Chest pain is associated with adolescence and old age, female sex, tall stature, stoop, overweight, musculoskeletal pain of other localization, maladaptive movement patterns of work and rest, and accompanying psychological problems. Analysis of the literature data regarding the diagnosis and treatment of thoracalgias, as well as our own clinical experience, show that the work of a multidisciplinary team is most effective in overcoming pain.

Neuropathic orofacial pain caused by trauma to the distal branches of the trigeminal nerve is most often an iatrogenic complication in the practice of dentists, maxillofacial surgeons, ENT surgeons, cosmetologists and plastic surgeons. The pain is often high-intensity, persistent, and difficult to treat with pain medications. Early signs of spontaneous pain aggravate the course of the disease. There is evidence of the use of N-methyl-d-aspartate (NMDA) receptor antagonists in the treatment of neuropathic pain in the practice of oncologists and diabetologists. The present study was designed to test the efficacy of administration of the NMDA receptor antagonist amantadine (PK-Merz) in the treatment of neuropathic orofacial pain in patients with posttraumatic trigeminal neuropathy (PTN). Our task was to study the effect of amantadine (PK-Merz) on spontaneous burning and evoked types of pain.

Objective. To present a treatment protocol using amantadine (PK-Merz) and evaluate the effect of a three-time infusion of the drug on the clinical manifestations of pain in patients with post-traumatic trigeminal neuropathy.

Materials and methods. 30 patients were examined (22 women, 8 men). The average age is 42.6 years. Patients are experiencing amantadine (PK-Merz, Merz + Co., Germany) – 200 mg (500 ml) intravenously, drip, for 2 hours with a frequency of 1 time per week. A total of three infusions were performed. Spontaneous and evoked pain was measured within 48 hours before treatment, during treatment (after 1 hour), immediately after infusion (after 2 hours), as well as after 7, 14 and 21 days from the start of therapy. The effectiveness of therapy was studied according to the highest criteria: VAS, questionnaires for neuropathic pain DN 4 and Pain DETECT. Spontaneous and induced pain were considered separately. To assess the immediate effects of treatment, spontaneous pain was measured using a visual analog scale (VAS) before, after 1 hour, and at the end of each treatment (after 2 hours), as well as at visits on days 7th, 14th, and 21st. A series of mechanical and thermal stimuli was applied to each patient before, after 1 hour, and at the end of each treatment session to study the pain evoked. Pain caused by these stimuli was also measured using VAS.

Results. The patients were divided into two groups, which were formed according to the duration of the disease. Group 1 (n = 12) included patients in the acute period – the time after nerve injury ranged from 5 to 30 days. In group 2, patients were in subacute and chronic periods (time after injury ranged from 30 days to 1.5 years). The mean score of spontaneous pain according to VAS in patients of group 2 was significantly higher than in patients of group 1 (6.1 ± 2.1 vs 4.2 ± 1.6; p = 0.0001). A mean pain reduction of 71 % was reported at the end of amantadine infusion (after 2 hours) in patients in the acute period (Group 1) compared with 29 % in patients in Group 2. The difference in pain reduction between the two patient groups was statistically significant (p = 0.009). Further dynamics of pain also showed the best analgesic result in patients of group 1 – after the completion of treatment with amantadine (PK-Merz), in patients of group 1, a significant decrease in the average score of spontaneous burning pain according to VAS was demonstrated from 4.2 ± 1.6 points to 1.2 ± 1.1 points (p = 0.006; 71 ± 10 % reduction). After treatment of patients in group 2, only a slight and insignificant decrease in VAS was found from 6.1 ± 2.1 to 5.0 ± 1.7 (p = 0.400; 18.0 ± 8.5 %). Symptoms of induced pain were determined mainly among patients of the 2nd group – allodynia (n = 12), hyperalgesia to a needle prick (n = 10), thermal (cold) hyperalgesia (n = 10), "inflated" pain in response to repeated injections (n = 10). A mean decrease in allodynia of 52 % ± 8 % was found at the end of the course of treatment (3.8 ± 1.1 points at the beginning and 1.9 ± 1.1 points at the end; p = 0.006). Indicators of cold hyperalgesia (4.4 ± 1.4 points at the beginning, 2.7 ± 1.4 points at the end; p = 0.004) and ‘inflated’ pain (2.9 ± 1.1 points at the beginning, 1.5 ± 1.2 at the end; p = 0.004) before treatment and at the end of therapy (after 21 days) also differed significantly.

Conclusions. We concluded that amantadine (PK-Merz) infusion is a safe and effective treatment for neuropathic pain in the acute period of KITN, and also has a positive effect on the manifestations of induced pain in patients with chronic orofacial pain. Further trials of long-term oral or parenteral treatment with amantadine should be conducted.

The article analyzes results of a Doppler study of brachiocephalic vessels in the acute period of ischemic stroke. The role of the venous link of blood flow in maintaining the intracerebral constant in the acute period of ischemic stroke was revealed. The features of the reactivity of cerebral venous hemodynamics in patients with different volumes of brain damage during the formation of ischemic foci of various localization are shown. Attention is paid to the importance of a comprehensive assessment of cerebral venous circulation in the acute period of ischemic stroke. It was shown that in patients with ischemic stroke involving one or two lobes of one hemisphere of the brain, there was a significant increase in the size of the areas and a significant decrease in the speed indicators in the internal jugular and vertebral veins, respectively, the localization of the ischemic focus. It was found that in hemispheric ischemic strokes with signs of cerebral edema, cerebral blood flow disturbances were maximal and were accompanied by a paradoxical reaction of hemodynamic compensatory mechanisms, but no lateralization of dysgemia was observed according to the focus of ischemia.

Polymyalgia rheumatica (RPMA) is an inflammatory disease of the musculoskeletal system that is rarely diagnosed in patients over 50 years of age. RPMA is characterized by pain and prolonged morning stiffness in the shoulder, pelvic girdle, and neck. To date, there is no single clinical, laboratory or instrumental sign, the presence of which would confirm the diagnosis. The main method of treatment is oral therapy with glucocorticosteroids. Alternative treatment options include steroid-sparing therapy (methotrexate, tocilizumab). NSAIDs may be used to reduce pain.

Drooling is a common non-motor symptom of Parkinson's disease, affecting about half of patients at different stages of the disease. Drooling can significantly reduce quality of life and be a source of aspiration. This article reviewsfeatures and prevalence of this symptom in Parkinson's disease, as well as its assessment and current treatment options, including botulinum toxin therapy.

The article describes the peculiarities of a rare disease – hemiplegic migraine in three patients (two boys aged 7 and 15 and a girl of 12 years old). The family history of migraine was not burdened. Attack symptoms were almost identical: hemiparesis, dysphasia, and headache. The electroencephalograms, magnetic resonance imaging in all patients not presented signs brain dysfunction. Analysis of the literature data has been carried out. Thediagnostic criteria for hemiplegic migraine, its differential diagnosis is described. The considered description increases the awareness of doctors on the issue, which is very rare in the practice of pediatrician and neurologist.

Alzheimer's disease (AD) is the most common neurodegenerative disease-causing dementia. The severity of symptoms determines the diagnosis of AD, although an accurate diagnosis can only be made postmortem. Neuropsychological testing is the «gold standard» for early diagnosis of AD, but is time-consuming, does not allow a complete diagnosis with complete accuracy, is highly dependent on the correctness of the tests, and is rather an adjunct to the examination of the patient. Lumbar puncture and positron emission tomography are not available for routine screening of the population. Because the eye is an extension of the central nervous system, the study of its changes may lead to the development of a number of non-invasive differential diagnostic tests to identify patients with AD at an early stage. In recent years, the advent of quantifiable high-resolution imaging techniques that are non-invasive, rapid, and widely available has opened up a new field of ocular-neural imaging. In this paper, we review current foreign and domestic studies of some ocular biomarkers and the methods that could potentially be used in the early diagnosis of Alzheimer's disease.

The aim of the study. To study clinical, psychological and neuroimaging characteristics of chronic tension headache (CTH) in the elderly.

Materials and methods. 92 patients with CHTHN (37 men and 55 women aged 55–74 years) were examined. The control group consisted of 53 people (22 men and 31 women of the same age) who did not have neurological complaints, including headache. Pain intensity was assessed on a 10-point visual analogue scale. The severity of neurological symptoms was determined using the NIH-NINDS scale. For the study of cognitive functions, a short scale for assessing mental status was used Mini Mental State Examination (MMSE) and a frontal assessment battery (FAB). Memory was assessed according to the results of the memory subtest MMSE and the 10 words test. The level of attention was studied using the Schulte table, speech fluency – in the «fluency of speech» subtest of the FAB and in the test of verbal associations, visuospatial functions were assessed using the clock drawing test. Memory was assessed by the results of the subtest of memory MMSE and the 10-words test. The level of attention was studied using the Schulte table, the fluency of speech – in the subtest ‘fluency of speech’ FAB and in the verbal association test, visuospatial functions were assessed using the clock drawing test. Magnetic resonance imaging of the head was performed on a Magnetom Impact Expert (Siemens, Germany) tomograph with a magnetic field strength of 1.5 Tesla in T1 and T2 modes. The localization and severity of leukoaraiosis, signs of external and internal atrophy of the brain were determined, the linear dimensions of the anterior horns and central sections of the bodies of the lateral ventricles were measured, and the indices of the anterior horns and bodies of the lateral ventricles were calculated.

Results. Patients with chronic tension headache were characterized by clinical and cognitive heterogeneity: frequent «non-standard» characteristics of headache, severe polymorphism of algic manifestations, high frequency of comorbid disorders, cognitive dysfunction and somatic burden, high representation of leukoaraiosis, external and internal hydrocephalus according to MRI study.

The article reflects the significant domestic and foreign literature data result on the development of cerebral stroke against the background of malignant neoplasm analysis and the identification of specific risk factors for brain acute vascular lesions in patients with cancer.

Aim. Literature data analysis on cerebral stroke and specific risk factors for its development in patients with malignant neoplasms.

Materials and methods. Domestic and foreign literature sources on the influence of oncopathology on the cerebral stroke occurrence subject were studied.

Results. The presence of a malignant neoplasm seems to be an independent risk factor for death in patients with cerebral infarction, and its risk is the same in men and women. The main link in acute ischemic brain injury in patients with malignant neoplasms is the tissue factor expression that triggers a coagulation cascade with an increase in the level of D-dimer and other fibrin degradation products. Stroke risk is highest in the first 3 months after the detection of the tumor and significantly decreases by the year.

Conclusions. Scientific research of the oncopathology on the cerebral stroke development influence mainly concern the hemostasis study without assessing its platelet component and the oncopathology type in this category of patients, but do not sufficiently reflect the structure of acute cerebrovascular accidents. Literature analysis showed the absence of studies on the relationship between the strokes’ frequency and histological and immunohistochemical data.

The purpose of this review is to analyze the data of the modern literature on pathological postural postures in neurodegenerative diseases. This review provides data on the prevalence, clinical presentation, and treatment of axial postural deformities in parkinsonism and other neurodegenerative diseases. It also discusses possible pathophysiological mechanisms that require further study. Postural pathological postures were divided into deformities in the sagittal or frontal plane in accordance with the plane in which the deformity predominates. The most common pathological postural positions in neurodegenerative diseases are camptocormia, Pisa syndrome, antecollis, retrocollis, and scoliosis. Epidemiological studies of pathological postural postures in various neurodegenerative diseases are necessary to understand the frequency of occurrence of these conditions in the population and are necessary to identify and describe new types of postures. The study of the pathomechanism of each specific pathological posture in a particular patient is necessary to understand the tactics of managing this patient. The use of rehabilitation regimens of drug and non-drug therapy, depending on the type of course and the severity of the pathological postural posture, will help prevent this often irreversible condition and reduce the number of complications, for example, falls in patients with neurodegenerative diseases.