The article covers the pathogenic depression basis under Parkinson's disease. The mechanisms of limbic level depression, cognitive depression aspects have been observed. The literature analysis and author's research data allowed to develop the new conception – theoretical model of goal‑seeking behavior and depression in patients with Parkinson's disease.

Keywords: depression, Parkinson's disease, mesolimbic dopaminergic system, dorsolateral prefrontal cortex, amygdale, hippocampus.

The article presents the contemporary view on the determination of vegetative state, ethiological factor, pathogenesis and clinical data of this state. Vegetative state is one of the variant of the exit from coma, when the patient is in consciousness, but doesn't realize himself and surrounding. The different injuries of brain may be a cause of vegetative state. The specific morphological substrate for vegetative state has not been found yet. This state is clinically diagnosed, the additional method of clinical investigation does not allow to confirm the diagnosis and make prognosis of vegetative state. Some patients may exit from coma. The development of prognosis methodic of vegetative state is topical issue.

Keywords: vegetative state, coma, realization of himself and surrounding.

The special value has a study of a problem of minimum cerebral dysfunction (MCD) for a theory and practice of medicine, as, from data of different authors, 20–40 % makes the displays of MCD children of school age.
Electroencephalography is the reliable method of paraclinic diagnostics of the central nervous system. Changes of EEG at minimum cerebral dysfunction allow to estimate accordance of maturity level of CNC to the age of a child and to discover a delay in development, make possible to estimate therapeutic efficiency of medicinal treatment. EEG enables differential diagnostics of displays of MCD (hyperkinetic disorders and epileptic hyperkinetic disorders).

Keywords: electroencephalogram, minimum cerebral dysfunction, immaturity of brain, hyperactivity.

Изучение проблемы минимальной мозговой дисфункции (ММД) имеет особое значение для теории и практики медицины, так как проявления ММД, по данным разных авторов, встречаются у 20—40 % детей школьного возраста. Электроэнцефалография является надежным методом параклинической диагностики центральной нервной системы. Изменения ЭЭГ при ММД позволяют оценить соответствие уровня зрелости ЦНС возрасту ребенка и обнаружить задержку в развитии, оценить терапевтическую эффективность медикаментозного лечения. ЭЭГ следует использовать для дифференциальной диагностики проявлений ММД (гиперкинетические и эпилептические гиперкинетические расстройства).

Keywords: электроэнцефалография, минимальная мозговая дисфункция, незрелость мозга, гиперактивность.

The aim – to investigate the level of knowledge of the proper diagnosis and treatment of patients with cognitive impairment among the general practitioners.
Methods and subjects. To investigate the level of knowledge among the clinicians on the problem of the vascular cognitive impairment we questioned 268 physicians working in the primary medical care in the city of Uzhhorod.
Results. The diagnostic criteria of the cognitive impairment were known to less then a half of the questioned physicians 46.6 %, 24.6 % did not know the criteria and 28.7 % were hard to answer the question, the majority was insufficiently informed on the current treatment opportunities for the demented patients.
Conclusions. To emphasize the problem we recommended to include the seminars on the diagnosis and treatment of the vascular cognitive impairment to the teaching program of the Department of Postgraduate Education of Uzhhorod National University and to prepare a textbook on the topic for the general practitioners.

Keywords: cognitive impairment, level of knowledge, questionnaire.

The aim – an all-round evaluation of the immune status in patients with a verified herpesvirus neuroinfection manifesting itself as a cramp syndrome, based upon the analysis of the results, obtained in clinicoanamnestic, genealogical and laboratory investigations.
Methods and subjects. The study group consisted of 69 patients aged from 11 to 60 who verified the herpesvirus neuroinfection by means of PCR method or by the comparative serologic investigations.
Results. A high specific gravity of primary immunodeficiencies was demonstrated in patients with herpesvirus neuroinfection, manifesting the generalized tonico-clonic seizures (27 % of cases) with immunodeficiency diseases associated to hypoimmunoglobulinemia and disorders of phagocyte’s activity being mainly registered (81 % of cases). A detailed analysis of the results obtained in clinical, laboratory and instrumental investigations in this category of patients was carried out, some clinical cases were described and the ways were proposed to optimize the diagnosis and treatment at the expense of immunological examinations and therapy to be carried out.
Conclusions. The results of this study may be helpful to raise the quality of diagnosis and treatment for the human secondary epilepsy associated with herpesvirus infection.

Keywords: herpesvirus neuroinfection, epilepsy, primary immunodeficiency, immune therapy.

Цель — комплексная оценка иммунного статуса у пациентов с верифицированной герпесвирусной нейроинфекцией, проявляющейся судорожным синдромом, на основании анализа результатов клинико-анамнестических, генеалогических и лабораторных исследований.
Материалы и методы. Исследуемую группу составили 60 пациентов в возрасте от 11 до 60 лет, у которых методом полимеразной цепной реакции или путем сравнительных серологических исследований была верифицирована герпесвирусная нейроинфекция, проявляющаяся в виде эпилептического синдрома.
Результаты. Выявлен большой удельный вес первичных иммунодефицитов у пациентов с герпесвирусной нейроинфекцией, манифестирующей генерализованными тонико‑клоническими припадками (27 % случаев), преимущественно регистрировали иммунодефицитные заболевания, связанные с гипоиммуноглобулинемией и нарушениями деятельности фагоцитирующих клеток (81 % случаев). Проведен детальный анализ результатов клинических, лабораторных и инструментальных исследований у этой категории больных, описаны несколько клинических случаев и предложены пути оптимизации диагностики и лечения за счет проведения иммунологических обследований и иммунотерапии.
Выводы. Результаты данного исследования могут быть полезны для повышения качества диагностики и лечения вторичной эпилепсии человека, ассоциированной с герпесвирусной инфекцией.

Keywords: герпесвирусная нейроинфекция, эпилепсия, первичный иммунодефицит, иммунотерапия.

The aim – to investigate the role of immune changes in patients with dyscirculative encephalopathy (DE), exposed to low doses of ionizing radiation due to the Chernobyl accident.
Methods and subjects. The main parameters of cellular (CD3, CD4, SD8, SD16, SD22) and humoral immunity (IgG, IgA, IgM, CIC) were studied in 80 patients with DE, exposed to ionizing radiation due to the accident in Chernobyl, taking into consideration the concomitant pathology of internal organs, the level of endotoxemia, received dose of radiation, previous history of stroke, and the stage of the disease.
Results. In patients with DE parameters of cellular immunity were lower than control, the parameters of humoral immunity were higher compared with control. It indicates a violation of cooperative connections between the cells and can be a result of dysfunctional and dysregulatory disorders of immune status. Increased endotoxemia was accompanied by a tendency to reduce concentration of CD3, CD4, CD8, the increased level of CIC and activation of products IgA and IgM. The concentration of CIC increased with the extent of total radiation dose, and the level of immunoglobulin G, by contrast, decreased. The content of immunoglobulins A and M was higher than the control, but depended on the received radiation dose (IgA – decreased with the growth of the latter, IgM on the contrary, increased).
Conclusions. In patients with DE, exposed to low doses of ionizing radiation, the inhibition of T-cell level of immune protection and synthesis of IgG on the background of increased level of some indicators of humoral (IgA, IgM) immunity have been evidenced. These changes increased in cases of endotoxemia and at total dose of irradiation of 21–60 Ber. Received data confirmed the activation of some immune protection in patients with critical course of the disease, and, depression was observed with a worsening of neurological deficit.

Keywords: dyscirculative encephalopathy, immune defense, small doses of ionizing radiation.

The aim – to identify changes in the peripheral nervous system using electroneuromyography in patients with chronic pancreatitis and to establish correlations between biochemical and electrophysiological parameters.
Methods and subjects. The complex clinical neurological examination and electroneuromyographic in 20 patients with chronic pancreatitis has been performed. The average patient age was 51 ± 7.3 years. The diagnosis of chronic pancreatitis was established by a physician-gastroenterologist. The control group included 20 healthy people.
Results. Clinical signs of polyneuropathy were observed in 90% of patients with chronic pancreatitis identified.
Eelectroneuromyography revealed that in all patients with a high level of confidence a reduction in average amplitude M – response, speed of excitation and increasing the duration of residual latency were observed. Strong correlation dependence between the level of glucose and amylase in blood and electro-physiological indexes have been established.
Conclusions. In 90 % of the inspected patients with chronic pancreatitis had clinical manifestations of polyneuropathy. It has been exposed, that the involvement of peripheral nerves and formation of the mixed axonal-demyelinating polyneuropathy form were observed.

Keywords: chronic pancreatitis, polyneuropathy, electroneuromyography.

Цель — выявить изменения периферической нервной системы при помощи электронейромиографии у больных хроническим панкреатитом и установить корреляционные связи между биохимическими и электрофизиологическими показателями.
Материалы и методы. Проведено комплексное клинико-неврологическое и электронейромиографическое обследование 20 больных хроническим панкреатитом (ХП). Средний возраст пациентов составил (51 ± 7,3) года. Диагноз ХП устанавливал врач-гастроэнтеролог. В контрольную группу вошли 20 здоровых лиц.
Результаты. У 90 % больных ХП выявлены клинические признаки полиневропатии. При проведении электронейромиографии у всех обследованных пациентов с высоким уровнем достоверности обнаружено снижение средних показателей амплитуды М-ответа, скорости проведения возбуждения и увеличение длительности резидуальной латентности. Выявлена сильная корреляционная зависимость между уровнем глюкозы и амилазы в крови и электрофизиологическими показателями.
Выводы. Клинические проявления полиневропатии имеют место у 90 % больных ХП. При проведении электронейромиографии у всех обследованных пациентов выявлено поражение периферических нервов с формированием смешанной аксонально-демиелинизирующей формы полиневропатии.

Keywords: хронический панкреатит, полиневропатия, электронейромиография.

The aim – to define the efficiency of integral index application as a marker of total information of electroneuromyography (ENMG) data, received at nerves of upper and lower extremities for the estimation, of the conducting treatment of patients with type 2 diabetes mellitus (DM), complicated with diabetic distal symmetric polyneuropathy (DDSP).
Methods and subjects. 61 patients with type 2 DM, complicated with DDSP have been examined. 28 of them got base therapy (I group), 33 – analogical treatment with including of native antioxidant Byocerulin (II group). The integral indexes of the ENMG data of peripheral nerves testing on ENMG «Neuro-EMG-Micro» (RF) have been estimated in a dynamics of treatment. They have been estimated by the factor analysis of ENMG indexes with the package of «StatSoft/ Statistica 6.0».
Results. Two integral indexes of ENMG testing, which include the parameters of motor and sensory nerves examination of lower and upper extremities and also F-wave of tibial and medianus nerves have been worked over. They have represented total information about nerves functional state of patients with type 2 DM, complicated with DDSP.
In 3 months in both groups a reliable dynamics of both integral indexes of ENMG peripheral nerves testing was marked (р < 0,05). In a half-year after the beginning of research, stabilizing of integral indexes was noticed in the II group, a reliable difference was marked with the initial values of indexes (р < 0,05) unlike patients of I group, integral indexes of which did not differ from information, got before thetreatment (р > 0,05).
Conclusions. The expedience of Byocerulin application in complex treatment of patients with diabetic polyneuropathy has been set. This concurs to prevention the DDSP progress, retaining the results of therapy during 6 months from the integral indexes data, afterwards it is advisable to repeat the course of analogical treatment.

Keywords: diabetic polyneuropathy, type 2 diabetes mellitus, electroneuromyography, Byocerulin.

The aim – the development and introduction of neurosurgical interventions directed on the sacral tumors removing, nervous structures decompression, fixation of a spine and studying of sacral tumors surgery efficiency.
Methods and subjects. The diagnostic data, surgical treatment and its results at 23 patients with sacral tumors operated in institute of neurosurgery within 1999–2009 has been analyzed. Among them 10 patients had big tumors involving all sacral vertebrae (S1–S5), 8 – had tumors involving S1—S3 vertebrae, and 5 patients had tumors involving S3–S5 vertebrae. The fixation of spine and pelvis was performed in the 6 patients after tumor removal.
Results. Among 10 patients with big tumors of all sacral vertebrae (S1–S5) 6 patients underwent complete tumors removal, the rest patients had partial tumors removal. Among 8 patients with a tumor of S1–S3 vertebrae complete tumors removal was performed in 6 patients, 2 patients had partial removal. In all 5 patients with tumors of S3–S5 vertebrae we performed total removal of a tumor. Tumors removal as a whole block was performed only in 4 patients with tumors affected S3–S5 vertebrae. Other patients had tumors removal by piecemeal fashion. The chordomas were found in 2 patients, osteosarcomas – 1, chondrosarcomas – 3, osteoblastomas – 6, aneurismatic bone cyst – 4, giant cell tumors – 2, hemangioendotheliomas – 1, angiosarcoma – 1, plasmocytoma – 2, a metastasis of a cancer – 1. The remote supervision on the average lasted 7.9 months, the longest period of the remote supervision was 2.1 years. Data on the remote period have been received at 11 patients. Among 11 patients surveyed in the remote period relapses have been found at 6.
Conclusions. Sacral tumors treatment results and prognosis are favorable on the conditions of drastic surgery, solid intrasurgical spinal fixation with a ring, radiation therapy application during the post surgery period.

Keywords: neurosurgical treatment, sacral tumors.

The aim – the development of an effective method of treatment for patients with reflex and compression syndromes of degenerative disc disease of the lumbar spine by manual therapy gentle techniques application.
Methods and subjects. We examined and treated 47 patients with neurological syndromes of lumbar osteochondrosis. A special neuroorthopedic, radiographic methods as well as KT- and MRI-study were performed. In the treatment of patients the specially developed method of intensive manual therapy with the application of gentle techniques was used.
Results. Applying the proposed method of intensive manual therapy with the using of gentle techniques for the treatment of compression radicular and reflex syndromes of degenerative disc disease of lumbar spine we have achieved positive results of treatment of 46 (97.87 %) patients.
Conclusions. We recommend the proposed treatment strategy with the using of intensive methods of manual therapy with the inclusion of gentle techniques for patients with reflex and compression radicular syndromes of degenerative disc disease of lumbar spine for treatment of patients in a neurological hospital. Also it makes possible to reduce the duration of treatment in hospital and earlier rehabilitation.

Keywords: osteochondrosis of the spine, manual therapy, postisometric relaxation of muscles, the spinal motor segment.

The aim – to evaluate effectiveness of mononeuroprotection with сerebrolizin and combined neuroprotection with сerebrolizin and Ceraxon in the treatment of acute ischemic stroke with localization in vertebro-basilar pool.
Methods and subjects. Clinical and neurological study, CT, ultrasound dopplerography have been carried out in patients with acute ischemic stroke with localization in vertebro-basilar pool. Group 1 (n = 24) received traditional therapy with neuroprotector сerebrolizin, at group 2 (n = 24) traditional therapy was used with combined neuroprotectiv therapy with Ceraxon and сerebrolizin. Assessment of the degree of neurological deficit was performed using NIHSS scales and Rankin scale on the 1–3 and 19–21 days of stroke.
Results. The rate of reduction of neurological deficit, its severity and the statistical reliability were higher in patients with combined neuroprotection. At those patients good analysis of the dynamics of reducing the average total score on a NIHSS scale were observed.
Conclusions. Mononeuroprotection with cerebrolysin is quite efficient, though, on the basis of clinical studies and statistical analysis this method is less effective than combined neuroprotection with сerebrolizin and Сeraxon.

Keywords: ангіогенез, ішемічний інсульт, нейросудинна ніша, судинний ендотеліальний фактор росту.

The modern views on pathophysiology of the brain tissue damage after intracerebral hemorrhage are reviewed in the article. Primary and secondary mechanisms of destruction of perihematomal tissue are lightened. The main role of different mechanisms of brain tissue damage such as metabolic, pathophysiological, cellular and molec‑ular reactions, has been demonstrated. Recent publications of conservative intracerebral hemorrhage treatment covering pathophysiological mechanisms of the brain tissue damage have been analyzed.

Keywords: intracerebral hemorrhage, perihematomal tissue damage, treatment.

The aim – the development of an effective method of treatment for patients with reflex and compression syndromes of degenerative disc disease of the lumbar spine by manual therapy gentle techniques application.
Methods and subjects. We examined and treated 47 patients with neurological syndromes of lumbar osteochondrosis. A special neuroorthopedic, radiographic methods as well as KT- and MRI-study were performed. In the treatment of patients the specially developed method of intensive manual therapy with the application of gentle techniques was used.
Results. Applying the proposed method of intensive manual therapy with the using of gentle techniques for the treatment of compression radicular and reflex syndromes of degenerative disc disease of lumbar spine we have achieved positive results of treatment of 46 (97.87 %) patients.
Conclusions. We recommend the proposed treatment strategy with the using of intensive methods of manual therapy with the inclusion of gentle techniques for patients with reflex and compression radicular syndromes of degenerative disc disease of lumbar spine for treatment of patients in a neurological hospital. Also it makes possible to reduce the duration of treatment in hospital and earlier rehabilitation.

Keywords: osteochondrosis of the spine, manual therapy, postisometric relaxation of muscles, the spinal motor segment.

The aim – the development and introduction of neurosurgical interventions directed on the sacral tumors removing, nervous structures decompression, fixation of a spine and studying of sacral tumors surgery efficiency.
Methods and subjects. The diagnostic data, surgical treatment and its results at 23 patients with sacral tumors operated in institute of neurosurgery within 1999–2009 has been analyzed. Among them 10 patients had big tumors involving all sacral vertebrae (S1–S5), 8 – had tumors involving S1—S3 vertebrae, and 5 patients had tumors involving S3–S5 vertebrae. The fixation of spine and pelvis was performed in the 6 patients after tumor removal.
Results. Among 10 patients with big tumors of all sacral vertebrae (S1–S5) 6 patients underwent complete tumors removal, the rest patients had partial tumors removal. Among 8 patients with a tumor of S1–S3 vertebrae complete tumors removal was performed in 6 patients, 2 patients had partial removal. In all 5 patients with tumors of S3–S5 vertebrae we performed total removal of a tumor. Tumors removal as a whole block was performed only in 4 patients with tumors affected S3–S5 vertebrae. Other patients had tumors removal by piecemeal fashion. The chordomas were found in 2 patients, osteosarcomas – 1, chondrosarcomas – 3, osteoblastomas – 6, aneurismatic bone cyst – 4, giant cell tumors – 2, hemangioendotheliomas – 1, angiosarcoma – 1, plasmocytoma – 2, a metastasis of a cancer – 1. The remote supervision on the average lasted 7.9 months, the longest period of the remote supervision was 2.1 years. Data on the remote period have been received at 11 patients. Among 11 patients surveyed in the remote period relapses have been found at 6.
Conclusions. Sacral tumors treatment results and prognosis are favorable on the conditions of drastic surgery, solid intrasurgical spinal fixation with a ring, radiation therapy application during the post surgery period.

Keywords: neurosurgical treatment, sacral tumors.

The aim – to define the efficiency of integral index application as a marker of total information of electroneuromyography (ENMG) data, received at nerves of upper and lower extremities for the estimation, of the conducting treatment of patients with type 2 diabetes mellitus (DM), complicated with diabetic distal symmetric polyneuropathy (DDSP).
Methods and subjects. 61 patients with type 2 DM, complicated with DDSP have been examined. 28 of them got base therapy (I group), 33 – analogical treatment with including of native antioxidant Byocerulin (II group). The integral indexes of the ENMG data of peripheral nerves testing on ENMG «Neuro-EMG-Micro» (RF) have been estimated in a dynamics of treatment. They have been estimated by the factor analysis of ENMG indexes with the package of «StatSoft/ Statistica 6.0».
Results. Two integral indexes of ENMG testing, which include the parameters of motor and sensory nerves examination of lower and upper extremities and also F-wave of tibial and medianus nerves have been worked over. They have represented total information about nerves functional state of patients with type 2 DM, complicated with DDSP.
In 3 months in both groups a reliable dynamics of both integral indexes of ENMG peripheral nerves testing was marked (р < 0,05). In a half-year after the beginning of research, stabilizing of integral indexes was noticed in the II group, a reliable difference was marked with the initial values of indexes (р < 0,05) unlike patients of I group, integral indexes of which did not differ from information, got before thetreatment (р > 0,05).
Conclusions. The expedience of Byocerulin application in complex treatment of patients with diabetic polyneuropathy has been set. This concurs to prevention the DDSP progress, retaining the results of therapy during 6 months from the integral indexes data, afterwards it is advisable to repeat the course of analogical treatment.

Keywords: diabetic polyneuropathy, type 2 diabetes mellitus, electroneuromyography, Byocerulin.

The aim – to identify changes in the peripheral nervous system using electroneuromyography in patients with chronic pancreatitis and to establish correlations between biochemical and electrophysiological parameters.
Methods and subjects. The complex clinical neurological examination and electroneuromyographic in 20 patients with chronic pancreatitis has been performed. The average patient age was 51 ± 7.3 years. The diagnosis of chronic pancreatitis was established by a physician-gastroenterologist. The control group included 20 healthy people.
Results. Clinical signs of polyneuropathy were observed in 90% of patients with chronic pancreatitis identified.
Eelectroneuromyography revealed that in all patients with a high level of confidence a reduction in average amplitude M – response, speed of excitation and increasing the duration of residual latency were observed. Strong correlation dependence between the level of glucose and amylase in blood and electro-physiological indexes have been established.
Conclusions. In 90 % of the inspected patients with chronic pancreatitis had clinical manifestations of polyneuropathy. It has been exposed, that the involvement of peripheral nerves and formation of the mixed axonal-demyelinating polyneuropathy form were observed.

Keywords: chronic pancreatitis, polyneuropathy, electroneuromyography.

The aim – to investigate the role of immune changes in patients with dyscirculative encephalopathy (DE), exposed to low doses of ionizing radiation due to the Chernobyl accident.
Methods and subjects. The main parameters of cellular (CD3, CD4, SD8, SD16, SD22) and humoral immunity (IgG, IgA, IgM, CIC) were studied in 80 patients with DE, exposed to ionizing radiation due to the accident in Chernobyl, taking into consideration the concomitant pathology of internal organs, the level of endotoxemia, received dose of radiation, previous history of stroke, and the stage of the disease.
Results. In patients with DE parameters of cellular immunity were lower than control, the parameters of humoral immunity were higher compared with control. It indicates a violation of cooperative connections between the cells and can be a result of dysfunctional and dysregulatory disorders of immune status. Increased endotoxemia was accompanied by a tendency to reduce concentration of CD3, CD4, CD8, the increased level of CIC and activation of products IgA and IgM. The concentration of CIC increased with the extent of total radiation dose, and the level of immunoglobulin G, by contrast, decreased. The content of immunoglobulins A and M was higher than the control, but depended on the received radiation dose (IgA – decreased with the growth of the latter, IgM on the contrary, increased).
Conclusions. In patients with DE, exposed to low doses of ionizing radiation, the inhibition of T-cell level of immune protection and synthesis of IgG on the background of increased level of some indicators of humoral (IgA, IgM) immunity have been evidenced. These changes increased in cases of endotoxemia and at total dose of irradiation of 21–60 Ber. Received data confirmed the activation of some immune protection in patients with critical course of the disease, and, depression was observed with a worsening of neurological deficit.

Keywords: dyscirculative encephalopathy, immune defense, small doses of ionizing radiation.

The aim – an all-round evaluation of the immune status in patients with a verified herpesvirus neuroinfection manifesting itself as a cramp syndrome, based upon the analysis of the results, obtained in clinicoanamnestic, genealogical and laboratory investigations.
Methods and subjects. The study group consisted of 69 patients aged from 11 to 60 who verified the herpesvirus neuroinfection by means of PCR method or by the comparative serologic investigations.
Results. A high specific gravity of primary immunodeficiencies was demonstrated in patients with herpesvirus neuroinfection, manifesting the generalized tonico-clonic seizures (27 % of cases) with immunodeficiency diseases associated to hypoimmunoglobulinemia and disorders of phagocyte’s activity being mainly registered (81 % of cases). A detailed analysis of the results obtained in clinical, laboratory and instrumental investigations in this category of patients was carried out, some clinical cases were described and the ways were proposed to optimize the diagnosis and treatment at the expense of immunological examinations and therapy to be carried out.
Conclusions. The results of this study may be helpful to raise the quality of diagnosis and treatment for the human secondary epilepsy associated with herpesvirus infection.

Keywords: herpesvirus neuroinfection, epilepsy, primary immunodeficiency, immune therapy.

The aim – to investigate the level of knowledge of the proper diagnosis and treatment of patients with cognitive impairment among the general practitioners.
Methods and subjects. To investigate the level of knowledge among the clinicians on the problem of the vascular cognitive impairment we questioned 268 physicians working in the primary medical care in the city of Uzhhorod.
Results. The diagnostic criteria of the cognitive impairment were known to less then a half of the questioned physicians 46.6 %, 24.6 % did not know the criteria and 28.7 % were hard to answer the question, the majority was insufficiently informed on the current treatment opportunities for the demented patients.
Conclusions. To emphasize the problem we recommended to include the seminars on the diagnosis and treatment of the vascular cognitive impairment to the teaching program of the Department of Postgraduate Education of Uzhhorod National University and to prepare a textbook on the topic for the general practitioners.

Keywords: cognitive impairment, level of knowledge, questionnaire.

Цель — изучение осведомленности врачей поликлинического звена относительно проблемы когнитивных нарушений, их умения диагностировать и лечить этих больных.
Материалы и методы. Проведено анкетирование 268 врачей, которые ведут прием в поликлиниках г. Ужгорода.
Результаты. Установлено, что только 46,6 % опрошенных врачей знают критерии диагностики когнитивных нарушений, большинство врачей мало информированы о современных методах лечения деменции.
Выводы. Для улучшения осведомленности практикующих врачей о проблеме когнитивных нарушений в програму курсового обучения на предаттестационных циклах ФПО УжНУ рекомендовано ввести семинарские занятия по проблеме диагностики и лечения когнитивных нарушений сосудистого генеза, подготовить методическое пособие для семейных врачей и терапевтов поликлинического приема.

Keywords: когнитивные нарушения, осведомленность врачей, анкетирование.

The aim – to investigate the level of knowledge of the proper diagnosis and treatment of patients with cognitive impairment among the general practitioners.
Methods and subjects. To investigate the level of knowledge among the clinicians on the problem of the vascular cognitive impairment we questioned 268 physicians working in the primary medical care in the city of Uzhhorod.
Results. The diagnostic criteria of the cognitive impairment were known to less then a half of the questioned physicians 46.6 %, 24.6 % did not know the criteria and 28.7 % were hard to answer the question, the majority was insufficiently informed on the current treatment opportunities for the demented patients.
Conclusions. To emphasize the problem we recommended to include the seminars on the diagnosis and treatment of the vascular cognitive impairment to the teaching program of the Department of Postgraduate Education of Uzhhorod National University and to prepare a textbook on the topic for the general practitioners.

Keywords: cognitive impairment, level of knowledge, questionnaire.

The special value has a study of a problem of minimum cerebral dysfunction (MCD) for a theory and practice of medicine, as, from data of different authors, 20–40 % makes the displays of MCD children of school age.
Electroencephalography is the reliable method of paraclinic diagnostics of the central nervous system. Changes of EEG at minimum cerebral dysfunction allow to estimate accordance of maturity level of CNC to the age of a child and to discover a delay in development, make possible to estimate therapeutic efficiency of medicinal treatment. EEG enables differential diagnostics of displays of MCD (hyperkinetic disorders and epileptic hyperkinetic disorders).

Keywords: electroencephalogram, minimum cerebral dysfunction, immaturity of brain, hyperactivity.

The article presents the contemporary view on the determination of vegetative state, ethiological factor, pathogenesis and clinical data of this state. Vegetative state is one of the variant of the exit from coma, when the patient is in consciousness, but doesn't realize himself and surrounding. The different injuries of brain may be a cause of vegetative state. The specific morphological substrate for vegetative state has not been found yet. This state is clinically diagnosed, the additional method of clinical investigation does not allow to confirm the diagnosis and make prognosis of vegetative state. Some patients may exit from coma. The development of prognosis methodic of vegetative state is topical issue.

Keywords: vegetative state, coma, realization of himself and surrounding.

The article covers the pathogenic depression basis under Parkinson's disease. The mechanisms of limbic level depression, cognitive depression aspects have been observed. The literature analysis and author's research data allowed to develop the new conception – theoretical model of goal‑seeking behavior and depression in patients with Parkinson's disease.

Keywords: depression, Parkinson's disease, mesolimbic dopaminergic system, dorsolateral prefrontal cortex, amygdale, hippocampus.

The aim – to evaluate effectiveness of mononeuroprotection with сerebrolizin and combined neuroprotection with сerebrolizin and Ceraxon in the treatment of acute ischemic stroke with localization in vertebro-basilar pool.
Methods and subjects. Clinical and neurological study, CT, ultrasound dopplerography have been carried out in patients with acute ischemic stroke with localization in vertebro-basilar pool. Group 1 (n = 24) received traditional therapy with neuroprotector сerebrolizin, at group 2 (n = 24) traditional therapy was used with combined neuroprotectiv therapy with Ceraxon and сerebrolizin. Assessment of the degree of neurological deficit was performed using NIHSS scales and Rankin scale on the 1–3 and 19–21 days of stroke.
Results. The rate of reduction of neurological deficit, its severity and the statistical reliability were higher in patients with combined neuroprotection. At those patients good analysis of the dynamics of reducing the average total score on a NIHSS scale were observed.
Conclusions. Mononeuroprotection with cerebrolysin is quite efficient, though, on the basis of clinical studies and statistical analysis this method is less effective than combined neuroprotection with сerebrolizin and Сeraxon.

Keywords: ангіогенез, ішемічний інсульт, нейросудинна ніша, судинний ендотеліальний фактор росту.

The modern views on pathophysiology of the brain tissue damage after intracerebral hemorrhage are reviewed in the article. Primary and secondary mechanisms of destruction of perihematomal tissue are lightened. The main role of different mechanisms of brain tissue damage such as metabolic, pathophysiological, cellular and molec‑ular reactions, has been demonstrated. Recent publications of conservative intracerebral hemorrhage treatment covering pathophysiological mechanisms of the brain tissue damage have been analyzed.

Keywords: intracerebral hemorrhage, perihematomal tissue damage, treatment.

Статья посвящена патогенетическим основам депрессии при болезни Паркинсона. Рассмотрены механизмы депрессии лимбического уровня, когнитивные аспекты депрессии. Анализ литературы и результатов собственных исследований дал возможность авторам предложить новую концепцию — теоретическую модель целенаправленного поведения и депрессии у пациентов с болезнью Паркинсона.

Keywords: депрессия, болезнь Паркинсона, мезолимбическая дофаминовая система, дорсолатеральная префронтальная кора, миндалина, гиппокамп.

В статье рассмотрены современные взгляды на патофизиологию повреждения ткани мозга после острого внутримозгового кровоизлияния. Освещены первичные и вторичные механизмы деструкции ткани перигематомы. Показана ведущая роль метаболических, патобиохимических механизмов, клеточных реакций, молекулярных факторов повреждения ткани мозга. Проведен анализ современных научных публикаций, посвященных консервативному лечению внутримозгового кровоизлияния с учетом патофизиологических механизмов повреждения ткани мозга.

Keywords: внутримозговое кровоизлияние, повреждение ткани перигематомы, лечение.

Освещены современные взгляды на определение, этиологию, патогенез и клинические проявления вегетативного состояния (ВС), представляющего собой один из вариантов выхода из комы, при котором на фоне бодрствования у пациентов отсутствуют признаки осознания себя и окружающего. Причиной комы с последующим переходом в ВС могут быть различные поражения головного мозга. Специфичного для ВС морфологического субстрата не обнаружено. Диагноз «вегетативное состояние» устанавливают клинически, дополнительные методы исследования не позволяют подтвердить диагноз или прогнозировать исход ВС. Часть больных могут выходить из ВС. Актуальной является разработка методик прогнозирования исхода ВС.

Keywords: вегетативное состояние, кома, oсознание себя и окружающего.

Цель — исследовать роль иммунных нарушений у больных с дисциркуляторной энцефалопатией (ДЭ), подвергшихся воздействию ионизирующего излучения вследствие аварии на ЧАЭС.
Материалы и методы. Проведено исследование основных показателей клеточного (CD3, CD4, СD8, СD16, СD22) и гуморального иммунитета (IgG, IgA, IgM, циркулирующих иммунных комплексов (ЦИК)) у 80 больных с ДЭ, подвергшихся воздействию ионизирующего излучения. Учитывали наличие сопутствующей патологии внутренних органов, уровень эндотоксемии, полученную дозу облучения, инсульт в анамнезе, стадию и вариант течения заболевания.
Результаты. У больных ДЭ параметры клеточного иммунитета были ниже контрольных, а показатели гуморального звена — превышали их. Это может свидетельствовать о нарушении кооперативных связей между клетками и быть следствием дисфункциональных и дисрегуляторных нарушений иммунного статуса. Нарастание явлений эндотоксемии сопровождалось тенденцией к уменьшению концентрации CD3, CD4, CD8, повышением
содержания ЦИК и активацией продукции IgA и IgM. Концентрация ЦИК возростала по мере нарастания суммарной дозы облучения, а уровень IgG, наоборот, уменьшался. Содержание иммуноглобулинов A и M было выше контрольных показателей, но изменялось в зависимости от полученной дозы (IgА — уменьшалось по мере нарастания последней, а IgМ, наоборот, — увеличивалось).
Выводы. У больных ДЭ, подвергшихся воздействию малых доз ионизирующего облучения, установлено угнетение Т-клеточного звена иммунной защиты и синтеза IgG на фоне повышения некоторых показателей гуморального звена (IgA, IgM). Указанные изменения усиливались в случае нарастания явлений эндотоксемии и суммарной дозы облучения 21—60 бэр. Полученные данные подтвердили некоторую активацию иммунологической защиты у больных с кризисным течением заболевания и, наоборот, угнетение — у пациентов с углублением неврологического дефицита.

Keywords: дисциркуляторная энцефалопатия, иммунная защита, малые дозы ионизирующего облучения.

Цель — определить эффективность применения интегрального показателя (ИП) как маркера суммарной информации электронейромиографической (ЭНМГ) диагностики функционального состояния нервов верхних и нижних конечностей для оценки проведенного лечения у больных сахарным диабетом (СД) 2 типа, осложненным диабетической дистальной симметричной полиневропатией (ДДСП).
Материалы и методы. Обследован 61 больной СД 2 типа, осложненным ДДСП. 28 пациентов получали базисную терапию (I группа), 33 — аналогичное лечение и дополнительно антиоксидант церулоплазмин (ІІ группа). Оценивали в динамике ИП ЭНМГ-тестирования периферических нервов с помощью компьютерного электромиографа «Нейро-ЭМГ-Микро» («Нейрософт», РФ). Построение ИП проведено с помощью факторного анализа показателей ЭНМГ.
Результаты. Прорабатывали два ИП ЭНМГ-тестирования, которые включали параметры исследования моторных и сенсорных нервов верхних и нижних конечностей, а также F-волны большеберцового и срединного нервов, и отображали суммарную информацию об их функциональном состоянии у больных СД 2 типа, осложненным ДДСП. Через 3 мес в обеих клинических группах наблюдали значимую динамику обоих ИП ЭНМГ-тестирования периферических нервов (р < 0,05). Через полгода после начала исследования отмечали стабилизацию ИП во ІІ группе, а также достоверные различия с начальными значениями показателей (р < 0,05), в отличие от пациентов I группы, ИП ЭНМГ которых недостоверно отличались от данных, полученных до лечения (р > 0,05).
Выводы. Установлена целесообразность применения церулоплазмина в комплексном лечении больных диабетической полиневропатией, что позволяет предупредить прогрессирование ДДСП с сохранением результатов терапии по данным ИП ЭНМГ-тестирования в течение 6 мес, после чего рекомендуется повторить курс лечения.

Keywords: диабетическая полиневропатия, сахарный диабет 2 типа, электронейромиография, церулоплазмин.

Цель — разработать и внедрить в клиническую практику нейрохирургические вмешательства, направленные на удаление опухолей крестца, декомпрессию нервных структур, фиксацию позвоночника, а также изучить эффективность оперативного лечения опухолей крестца.
Материалы и методы. Проанализированы результаты обследования и хирургического лечения 23 больных с опухолями крестца, оперированных в Институте нейрохирургии в период с 1999 по 2009 г. Из них у 10 были большие опухоли с поражением всего крестца (S1—S5 позвонков), у 8 — были поражены верхние крестцовые позвонки (S1—S3 позвонки) и у 5 — нижние крестцовые позвонки ( S3—S5). У 6 больных после удаления опухоли выполнена пельво-люмбарная фиксация.
Результаты. Из 10 больных с большими опухолями у 6 опухоли удалены тотально, у остальных — частично. Из 8 больных с опухолью верхних крестцовых позвонков у 6 опухоли удалены тотально, у 2 — частично. У всех 5 больных с поражением нижних крестцовых позвонков проведено тотальное удаление опухоли, удаление блоком удалось выполнить только у 4 больных, у остальных — кускованием. При патогистологическом исследовании хордомы обнаружены у 2 больных, остеосаркома — у 1, хондросаркомы — у 3, стеобластокластомы — у 6, аневризматические костные кисты — у 4, гигантоклеточные опухоли — у 2, гемангиоэндотелиома — у 1, ангиосаркома — у 1, плазмоцитомы — у 2, метастаз рака — у 1. Отдаленные наблюдения в среднем составили 7,9 мес, наибольший период отдаленных наблюдений — 2,1 года. Сведения об отдаленном периоде получены у 11 больных, рецидивы обнаружены у 6.
Выводы. Результаты лечения и прогноз относительно опухолей крестца благоприятны только при условии выполнения радикальных операций, надежной интраоперационной фиксации позвоночника с тазовым кольцом, применения лучевой терапии в послеоперационный период.

Keywords: нейрохирургическое лечение, sacral tumors.

Цель — разработать эффективный метод интенсивного лечения больных с рефлекторными и компрессионными синдромами остеохондроза поясничного отдела позвоночника с использованием «мягких» методик мануальной терапии.
Материалы и методы. Обследовано и пролечено 47 больных с неврологическими синдромами поясничного остеохондроза позвоночника. Обследование проводили с помощью специальных нейроортопедических, рентгенологических методов, а также компьютерной и магнитно-резонансной томографии. В лечении пациентов использовали специально разработанный метод интенсивной мануальной терапии.
Результаты. Применяя метод интенсивной мануальной терапии для лечения рефлекторных и компрессии онных корешковых синдромов остеохондроза поясничного отдела позвоночника, мы добились положительных результатов лечения у 46 (97, 87 %) больных.
Выводы. Мы рекомендуем разработанную лечебную тактику для лечения больных с рефлекторными и компрессионными корешковыми синдромами остеохондроза поясничного отдела позвоночника в условиях неврологического стационара, что будет способствовать сокращению сроков лечения в стационаре и более раннему восстановлению трудоспособности.

Keywords: остеохондроз позвоночника, мануальная терапия, постизометрическая релаксация мышц, позвоночный двигательный сегмент.

Цель — оценить эффективность мононейропротекции церебролизином и комбинированной нейропротекции церебролизином и Цераксоном в лечении острого ишемического инсульта (ОИИ), локализованного в вертебробазилярном басейне (ВББ).
Материалы и методы. Проведено клинико-неврологическое исследование и применены компьютерная томография и УЗДГ у больных с ОИИ в ВББ. 1-я группа (n = 24) получала традиционную терапию и нейропротектор церебролизин; 2-я (n = 24) — традиционную терапию и комплексную нейропротекцию церебролизином и Цераксоном. Оценку неврологического дефицита и степень восстановления утраченных функций проводили с использованием шкал NIHSS и Ренкина на 1-е—3-и и 19—21-е сутки инсульта.
Результаты. Скорость редукции неврологического дефицита была выше у больных на фоне комбинированной нейропротекции, что подтвердждается динамикой снижения среднего суммарного балла по шкале NIHSS.
Выводы. Мононейропротекция с использованием церебролизина является менее эффективной, чем комбинированная нейропротекция церебролизином и Цераксоном.

Keywords: ишемический инсульт, нейропротекция, церебролизин, Цераксон.