Vol 6, No 1 (2012)

Screening of the open population of men and women at the age of 35-64 years was performed. The random representative sample of the population of one of the Moscow’s districts was examined (726 people – 70.2% from the original sample). The unified criteria were used to diagnose the nervous system diseases (NSD). Not only the diseases but also the certain syndromes (headache, low-back pain etc.), which considerably influence the quality of life, were analyzed. Both mild (which do not require the medical assistance) and severe forms of disorders were taken into account. Not only recent cases of the NSD were revealed (which occurred within the last year), but also the ones which occurred in the past but were absent for the moment of screening. The prevalence of the NSD at the moment of examination was 75.8%, including peripheral nervous system diseases (56.7%), cerebrovascular diseases (45.4%), headaches (44.5%), craniocerebral injury consequences (5.9%), and paroxysmal impairment of consciousness (5.0%). The other NSD occurred more infrequently. The structure of certain classes and types of the NSD was assessed. It was shown that the found rates exceed several times the prevalence of the NSD according to official healthcare statistics. The article discusses probable reasons for that discrepancy.

Guillain-Barre syndrome often requires administration in intensivecare unit but is associated with good prognosis. That usually means partial or full regress of motor impairment. However, we found that many reconvalescents after Guillain-Barre syndrome were suffering from different sensory disorders for a long period of time. The analysis of the sensory impairment in patients with severe forms of Guillain-Barre syndrome showed discordance between the results of clinical examination and neurophysiological tests. We also found that some kind of sensory loss was present in patients with “pure motor” form. In this article we review our experience of treatment with plantar imitator of bearing load which seems positive in correction of sensory disturbances in patients with severe forms of Guillain-Barre syndrome.

Creutzfeldt-Jakob disease and others human prion diseases are fatal neurodegenerative conditions. Etiologic classification includes sporadic, hereditary and acquired forms. Conformational change of the normal (cellular) form of prion protein (PrPc) to a pathological form (PrPSс) is considered central to formation of the infectious agent. In this article the molecular classification of sporadic CJD, the phenotypic variability and the major pathogenetic pathways in prion diseases have been analyzed. The unique resistance of prions to classic methods of decontamination, and evidence that prion diseases can be transmitted iatrogenically pose a serious control to decontamination procedures. Many therapeutic strategies have been tested as potential treatments for prion diseases in cell cultures and in animals. But only few trials of human prion disease have been published or ongoing.

Functional magnetic resonance imaging (fMRI) is widely applicable for sensorimotor cortex mapping in human. The most challenging fMRI task for researchers is the assessment of locomotion. The aim of our study was to design of a passive motor fMRI paradigm for assess supraspinal control of the skillof walking in normal subjects and in patients with motor neurologic deficit after ischemic stroke. We conducted fMRI in two groups of human subjects: first group – 19 healthy subjects (10 females and 9 males, mean age = 38 [31,5; 60] years), second group – 18 ischemic stroke patients in early recovery period (first 6 months) (6 females, 12 males, mean age = 55,5 [45,5; 64,5] years) with severe and moderate (mean Fugl- Meyer scale score = 22 [15; 28]).The protocol consisted of blocked-design paradigm: plantar stimulation by imitation of slow walking vs rest. Individual and group activation patterns were analyzed using statistical package SPM5. A significant activation (pcorrect<0.05 at cluster level) in first group was observed in the primary and secondary sensorimotor cortex, premotor and dorsolateral prefrontal cortex, in insula. Due to lesion localization second group was subdivided into corticalsubcotrical (CS) and subcortical (S) subgroups. In CS subgroup there was reduce of activation size, more prominent in the affected hemisphere, whereas in S subgroup the extension of activation regions in both hemispheres was revealed, comparing to group 1. It was demonstrated that our passive motor fMRI paradigm of walking imitation with the use of plantar load imitator Korvit can be used to localize the ensorimotor brain areas involved in locomotion in both healthy people and patients. Concerning stroke patients, such an approach can help in understanding the mechanisms of supraspinal control of the skill walking and optimal rehabilitation strategy.

The case of severe thrombocytopenia caused by direct anticoagulant therapy, immunologically confirmed in patient with Guillain-Barre syndrome, is presented. The clinical presentation was characterized by acute peripheral tetraparesis, accompanied by multiple embologenic thrombosis in deep venous system of shanks. As a result of direct anticoagulant treatment, improvement of ultrasonic image was demonstrated. At the same time the decay of the thrombocytes level and development of haemorrhagic syndrome were observed. The assay of coagulation factors didn’t demonstrate consumption coagulopathy. The results of the bone marrow examination excluded the oncological process in haematopoietic system. Considering that the thrombocytopenia developed exactly 10 days after the onset of the direct anticoagulant therapy, the analysis of the antibodies to the platelet factor 4/heparin complex was performed; the result was positive. Withdrawal of fraxiparine and implementation of plasmapheresis to eliminate the antibodies improved the patient’s condition. The presented case demonstrates the necessity of regular control of all parts of haemostasis, because treatment with remedies intended to correct the coagulation system may cause itself strong hemorheological disorders.