HEADACHE, SEIZURES, COGNITIVE DISORDERS, AND CEREBROVASCULAR DISEASES AS THE MOST COMMON NEUROPSYCHIC SYNDROMES IN SYSTEMIC LUPUS ERYTHEMATOSUS

The nervous system is often involved in the pathological process in systemic lupus erythematosus (SLE). Neuropsychic SLE includes a combination of syndromes. Headache, seizures, cognitive disorders, cerebrovascular diseases are the most common ones. Pathogenetic mechanisms for the development of neuropsychic syndromes are different. Individual diagnostic and therapeutic strategies for the disease and the patient should be used. This article presents the literature and our own data on the most common neuropsychic syndromes associated with SLE

Cognitive impairments in some cardiovascular and somatic diseases

The paper gives an update on the pathogenesis, clinical presentation, and pathomorphology of cognitive impairments (CIs) in different autoimmune, endocrine, and infectious diseases: systemic lupus erythematosus, Sjögren’s syndrome, Behchet’s disease, primary angiitis of the central nervous system, polyarteritis nodosa, cryoglobulinemic vasculitis, hypothyroidism, herpetic lesion, and neurosyphilis. It is noted that treatment for CIs should be individual in terms of virulence factors. In vascular CIs, therapy should be aimed primarily at modifying risk factors and eliminating or reducing chronic brain ischemia. The prevention of progressive CI encompasses antihypertensive and antithrombotic therapies and surgical correction of atherosclerotic great artery stenosis. Control of hyperlipidemia, hyperglycemia and treatment of other somatic diseases are also of great importance. Such patients are usually given cetylcholinesterase inhibitors, acetylcholine precursors, antiglutamatergic agents, and metabolic and vascular drugs. By taking into account brain ischemia/ hypoxia in the above diseases, it is shown to be advisable to use antioxidants, cerebral active agents in particular, which have a complex neurometabolic effect

Potential use of dimensionhydrinate/cinnarizine combination in the treatment of vertigo

Vertigo is a fairly common complaint with which patients present to physicians of various profiles, and especially to general practitioners, neurologists, and otorhinolaryngologists. Vertigo is a condition where a person has the illusion of movement or of surrounding objects moving when they are not. Vertigo is a symptom of a wide range of diseases, both benign and life-threatening. Vertigo can have a variety of causes, and the suggested treatment should depend on the cause. Due to the multifactorial etiology of medical care, many patients receive inadequate treatment under the primary healthcare scheme, especially during initial presentation. The main causes of vertigo are benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuritis, vestibular migraine, and cerebrovascular diseases. Patients with other disorders, such as depression and hyperventilation syndrome, may present with complaints of nonrotary vertigo. Differential diagnosis of vertigo can be made using easy-to-perform tests during physical examination, including assessment of nystagmus, Dix-Hallpike maneuver, and blood pressure measurements with head-up tilt table tests. Treatment of patients with complaints of vertigo includes drug and non-drug therapy, depending on the established nosological form. However, due to the multifactorial etiology, many patients receive inadequate treatment under the primary healthcare scheme, especially during initial presentation. The dimensionhydrinate/cinnarizine combination is one of the drugs for the symptomatic treatment of vertigo of various origins in adults

Role of lipoprotein (a) in the development of ischemic stroke and other cardiovascular diseases

The paper gives the data available in the literature on the role of a level of elevated lipoprotein (a) (Lp (a)) in the development of ischemic stroke and other cardiovascular diseases. It shows the normal level of Lp (a) and the typical distribution of its concentration for people of European origin and representatives of other races. There is evidence on the genetic determination and variability of the Apo (a) gene. The paper presents the results of the recent large survey of 8000 patients with coronary heart disease and 8000 control persons, which has studied candidate genes for cardiovascular diseases. It indicates the role of Lp (a) as a risk factor for early atherosclerosis and describes main pathomorphological mechanisms. The propositions that it is necessary to screen Lp (a) in different risk groups, its target level, and possible methods for correcting the elevated Lp (a) level are given

CAROTID CHEMODECTOMA: DIFFERENTIAL DIAGNOSIS ACCORDING TO ULTRASOUND DATA

Carotid chemodectoma (“chemodectoma caroticum”, a carotid glomus tumor) is a benign slow-growing, vascularized tumor that is one of the most common paragangliomas of the head and neck. The ultrasound examination of 18 000 patients referred for various reasons revealed 2 cases of carotid chemodectoma verified by angiography. The paper gives the current ideas of the rate, etiology, pathomorphology, and clinical manifestations of chemodectoma, as well as its major ultrasound differential diagnostic criteria

Cognitive impairments in epilepsy

Cognitive impairments in epilepsy are a current problem in neurology. The basis of the idea on the pathogenesis of higher nervous system dysfunctions is the interaction of a few factors that include the form and duration of the disease, gender differences, and the impact of antiepileptic therapy. The role of interattack epileptiform changes in the development of cognitive deficit in adults and epileptic encephalopathies in children is discussed. Up-to-date neurophysiological and neuroimaging diagnostic methods allow the detection of new features in the course and progression of higher nervous system dysfunctions in epilepsy

Гипоплазия позвоночной артерии и мозговой кровоток у пациентов с острыми и хроническими нарушениями мозгового кровообращения

To assess peculiarities of cerebral blood flow in patients with hypoplasia of vertebral artery, 100 patients were examined. Patients after acute ischemic stroke, chronic ischemic diseases, and a group of healthy patients were separated. In patients with acute ischemic stroke, a reliable decrease was found in the degree of blood flow increment in the posterior cerebral artery at rhythmic photostimulation, as well as in the total volume blood flow in the vertebral-basilar basin.Представлено исследование особенностей мозгового кровотока у пациентов с гипоплазией позвоночной артерии и нарушениями мозгового кровообращения. У пациентов с острыми нарушениями мозгового кровообращения выявлено достоверное уменьшение степени прироста кровотока в задней мозговой артерии при ритмической фотостимуляции, уменьшение общего объемного кровотока в вертебрально-базилярном бассейне

«Masks» of alcoholic polyneuropathy

The paper considers the aspects of clinical manifestations, diagnosis, and therapeutic approaches in alcoholic polyneuropathy (PNP). It gives the data available in the literature on the prevalence of this disease in different countries and on the frequency of alcohol drinking in men and women. The author describes main risk factors for alcoholic PNP, such as malnutrition, thiamine deficiency, direct alcohol toxicity, and a familial history of alcoholism. She characterizes the most important pathogenetic mechanisms in the development of PNP. Particular attention is paid to the clinical presentations and diagnosis of main types of PNP, such as toxic alcoholic (due to directly toxic effects of alcohol metabolites) and alcohol-related thiamine-deficient ones. The paper presents the management tactics in patients with various types of alcoholic PNP, which include combination treatment and ensure the impact (alcohol refusal; balanced nutrition with the addition of various medications) on the etiological factor of the disease. Taking into account the available evidence base, it is necessary to prescribe B-group vitamins to these patients. Alpha-lipoic acid preparations that have an effect on the peripheral and central nervous systems occupy a separate place in the treatment

SOME OF THE PAIN FEATURES AT THE BOTTOM OF THE BACK

The article discusses pain at the bottom of the back as one of the common musculoskeletal diseases. The characteristics and prevalence of pain syndrome at the bottom of the back of children and adolescents, young, mature and old are demonstrated. The frequency of this syndrome for men and women is examined separately. The treatment of patients with acute and chronic pain at the bottom of the back is considered. Nonsteroid anti-inflammatory drugs in the arresting of pain syndrome are given a separate place

Experience with mildronate in cerebrovascular diseases

Over the past years, results of various clinical trials of drugs demonstrating their efficacy in the treatment of cardiovascular diseases have been published. The article discusses the results of clinical use of Mildronate (meldonium) in the treatment of ischemic brain injuries; the results of trials show that the medicine has a cytoprotective effect on a number of pathogenic factors determining ischemic cell death in the brain