[Anamnestic headache in patients with cervical artery dissection: clinical characteristics and pathogenetic mechanisms]. / Anamnesticheskaia golovnaia bol' u bol'nykh s dissektsiei magistral'nykh arterii golovy: klinicheskie osobennosti i mekhanizmy razvitiia.

AIM: To study the frequency and characteristics of headache which is in the past history (HPH) of patients with cervical artery dissection (CeAD) and evaluate with the help of EEG and visual evoked potentials (VEP) the role of central mechanisms in its development. MATERIAL AND METHODS: Two hundred and twenty-seven patients with CeAD verified by neuroimaging were studied. All patients were interviewed about the presence of a headache in the past history and its features. The comparison group comprised 35 patients (mean age - 32,3±8,9 years, 77% female) with migraine. Thirty-five patients with HPH and 35 patients of the comparison group underwent EEG and VEP. RESULTS: HPH was found in 101 patients (average age of 38.5±8.5 years, 70% female) (44.5%) out of 227 patients. In 35 patients (15.4%), HPH met the International Criteria for migraine (with aura - 3.1%, without aura - 12.3%) and in 66 patients (29.1%) did not (non-migraine headache). The latter started at the age of 24.5±10.2 years, had mild/ moderate intensity (95%), diffuse localization (68%), dull/pressing/squeezing character (53%), never accompanied by vomiting and rarely by nausea (8%), photo- phonophobia (11%). HPH, which met the migraine criteria unlike migraine in the comparison group began at a later age (19.9±9.6 vs 16.2±4.4 years, p<0.03), more frequently did not have aura (80% vs 48%, p<0.003), less often was unilateral (31% vs 71%, p<0,004) and had less intensity. The visual EEG analysis less often found rhythmic disorganization in CeAD patients with HPH than in comparison group with migraine. The hyperventilation caused a slight increase in the spectral power of Teta, Delta waves in HPH patients and significant enhancement in comparison group with migraine (p<0.05). Pattern reversal VEP in patients with HPH had a greater latency and smaller amplitude of cortical responses than in comparison group with migraine (p=0.028 and =0.037, respectively). The flash VEP amplitude was lower in HPH patients than in migraine (p=0.01). CONCLUSION: HPH in patients with CeAD meets criteria of migraine in 15.4% (with aura - 3.1%, without aura - 12.3%), 29.1% patients have nonmigraine HPH. Central mechanisms, namely, the hypersensitivity of the cerebral cortex playing the main role in migraine pathogenesis, are not significant in HPH genesis. The main role appears to have peripheral mechanisms - dysplastic changes in the wall of extra- and intracranial arteries that predispose both to headache and dissection.

Memory, Cognition and the Endogenous Evoked Potentials of the Brain: the Estimation of the Disturbance of Cognitive Functions and Capacity of Working Memory Without the Psychological Testing.

Cognition, cognitive and memory impairments is widely discussed in the literature, especially in the psycho physiological and the neurologic. In essence, this literature is dedicated to the psycho physiological tests, different scales. However, instrument neurophysiologic methods not so widely are used for these purposes. This review is dedicated to the instrument methods of neurophysiology, in particular to the endogenous evoked potentials method Р 300 (by characteristic latency 300 ms), in the estimation of cognitive functions and memory, to their special features dependent on age and to special features to their changes with the pathology. Method cognitive EP - Р 300 is the response of the brain, recorded under the conditions of the identification of the significant distinguishing stimulus, it facilitates the inspection of cognitive functions and memory in the healthy persons and patients with different manifestation of cognitive impairments. In the review it is shown on the basis of literature and our own data, that working (operative) memory and the capacity of the working memory it can be evaluated with the aid of the indices Р 300 within the normal subject and with the pathology. Testing with the estimation of working memory according to latent period of the peak Р 300 can be carried out and when conducting psychological testing is not possible for any reasons. Together with these cognitive EP are used for evidence pharmacotherapy of many neurotropic drugs.

[Surgical treatment of severe spondylogenic cervical myelopathy by laminoplasty].

AIM: The objective of this study is to analyze the results of surgical treatment of patients with cervical myelopathy by laminoplasty. MATERIAL AND METHODS: The experience of surgical treatment of 30 patients (mean age 59.4) with cervical stenosis complicated with myelopathy was analyzed. Hirabayashi laminoplasty was performed in 26 patients and Kurokawa laminoplasty was performed in 4 patients. All patients were diagnosed with extended cervical spinal stenosis. Diagnosis was based on the survey RESULTS: including the dynamic clinical and neurological examination, x-ray study, CT, MRI, SSEP, and TMS. Nurick scale, the scale of the Japanese Orthopaedic Association (JOA), and the recovery rate scale were used to assess the severity of myelopathy. RESULTS: The long-term outcome of the clinical status, radiographic and neuroimaging parameters in patients with cervical myelopathy who underwent laminoplasty was evaluated. CONCLUSION: Laminoplasty is the method of choice in the treatment of extended spondylogenic cervical stenosis. Proper selection of patients based on clinical symptoms, assessment of the extent of stenosis, neurological examination and neuroimaging data leads to excellent results.

Pathophysiological aspects of the formation of neurological deficit in multiple sclerosis.

The results of complex studies were used to formulate a concept of the development of neurological impairments in multiple sclerosis (MS). Acutely developing impairments to spike propagation, reaching the level of conduction blockade, due to the active pathological process with demyelinating and axonal damage to the CNS lead to the formation of neurological impairments in exacerbations of MS, while complete or partial reversion (regression) of these symptoms in the stage of remission results from compensatory changes in the nature of conduction, which were not, however, accompanied by recovery of electrophysiological measures. The development of stable neurological deficit in secondary-progressive MS is determined by impairments to spike conduction processes associated with significant levels of demyelination and atrophic changes in the CNS, with myelin loss and axon death. Finally, the severity of cognitive changes is determined by differences in the severities of both the focal demyelinating process and diffuse damage to brain substance in MS, including the neurodegenerative component. The main factor in transient increases in symptoms is the universal lability of electrophysiological parameters, including those developing on the background of ion and neurotransmitter imbalance.

[Structural and functional analysis of the cortico-spinal tract in multiple sclerosis].

The study aimed at comparison of transcranial magnetic stimulation (TMS) parameters to MRI data in multiple sclerosis (MS), taking into account clinical course of the disease. TMS was conducted in 56 patients and in 10 age- and sex-matched healthy controls. According to stage of activity and variant of the course, the patients were divided into 2 groups: one at the stage of exacerbation and another--at the stage of remission with secondary progressive MS. Latency of segmental evoked motor response was similar in patients and controls. Statistically significant between-group difference or trend toward changing of some TMS parameters were found that indicates a slow-down of the impulse conducting along the cortico-spinal tract, which is characteristic of demyelinization process. The changes were more pronounced in secondary-progressive MS. According to MRI data, a square of the spinal cord on the level of the intervertebral disk center C2/C3 was significantly smaller in the group of patients with secondary progressive MS than in that with exacerbation of the disease. The TMS parameters correlated both with the level of the focal demyelinization process and with the square of the spinal cord on a level selected. It allows to estimate expression of atrophic changes caused, in its turn, not only by myelin loss but also by axon loss.

[The analysis of brainstem acoustic evoked potentials in diphtheritic polyneuropathy].

The possibility of central and peripheral impairment of the acoustic analyser was studied in 18 patients with severe diphtheritic polyneuropathy (DP) using brainstem acoustic evoked potentials (BAEPs). The acoustic nerve impairment was found in 27.8%, the central abnormalities--in 44.4%. All the patients with CNS impairment suffered from chronic alcoholism. The data obtained have been compared to those of 26 patients with chronic alcoholism. In this group, peripheral polyneuropathy was confirmed in 76.9% cases; BAEPs revealed isolated involvement of the peripheral part of the acoustic nerve in 7.7% and CNS impairment was found in 84.6% patients. The results of the study suggest that diphtheritic toxin is not implicated in CNS lesions. Central changes found in the BAEPs analysis were related to chronic alcohol intake and did not aggravate diphtheria course.

[Evoked potentials in assessing the sensory, activating and cognitive functions of the normal human brain and in cortical and subcortical types of vascular dementia]. / Vyzvannye potentsialy v otsenke sensornykh, aktiviruiushchikh i kognitivnykh funktsii mozga cheloveka v norme i pri sosudistoi dementsii korkovogo i podkorkovogo tipa.

Characteristics of the auditory EP under conditions of stimulus recognition (the P300 technique) and parameters of the visual "nonspecific" EP to light flash were studied in healthy subjects of the wide age range (18-78 years old) and patients with vascular dementia of different severity. It was shown that P300 parameters depended on age in healthy patients and on expression of cognitive dysfunction in demented patients. The changes were more pronounced in dementia of the cortical type. The P300 to nonrelevant stimulus was not age-dependent and slightly changed at cognitive dysfunction. Parameters of the nonspecific visual responses (the latency and duration--the index of homeostatic regulation) and maximal amplitude (reflecting the extent of activation processes) were not age-dependent and changed both in subcortical and cortical dementia types (increase in response latency and duration). In cognitive dysfunctions of subcortical origin homeostatic changes in the form of increase in time of homeostatic regulation and deterioration of stabilization of brain electrical processes were more pronounced.