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The article presents a case of acute uremic neuropathy. Without any visible cause, a 71-year-old patient felt weakness in legs and numbness in feet. Her neurological status assessment on admission to the hospital showed peripheral tetraparesis and impaired sensitivity of the polyneuropathic type. Neurological symptoms appeared due to renal dysfunction, which had been confi rmed with laboratory test. Electroneuromyography revealed signs of acute demyelinating polyneuropathy. Аt the hospital, the patient was diagnosed Alzheimer’s disease. The treatment provided at the hospital led to normalization of her laboratory parameters and complete restoration of motor functions. The peculiarity of the presented clinical case is that the patient started violating drinking regime due to her cognitive impairment which resulted in renal dysfunction and acute uremic neuropathy. The other peculiarity of the case is that it was enough to correct the water-electrolyte disorders to fully restore the patient’s motor functions within a month, without the use of dialysis. Finally, the article discusses the issue of pathogenesis and diff erential diagnosis of other types of polyneuropathies.

Isolated oculomotor disorders caused by central nervous system damage are quite rare. As a rule, they are combined with other signs of cerebral trunk damage. A clinical case with the focus of amyelination in the cerebral trunk area, which manifests itself in the form of bilateral horizontal gaze palsy in the absence of other focal neurological symptoms is presented. A complete regression of oculomotor disorders was observed against the background of glucocorticosteroid therapy. A differential research was carried out among amyelinating, ophthalmic, endocrinologic diseases, ANCA-associated vasculitis (AAV).

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.

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.

A medical case of an acute demyelinating process in cerebrum caused by taking levamisole is presented. The issues of pathogenesis and differential diagnosis of levamisole-induced leukoencephalopathy with acute disseminated encephalomyelitis, multiple sclerosis, progressive multifocal leukoencephalopathy, and cerebral lymphoma are discussed.

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.

Dementia with Lewy bodies (DLB) is characterized by a combination of progressive cognitive, motor impairments and autonomic dysfunction. Motor impairments in DLB may manifest themselves with mild parkinsonian signs as well as with classic parkinsonism. A case of a female patient, who developed LBD 5 years after being diagnosed with oromandibular dystonia, is presented.Деменция с тельцами Леви характеризуется сочетанием прогрессирующих когнитивных, двигательных и вегетативных нарушений. Двигательные расстройства проявляются как легкими паркинсоническими проявлениями так и классическим паркинсонизмом. Представлено собственное наблюдение пациентки, у которой развилась деменция с тельцами Леви через 5 лет после постановки диагноза оромандибулярной дистонии.

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

The authors present a case-report of Segawa's syndrome. Clinical characteristics, genetic background and treatment options with special emphasis on a differential diagnosis are discussed.Представлен клинический случай синдрома Сегавы. Обсуждаются клинические особенности заболевания, генетическая детерминированность, специфика лечения. Особое внимание уделяется дифференциальной диагностике.

To study the diagnostic significance of additional vascular lesion markers in patients with chronic cerebral ischemia (CCI).Markers of inflammation (МСР-1, CRP) and angiogenesis (VEGF in blood serum and plasma) were studied in 50 patients with CCI and 60 healthy people.It was shown that the development of immunoinflammatory processes in patients with CCI is accompanied by the decrease in the content of vascular endothelial growth factor in the serum and blood plasma.Цель исследования. Выявление диагностического значения дополнительных биомаркеров поражения сосудистого русла у больных с хронической ишемией головного мозга (ХИМ). Материал и методы. Исследованы маркеры воспаления (МСР-1, СРБ) и ангиогенеза (VEGF) в сыворотке и плазме крови у 50 пациентов с ХИМ и 60 здоровых. Результаты и заключение. Показано, что развитие иммуновоспалительных процессов у больных с ХИМ сопровождается снижением содержания фактора роста эндотелия сосудов в сыворотке и плазме крови.Цель исследования. Выявление диагностического значения дополнительных биомаркеров поражения сосудистого русла у больных с хронической ишемией головного мозга (ХИМ). Материал и методы. Исследованы маркеры воспаления (МСР-1, СРБ) и ангиогенеза (VEGF) в сыворотке и плазме крови у 50 пациентов с ХИМ и 60 здоровых. Результаты и заключение. Показано, что развитие иммуновоспалительных процессов у больных с ХИМ сопровождается снижением содержания фактора роста эндотелия сосудов в сыворотке и плазме крови.

To study a relationship of arterial hypertension (AH) severity with the cerebral blood flow and structural changes in the brain matter, processes of lipid peroxidation and antioxidant defense, parameters of homeostasis, indicators of endothelial dysfunction and apoptosis.A complex study of 84 patients with AH, aged from 43 to 64 years, was carried out.The severity of atherosclerotic damage increased with the increasing of the AH degree. There were the sings of cerebral atrophy, changes in the white matter of brain hemispheres accompanied by the increase of oxidative stress and insufficient antioxidant activity, appearance of procoagulation shifts in the homeostasis system, along with the moderate activity of fibrinolysis, increase in the level of proinflammatory cytokines and markers of apoptosis, endothelin-1, decrease in nitrogen oxide concentration.Цель исследования. Изучение состояния церебрального кровотока и структурных изменений вещества головного мозга, процессов перекисного окисления липидов и антиоксидантной защиты, параметров гемостаза, показателей эндотелиальной дисфункции и апоптоза в зависимости от степени артериальной гипертензии (АГ). Материал и методы. Проведено комплексное обследование 84 больных с АГ в возрасте от 43 до 64 лет. Результаты и заключение. По мере нарастания степени АГ увеличивается выраженность атеросклеротического поражения магистральных сосудов, проявляются признаки церебральной атрофии, изменения белого вещества полушарий головного мозга, сопровождающиеся нарастанием явлений оксидативного стресса на фоне недостаточной антиоксидантной активности; с появлением в системе гемостаза прокоагуляционных сдвигов наряду с умеренной активацией фибринолиза; повышением уровня провоспалительных цитокинов и маркеров апоптоза, эндотелина-1; снижением концентрации оксида азота.

To study the correlation between expressiveness of focal changes of brain tissue and VEGF and MCP-1 levels in plasma and blood serum of patients with chronic cerebral ischemia (CCI).Markers of inflammation (MCP-1, CRP) and angiogenesis (VEGF) in serum and blood plasma of 35 patients with CCI depending on expressiveness of structural changes of brain substance according to MRI were investigated.The increase in MCP-1 and CRP content in blood serum and simultaneous decrease in VEGF level in serum and blood plasma were correlated with the increase in the number of focal changes of substance of the brain in patients with CCI.Цель исследования. Изучение связи между выраженностью очаговых изменений ткани головного мозга и уровнями VEGF и МСР-1 в плазме и сыворотке крови у больных с хронической ишемией головного мозга (ХИГМ). Материал и методы. Исследованы маркеры воспаления (MCP-1, CPБ) и ангиогенеза (VEGF) в сыворотке и плазме крови у 35 пациентов ХИГМ в зависимости от выраженности структурных изменений вещества мозга по данным МРТ. Результаты и заключение. Показано, что нарастание содержания в сыворотке крови МСР-1 и СРБ одновременно со снижением уровня VEGF в сыворотке и плазме крови связано с увеличением количества очаговых изменений вещества головного мозга у больных с ХИГМ.

Traumatic brain injury is among the leading social-medical problems that causes preventable deaths, health deterioration and disability in young individuals. It is manifested by neurologic and psychiatric disorders, firstly by neurocognitive impairment. Therapeutic interventions in traumatic brain injury include correction of cerebral disorders in the acute phase of trauma, treatment of neurocognitive impairment and symptomatic treatment of mental disorders. The efficacy of treatment of neurocognitive deficits associated with brain injury is still unsatisfactory, which determines the need to find new medicines and therapeutic approaches.Травматическое повреждение мозга является одной из ведущих социально-медицинских проблем, поскольку обусловливает высокую частоту случаев смерти, ухудшения здоровья и утраты трудоспособности у молодых людей. Оно проявляется различными неврологическими и психическими расстройствами, в первую очередь нейрокогнитивными. Терапевтические вмешательства при травматическом поражении мозга включают коррекцию церебральных нарушений в острый период травмы, лечение нейрокогнитивных нарушений и симптоматическую терапию психических расстройств. Эффективность лечения нейрокогнитивного дефицита, связанного с мозговой травмой, до сих пор остается неудовлетворительной, что определяет необходимость поиска новых лекарственных средств и лечебных подходов.