Delayed post-hypoxic leukoencephalopathy is a clinical syndrome caused by a lesion of the white matter of the brain with an acute onset developing several days after emerging from coma. The reason of delayed post-hypoxic leukoencephalopathy is prolonged cerebral hypooxygenation, it often results from carbon monoxide poisoning, less often it is associated with acute brain hypoxia caused by respiratory failure, an overdose of opiates. The leading role in the clinical picture of delayed post-hypoxic leukoencephalopathy is played by the duration and severity of cerebral anoxia in the acute period of the disease. The period of temporary well-being of a patient with an episode of acute hypoxia lasts 2 to 40days. Pathogenesis and pathophysiology have not been well studied. Its development after carbon monoxide poisoning is considered to be caused by direct myelinotoxic effect. Itis essential to collect a detailed history for diagnosing a case, neurovisualization is an informative method for investigation. Magnetic resonance imaging may detect the signs that are pathognomonic for delayed post-hypoxic leukoencephalopathy, that is diffuse hyperintensity of the white matter of the cerebral hemispheres in T2-mode, symmetry of the damage of both cerebral hemispheres, damage of the subcortical gray matter globus pallidus. The standards for the treatment of delayed post-hypoxic leukoencephalopathy have not been developed. The use of glucocorticoids has been described, perspective use of amantadine were shown in case of frontal-subcortical syndrome. There are recommendations on prescribing the following therapy for the patients with delayed post-hypoxic leukoencephalopathy: hyperbaric oxygenation, coenzymeQ10, vitaminE and groupB. We present a clinical observation that demonstrates the complexity of the clinical picture of delayed post-hypoxic leukoencephalopathy, the difficulty of its diagnosis without taking into account information about previous carbon monoxide poisoning. The results of magnetic resonance imaging at the onset of the disease are considered to be of utmost interest. The clinical observation of the patient presented in the article allows us to make an assumption about pathogenesis and contributes to search for means aimed at preventing the development of delayed post-hypoxic leukoencephalopathy in people with acute carbon monoxide poisoning.

The aim of this study is to research the structure of acute vestibular disorders at the stage of the emergency room and to determine the frequency of occurrence of life-threatening conditions. Material and methods. It was made the analysis of acute vestibular disorders at the stage of emergency room of the Neurology department of Clinical Hospital No. 7, City Clinical Hospital No. 18 and stroke center of Interregional Clinical Diagnostic Center in Kazan, Tatarstan Republic, Russian Federation, for the period 20162020. The diagnosis of vestibular disorders was established on the basis of clinical data. There were additional instrumental researches made in doubtful cases. Statistical data processing was made using Microsoft Excel 10.0 program. Results. The study included 106 patients in total with reliably established pathology of the peripheral or central vestibular system. The peripheral or functional nature of vestibular disfunctions were identified in 84% patients. 57% patients had benign paroxysmal positional vertigo. 42% of these patients had repeated benign paroxysmal positional vertigo attack. Vestibular neuronitis and Ramsey Hunt syndrome were detected in 15% patients. Acute cerebrovascular origin was diagnosed in 10% patients (10 ischemic strokes and 1 transient ischemic attack). 1 patient had an ArnoldChiari malformation with the development of occlusive hydrocephalus. So, 12 patients had a life-threatening cause of vestibular pathology, among them only 2 patients had isolated vestibular symptoms. Vestibular migraine was diagnosed in another 5% patients. Conclusions. Life-threatening causes of vestibular pathology account for 11% of all cases. Focal neurological symptoms are the main red flags of systemic vertigo. Benign paroxysmal positional vertigo is detected in 57% of cases of vertigo in the emergency room.