[Current concepts about small vessel disease]

[The use of neuropeptides of animal origin in the treatment of neurological diseases]

The issues of effective treatment of neurological diseases remain relevant to this day. Neuropeptide preparations have been used in domestic neurological practice for more than 20 years. The physiological activity of neuropeptides is many times greater than that of non-peptide compounds. Neuropeptides include preparations from the brain of animals and synthetically synthesized analogues. The drugs differ from each other not only in composition, but also in different mechanisms of action, while maintaining the commonality of a pronounced neurotrophic and neuroreparative action. Large peptides and amino acids work on the principle of «replacement therapy», minipeptides affect the signaling system of the nuclear erythroid factor and bind to molecular targets, being bioregulators. The specific action of bioregulators is the ability to prolong their action and change the prevailing mechanism by reducing or increasing the required dose when physiologically necessary. They are called SMART-peptides, have high selectivity and efficiency, safety can potentiate the actions of other drugs.

Cerebral Small Vessel Disease: A Bibliometric Analysis

Cerebral small vessel disease is a common neurological disease, and its incidence is increasing year by year worldwide. In recent years, research on cerebral small vessel disease has gained more and more attention. Our research aims to visualize publications to identify the hotspots and frontiers of cerebral small vessel disease research, and to provide reference and guidance for further research. Publications related to cerebral small vessel disease were searched from the Web of Science Core Collection and screened according to inclusion criteria. CiteSpace 5.8.R3 was used to evaluate and visualize results, including generating web maps and analyzing annual publications, countries, institutions, bibliographic and co-cited references, and keywords; in this article, we use CiteSpace and VOSviewer for the 2012 Cerebral small vessel disease and bibliometric analysis from January 1, 2022 to April 30, 2022. A total of 3037 papers related to cerebral small vessel disease were retrieved, and the number of published papers showed a steady upward trend. Among them, Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration, the most symbolic references in the field of cerebral small vessel disease have been cited a total of 438 times. Stroke is the most active journal (227 articles) and USA publishes up to 800 articles. Harvard Med SchUniv Edinburgh (133 papers) and Charidimou (85 papers) are the institutions and authors who have made the most contributions in this field, respectively. Among the keywords, most of them are related to the pathogenesis of cerebral small vessel disease. After 2018, gut-brain axis and cortex are the keywords with the strongest number of cited outbreaks. There is increasing evidence that cerebral small vessel disease is a research frontier and may remain a research hotspot in the future.

SARS-CoV-2 (COVID-19) as a Predictor of Neuroinflammation and Neurodegeneration: Potential Treatment Strategies

The SARS-CoV-2 (COVID-19) pandemic has attracted attention to the challenge of neuroinflammation as an unavoidable component of viral infections. Acute neuroinflammatory responses include activation of resident tissue macrophages in the CNS followed by release of a variety of cytokines and chemokines associated with activation of oxidative stress and delayed neuron damage. This makes the search for treatments with indirect anti-inflammatory properties relevant. From this point of view, attention is focused on further study of the treatment of patients with COVID-19 with dipyridamole (Curantil) which, having antiviral and anti-inflammatory effects, can inhibit acute inflammatory activity and progression of fibrosis, is a drug with potential, especially among patients with early increases in the D-dimer concentration and severe signs of microangiopathy.

Cutaneomeningospinal Angiomatosis (Cobb Syndrome) in a Young Patient

Cobb Syndrome (Spinal Arteriovenous Metameric Syndrome 1-31 (SAMS 1-31)) is a rare, non-hereditary disorder. Approximately 100 cases of CS have been described to date. The actual incidence may be much higher since only symptomatic patients were documented. In particular, post mortem studies suggest a possibly higher incidence of this syndrome. The main clinical manifestations of this syndrome include skin stains of vascular nature on the torso, in combination with spinal vascular malformations localized in one and the same metameric or spinal segment. A rare diagnosis of this syndrome in patients over 18 is probably related to the fact that the disease may be asymptomatic throughout a long period of time [3], while patients may tend to disregard the skin lesions [5,6]. As a result, most publications on this pathology are based on separate case reports [7-9]. Significant variability of clinical manifestations as well as prolonged progress of the disease often cause errors in diagnosis. What follows is a case report of a young patient with Cobb Syndrome, who was admitted to a regional vascular centre with a misdiagnosis of stroke. 20 patients of young age (from 20 to 35 years old), with a diagnosis of stroke, who were admitted to a University Clinic (of the Russian National Research Medical University Named After Pirogov N.I., Moscow). Among this group of patients, a patient with Cobb syndrome was identified. Patient P., of 22 years, presented with acute, intensive cervical spinal pain, predominantly on the right, numbness and weakness in the arms and legs. About 3 weeks before admission to the hospital the patient had ARVI with a fever of up to 37.5°C: two weeks before the onset of symptoms he had undergone extirpation of 2 teeth, for which reason he spent over 2 hours in a forced position with his head thrown back (prolonged overextension in the cervical spine). Multiple skin angiomas on the chest spreading to the shoulder and scapula region. Tetraparesis up to 4 points: tetraparesis in hands with low muscle tone, low reflexes, tetraparesis in legs with high muscle tone, high reflexes. Foot clonus when causing Achilles reflexes. Tremor in the extremities. No plantar reflex pathology detected. Sensitivity disorders in the hands - "the high gloves". No pelvic disorders detected. Given the presence and exacerbation of neurological symptoms and cutaneous angiomas MRI with contrast agent of the cervical spine was recommended. MRimage of an advanced arteriovenous malformation (AVM) of the cervical spinal cord with signs of gliosis and spinal cord oedema at the С2 - С7 level. Endovascular embolization of the AVM in cervical spinal cord was performed. The treatment led to complete reversal of neurological symptoms. In the presence of skin lesions the diagnosis of CS does not present particular difficulties, so in children and young patients with skin angiomatosis it is advisable to conduct a comprehensive examination using selective spinal angiography or MR angiography to exclude arteriovenous malformations in spinal cord.