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. We 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. Physicians 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.
{"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}
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. Methods 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. The 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. Results. 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. Conclusions. The identified patterns should be taken into account when developing treatment, rehabilitation and preventive measures for patients with CS.
目的:研究心脏手术(CS)中各种形式的神经和缺血性并发症患者的认知功能障碍特征，并考虑在制定这类患者的康复计划中获得的数据。方法和对象。我们检查了700名在乌克兰卫生部心脏研究所接受人工循环CS手术后治疗的患者。样本量非常大，因此有可能将结果转移到患有CS的整个患者群体。在检查的患者中确定了以下组:a)术后期脑梗死(CI)患者86人，将该组患者的表现与术后期无心肌梗死的CS患者(同一样本中取614人)进行比较;b)有术后脑病体征的患者，217人(包括CI患者)。将该组患者的表现与来自同一样本的483例无术后脑病体征的CS患者的表现进行比较。本研究采用Trail Making Test (R. M. Reitan, Wolfson D.， 1993);语言流畅性测试(M. D. Lezak, 1995);Stroop颜色干涉试验(J. R. Stroop, 1935);Luria的十个不相关单词记忆测试(Luria AR, 1969)。采用非参数Mann - Whitney检验对指标定量值的差异进行统计分析。结果。我们的研究发现CS患者存在显著的认知障碍。研究发现，术后出现缺血性和神经系统并发症会严重损害患者的认知功能。对认知领域最显著的负面影响是术后CI的存在:CI患者表现出严重的认知缺陷迹象。术后脑病患者也有认知功能障碍的表现，但该组患者的认知功能定量指标优于CI患者。结论。在为CS患者制定治疗、康复和预防措施时，应考虑到已确定的模式。
{"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}
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. Treatment 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.
{"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}
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. Methods 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. Results. 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). Conclusions. 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
目的:分析MS患者丘脑体积变化与MS临床病程特征、疼痛综合征特征、患者生活质量之间的关系，并评价利用丘脑体积变化客观化这些特征的可能性。方法和对象。17名确诊为多发性硬化症的患者在利沃夫地区多发性硬化症中心接受了检查。收集患者的投诉和记忆，分析医疗记录，并对患者进行神经学和一般医学检查。SF - 36问卷用于评估生活质量。使用HADS问卷来评估焦虑和抑郁。采用疼痛检测、VAS和SF - MPQ - 2问卷评估疼痛综合征的特征。进行核磁共振扫描，然后用VolBrain算法进行处理，进一步分析丘脑体积。样本年龄中位数为37.0 [35.0;46.0)年。其中女性占82.35%，男性占17.65%。病程0 ~ 25年，中位数为12 [5.0];18.0)年。EDSS量表评分为3.5分[3.0分;4.0]。患者史检查前MS复发的中位数为12.0 [8.0;18.0]。MS病程特征分析显示，一般复发次数增加(rs = -0.728, p = 0.001)和3年以上复发次数增加(rs = -0.557, p = 0.020)与丘脑体积减少相关，而与最近一年复发次数、MS病程和EDSS评分无相关性。在分析与疼痛特征的关系时，发现左右丘脑的不对称性与疼痛的神经性成分(疼痛检测评分)有统计学意义(rs = -0.519, p = 0.037)。左右丘脑体积的增加与平均疼痛强度(VAS评分)和神经性疼痛成分(SF - MPQ - 2评分)的增加也有统计学意义。左右丘脑之间的不对称与生活质量的物理组成部分的下降(rs = -0.679, p = 0.003)，即身体功能等特征的下降(rs = -0.697, p = 0.002)有明显的关系。此外，身体功能与丘脑体积(rs = +0.509, p = 0.037)，即左侧丘脑(rs = +0.592, p = 0.012)有显著关系。丘脑体积的变化是评估MS进展、疼痛特征和MS患者生活质量的一个有希望的标志物。多发性硬化症患者丘脑体积的减少可以被认为是多发性硬化症进展的标志(一般加重次数和近年来加重次数)。较高的平均疼痛强度和疼痛的神经性成分与MS患者较少的左右丘脑萎缩有关。MS患者的丘脑体积在左侧丘脑体积相对于右侧丘脑体积减少的方向上的不对称性可以被认为是生活质量的物理成分减少的预测因素，特别是身体功能。
{"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}
Objective — to study the features of clinical symptoms of progressive muscular dystrophies (PMD) in children and to improve their clinical diagnostic algorithm. Methods 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. Results. 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. Conclusions. Treating a patient according to international standards will help stop the process of muscle atrophy with a timely diagnosis.
目的:探讨儿童进行性肌营养不良症(PMD)的临床症状特点，提高其临床诊断水平。方法和对象。研究人员对三组儿童进行了检查:33名儿童患有2至16岁的杜氏PMD, 7名儿童患有3个月至16岁的腰骶肌营养不良，19名儿童患有3个月至16岁的脊髓性肌萎缩。病程从3个月到12年不等。患者接受临床和神经学检查以确定主要临床综合征。运动功能在统一的尺度上进行评估。根据获得的数据，客观地确定活动运动和肌肉力量的丧失程度。采用NSA (North Star动态评估工作表)量表、6分钟步态测试和其他功能测试对运动动力学进行评估。I型脊髓性肌萎缩症患者采用CHOP - intention和HINE2量表，II型和III型儿童采用运动功能量表(MFM)、Hammersmith、RULM等量表。血液生化分析测定血中肌酸磷酸激酶和乳酸脱氢酶的水平。仪器研究方法被使用(神经肌电图，脊柱放射成像在两个投影)，在某些情况下-磁共振成像应用。最后阶段为分子遗传学诊断和临床诊断的验证。在最终诊断后，根据国际护理协议，为Duchenne PMD患者开处方联合治疗(激素(皮质类固醇)和物理治疗)。病人正在接受监测。结果。完整的病史记录，及时发现疾病的首发症状并评估其动态，分析神经系统症状对于确认PMD的诊断非常重要。鉴于各种形式的PMD在发病时具有相似的临床症状，确认诊断还需经过一定阶段的研究。只有在对儿童的一般临床、仪器和实验室检查结果进行评估后，才能进行分子遗传学诊断。及时澄清PMD的临床诊断，特别是杜氏型，有助于证明糖皮质激素和疾病修饰治疗的合理性。结论。按照国际标准治疗患者将有助于及时诊断，阻止肌肉萎缩的进程。
{"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}
Y. Flomin, S. O. Malyarov, V. Guryanov, L. Sokolova
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. Methods 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. Results. 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
{"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}
K. Antonenko, Y. Flomin, A. Antonenko, L. Vakulenko, L. Sokolova
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. Leading 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. It 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.
{"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}
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. The 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.
{"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}
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. Methods 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. Results. 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
{"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}
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.
{"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}
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