Acute cerebrovascular accident  (ACV) is an important medical and social problem, which is associated with high morbidity, mortality and frequent  disability. The current  system  for providing  specialized  medical  care to patients with stroke  has shown  its effectiveness, as evidenced by a decrease in hospital  mortality  and  an increase  in the  number  of patients returning  to work. However, the incidence  of stroke remains  high, which is also associated with the COVID-19 pandemic. Every third patient  with COVID-19 had neurological symptoms, and a pathomorphological study of the  brain of the  deceased showed  signs of hypoxic encephalopathy in every fifth. Due to the fact that with COVID-19 there  is a high probability of developing ischemic stroke (IS), it is necessary  to promptly identify and correct  the  following  factors  that  contribute to the  occurrence  of stroke  with COVID-19: cardiovascular  diseases, diabetes mellitus, arterial  hypertension, atherosclerosis. Direct exposure  to the virus results  in systemic inflammatory  hyperactivity  with a prothrombotic state  secondary  to protein  C and S deficiency. An important problem  is both the  prevention of the  first and recurrent  stroke, regardless of the  etiology. The basis of secondary  prevention is the  correction of risk factors, as well as the development of an individual program  with antihypertensive, lipid-lowering  therapy. The leading line of secondary  prevention of IS is antiplatelet therapy, which reduces  the risk of developing acute  vascular episodes by 25%. For the purpose  of secondary  prevention of ischemic stroke, acetylsalicylic  acid, dipyridamole, clopidogrel  are used. In the discussed clinical observation, a patient  developed repeated episodes of transient ischemic attack against  the background  of a stenosing  process  in the  common  carotid  artery, hypertension, and a previous  coronavirus  infection. Given that  the  greatest risk of recurrent  stroke is associated with atherosclerosis, which can be complicated by thrombus  formation, chimes and acetylsalicylic acid were chosen for secondary prevention. Follow-up observation showed  the correctness of the chosen tactics.

In most neurological hospitals, spinal strokes are still rare, although the acute development of the disease, the ability to localize the lesion in the spinal cord, and knowledge of some basic features of this disease make the diagnosis of spinal circulation disorders uncomplicated even in outpatient settings. A certain role is probably played by the long-standing prejudice that spinal strokes do not exist at all. There is no information about this pathology in textbooks and manuals on neurology even ten years ago. As for the possibility of spinal strokes in children, this assumption may seem implausible. But, unfortunately, spinal strokes in children do exist and are relatively not that rare. Knowing how to recognize them allows us to start immediate adequate therapy and only then can good results be achieved.

Back pain and insomnia (insomnia) significantly impair the quality of life of patients. Pain contributes to the development of sleep disorders and vice versa, poor quality sleep increases pain. Sleep disorders are widespread in the population, and in chronic pain syndrome, almost 70% of patients suffer from insomnia. The National Sleep Association singles out pain as one of the leading causes of sleep disorders. The article discusses a typical clinical case of the combination and interaction of chronic pain syndrome and insomnia. A patient with acute back pain developed a sleep disorder for which therapy was not carried out. The prescribed standard therapy for back pain, which included a non-steroidal anti-inflammatory drug, muscle relaxant, made it possible to relieve pain in a short time. However, the patient’s insomnia not only persisted, but also progressed, which led to the appearance of symptoms of asthenia in the form of fatigue, irritability, decreased performance, and ultimately significantly reduced the quality of life. In order to normalize sleep, the patient was prescribed a histamine H1 receptor blocker from the ethanolamine group, namely the drug Doxylamine. Follow-up observation for 1 year showed no exacerbation of back pain and sleep disturbances. In the treatment of patients with chronic back pain, it is necessary to pay attention to the presence of sleep disturbances and provide appropriate therapy. Today, three groups of hypnotics are used in clinical practice: melatonin receptor agonists (insufficient effectiveness in acute sleep disorders), benzodiazepines (addictive and addictive), and antihistamines. The modern drug Doxylamin belongs to the group of antihistamine hypnotics, has a good efficacy and safety profile and is included in the domestic recommendations for the treatment of insomnia.

At present, when classifying vertebrogenic diseases of the nervous system (VZNS), methodological recommendations "Clinical classification of diseases of the peripheral nervous system", approved by M3 of the USSR (1987), are used as the basis. The applied classification does not fully reflect modern concepts of patho- and sanogenesis and complicates the use of many methods (manual therapy and reflexotherapy) necessary for the treatment and rehabilitation of patients with VNS.