Neurology for Practice - Latest articles
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Diagnosis and treatment of myasthenic syndromes -commentary on the updated version of the German guidelinesComments
MUDr. Michaela Týblová, Ph.D.
Neurol. praxi. 2026;27(1):74-78 | DOI: 10.36290/neu.2026.009
The German guidelines are the first to have been developed following the introduction of novel therapeutic agents. Reimbursement of these therapies in the Czech Republic differs, as does the socioeconomic context. Nevertheless, the concept of extending clinicians' attention to all active forms of generalized myasthenia gravis, not only to refractory patients, clearly deserves consideration. Therefore, we present a very concise summary of the German guidelines in Czech for the professional community.
Diagnostic procedure in a patient with tremorFrom symptom to diagnosis
MUDr. Petr Hollý, Ph.D.
Neurol. praxi. 2026;27(1):70-73 | DOI: 10.36290/neu.2025.076
This article provides a clear guide for the differential diagnosis of patients presenting with tremor. It focuses on distinguishing the main types of tremor, their clinical features, diagnostic methods, and considerations. Emphasis is placed on recognizing signs that help differentiate essential tremor from Parkinson's disease or other neurological disorders. The article also includes a diagnostic flow chart to facilitate decision-making in clinical practice. It is intended for neurologists and other physicians encountering patients with movement disorders.
The Great Moravian Franz Gerstenbrand (1924-2017)From the History of Neurology
prof. MUDr. Petr Kaňovský, CSc., FEAN
Neurol. praxi. 2026;27(1):64-69
Franz Gerstenbrand (1924-2017) was born in Hof in Mähren to parents who were native South Moravians from the Znaim region; his father worked as a family doctor in Hof. Shortly after little Franz was born, the family returned to South Moravia because doctor Gerstenbrand found a job as a family doctor in Unter Tannowitz. This is where Franz Gerstenbrand spent the days of his childhood and youth, graduating from a grammar school in Nikolsburg. Immediately after graduation, he had to enlist in the army, was assigned to the air force, and spent the rest of the war as an operational fighter pilot. After the war ended, he was captured by the Western Allies...
Wing-beating tremor and double panda sign in a patient with Wilson's disease - case reportVideo case reports
MUDr. Martin Daniš, MUDr. Rastislav Lackovič, MUDr. Zuzana Jankovičová, MUDr. Petra Jungová, MUDr. Natália Keléšiová, MUDr. Georgi Krastev, PhD.
Neurol. praxi. 2026;27(1):61-63 | DOI: 10.36290/neu.2025.066
In this case report, we present a 51-year-old patient who sought medical help for approximately 3 years of complaints of impaired limb mobility and coordination, altered behavior, speech articulation disorders, and gait disorders. Magnetic resonance imaging of the brain in T2-weighted images showed pathological changes in the mesencephalon namely the "face of the giant panda" sign and also the rarer "double panda sign" in pons Varoli. These MRI findings were corresponding with a metabolic disease with copper accumulation. Laboratory tests confirmed decreased serum copper and ceruloplasmin levels. Following these results, increased urinary copper excretion...
Clinical presentation of purulent inflammation of central nervous system in possible autoimmune encephalitis with a good response to corticotherapyCase report
MUDr. Šárka Reischlová, MUDr. Kateřina Matějová
Neurol. praxi. 2026;27(1):56-60 | DOI: 10.36290/neu.2025.044
Encephalitis is a serious inflammatory disease of the brain that involves a complex differential diagnostic assessment due to the wide range of possible causes. This report presents a case of a 71-year-old patient who underwent neurosurgery and subsequently developed subacute cognitive deterioration and recurrent epileptic seizures. The diagnosis of autoimmune encephalitis was prolonged due to a premorbidly diagnosed and treated structural epilepsy and the detection of serous to purulent encephalitis, which presented an atypical cerebrospinal fluid profile. Due to the lack of evidence of an infectious cause and suspicion of autoimmune encephalitis,...
Multiple cerebral venous thrombosis under the guise of lactational psychosisCase report
MUDr. Ing. David Černík, MBA, Ph.D.
Neurol. praxi. 2026;27(1):53-55 | DOI: 10.36290/neu.2025.062
Cerebral venous thrombosis is a rarer cause of stroke. It can be a life-threatening condition. It mainly affects women, and pregnancy and the postpartum period are also significantly at risk. Lactational psychosis is a serious psychological condition in the postpartum period, in which the woman is dangerous to herself and the newborn baby. We present a case report in which the clinical picture of encephalopathy together with the symptoms of migraine attacks in the observed migraineur faithfully imitated lactational psychosis. Early diagnosis and treatment of multiple cerebral venous thrombosis reversed the unfavorable clinical development and prevented...
Speech and language impairments in people with multiple sclerosis - assessment and digital biomarkersFrom the boundary of neurology
Mgr. Lucie Nohová, Ph.D.
Neurol. praxi. 2026;27(1):46-52 | DOI: 10.36290/neu.2026.003
From a speech therapist's perspective, multiple sclerosis causes speech (dysarthria), voice (dysphonia), and language difficulties. Currently, automated analysis is increasingly used to assess voice, speech, and language deficits, as it is much more accurate than perceptual assessment or standard tests. Acoustic analysis can be used to detect features that might be potential biomarkers for the early detection of multiple sclerosis or indicators of the severity of the disease. The aim of this paper is to present speech and language deficits in people with multiple sclerosis, outline the possibilities for their assessment using available tools with automated...
Cluster headache - course of the attack and its clinical variants Cluster headache awareness day 2026Review articles
MUDr. Pavel Řehulka, Ph.D.
Neurol. praxi. 2026;27(1):40-44 | DOI: 10.36290/neu.2025.060
The aim of this review article is to provide information on the clinical course of cluster headache (CH). Individual attacks, cluster periods, and the long-term course of the disease show significant variability, which contributes to diagnostic delay. Notably, some of the CH variants are not uncommon: in a retrospective analysis of own cohort of 70 patients with CH, eight (11,4 %) did not meet the strict wording of the criteria defined by the International Classification of Headache Disorders (ICHD-3). Five patients (7,1 %) due to a change in symptom lateralization, one (1,4 %) due to atypical localization outside the first trigeminal branch (orofacial...
Carriers of dystrophinopathies - a neglected group of patientsReview articles
MUDr. Hana Drašnarová, MUDr. Livie Mensová, MUDr. Radim Mazanec, Ph.D.
Neurol. praxi. 2026;27(1):34-39 | DOI: 10.36290/neu.2025.052
Dytrophinopathies are X-linked genetic dysorders caused by Dystrophine gene mutation. The phenotypes of patients include the well-known forms of Duchenne and Becker muscular dystrophy, DMD-related dilated cardiomyopathy in men, but also less well-known and highly variable forms of dystrophinopathies in female carriers. The disease in women is most often caused by inactivation of chromosome X. It may be manifested as an isolated elevation of muscle enzymes tests, other female patients may suffer from severe muscle weakness, dilated cardiomyopathy or other extramuscular complications. The diagnostic method of choice is a molecular genetic examination...
Clinical relevance of CSF analysis in various neurodegenerative diseasesMain topic
MUDr. Zuzana André, MUDr. Barbora Gaštanová, MUDr. Andrea Kopániová, doc. MUDr. Karin Gmitterová, PhD.
Neurol. praxi. 2026;27(1):28-33 | DOI: 10.36290/neu.2025.022
Neurodegenerative diseases are broadly characterized by progressive damage of CNS with dementia being the most common clinical presentation. Several diseases fall into this category such as Alzheimer´s disease (AD), Parkinson´s disease (PD) and frontotemporal dementia (FTD). Coexisting brain pathology and clinical heterogeneity may hamper the diagnostic accuracy and delay effective treatment. Disease- specific biomarkers, alongside clinical features and imaging methods can substantially improve the diagnosis. Some of the most recent criteria rely on the involvement of CSF core biomarkers in the diagnostic work-up. Despite the distinct pathomechanism,...
Laboratory biomarkers of multiple sclerosisMain topic
MUDr. Kamila Žondra Revendová, Ph.D., MUDr. Ing. David Zeman, Ph.D., MUDr. Radovan Bunganič, MUDr. Kryštof Damián Švub, MUDr. Ondřej Pelíšek, doc. RNDr. Pavlína Kušnierová, Ph.D.
Neurol. praxi. 2026;27(1):22-26 | DOI: 10.36290/neu.2025.032
Laboratory biomarkers play a crucial role in the diagnosis, prediction, and monitoring of treatment efficacy in patients with multiple sclerosis (MS). Their use enables better individualization of therapy, increasing the chances of slowing disease progression and improving patients' quality of life. The most important diagnostic laboratory biomarkers in MS are oligoclonal IgG bands and free kappa light chains, while neurofilament light chains are essential for disease prediction and monitoring treatment efficacy. Research in this area is continuously evolving with the aim of discovering new indicators that further improve diagnostic accuracy and enable...
The importance of cerebrospinal fluid examination in the diagnosis and differential diagnosis of neuroinfectionsMain topic
doc. RNDr. Pavlína Kušnierová, Ph.D., MUDr. Petr Kümpel, MUDr. Mgr. Ivana Kohnová, Mgr. Karin Lichá, MUDr. Ing. David Zeman, Ph.D.
Neurol. praxi. 2026;27(1):15-21 | DOI: 10.36290/neu.2025.054
Cerebrospinal fluid analysis represents a key diagnostic instrument in confirming and differentiating various forms of CNS infections due to its ability to reveal specific cytologic, biochemical and microbiological changes. In cases where CNS infection is suspected, a basic cerebrospinal fluid examination includes the enumeration of nucleated cells and erythrocytes, the differentiation of nucleated cells into mononuclear and polymorphonuclear cells, and, if applicable, a detailed qualitative analysis from a permanent cytological slide. Furthermore, the determination of total protein, glucose and lactate concentrations and the coefficient of energy...
The use of flow cytometry in cerebrospinal fluid diagnosticsMain topic
Ing. Inka Matuchová, Ph.D., MUDr. Ondřej Sobek, CSc., M.I.A.C., MUDr. Lenka Ceprová, doc. MUDr. Iuri Marinov, CSc., prof. MUDr. Jaroslava Dušková, CSc., F.I.A.C.
Neurol. praxi. 2026;27(1):10-14 | DOI: 10.36290/neu.2025.041
Diagnosis of central nervous system (CNS) tumor involvement is a highly responsible and demanding discipline. Qualitative cytological examination of cerebrospinal fluid (CSF) plays a key role, particularly in meningeal tumor infiltrations, allowing the detection of morphological abnormalities of cells. Subsequent special staining immunocytochemical techniques and subsequent evaluation by a cytopathologist allow these atypical cells to be specified closer. If a tumor process originating from hematopoietic cells is suspected, immunophenotyping analysis is appropriate. In a limited sample, this allows the malignant leukocyte clone to be further characterized....
Neuroimunologie - úvodní slovoEditorial
Ing. MUDr. David Zeman, Ph.D.
Neurol. praxi. 2026;27(1):3-4
Od transplantace k fSCIGZaznělo na 4. české neurologické akademii v Plzni 23.-24. října 2025Zaznělo na
MUDr. Zuzana Zafarová
Neurol. praxi. 2025;26(6):527-530
NMOSD as a comorbidity of clinically silent Sjögren's syndromeCase report
MUDr. Tereza Strnadová, MUDr. Dalibor Zimek
Neurol. praxi. 2025;26(6):520-526 | DOI: 10.36290/neu.2025.045
NMOSD (Neuromyelitis optica spectrum disorders) is a group of rare inflammatory autoimmune demyelinating diseases affecting most commonly the optic nerve, brainstem and spinal cord. During diagnostic process is necessary to rule out multiple sclerosis and myelin oligodendrocyte glycoprotein antibody-positive disease (MOGAD). NMOSD and MOGAD are still quite new diagnostic entities. Without treatment, NMOSD has a high risk of relapse and the possibility of permanent disability, especially in young people and those of working age, which is multiplied by its comorbidities. Part of the diagnostic process involves ruling out other neurological causes of...
Vitamin B12 deficiency - a case report of subacute combined degeneration of the spinal cord in comparison with NMOSDCase report
MUDr. Viktorie Neumannová, MUDr. Adam Váchal, MUDr. Pavel Potužník, Ph.D., MUDr. Ing. Radek Tupý, Ph.D.
Neurol. praxi. 2025;26(6):515-519 | DOI: 10.36290/neu.2025.064
Subacute combined degeneration of the spinal cord arises due to vitamin B12 deficiency and belongs to the differential diagnosis of spinal cord lesions. In addition to involvement of the spinal cord tracts, vitamin B12 deficiency can also lead to lesions of the peripheral nerves, optic nerves and brain. Furthermore, vitamin B12 deficiency may manifest with hematological and gastrointestinal disorders. Given the findings on spinal cord MRI, demyelinating diseases, including neuromyelitis optica spectrum disorder (NMOSD), should be considered in the differential diagnosis. In cases of spinal cord lesions, a careful diagnostic...
Altered pharmacokinetics of selected neurological drugs in patients with chronic kidney diseaseFrom the boundary of neurology
Mgr. Michaela Jelínková, PharmDr. Alena Pilková,Ph.D., PharmDr. Jan Miroslav Hartinger, Ph.D.
Neurol. praxi. 2025;26(6):505-514 | DOI: 10.36290/neu.2025.065
Chronic kidney disease significantly affects the pharmacokinetics of various neurological drugs, necessitating careful dosage adjustments. Due to reduced renal clearance, drugs eliminated via the kidneys experience prolonged biological half-lives and accumulation, increasing the risk of toxicity or delaying therapeutic effects. Hypoalbuminemia leads to an increased free fraction of drugs bound to plasma proteins, further complicating accurate interpretation of therapeutic drug levels, as demonstrated with valproic acid. The article addresses the impact of impaired renal function and extracorporeal elimination methods on neurologic renally eliminated...
Ocrelizumab and treatment of multiple sclerosis during pregnancy and breastfeedingTrends in neuropharmacotherapy
MUDr. Jana Pavlíčková, Ph.D.
Neurol. praxi. 2025;26(6):498-504 | DOI: 10.36290/neu.2025.081
Multiple sclerosis is an autoimmune neurological disease that is very often diagnosed in women of childbearing age. Multiple sclerosis does not worsen the course of pregnancy; the risk of relapse is low during pregnancy, but increases after delivery. A key factor in the treatment of our patients is therefore pregnancy planning and therapy that stabilizes patients during pregnancy and postpartum and does not pose a risk to the fetus or newborn. Ocrelizumab (humanized anti-CD20 monoclonal antibody) administered before planned pregnancy and during lactation shows minimal transfer through the placental barrier and into breast milk, allowing according to...
The importance of monitoring asymptomatic carriers of the TTR gene mutation in hereditary transthyretin amyloidosis - a neurologist´s perspectiveReview articles
MUDr. Ivan Martinka, PhD., MUDr. Alexandra Mražíková
Neurol. praxi. 2025;26(6):490-496 | DOI: 10.36290/neu.2025.074
Hereditary transthyretin amyloidosis (hATTR) is an autosomal dominant inherited disorder caused by the deposition of amyloid composed of mutated transthyretin (TTR) or its fragments. TTR amyloid preferentially accumulates in peripheral nerves and the myocardium. Involvement of the peripheral nervous system manifests with autonomic, sensory, and motor symptoms. Without treatment, the disease is relentlessly progressive, leading to death within a few years. Causal therapy can significantly slow disease progression. It is essential to initiate treatment as early as possible, since prolonged disease duration may lead to only partially reversible changes...
Healthcare organization for patients with migraine: differences between Slovak and Czech healthcare systemMain topic
MUDr. Andrea Petrovičová, PhD., MUDr. Pavel Řehulka, Ph.D.
Neurol. praxi. 2025;26(6):482-487 | DOI: 10.36290/neu.2025.029
The primary goal of healthcare for patients with headaches is to improve the quality of life. This requires recognizing headaches as a disease, improving healthcare and ensuring its easy accessibility. These conditions can be achieved by appropriate organization of the health system and increasing efficiency. The organizational model of care recommended by the consensus of the European Headache Federation and Lifting The Burden: the Global Campaign against Headache is suitable for most European countries. However, health services are structured differently in countries. In this article, we present the differences in the organization of healthcare for...
Resistant and refractory migraineMain topic
MUDr. Andrea Bártková, Ph.D.
Neurol. praxi. 2025;26(6):477-481 | DOI: 10.36290/neu.2025.030
The author in the article presents current definitions of resistant, refractory migraines and treatment failure in relation to recent migraine therapeutic options and their implementation in clinical practice.
Migraine treatment in seniors and patients with cardiovascular diseaseMain topic
MUDr. Petr Mikulenka, PharmDr. Markéta Pitrová, MUDr. Jolana Mračková, Ph.D., prof. MUDr. Ivana Štětkářová, CSc., MHA
Neurol. praxi. 2025;26(6):472-476 | DOI: 10.36290/neu.2025.046
Migraine is a common neurological disorder that also affects seniors, despite its prevalence decreasing with age. Even in this population, it can significantly impact quality of life and complicate the management of comorbidities. The clinical presentation of migraine in older patients often differs - attacks tend to be less frequent and milder, may be bilateral, and accompanying symptoms such as photophobia or phonophobia occur less frequently. A major diagnostic challenge is distinguishing aura without headache from a transient ischemic attack (TIA). Migraine treatment in seniors requires an individualized approach, considering pharmacokinetic and...
Management of migraine in a womanMain topic
MUDr. Radka Marková, MUDr. Halina Hevková
Neurol. praxi. 2025;26(6):465-470 | DOI: 10.36290/neu.2025.034
Migraine is a chronic neurological disease that affects 15-20 % of women of reproductive age. Migraine treatment in women involves specific approaches due to hormonal influences. Estrogens play a key role in menstrual migraine, which often occurs during the luteal phase of the cycle. Migraine is three times more common in women than in men, with differences becoming apparent after puberty. Hormonal changes, including the menstrual cycle, pregnancy and menopause, contribute significantly to the higher prevalence of migraine in women. Female gender is also a risk factor for chronic migraine and overuse headache. Pregnancy and breastfeeding place specific...
Migraine in children and adolescents: specific features and treatmentMain topic
MUDr. Hana Medřická, MBA, MUDr. Zuzana Krška Kušníriková, Ph.D., MUDr. Petra Migaľová
Neurol. praxi. 2025;26(6):457-462 | DOI: 10.36290/neu.2025.050
Migraine is a condition that occurs across all age groups. In the pediatric population, it is underdiagnosed compared to adults. Pediatric migraine has specific neurodevelopmental and clinical characteristics, and its diagnostic and therapeutic approaches differ partially from those used in adults. In this article, we aim to highlight these issues.We present some epidemiological data on migraine occurrence, migraine phenotypes in the pediatric population, diagnostic and treatment approaches, and practical insights, with a broader focus on treatment.
Bolesti hlavy - nové možnosti léčbyEditorial
MUDr. Pavel Řehulka, Ph.D.
Neurol. praxi. 2025;26(6):447-451 | DOI: 10.36290/neu.2025.021
Autoimunitní neuromuskulární onemocněníEditorial
MUDr. Radim Mazanec, Ph.D.
Neurol. praxi. 2025;26(5):359
A Colonial Briton from Denmark Hill: Charles David Marsden (1938-1998)From the History of Neurology
prof. MUDr. Petr Kaňovský, CSc., FEAN
Neurol. praxi. 2025;26(5):436-442
Charles David Marsden (1938-1998) was a British neurologist, one of the founders of the subspeciality of movement disorders for which the Czech language prefers to use the term "extrapyramidal diseases". He graduated from St Thomas's Hospital Medical School in London and began his career at Queen Square Neurological Hospital. However, he soon changed jobs and became a doctor at another NHS trust, Maudsley and Bethlem Royal Hospital and King's College Hospital, which were nicknamed "Denmark Hill" due to their location in London. Here, he established a centre that became the benchmark in the field of European neuroscience research for a long time; Marsden...
Oculomotor palsy - a diagnostic challengeVideo case reports
MUDr. Sabina Flašarová, MUDr. Iva Šrotová, Ph.D., MUDr. David Šálek, MUDr. Zuzana Pazdičová
Neurol. praxi. 2025;26(5):430-433 | DOI: 10.36290/neu.2025.058
Oculomotor palsy can have a variety of etiologies and can therefore present a diagnostic challenge. In the differential diagnosis, the most common are stroke, craniotraumata, inflammatory and/or autoimmune diseases. Oculomotor nerve paresis may also be the first clinical manifestation of systemic diseases, such as haemato-oncological malignancies. In this case report, we present a 48-year-old patient in whom disseminated Burkitt's lymphoma manifested specifically as an oculomotor disorder, without associated symptoms related to hematooncological disease.
Paroxysmal blindness in a young patientCase report
MUDr. Dušan Ospalík
Neurol. praxi. 2025;26(5):428 | DOI: 10.36290/neu.2025.053
Acute blindness is a severe disabling deficit. We report a case of a seventeen-year-old boy who, during a common seasonal infection, developed symptoms of complete amaurosis atypical for its paroxysmal course. The case illustrates the need for a thorough history and the irreplaceability of MRI in neurology. Hyperintense changes of the corpus callosum are a common finding on brain MRI. Cytotoxic lesions of the corpus callosum (CLOCCs) can occur due to a variety of causes ranging from metabolic or infectious ones to trauma, malignancy to autoimmunity, vaccination and others. CLOCCs may be of a transient nature and, in our case, have a good prognosis as well.