[Bioregulatory drug Newrexan in the treatment of anxiety and dissomnia. Resolution of the Council of Experts (June 8, 2023)]. / Bioregulyatsionnyi preparat N'yureksan v lechenii trevozhnosti i dissomnii. Rezolyutsiya Soveta ekspertov (8 iyunya 2023 g.).

Bioregulatory drug Newrexan in the treatment of anxiety and dissomnia. Resolution of the Council of Experts.

[Insomnia in the context of affective disorders]. / Insomniya v kontekste affektivnykh rasstroistv.

The article analyzes the current literature on the relationship of insomnia with affective disorders, in particular with depression and anxiety. Research shows that there is a strong multi-channel relationship between insomnia, depression, and anxiety, with insomnia being considered a risk factor for mood disorders more often than vice versa. The so-called insomnia paradox of bipolar disorder is described, the essence of which is that in manic episodes the frequency of insomnia is higher than in depressive episodes. The data of a network meta-analysis, which found an evidence base for the use of a variety of drugs used for the pharmacological treatment of insomnia in adults, are presented. Efficiency and convenience in taking the drug Valocordin-Doxylamine are noted.

[Chronic cerebral ischemia and dizziness]. / Khronicheskaya ishemiya golovnogo mozga i golovokruzhenie.

Older age is characterized by a high prevalence of dizziness/vertigo, including various variants - central and peripheral vestibular disorders, feelings of instability, balance disorders. High frequency of dizziness and chronic cerebral ischemia in the elderly age category supports traditional ideas about relationship of these pathologies. However, there is a known overestimation of Chronic cerebral ischemia as a cause dizziness of and unclear mechanisms of this process. With a high prevalence of vestibular disorders in the elderly and their verification, in some cases, the causes of dizziness cannot be identified. This has prompted the designation of this type of dizziness as «unexplained¼. The article cites recent studies demonstrating a relationship between «unexplained¼ dizziness and chronic cerebrovascular pathology. The theories explaining the mechanisms of this association are proposed. The role of choline alphoscerate in the treatment of dizziness in Chronic cerebral ischemia has been demonstrated. The mechanisms of positive effect of choline alphocerate and prospects of its using.

The post-syrinx syndrome: stable central myelopathy and collapsed or absent syrinx.

Among 168 cases with neurologic findings of cervicothoracic syringomyelia and MRI findings of Chiari 1 malformation and/or underdevelopment of the posterior cranial fossa, 15 patients (9.1 %) had collapsed, flat syrinxes and 14 patients (8.3 %) did not have syrinxes. Both groups of patients had clinical findings of central myelopathy that had been stable for at least 3 years. Magnetic resonance imaging detected atrophy of the cervical spinal cord in both groups and spontaneous communications between the syrinx and the subarachnoid space in 3 patients of the group with collapsed syrinxes. Analysis of these results and review of the literature suggest that patients with clinical signs of syringomyelia and Chiari 1 malformation or underdeveloped posterior fossa, but with small or absent syringomyelitic cavities, have the "postsyrinx" state as a result of spontaneous collapse of distended syrinxes.

Clinical and neuroimaging features of "idiopathic" syringomyelia.

In some adult patients with cervical syringomyelia, MRI studies do not identify primary disease within the foramen magnum or spinal canal. To identify the etiology of this idiopathic type of syringomyelia, clinical features and posterior fossa (PF) measurements from 17 of these patients, 17 patients with Chiari I-type syringomyelia, and 32 control subjects were compared. Idiopathic syringomyelia and Chiari I-type syringomyelia manifested central cervical myelopathy and a small PF with narrow CSF spaces, suggesting that they develop by the same mechanism.

[Clinical and neuro-visual study of syringomyelia]. / Kliniko-neirovizualiziruiushchie issledovaniia pri siringomielii.

One hundred fifty one patients with syringomyelia of different duration were studied using magnetic resonance imaging (MRI). An association between syringomyilia cavitation and Arnold--Chiari malformation as well as cerebellar tonsils location was found. No definite relationship between syringomyelia course and degree of cerebellum ectopia was detected. With disease duration increasing, cross dimensions of spinal cord cavitation are getting smaller. This may be due to spontaneous cavitations collapse. The hypothesis is supported by flattened out cavitation phenomenon found by MRI on the axial spinal cord sections of 39 patients. Such deformation corresponds to spinal cord atrophy developing during long-term disease course.

Syrinx size and duration of symptoms predict the pace of progressive myelopathy: retrospective analysis of 103 unoperated cases with craniocervical junction malformations and syringomyelia.

OBJECTIVE: the clinical course of syringomyelia associated with craniocervical junction abnormalities is variable. About half of the unoperated patients have benign course. This is difficult to explain on the basis of the present pathogenetic theories. Therefore, to understand the mechanism of syrinx progression better, we studied the value of syrinx size, syrinx morphology, and the syrinx/spinal cord size ratio in predicting the rate of progression and the severity of myelopathy in these patients. METHODS: 103 adult patients with syringomyelia associated with Chiari 1 malformation and/or radiographic signs of underdeveloped posterior cranial fossa were clinically and MRI examined. Patients were subdivided according to the type of disease progression. Severity of neurological deficits, and MRI features (the extent of cerebellar tonsillar displacement, anteroposterior diameter of cavities, the spinal cord and cyst/cord ratio and the shape of cavities) were measured. RESULTS: a significant relationship was found between the mid-sagittal diameter of the syrinxes and the type of disease course; patients with short duration and rapid progression had the largest diameters of cavities, whereas patients with longer duration as well as with slow rate of progression had smaller diameters (chi(2)=28.90, P<0.05; chi(2)=29.89, P<0.01; r=-0.24, P<0.05). In addition, a correlation was found between the anteroposterior diameter of the spinal cord and cyst/cord ratio and the disease duration (r=0.52, P<0.05 and r=0.48, P<0.05, respectively). CONCLUSIONS: the initial years for the development of symptomatic syringomyelia associated with CCJ malformations are characterized by relatively rapid clinical progression accompanied with distended cavities. In the later periods of unoperated syringomyelia, some patients show delay in the progress of syrinxes accompanied with collapse of cavities, probably either due to a spontaneous formation of drainage between the syrinx and the subarachnoidal space, or due to the restoration of abnormal CSF dynamics at the CCJ level.

Spontaneous drainage in syringomyelia: magnetic resonance imaging findings.

We present five cases of syringomyelia associated with Chiari I or other causes of partial obstructions at the cervicomedullary junction, with spontaneous disruption of the wall of a cervical syrinx and formation of a communication between the cavity and the subarachnoid space, shown on axial MRI. MRI can be used to investigate the hydrodynamics, showing the liquid inside the disrupted syrinx wall and the pathway of drainage. The finding of spontaneous drainage may be important for understanding the pathogenesis of syringomyelia and may be helpful for choosing a surgical approach.