Abstract. Despite a high prevalence of mild cognitive impairment (MCI), there are no accepted algorithms of diff erentiating the syndrome and the prognosis evaluation of later cognitive decline at this time.

Objective. To identify biomarkers of poor prognosis in the various MCI types by optimizing neuropsychological examination in combination with MRI morphometry of brain structures.

Patients and methods. We examined 45 patients (9 men, 36 women, mean age 72 ± 6.7 years) with MCI according to the modifi ed Petersen’s criteria and the DSM-5 criteria. All patients underwent the MMSE scale, the Detailed Neuropsychological Testing (DNT), which included a Ten Words Test (TWT), a “Double Test” (DT), a visual acuity test, a high-fi eld magnetic resonance imaging (MRI) of the brain with morphometry of cerebral structures (FreeSurfer, FSL).

Results. According to the MMSE score, MCI were found in 26 (58%) patients. During the DNT, depending on the state of memory, 14 participants of the study identifi ed a non-amnestic type of MCI (na-MCI), 15 — an amnestic variant with impaired reproduction (ar-MCI), and 16 people — an amnestic type with a primary memory defect (apm-MCI). Volume changes of the anterior corpus callosum segment (CCA) were signifi cantly associated with the Immediate Recall after 4th reading and the Delayed Recall in the general MCI group (rho = 0.58; 0.58; p < 0.05) and the apmMCI group (rho = 0.6; 0.56; p < 0.05). Kruskal–Wallis Test showed that there were signifi cant group diff erences in the volumes of the CCA, right caudate nucleus, left cerebellar hemisphere cortex, posterior corpus callosum segment and left thalamus. At the same time, the fi rst three structures were combined into a set of informative features for differentiating the type of MCI based on the results of Forward stepwise Discriminant Analysis with a 77.3% accurate classifi cation rate (Wilks’s Lambda: 0.35962; approx. F (6.78) = 8.678, p < 0.001). ROC-analysis established the threshold values of the CCA volumes of ≤ 0.05% and the right caudate nucleus volumes of ≤ 0.23% (81.25% sensitivity in both cases; 62.1% and 60.7% specifi city; AUC 0.787 and 0.767; 95% CI 0.639–0.865 and 0.615–0.881; OR 7.1 and 6.7 (95% CI 1.6–30.6 and 1.6–29), associated with a memory defect in persons with MCI, while the ORs are 7.1 and 6.7 (95% CI 1.6–30.6 and 1.6–29), respectively. When both cerebral structures were included in the logit model, 88.6% classifi cation accuracy, 92.6% sensitivity, and 82.4% specifi city of the method were achieved.

Conclusion. It has been demonstrated that classifying patients into the various types of MCI based on the data of memory function refl ected by the DNT and supplemented with MRI morphometry of the brain areas may be used as a sensitive and specifi c instrument for determining the category of patients with a high risk of Alzheimer’s disease. A neuropsychological profi le with a defect in primary memory, atrophic changes in anterior segment of the corpus callosum and the right caudate nucleus have been proposed as biomarkers of poor prognosis. Further longitudinal studies are necessary to clarify the proposed biomarkers of poor prognosis information and to detail the mechanisms of the neurodegenerative process.

The aim of the research. Alzheimer’s disease is the most common form of dementia. One of the potential tools for early detection of the onset of the disease is the handwriting analysis. It can be a warning signal for a serious medical investigation. The dynamics of handwriting changes are also a good indicator of the progression of the disease and the eff ectiveness of therapy.

Methods. The authors have developed two corresponding tests. The fi rst (AD-HS) allows the assessment of handwriting markers of cognitive impairment and Alzheimer’s disease from an available handwriting sample. The second (ADHC) is designed to assess dynamics by comparing two handwritten documents written at diff erent times.

Results. The pilot study includes 16 patients who were found to be at diff erent stages of the disease by medical examination. They all provided old handwriting samples dated 10–20 years ago and new handwriting samples specifi cally written as part of the experiment. Evaluation of 36 handwriting characteristics showed that both tests were eff ective in identifying Alzheimer’s disease and its stage. The correlation between the handwriting analysis and the medical test result was 0.62.

Conclusion. Further refi nement of the proposed tests and expansion of the research base will enable handwriting exercises to be incorporated into supportive therapy to slow the progression of the disease.

In Parkinson’s disease (PD), some structural changes in the retina have been shown using optical coherence tomography (OCT). Among them most attractive are atrophic changes in retinal nerve fi ber layer (RNFL). However, diagnostic signifi cance of the OCT method in PD remains debatable.

Objective: to investigate a thickness of RNFL in Parkinson’s disease patients and to determine the signifi cance of the OCT method in the PD diagnostics.

Materials and methods. In PD patients (n = 24) and in a control group (n = 20) OCT was used to study the thickness of RNFL — average, in quadrants and in 10 sectors.

Results. In patients with PD thinning of RNFL in the inferior quadrant was revealed (p = 0.009). The sensitivity and specifi city of the method were 56% and 82%, respectively. The thickness of RNFL was not associated with parkinsonian symptoms asymmetry, duration and severity of the disease. In the control group and in PD patients, there was a relationship between the RNFL thickness and age.

Conclusion. PD is characterized by atrophic changes in the retina in the form of thinning of RNFL in the inferior quadrant, which confi rms the systemic nature of neurodegenerative pathology in this disease going beyond the substantia nigra and brain tissue. At the same time, the thickness of RNFL showed limited diagnostic value for detecting PD cases.

Acute onset of chronic infl ammatory demyelinating polyneuropathy (A-CIDP) presents signifi cant diffi culties in differential diagnosis with acute infl ammatory demyelinating polyneuropathy (AIDP). The article presents review of literature about diff erential diagnosis between A-CIDP and AIDP and a clinical case of A-CIDP at 26-year-old man. The disease started after vaccination against infl uenza and an episode of enteritis, the clinical picture matched Guillain–Barré syndrome criteria, according to electromyography data: demyelinating lesion of the left facial nerve, motor and sensory fi bers of the median and ulnar nerves on both sides, demyelinating lesions of motor fi bers of the tibial nerve and peroneal nerve on both sides. Chronic infl ammatory demyelinating polyneuropathy was diagnosed. Lack of eff ect from plasma exchange was the reason for changing the treatment to pulse therapy with prednisolone (with a subsequent transition to a 1 mg/kg dose and further reduction until canceled within 16 weeks). Response to prednisolone — rapid recovery of motor functions, which worsened signifi cantly due to a new coronavirus infection during treatment in the neurology department. Further continuation of prednisolone therapy made it possible to restore motor functions completely, except mild prosopoparesis. At the same time, deep refl exes were absent; no signifi cant EMG dynamics was observed. Considering the eff ect of glucocorticosteroids and lack of positive dynamics on the second electromyography, the patient was diagnosed as A-CIDP.

We report a case of transverse myelitis and Guillain–Barre syndrome (GBS) overlap in the 42-year-old patient with moderate course of Coronavirus disease 2019 (СOVID-19). Nasopharyngeal SARS-CoV 2 RT-PCR was positive. Severe neck pain developed in this patient on the 5-th day of СOVID-19. A few hours later weakness in the feet arised and then spread to the thighs and arms.

Quadriparesis, arefl exia in all limbs, sensory loss below the level of T4 and bladder/bowel dysfunction were present. Pyramidal signs were negative. There was no increase of COVID-19 severity at the time of neurological signs development.

Magnetic resonance imaging of the spinal cord showed the focal lesion in the C2-T1 segments, which was consistent with the features of longitudinally extensive transverse myelitis.

Along with the myelitis, acute motor axonal polyneuropathy was diagnosed. This diagnosis of GBS was supported by ascending weakness with arefl exia, albumin-cytological dissociation in cerebrospinal fl uid and the data of neuroelectrophysiological examination.

We proposed that both myelitis and GBS had disimmune nature associated with COVID-19. The other possible causes of damage to the spinal cord and peripheral nervous system were excluded.

Immunotherapy with high dose of intravenous immunoglobulins was administered. Steroids also were used taking into account the myelitis.

At the follow up in 4 months the motor functions were found to be improved nonsignifi cantly, the patient was still severe disabled.

The modern integrated approach to the treatment of ischemic stroke (IS), in addition to pharmacotherapy, provides for the impact of physical factors. Among them is injectable carboxytherapy (ICBT).

Objective. The aim of the study was to evaluate the effi cacy and safety of using ICBT in combination with a standard treatment program in patients with acute ischemic stroke.

Material and methods. The main group (MG) included 39 patients with acute IS, the comparison group (GC) — 31 patients. On the second day of hospitalization, patients with MG underwent ICBT on the background of standard therapy, and GC — procedures that mimic ICBT. Clinical, laboratory and instrumental data, IS outcomes, complications, timing were assessed.

Results. There were no statistically signifi cant diff erences in physiological parameters (heart rate, blood pressure, SpO2) between MG and GC during and after the course of treatment. Positive dynamics of the neurological status was observed in both groups in the form of a decrease in the NIHSS score — in the MG from 6 to 4 (p = 0.047), in the GC — also from 6 to 4 (p = 0.25). In patients with MG, trophic disorders were less likely to develop in comparison with GC — 1 (2.6%) versus 6 (19.4%), p = 0.039. ICBT did not aff ect the duration of hospitalization of patients, the duration of treatment in the intensive care unit and carrying of resuscitation and also did not contribute to reducing mortality. Changes in the indicators of the acid-base state of the blood were compensatory in nature and did not lead to changes in the pH of the blood. The decrease in pH from 7.5 to 7.4 in 30–90 minutes after the procedures was a physiological reaction of the body to the introduction of CO2 and was not accompanied by negative consequences.

Conclusions. ICBT is a safe method, does not aff ect the duration of hospital stay and mortality, help lower the likelihood of complications.

This article presents an observation of an intraneural cyst of the peroneal nerve in a 16-year-old boy after a knee injury. Surgical treatment of an intraneural cyst of the peroneal nerve was performed 9 months after the appearance of peroneal nerve neuropathy. One month after the operation, the peroneal muscle strength increased from 2 to 4 points on the MRC scale; positive dynamics after the operation was also noted according to the data of electroneuromyography and ultrasound examination. Children often observed intraneural cyst of the peroneal nerve at the knee (90% of cases among all sites intraneural cysts). For diff erential diagnosis with compression-ischemic neuropathy and nerve cysts, clinical and neurophysiological data should be supplemented by ultrasound and/or MRI examination. Early diagnosis and surgical treatment are critical to the full recovery of motor and sensory function.