Том 43, № 8 (2017)

Investigation of the hemorheology and hemostasis system in patients with stroke of various types, location, and severity as well as with and without venous thromboembolic complications (VTECs), who were treated at critical and intensive care units, demonstrated the significance of impairments in the hemorheology and hemostasis system for VTEC pathogenesis in stroke patients. Despite ongoing anticoagulant therapy, aggravation of the prothrombogenic state was observed in VTEC patients. Ischemic stroke was associated with more severe changes compared to hemorrhagic stroke. Hemostasiological predictors of VTEC were identified. In patients without VTEC, both the coagulation and anticoagulation systems as well as the fibrinolysis system were preserved. The D-dimer and thrombophilia markers, such as hyperhomocysteinemia and antiphospholipid syndrome, were shown not to contribute to the development of VTEC in stroke patients.

The paper touches upon current views on the pathophysiology of visuospatial impairments in Parkinson’s disease (PD). To assess thickness of retina’s ganglionic layer, retinal nerve fiber layer, and macular map, optical coherence tomography method was used. Brain MRI was also performed followed by evaluation of the cortical thickness. Patients underwent neuropsychological tests, including those for assessment of visuospatial perception and cognitive functions. We found certain retinal regions and areas of visual cortex with significant changes in PD patients on different stages. Our findings allowed us to speculate on the role of changes in the peripheral and central structures of the visual sensory system in the pathophysiology of visuospatial impairments in PD.

Development of immunopathological responses in the central nervous system (CNS) is one of the key events in the pathogenesis of multiple sclerosis (MS). Humoral immune responses with formation of antibodies against the components of the myelin sheath play an important role. However, the targets for antibodies, their contribution to the development of pathologic process, and stages of the disease where they play the most important role are still not quite clear. In this study, we investigated the frequency of detection of antibodies against myelin glycolipids in MS and their relationship with clinical features of the disease. The results of the study showed that patients with MS demonstrate a trend towards more frequent detection of antibodies against glycolipids and sulfatide in blood serum, being especially pronounced in patients with secondary progressive course. Antibodies against GM1 ganglioside were detected significantly more frequently in patients with secondary progressive MS as compared to patients with remitting course and healthy volunteers. These results are indicative of the fact that antibodies to lipids may participate in the development of demyelinating and neurodegenerative processes in MS and be the markers of disease progression. Further development of the concept of the mechanisms of humoral response to myelin lipids in MS and identification of the most significant antibody targets will facilitate the development of new approaches to prediction of disease course and discovery of new targets for immunomodulating therapy.

Intensive development of DNA analysis technologies and large-scale genome-wide association studies have led to accumulation of a large array of data on the relationship between genetic factors and various phenotypic manifestations, including monogenic and polygenic hereditary diseases. This has greatly extended the capabilities of clinical diagnostics and predictive medicine in the field of socially significant diseases. For example, the role of a genetic component of the risk for such multifactorial and polyetiologic disease as stroke is now actively explored. Large-scale studies have revealed both general and specific genetic markers associated only with a certain type and subtype of stroke. This review analyzes the current state of the problem of using genetic markers for diagnosis of predisposition to stroke, complex issues associated with multiplicity of risk factors for stroke, and potential development in this area.

The article discusses the issues related to the personalization of preventive measures for ischemic stroke, in particular those associated with resistance to one of the most common antiplatelet drugs, aspirin. A brief historical note on investigation of acetylsalicylic acid is provided. The paper addresses the issue of etiological factors and epidemiology of aspirin resistance. An analysis and comparison of various techniques for evaluation of this phenomenon are performed. Separately, a molecular genetic aspect of the pathology is considered. In conclusion, the recommendations for overcoming tolerance to aspirin therapy are provided.

Stereotactic functional neurosurgical interventions for basal ganglia are an important method for treating pain, obsessive–compulsive, movement and depressive disorders. These interventions include destructive surgeries and deep brain stimulation through implanted electrodes. Destructive surgeries have a number of serious limitations, since they are associated with a higher risk of complications, especially in case of bilateral interventions. High-intensity focused ultrasound (HIFU) is a novel noninvasive approach proposed for destruction of a certain target point in the brain. We discuss the technical foundations of HIFU, thoroughly analyze the advantages and drawbacks of the method compared to other methods of modern functional neurosurgery, and summarize the first results of using HIFU in the world’s leading clinics. Further accumulation of experience is needed to perform a well-considered analysis of the potential of HIFU and to assess the long-term effects of the interventions performed and the role of this procedure in the algorithms for treating various nervous system diseases.

Psychogenic movement disorders pose a complex problem in modern neurology, which requires an interdisciplinary approach to solve a number of questions related to classification, diagnosis, treatment, and rehabilitation. The most frequent forms of psychogenic movement disorders include tremor, dystonia, myoclonus, and gait abnormality. A clinical case of a 46-year-old male patient with a psychogenic movement disorder presenting as fixed hand dystonia not accompanied by pain is reported. The terminology issues related to the most accurate determination of this type of hyperkinesis, as well as clinical tests (standard motor-skill tasks, ballpoint pen writing) that allow one to identify the psychogenic nature of hyperkinesis, are discussed using the example provided. The clinical phenomenology of psychogenic dystonia is thoroughly analyzed, and the differential diagnostic criteria of psychogenic and primary (idiopathic) dystonia are presented.