Slovo úvodem

prof. MUDr. Ivan Rektor, CSc.

Neurol. praxi. 2014;15(3):115  

Úvodné slovo k hlavnej téme

doc. MUDr. Miroslav Brozman, CSc.

Neurol. praxi. 2014;15(3):119  

Systemic intravenous thrombolysis of ischemic strokes - the best treatment alternative?

doc. MUDr. Miroslav Brozman, CSc.

Neurol. praxi. 2014;15(3):120-124  

Systemic intravenous thrombolysis is considered gold standard for the treatment of ischemic cerebral strokes up to 4,5 hours from the onset of symptoms. It´s efficacy and safety are greatest when given lege artis, i. e. at appropriate time, at appropriate dosis and to appropriate patient. Which time is the best? Which dosis is correct? Which patient is the best candidate? Is really systemic thrombolysis the best alternative of treatment for the patients with ischemic stroke? Do we have answers for all these questions? On the basis of recently published data and personal experience we discuss several aspects of this interesting topic.

Recanalization therapy of ischemic stroke - what next?

doc. MUDr. David Školoudík, Ph.D., FESO

Neurol. praxi. 2014;15(3):125-130  

Acute occlusion of the cervical or intracranial cerebral artery is the most common cause of ischemic stroke. Early arterial recanalization with brain reperfusion is currently the most effective method of treatment of ischemic stroke. The gold standard of stroke reperfusion therapy is na intravenous thrombolysis with administration of 0.9 mg/kg tPA in hourly infusion. Intra-arterial thrombolysis and different mechanical recanalization methods of cerebral arteries including sonolysis are alternative treatment especially for patients who have failed systemic thrombolysis (recanalization of the artery) or a thrombolysis was contraindicated. Despite the...

Monitoring of the efficacy of novel oral anticoagulants

Mgr. Adriana Ruzsiková, MUDr. Aleš Tomek, MUDr. Marta Zvarová, doc. MUDr. Robert Mikulík, Ph.D.

Neurol. praxi. 2014;15(3):131-135  

Clinical situations that require monitoring of novel oral anticoagulants (NOAC) are: presence of bleeding, renal impairment, suspicion of overdose or in case of ischemic stroke an indication of thrombolytic therapy. Conventional coagulation assays as aPTT, TT or PT may not be sufficient for NOAC monitoring. Clinicians deciding about thrombolysis have to understand the interpretation of measured values, which can be different in patients taking dabigatran, rivaroxaban or apixaban. In addition, for NOAC, new specific tests are used, for example Hemoclot or standardized Anti-Xa tests and it is again essential to correctly interpret the measured results....

Link atrophy and disability in multiple sclerosis

MUDr. Jiří Piťha

Neurol. praxi. 2014;15(3):136-140  

Brain and spinal cord atrophy in multiple sclerosis occurs due to neurodegeneration either demyelinated axons or their direct damage. The development of unconventional techniques of magnetic resonance imaging allows accurate assessment of global or regional atrophy that correlates with disability. Some of already registered drugs and others that are in the stage of clinical testing show a neuroprotective effect, affecting disability and therefore quality of life.

Ideopathic „benign” focal epilepsies in childhood

MUDr. Ondřej Horák, doc. MUDr. Hana Ošlejšková, Ph.D.

Neurol. praxi. 2014;15(3):141-145  

Benign focal epilepsies (BFE) are one of the most frequent epilepsies in childhood. They are usually described as an epileptic spectrum, whose nosologic units have the same pathogenetic base, may show blurry boundaries among them and may convert during the time. Besides well-known epilepsy with centro-temporal spikes or Panayiotopoulos syndrome, there are new recently defined syndromes, completing the spectrum. Nowadays, the molecular genetic background of BFE is the largest area of interest as well as the research of psychologic-psychiatric comorbidities, which acquire searching for answer the question: Are the benign focal epilepsies really benign?...

CSWS and SIADH associated with CNS disease

MUDr. Ladislav Gurčík, PhD.

Neurol. praxi. 2014;15(3):146-150  

Disorder of water and sodium balance with no obvious associated disease of other internal organs can sometimes be encountered in a patient with a neurological disease. In neurological disease, such disorders result from centrally mediated dysregulation of water and sodium excretion by the kidneys with the development of hypoosmolar hyponatremia. Cerebral salt-wasting syndrome (CSWS) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) are the most common causes of this disorder. In prognostic terms, it is very important to identify and appropriately treat these two entities. Negative salt balance, hypovolemia, and good therapeutic...

Chronic low back pain and use of new opiod analgesic tapentadol

MUDr. Jan Lejčko

Neurol. praxi. 2014;15(3):151-154  

Chronic low back pain with radicular component may not be adequately managed with available therapeutic options. Multi-modal approach to chronic pain treatment is more effective than monotherapy. Treatment with strong opioids is justified if pain is intractable. Combination of opioids and gabapentinoids takes advantage of various mechanisms of action and is more efficient than monotherapy. However, pharmacological tolerability of these agents is individual to a considerable extent and thus may decrease appropriate utilization their dosage potential. Opioid tapentadol is the first compound of the new pharmacological class MOR-NRI, that combines μ-opioid-...

Long-term treatment with intraduodenal levodopa - case report of three patients

MUDr. Marek Baláž, Ph.D., MUDr. Bohuslav Kianička, Ph.D., prof. MUDr. Martin Bareš, Ph.D.

Neurol. praxi. 2014;15(3):155-157  

We present case reports of three patients with Parkinson‘s disease (PD) treated with intradudodenal levodopa – Duodopa. Duodopa enables continuous administration of dopaminergicv treatment indicated for patients with late motor complications. Administration of levodopa into the jejunal part of duodenum and easy dose setting leads to stable plasma levels of levodopa and an improvement of motor state of patients with PD. This invasive procedure plays an important role in therapy of late motor complications of PD.

Facial hemispasm - interneural artery course

MUDr. Václav Masopust, prof. MUDr. Vladimír Beneš, DrSc., doc. MUDr. David Netuka, Ph.D., doc. MUDr. Ing. Jaroslav Plas

Neurol. praxi. 2014;15(3):158-160  

Microvascular decompression (MVD) is the method of choice for diseases that are caused by neurovascular conflict. The aim of the following paper is to present a rare case when anterior inferior cerebellar artery penetrated between statoacustic and facial nerve and caused facial hemispasm. A surgical strategy and treatment effectiveness are described. Pathophysiology of neurovascular compression syndromes is discussed.

Prof. MUDr. Josef Bednařík, CSc., slaví životní jubileum

prof. MUDr. Ivan Rektor, CSc.

Neurol. praxi. 2014;15(3):164-165  

Neurologové se ptají

Neurol. praxi. 2014;15(3):166  

Pharmacological profile of Cymbalta

doc. MUDr. Edvard Ehler, CSc.

Neurol. praxi. 2014;15(3):161-163  

Cymbalta is manufactured by Eli Lilly. The active substance is duloxetine hydrochloride in a dose of 30 or 60 mg in enteric soluble tablets. Duloxetine is a dual selective serotonin and norepinephrine reuptake inhibitor (SNRI) at neuronal synapses. The effect of duloxetine on other mediators is negligible, acting relatively most on dopamine and substantially less on epinephrine, histamine, acetylcholine, opioids, glutamate, and gamma-aminobutyric acid (GABA). Both the target mediators, i.e. serotonin and norepinephrine, are engaged in the modulation of central pain pathways, predominantly via descending inhibitory pathways. Imbalance of inhibitory...