Introduction. In the structure of the total mortality of the population, cerebral stroke ranks second and leads among the causes of disability. Despite the huge number of patients with diabetes and stroke, the mechanisms underlying this predisposition remain poorly understood. Morphological changes of the brain in diabetes-induced neuroinflammation are practically not described anywhere.
Objective. To establish the patterns of pathomorphological changes of the brain associated with neuroinflammation in patients with type 2 diabetes mellitus who have suffered a stroke.
Materials and methods. On the sectional material, changes in the brain and arteries were studied in 27 stroke deaths (6 men and 21 women), aged 60 to 97 years, average age 75 ± 7.2 years, who had type 2 diabetes mellitus, the comparison group consisted of 32 stroke deaths (14 men, 18 women) with dyscirculatory encephalopathy without type 2 diabetes aged 42 to 100 years (average age 68.5 ± 14.2 years). Light-optical and electron microscopic examination of the brain, immunohistochemical reactions were performed: indirect immunoperoxidase reaction with gliofibrillary protein, vimentin and macrophage immunophenotyping markers – CD-68, CD-163, CD-21, CD-23, CD-11c, HAM.
Results. It has been established that neuroinflammation is characterized by macrophage-microglial activation, penetration of antigen-presenting cells through the damaged blood-brain barrier, damage to neuronal and glial cell pools. Pronounced macrophage infiltration was revealed using immunohistochemical methods of investigation with CD-68. Monocytic macrophages and antigen-presenting cells are located perivascularly, migrating through the damaged blood-brain barrier and expressing the CD-11c receptor. There is a phenomenon of changing the phenotype of macrophages from M2-type, with sanogenetic activity, to M1-type, responsible for inflammatory damage.
Conclusions. Pronounced infiltration of brain tissue in stroke patients with type 2 diabetes mellitus by both resident macrophages and monocytic macrophages is associated with progressive neuroinflammation.

Introduction. Cerebrovascular diseases are often associated with the development of epileptic seizures. It was suggested that in the implementation of epileptogenesis in patients with ischemic brain damage, a hemodynamic factor, namely the state of the perfusion reserve, may be important.
Objective. The examination of the state of cerebrovascular reactivity of different cerebral vascular basins in patients with the development of epileptic seizures affected by cerebral ischemia.
Materials and methods. 772 patients with acute and chronic cerebral ischemia (265 stroke patients with epileptic seizures and 174 patients with seizures on the background of chronic cerebral ischemia and 203 patients with stroke and 130 patients with chronic cerebral ischemia without seizures) was comprehensively examined.
Results. In patients with cerebral ischemia, focal seizures prevail. Cortical localization of ischemic foci prevailed in patients with both acute and chronic cerebral ischemia. Stenosis of the main arteries were more often detected as in patients with ischemic stroke with the development of epileptic seizures – 218 (82.3%) compared with patients with stroke in the comparison group – 151 (74.4%) patients, р < 0.05), and in patients with CBI (chronic brain ischemia) with the development of epileptic seizures – 121 (69.5%) people, p < 0.05) compared with patients in the comparison group – 74 (56.9%) patients. The prevalence of stenosis
of the main cerebral arteries was revealed in more than 70% in patients with pre-stroke epileptic seizures – 77 (33.5%) compared with patients without precursor seizures, who have been diagnosed with stenosis of more than 70% were found in only 4 (11.5%) patients (χ2 = 10.1; p = 0.03). In the comparison group of patients, there was no significant difference in CVR (cerebrovascular reactivity) changes in the carotid system and in the VBS (vertebrobasilar system) – 30 (36.6%) and 42 (47.7%) examined, respectively.
Conclusion. The revealed decrease in cerebrovascular reactivity in the vertebrobasilar basin can be considered as one of the risk factors for the development of epilepsy in conditions of brain ischemia.

Introduction. The COVD-19 pandemic caused by the SARS-CoV-2 continues from March 2020. The virus primarily affects the respiratory system. Moreover, there is new data about the various organ damage caused by COVID-19 such as heart, skin, kidney and central nervous system. That’s why it is necessary to investigate the neurological features of the COVID-19.
The aim of the study. To investigate the effect of COVID-19 on the cognitive functions of hospitalized patients.
Materials and methods. the PCR-positive patients hospitalized at the University Clinical Hospital No. 3 had been included in the study since March 2020 for May 2021. Thorax CT scan, physical and neurological examination, the biochemical blood test was provided for all patients. The neuropsychological examination was made by: MoCA, TMTA, TMTB, and emotional condition was tested by HADS.
Results. 33 patients (21 (64.6%) women) were included; the median age was 73.0 [67.0; 76.0]. The average MoCA value was 22.64 points, median: 24.00 points [20.00; 25.00], median TMTA execution speed: 68 seconds [49.00; 84.00], TMTB: 194 seconds [153; 245.75]. HADS (depression) median: 7.0 [5.00; 9.00], for HADS (anxiety) median: 8.0 [4.00; 10.00]. A link between the olfactory disorders and low MoCA results (p = 0.015) was found according to the regression analysis. Moreover, the patient’s age, lung damage degree had a negative impact on the duration of TMTB (p = 0.001 and p = 0.049). The propensity score matching was made to confirm that the olfactory disturbances, regardless of other factors, are associated with a lower MoCA result (p = 0.012).
Conclusion. The potential mechanisms, modality, defect duration and pharmacological response of cognitive disorders have a great interest. That’s why it is necessary to conduct clinical and experimental studies on patients, pathomorphological material and animal models.

Cardiovascular risk factors for the development of cognitive impairment and Alzheimer’s disease are ranked among the most significant ones, especially in elderly patients. The review provides data on the influence of such factors as arterial hypertension, arterial hypotension, heart failure, coronary heart disease, etc. on the development of cognitive deficiency. The presence of two or more of these risk factors generally tends to increase the possibility of the development of Alzheimer’s disease. The author examines the relationship between these factors and the development of Alzheimer’s disease. Insights into how CVD risk factors can cause progressive cognitive impairment provides further insight into the pathophysiology of Alzheimer’s disease and the identification of methods to prevent or treat CV risk factors for cognitive decline. The course and outcome of cardiovascular diseases depend on the patient’s age, previous medical history, lifestyle, primary prevention, genetic and pathological factors that affect structural and hemodynamic functions. The article addresses issues of therapy of these disorders. Methods of non-pharmacological therapy are discussed: the importance of the patient’s lifestyle, physical activity, nutritional issues, social activity of patients. Much attention is paid to the role of cognitive training in the management of patients with cognitive impairments. The correction of risk factors for stroke and the progression of chronic circulatory disorders is one of the most elaborated areas. The therapeutic potential drugs with a multifactorial mechanism of action are discussed. One of them is Ginkgo biloba extract EGb 761®, which meets the regulated content of active ingredients (flavone glycosides, terpene lactones and ginkgolic acid) and, perhaps, promises to be a more rational choice in the treatment of cognitive impairment. The role of Ginkgo biloba extract EGb 761® in the treatment of cardiovascular diseases is discussed.

Introduction. Non-drug methods of therapy for cognitive impairment is one of the topical areas of neurology. Studies have shown that cognitive training may be beneficial for maintaining mental alertness in healthy older adults, while patients with dementia and mild cognitive impairment are more likely to benefit from cognitive-motor training or rehabilitation. It is possible that the severity and type of cognitive disorders, as well as patients’ adherence to training, the correct construction of tasks, may affect the effectiveness of non-drug therapy for cognitive disorders.
Аim. The aim of this study was to evaluate the effectiveness of cognitive-motor training developed at Sechenov University in patients with moderate cognitive impairment (MCI).
Materials and methods. 41 patients were included in the study, including 8 women and 33 men, the average age of patients was 60.3 ± 8.5 years, the average level of education was 14.2 ± 8.7 years, of which 15 patients met the criteria AD, 26 – VCI criteria. Patients underwent quantitative neuropsychological testing, assessment of emotional disorders, and also assessed such indicators as satisfaction with the quality of life, adherence to therapy. Subsequently, the patients were divided into groups of individual and group cognitive training. Classes with patients were held according to the standard scheme, 30–50 minutes a day, for 40 days. After 3 months, 10 patients were randomly selected from the individual training group and received an additional course of group cognitive-motor training.
Results. Тhe study showed that after 1.5 months, patients showed a significant decrease in the severity of cognitive disorders (p < 0.05). The greatest positive dynamics was noted in relation to the level of attention (p < 0.05), memory (including primary modal-nonspecific mnestic impairment, p < 0.05), logical operations (p < 0.05). The patients included in the study also showed a significant decrease in the severity of depression (p < 0.05). The analysis showed that significant positive dynamics was recorded both in patients of the individual CT group and in patients who received group CT (p < 0.05). The positive effect on cognitive functions was maintained during the three months of follow-up. Comparative analysis of study patients after 6 months showed that patients who received additional sessions with a trainer reported an additional improvement in well-being. These differences were statistically significant, despite the small number of patients included in the repeat CT group (p < 0.05).
Conclusions. The effectiveness of cognitive-motor training in patients with MCI was noted. The results obtained allow us to recommend this type of cognitive-motor training for use in clinical practice by neurologists, therapists and psychiatrists as an additional effective method for the treatment of cognitive impairment.

Neck pain is widespread in the population and reaches 60%. Women in the age group under 60 are more likely to be affected than men. Acute pain is typical for young people, chronic – for patients of the older age group. Neck pain can be nonspecific, neural or mixed, depending on the involvement of various anatomical structures in the pathological process.
Nonspecific (nociceptive, musculoskeletal) pain accounts for about 80–90% of all cases. The clinical picture may also include limited range of motion in the cervical spine (CS), changes in muscle tone in the region. With damage to the cervical spinal roots, neural symptoms join, which is observed in 11.9–43% of cases.
The key to making the correct diagnosis is a deep study of complaints, anamnesis, and a thorough physical examination. Paraclinical research methods play a secondary role in the diagnosis, they are prescribed only if their results can affect the formulation of the diagnosis and further treatment. The need for differential diagnosis between nonspecific and neuropathic pain arises in the presence of complaints and clinical manifestations characteristic of both options. Standard schemes of drug therapy for nonspecific and neuropathic pain have certain differences, while they do not depend on the localization of the process and the involvement of certain structures in the process. In both cases, the main therapeutic tasks are to provide effective pain relief and influence on the inflammatory process. With these tasks, NSAIDs are most fully coping. The original diclofenac has a pronounced analgesic and anti-inflammatory effect with a high safety profile, which, together with a variety of dosage forms, makes it attractive for the treatment of various types of neck pain. An additional local effect on pathologically altered structures by the topical diclofenac forms significantly increases the effectiveness of the treatment. In the above clinical cases, two variants of neck pain are considered, which have similar symptoms, while being different forms of pathology.

Introduction. Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. Among the possible pathophysiological concepts, the largest evidence to date has been collected on the relationship of BPPV with a lack of vitamin D. Few studies have also been published on the assessment of factors of endothelial dysfunction (and, as a result, disturbances in the microcirculation of the inner ear) and BPPV. The problems of metabolic disorders in BPPV were still poorly highlighted in Russian sources.
Objective. To investigate the levels of 25-OH-vitamin D and homocysteine among patients with BPPV and compare these factors depending on recurrence.
Materials and methods. The study included 53 patients with BPPV, age 60 ± 12.6 (Me 62 [55; 68]), men accounted for 24.5%, women – 75.5%. All patients underwent a study of the neurological status and neurovestibularexamination, which included the Halmagi test, the head shake test, the Fukuda test, the Dix – Hallpike and McClure – Pagnini tests. Plasma 25-OH-vitamin D and homocysteine levels were assessed using enzyme-linked immunosorbent assay. The severity of vertigo was assessed using the dizziness handicap inventory (DHI).
Results. The level of 25-OH vitamin D in with BPPV varied from 5.2 to 40 ng/ml, the average value was 19.53 ± 9.07 ng/ml, which corresponds to the deficit according to international recommendations (Me 17 [13; 24.8]). The level of 25-OH vitamin D in the group with recurrent BPPV was (Me 15 [12 and 22]), which was significantly lower than in the group with a single BPPV episode. The DHI score was significantly lower in the group with recurrent BPPV. There was a negative relationship between 25-OH-vitamin D levels and age, and a negative relationship between 25-OH-vitamin D and homocysteine in the DPPV group.
Conclusion. There was a decrease in the level of 25-OH-vitamin D among patients with BPPV; in the group with recurrent BPPV, the level of 25-OH-vitamin D was significantly lower than in the group with a single dose of BPPV. The presence of an inverse correlation between the level of homocysteine and 25-OH-vitamin D indicates the advisability of more detailed studies of the potential contribution of endothelial dysfunction to the development of peripheral vestibular disorders due to impaired microcirculation of the otoconial apparatus.

There are both scientific interest and practical value to study the medical consequences of the Coronavirus disease 2019 (COVID-19) due to its pandemic status and high prevalence of different complaints among COVID-19 survivors. These complaints are called “post-COVID” or “long COVID” syndrome. One of the frequent symptoms of post-COVID syndrome is sleep disturbances, predominantly insomnia. The article provides epidemiological data, pathogenesis, socioeconomic factors, and therapeutic approach to insomnia associated with post-COVID syndrome.
The increase of sleep disturbances prevalence in pandemic conditions has a comprehensive nature. It includes the disease consequences itself and change of lifestyle due to lockdown. The lifestyle change leads to physical activity decrease and inadequate sleep hygiene. Besides, the high stress level is also the reason for sleep disturbances. The direct effects of COVID-19 on the central nervous system are understudied at the moment. Nevertheless, there are reasons to suggest neurotropic characteristics of SARS-CoV-2 to underlie post-COVID neurological and psychiatric disturbances.
Taking into account that general practitioners are mainly addressed post-COVID complaints, the recommended hypnotics should be safe, easily prescribed, and highly effective. The probable presence of the psychiatric pathology should be also assessed because the sleep complaints might be its manifestation.

Introduction. Asthenia, vegetative manifestations, sleep disturbances and psycho-emotional background are companions of the coronavirus infection, the issue of drug correction of which is especially relevant. These symptoms disrupt the habitual way of life of patients for a long time, and in special cases lead to disability.
Aim. To study the mental, somatoform and cognitive aspects of anxiety disorders after coronavirus infection during treatment with tofisopam (Grandaxin®) 150 mg/day.
Materials and methods. The study included patients who had experienced a new coronavirus infection, who, after the end of treatment for the underlying disease, had complaints suggesting the presence of an anxiety disorder. The Hamilton scale was used to assess the level of anxiety. Examination of patients was carried out before the start of treatment, after 2, 4 and 6 weeks of therapy.
Results and discussion. Prior to the start of therapy, all patients had an overall high level of anxiety: the average HAM-A score was 31.4 ± 2.92 points. At the end of Grandaxin® therapy, all patients showed a decrease in the level of anxiety: the average HAM-A score was 12.08 ± 2.27 points (p < 0.001). The maximum decrease in the severity of vegetative disorders was noted by the end of the 6th week of therapy with Grandaxin®. Thus, the indicator of this subscale decreased by more than 2 times – from 2.46 ± 0.54 to 1.05 ± 0.28 points (p < 0.001). The severity of insomnia during six weeks of therapy with Grandaxin® decreased from 2.56 ± 0.54 to 0.96 ± 0.45 points (p < 0.001).
Conclusion. Psycho-emotional disorders (more often in the form of increased personal anxiety), sleep disorders, vegetative disorders, asthenic syndrome significantly affect the quality of life of patients who have had a new coronavirus infection. Involvement of the structures of the autonomic nervous system and central structures that regulate GABAergic transmission leads to significant vegetative failures, which requires pathogenetically substantiated drug correction of these disorders.

Dopamine receptor agonists (DRA) are a class of therapeutic drugs able to directly stimulate dopaminergic receptors facilitating a stronger effect of the endogenous dopamine, which is widely used in treatment of diseases that are accompanied with dopaminergic neurotransmission deficiency. A classical hypodopaminergic condition is Parkinson’s disease and DRA are traditionally associated with it. However, even the first DRA, Bromocriptine, widely adopted in PD treatment, was initially registered as a medication for treatment of prolactinaemia and associated pituitary adenomas and is still widely used in gynecology and endocrinology. In several countries DRA are used in treatment of diabetes, eating disorders, and addictions. Dopamine is the cardinal neurotransmitter of the emotional control and the main neurotransmitter of the reward system, and that defines the interest for researching the dopaminergic agents in treatment of primarily mental illnesses, as well as correction of secondary affective disorders. The experimental effectiveness of ADR in slowing down the rate of progression of the neurodegenerative process in severe incurable diseases, as well as potential neuroprotection in cerebrovascular insufficiency, will allow in the future to determine the criteria for the use of ADR in these non-standard situations, which may even lead to a change in clinical recommendations for the treatment of individual nosologies. Presented in this article are both traditional uses of DRA and an overview of non-standard applications of this class of medications with a discussion of recent studies. In the future, the likelihood of a rethinking of ADRs as a class of only antiparkinsonian drugs, with the expansion of their therapeutic indications.

Diabetic polyneuropathy (DPN) is the most common neurological complication of diabetes mellitus. The most common type of DPN is distal symmetric, predominantly sensory, polyneuropathy. Chronic hyperglycemia plays a key role in DPN pathogenesis. It leads to accumulation of advanced glycation end products in tissues, including vasa nevrorum that supply peripheral nerves with oxygen. Thorough diagnostic approach to DPN is crucial for early detection of this condition. Early diagnosis and treatment slow DPN progression rates and leads to symptom reduction. Long-lasting metformin therapy may cause vitamin B deficiency. This article describes a comprehensive approach to the treatment of patient with type 2 diabetes and symptomatic diabetic and vitamin deficiency neuropathy. Apart from DM therapy, the patient received pathogenesis-based therapy of DPN with alpha-lipoic acid and a combination of vitamins B1, B6 and B12. Such pathogenesis-based approach has shown to decrease severity of DPN symptoms and reduce sensory ataxia.

The article deals with local injection therapy (LIT) in arthrological practice, the purpose of which is the introduction of a drug into the joint cavity or periarticularly, removal of excess synovial fluid from the joint cavity with subsequent analysis of its composition for differential diagnosis and decision-making on treatment tactics. The most commonly used in LIT are glucocorticoids, hyaluronic acid (GlK), autologous platelet-rich plasma. The method of introducing GLA into the joint cavity is considered by experts as a promising method for the treatment of osteoarthritis, the most common chronic joint disease. GlK-based preparations differ in concentration, molecular weight and production method. The article presents the results of studies using high- or low-molecular drugs GlK in the treatment of patients with osteoarthritis of the knee, hip and small joints. Attention is drawn to the fact that LIT with GlK preparations is used in the treatment of other diseases of the musculoskeletal system. Data are presented, including those of Russian authors, on the effectiveness of GlK in OA of the shoulder joints, in the syndrome of compression of the shoulder rotators. Thus, the restoration of range of motion and a significant reduction in pain in the shoulder area was achieved against the background of the use of 3 to 5 injections of the GlK preparation produced in the Russian Federation by bacterial fermentation. The unique production technology of the GlK preparation makes it possible to reduce the risk of bacterial endotoxins, completely purify the solution from hyaluronidase, increase homogeneity, and preserve the molecular weight. On the basis of the obtained evidence of efficacy and safety, HLA preparations are included by various medical associations and professional communities in Russian and international clinical guidelines for the treatment of OA.

Introduction. In modern reality postcovid syndrome (PCS) is characterized by clinical heterogeneity and multi-organ involvement, often presenting a differential diagnostic and therapeutic problem. However, in most studies of PCS, stratification of patients taking into account individual comorbid conditions was not performed. Thus, only an extremely small number of studies have been devoted to assessing the course of PCS in rheumatic diseases
Purpose. To characterize the features of the course of COVID-19 in patients with rheumatoid arthritis, as well as to conduct a comparative assessment of clinical and demographic parameters in groups of patients with rheumatoid arthritis, differentiated by the presence of PCS.
Materials and methods. The material of the questionnaire which contained questions regarding socio-demographic data of respondents, information on rheumatological history, comorbid diseases, data on past COVID-19, including cases of re-infection, and PCS.
Results.The study included 32 adult patients (29 women, 90%) with a reliable diagnosis of rheumatoid arthritis. Of the 32 patients who underwent COVID-19, in 23 cases it was possible to form a judgment about the presence or absence of PCS. To study PCS, 23 patients were stratified into two groups: 11 (47.8%) patients developed PCS (Group 1) and 12 patients had COVID-19 without consequences (Group 2). Both groups were represented predominantly by women (90.9% and 91.7%, respectively). In the general group 37.5% of patients with COVID-19 required inpatient treatment. The number of symptoms associated with COVID-19 did not correlate with RA activity, however, patients with higher RA activity were more likely to report increased arthralgia as a symptom of COVID-19. 47.8% of COVID-19 survivors experienced PCS. The average age, the number of comorbid diseases and the severity of RA symptoms at the time of COVID-19 were relatively higher in the group of patients with RA and PKS. Patients with PKS also noted a higher frequency of hospitalizations and a more severe course of COVID-19.
Conclusions. A quantitative assessment of the risk of developing PKS is needed, which will serve as a basis for developing a strategy aimed at prevention, timely diagnosis and treatment of this syndrome in patients with RS. To this end, further studies on larger cohorts of patients are required.

The limitation of the range of motion of the upper limb in combination with chronic pain syndrome and a decrease in the muscle strength of the arms leads to a significant deterioration in the quality of life of patients, often negatively affects their psychoemotional status, and reduces the ability to work. Arthrosis of the shoulder joint and pathology of the periarticular tissues of the shoulder affect up to 21% of the adult population and up to 33% of people over 60 years of age. Disagreements in the etiology, pathogenesis, terminology, approaches to the diagnosis and treatment of pain syndromes in the shoulder joint area do not contribute to the development of a unified concept of therapy for this pathology. The article provides a review of the literature on the epidemiology and pharmacotherapy of osteoarthritis and soft tissue pathology of the shoulder joint with an analysis of two clinical cases. The peculiarity of the first clinical case is the rapid achievement of therapeutic goals for third grade shoulder osteoarthrosis in an elderly patient with high comorbidity. This allows us to draw conclusions about the predominant role of periarticular tissues inflammation in the generation of severe pain syndrome. The second clinical case presents the dynamics of the development of calcifying tendinitis of the right, later of the left shoulder joint in a woman of working age. The use of a bioactive concentrate of small sea fish (BCSSF) (Alflutop®, Biotechnos) made it possible to quickly reduce the severity of the pain syndrome and return to the usual way of life in the first patient, which made it possible to shorten the use of non-steroidal anti-inflammatory drugs. In the second clinical example, BCSSF promoted the stimulation of regenerative processes in the periarticular tissues of the shoulder joint, the restoration of the function of the dominant limb and the ability to work. Thus, BCSSF may be the drug of choice for patients with osteoarthritis of the shoulder joints with a high risk of cardiovascular and gastrointestinal complications, as well as the drug of choice for a faster recovery of function in case of damage to the periarticular apparatus.

Stress is one of the most significant and widespread medical and social problems in the world and it is the etiological factor in 80% of diseases. In the modern world any person is subject to the influence of stress, regardless of the age and gender differences, culture and social status. Stress is a non-specific reaction of the body to the extreme impact of various factors - stressors. As stressors can be: emotional, social, physical, informational and other factors. In functional and morphological terms, stress is manifests itself as a general adaptation syndrome which mobilizes the body’s resources in order to maintain homeostasis. Stress is characterized by staging. The early period of stress is manifested by transient anxiety, with a decrease in body resistance – it is the first stage of the adaptation syndrome. The second stage of stress is characterized by the functional tension of the body’s systems and adaptation to new conditions. In the case of prolonged stress, the body’s reaction becomes pathological, with the depletion of adaptive reserves and the failure of protective mechanisms. At this stage is increase a vulnerability to any stressors. There is a further violation of the consistency of vital functions, and persistent anxiety is formed. In overwhelming majority of cases, stress-induced anxiety is develop of psychovegetative syndrome. In the case when combined the strategies of coping (it is the second stage of the reaction to stress - the stage of resistance) with stress and if it is interrupted at an early stage, in such a way the somatic symptoms are also interrupted at the stage of autonomic dystonia syndrome. When the persistent stress is, we have a development of the third stage – exhaustion. And against the background of limited adaptive reactions, there is a psychosomatic pathology. The above determines the need for early detection of psychovegetative syndrome and its timely treatment. The optimal choice is the appointment of combined drugs for stress, which have anti-anxiety, sedative and hypnotic effects. The combination of phenobarbital and ethylbromisovalerinate is one of the highly effective and widely used for the relief of stressinduced anxiety and manifestations of autonomic dysfunction, reducing the risk of developing psychosomatic pathology.

Introduction. In the Russian Federation, neuroprotective agents are widely used in the treatment of patients with ischemic stroke. There are accumulated data on the efficacy and safety of the neuroprotective agent Cellex® in ischemic stroke. The use of this drug in hemorrhagic stroke has been studied to a lesser extent.
Aim. To study the efficacy and safety of Cellex® in non-traumatic intracerebral hemorrhage.
Materials and methods. The study included 60 patients with hypertensive intracerebral hemorrhage aged 30 to 80 years. Thirty patients (the main group) received Cellex 0.1 mg (1 ml) once a day for 10 days in addition to basic therapy; the remaining 30 patients (control group) received only basic therapy. Over the course of 30 days, the patients were evaluated for various parameters on the Glasgow Coma Scale, stroke severity on the NIHSS scale, patient disability on the Modified Rankin Scale, Barthel Index and Rivermead Mobility Index, speech disorders on the Speech Questionnaire, cognitive function on the Montreal Cognitive Scale (MoCA), and other parameters.
Results and discussion. The survival rate was higher in the treatment group than in the control group (p = 0.0237). Speech function improved from 17.0 (14.0–22.0) to 25.0 (21.0–27.0) scores (p = 0.0073) in the Cellex group, no significant improvement in speech function was noted in the control group. There was a trend toward a more significant reduction in stroke severity according to the NIHSS scale and inpatient disability according to the Rankin, Barthel, and Rivermead scales in the Cellex group compared with the control group. Cognitive function on MoCA score improved in Cellex® group from 14.0 (12.0; 22.5) to 20.0 (14.5; 25.0). No adverse events were observed in the group of patients taking Cellex.
Conclusion. The efficacy and safety of Cellex® in patients with hypertensive intracerebral hemorrhage has been proven.

Neuropathic pain (NP) is not uncommon in clinical practice. NP can occur when various neural structures are damaged, such as peripheral nerves, spinal roots, spinal cord, and brain structures. Depending on the level of damage, NP is divided into central and peripheral. At the same time, peripheral NP is more common. When diagnosing NP, the results of a physical examination of the patient are the most valuable. In order to study the state of the peripheral neuromotor apparatus, patients undergo stimulation electromyography with an analysis of the conduction along motor fibers and sensory fibers caused by the skin sympathetic potential, and EMG using needle electrodes is often used to verify the level and stage of the pathological process. Difficulties in making a diagnosis arise when a patient has a combination of several types of neuropathic pain and comorbid pathology. For the treatment of NP, antidepressants, anticonvulsants, opioid analgesics, drugs for local anesthesia, botulinum toxin type A are used. Alpha-lipoic (thioctic) acid preparations are used in the treatment of diabetic polyneuropathy. The presence of several nosologies in a patient, each of which has individual manifestations of NP, determines the tactics of treating a particular patient, which is considered on the example of two clinical cases.