Hyperkinetic movements (HM) as the sole or leading syndrome in the onset of stroke is observed in less than 1% of stroke cases and can lead to diagnostic difficulties, disrupting routing and delaying the administration of reperfusion therapy.

Four observations are presented: two with acute development of hemichorea/hemiballismus and one each with recurrent transient episodes of myoclonus and spastic torticollis. According to neuroimaging data, in patients with hemichorea/hemiballismus, the foci were located in the anterior parts of the corona radiata in the projection of the descending pathways from the cortex to the striatum and in the putamen. In a patient with spastic torticollis, the focus was in the thalamus. In a patient with recurrent myoclonic hyperkinesis, no changes in perfusion (CBV and Tmax) were found during hyperkinesis, but computed tomography revealed post-stroke cysts in the right somatosensory area and in the right hemisphere of the cerebellum.

The occurrence of HM may be caused not only by structural changes, but also by functional disorders of the neural networks involved in the integration of motor activity.

Objective: to evaluate the functional outcomes of ischemic stroke (IS) depending on the level of biological markers of inflammation in blood serum in patients who had undergone coronavirus infection (CI) COVID-19.

Material and methods. The study included 80 patients with IS, 58 of whom had documented CI no later than 4 months prior to inclusion in the study. The comparison group consisted of 22 patients with IS who had not had any infectious diseases in the previous 4 months. The pathogenetic subtype of IS was determined according to the generally accepted SSS-TOAST classification. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcome was assessed using the modified Rankin Scale (mRS). In addition to routine laboratory tests, serum concentrations of a number of cytokines were determined in all patients using enzyme-linked immunosorbent assay. The list of measured parameters included interleukin 6 (IL6), monocyte chemoattractant protein 1 (MCP1), and interferon gamma (IFNγ). Only patients who did not receive thrombolytic therapy for various reasons were included in the study.

Results. In the main group, the proportion of patients with an unfavourable outcome (mRS ≥3) was 69%, while in the comparison group it was 23%. In all patients with IS who had COVID-19, a significant increase in the levels of leading mediators of the pro-inflammatory cytokine cascade, such as IL6 (p<0.05), MSP1 (p<0.05), acute phase proteins – CRP (p<0.05) and ferritin (p<0.05) was recorded in the peripheral bloodstream. These processes are observed against the background of a decrease in IFNγ content (p<0.05).

Conclusion. Patients with IS who have had COVID-19 have higher mRS scores at discharge, accompanied by elevated serum inflammatory markers. Given the results obtained, the most likely mechanisms for this effect may be systemic inflammation and endothelial dysfunction induced by COVID-19, as well as hypercoagulability syndrome, which contributes to a more severe course of stroke.

Professional stress is a key factor in the development of emotional burnout syndrome (EBS), which is particularly prevalent among psychiatrists. The nosological status of EBS is undefined. Studies shows that emotional burnout is conceptually linked to anxiety and depressive disorders.

Objective: analysis of clinical manifestations of EBS by psychiatrists.

Material and methods. The study involved 126 psychiatrists working in Moscow psychiatric hospitals. Respondents completed the Maslach Burnout Inventory (MBI) and the Hospital Anxiety and Depression Scale (HADS). Multiple logistic regression was used. Critically high values in the MBI and its subscales served as dependent variables. The predictors were HADS values, age, and gender of the respondents.

Results. The prevalence of EBS in the study sample was 26.2%, with 14.3% experiencing severe forms. Significant levels of depression and anxiety were demonstrated by 50.8% and 42.9% of respondents, respectively. Established EBS was described by an increase in anxiety [odds ratio (OR) 1.51; 95% confidence interval (CI) 1.30–1.82], the presence of a critical level of depression (OR 10.86; 95% CI 3.47–41.43); and male gender as a factor preventing EBS (OR 0.33; 95% CI 0.10–0.95). Severe EBS was described as a combination of critical levels of anxiety and depression (OR 11.02; 95% CI 3.63–36.76); with age, the chances of severe EBS decreased (OR 0.95; 95% CI 0.90–1.00). Emotional exhaustion as a symptom of EBS was most fully described by the level of anxiety, and ‘depersonalisation’ by the level of depression. Reduction in professional achievements was least predicted by anxiety and depressive symptoms.

Conclusion. Depending on the structure of emotional burnout in psychiatrists, it can manifest clinically as anxiety, depressive symptoms, or a combination of both. Identifying the various clinical manifestations of EBS will be useful for developing specific methods to combat emotional burnout.

Aortic stenosis (AS), the prevalence of which increases with age, raises the risk of developing ischaemic stroke (IS), but the risk factors for cerebral ischemic events have not been fully established.

Objective: to evaluate IS predictors in patients with moderate or severe AS, which will help identify high-risk groups and optimise stroke prevention.

Material and methods. A retrospective review of data from the hospital information system for case-control analysis was conducted at one of the Federal Centers for Cardiovascular Surgery. Inclusion criteria: moderate or severe AS, patient age ≥18 years. Exclusion criteria: moderate or severe mitral stenosis, moderate or severe mitral regurgitation. Logistic regression was used to determine IS predictors. Odds ratio (OR) with 95% confidence intervals (CI) were calculated for each of the significant risk factors.

Results. The study included 208 patients with AS (the main group consisted of 51 patients with a history of IS or transient ischemic attack). The median age of patients was 68 [62.0; 72.0] years, the proportion of men was 53.8%. According to the multivariate analysis, the following predictors of cerebral ischemic events were identified: male gender (OR 2.739; 95% CI 1.048–7.156, p=0.040), extra-, intracranial stenosis >50% (OR 2.488; 95% CI 1.089–5.686, p=0.031), aortic arch atheromas (OR 5.947; 95% CI 1.179–29.994, p=0.031), the result of the CHA2DS2VASc scale with an increase of 1 point (OR 4.030; 95% CI 1.912–8.499, p<0.001).

Conclusion. Supra-cardiac atherosclerosis (extraand intracranial atherosclerosis, aortic atheromas) is the main predictor of IS in patients with AS, which determines the need for its assessment in order to optimise patient treatment.

Objective: Evaluation of the effectiveness of the “Fresubin Protein” module in a comprehensive second-level rehabilitation programme for patients with ischemic stroke (IS).

Material and methods. A single-center prospective clinical study was conducted involving 45 patients (21 in the main group and 24 in the control group) aged 45–90 years between 14 and 35 days after IS. Patients in the main group received “Fresubin Protein” in addition to their standard diet for 12 days. Rehabilitation indices, nutritional status indicators and muscle strength were assessed on the 1st and 12th days of the study.

Results. A positive effect of a high-protein diet on the Barthel Index of daily activity (p=0.0117), muscle strength dynamics on the paresis side (p=0.0175) and on the intact side (p=0.0365), and on the absolute value of peripheral blood lymphocytes (p=0.0368) was noted. Statistically significant differences from the control group were noted in the main group. No adverse effects of protein module use were identified.

Conclusion. The use of the “Fresubin Protein” module as a nutritional supplement in patients with IS during the second stage of rehabilitation contributes to improved daily activity levels and increased muscle strength. The results of the study confirm the advisability of using a high-protein diet in a comprehensive rehabilitation programme for patients with IS.

Chronic nonspecific neck pain (CNNP) is widespread and often caused by facet joint (FJ) pathology. If conservative therapy is ineffective, radiofrequency denervation (RFD) of the FJ is used.

Objective: to investigate the effectiveness of combining therapeutic exercises and RFD cervical FJ in patients with CNNP.

Material and methods. Over a period of 6 months, 60 patients (41 women and 19 men, median age 62 [52; 74] years) with CNNP were observed, in whom FJ involvement was confirmed by positive diagnostic blockade. After RFD, participants were randomised into two groups: the main group, which underwent kinesiotherapy (30 patients, including 20 women and 10 men, median age 62 [52; 74] years) and a control group (30 patients, including 21 women and 9 men, median age – 61.5 [52; 76] years). Pain intensity was assessed using a numerical rating scale (NRS), the Neck Disability Index (NDI), and the Tampa Scale for Kinesiophobia (TSK) 3 and 6 months after RFD.

Results. In the main group, a significant reduction in NRS, NDI and TSK indicators achieved by the third month (p<0.0001) remained unchanged at the sixth month (p>0.05). In the control group, all indicators also improved by the third month (p<0.001), but by the sixth month, a significant deterioration in all indicators was observed (p<0.05). After 3 months, the advantage in the main group was only evident in the TSK (p=0.014), but by the 6th month, the main group surpassed the control group in all parameters studied: NDI (p=0.018), NRS (p=0.038) and TSK (p=0.004).

Conclusion. In patients with CNNP, adding kinesiotherapy to RFD reduces pain, improves functional status, and reduces recurrence rates 6 months after RFD.

The management of patients with generalised anxiety disorder (GAD) is a pressing issue in modern medicine. A new Russian drug, Aviandr (maritupridine), has demonstrated efficacy and good tolerability in the treatment of GAD in clinical trials.

Objective: To study the effectiveness of treating GAD with Aviandr in real clinical practice.

Material and methods. An open-label, non-comparative prospective study included 98 patients over the age of 18 with a confirmed diagnosis of GAD. Patients received Aviandr therapy and were monitored on an outpatient basis for 36 weeks. Clinical-psychopathological and psychometric examinations were conducted before treatment and at 2, 8, 16, 24, and 36 weeks after the start of treatment. Anxiety symptoms were measured using the Hamilton Anxiety Rating Scale (structured interview, SIGH-A). Additionally, symptoms of depression (Montgomery-Asberg Depression Rating Scale – MADRS), cognitive functions (Montreal Cognitive Assessment Scale – MoCA), and the somatic condition of patients were assessed.

Results. Aviandr has proven to be an effective drug for treating GAD. A statistically significant reduction in the total SIGH-A score was observed as early as the second week of therapy (from 22.06±5.80 before therapy to 19.12±5.91; p<0.001), followed by a progressive decrease by week 8 (14.12±5.44), week 16 (9.84±5.44), week 24 (7.44±5.13) and week 36 (6.90±6.20; p<0.001 for all visits). By the 36th week of therapy, the number of patients who responded to treatment (a decrease in the SIGH-A score by 50% or more from baseline) was 83.7%, and 66.7% of patients achieved remission (total SIGH-A score ≤7). Depressive symptoms on the MADRS scale decreased significantly from 14.60±7.62 at baseline to 4.15±5.33 at week 36 (p<0.001). Cognitive function scores on the MoCA scale improved significantly from 27.40±1.91 to 29.00±1.54 (p<0.001).

Conclusion. The use of Aviandr is an effective method of treating GAD. The therapeutic effect of the drug manifested itself gradually, demonstrating a progressive increase throughout the course of therapy, with maximum symptom reduction achieved by the 36th week of treatment.

Currently, glucagon-like peptide-1 receptor agonists (GLP-1RAs) are considered promising drugs for the treatment of Alzheimer's disease (AD) and other neurodegenerative diseases due to their complex mechanism of action, which includes (in addition to general somatic effects) an impact on neuroplasticity. This necessitates a detailed study of drugs in this group using appropriate informative experimental models.

Objective: to characterise the effect of semaglutide, one of the main representatives of the GLP-1RAs class, on the development of neurodegenerative processes in the hippocampus and cognitive impairments in animals with a streptozocin (STZ) model of AD.

Material and methods. Streptozocin at a dose of 3 mg/kg was administered into the lateral ventricles of Wistar rats, and semaglutide at a dose of 0.1 mg/kg was administered intraperitoneally (every other day for 5 weeks). The behaviour of the animals was assessed in the ‘Novel Object Recognition’ and ‘T-Maze’ tests. Nine weeks after discontinuation of the drug, immunomorphological methods were used to determine the effect of semaglutide on neurodegenerative processes in the CA3 field of the hippocampus.

Results. Streptozocin caused impaired recognition of a new object and increased the latency period for entering the closed arm of the T-maze, as well as leading to tau protein accumulation and mitochondrial and synaptic abnormalities in the CA3 field of the hippocampus. Semaglutide significantly attenuated streptozocin-induced memory impairment and depression-like behaviour and improved morphological indicators of synaptic integrity (based on the detection of synaptophysin and PSD95 proteins) neuronal energy metabolism (as determined by the detection of glycolysis and oxidative phosphorylation enzymes), and reduced tau protein phosphorylation.

Conclusion. In a model of sporadic AD, semaglutide has been shown to attenuate cognitive impairment in laboratory animals and reduce the severity of morphological abnormalities in the CA3 region of the hippocampus, with the neuroprotective effect of the drug persisting after discontinuation of therapy.

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that is the leading cause of dementia globally. First-line AD therapy using cholinesterase inhibitors such as donepezil, galantamine, and rivastigmine shows interindividual variation in effectiveness, indicating the involvement of genetic factors. This study aims to identify genetic variants that influence response to AD therapy through bioinformatics and pharmacogenomic approaches. Data were retrieved from PharmGKB and analyzed based on therapy efficacy, allele frequencies across populations (1000 Genomes), and gene expression (GTEx). Four SNP variants were found to be relevant: rs6494223 (CHRNA7), rs3793790 and rs2177370 (CHAT), and rs1803274 (BCHE). Specific genotypes such as CC (rs6494223), GG and AA (CHAT), and TT (rs1803274) showed better therapy response. Expression analysis showed that the CHAT gene is highly expressed in the brain, reinforcing its pharmacogenetic relevance. In contrast, CHRNA7 and BCHE showed high expression in non-neuronal tissues, yet still play a systemic role in acetylcholine metabolism. Variations in allele frequencies between populations were also identified, underscoring the importance of population-based therapeutic approaches. These results support the importance of simple genetic screening in the development of precision therapies for Alzheimer’s. This study demonstrates that integrating pharmacogenomic and gene expression data can provide a better understanding of the heterogeneity of AD therapy response and open the possibility of personalized treatment based on the patient’s genetic profile.

Siponimod is a sphingosine-1-phosphate receptor modulator approved in most countries for the treatment of secondary progressive multiple sclerosis (SPMS) with activity. The EXPAND study showed that the drug effectively reduces disease activity at the peripheral level by preventing autoreactive immune cells from leaving the lymph nodes, as well as reducing neurodegeneration by limiting the development of central inflammation and promoting oligodendrocyte survival. To more fully assess the therapeutic effect of siponimod, it is necessary to analyse the efficacy and safety of the drug in real-world clinical practice.

Objective. To evaluate the effect of siponimod on disease activity and progression in patients with SPMS in real-world clinical practice.

Material and methods. A retrospective-prospective observational cohort study was conducted in real-world clinical practice, involving 162 patients receiving siponimod and monitored at the Centre for Multiple Sclerosis and Other Neuroimmunological Diseases (CMS), organised on the basis of the M.F. Vladimirsky Moscow Regional Scientific and Clinical Institute.

Results. In patients with active MS, stabilisation of the condition was observed in 76.7% of cases after 24 months. The number of exacerbations in SPMS decreased threefold with siponimod therapy. 86.7% of patients remained compliant with therapy in the second year. No adverse events requiring discontinuation of siponimod therapy for medical reasons were reported in the study group.

Conclusion. The results obtained demonstrate the high efficacy and favourable safety profile of siponimod and are consistent with data from clinical trials. Stabilisation of the condition, minimal side effects, oral administration and a convenient dosing regimen increase patient compliance when using this drug.

The use of botulinum toxin therapy to correct spasticity and sialorrhea in a single injection session is an adequate treatment strategy for children with cerebral palsy (CP), as these two conditions are often observed simultaneously in patients and negatively affect the course of the disease and quality of life.

Objective: to evaluate the efficacy and safety of simultaneous correction of spasticity and sialorrhea with incobotulinumtoxin A in patients with CP.

Material and methods. A retrospective analysis was conducted of the medical records of pediatric patients with spastic forms of CP with varying levels of motor ability (from level I to level V according to the Gross Motor Function Classification System, GMFCS) who had spasticity and sialorrhea of varying severity. The analysis included only those patients who underwent simultaneous correction of spasticity and sialorrhea with incobotulinumtoxin A during a single injection session. The total average dose for the correction of spasticity of the upper limbs (UL) and lower limbs (LL), the average dose for the correction of sialorrhea, the total average and maximum dose of the drug per injection session, the dynamics on the modified Ashworth scale (MAS) and the Drooling Impact Scale (DIS), as well as the overall improvement in sialorrhea on the Global Impression of Change Scale (GICS) during treatment were assessed. The severity of the therapeutic effect of the drug after repeated injections was studied, and an analysis of adverse events (AEs) was performed throughout all injection cycles.

The analysis included 162 patients with a mean age of 7.23±3.73 years. Spastic tetraparesis was present in 46.9% of patients, spastic diplegia in 46.3%, and hemiplegic form in 6.8%. 3.1% of patients had GMFCS I, 19.1% had GMFCS II, 18.5% had GMFCS III, 44.4% had GMFCS IV, and 14.8% had GMFCS V. Initially, the severity of spasticity in the upper limbs was 2.33±0.71 points on the MAS, and spasticity in the lower limbs was 2.67±0.74 points on the MAS. The severity of sialorrhea on the DIS scale was 72.96±13.21 points.

Results. All patients underwent one injection cycle (IC), of which 40.1% underwent two ICs, 19.1% underwent three ICs, and 12.3% underwent four ICs. The average dose for correction of spasticity of the upper limbs was 77.10±57.53 U, for NC – 157.10±68.59 U, for sialorrhea – 41.91±19.15 U, the average total dose of the drug per IC – 257.65±92.86 U (13.19±3.91 U/kg), maximum dose – 500 U. After the first IC, UL spasticity decreased by an average of 1.18 points on the MAS, and UL spasticity decreased by 1.23 points. The DIS sialorrhea score decreased by 27.3 points. Repeated ICs showed similar efficacy in correcting spasticity and sialorrhea. The overall improvement in sialorrhea on the GICS scale averaged 1.70±0.51 points after the first IC, and by the fourth IC it increased to 2.00±0.46 points, i.e., a tendency toward an increase in effect was noted. After the first IC, 8% of patients experienced AEs, most commonly pain at the injection site, less commonly dry mouth, increased saliva viscosity, and fever. The frequency of AEs did not increase with repeated ICs.

Conclusion. Simultaneous treatment of spasticity and sialorrhea is a highly effective and safe approach in patients with CP. Repeated injections of incobotulinumtoxin A maintain the high efficacy and safety of this comprehensive therapeutic approach.

A history of migraine is a predictor of more frequent and severe vasomotor symptoms during periand postmenopause.

Objective: to study the connection between migraine and climacteric syndrome (CS) in periand postmenopausal patients.

Material and methods. The study included 120 female patients with migraine in periand postmenopause. The patients were divided into two groups: severe climacteric syndrome (CS; n=78) and mild CS (n=42).

Results. The risk of chronic migraine, frequent migraine attacks, high pain intensity during attacks, severe impact of headache on quality of life, severe maladjustment of patients with migraine, severe burden of migraine outside attacks, and insufficient response to headache treatment was significantly higher in the severe CS group than in the non-severe group (p<0.05). In the group of patients with severe migraine, the risk of clinically significant anxiety and clinically significant depression was significantly higher than in the group with mild migraine (p<0.05). When constructing a multiple linear regression model, it was found that MIBS-4 scores, mental health and role functioning due to emotional state (SF-36), anxiety and depression (HADS) can predict the Green Climacteric Scale score in patients with migraine in periand postmenopause (F=25.2; Fcrit=2.29; p<0.05).

Conclusion. The course of migraine in patients with severe manifestations of CS is less favourable than in patients with mild CS. The course of migraine and the mental status of patients can influence the severity of CS, and vice versa. Further research is needed to identify the causes of the observed phenomena.

In recent decades, our understanding of patients with prolonged disorders of consciousness (PDOC) has expanded significantly thanks to the description of the phenomenon of ‘covert cognition.’ An individual approach is important in its diagnosis, involving the comparison of behavioural and instrumental data for each patient. In our country, research into this phenomenon is only just beginning to develop, which makes it important to accumulate cases of successful detection of various ‘covert’ signs of consciousness. This article presents clinical observations of two patients with PDOC. According to clinical assessment using specialised scales, the first patient was in a vegetative state/had unresponsive wakefulness syndrome. Using functional magnetic resonance imaging (fMRI) with a specially designed set of paradigms, the phenomenon of ‘covert cognition’ was detected in her (cerebral activation, partially correlated with the norm, in response to passive somatosensory, auditory non-verbal and verbal stimuli). The second patient, according to the clinical assessment, corresponded to a minimally conscious state ‘minus’. As a result of fMRI examination, instrumental confirmation of the preservation of certain aspects of consciousness (cerebral activation in response to auditory non-verbal and auditory verbal paradigms) was obtained. The use of a comprehensive multimodal personalised approach to the diagnosis of the phenomenon of ‘covert cognition’ and the possibilities of neurorehabilitation of patients based on the data obtained with its help are discussed.

Cognitive impairment (CI) is one of the most common types of neurological disorders and a frequent cause of disability. However, in 20–30% of patients who visit specialized centers (memory clinics) with cognitive complaints, no abnormalities are detected in extended neuropsychological testing. This condition is referred to as subjective cognitive impairment (SCI). According to international studies, SCI in older adults may be a predictor of clinically significant CI in the future, up to and including the development of dementia. We present our own observations of two patients with SCI who, despite subjective complaints of memory loss and a family history of Alzheimer's disease (AD), did not show any clinically significant deviations from the norm in an extended neuropsychological examination. Both patients had emotional disturbances (anxiety). The first patient with SCI had positive biological markers of AD in the cerebrospinal fluid (CSF), which allowed her condition to be classified as SCI with Alzheimer's pathological changes. In another observation, no positive biomarkers were found, which allowed SCI to be diagnosed against a background of emotional disorders (severe anxiety). A number of studies have shown that cognitive complaints in the absence of objective cognitive decline are often explained by the presence of emotional disorders (anxiety and depression). However, on the one hand, emotional disorders are the cause of SCI, and on the other hand, their presence in patients with SCI may be a reflection of cognitive decline and a consequence of an incipient degenerative process in the brain. Issues related to the management of patients with SCI based on non-pharmacological methods are discussed. In our country, nootropic agents are widely used to treat patients with CI. Data on the use of Prospekta in vascular CI are analyzed, highlighting its efficiency and safety based on the results multicenter placebo-controlled trials.

Cognitive impairment (CI) occupies a special place among the medical and social problems of modern gerontology, directly affecting both the duration and quality of life of older people.

One of the important pathogenetic mechanisms in the development of cognitive dysfunction is cholinergic deficiency, which is observed in both cerebrovascular pathology and Alzheimer's disease. This imbalance not only exacerbates cognitive decline, but also disrupts the complex mechanisms of cerebral haemodynamic regulation. In this context, choline alfoscerate is of particular therapeutic interest. It is a unique molecule that serves as a precursor to both acetylcholine and the structural phospholipids of neuronal membranes and their receptor apparatus.

Numerous clinical studies convincingly demonstrate the ability of choline alfoscerate to provide statistically significant improvement in cognitive function, reduce the risk of mild CI transforming into dementia, and slow the progression of dementia. Particularly impressive results are observed when the drug is combined with acetylcholinesterase inhibitors: the synergistic effect is not only manifested in improved neuropsychological parameters, but is also reflected in objective neuroimaging data, indicating a slowdown in the rate of cerebral atrophy.

Thanks to its optimal safety profile and good tolerability, choline alfoscerate has proven itself to be a promising agent for preventive therapy and long-term treatment of CI in clinical practice.

Thoracic pain caused by musculoskeletal disorders is a significant social and medical problem that significantly reduces patients' quality of life. Myofascial pain syndrome (MPS) is the leading cause of non-cardiac chest pain. Currently, the diagnosis of MPS is clinical and based on the nature of the pain syndrome and the detection of trigger points. However, there is considerable variability in the results of physical examinations by different specialists in the diagnosis of MPS. There is a clear need to standardise the clinical and instrumental diagnosis of MPS. The pathophysiological mechanisms of trigger point formation, clinical symptoms, and diagnostic criteria for the disease are discussed. Treatment of MPS should be comprehensive and include informing the patient about the benign nature of the disease, maintaining an active lifestyle, taking nonsteroidal anti-inflammatory drugs and muscle relaxants, as well as a wide range of non-drug methods, among which kinesiotherapy is of great importance. Kinesiotherapy has proven to be an effective tool for relieving and preventing pain, correcting postural disorders, and restoring functional activity in myofascial pain. Particular attention is paid to combination therapy, which combines kinesiotherapy with other methods such as myofascial release, breathing exercises, or sensory modulation techniques.

Stroke is one of the leading causes of death and disability worldwide. Post-stroke cognitive impairment (PSCI), characterised as a decline in cognitive function following a stroke, can range from mild deficits to dementia and is a common and serious long-term consequence of stroke. CI can develop after both ischemic and hemorrhagic strokes. The risk and timing of PSCI may depend on various factors. The presence of PSCI is independently associated with a lower quality of life after stroke and higher mortality. Understanding the pathogenesis of PSCI is fundamental to reducing the global burden of stroke. Treatment of PSCI involves a multidisciplinary approach to addressing the underlying causes and cognitive symptoms. Management strategies focus on cognitive rehabilitation, pharmacological interventions, and the elimination of modifiable risk factors.

Acute vestibular vertigo (AVV) accompanied by hearing loss may be caused by ischemic stroke in the vertebrobasilar system, labyrinthine infarction, Meniere's disease (MD) attack, labyrinthitis, and secondary hydrops. Due to the clinical similarity to the triad of symptoms characteristic of MD (AVV, hearing loss, and tinnitus), such patients, if MD is excluded, are often diagnosed with 'Meniere-like syndrome' without a full differential diagnosis. Patients with Meniere-like syndrome have an increased risk of chronic vertigo and the development of comorbid conditions such as anxiety-depressive syndrome, neck pain syndromes, tension headaches, and instability with falls. Improving physicians' knowledge of the differential diagnosis of AVV accompanied by acute hearing loss is necessary to optimise treatment and prevent the chronic course of the disease. The manifestations and diagnosis of the main causes of AVV with hearing loss are discussed.

Nonspecific (musculoskeletal) neck and back pain (NNBP) is one of the most common reasons for seeking medical advice. The diagnosis of NNBP is based on clinical examination, the absence of signs of dangerous disease ('red flags'), radiculopathy and spinal stenosis. If there are no signs of a dangerous disease, early (within the first 4 weeks) instrumental examination, including magnetic resonance imaging, is not recommended. Fibromyalgia is common among patients with chronic NNBP, but it is rarely diagnosed due to poor awareness among doctors about its manifestations and diagnostic criteria. In NNBP, it is recommended to inform the patient about the favourable prognosis of the disease and risk factors, the need to avoid excessive static and physical exertion, incorrect positions and postures, and the advisability of maintaining physical, social and professional activity. Nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants are most commonly used to relieve NNBP. Extensive clinical experience has been accumulated regarding the efficacy and safety of aceclofenac (Airtal) as an NSAID and tolperisone (Mydocalm) as a muscle relaxant in the treatment of NNBP. The combination of aceclofenac (Airtal) and tolperisone (Mydocalm) is more effective than monotherapy, as it reduces the duration of NSAID use and lowers the risk of complications from long-term use. For subacute and chronic NNBP, a multimodal approach is most effective, which should include physical exercise (therapeutic physical training – TPT), manual therapy, and, for some patients, psychological therapy methods as non-drug methods. In cases where chronic back pain is caused by fibromyalgia, antiepileptic drugs may be effective as part of complex therapy, among which gabapentin (Tebantin) has been shown to be effective and safe. To prevent NNBP, therapeutic exercise, an educational programme on avoiding excessive static and physical stress, and incorrect positions and postures are recommended.