age 37.2 ± 8.9 years; 72.5 % women) and 109 control subjects. Odds ratios (OR) with 95 % confidence intervals (CI) were estimated using logistic regression analyses.
Results. Higher sun exposure during childhood and early adolescence was associated with a decreased risk of MS (OR 0.32, 95 % CI 0.19 — 0.56 for a link between sun exposure in summer and MS; OR 2.94, 95 % CI, 1.62 — 5.34 for a link between sun exposure in winter and MS). Consumption of fish, yolk and milk two or more times a week, cheese four or more times a week was also associated with reduced risk of MS (OR 3.82, 95 % CI 1.99 — 7.32; OR 3.2, 95 % CI 1.69 — 6.05; OR 7.86, 95 % CI 3.6 — 17.16; OR 8.33, 95 % CI 4.27 — 16.3; p < 0.001, adjusted for sun exposure in summer). A protective effect of supplementation with vitamin D was suggested in the subgroup that reported low summer and/or winter sun exposure during childhood and early adolescence.
Conclusions. Higher sun exposure and adequate vitamin D dietary intake during childhood and early adolescence is associated with a reduced risk of adult onset multiple sclerosis.

Keywords: multiple sclerosis, vitamin D, Vinnytsya region.

Objective — to study the features of cognitive impairments in MS patients and their dependence on the set of demographic and social indicators such as age, sex, level of education, employment of patients, family status.
Methods and subjects. We examined 65 MS patients. Female patients prevailed (67.69 %). The average duration of illness was 7.83 ± 0.97 years, the average score on a scale EDSS — 4.3 ± 0.17. On remitting relapsing MS type there were 58.46 % patients, with secondary-progressive — 23.08 %, primary progressive — 6.15 %, and the onset of the disease — 12.31 %. All patients underwent a comprehensive clinical and neurological examination and cognitive status was assessed. Control group consisted of 20 healthy individuals of appropriate age and gender.
Results. In MS patients were the most severe violations of information processing rate, fluidity of language, attention and indicators of frontal dysfunction. The best indicators of cognitive functions observed in MS patients surveyed at age 40, males, patients with high education and intellectual nature of work. The worst scores were in patients 50-years and older, females, unemployed or with physical nature of work and secondary education.
Conclusions. In MS patients cognitive impairment are found with significant frequency. Young age, male gender, high education and intellectual labor are favorable factors on cognitive functions in patients with MS.

Keywords: multiple sclerosis, cognitive impairments.

Objective — to determine the features of cellular immunity indexes changes in Chernobyl NPP accident consequences liquidators (CACL) with cognitive disorders in long-time period after the accident.
Methods and subjects. 120 CACL underwent the clinical and immunologic examination who were irradiated in 1986 — 1988 in dose (0.65 ± 0.09) Gy. All CACL were male. Mean age was (55.25 ± 0.59) years. Neuropsychiatric examinations were conducted by means of standard neurological examinations and psychiatric examination with Mini-Mental State Examination (MMSE). Immunophenotyping of peripheral blood cells was carried out by means of flow cytometry with panel of monoclonal antibodies specified to СD45/14, CD3/19, CD4/8, CD3/HLA-DR, СD3/16/56-cells. The ratio of СD45+14 – /СD45 – 14+ cells and immune regulator index was calculated.
Results. There was defined the tendency for СD3 HLA-DR cells number reduction and absence of natural killers activation in all CACL comparing with healthy persons without irradiation. CACL irradiated with the dose more 0.25 rs had СD45+14 – /СD45 – 14+ cells ratio changed with age and dose; those irradiated with 0.25 — 1.00 Gy had inverse ratio of СD3+19- and СD3+HLA-DR-cells and dose (rs = –0.716, p = 0.0002 and rs = –0.526, р = 0.012 accordingly); those irradiated with more than 1.00 Gy had strong inverse ratio of immune regulator index and age (rs = –0.712, p = 0.0004).
Conclusions. The cognitive disorders extend is defined with the character of organic brain damage which is accompanied with cellular immune changes specific for secondary immune deficiency state and immune aging. Additional irradiation affect and age in psycho neurological pathogenesis, which are associated with immune deficiency, cause cognitive disorders in long-time period after irradiation.

Keywords: cognitive disorder, cellular immunity, ionizing irradiation.

Objective — to study the effectiveness of combined treatment with cortexin and diosmin on the treatment of venous encephalopathy in patients with chronic obstructive pulmonary diseases.
Methods and subjects. 20 patients with venous encephalopathy against the background of chronic obstructive pulmonary diseases were examined. The mean age of patients was 58.65 ± 8.09 years. Courses of treatment with сortexin was carried out for 10 days at a dose of 10 mg parenterally  daily and diosmin orally at a dose of 500 mg in the morning and 500 mg in the evening for 1 month. Аll patients underwent clinical, neurological, instrumental (doplerography, CT/MRI brain) and neuropsychological examination.
Results. It was established that under the influence of treatment with cortexin and diosmin, short-term and long-term associative memory improved, sensorimotor reactions rate and attention concentration increased . As a result of the treatment , the degree of emotional and personality disorders manifestations was eliminated by reducing the performance of reactive and personal anxiety by Spielberger-Hanin scale and depression by Hamilton scale. Against the background of the medication therapy cerebral hemodynamics was improved, it was evidenced by reduced speed of blood circulation in the deep veins of the brain.
Conclusions. Based on the results of the impact of combination therapy with cortexin and diosmin analysis it is advisably to use the medications in therapy for treatment of venous encephalopathy against the background of  IV stage COPD.

Keywords: chronic obstructive pulmonary disease, cognitive disorders, cerebral hemodynamics, treatment.

Thrombolysis is a routine method of acute ischemic stroke treatment in developed countries. Unfortunately, thrombolysis in Ukraine is still technique that is rarely used in ischemic stroke. The experience of thrombolytic therapy application in Regional Clinical Center of Neurosurgery and Neurology (Uzhhorod) in patients with ischemic stroke is presented.

Keywords: ischemic stroke, thrombolytic therapy, reperfusion, recombinant tissue plasminogen activator, computed tomography, magnetic resonance imaging, National Institute of Health Stroke Scale, stroke unit.

Objective — to study the dynamics of neuroophthalmological disorders and to develop a complex of the therapeutic measures to restore disturbed functions of patients with arteriovenous fistula of the cavernous sinus of the brain in the early postoperative period.
Methods and subjects. The treatment results analysis of 172 patients (89 — carotid-cavernous fistula, 83 — dural arteriovenous connections) with neuro-ophthalmological disorders was performed. Neurological, ophthalmological examinations, clinical and instrumental diagnosis were carried out.
Results. Neuroophthalmological disorders are frequently observed in a co dysfunction III, IV, VI cranial nerves (CN) (97 (56.4 %) patients) and isolated dysfunction III CN (31 (18 %) patients) and VI CN (42 (24.4 %) patients), isolated dysfunction IV CN (2 (1.2 %) patients). The dynamics of exophthalmos, indicators of intraocular pressure and the pressure in the central retinal artery, spontaneous pulsation of the central retinal vein have been studied. It has been revealed that in the early postoperative period oculomotor disorders and eye functions restore simultaneously with a reduction in intraocular pressure. A complex restorative treatment that includes medication, physical medicine and physical therapy has been proposed. As a result, the treatment of oculomotor disorders completely regressed in 164  (95.3 %) patients.
Conclusions. Neuroophthalmological violations are rather typical for patients with arteriovenous fistula cavernous sinus of the brain, but they regress after the surgery. The proposed complex of restorative treatment in the early postoperative period is highly effective: it provides restoration of disturbed functions and significantly improves the quality of the patients’ lives.

Keywords: arteriovenous fistula, cavernous sinus, brain, early postoperative period, restorative treatment.

Objective — to propose a variant for systematizing the secondary affection of trigeminal nerve structures at maxillofacial pathology in order to refine on their diagnostics.
Methods and subjects. Being under the clinical observation at NMAPE Centre of Maxillofacial Surgery 1100 patients (aged 18 — 75 on average) with the secondary affection of the structures of trigeminal nerve system at maxillofacial pathology underwent complete clinical and paraclinical examinations. General clinical examinations, the maxillofacial area local examination, facial and dental bones roentgenography were carried out; the sensitivity to pain, temperature and touch sensibility in the innervation areas of trigeminal nerve structures was examined. When performing the treatment we applied the hardware-software integrated device DIN-1 to study a number of electrophysiological indices of the trigeminal nerve branches.
Results. We proposed a variant for systematizing the secondary affection of the structures of trigeminal nerve system at maxillofacial pathology of different genesis taking into account etiological and pathogenic agents, lesion site and the course of the disease.
Conclusions. The suggested variant for systematizing the secondary affection of the structures of trigeminal nerve system at maxillofacial pathology can be used both to improve the diagnostics and enhance the efficiency of therapeutic approach.

Keywords: trigeminal nerve, secondary affection, maxillofacial pathology, systematization.

The article presents the stages of  manual therapy formation as a science  and  problems of its development at the present stage. Possible ways to overcome manual therapy problems development are outlined.  The features  of manual therapy school at SI «Zaporizhzhya Medical Academy of Post-Graduate Education of Health Ministry of Ukraine» are described.

Keywords: manual therapy, spinal osteochondrosis.

The article deals with the neuroprotection in cerebrovascular pathology management. Common features of pathogenic mechanisms of pathogenic processes development for different CNS disorders are defined. Vascular impairments (acute and chronic), craniocerebral trauma, metabolic disorders (diabetes), degenerative disorders are considered as nosologic units which are accompanied with endothelium dysfunction and neuronal tissue hypoxia. It requires medications administration which can affect the neurons metabolic processes, restore their structure and functions. Neuroprotection by means of citicoline is suggested. The information about world wide citicoline usage experience and data of clinical researches about citicoline application are outlined. The medication proved its high efficiency and tolerance for acute vascular pathology as well as for chronic disorders of cerebral blood flow caused by systemic diseases connected with aging. The necessity of citicoline introduction into complex therapy for cerebrovascular disorders is substantiated.

Keywords: neuroprotection, cerebrovascular pathology, citicoline.

This review focuses on the impairment of BDNF-mediated mechanisms of neuroplasticity in a number of affective, anxiety and neurocognitive disorders. The evidence from experimental and clinical studies to reduce the expression of BDNF in the brain at the same pathology is given. We obtained the data on the positive effects of escitalopram on the increased expression of BDNF as a possible mechanism of regression of depressive, anxiety, and cognitive symptoms.

Keywords: disturbances of neuroplasticity, BDNF, escitalopram, correction.

The article presents the review of French-speaking literature devoted to the problem of dementia with Lewy bodies. Authors views on dementia diagnostics, its clinical manifestation and management are outlined. Scales to make primary diagnostics simpler are presented. The discussed special information and correct approach are important for doctors to avoid mistakes while psychotropic medication administration. It will enable to prolong stable state and sometimes to save patient’s life.

Keywords: dementia with Lewy bodies, synucleinopathies, consciousness fluctuation, extrapyramidal disorders, diagnostic criteria, scales.

Цель — определить особенности изменений показателей клеточного иммунитета у участников ликвидации последствий аварии (УЛПА) на Чернобыльской АЭС (ЧАЭС) с когнитивными расстройствами в отдаленный период после аварии.
Материалы и методы. В отдаленный период проведены клинико-диагностические и иммунологические исследования у 120 УЛПА на ЧАЭС, облученных в 1986 — 1988 гг. дозой в среднем (0,65 ± 0,09) Гр. Все УЛПА — мужчины. Средний возраст — (55,25 ± 0,59) года. Нейропсихиатрические исследования проведены в виде стандартных неврологических обследований и психиатрического интервью с использованием короткой шкалы оценки психического статуса (Mini-Mental State Examination (MMSE)). Иммунофенотипирование клеток периферической крови осуществляли методом проточной цитометрии с использованием панели моноклональных антител, специфических к СD45/14, CD3/19, CD4/8, CD3/HLA-DR, СD3/16/56-клеткам. Рассчитывали значение соотношения клеток СD45+14 – /СD45 – 14+ и иммунорегуляторного индекса.
Результаты. Выявлена тенденция относительно снижения доли СD3 HLA-DR-клеток и отсутствие признаков активации naturаl killer у всех УЛПА с когнитивным дефицитом разной степени по сравнению со здоровыми лицами и пациентами репрезентативной группы сравнения без радиационного облучения в анамнезе. У УЛПА, облученных дозой свыше 0,25 Гр, соотношение клеток СD45+14 – /СD45 – 14+ изменялось в зависимости от дозы и возраста. У УЛПА, облученных дозами 0,25 — 1,00 Гр, выявлены обратно пропорциональные корреляционные связи между уровнем СD3+19- и СD3+HLA-DR-клеток и дозой (rs = – 0,716, p = 0,0002 и rs = – 0,526, р = 0,012 соответственно), у УЛПА, облученных дозой свыше 1,00 Гр, — сильная обратная связь между иммунорегуляторным индексом и возрастом (rs = – 0,712, p = 0,0004).
Выводы. Степень когнитивных нарушений определяется характером органического поражения головного мозга, которое сопровождается изменениями в клеточном иммунитете, присущими вторичным иммунодефицитным состояниям, и признаками иммунологического старения. Дополнительное влияние радиационного излучения и возраста в патогенезе психоневрологических заболеваний, которые ассоциируются с иммунодефицитом, создает условия для нарушения когнитивной функции в отдаленный период после облучения.

Keywords: когнитивный дефицит, клеточный иммунитет, ионизирующее облучение.

Цель — выявить влияние времени суток, в которое возник ишемический инсульт, на регресс неврологического дефицита.
Материалы и методы. Обследовано 120 пациентов, которые перенесли ишемический инсульт (66 мужчин и 54 женщины), в возрасте от 42 до 84 лет (средний возраст — (65,2 ± 9,7) года). В зависимости от времени суток, в которое возник инсульт, больных распределили на две группы. В первую включили 97 пациентов, мозговой инсульт у которых возник во время дневной активности, во вторую — 23 больных, ишемический инсульт у которых возник во время сна или непосредственно после него. Для оценки неврологического статуса применяли клинико-неврологические методы. Диагноз мозгового инсульта и локализацию инсультного очага устанавливали с помощью клинических методов, а также методов нейровизуализации.
Результаты. Анализ регресса неврологического дефицита по шкале NIHSS показал, что достоверное уменьшение среднего балла неврологического дефицита по сравнению с исходным показателем в 1-й группе наблюдалось на 14-е сутки от начала заболевания ((9,6 ± 2,4) балла), во 2-й — только на 21-е сутки ((9,4 ± 3,8) балла). Сравнение уровня функционального восстановления по индексу Бартел на 21-е сутки также выявило высокие показатели у пациентов, перенесших инсульт в дневное время ((86,1 ± 4,3) балла) по сравнению с больными, симптомы у которых возникли во время сна в ночное время суток ((74,1 ± 7,1) балла).
Выводы. У пациентов, у которых острый ишемический инсульт возник в ночной период во время сна, наблюдалась худшая динамика неврологического дефицита, чем у пациентов, у которых нарушения мозгового кровообращения возникли в дневное время суток. Таким образом, время суток, в которое возникла симптоматика ишемического инсульта, имеет значительное влияние на характер и тяжесть течения заболевания и во многом определяет прогноз пациентов в отношении выздоровления и восстановления полноценной неврологической функциональности.

Keywords: ишемический инсульт, время суток, неврологический дефицит.