The aim of the article is to review the main conditions associated with vertigo and dizziness, modern approaches to their diagnosis and medical treatment.
The review presents the update approach to etiology, pathogenesis, diagnostic strategies of benign paroxysmal positional vertigo, Meniere’s disease, vestibular neuritis, functional dizziness, vestibular migraine, bilateral vestibylopathy, vestibular paroxysmia and etc. Diagnostic criteria and basic treatment of these conditions are discussed.

Introduction: The number of patients living with the consequences of stroke is increasing worldwide due to the improving stroke care and the modern differentiated treatment options for ischemic stroke – thrombolysis and thrombectomy. Hence, a significant interest has arisen in quality of life (QOL) measurement in post-stroke patients. Objectives. Measuring QOL in stroke survivors can be achieved by using various generic and stroke specific questionnaires. All tools should assess different domains of health such as physical acting, communication, daily activities and others. This article describes the most commonly used scales for measuring post-stroke QOL. Methods. We searched the PubMed electronic databases with the keywords — Quality of life, Stroke, Measuring for the period from January 2000 to May 2020. Results. Various generic and specific scales for quality of life measuring are available. The advantages of the specific scales include high accuracy and detailed information for the assessed domains. The limitations are due to numerous items, long evaluation time and high dependency on patient’s compliance. The generic scales give the ability to compare the QOL in patients with different diseases. The disadvantage is lack of detailed information for the health status in certain disease or condition. Conclusion. Measuring the different aspects of QOL in post-stroke patients is powerful tool in order to focus the further efforts to the most affected domains. A combination between generic and stroke-specific measure might be considered in order to overcome the limitations. The choice of measuring scales must be balanced in the terms of lengthy and repetitive surveys.

Abstract. Early rehabilitation (ER) of patients with acute cerebrovascular accident (ACA) is one of the priority tasks of the vascular centers; the issue of increasing the volume of rehabilitation measures in the resuscitation and intensive care units (ICU) is relevant. Objective. To evaluate the safety and effectiveness of the progressive ER program in patients with ACA. Material and research methods. The study included 129 patients with ACA in ICU. Each patient of the main group (MGr, n = 61) underwent progressive ER: at least 4–5 vertical adjustments per day, passive mode Kinesiotherapy 49 ± 9.3 minutes, a double load of physiotherapy exercises, preventive physiotherapy; the total time of classes reached 240 minutes per day. In the comparison group (СGr, n = 68), standard ER was performed no more than 120 minutes per day. The groups are comparable by sex, age, severity of the disease and comorbidity. The severity of ACA, the gravity gradient, patient mobility, functional status, degree of dependence, and the presence of complications were evaluated. Results. During a month of work with the MGr, 102 ICU bed-days, 94 days of the artificial lung ventilation use, p < 0.05 were saved. Mortality in MGr decreased -— 8 patients (13.1%) versus 14 (20.6%) in CGr (p < 0.05). In patients within CGr, pulmonary thromboembolism developed in 8.8%, in MGr – in 3.3%. The severity of the apoplectic attack decreased ( by 28% in MGr, and by 20% in CGr ), mobility increased. Comparing the modalities of post resuscitationsyndrome in MGr, it was noted that the score decreased by 2 times from 6 [5; 6] to 3 [2.3; 3.3], but it has not changed in the CGr. Patients in the MGr were 2-–3 days earlier adapted to the vertical adjustment. Conclusions. The progressive ER program in ICU is safe, effective, realisable, and allows reducing the number of bed-days in ICU, the number of days of the artificial lung ventilation use, complications, and mortality in comparison with standard medical care.

Abstract. Obstructive sleep apnea syndrome (OSAS) is considered one of the risk factors for cognitive impairment (CogI). The role of central apnea (CA) in the development of CI has not been established. Aim — to study the features of the structure of sleep-disordered breathing (SDB) in patients with chronic cerebrovascular disease (CVD) and clarify their significance as a risk factor for CogI. Material and methods. 100 patients (50 men, 50 women) at the age of 65 (58; 74.5) years were examined. Most had arterial hypertension (AH) and atherosclerosis of the brachiocephalic arteries; less commonly, stable forms of coronary artery disease and diabetes mellitus (DM) type 2. All patients were diagnosed with stage I–II dyscirculatory encephalopathy. Previously, non-disabling stroke was suffered by 37% of patients (mRS 0–2 points). Everyone completed the MoCA test. SDB was verified during cardiorespiratory monitoring (CT-04-3R (M), “INKART”, St. Petersburg). We estimated the number of episodes of SDB, obstructive apnea, CA, apnea/hypopnea index (AHI), duration and degree of desaturation. The correlation, discriminant and ROC analysis, the calculation of the odds ratio (OR) and the confidence interval (CI) of the occurrence of the event are performed. Results. SDB (AHI ≥ 5) according to the type of OSAS and CA were detected in 82% of patients. The average AHI was 13 (8; 21). CogI (MoCA < 26) were detected in 28% of patients without SDB and 52% of patients with SDB (p = 0.03). The relationship between the assessment of MoCA and AHI (Spearman, r = –0.24, p = 0.02) was established. A discriminant analysis with step-by-step inclusion of cardiovascular risk factors and SDB parameters revealed that CA, the degree of AH, age and DM are associated with the development of CN (Wilks’s Lambda: 0.75542; approx. F(4,73) = 5.9087, p < 0.0004). A threshold value of CA ≥ 5 was established (AUC 0.741, 95% CI 0.595–0.828; sensitivity 64%, specificity 76%), while the OR is 5.5 (95% CI 2.09–14.90). Conclusion. In 82% of patients with chronic CVD, SDB is detected, which is associated with a twofold increase in the frequency of CogI. Moreover, the most significant is the presence in the SDB structure of 5 or more episodes of CA, which serve not as a cause of CogI, but as a marker of more severe structural and functional cerebral changes.

Purulent meningitis in children can be both primary and secondary. The latter are the result of various surgical interventions, ENT pathology, immunosuppressive therapy, as well as craniocerebral and spinal trauma, which justifies the need for an integrated approach to differential diagnosis to select the appropriate therapy tactics. The article presents a clinical observation of a child in whom purulent meningitis developed on the background of epiduritis, which was the result of a spinal injury. The diagnostic search algorithm is described. The authors concluded that if the patient has laboratory confirmed purulent meningitis and adequate therapy with clinical improvement in the patient’s condition, but persistent febrile fever, an increase in inflammatory changes in the blood amid a decrease in the level of acute phase inflammation proteins (C-reactive protein) and negative procalcitonin the test requires a search for a local inflammatory focus using additional examination methods, such as MRI or CT, as well as consultations with a neurosurgeon That allows you to specify the diagnosis and to determine the conduct of tactics, thus providing a favorable outcome.

In development of the «serotonin» hypothesis of depression put forward by I.P. Lapin and G.F. Oxenkrug in 1969, the combination of the two factors is proposed which are responsible for depression formation: reduced “basal” 5-HT cerebral level and excessive duration of early morning REM sleep periods during which the release of cerebral serotonin ceases altogether. As a means of prevention and treatment, not the deprivation, but rather fragmentation of REM sleep is proposed, which is much easier for patients to tolerate.

The article analyzes the origin and competence of using several eponyms widely known in neurology. It is shown that some of them are not used correctly. So, the alternates “Jakob–Creutzfeldt disease” and “Arnold– Chiari malformation” are more correct. The eponym “Steele–Richardson–Olszewski syndrome” should not be used as a synonym for progressive supranuclear palsy syndrome. The historical aspects and correct variants of the use of a number of other neurological eponyms are highlighted in the article.