Neurocysticercosis with symptomatic epilepsy manifestation.

Aim To present a unique case of a 22-year-old male patient with symptomatic epilepsy manifestation on a background of neurocysticercosis (NCC). Methods An Indian student in Kharkiv, who lived in rural parts in India, presented with sudden episodes of seizure followed by severe headaches. Laboratory analyses and neurological status (MRI) were performed. Results Neurological status of the patient revealed nystagmus and difficulty in performing co-ordination tests. General analysis of blood showed raised eosinophil count to 8%. The MRI showed a few small conglomerating peripherally enhancing thick-walled infective granulomas in left frontal lobe with extensive surrounding oedema in the left fronto-parietal lobe. The patient was treated with albendazol, levipil, methylprednisolone and pantoprazole. Clinical symptoms and subsequent MRI showed improvement. Conclusion Neurocysticercosis is often misdiagnosed in the early stages, which leads to adverse outcomes. Although seizures are the most common clinical manifestation, it is a symptom that is not found in majority of the patients. The NCC of adult onset accompanying epileptic seizures is not well studied and a link between the helminthic invasion, epilepsy and psychiatric conditions needs to be established. This disease is potentially eradicable with wellplanned eradication programs targeting all stages of Taenia solium life cycle.

Tourette syndrome or PANDAS-a case report.

Tourette syndrome (TS), a relatively common disorder, has been gaining more attention during the past two decades because of an increased number of reports. Nevertheless, it is still not completely understood. Furthermore, a clinical entity called "pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections" (PANDAS) has been introduced, which describes a tic disorder, accompanied by psychiatric disorders such as obsessive compulsive disorder (OCD), after a streptococcal infection in childhood. We present a case report of a 19-year-old adolescent Ukrainian female, with a history of anxiety disorder and OCD, who, despite TS remission during childhood, presented with new-onset motor and phonic tics after 1 month of severe tonsillitis. Blood and cerebrospinal cultures showed Streptococcus pyogenes, with magnetic resonance imaging revealing hypo-intense changes in the caudate nucleus on both sides. Treatment with clonazepam and fluoxetine, along with behavioral therapy, have improved the severity of her condition. This report presents a case of TS reemergence against the background of immunological reaction or PANDAS with a late adolescent onset.

FEATURES OF LOCAL IMMUNE REACTIONS IN SKIN WITH UNDERLYING SOFT TISSUES IN PATIENTS WITH MULTIPLE SCLEROSIS.

OBJECTIVE: The aim of the study is to identify the peculiarities of local immune reactions in the skin with underlying soft tissues in patients with different variants of the multiple sclerosis' course. PATIENTS AND METHODS: Material and methods: The study included 35 patients, hospitalized in the neurological department of the Communal Nonprofit Enterprise of Kharkiv Regional Council «Regional Clinical Hospital¼ with the established diagnosis of multiple sclerosis. The patients were divided into three study groups, based on different variants of this pathology's course. Group 1 included 16 patients with relapsing-remitting type of multiple sclerosis. Group 2 included 11 patients with a secondary-progressive type of multiple sclerosis course. Group 3 included 8 patients with a primary progressive type of multiple sclerosis. Patients of all groups underwent a biopsy of the skin with underlying soft tissues in the lower third of the inner surface of the right lower leg. The comparison group (group 4) was represented by 10 autopsy cases (7 women and 3 men) conducted on the basis of the pathological anatomy department of the Communal Nonprofit Enterprise of Kharkiv Regional Council «Regional Clinical Hospital¼. There were no signs of the nervous system's pathology during life in all cases of this group. The cause of death was a dislocation of the brain stem or hematocephaly and the main disease was arteriovenous malformation or congenital aneurysm of the cerebral vessels. The material for the morphological study was skin with underlying soft tissues. Microspecimens stained with histological and immunohistochemical methods were studied, using an Olympus BX-41 microscope. The obtained data were statistically processed, using Statistica 6.0 and Microsoft Excel 2003 programs. RESULTS: Results: Survey microscopy showed that in groups 1-3 in comparison with group 4 immune cell infiltrations were more pronounced in the skin with underlying hypodermis. Significantly larger mean values of the absolute number of CD 3-, CD 20- and CD 68-positive cells were revealed immunohistochemically in groups 1-3 compared with group 4. Thus, it was found in patients with multiple sclerosis the activation of T-cell immunity, B-cell immunity and macrophage system with the development of an immune imbalance between them. Our results allow us to think about the participation of all the above immune cells in the pathogenesis of multiple sclerosis development. The revealed disorders of local immune reactions in the skin with underlying hypodermis in patients with multiple sclerosis are less pronounced in the remitting-recurrent variant of the course of the disease, more pronounced in the secondary-progressing and, especially, primary-progressing variants. CONCLUSION: Conclusions: In patients with multiple sclerosis in the skin with underlying hypodermis activation of T-cell immunity, B-cell immunity and the macrophage system is observed with the development of an immune imbalance between them, characterized by the prevalence of the absolute number of macrophages among all immune cells. Less pronounced violations of local immune reactions in the skin with underlying hypodermis are noted in remitting-relapsing variant of multiple sclerosis course, more pronounced in a secondary-progressing and, especially, primary-progressing variants.