NEUROFIBROMATOSIS TYPE I AND ITS DIAGNOSTIC CRITERIA: A CLINICAL OBSERVATION.

The aim - to consider the etiopathogenesis, the main clinical manifestations, diagnostic criteria of NF1, and present a clinical case from their practice. The paper analyzes the research findings in recent publications, focused on the studied issue using the methods of continuous sampling, synthesis and generalization, bibliosemantic evaluation and content analysis. In order to attract the attention of family physicians, neurologists, dermatologists, ophthalmologists, surgeons and other specialists, we present our own clinical observation of NF1. The patient was examined using the methods of neurological examination, as well as other laboratory and instrumental methods of research. Early diagnosis and medical examination of patients with NF1 is crucial for predicting and improving the quality of life of patients. NF1 is a complex disease where the cooperation of doctors of different specialties is important. A favorable prognosis for patients is associated with the possibility of early diagnosis of malignant transformation and timely treatment.

THE INFLUENCE OF ACTIVE REHABILITATION ON THE RECOVERY OF COGNITIVE AND PSYCHOEMOTIONAL DISORDERS AFTER ISCHEMIC STROKE.

OBJECTIVE: The aim: Was to evaluate the impact of active rehabilitation treatment in the scheme of comprehensive therapy of patients with cerebral hemispheric ischemic stroke on the dynamics of recovery of cognitive and psychoemotional disorders, as well as to study their correlations. PATIENTS AND METHODS: Materials and methods: The study involved 138 patients: 30 apparently healthy individuals (control group, CG, n = 30) without acute cerebrovascular disorders (anamnestic and neuroimaging), of whom 53.33% were men (n = 16) and 46.67% women (n = 14), the average age of patients in the group was 57.9 ± 1.45 years; 108 people diagnosed with cerebral hemispheric ischemic stroke (n = 108), of whom 62.96% were men (n = 68) and 37.04% women (n = 40), the average age of patients in the group was 58.4 ± 0.76 years. The neurocognitive assessment was performed using the international standardized scales: MMSE, MoCa were used to assess the cognitive sphere, and BDI, STAI (STAI SA, STAI TA) were used to assess psychoemotional disorders. RESULTS: Results: Patients in the comprehensive treatment scheme were additionally prescribed and given two courses of rehabilitation treatment using active rehabilitation methods after the first and third examinations, recovery of cognitive and psychoemotional disorders was significantly faster and better than in group 1, where "classical" measures were applied with the predominance of medicinal therapy. Thus, the average score on the MoCa scale during examination on days 3-7 after cerebral hemispheric ischemic stroke in group 1 was 19.71 ± 0.62 points, in group 2 - 19.17 ± 0.54 points, and during evaluation after 6 months in group 2 - 24.72 ± 0.26 points against 22.19 ± 0.41 points (p <0.0001) in group 1. According to the MMSE scale during examination on days 3-7 after cerebral hemispheric ischemic stroke, the average indicator in group 1 was 22.56 ± 0.43 points, in group 2 - 22.47 ± 0.37 points, and when evaluated after 6 months in group 2 - 25.83 ± 0.23 points against 24.35 ± 0.27 points (p = 0.0001) in group 1. CONCLUSION: Conclusions: The use of methods for active rehabilitation in the treatment of patients in acute and recovery periods of cerebral hemispheric ischemic stroke significantly contributes to the acceleration and enhancement of the recuperation of cognitive and psychoemotional functions after the acute cerebral accident. The obtained results can find practical application in improving the effectiveness of therapeutic and rehabilitation programs in patients with cerebral hemispheric ischemic stroke to reduce their post-stroke deficit.

DEVIC'S OPTICOMYELITIS: A CASE REPORT FROM THE AUTHORS' CLINICAL PRACTICE.

The aim was to analyze the contemporary scientific literature on Devic's opticomyelitis and to present a case report from our clinical practice. Based on the patient's complaints, case history and features of clinical course, objective neurological status, clinical laboratory and additional examination methods, characteristic MR-patterns, consultations of related specialists and differential diagnostics, we made the clinical diagnosis according to ICD-10: G36.0 Devic's opticomyelitis, exacerbation, with a sustained bilateral lesion of the optic nerves in the form of retrobulbar neuritis with the development of partial atrophy of the optic nerves in both eyes, spinal cord lesions with common cystic, cicatrical and atrophic alterations at C1-Th8 level with moderate lower paraparesis, expressed by sensory ataxia, sensory disturbances by the descending conductive type from Th10, impaired function of pelvic organs by the type of acute urinary retention, asthenic and neurotic syndrome. Widespread cases of demyelinating pathology in medical practice and complexity of differential diagnostics determine the need for a specific diagnostic algorithm. This algorithm should consider anamnestic data along with the course of the disease, clinical, laboratory and instrumental examination, including neuroimaging, analysis of CSF for oligoclonal bands, analysis for IgG antibodies to AQP4, which will allow to carry out diagnostics and to decide on tactics for further management of patients of this cohort. Further research is needed to conduct additional studies for optimization of tactics for dynamics monitoring and improvement of diagnostic, treatment and rehabilitation measures in patients with Devic's opticomyelitis, including appropriate immunological control, given the complexity of differential diagnostics and the affinity of this pathology to multiple sclerosis.