A single-center, prospective, randomized study was conducted to evaluate endothelial function in women with preeclampsia after cesarean section using different postoperative analgesia methods. Group 1 (n = 54) received multimodal analgesia, while group 2 (n = 50) supplemented this with a TAP block. We assessed brachial artery reactive hyperemia after compression and the uterine artery pulsatility index before and after surgery. It was found that endothelial dysfunction associated with preeclampsia resolved more quickly after the TAP block. The TAP block did not negatively impact uterine blood flow in women with preeclampsia during uterine involution after childbirth. This was demonstrated by comparing the uterine artery pulsatility index in women after different postoperative analgesia methods.

The article presents an analysis of the impact of cesarean section (CS) on the health of newborns, driven by the high (28.5%) and continuously growing rate of operative delivery in the Russian Federation. The aim of the work was to develop an algorithm for the early detection of hypoxic, metabolic, and neurological disorders in children. The study included a retrospective analysis of 6629 births and a prospective observation of 104 full-term newborns (after vaginal delivery, planned, and emergency CS). It was established that CS, especially emergency CS, is associated with a higher frequency of neurological abnormalities (62-67% versus 18% in vaginal delivery), metabolic stress (lactate level 4.4 mmol/L), and problems with breastfeeding. Independent predictors of neonatal disorders were identified. Based on the obtained data, a two-stage monitoring algorithm (in the maternity hospital and outpatient setting) was developed for the timely diagnosis and prevention of pathologies in children born by CS.

The aim of the study was to investigate the relationship between the serum level of C-terminal telopeptides of type I collagen and clinical and laboratory features of rheumatoid arthritis in elderly female patients. We observed 87 patients with a reliable diagnosis of RA. The average age of the patients was 67.4±6.9 (61.7-73.4) years. The duration of RA ranged from 0.2 to 33 years (9 [4-16]). The average level of β-Cross Laps in patients with RA was 0.684 [0.40-0.78] ng/ml, an increase in the upper limit of the norm was observed in 28 (32.2%) patients. No significant relationship was found between the level of β-Cross Laps and age, as well as height, weight and BMI of the patients. A relationship was found between the concentration of β-Cross Laps and disease activity (K-W χ2=3.318, p=0.042), radiographic stage (K-W χ2=2.960, p=0.036), functional class (K-W χ2=3.639, p=0.030) and CRP level (ρ=3.1907; p= 0.037).

The article demonstrates dynamics of inflammatory laboratory tests in patients with severe community-acquired pneumonia (sCAP) and evaluates their prognostic value as mortality predictors. Fifty patients with sCAP admitted to the Anesthesiology and Intensive Care Unit (AICU) of the State Budgetary Institution of the Republic of Sakha (Yakutia) "Yakut Republican Clinical Hospital" in the period from 01.08.2024 to 16.02.2025 were examined. In the groups of survivors and deceased, laboratory tests were studied over time for the first 5 days of treatment, as well as an analysis of estimated hematological indices was carried out: neutrophil-lymphocyte index (NLI), delta-neutrophil index (DNI), C-reactive protein to albumin ratio. As a result, thrombocytopenia increased in the deceased group by day 3 (p=0,039), procalcitonin level from day 4 (p=0,044), hypoalbuminemia by day 5 (p=0,01). According to ROC analysis, ferritin on day 1 (AUC 0,711 ± 0,088, p = 0,022) and platelet count on day 5 (AUC 0,727±0,089, p=0,031) are of average prognostic value as markers of death in patients with PVI.

Musculoskeletal disorders (MSD) are an urgent health problem, especially among students. Early diagnosis of risk factors and initial symptoms is critically crucial for maintaining the quality of life of students. This study aimed to evaluate the effectiveness of plantographic analysis in early MSD diagnosis in students and explore the correlation between objective foot indicators and subjective complaints. We examined 152 third-year medical students of K.E.Tsiolkovski Kaluga State University. A statistically significant relationship was revealed between physical inactivity, prolonged static loads and deformities of the feet. Based on the data obtained, recommendations have been for the introduction of plantography into the system of screening and prevention of MSD violations in universities.

A comparative assessment was carried out from 2020 to 2024 to investigate the complex relationship between dietary habits and colorectal cancer (CRC) incidence in two geographically and environmentally distinct Russian regions: the Irkutsk Oblast (IO) and the Krasnodar Krai (KK). Over the research period, we conducted a comprehensive comparative analysis of per-capita consumption patterns of key food groups — vegetables, fruits, and meat products — alongside regional CRC incidence rate. The findings revealed strikingly contrasting patterns between the two regions. In the Irkutsk Oblast, we observed a paradoxical positive correlation between vegetable and fruit consumption and CRC incidence, with correlation coefficients of r = +0.87 (vegetables) and r = +0.63 (fruits). Conversely, in the Krasnodar Krai, the analysis showed a clear negative correlation, with coefficients of r = −0.79 (vegetables) and r = −0.71 (fruits). These counterintuitive results prompt a critical re-examination of the protective role of plant-based diets. We hypothesize that in the Irkutsk Oblast, the potential health benefits of vegetables and fruits may be compromised by several environmental and logistical factors. This research underscores the importance of considering regional environmental and food supply chain factors when evaluating diet-disease relationships, suggesting that the health impact of certain foods may vary significantly depending on local conditions.

The aim of the study was to evaluate the effect of ozone-oxygen mixture (OOM) as a radiomodifier in neoadjuvant chemoradiotherapy on the incidence of radiation complications and toxic effects of treatment, as well as on five-year overall survival rates in patients with stage IIb squamous cell carcinoma of the cervix. A retrospective comparative analysis of the treatment of 81 patients with stage IIb squamous cell carcinoma of the cervix (T2bN0M0) was performed. The patients were divided into a study group (n=50) who received standard neoadjuvant chemoradiotherapy in combination with transrectal insuflation of OOM, and a control group (n=31) who received standard neoadjuvant chemoradiotherapy without OOM. In the study group, a statistically significant decrease in the incidence of radiation colitis (14.9% vs. 29%; p=0.046) and radiation cystitis (4.3% vs. 29%; p=0.005) was revealed. No cases of post-radiation dermatitis have been reported. The incidence of haematological toxicity was lower in the study group (46% vs 58%; p=0.005). The five-year overall survival rate was 89.3% in the study group and 74.3% in the control group (p<0.05). Conclusion. The use of OOM as an additional radiomodifier in neoadjuvant chemoradiotherapy is associated with a reduction in the incidence of individual radiation complications and hematologic toxicity, as well as with higher five-year overall survival rates in the study cohort.

Using a clinical case study, the effectiveness of metacarpophalangeal joint endoprosthetics with simultaneous reconstruction of the tendon-muscular apparatus in the surgical rehabilitation of the hand in late-stage rheumatoid arthritis is demonstrated. The work shows the immediate results of the operation and the long–term results after 6 and 12 months. A clinical example demonstrates the possibility of a wider application of this type of surgery for rheumatoid arthritis, which can reduce the intensity of pain, increase joint movement and achieve a good cosmetic effect.

Neurogenic tumors located in the larynx are extremely rare. Among them, schwannoma, which is a benign encapsulated tumor arising from Schwann cells that form the sheaths of nerve fibers in the peripheral nervous system. In this article, we provide a review of the literature on the clinical and morphological diagnosis of laryngeal schwannoma and present a macro- and microscopic picture of a case of laryngeal schwannoma in a woman in the area of the right laryngeal ventricle. At an early stage, they can be asymptomatic and grow slowly. As the tumor enlarges, patients often experience dysphagia, cough, a sensation of a foreign body, sore throat and difficulty swallowing. The main method of diagnosis is morphological diagnostics, with such histological criteria as encapsulation, the presence of Antoni zones A and B and a positive reaction to the S-100 protein. The only effective treatment is surgical excision, which ensures airway patency and prevents tumor recurrence.

Currently, the incidence of dental defects due to tooth loss due to complications of caries and periodontal disease is quite high (paraphrase). This necessitates restoration of these defects, including the placement of dental implants. The literature provides insufficient information on the rehabilitation of patients using dental implants with palatal exposure (vestibular bone shield) for single defects with moderate lateral atrophy of the maxillary alveolar process, which prompted this research. Therefore, this paper presents the clinical results of the practical application of this method using implants with a less rough and anodized neck. The paper presents the results of a 5-year application of the developed method in 118 clinical cases of middle-aged and elderly patients with single partial secondary adentia in the form of included defects with moderate lateral atrophy of the maxillary alveolar process. The obtained data were processed using MS Office Excel. The combination of significant features contributes to the solution of the methodological problem: increasing the effectiveness and minimally invasiveness of rehabilitation for single, included defects with moderate lateral atrophy of the maxillary alveolar process using implants with milled and anodized necks when placed in the maxillary ridge with lateral atrophy and palatal exposure (vestibular bone shield). This eliminates the need for bone augmentation and allows for immediate loading with orthopedic structures. Thus, the use of dental implantation with palatal exposure (vestibular bone shield) and a milled and anodized neck contributes to the effectiveness of surgical interventions and orthopedic rehabilitation for moderate lateral atrophic changes in the maxillary alveolar process.

The study showed that women with premature ovarian insufficiency and early menopause already at a young age develop a marked deterioration in bone quality, mainly by the type of osteopenia, and in some patients (11,9%) — osteoporosis. In women of reproductive age with estrogen deficiency, basic hormone therapy prevents further bone loss, but osteoanabolic therapy is required to actively restore bone tissue with a more pronounced decrease in mineral density.

An analysis of medical death certificates for women aged 15-29 years was conducted, collected by covering all cases for 2020, 2021, 2022 and 2023 (242, 303, 298 and 293 cases, respectively). The material was grouped by administrative districts and cities (places of permanent residence), united in the form of economic districts (12 economic districts in total). The mortality rate was calculated per 100,000 women aged 15-29 years. In the cities of republican subordination, the indicator ranged from 14.5±5.5 to 43.0±21.5 0.0000. The mortality rate of women aged 15-29 in Azerbaijan is 26.6±1.5 0.0000. In its regions, it ranges from 9.9±4.4 to 36.0±18.0 0.0000, the differences in indicators in administrative districts, cities and economic regions are significant.

This study addresses the issue of knowledge management in healthcare. It presents the experience of a federal scientific medical organization, where a process-based approach implemented within a quality management system is the basis for addressing this issue. The study presents both the results of medical personnel's subjective assessments of the existing knowledge management system and objective data allowing for an assessment of its maturity level using the G-KMMM model. The role of information technology in the knowledge management system is demonstrated and future improvements are identified. The practical value of this study lies in the potential for replicating the experience of the Research Institute of KPSSZ to other scientific and medical organizations.

Modern healthcare is in a state of constant change. Numerous models for managing organizational change have been described to date. Practical experience is represented by a number of studies; the number of publications in the PubMed database in 2000 was less than 1,000, while in 2022 it reached 12,500. The most frequently used models were those by Lewin and Kotter, with numerous applications of the McKinsey 7S and ADKAR models also described. While international studies describe the application of a specific model in healthcare practice, domestic literature emphasizes general recommendations and methods for implementing change in healthcare organizations. Experience shows that the application of models in healthcare practice can help managers solve specific management problems to achieve the goals of a healthcare organization, which is a key factor in the successful functioning of an organization in the constantly changing conditions of the modern world.

The personnel sustainability of the healthcare and higher education systems constitutes a fundamental prerequisite for ensuring the quality of life of the population. Employees’ trust in working conditions, management, and career progression prospects serves as an integral indicator reflecting the degree of congruence between the organizational environment and employee expectations. The objective of this study is to develop a methodological approach for constructing an employee trust index and to perform a comparative analysis of the indices and structure of trust among physicians and higher education faculty members. The empirical framework comprised data from two sociological surveys conducted in 2023 and 2025 among physicians and faculty members. Selecting significant statements involved binary probit regression. Common trust factors for both groups were identified (remuneration, management support, objectivity of evaluation, and attractiveness for young specialists) along the specific factors for physicians and faculty members. The results obtained may be utilised for the development of targeted human resources policy measures in healthcare and education.

The study examined the elemental profiles of maternal and neonatal hair samples, as well as placental tissue, in a region with long-standing mining activity and specific biogeochemical conditions. Biomonitoring of the elemental composition in the mother-placenta-newborn system revealed the accumulation of toxic (Pb, Cd, As, Ni, Cr, Hg) and essential (Fe, Mn, Ca, Mg) elements in mothers, their elevated levels in newborns (except Ca), and the inability of the placenta to effectively perform a barrier function. Correlation analysis of mother-newborn bioenvironments revealed statistically significant relationships, the most pronounced of which was between arsenic levels in maternal hair and calcium in the placenta (r = 0.763). The observed correlations (e.g., Hg in maternal hair – Zn, Cu, and Ca in the fetus's hair) are interpreted as a consequence of the combined maternal exposure to a complex of environmental pollutants and their subsequent distribution within the mother-placenta-fetus system.

The article examines the prevalence and causes of fatal industrial accidents due to occupational injuries and common diseases at enterprises in various sectors of the economy of the Republic of Bashkortostan and develops proposals to reduce the risk of their occurrence. The paper uses the method of retrospective analysis based on the materials of the investigation of fatal accidents that occurred at the workplace in the enterprises of the republic. The analysis showed that as a result of injuries, men in the age range of 30-49 years with short work experience most often died. Falls from heights and traffic accidents dominated among the causes of death. In the workplace, men aged 50-64 died more often from common diseases due to diseases of the circulatory system. The conducted research made it possible to identify the sectors of the economy and professions with the highest risk of fatal accidents, identify the main causes and circumstances that led to deaths and develop preventive measures to minimize them.

A comparative analysis of morbidity with temporary disability due to circulatory system diseases (CSD) in the Russian Federation in the pre-pandemic and early post-pandemic period was carried out. In 2023, there was a statistically significant increase in the incidence rate among workers in the age groups under 30. In order to reduce mortality from CVD, health authorities and employers are advised to pay attention to the circulatory system health of younger workers.

An observational, analytical, cross-sectional study was conducted to assess the relationship between iodine status, thyroid hormonal profile parameters, and physical developmental deviations in children living in the Arctic zone of the Far Eastern Federal District (Chukotka Autonomous Okrug, Anadyr). Iodine deficiency in children aged 1 to 18 years (n=120) was observed in 80.9% of cases, with moderate deficiency being the most common (37.5% of children). A trend toward accelerated physical development was identified, with a high prevalence of overweight and obesity – 16.2% and 16.8% of cases, respectively. A correlation analysis revealed an increase in BMI values in school-age children with increasing iodine deficiency (r = -0.312, p = 0.015). An analysis of thyroid status revealed that 13.5% of children had signs of subclinical hypothyroidism, the prevalence of which did not differ statistically significantly when comparing different age groups (p = 0.270). A ROC-analysis revealed that iodine levels in children of 42.5 μg/ml or less increase the risk of thyroid-stimulating hormone levels exceeding 4.0 μIU/ml.

The review article presents the epidemiological, etiopathogenetic, clinical, and diagnostic aspects of monkeypox (MPOX), as well as possible measures for the prevention and treatment of this infectious disease. The causative agent, the monkeypox virus (MPXV), is transmitted in various ways: sexually, through household contact, and airborne droplets, which determines the clinical features of patients and a high mortality rate. Currently, a limited number of drugs are used that affect viruses of the Poxviridae family. Therefore, MPXV retains the status of a priority object for research in virology and epidemiology.

The purpose of this work was to analyze and systematize the data of modern scientific literature on predictors of hepatocellular carcinoma (HCC) development in chronic hepatitis B. Studies show that the most significant risk factors for developing HCC are old age, male gender, genetic predisposition, presence of metabolic syndrome, liver fibrosis, smoking, alcohol consumption, exposure to hepatotropic toxins and environmental pollution. Of particular importance is the identification of mutant forms of hepatitis B virus, such as A1762T/G1764A, E64D, E77Q, and A80I/T which increase the risk of developing HCC. The development of universal and accessible diagnostic models that make it possible to identify patients at increased risk of developing HCC in a timely manner is a priority task for improving the quality of medical care and improving the effectiveness of combating this serious disease. Thus, the study confirms the importance of further studying the mechanisms of HCC development and introducing new approaches to the treatment and prevention of hepatitis B complications.

Gastroesophageal reflux disease (GERD) is a chronic, multifactorial disorder characterized by dysfunction of the gastroesophageal junction and impaired esophageal clearance, leading to pathological reflux. Objective: To analyze the literature on the role of genetic factors in the development of GERD and its complications. It was found that the development and progression of GERD is associated with polymorphisms in key genes. These include genes encoding proinflammatory cytokines, signaling molecules, epidermal growth factor, and the FOXF1 and MHC markers. Damage to mtDNA plays a significant role, leading to activation of oxidative stress and cellular dysfunction. Genetic factors create an individual predisposition, determining the response of the esophageal mucosa to chronic reflux and the risk of malignant transformation. Genetic factors (genetic polymorphisms, mtDNA damage) can play a key role in the severity of clinical manifestations of GERD and the development of complicated forms of the disease.

Innate immunity is the body's first line of defense against pathogens, and its genetic variability can significantly determine individual susceptibility to infections. The aim of this review is to investigate the role of single nucleotide polymorphisms responsible for innate immunity and their impact on the development and course of viral infections. This is especially relevant given the increasing incidence of infectious diseases and the need to develop new methods for their prevention and treatment. Furthermore, identifying genetic risk factors facilitates the development of personalized medicine and improved treatment outcomes. The study revealed a significant association between certain single nucleotide polymorphisms in the genes encoding toll-like receptors, cytokines (interleukins, interferons), and other components of innate immunity and predisposition and resistance to viral diseases. Some polymorphisms are associated with a higher risk of infection, more severe infections, reduced effectiveness of the immune response, and an increased risk of complications. The obtained results highlight the importance of studying this issue to understand individual differences in the body's response to infectious agents. The study highlights the need for further research into genetic predisposition to infections and the potential use of genetic markers to assess risk and optimize treatment strategies.

In recent years, the concept of exposome, which includes a complex of external and internal factors, has been increasingly applied in complex biological and medical research, taking into account the cumulative effect of multifactorial effects on the body. The exposome concept is quite applicable in assessing the risk of developing psoriasis, ranging from lifestyle analysis, bad habits, the influence of man-made environmental factors, concomitant diseases, and ending with the genetic characteristics of patients. The purpose of this review is to analyze modern scientific data on the relationship of external and internal exposure factors with the pathogenesis of psoriasis. In the process of writing the article, 165 literary sources presented in databases were analyzed: PubMed, Medline, Scopus, Web of Science, RSCI, without language restrictions. Using the keywords "psoriasis", "genome concept", "single nucleotide polymorphisms of genes", "comorbid diseases", "environmental factors", 54 scientific papers were selected, which are discussed in detail in the presented review. An analysis of scientific publications has shown a significant role of single-nucleotide polymorphisms in the risk of psoriasis; the presence of common inflammatory and immune pathways involved in psoriasis and concomitant diseases; convincing evidence of the trigger role of external exposure factors (environmental pollution, bad habits - smoking, alcohol, stress and other lifestyle aspects) in the development of psoriasis.

It is known that fetal communications are pathological conditions in which elements of intrauterine blood circulation remain after birth, leading to impaired oxygenation and hypoxemia of newborns. The review analyzes the literature sources, examines the causes, pathogenesis, risk factors and correction of fetal communications (functioning ductus arteriosus, open oval window). This pathology is a serious problem requiring immediate intervention in case of its hemodynamic significance. The outcome of treatment depends on early diagnosis and choosing the right management tactics.

This review examines the etiology, pathogenesis, and clinical features of deafness-infertility syndrome (DIS) caused by biallelic contiguous gene deletions involving STRC and CATSPER2, encoding the structural protein stereocilin, responsible for sound perception in the inner ear, and the cation channel CatSper, which is crucial for male fertility, respectively. A literature review demonstrates that DIS has only been confirmed in 6 patients worldwide to date, and its general population prevalence has not been established. However, this study revealed that in untargeted patient samples considering only one of the phenotypes of this syndrome (patients with hearing impairment or men with infertility), the prevalence rate of DIS chromosomes carrying biallelic CNVs in the STRC-CATSPER2 genes was 1,9% (232/12 388). Furthermore, recent studies have revealed a relatively high allelic frequency of DIS-chromosomes among population cohorts (0.55%). These results suggest that the global prevalence of DIS syndrome may be significantly higher. To clarify the true prevalence of this deafness and infertility syndrome, targeted studies are needed to identify large deletions of contiguous STRC and CATSPER2 genes in patient samples designed to account for both phenotypes — sensorineural hearing loss and decreased male fertility.

This article analyzes the serum homocysteine, folate (B9), and vitamin B12 levels in patients (n=105) with neurological diseases in the Sakha Republic (Yakutia). The study confirmed a relationship between homocysteine levels and vitamin B12 (-0.416; p <0.01) and folate (B9) (r= -0.416; p <0.01) levels. Women showed a tendency toward decreased vitamin B12 and folate levels (p <0.005) depending on age, and a simultaneous increase in homocysteine concentrations (p <0.001). The highest proportion of hyperhomocysteinemia cases occurred in women with neurological diseases aged 75 years and older. Given that Alzheimer's disease is most often diagnosed in women in this age group, these data are of particular significance.

Age-related changes in women's bodies are characterized by decreased blood folate levels, while in men this level tends to increase. These age-related changes in homocysteine and folate metabolism in women must be taken into account when interpreting research results.

We presented a clinical case of unusual combination of four malignant tumors in one patient. The combination of multiple primary cancers of the reproductive system in women is the most common. This clinical case is a medical history of a 69-year-old patient who first developed metachronous cancer and then synchronous cancer, with all tumors presenting the most unfavorable histological types, which is likely related to a hereditary syndrome. We have analyzed the possible causes of malignant tumors in this patient and presented a treatment strategy for synchronous tumors.

The article describes a clinical case of functional mitral regurgitation in a 76-year-old patient. Upon hospitalization, an echocardiography was performed on an emergency basis, which visualized a violation of the coaptation of the mitral valve flaps, regurgitation of 3-4 degrees on the mitral valve. In this regard, a differential diagnosis of the cause of mitral regurgitation was performed: between the separation of the chords of the mitral valve and functional regurgitation. After angioplasty and stenting of the infarct-related artery, a decrease in the degree of mitral regurgitation was observed on the 7th day of hospitalization, which confirms the effectiveness of treatment and the functional nature of the developed condition. The presented clinical case clearly demonstrates the problems of differential diagnosis of ischemic mitral regurgitation. Increasing doctors' alertness and awareness of functional mitral regurgitation can help in choosing treatment tactics and determining indications for surgery.

The paper discusses the diagnosis and treatment of mitochondrial DNA depletion syndrome (MDS), which is associated with a defect in the thymidine kinase 2 (TK2) gene. Despite the expansion of neonatal screening (up to 36 diseases, with plans to increase it to 62), the detection of MDS requires expensive whole-genome sequencing and is not yet available on a large scale. A case of a girl with TC-2-associated mitochondrial myopathy is described: the disease manifested itself at 9 months with weakness of the limbs and regression of motor skills, complicated by pneumonia, respiratory failure and cardiomyopathy. The diagnosis was confirmed genetically. The patient received therapy with deoxytimidine and deoxycytidine — the condition stabilized, new skills appeared. Long-term follow-up showed a decrease in the frequency of pneumonia, improvement of tests and a decrease in dependence on respiratory support. The importance of early genetic diagnosis and access to treatment is emphasized; research centers and telemedicine can help with this.

A steady increase in the incidence of multiple primary malignant tumors (MPMTs) has been observed in recent years. We report a case of a 67-year-old male patient diagnosed with synchronous multiple primary tumors in the rectum and stomach. The patient was initially hospitalized with a diagnosis of rectal cancer (RC); however, comprehensive diagnostic workup revealed gastric cancer as a second primary malignancy. The histological type of both tumors was adenocarcinoma. Based on the oncological medical consultation, neoadjuvant chemotherapy mFOLFOX6 was administered, which resulted in partial regression of the RC and complete regression of the gastric tumor, confirmed morphologically. Given the good response and the patient’s refusal of surgical treatment for gastric cancer, only surgery for RC was performed. No adjuvant therapy was administered. No progression was observed over 32 months. This case highlights the importance of comprehensive diagnostics and an individualized approach to the treatment of MPMTs.

In recent decades, with the growth of such pathological conditions and diseases as: multifocal atherosclerosis, diabetes mellitus, malignant neoplasms and a number of others, the number of acute mesenteric circulatory disorder (AMCD) has increased. Currently, there are no uniform clinical guidelines for AMCD approved by the Ministry of Health of the Russian Federation in Russia in the form of a separate document. Diagnosis and treatment are regulated by protocols for the treatment of intestinal obstruction and the recommendations of vascular surgeons, which necessitates further study of this problem and the creation of a unified treatment protocol.

This article presents a clinical case of ischemic stroke in the artery of Percheron territory in a 34-year-old man with acute onset of cognitive impairment and psychomotor agitation. Diagnosis was challenging due to the absence of pathological findings on computed tomography within the first 24 hours, highlighting the low sensitivity of this imaging modality in thalamic infarcts. Magnetic resonance imaging with diffusion-weighted imaging (DWI) played a decisive role in verifying the diagnosis, revealing bilateral ischemic lesions in the thalami, while magnetic resonance angiography confirmed the presence of the artery of Percheron. Differential diagnosis allowed the exclusion of Wernicke’s encephalopathy, tick-borne encephalitis, autoimmune encephalitis, first-episode psychiatric disorder, and exogenous intoxication. Molecular genetic testing revealed a homozygous mutation in the MTHFR gene (677 C/T, T/T) in the setting of hyperhomocysteinemia. Comprehensive therapy resulted in regression of psychomotor agitation and cognitive impairment.