Introduction. Osmotic demyelinating syndrome(ODS) is a life-threatening condition caused by water and electrolyte disturbances, usually associated with rapid correction of hyponatremia, manifested by acute demyelination of the brain. The average age of development of patients with ODS varies from 30 to 50 years. The incidence of unfavorable outcome (mortality/complete dependence on outside help) varies from 33 to 55%.

Objective. Systematization of data on the etiology, pathophysiology, clinical manifestations, diagnosis and treatment of osmotic demyelinating syndrome.

Material and methods. The literature search was performed in the electronic search engines Scopus, eLibrary, PubMed using the keywords: osmotic demyelinating syndrome, central pontine myelinolysis, extrapontine myelinolysis. Scientific articles published between 1959 and 2024 were selected for analysis.

Results. The main reason for the development of ODS is water and electrolyte disturbances that occur secondary to severe somatic pathology. Clinical manifestations of ODS are intermittent. Сlinical improvement is typical after rapid correction of osmolarity, followed by the development after 3–5 days of a clinical picture of acute myelinolysis. Currently, there is no specific therapy for ODS. However, early diagnosis of this disease is extremely important due to the high incidence of disorders of consciousness and breathing that require artificial ventilation. The polymorphism of clinical symptoms, as well as the low awareness of doctors, complicate the diagnosis and timely initiation of therapy for ODS. The optimal method of neuroimaging in patients with ODS is MRI in DWI, T2 and T2 FLAIR modes. The rate of correction of hyponatremia by no more than 10 mmol/l in the first 24 hours and no higher than 8 mmol/l every subsequent day is the main way to prevent the development of ODS.

Neuro-POCUS (Point-of-Care Ultrasound in neurology) is the international abbreviation for a new strategic direction in neuromedicine. It provides the clinician with a unique opportunity to perform neuroimaging themselves during patient examination or surgical manipulation to solve specific practical problems. In the domestic literature, the term «clinical-sonographic examination» was proposed for this approach. This direction is of particular importance in screening diagnosis, monitoring and surgical navigation in the most frequent and dangerous structural intracranial changes (hematomas, tumors, cysts, hydrocephalus, etc.). For the development of Neuro-POCUS technologies, an international scientific group was established in 2022, according to the report of which the assessment of brain parenchyma is discussed in the framework of monitoring midline shift and third ventricle width and mainly using transcranial color-coded duplex sonography. A review of the literature and our own 30 years of research suggest that B-mode transcranial ultrasonography is the optimal option for brain imaging within Neuro-POCUS. The history, foundations and prospects of Neuro-POCUS are discussed.

Blood concentration of neurotrophic factors (NTF) in patients with cerebral palsy after the use of the “non-invasive brain-computer-exohand interface” technique demonstrated a decrease in the level of NTFs on the 10th day after rehabilitation training, which was accompanied by an improvement in motor, cognitive functions and emotional status of patients. Moreover, different NTFs demonstrated different levels of concentration changes. The literature base about influence of NTFs on the mechanisms of neuroplasticity was analyzed. The review presents the results of studies on the therapeutic targets of NTFs and their different abilities to penetrate the blood-brain barrier, which apparently explains their participation in the processes of neuroplasticity. Analysis of literature data indicates the active involvement of NTF in the mechanisms of functional restructuring and their possible role in restoring motor activity in children with cerebral palsy, positive effect on cognitive functions and emotional status.

Cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS) is a hereditary slowly progressive adultonset disorder characterized by sersory and cerebellar ataxia, sensory polyneuropathy and bilateral vestibulopathy. In most cases the cause of this disease is biallelic AAGGG-repeat expansion in the RFC1 gene, encoding eplication factor C subunit 1. Today, CANVAS is one of the most common forms among late-onset hereditary ataxias in the world. The differential diagnosis of this syndrome is carried out with a wide range of hereditary and acquired disorders, which are characterized by a combination of cerebellar and sensory ataxia, polyneuropathy and vestibulopathy. The article describes two clinical cases in which the diagnosis of CANVAS caused several diffculties. The phenotypic diversity of this syndrome and the role of videooculography in the diagnostic algorithm and diagnosis verification are discussed.

The aim of the study was to investigate the pattern of cognitive impairment and immune status of patients with MRI changes corresponding to CMA.

Material and methods. 65 patients with CMA according to the MRI criteria were examined. Depending on the degree of white matter hyperintensity (Fazekas scale), patients were divided into 2 groups: Group 1 — 40 patients with Fazekas stage 2; Group 2 — 25 patients with Fazekas stage 3. The control group consisted of 24 patients of the corresponding age category without MRI signs of CMA. Cognitive function was investigated using MoCA and additional tests to assess memory, executive function, attention, perception and praxis. Laboratory diagnostics included assessment of interleukin concentrations (IL), monocyte chemoattractant proteins (MCP-1/CCL2, MCP-2/CCL8, MCP-3/CCL-7, MCP-4/CCL13), macrophage inflammatory protein-1d (MIP-1d /CCL15), myeloid progenitor inhibitory factor — 1, (MPIF-1/CCL23) and tumor necrosis factor alpha (TNFα).

Results. Compared to the control group, patients in groups 1 and 2 showed more pronounced cognitive dysfunction, lacunar lesions, prevalence of hypertension and obesity, in the 2nd group of patients — prevalence of MRI — signs of CMA, decreased memory, perception and executive functions. Increased level of IL-16 in patients of both groups, higher concentrations of MCP-1/CCL2, MCP-2/CCL8, and MIP-1 d/CCL15, IL-6, IL-1b and TNFα were found in the 2nd group compared to the 1st and the control groups.

Conclusion. Progression of cerebral microangiopathy objectified by MRI data is accompanied by increasing cognitive deficit mainly in the mnestic and executive spheres. The results of the study allow us to consider increased IL-16 production as an indicator of CMA progression, and the expression of IL-1b, IL-6, TNFα, MCP-1/CCL2, MCP-2/ CCL8 and MIP-1d/CCL15 as biomarkers of athero- and angiogenesis in patients with severe cerebral microangiopathy.

Introduction. One of the new methods for assessing atrial cardiomyopathy is speckle tracking echocardiography, which allows for non-invasive diagnosis of left atrial (LA) dysfunction.

Purpose. Determination the diagnostic role of LA myocardial deformation in the development of cardioembolic stroke (CS).

Materials and methods. The study included 150 patients in the acute period of ischemic stroke (IS). The patients were divided into 2 groups: group I consisted of 30 patients with EI, group II — 120 people with other etiopathogenetic types of IS. All patients underwent transthoracic echocardiography with assessment of myocardial deformation of the left chambers of the heart.

Results. The values of LA diameter, volume and indexed volume in group I were greater and amounted to 39 [36.3; 41] mm, 65.5 [55.8; 77.5] ml and 37 [25.8; 44.8] ml/m2, respectively. Indicators of myocardial deformation of the LA in patients of group I went beyond normal values and differed statistically significantly, amounting to 14.1 [5.25; 22]%, −10 [−11.5; −5.25]% and −4.25 [−10.4; 0.575]% for the deformation indicators in the reservoir phase (LP-SrKD), conductor (LPSprKD) and contraction (LPSkKD), respectively. When conducting multivariate regression analysis adjusted for confounders, LPSprKD and LPScrKD remained statistically significant indicators. Thus, each subsequent increase in the LPScrCD indicator by 1% increased the chances of CEI by 1.151 times (OR: 1.151, 95% CI: 1.043–1.271, p = 0.006), each subsequent increase in the LPScrCD indicator by 1% — by 1.11 times (OR : 1.102, 95% CI: 1.032–1.178, p = 0.004). ROC analysis was performed to determine the optimal diagnostic threshold and diagnostic performance of strain analysis in relation to CS.

Conclusions. In group I, statistically significantly higher values of LA sizes and volumes were recorded, and LA deformation indicators were statistically significantly different from the indicators of group II and were outside the normal range. It was established that statistically significant indicators of LA myocardial deformation, allowing for the diagnosis of CEI, were LPSprCD and LPScrCD. 

Introduction. Neurophysiological methods, such as nerve conduction studies (NCS) and transcranial magnetic stimulation (TMS), as well as nerve ultrasound (US), can be used to examine patients with facial neuropathy. Currently, normative instrumental facial parameters exist only for adults and have not been studied in children. We have provided age-related reference values for NCS, TMS and nerve US of the facial nerve in healthy children.

Objective. The determination of age-specific neurophysiological and ultrasound parameters of the facial nerve in healthy children.

Material and methods. NCS, TMS, and nerve US were used to examine 65 children aged 5 to 18 without neurological symptoms. In addition, the results of facial NCS in healthy children under 5 (n = 24) were analyzed retrospectively. Statistical analysis was processed with an assessment of normality of distribution and the use of parametric or nonparametric tests.

Results. An age-related increase in the amplitude of M-wave was revealed for m. nasalis and m. orbicularis oculi, as well as in the amplitude, the latency and the area of motor evoked potentials (MEP) for m. frontalis, m. orbicularis, and m. nasalis. According to nerve US, there were no significant differences in diameter and depth of the facial nerve between children aged 5–12 and 12–18.

Conclusion. The obtained normative parameters for facial NCS, TMS, and nerve US in children of different age groups can be used in both everyday clinical and research practices. 

Specialised nutritional supplements that promote wound healing shorten the duration of pressure ulcer (PU) healing, but such data are limited in tube-fed patients.

Material and methods. The effectiveness of a specialized enteral tube feed with arginine, zinc and antioxidants (Nutrison Advanced Cubison) in hospitalized patients with PUs was assessed in a multicenter, prospective, randomized, open-label, parallel-group study involving 67 adult patients with stroke or traumatic brain injury with stage 2–3 pressure ulcers. Tube feed using a specialized product (SpP) was compared with standard enteral tube feed (StdP).

Results. Over 28 days, the PU area in the SpP group decreased by an average of 76.9% while in the StdP group by 51.3%; the difference was 26% (95% CI from 5.9% to 45.3%; p = 0.013). By the end of the trial, a decrease in the average PU area by 20% and more from the initial size occurred in most patients in both groups, while the difference between the groups was statistically insignificant (SpP 86.2% vs StdP 69.2%; p > 0.05). The change in total score and components of PUSH© score over 28 days was significant for intragroup changes in both groups (p < 0.001), but intergroup change was statistically insignificant. By the end of the study, complete healing of the PU occurred in 62% of patients in the SpP group compared with 34.6% of patients in the StdP group (difference 27%, 95% CI from 1,6% to 56,5%; p = 0.04). The mean time for complete PU healing was reduced by 3.2 days (SpP 21,3 days vs StdP 24,4 days, 95% CI 1.4 to 4.9; p = 0.005).

Conclusion. Specialised enteral tube feed stimulates PU healing in hospitalised patients compared with a standard tube feed.