Systemic rheumatological diseases are often accompanied by the development of central and peripheral nervous system pathology. Data providing evidence of the high incidence of peripheral nervous system lesions in systemic lupus erythematosus and systemic scleroderma are presented. These diseases in particular are characterized by polyneuropathies and tunnel syndromes. Our own observations, along with published data, revealed the following major pathogenetic mechanisms of peripheral nervous system lesions in diffuse connective tissue diseases - ischemic, immunological, and metabolic. Consideration of these mechanisms will lead to pathogenetically based treatment and improved therapeutic outcomes.
The new COVID-19 coronavirus infection caused by SARS-CoV-2 is a global health threat. Neurological disorders detected in patients with coronavirus infection have a wide range of clinical signs: headache, dizziness, altered level of consciousness, acute ischemic stroke, intracerebral hemorrhage, cerebral venous sinus thrombosis. Evidence suggests that patients with more severe systemic symptoms were more likely to experience neurological symptoms. The main risk factors for the development of ischemic stroke in patients with coronavirus infection are considered. It was shown that COVID-19 more often occurred in people with vascular risk factors, among which the mortality rate was higher. Various possible and not mutually exclusive mechanisms which may play a role in the development of ischemic stroke in patients with COVID-19 are described in detail, including hyper-inflammatory state («cytokine storm»), «COVID-19-associated coagulopathy», and disseminated intravascular coagulation syndrome. Stroke risk factors associated with the critical condition in these patients are presented. Stroke, the leading cause of death and disability worldwide, requires immediate treatment and decision-making as well as 24/7 availability for specialized vascular centers. The results of observation of patients with acute cerebral circulation disorder in specialized vascular centers 2 months before and 15 days after quarantine due to COVID-19 are presented. The tactics of managing patients with ischemic stroke under conditions of coronavirus infection is considered.
Cognitive impairments in epilepsy are a current problem in neurology. The basis of the idea on the pathogenesis of higher nervous system dysfunctions is the interaction of a few factors that include the form and duration of the disease, gender differences, and the impact of antiepileptic therapy. The role of interattack epileptiform changes in the development of cognitive deficit in adults and epileptic encephalopathies in children is discussed. Up-to-date neurophysiological and neuroimaging diagnostic methods allow the detection of new features in the courseand progression of higher nervous system dysfunctions in epilepsy.
В статье представлены данные о частоте, патогенетических механизмах развития цереброваскулярных заболеваний (ЦВЗ) при различных распространенных соматических болезнях, таких как артериальная гипертензия, атеросклеротическое поражение магистральных артерий головы, сахарный диабет. Рассмотрены данные о возникновении цереброваскулярной патологии при более редких заболеваниях: наследственных болезнях, гипергомоцистеинемии, мигрени. Отмечено, что имеющиеся в настоящее время данные свидетельствуют о гетерогенности патогенетических механизмов ЦВЗ, существовании разнообразных вариантов ишемического поражения вещества головного мозга и их клинических проявлений. Поэтому терапевтические стратегии при ЦВЗ должны учитывать не только клинические особенности, но и механизмы развития заболевания. Освещены основные направления терапии. Обсуждаются вопросы применения препарата вазобрал при ЦВЗ.
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