[Multifocal central nervous system lymphoma misdiagnosed as acute disseminated encephalomyelitis]. / Pervichno-mnozhestvennaia limfoma tsentral'noi nervnoi sistemy, oshibochno diagnostirovannaia kak ostryi rasseiannyi éntsefalomielit.

Primary central nervous system lymphoma (PCNSL) is a rare aggressive extranodal non-Hodgkin lymphoma. Difficulties in diagnosing PCNSL are associated with the absence of pathognomonic clinical and neuroimaging findings of this disease. The article describes the clinical case of a female patient with autopsy-confirmed multifocal large-cell B-cell CNS lymphoma misdiagnosed as acute disseminated encephalomyelitis (ADEM). Clinical and neuroimaging characteristics of PCNSL and ADEM as well as the role of diagnostic methods in establishing the correct diagnosis are discussed.

[Venous thromboembolism in patients with Guillain-Barre syndrome].

OBJECTIVE: To perform an in-depth prospective analysis of the prevalence, risk factors, specific characteristics of venous thromboembolism (VTE) and the dynamics of venous thrombosis during the treatment with low-molecular-weight heparin (LMWH) in patients with different forms and severity of Guillain-Barre syndrome (GBS) admitted to an intensive care unit (ICU). MATERIAL AND METHODS: Prevalence, risk factors and course of VTE were analyzed for the first time in 65 ICU inpatients with various forms and severity of GBS. Neurological status was evaluated at baseline and in dynamics, duplex scanning of veins of the legsin the system of inferior vena cava was performed. RESULTS AND CONCLUSION: Despite the preventive using of LMWH, a half of patients with GBS, regardless of the form of the disease during the progression of neurological symptoms, have VTE (deep vein thrombosis--52%, pulmonary embolism--15%). Significant risk factors include: severe disease course requiring artificial ventilation, bed rest for more than 3 days, infectious complications, the presence of the catheter in the central vein, age over 40 years. Venous thrombosis in the system of inferior vena cava in patients with GBS does not differ from that in other critical illnesses suggesting that this pathological process is universal. Preventive measures for this category of patients is insufficient and requires a search for other prevention strategies.

[Prevention of venous thromboembolism in the acute stroke]. / Profilaktika venoznykh tromboémbolicheskikh oslozhnenii v ostroi stadii insul'ta.

OBJECTIVE: To assess the effectiveness of preventive measures to reduce VTE rates among patients with severe stroke in intensive care unit (ICU). MATERIAL AND METHODS: The efficacy and safety of previously developed protocol for VTE prevention was assessed in 378 stroke patients in the ICU who received different levels of preventive measures. Subjects were distributed into three groups. We assessed neurological status of all patients on admission and in the course of stroke, and performed ultrasound scanning of lower limb veins for groups II and III. RESULTS: The rate of VTE events remained high regardless of the level of preventive measures. However, we observed a changing nature of PE from massive to nonmassive without increasing the rate of hemorrhagic complications while the strict protocol of VTE prevention with mandatory use of low molecular weight heparins was applied, including patients with hemorrhagic stroke. CONCLUSION: The use of the proposed protocol of VTE prevention in routine care for patients with stroke in ICU is safe and may significantly reduce the incidence of fatal pulmonary embolism.

[STROKE: INCIDENCE AND RISK FACTORS FOR VENOUS THROMBOEMBOLIC COMPLICATIONS IN INTENSIVE CARE UNIT].

AIM: To study the evidence of venous thromboembolic complications (VTE (acute venous thrombosis (DVT) and pulmonary embolism (PE)) at the background of modern prevention for different characteristics and localization of stroke, as well as defining the role of the main clinical risk factors in the pathogenesis for ITE in stroke patients in intensive care unit. MATERIAL AND METHODS: The study included 123 patients with different types, localization and severity of stroke. All patients received standard prophylaxis VTE with low molecular weight heparin (LMWH). Neurological status, the severity of the general condition, the main clinical risk factors of stroke were assessed when income and in dynamics. There was planned duplex scanning of the veins of the inferior vena cava performed. RESULTS AND DISCUSSION: In spite of the application of modern preventive measures VTE, their frequency remains high accounting for 56%. All patients have a place DVT, in 26% of pulmonary embolism occurs. Groups at highest risk of VTE are patients with stroke more than 8 points of NIHSS, who are ventilated and assessed infection-inflammatory disorders, especially pulmonary. This group is considered to be at the highest risk of VTE. Modern preventive strategy for them is not sufficient and needs for the search of other preventive approaches.