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Background. Inflammatory polyneuropathies (IPNP) are diseases caused by an immune response against antigens in the peripheral nervous system. Epidemiological research is essential for health resource planning.Objective: to assess the clinical and epidemiological characteristics of acute and chronic IPNP in adults in the Leningrad region.Materials and methods. We analyzed the incidence of acute and chronic IPNP the Leningrad region for the last 24 years.Results. A gradual increase in the incidence rate since 2003 with slight fluctuations has been shown. A particularly significant increase was recorded in 2015 from 14 (2014) to 22 patients, while in previous years fluctuations ranged from 4 to 10 people. In 2016 and 2017, the number of cases increased even more to 26–27 per year (there are 1 600 000 residents over 18 years of age in the region). At the same time, an increase in the incidence of both Guillain–Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) was noted. The incidence of GBS in the last 10 years was 0.18–0.88, the incidence of CIDP was the same 0.18–1.0 per 100 000 population. With GBS, women were more likely to get sick, with CIDP – men. With GBS, the debut was more often in winter (35 %), in summer and autumn, 25 % each, less often in spring – 17 %. The average age of GBS development in our study was 50.3 years. CIDP also fell ill at all age periods from 19 to 84 years (average age 55.6 years). The most common GBS triggers were acute respiratory viral infections in 36 % and enterocolitis in 13 %. Respiratory disorders requiring mechanical ventilation were observed in 8 % of patients with GBS.Conclusions. The incidence of IPNP in adults, both acute and chronic in the Leningrad region, is growing with some fluctuations. This should be taken into account for health resource planning.

Central pontine myelinolysis (CPM) is a concentrated, symmetric, non-inflammatory demyelination within the central basis pontis. In 10 % of patients with СРМ, demyelination also occurs in extrapontine regions: the mid brain, thalamus, basal nuclei, and cerebellum. Demyelination occurs in regions of compact interdigitation of white and gray matter as a result of cellular edema, which is caused by fluctuating osmotic forces, results in compression of fiber tracts. The most frequent cause of abrupt change in osmotic pressure is the rapid sodium correction of prolonged hyponatremia. In case that we report, there is a combination of central pontine and extrapontine myelinolysis, which occurs in 71-year-old woman owing to rapid sodium correction of prolonged hyponatremia which by turn developed due to salt-free diet, improper antihypertensive therapy and overheating. The diagnosis was confirmed by magnetic resonance imaging (MRI). The treatment led to significant decrease of neurological deficit.

Objective: description of a clinical case of the development of longitudinally spread transverse myelitis in a young woman suffering from nonHodgkin’s lymphoma (follicular, 1 degree, IIIA stage, complete remission from February 2017). This is a rare, significant case in clinical practice for both residents and neurologists, and the case is under discussion. It requires certain scientific studies in the search for specific antionkoneural antibodies or a more detailed study of the already known. It is necessary to introduce these studies into laboratory practice in Russia, which would help to accelerate the diagnosis of paraneoplastic myelitis.Materials and methods. Patient B., 30 years old, has been suffering non-Hodgkin’s lymphoma since February 2016 (follicular, I degree, IIIA stage, complete remission from February 2017), receives infusions of Rituximab with a dose of 600 mg once in 2 months, the subacute developed pronounced lower spastic paraparesis. In November 2018, suddenly, against the background of complete well-being, weakness and numbness of the legs appeared. The patient asked for help at the Center for Multiple Sclerosis on 11.17.2018, then she was hospitalized and examined. Patient B. received a pulse therapy with methylprednisolone 1000 mg intravenously № 5. Discharged with positive dynamics with a diagnosis of Demyelinating CNS disease, unspecified. Acute protracted transverse myelitis (LETM), EDSS = 3.5 points. On December 13, due to the increase in spacity and leg weakness, she was urgently hospitalized in the neurological department of the Clinical Hospital.Results. After the completion of laboratory and instrumental examination, the condition was regardedby us as paraneoplastic myelitis. Relapse of lymphoma was ruled out. The treatment was carried out: pulse therapy with methylprednisolone, Plasmapheresis and intravenous administration of IgG (Privigen) with a distinct positive dynamics.Conclusion. This clinical observation allowed us to become more familiar with paraneoplastic syndromes and, in particular, with paraneoplastic myelitis. In the clinical situation previously described, we encountered a number of features: longitudinally extensive transverse myelitis developed without relapse of lymphoma, progressed rapidly, there was no response to treatment (glucocorticosteroids, plasmapheresis, Rituximab). All these signs and MRI data of the cervical and thoracic spine (a symmetric hyper-intensive signal from level CII to level ThXI, mainly involving the central spinal cord T2 MRI mode) testified in favor of the paraneoplastic etiology of longitudinally extensive transverse myelitis.

The objective of the study is to evaluate the results and compare the methods of different variants of surgical treatment for the occlusive-stenotic lesion in extracranial parts of the carotid arteries.Material and methods. Comparative analysis of immediate and remote results, and evaluation of patency after 450 carotid endarterectomy performed by classic and eversion technique.Results. A significant advantage of eversion carotid endarterectomy was confirmed.Conclusion. The good results show not only the high qualification of each operating surgeon as well the entire staff, providing competent logistics and selection of patients for both planned and emergency surgical interventions.

Locked-in syndrome (LIS) is a rare neurological disorder, usually appears as a result of the pons cerebellar damage, mostly after the brain stroke. Locked-in syndrome is characterized by the paralysis of skeletal muscles (respiratory, facial, pharyngeal, lingual and muscles of the extremities). Patient is unable to speak and breath, facial expressions and voluntary movements are also impossible. Acromegaly is a disease that can be described by the increase of the growth hormone (GH) and Insulin-like growth factor (IGF-1) and develops in most cases due to the pituitary adenomas. Pituitary adenoma (PA) can be treated by neurosurgical techniques, pharmaceutical and radiation therapy (RT). We present a clinical case of 33-year-old woman with PA-caused acromegaly, that developed muscle weakness, nausea, vomit and respiratory disturbance in a 2 months after the radiation therapy. Subacute comatose state was developed in the patient. MRI of the brain revealed a multi-focal lesion of the media-basal regions on both sides, frontal corpus callosum and brain stem. Differential diagnosis included an acute demyelination (SD, PML), viral encephalitis and vasculitis. Treatment included methylprednisolone pulse therapy and plasmapheresis. The consciousness cleared up, but there was no spontaneous breathing, tetraplegia persisted. Autoimmune and infectious diseases was excluded. The homozygous mutation PAI-1-675 4G/4G was found. In this case, acromegaly induced endothelial dysfunction was the pathogenesis factor of multiple cerebral infarctions and demyelinating lesions, as well as RT and its proven pathological influence on the vascular wall and the fibrinolytic system. The revealed thrombophilia was also a factor of multiple cerebral infarctions. A Potential combination of pathogenic factors in the development of cerebral should be taken into account in predicting complications of RT.

Neuroblastoma is a malignant tumor derived from the neuroblasts of the sympathetic nervous system, which develop in any region of the nervous system. Usually, neuroblastoma is detected in children aged 1–2 years. About 90% of cases are diagnosed before the age of 5 years. The incidence of adult neuroblastoma is only 0.3 cases per million people per year. The clinical course and biological activity of adult neuroblastoma is different than children neuroblastoma. Early diagnosis of this disease in adults is necessary for timely start of treatment and increasing life expectancy. In this clinical observation, we present a detailed description of the course of this rare disease in the 34-year-old male and literature review on adult neuroblastoma.