Modern understanding of the mechanisms of the pathogenesis of ischemic stroke has expanded due to the study of neuroinfl ammation processes, in which matrix metalloproteinases (MMPs) play an important role. This literature review describes the main types of MMPs and provides current data on the pathophysiological role of this group of proteases in acute cerebral ischemia, which have multidirectional eff ects depending on the stage of the disease. Clinical studies assessing the role of MMPs in ischemic stroke are in most cases based on experimental models, and their results are ambiguous, which is determined by the versatility of their actions. MMPs are an important regulator of infl ammatory processes, the permeability of the blood-brain barrier and, as a consequence, cerebral edema. However, the positive eff ect of MMPs in the processes of angiogenesis, neurogenesis and neuroplasticity has been proven. Thus, further study of MMPs is relevant from the point of view of their role in functional recovery after ischemic stroke.

   Multiple sclerosis is an autoimmune infl ammatory demyelinating neurodegenerative disabling disease of the central nervous system of multifactorial genesis. In the initial stages of remitting multiple sclerosis, autoimmune inflammation prevails with alternation of exacerbations and remissions, but, subsequently, progressive neurodegeneration develops, which underlies the persistent disability of patients. The transition of remitting multiple sclerosis into a secondary progressive form is a critical factor for long-term prognosis and makes it necessary to find accurate biomarkers, predictors of the risk of transformation of MS. One such marker is the thickness of the nerve fiber layer and ganglion cells, as well as the condition of the retinal microvasculature, which is easily verifi ed by optical coherence tomography (OCT), a non-invasive method that allows for real-time retinal segmentation in the axial plane.

   The aim of this review is to discuss the results achieved in the study and application OCT of the retina as a potential imaging biomarker of multiple sclerosis progression.

   The purpose of this study was to assess immunological status and correlations of cytokines of diff erent groups in patients in the acute period of ischemic stroke (IS).

   Material and methods. 80 patients with IS (treatment group) and 20 patients with cardiovascular diseases (control group) were examined. All patients were assessed for comorbidity, cognitive function and demographic characteristics. The following were assessed in patients with IS: IS subtype, functional status using Barthel Index (BI), Ranking scale (mRS), National Institutes of Health Stroke Scale (NIHSS), neuroimaging parameters. Laboratory diagnosis included assessment of serum concentrations of interleukins, interferons, CXC- and CC-chemokines, MIF, GM-CSF and TNF-α. Statistical analyses were performed using Python and its libraries Pandas and SciPy.

   Results. Higher levels of IFN-γ, CXCL1, and CCL23 were determined in patients with IS. CXCL1 was found to correlate with BI, NIHSS, MoCA, foci size; IL — 6 — with BI, NIHSS, presence of diabetes, overweight; IFN-γ — with hyperlipidemia, BI, NIHSS. CCL23 levels were associated with mRS at day 14, presence of atherosclerosis, atherothrombotic subtype of IS; CCL2 — with BI, presence of atherosclerosis, leukoaraiosis, and hypertension; CXCL8 — with MoCA, NIHSS, diabetes.

   Conclusion. The research of the level and differential expression of cytokines in patients in the acute period of IS is an actual direction of clinical medicine. The verifi cation of cytokines CXCL1, CXCL8, CCL23, CCL2, IL-6 and IFN-γ as potential biomarkers of severity, course and outcomes of AI requires clarifi cation through further studies.

   Background. Inflammatory changes in the vascular wall play an important role in the progression of cerebral atherosclerosis and the occurrence of its complications, including stroke. The infl uence of transcranial direct current stimulation and methods of secondary prevention of stroke on the inflammatory changes in the blood that develop in the acute period of acute cerebral catastrophe has not been fully studied.

   Objective: to evaluate changes in blood parameters reflecting inflammatory changes in patients in the early recovery period of ischemic stroke against the background of complex rehabilitation measures, including transcranial direct current stimulation and secondary prevention measures.

   Material and methods. 78 patients in the early recovery period of ischemic stroke aged from 42 to 75 years (average age 59.50 [54.50; 64.50]) were examined. Patients are divided into 2 groups: 1 — transcranial direct current stimulation was used (46 people, 59.0 %), 2 — it was not used (32 people, 41.0 %). In all patients, before starting the rehabilitation course and after its completion, the blood levels of C-reactive protein, fibrinogen, glycoprotein sCD40L, homocysteine and uric acid were determined.

   Results. The level of C-reactive protein, fibrinogen and uric acid in patients during the rehabilitation course did not change signifi cantly, and the glycoprotein sCD40L exceeded the normative values before and after the course, decreasing during treatment in patients of group 1 (p = 0.027). The blood homocysteine concentration during the rehabilitation course was within the reference values, decreasing in patients of group 1 (p = 0.004). A statistical analysis revealed a dose-dependent relationship between taking atorvastatin and a decrease in the levels of uric acid, C-reactive protein and fibrinogen.

   Conclusion. A course of rehabilitation using transcranial direct current stimulation in patients in the early recovery period of stroke is accompanied by a decrease in the level of glycoprotein sCD40L and blood homocysteine. Aggressive treatment with statins is accompanied by improvements in blood C-reactive protein, fibrinogen and uric acid levels.

   Introduction. Systemic thrombolysis is a generally recognized highly eff ective treatment for ischemic stroke. Malignant cerebral infarction (MCI) in the territory supplied by the middle cerebral artery is characterized by a lesion affecting 50 % or more of the vascular territory therefore acting as a contraindication to systemic thrombolytic therapy. At the same time, when admitted to the hospital during the therapeutic time window, some patients with MCI remain candidates for systemic thrombolysis until an infarcted focus is identifi ed in the area supplied by the middle cerebral artery (MCA).

   Purpose of the study: to assess the eff ectiveness of intravenous thrombolytic therapy in patients with occlusion at the proximal segment of the middle cerebral artery.

   Material and methods: the study was conducted among 75 MCI patients, 9 of them received intravenous thrombolytic therapy (IVTT), in one case it was combined with endovascular mechanical thrombectomy. One patient underwent surgery (decompressive hemicraniectomy) after ineff ective intravenous IVTT. Results: intravenous thrombolytic therapy and/or endovascular mechanical thrombectomy performed for patients with occlusion of the M1 segment of the MCA did not prevent the natural development of extensive ischemic damage and edema of the cerebral hemisphere in patients with occlusion of the proximal MCA segment. In 20 % of the patients, intracerebral hemorrhage developed. A fatal outcome following IVTT occurred in 30 % of patients; it was caused by increasing swelling of the cerebral hemisphere and the development of dislocation syndrome.

   Conclusion: intravenous thrombolytic therapy and/or endovascular mechanical thrombectomy performed in patients with occlusion at the proximal segment of the MCA does not prevent the natural development of extensive ischemic damage in the cerebral hemisphere (MCI).

   The objectives of surgical treatment of patients with diff use brain gliomas include achieving control over epileptic seizures and improving quality of life, in addition to prolonging relapse-free period and life duration.

   The aim of the research is to study the factors that determine the eff ectiveness of epilepsy surgery in patients with diffuse brain gliomas.

   Material and methods. The study group comprised 104 patients with diff use brain gliomas, aged 41.21 ± 14.74. Results of author’s research. Clinical, neuroimaging and morphological factors were studied. Of the studied group of 104 patients with diffuse brain gliomas who had been diagnosed with epilepsy prior to surgery, the remission of 6 months after surgery was achieved in 58 (55.77 %) patients and of 12 months in 55 (52.88 %) patients. The development of acute symptomatic epileptic seizures (p = 0.68067) and acute symptomatic status epilepticus (p = 0.41626) in post-operative period do not determine the outcomes of epilepsy surgery. Neither the histological subtype of the diffuse brain gliomas, nor the molecular-genetic factor (IDH1/2 mutation, 1p/19q codeletion) determines the outcomes of epilepsy surgery in this patient category. The group of antiepileptic medications or the medication regimen (monotherapy, two-drug therapy) also does not determine the surgery outcomes. The factors that determine a favorable outcome of surgical treatment for epilepsy in patients with diff use brain gliomas are complete tumor removal and involvement of brain commissures after magnetic resonance imaging before surgery.

   Conclusion. The effectiveness of epilepsy surgery is determined by the radical removal of the diff use brain glioma, thereby eliminating the glutamate-mediated mechanisms of epileptogenesis.

   Introduction. Superficial hemosiderosis of the central nervous system is a chronic, progressive disease caused by continuous low-volume bleeding into the subarachnoid space and, as a result, subpial deposition of hemoglobin de-
tritus. Infratentorial superfi cial hemosiderosis (ISS) is characterized by hemosiderin accumulation primarily on the surface of the cerebellum, brainstem and spinal cord. Early detection of ISS may prevent severe disability and raise the chance of successful medical treatment.

   The purpose of this study was to analyze clinical, radiological, instrumental, and laboratory findings, based on a series of ISS cases diagnosed at the Research Center of Neurology.

   Material and methods. Seven patients diagnosed with ISS were included in this study (4 men, 3 women). Evaluation of the clinical findings, disease history, brain and spinal cord MRI, MR-angiography, brainstem auditory evoked potentials, audiometry, abdominal ultrasound, and laboratory iron metabolism tests was performed.

   Results. The median age of subjects was 63 years, and the median duration of disease was 3 years. We identified the cause of ISS in four patients. The most common clinical symptoms were cerebellar ataxia and sensorineural hearing loss. All patients had a typical ISS pattern on brain MRI images.

   Conclusion. With the development of neuroimaging, iSS is becoming a more frequent finding. Clinicians should be aware of its causes and optimal management strategy. Further studies of possible iSS treatments are needed to reduce free iron neurotoxicity and minimize clinical manifestations of the disease.

   The post-pandemic COVID-19 period is characterized by the growth of bacterial infection with septic cause. And different infectious diseases show new specific features in patients with high level of SARS-Cov-2 antibodies. The role of antibody level is not proved. The article presents a clinical observation of a patient with a complicated course of chickenpox, due to an attached bacterial streptococcal infection with a septic course, which led to a fatal outcome.

   Thе article describes two clinical cases of alternating hemiplegia (AH) in children of the same age group, but with different severity of clinical manifestations. The first patient, along with hemiplegic and epileptic seizures, demonstrates speech, behavioral and intellectual disorders, as well as motor disorders. The second patient, despite the presence of fairly frequent hemiplegic attacks, has no motor and intellectual disorders. The exact causes of such clinical variability are not yet known, which makes it difficult to predict the course in patients with AH.