The symptom of vertigo and dizziness is often detected in patients with COVID-19. The article discusses issues related to damage to the peripheral and vestibular parts of the vestibular analyzer in patients infected with the SARS-CoV-2 virus. The possible mechanisms of the pathogenesis of the development of cerebral stroke in this viral infection, its features are described. A description of the forms of damage to the peripheral part of the vestibular analyzer, including vestibular neuronitis, benign paroxysmal positional vertigo, Meniere’s disease, is presented. Other possible causes of the development of the symptom of vertigo and dizziness in patients with COVID-19 that are not associated with damage to the vestibular analyzer are also considered

The main treatment for cervical dystonia (CD) is botulinum toxin type A (BTA) injections, but several long-term studies have found that between 19-46% of patients discontinue treatment. Anxiety and depression play a signi fi cant role in reducing the quality of life in patients with CD, according to previous surveys.

Aim: to assess the dynamics of CD symptom severity, emotional disturbance, and quality of life in patients under different treatment methods.

Material and methods. 61 patients with CD, 16 (26%) men and 45 (74%) women, age 50 [40; 59] years, duration of illness 4 [2; 7] years, age at onset 44 [34; 54] years, were studied. Changes in motor and aff ective disturbances, quality of life in patients with CD were assessed after 2 and 4 months in the context of diff erent treatment methods — BTA monotherapy, antidepressant (AD), combined therapy (AD + AD).

Results. Combination therapy (BT + AD) was shown to be superior to BTA monotherapy in long-term follow-up of patients in terms of correction of depression, anxiety, integrative assessment of quality of life and severity of dystonia. After 4 months of treatment, the (BT + AD) subgroup maintained the positive trend achieved in dystonia severity (p < 0.001). At the end of the follow-up period in the BT group, the positive eff ect of therapy had regressed to baseline levels of dystonia severity.

Conclusion. To achieve a sustained therapeutic response in patients with CD, diagnosis and appropriate correction of emotional disturbances is necessary. The potential effi cacy of antidepressants in the treatment of motor and sensory symptoms of CD requires further investigation.

The timing and volume of neuroimaging for patients with facial nerve neuropathy (FNN) are a cause for discussion.

Aim. To study the current volume of neuroimaging in patients with FNN and to determine the essential diagnostic protocol.

Material and methods. Magnetic resonance imaging (MRI) data analysis of adult patients with FNN (n = 833). Protocols were taken from the Uni fi ed Medical Information and Analytical System of Moscow (EMIAS). The essential diagnostic protocol was created. A prospective study was conducted with new protocol.

Results. According to EMIAS, the timing of MRI was 3 months from the fi rst symptoms to do diagnostics, the longest period from diagnosis to appointment to MRI was 83 days. The list of pulse sequences was given in the protocol in ¾ of cases. The most indicated regimes were T1 WI (80.7%), T2 WI (90.6%), T2 FLAIR (73.2%), less often DWI (54.9%). Studies with contrast amounted to 22.8%. In total, the pathology was detected in 429 (51.5%) patients, including 88 (20.5%) intracranial tumors. In 216 (25.9%) patients, the changes were most likely associated with FNN, of which in 44.5% of cases were in fl ammatory, 21.3% — tumor, 16.2% — demyelinating process, 11.2% — postoperative changes.

According to the new protocol, the cause of FNN was directly identi fi ed in 56.6% of patients, of which in idiopathic — 31,6% of cases, in symptomatic — 70.6% (p = 0.005). Changes that cannot be associated with FNN, but require the participation of a specialist, were detected in a 1/4 of patients. Only in 20.8% of cases, the MRI results were normal.

Conclusion. Recommended volume of neuroimaging for patients with FNN is MRI of the brain and parotid salivary glands with contrast within 1 month from the fi st symptoms. Regimes: T1 WI, T2 WI, FLAIR (with a slice thickness of 1 mm), DWI, 3D TOF, free recession in equilibrium (SSFP, FIESTA-C, CISS, FFE, etc.), sensitive to magnetic fi eld inhomogeneity (T2*, SWI, SWAN, etc.), and also T1 WI after intravenous contrast.

Rationale. Walking and balance disorders, modi fi ed foot muscles kinematics and walking stereotypes are typical for the patients with Multiple Sclerosis (MS).
Objective. To assess the biomechanical parameters of the feet in MS patients with diff erent neurological status during walking.
Material and methods. Data analysis of 102 patients with relapsing-remitting MS was carried out for two groups depending on the value of the Expanded Disability Status Scale (EDSS). Plantar pressure distribution was measured on with the pedographic platform emed, novel gmbh, Munich, Germany, using a “fi rst step” protocol.
Results and conclusion. Loading of the heel, the area of central metatarsal heads is decreased and loading of the toes is increased during walking in MS patients. Diff erences were found for the spreading coeffi cient (the ratio of the width to the length of the foot), the dynamic width of the foot in patients with an EDSS ≥ 4 is signi fi cantly less in the instep, in the middle and in the narrowest parts of the foot, which leads to the decrease of the contact area. It has been shown that patients with MS who are mobile or walk without assistance are more likely to have pes cavus foot compared to MS patients with minor impairments. The load of the medial side of the foot is greater than the lateral side, which indicates the predominance of the valgus foot. The pronation-supination index is signi fi cantly higher in the patients with moderate impairments in toe-off phase. Evaluation of foot deformity based on the measurement of biomechanical parameters of plantar pressure distribution makes it possible to plan the treatment and rehabilitation tactics in MS patients.

Introduction. Paraneoplastic cerebellar degeneration (PCD) is an immune-mediated and rapidly progressive cerebellar syndrome that develops as a result of a cross-immune response to the common antigens for the tumor and cerebellar cells. Timely diagnosis and treatment of PCD improves the functional status and survival of these patients.
Objective. To analyze the clinical, laboratory and neuroimaging characteristics of PCD case series in comparison with literature data.
Material and methods. 16 patients with PCD (13 women, 3 men) were examined. An assessment of the clinical presentation, brain MRI study, blood and cerebrospinal fl uid laboratory tests were carried out, the data of cancer search and patients follow-up were analyzed.
Results. The median age of PCD patients was 55 years, the duration of the disease was 8.5 months (range 4 to 16 months). In 12 patients, PCD was the fi rst manifestation of cancer. The clinical prentation was presented by rapidly progressive cerebellar ataxia, often in combination with oculomotor disturbances, pyramidal and bulbar syndrome, hand tremor and dystonia. An associated cancers were detected in 13 patients (81%). Antineuronal antibodies were found in 14 patients (88%): anti-Yo-1, antibodies to amphiphysin, anti-Hu, anti-CV2 and anti-GAD. Mild atrophic changes of the cerebellum were found in 6 patients, and in 2 cases cerebellar hemiatrophy was observed.
Conclusion. PCD is a rare disabling but potentially curable disease. The basis of diagnosis is the analysis of the clinical presentation and neuroimaging data, the detection of antineuronal antibodies and in fl ammatory changes in the cerebrospinal fl uid, as well as a thorough cancer search.

Autoimmune encephalitis associated with anti-LGI-1 antibodies is a new type of autoimmune neurological disease.
We present a description of a clinical case — this disease in a patient who was hospitalized at the Republican Scienti fi c and Practical Center for Neurology and Neurosurgery. During the analysis of blood and cerebrospinal fl uid for the presence of antibodies to autoimmune encephalitis, antibodies — IgG to anti-LGI-1 in the blood and cerebrospinal fl uid were detected. Conducted immune therapy, including intravenous administration of glucocorticosteroids, plasmapheresis and intravenous immunoglobulin led to a pronounced positive dynamics in the patient’s condition. Follow-up data indicate that the patient returned to her previous work after a course of therapy.

The article presents a clinical case of a 19-year-old patient with reliable autoimmune anti-NMDA encephalitis, developed after a coronavirus infection, which was accompanied by the signs of catatonia, epilepsy and mutism at the onset of the disease. This case enlarges the statistics of observations of this pathology by including the SARS-COV 2 virus to the list of possible etiological factors. The analysis of the catatonia signs, dominating at the onset of the disease, was carried out.

Among the in fl ammatory diseases of the central nervous system, with progressive demyelination is acute disseminated encephalomyelitis. This disease proceeds with the development of diverse neurological symptoms, the formation of foci of demyelination. The etiology of the disease is not known for certain, but there is a connection with viral diseases. The clinical case considered in this article shows the rapid development of the disease with extensive demyelination, with the formation of foci in almost all brain structures in a short period of time, and a progressive deterioration of the patient’s condition against the background of ongoing therapy.

The article presents the result of a two-year follow-up of a patient with a combination of parkinsonism syndromes and amyotrophic lateral sclerosis, a rare form of a neurodegenerative disease of the central nervous system called “Bright–Fan–Schwarz disease”. The diversity and polymorphism of symptoms in this disease can lead to diffi culties in diagnosis and therapy. The data of the patient’s anamnesis, the dynamics of the clinical picture during the stay in the hospital, the diagnostic and therapeutic measures taken, and the subsequent follow-up are given. In conclusion, a generalization of the features of the clinical picture and the progression of the disease in question is presented.

The development of autoimmune encephalitis (AIE) is due to the formation of intracellular and extracellular neuronal antibodies to various structures of the brain tissue. Their prevalence and morbidity are comparable to infectious ones, and the detection rate has recently been increasing. Acute symptomatic seizures are an important component of the clinical core of AIE and are associated with a heterogeneous group of autoantibodies, which along with the features of the lesion topic causes a signi fi cant clinical variety of seizures. The EEG has ictal and interictal features, and the development of electrographic subclinical seizures is also possible. The basis of the treatment of AIE with epileptic seizures is immunotherapy along with the use of antiepileptic drugs with sodium channel blocking properties.