Acquired Immune Deficiency Syndrome (AIDS) is now considered one of the most global pandemics in human history. Despite the use of highly active antiretroviral therapy (HAART), HIV-1 infection is often accompanied by the development of CNS disorders, including neurocognitive disorders. The use of etiologic therapy has successfully prevented many of the possible terminal complications of the disease, but as patient survival time increases, the prevalence of cognitive impairment among AIDS patients is increasing. Theclinical manifestations of these disorders can rapidly progress from subtle attention deficits and behavioral disorders to the development of dementia. Diagnosing neurocognitive impairment in HIV-infected patients is usually difficult and requires consistent diagnostic procedures from the clinician, including initial screening and, if necessary, neuropsychiatric testing and neuroimaging. Early diagnosis and correction of neurocognitive impairment in HIV-infected individuals with adequate antiretroviral therapy is essential for successful treatment. The review also considers the use of drugs for the prevention and treatment of neurocognitive impairment, taking into account the peculiarities of persistence of the pathogen in the nervous system and the capabilities of modern medicine. One of the most promising methods of supporting therapy for such disorders is the delivery of antiretroviral drugs using various nanosystems (polymeric nanoparticles, lipid nanoparticles, nanogels, magnetic particles).

Facial synkinesis is involuntary contractions of unrelated groups of facial muscles that occur during voluntary movement. The article presents a review of scientific literature of the problem pathological synkinesis as a complication of facial neuropathy. The mechanism of their development and the main theories of occurrence are described. We describе the types (patterns) of synkinesis, methods for theirs detecting, description of clinical manifestations, methods of instrumental diagnostics. We reviewed approaches to treatment and rehabilitation, the main types of conservative and surgical treatment.

Introduction. In 2018–2020, a study was conducted in the Russian Federation on the efficacy and safety of highdose immunosuppressive therapy with autologous hematopoietic stem cell transplantation (HDIT-AHSCT) in multiple sclerosis (MS).

The aim of the study was to analyze preliminary data on the effectiveness and safety of the HDIT-AHSCT in patients with MS who participated in the clinical approbation of the method.

Material and methods. 21 patients were included in a single-center Pavlov University (Saint Petersburg) observational study. In 10 patients (47.6%) the Expanded Disability Status Scale (EDSS) ranged from 1.0 to 4.0, in 10 — from 4.5 to 6.0 points, 1 patient with primary-progressive MS (PPMS) had 6.5 EDSS points. Cyclophosphamide conditioning regimen (200 mg/kg) in combination with rituximab (1000 mg/m2) was used. Neurological assessment (EDSS, SNRS, T25-FW, 9-HPT, PASAT, MoCA, HADS) and brain MRI were performed before and after 12 months. The early and long-term complications of HDIT-AHSCT were also analyzed.

Results. One year after HDIT-AHSCT improvement and significant improvement were noted in 10 patients (47.6%), stabilization — in 8 (38.1%), relapse/progression — in 3 (14.3%). A lower effect was observed in patients with spasticity of more than 3 points by the MAS. According to MRI data 18 patients (85.7%) had stabilization of MS with no disease activity after 1 year, that met the No Evidence of Disease Activity (NEDA) criteria. Long-term complications included autoimmune thyroiditis (n = 1) and amenorrhea in two patients older than 38 years. No TRM were registered during the observation period.

Conclusion. HDIT-AHSCT is an effective method of treating patients with multiple sclerosis. The results of the research demonstrate the safety and effectiveness of HDIT-AHSCT and it can be used to expanse the opportunities for providing treatment of patients with MS in the Russian Federation.

Introduction. According to foreign studies, the frequency of asymptomatic deep vein thrombosis (DVT) in the acute period of stroke varies from 10 to 75%, clinically obvious — from 2 to 10%. DVT is a life-threatening complication as it can lead to the development of pulmonary embolism (PE).

Purpose of the study: to identify predictors of DVT development in the lower extremities in patients with stroke according to the registry of the Regional Vascular Center (RVC).

Materials and methods. 100 patients with stroke who were admitted to the wards/intensive care unit of the RVC from November to December 2021 were examined. In addition to the standard examination, all patients underwent duplex scanning of the veins of the lower extremities upon admission and on the 7th day of inpatient treatment.

Results. The incidence of DVT was 13%. Compared with patients without DVT, patients with thrombosis were characterized by higher median values of age (77 vs 67 years, p = 0.015), time from stroke to hospital admission (24 vs 5 hours, p = 0.026), stroke severity by NIHSS score at admission (16 vs 5 points, p = 0.006) and completion of the first stage of treatment (10 vs 3 points, p = 0.010), movement disorders in the leg according to the Medical Research Council scale (4 vs 1 points, p = 0.011) and IMPROVE-VTE scales (4 vs 2 points, p < 0.001). In half of patients with DVT, thrombosis occurred already at admission to the hospital, in the rest it occurred during treatment. In a quarter of patients, thrombosis involved the proximal veins and was complicated by the development of PE in one patient, the rest had distal DVT. In all cases, DVT developed in the paretic limb. In all patients, thrombosis was initially regarded as asymptomatic and was diagnosed only by duplex scanning of the veins. The most significant risk factors for developing DVT in the acute period of stroke were age 64 years and over (OR = 8.1), stroke severity on the NIHSS scale at admission of 6 points and above (OR = 5.6), time to admission from 10 hours or more (OR = 3.8), leg strength not more than 3 points (OR = 4.5) and an IMPROVE-VTE score of 3 points or more (OR = 9.5). When building a logistic regression model using the identified risk factors, accuracy values were obtained equal to 83% and 85% for the training and test samples, respectively.

Conclusion. DVT is observed in 13% of patients in the acute period of stroke and is associated with the age of patients, the severity of stroke and movement disorders, the time from the development of symptoms to hospital admission, and the risk of venous thromboembolic complications according to the IMPROVE-VTE scale.

Myofascial pain syndrome caused by damage to the paravertebral muscles is considered as one of the causes of chronic back pain. At the same time, there is not enough information about the condition of the paravertebral muscles, and it is contradictory.

The aim of the work is to elucidate the presence and severity of structural and functional changes in the paravertebral muscles and their role in the development of chronic nonspecific pain in the lower back in women.

Material and methods. Morphological, immunohistochemical examination of a muscle tissue biopsy was performed in 17 patients aged 24 to 59 years (average age — 41.5 ± 12.1 years) with CNS (average duration of pain syndrome 10.0 ± 6.9 months) caused by myofascial pain syndrome, as well as determination by gel electrophoresis of the isoform composition of giant sarcomeric proteins titin and nebulin.

Results. Morphological examination revealed no signs of necrosis, proliferation of connective and adipose tissue, inflammatory infiltration. The transformation of the myosin phenotype in the direction of an increase in the proportion of “fast” type II muscle fibers was revealed in the biopsies of the patients’ muscles. A decrease in the content of giant titin and nebulin proteins associated with myosin and actin in the sarcomere was also found.

Conclusion. The data obtained indicate a violation of the contractile function of the paravertebral muscle in CNS.

Introduction. Discogenic lumbosacral pain in young people has a complex and multicomponent pathogenesis. Evidence of the content of cytokines and neoangiogenesis factors in patients with acute discogenic lumbosacral radiculopathy are deficiency and often contradictory. Objective: to evaluate the cytokine and neoangiogenesis parameters in the blood of young patients with acute discogenic lumbosacral radiculopathy.

Materials and methods. The study involved 49 patients (27 (55.1%) men and 22 (44.9%) women) with a mean age of 36 [27; 45] years with acute lumbosacral pain caused by degenerative changes in the spine and signs of compression of the spinal nerves, according to MRI. The control group consisted of 17 healthy individuals (10 (58.8%) men and 7 (41.2%) women) with a mean age of 33 [25; 41] years. The level of C-reactive protein was measured by an automatic biochemical analyzer Konelab 30Iprime (ThermoFisher, Finland). The levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor A (VEGF-A) in blood were determined by enzyme-linked immunosorbent assay (ELISA) on a plate ELISA analyzer Real-best (Russia) using reagent kits Cloud-Clone Corp. (USA, China).

Results. Patients with acute discogenic lumbosacral radiculopathy, compared with the control group, has an increase in the levels of C-reactive protein (11.2 [7.1; 15.3] vs. 4.2 [3.5; 4.9] mg/ml; р = 0.011), TNF-α (23.1 [16.8; 29.5] vs. 9.7 [6.9; 12,5] pg/ml; р = 0.001), IL-1β (4.7 [3.1; 6.3] vs. 3.2 [2.3; 4.1] pg/ml; р = 0.041), IL-6 (11.2 [6.1; 16.3] vs. 4.5 [3.1; 5.9] pg/ml; р = 0.007), IL-8 (30. [21.9; 48.8] vs. 20.5 [8.5; 32.6] pg/ml; р = 0.023) and VEGF-A (318 [260; 570] vs.168 [100; 240] pg/ml; р = 0.002).

Conclusion. The obtained results confirm the importance of pro-inflammatory factors and indicators of neoangiogenesis in the development of acute discogenic lumbosacral radiculopathy in young patients.

A 20-year-old patient was presented with subacute onset of headache, nausea and vomiting. Testing of nasal/oropharyngeal swabs indicated the presence of SARS-CoV-2 RNA, and later the antibodies to this virus were found. The treatment in the hospital for Coronavirus 19 Disease (COVID-19) provided only temporary relief, and the patient then was referred to the Regional Stroke Center (RSC) to exclude a subarachnoid hemorrhage. RSC neurologists drew attention to multiple skin nevi in the patient. Brain MRI demonstrated abnormal T1 hyperintensity in the brain leptomeninges, with leptomeningeal contrast enhancement as well as hyperintensity in amygdala regions on T1 weighted images, bilaterally. The anomaly of the Dandy-Walker malformation complex was also revealed. Cerebrospinal fluid (CSF) analysis showed elevated protein (0.52 g/L), low lymphocytosis (lymphocytes, 6 in mm3), and decreased glucose (1.8 mmol/L). Neurocutaneous melanocytosis (NCM) was diagnosed, which neurological manifestation was probably triggered by COVID-19. The patient’s vision gradually progressively worsened. In 2.5 months after the clinical manifestation of NCM, fundoscopy revealed optic discs atrophy (despite the absence of previous edema), and repeated CSF analysis showed atypical cells with characteristics corresponding to melanoma. Malignant transformation of cerebral melanocytosis was suspected, and the patient was referred to an oncological dispensary for further therapy. In the presented literature review, special attention is paid to the issues of neuroimaging, cytological and immunocytochemical diagnostics of NCM.

Motor chronic inflammatory demyelinating polyneuropathy (M-CIDP) is a form of atypical CIDP. This article presents a clinical observation of M-CIDP in a 15-year-old boy, as well as a description of laboratory and instrumental diagnostic data. The boy had a chronic development (> 2 months) of flaccid tetraparesis, predominantly of the proximal muscles of the limbs, without sensory disorders. According to electroneuromyography, there were signs of demyelinating lesions of the proximal parts of the peripheral nerves. There was an increase in the thickness of the nerves of the upper limbs according to ultrasound. In the liquor protein-cell dissociation, as well as in the blood, IgG antibodies to the surface glycoprotein S of the SARS-CoV-2 coronavirus were found. The clinical and neurophysiological picture corresponded to the reliable criteria for CIDP. The therapy with intravenous immunoglobulins had a significant positive effect in the form of an increase in the strength of the limb muscles.

Wolff–Hirschhorn syndrome is a rare genetic disease associated with a chromosomal aberration of chromosome 4. A feature of the disease is the characteristic appearance of the face, anomalies in the development of internal organs and the skeleton, disorders in the motor, cognitive and psychospeech sphere, convulsive syndrome. Clinical observation presents a description of a 5-year-old 11-month-old child with a rare hereditary pathology — Wolff–Hirschhorn syndrome, who was treated in the neurological department of the Children’s Center for Psychoneurology and Epileptology of the Republican Children’s Clinical Hospital in Ufa. The disease was manifested by epilepsy, psychomotor retardation, and alalia. Multiple stigmas of dysembryogenesis were determined.

Stroke is one of the most important causes of mortality and disability of the population worldwide. In 16–20% of patients with acute stroke at admission, during hospitalization and rehabilitation, protein-energy deficiency, as well as micronutrient insufficiency is observed, which is associated with an unfavorable prognosis and the development of pressure ulcers. The widespread use of high-calorie mixtures for oral or probe enteral nutrition for such patients, containing increased amounts of protein, arginine, vitamins A, E, C and minerals (zinc and selenium) of an antioxidant orientation, can have a positive effect on the healing of pressure ulcers. The inclusion of specialized therapeutic mixtures in diet therapy can also potentially reduce the risk of developing pressure ulcers.