Posterior fossa meningiomas are among the most difficult neoplasms for microsurgical removal. The main causes of postoperative mortality are circulatory disorders in the brainstem structures. The aim of the study was to identify risk factors for the development of ischemic complications in surgery for meningiomas of the posterior fossa. The results of surgical treatment of 59 patients with posterior fossa meningiomas were analyzed. All patients underwent microsurgical tumor removal through a retrosigmoid approach. Ischemic complications were reported in 10.1 % of patients. The mortality rate was 1.7 %. The results of the study have demonstrated that significant risk factors for the development of cerebellar and brainstem ischemia in the postoperative period are the male sex (p=0.002), decompensated state (p=0.01), the broad-based dural attachment along the entire surface of the pyramid of the temporal bone (p=0.002), gross compression and dislocation of the pons (p=0.0007), the presence of peritumoral edema (p=0.00003), the absence of the CSF cleft (p=0.0000004), prolapse of the cerebellar tonsils (p=0.007), and intraoperative resection of the cerebellar hemisphere (p=0.0003).

Drug addiction poses a serious threat to the cultural development of any country and leads to adverse economic, medical and social consequences. Among the medical consequences, the leading ones are disabling diseases of the nervous system. Signs of damage to the nervous system in drug addiction are most often represented by scattered focal neurological symptoms and mild cognitive disorders, however, severe complications often develop against this background. The treatment of the consequences of drug addiction is based on the use of drugs with polymodal effects. An option for finding effective means of complex pharmacotherapy for the mental and somatoneurological consequences of drug addiction is the testing of drugs with metabolic activity, for example, hepatoprotectors. The aim of the study was to analyze the dynamics of neurological symptoms, cognitive disorders and laboratory indicators of toxic liver damage in psychoactive substance users to assess the possibility of using morpholinium thiazotate (Thiotriazoline®) as a means of choice in the treatment of chronic anesthesia effects syndrome. The polymodality of morpholinium thiazotate allows the use of Thiotriazoline® in the complex therapy of chronic liver diseases, as well as for the correction of cognitive and neurological disorders associated with drug addiction. The results of oral administration of morpholinium thiazotate at a dosage of 200 mg 3 times a day make it possible to recommend Thiotriazoline® in the complex therapy of the syndrome of the effects of chronic anesthesia in outpatient settings.

Macro-CPK is a rare, benign condition that is little known to practicing physicians. Timely diagnosis of macroenzyme presence plays a key role in determining the diagnosis and choosing the correct treatment strategy, as well as prevents a number of unnecessary diagnostic measures, making it an important aspect in clinical practice.

POEMS syndrome is a rare disorder, which name is an acronym formed from the first letters of the English names of the most common symptoms: polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes. This paper describes the diagnostic search for pathology in a 34-year-old woman who was admitted to the 1st Republican Clinical Hospital of the Ministry of Health of the Udmurt Republic with neurological symptoms.

The article presents the data from modern international literature on materials and epidemiology of combat injury and summarizes information on possible complications of cranioplasty in patients with a skull bone defect as a result of military operations. The possible general complications of cranioplasty are analyzed and compared with the complications of cranioplasty for cranial arch defects after wounds. Recommendations are given to reduce these complications. Purpose of the study: Review and generalization of scientific literature on complications of cranioplasty for cranial arch defects resulting from combat action. Materials and methods: The scientific material on the topic of cranioplasty and complications of cranioplasty for civil and military injuries has been studied. The material included: monographs, patents, clinical recommendations, articles by leading Russian and foreign specialists. The following databases were used: ELibrary.ru, Google Scholar, Web of Science, Scopus, PubMed Europe PMC, ResearchGate, NCBI, ScienceDirect, Cambridge Core. 24 publications were found (of which: 19 in English; 5 in Russian).

The article discusses spondylolisthesis, the characterization of this disease and its specific development. Studies indicating the cause of the occurrence of lumbosacral spine spondylolisthesis are presented. Conservative, epidural and surgical treatment is considered. The essence of the expediency of surgical intervention in progressive spondylolisthesis of the lumbosacral spine is revealed. The results of studies within the framework of this problem, which have been conducted in recent years in relation to adult patients and children, are presented. The effectiveness of minimally invasive types of surgical intervention is indicated. The importance of individual components of clinical practice in the implementation of approaches in the process of minimally invasive surgery of lumbosacral spine spondylolisthesis is determined. The importance of conducting separate studies related to minimally invasive surgery is revealed due to two problems existing in the scientific community related to insufficient evidence of the effectiveness of a conservative course of treatment and the specifics of implementing minimally invasive surgical intervention on a planned basis.

Assessment of pain syndrome is an integral part of the oncologist’s work, and the problem of determining the level of pain remains one of the most urgent in oncological practice due to the fact that pain syndrome most often has a direct correlation with the degree of tumor progression. Along with that, chronic pain syndrome can lead to the formation of mental disorders and asthenic syndrome, which can aggravate the course of the underlying disease. In the process of treatment, a specialist needs to establish the cause, severity, and nature of pain syndrome. Many scales and techniques are used to assess this pathology, but specific recommendations for pain syndrome assessment are currently lacking. The analysis of modern literature has shown a great variability of scales for the assessment of pain syndrome in oncology patients. The scales assess the level of pain, its character and localization. The physical and emotional state of the patient is taken into account. Questionnaires and scales make it possible to monitor and assess the dynamics of the development of oncological disease in patients. A complex analysis of the impact of pain syndrome on various aspects of the patient's life is performed. Currently, many scales for determining the severity of pain are used. VAS, BPI, and DN4 can be applied in oncology practice, but there is no unique method of assessment. Therefore, it is necessary to continue developing new methods of pain determination.

The issue of organic mental disorders (OMD) in a general hospital in Udmurtia is currently understudied. The purpose of the study was to determine the OMD prevalence, structure, and risk factors in the considered category of patients. The study group (100 patients aged 18 to 59 years) was compiled using a continuous sampling method. The prevalence of OMD was 36 %. OMD was significantly more frequently diagnosed in the respondents with chronic rather than acute somatic diseases (83.3 % vs 16.7 %) and among older patients (50–59 years). 18.9 % of OMD patients were diagnosed with predementia. A statistically significant comorbidity of OMD with depression and generalized anxiety disorder was revealed. Information about risk factors for OMD can improve the diagnosis and treatment of comorbid diseases in a general hospital.

This article examines a clinical case of migraine aura without headache in a 31-year-old woman who reported experiencing a visual aura resembling «brain fog». A differential diagnosis was conducted to rule out secondary disorders that may have been the cause of her symptoms. Due to the frequency of visual disturbances (up to 12 per month) and the negative impact on the patient's quality of life, she was prescribed sumatriptan 100 mg for acute visual aura attacks. Additionally, cinnarizine 25 mg for a month was recommended for prevention. Following the initiation of treatment, there was a positive response with a reduction in symptoms.

Generalized anxiety disorder is a common mental illness characterized by generalized anxiety and excessive worrying. Current therapy consists of a range of pharmacological and psychological treatments. However, many patients do not respond to first-line pharmacological treatment, and new anxiolytic drugs are being developed. This review examines effective pharmacological treatments for generalized anxiety disorder and their tolerability. Finally, information on new anxiolytics under development is presented, with an emphasis on those that have completed clinical trials. A wide range of effective treatments for generalized anxiety disorder are available, with duloxetine, escitalopram, pregabalin, quetiapine, and venlafaxine being particularly commonly used. There is a limited evidence base for the pharmacological management of patients with generalized anxiety disorder who have not responded to initial treatment. Although many new anxiolytics have advanced to clinical trials, transition from animal models has been largely unsuccessful. However, the potential of several compounds, including psilocybin, ketamine, oxytocin, and orexin- and endocannabinoid-modulating compounds, merit further study.

In recent decades, the problem of comorbidity of schizophrenia and the syndrome of dependence on various psychoactive substances has been of considerable interest, which is due not only to the scale of the combined pathology, but also to the difficulties of differential diagnosis. The clinical picture and course of the disease in the given example, taking into account the clinical originality, progrediency, allows us to talk about a combination of the schizophrenic process and alcoholic illness. The presence of four psychotic attacks of varying degrees of duration, the progrediency of the disease with a complication of positive symptoms along with an increase in negative ones, indicate an attack-like progredient course of schizophrenia, and the manifestation of the schizophrenic process fits perfectly into the “Greter schizophrenia”.

The article presents the results of the analysis of the Gomel Region population mortality from cerebrovascular diseases from 2009 to 2019. During the analyzed period, a statistically significant decrease in the mortality rate of the Gomel Region population from cerebrovascular diseases was registered, including among urban residents. The decrease in the mortality rate from cerebrovascular diseases of the region rural population during the analyzed period is statistically insignificant. The lowest rate of rural population mortality exceeding urban mortality was observed in 2014, the highest — in 2019. The highest mortality rates from cerebrovascular diseases were observed among the urban and rural population of the Khoyniki, Petrikov, and Kalinkovichi districts. A statistically significant increase in mortality from cerebrovascular diseases in 2019 compared to 2018 was found among the population over working age in the Khoyniki, Petrikov, and Buda-Kashalyova districts of the Gomel Region. The highest mortality rates of the working-age population from cerebrovascular diseases were registered in Petrikov, Kalinkovichi, Khoyniki, Oktyabrsky, and Svetlogorsk districts. The highest mortality rate for people over working age was noted in the Khoyniki district of the Gomel Region. In the structure of mortality causes from cerebrovascular diseases, cerebral infarction ranks first, intracerebral and other intracranial hemorrhages rank second, and other cerebrovascular diseases rank third. Recommendations are given to reduce mortality from the described pathology in this region.

The problem of various kinds of obsessions is becoming increasingly urgent. In the last two decades, obsessive (maladaptive) daydreaming ranks first among ideational obsessions. The purpose of our study was to investigate this phenomenon in a sample of students. The study was conducted remotely (the answers to the questions were generated in Google Form), was anonymous and voluntary. The work used clinical-anamnestic, experimental-psychological, and statistical methods. As a result of the study, maladaptive daydreaming was identified in almost every seventh respondent (according to the MDS-16 questionnaire). There were no significant differences in assessing gender characteristics in the sample. The results regarding subjective assessment of the level of attention were mixed. Analyzing the data obtained through modeling, a relationship between maladaptive daydreaming and manifestations of obsessive-compulsive disorder, as well as a connection between obsessive-compulsive disorder and adverse life experiences in childhood were identified.

The treatment of glial brain tumors is currently a complex and an unresolved issue in neuro-oncology. All existing methods, including tumor resection, chemotherapy, radiation therapy, radiosurgery, intraoperative photodiagnosis, photodynamic therapy, etc., aim to increase the relapse-free period. Fluorescence diagnosis and photodynamic therapy are promising methods used to increase the tumor resection rate and for additional treatment of residual parts and the bed of the tumor that has been removed. The use of one type of photosensitizer for photodynamic therapy may be ineffective, and the relapse-free period does not increase significantly. This work presents the preliminary results of the combined use of 5-ALA-induced protoporphyrin IX and Chlorin e6 photosensitizers for fluorescence-guided resection and photodynamic therapy of the malignant glial brain tumor, glioblastoma. According to MRI, CT, and PET scans, the simultaneous use of two photosensitizers allowed achieving gross total resection of the tumor, including tumor parts with increased fluorescence intensity in perifocal zone without neurological deficit, and performing photodynamic therapy of the tumor bed. The combined use of 5-ALA and Chlorin e6 photosensitizers for fluorescence-guided resection and photodynamic therapy of recurrent glioblastoma in the functional motor area under neurophysiological control allowed increasing the relapse-free period up to 20 months after the 4th neurosurgical intervention and overall survival to 36 months at the moment.

The study of walking function is actively carried out by both Russian and foreign researchers. Before making a conclusion about the presence of pathological changes in the spatial or temporal step parameters, it is necessary to have an idea of the normative data. Normative indicators are quite variable even in groups of clinically healthy individuals, depending on gender and age. Since the first studies, methods for diagnosing gait parameters have undergone significant evolution. Currently, it is possible to register temporal, spatial, electromyographic, and goniometric gait parameters and build 3D models. Along with this, the use of high-tech methods is not always applicable in real clinical practice for various reasons (financial, technical, related to human resources). In this study, when assessing gait parameters, the authors turned to the simplest method from a technical point of view — ichnography. This was due not so much to financial limitations, but mostly to technical ones. This method is the most accessible. In addition, one of the fundamental aspects of choice was further plans to study the function of walking in patients with central hemiparesis syndrome. Patients in this category often move with the help of a cane, which in this case limits the study of movement by means of high-tech methods. As a result of the gait study in various age groups, data confirming changes in the spatial and temporal step parameters in clinically healthy individuals were obtained. The data obtained are consistent with previously published information and allow planning further studies in groups of neurological patient.