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M.S. Selikhova1, E.S. Zvereva2 1Volgograd State Medical University, Volgograd, Russian Federation 2Emergency Clinical Hospital No. 7, Volgograd, Russian Federation Pubertal abnormal uterine bleeding (AUB) is the leading cause of visits to health care provider during adolescent period. The paper describes clinical course of pubertal AUB and the assessment of their severity and hemostasis. The importance of stress factors and somatic comorbidities is discussed. Data on anemia severity in girls with AUB to assess blood loss and treatment efficacy are addressed. Ultrasound reveals ovarian cysts in 10% and endometrial hyperplasia in 17% of these girls. In girls with comorbidities (including obesity), symptomatic hemostasis is associated with high risks of recurrent AUB. When selecting antianemia drugs, the lack of toxicity, good tolerability, and availability of both parenteral and peroral formulations used in various clinical situations should be considered. After homeostasis was achieved, hormonal and antianemic treatment is continued for 3 months. Keywords: abnormal uterine bleeding, pubertal period, hemostasis, anemia, iron deficiency, iron supplements. For citation: Selikhova M.S., Zvereva E.S. Abnormal uterine bleeding in girls: tips and tools. Russian Journal of Woman and Child Health. 2019;2(4):351–354.

A neurological syndrome characterized by levodopa unresponsive bradykinesia, retropulsion with falls backwards, dysarthria, gait disturbance, dystonia, and emotional lability was identified in 13 male opiate addicts following the prolonged intravenous use of ephedrone (methcathinone), a central nervous stimulant prepared from pseudoephedrine, potassium permanganate, and vinegar. The natural history, response to treatment, and clinical features has been studied, and MR and dopamine transporter SPECT brain imaging were carried out. Pubic hair was sampled for manganese. The clinical and radiological picture closely resembled previous reports of chronic manganese poisoning and increased mean manganese level in pubic hair observed for at least 1 year after cessation of ephedrone. Odor identification was intact. Cognitive assessment showed a mild executive dysfunction and a mild depression. DaTSCANs were all normal. The neurological syndrome bears some similarities to PSP but differs from Parkinson's disease. Delayed neurological progression despite discontinuation of ephedrone occurred in one-third of cases. Ephedrone poisoning should be considered as a possible cause of secondary Parkinsonism in young adults, particularly from Eastern Europe. [ABSTRACT FROM AUTHOR]

Hormonal contraception and its role for the maintenance of reproductive potential in women with pelvic inflammatory disease M.S. Selikhova, P.A. Soltys, A.A. Smol’yaninov Volgograd State Medical University, Volgograd, Russian Federation Aim: To study the effect of pelvic inflammatory disease (PID) on female reproductive functions and the importance of hormonal contraception for the rehabilitation of these women. Patients and Methods: The study included two steps. During step 1, 117 women with acute manifestations of PID were examined. These women were subdivided into 2 groups. Group 1 included 36 women (30.8%) with acute PID diagnosed for the first time. Group 2 included 81 women with exacerbations of chronic PID (69.2%). During step 2, the effects of combined oral contraceptive pills (COCPs) on the rehabilitation of 87 women were analyzed. Results: Our findings demonstrate that PID is diagnosed in the active reproductive age (29.4±4.9 years). In a half of these women, reproductive function was not realized. Adequate antibiotic therapy considering antibiotic susceptibility does not provide complete rehabilitation after the disease. In the second stage 87 women took part, 21 of them women received COCPs (Midiana®) for a year after PID, 47 — for 6 months, 8 — for 3 months, 11 — did not received COCs. In 3 women who did not received COCPs (27.3%), inflammation has exacerbated. Menstrual disorders were reported in 5 women (45.5%). Conclusions: Combined single-phase low-dose contraceptive containing 30 μg of ethinylestradiol and 3 mg of drospirenone (Midiana®) provides rehabilitation after PID thus preventing PID recurrences within a year, regaining regular menstrual cycle, and restoring reproductive potential. Keywords: active reproductive age, pelvic inflammatory disease, rehabilitation, single-phase low-dose contraceptive, decrease in recurrence rate, regaining menstrual cycle, contraception. For citation: Selikhova M.S., Soltys P.A., Smol’yaninov A.A. Hormonal contraception and its role for the maintenance of reproductive potential in women with pelvic inflammatory disease. Russian Journal of Woman and Child Health. 2019;2(2):102–106.

Background and Purpose: This update of the treatment guidelines was commissioned by the European Academy of Neurology and the European section of the Movement Disorder Society. Although these treatments are initiated usually in specialized centers, the general neurologist and general practitioners taking care of PD patients should know the therapies and their place in the treatment pathway., Methods: Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the spectrum of approved interventions including deep brain stimulation (DBS) or brain lesioning with different techniques (radiofrequency thermocoagulation, radiosurgery, magnetic resonance imaging-guided focused ultrasound surgery [MRgFUS] of the following targets: subthalamic nucleus [STN], ventrolateral thalamus, and pallidum internum [GPi]). Continuous delivery of medication subcutaneously (apomorphine pump) or through percutaneous ileostomy (intrajejunal levodopa/carbidopa pump [LCIG]) was also included. Changes in motor features, health-related quality of life (QoL), adverse effects, and further outcome parameters were evaluated. Recommendations were based on high-class evidence and graded in three gradations. If only lower class evidence was available but the topic was felt to be of high importance, clinical consensus of the guideline task force was gathered., Results: Two research questions have been answered with eight recommendations and five clinical consensus statements. Invasive therapies are reserved for specific patient groups and clinical situations mostly in the advanced stage of Parkinson's disease (PD). Interventions may be considered only for special patient profiles, which are mentioned in the text. Therapy effects are reported as change compared with current medical treatment. STN-DBS is the best-studied intervention for advanced PD with fluctuations not satisfactorily controlled with oral medications; it improves motor symptoms and QoL, and treatment should be offered to eligible patients. GPi-DBS can also be offered. For early PD with early fluctuations, STN-DBS is likely to improve motor symptoms, and QoL and can be offered. DBS should not be offered to people with early PD without fluctuations. LCIG and an apomorphine pump can be considered for advanced PD with fluctuations not sufficiently managed with oral treatments. Unilateral MRgFUS of the STN can be considered for distinctly unilateral PD within registries. Clinical consensus was reached for the following statements: Radiosurgery with gamma radiation cannot be recommended, unilateral radiofrequency thermocoagulation of the pallidum for advanced PD with treatment-resistant fluctuations and unilateral radiofrequency thermocoagulation of the thalamus for resistant tremor can be recommended if other options are not available, unilateral MRgFUS of the thalamus for medication-resistant tremor of PD can be considered only within registries, and unilateral MRgFUS of the pallidum is not recommended., Conclusions: Evidence for invasive therapies in PD is heterogeneous. Only some of these therapies have a strong scientific basis. They differ in their profile of effects and have been tested only for specific patient groups., (© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Background: Procedural aspects and complications of gastrojejunostomy insertion are important considerations in the use of levodopa-carbidopa intestinal gel therapy (LCIG) and may limit uptake. We describe our experience of using per-oral image guided gastrojejunostomy (PIG-J) which avoids the need for endoscopy and routine sedation in percutaneous endoscopic gastrojejunostomy (PEG-J) and allows more secure tube placement than radiologically inserted gastrojejunostomy techniques., Methods: We describe a case series of 32 patients undergoing PIG-J insertion for LCIG therapy in a single centre. Under local anaesthetic, a fluoroscopy-guided gastric puncture allows access for the guidewire which is then used to pull through the gastrostomy tube allowing for secure fixation, followed by placement of the gastrojejunal extension., Results: Between December 2015 to April 2020, 32/34 patients referred for PIG-J underwent this procedure successfully, 2 cases unsuccessful due to technical considerations. One patient developed delirium following successful implantation. Ten patients (31%) required a replacement tube due to blockage or displacement within the first 12 months of placement, including 2 patients who needed more than one replacement. Minor complications occurred in 10 other patients (31%), including infection (9 patients); a small haematoma not requiring intervention who later developed an infection (1 patient); and peri-stomal acid leakage (1 patient)., Conclusion: In summary, PIG-J insertion is safe with a similar complication rate to traditional PEG-J, well tolerated and effective for use in LCIG administration. This may widen access to LCIG for PD patients who may not be suitable or unable to tolerate PEG-J., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: A number of cases of severe parkinsonism-dystonia have been recognized and reported following the illicit use of ephedrone prepared from pseudoephedrine and potassium permanganate. The pathology associated with ephedrone neurotoxicity has not been described yet in the scientific literature., Objectives: To report the first neuropathological study of ephedrone toxicity., Methods: The brain of a 33-year-old Ukrainian female ex-ephedrone addict with a long history of l-dopa-unresponsive parkinsonism with dysarthria, dystonia, profound postural instability, cock-gait, and frequent falls, and on antiretroviral treatment, was examined using routine stains and immunohistochemistry., Results: Neuropathological findings included diffuse pallidal astrogliosis without neuronal depletion. There was also widespread vascular pathology with small vessels occluded by foreign material, associated with giant cell response without any evidence of consequent focal infarction and a cerebellar abscess., Conclusions: Clinical findings of l-dopa-unresponsive parkinsonism with dystonia, caused by illicit use of ephedrone, are fully consistent with neuropathological changes in the pallidum, lack of change in the SN, and preserved tyrosine hydroxylase activity. The findings in the basal ganglia are compatible with manganese toxicity. The vascular pathology is likely a joint effect of infection and the ephedrone toxicity on the vessels. © 2020 International Parkinson and Movement Disorder Society., (© 2020 International Parkinson and Movement Disorder Society.)

The aim of the study was to estimate the efficacy of various variants of antibiotic prophylaxis of infectious complications in female patients after histeroscopy. 109 patients were examined. The patients were hospitalized for planned historoscopy. 55 of them were treated prophylactically to prevent infectious complications with a broad spectrum antibiotic administered intravenously 30 min prior to the operation. A course antimicrobial therapy during the postoperative period was applied to 54 females. The results of the trial showed that single administration of an antimicrobial provided high level prevention of infectious complications, whereas the use of course antimicrobial therapy during the postoperative period was of no advantage by the efficacy.

Background: Dementia is one of the milestones of advanced Parkinson's disease (PD), with its neuropathological substrate still being a matter of debate, particularly regarding its potential mechanistic implications., Objective: The aim of this study was to review the relative importance of Lewy-related α-synuclein and Alzheimer's tau and amyloid-β (Aβ) pathologies in disease progression and dementia in PD., Methods: We reviewed studies conducted at the Queen Square Brain Bank, Institute of Neurology, University College London, using large PD cohorts., Results: Cortical Lewy- and Alzheimer-type pathologies are associated with milestones of poorer prognosis and with non-tremor predominance, which have been, in turn, linked to dementia. The combination of these pathologies is the most robust neuropathological substrate of PD-related dementia, with cortical Aβ burden determining a faster progression to dementia., Conclusion: The shared relevance of these pathologies in PD progression and dementia is in line with experimental data suggesting synergism between α-synuclein, tau and Aβ and with studies testing these proteins as disease biomarkers, hence favouring the eventual testing of therapeutic strategies targeting these proteins in PD.

Aims: To examine a syndrome of chronic manganism that occurs in drug addicts in eastern Europe who use intravenous methcathinone (ephedrone) contaminated with potassium permanganate. In many cases the basal ganglia, especially the globus pallidus and the putamen, are damaged irreversibly. Routine neuropsychological assessment has revealed no cognitive deficits, despite widespread abnormalities on brain imaging studies and severe extrapyramidal motor handicap on clinical examination., Design: Case-control study., Setting: Ephedrone patients and patients with opioid dependence were recruited from Lviv, Ukraine., Participants: We tested 15 patients with ephedrone-induced toxicity, 13 opiate-dependent patients who were receiving opioid replacement therapy and 18 matched healthy volunteers., Measurements: The 'beads task', an information-gathering task to assess reflection impulsivity, was used and feedback learning, working memory and risk-taking were also assessed., Findings: Opiate-dependent patients differed from controls on three of four tasks, whereas ephedrone patients differed from controls on only one task. More specifically, both patient groups were more impulsive and made more irrational choices on the beads task than controls (P < 0.001). However, ephedrone patients had no deficits in working memory (P > 0.1) or risk-taking (P > 0.1) compared with controls. Opioid-dependent patients had significantly worse working memory (P < 0.001) and were significantly more risk-prone than controls (P = 0.002)., Conclusions: Ephedrone patients may have similar deficits in information-gathering and decision-making to opiate-dependent patients, with preservation of working memory and risk-taking. This may reflect specific damage to anterior cingulate- basal ganglia loops., (© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.)

Benign tremulous parkinsonism, a tremor dominant syndrome with a relatively slow rate of deterioration, is recognized by clinicians although its pathological basis is not well understood. A systematic review of Queen Square Brain Bank donors was carried out to determine the natural history and pathology of individuals who had tremor dominant parkinsonism with mild non-tremor components and minimal gait disability for at least 8 years. We identified 16 cases of pathologically proved benign tremulous Parkinson's disease (PD); another 5 individuals conformed to the definition but did not have the pathology of PD. Patients with verified benign tremulous PD had less severe neuronal loss in the substantia nigra than controls (χ(2): P = .003). Twelve of these had been correctly diagnosed with PD at their first neurological evaluation, whereas the other 4 were originally thought to have another tremor disorder. The only consistent distinguishing feature of the 5 pathologically disproved cases, who may have had either essential tremor with associated rest tremor or dystonic tremor, was a failure to develop unequivocal bradykinesia within a decade of onset of tremor at rest. Our findings support the existence of a distinct subgroup of benign tremulous PD. The slower rate of clinical progression correlates with less severe nigral cell loss at postmortem, although many of these patients transgress the benign tremulous parkinsonism definition by the final third of their disease course and develop the common features of advanced PD., (Copyright © 2012 Movement Disorders Society.)

Links between impulsive-compulsive behaviors (ICBs) in treated Parkinson's disease (PD), behavioral addictions, and substance abuse have been postulated, but no direct comparisons have been carried out so far. We directly compared patients with PD with and without ICBs with illicit drug abusers, pathological gamblers, and age-matched healthy controls using the beads task, a test of reflection impulsivity, and a working memory task. We found that all patients with PD made more impulsive and irrational choices than the control group. PD patients who had an ICB showed similar behavior to illicit substance abusers, whereas patients without ICBs more closely resembled pathological gamblers. In contrast, we found no difference in working memory performance within the PD groups. However, PD patients without ICBs remembered distractors significantly less than all other patients during working memory tests. We were able to correctly classify 96% of the PD patients with respect to whether or not they had an ICB by analyzing three trials of the 80/20 loss condition of the beads task with a negative prediction value of 92.3%, and we propose that this task may prove to be a powerful screening tool to detect an ICB in PD. Our results also suggest that intact cortical processing and less distractibility in PD patients without ICBs may protect them from developing behavioral addictions., (Copyright © 2012 Movement Disorder Society.)

A 20-year-old ambidextrous female student with a 15-year history of refractory seizures was admitted to the epilepsy department for a second opinion on her diagnosis and treatment. She developed frequent motor paroxysms at the age of 4-5 years, which appeared resistant to antiepileptic therapy and which have continued to the present day. Over the last 8 years she also had five generalised tonic-clonic seizures. There is a family history of epilepsy on the maternal side. The first type of episode is characterised by left-hand flickering, associated with head turning and loss of awareness. During the second type of attack the patient demonstrates vigorous hand biting which starts without warning. The patient appears disorientated subsequently. EEG telemetry was performed and confirmed the diagnosis of both epilepsy and non-epileptic attacks. Literature reports of the relevant cases are discussed.

The Hospício de Juquery, near the city of São Paulo (Brazil) was founded in 1896 and after few years it was decided that the institution should have the best possible facilities to study neuropathology. In 1921, a young psychiatrist, Antonio Carlos Pacheco e Silva was sent to the Hôpital de la Salpêtrière (Paris) to study neuropathology. There, Pacheco e Silva (later Prof.Pacheco e Silva) befriended Konstantin N. Tretiakoff accepted an invitation to become the first Chairman of the newly created neuropathology department of the Hospício de Juquery. During his stay in this institution, from 1922 to 1924 or early 1925, he worked very hard and produced many publications. Here we present and comment some of the papers he published in a Journal (Memórias do Hospício de Juquery - 'Memoirs de l'Hôspice de Juquery'), which had been recently created and present some information of this poorly known period of his life.

Konstantin Tretiakoff's doctoral dissertation "Contribution a l'Etude de L'Anatomie pathologique du Locus Niger de Soemmering avec quelques déductions relatives à la pathogénie des troubles du tonus musculaire et De La Maladie de Parkinson" (A Study of the Pathological anatomy of the locus niger of Soemerring and its relevance to the pathogenesis of changes in muscular tone in Parkinson's disease) published in 1919 earned him a silver medal awarded by the University of Paris but failed to gain him the recognition its importance deserved. Despite belated acknowledgment of the importance of his findings Tretiakoff received little acclaim during his life and there have been no biographical accounts written in English or French. Fifty years after his death it seems appropriate to relate some aspects of his interesting peripatetic life and recognize the continuing relevance of his pioneering research on "the black stuff" to our understanding of Parkinson's disease., ((c) 2008 Movement Disorder Society.)

47 PD patients were investigated with the single-pulse TMS to find out changes in motor evoked potential and motor conduction related to the stage of minimal motor symptoms and its further deterioration in groups with the different clinical types of the disease. The investigation revealed a markedly longer MEP duration along with the increased number of phases, than in controls, which were bilateral and advanced despite the minimal unilateral motor symptoms. There was also increased MEP amplitude in facilitation, with a higher degree of asymmetry, compared to controls. Patients with predominant rigid clinical forms had the further MEP duration and amplitude increase proportionally to bradikinesia and rigidity in the early stages of the disease. Patients with tremor predominant forms had no further changes in the MEP duration and amplitude, but had their motor CCT decreased in the early stages. Patients with the akinetic form were characterized by the asymmetric increase in the MEP Amplitude in relaxation and motor CCT shortening. Thus, TMS allows us to diagnose early the possible central motor changes secondary to Parkinson's disease, reveals the difference in compensational capacity according to the clinical type of the disease and helps in monitoring of the severity of motor changes in early stages.

A conception of the approach to Parkinson's disease treatment at early stage, which could be realized in practice is suggested. The conception is based on the results of dopaminergic drugs treatment of 149 patients, aged 33-87 years. The patient's state was assessed by neurological examination and clinical scales with regard to different disease types, tremor and rigid, and levodopa doses--from moderate (up to 500 mg) to high (above 500 mg). A general treatment policy, including therapy directed to activation of regulatory and compensatory influences and differentiated usage of levodopa and combined therapy with levodopa and dopamine agonists, is presented.

One hundred and forty-nine patients with Parkinson's disease (PD), mean age 66.3 years, have been examined. It was found that the early stage of the disease might include isolated depression, minimal movement disorders and functional compensation, the latter being observed during L-Dopa treatment. In general, the peculiarities of this stage comprise polymorphism of clinical symptoms, predominance of movement disorders over high mental dysfunctions and slow progression of pathological disorders with patient's adaptation to developing defect and reversibility of some dysfunctions under the treatment. The early stage was distinguished also by independence of high mental functions damage on movement disorders severity. More pronounced disturbances were detected in akinetic PD type in the presence of depression in the older patients. Depression may be a prodrome of movement disorders manifestation. The above peculiarities of the early stage are important for early PD diagnosis.

Daily urinary catecholamine excretion (DOPA, DA, DOPAC, NA, A) was studied in 66 patients with Parkinson's disease, 38 of them with differently expressed depression. Depression severity correlated with rigid form of disorders (p < 0.001). Biochemical profile of the depressive patients was characterized by noradrenaline (NA) to adrenaline (A) ratio reduction (p < 0.01) and dopamine to NA (p < 0.01) ratio increase on the background of total catecholamines deficit. Changes of NA/A and DOPA and correlation between DOPA and depression severity imply a role of dopamine neuromediator deficit in depression development.

Catecholamine metabolism was evaluated by daily urine excretion in patients with Parkinson's disease of tremor (18 patients) and rigid (14 patients) types. The group included 16 untreated patients. According to urine analysis, most informative peripheral markers for dopamine metabolism proved to be DOPA excretion, 3,4-dioxyphenylacidic acid (DOPAA) level and DOPA/DOPAA ratio. In the initial disease stage, a marked decrease of free dopamine and noradrenaline as well as dopamine metabolism intensification with corresponding DOPA/DOPAA ratio decrease were found. Significantly lower DOPAA and DOPA excretion was detected in patients with predominance of akinesia and rigidity types compared to tremor ones. In contrast to untreated patients, those treated with drugs containing dopamine revealed correlations between daily urine DOPA excretion as well as DOPA/DOPAA ratio with neurological symptoms severity.

The study included 22 patients with poststroke epilepsy (group 1) and 30 patients with stroke without epilepsy (group 2). A bilateral decrease of the time of central conduction (TCC) through pyramidal path (both on the paretic and intact side) was revealed in group 1. This was not observed in patients of group 2 with similar gravity of motor disorders (p < 0.01). Tendency to TCC decrease was also observed in patients without epileptic disorders by day 5-6 after ischemic stroke. However, TCC values were increased in such patients by day 10-14. Low indices persisted for a long time in patients with poststroke. There was also an increase of delta index of facilitation (the difference between TCC in rest and in muscle effort). It was also found that motor disorders in the group of patients with poststroke epilepsy were characterised by higher muscular tone than in poststroke patients with the same degree of the paresis.

The paper presents the results of clinical and neurophysiologic study of muscular tonus in 94 patients aged 42-70 years in early recovery after ischemic stroke. Selective role of spasticity was estimated in clinical pattern of motor disorders in groups of the patients with different disorders of muscular tonus with the same degree of paresis. Efficiency of antispastic preparation sirdalud was analyzed in 28 patients from this group. Sirdalud in daily dose of 6-12 mg in patients with prevalence of a spasticity in a clinical picture of the paresis and with either moderate or manifested degree of paresis of the extremities has significant antispastic effect without any decrease of muscular strength, which, in turn, increases the degree of restoration of motor functions.

The paper presents the results of follow-up study of 610 patients with ischemic stroke. In 52 patients (8.6%) there was observed symptomatic epilepsy conditioned by local causes (2 and more epileptic fits in anamnesis). The age of the onset of epileptic seizures was in the range 50-69 years, and men prevailed. From all 52 patients with episyndrome 36 had only one stroke, 16 patients-two and more strokes. 14 patients had fits before the stroke development. Meanwhile in 10 patients the fits were the first stroke symptoms (early) and in 28 individuals the fits arose 7 days after the stroke development (late). Significantly more severe disorders of dynamic praxis were revealed in psychologic examination of the patients with secondary generalized fits than of ones with partial seizures. Pathogenetic and clinical aspects of vascular epilepsy, interactions between transitory ischemic attacks and the fits which developed before the stroke are considered.

54 patients were treated by notropil (pyracetam). The results of therapy were evaluated statistically according to a number of clinical scales and neurophysiologic indices (EEG and evoked potentials with mapping of bioelectric activity). The results were compared with the data about 56 patients of the control group which were treated by traditional method without application of notropil. Notropil was applied by two ways: small doses (4-12 g daily) during 5 days or high doses (10-12 g daily) during 30 days from the moment when the patient admitted to the hospital. Intravenous injections of the drug were used in all cases as well as its internal administration. It was showed either efficiency of the drug, especially in high doses, in early beginning of the treatment and its duration for at least 30 days or good tolerance of the drug. Authors supposed that application of pyracetam is not adequate in strokes with severe disorders of consciousness and cerebral edema.

Bronchial asthma (BA) patients with hyperventilation (HV) were examined by means of evoked cutaneous sympathetic potential (ECSP) and short-latency evoked stem potentials to acoustic stimulation (SLESP to AS). Measurements of these parameters allowed quantitation and differentiation of hyperventilation disorders in BA patients. The latter were divided into 4 groups: BA patients with HV syndrome (HVS), BA patients with functional HV (FHV), BA patients with spontaneous HV (SHV) and BA patients without HV. BA patients with HVS exhibited a significant increase of latent ECSP period and latent periods III and V SLESP to AS peaks. This evidences for vegetative neuropathy and dysfunction of the pons and mesencephalic brain compartments. In BA patients with FHV there was a longer latent period II of SLESP to AS peak indicating dysfunction of caudal brain stem. BA patients with SHV and without HV had no significant shifts.

Thirty patients with acute ischemic stroke and at early terms of postapoplectic recovery received cerebrolysin in daily doses 10, 20 and 30 ml for 5 days or 10 ml, i. v. for 10 days, respectively. The patients were examined for neurological status and cerebral function. In acute stroke the highest effect occurred in the affection of moderate severity. In severe stroke the drug stimulated recovery of impaired functions which tended to restore more quickly than in control subjects. In early convalescents cerebrolysin improved motor functions. Details of the results of the combined neurophysiological examination in the course of the treatment are discussed.