We conducted a systematic review of 23 original studies published from 2010 to 2022, which participated a total of 168 thousand people, including 48 thousand patients with chronic obstructive pulmonary disease (COPD) aged 45 to 93 years.

Results. The prevalence of cognitive impairment (CI) in patients with COPD varies from 6 to 63%. COPD patients have a higher risk of developing mild CI (HR from 1.1 to 1.9; OR from 1.4 to 2.4) and dementia (HR from 1.3 to 1.9; OR = 1.2). The risk of cognitive dysfunction increases along with a decrease in the values of forced expiratory volume in one second as a percentage of its expected value (FEV1%) (OR = 1.34), arterial oxygen partial pressure (PaO₂) (OR = 5.45), oxygen saturation (SaO₂) and an increase in the level of arterial carbon dioxide partial pressure (PaCO₂). There is a significant direct relationship between FEV1% and Mini-Mental State Examination (MMSE) (p < 0.0001) and an inverse relationship between COPD severity and MMSE (p < 0.0001). The MMSE score is correlated with FEV1% (r = 0.46, p < 0.01) and PaO₂ (r = 0.43, p < 0.05).

Conclusion. The available data confirm the association of COPD with an increased risk of occurrence and progression of CI. It is discussed that this is due to the unfavorable course of concomitant vascular and neurodegenerative diseases against the background of chronic hypoxia.

Abstract. Cerebral neurological complications (CNC) are the most common form of infective endocarditis (IE) extracardiac manifestations. They have important clinical implications, which justifies the need to study them.

Purpose of the study: to evaluate symptomatic CNC (prevalence, predictors, effect on the prognosis) in patients with «left-sided» IE who have undergone cardiac surgery, according to the register of the Federal Center for Cardiovascular Surgery.

Materials and methods. A retrospective review of data from the hospital information system was carried out in one of the Federal Centers for Cardiovascular Surgery of the Ministry of Health of the Russian Federation. In patients with significant/probable «left-sided» (mitral and/or aortic valves) acute/subacute IE at age of ≥ 18 years, the frequency of CNC and their subtypes was assessed, predictors and effect on the prognosis of the disease were determined. Differences between groups of patients depending on the status of the presence of CNC were assessed using the χ² test, Fisher’s exact test and the Mann–Whitney test. Binary cross tables were further analyzed to calculate the odds ratio (OR). Integral predictive models were also built using the logistic regression algorithm. To assess the effect of CNC on patient survival, Kaplan–Meier analysis was used with the construction of survival curves.

Results. For the analysis, 222 cases of IE in 216 patients were used. The incidence of CNC was 25.7% (19.4% – ischemic stroke, 5.4% – intracranial hemorrhage, 2.7% – meningitis, encephalitis and/or abscess). CNC predictors were embologenic vegetations: size > 10 mm (OR 6.3; 95% CI: 3.0–13.0), mobile (OR 8.5; 95% CI: 3.2–22.3) and multiple (OR 4.9; 95% CI: 2.1–11.4) vegetation; the level of white blood cells ≥ 10 × 109/L (OR 2.1, 1.1–3.8), as well as systemic embolism (OR 3.6; 95% CI: 1.6–7.9). The accuracy of the logistic regression model obtained using the above predictors was 83% (on the test set). No effect of CNC on the prognosis (in-hospital and long-term mortality, stroke in the long-term period) was found.

Conclusion. Neurological complications have a high prevalence, occurring in one in four patients with «left-sided» IE. Ischemic stroke is the most common subtype of CNC, and vegetation characteristics are a determining factor of the embologenic potential of endocarditis. There was no effect on the prognosis (in-hospital and long-term mortality) in patients undergoing cardiac surgery.

Currently, instrumental brain imaging plays a significant role in the examination of patients with cognitive impairment. It is important for diagnostic process, prognosis of the course of neurodegenerative, cerebrovascular and other diseases, clarification of the role of individual brain structures and systems in the development of cognitive and other neuropsychiatric disorders.

The purpose of the study was to analyze the volumes of the medial temporal lobes (MTL), hippocampus and brain volume in middle-aged patients with pre-mild cognitive decline.

Material and methods. 38 patients (33 women, 5 men) of middle age (60.77 ± 9.4 years) were examined. Patients were divided into two groups: with subjective cognitive decline (SCD) – 15 patients, aged 53.5 ± 6.94 years and subtle cognitive decline (StCD) – 23 people aged 63.35 ± 8.64 years (groups statistically did not differ in age). All patients underwent a neuropsychological examination with an assessment of the cognitive sphere, magnetic resonance imaging of the brain, including the assessment of the presence and degree of microangiopathy (MAP), morphometry of the medial temporal lobes, hippocampus, brain volume and a study for the presence of the allele of the apolyprotein E gene (ApoE4).

Results. A decrease in the average and total hippocampal volume was found in patients with StCD compared to patients with SCD. Also, MAP was significantly more common in patients with StCD. There were no differences in the degree of MTL atrophy. A decrease in the volume of the left hippocampus was revealed in patients with aggravated heredity for dementia. The average and total volume of the hippocampus is reduced in carriers of the ApoE4 allele of the apolyprotein gene. Correlation analysis showed the relationship between the average volume of the hippocampus and the volume of the brain.

Treatment of patients with facial neuropathy (FN) is a big scientific problem. There is no single protocol and patient management tactics are different. We have conducted an analysis of clinical practice in the treatment of patients with FN.

Material and methods. An anonymous online survey of neurologists positioning themselves as supporters of evidencebased medicine was conducted (n = 139, work experience – 5 [3; 10] years). It included 10 questions. The analysis of methods of treatment was carried out. We compared the experience of specialists, who prescribed a certain drug, and who did not prescribe it. Descriptive statistics are given in the form of: absolute (n) and relative values (%), medians (Me), lower [q1] and upper [q3] quartiles.

Results. In the studied sample with FN, all doctors recommend glucocorticosteroids, of which almost 2/3 allow use only in the first 3 days of the disease. Antiviral drugs are prescribed by 91.4% (n = 127) of specialists, the main indication is the presence of herpetic infection in visual examination (n = 104; 74.8%), less often a positive test for herpes infection (n = 23; 16.5%) or prosoplegia (n = 16; 11.5%). Anticholinesterase agents are prescribed by 38.1% (n = 53) of neurologists, their work experience is greater – 7 [5; 13] versus 5 [2; 9.75], p = 0.035. More than half (n = 81; 58.3%) of doctors do not recommend medications for additional drug therapy. Botulinum therapy is considered in the clinical practice of treatment of FN by 59% (n = 82) of doctors, regardless of work experience (p = 0.697), however, we observed a large variability of opinions according to the indications for use. When deciding on referral for surgical treatment, the most important doctors considered the problem of poor awareness of the types of operations (n = 83; 59.7%), as well as the lack of clear indications for surgical treatment (n = 62; 44.6%).

Conclusion. The study revealed a diversity of opinions even among specialists who position themselves as supporters of evidence-based medicine. There is a great need to develop Russian clinical guidelines for facial nerve neuropathy.

Drug-resistant forms of epilepsy are an important medical and social problem.

Goal of the work. Evaluation of the probability of achieving remission after correction of therapy in patients with drug-resistant focal epilepsy.

Material and methods. The study included 309 patients divided into three heterogeneous groups: a group of patients with focal pharmacoresistant epilepsy; a group of patients with super refractory focal epilepsy; control group – patients who had not previously received treatment. The examination included history taking, clinical and neurological examination, routine EEG and/or EEG video monitoring, MRI of the brain, and analysis of medical records. Therapy was adjusted.

Results. After correction of therapy, remission in patients in Group 1 was achieved in 27.8% of patients, improvement – in 27.1%, no effect – in 45.1%; in Group 2, remission was achieved in 13.2% of patients, improvement – in 28.6%, no effect – in 58.2%; in Group 3, remission was achieved in 41.2% of patients, improvement – in 32.9%, no effect – in 25.9%. Negative prognostic factors did not show a significant correlation with the lack of effect of therapy.

Conclusion. After correction of therapy, remission was achieved in several patients with drug-resistant focal epilepsy, while negative prognostic factors do not exclude the possibility of achieving remission.

Myotubular (centronuclear) myopathy is a rare hereditary disease with primary muscle damage and clinical manifestations of congenital myopathy. The article describes a clinical case of myotubular myopathy in a boy who was observed by us from the age of 2 months to 2 years 5 months. The disease was manifested by muscle weakness, hypotension, respiratory failure, peripheral tetraparesis, bulbar disorders, the need for artificial lung ventilation and probe nutrition.

Degos disease is a rare disease that manifests itself as multifocal vasculopathy, the consequence of which is the defeat of many systems, including the nervous system. This disease is difficult to diagnose, today it does not have a standardized approach to treatment, and it is deadly.

In the presented clinical case, the course of BD is described in a 66-year-old patient, whose debut of the disease was a lesion of the skin. The cause of hospitalization of the patient was the defeat of the central nervous system. During the additional examination, the patient was diagnosed with ischemic stroke in the basin of the left middle cerebral artery, posterior cerebral artery, right middle cerebral artery of another established etiology according to TOAST, aseptic leptomeningitis, pachymeningitis. The course of the disease was complicated by damage to the gastrointestinal tract, the cardiovascular system, as well as the addition of a coronavirus infection, which led to death.

A clinical analysis of a patient with undifferentiated granulomatous systemic vasculitis with a predominant lung lesion and its complication in the form of chronic hypertrophic convexital pachymeningitis of fungal (candidal) etiology is presented. A differential diagnosis with granulomatosis with polyangiitis was carried out. Modern literature data on diagnostic criteria and methods of treatment of this rare pathology are given.

Kinesiotherapy is eff ective in the treatment of chronic nonspecific back pain (CNBP), but its eff ectiveness in tensiontype headache (TTH) is unclear. The effectiveness of kinesiotherapy in patients with CNBP and comorbid TTH has been little studied.

The aim of the study was to evaluate the effectiveness of kinesiotherapy in patients with CNBS and comorbid TTH. Patients and methods. 52 patients (22 men and 30 women, mean age 32.4 ± 7.5 years) with CNBP and combined TTH were included in the study. All patients received standard treatment, of which 28 patients received kinesiotherapy (Group 1) and 24 patients were included in the comparison group (Group 2). All patients used pain diaries. All patients were tested by using the Beck Anxiety Inventory, the Beck’s Depression Inventory, the Pain Catastrophization Scale, the Kinesiophobia Scale, the Oswestry Disability Index, the Roland–Morris Disability Questionnaire, the Headache Impact Test 6, numerical pain rating scale before treatment and 3, 6 months after treatment. Clinical effcacy was assessed by reducing the frequency and intensity of headache (by ≥ 50%), back pain (by ≥ 30%), and by increasing functional activity during the day (by ≥ 30%).

Results. At 6 months follow-up signifiantly more patients in group 1 than in group 2 achieved a clinical effect on TTH and CNBP: 78.5% (n = 22) compared to 41.7% (n = 10); OR (95% CI) = 1.99. In 9 patients (32%) of group 1, a complete remission of TTH and CNBP was noted, in group 2 there were no such patients. At 6 months follow-up group 1 showed a significant improvement (p < 0.05) in comparison with group 2 in terms of functional activity and emotional state.

Conclusion. Kinesiotherapy for CNBP and combined TTH is effective both for back pain and headache. It increases functional activity and improves the emotional state of patients.

Acute cerebrovascular accident is one of the main causes of disability in patients and has a significant impact on the functions of daily activity and the ability to self-care. With the improvement of methods of medical care and the increase in patient survival, active rehabilitation of patients is becoming increasingly important. Malnutrition and loss of muscle mass are among the most frequent complications associated with a decrease in rehabilitation potential and an increased risk of adverse outcomes, and therefore the issues of timely assessment and correction of nutritional deficiency are relevant for all specialists of the interdisciplinary team that takes part in the rehabilitation treatment at all stages of rehabilitation