编号 10 (2018)

The article deals with the mechanisms of neuroplasticity, the final outcome of which is a negative result (maladaptive neuroplasticity). By the example of post-stroke motor disorders, its causes are analyzed. The significance of activation of the contralesional cerebral hemisphere, is discussed; although it facilitates the process of restoration of lost functions, it can, however, adversely affect the degree of paresis restoration due to the formation of a pathological motor pattern. The mechanism of transscollosal inhibition also plays a role by the slowing down recovery in the affected area. The maladaptive effect of neuroplasticity is also discussed in the context of sensory disturbances of central origin. The structural and functional bases of cross-modal neuroplasticity are considered in detail. It is emphasized that for violations in one of the sensory modalities, created cross-modal system can have a maladaptive effect due to differences from the existing reality, adversely affecting the unimpaired sensory functions and hindering the processes of optimal recovery. It is noted that such maladaptive manifestations are less pronounced in children. It is concluded that the mechanisms of maladaptive neuroplasticity are heterogeneous. In any case, however, they must be taken into account when planning rehabilitation measures.

To date, cardiovascular diseases in patients with rheumatoid arthritis (RA) remains the leading cause of death. the presence of arterial hypertension (AH) contributes significantly to this fact. The presented literature review discusses the problem of the arterial stiffness in RA patients with AH. Pathogenetic mechanisms of the influence of both the AH itself and the activity of the immune-inflammatory process on the condition of the arterial wall and the development of its stiffness in RA are considered. Possible ways or correction of high arterial stiffness (arterial rigidity) in RA patients with AH are analyzed.

Posthypoxic encephalopathy is a kind of transient or persistent cerebral dysfunction resulting from a damaging effect of hypoxia on the brain. Symptom complexes presented with neurological, neuropsychological and mental disorders are characterized by high prevalence after cardiosurgical interventions. The article provides information on the methods of prevention of cerebral complications developing on the background of cardiosurgical interventions. The most common non-pharmacological strategy is based on reducing the adverse effects of such risk factors as cerebral hypoperfusion, nonpulsatile blood flow, microembolism, and includes an individual approach to the reduction of operational stress by optimizing intervention techniques. The advantages and disadvantages of local hypothermia, hyperbaric oxygenation, and other methods are analyzed. Information on the influence of the method of drug neuroprotection with the use of drugs of neurometabolic, antihypoxic, nootropic actions, as well as preparations of other pharmacological groups on the prevalence and severity of postoperative cerebral dysfunction is summarized. Aspects that need further clarification are demonstrated.

Background. Arterial hypertension (AH) is one of the most important and common risk factors for cardiovascular complications. According to the data of a number of studies, various disorders of the thyroid gland function have an impact on the cardiovascular system. Objective. Evaluation of the relationship between thyroid status parameters and the blood pressure (BP) level in persons with AH. Methods. 180 patients with essential AH aged 53.1±9.5 years were examined. Patients underwent thyroid status examination and 24-hour BP monitoring. Results. A direct correlation of thyroid-stimulating hormone level with average daily systolic (SBP) and diastolic blood pressure (DBP), mean BP and with a degree of nocturnal BP decrease (DNBPD) was revealed; inverse correlation of free T3 with average daily SBP, DBP, with mean BP, and direct correlation - with DNBPD were established. Direct correlation of free Т4 and DNBPD was noted. Conclusion. The revealed correlations of the thyroid status parameters, in particular TSH, with the 24-hour BPM datA suggest their participation in the regulation of vascular tone through influence on pressor and depressor mechanisms.

Background. Systemic scleroderma (SS) is one of the rarest forms of collagenosis, and as many researchers note, primary damage to the central nervous system is much less likely with this disease. In the literature, cases of development of stroke and transient ischemic attacks in patients with SS are usually represented by single observations. However, with the use of modern methods of neuroimaging, the frequency of detection of individuals who have had a stroke against the background of the SS may be significantly higher. Description of the clinical case. The clinical observation of 66-year-old SS patient with ischemic stroke developed against the background of the rapidly progressing course of SS is presented. This case reflects the complexity of diagnosis and treatment in the pre-stroke period with the combination of SS and peripheral vascular disease, as well as difficulties and interpretation of the causes of stroke in such patients. Conclusion. After discussing the presented observation at the pathoanatomical conference, the causal relationship between the SS and the developed multifocal cerebral infarction was confirmed, the pathogenetic variant of ischemic stroke was reviewed: the atherothrombotic subtype was replaced by the «other established etiology» according to the TOAST classification.

Background. Hypopituitarism - HP (pituitary insufficiency) is a disease caused by loss of function of tropic hormones (tropins) of the anterior lobe of the pituitary gland and manifested by a deficiency in the function of the peripheral endocrine glands. There are the following types of HP: isolated - reducing the secretion of one tropic hormone; partial - combined loss of function of several tropic hormones; and total (panhypopituitarism) and hypothalamic-pituitary insufficiency - a combination of HP and diabetes insipidus. Among the main causes of HP special mention should go to adenomas and tumors of the pituitary gland and hypothalamus or other parts of the central nervous system, congenital pituitary aplasia, sarcoidosis, tuberculosis, syphilis, inflammatory brain diseases, vascular disorders in the arteries supplying the pituitary gland and the hypothalamus. Description of the clinical case. The article presents a clinical observation of a patient with myocardial damage (probable infectious myocarditis) and HP. Conclusion. The lack of literature data and, accordingly, the lack of clinical experience in the management of such patients make this case unique.