Slovo úvodem

prof. MUDr. Ivan Rektor, CSc., FCMA, FANA, FEAN

Neurol. praxi. 2019;20(1):3  

Sekundární prevence ischemické cévní mozkové příhody

Aleš Tomek

Neurol. praxi. 2019;20(1):11 | DOI: 10.36290/neu.2019.082  

Basic algorithm for the diagnostic evaluation of ischemic stroke

MUDr. Aleš Tomek, Ph.D., FESO

Neurol. praxi. 2019;20(1):12-16 | DOI: 10.36290/neu.2019.083  

The presented article summarizes the algorithm for the diagnostic evaluation of patients with ischemic stroke. The general principles of stroke etiology classification, i.e. causative and phenotypic, are discussed. The classification system deemed the most practical for daily clinical practice SSS-TOAST is described in detail. SSS-TOAST is an upgrade of the most widely used classification system TOAST. It divides the ischemic strokes into five etiology subgroups (cardioembolic, large artery atherosclerosis, small artery occlusion, other etiology and undetermined). Based on the weight of evidence, each subtype is subdivided into three subcategories...

Indications of antithrombotic therapy for secondary stroke prevention

MUDr. Hana Magerová, Ph.D.

Neurol. praxi. 2019;20(1):17-20 | DOI: 10.36290/neu.2019.084  

This article is related to previous articles in this issue discussing ischemic stroke. It provides an overview of antiplatelet and anticoagulationtherapy that is a crucial part of stroke secondary prevention. The article focuses on specifics and side-effects of each single medication,on choosing appropriate therapy according to the stroke etiology and it also mentions some less common clinical situations.

Detection of paroxysmal atrial fibrillation in ischaemic stroke patients

MUDr. Petr Janský

Neurol. praxi. 2019;20(1):21-24 | DOI: 10.36290/neu.2019.085  

Paroxysmal atrial fibrillation is frequently undetected by standard examination procedures in patients with acute ischaemic stroke. However, its detection is crucial for choosing appropriate secondary stroke prevention. In this review article, the relation of particular forms of atrial fibrillation and ischaemic stroke is firstly characterized. All available means of heart rhythm monitoring are then compared. Particular aspects of optimal monitoring strategy are assessed – the length of monitoring, the choice of monitoring method, the appropriate time interval of monitoring commencing after stroke event and the use of biomarkers in atrial fibrillation...

When to close patent foramen ovale?

MUDr. Martin Šrámek

Neurol. praxi. 2019;20(1):25-27 | DOI: 10.36290/neu.2019.086  

Closure of patent foramen ovale (PFO) is effective secondary prevention after ischemic stroke proven by randomised clinicaltrials. The key is selection of the right patient by excluding usual cerebrovascular risc factors (atherosclerosis, atrial fibrilation,…).A suitable tool to identify the proper patient is the ROPE score (risc of paradoxial embolization). Closure of PFO is not indicatedeither in patients with migraine or in most divers with identified PFO.

Embolic stroke undetermined source

MUDr. Aleš Tomek, Ph.D., FESO, MUDr. Anna Olšerová

Neurol. praxi. 2019;20(1):28-32 | DOI: 10.36290/neu.2019.087  

Embolic stroke of undetermined source (ESUS) is a recent subtype of cryptogenic ischemic stroke. ESUS is defined as non-lacunar brain infarct without proximal arterial stenoses or cardioembolic sources with a clear indication for anticoagulation. Optimal secondary prevention in ESUS according to the current guidelines is antiplatelet treatment. The risk of recurrence is relatively high and therefore the new direct oral anticoagulants (DOAC) are tested in clinical trials. The article reviews recently published and ongoing studies of DOACs in ESUS patients. Based on available results seems reasonable that the ESUS concept should be refined into three...

Multiple sclerosis – maternity and breastfeeding

MUDr. Olga Zapletalová

Neurol. praxi. 2019;20(1):33-36 | DOI: 10.36290/neu.2019.088  

Multiple sclerosis (MS) is disease induced by immunopathogenetic autoimmune inflammation and neurodegenerative process, which demage central nervous system. The young women of childbearing age are mostly affected by MS. Biological role of women is fullfiled by maternity and their wish to have a child is also common for women with MS. Conception, pregnancy and delivery is immunological action and maternal immune system undergoes great changes. Brestfeeding is greatly important for optimal development of the newborn in the first months after delivery. The hormonal changes during brestfeeding are positively modulating the autoimmune reactivity of MS females...

Does dietary fat composition matter in multiple sclerosis?

MUDr. Zuzana Dean, prof. MUDr. Branislav Kollár, PhD., doc. Ing. Ingrid Žitňanová, PhD., MUDr. Adela Penesová, PhD.

Neurol. praxi. 2019;20(1):37-42 | DOI: 10.36290/neu.2019.089  

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system. The etiology is still unknown, the disease is believed to be autoimmune. The immune dysregulation is affected by genetic and environmental factors. Relation to sun exposure, vitamin D levels, exposure to infectious pathogens as well as dietary habits, obesity and GUT microbiota have all been implicated in the pathogenesis. There are however no firm recommendations regarding diet in the treatment of MS. Our review deals with the available evidence from epidemiological, clinical and laboratory studies that dietary fats may play an important...

Corticosteroids – therapy of the first choice?

doc. MUDr. Edvard Ehler, CSc.

Neurol. praxi. 2019;20(1):43-48 | DOI: 10.36290/neu.2019.090  

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most frequent autoimmune neuropathy. The processes participating in pathogenesis of CIDP are primarily of humoral and also cellular immunity. In CIDP, the most frequent is classical form, which is characterized by clinically nearly symmetric and electrophysiologically multifocal impairment of motor and sensory fibers. Therapy of CIDP is initiated by „induction therapy“, consisting of corticosteroids, intravenous administration of high doses of immunoglobulins (IVIG) or therapeutic plasma exchange (TPE). In view of the high demands on the equipment and of more frequent...

Imaging possibilities of the brachial and lumbosacral plexus using advanced magnetic resonance techniques

MUDr. Ivan Humhej, Mgr. Ibrahim Ibrahim, Ph.D., prof. MUDr. Martin Sameš, CSc., doc. Ing. Jaroslav Tintěra, Ph.D., doc. MUDr. Igor Čižmář, Ph.D.

Neurol. praxi. 2019;20(1):49-53 | DOI: 10.36290/neu.2019.091  

Visualization of the brachial plexus (BP) and lumbosacral plexus (LSP) by magnetic resonance imaging (MRI) allows us to obtain detailed information useful in diagnosing and treatment of disorders affecting these complex nerve structures. MR techniques helpful in visualising BP and LSP include conventional methods, MR neurography (MRN), diffuse tensor imaging (DTI) and MR tractography (MRT). MRN provides detailed analysis of anatomical structure, DTI and MRT inform us on the functional integrity of the nerve fibers. With continuing development and improvement of these advanced MR techniques, we can assume their gradual introduction into standard MR protocols.

Recurrent isolated sleep paralysis

MUDr. Jitka Bušková, Ph.D., Mgr. Monika Kliková

Neurol. praxi. 2019;20(1):54-56 | DOI: 10.36290/neu.2018.018  

Isolated sleep paralysis occurs in up to 7,6 % of general population, which makes it to be a common sleep disorder. Recurrent isolated sleep paralysis (RISP) means REM (rapid eye movement) related parasomnia, which occurs recurrently during the transition between sleep and wake that means during falling asleep or awakening. It is a transient loss of speech and voluntary movement that affects limbs and trunk muscles, which is especially at the beginning of the accompanied by an intensive fear. This burdensome experience can be elevated by accompanying fearful dreamy delusions, so called hypnagogic/hypnopompic hallucinations. Pathophysiological background...

Sudden parkinsonism, cognitive decline and behavioral changes – drug-induced or other iatrogenic origin?

MUDr. Petr Hollý, doc. MUDr. Robert Rusina, Ph.D., Mgr. Eva Bolceková, Ph.D., prof. MUDr. Manuela Vaněčková, Ph.D., prof. MUDr. Evžen Růžička, DrSc.

Neurol. praxi. 2019;20(1):57-60 | DOI: 10.36290/neu.2018.067  

Central pontine myelinolysis and extrapontine myelinolysis are osmotic demyelination syndromes due to rapid correction of severehyponatremia. Their clinical manifestations may often vary. We report a case of a patient with rapid onset of neuropsychiatricsymptoms and parkinsonism following rapid correction of hyponatremia, with an initially considered drug-induced etiology. MRIfindings compatible with central pontine and extrapontine myelinolysis, however, developed only with a delay of several weekswhen clinical symptoms were already disappearing.

Dissociative movement disorder or stiff limb syndrome?

MUDr. Eva Pešlová, MUDr. Irena Doležalová, Ph.D., MUDr. Daniela Sochůrková, Ph.D., prof. MUDr. Milan Brázdil, Ph.D.

Neurol. praxi. 2019;20(1):61-65 | DOI: 10.36290/neu.2019.092  

Stiff person syndrome (SPS) is a rare autoimmune disease characterized by progressive fluctuating muscle hypertonia and superimposed painful muscle spasms, resulting in a gait disorder. Its variant – stiff limb syndrome (SLS) – particularly affects limb muscles, with axial muscles being affected substantially less. The disease may respond favourably to immunosuppressive therapy. The video case report presents a female patient examined repeatedly for transient lower limb stiffness. The patient has been suspected to have a functional movement disorder. The disease had progressed gradually and led to loss of self-sufficiency and becoming bedridden....

Brivaracetam (Briviact®)

prof. MUDr. Milan Brázdil, Ph.D.

Neurol. praxi. 2019;20(1):67-72 | DOI: 10.36290/neu.2019.093  

New AED Briviact® described below is actually registered in EU and indicated as adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in adults, adolescents and children from 4 years of age with epilepsy. The efficacy and safety profile of brivaracetam was established in 3 randomized, clinical trials. The most frequently reported adverse reactions with brivaracetam were somnolence and dizziness. Its main mode of action is a high and selective affinity for synaptic vesicle protein 2A. The binding affinity of brivaracetam for SV2A is twenty times higher compared with levetiracetam. The biggest benefit...

Právní poradna

JUDr. Šárka Špeciánová

Neurol. praxi. 2019;20(1):78  

Životné jubileum doc. MUDr. Pavla Sýkoru, CSc.

MUDr. Miriam Kolníková, PhD.

Neurol. praxi. 2019;20(1):74  

prof. MUDr. Zuzana Gdovinová, CSc., FESO, FEAN, oslavuje šesťdesiate narodeniny

doc. MUDr. Jarmila Szilasiová, PhD.

Neurol. praxi. 2019;20(1):75-76  

prof. MUDr. Josef Bednařík, CSc., FCMA, FEAN, slaví životní jubileum

prof. MUDr. Ivan Rektor, CSc., FCMA, FANA, FEAN

Neurol. praxi. 2019;20(1):77