Vol 18, No 3 (2024)

Introduction. Cognitive impairment (CI) is a common manifestation of multiple sclerosis (MS), which significantly affects patients’ daily life and professional activity. Despite the development of methods to screen MS patients for CI, data on its prevalence in the Russian population are still lacking.

Aim: to comprehensively assess cognitive functions in patients with different types of MS.

Materials and methods. The study included MS patients who did not have any other possible causes of CI and no diseases or conditions that confounded this assessment. CI was determined using the Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS) test battery and the Stroop test as a decrease in the scores below the mean by at least 1.5 standard deviations. CI was subjectively assessed using the Perceived Deficit Questionnaire; fatigue was subjectively assessed using the Modified Fatigue Impact Scale (MFIS). The Mann–Whitney test and Fisher’s exact test were used for comparison, and the Spearman test was used to evaluate correlations.

Results. We evaluated 77 MS patients (30 men; age 40 [30; 48] years; 47 with relapsing-remitting MS, 30 with progressive MS). CI incidence was 23.4% in patients with relapsing-remitting MS and 77% in patients with progressive MS, while multi-domain CI was statistically significantly more common in patients with progressive MS. Impairment of processing speed was the most common. Patients with relapsing-remitting MS and CI were statistically significantly older and had longer disease duration than those without CI. There was a statistically significant correlation of subjective CI severity with MFIS scores but not with testing results.

Conclusion. CI incidence in MS patients was relatively high with greater severity and involvement of more domains in patients with progressive MS. No correlation was found between subjective and objective CI assessment results, which may suggest that patients underestimated their deficit.

The objective of our study was to compare complications of endovascular thrombectomy (EVT), in ischemic stroke (IS) patients admitted with or without COVID-19 to hospitals converted to deliver COVID-19-specific care.

Materials and methods. A retrospective analysis of 817 clinical cases of IS patients aged 25–99 years treated in regional vascular centers of Saint Petersburg from 1 January to 31 December 2021, with confirmed thrombotic occlusion of cerebral vessels and subsequent EVT intervention.

Results. The EVT number per bed was significantly higher (1.6) in the non-converted hospitals compared to the COVID-19-converted hospitals (0.49; p < 0.001). At the same time, more intraoperative complications (12% vs. 7.1%; p = 0.03) were reported in non-converted hospitals compared to COVID-19 converted hospitals. The likelihood of a favorable functional outcome was higher in younger patients with less severe neurological deficits on admission and without concomitant COVID-19 or post-operative complications.

Conclusion. COVID-19 is a limiting factor for the effectiveness of an IS treatment in patients who underwent EVT, affecting thereby functional outcomes in this cohort of patients. The impact of the COVID-19 pandemic on intra-operative EVT complication rate was associated with disrupted triage of IS patients and an uneven distribution of the workload among surgical teams in the city hospitals.

Introduction. Dysfunction of the glymphatic system glymphatic system of the brain is considered a pathogenetic factor in some age-dependent neurodegenerative diseases, including Alzheimer's disease (AD), dementia with Lewy bodies (DLB), Parkinson's disease (PD), and normal pressure hydrocephalus (NPH). The innovative method for calculating DTI-ALPS (Diffusion Tensor Image Analysis ALong the Perivascular Space) allows non-invasive assessment of the glymphatic system status using magnetic resonance imaging (MRI).

The aim of the study is to compare DTI-ALPS in patients with AD, DLB, PD, and NPH and to evaluate its potential use as a biomarker of the glymphatic system status in these diseases.

Materials and methods. The study included 116 subjects: 32 patients with AD, 15 patients with DLB, 31 patients with PD, 11 patients with NPH, and 27 healthy volunteers. Cognitive testing was performed for patients in the main groups using the Montreal Cognitive Assessment (MoCA) score. All subjects underwent diffusion tensor imaging (DTI) of the brain. DTI-ALPS was then calculated.

Results. DTI-ALPS index significantly differed across groups (p < 0.001). Patients with AD, DLB, and NPH had a significantly lower DTI-ALPS index on both sides compared to the PD group and healthy volunteers (p < 0.01). Analysis of the entire sample showed a direct correlation between MoCA score and DTI-ALPS index (p < 0.05).

Conclusion. This is the first comparison of DTI-ALPS across such a broad range of age-dependent neurodegenerative diseases. Since our DTI-ALPS results were comparable to previously reported data, we believe that this parameter can be used as an indirect marker of the glymphatic system status.

The ability to adequately perceive and recognize emotions is a key and universal tool in interpersonal communication, which allows people to understand feelings, intentions, and emotional reactions of themselves and others. Throughout their life, people have to make inferences about mental state of others by interpreting subtle social signals, such as facial expressions, to understand or predict others’ behavior, which is crucial in constructive social interactions. Therefore, emotional memory associated with the ability to identify emotions based on one’s life experience is the cornerstone of social cognition and interpersonal relationships. Oxytocin and vasopressin are neurohypophysial peptides that have attracted scientific attention due to their role in the emotional and social aspects of behavior. Variable and contrasting effects of oxytocin and vasopressin may be related to the sites of the brain where they exert their activity.

Aim. This review aimed to evaluate neural mechanisms underlying oxytocin-mediated and vasopressin-mediated modulation of emotional memory; to assess how cerebral oxytocin-signal and vasopressin-signal transduction mediates emotional and social behavior; to discuss the role of the two neuropeptides in non-verbal interpersonal communication; and to present their cerebral effects in relation to an ability for “face reading” in patients with mental disorders.

Magnetic resonance imaging (MRI) is the method of choice in diagnostics and differential diagnosis of spinal cord arterial infarction and venous insufficiency. However, imaging of vascular myelopathy is complicated by the lack of clear diagnostic criteria. Basic MRI sequences have low sensitivity at disease onset, and described MR patterns do not sufficiently increase imaging specificity for spinal cord ischemia, so imaging protocols are to be elaborated.

Diffusion-weighted imaging is a key additional sequence that allows establishing the ischemic nature of myelopathy.

Inclusion of spinal MR angiography in comprehensive MR examination allows visualization of aorta abnormalities, its large branches or spinal arteriovenous fistulas, so that they can be treated early.

We presented an optimal MRI protocol for patients with suspected ischemic spinal stroke. Promising high-tech MR sequences for visualization of vascular myelopathies were reviewed.

Botulism is a rare cause of bulbar and oculomotor syndromes. A late diagnosis and, therefore, late initiation of specific therapy may lead to multiple life-threatening complications. Epidemiological history and clinical findings are key to the correct diagnosis, but if these data are not available due to atypical clinical findings, botulism identification is challenging.

In our clinical case, a 31-year-old man was admitted to the hospital with double vision, impaired eye movements, and difficulty swallowing rapidly developing for 2 days. Ocular motility dysfunction included disturbed conjugate eye movements. In young patients, this is most often caused by demyelinating disease with medial (posterior) longitudinal fasciculus damage and symmetrical bilateral ptosis. The patient denied eating foods that could cause botulism and did not have any gastrointestinal symptoms. Differential diagnoses included demyelinating disease onset and Miller–Fisher syndrome. The next morning, completely identical clinical signs appeared in the patient’s mother who had eaten canned mushrooms, so botulism was suspected. Over the next few hours, despite the administration of anti-botulinum serum, acute respiratory failure developed, and the patient was placed on a ventilator for 28 days. The patient and his mother were discharged in a satisfactory condition, and their symptoms completely resolved within a few months. The diagnosis of botulism was confirmed by toxicological examination.