Evaluation of the nutritional status at an early stage of hospitalization in patients with acute cerebrovascular insufficiency (CVA) is important for providing timely nutritional support. According to the Russian clinical guidelines for nutritional support of patients with stroke, the NRS‑2002 scale is essential to assessment the nutritional status. However, due to the obesity, about 30 % of patients do not entered into the general category of patients with CVA to get the standard examination.

Aim. To analyze the NRS‑2002 scale effectiveness in patients with acute cerebrovascular accident, taking into account the somatic and visceral protein pools.

Materials and methods. In the case of the prospective study the 140 patients with CVA were hospitalized in the primary vascular department of the City Clinical Hospital n. a. V. V. Vinogradov (Moscow, Russia), and were screened by the simplified malnutrition scoring system and the NRS‑2002 scale.

Results. The research reveals: A low risk of malnutrition in 34,3 % of all cases and 72,7 % in patients under 70 years; the high BMI – Me‑26,6 (24,2–30,8) kg/m²; the protein deficiency in 140 (25.7 %) of patients with normal somatic protein pool and in 66 (28.8 %) of patients under 70 years.

Conclusions. Detecting the risk of malnutrition with the NRS‑2002 scale in the early stage after hospitalization is not always informative due to the overweight and the age less than 70 years. The visceral protein pool analysis should be performed in all patients, independently of the NRS‑2002 scale and the somatic protein pool results.

Myasthenia gravis is a rare autoimmune disease, the clinical picture of myasthenia gravis is manifested by fluctuating weakness, pathological muscle fatigue and it is difficult for clinicians to diagnose it appropriately. The article presents a clinical case of misdiagnosis of late-onset myasthenia gravis, it provides a chronology of the development of symptoms of the disease and an analysis of the difficulties of differential diagnosis. Despite the typical manifestations of myasthenia gravis, the patient did not receive propriate pathogenetic therapy for a long time, while he was prescribed drugs that block neuromuscular conduction and worsen the course of the disease.

Involutionary forms of muscle pathology for the neurological community is ‘terra incognita’. The purpose of this publication is to describe clinical forms, pathogenesis, diagnostic and treatment methods of skeletal muscle diseases in the aging population.

Aim. To assess the impact of nightmarish dreams on various aspects of medical students' lives.

Materials and methods. A sociological survey was conducted among students of 1–6 courses of five medical universities using an online form which included the following questionnaires: the Pittsburgh Sleep Quality Index, the Hamburg Nightmare Questionnaire, the Insomnia Severity Scale, the Hospital Anxiety and Depression Scale, the Beck Anxiety and Depression Scale. Academic performance was assessed according to the average score of the student's record book according to a 5-point system.

Results and conclusions. A high prevalence of both insomnia and nightmares among medical students was found. The high frequency of nightmares was associated with high levels of anxiety and depression. The frequency of nightmares was associated with deterioration of sleep quality, frequency and degree of sleep impairment. Nightmarish dreams had a negative impact on the quality of cognitive activity assessed by academic performance.

Study of motor function restoration in patients with non-cardioembolic ischemic stroke during early rehabilitation period is presented. The first group (n = 92) consisted of patients who received standard rehabilitation treatment with biofeedback trainings of electromyographic modality. The second group (n = 100) of patients received standard rehabilitation treatment. There were no significant differences between the compared groups by gender, age, stroke risk factors and severity of the condition at the rehabilitation treatment start. Biofeedback trainings significantly improved kynesiophobia and increased the proportion of patients with a mild degree of addiction in daily living.

Aim. To study the features of heart rate variability in patients with obstructive sleep apnea (OSA) and comorbid pathology.

Materials and methods. Polysomnography and registration of heart rate variability (HRV) were performed in 98 patients who applied to a neurologist.

Results. Most of the HRV indicators in patients with OSA were significantly lower compared to the control group with orthostatic loading. The most notable of these were: TP (ms2), SDNN (ms), CV (%), HF (ms2), RMSSD (ms), DX (ms), LF (ms2). There were higher CI at rest (3.29 (1.53; 6.10), p = 0.034) and IVR (455.45 (286.95; 704.87), p = 0.014) during exercise in patients with OSA in comparison with the control group (1.73 (0.79; 3.93) and 344.00 (171.57; 440.87), respectively). It was found that arterial hypertension (94.6 %), chronic cerebral ischemia (80.4 %), and acute cerebrovascular accident (10.7 %) were significantly more common in patients with OSA than those examined without apnea (71.4 %, 42.9 % and 0.0 % respectively).

Conclusions. BMI, neck volume, saturation level, and desaturation index can be considered as criteria for referring patients for HRV registration in order to assess the state of adaptive reserves. In patients with OSA, according to HRV indicators, a shift in the autonomic balance was found, which is expressed by a weakening of vagal influences and the degree of participation of the autonomic circuit in the regulation of heart rate with an increase in sympathetic orientation and central control mechanisms, a decrease in the body's adaptive resources. Work should be continued to clarify the contribution of comorbid pathology in patients with OSA to the development of autonomic dysfunction.

Relevance. During the COVID‑19 pandemic, there has been an increase in the frequency of cerebral venous thrombosis (CVT) by 30–60 times. At the same time, the development of CVT does not depend on the severity of COVID‑19. Diagnosis of CVT during the COVID‑19 pandemic is particularly difficult, since the most common symptom of CVT, headache, can be regarded as a manifestation of COVID‑19. A wide range of clinical symptoms and low alertness of doctors leads to late diagnosis and verification of CVT.

Purpose of the study. To analyze the features of clinical manifestations and neuroimaging signs of CVT against the background of COVID‑19. Patients and methods. We examined 70 young and middle-aged patients with COVID‑19 of varying severity, who underwent inpatient treatment in angio-neurological and re-profiled infectious diseases departments of North-Western State Medical University n. a. I. I. Mechnikov (Saint Petersburg, Russia) at the age of 18 to 59 years (38.5 ± 11.58), of which 49 (70 %) women and 21 (30 %) men.

Results. The most common neurological symptom in patients with CVT due to COVID‑19 was diffuse headache. The severity of COVID‑19 and the degree of lung damage did not correlate with the severity of CVT. In 32 (46 %) cases, CVT was accompanied by the development of venous stroke: ischemic – in 13 (19 %) patients, hemorrhagic – in 7 (10 %), ischemic stroke with hemorrhagic impregnation – in 12 (17 %) patients. According to the localization of the thrombus, thrombosis of the left transverse sinus was most often noted – in 39 (57 %) cases.

Conclusions. The leading symptom in all patients with CVT was headache, which was not relieved by taking conventional analgesics, which caused clinical alertness of doctors. Early diagnosis of CVT ensured the immediate start of anticoagulant therapy and contributed to positive dynamics in all patients in the form of regression of neurological deficit and improvement in general condition.

Increasing in count of middle-aged and elderly people is setting a new direction for the development of medicine. The popular anti-age therapy is aimed at preventing the development and effective treatment of age-associated diseases. For female body the aging process is primarily associated with sex steroids production decreasing. Deterioration of cognitive activity affecting patients' ability to work and social involvement in perimenopausal period. A large number of estrogen and progesterone receptors have been found in different parts of the CNS. These receptors respond to signaling cascades triggered by hormones better during the period of primary estrogen deficiency, which determines the critical window period. Acting from this position, we studied 120 perimenopausal patients, who were divided into four groups: The first, the second and the third groups received different types of MHT, the fourth (control) group didn’t receive any treatment. All participants underwent clinical, laboratory and instrumental examination at the beginning and after 360 days of research. Our results demonstrated the efficacy of early start hormonal therapy to improve the cognitive abilities of women during the menopausal transition.

A clinical case of late manifestation of Wilson's disease. Etiology, features of neurological and somatic manifestation of disease, complexity of differential diagnosis in late manifestation of Wilson's disease are considered. Particular attention is paid to methods of diagnosis and treatment.