Amyotrophic lateral sclerosis (ALS) is a continuously progressing neurodegenerative disease that is characterized by selective damage to motoneurons in the neocortex, brainstem, and spinal cord. The gen eral opinion is that sporadic ALS is a multifactor and multigene disease. Realization of its genetic predispo sition is determined by environmental factors. The blood-brain barrier (BBB) is the border for the neurons of the brain and spinal cord, where they interact with environmental factors. Current knowledge on BBB alterations during ALS helps to reevaluate views on the pathogenesis of the disease, as well as on the develop ment of therapeutic means and methods of their delivery. It has been found that in ALS all BBB components, which separate CNS neurons from endogenous and exogenous damaging factors and participate in the com munication between cells of nerve and immune systems, are involved in the pathological process. Currently, there are no data that show that BBB disruption triggers the death of neurons; however, it is an important mechanism of ALS pathogenesis. This should be considered during studies of this disease and development of new methods of treatment. Keeping in mind alterations of the BBB, it is possible to consider CNS cells, BBB cells, and peripheral immune cells as targets of new drugs for ALS treatment.
Neuromyelitis optica (Devic's disease) is a chronic autoimmune disease associated with the production of anti-bodies to aquaporin-4 (AQP4). Area postrema lesions is the third, after optic neuritis and myelitis, syndrome of opticomyelitis-related disorders. Clinical symptoms of this disorder include intractable nausea, vomiting and hiccups. In many cases, area postrema syndrome manifests as the first clinical symptom of a neuromyelitis optica spectrum disorder that hampers the diagnosis. The authors present a case report of a female patient with area postrema lesions developed several months before the first disabling attack of myelitis.
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