Assessment Of Neurological Status Research Articles

Neurological symptomatology features in patients with spine and spinal cord trauma at the thoracolumbar junction level

Background. Traumatic injuries to the thoracolumbar junction account for over 60 % of all injuries to the thoracolumbar spine. The neurological symptomatology accompanying injuries at this level is characterized by diverse patterns of both motor and sensory dysfunction, which are determined by the topographic-anatomical features of this area. Neurological deficit may be caused by conductive, segmental, and radicular disturbances. The aim of the study is to determine the nature and frequency of neurological disorders in patients with spine and spinal cord trauma at the level of the thoracolumbar junction, depending on the likely substrate of the traumatic impact. Materials and methods. An analysis of the neurological status assessment was conducted in 101 patients who suffered spine and spinal cord trauma at the level of the thoracolumbar junction. The average age of the patients was 41 years (95% confidence interval 36–44). Most patients were male (75.25 %). The number of motor segments with signs of upper and lower motor neuron lesion, and dermatomes with sensory impairment of radicular, segmental, or conductive types were determined. Results. It was found that 83.5 % of motor segments with dysfunction had clinical signs of lower motor neuron lesion, 41.3 % of dermatomes with sensory impairment had traumatic root damage, 57.9 % of dermatomes showed impairments of a segmental type, and 28.9 % were of a conductive type. Conclusions. The data obtained indicate a significant role of segmental disturbances in forming the symptoms in patients with spine and spinal cord trauma at the level of the thoracolumbar junction.

Endovascular Recanalization and Carotid Stenting: The New Approach to Restore Cerebral Perfusion during Aortic Dissection.

Two clinical cases of TAAD complicated by cerebral malperfusion are described. The first patient is 73 years old and was admitted as planned to perform transcatheter aortic valve implantation (TAVI) for grade III aortic stenosis. The patient underwent transcatheter aortic valve implantation (TAVI) on the second day after admission. The second patient is 60 years old and was hospitalized by an ambulance with strong hypertension and ischemia. The surgical correction of aortic dissection was postponed until the neurological status assessment in both patients. The surgery to correct the aorta dissection was deemed inappropriate. The carotid arteries have been reanalyzed, and cerebral perfusion has been restored in a short time in both patients. Acute bilateral internal carotid occlusion is a potentially fatal TAAD outcome. Emergency endovascular recanalization and carotid stenting may be considered one of the few ways to restore cerebral perfusion.

Nueroprotection by Anesthetics in Brain Injury Models

The aim of the study was to compare the effect of sevoflurane and chloral hydrate on the neurological status and volume of brain damage after trauma and ischemia in experimental models of traumatic brain injury (TBI) and focal ischemic stroke (IS) induced by photothrombosis (PT).Materials and methods. The experiments were performed on mongrel Wistar rats weighing 250–300 g (N=43). There were 4 groups: the Ischemia + Sevoflurane group (ISSEV) (N=10), the Ischemia + Chloral hydrate group (ISCH) (N=10), TBI + Sevoflurane group (TBISEV) (N=13), and TBI+Chloral hydrate group (TBICH) (N=10). Ischemic brain damage was modelled using Rose Bengal (RB) dye-induced PT, and TBI was modelled using mechanical force-induced concussion.Results. MRI findings indicate lower volumes of brain damage (mm³) in rats from TBISEV group compared with the TBICH group (19±5 vs. 60±5, P<0.0001), and in the ISSEV group compared with the ISCH group (9.8±1.5 vs. 21.5±2, P=0.0016). Moreover, there was a significant difference between ISSEV and ISCH groups based on the protocol assessment of neurological status on day 14 with higher scores in ISSEV (11.4±1.8 vs. 4.9±2.6, P<0.0001).Conclusion. Taking into account the data obtained, we recommend a careful choice of anesthesia when modeling ischemic stroke and traumatic brain injury in animals. In particular, the neuroprotective effect of sevoflurane should be taken into account in the PT and TBI models.

Non-occlusive hydrocephalus after radiosurgery for vestibular schwannomas

Stereotactic radiosurgery has firmly entered the arsenal of methods for treating vestibular schwannomas along with traditional surgical removal, providing high control of tumor growth and a low level of functional complications. Meanwhile, there is evidence of a possible relationship between the irradiation performed and the subsequent development of non-occlusive hydrocephalus. Purpose: to retrospectively assess the current level of development of hydrocephalus after stereotactic radiosurgery for vestibular schwannomas. Materials and methods: of 541 patients who received treatment with the Gamma Knife for unilateral vestibular schwannoma, 456 (84.3%) patients initially had no signs of non-occlusive hydrocephalus (group 1), while in 85 (15.7%) patients, MRI signs of internal non-occlusive hydrocephalus were revealed at the time of radiosurgery (group 2), of whom in 1 case VP shunting had previously been performed. In all cases, non-occlusive hydrocephalus at the time of SRS had a compensated course without clinical manifestations. Results: after radiosurgery, the development of de novo non-occlusive hydrocephalus in 7 (1.5%) patients from group 1 and its progression in 11 (12.9%) patients from group 2 were noted. The overall incidence of non-occlusive hydrocephalus after radiosurgery was 3.3%. Ventriculoperitoneal shunting was required in 3 cases in group 1 and 7 cases in group 2 due to the occurrence of neurological symptoms (1.8%). Conclusion: In some cases, radiosurgery can lead to decompensation of existing non-occlusive hydrocephalus, but it rarely occurs de novo. The asymptomatic course of non-occlusive hydrocephalus allows for SRS, as the risk of decompensation with subsequent need for VP shunting is low. Patients with non-occlusive hydrocephalus before SRS require more careful monitoring with assessment of neurological status and control MRI.

Functional disorders of the peripheral nervous system in metallurgical workers

Introduction. Early detection of functional changes in the nervous system makes it possible to clarify the etiopathogenetic effect of a whole set of adverse industrial factors, form a group at risk of occupational diseases, and develop preventive programs for given the main structural targets. 
 The purpose of the study was to identify characteristics of functional disorders of the peripheral nervous systems in metallurgists exposed to occupational hazards.
 Materials and methods. We examined two cohorts of workers: a control cohort of forty men unexposed to occupational risk factors and a case cohort of 60 male employees of a metallurgical plant situated in the Sverdlovsk Region. The cohorts were matched by age (mean: 38.8±7.6 years) and work experience (5.1±4.7 years). The mean duration of exposure to occupational hazards was 7.1±6.0 years. We included 38 cases in the program of in-depth neurophysiological examination that consisted of assessment of neurological status, electroneuromyography (ENMG).
 Results. 73.9 % of the cases had no complaints. Functional disorders of peripheral nerves were diagnosed as distal polyneuropathy of the upper and lower extremities (47.4 %), median neuropathy (42.1 %), ulnar neuropathy (23.7 %), and radiculopathies (9.6 %). Noteworthy is the presence of additional damages of the median nerve at the carpal tunnel in 55.6 % of the cases having signs of distal polyneuropathy.
 Conclusions. A comprehensive neurophysiological examination, not required by the current order for periodic medical examinations, helps to identify dysfunctions of the nervous system at their early stages. It is necessary to form high-risk groups of patients to monitor the development of work-related nervous diseases.

Some neurological and laboratory indexes in active duodenal ulcer depending on Helicobacter pylori presence

Somatic-neurological and psychosomatic relationships are an integral part of the pathophysiological mechanisms in numerous diseases. The results of one of the fragments of a comprehensive clinical and paraclinical study of the nervous system state indexes in active duodenal ulcer (DU) are reported. It aimed to assess the effect of Helicobacter pylori (H.pylori) on clinical-neurological and laboratory indexes. Sixty persons with an average age of 39.80 ± 1.29 years were examined. The patients were divided into two groups based on H.pylori presence or absence. The examinations included the following: analysis of complaints according to the developed questionnaire, neurological status assessment, autonomic dysfunction analysis (by A.M. Vayn questionnaire), complete blood count, evaluating the levels of C-reactive protein, total cholesterol, urea and creatinine in blood, neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio calculation. The appropriate statistical methods were used for data processing. It was found that complaints of headache, dizziness and paresthesia as well as asthenodepressive syndrome and polyneuropathy of various severity and with different clinical manifestations were more common (p < 0.05) in patients with active DU on the background of Н.pylori. Sympathicotonia was significantly more frequent and eutonia was significantly less frequent in the active DU in patients infected with Н.pylori. An increased C-reactive protein level was significantly more common in Н.pylori patients. The identified neurological and laboratory features indicate a probable pathophysiological significance of Н.pylori in somatoneurological relationships, particularly in DU.

Lumbar fusion through the anterolateral mini-approach: comparison of anterior interbody (OLIF-AF) and percutaneous pedicle (OLIF-PF) fixations in the surgical treatment of single-level stenosis

Objective. To perform comparative analysis of the clinical efficacy and safety of indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach (OLIF) with anterolateral (OLIF-AF) and posterior percutaneous (OLIF-PF) screw fixations in the surgical treatment of single-segment lumbar stenosis.Material and Methods. A retrospective comparative analysis of treatment of 88 patients aged 29 to 72 years with single-level lumbar stenosis was carried out. Posterior instrumental fixation (OLIF-PF) was performed in 60 cases, and anterolateral (OLIF-AF) – in 28.Results. The compared groups did not statistically significantly differ from each other in terms of age, gender, body mass index, clinical picture and duration of symptoms before surgery, assessment of neurological status according to the Zurich Claudication Questionnaire (ZCQ), preoperative diagnosis, localization of stenosis, pain assessment in the back and leg before surgery according to a digital rating scale, physical status (ASA), health assessment (SF-12, ODI), follow-up period, as well as smoking and the presence of comorbidities (p > 0.05). In the OLIF-AF group, compared to the OLIF-PF group, a statistically significant advantage was found in terms of blood loss, duration of surgery and anesthesia, the level of radiological exposure, duration of patient’s hospitalization and hospital stay in the postoperative period, as well as the duration of antibiotic prophylaxis and intraoperative volume of infusions (p < 0.05). Despite earlier discharge and less use of local anesthesia (35.7 % vs 73.3 %; p = 0.001), patients in the OLIF-AF group had statistically significantly lower level of back pain on the day of discharge (3.0 vs 3.5; p = 0.034) and were less likely to need opioids (3.6 % vs 31.7 %; p = 0.003). With regard to complications and adverse events, there were no statistically significant differences during dynamic follow-up period from 3 to 50 months in both groups (17.9 % vs 28.3 %; p = 0.290), including depending on the timing of complications (early or late). In addition, no statistically significant differences were found for neurological, infectious, gastrointestinal, urological, or implant-related complications (p > 0.05).Conclusions. Indirect decompression of the spinal roots and interbody fusion through the lateral pre-psoas approach in combination with OLIF-AF is an effective and safe technique for the surgical treatment of single-segment lumbar stenosis. This method allows to reduce the invasiveness of surgery and severity of the pain syndrome and to create conditions for enhanced recovery after surgery. Further multicenter randomized trials are needed to comprehensively evaluate long-term outcomes.

Modern treatment of epileptic encephalopathies in young children: improvement of precision medicine

Background. Treatment of epileptic seizures in young children, especially with epileptic encephalopathies (EE), is a difficult task, which is impossible in modern conditions without the use of a personified (precision) therapy. The diagnostic algorithm for EE must include genetic examination by the next-generation sequencing, which makes it possible to prescribe targeted therapy depending on the genetic etiology of the disorder. The article presents the results of own research on the effectiveness and approaches to targeted therapy of genetic epileptic encephalopathies in young children. Materials and methods. Fifty-eight children aged 0–3 years with clinical manifestations of epileptic encephalopathies, onset of seizures in the first year of life and diagnosed genetic etiology were included in the study. Pathogenic variants in genes associated with the development of epileptic seizures were identified in all children using the next-generation sequencing. The study included assessment of neurological status, history collection, evaluation of semiology and seizure type, development and screening for autism spectrum disorders at the age of 18 and 24 months, video-electroencephalography during night sleep, magnetic resonance imaging of the brain, assessment of antiepileptic treatment received by the child. Results. Of 58 children with EE who were prescribed antie­pileptic drugs, 10 (17.2 %) received monotherapy, 40 patients (69 %) received combined therapy with two anticonvulsants, and 8 children (13.8 %) — combined therapy with three or more anticonvulsants. Levetiracetam (31 patients), valproic acid salt preparations (20 cases), topiramate (11 children) and vigabatrin (10 cases) were most used antiepileptic drugs. In all examined patients with EE, we used schemes of targeted (persona­lized) antiepileptic therapy focused on the genetic etiology of the disorder. In children with tuberous sclerosis caused by mutations in the TSC1 and TSC2 genes, vigabatrin (50–150 mg/kg per day) was included in the antiepileptic therapy and showed efficacy in 75.0 % (9/12) of children with infantile spasms. Corticosteroids (adrenocorticotropic hormone or prednisone) were additionally included in the treatment regimen and showed effectiveness in 66.7 % of cases (4/6). In children with mutations in SCN1A gene, combined therapy including valproic acid, topiramate and clobazam, or valproic acid with levetiracetam and corticosteroids was used, which showed effectiveness in reducing the frequency of seizures in 100 % of cases. Conclusions. Epileptic encephalopathies are a heterogeneous group of genetic disorders in young children that are difficult to treat and often have a malignant course. Since standard antiepileptic drugs are often insufficiently effective in epileptic encephalopathies, the use of targeted therapy drugs and alternative treatments such as hormone therapy are extremely important. The goal of treatment for epileptic encephalopathies is not only to control seizures, but also to prevent the development of neurological and cognitive deficits and restore lost functions.

Clinical diversity and main directions of medical rehabilitation of dorsopathies of cervical-thoracic localization

Introduction. The high prevalence and increase in cases of seeking medical help for pain in dorsopathies determines the relevance of this problem. Among all the conditions included in the study of health care costs, non-specific musculoskeletal back pain ranks first in the world. A special place belongs to cervicothoracic dorsopathy (CTD), which are most common in developed countries and are characterized by a variety of clinical forms. In our opinion, a comprehensive method of treating CTD with the mandatory use of non-drug methods of therapy is the most optimal.Aim. Determination of the relationship between the pathogenetic form of CTD (verification of pain triggers) and a personalized method of treating patients, containing a combination of drug therapy and a rehabilitation complex of physiotherapeutic, psychotherapeutic effects.Materials and methods. Patients with CTD were included in the study. Neurological status assessment and biomechanical tests were carried out for accurate clinical verification of pathogenetic forms of CTD. Depending on the choice of treatment, respondents were stratified into comparable groups. The main group included patients to whom the original technique was applied, which implied a combination of drug therapy, a complex of rehabilitation physiotherapy and psychotherapeutic effects (n = 155), the control group (n = 65) – respondents who received a standard course of therapy. The statistical analysis included a comparative assessment of the intensity of pain syndrome, static-dynamic and reflex disorders before and after therapy.Results. Both methods have shown their effectiveness. The original technique more effectively reduced the intensity of pain syndrome, reduced the frequency of reflex disorders (p < 0.05), significantly reduced static-dynamic disorders in all subgroups (p < 0.05), while the standard significantly reduced them only in the subgroup with uncomplicated forms of CTD, without achieving a therapeutic effect in complicated CTD.Conclusion. The original method of therapy of patients with HCG has confirmed its effectiveness.

Direct withdrawal of a retained foreign body bisecting the thoracic spinal canal in a neurologically intact pediatric patient: illustrative case.

Nonmissile penetrating spinal cord injury (NMPSCI) with a retained foreign body (RFB) is rare and usually results in permanent neurological deficits. In extremely rare cases, patients can present without significant neurological deficits despite an RFB that traverses the spinal canal. Given the rarity of these cases, a consensus has not yet been reached on optimal management. In a patient with an RFB and a neurologically normal clinical examination, the risk of open surgical exploration may outweigh the benefit and direct withdrawal may be a better option. A 10-year-old female suffered an NMPSCI to the thoracic spine with an RFB that bisected the spinal canal but remained neurologically intact. Direct withdrawal of the RFB was chosen instead of open surgical exploration, leading to an excellent clinical outcome. The literature was reviewed to find other examples of thoracic NMPSCI with RFB and neurologically normal examinations. Management strategies were compared. For NMPSCI with RFB and without significant neurological deficits, direct withdrawal is a viable and possibly the best treatment option. The use of fast-acting anesthesia without intubation minimizes patient manipulation, speeds up recovery, and allows early assessment of neurological status after removal.

Клініко-генетичні характеристики дітей раннього віку з епілептичними енцефалопатіями та їхня роль у розвитку розладів аутистичного спектра

Purpose - to analyze the clinical and genetic characteristics of young children with developmental and epileptic encephalopathies and to determine their role in the formation of autism spectrum disorders (ASD). Materials and methods. The study included 58 children aged 0-3 years with the onset of epileptic seizures in the first year of life, clinical manifestations of developmental and epileptic encephalopathies with genetic etiology. The examination included assessment of neurological status, collection of anamnesis, assessment of semiology and determination of seizure type, assessment of development and screening for ASD at the age of 18 and 24 months, night sleep electroencephalography (video EEG), brain magnetic resonance imaging (MRI), screening for pathogenic variants by whole-exome sequencing or examination of relevant gene panels. Pathogenic variants of 33 different genes were found in the examined children. Pathogenic variants of genes responsible for the function of ion channels (41.3%), intracellular signaling systems (17.2%), organelles and intracellular membranes (12.1%) were most frequently found. 44.8% of children had symptoms of ASD at the age of 18 months, and 68.9% of children at the age of 24 months. The predominant types of epileptic seizures were myoclonic (37.9%) and focal clonic (34.4%). According to video EEG monitoring, interictal focal (39.6%) and multifocal (22.4%) epileptiform changes dominated in the examined children. According to MRI, structural changes of the brain were found in 86.2% of children. Conclusions. It is shown that children with a history of myoclonic seizures (RR=1.264) and infantile spasms (RR=1.44) have a high risk of developing ASD at 24 months. It has been established that there is a positive relationship between the presence in the child of mutations in the genes responsible for the functioning of ion channels (RR=1.32), as well as for the functioning of synapses, neurotransmitters and receptors (RR=1.5) and the development of ASD in 24 months. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Bioethics and Deontology Commission. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.

Serum Level of Brain-Derived Neurotrophic Factor and Thrombotic Type Are Predictive of Cognitive Impairment in the Acute Period of Ischemic Strokes Patients.

40-70% of patients after a stroke, including a mild one, may experience cognitive impairment. Brain-derived neurotrophic factor (BDNF) plays a significant role in the pathogenesis and rehabilitation of ischemic stroke and also affects the patients' recovery prognosis. An association between cognitive impairment in the poststroke period and lower peripheral BDNF levels is known, but the prognostic significance of serum BDNF levels and clinical characteristics for the risk of developing cognitive impairment in the acute period remains uncertain. We conducted a prospective cohort study of patients in the acute phase of ischemic stroke. Clinical examination, assessment of neurological status, neuropsychological testing, and laboratory analyzes were performed on patients at 1 and 14 days after ischemic stroke. The state of cognitive functions was assessed by the Mini-Mental State Examination scale. Quantification of BDNF in blood serum was performed by solid-phaseenzyme-linked immunosorbent assay (ELISA). We found that within 14 days after an acute ischemic stroke, we found a decrease in the clinical severity of patients compared to 1 day of the onset of the disease before the start of treatment and a significant decrease in the level of BDNF in the blood serum of patients with ischemic stroke both on the first and on the 14th day. However, during the 2 weeks of the acute period, no significant changes were detected, despite the general improvement of the clinical condition. In our study, cognitive impairment was found in almost half of the patients on the first day of ischemic stroke, and there was no significant reduction in this prevalence over 2 weeks. We found that a low level of BDNF and a thrombotic subtype of ischemic stroke can be risk factors for cognitive impairment in the acute period, which can be useful in planning treatment and rehabilitation measures.

Comment on the Need to Fill a Gap in the Assessment of Neurological Status Before Elective Surgery.

Comment on the Need to Fill a Gap in the Assessment of Neurological Status Before Elective Surgery.

Acute uremic polyneuropathy in a patient with Alzheimer’s disease

The article presents a case of acute uremic neuropathy. Without any visible cause, a 71-year-old patient felt weakness in legs and numbness in feet. Her neurological status assessment on admission to the hospital showed peripheral tetraparesis and impaired sensitivity of the polyneuropathic type. Neurological symptoms appeared due to renal dysfunction, which had been confi rmed with laboratory test. Electroneuromyography revealed signs of acute demyelinating polyneuropathy. Аt the hospital, the patient was diagnosed Alzheimer’s disease. The treatment provided at the hospital led to normalization of her laboratory parameters and complete restoration of motor functions. The peculiarity of the presented clinical case is that the patient started violating drinking regime due to her cognitive impairment which resulted in renal dysfunction and acute uremic neuropathy. The other peculiarity of the case is that it was enough to correct the water-electrolyte disorders to fully restore the patient’s motor functions within a month, without the use of dialysis. Finally, the article discusses the issue of pathogenesis and diff erential diagnosis of other types of polyneuropathies.

Hypoxic-ischemic brain damage of the fetus and newborn with hemodynamic disorders in the “mother-placenta-fetus” system

Objective: to identify the dependence of the severity of cerebral disorders in newborns and children of the first year of life on the indicators of blood flow in the utero-placental complex. Materials and methods: a total of 184 full-term newborns were examined in the period from birth to one year of life. The main group included children with cerebral ischemia of II and III severity and its consequences (group II, n=78; group III, n=42). Group I included newborns without signs of central nervous system damage, 14 of them had neurological symptoms by the end of the neonatal period (after a month, group I n =50, group II n =92). All children underwent general clinical examination, assessment of neurological status, ultrasound examination of the brain, transcranial dopplerography of cerebral vessels, electroencephalography. Maternal medical records were analyzed to identify hemodynamic parameters in the "mother-placenta-fetus" system at 12-13, 20-21, 28-32, and 36-40 weeks of gestation. Results: The features of uterine and fetal blood flow in the dynamics of gestation in mothers of the examined groups of children were determined. The associations between the values of Pi AUD, AUS, and AUM in the second and third trimesters of pregnancy in different groups were shown. The relationship between disorders of uteroplacental hemodynamics and the severity of cerebral pathology was revealed. A "method of antenatal prediction of the severity of cerebral disorders in newborns" was proposed. Conclusions: The obtained results make it possible to predict the risk of hypoxic-ischemic damage to the central nervous system in newborns antenatally using hemodynamic parameters in the mother-placenta-fetus system at 36 weeks of gestation.

Клинико-инструментальная диагностика ранних изменений атлантоаксиальной области при анкилозирующем спондилите

The purpose — to assess the early imaging changes in the atlantoaxial area and to compare them with clinical and laboratory characteristics in patients with ankylosing spondylitis (AS). Material and methods. 20 patients with AS were examined, the average age is 44.2 ± 12.66 y. o. Activity (ASDAS(CRP)): very high — 85%, high — 5%, low — 10%. X-ray stage of sacroiliitis: 2 — 60%, 3 — 15%, 4 — 25%. Functional deficiency (FD): 3 — 55%, 2 — 20%, 1 — 25%. The duration of illness was 176 [2; 360] months. The extended clinical examination included: assessment of neurological status, presence of components of neuropathic pain (NP) and central sensitization (CS), assessment of quality of life, degree of functional disorders. Magnetic resonance imaging (MRI) of the craniovertebral junction was performed with the measurement of 5 craniometric parameters (CMP) for the presence of translocation of the dens axis. Results. Neck pain syndrome — 75%: inflammatory — 95%, non-inflammatory — 80% (NP — 65%, CS — 50%). VAS: 5.75 ± 2.09. FD: BASMI — 3.86 [2; 7], BASFI — 4,84 [0,7; 8,7]. 75% — limitation of neck rotation, 65% — increase in the distance of the trestle-wall. CMP: 100% — decrease in the retroflex angle, 20% — increase in the anterior atlantodental index, 15% — translocation relative to the Chamberlain line, 10% increase in pB-C2, 5% — decrease in the posterior atlantodental index. A correlation was revealed between the CMP with the X-ray stage (rSp = 0.629; p = 0.021), BASMI (rSp = 0.575; p = 0.04) and the psychological component SF-36 (rSp = 0.570; p = 0.042). The angle of retroflexion with the duration of the disease (rSp = -0.580; p = 0.038), CRP (rSp = 0.624; p = 0.023). Conclusions. All patients with AS had pathological MRI changes in the form of initial manifestations of translocation of the dens, which had nonspecific clinical manifestations. Changes in craniovertebral transition to MRI did not correlate with disease activity (ASDAS (CRP)), but were associated with the level of CRP, duration of the disease, X-ray stage of sacroiliitis and functional indices (BASMI).

Digital technologies in the assessment of neurological status

Digital technologies (DT) can be used at all stages of the neurologist's work with the patient. The medical professional can obtain online information on the patient's complaints and history. DT may help to assess cognitive functions, muscular power, details of the movements including gate. The methods of the assessment of sensory functions are being currently developed. The methods of the assessment of the olfaction, vision, oculomotor function, pupillary reactions, mimic muscles, hearing and balance are also developed, however the methods of assessment of the function of trigeminal nerve, movement of the head, neck and tongue using DT are not available. The assessment of the reflexes using DT is not developed yet. The use of DT is possible in telemedicine, in long-term monitoring of the neurological status of the patient, as well as in the clinical exam in order to obtain additional, more detailed data.

Application of Patient-Reported Outcomes in Back Pain in Adults: Part 1

The aim of the research is generalization of information about the most common foreign and domestic scales and questionnaires used in acute and chronic back pain (BP). The analysis of Russian-language and foreign literature was carried out with a search depth of 5 years (2016–2021) in the following databases: e-Library, PubMed, Oxford Press, Clinical Keys, Springer, Elsevier, Google Scholar. For the diagnosis of acute and chronic BP and the assessment of the characteristics of its course in dynamics, both a standardized study may be use: collection of complaints, anamnesis, objective examination, assessment of neurological status, as well as valid scales and questionnaires. For the timely diagnosis and monitoring of the development of BP in patients, a wide range of scales and questionnaires were proposed, which were conventionally ranked into 4 groups: scales for assessing the quality of life of patients with BP; scales for assessing the characteristics of pain in BP; scales for assessing the outcomes of the disease in BP; scales for assessing disability in BP. The first part of the thematic review presents an analysis of the advantages and disadvantages of scales for assessing the quality of life of patients with BP. These perspective scales for assessing the quality of life of patients with BP are popular in the world neurological practice. It is necessary to adapt to the use in domestic clinical practice the Stratford Functional Back Pain Scale, the Index of Disability Associated with Pain, The Patient Assessment for Low Back Pain–Impacts.

Dynamics of the Alterations of Cognitive Functions in Patients with Past Interventions on the Carotid System

INTRODUCTION: Among the European population of 715 million people, 1.4 million cases of strokes are recorded annually. Of them, approximately 87% are ischemic strokes, and approximately 20% were accounted for by atherosclerosis of the carotid arteries. To prevent an ischemic cerebral event associated with atherosclerosis of brachiocephalic arteries, different surgical techniques have been developed including carotid endarterectomy (CEAE) and carotid artery stenting (CAS). CEAE and CAS reliably reduce the risk of recurrent stroke associated with atherothrombosis, but with this, the level of alterations of cognitive functions and the restoration of cerebral functional deficit have not been widely studied. At present, no randomized studies and meta-analyses have met all the standards of conducting research concerning alterations in cognitive functions in patients with past interventions on carotid arteries. Some medical centers have performed such interventions, but data are not unambiguous: some authors describe the improvement of cognitive functions, whereas others do not note any differences or even see signs of impairment.
 CONCLUSION: This literature review highlights an issue concerning the assessment of the alteration of postoperative cognitive deficit in patients with past CEAE or CAS. Comparisons in the context of cognitive cerebral functions in the postoperative period of endarterectomy or stenting and assessment of neurological status in patients with or without a history of acute cerebrovascular accident, different variants of anesthesia, and CEAE techniques are considered.

Neurological monitoring and sedation protocols in the Liver Intensive Care Unit

Patients with liver disease often have alteration of neurological status which requires admission to an intensive care unit. Patients with acute liver failure (ALF), acute-on-chronic liver failure (ACLF) and rarely cirrhosis are at risk of cerebral edema. These patients require prompt assessment of neurological status including assessment of intra-cranial pressure (ICP) and monitoring metabolic parameters like arterial/venous ammonia levels, serum creatinine and serum electrolytes so that timely specific therapy for raised ICP can be instituted to prevent permanent neurological dysfunction. The overall aims of neuromonitoring and sedation protocols in a liver intensive care unit are to identify the level of multifactorial metabolic encephalopathy, individualize sedation and analgesia requirements for patients on mechanical ventilation, institute specific therapy to correct the neurological insult in ALF and ACLF, provide clear physiological data for guided therapy of drugs like muscle relaxants, antiepileptics, and cerebral edema reducing agents, and assist with overall prognostication. In this review article we will outline the clinical scenarios related to liver disease requiring intensive care and neuromonitoring, current techniques of neurological assessment, sedation protocols and point of care tests which enable the treating physician and intensivist guide therapy for raised ICP.