Cerebral venous thrombosis is rarely diagnosed in young patients, approximately 3–4 cases per a million people in the general population. This is probably due to the fact that the clinical manifestations of CVT are nonspecific and vary from isolated headaches to individual neurological symptoms. On the other hand, the detection of this pathology is difficult due to the lack of awareness of physicians about the diagnostic screening of risk factors. In recent years, risk factors associated with disorders in the blood coagulation system (genetically determined and acquired coagulopathy) and changes in the vascular wall have come to the fore, especially in female patients using oral contraceptives. However, the prescription of this group of drugs does not take into account the risk of developing vascular complications, such as cerebral vein thrombosis, so the concept of primary vigilance in adolescents with menstrual irregularities and women of reproductive age when prescribing hormonal drugs should be based on careful screening for changes in the coagulation system. organism. The concept of primary vigilance in the appointment of hormonal drugs should be based on careful screening for congenital or acquired changes in the coagulation system of the body. Significant genetic mutations for diagnosis are Leiden and F2-prothrombin G20210A, methylenetetrohydrophosphate reductase (MTHFR), plasminogen activator inhibitor (PAI-I), factor VII, glycoprotein (GP IIIa), deficiency of proteins C, S, and antithrombin. It is advisable to include the determination of vitamins B in screening. In non-pregnant women, folate deficiency can only be detected in erythrocytes, while normal in plasma. If any mutation is found in a patient, it is necessary to examine his next of kin to clarify their genetic profile and timely use of preventive measures against thrombosis, it is recommended to replace oral contraceptives with other methods of contraception. If a history of thrombosis has previously occurred, lifelong treatment with anticoagulants is indicated.
Aim. To study the effect of insomnia on the severity of the condition and quality of life in patients with disabilities.
Materials and methods. A prospective cohort study was conducted from 2019 to 2022, in which 100 patients participated. As a clinical model of persons with disabilities, patients who suffered cerebrovascular accidents were selected. The patients were divided into two groups: the main group – 50 patients who had suffered acute cerebrovascular accident and suffered from insomnia, and the comparison group – 50 patients who had suffered acute cerebrovascular accident, without concomitant insomnia. All patients were examined by the Rankin Scale, sleep quality questionnaires (Pittsburgh Sleep Quality Questionnaire and Insomnia Severity Scale) and the SF-36 Quality of Life Questionnaire.
Results and conclusions. The study made it possible to prove the influence of insomnia on the severity of patients' condition and their quality of life. This indicates the relevance of the detection and correction of sleep disorders in the complex treatment of patients with disabilities who have suffered acute cerebrovascular accident, which can increase the effectiveness of therapy for this category of patients.
Objective. To evaluate the relationship between the frequency of exacerbations and the rate of progression of multiple sclerosis (MS) and polymorphisms of the calcitriol receptor gene VDR FokI (rs2228570), BSMI (rs1544410), TaqI (rs731236), ApaI (rs7975232).
Material and methods. Ninety patients with relapsing-remitting MS took part in the study. All patients are Caucasians, were born and lived in the Altai region of the Russian Federation. Genotyping was performed by TaqMan probes.
Results. A protective effect of the TT genotype VDR FokI (rs2228570) on the risk of increasing disability of more than 0.75 points per year according to the expanded disability scale was found (p = 0.034). The protective effect of the TT genotype of the TaqI polymorphism (rs731236) on exacerbations of MS more than once a year (p = 0.041) was also revealed. Associations of the MS course with other studied polymorphisms were not found.
Conclusions. It can be assumed that the VDR FokI (rs2228570) and TaqI (rs731236) polymorphisms may influence the course of relapsing-remitting MS. The mechanisms of these influences may include the modulation of immune-inflammatory responses in the central nervous system, which are a key link in the MS pathogenesis.
Objective. To evaluate clinical and electroneuromyographic characteristics of vincristine polyneuropathy in children with acute lymphoblastic leukemia.
Materials and methods. A single-centre prospective cohort study involved 106 children with acute lymphoblastic leukemia, aged 3 to 17 years, with vincristine polyneuropathy; clinical and electroneuromyographic data were analyzed.
Results. In the majority of cases, 84.9 % (n = 90) of patients, vincristine polyneuropathy debuted during the induction phase of chemotherapy. The clinical picture was dominated by combined neurological disorders in 67.9 % (n = 72) cases, with sensory and motor disorders dominating. Sensory dysfunction was manifested predominantly by pain in the lower extremities, changes in the motor sphere were characterized by the development of distal paresis of the lower extremities. In 66.0 % (n = 70) of patients, neurological disorders corresponded to the 2nd degree of severity according to the toxicity scale (NCI-STAE). According to the ENMG study, all children had motor axonal neuropathy of the peroneal nerves.
Conclusions. The results of the study showed that the clinical picture of vincristine polyneuropathy is accompanied by sensory and motor symptoms. Currently, a complex of clinical and instrumental methods is used to verify the neurotoxic complication. The main objective method of diagnosis is an electroneuromyographic study. However, its capabilities are limited for determining the clinical manifestations associated with sensory disorders.
Myodistonic pain syndrome is a common cause of algia in the neck, back, limbs, emanating from skeletal muscles and adjacent fascia. Pathophysiologically, in this condition, myogenic trigger points are formed, which, increasing muscle tone, cause their spasm. The resulting discomfort can be both local and causing reflected signs in other areas. The article presents the main mechanisms of implementation and clinical classification of neurological manifestations of myodistonic pain phenomena from the position of pathomorphology of muscular and tendon-ligament localization. Separately, the possibility of a pathogenetic approach to preventive and therapeutic measures in the clinical manifestations of myodistonic pain syndromes is considered. In general, the article contains historical bibliographic material on the study of the development and formation of an autonomous scientific direction of myogenic pain pathology.
Objective. To study the structure and clinical features of vertigo in elderly patients with chronic cerebral ischemia (CCI) who underwent a new SARS-CoV-2 coronavirus infection.
Materials and methods. Clinical characteristics of vertigo were determined in 98 patients (48 men and 50 women aged 60–75 years) with CCI caused by arterial hypertension and its combination with atherosclerosis. The type and main characteristics of dizziness were determined using diagnostic criteria and an algorithm for examining patients. The level of anxiety was determined using the scale of Spielberger, depression – the Beck questionnaire.
Results. Dizziness in elderly patients with CCI was characterized by clinical heterogeneity with a predominance of non-systemic vertigo and systemic benign paroxysmal positional vertigo in the structure of vertigo. Elderly patients with CCI who underwent a new SARS-CoV-2 coronavirus infection were more likely to have psychogenic and systemic benign paroxysmal positional vertigo, increased levels of anxiety and depression.
Relevance. Cerebral venous thrombosis is a relatively rare pathological condition that often leads to the development of ischemic and/or hemorrhagic stroke.
Objective. Describe a clinical case of cerebral venous thrombosis, accompanied by the ischemic stroke with hemorrhagic transformation, in a reproductive age woman taking a combined estrogen-progestin drug from the group of oral contraceptives.
Patients and methods. The analysis based on the anamnesis data, clinical, laboratory and instrumental examination of the patient.
Results. A clinical case of a 23-year-old patient who had an acute ischemic stroke with hemorrhagic transformation is presented. According to the history data and instrumental methods, the stroke was caused by thrombosis of the cerebral sinuses, which developed on the background of hormonal contraception use. The clinical case is accompanied by MRI images of the patient's brain.
Conclusions. The risk of cerebral venous thrombosis in women with hormonal contraceptives use is almost 8 times higher than in those who do not receive hormone therapy. The occurrence of neurological symptoms in women of reproductive age requires a thorough study of the life history, obstetric/gynecological and pharmacological history to establish the fact of estrogen-progestin drugs use for contraception or treatment of hormonal disorders. The described case focuses on the importance of a delicate approach to prescribing hormonal therapy in the treatment of gynecological and other pathological conditions, and indicates the necessity to consider and recommend other contraceptives for young patients.
Currently, the multiple sclerosis (MS) is the second most common cause of disability in young people after injury [1]. Approximately 85 % of patients with MS have a relapsing course, which in a half of cases occurs within 15–20 years, culminating in steady progression with or without activity remaining in the form of an exacerbation or new active foci. Diagnosis of secondary progressive MS (SPMS) is difficult and the diagnosis of SPMS is made retrospectively. Therefore, in our article, we considered options for reliable and objective biomarkers that are natural predictors of conversion and are sources for long-term prediction of diseases.
Glioblastoma-related epilepsy requires paying careful attention to a combination of factors with an integrated approach. Major interrelated issues must be considered in the seizure care of glioblastoma patients. Seizure control frequently requires the administration of antiepileptic drugs simultaneously with other treatments, including surgery, radiotherapy and chemotherapy, with complete seizure relief often being difficult to achieve. The pharmacological interactions between antiepileptic drugs and antineoplastic agents can modify the activity of both treatments, compromising their efficacy and increasing the probability of developing adverse events related to both therapies. This review summarizes the new pathophysiological pathways involved in the epileptogenesis of glioblastoma-related seizures and the interactions between antiepileptic drugs and oncological treatment, paying special attention to its impact on survival and the current evidence of the antiepileptic treatment efficacy, including the potential usefulness of new third-generation compounds.
Introduction. In 2022, new clinical guidelines ‘Epilepsy and status epilepticus in adults and children’ were released, according to which it is recommended for adult patients with epilepsy to include behavioral methods in the form of self-management programs in addition to standard antiepileptic therapy as rehabilitation measures in comprehensive care for patients with epilepsy in order to improve the quality of life, cognitive functions and adherence to treatment. Considering the urgency of this problem and the opportunities offered by new clinical guidelines, there has been interest in a more detailed study of the EpiTapp® technique as an element of a self-management program in addition to standard antiepileptic therapy as a comprehensive care, using the example of a patient with structural focal epilepsy (SFE).
Objective. To present a clinical case of using the EpiTapp® application as part of a self-management program in addition to standard antiepileptic therapy as a comprehensive care for an adult patient with SFE.
Materials and methods. The study used the author's technique of brush tapping (RF patent No. 2606489 dated 10.01.2017). Patient A. used the EpiTapp® application in addition to the antiepileptic therapy she received, as a part of rehabilitation program for self-management of epileptic seizures, on an outpatient basis.
Results. The analysis of the diary of observation of epileptic seizures showed that in 93 % of cases, patient A. managed to stop the incipient motor focal seizure (FS) and prevent its transformation into a bilateral tonic-clonic seizure. Thus, against the background of regular use of the EpiTapp® method, the patient's frequency of FS decreased by 55.8 % by visit 4 compared to visit 2. Patient A. rated the effectiveness and safety of the EpiTapp® application by 95 %.
Conclusions. Thus, the use of the EpiTapp® application allowed a woman with difficult-to-treat SFE to gain control over epileptic seizures without changing the regimen and dose of antiepileptic therapy.
ISSN 2949-2807 (Online)