Ukrainian Neurological Journal最新文献

{"title":"Wernicke encephalopathy after chronic pancreatitis exacerbation. Case report","authors":"Nagla Elimam, L. Panteleienko","doi":"10.30978/unj2022-1-60","DOIUrl":"https://doi.org/10.30978/unj2022-1-60","url":null,"abstract":"Wernicke encephalopathy (WE), is an emergency acute neuropsychiatric condition, which develops secondary to thiamine deficiency. According to data of multiple investigations, this disorder is greatly underdiagnosed. WE classically connected to chronic alcohol abuse, but also diagnosed in non‑alcoholic patients with different risk factors including severe vomiting, chronic malnutrition, systemic infections, malignancies, chemotherapy, HIV/AIDS, gastrointestinal surgeries or disease, and renal problems. \u0000We present a case of a 33‑year‑old woman with history of chronic pancreatitis exacerbation with prolonged vomiting, present to the neurological department with neurological symptoms consistent with WE. WE was suspected according to triad of symptoms, such as altered mental state, oculomotor disturbances and ataxia. Brain magnetic resonance imaging (MRI) and thiamine blood level aid us to confirm WE diagnosis. The patient was given thiamine, at the dosage of 200 mg 3 times per day intravenously for seven days, followed by oral thiamine. Gaze paresis disappeared at day 10, truncal ataxia noticeably improved after two weeks. The patient was left with some signs of anterograde amnesia, gaze‑provoked nystagmus at the two month follow‑up. \u0000Physicians should be familiar with clinical presentation of WE in non‑alcoholic patients with appropriate history and risk factors, like prolonged emesis, unbalanced diet, malignancies, etc. Presence of classic triad of clinical symptoms and pathological findings on brain MRI are the most important diagnostic tool, while the blood thiamine level may be within the normal range. Early diagnosis and therapy onset are crucial for patients to prevent further irreversible complications or death. \u0000 ","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127884409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of cognitive disorders in patients with different forms of neurological and ischemic complications who underwent cardiac surgery","authors":"Dmytro Mankovsky","doi":"10.30978/unj2022-1-17","DOIUrl":"https://doi.org/10.30978/unj2022-1-17","url":null,"abstract":"Objective — to study the features of cognitive impairment in patients with various forms of neurological and ischemic complications who underwent cardiac surgery (CS), to consider the data obtained in the development of rehabilitation programs for this category of patients. \u0000Methods and subjects. We examined 700 patients who were treated at the Heart Institute of the Ministry of Health of Ukraine after undergoing CS with an artificial circulation procedure. The sample size is extremely large, and makes it possible to transfer the results to the entire population of patients who have suffered from CS. Among the examined patients the following groups were identified: a) patients with cerebral infarction (CI) in the postoperative period, numbering 86 people, the performance of patients in this group was compared with patients with CS without myocardial infarction in the postoperative period, numbering 614 people taken from the same sample); b) patients with signs of postoperative encephalopathy, numbering 217 people (which included patients with CI). The performance of patients in this group was compared with that of 483 patients with CS without signs of postoperative encephalopathy, taken from the same sample. \u0000The study was conducted using the Trail Making Test, TMT (R. M. Reitan, Wolfson D., 1993); Verbal Fluency Test, VFT (M. D. Lezak, 1995); Stroop Color Interference Test (J. R. Stroop, 1935); Luria’s test for memorizing ten unrelated words (Luria AR, 1969). Statistical analysis of differences in the quantitative values of indicators was performed using the nonparametric Mann‑Whitney test. \u0000Results. Our study found significant cognitive impairment in patients with CS. It was found that the presence of ischemic and neurological complications in the postoperative period significantly impairs cognitive function. The most significant negative impact on the cognitive sphere has the presence of CI in the postoperative period: patients with CI showed signs of severe cognitive deficits. Manifestations of cognitive deficits were also found in patients with postoperative encephalopathy, although the quantitative indicators characterizing cognitive functioning in this group of patients were better than in patients with CI. \u0000Conclusions. The identified patterns should be taken into account when developing treatment, rehabilitation and preventive measures for patients with CS. \u0000 ","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126135291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent toxoplasma chorioretinitis in a patient with a selective deficiency of NKT cells and CD8+ cytotoxic T lymphocytes associated with a genetic deficiency of the folate cycle. Case report","authors":"D. Maltsev, O. Hurzhii","doi":"10.30978/unj2022-1-54","DOIUrl":"https://doi.org/10.30978/unj2022-1-54","url":null,"abstract":"This article describes a case study of recurrent Toxoplasma chorioretinitis in a young patient with cell immunodeficiency. Patient K., 37 years old, was admitted to ophthalmologist with complaints of decreased visual acuity and discomfort in the left eye. The history of the disease evidenced  that he had suffered at least 2 episodes of acute posterior uveitis in the past without finding out the etiological factor. Ophthalmological examination revealed an old scar on the retina of the right eye and signs of acute vitreous and chorioretinitis around the old scar on the retina of the left eye. By applying the method of paired sera, it was possible to establish the etiological factor of ophthalmic lesions — Toxoplasma gondii. Assessment of immune status demonstrated selective deficiency of CD8+ cytotoxic T lymphocytes and NKT cells. Obvious causes of secondary immunosuppression, including HIV, were ruled out. The Genetic Panel «Primary Immunodeficiencies» with sequencing of more than 400 genes of known primary human immunodeficiencies did not reveal pathology. However, persistent hyperhomocysteinemia was noted, and a genetic test for folate deficiency was performed. MTHFR A1298C in the heterozygous state and MTRR A66G in the homozygous state were detected, which was associated with the detected cell immunodeficiency, taking into account the results of studies on immune status in folic acid metabolism disorders and reports of severe opportunistic infections in humans with genetic deficiency of folate cycle. \u0000Treatment included spiramycin at a dose of 3 million IU orally three times a day for 14 consecutive days (to inhibit Toxoplasma), recombinant human a2b interferon at a dose of 3 million IU i/m every other day at night №15 (to compensate for the deficiency of NKT cells and CD8+ cytotoxic T lymphocytes), oxodihydroacridinylacetate sodium 2 mL i/m every other day at night №15, alternating with interferon (to compensate for the deficiency of NKT cells and CD8+ cytotoxic T lymphocytes) and local peribulbar injections of betamethasone № 3 (to eliminate the inflammation in the left eye). Improvement in visual acuity was observed on day 8 of treatment, and recovery of left eye function was observed at the end of the month of therapy. Due to the additional three‑month courses of recombinant human alpha2b‑interferon to compensate cell immunodeficiency, which were carried out during the next 2 years of  follow‑up, it was possible to prevent further recurrence of toxoplasma invasion. \u0000 ","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121290812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thalamus volume reduction and asymmetry as markers of MS progression, pain characteristics and low quality of life in patients with multiple sclerosis","authors":"M. Bozhenko, T. Nehrych, A. Bachun","doi":"10.30978/unj2022-1-34","DOIUrl":"https://doi.org/10.30978/unj2022-1-34","url":null,"abstract":"Objective — to analyze the relationship between changes in thalamic volumes in patients with MS with the characteristics of the clinical course of MS, pain syndromes, and patient’s quality of life and to evaluate the possibility of using changes in thalamic volumes to objectify these characteristics.\u0000Methods and subjects. 17 patients with a confirmed diagnosis of multiple sclerosis were examined at the Lviv Regional Multiple Sclerosis Center. Complaints and anamnesis were collected, medical documentation was analyzed and neurological and general medical examination of patients was performed. The SF‑36 questionnaire was used to assess the quality of life. The HADS questionnaire was used to assess anxiety and depression. Characteristics of pain syndromes were evaluated using Pain Detect, VAS, and SF‑MPQ‑2 questionnaires. MRI scans were performed, followed by processing with the VolBrain algorithm with further analysis of thalamic volumes.\u0000Results. The median age in the sample was 37.0 [35.0; 46.0] years. Among patients there were 82.35 % women, and 17.65 % men. The disease duration was from 0 to 25 years, the median was 12 [5.0; 18.0] years. EDSS scale score was 3.5 [3.0; 4.0]. The median number of MS relapses before the time of examination in the history of patients is 12.0 [8.0; 18.0]. Analysis of the MS course characteristics showed that the increase in the number of relapses in general (rs = –0.728, p = 0.001) and relapses over 3 years (rs = –0.557, p = 0.020) were associated with a decrease in thalamic volume, while the relationship with the number of relapses in the last year, duration of MS and EDSS score were not found. When analyzing the relationship with pain characteristics, a statistically significant correlation (rs = –0.519, p = 0.037) of asymmetry between the right and left thalamus and the neuropathic component of pain (Pain Detect score) was found. There were also statistical significance between an increase in right and left thalamic volumes and an increase of pain intensity (VAS score) in average and the neuropathic pain component (SF‑MPQ‑2 score). The asymmetry between the right and left thalamus had a pronounced relationship with a decrease in the physical component of quality of life (rs = –0.679, p = 0.003), namely its characteristics such as physical functioning (rs = –0.697, p = 0.002). Also, physical functioning has a significant relationship with the volume of the thalamus (rs = +0.509, p = 0.037), namely the left thalamus (rs = +0.592, p = 0.012).\u0000Conclusions. Changes in the thalamic volumes are a promising marker for assessing MS progression, pain characteristics, and quality of life in MS patients. Decreased thalamic volume in MS patients can be considered a marker of MS progression (the number of exacerbations in general and the number of exacerbations in recent years). Higher average pain intensity and the neuropathic component of pain are associated with less right and left thalamuses atrophy in MS patients. The asy","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114341465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Approach to a problem of the progressive muscular dystrophies in children: modern clinic-diagnostic algorithm","authors":"V. Svystilnyk, M. Trishchynska, T. Golovchenko","doi":"10.30978/unj2022-1-41","DOIUrl":"https://doi.org/10.30978/unj2022-1-41","url":null,"abstract":"Objective — to study the features of clinical symptoms of progressive muscular dystrophies (PMD) in children and to improve their clinical diagnostic algorithm. \u0000Methods and subjects. Three groups of children were examined: 33 children with Duchenne PMD aged 2 to 16 years, 7 — with lumbosacral forms of muscular dystrophies aged 3 months to 16 years and 19 — with spinal muscular atrophy aged 3 months to 16 years. The duration of the disease ranged from 3 months to 12 years. Patients underwent clinical and neurological examination to determine the leading clinical syndromes. Motor functions were evaluated on unified scales. Based on the obtained data, the degree of loss of active movements and muscle strength was objectively determined. Assessment of motor dynamics was performed using the NSA (North Star Ambulatory Assessment Worksheet) scale, the 6‑minute gait test, and other functional tests. CHOP — INTEND and HINE2 scales were used in patients with type I spinal muscular atrophy, and Motor Function Measure (MFM), Hammersmith, RULM, etc. scales were used in children with type II and III. Blood biochemical analysis was also performed to determine the level of creatine phosphokinase and lactate dehydrogenase in the blood. Instrumental research methods were used (electroneuromyography, spinal radiography in two projections), in some cases — magnetic resonance imaging was applied. The last stage was molecular genetic diagnosis and verification of clinical diagnosis. After the final diagnosis, patients with Duchenne PMD were prescribed combination therapy (hormonal (corticosteroids) and physiotherapy) according to an international care protocol. Patients are being monitored. \u0000Results. Complete history taking, timely detection of the first symptoms of the disease and assessment of their dynamics, analysis of neurological symptoms are important for confirming the diagnosis of PMD. Given the similar clinical symptoms in the onset of various forms of PMD to confirm the diagnosis should follow a certain stage of research. Molecular genetic diagnostics should be performed only after evaluation of the results of general clinical, instrumental and laboratory examination of the child. Timely clarification of the clinical diagnosis of PMD, in particular Duchenne forms, helps to justify the appointment of glucocorticosteroids and disease‑modifying therapy. \u0000Conclusions. Treating a patient according to international standards will help stop the process of muscle atrophy with a timely diagnosis. \u0000 ","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133177110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment and prediction of affective disorders in patients after cerebral stroke using modern measurement scales","authors":"Y. Flomin, S. O. Malyarov, V. Guryanov, L. Sokolova","doi":"10.30978/unj2022-1-24","DOIUrl":"https://doi.org/10.30978/unj2022-1-24","url":null,"abstract":"Objective — to analyze the results of scale‑based assessments of post‑stroke depression (PSD) and post‑stroke anxiety disorders (PSAD) in different phases of cerebral stroke (CS) as well as to determine independent predictors of PSD at discharge from the Stroke Center (StC), and to evaluate the characteristics of the respective predictive models.\u0000Methods and subjects. Two hundred patients, including 92 (46.0 %) women and 108 (54.0 %) men with the median age of 65.6 years (IQR 58.2 — 75.1) were enrolled. The health status of all patients was assessed after hospitalization using the National Institutes of Health Stroke Scale (NIHSS), Barthel Index, Modified Rankin Scale, Mini‑Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). 172 (86.0 %) patients were diagnosed with ischemic stroke (IS), 28 (14.0 %) — intracerebral hemorrhage. Among patients with IS, 58 (33.7 %) had an atherothrombotic subtype, 85 (49.4 %) had a cardioembolic subtype, 16 (9.3 %) had a lacunar subtype, 13 (7.6 %) had another or unknown subtype. The PSD and PSAD were assessed using the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ‑9) before discharge from the Stroke Center. The impact of factors was assessed by odds ratio (OR) and its 95 % confidence interval (95 % CI). The method of constructing and analyzing logistic regression models was used to determine independent predictors of PSD at discharge.\u0000Results. The baseline NIHSS score ranged from 1 to 29. The mRS scores upon admission were from 1 to 5, and the BI scores from 0 to 100. Forty‑one (20.5 %) patients were admitted in the hyperacute period, 55 (27.5 %) in the acute period, 68 (34.0 %) in the early subacute period, 13 (6.5 %) in the late subacute period, and 23 (11.5 %) in the chronic phase of stroke. The HADS‑D score ranged from 0 to 18, and the HADS‑A score from 0 to 15. PHQ‑9 scores ranged from 0 to 21. Based on the HADS score, 19 (9.5 %) of the patients had clinically significant PSD and 16 (8.0 %) of the participants had clinically significant PSAD. According to the total HADS score, 22 (11.0 %) of the patients had clinically significant affective disorders. With PHQ‑9 showed that clinically significant PSD was detected in 45 (22.5 %) patients. The HADS and PHQ‑9 scores had a strong positive significant correlation, but neither of them correlated with the age or sex of the patients, the subtype or severity of CS. However, univariate analysis showed that the risk of clinically significant PSD at discharge (according to HADS‑D) was significantly directly related to age and atrial fibrillation in addition to inverse relationship with the BI, MMSE and MoCA scores, LA subtype of IS and ICH. The risk of moderate to severe PSD (according to PHQ‑9) had a statistically significant direct corelation with the initial NIHSS score, as well as an inverse corelation with the baseline BI, MMSE, and MoCA scores. In multivariate analysis, 4 features were independently ass","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"20 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121015811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial fibrillation as a risk factor of cognitive impairment. Review","authors":"K. Antonenko, Y. Flomin, A. Antonenko, L. Vakulenko, L. Sokolova","doi":"10.30978/unj2022-1-5","DOIUrl":"https://doi.org/10.30978/unj2022-1-5","url":null,"abstract":"Atrial fibrillation (AF) and cognitive impairment (CI) are now common problems, especially among the elderly. Numerous studies in recent years demonstrated the relationship between AF and CI, including dementia. Given the increasing prevalence of AF with age and aging, the number of people with CI is prognosed to increase.\u0000Leading pathogenetic factors that play a role in the development of CI in AF include focal lesions (macro‑ and microinfarctions, microhemorrhages), cerebral hypoperfusion and systemic inflammatory response. Asymptomatic (hidden, or «silent») cerebral infarcts, which are an accidental finding during neuroimaging, are more common than manifest cerebral strokes and are associated with CI. In patients with AF they are found more often than in people without AF, so, according to many researchers, AF is a significant factor in their occurrence.\u0000It should be emphasized that CI, dementia and brain aging can be prevented. Healthy lifestyles (special attention to a healthy diet, adequate physical activity and normal body weight) and proper treatment of vascular risk factors such as hypertension, diabetes mellitus, hypercholesterolemia and AF are of the utmost importance for maintaining healthy brain. Recent studies have shown the advantage of direct oral anticoagulants over warfarin in preventing the development of CD in patients with AF. Promising areas of research are the study of new (including genetic) biomarkers of high risk of KR, comparison of direct oral anticoagulants to determine optimal prevention of KR, increase patient adherence to therapy, the use of non‑pharmacological strategies to maintain sinus rhythm.\u0000 ","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125730208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of acute post-infection demyelinating disease. Case-study","authors":"M. Shorobura, T. Nehrych, N. Bozhenko, N. Negrych","doi":"10.30978/unj2022-1-47","DOIUrl":"https://doi.org/10.30978/unj2022-1-47","url":null,"abstract":"For almost 2 years, the SARS­CoV­2 pandemic has had a profound impact on the world of medicine and research. Research excitement caused by the new SARS­CoV­2 coronavirus may stimulate the study of demyelinating diseases (multiple sclerosis, acute disseminated encephalomyelitis acute), conversely, deepening our knowledge of the pathogenesis of demyelination and its association with viral infections may lead to studies in the immunopathogenesis of COVID­19. Technological advances that have been rapidly mastered to combat SARS­CoV­2 may soon be used to address multiple sclerosis. A striking example is the potential use of mRNA­based technology to develop tolerant vaccines that suppress CNS autoimmunity. Clinical trials are already underway to evaluate IFN­B, fingolimod, dimethyl fumarate, and masitinib (a tyrosine kinase inhibitor that is effective in phase 3 studies for primary progressive multiple sclerosis) as potent inhibitors of coronavirus. \u0000The study presents a clinical case of acute disseminated encephalomyelitis (ADEM) associated with SARS­CoV­2 in a 39­year­old woman who was examined and treated at the Lviv Regional Clinical Hospital. The woman complained of severe dizziness, periodic numbness of the tongue, and snowlines of speech. From the anamnesis, it is known that from 07.05.2020 to 20.05.2020 she was treated for confirmed COVID19 infection in the Lviv Regional Infectious Diseases Hospital. Her condition was of moderate severity, she received an oxygen therapy. Neurological manifestations are horizontal nystagmus in both directions, high tendon and periosteal reflexes on all limbs, bilateral Babinski’s symptom, intentional tremor when performing a finger test on both sides. The diagnosis of demyelinating disease (possibly caused by COVID19) was established on the basis of serological studies (polymerase chain reaction to SARSCoV2), clinical findings, magnetic resonance imaging (multiple supra and infratentorial focal lesions of the white matter of the brain). The positive use of corticosteroids in the treatment of acute diffuse encephalomyelitis associated with SARSCoV2 has been reported. Thus, accurate diagnosis and timely treatment of acute demyelinating disease caused by SARSCoV2 virus are of great clinical importance. \u0000 ","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114068851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical neurological manifestations in patients suffering from peptic ulcer disease in the acute phase and in remission","authors":"O. V. Demydas","doi":"10.30978/unj2021-3-49","DOIUrl":"https://doi.org/10.30978/unj2021-3-49","url":null,"abstract":"Objective — to analyze clinical neurological manifestations in patients suffering from peptic ulcer disease in the acute phase and in remission, based on the findings of a comprehensive clinical neurological, neuropsychological and paraclinical study.\u0000Methods and subjects.  84 patients suffering from PUD were comprehensively examined while in the acute phase of the disease and then all 84 were reexamined while in remission. The age range of the patients was from 25 to 60 years. The average age of the patient was 39.90 ± 1.29 years. The examined individuals were destributed into two groups based on whether they presented symptoms of an acute phase or remission of the peptic ulcer disease. The comprehensive examination included: interview and complaint analysis, neurological examination focused on the state of the autonomic nervous system, study of the neuropsychological differences (the trait and state anxiety levels monitoring based on the Spielberg‑Khanin scale, depressive state evaluation using Beck Depression Inventory, self‑perceived health assessment, mood and activity monitoring using the SAN questionnaire, cognitive impairment evaluation using the MMSE scale, assessment of the refocusing speeds and performance distribution using Schulte tables), as well as lab tests and procedures.\u0000Results. Most often, subjects complained of headache (74 (88.0 %) in the acute stage and 37 (44.0 %) in remission). The second most common was a complaint of pain in the thoracic spine (69 (82.1 %) and 35 (41.6 %), respectively). Complaints of dizziness, pain in the heart, palpitations, «interruptions» in the heart, paresthesia were often recorded. In 11 (12.4 %) patients with duodenal ulcer in the acute stage experienced episodes of syncopal state, while in the remission stage they were absent. Complaints that indicated the presence of psychoemotional disorders were anxiety, decreased memory and attention, and sleep disturbances. In patients with duodenal ulcer disease we revealed lesions of the central and peripheral nervous system. Central nervous system disorders were manifested in the form of vestibulo‑cerebellar syndrome (in 30 (35.7 %) patients in the acute stage and in 14 (16.6 %) in the remission stage), extrapyramidal disorders (respectively in 10 (11.9 %) and 4 (4.76 %)) and signs of pyramidal dysfunction (37 (44.0 %) and 15 (17.8 %)). Clinical and neurological examination of the peripheral nervous system in 68 (80.9 %) patients with peptic ulcer in the acute stage and in 31 (36.9 %) in the remission stage revealed polyneuropathy syndrome of varying degrees. Signs of polyneuropathy were accompanied by complaints of disorders of the peripheral nervous system (45 (53.5 %) and 15 (17.8 %) cases, respectively). In 27.4 % of patients with peptic ulcer disease in the acute stage of the complaint were absent at all, and only a thorough neurological examination revealed signs of polyneuropathy. In 56 (66.6 %) patients with peptic ulcer disease in the acute st","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115501750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic depression: the case of Frederic Chopin","authors":"V. Berezutskyi, M. Berezutska","doi":"10.30978/unj2021-3-61","DOIUrl":"https://doi.org/10.30978/unj2021-3-61","url":null,"abstract":"Psychological disorders caused by the doctor’s rash words are as common as the side effects of drug. Iatrogenic depression caused by ethical and psychological mistakes of doctors will never go away. Their frequency can be reduced only by improving the physicians’ skills in the fields of medical ethics and psychology. A clinical case analysis based on a famous person’s history of the disease is an effective pedagogical tool. The study aims to present the case of the famous Polish composer Frederic Chopin. The A comparative analysis of doctors’ objective actions and patients’ subjective evaluations of their actions were made based on a study of Chopin’s and Sand’s letters as well as the works of composer’s biographers. This approach provides a valuable opportunity to see doctors through the patient’s eyes. In the fall of 1838, during his rest in Majorca, the local doctors diagnosed pulmonary tuberculosis in Chopin. The Majorcan doctors made a serious ethical mistake. They ignored the patient’s anamnesis vitae indicating his phthisiophobia and informed Chopin about the diagnosis of pulmonary tuberculosis and a poor prognosis in a very cynical manner. Chopin wrote: ‘One (doctor) said I had died the second that I am dying, the 3rd that I shall die’. Chopin perceived the diagnosis of tuberculosis as a ‘death sentence’, as a result of which he developed iatrogenic depression. All previous and subsequent Chopin’s doctors used other tactics: they prescribed the correct treatment, but the diagnosis was not voiced. The analysis shows the effectiveness of this tactic: Chopin lived another 10 years after the Majorcan episode. Chopin’s case shows typical doctors’ ethical and psychological issues in informing the patient about the dangerous diagnosis and poor prognosis as well as tactics for building a good physician‑patient relationship.","PeriodicalId":296251,"journal":{"name":"Ukrainian Neurological Journal","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127297306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}