Central pontine myelinolysis (CPM) is a concentrated, symmetric, non-inflammatory demyelination within the central basis pontis. In 10 % of patients with СРМ, demyelination also occurs in extrapontine regions: the mid brain, thalamus, basal nuclei, and cerebellum. Demyelination occurs in regions of compact interdigitation of white and gray matter as a result of cellular edema, which is caused by fluctuating osmotic forces, results in compression of fiber tracts. The most frequent cause of abrupt change in osmotic pressure is the rapid sodium correction of prolonged hyponatremia. In case that we report, there is a combination of central pontine and extrapontine myelinolysis, which occurs in 71-year-old woman owing to rapid sodium correction of prolonged hyponatremia which by turn developed due to salt-free diet, improper antihypertensive therapy and overheating. The diagnosis was confirmed by magnetic resonance imaging (MRI). The treatment led to significant decrease of neurological deficit.

Background. Mitoxantrone (MTX) and Rituximab (RTX) are successfully used for treatment of multiple sclerosis (MS) and can be combined to increase efficacy. Objective. We used MTX, RTX, and methylprednisolone in a single combined regiment and observed patients prospectively. Methods. We present results of observational pilot study of combined therapy of RTX and MTX in 28 patients with active MS. Therapeutic protocol consisted of two infusions within 14 days. First infusion was 1000 mg methylprednisolone (MP) IV, 1000 mg RTX IV, and 20 mg MTX IV. On day 14, 1000 mg MP IV and 1000 mg RTX IV were given. Patients were followed prospectively from 12 to 48 months. Results and Conclusion. There were no relapses among all 28 patients during the observation period. B-cell depletion of CD19+ and CD19+/CD27+ memory B-cell subpopulation in both compartments was confirmed in all patients at 6 months. We found a more rapid reconstitution of B cells in the CSF than in the peripheral blood and longstanding depression of CD19+CD27+ memory B-cell. Conclusion. Effectiveness of combined regimen of RTX and MTX could be related to longstanding depletion of CD19+CD27+ memory B-cell subset.

The objectiveof the study is to evaluate the results and compare the methods of different variants of surgical treatment for the occlusive-stenotic lesion in extracranial parts of the carotid arteries.Material and methods.Comparative analysis of immediate and remote results, and evaluation of patency after 450 carotid endarterectomy performed by classic and eversion technique.Results.A significant advantage of eversion carotid endarterectomy was confirmed.Conclusion.The good results show not only the high qualification of each operating surgeon as well the entire staff, providing competent logistics and selection of patients for both planned and emergency surgical interventions.

Objective: to conduct a study of the basic epidemiological and clinical data of myasthenia in Leningrad region. The analysis of inpatient and outpatient charts of all patients with myasthenia, who were treated at the neurology department of the Leningrad Regional Clinical Hospital (LOKB) from 2003 to 2012. The estimation of incidence and prevalence of the disease per 100 000 population, the basic gender-age characteristics and clinical features of myasthenia in Leningrad region. According to the findings myasthenia gravis is not a rare disease, the prevalence of myasthenia gravis in the whole area is 4.6 cases, the average incidence was 0.29 cases per 100 000 population. The prevalence of myasthenia gravis in Leningrad region is lower than in other regions of Russia. Among patients women predominate in the age group 45-59 years, and there is a significant number of patients with disease onset in middle and old age.

Рассеянный склероз (РС) является хроническим воспалительным демиелинизирующим за-болеванием ЦНС, которое ввиду своей распространенности (50 случаев на 100 тыс. населения) и преимущественным поражением лиц трудоспособного возраста имеет важное медикосоциальное значение. На сегодняшний день РС представляется мультифакториальным заболеванием, ведущим патогенетическим механизмом которого, лежащим в основе воспаления, является аутоиммунный процесс. Многочисленные доказательства аутоиммунной природы РС получены в серии экспериментальных и клинических работ.