[Vertical nystagmus]

The review article provides a definition and classification of different nystagmus types, a comparative description of the central and peripheral vestibular nystagmus. The pathogenetic patterns of up-beating and down-beating nystagmus are accurately described. The features of nystagmus formation in various diseases are discussed, such as Wernicke encephalopathy, Arnold-Chiari anomaly, spinocerebellar ataxia and vestibular migraine. The authors provide their own data on oculomotor disorders in 100 patients with vestibular migraine and migraine with a brain stem aura. This article considers approaches to treatment: surgical and conservative. In conclusion, was noted the possibility of differentiating the central and peripheral vestibular nystagmus by means of clinical study. As well, the differences between vertical nystagmus associated with organic lesions of the brain stem or cerebellum and transient nystagmus with vestibular migraine are highlighted. The authors note the need for in-depth studies of nystagmus in vestibular migraine patients and methods of dealing with it.

[Tinnitus: clinical and pathogenetic aspects]

The article discusses the pathogenetic and clinical features of tinnitus. It is emphasized that various causes contribute to the appearance of tinnitus, including somatic diseases, excess body weight, iatrogenies, otological diseases with an outcome in hearing loss. The anatomical and physiological features of the structure of the central part of the auditory system are considered. It is suggested that the occurrence of tinnitus is associated with the processes of maladaptive neuroplasticity caused by pathological changes in the neuronal activity of cortical structures of the CNS, and not with changes in the peripheral part of the auditory analyzer - the structures of the cochlea. The results of recent studies, including those using functional neuroimaging methods, indicate the significance of cortical connection disorders (human connectome) in patients with tinnitus. In patients with tinnitus, there are changes in regional neuronal activity and connections not only in the auditory cortex, but also in areas not directly related to the analysis of auditory afferentation. Thus, tinnitus can be considered as one of the variants of dysfunction of the human connectome, triggered primarily from the «auditory input».

[Positional vertigo variant]

The article describes case history and multiphase treatment of the patient with attacks of vertigo, initially regarded as the onset of Meniere's disease, but later qualified as secondary positional attacks with combined musculoskeletal pathology of the craniovertebral region and temporomandibular joint. Medicinal, local and surgical treatment led to the perfect result. Thus, the team work of neurologist, otolaryngologist, maxillofacial surgeon and orthodontist led to the successful elimination of vertigo attacks.

[Comprehensive treatment of Costen syndrome]

OBJECTIVE

To develop an integrated therapy for the combination of pain syndrome and cochleovestibular syndrome (CVS) in patients with temporomandibular joint (TMJ) dysfunction.

MATERIAL AND METHODS

Forty-five patients (42 women and 3 men), aged from 23 to 54 years, with TMJ dysfunction, signs of CVS and complaints of pain in the ear area were stratified into three groups (15 patients each). Patients received pharmacological and osteopathic therapy (group 1); splint therapy followed by orthodontic treatment (group 2) and a combination of the abovementioned methods (group 3). Re-examination was carried out 3 months after completion of treatment.

RESULTS

After treatment, complaints of pain, tinnitus, dizziness and nystagmus, the degree of TMJ dysfunction decreased significantly (p<0,05) compared to baseline in groups 1 and 2. In group 3, the most significant and persistent results were obtained, which significantly differed not only from the initial level, but also from the final level of indicators in the first and second groups (p<0,05), including a decrease in the degree of maladaptation associated with vertigo and trait anxiety.

CONCLUSIONS

Differential diagnosis of CVS in patients with TMJ dysfunction requires the joint participation of dentist, neurologist and ENT doctor and should be comprehensive, including medical, orthodontic and osteopathic components.

[Possibilities of digital fluorography and other X-ray methods in the detection of carotid atherosclerosis]

AIM

To evaluate possibilities of routine X-ray methods for the diagnosis of atherosclerosis of carotid arteries.

MATERIAL AND METHODS

At the initial stage of the study, 468 X-ray radiograms of the cervical spine with the detailed description of soft tissues and projections of the neck vessels were studied. The next stage included evaluation of 'screening' abilities of digital fluorography of lungs (886 X-ray radiograms were analyzed). The last stage is a current pilot project aimed to introduce opportunistic screening of atherosclerosis of carotid arteries using X-ray and ultrasound examination of the thyroid gland taking into account disease history collected with help of a special questionnaire and clinical examination.

RESULTS AND CONCLUSION

The study shows a high specificity of the shadows in the projections of the neck vessels as a sign of atherocalcinosis. During mass examinations these X-ray findings are useful to identify patients who need duplex scanning and other high-tech methods.

Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 2. Association of Breast Arterial Calcification and Cardiovascular Diseases

Prospects for the use of mammographic detection of breast arterial calcification (BAC) to improve the stratification of cardiovascular risk in the female population are of increasing interest. The purpose of the 2 part of the review is the analysis of modern literature on the relationship of the BAC with the prevalence and mortality from cardiovascular diseases (CVD). The presence of BAC on mammograms is associated with a higher likelihood of myocardial infarction, death from coronary heart disease (CHD) and CVD, as well as a 3.5-fold increase in the risk of CHD and a 5-year coronary incident (p=0.003). Women with BAC have a higher likelihood of coronary artery disease detected during angiography than women without BAC (p<0.001). Severe BAC has a stronger association with CVD than mild calcification. The association of BAC with cerebrovascular diseases and a 1.4-fold increase in the risk of ischemic stroke (p=0.004), atheromatosis of the carotid arteries and an increase in the thickness of the intima-media complex is shown. BAC is associated with atherosclerotic lesions of peripheral arteries and a decrease in the ankle-brachial index <0.9 (p=0.048). In women with chronic kidney disease, the presence of BAC indicates a 4.5-fold increase in the risk of complications associated with impaired blood flow in peripheral arteries. It is shown that the addition of BAC to the generally accepted (standard) vascular risk assessment algorithms Framingham Risk Score and Pooled Cohort Equation significantly increases the accuracy of prediction of CHD (p=0.02 and p=0.010, respectively). The detection of BAC on mammographic screening is a new promising direction for cardiovascular prophylaxis in women and opens up new opportunities for identifying groups of people with subclinical forms of CVD and high cardiovascular risk.

[Predictors of remote outcomes of brain injury]

AIM

To determine predictors of remote outcomes of complex combat brain injury.

MATERIAL AND METHODS

A survey of 145 combatants with long-term combat injury (from 1 to 10 years) was conducted. Responses were received from 30 people from 18 regions of the Russian Federation. Data analysis included nonparametric correlation analysis using Spearman coefficient.

RESULTS AND CONCLUSION

Significant correlations were between the remote functional outcome and the following predictors: the severity of injury at admission (r=0.527; p<0,01), leukocyte level at admission (r=0.594; p<0,01), presence and severity of pelvic disturbances (r=0.574; p<0,01), the duration of staying in intensive care (r=0.476; p<0,01), neurological deficit severity and scores on the Glasgow Outcome Scale (r=0.469; p<0,01). Character of remote outcome was associated with posttraumatic amnesia (r=0.491; p<0,05), concomitant injuries of abdominal cavity organs, kidney, bladder, time of starting peroral feeding (r=0.377; p<0,05), mean heart rhythm rate during the first 14 days of treatment, pneumonia (r=0.377; p<0,05) and episodes of psychomotor agitation (r=0.381; p<0,05) within a period of hospital treatment. These results need confirmation in a larger study.

[Prevention of venous thrombosis of the lower extremities and pulmonary embolism in neurological patients in the intensive care unit using intermittent pneumatic compression]

AIM

To assess the efficacy of intermittent pneumatic compression (IPC) in the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) in neurological patients.

MATERIAL AND METHODS

The study included 101 patients with acute disorders of cerebral circulation: 52 patients underwent IPC for prevention of DVT of the lower extremities, 49 patients received only basic treatment. Clinical examination, venous duplex scan of the lower extremities and telethermography were performed.

RESULTS AND CONCLUSION

IPC significantly reduces the risk of DVT of the lower extremities and PE mortality in the first 20 days in patients with stroke and motor deficit. Ultrasound and thermography can effectively assess the dynamics of treatment.

[The dynamics of cerebral vascular reserve in sleep apnea patients during continuous positive airway pressure therapy]

AIM

To explore the possibility of cerebral hemodynamic reserve (CHR) normalization in patients with obstructive sleep apnea syndrome (OSAS), aged over fifty, who received continuous positive airway pressure (CPAP) therapy.

MATERIAL AND METHODS

The main group (20 patients, aged 50-65 years, with severe OSAS) and the control group (20 volunteers without snoring and OSAS matched for age and physical status) were studied. Diagnosis included cardio-respiratory monitoring of nocturnal sleep and ultrasound examination of cerebral blood flow with functional tests (breath holding and hyperventilation) and calculating the coefficient of vasomotor reactivity (CVMR) before the start of CPAP-therapy and after one month therapy.

RESULTS

The significant CVMR decrease in vertebral (VA) and basilar arteries (BA) in patients with OSAS compared to the control group was identified: 38.9±8.5 and 55.7±11.3 for VA, 36.8±15.7 and 54.0±5.4 for BA. After one month CPAP-therapy, no significant coefficient gains was observed: 38.9±8.5 and 42.3±9.1 for VA, 36.8±15.7 and 37.2±7.7 for BA.

CONCLUSION

The reduction of CVMR in patients older than 50 years with severe OSAS suggests the disturbance of CHR. The absence of its recovery within one month of CPAP-therapy may be indicative of the irreversible damage of the cerebral blood flow regulation mechanisms. Continued observations for a longer period are needed.

[Factors influencing the detection of ischemic stroke in neuroimaging]

AIM

To determine the detectability of foci of acute ischemic stroke (AI) using neuroimaging methods depending on the localization, timing and severity of stroke.

MATERIAL AND METHODS

A retrospective evaluation of 100 case histories of patients hospitalized for ischemic stroke (IS) with determination of the timing of neuroimaging study, fibrinogen level, glucose, INR, NIHSS scores on admission to the hospital, assessment of stroke localization (hemispheric or brainstem), the severity of atherosclerosis of the brachiocephalic arteries (BCA) and presence of atrial fibrillation (AF) was performed. During the stay in the hospital, 54 patients were re-examined to clarify the diagnosis. All patients were divided into 2 groups: patients with the focus of AI revealed on primary neuroimaging study (group 1) and patients with the focus of AI at repeated neuroimaging or patients without lesions on CT or MRI (group 2).

RESULTS

Stem strokes were dominated in group 2. An increase in glucose above 10 mmol/l was more often detected in group 1 (p<0.05). AF was detected in 13 patients of group 1 and 9 of group 2. NIHSS <10 values were detected in 8 patients of group 1 and 3 patients of group 2 (p<0.05). An occlusive BCA lesion was found only in patients of group 1(n=4).

CONCLUSION

Cases of AI not detected by CT/MRI on admission to the hospital are more common in women, have stem localization, characterized by low values of NIHSS and lower glucose levels on admission to the hospital.

[Combined prosopalgia with acute onset]

Complexity of facial anatomy and its rich innervation complicate the diagnosis of prosopalgias. An acute syndrome, including trigeminal, myofascial and cervical pains, is described. Authors discuss algesic interrelations, combined therapeuric effect and peculiarities of diagnosis.

[Clinical and instrumental diagnosis of concomitant venous dysfunction of the brain and extremities]

OBJECTIVE

to compare the frequency, preferential localization, severity of disturbances of venous circulation in the brain and limbs.

MATERIAL AND METHODS

Authors examined 140 people during 2009-2014: 20 apparently healthy people without clinical manifestations of extra-intracerebral venous insufficiency; 70 patients with clinical and instrumental signs of venous encephalopathy; 50 patients with varicose disease. History and clinical status were studied for all patients. In addition to physical methods, dynamic teletermography and triplex study of head, neck and extremity vessels were used.

RESULTS AND CONCLUSION

-A higher, than previously estimated, frequency of concomitant venous dysfunction of the brain and other locations was identified. It has been shown that venous insufficiency is a systemic pathology that affects venous circulation of the brain and extremities.

[Influence of acupuncture on cerebral hemodynamic reserve during the preoperative period in patients with associated brachiocephalic stenosis]

OBJECTIVE

To evaluate the possibility of acupuncture, as an element of preoperative preparation of the patient to carotid endarterectomy, for increasing the tolerance of patients with brachiocephalic stenosis to cerebral ischemia.

MATERIAL AND METHODS

We studied 40 inpatients with low tolerance to carotid compression test. Ultrasound examination of brachiocephalic and intracranial blood flow was carried out, including carotid compression, apneic and hyperventilation tests. We examined 20 people from the control group before traditional medicinal treatment as well as after first and second therapeutic courses; 20 patients from the main group were tested before and after medicinal treatment, and after acupuncture course.

RESULTS

We couldn't identify any significant changes in cerebral hemodynamic reserve in patients with severe carotid stenosis after medicinal therapy; at the same time we registered its reliable 2.16 fold growth after acupuncture treatment.

CONCLUSION

Аcupuncture treatment leads to cerebral hemodynamic reserve growth in most patients with significant brachiocephalic stenosis. The inclusion of acupuncture in therapeutic complex improves the quality of preoperative preparation to carotid endarterectomy and its tolerability.

[Basilar type migraine: clinical features, differential diagnosis]

The work is devoted to the description of neurological, vestibulometric and audiologic data obtained in the examination of 11 patients with basilar type migraine. The features of the disease (neck injuries before the disease, prolonged aura, protracted attacks, similarity with the clinical picture of stroke, occipital pain, cervical root syndrome, muscle-tonus phenomena and others) are described. A role of cervical pathology and labyrinthine hydrops in the disease pathogenesis as well as difficulties of differential diagnosis with Ménière's disease and Barre-Lieou syndrome are discussed.

[Complex types of vertigo: diagnostic possibilities]

OBJECTIVE

To study diagnostic possibilities of a complex vestibular examination of patients with hard curable vertigo.

MATERIAL AND METHODS

We studied 312 patients with complex types of vertigo. Neurologic and othoneurologic examination and some audio- and vestibulometry tests were carried out.

RESULTS

The high frequency of comorbid lesions of the vestibular analyzer and coordination system was identified.

CONCLUSION

Diagnostic and therapeutic approaches to hard curable vertigo are discussed.

[Transcranial dopplerography in the combination with echopulsography in the assessment of intracranial and cerebral perfusion pressure in patients with intracranial hemorrhages]

OBJECTIVE

To study the possibilities of common ultrasound diagnostic methods in the evaluation of intracranial pressure (ICP) and central perfusion pressure (CPP) and to search for the ways of increasing the accuracy of these methods.

MATERIAL AND METHODS

Thirty-eight patients, aged 28-66 years admitted to a neuroreanimation department of a hospital due to acute intracranial vascular and traumatic hemorrhages were examined. An instrumental study included transcranial dopplerography (TCDG) and digital echoencephalography. Accuracy of measurement was evaluated for ICP and CPP in clinical conditions.

RESULTS

The data obtained confirm the possibility of quantitative assessment of ICP and CPP using TCDG. We suggest a new formula for more precise calculation of CPP.

CONCLUSION

The complex use of noninvasive ultrasound methods allow in most cases to measure with acceptable accuracy and assess the degree of intensity of ICP and CPP changes at the acute stage of intracranial hemorrhages.

[A new clinical sign - asymmetrical pulsation of neck vessels with a predominance in the right supraclavicular area in healthy people at supine position]

This is a report on a new clinical symptom manifested in the form of an asymmetrical pattern of pulsation in the cervical vessels in healthy people. A study included 820 healthy people of different sex and age, including 40 children. The physiological asymmetry of the jugular veins was demonstrated.

[An X-rays study of the cervical part of spinal cord for detection of atherosclerosis of carotid and vertebral arteries]

The paper is intended for neurologists and radiologists and addresses a problem of accurate and scrupulous assessment of soft cervical tissues. The most distinct changes of infiltrations, which vary by the form and intensity, were detected in the projection of the extracranial segments of the carotid and/or vertebral arteries on the X-ray- and spondylograms of the cervical part. The presence of calcium deposits found in 13% out of 300 patients over 55 years of age was confirmed by the duplex study of the great brain arteries. A simple and logic algorithm of diagnosis of carotid arteries atherosclerosis, working in accordance to from-the-simple-to-the-complex principle, was suggested. It includes scrupulous clinical examination - palpation, auscultation followed by assessment of the soft cervical tissues on cervical X-ray-and spondylogram and finally, if necessary, duplex and/or CT-MRI in "vascular regime".

[Noncontact impedancemetry for diagnosis of cerebral edema]

An original method of impedancemetry designed by the authors and applied in 88 cases of cerebral edema caused by brain aneurysm rupture (n = 23), by acute hemorragic stroke of hypertensive type (n = 13) and craniocerebral injury (n = 52) is described. Diagnostic value of the method, its safety and convenience for clinical practice are demonstrated.

Use of transcranial magnetic stimulation with measurement of motor evoked potentials in the acute period of hemispheric ischemic stroke

Functional derangements in the brain during the acute period of ischemic hemispheric stroke (IS) were assessed in terms of the severity of the motor neurological deficit in the acute period of IS and neurophysiological measures of motor evoked potentials (MEP) using transcranial magnetic stimulation (TCMS). A total of 52 patients (23 women, 29 men, mean age 58.5 +/- 8.7 years) were studied. Patients were divided into two subgroups: group 1 consisted of 29 patients with good functional outcomes from the acute period; group 2 consisted of 23 patients with poor functional outcomes. The use of TCMS for recording MEP demonstrated increases in the latency of the M response both after stimulation of the projection of the motor area of the cortex of the lesioned hemisphere and after stimulation of the spinal cord. There were increases in the central motor conduction time (CMCT) in the lesioned hemisphere of the brain and a negative correlation was seen between the severity of the neurological defect and CMCT on the one hand (r = -0.65 to -0.78; p < 0.001) and, on the other, the latency of the M response in TCMS of the motor zone of the cortex on the side of the hemispheric stroke (r = -0.65 to -0.79; p < 0.001). The increases in the latency of the M response and CMCT have prognostic significance for early assessment of the outcome of IS.

[Is the asymmetrical pulsation in the supraclavicular regions of the necks of healthy subjects in a horizontal posture a physiological or pathological phenomenon? (clinico-ultrasonic study)]

This is a report on a previously undescribed clinical symptom manifested in the form of an asymmetrical pattern of pulsation in the cervical vessels in healthy people, with a more pronounced nature on the right side. Using ultrasound angiography and flowmetry, 300 volunteers (200 healthy people and 100 patients with diseases of the peripheral nervous system) were studied and the physiological asymmetry of the blood flow along the jugular veins was demonstrated.

[Thermography and ultrasonic methods of diagnosis in neurology]

The results of a 10-year experience with application in a neurological clinic of modern non-invasive thermovision and ultrasonic methods are described. Some 5000 patients with various distrubances in the central and peripheral nervous system, and 1000 nonneurological patients were examined with a view to detect subclinical forms of cerebrovascular insufficiency. Recommendations are given for improving technical characteristics of the Soviet thermovisors.