The lecture is devoted to a problem of primary headache: migraine and cluster headache. The classification of a migrain and a cluster headache is submitted. Primary cephalalgias basic clinical forms,  epidemiology, pathogenesis and modern  treatment approaches are outlined.

Keywords: cluster headache, migrain, migraine forms, phases of migrain crisis, modern treatment approaches.

Objective — highlighting the clinical peculiarities of atypical chronic inflammatory demyelinating polyneuropathy (CIDP); comparative analysis of nerves conduction studies (NCS) parameters in typical and atypical CIDP; utility of ­somatosensory evoked potentials to demonstrate the proximal demyelination in pure sensory CIDP with normal NCS parameters; the role of superficial peroneal nerve biopsy in the diagnosis of CIDP.
Methods and subjects. The study included 30 patients with atypical CIDP and 30 patients with typical CIDP. All patients underwent NCS, blood was drawn for biochemical tests, also electrophoresis and serum protein immunofixation. Peroneal  nerve biopsy was performed in 9 patients (4 with atypical CIDP and 5 patients with typical CIDP). Overall Neuropathy Limitation Scale questionnaire (ONLS) was used for the assessment of functional disability in all patients.
Results. The mean value ONLS within atypical CIDP was 2.43 ± 0.29 points, lower compared to typical CIDP — 4.17 ± 0.24 points. Monoclonal gammopathies were found in 13 patients, representing 22 % of patients with CIDP. Demyelinating criteria most frequently observed in the biopsy material is decreased number of myelinated thick fibers.
Conclusions. NCS is not a gold standard for diagnosis atypical sensory CIDP. According to ONLS scale, atypical CIDP are less disabling compared with typical CIDP. Peroneal nerve biopsy within CIDP is performed only when electrophysiological studies do not elucidate demyelination criteria.

Keywords: atypical demyelinating polyneuropathy, biopsy, diagnostic criteria.

Objective — assessment of cognitive functions in patients with comorbidity of dyscirculatory encephalopathy (DE) with metabolic syndrome (MetS) in the cases of the ratio leptin/triglycerides > 2.7 raise.
Methods and subjects. We examined 82 patients with DE and MetS aged 48 to 85 years. All patients were divided into 3 age groups: 45 — 59 — middle age (n = 30), 60 — 74 — elderly age (n = 32), 75 — 89 years — senile age (n = 20). Diagnostic evaluation included neurological, neuropsychological examination, laboratory and instrumental assessment.
Results. According to results of our study, signs of leptin resistance (increasing the ratio leptin/triglycerides > 2.7) were diagnosed in 58 (71 %) patients, leptin resistance was not found — in 24 (29 %) of patients with MetS. Presence of leptin resistance adversely affected MMSE total score, different aspects of memory, the rate of sensorimotor reactions, the efficiency of information processing and attention, functions of conceptualization, simple and complicated reactions of choice, language speed (p < 0.001). Among patients of middle and elderly age with the presence of leptin resistance significantly lower proportion of pre-mild cognitive impairment (CI) and higher frequency of mild CI (p < 0.001) was found compared with patients without leptin resistance of coincident age. Among senile patients with leptin resistance compared with patients without leptin resistance of appropriate age, was significantly lower proportion of mild CI (p < 0.001) and in 57 % of patients dementia was found.
Conclusions. Increased serum ratio leptin/triglycerides > 2.7 was accompanied by worsening of cognitive status in all age groups of patients with DE and MetS. Absence of leptin resistance combined with hyperleptinemia positively influenced on the cognitive status in all age groups of patients with MetS. Deterioration of cognitive functions was observed in patients with MetS with and without signs of leptin resistance with the increase of age.

Keywords: cognitive impairment, age, metabolic syndrome, signs of leptin resistance.

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Objective — to analyze the early and long-term results of surgical treatment of the cervical spinal nerves tumors with paravertebral extension depending on the timing of the disease diagnosis.
Methods and subjects. 58 patients with tumors of the mentioned localization were examined in the period from 2006 to 2016. All patients were operated at SI «Institute of Neurosurgery named after acad. A. P. Romodanov of NAMS of Ukraine». Evaluation of the patient condition included general and neurological examinations, laboratory and instrumental tests before and after the surgical treatment. The results of computed tomography (CT) and magnetic resonance imaging (MRI) studies, spine radiography in two projections prior to the operation were taken into the consideration in order to determine the tumor growth direction, its proliferation into the spinal cord, the presence of compression and spinal cord myelomalacia. Due to these findings it was possible to specify tactics transaction with the choice of surgical approach. We used the front, side, rear and posterolateral approaches. The spinal stabilization was the key procedure.
Results. The determination of surgery tactics and choice of surgical approach depends on the localization and size of the tumor, its paravertebral extension, which correlated with the severity of the segmental and conductive disorders. The degree of bone structures degradation and the risk of instability stipulated the use of stabilizing systems 50 (93 %) patients. The total tumor removal was performed in 100 % of patients, followed by regression of neurological symptoms.
Conclusions. Early diagnosis of the cervical spinal nerves tumors on the basis of an adequate assessment of the neurological picture of the disease and CT and MRI studies data allows to determine a rational determination of surgical treatment with the choice of surgical approach, to remove the tumor, to reduce intervention time, blood loss, neural structure trauma, postoperative complications, and recovery time of patients.

Keywords: tumors of the spinal nerves, surgical treatment tactics, treatment outcomes, paravertebral tumor extension.

Objective — to assess the connective tissue dysplasia impact on the course of lumbosacral spine vertebrogenic syndrome and clinical and neurological features of the course in the dynamics of lumbosacral spine vertebrogenic syndrome complex treatment in patients who take up sport activities.
Methods and subjects. The clinical neurological examination was conducted in 120 patients, who had neurological manifestations of vertebral syndrome of lumbosacral spine. The treatment duration was 10 days. Patients were prescribed nonsteroid anti-inflammatory medicines, neuromuscular blocking agents, vitamins B. All patients underwent complex treatment with standard and reflex therapy, clinical and neurological examinations, lumbosacral spine MRI, electrocardiography, laboratory tests (blood and urine), Baton’s criteria test and connective tissue dysplasia extension by T.Yu. Smolnova.
Results. Analysis of the clinical examination results demonstrated that patients with vertebral syndrome of lumbosacral spine (p < 0.05) have more frequent protrusion of m/s disk changes, joints pathologies, varicose veins, and  ligamentum flavum thickening.
Conclusions. Associated diseases (manifestations connective tissue dysplasia: scoliosis, kyphosis, kyphoscoliosis, tendency to dislocation, stretching the ligaments) increase the duration of treatment significantly (p < 0.05) and the pain syndrome severity. The results of examination and monitoring of patients in the dynamics of the treatment showed that patients with vertebral syndrome of lumbosacral spine (p < 0.05) more often have anatomical changes in the lumbosacral spine than patients without evidence of connective tissue dysplasia.

Keywords: connective tissue dysplasia, sportsmen, vertebral syndrome of lumbosacral spine, autonomic dysfunctions.

Objective — to study the quantitative and qualitative characteristics daily blood pressure indicators in patients with primary and secondary stroke to optimize diagnosis of acute cerebral ischemia re considering risk factors for stroke.
Methods and subjects. A clinical and neurological examination was conducted among 76 patients with recurrent ischemic stroke (group 1) and primary ischemic stroke (group 2) aged from 44 to 86 years (average age was 63.3 ± 8.4 years), including 40 (52.63 %) men and 36 (47.37 %) women, with localization in hemispheres, brainstem or cerebellum. All patients underwent clinical and instrumental monitoring in the dynamics that included a general examination, consultations of physician and cardiologist, assessment of neurological deficit severity (NIHSS, Scale Rankin, index Bartel), clinical laboratory diagnostics (general and biochemical blood test), ambulatory blood pressure monitoring, neuroimaging techniques (CT/MRI of the brain).
Results. The daily profile of blood pressure in patients of group 1 demonstrated high levels of SBP, DBP and РВР at all times of a day, and a significant (p < 0.05) increase in the average values ​​of the nocturnal SBP and РВР compared to daily ​​may be taken into account when analyzing the circadian rhythm of blood pressure failure. The reliability index difference РВР per day in patients of group 1 and group 2 (for the F-test p = 0.0017 by t-test p = 0.0072) indicates the presence of significant differences associated with the incidence of stroke and the importance of studying РВР in patients with ischemic stroke. During the 1st day there were not significant differences in circadian blood pressure indexes, but on the 10th day it was observed that the group 1 patients demonstrated significantly (p < 0.05) prevailed circadian rhythm of blood pressure «night-peaker » type, and in group 2 the circadian rhythm of blood pressure was by the type of «non-dipper».
Conclusions. The survey revealed that conducted daily monitoring of blood pressure during the development of ischemic stroke is important, since received significant differences of many indicators of blood pressure. The received data confirmed differences in blood pressure of patients with primary and repeated ischemic stroke. Indicators SBP and РВР are of the most important parameters of pressure, that affect the development of stroke and different types of infringement circadian rhythm.

Keywords: recurrent stroke, risk factors, ambulatory blood pressure monitoring, hypertension, diagnosis.

Objective — to investigate the clinical and neurological features of multiple sclerosis (MS) family cases, prevalence in MS patients of Kharkiv region, identifying risk factors for its development.
Methods and subjects. This study was carried out on the patient cohort consistent of 170 patients (139 women (81.76 %) and 31 men (18.24 %) with different MS types living in Kharkiv and Kharkiv region. Among them 5 (4 women and 1 man) patients cases revealed family cases of multiple sclerosis (2.94 %). Family cases of multiple sclerosis was identified if a patient had at least one relatives of any degree of relationship with this disease. All analyzed cases of MS were divided into two groups: 1 group (n = 165; 97.06 %) — sporadic MS and II main clinical group (n = 5; 2.94 %) — MS family cases.
Results. In our study, we found in patients with MS family cases prevalence of mother line (4 : 1), the parents of the disease were women (mother, grandmother) and only in one case — father. The MS family cases patients had no associated related autoimmune diseases; the endocrine and/or other neuropsychiatric pathology have not been reported in this patient cohort, too. There were no any statistically proven data in demographic parameters between two patient’s groups: in patients with sporadic MS, the average duration of disease and the median age onset didn’t differ from MS family cases. It was shown that patients with multiple sclerosis family cases comparing to multiple sclerosis sporadic cases have a little more severe degree of neurological deficit, polysymptomatic and earlier disease onset (under 27 years) and, as usual, the progression type course of MS. To evaluate the velocity of neurological deficit progression using MSSS scale it was shown that the progression of neurological deficit was lower in patients with MS family cases comparing to patients with MS sporadic cases.
Conclusions. On representative clinical material, on the Kharkiv patient cohort example, it was shown that MS patients with family cases comparing to the patients with sporadic MS cases had a little more severe neurological deficit degree, polysymptomatic and earlier disease onset, and as usual progressive disease type course.

Keywords: multiple sclerosis family cases, multiple sclerosis sporadic cases, prevalence, EDSS.

Objective — to evaluate the effectiveness of the developed innovative complex treatment (with a combination of medication, nutriological, leech and manual therapy) in patients with non-motorized symptoms of Parkinson’s disease through the study of lipid homeostasis hair follicle and patients’ hair and their objective condition evaluation according to UPDRS.
Methods and subjects. 32 patients with non-motorized symptoms of Parkinson’s disease 2.5 — 3 stage according to Hoehn and Yahr Rating Scale were examined. The lipid homeostasis in hair follicles and the hair of patients was studied with the thin layer silica gel chromatography prior and after the treatment. An objective state of patients was assessed by unified rating scale (UPDRS). The innovative complex treatment: leech therapy, nutriological correction, and manual therapy was applied.
Results. The efficiency and effectiveness of the complex treatment has been proved not only clinically but biochemically as well. The lipid metabolism in hair follicles tissues was restored, and patients’ condition improved according to evaluation scale UPDRS.
Conclusions. Considering the restoration of lipid homeostasis after combined treatment applied and patients’ objective condition, we recommend the specified therapeutic technique for the treatment of patients with non-motorized symptoms of Parkinson’s disease and its progression suspension.

Keywords: Parkinson’s disease, lipid homeostasis, nutriological correction, leech therapy, manual therapy.

Objective — to examine the effect of allogeneic transplantation of olfactory bulb tissue (TOBT) on spasticity and chronic pain syndrome in ipsilateral hindlimb (IH) on the mature rat left-side spinal cord hemisection model.
Methods and subjects. Animals: albino male rats (5.5 months, 300 grams, inbred line, the original strain — Wistar); main experimental groups: 1 — spinal cord injury + immediate homotopical implantation of a fragment of the olfactory bulb tissue (n = 34), 2 — spinal cord injury only (n = 16). The group of mature (3 mo) intact animals (n = 14) with the same biometric data were used for electroneuromyography data comparing. Model of injury — left-side spinal cord hemisection at Т11 level; verification of spasticity — by the Ashworth scale and by the electroneuromyography.
Results. TOBT significantly reduces the severity of spasticity syndrome in caudal region of the motor system efferent part (IH ankle joint) during the first 2 weeks, stimulates its development in the adjacent caudal spinal cord segments (IH knee and hip). In the remote period of injury (within 5 — 6 months after the first TOBT) a significant increase in the frequency of severe regional pain syndrome (distal part of IH) was reported in comparison with the control group, which was accompanied by the phenomena of autophagy (self mutilation). Possible early antialgesic and verified antispastic effect of the TOBT is probably related to the caudal migration of transplanted GABAergic neurons precursors, it is temporary and causes the severe pain manifestation in the remote period of injury.
Conclusions. The effectiveness of immediate TOBT is limited to the first weeks after spinal cord injury, its mechanisms require further investigation.

Keywords: spinal cord injury, transplantation of olfactory bulb tissue, motor function recovery, posttraumatic spasticity syndrome, chronic pain syndrome.

Когнитивные нарушения — распространенная патология нервной системы у пациентов, перенесших инсульт, ассоциирующаяся с ростом смертности, увеличением риска возникновения повторного инсульта и медленным восстановлением двигательных функций, что ведет к увеличению частоты инвалидизации населения. Небольшое количество пациентов, перенесших инсульт, возвращаются к трудовой деятельности. Патогенез и этиология когнитивных нарушений являются сложным и дискутабельным вопросом современной неврологии. Для разработки эффективных методов лечения и реабилитации пациентов с постинсультными когнитивными нарушениями необходимо исследовать патофизиологические и этиологические аспекты этой патологии.

Keywords: инсульт, когнитивные нарушения, деменция.