Nervous System Lesions Research Articles

Course of Niemann – Pick disease type A/B in the context of hematopoietic stem cell transplantation

Niemann – Pick disease type A/B (NPAB) is a rare severe inherited disease from the group of accumulation diseases with a defect in the acid sphingomyelinase gene (Niemann-Pick disease types B, A/B) (ASMD). Symptoms of damage to the nervous system and internal organs manifest in infancy, leading to disability, fatalities in childhood. NPAB is so far incurable. Optimal management of the disease requires a multidisciplinary team of physicians, specialists. The basis of therapy is the elimination of existing/forming complications, symptomatic treatment. Enzyme replacement therapy as a means of modifying the course of this disease is expected to slow down the progression of pathologic manifestations of the disease not related to the central nervous system lesions. Single cases of hematopoietic stem cell transplantation (HSCT) have been described in the treatment of ASMD, which is one of the new methods aimed at normalizing the level of acid sphingomyelinase, blood parameters, as well as reducing the severity of pathological visceral manifestations. However, the development of complications during HSCT, absence of positive therapeutic effect in severe CNS lesions does not allow to widely implement this method. Taking into account the contradictory data on the efficacy of HSCT in ASMD, further clinical studies are required. Analysis of 2 clinical cases of NPAB in children from the same family allowed us to reveal differences in the course and outcomes of the disease at verification of the diagnosis at birth followed by HSCT. Difficulties in diagnosing this extremely rare pathology, which requires a multidisciplinary approach, justify the need to improve methods of early diagnosis, including the organization of genetic risk determination, introduction of prenatal genetic testing before pregnancy.

Role of MRI in Assessment of Central Nervous System Lesions and Post Treatment Complications in Pediatric Patents with Leukemia

Abstract Background In terms of pediatric oncology, leukemia is one of the most frequent deadly illnesses. Early CNS problem identification and appropriate therapy were enhanced by MRI. Aim Describe the MRI results brought on by leukemia's involvement in CNS structures and treatment-related CNS side effects, and evaluate their efficacy for early therapy and preventing long-term adverse effects. Patients and Methods A prospective observational study included 52 children with leukemia. All patients undergone MR examination including conventional MRI, MR diffusion imaging and MR venography (MRV). Results Regarding MRI finding of CNS, leukemic infiltration was found in 57.7%, sub volimic changes in mild manner in 50% and about 26% in a moderate manner while absent in 23.1%, PRES was present in 19.2%, venous thrombosis present in 30.8% and post treatment complications were found in 7.7%. Conclusion Diffusion-weighted MRI proved very helpful in the early diagnosis and distinction of various CNS lesions seen in young patients with leukemia and post-treatment CNS sequelae. These techniques included conventional, post- contrast, MR venography, and diffusion-weighted MRI.

Dietary acid load as well as dietary phytochemical index, and association with multiple sclerosis: results from a case–control study

IntroductionMultiple sclerosis (MS) is a chronic inflammatory disease characterized by central nervous system (CNS) lesions. Although the etiology and pathogenesis of MS remains unclear, nutrition is among the environmental factors that may be involved in developing MS. Currently, no specific diet has been associated with MS. This study aimed to investigate the relationship between the dietary phytochemical index (DPI), dietary acid load (DAL), and the risk of developing MS.MethodsThis case‒control study was conducted on 174 patients with MS and 171 healthy individuals in Mashhad, Iran. Data were collected using a 160-item semiquantitative food frequency questionnaire (FFQ). The study investigated the association between DPI, DAL, and MS, considering anthropometric measures, dietary intake, smoking habits, and sex. DPI, potential renal acid load (PRAL), and net endogenous acid production (NEAP), as indicators of DAL, were calculated based on the FFQ.ResultsThe study analyzed 345 participants, comprising 174 (50.4%) MS patients and 171 (49.6%) healthy individuals. The mean age of the participants was 32.45 ± 8.66 years. The DPI score was significantly lower among MS patients, while the NEAP and PRAL scores were significantly higher among MS patients compared to the healthy group. There was no relationship between NEAP (OR 1.001; 95% CI 0.959–1.044; P = 0.974) and PRAL (OR 1.019; 95% CI 0.979–1.061; P = 0.356) and MS incidence.ConclusionsThe study found higher smoking and obesity rates in MS patients, with a reduced DPI score and increased DAL. Further studies are needed before recommending plant-based foods and dietary acid–base balance evaluation as therapeutic approach.Graphical

Character and Frequency of the Syntropic Extrahepatic Lesions in Cirrhotic Patients with Hepatopulmonary Syndrome of Various Severity Degree

Introduction. All over the world, and in Ukraine in particular, the incidence of liver diseases is constantly increasing. By practicing the most effective individualized appointment of complex treatment, it should be taken into consideration the involvement of different organ systems to the pathological processes of the cirrhotic patients, which we define as syntropic polymorbid lesions. The aim of the study. To determine the frequency and character of syntropic extrahepatic lesions in cirrhotic patients depending on the hepatopulmonary syndrome severity degree. Materials and methods. In a randomized manner with preliminary stratification by the presence of hepatopulmonary syndrome were studied 93 patients with liver cirrhosis, who underwent the comprehensive clinical-laboratory and instrumental examination. Results. According to the obtained results, most often in patients with liver cirrhosis associated with hepatopulmonary syndrome syntropic extrahepatic lesions affected other organ systems as follows: digestive system - 100.0 % patients under investigation; hematopoietic system - 84.9 %; nervous system - 81.7 %; integumentary system and mucous membranes - 78.5 %; blood circulatory system - 76. 3%;osteoarticular system - 67.7 %; urinary system - 22.6 %. Increased severity of hepatopulmonary syndrome significantly (p < 0.05) correlated with thein creased frequency of lesions. Among syntropic polymorbid lesions of the integumentary system and mucous membranes, 68.8 % patients with hepatopulmonary syndrome had jaundice, 66.7 % - telangiectasia. Among lesions of the osteoarticular system osteopenia was diagnosed in 44.7 % of patients, osteoporosis - in 27.7 %. Among lesions of the circulatory system 52.7% of patients suffered from heart rhythm disorders, 49.5 % - from arterial hypotension, 20.4 % - from cirrhotic cardiomyopathy. Among lesions of the hematopoietic system anemia (76.3 %), coagulopathy (73.1 %) and thrombocytopenia (61.3 %) were diagnosed most often. Digestive system lesionsinclude esophageal veins varicosities (94.6 % of patients), hemorrhoidal veins varicosites (68.8 %), and cirrhotic gastropathy (62.4 %). Among lesions of the urinary systemin 21.5 % of patientswas diagnosed type II hepatorenal syndrome. Among the lesions of central nervous system in 81.7 % of patientswas diagnosed hepatic encephalopathy. The frequency of syndromes and nosological units increased significantly (p < 0.05) with the increase of hepatopulmonary syndrome severity. Conclusions. 100.0 % patients with liver cirrhosis accompanied byhepatopulmonary syndromewere affected by syntropic polymorbid lesionsof the digestive system, 94.6 % of which were represented by esophageal vein varicosites. Out of 84.9 % of patients with hematopoietic lesions anemia was diagnosed in 76.3 %, coagulopathy - in 73.1 % of cases. Of total 81.7 % patients withnervous system injurieshepatic encephalopathy was diagnosed in 81.7 % patients. In 78.5 % cases of damaged skin, its appendages and mucous membranesjaundice covered 68.8 %, and telangiectasia 66.7 % of cases. In 76.3 % of cardiovascular system lesions arrhythmias were diagnosed in 52.7 %.With the increasing severity of hepatopulmonary syndrome, the frequency of the above lesions increased significantly (p < 0.05).

Derivation and transcriptional reprogramming of border-forming wound repair astrocytes after spinal cord injury or stroke in mice

Central nervous system (CNS) lesions become surrounded by neuroprotective borders of newly proliferated reactive astrocytes; however, fundamental features of these cells are poorly understood. Here we show that following spinal cord injury or stroke, 90% and 10% of border-forming astrocytes derive, respectively, from proliferating local astrocytes and oligodendrocyte progenitor cells in adult mice of both sexes. Temporal transcriptome analysis, single-nucleus RNA sequencing and immunohistochemistry show that after focal CNS injury, local mature astrocytes dedifferentiate, proliferate and become transcriptionally reprogrammed to permanently altered new states, with persisting downregulation of molecules associated with astrocyte–neuron interactions and upregulation of molecules associated with wound healing, microbial defense and interactions with stromal and immune cells. These wound repair astrocytes share morphologic and transcriptional features with perimeningeal limitans astrocytes and are the predominant source of neuroprotective borders that re-establish CNS integrity around lesions by separating neural parenchyma from stromal and immune cells as occurs throughout the healthy CNS.

Clinical effects of neuroendoscopic infratentorial supracerebellar approach surgical technique for resecting pineal tumors: a retrospective study

ObjectivePineal tumors are relatively rare central nervous system lesions with a predilection for the pediatric population. This article aims to explore the clinical effects of neuroendoscopic infratentorial supracerebellar approach for resecting tumors in the pineal area. MethodsThis is a retrospective study that included patients who underwent neuroendoscopic infratentorial supracerebellar approach to resect nine tumors in the pineal area at the Department of Neurosurgery of the Second Hospital of Lanzhou University from December 2017 to October 2023. ResultsThe results of postoperative MRI revealed that all tumors were resected. Five patients received postoperative radiotherapy, three patients received radiotherapy along with chemotherapy, and one patient received neither radiotherapy nor chemotherapy. The pathological results showed that four patients were diagnosed with germinoma, two patients with teratoma, two patients with mixed germ cell tumors, and one patient with central neurocytoma. After surgery, one patient developed psychiatric symptoms, two patients developed binocular upward vision and diplopia, and one patient developed unstable walking and diplopia. With a follow-up of 1.7–4.8 years, all nine patients lived normally. Furthermore, none of them had tumor recurrence or death. ConclusionThe simple neuroendoscopic infratentorial supracerebellar approach has some safety and efficacy. It is suitable for tumors in the pineal region where the disease is mainly located below the Galen vein complex.

Practical Aspects of Assessing Toxic Lesions of the Peripheral Nervous System in Preclinical Studies in Rodents: A Review

INTRODUCTION. In the current practice of preclinical safety studies of pharmacologically active substances, standard neurotoxicity assessment procedures are mainly aimed at diagnosing higher nervous activity and behavioural disorders. However, it is the structures of the peripheral nervous system that are particularly susceptible to drug-induced neurotoxicity, which renders these structures an easy target and leads to a high incidence of neurotoxic side effects. These circumstances dictate the importance of refining methodological approaches to the assessment of toxic injury in the peripheral nervous system.AIM. The study aimed to analyse the current methodological level of clinical and functional tests for assessing the toxic effects of pharmacologically active substances on the structures of the peripheral nervous system, as well as to formulate practical recommendations for using these tests in preclinical studies in rodents.DISCUSSION. Rodents are considered the optimal test system for preclinical studies of pharmacologically active substances, but it is impossible to reproduce the entire neurological examination that is conducted to identify clinical equivalents of neurotoxicity in humans using these animals. This article presents a systematic approach to using available diagnostic tests to increase the translatability of data. The article briefly describes the neurological deficits due to adverse drug reactions in humans, as well as the main toxidromes that can also occur in animals. Based on a literature review and experience, the authors provide practical recommendations for performing basic tests to study the strength and tone of muscles, the state of physiological reflexes, the coordination of movements, and various types of sensitivities in rodents. The article provides a brief overview of the diagnostic utility of electrophysiological testing for identifying toxic damage to the peripheral nervous system. The following tests are recommended as a minimum list of primary screening techniques for detecting neurotoxic side effects in study animals: a resting posture assessment, the beam walking test, the horizontal bar test, the digit abduction score assay, the tail flick test, and the Preyer reflex test.CONCLUSIONS. The results of a comprehensive assessment of neurological deficits in rodent experiments should be analysed from a clinically relevant perspective— that is, with a focus on topical diagnosis and common pathological process components. It is advisable to verify the pathological process at the level of the peripheral nervous system using a set of electrophysiological techniques.

Surgical treatment of brain metastases: problems and nuances

Brain metastases are the most common type of intracranial tumor formation. Modern treatment of brain metastases is a complex problem and traditionally patients with central nervous system lesions have a poor prognosis. However, advances in systemic drug therapy, advances in radiation treatments, and a multidisciplinary approach that individualizes the differential approach to each patient have significantly improved survival rates in this group of patients. Surgical resection plays an important role in the treatment of brain metastases. In this article, we discuss the evolving role of surgery in the treatment of this diverse group of patients with brain metastases.

Daphnetin Ameliorates Neuropathic Pain via Regulation of Microglial Responses and Glycerophospholipid Metabolism in the Spinal Cord.

Neuropathic pain (NP) is a common type of chronic pain caused by a lesion or disease of the somatosensory nervous system. This condition imposes a considerable economic burden on society and patients. Daphnetin (DAP) is a natural product isolated from a Chinese medicinal herb with various pharmacological activities, such as anti-inflammatory and analgesic properties. However, the underlying mechanisms of these effects are not fully understood. In the present study, we aimed to investigate DAP's anti-inflammatory and analgesic effects and explore the underlying mechanisms of action. The NP model was established as chronic constrictive injury (CCI) of the sciatic nerve, and pain sensitivity was evaluated by measuring the mechanical withdrawal threshold (MWT) and thermal withdrawal threshold (TWT). The activation of microglia in the spinal dorsal horn was measured via immunofluorescence staining. Protein levels were measured using a western blot assay. Using a mass-spectrometry proteomics platform and an LC-MS/MS-based metabolomics platform, proteins and metabolites in spinal cord tissues were extracted and analyzed. DAP treatment ameliorated the MWT and TWT in CCI rats. The expression of IL-1β, IL-6, and TNF-α was inhibited by DAP treatment in the spinal cords of CCI rats. Moreover, the activation of microglia was suppressed after DAP treatment. The elevation in the levels of P2X4, IRF8, IRF5, BDNF, and p-P38/P38 in the spinal cord caused by CCI was inhibited by DAP. Proteomics and metabolomics results indicated that DAP ameliorated the imbalance of glycerophospholipid metabolism in the spinal cords of CCI rats. DAP can potentially ameliorate NP by regulating microglial responses and glycerophospholipid metabolism in the CCI model. This study provides a pharmacological justification for using DAP in the management of NP.

Research progress on monogenic inherited glomerular diseases with central nervous system symptoms

To date, approximately 500 monogenic inherited kidney diseases have been reported, with more than 50 genes associated with the pathogenesis of monogenic isolated or syndromic nephrotic syndrome. Most of these genes are expressed in podocytes of the glomerulus. Neurological symptoms are common extrarenal manifestations of syndromic nephrotic syndrome, and various studies have found connections between podocytes and neurons in terms of morphology and function. This review summarizes the genetic and clinical characteristics of monogenic inherited diseases with concomitant glomerular and central nervous system lesions, aiming to enhance clinicians' understanding of such diseases, recognize the importance of genetic diagnostic techniques for comorbidity screening, and reduce the rates of missed diagnosis and misdiagnosis.

ПАРАНЕОПЛАСТИЧЕСКИЙ НЕВРОЛОГИЧЕСКИЙ СИНДРОМ У РЕБЕНКА С НЕЙРОБЛАСТОМОЙ: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Paraneoplastic syndromes are of particular difficulties in establishing a timely diagnosis of a malignant tumor esp. in cases when the decease development is occurred chronologically much earlier than the appearance of its specific symptoms and the neoplasm growth’s first signs. And the clinical manifestation can be represented solely by an isolated clinic of paraneoplastic syndrome, which in its turn is much alike the symptoms of the paraneoplastic neurological syndrome (PNS). Authors represent a clinical case of a severe PNS coupled with the central nervous system (CNS) lesion, mainly the cerebellum, which was manifested clinically by ataxia, tremor, myoclonus, dysartria, cognitive and mental impairment and psychotic disorders, which in its turn had delayed the timely diagnosis of neuroblastoma (left-sided intermixed adrenal ganglioneuroblastoma with metastatic tumors in ipsilateral lymph nodes and paranephric fat, deletion 1q, deletion 1p36 and MYCN amplification - all negative and INSS stage 2B) in a 5 y/o male patient. No ‘classical’ opsoclonus-myoclonus was a matter of diagnosis due to the opsoclonus absence during the whole disease course. This clinical case observation publication is having a practical purpose of pinning attention to paraneoplastic syndromes among practitioners of wide spectrum: neurologists, infectionists and pediatricians.

Predominant localization and ways of metastatic dissemination to the brain of malignant tumors of the female reproductive system

Background. Metastases of the female reproductive system cancer to the brain are rare and reach about 5 % of all cases with metastatic lesions of the central nervous system. The most common metastases are ovarian cancer (0.49–6.1 %), endometrial cancer (0.4–1.2 %) and cervical cancer (0.3–0.9 %). The predominant localization and ways of spreading metastases to the brain in this category of tumors may differ from lung cancer, breast cancer, kidney cancer or melanoma.Aim. To analyze the localization of brain metastases of malignant tumors of the female reproductive system and the ways of dissemination of malignant cells from the primary focus to the central nervous system.Materials and methods. From 2013 to 2020, a total number of 448 patients with metastatic brain tumors from different cancers were operated on at the Department of Neuro‑Oncology of the Federal Center of Neurosurgery (Novosibirsk). Metastases of tumors of the female reproductive system were presented in 32 (7.1 %) cases. The average age was 55.1 (27–72) years. Ovarian cancer was the primary focus in 24 (5.3 %) cases, endometrial cancer – in 6 (1.3 %), cervical cancer – in 2 (0.4 %). Occipital lobe was the most often location for the metastases in the brain and occurred in 10 (31.3 %) patients. Subtentorial localization was on the second place and noted in 9 (28.1 %) cases. Of these, metastases to the cerebellum were registered in 8 cases and in 1 case the metastasis was located in the brain stem.Results. Gross total removal of metastasis was achieved in all 32 patients. Of 9 cases with subtentorial localization of metastasis, only 1 patient had lung metastases verified. Regression of neurological symptoms and improvement of the condition were noted in 16 patients after surgery. The Karnovsky performance score at the time of discharge was 85.2.Conclusion. The subtentorial location of metastases in malignant tumors of the female reproductive system occupies one of the leading places. This is because the dissemination of tumor cells from the pelvis can occur through a Batson vertebral venous system directly to the cerebellum or brain stem without the pulmonary blood circulation and lung dissemination. This should be taken into account for the early diagnosis of subtentorial metastatic brain tumors and referral of these patients for neurosurgical treatment.

Assessing muscle architecture with ultrasound: implications for spasticity.

Botulinum Neurotoxin Type A (BoNT-A) injections using Ultrasound (US) guidance have led to research evaluating changes in muscle architecture. Controversy remains as to what constitutes increased Echo-Intensity (EI) in spastic muscles and whether this may affect outcomes. We aim to provide a narrative review of US muscle architecture changes following Central Nervous System (CNS) lesions and explore their relationship to spasticity. Medline, CINAHL, and Embase databases were searched with keywords: ultrasonography, hypertonia, spasticity, fibrosis, and Heckmatt. Three physicians reviewed the results of the search to select relevant papers. Reviews identified in the search were used as a resource to identify additional studies. A total of 68 papers were included. Four themes were identified, including histopathological changes in spastic muscle, effects of BoNT-A on the muscle structure, available US modalities to assess the muscle, and utility of US assessment in clinical spasticity. Histopathological studies revealed atrophic and fibro-fatty changes after CNS lesions. Several papers described BoNT-A injections contributing to those modifications. These changes translated to increased EI. The exact significance of increased muscle EI remains unclear. The Modified Heckmatt Scale (MHS) is a validated tool for grading muscle EI in spasticity. The use of the US may be an important tool to assess muscle architecture changes in spasticity and improve spasticity management. Treatment algorithms may be developed based on the degree of EI. Further research is needed to determine the incidence and impact of these EI changes in spastic muscles.

Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A.

Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with central nervous system (CNS) lesions. Cases of cerebrovascular accidents (CVA), Parkinson's disease, dementia, and other intracranial lesions develop poor bladder control with or without urinary difficulty due to loss of cortical perception of bladder filling sensation and poor coordination of urethral sphincter relaxation during reflex micturition. Patients with CNS lesions usually have overactive bladder (OAB) symptoms, including urgency, frequency, incontinence, voiding symptoms of dysuria, large postvoid residual volume, and retention. In elderly patients with severe CNS disease the OAB symptoms are usually difficult to adequately relieve by medical treatment, and thus, their quality of life is greatly. Botulinum toxin A (BoNT-A) is currently licensed and has been applied in patients with idiopathic and neurogenic OAB due to spinal cord injury or multiple sclerosis. However, the application of BoNT-A in the treatment of urinary incontinence due to NLUTD in chronic CNS lesions has not been well-documented. Although cohort studies and case series support BoNT-A treatment for neurogenic OAB, chronic urine retention after intravesical BoNT-A injection for OAB and exacerbated urinary incontinence after urethral BoNT-A injection for voiding dysfunction have greatly limited its application among patients with NLUTD due to CNS lesions. This article reviews the pathophysiology and clinical characteristics of NLUTD in patients with CNS lesions and the clinical effects and adverse events of BoNT-A injection for patients with NLUTD. A flowchart was created to outline the patient selection and treatment strategy for neurogenic OAB.

Neurobrucellosis: laboratory features, clinical characteristics, antibiotic treatment, and clinical outcomes of 21 patients

BackgroundNeurobrucellosis (NB) is a rare and serious complication of brucellosis. Its clinical manifestations vary, with no obvious specificity. At present, there is no clear clinical diagnosis or treatment for reference. In this study, we retrospectively analyzed the clinical data for 21 patients with NB to provide reference data for its further study.MethodsWe analyzed the epidemiological and clinical manifestations, laboratory tests, imaging examinations, cerebrospinal fluid, and treatment plans of 21 patients diagnosed with NB in the Department of Neurology, Xuanwu Hospital, Capital Medical University Beijing, China.ResultsThe ages of the patients ranged from 15 to 60 years old (mean age 40.1 ± 13.33 years), the male: female ratio was 4.25:1. Thirteen patients had a history of animal (sheep, cattle) contact, three had no history of animal contact, and the contact status of four was unknown. Brucella can invade various systems of the body and show multi-system symptoms, the main general manifestations were fever (66.67%), fatigue (57.14%) and functional urination or defecation disturbance (42.86%). The main nervous system manifestations were limb weakness (52.38%) and hearing loss (47.62%).The main positive signs of the nervous system included positive pathological signs (71.43%), sensory abnormalities (52.38%), limb paralysis (42.86%). Nervous system lesions mainly included spinal cord damage (66.67%), cranial nerve involvement (61.90%), central demyelination (28.57%) and meningitis (28.57%). In patients with cranial nerve involvement, 69.23% of auditory nerve, 15.38% of optic nerve and 15.38% of oculomotor nerve were involved. The blood of eight patients was cultured for Brucella, and three (37.5%) cultures were positive and five (63.5%) negative. The cerebrospinal fluid (CSF) of eight patients was cultured for Brucella, and two (25.00%) cultures were positive and six (75.00%) negative. Nineteen of the patients underwent a serum agglutination test (SAT), 18 (94.74%) of whom were positive and one (5.26%) of whom were negative. A biochemical analysis of the CSF was performed in 21 patients, and the results were all abnormal. Nineteen patients underwent magnetic resonance imaging (MRI). Twenty-one patients were treated with doxycycline and/or rifampicin, combined with ceftriaxone, quinolone, aminoglycoside, or minocycline. After hospitalization, 15 patients improved (71.43%), two patients did not recover, and the status of four patients was unknown.ConclusionsThe clinical manifestations, CSF parameters, and neurological imaging data for patients with NB show no significant specificity or correlations. When patients with unexplained neurological symptoms accompanied by fever, fatigue, and other systemic manifestations in a brucellosis epidemic area or with a history of contact with cattle, sheep, animals, or raw food are encountered in clinical practice, the possibility of NB should be considered. Treatment is based on the principles of an early, combined, and long course of treatment, and the general prognosis is good.

Brucellar Granulomas as Focal Parenchymal Central Nervous System Lesions: A Case Series

Brucellar Granulomas as Focal Parenchymal Central Nervous System Lesions: A Case Series

A case of multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome presenting with central nervous system lesions and circulatory failure

A case of multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome presenting with central nervous system lesions and circulatory failure

Misperception of body verticality in neurological disorders: A systematic review and meta-analysis.

The internal representation of verticality could be disturbed when a lesion in the central nervous system (CNS) affects the centers where information from the vestibular, visual, and/or somatosensory systems, increasing the risk of falling. The aim was to evaluate the vestibular and somatosensory contribution to the verticality pattern in patients with stroke and other neurological disorders. A literature search was performed in PubMed, Scopus, Web of Science, and CINAHL databases. Cross-sectional, case-control, and cohort studies comparing body verticality in patients with stroke or CNS diseases (CNSD) versus healthy controls were selected. Subjective postural vertical (SPV) in roll and pitch planes was used as the primary variable. Ten studies reporting data from 390 subjects were included. The overall effect for CNSD patients showed a misperception of body verticality in roll (standardized mean difference [SMD]=1.05; 95% confidence interval [CI].84-1.25) and pitch planes (SMD=1.03; 95% CI.51-1.55). In subgroup analyses, a high effect was observed in the perception of SPV both in roll and pitch planes in stroke (p=.002) and other CNSD (p<.001). These findings suggest a potential misperception of SPV in patients with stroke and other neurological disturbances. Patients with CNSD could present an alteration of vestibular and somatosensory contribution to verticality construction, particularly stroke patients with pusher syndrome (PS), followed by those with PS combined with hemineglect.

A clinical case report of HIV-associated encephalopathy

Due to the fact that neurological and psychiatric symptoms are frequent manifestations of NeuroAIDS, a neurologist and a psychiatrist may be the first to meet with an HIV-infected patient in clinical practice. The article presents a clinical case of HIV-associated encephalopathy identified in a patient in a psychiatric hospital; the clinical picture and diagnosis of dementia caused by the human immunodeficiency virus are described. The case study method and MRI analysis were used. It has been concluded that there is a need for more careful monitoring of patients registered with AIDS centers, achieving 100 % HAART coverage of HIV patients at the early stages of the disease, which will significantly reduce residual neurological and psychiatric consequences, as well as mortality from HIV-associated lesions of the central nervous system.

Modern ideas about the state of neurofunctional activity of the brain under the professional influence of physical and chemical factors

The article provides an overview of modern scientific approaches to assessing the state of neurofunctional activity of the brain under the professional influence of physical and chemical factors is presented, carried out using bibliographic databases Scopus, MedLine, Web of Science, PubMed, The Cochrane Library, RSCI, Cyberleninka, Google Academy, Index Copernicus, SJR, Science Direct, Arxiv.Org. The work reflects the results of research by domestic and foreign scientists stating the fact of violations of neurobioelectric activity, cerebral hemodynamics, afferent conductive structures, cytokine and neuropsychological status in patients with vibration disease, sensorineural hearing loss, chronic mercury intoxication. There are prospects for using neuroenergic mapping with registration of the level of constant potential. The effects of biofeedback training (biofeedback method) on the reference reaction in order to stabilize and activate the neurofunctional activity of the brain in the treatment of neurological patients are reflected. The analysis of literary sources allowed us to substantiate the need to use artificial intelligence technologies to automate processes as a highly sensitive and specific method of detecting occupational pathology. The presented data indicate the relevance of the problem of studying disorders of neurofunctional activity, the relationship between the nervous and immune systems under the influence of vibration, noise, metallic mercury to improve the criteria for diagnosing lesions of the central nervous system.