The objective of our research was to investigate up-to-date approaches to the diagnostics and differential diagnostics of multiple system atrophy.  In order to carry out the research, the following data base was searched: PubMed (1990 — 2013) and UpToDate (2012).

Keywords: multiple system atrophy, differential features, diagnostics, treatment.

This article is devoted to a brief analysis and systematization of the clinical manifestations of the most common types of dizziness in general clinical practice and in the structure of neurological care. Dizziness is one of the most frequent and common complaints among patients, affecting the quality of life due to the severity of subjective and social dysfunction. We have defined many physical  causes as well as neurological once, causing the disruption of the functioning of the system of equilibrium. There are two fundamentally different approaches to the classification of vestibular syndromes: the one is used by the level of damage — the peripheral or central; the other is based on the nosological principle. The attention is focused on the algorithms of diagnosis and treatment tactics of dizziness. The last mainly determined by dizziness. In general, patients with dizziness need professional help of neurologist because timely diagnostics of dizziness with the correct evaluation of the results of clinical examination and analysis of the relationship of vestibular formations with hearing, eye-motor and spinal cerebellar systems leads to further effectiveness of treatment and rehabilitation.

Keywords: vertigo, non-systemic dizziness, vestibular-ocular reflex, vestibular-spinal reflex.

Objective — to investigate peculiarities of clinical picture, cognitive disorders and dynamics of neurologic deficit recovery during 1-year period of follow-up in patients with ischemic stroke in the vascular territory of the posterior cerebral artery (PCA).
Methods and subjects. The clinical and neurological examinations of 74 patients with acute PCA infarct aged 36 to 85 years (mean age — (62.1 ± 11.2) years) were carried out. Patients were prospectively followed during 1-year after stroke. It was evaluated the dynamics of patients’ neurological deficit, cognitive disorders and functional recovery using scales NIHSS, B. Hoffenberth et al. (1990), MMSE, Beck Depression Inventory, modified Rankin Scale.
Results. In clinical picture prevailed vertigo (87.8 %), visual-spatial disorders (87.8 %) such as homonymous hemianopsia (88.2 %), upper quadrant (9.2 %) or lower quadrant hemianopsia (4.6 %), visual agnosia (6.8 %), visual neglectus (13.5 %), headache (48.6 %), sensory (12.3 %) and motor disturbances (16.2 %). In the group of patients with the lesion of the occipital region the overall evaluation of cognitive disorders using MMSE was in average 28.1 ± 2.3 points, in the case of combined lesions of the occipital and temporal lobes of the brain — 25.4 ± 1.9 points (p < 0.001). Combined PCA infarcts were characterized by higher background neurological deficit in comparison with isolated cortical lesions with the use of NIHSS and B. Hoffenberth et al. scales (10.1 ± 1.6 versus 6.3 ± 2.0; р < 0.001) and (16.6 ± 2.8 versus 10.6 ± 2.8; р < 0.001), accordingly. After the course of treatment the number of patients with unfavorable functional outcome among patients with combined PCA infarcts was 63.3 % compared to 22.7 % (p = 0.001) with pure cortical-only stroke, at 3 months — 30.0 % compared to 9.1 % (p = 0.029), and after 1-year — 14.3 % compared to 4.5 %, accordingly.
Conclusions. Visual-spatial disorders and vertigo dominate among clinical symptoms of ischemic PCA strokes. The combined lesion of the occipital and temporal lobes is characterized by more evident cognitive disorders. A higher background level of neurological deficits and worse clinical outcome were observed in patients with bilateral involvement of both PCA and also in combined cortical and deep PCA infarcts.

Keywords: ischemic stroke, posterior cerebral artery, clinical manifestation, cognitive disorders.

Objective — to determine the connection of glial damage marker S-100 in the serum of patients within the first 7 days after ischemic stroke and its effects in acute and remote post-stroke periods.
Methods and subjects. 48 patients were examined: 28 men and 20 women aged from 45 years to 73 (man age 57.7 ± 3.2 years). Neurological deficit in patients was evaluated with NIHSS scale during the acute period and one year later. Functional recovery was assessed with Barthel index one year after previous stroke. S-100 concentration in serum was determined with quantitative ELISA on the 1, 3 and 7 day.
Results. Patients with different severity of neurological disorders differ by the dynamics of the concentration of S-100 within 7 days. Decline in concentrations from 3 to 7 days in patients with neurological improvement in acute post stroke period was longer than patients with deterioration and fatal consequences. The predicted favorable outcome of stroke can be in the case of 32.2% concentration decline. The content of S-100 protein on the seventh day correlates with the degree of neurological recovery on 21 days (r = 0.68) and on the third day — with a degree of functional failure for BI one year after the stroke.
Conclusions. Changes of the marker in the first 7 days of the acute period allow us to predetermine not only the course and extent of regression of neurological disorders in the acute period but also to predict functional consequences of one year after vascular accident

Keywords: ischemic stroke, dynamic of the S-100 concentration, Barthel index.

Objective — to study the peculiarities of clinical course, recovery and quality of life (QoL) of patients with ischemic stroke (IS) and diabetes mellitus (DM).
Methods and subjects. We have studied 75 patients with acute IS. Thirty six of them also had DM of various severity (main group). Thirty nine patients had no misbalance of carbohydrates metabolism. Methods included comprehensive neurologic study, MRI and/or CT, ultrasonography of head and neck vessels. Assessment by NIHSS was done on 1st, 7th and 14th days of stroke. On 14th day we also assessed the functional status by Barthel Index and Modified Renkin Scale. The degree of cognitive defects was estimated by MMSE scale. Patients also answered SF-36 QL questionnaire before discharge.
Results. DM increases the risk of cerebral and extracerebral complications, including chronic renal insufficiency by 3.4. Tendency to decelerated restoration of neurologic functions impaired by IS was revealed. It was shown that severity of DM negatively impacts the degree of functional dependency. DM increases the probability of atherosclerotic stenosis of great vessels of head and neck with hemodynamic disturbances. In DM, the rate of one-sided stenosis of internal carotid artery increased by 1.3 and two-sided one grew by 1.5. DM affects QoL of patients with IS. Patients with severe DM assess their both physical and psychic status as worsened, while patients with moderate DM complain mainly about psychological status and its components.
Conclusions. DM does not only independently impact the development, severity and outcomes of IS, but also worsens main factors linked to its development. In patients with DM we revealed tendency to the increased number of various disturbances like atrial fibrillation, myocardial infarction, arterial hypertension and chronic renal insufficiency. Severity of DM negatively impacts the degree of restoration of functions lost due to IS and increases functional dependency of patients. DM also increases the probability of atherosclerosis of great vessels of head and neck. DM significantly impacts QoL of patients with IS, worsens their physical and psychological status.

Keywords: ischemic stroke, diabetes mellitus, functional status, recovery, quality of life.

Objective — to determine the predictors of course and functional outcome of an acute period of hypertensive supratentorial intracerebral hemorrhages in patients with arterial hypertension (AH).
Methods and subjects. We analyzed 120 (70 male and 50 female) AH patients with acute hypertensive supratentorial intracerebral haemorrhage. Patients age was 37 — 83 years. Their mean age was 58.3 ± 9.1 years, 58.3 % were males. Patient received surgical evacuation of clot were excluded from the research. They were divided into three groups depending on the functional outcome of an acute period: 1st — 19 patients with favorable functional outcome, 2nd — 85 patients with unfavorable functional outcome and 3rd — 16 patients who died before completion of day 21. Functional outcome was obtained at 21 days with the modified Rankin Scale.
Results. Statistically possible increasing of fatal outcome can be due to: Glasgo Coma Scale score which is less than 8 (RR 19.3; р < 0.05), severe stroke with NIHSS score more than 15 (RR 13.49; р < 0.05), leukocytosis more than 12.0 · 109 (RR 4.39; р < 0.05), hyperglycemia more than 10 mmol/l (RR 5.44; р < 0.05), midline shift more than 6 mm (RR 18.3; р < 0.05) and hematoma volume more than 50 sm3 (RR 10.3; p < 0.05). Intraventricular extension of bleed was highly correlated with an adverse outcome (RR 30.0) in acute period of intracerebral hemorrhages.
Conclusions. Poor outcome in acute period of hypertensive intracerebral hemorrhage can be predicted on admission by readily assessable factors such as GCS score less than 8, NIHSS score more than 15, leukocytosis more than 12 · 109, hyperglycemia more than 10.0 mmol/l, midline shift more than 6 mm, intraventricular extension of the hematoma and hematoma volume more than 50 сm3. These predictors may be helpful in therapeutic strategies.

Keywords: supratentorial intracerebral hemorrhages, prediction, acute period, functional outcome.

Objective — to improve the diagnosis and surgical treatment of extramedullary tumors of ventral and ventral-lateral localization.
Methods and subjects. The research is based on results of surgical treatment at 350 patients with extramedullary tumors of ventral and ventral-lateral localization, been operated in SI «Institute of neurosurgery named after acad. A. P. Romodanov of NAMS of Ukraine» from 1989 to 2014. There were 238 (68 %) women and 112 (32 %) men.
Results. The algorithm for surgical approach choice depending on tumor location has been developed. For tumor removing, located in front of spinal cord, next approaches were used (according to international classification): posterior — in 196 cases, posterior-lateral — in 118, anterior-lateral — in 1, lateral — in 11, anterior — in 4, far-lateral — in 16, external-lateral — in 4. The differences of disease clinical course, neurological symptomatic, instrumental, laboratory and differential diagnostics, results of surgical treatment at extramedullary tumors of ventral and ventral-lateral localization were considered.
Conclusions. The proper choice of surgical approach depends on the tumor localization, size and expansion. At ventral-lateral tumor localization in all spinal cord segments a surgeon should apply all variants of posterior-lateral approach, at ventral localization it should be lateral, at mild paravertebral tumor growth it is necessary to apply posterior-lateral approach, at significant growth it is better to apply anterior-lateral approach. The key point of successful extramedullary tumors of ventral and ventral-lateral localization surgery is the proper resection of bone elements that provides with the direct access to a tumor and allows to reduce neural structures traction.

Keywords: extramedullary tumor, spinal cord, neurinomas, meningioma, diagnosis, surgical treatment.

Objective — to study the persistence of the herpes viruses in brain tumors: medulloblastomas and gliomas.
Methods and subjects. In total 103 different samples of brain tumors were taken for analysis immediately after the neurosurgical removal. Virus research conducted by PCR and electrophoresis in real time using commercial kits «AmpliSens» and «DNA technology» to determine herpes 1/2, 6.7, CMV, VEB.
Results. It is found that in 45 — 50 % of samples of different types of brain tumors contain CMV and the VEB, and other viruses are much rarer. The medulloblastoma CMV contamination frequency in adults is 1.5. times more comparing with children while VEB contamination was the same in adults and children. Depending on the viral contamination medulloblastomas tissue and glioma brain tumors can be divided into 4 groups: the tumor without viruses, tumors with two or with one of these viruses.
Conclusions. Depending on the viral contamination the brain tumors can be with viruses and virus-free. PCR allows very quickly to determine the viral contamination in the tumor tissue, which opens up new options capability in the treatment of these tumors

Keywords: herpes viruses 4 and 5 types, Epstein — Barr virus, cytomegalovirus, medulloblastoma, glial brain tumors.

Objective — to find out the peculiarities of peripheral blood leukocytes’ necrosis and apoptosis according to the leading syndrome of traumatic brain disease
Methods and subjects. In 280 patients with consequences of traumatic brain injury (TBI) the content of APK, PI+ and AnV+ in peripheral blood was examined by flow cytofluorometry. Neurological status was evaluated by means of Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI), cognitive status was evaluated by means of Montreal Cognitive Assessment scale (MoCA). For screening of anxiety and depression all patients filled out a questionnaire of HADS.
Results. In 138 (49.3 %) patients a progression of the pathological process has been observed regardless of the severity of the initial episode. The proportion of these patients was: mild TBI — 44.2 %, moderate severity of TBI — 50.0 %, severe TBI — 53.1 %. The leading syndromes of traumatic brain disease were: extrapyramidal insufficiency (1st group, 36 patients, 26.87 %), syndrome of cognitive decline (2nd group, 42 patients, 31.34 %), seizures (3rd group 32 patients, 23.88 %) and CSF-hypertensive syndrome (4th group, 24 patients, 17.91 %). Progression of the leading syndrome at traumatic brain disease has been accompanied by activation of necrosis/apoptosis of peripheral blood leukocytes.
Conclusions. Significantly higher values of AnV+ were observed in patients with extrapyramidal insufficiency and cognitive decline. Regardless of the TBI severity the highest rates of PI+ were diagnosed in case of CSF-hypertensive syndrome in combination with seizures (LTBI), cognitive decline (MTBI) and extrapyramidal insufficiency (STBI). A direct correlation was established between the percentage of cells in the stage of apoptosis and the level of depression according to the scale of HADS (LTBI) and term of injury (MTBI).

Keywords: consequences of traumatic brain injury, syndromes, apoptosis, reactive oxygen species, leukocytes.

Objective — to investigate the state of vegetative regulation of cardiac rhythm in peritoneal dialysis (PD) patients and its impact on dialysis adequacy criteria and technique survival.
Methods and subjects. A total of 44 patients with end-stage renal disease treated with PD have been included in a prospective, observational study (average age 50.8 ± 12.5). The research of heart rate variability (HRV) has been carried out under the Standards of Working Group of Cardiac Pacing of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. The dialysis adequacy indices have been evaluated taking into account weekly creatinine clearance and total weekly urea clearance (Kt/V).
Results. The study has stated that the displacement of autonomic balance towards the sympathetic link of autonomic nervous system due to lower total power of the heart rate and the parasympathetic failure are shown in PD patients. The research also has proved that hyperactivity of the sympathetic nervous system was significantly associated with a reduction of the adequacy of PD and reduces of technique survival.
Conclusions. We consider that the achieved results demonstrate the potential of HRV not only for prediction of cardiovascular events, but coincidently reveal itself as useful instrument to determine the predictors of the best PD technique and the patient’s survival.

Keywords: peritoneal dialysis, cardiac autonomic nervous activity, heart rate variability, dialysis adequacy, technique survival.

Objective — to determine the prevalence of associated diseases in Volyn patients with multiple sclerosis (MS) compared with the general population and clarify the influence of concomitant diseases to epidemiological indicators of MS.
Methods and subjects. In total 292 patients with MS were under the examination. In order to determine the frequency of comorbidity among 100 000 population in cohort MS patients in Volyn region we applied data from aluminum statistics reference of Volyn region clinics performance data (2012 — 2013).
Results. The most common comorbid conditions among people with MS in the Volyn region is the pathology of the gastrointestinal tract, hypertension disease, ischemic heart disease, goiter, urolithiasis, radiculopathy. The prevalence rates of gastrointestinal pathology, urolithiasis, radiculopathy, tumors of ovary, breast disease are significantly higher (more than 5 times) among MS patients comparing with general population. It is typical for patients of senior age and late onset time to have two and more comorbid conditions comparing with patients MS. There are significantly less H. pylori-positive patients among subjects suffered from MS. This fact could be the evidence of protective influence of Hp infection to the risk of development of MS.
Conclusions. Patients with comorbid condition demonstrate late MS onset, but its duration from the first symptoms to diagnosis is less. Studies of features of comorbid diseases in MS patients could improve the diagnostic process and quality of medical care.

Keywords: multiple sclerosis, Volyn region, comorbidity.

Objective — to study the dynamics of neurological functions restoration during the early 3 months period of IS  with the application Magnesium sulfate different dosages in the acute critical period (first 5 —7 days).
Methods and subjects. Patients in acute period of IS were under the examination. They were administered Cormagnesine 10 — 20 ml (4 g) (30 patients of the control group) and 25 % solution of magnesium sulfate 5 mg (20 patients comparing group) intravenous per day during 5 days. The period of observation was 90 days. Patients underwent clinical and neurological examination with the application of Glasgo scale, NIHSS, Bartel index, eye fundus examination, cerebral tomography, transcranial dopplerography.
Results. The consciousness level elevated for 3.5 points (p < 0.05) on the 5th day against the background of Cormagnesin application and for 4.0 points with the traditional therapy (p < 0.05). 47.6 % patients of the control group demonstrated the highest consciousness level during 2nd — 3rd days. The positive dynamic was observed in relation to neurological deficiency against the background of evidenced improvement of hemodynamic data. At the of the examination complete recovery of neurological functions or minimal limitation was determined in 21 (70 %) control group patients and in 7 (35 %) comparing group.
Conclusions. Cormagnesine administration in an acute IS period contributes to fast consciousness recovery, improvement of cerebral hemodynamic data and functional outcome in comparing with the traditional therapy. Cormagnesine application in suggested dosage is associated with satisfactory safety and tolerance profile.

Keywords: ischemic stroke, magnesium sulfate, neuroprotective therapy.

Tuberculosis of central nervous system (CNS) is one of the most devastating forms of micobacterial infection with high mortality. Basal meningitis accounts for about 70 % of CNS tuberculosis and about 1/3 of cases have atypical manifestations. The risk of acquiring neurotuberculosis in HIV patients is 10 times higher than in non-HIV individuals and its related mortality exceeds 50 %. In the article the case of tuberculosis meningitis in HIV positive patient with hyperkinetic hemiballism manifestation is presented. We reviewed literature on pathogenesis of motor disorders, update diagnostic criteria and treatment approaches of the co-infection.

Keywords: tuberculosis meningitis, hemiballism, HIV-infection.