Aim. The study of Actovegin effectin clinical presentations and hemorheological characteristics in patients with chronic cerebrovascular pathology (CCVP) and mild cognitive impairment. Materials and methods. The study group included 47 patients (25 male and 22 female), aged 61-75 years (mean age 63.8±5.4) with CCVP who were treated with Actovegin. The control group comprised 28 patients matched by gender and age, without associated cerebrovascular pathology. All patients along with thorough neurological examination underwent laboratory analyses (platelet and erythrocyte rheology), neurovisualization studies (functional magnetic resonance imaging of the brain). Depending on the dosage all patients were divided in two groups: Actovegin 1000 mg and 160 mg daily. Results and discussion. Overall, with Actovegin treatment in 81% of cases positive dynamics both in subjective symptoms, and somatic status was observed. A favorable effect on cognitive function in patients with CCVP was noted. The dose-dependent drug effect was demonstrated. The effect of Actovegin on blood cell functioning included the formation of smaller (Tf and Ts; p=0.0096 and p=0.016) and less solid (γ dis) erythrocyte aggregates (p=0.0034) both in the study and control group. The increase in erythrocyte deformability during therapy was significantly associated with cognitive improvement (via MoCA test, r=0.28). Conclusion. Complex (including neuropsychological and neurovisualizational) examination may not only help determine the cognitive status in patients with CCVP, but also assess the efficacy of neurometabolic therapy. New facts of Actovegin’s influence on erythrocyte aggregation and deformability have been identified, which may enhance micro - and macrocirculation. The acquired data may prove the wide spectrum of Actovegin’s pharmacological effect, which allows to use it in all forms of cerebrovascular pathology.

Neuromyelitis optica (Devic's disease) is a chronic autoimmune disease associated with the production of anti-bodies to aquaporin-4 (AQP4). Area postrema lesions is the third, after optic neuritis and myelitis, syndrome of opticomyelitis-related disorders. Clinical symptoms of this disorder include intractable nausea, vomiting and hiccups. In many cases, area postrema syndrome manifests as the first clinical symptom of a neuromyelitis optica spectrum disorder that hampers the diagnosis. The authors present a case report of a female patient with area postrema lesions developed several months before the first disabling attack of myelitis.

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Quantitative assessment of cerebral hemodynamics is important for patients with chronic cerebral ischemia (CCI), as it helps to reveal the pathogenesis of the disease and set the course for effective prevention and treatment. The study was aimed to assess the correlation of the left carotid artery (ICA) resistive index (RI) with cognitive functions and brain network organization based on fMRI data in patients with CCI (51 males and 105 females). The listed above indicators were studied in patients with the left ICA RI values below and above the average (0.54 ± 0.013). The lower, normal physiological ICA resistance levels corresponded to the more successful realization of verbal cognitive functions. In the first group, RI was within normal range (RI = 0.42 ± 0.007), and in the second group RI exceeded normal levels (RI = 0.61 ± 0.01). Variation of the right ICA RI did not correlate with the characteristics of verbal cognitive functions. FMRI data analysis was used to assess the differences in connectivity between various brain regions in the groups with low and high RI. The normal physiological and elevated RI values of the left ICA correlated with differences in the organization of brain networks: normal physiological RI values corresponded to a better organization of hemispheric connections in the basal ganglia and brainstem, and high RI values corresponded to a better organization of connections between the frontal regions and the cerebellum as well as occipital areas of the cerebral cortex. The left ICA RI can be considered as a biomarker of cognitive decline and brain networks reorganization in patients with CCI.

Izuchenie kolichestvennyh pokazatelej cerebral'noj gemodinamiki aktual'no dlya bol'nyh hronicheskoj ishemiej mozga (HIM), poskol'ku ono pomogaet raskryt' patogenez etogo zabolevaniya, a takzhe opredelit' napravleniya ego effektivnoj diagnostiki i lecheniya. Cel'yu raboty bylo ocenit' sopryazhennost' indeksa rezistentnosti (RI) levoj vnutrennej sonnoj arterii (VSA) s kognitivnymi funkciyami i organizaciej cerebral'nyh nejrosetej po dannym fMRT u bol'nyh HIM (51 muzhchina i 105 zhenshchin). Ukazannye pokazateli issledovali pri znacheniyah RI levoj VSA nizhe i vyshe srednego urovnya (0,54 ± 0,013). Bolee nizkij, fiziologicheski normal'nyj uroven' rezistentnosti levoj VSA sootvetstvoval bolee uspeshnomu vypolneniyu kognitivnyh verbal'nyh funkcij. V pervoj gruppe RI nahodilsya v predelah fiziologicheskoj normy (RI = 0,42 ± 0,007), togda kak vo vtoroj RI byl vyshe normal'nyh znachenij (RI = 0,61 ± 0,01). Variaciya RI pravoj VSA ne byla vzaimosvyazana s harakteristikami verbal'nyh funkcij. Posredstvom analiza fMRT opredelyali raznost' pokazatelej konnektivnosti mezhdu razlichnymi oblastyami mozga v gruppah s nizkim i vysokim RI. Fiziologicheski normal'nyj i povyshennyj RI levoj VSA sopryazheny s razlichiyami v organizacii nejrosetej: pri fiziologicheski normal'nom RI luchshe vyrazheny mezhpolusharnye kommunikacii na urovne bazal'nyh gangliev i stvola mozga, a pri vysokom — svyazi, soedinyayushchie lobnye oblasti s mozzhechkom i zatylochnymi oblastyami kory. RI levoj VSA mozhno rassmatrivat' kak biomarker kognitivnogo snizheniya i reorganizacii nejronnyh setej u bol'nyh HIM.