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Objective: to determine the sensitivity and specificity of simultaneous analysis of the central vein sign (CVS) and the concentration of free kappa chains (FKC) in cerebrospinal fluid (CSF) in the diagnosis of multiple sclerosis (MS).Material and methods. Eighty patients participated in the study. The main group comprised 54 patients who had been diagnosed with MS according to the 2017 McDonald criteria. The comparison group comprised 26 patients with other diseases of the central nervous system. An enzyme-linked immunosorbent assay was used to determine the concentration of FKC in the CSF. MRI of the brain was performed in all patients. The total and relative number of lesions with CVS were calculated.Results. An increased level of FKC in the CSF and a higher frequency of lesions with CVS were found in the group of MS patients compared to the control group (p

Objective: to determine the sensitivity and specificity of method of determining the concentration of immunoglobulin free light chains (FLCs) in cerebrospinal fluid (CSF) in the diagnosis and differential diagnosis of multiple sclerosis (MS).Material and methods. 80 patients participated in the study. The main group consisted of 54 patients diagnosed with MS according to the 2017 McDonald criteria. The comparison group (n=26) comprised patients with other diseases of the nervous system. An enzyme-linked immunosorbent assay (ELISA) was used to determine the concentration of FLCs (kappa- and lambda-chains) in the CSF.Results. In the group of patients with MS, an increase in the concentration of free kappa-chains (к-FLCs) in the CSF was found compared to the comparison group (p

Objective: to determine the specificity and sensitivity of the central vein sign (CVS) for the diagnosis of multiple sclerosis (MS). Material and methods. We analyzed 76 patients. The main group consisted of 40 patients with a confirmed diagnosis of MS according to the McDonald criteria, 2017. The comparison group included 20 patients with migraine and 16 patients with cerebral microangiopathy. All patients underwent a standardized MRI scan of the brain, including 3D FLAIR and SWI modes. The total number of T2/FLAIR hyperintense lesions in the brain and the number of lesions with CVS were calculated. Results. In the group of MS patients, the total and relative number of lesions with CVS was higher than in the comparison group (p

Neuromyelitis optica spectrum disorders (NMOSD) are a group of autoimmune inflammatory demyelinating diseases of the central nervous system. In 2015, International Expert Panel established diagnostic criteria for NMOSD. The majority of patients with NMOSD have aquaporin-4 autoantibody (AQP4-IgG). This case describes a 43-year-old woman who presented with weakness in her limbs followed by intractable vomiting. One year and 3 months later, she experienced acute visual impairment, which recurred several times. MRI of the spinal cord revealed a T2-hyperintense signal lesion at the cervical level extending over 4 vertebral segments. MRI of the brain showed involvement of the brainstem. AQP4-IgG was detected in her blood serum. It took 30 months from the onset of symptoms to establish the correct diagnosis. During this time, several incorrect diagnoses were made, including ischemic stroke, functional movement disorder and vertebrobasilar insufficiency. As a result of delayed diagnosis and treatment, the patient developed severe irreversible visual impairment. This case underscores the importance of early diagnosis and early treatment of NMOSD.

Objective: to study the level of inflammatory biomarkers and growth factors in the peripheral blood of patients with chronic cerebrovascular disease (CCVD) and anamnesis of coronavirus infection COVID-19.Material and methods. The study included patients with CCVD (n=41), 26 of them had a documented anamnesis of coronavirus infection within 4 months before inclusion in the study, 15 people did not have COVID-19. The control group consisted of 20 apparently healthy individuals of the same age. Neuroimaging was performed using a Philips Achieva 1.5 T device. Pro-inflammatory cytokines were determined in blood serum – tumor necrosis factor α (TNF α ), interleukin 6 (IL6), IL18, interferon γ (IFN γ ); chemokines – monocytic chemoattractant protein 1 (MCP-1), IL8; growth factors – vascular endothelial growth factor type A (VEGF-A), transforming growth factor β 1 (TGF β 1).Results. In patients with CCVD, compared with the control group, an increase in the level of proinflammatory cytokines (TNF α , IL6, IL18), chemokines (MCP1 and IL8), a decrease in the concentration of IFN γ , and divergent changes in the content of growth factors (VEGF-A and TGF β 1) were noted. Patients who recovered from COVID-19 showed an increase in the level of IL6 and a decrease in the level of IFN γ compared with those who had not been ill, which indicates a persistently high activity of immunoinflammatory processes and an insufficient humoral immune response.Conclusion. Postponed coronavirus infection COVID-19 aggravates the existing endothelial dysfunction and intravascular inflammation in patients with CCVD, which may probably require changes in their treatment and prevention strategies in the future.

Objective: to evaluate the impact of various forms of atrial fibrillation (AF) on the development of mild cognitive impairment (MCI) and cerebral small vessel disease.Patients and methods. The study included 31 patients with AF (paroxysmal form – 22 patients, permanent form – 9 patients). Arterial hypertension was diagnosed in 26 patients and diabetes mellitus in 6 patients. All patients were taking direct oral anticoagulants (DOACs). Patients underwent cognitive testing, screening ultrasound examination of the main arteries of the head and neck, MRI on a Siemens Skyra 3 T tomograph according to a protocol including diffusion tensor imaging and perfusion determination. To create a control group of healthy elderly individuals, the open database of clinical and MR data OASIS 3 was used that retrospectively evaluated more than 1000 people over a period of 30 years. Participants whose cognitive status was assessed clinically as "normal cognitive function" were selected.Results and discussion. The frequency of MCI and indicators of cognitive tests did not differ in groups of patients with permanent and paroxysmal forms of AF. The distribution of foci of hyperintense white matter, the thickness of the cerebral cortex also did not differ in patients with different forms of AF. The neuroimaging pattern of cerebral small vessel disease in AF patients without stroke was consistent with population controls.Conclusion. Prescribing DOACs to patients reduces the risk of cognitive impairment of vascular origin development due to the clear and predictable effect of this class of drugs that prevent the development of cerebral embolism.

Introduction. The original English-language questionnaire for identifying the risks of developing chronic back pain The Keele STarT Back Screening Tool was developed in 2007 and adapted for use in many languages. The article describes the linguistic adaptation of the Russian version of the questionnaire The Keele STarT Back Screening Tool conducted in accordance with generally accepted rules.Aim. Linguistic adaptation of the Russian-language version of The Keele STarT Back Screening Tool.Materials and methods. Linguistic adaptation was carried out in five stages: 1) direct translation by three translators; 2) development of one version of direct translation; 3) reverse translation by two native English speakers; 4) development of one reverse version and its discussion by a committee of experts; 5) preliminary testing of the Russian version in a group of 30 patients (10 men and 20 women) aged from 28 to 84 years (average age 61.3 ± 8.7 years) with acute back pain, who in the period of April-June 2022 were on outpatient or inpatient treatment at the Clinic of Nervous Diseases of Sechenov University for nonspecific back pain (n = 21) and radiculopathy (n = 9).Results and discussion. All patients reported that the wording of the questionnaire items was clear and did not raise additional questions. The response time to the questions ranged from 30 seconds to 2 minutes 20 seconds (on average – 1 minute 18 seconds).Conclusion. The adapted Russian version of The Keele STarT Back Screening Tool questionnaire to identify the risks of developing chronic back pain did not cause comments from patients and experts. This version can be used to confirm its psychometric properties.

Objective: to study the efficacy, safety and tolerability of agomelatine in mixed anxiety and depressive disorder.Patients and methods. Agomelatine was administered to 30 patients diagnosed with mixed anxiety and depressive disorder for 3 months. The patients' condition was assessed using a battery of psychometric methods – the Hamilton Depression Scale, the Hamilton Anxiety Scale, and a short form of the SF-12v2 quality of life questionnaire.Results and discussion. It was shown that agomelatine effectively reduces both symptoms of depression and anxiety, begins to have a therapeutic effect a week after the start of administration, however, the drug shows the best clinical effect when administered for a period of three months or more. The predictors of complete remission on agomelatine therapy in this sample were: the presence of sleep disorders (early and medium, but not late insomnia), a greater severity of somatized anxiety, the presence of complaints of decreased workplace performance and activity.Conclusion. Our study has shown that agomelatine is an effective, safe and well-tolerated drug in the treatment of mixed anxiety and depressive disorder.

Apathy is one of the most common manifestations of neurodegenerative pathology, including Alzheimer's disease (AD). Despite such a significant role of apathy in the course of the disease, there are no unambiguous recommendations for the treatment and prevention of this symptom complex. Some classes of psychotropic drugs commonly prescribed for AD, such as antidepressants of the SSRI class, may themselves cause apathy. The authors present a series of clinical observations describing four cases of deterioration in the condition of patients with AD during SSRI therapy. The features of the clinical course of the disease are discussed, new strategies for drug therapy are proposed.

Antiphospholipid syndrome (APS) is an autoimmune process that increases the risk of arterial and venous thrombosis. The mechanism of damage to the central nervous system (CNS) can be not only due to thrombosis, but also antiphospholipid antibodies (APA) circulating in the peripheral blood. The latter can damage the cerebral vascular endothelium, alter the resistance of the blood-brain barrier and penetrate into the central nervous system, exerting a damaging effect on astroglia and neurons, as evidenced by the release of neurospecific proteins into the peripheral bloodstream. The role of APS in developing cerebral ischemia, migraine, epilepsy, chorea, transverse myelitis, multiple sclerosis, cognitive impairment and mental disorders, as well as the peripheral nervous system is described. It should also be noted about a role of APS for emerging neurological disorders in COVID-19, enabled apart from thrombogenesis due to APA via 2 potential mechanisms - molecular mimicry and neoepitope formation. Further study of the APS pathogenesis and interdisciplinary interaction are necessary to develop effective methods for patient management.

Osmotic demyelinating syndrome (ODS) is a severe complication that occurs due to rapid correction of hyponatremia. Central pontine myelinolysis (CPM), in which a focus of demyelination occurs in the pontine region, and extrapontine myelinolysis (EPM), in which foci of demyelination appear in the white matter of the cerebral hemispheres, can be distinguished as a part of this syndrome. We describe two clinical cases of CPM that developed due to hyponatremia and hypokalemia in patients with SARS-CoV-2 infection (COVID-19). Differential diagnosis included acute disseminated encephalomyelitis, infectious encephalitis, and brain tumor. In both cases, a significant recovery of the lost functions was noted. The pathogenetic mechanisms of CPM development in patients with COVID-19 are discussed. ODS development in COVID- 19 necessitates strict control and correction of electrolyte disturbances in this category of patients in accordance with existing recommendations, which can reduce the risk of CPM.

There is now increasing evidence that demyelinating disease with anti-myelin oligodendrocyte glycoprotein (anti-MOG) antibodies is an independent nosological unit. The paper describes a clinical case of anti-MOG associated myelitis at the CI-TXlevel. Differential diagnosis was made between multiple sclerosis, Devic's myelitis optica, and idiopathic transverse myelitis. The clinical, morphopathological, and diagnostic features of anti-MOG associated myelitis are discussed. There are new diagnostic criteria for neuromyelitis optica spectrum diseases (NMOSD), as well as red flags, in the absence of which the diagnosis of NMOSD can be established as a diagnosis of exclusion.

Aim. To test a hypothesis of hypoperfusion-induced white matter changes in patients with atrial fibrillation (AFib) and to present statistics to compute sample size for the upcoming studies.Material and methods. We included 30 inpatients with AFib and investigated them with magnetic resonance imaging (MRI) with standard sequencies and diffusion tensor imaging (DTI). DTI data were analyzed with conventional ROI analysis in the Olea Sphere software and with watershed areas (WSA) mask in the FSL toolbox after nonlinear transformation of images to the Montreal Neurological Institute (MNI) space. Wilcoxon test was used to compare diffusion characteristics across subgroups.Results. Median age of participants was 73 years (69-78), 18 (60%) patients had moderate signs of small vessel disease with Fazekas score of one. Twenty-one patients had paroxysmal AFib. Analysis of WSA revealed decreased white matter integrity in the parieto-occipital cortical WSA with a pattern of significantly increased mean diffusivity (p=0,039), and marginally significant decrease in fractional anisotropy (p=0,056). Rank-based effect size across areas under comparison was either small (0,2) or negligible, and with statistical power in the range of 0,05-1.Conclusion. Atrial fibrillation could have pathophysiologically feasible mechanism to affect white matter integrity in the watershed areas.

Introduction. Migraine is one of the most common primary headaches and a risk factor for cardiovascular and cerebrovascular diseases. Antiphospholipid syndrome (APS) and hereditary thrombophilia (HT) causing pathological pregnancy are highly associated with migraine. Timely migraine recognition related to APS and HT facilitates earlier initiation of thrombophilia pathogenetic therapy and prevention of potential complications.Aim: to analyze the literature data on migraine clinical and diagnostic features in APS and HT as well as pregnancy-related therapeutic issues.Materials and Methods. A search for scientific literature was conducted in electronic databases including PubMed, Google Scholar, eLibrary from 2004 until May 2024. The search methodological basis included the presence of the following keywords and their combinations in Russian and English: "migraine", "antiphospholipid syndrome", "thrombophilia", "migraine and pregnancy", "migraine and thrombophilia", "migraine and cardiovascular diseases". As a result, a total of 184 publications were identified. Next, 62 articles were included in the review.Results. At the current stage, neurologists have no means to diagnose migraine in APS and HT based on headache-intrinsic characteristics. Pregnancy increases a risk of thrombotic complications. A migraine observed in patient's history should be crucial while assessing pregnancy-related obstetric risk. While diagnosing migraine, neurologists need to examine patient obstetric history. The data on most effective and safe therapy for pregnancy-related migraine attacks remain scarce.Conclusion. The frequent association between APS and HT with migraine, the lack of clear migraine clinical features in thrombophilia, patients’ reproductive age, and the high risk of thrombotic complications necessitate collaboration between neurologists and obstetricians-gynecologists for timely diagnostics and management of such patients. The impact of various types of antithrombotic therapy on migraine course requires further clarification. It is promising to conduct studies able to determine of whether migraine attack prevention can avoid adverse pregnancy outcomes in women with former migraine.

CLIPPERS syndrome (Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids) is a recently described rare disease affecting the central nervous system. It is characterized by subacute development of symptoms of lesions predominantly in the brain stem and cerebellum, by specific magnetic resonance imaging (MRI) changes, perivascular lymphocytic infiltration in the brain substance and a good response to glucocorticoid (GC) therapy. The paper describes CLIPPERS syndrome in a patient who has been followed up in a clinic for 10 years. During this period, different variants of clinical diagnosis have been considered. The final diagnosis was made only when comparing the clinical course and manifestations of the disease, MRI data, as well as the reaction to GC therapy and its discontinuation. Literature data and diagnostic criteria of this disease are presented.

Cognitive impairment (CI) is a basis for the clinical presentation of chronic cerebral ischemia (CCI). However, the role of the mechanisms of inflammation and angiogenesis in the origin of CI is unclear, as is its relationship to the number and localization of foci during a neuroimaging examination.Objective: to investigate the relationship between the presence of CI, focal brain tissue changes, and the plasma and serum levels of vascular endothelial growth factor (VEGF) and monocyte chemoattractant protein-1 (MCP-1) in patients with CCI.Patients and methods. Examinations were made in 59 patients with CCI and in 20 apparently healthy individuals. The investigators evaluated the cognitive status using the Mini-Mental State Examination (MMSE) and the clock drawing test), performed brain magnetic resonance imaging (MRI), duplex scanning of cerebral vessels, and determined laboratory indicators: the serum levels of MCP-1 and C-reactive protein, and the serum and plasma concentrations of VEGF.Results. The patients with CI were found to have higher values of inflammatory markers, lower serum and plasma concentrations of angiogenic factors, and a greater number of focal changes on MRI than those without CI (5.06±0.23 and 2.36±0.3 scores, respectively; p

Eighty patients with arterial hypertension (AH), aged 52,4 years, were studied. A diagnosis of mild cognitive impairment (MCI) in 61 patients met traditional clinical approach, neuropsychological examination. Significant correlation between the level of cognitive dysfunction and blood concentration of NO, endothelin-1 and apoptosis markers in researching groups were found. The results obtained suggest that markers of endothelial dysfunction and apoptosis could prove to be the early predictors of cognitive impairment in patients with arterial hypertension.