ABSTRACT. This article discusses the clinical cases of rare and difficult to diagnose brain damage — osmotic demyelinating syndrome (ODS). ODS is a lifethreatening condition, manifested by acute demyelination of the headbrain on the background of water-electrolyte disturbances,usually associated with fast management of hyponatremia. Within the framework of ODS, central pontine myelinolysis (CPM) and extra-pontine myelinolysis (EPM) are observed, which are accompanied by acute demyelination in the pons and white matter of the cerebral hemispheres, respectively. In 60%, CPM combine with EPM. The main reason for the development of ODS is a violation of water-electrolyte metabolism associated with alcohol abuse, chronic hepatic and/or renal failure, diabetes mellitus, Sheehan syndrome, polydipsia, condition after the removal of pituitary adenoma, bulimia, immunodeficiency syndrome. Today, the diagnosis of ODS is based on magnetic resonance imaging of the brain. The article indicates the main causes of the disease, clinical features, methods of diagnosis and treatment, as well as the outcomes of the disease.

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Introduction. Currently, despite the introduction of modern diagnostic algorithms in 20-40 % of patients with ischemic stroke, it is not possible to establish its cause. Potential causes of acute cerebral ischemia in patients with cryptogenic ischemic stroke include paroxysmal atrial fibrillation, patent foramen ovale, atrial cardiomyopathy, carotid network, aortic arch atheroma, and cancer-associated thrombophilia.Target: to systematize data on methods for diagnosing and preventing aortic arch atheroma.Material and methods. The literature search was carried out in electronic search systems Scopus, eLibrary, PubMed using the key words: ischemic stroke, cryptogenic stroke, aortic arch atheroma, pathogenesis of ischemic stroke.Results. At present, despite such a detailed study of therapeutic strategies for the prevention of recurrent thrombotic events in patients with aortic arch atheroma, none of the drugs has proven its advantage. Although the NAVIGATE ESUS and RESPECT ESUS trials did not show the superiority of oral anticoagulants over antiplatelet agents in preventing recurrent ischemic strokes in patients with cryptogenic stroke, it was found that cryptogenic ischemic stroke is heterogeneous, which requires a differentiated approach to secondary prevention.Conclusion. Аortic atheroma can be the cause of embolic syndrome and cryptogenic stroke. The main methods for diagnosing aortic atheroma are transesophageal echocardiography and computed tomographic angiography. The therapeutic strategy for the treatment of aortic atheroma is lipid-lowering, antithrombotic therapy in combination with blockers of the renin-angiotensin-aldosterone system.