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In this review, we discuss different aspects of pain syndrome in patients with amyotrophic lateral sclerosis: etiology, incidence, pathophysiology and main clinical features. Also we review the modern approaches to the treatment of pain in amyotrophic lateral sclerosis. Pain is actually not rare in this condition: it appears in 80% of patients, affecting their quality of life and functional activity, leading to the development of depressive and anxiety disorders. Pain in amyotrophic lateral sclerosis is often overlooked by clinicians, since their attention may focus on the motor symptoms of the disease. Thus, a more careful approach is needed to diagnose and treat pain in amyotrophic lateral sclerosis.

Chest pain can be a mask of a life-threatening condition, which the practitioner must remember. One of such life-threatening condition is aortic aneurysm, which diagnosis presents significant difficulties in routine clinical practice. Clinical manifestations of thoracic aortic aneurysms are extremely variable and non-specific and are mainly depends on the size of the aneurysmal sac, its localization and extent, as well as the etiology of the disease. Here we present a clinical case report of a 48 y.o. patient who died because of the acute cardiac tamponade as a complication of dissecting thoracic aorta aneurysm. The lack of symptoms and clinical instrumental data, initially suggesting the presence of life-threatening disease did not allow the physician to suspect aortic aneurysm and urgently take action regarding it.

Ischemic stroke is still leading in terms of primary disability caused by residual neurologic de-fect in the majority of patients. Persistent motor disorders are observed even after timely and ade-quately carried out rehabilitation measures. The article discusses the possibilities of modern instru-mental technologies for diagnostics and further monitoring of the process of restoration of post-stroke deficit, which is based on the phenomenon of neuroplasticity.

The article discusses the phenomenon of neuroplasticity and itsfeatures after stroke. The main methods for studying processes of reorganization and plastic changes in the central nervous system are described. Particular attention is paid to the factors determining post-stroke structural and functional reorganization, time parameters starting with the onset of stroke, and stages of post-stroke plastic reorganization; as well as to the afferent andefferent components of neuroplasticity that are closely interrelated. Various aspects of structural and functional reorganization both in the early ontogeny and in the acute and subacute period after stroke are considered. The role and significance of activation patterns in both cerebral hemispheres in recovery of impaired functions after stroke are discussed. The dynamism of neuroplasticity processes and their significance for the poststroke rehabilitation period are emphasized.

Abstract This study was conducted to address the clinical and neurophysiological features of pyramidal syndrome in patients with lateralized hemispheric lesions. A total of 52 patients were studied, all with hemiparesis following acute cerebrovascular accidents of the ischemic type in the right (24 patients) or left (28 patients) hemispheres of the brain. Clinical neurological analysis was performed, along with transcranial magnetic stimulation, evoked abdominal reflexes, movement-associated motor potentials, and somatosensory evoked potentials. Lesions of the right hemisphere resulted in significant weakening of activatory influences at both the hemisphere level and on descending motor structures, with marked impairment of the afferent flow from both sides of the body and excessive disorganization of activity in the left, presumptively healthy, side. Left-sided pathology impaired efferent control not only of the contralateral, but also of the ipsilateral side of the body. These data identify different neuroanatomical and neurophysiological features of the cerebral hemispheres not only in healthy people, but also in pathological conditions, this probably accounting for the polymorphism and heterogeneity of pyramidal syndrome in patients with lateralized cerebral lesions. [ABSTRACT FROM AUTHOR]

Our aim was to study efficacy of pathogenetically substantiated rehabilitation of sensorimotor disorders in patients after ischemic stroke. Methods. A total of 119 patients were studied all with hemiparesis following ishemic stroke. There were 35 controls. All patients underwent rehabilitation which included robotized mechanotherapy, stabilography, neuro-muscular stimulation, physical therapy, ergotherapy, massage etc. Before and after the rehabilitation therapy TMS and SSEP parameters were evaluated in all patients. Results. Rehabilitation with the use of a personified, pathogenetically grounded approach contributed to a better recovery of the neurological deficit. In those patients who received personalized therapy significant changes of TMS parameters (central motor conduction time at rest and in facilitation probe), but not SSEP ones were registered. Conclusions. The effectiveness of the pathogenetically substantiated rehabilitation of patients after ischemic stroke was demonstrated. Were demonstrated more effective in restorative treatment of motor deficits. Somatosensory functions were restored worse, which implies the identification and takes into the account of the sensory deficit, as well as neurophysiological monitoring of the recovery process with the use of TMS and SSEP to improve the effectiveness of ongoing rehabilitation in this category of patients.

The aim of the study was to investigate the clinical and neurophysiological features of sensorimotor disturbances in patients at different time periods after ischemic stroke. Methods. The study involved 133 patients with ischemic stroke in the right and left cerebral hemispheres in the late recovery (58) and residual (75) periods. There were 35 controls. Were performed transcranial magnetic stimulation, evoked abdominal reflexes and somatosensory evoked potentials. Results. It was shown that functional recovery processes are continuing with varying degrees of severity in patients and in a year after stroke. Conclusions. Persistence and severity of sensorimotor disturbances, as well as compensatory opportunities, defined afferent component of poststroke deficit, which implies an additional impact in this area to expand the possibilities of neurorehabilitation in patients after stroke.