Transient global amnesia (TGA) is a benign, stress-induced neurological syndrome associated with reversible hippocampal dysfunction that manifests as isolated, predominantly anterograde amnesia. Since it is impossible to make a definitive diagnosis of TGA when the patient is admitted to hospital, the primary condition should be interpreted as an acute cerebrovascular accident, which implies a mandatory neuroimaging examination and clarification of the question of thrombolysis according to general principles. When taking a medical history, attention should be paid to the presence of predisposing conditions and triggers: migraine, chronic and acute stress, physical activity, sudden changes in temperature, Valsalva maneuver, coitus, medical procedures. If amnesia does not resolve within 24 hours, a differential diagnosis with stroke, Wernicke–Korsakoff encephalopathy, limbic encephalitis, intoxication and psychogenic (dissociative) amnesia is required. If the symptoms resolve within 24 hours and the classic diagnostic criteria are met, magnetic resonance imaging of the brain in diffusion-weighted mode is performed on days 2 to 4 in order to detect pinpoint zones of diffusion restriction in the hippocampus. If these lesions are visible and a typical medical history is available, the diagnosis of TGA can be made; if no lesions are present, the diagnosis is probable. In the absence of lesions and an atypical history of TGA, differentiation from transient epileptic or dissociative amnesia and transient ischemic attack is required.

Objective: to determine the specificity and sensitivity of the central vein sign (CVS) for the diagnosis of multiple sclerosis (MS).
Material and methods. We analyzed 76 patients. The main group consisted of 40 patients with a confirmed diagnosis of MS according to the McDonald criteria, 2017. The comparison group included 20 patients with migraine and 16 patients with cerebral microangiopathy. All patients underwent a standardized MRI scan of the brain, including 3D FLAIR and SWI modes. The total number of T2/FLAIR hyperintense lesions in the brain and the number of lesions with CVS were calculated.
Results. In the group of MS patients, the total and relative number of lesions with CVS was higher than in the comparison group (p<0.001). The 40% lesion rule had a sensitivity of 97.5% and a specificity of 94.4%. The sensitivity of the 3-lesion rule was 92.5% and the specificity 66.7%. The use of the 5-lesion rule had a sensitivity of 75% and a specificity of 83.7%.
Conclusion. The data obtained indicate a significant diagnostic role for SCV in MS. The use of the 5-lesion rule provides high sensitivity and specificity with relative ease of use.

Objective: to evaluate the efficacy of a comprehensive rehabilitation program on functional independence in daily life, exercise tolerance and quality of life (QoL) in patients with relapsing-remitting multiple sclerosis (RRMS) in remission.
Material and methods. 38 patients with RRMS were analyzed (33 women and 5 men; age – 41.6±7.7 years; EDSS – 4.0 [3.5; 5.0] points, duration of MS – 8.0 [3.0; 21.0] years). The patients received comprehensive rehabilitation in a hospital for 2.5 weeks. The examination was carried out before and after the rehabilitation program. Independence in daily activities was assessed using the Functional Independence Scale, the Get Up and Go Test and the Berg Balance Scale. Exercise tolerance was determined using a cardiopulmonary exercise test (CPET) on a cycle ergometer. The following parameters were measured: oxygen consumption during exercise (VO_{2 peak} oxygen uptake), percentage from the predicted VO_{2 peak} (% pred VO_{2 peak}) and maximal workload in metabolic units (MET). Walking speed was measured according to the Davis protocol in the SMART-D laboratory (Italy). QoL was determined using the SF-36 questionnaire, which assesses physical functioning (PF), general health (GH), vital activity (VT) and social functioning (SF). Cognitive functioning was assessed using the Montreal Cognitive Scale (MoCA) and depression using the Beck Depression Inventory (BDI).
Results. After completion of the rehabilitation course, there was a significant increase in VO_{2 peak} (from 18.8±3.8 to 20.4±4.3 ml/kg/min), % pred VO_{2 peak} (from 59±13 to 63±14%), maximal workload (from 5.4±1.2 to 5.8±1.2 MET), maximal heart rate (from 140±14 to 147±13) and walking speed (from 0.84±0.29 to 0.97±0.28 m/s). At the same time, despite an improvement the patients did not reach the age- and gender adjusted reference values for exercise tolerance. QoL indicators also increased, reaching or exceeding the populational values obtained for the Russian population: PF – from 45 to 52.2; GH – from 51 to 52; VT – from 45 to 50; SF – from 62.5 to 75. The number of points on the BDI also decreased significantly (from 9 to 6), and the increase on the MoCA scale had tendency to significant difference (p=0.064).
Conclusion. A comprehensive rehabilitation program in patients with RRMS in remission helps to increase exercise tolerance and improve functional independence and QoL.

Objective: to evaluate laboratory parameters of hemostasis, lipid metabolism and endothelial dysfunction and their relationship in men aged 18–50 years with atherothrombotic (ATS), lacunar (LS) and cardioembolic (CES) stroke.
Material and methods. The study included 89 men with ATS (n=36), LS (n=34) and CES (n=19). Neuroimaging, ultrasound and laboratory blood serum analyses were performed in all patients.
Results. The mean age of the patients was 42.6±5.3 years. The main risk factors for ATS, LS and CES included: arterial hypertension (75; 97.8 and 73.7% of cases, respectively), dyslipidemia (60; 41.3 and 42.1%), tobacco smoking (71.7; 67.4 and 52.6%), regular alcohol consumption (35; 19.6 and 36.8%), obesity (23.3; 8.7 and 15.8 %), diabetes mellitus (8.3; 6.5 and 10.5 %). Lower tissue plasminogen activator levels were found in patients with CES (2.66±1.77 ng/ml) compared to patients with LS (3.38±3.0 ng/ml) and ATS (3.48±2.45 ng/ml). Plasminogen activator inhibitor-1 levels were significantly increased in all stroke subtypes. The mean level of soluble thrombomodulin was highest in patients with LS (100.86±58.22 pg/ml) compared to patients with ATS (96.37±85.71 pg/ml) and CES (75.28±39.36 pg/ml). The level of asymmetric dimethylarginine was higher in patients with ATS (1.46±0.42 μmol/l) and in patients with LS (0.79±0.37 μmol/l), and in patients with CES (0.4±0.13 μmol/l) it was within the reference values.
Conclusion. We noted differences in laboratory parameters of the hemostasis, lipid metabolism and endothelial dysfunction in men aged 18–50 years with different stroke subtypes (ATS, LS and CES), as well as clinical and laboratory correlations.

Objective: to evaluate the efficacy of antiparkinsonian drugs of different groups considering the frequency-amplitude characteristics in the correction of tremulous hyperkinesis in Parkinson's disease (PD) using tremorography.
Material and methods. 172 patients with a confirmed diagnosis of PD were observed. Taking into account age and contraindications, patients were divided into four groups receiving one of four drugs in monotherapy: dopamine receptor agonists (ADR; pramipexole), levodopa (Tidomet forte), anticholinergics (biperiden), amantadines (amantadine sulfate). Before starting treatment and after completion of the selected therapy, patients underwent tremorography to analyse the frequency, amplitude and duration of tremor over time in four standard tests.
Results. All antiparkinsonian drugs reduced rest tremor, and the efficacy of pramipexole in treating tremor was comparable to that of levodopa in the early stages of the disease. As the severity of the disease increased, the efficacy of ADRs decreased, whereas levodopa became more important. Amantadine sulfate showed the lowest efficacy in rest tremor. The efficacy of anticholinergics against tremor is high but inconsistent.
Conclusion. We demonstrated feasibility of using tremorography in the selection of an individualised treatment programme for patients with shaking hyperkinesis in PD , and the high efficacy of levodopa in shaking hyperkinesis was confirmed.

The effectiveness of staged reperfusion therapy in real clinical practice requires clarification.
Objective: to evaluate the efficacy and safety of mechanical thromboextraction and staged reperfusion therapy with alteplase in real clinical practice.
Material and methods. The study included 106 patients who were retrospectively divided into two groups: Group I underwent staged reperfusion therapy (intravenous thrombolysis with alteplase followed by aspiration thromboextraction), Group II underwent thromboaspiration only. The clinical and functional results, incidence of hemorrhagic transformation and mortality rate were compared.
Results. The groups did not differ in terms of demographic data, cardiovascular risk factors or stroke severity. Group II patients were characterized by a longer delay in reperfusion therapy (225 minutes versus 180 minutes) and a lower score on the Alberta Stroke Programme Early CT score (ASPECTS; 8.8 points versus 9.3 points). There were no differences in National Institutes of Health Stroke Scale (NIHSS) scores at day 28, dynamics of NIHSS scores, Rankin scores at day 28, rates of hemorrhagic transformation or mortality. In both groups, the deceased patients were older; in Group I they suffered more frequently from atrial fibrillation, in Group II – from diabetes mellitus type 2. In addition, mortality in Group II was associated with a higher severity of early signs of cerebral infarction.
Conclusion. The results of the analysis of real-life clinical practice show the comparability of the efficacy and safety of staged reperfusion therapy and isolated thromboaspiration in a “natural” selection of patients.

The use of biological markers for Alzheimer's disease (AD) allows diagnosis at the stage of moderate cognitive impairment and atypical course of the disease. We present two clinical cases of patients with posterior cortical atrophy (PCA), characterized by progressive impairment of visual and spatial functions due to atrophy of the parietal and occipital lobes of the brain. A differential diagnosis was made between AD, corticobasal degeneration and other diseases in which PCA syndrome occurs. In the cases observed, the patients showed a significant decrease in the level of beta-amyloid in the cerebrospinal fluid, which allowed the diagnosis of AD to be made. Clinical manifestations, diagnosis and treatment of PCA syndrome are discussed. At present, the diagnosis of AD at the stage of moderate cognitive impairment and mild dementia is of practical importance, as anti-amyloid therapy can prevent the progression of AD.

The high prevalence of primary affective disorders in patients with epilepsy is beyond doubt. However, patients in this group are often identified as suffering from mood disorders that do not fulfil the criteria for primary mood disorders, such as recurrent depressive disorder and bipolar affective disorder. The aim of this paper is to analyze the classification and clinical picture of affective disorders in patients with epilepsy and differential diagnostic approaches to identify primary affective disorders and secondary affective disorders in epilepsy. A set of diagnostic signs for the differential assessment of affective disorders in patients with epilepsy is presented. Research of affective pathology in patients with epilepsy and the development of strategies for its successful treatment are still needed.

To date, there are no Russian or international studies investigating the long-term efficacy of botulinum therapy (abobotulinum toxin injections – AboBTX) during rehabilitation in patients with post-stroke spasticity in terms of its impact on the risk of death from all causes and the development of cardiovascular complications. A 10-year study conducted in the United Kingdom analyzed the effects of AboBTX injections in patients with post-stroke spasticity on long-term clinical (all-cause mortality, cardiovascular events, length and quality of life) and economic (direct medical costs) outcomes. For the first time ever, a model was developed to evaluate the clinical (quality-adjusted life expectancy) and economic benefits of AboBTX injections in the structure of rehabilitation compared to rehabilitation without botulinum therapy in patients with post-stroke spasticity. It was shown that the inclusion of regular injections of AboBTX in the rehabilitation process resulted in an 8.8% reduction in the risk of death from all causes, a 13% increase in life expectancy (and by 59% in quality-adjusted terms compared to rehabilitation without botulinum therapy) and proved to be cost-effective. The use of AboBTX injections in patients with post-stroke spasticity as part of rehabilitation is cost-effective in the long term and improves long-term outcomes, including post-stroke survival.

We present an analysis of anatomical and clinical studies investigating the morphological and functional characteristics of various structures of the limbic system involved in the development of post-traumatic stress disorder (PTSD). Understanding the structural organization and functional interactions of this system will provide new insights into the mechanisms underlying PTSD. The results of various morphological and clinical studies are considered, including information on the architecture and interconnections of the structures of the limbic system and their alteration by traumatic events. The generalized results provide new data on the role of the individual structures of the limbic system in the development of PTSD, enabling more accurate prediction of the development of PTSD and prompt appropriate measures to alleviate the course of this disorder

Many patients with chronic migraine abuse symptomatic medications, have drug-induced headaches, psychiatric comorbidities and respond poorly to conventional preventive therapy. In these cases, the terms “resistant” and “refractory migraine” are used and an expanded therapeutic armamentarium is recommended. Currently, the use of monoclonal antibodies against calcitonin gene-related peptide is the best-studied and most effective method of preventive therapy in resistant migraine cases.

Chronic musculoskeletal pain (CMSP) is one of the most common pathological conditions that limits patients' physical activity and reduces their quality of life. The analgesic and anti-inflammatory effects of non-steroidal anti-inflammatory drugs (NSAIDs) make them the basis of pharmacotherapy for patients with chronic conditions affecting various parts of the musculoskeletal system. The main target of NSAIDs, cyclooxygenase (COX), exists in the form of two main isoforms, COX-1 and COX-2, the inhibition of each of which leads to a cascade of reactions at the cellular and tissue level that can cause both targeted pharmacological effects and side effects. The diversity of the chemical structures of NSAIDs leads to differences in their pharmacodynamic and pharmacokinetic parameters and correspondingly to differences in their efficacy and safety profile. Selective COX-2 inhibitors, coxibs, have shown an increased risk of cardiovascular side effects, which has led to significant restrictions on their use. Cardiotoxicity is not as pronounced with the non-selective COX inhibitors, but the range of their side effects is extremely wide. These side effects are dose-dependent and are characteristic, first of all, of systemic NSAIDs.The combination of systemic and topical NSAIDs makes it possible to reduce the dose of the former and improve the safety profile of anti-inflammatory therapy. Among the non-selective COX inhibitors with a satisfactory safety profile and high anti-inflammatory activity, the group of oxicams and especially tenoxicam should be emphasised, which are characterised by a maximum duration of action, which is an advantage in the treatment of patients with CMSP. This review addresses the issues of rational selection of NSAIDs based on comparative data on pharmacodynamics, pharmacokinetics and clinical trial results.

Alzheimer's disease (AD) is the most common degenerative disease of the brain leading to dementia. AD is the most common cause of disability among age-related diseases. The diagnosis of AD is based on clinical findings and is confirmed by the presence of positive biological markers of the disease, which reflect the pathological formation of beta-amyloid and tau protein in the brain. Magnetic resonance imaging of the brain shows brain atrophy in AD and helps to rule out other diseases. Psychosocial and behavioral approaches form the basis for the treatment of patients with AD; cognitive training in combination with regular physical exercise is recommended. Acetylcholinesterase inhibitors and the glutamate receptor blocker memantine are used as drugs that improve the cognitive functions of patients with AD. Dispersible forms of memantine are used to treat dysphagia in patients with AD. The efficacy and safety of pathogenetic therapy aimed at eliminating cerebral beta-amyloid by passive immunization is under discussion. Unfortunately, AD is rarely diagnosed in our country; doctors are not sufficiently informed about the diagnosis and modern treatment methods of AD. Many AD patients are observed with the misdiagnosis of chronic cerebrovascular disease and do not receive effective therapy. A clinical observation of a patient with early-onset AD is presented, reflecting typical errors in patient management. Issues for optimizing the management of AD patients are discussed.

Low back pain (lumbar pain) is one of the most common causes of disability in the population. In cases where conservative treatment of discogenic or musculoskeletal low back pain does not have a positive effect, interventional methods of diagnosis and treatment are used, which are developing actively on the background of rapid technological progress. Being on the border of interdisciplinary interaction, interventional methods can significantly shorten the duration of conservative therapy and, in many cases, avoid surgical decompressive interventions, which are associated with a considerable risk of complications. The methods, efficacy and safety of epidural administration of glucocorticoids for discogenic radiculopathy and lumbar stenosis as well as the methods of radiofrequency denervation for musculoskeletal pain due to the facet joints and the sacroiliac joint involvement are discussed. The possibilities of drug therapy for musculoskeletal pain of the lumbar spine, and combination of non-steroidal anti-inflammatory drugs and a vitamin B complex, are discussed.