Vol 12, No 2 (2018)

Introduction. Compression of extracranial parts of the subclavian and vertebral arteries by neck muscles takes a certain place in the pathogenesis of cerebral circulation disorders.
Objectives. To study pathogenic mechanisms of vertebrobasilar insufficiency in sсalenus syndrome and to evaluate the results of surgical treatment.
Materials and methods. 68 patients with the scalenus syndrome (52 men and 16 women) aged 35 to 55 years were enrolled in the study. Patients were divided into two groups depending on the clinical manifestations: group I (38 patients) – patients with compression-irritative form and the group II (30 patients) – patients with reflex angiospastic form. Scalenotomy and arteriolysis were performed in group I. Scalenotomy and selective cervico-thoracic sympathectomy – in group II.
Results. The detailed description of the clinical picture was presented. Ultrasonic scanning with hyperabduction of the hand and Adson manoeuver revealed compression of the subclavian artery. Compression of the subclavian artery by the anterior scalene muscle was verified with the use of computed tomographic angiography. On scalenotomy it was found that autonomic vascular abnormalities were caused by the compression of the brachial plexus and subclavian artery in the interscalenum spatium and irritation of the autonomic nerves by the scalene muscles and surrounding fibrous-altered tissues. In all cases symptoms immediately diminished after the surgery.
Conclusion. Hemodynamic disturbances in extravasal compression of the subclavian and vertebral arteries by the anterior scalene muscle were confirmed by the effectiveness of scalenotomy. Disappearance of vertebral artery syndrome, hand ischemia symptoms and brachial plexus compression was observed clinically.

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.

Progressive supranuclear palsy (PSP) is a sporadic neurodegenerative disease characterized by oculomotor disorders, early onset of postural instability and cognitive dysfunction. Classic form of the disease (Richardson’s syndrome) develops only in 24% of all cases, while other phenotypes are registered in most patients. Clinical manifestations of the various types the PSP, as well as their similarities and differences with other nosological forms of extrapyramidal disorders are described in the current review. New diagnostic criteria of PSP developed by the International Society for the Parkinson's Disease and Movement Disorders in 2017 are discussed. Two clinical cases of PSP in patients of Yakhut ethnic origin are presented: in the first case there was classical variant of the disease (Richardson’s syndrome), and in the second case – a PSP-parkinsonism variant.

Introduction. Coexistent involvement of upper and lower motor neurons is a characteristic feature of amyotrophyc lateral syndrome (ALS) necessary for the diagnosis. Diagnosis of upper motor neuron involvement in ALS is based solely on clinical features, which may not be detected at the disease onset and in rare forms manifesting clinically as the local lower motor neuron syndrome (LLMNS). The main method of assessment of the functional state of the upper motor neuron in ALS is transcranial magnetic stimulation (TMS). It allows assessing the excitability of motor cortex, corticospinal path function, and mapping of cortical representation of the muscles. In patients with ALS changes of various indicators demonstrating hyperexcitability as well as degenerative lesions of the motor cortex and the corticospinal tracts are recorded on TMS.

Objective: to discuss changes in the TMS in patients with LAS, pathophysiological mechanisms of their formation and possible diagnostic value.

Results. In 22 patients with LLMNS, navigation TMS revealed disturbances of intracortical suppression on paired stimulation with recording period of silence, increase of motor threshold in dominant hemisphere, decrease of the weighted square and reorganization of cortical representations of the hand muscles.

Conclusion. The data obtained allow to consider navigation TMS as a promising technology for identifying upper motor neuron involvement in patients with ALS.

Introduction. The clinical case of a patient with a generalized degenerative lesion of the lumbar spine in combination with clinical and radiological signs of the adjacent disk syndrome is presented in the article.

Materials and methods. The patient turned to the neurosurgical department of the Research Center of Neurology with complaints of low back pain with irradiation on the external surface of the left leg, and numbness in this area. In the anamnesis: microsurgical removal of the HIVD at the levels L4–L5 and L5–S1. According to magnetic resonance imaging (MRI), a disc herniation and according to functional radiography – signs of instability were revealed at the level of L3–L4. In order to prevent further progression of the degenerative cascade, the patient underwent surgical intervention – dynamic transpedicular fixation with nitinol rods, a metal with shape memory effect. At pre- and postoperative periods we performed clinical evaluation (VAS pain scale, Oswestry quality of life assessment, modified Macnub scale), MRI of the lumbar spine (an analysis of the fixed and adjacent segments degeneration extent according to Pfirman classification), and functional radiography (estimation of the range of motion in the fixed and adjacent segments).

Results. We observed a significant reduction in back pain, a complete regression of leg pain and an improvement in the quality of life compared to the preoperative level. Twelve months after the surgery, on the MRI scan we observed signs of rehydration and regeneration on a fixed segment and the absence of acceleration of degeneration on adjacent segments

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