Introduction. Hypertension (HT) is a significant and independent risk factor for the development of cerebrovascular disease, which is a leading cause of death and disability and is one of the most common cardiovascular diseases in most countries of the world. In Ukraine, the percentage of patients with arterial hypertension is between 30 and 41%, which is more than 12 million patients. the aim of our research-to improve the diagnostic approaches of cerebrovascular disorders in patients with hypertensive encephalopathy (HE) by clarifying the development of pathogenetic mechanisms, based on a comprehensive clinical and paraclinical study. Materials and methods. Clinical and neurological examination; neuropsychological examination; instrumental examination (chronobiotic structure of blood pressure (ВР) according to daily blood pressure monitoring; heart rate variability (HRV); single photon emission computed tomography (SPECT); laboratory testing (determining homocysteine levels). results. The normal level of homocysteine (GC) has been registered among 64.7% of patients with HE, moderate increase of GC has been noticed in 5.9% of cases, and a significant degree of increasment-only among 2.9% of patients. The spectral analysis of HRV has shown a decrease in the values of indicators of the overall variability of the heart rate, accompanied by a weakening of the parasympathetic and increased sympathetic effects on the cardiovascular system. conclusions. It has been established that vascular lesions of the retina, signs of left ventricular hypertrophy and hypercholesterolemia were more commonly observed among patients with HE II stage than among patients HE stage I. According to the results of daily blood pressure monitoring, changes in the parameters among patients with HE І stage, were characterized by an increase in pulse pressure (especially at night) in conjunction with an increase in the rate of morning blood pressure. High pulse pressure is accompanied by a decreasement of brain perfusion (according to the SPECT) and this is an independent risk factor for the development of HE.

The study of clinical and anamnestic and paraclinical characteristics, highlighting their dominant features in patients with DP and existing thyroid diseases occupies an important place in modern neuroendocrinology and requires more focused attention of clinicians. The objective: to determine the leading clinical and laboratory-instrumental parameters in patients with DP and thyroid pathology, to analyze the mutual influence of neuroendocrine pathology on the patient’s somatoneurological condition. Materials and methods. Was done a clinical examination of 64 patients with DP , in 27 (42 %) of them was diagnosed the comorbid thyroid pathology, in 37 (58 %) it was absent. All patients were divided into two groups: with DP in the background of type I, II DM and thyroid pathology (A) and with DP in the background of type I, II DM without thyroid pathology (B). During the examination of patients were used clinical-anamnestic, clinical-neurological, laboratory-instrumental, neurophysiological methods of examination. Pain characteristics were assessed using the McGill Pain Questionnaire (MPQ). Statistic calculation was done in MS Excel 2003 and using the package for statistical analysis STATISTICA 10. Results. In patients of both groups comorbidly were dominated diseases of the cardiovascular system, in group A, increasingly was revealed gastrointestinal pathology. Polyneuritic disorders of sensitivity and autonomic-trophic disorders are more common in persons of group B, they have a higher frequency of comorbid pathology and longer duration of DM. In group A lack of Achilles and knee reflexes was recorded more often than in comparison group. In 18 (65 %) of the examined persons of group A was detected a fatty liver dystrophy by ultrasound scanning of the abdominal organs, which exceeds the number in group B – 13 (35 %). There is an inverse average dependence between the level of TSH and BMI (correlation coefficient = –0,65). The general index of pain rating (Pain Rating Index – PRI) in group A is higher (30,62±2,64 scores). Conclusions. Among the thyroid diseases in the examined patients of group A hypothyroidism was most often detected, so 30 % of patients had a pronounced violation of lipid metabolism in the form of obesity, besides, in this group the number of people with type II DM was prevailed. The influence of thyroid pathology on the manifestations of DP is reflected in the intensification of neuropathic pain syndrome. There is also a significant effect on the metabolism of fats and carbohydrates, which aggravate and sometimes deepen the somatic condition of the patient.

Diabetic polyneuropathy (DP) and angiopathy are interdependent processes, as disturbances in the microcirculatory system of peripheral nerves lead to increased axonal damage and is a kind of predictor of polyneuropathy progressing [6]. 80% of deaths from diabetes mellitus (DM) are associated with cardiovascular catastrophes, including coronary heart disease (CHD), stroke and peripheral artery disease [3]. The objective: to analyze the most common cardiovascular pathology (CVP) and show its impact on the course of DP in type I and II DM. Materials and methods. Was clinically examined 101 patient with DP. The examined patients were divided into groups: with DP on the background of type 1 DM (group I) (n=54) and with DP on the background of type II DM (group II) (n=47), and also were divided into subgroups: DP on the background of type I and II DM and existing CVP (including diabetic angiopathy) 82 (82%) (subgroup А) and with the DP on the background of DM type I and II without CVP – 19 (19%) (subgroup В). Patients were examined to determine the neurological status, were performed laboratory and instrumental methods of examination. Static calculation was performed in MS Excel 2003 and in the programme STATISTICA 10. Results. Regarding to the patients of subgroup А and В we noted the natural predominance of trophic disorders, changes in the reflex sphere and sensitivity in subgroup А. Patients of group II more often than in group I had pathology of the cardiovascular system. Hypertension (HT) and CHD in both cases were registered with a high frequency. In subgroup А there was a combination of several nosologies: from the respiratory, urinary, gastroenterological system (1%), urinary and gastroenterological (3%), gastroenterological and endocrine (2%), urinary and endocrine (1%). In subgroup В diseases of urinary and gastroenterological pathology were found in (5%), gastroenterological (5%), endocrine (11%). The examined patients from group I and with the concomitant CVP have lower linear velocity of blood flow (LVBF) on both tibial arteries, patients in group II – have marginally higher LVBF. Analysis of the results of duplex scanning of lower extremity arteries showed a high incidence of stenosis, in particular the anterior tibial arteries (ATA) up to 30–40%, posterior tibial arteries (PTA) up to 40–50% and occlusion (PTA and femoral, popliteal, tibial segment) in individuals of group I. Conclusions. In patients with DP on the background of type I and II DM and available CVP (subgroup А), the clinical manifestations of polyneuropathy were quite pronounced, especially in the field of trophic disorders, because CVP enhances the ischemia of the microsaceous channel of the peripheral nerves. In addition, persons with concomitant CVP have a wide range of another comorbid pathology, which accelerates the onset of DM complications.

The objective: to investigate the relationship between clinical manifestations of neuropsychological disorders and neuroimaging data (MRI) and electrophysiological (EEG mapping, somatosensory evoked potentials) methods of diagnosis in patients with multiple sclerosis (MS) in the aspect of comorbidity. Patients and methods. Achieved the clinical, neuropsychological, instrumental study 216 MS patients with the presence of (107) or absence (109) comorbid pathology. Spend a numerical score of neurological deficit symptoms (the FS scale) with the total score counting, defined EDSS level evaluated symptoms of fatigue (the FSS), pain (VAS), depression (BDI-II), the degree of cognitive impairment (MMSE). Implemented neyrovizualizuatsionnoe (MRI) study of the brain and spinal cord and EEG mapping study of electrical activity (EA) of the brain., somatosensory evoked potentials (SSEP). Results. It is found that the presence of foci of demyelination in the brain stem in both groups correlated with the severity of the manifestations of depression BDI-II data. It also shows that about 65% of both groups of MS patients had signs of decrease ascending activating effects on the cortex from the reticular formation of the brainstem. It was found that 70% of MS patients in both groups there are irritative and hypersynchronous types EA brain, reducing the symptoms of seizure threshold, with the presence of a strong direct correlation between them and multimodal pain. Conclusions. In the presence of comorbid disease in MS patients observed clinically deeper and more frequent manifestations of NPM, which is confirmed by the results of neuropsychological testing conducted. The presence of foci of demyelination in the cervical spinal cord was significantly more frequent in the MS group with comorbidity (p<0.05), and both groups of patients clinically directly correlates with the severity of pain according to VAS.

Reduced muscle strength is one of the most important factors in violation of life in multiple sclerosis (MS). Muscle spasticity – another significant common symptom in patients with MS, which is one of the main reasons for the deepening of disability. The objective: to determine the prevalence of pyramidal disorders (PD), and sensory disorders (SD) in patients with MS and to find out the characteristics of their curs in the aspect of comorbidity. Patients and methods. Neurological examination 216 MS patients with different forms of process was held a points assessment of the disturbed functional systems of the FS11 – FS17 (scale FS1 Functional System for J. Kurtzke, 1983), determined the level of disability (the EDSS), revealed the presence or absence PD and SD in the survey, to determine the degree of severity and character. Results. At 88,4% PC patients had PD. Changes in muscle tone were found in 73.2% of patients with MS. In 65.3% of MS patients the total sample were clinical signs of superficial and deep sensitivity changes. In addition to medication for relief of PD and SD in patients with MS were effectively used methods of acupuncture, which allowed more quickly and efficiently to reduce the severity of spasticity and pain. Conclusions. 1. The average prevalence of PD in our study of MS patients is 88.4%, and the average prevalence of the SD – 65.3%. 2. In the group with the presence of comorbid pathology PD significantly more often manifested tetraparesis and high spastic tone. 3. In the group with the presence of comorbid pathology SD significantly more often manifested dysesthesia, termogiperestesia, palleanestesia.