DISTRIBUTION OF TYPES OF PSYCHOLOGICAL RESPONSE TO THE DISEASE IN DIFFERENT GROUPS OF PATIENTS WITH CHRONIC PHASE OF ISCHEMIC STROKE

The objective of our research was to study the types of psychological response to the disease in different groups of patients with chronic phase of ischemic stroke. Material and methods. 100 consecutive patients with chronic phase of ischemic stroke and 17 patients with chronic cerebral ischemia were questioned in neurology in-patient department. The types of attitude towards disease were identified with the help of the Personal Questionnaire of the Bekhterev Institute. Results. Our data indicate that clinical (location of the ischemic lesion, severity of paresis), laboratory (cholesterol level) and individual (gender and education) factors are involved in the formation of the internal picture of the disease in patients with chronic phase of ischemic stroke. Keywords: ischemic stroke, the Personal Questionnaire of the Bekhterev Institute, attitudes towards disease.

ON THE VERGE OF THE PROFESSIONAL HALF-CENTURY WITH THE GLORY

The article tells about the history of the Anthem of Neurology, publishes words, notes and provides a link to the audio file (https://youtu.be/zVAVNAukUOA). The author of the words is Oleksiy Onoprienko. Composer is Volodymyr Ilemsky. The men’s choir of the G. Veryovka Ukrainian National Honored Academic Folk Choir sings. Keywords: neurology, Anthem of Neurology, The men’s choir of the G. Veryovka Ukrainian National Honored Academic Folk Choir sings.

GLUTEN ATAXIA - A COMMON, COMMONLY MISDIAGNOSED DISEASE

The objective of our research was to raise awareness of neurologists and family physicians about gluten ataxia and improve the diagnostic approaches. Methods. PubMed and Google Scholar resources were used to write the review article. Discussion. It is incredibly important not to overlook treatable courses of ataxia. One of these diseases is gluten ataxia. Early diagnosis and timely treatment (gluten-free diet) of gluten ataxia leads to a significant improvement of clinical symptoms and prevents their progression. Gluten ataxia is one of the most common and commonly misdiagnosed ataxia. Its prevalence among all ataxias is 15% and reaches 40% among all idiopathic sporadic ataxias (Hadjivassiliou M., Sanders D.D., Aeschlimann D.P., 2015). Keywords: gluten ataxia, celiac disease, gluten-related disorders.

ATTITUDES TOWARDS DISEASE IN PATIENTS WITH CHRONIC PHASE OF ISCHEMIC STROKE BY THE RESULTS OF THE PERSONAL QUESTIONNAIRE OF THE BEKHTEREV INSTITUTE

Every year, strokes are diagnosed in about 16 million people, of whom 5.7 million die and about the same number become disabled (Feigin V.L., Forouzanfar M.H., Krishnamurthi R., et al., 2014; Virani S.S., Alonso A., Benjamin E.J., et al., 2020; Kim J., Thayabaranathan T., Donnan G.A., et al. 2020). The objective of our research was to study the attitudes towards disease in patients with chronic phase of ischemic stroke. Material and methods. 100 consecutive patients with chronic phase of ischemic stroke and 17 patients with chronic cerebral ischemia were questioned in neurology in-patient department. The types of attitude towards disease were identified with the help of the Personal Questionnaire of the Bekhterev Institute. Results. We found that pathological types of attitude towards disease begin to form before the development of a stroke as a result of chronic cerebral ischemia. Among patients with chronic phase of ischemic stroke, pathological types of attitude towards disease prevailed significantly, and the harmonious type was rare (84.0% vs 16.0%, p < 0.001). The most frequently observed were neurasthenic (36.0%), harmonious (16.0%), anxious (16.0%), ergopathic (10.0%) and sensitive (8.0%) types of attitude towards disease. Our study has shown that any ischemic stroke, even in the case of complete recovery of the lost functions, can be associated with pathological types of attitude towards disease. Keywords: ischemic stroke, the Personal Questionnaire of the Bekhterev Institute, attitudes towards disease.

NEUROLOGICAL COMPLICATIONS OF COVID-19

After the first cases of the new disease COVID-19 (caused by the SARS-CoV-2 coronavirus) were registered in Wuhan, China in December 2019, its spread rapidly became a pandemic and within a few months it covered almost 200 countries [6]. The global COVID-19 pandemic has infected more than 79 million people around the world and claimed more than 1.7 million lives as of December 24, 2020 (according to the Center for Systems Science and Engineering at Johns Hopkins University). Thus, the mortality rate is 2.2%, which significantly exceeds the mortality rate for influenza. It is believed that the peak of the COVID-19 pandemic will continue in the next few months, after which the pandemic will decline. Although the predominant manifestations of COVID-19 are respiratory symptoms, more and more attention is paid to neurological complications. Some neurological complications are potentially life-threatening and can lead to death. The most common neurological complications of acute phase of COVID-19 are impairments of olfaction and taste, which are observed in 33-88% of patients [3]. These symptoms are important for differential diagnosis with influenza and ARVI viruses. Headaches, dizziness, fatigue, and myalgia according to different studies can be observed in 6.5-16.8% of patients. Other neurological complications of COVID-19 often develop in severe and very severe disease (although there are exceptions). Apparently, such neurological complications as ischemic stroke, transient ischemic attack, encephalopathy, delirium can be observed in approximately 0.5-3% of patients. Even less common are hemorrhagic stroke, venous sinus thrombosis, meningitis, encephalitis, encephalomyelitis, cerebral vasculitis, III, V, VI, VII, VIII, IX cranial nerves lesions, Guillain-Barre syndrome, Miller-Fisher syndrome, polyneuropathy, acute dysautonomia, myopathy, myoclonus, epileptic seizures and status epilepticus [2, 4-8]. Awareness of the neurological complications of COVID-19 can influence treatment strategies and simultaneously improve the prognosis for critically ill patients [5]. Keywords: COVID-19, SARS-CoV-2, coronavirus, neurological complications

PHYSICAL AND MENTAL FUNCTIONING OF PEOPLE WITH DIABETIC POLYNEUROPATHY ON THE BACKGROUND OF MULTIMORBIDITY

The article analyzes the physical and psychological components of the quality of life (QOL) in patients with diabetic polyneuropathy (DP) on the background of type I and II diabetes mellitus (DM) with comorbidity. Has been demonstrated the prevalence of more frequent multimorbidity in this nosology and its effect on patients’ QOL. QOL is recognized as an integral part of a comprehensive analysis of new methods of diagnosis, treatment, prevention, quality of treatment and medical assistance [2]. With the highest frequency in DM detect sensory or sensorimotor forms of distal symmetrical DP. However, there are motor symptoms in DM, including cranial neuropathy and Bruns-Garland syndrome (diabetic amyotrophy) [3], which interfere with the satisfactory functioning of patients. The purpose of our work was to assess the extent of physical and mental functioning of people with DP on the background of multimorbidity. Materials and methods. We examined 92 patients with DP on the background of type I and II DM, aged from 19 to 69 years, which were divided into 2 groups: from DP on the background of type 1 DM (group I) and type II (group II). We distinguished such subgroups: DP on the background of type I DM and concomitant cardiovascular pathology (CVP) (group A), DP on the background of type II DM and concomitant CVP (group B), DP on the background of type I DM and gastroenterological pathology (GEP) (group C), DP on the background of type II DM and GEP (group D), DP on the background of type I DM and pathology of the thyroid gland (thyroid) (group E), DP on the background of type II DM and thyroid pathology (group F). Patients underwent clinical and neurological examination, laboratory tests and ultrasound examination of the abdominal cavity and thyroid gland, electromyography (EMG). Static calculation was done in MS Excel 2003. Results and discussion. In groups A and B with the highest frequency among CVP was arterial hypertension - 91% vs 97% and coronary heart disease - 27% vs 41%. In group C - chronic hepatitis (40%), chronic cholecystitis (40%), chronic pancreatitis (40%), chronic gastroduodenitis (40%). In people of group D, gallstone disease was diagnosed more often than in other pathologies (43%). The leading place in group E was occupied by autoimmune thyroiditis (29%), idiopathic hypothyroidism (29%), thyrotoxicosis (29%), in group F - nodular goiter (57%). The longest duration of DM was observed in group A - 24.54 ± 2.46 years, the smallest in group D - 7.14 ± 1.01 years. Diabetic foot syndrome was diagnosed in patients of groups A and B in 14%, group C - in 2%. In patients of group I, the indicators of QOL were higher than in group II. The highest indicators were of groups I and II in the domains social (SF) and physical functioning (PF) - 66.75 ± 2.41; 65.5 ± 3.23 and 63.39 ± 3.54; 61.42 ± 3.88. In group A, the level of QOL was slightly higher than in group B, in particular in the domains of mental health (MH) - 53.09 ± 3.12, bodily pain (BP) - 50.90 ± 4.05. In addition, the manifestations of DP in such group of individuals (group A) were manifested by the absence or mild pain, which causes in people of this group higher rate of QOL. QOL in patients of group C was higher than in group D, in particular, the indicators of physical functioning (PF) - 68.75 ± 5.88, social functioning (SF) - 65.62 ± 5.35, role emotional (RE) - 58.33 ± 18.75, mental health (MH) - 54 ± 5.36. In group D, the data were high in the domains of social functioning (SF) 60.71 ± 16.0 and physical functioning (PF) 57.14 ± 8.37. In the examined patients of group F the level of QOL was higher than in group E, it was, in the domains of physical functioning (PF) - 76.42 ± 7.99, bodily pain (BP) - 61.28 ± 11.18, general health (GH) - 60.85 ± 7.33. Physical health (PH) was low in all groups, but slightly higher in group F (47.90 ± 3.45). The mental health (MH) was low in all groups of patients, slightly higher in group C (47.89 ± 3.59). Conclusions. The level of QOL in persons with DP on the background of type I and II DM with multimorbidity was generally not high. Patients in group D showed the lowest levels of QOL, they also had a level of glycated hemoglobin much higher than in other groups. In group F, the data of QOL were higher, because people with DP on the background of type I DM (group E) had a higher frequency of concomitant thyroid damage, the manifestations of which significantly complicate the course of the underlying disease and reduce levels of functioning. Often manifestations of diabetic foot occur in the onset of DP, when the fibers responsible for sensitivity were damaged, which causes the appearance of the neuropathic component of pain, so in persons of group B the lowest among all groups was the level of QOL in the domain of pain intensity. In addition, it was convenient to monitor the results of treatment by conducting a QOL survey several times a year. Careful analysis of QOL in all areas of functioning in patients with DP allowed detecting early mental disorders and timely start treatment, including psychotherapy sessions. Keywords: quality of life, diabetic polyneuropathy, comorbidity, diabetic foot.

STIFF PERSON SYNDROME (SPS) THE IMPORTANCE OF EXTENSIVE PHYSICAL EXAMINATION

Stiff Person Syndrome (SPS) is a rare condition with a prevalence of one to two cases per million and an incidence of one case per year. Characterized by progressive muscle stiffening, rigidity and spasm, mainly involve the axial muscles, resulting in severely impaired ambulation. The pathogenesis is not that clear. Classic SPS presents with extreme and persistent rigidity and stiffness of truncal and proximal limb muscles, significant lumber/cervical lordosis resulting from simultaneous actions of opposing paraspinous muscles are the hallmark. Wide and unsteady gait (Frankenstein’s gait) resulting from stiff muscles increases the risk of fall and fracture. Patient’s ADLs get severely restricted progressively. Startle reflex which is a superimposed episodic muscle spasm precipitated by sudden movement, noise, or emotional upset is a sensitive and specific feature of SPS and can be visible and palpable. Autonomic dysfunctions are common and are common cause of death in patients with SPS. In cases of partial SPS, we can find that truncal muscles are spared and limb muscles are affected, hence the term stiff-limb syndrome is used sometimes. Can involve a limb or focal part of a limb. As for treatment, symptom control and improving mobility and overall functionality is the primary target. High dose benzodiazepine is the best initial treatment. Those who are refractory can be benefit from Baclofen, IVIG, Plasma exchange, biological agent, e.g. Rituximab. Treatment of primary malignancies in paraneoplastic SPS can achieve remission. Keywords: Stiff Person Syndrome, clinical features, diagnosis and treatment.

FIVE CASES OF ACUTE HYPOACUSIA/DEAFNESS SECONDARY TO ARTERIAL AND VENOUS CEREBROVASCULAR DISEASE

I present five cases of acute onset hypoacusia (four unilateral and one bilateral), all of different physiopathological mechanisms and vascular territories, secondary to either arterial or venous causes. First case is a 39-year-old male with Left Middle Inferior Pontine Syndrome (Foville Syndrome) with associated Vertebro-Basilar Insufficiency (VBI) secondary to Spontaneous Vertebral Artery Dissection (SVAD) and secondary hypoacusia. Case two, is a 76-year-old female with right Anterior Inferior Cerebellar Artery (AICA) Syndrome generating a lateral pontine infarct with hypoacusia as an initial presentation. Case three, is a 77-year-old male presenting a left Superior Cerebellar Artery (SCA) infarct with hypoacusia as an initial presentation. Case four, a 79-year-old female patient presenting sudden onset bilateral hypoacusia secondary to Basilar Artery (BA) thrombosis. Finally, case five, is a 23-year-old post-partum female presenting a right Transverse Venous Sinus Thrombosis (CVST) presenting with acute hypoacusia as only clinical manifestation. Keywords: hypoacusia, deafness, cerebrovascular disease.