Background. Migraine is a chronic neurovascular disease with high prevalence (12-15% of the population) and social significance [1]. Pathogenesis of migraine has not been clear. Some studies report an association between migraine and the presence of a patent foramen ovale (PFO) and right-to-left shunt [2, 3, 4]. Introduction. The objectives of this study were to clarify the prevalence and clinical characteristics of migraine, as well as the effect of endovascular PFO closure on the course of migraine in a cohort of patients who suffered ischemic stroke (IS) by paradoxical embolism due to PFO. Material and methods. We examined 97 patients from 18 to 50 y.o. (average age 32.29 ± 2.19 years, women 70.8%) with IS due to PFO in The Research Center of Neurology since January 2018 until October 2023. All patients were assessed for migraine, characteristics of headaches and the impact of migraine on social adaptation. Endovascular surgery was performed in 61 patients. The data from a dynamic examination of 24 patients with migraine were assessed before and after PFO closure. Results. Among a cohort of IS due to PFO patients, the prevalence of migraine was 39.2% (migraine with aura - 55%, migraine without aura - 45%), the ratio of women to men was 1.9:1. The frequency of headaches was 4 [1;7] days per month. Six months after PFO closure, patients with migraine showed a significant decrease in the frequency of headaches from 4 [2; 24] up to 2 [1;5] days per month (p=0.009); reduction in pain intensity from 7 [7; 9] to 3 [3; 7] points according to VAS (p=0.0001); reduction of disability from 20 [6; 89] to 17 [2; 26] points (p=0.019) according to the MIDAS. Conclusion. The present study confirmed the high prevalence of migraine in the PFO cohort. PFO closure led to decrease in frequency and intensity of headaches and decrease of migraine’s impact on social adaptation.

BACKGROUND: Migraine is a chronic neurovascular disease with high incidence rate and medical-social significance. Despite more than half a century of studying the disease, the pathogenesis of migraine is not yet completely clear. The results of separate research works demonstrate the inter-relation of migraine with the presence of patent foramen ovale and circulation shunting from the right side to the left one. AIM: Detailing the incidence rates and the clinical characteristics of migraine, as well as the effects of endovascular installation of the occluding device into the patent foramen ovale in terms of migraine course in a cohort of patients that had an ischemic stroke episode according to the mechanism of paradoxical embolism due to having a functionally significant patent foramen ovale. METHODS: The examined population included 97 patients aged from 18 to 50 years old (mean age 32.29±2.19 years; 70.8% females), undergoing examination procedures at the Research Center of Neurology from January 2018 until October 2023. All the patients previously had an ischemic stroke that had involved the mechanism of paradoxical embolism, associated with the presence of patent foramen ovale and high functional significance shunting. All the patients underwent an assessment of their conditions associated with the presence of a patent foramen ovale — migraine with or without aura, other procedures included the detailing of headache characteristics and of the effects of migraine on social adaptation. The endovascular intervention was performed in 61 patients. Dynamic follow-up data were obtained for 36 patients, of which 24 migraine patients had an assessment of headache characteristics before and after the foramen ovale closure. RESULTS: Within the cohort of patients with patent foramen ovale accompanied with functionally significant shunting and with a previous episode of ischemic stroke, the incidence of migraine was 39.2% (no aura — 21 patients or 55%; with aura — 17, or 45%), while the proportions of women and men being 1.9:1. The rate of headache attacks was 4 [1; 7] days per month. In 6 months after the installation of the foramen ovale occluder, migraine patients were showing a significant decrease in the rate of headache onsets from 4 [2; 24] to 2 [1; 5] days a month (р=0.009); a decrease was reported for pain intensity from 7 [7; 9] to 3 [3; 7] points of the visual analogue scale for pain (р=0.0001) along with a decrease in the degree of migraine affecting the patients’ everyday activity from 20 [6; 89] to 17 [2; 26] points (р=0.019) of the MIDAS questionnaire. CONCLUSION: The present research has confirmed the high incidence found in a cohort of patients with patent foramen ovale. Installation of the occluder resulted in a decrease in the rate and intensity of headache along with a decrease of migraine affecting the social adaptation. The research limitations were a small number of patients and the absence of data on the residual shunting circulation.

BACKGROUND: Transient Idiopathic Perivascular Inflammation of the Carotid artery (TIPIC) or carotidynia is a clinical and radiological syndrome manifested as ipsilateral neck pain and an ipsilateral perivascular infiltrate according to ultrasound and magnetic resonance imaging. Due to the low awareness of physicians, this pathology is often mistakenly regarded as dissection or atherosclerosis of the carotid arteries, which leads to additional unnecessary diagnosis and treatment. CLINICAL CASE DESCRIPTION: Here, we present a case of idiopathic carotidynia with a discussion of the diagnostic algorithm and management of patients with unilateral neck pain. CONCLUSION: Timely and competently interpreted ultrasound and magnetic resonance imaging studies of arteries is a key link in the diagnosis of carotidynia. The complete regression of symptoms and pathological changes in the arteries without a specific therapy classifies it as a benign variant of non-atherosclerotic arteriopathy.

OBJECTIVE:To evaluate the relationship of diet and food components with the frequency of migraine attacks. MATERIAL AND METHODS:Sixty patients (mean age 35.5±8.9 years, 85% women) with frequent episodic (EM) and chronic migraine (CM) were examined. Anamnestic information on food triggers was clarified for all participants. The patients kept a food diary for 7 days. For each meal, the content of food components (proteins, fats and carbohydrates) was calculated using tables and an electronic calculator of the Federal State Budgetary Institution «Nutrition and Biotechnology». Based on the data obtained, the average daily consumption of the main components of food and the ratio of their proportions to each other were calculated. The results of the data analysis were used to clarify the relationship between the individual characteristics of the diet in terms of food components and the severity of migraine. RESULTS:The main food triggers of migraine were red wine (43.3%), coffee (35.0%), cheeses (21.7%), spices (20.0%), additives of nitrite or monosodium glutamate (20.0%). The average daily intake of carbohydrates had an inverse relationship (p=0.044, r=-0.275), and fats had a direct relationship (p=0.011, r=0.336) with the number of days with migraine. CONCLUSION:The results indicate the protective role of carbohydrate consumption in the development of migraine, which may correspond to the compensatory strategy of the body aimed at energy supply to the brain. Further study of the cerebral metabolic aspects of migraine should improve the understanding of its pathophysiology and chronicity, which will allow the formation of a correct diet preventive strategy.

Involutionary forms of muscle pathology for the neurological community is ‘terra incognita’. The purpose of this publication is to describe clinical forms, pathogenesis, diagnostic and treatment methods of skeletal muscle diseases in the aging population.

Clarification of the aetiology of ischemic stroke (IS) in young adults (aged between 18 and 45 years) is an extremely difficult task, as rare causes that are hardly known to neurologists are very common. One of these causes is paradoxical embolism due to pulmonary arteriovenous malformation (AVM), one of the manifestations of hereditary hemorrhagic telangiectasia (HHT). The diagnosis of HHT-associated pulmonary AVMs and IS is a multistep task that requires a personalized multidisciplinary approach using high-tech ultrasound, tomographic and genetic examination methods. This article discusses the clinical case of a young patient with HHT and recurrent IS through the mechanism of paradoxical embolism from pulmonary AVMs; issues of diagnosis, treatment and prevention of both the underlying disease and recurrent vascular events are discussed.

Objective. To determine specific diagnostic criteria for detecting the type of the right-to-left shunt by contrast-enhanced transcranial Doppler ultrasound (cTCD) in young patients with paradoxical embolism and ischemic stroke/TIA. Material and methods. The study included 64 ischemic stroke or transient ischemic attack patients (age 28–44 years) with patent foramen ovale (PFO), atrial septal defect (ASD) or pulmonary arteriovenous malformation (PAVM). cTCD was used to assess the degree of shunting, its change during the Valsalva maneuver (VM), time to the fi rst microembolic signal (MES) detection, and the duration of MES registration. Results. According to cTCD data, 20% of patients with PFO had no shunt at rest, and 80% had a mild to moderate right-to-left shunt. After VM, a severe shunt was detected in 75% of patients in this group and a moderate shunt in 25%. All patients with ASD and PAVM had a marked shunt at rest. The difference in time to first MES detection from the start of contrast administration was not statistically significant for all groups. The duration of MES registration that indicated shunting was shorter in patients with PFO compared to those with ASD (p < 0.001) or with PAVM (p < 0.001) and it was significantly longer in patients with PAVM compared to those with ASD (p < 0.001). Conclusion. The key diagnostic criteria to defi ne the right-to-left shunt type are the functional shunt degree at rest and the duration of MES registration. Severe shunting at rest can suggest the presence of ASD or PAVM, while the duration of MES registration > 2 min suggests a PAVM.

Cryptogenic embolic stroke (embolic strokes of undetermined source, ESUS) is an intermediate diagnosis in patients with unknown etiology of stroke and implies the absence of large sources of cardioembolism and significant extra- and intracranial stenoses and probably embolic pathogenesis of cerebral infarction. In the previous parts of the article, we discussed the issues of diagnosis and secondary prevention of ESUS with underlying potential aortoaortic sources of embolism, paradoxical embolism and atrial cardiopathy. This article discusses the issues of epidemiology, pathogenesis, diagnosis and secondary prevention of ischemic stroke with underlying antiphospholipid syndrome (APS) and cancer-associated stroke (RAI). Both mechanisms of stroke are associated with hypercoagulability, often manifest as multifocal cortical brain lesions, and respond to anticoagulant therapy. While APS should be suspected primarily in young women with pathology of pregnancy, arterial and venous thrombosis, as well as livedo reticularis (racemosa), RAI does not have a specific clinical picture, but can manifest as diffuse cortical infarcts (symptom of three pools) combined with increased D-dimer level. If APS is suspected, appropriate haematological screening is required, followed by the use of the Sydney diagnostic criteria. Possible diagnosis of RAI often requires transesophageal echocardiography (ruling out non-bacterial thromboendocarditis) and oncological screening. Secondary prevention of APS consists in prescribing warfarin with the target international normalized ratio (INR) of 2.0 to 3.0. RAI is treated with anticoagulants, but the choice of a drug and dose is determined by the balance between thrombotic/thromboembolic and hemorrhagic risks.

OBJECTIVE To analyze clinical and instrumental characteristics of patients with ischemic stroke (IS) due to paradoxical embolism according to the data of hospital registers of Moscow and Perm. MATERIAL AND METHODS A comprehensive study of 114 patients, aged 18 to 55 years, with IS by the mechanism of paradoxical embolism was carried out. All patients underwent clarification of the cause of IS (electrocardiography, ultrasound scanning of the brachiocephalic arteries, CT or MRI of the brain, CT or MR angiography, transthoracic and/or transesophageal echocardiography). The presence of right-left shunt blood flow (RLS) was confirmed by transcranial dopplerography with a bubble test. The clinical significance of patent foramen ovale (PFO) was assessed according to The PFO-Associated Stroke Causal Likelihood Classification System (PASCAL). RESULTS Clinical and instrumental characteristics of patients with IS due to paradoxical embolism were obtained from two hospital registries. In both groups, the leading trigger for the development of IS was the Valsalva phenomen (>20%), the share of other provoking factors did not exceed 10%. Significant differences between the analyzed groups related to the ultrasonic characteristics of RLS/PFO: patients with a grade 4 shunt predominated in the Research Center of Neurology (RCN) population, while patients with a grade 3 shunt predominated in the City Clinical Hospital (CCH) №4 group. At the same time, there were twice as many patients with aneurysm of the interatrial septum in the CCH №4 group. In accordance with the PASCAL classification, in 93% of RCN patients, PFO can be considered as a probable cause of IS, while in the CCH No. 4 group, a probable causal relationship was traced only in 51% of cases, in 18% of patients, the role of an anomaly in the development of stroke was unlikely. CONCLUSION The analysis showed that the primary screening of RLS in a regional vascular center allows classifying PFO as a probable cause of IS in only half of the patients. For a more accurate selection of patients for whom endovascular occlusion of the PFO will be most effective, an in-depth examination in a specialized hospital is recommended.

Introduction. High prevalence of migraine and its impact on quality of life requires the development of original agents. In 2020, fremanezumab, a new calcitonin gene-related peptide monoclonal antibody was authorized in Russia. Objective: to evaluate safety and effectiveness of fremanezumab in patients with high-frequency episodic migraine (HF EM) and chronic migraine (CM). Materials and methods. We assessed 60 patients at the age of 35.5 8.96 years (85%, females) with HFEM and CM with and without aura who were either receiving preventive treatment or not. Fremanezumab was administered subcutaneously at a single dose of 675 mg. The study participants were followed-up for efficacy in 3 months. The investigators assessed change in the number of days with headache per month as well as headache intensity, its impact on the daily activities, anxiety, and depression. Results. By the end of month 3 post dosing, the number of days with headache decreased by 50% in 76.7% of participants where 77.8% of individuals suffered from HF EM and 72.7% of individuals had CM while headache intensity decreased in all the patients equally. No response (decrease in the number of days with headache by 30%) was reported in 15% of participants including 14.8% of individuals with HF EM and 15.2% of individuals with CM. By the end of study month 3, 81% of participants demonstrated no anxiety symptoms and 79% of participants showed no depression with significant MIDAS and HIT-6 score decline in both groups. Only 3 (5%) patients noted adverse events (redness, itching at the administration site). Conclusion. We documented higher fremanezumab safety and effectiveness in patients with EM and CM in real-world practice as compared to fremanezumab safety and efficacy in randomized clinical trials. A single dose of fremanezumab (675 mg) resulted in effective migraine prevention, decline in comorbid anxiety and depression, and improved quality of life during 3-month follow-up.

Interoception is critically important for allostatic adaptation and emotional regulation, and aberrant interoceptive processing is increasingly recognized to be involved in the pathogenesis of neurological, psychiatric and cardiovascular diseases. Despite the fact that interoceptive abilities decline with age, the corresponding neural correlates and clinical consequences of these age-related changes have yet to be discovered. We present a dataset that contains task-based functional neuroimaging data from 50 adults aged 40–65 years and 12 adults aged 18–25 years who performed an fMRI-based heartbeat-detection task. Of the 62, 38 participants also took part in a rubber hand illusion experiment outside the scanner. While the dataset was mainly created to study age-related changes in interoception, it can also be used in body perception research in general. The provided group data may serve as a reference for clinical studies on interoception involving older adults.

BACKGROUND: Rehabilitation of patients with post-stroke aphasia is an important medical and social goal. The use of traditional methods of rehabilitation is often not effective enough, which forces us to look for new methods aimed at restoring lost functions. AIM: The aim of this study is to determine the effectiveness of non-invasive brain stimulation using transcranial direct electric current stimulation (tDCS) in patients with post-stroke aphasia. MATERIALS AND METHODS: 28 patients with motor post-stroke aphasia were examined according to the method of L.S. Tsvetkova with co-authors. All patients received a traditional rehabilitation complex: psychological and correctional classes with a speech therapist-aphasiologist; neurometabolic therapy. 14 patients (Group I) additionally had transcranial direct electric current stimulation; 14 patients had placebo transcranial direct electric current stimulation. RESULTS: All patients with post-stroke aphasia showed an improvement in expressive and impressive speech, however, in patients who had true transcranial direct electric current stimulation, the improvement in expressive and impressive speech was higher than in patients who had placebo transcranial direct electric current stimulation. There were no complications from the use of transcranial direct electric current stimulation. CONCLUSION: Based on the results of the study, it can be concluded that it is expedient to include the non-invasive transcranial direct electric current stimulation method in the rehabilitation of patients with post-stroke aphasia.

Pulmonary arteriovenous malformation (PAVM) is considered a rare cause of ischaemic stroke in young patients. In this article, we present a case series of 5 patients with PAVM-associated ischaemic stroke. We discuss pathophysiology, clinical presentation, diagnostic approaches, and secondary prevention. In addition, two of the aforementioned cases are provided in detail: the one of 32-year-old female with ischaemic stroke associated with sporadic PAVM, the latter being treated with embolization, and the one of 24-year-old male with hereditary hemorrhagic telangiectasia (HHT) who developed PAVM-associated ischaemic stroke, who was treated with intravenous thrombolytic therapy and mechanical thrombectomy on admission, followed by video-assisted thoracoscopic PAVM resection.

OBJECTIVE:To assess the effectiveness and safety of Erenumab, a monoclonal antibody to calcitonin gene-related peptide receptors, in patients with high-frequency episodic migraine (HFEM) in real-life study.MATERIAL AND METHODS:35 patients with HFEM without aura (≥8-14 attacks per month) (30 females, mean age 32.4±8.1) received monthly subcutaneous administration of Erenumab 70 mg for 3 months. The primary endpoint was the change in monthly migraine days (MMDs) from baseline, the secondary endpoint was the proportion of patients who achieved a 50% reduction in the number of days with headache. The change in pain intensity, change in the number of days of use of acute migraine-specific medication, the effect on daily activity (HIT-6 scale, MIDAS), anxiety and depression (the Hospital Anxiety and Depression Scale) were assessed.RESULTS:At the end of the third month Erenumab decreased MMDs by 5±3.6 (p=0.00000). A 50% reduction in the mean number of migraine days per month was achieved for 60% of patients, the intensity of headache according to the visual analogue scale from 8±1.2 points to 5±2 points (p=0.00000), monthly analgesics intake passed from 11±7 to 4.5±3.7 (p=0.000001). 25.7% of patients did not respond to treatment, showing less than a 30% decrease in the number of days with headache. A decrease in pain intensity correlated with a decrease in anxiety (from 8±4 to 6±4 points (p=0.003)) and depression (from 6±4 to 4±3 points (p=0.0004)) according to HADS, reduced HIT-6 scale from 65±6 to 55±7 points (p=0.00000) and MIDAS from 45 [33; 67] points to 16 [5; 33] (p=0.000004)). Patients reported good tolerability of Erenumab. 25.7% of patients noted a tendency to constipation. No patient discontinued treatment due to adverse events.CONCLUSION:Real-life study confirmed the efficacy and safety of Erenumab in the treatment of HFEM, a decrease in the severity of comorbid anxiety and depression, and social maladjustment.

The diagnostic value of white matter hyperintensities (WMH) in different types of migraineare unknown. To evaluate the WMH pattern of different subtypes in migraine patients with no vascular risk factors. 92 migraine patients (73 females, mean age 34.6 ± 8.9; 61 episodic migraine, 31 chronic migraine, 36 migraine with aura, 56 migraine without aura) without vascular risk factors underwent brain MRI (3 T). We also included a matched healthy control group with no migraine (n = 24). The prevalence of WMH in different types of migraine was similar and ranged from 38.7 to 44.4%; the control group showed no WMH at all. Lesions were located within frontal, parietal and temporal lobes (in order of decreasing incidence) in juxtacortical and/or deep white matter. WMH appeared as round or slightly elongated foci with a median size of 2.5 mm [1.5; 3]. Total number, size and prevalence of WMH by lobes and white matter regions were similar between groups, and no interaction with age or sex was found. The number of lesions within the frontal lobe juxtacortical white matter correlated with the age of patients (r = 0.331, p = 0.001) and the duration since migraine onset (r = 0.264, p = 0.012). Patients with different migraine subtypes and without vascular risk factors are characterized by a similar pattern of WMH in the absence of subclinical infarctions or microbleedings. Therefore, WMH have no relevant prognostic value regarding the course of migraine and vascular complications. WMH pattern may be used to differentiate migraine as a primary disorder and other disorders with migraine-like headache and WMH.

The article presents a case report of a patient with cardioembolic ischemic stroke (IS), which was the first clinical manifestation of congenital atrial septal defect (ASD), asymptomatic until adulthood. The issues of anatomical classification, restructuring of intracardiac hemodynamics depending on the size and localization of ASD, its role in the development of IS are discussed. The diagnostic algorithm in patients with IS caused by paradoxical embolism is described, the current possibilities of ASD treatment and prevention of related disorders of cerebral circulation are discussed.

Minor atrial septal defect (ASD) may be one of the pathways of paradoxical embolism in the brain. Few scientific papers have investigated the relationship between ASD (excluding patent foramen ovale) and the occurrence of ischemic stroke. There is no definite opinion as to how functionally important such shunts are and how the shunt changes with age. The review analyzes modern ideas about the probability of paradoxical embolism in small ASDs from the viewpoint of pathophysiology, and also demonstrates the technological capabilities of assessing the functional significance of such shunts based on our own clinical observations.

Although the neural systems supporting interoception have been outlined in general, the exact processes underlying the integration of visceral signals still await research. Based on the predictive coding concept, we aimed to reveal the neural networks responsible for the bottom-up (stimulus-dependent) and top-down (model-dependent) processing of interoceptive information. In a study of 30 female participants, we utilized two classical body perception experiments-the rubber hand illusion and a heartbeat detection task (cardioception), with the latter being implemented in fMRI settings. We interpreted a stronger rubber hand illusion, as measured by higher proprioceptive drift, as a tendency to rely on actual sensory experience, i.e., bottom-up processing, while lower proprioceptive drift served as an indicator of the prevalence of top-down, model-based influences. To reveal the bottom-up and top-down processes in cardioception, we performed a seed-based connectivity analysis of the heartbeat detection task, using as seeds the areas with known roles in sensory integration and entering proprioceptive drift as a covariate. The results revealed a left thalamus-dependent network positively associated with proprioceptive drift (bottom-up processing) and a left amygdala-dependent network negatively associated with drift (top-down processing). Bottom-up processing was related to thalamic connectivity with the left frontal operculum and anterior insula, anterior cingulate cortex, hypothalamus, right planum polare and right inferior frontal gyrus. Top-down processing was related to amygdalar connectivity with the rostral prefrontal cortex and an area involving the left frontal opercular and anterior insular cortex, with the latter area being an intersection of the two networks. Thus, we revealed the neural mechanisms underlying the integration of interoceptive information through the interaction between the current sensory experience and internal models.