[CADASIL syndrome: differential diagnosis with multiple sclerosis]. / Sindrom CADASIL: differentsial'naia diagnostika s rasseiannym sklerozom.

Two cases of clinical and MRI manifestations of genetically verified CADASIL syndrome in female patients under 40 years of age are presented. The primary misinterpretation of clinical data and the neuroimaging results within multiple sclerosis indicates a lack of awareness of radiologists and neurologists about this disease. The article reviewed the current literature on the problems of diagnosis and treatment of CADASIL. The clinical and neuroimaging pattern of the syndrome, the approaches to genetic testing and the basic principles of patient management are considered in detail.

[Neuroinflammatory, Neurodegenerative and Structural Brain Biomarkers of the Main Types of Post-Stroke Cognitive Impairment in Acute Period of Ischemic Stroke].

Background: Post-stroke cognitive impairment is a clinically heterogeneous condition, some types of which cannot be fully differentiated neuropsychologically that necessitates the active search for biomarkers. Aims: Analyze parameters of neuroinflammation and neurodegeneration in combination with neuroimaging markers in patients with different types of post-stroke cognitive impairment in acute ischemic stroke. Materials and Methods: In 72 patients we performed the assessment of cognitive status and distinguished 3 types: normal cognition, dysexecutive, and mixed cognitive impairment. In each group we determined the concentration of cytokines (IL-1ß, IL-6, TNFα, IL-10) in liquor and serum, ß-amyloid 1−40 in liquor and a number of MRI morphometric parameters and fractional anisotropy. Results: In all groups of patients we detected higher level of IL-10 in serum compared with the control. Patients with dysexecutive cognitive impairment had higher concentration of IL-1ß, IL-10 in liquor, IL-6 level in serum, lower fractional anisotropy of ipsilateral thalamus compared with patients with normal cognition and largest size of infarct. Patients with dysexecutive and mixed cognitive impairment had the higher area of leukoareosis and ventricular volume, reduced fractional anisotropy of contralateral cingulum compared with patients with normal cognition. Patients with mixed cognitive impairment characterized by lower fractional anisotropy of contralateral fronto-occipital fasciculus compared with patients with dysexecutive cognitive deficit. Conclusions: Serum and cerebrospinal fluid concentrations of cytokines studied in combination with MRI parameters particularly fractional anisotropy seems to be informative biomarkers of pathogenic types of PSCI.

[The role of melatonin in the development of post-stroke cognitive impairment in elderly patients in comparison with middle-aged patients].

In the acute phase of ischemic stroke 73 patients aged from 61 to 86 years and 47 patients aged 36 to 60 years underwent a comprehensive neuropsychological testing, evaluation of the concentration of 6-sulfatoximelatonin 6-sulfatoximelatonin in the night urine and brain MRI morphometry in some patients. The control group consisted of 14 persons without cerebrovascular disease. Younger and middle-aged patients had higher levels of 6-sulfatoximelatonin compared to both controls and elderly patients. The level of the metabolite in patients older than 60 years and the control group did not differ. In the group of patients older than 60 years we revealed a direct correlation with the severity of the stroke and concentration of 6-sulfatoximelatonin. Metabolite concentration was inversely correlated with the results of the Mini Mental State Examination, Frontal Assessment Battery, verbal fluency, clock drawing test and directly - with the Shulte tables result. High concentrations of 6-sulfatoximelatonin was also associated with a large size of acute ischemic lesion and hippocampal volume. The highest concentration of the metabolite was observed in patients with dysexecutive cognitive impairment and the lowest in patients with normal cognitive status and amnestic deficit. Thus, in elderly patients a high concentration of 6-6-sulfatoximelatonin is a marker "pure" post-stroke cognitive impairment, whereas a low concentration of metabolite in the presence of cognitive deficits may be indicative of its mixed, that is, in part, of hippocampal type.

[Frontotemporal degeneration: a clinical case and experience of using of diffusion tensor magnetic-resonance imaging tractography].

Frontotemporal degeneration is a frequent cause of presenile dementia that makes up from 5 to 17% of autopsy-confirmed cases developed at the age of 70 years. Authors report a case of this disease, discuss the possible causes of its development and present the results of diffusion tensor magnetic resonance tractography. Clinical features of this case are practically isolated speech disturbance with the most likely domination of a semantic variant of primary progressive aphasia. Magnetic-resonance imaging has an important practical significance for this pathology due to the possibility of assessing atrophic zones. The use of DTI-tractography allows to extend diagnostic possibilities.