Vol 45, No 8 (2019)

Introduction: Biologically determined differences between males and females and different levels of sex hormones determine some specific features of their ischemic stroke (IS). Clinical studies aimed at identifying risk factors for the development of IS in persons of different sexes are considered to be necessary for elaborating strategies to increase life expectancy and to improve quality of life. Objective: to study risk factors for the development of IS in the arteries of the carotid system in males and females. Materials and methods: Risk factors for the development of IS in the arteries of the carotid system were analyzed in 268 patients for the period from 2010 to 2017. Among the patients, there were 148 (55%) men and 120 (45%) women aged from 47 to 79 years. MRI of the brain, duplex scanning of the cerebral arteries, and transthoracic and transesophageal echocardiography were used to establish the diagnosis of the stroke subtype. Results: In the age group 47–79 years, females had more often cardioembolic and lacunar stroke, while males had predominantly atherothrombotic stroke and stroke with competing causes. Atrial fibrillation, diabetes mellitus, atherosclerotic cardiosclerosis, chronic heart failure, thyroid disease and excess body weight were also more common in females. In contrast, there were significantly more smokers and over-consumption of alcohol among males, and the same was true for small heart attacks and transient symptoms in the past history. Atherosclerosis of the extracranial part of the internal carotid artery (ICA) ofhigh degree was found more often in males, while females with atherothrombotic stroke had significantly higher blood cholesterol level. The study of arterial hypertension (AH) revealed the following differences between groups: AH III degree (180/110 mmHg or higher) was more often in females, and AH I degree (140–159/90–99 mmHg) in males, while the proportion of patients with grade II AH (160–179/100–109 mmHg) and patients without AH was approximately equal in the two groups. Conclusions: The risk factors for the development of IS in the arteries of the carotid system in men are atherosclerotic carotid stenosis, smoking and excessive alcohol consumption. Development of stroke in men is preceded by small infarcts with transient symptoms. The risk factors for the development of IS in the arteries of the carotid system in women are atrial fibrillation, diabetes mellitus, atherosclerotic cardiosclerosis, chronic heart failure, thyroid disease, and excess body weight. As in men, despite significantly lower cholesterol levels, there are more pronounced atherosclerotic carotid stenosis and more frequent atherothombotic strokes, one may suggest the existence of an additional factor leading to stroke (alternatively, women may have some gender-specific protective factor).

Problems in curing disorders of the brain are caused by several characteristic features of the nervous tissue, such as postmitotic nature of neurons, their limited reparative potential, significant energy dependence, etc. Because of special vulnerability and extremely high specialization, neurons are very sensitive to the action of any pathological factors, while existing possibilities of their trophic and metabolic support are scanty. Therefore, the creation of new reparative strategies, including substitutive cell technologies, is immediate task in neurology. Neurodegenerative disorders, Parkinson’s disease (PD), Huntington’s disease and others, are an “ideal” model for elaborating such strategies. As main motor symptoms of PD are related to degeneration of the dopaminergic nigrostriatal pathway, treatment of these patients, theoretically, may be based on transplantation of dopamine-producing neurons into the striatum. In the paper, analyzed are the results of many-year experimental (on models of parkinsonism) and preliminary clinical trials of neurotransplantation with the use of fetal tissues (dopaminergic cells of the ventral midbrain) and dopaminergic neurons differentiated from embryonal stem cells and induced pluripotent. Newest scientific achievements in this field, improvement of cell protocols and successful resolving of a number of technical and medical problems allow saying that neurotransplantation becomes clinical reality just before our eyes.

Introduction: Traumatic trigeminal neuropathy in neurological practice occurs relatively rarely. Objectives: To study clinical and neurophysiological features of traumatic trigeminal neuropathy caused by orthognathic surgeries. Materials and methods: Patients (n = 24; aged 23–56 years) undergone orthognathic surgery, in short-term postoperative period (no more than 1 month since the surgery) received a therapeutic course of rhythmic magnetic stimulation. Stimulation pulse was 1–1.5 T, pulsing frequency 1 Hz, duration of the treatment 15–20 minutes daily, the course of treatment 10 days. Acoustic brainstem and trigeminal evoked potentials were recorded. Results: The clinical picture of post-operative trigeminal neuropathy is dominated by hypoesthesia of varying severity, and the trigger zone of the face and in the mouth are not determined. Tenderness of trigeminal nerve exit point was observed in 2nd, 3rd as well as in all three branches of the trigeminal nerve. In the study of acoustic brainstem evoked potentials there were identified changes at the medulla-pontine level more evident on one side (usually on the right), shortening of the latent periods of three peaks, I–III–V peaks amplitudes increase on both sides, and confluence of II–III peaks, mostly on one side. Reduction of latency and increase of amplitude of trigeminal evoked potentials components indicate dysfunction of the trigeminal system on both sides. Clinical effect expressed in improvement of sensitive disturbanses after the course of rhythmic magnetic stimulation was observed in 83% of patients; at the same time there was observed some delay of improvement of neurophysiological symptoms. Conclusion: Clinical-neurophysiological dissociation after the course of rhythmic magnetic stimulation can be explained by the short term of the course, incomplete recovery of functions of the structures involved in the stimuli conduction, as well as by the lack of adequate medical support.

The review provides modern understanding of the pathogenesis of progressive multifocal leukoencephalopathy (PML), a severe and potentially fatal form of multiple-lesion disorder of the brain white matter. Information about the frequency of its development in patients with disease-modifying treatment of multiple sclerosis is analyzed. The algorithms of optimization of PML risks in this category of patients with multiple sclerosis are described in detail. Summarized are the data on most significant PML biomarkers, the search for which is currently under way in many centers across the world. The first case of PML in Russia is briefly described.