ЖУРНАЛ НЕВРОЛОГИИ И ПСИХИАТРИИ, 8, 2018; Вып. 2 Рассеянный склероз (РС) в настоящее время рассматривается как иммунологически опосредованное демиелинизирующее и нейродегенеративное заболевание ЦНС, приводящее к инвалидизации пациентов при отсутствии своевременной адекватной патогенетической терапии. Для постановки диагноза РС разработаны и активно применяются постоянно обновляемые критерии. Диагноз РС прежде всего является клиническим и выставляется неврологом, исходя из анализа совокупности данных инструментальных и лабораторных методов исследования. Среди инструментальных методов диагностики ведущую позицию занимает МРТ, которая может дополняться при необходимости данными исследования вызванных потенциалов мозга и ЦСЖ (локальный синтез олигоклональных антител) [1]. В связи с активным внедрением МРТ в рутинную практику нев рологов все чаще специалисты стали сталкиваться с характерными для РС изменениями по данным МРТ при отсутствии анамнестических указаний на поражение ЦНС и нормальным неврологическим статусом. Это и послужило причиной тому, что в 2008 г.

Hirayama disease (HD) is a rare neurological condition typically thought to be endemic for South Asia andJapanregion. Disease is characterized by juvenile muscular atrophy of unilateral distal upper extremity with benign course. MRI of the cervical spine is the way to confirm HD in clinically supposed case. Some typical MR-signs can be visualized in neutral position (abnormal cervical curvature, loss of attachment between the posterior dural sac and subjacent lamina, localized lower cervical cord atrophy with asymmetric spinal cord flattening and hyperintensity) and in flexion position (anterior shifting of the posterior dura and posterior epidural space enlargement). Here we describe 5 HD cases in Russian population with a detailed MRI description and MRI protocol recommendations in case of HD suspicion.

Magnetic resonance imaging (MRI) nowadays is the main diagnostic tool in multiple sclerosis (MS). The article is aimed at reviewing basic signal changes, location and morphology of pathologic lesions in the brain in multiple sclerosis, the role of contrast agents in its diagnostics and monitoring. Among conventional MRI techniques T2-weighted and T2FLAIR-weighted images are the most sensitive for focal damage detection, contrast-enhanced T1-weighted images are still irreplaceable for active lesions visualization. Dissemination in space and time is necessary for confirming the diagnosis and forms the basis of McDonald criteria revision of 2005 and 2010. New or enlarged MS lesions on T2 and T2FLAIR images are important for disease activity evaluation together with contrast enhancing T1 lesions. MS lesions detection in the spinal cord is of great importance as it's seen in the majority of patients. MRI also let us identify atypical MS forms like Shilder's diffuse periaxial encephalitis, Balo's concentric sclerosis, Marburg disease and pseudotumorous MS, which are characterized by special neuroimaging signs and thus could be differentiated from classic multiple sclerosis and other central nervous system pathology.

Systemic (intravenous) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is a proved effective treatment modality in a certain group of patients with ischemic stroke (IS) in the first 4.5 hours after the onset of neurological symptoms. The main mechanism for improving functional outcomes in patients treated with intravenous thrombolysis is reperfusion of an ischemic brain portion. The results of intravenous thrombolytic therapy are shown in 60 IS patients (18 women and 42 men; mean age 61 years). Different mechanisms of reperfusion during systemic thrombolysis, which are not confined to thrombusor embolus-occluded artery recanalization, but are a portrait of the systemic effect of the thrombolytic drug and include collateral blood flow activation, gradual recanalization, etc.

Multiple sclerosis is the most common chronic progressive inflammatory demyelinating disease of the central nervous system characterized by different clinical phenotypes, degrees of central nervous system damage and disease progression. Conventional magnetic resonance imaging has become a useful tool for diagnosis, differential diagnosis and monitoring disease progression. Recent innovations in magnetic resonance imaging give an opportunity to specify certain aspects of multiple sclerosis pathogenesis. This article is a review of diffusion-tensor magnetic resonance tomography and tractography usage in the brain and spinal cord of patients with different clinical phenotypes of multiple sclerosis. Main features of pathologically damaged white and grey matter observed using diffusion-tensor magnetic resonance tomography and tractography, correlations between different diffusion indices and disability are described. The problems of pathogenesis are discussed.