The paper discusses the issues associated with the definition of the concept «transient ischemic attack» (TIA) and with the prognosis of cerebrovascular disease after prior TIA. It is stated that following TIA, there is a high risk for ischemic stroke and a risk for evolving and progressive cognitive impairments. Approaches to organizing a therapeutic and diagnostic process in patients with TIA are covered.
The article, which is a review-lecture, reflects the historical milestones in the description and study of cerebral edema (CE) from ancient times to the present. Great attention is paid to the Monroe–Kellie doctrine, without which it is impossible to understand the mechanism of development of a vitally significant complication of CE – intracranial hypertension. The importance of the Monroe–Kellie doctrine in substantiating the symptomatic treatment of increased intracranial pressure is emphasized. The possible involvement of the glymphatic system in both the decrease and the increase in increased intracranial pressure is discussed. The modern ideas about the blood-brain barrier (BBB), its role in the development of CE and an increase in intracranial volume are analyzed. With the study of the molecular mechanisms of BBB damage and the development of targeted therapy, the researchers associate future advances in the treatment of CE. The great interest of modern authors in the state of the BBB in various diseases, as well as in the violation of its integrity in COVID-19 is reflected. It is noted that the main and only, today, method for diagnosing CE is neuroimaging. Development has begun on the isolation of potential biochemical markers of CE from blood.
This article presents a clinical review of a patient with an extremely rare assotiation of opticoneuromyelitis and skin melanoma. The paper noted the typical clinical and neuroimaging signs of opticoneuromyelitis and the rare manifestations of myelitic syndrome such as segmental muscle hypertonicity and hand hyperkinesis. The question remains open as to whether these two processes in a patient are linked by a single pathogenesis in the form of a paraneoplastic neurological syndrome or whether two independent diseases are represent there. Two observations of a combination of melanoma and opticoneuromyelitis as a manifestation of the paraneoplastic syndrome have been analysed in the literature. The article highlights the difficulties in the treatment of this patient, as the immunomodulatory therapy used for both diseases has a different vectorial focus. Immunosuppression is recommended for the treatment of opticoneuromyelitis, while immune activation is recommended for melanoma.
Цереброваскулярные заболевания представляют собой одну из важнейших проблем в клинической неврологии. Половина всех инсультов приходится на трудоспособный возраст, и лишь около 20% выживших больных могут вернуться к прежней работе [1, 2]. Не вызывает сомнения, что одной из основных причин возникновения ишемического инсульта (ИИ) является тромбоз церебральных артерий. Этот факт привлекает особое внимание к изучению генов, которые связаны с системой свертывания крови.
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