Slovo úvodem

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

Neurol. praxi. 2021;22(6):444  

Úrazy hlavy

doc. MUDr. Štefan Sivák, PhD.

Neurol. praxi. 2021;22(6):449 | DOI: 10.36290/neu.2021.103  

Management of patients with mild traumatic brain injury

MUDr. Róbert Ružinák, MUDr. Martina Martiníková, prof. MUDr. Egon Kurča, PhD., FESO, doc. MUDr. Štefan Sivák, PhD.

Neurol. praxi. 2021;22(6):450-453 | DOI: 10.36290/neu.2021.108  

Mild traumatic brain injury (MTBI) is among the most common diagnoses encountered by a neurologist in the clinical practice. Despite several important findings in recent decades, there are still many question marks. The article provides an overview of disease terminology, the principles of diagnosis with a focus on the indication criteria for imaging in adult patients and children and the principles of treatment in the initial post-traumatic period.

Serum biomarkers in mild traumatic brain injury

MUDr. Martina Martiníková, MUDr. Róbert Ružinák, doc. MUDr. Vladimír Donáth, PhD., prof. MUDr. Egon Kurča, PhD., doc. MUDr. Štefan Sivák, PhD.

Neurol. praxi. 2021;22(6):454-458 | DOI: 10.36290/neu.2021.109  

More than 50 million people sustain a traumatic brain injury each year. Recently as a result of increased development of proteomics analysis and other discovery techniques, investigators have reported ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) as novel potential markers for brain injury. Blood-based brain biomarkers hold the potential to predict absence of intracranial injury and thus reduce unnecessary head CT scanning. Blood-based brain biomarkers also hold the potential to document whether a concussion occurred, especially when the history is unclear. For this reason, multi-markers analysis that presents...

Brain trauma and neurodegenerative diseases

MUDr. Filip Růžička, Ph.D.

Neurol. praxi. 2021;22(6):460-465 | DOI: 10.36290/neu.2021.104  

There now is little doubt that traumatic brain injuries of any severity can leave permanent changes in neural tissue and lead to long-term brain damage. However, many questions remain over the relationship between brain injury and the development of a chronic progressive neurodegenerative process. Chronic traumatic encephalopathy is most commonly associated with repeated mild brain injury, but this is a neuropathologically defined concept whose neurobiological and clinical significance remains to be elucidated. Nevertheless, epidemiological studies suggest that a history of brain injury is associated with an increased risk of clinical diagnosis of...

Multimodal monitoring in the patients after severe brain injury

Sabina Muzikářová, MUDr. Andrej Mrlian, Ph.D., prof. MUDr. Martin Smrčka, Ph.D., MBA, MUDr. Vilém Juráň, Ph.D.

Neurol. praxi. 2021;22(6):466-470 | DOI: 10.36290/neu.2021.110  

Severe brain injuries are characterized with high morbidity and mortality. Only 40 % of the patients end the therapy with favourable outcome. The bad outcome is caused by the severity of primary brain insult. However, the therapy should be focused on an elimination of secondary - ischemic damage, resulting from the high ICP. The use of multimodal monitoring is an important part of the therapy. ICP monitoring remains the fundamental method, on the other hand, there are several promising methods, like tissue oximetry and microdialysis, which can improve the treatment result. These methods are more focused on a brain metabolism. More detailed and complex...

An overview of surgical procedures in patients with severe traumatic brain injury

MUDr. Martin Hanko, PhD., MUDr. René Opšenák, PhD., MUDr. Pavol Snopko, PhD., doc. MUDr. Branislav Kolarovszki, Ph.D.

Neurol. praxi. 2021;22(6):471-476 | DOI: 10.36290/neu.2021.105  

Treatment of patients with severe traumatic brain injuries is an inseparable part of neurosurgical practice. It is typically a matter of multidisciplinary approach and from neurosurgical point of view it includes methods of invasive neuromonitoring, control of intracranial pressure, evacuation of cerebrospinal fluid and traumatic intracranial hematomas as well as methods of external decompression of the intracranial vault. Using these means we aim to minimise the damage originating from the primary insult, but mostly to reduce and prevent a development of secondary brain injury. Operated patients are also often treated by associated specialists such...

Long-term data of multiple sclerosis treatment with ocrelizumab - eficacy, safety and clinical experience

MUDr. Mgr. Matouš Rous, MUDr. Zuzana Rous, Ph.D.

Neurol. praxi. 2021;22(6):477-480 | DOI: 10.36290/neu.2021.092  

Both T lymphocytes and B lymphocytes are involved in the patogenesis of multiple sclerosis (MS). Ocrelizumab is a monoclonal antibody that targets B lymphocytes. It is indicated for the treatment of relapsing remitting MS (RRMS) as well as for the treatment of primary progressive MS (PPMS). While there are several possibilities for immunomodulatory therapy for the treatment of RRMS, until recently, there was no possibility of influencing the course of PPMS by immunomodulatory treatment. Ocrelizumab is currently the only registered DMD therapy for the treatment of PPRS in the Czech Republic. In general, it is well tolerated with minimal adverse events.

Driving motor vehicles in patients with epilepsy

doc. MUDr. Irena Doležalová, Ph.D., JUDr. Šárka Špeciánová, doc. MUDr. Jiří Hovorka, CSc., MUDr. Jana Zárubová, MUDr. Irena Novotná, prof. MUDr. Petr Marusič, Ph.D., prof. MUDr. Milan Brázdil, Ph.D.

Neurol. praxi. 2021;22(6):481-486 | DOI: 10.36290/neu.2021.111  

The article presents current information on assessing the medical fitness to drive motor vehicles in persons with epilepsy. There are two driving licence categories: Category 1 (Groups A, B, B+E, AM, and subgroups A1 and B1) and Category 2 (professional drivers in Groups A, B, B+E, AM, subgroups A1 and B1; as well as C, C+E, D, D+E and T, C1, C1+E, D1, and D1+E). In Category 1, driving can be allowed after 12 months of being seizure-free if the patient is taking antiepileptic drugs, or after 6 months of being seizure-free if there was an isolated seizure and no treatment with antiepileptic drugs was commenced. In Category 2, driving can be allowed...

Ischemic stroke during pregnancy and puerperium

MUDr. Stanislava Jakubíček, Ph.D., MUDr. Michal Reif

Neurol. praxi. 2021;22(6):489-495 | DOI: 10.36290/neu.2021.090  

Despite the rare occurrence of ischemic stroke in pregnancy and puerperium, the incidence of this disease is rising with the increasing prevalence of obesity, hypertension and cardiac disease among women of childbearing age (James et al., 2005). Ischemic stroke in pregnant women has specific etiological, diagnostic and therapeutic aspects. The purpose of this article is to address these aspects of ischemic stroke in pregnant women in greater detail, so that patient care for mother and fetus are approached safely and effectively at the same time.

Treatment of secondary progressive multiple sclerosis with siponimod and a case report

MUDr. Veronika Tichá, Ph.D.

Neurol. praxi. 2021;22(6):496-500 | DOI: 10.36290/neu.2021.096  

Siponimod is a selective modulator of S1P1 and S1P5 subtypes of sphingosin-1 phosphate receptors with dual mechanism of action. It exerts the anti-inflammatory effect by blocking the egress of lymphocytes from the lymph nodes and the neuroprotective effect due to direct interaction with glial a neuronal brain cells. EXPAND clinical trial showed the positive effect of siponimod on the risk of disability progression, number of relapses, cognitive performance and activity and progression on MRI compared to placebo. Siponimod is indicated for the treatment of secondary progressive Multiple Sclerosis with disease progression and clinical or MRI activity,...

Epilepsy and sleep in adults

MUDr. Jana Slonková, Ph.D.

Neurol. praxi. 2021;22(6):501-506 | DOI: 10.36290/neu.2021.106  

Sleep is an essential physiological trait and a need for the human organism. Epilepsy is a chronic disease that contributes significantly to sleep disturbance when compensated poorly. Sleep disorders, on the other hand, may be associated with a higher incidence and frequency of epileptic seizures. Differential diagnostic view of the causes of the difficulty of compensating an epilepsy patient in relation to sleep disorders in daily outpatient practice of the neurologist is presented in this article.

Antidepressants for prophylaxis and treatment of post-stroke depression

MUDr. Tomáš Novák, Ph.D.

Neurol. praxi. 2021;22(6):507-512 | DOI: 10.36290/neu.2021.107  

One-third of stroke survivors develop post-stroke depression (PSD), which has a negative impact on mortality, degree of disability, and overall prognosis. Hence, early initiation of antidepressants (ADs) could prevent the development of depression and (or at the same time) improve the post-stroke recovery. However, a series of recent multicenter studies do not demonstrate the efficacy of fluoxetine either in preventing depression or in other clinical indicators. Thus, the prophylactic indication of antidepressants currently lacks evidence. In the treatment of post-stroke depression, ADs (SSRI as the first choice) are still indicated, and studies to...

Neurosyphilis as a cause of ischaemic stroke

MUDr. Kamil Slowik, MUDr. Radka Neumannová, MUDr. Jiří Neumannn

Neurol. praxi. 2021;22(6):514-518  

Syphilis is a chronic systemic disease which is manifested by a wide range of signs and symptoms, particularly in the sex organs, but it also affects the cardiovascular, nervous, integumentary, or musculoskeletal systems. An involvement of the central nervous system may occur at any point of the primary, secondary, or tertiary stages of syphilis. Early forms of neurosyphilis currently prevail, with late parenchymal complications occurring rarely. Meningovascular syphilis typically presents five to seven years after the primary stage, and is among the rare causes of cerebrovascular disease in younger individuals. Imaging of the brain and cerebral arteries...

Creutzfeldt-Jakobov disease: clinical case report

MUDr. Petr Nohel, prof. MUDr. Radoslav Matěj, Ph.D.

Neurol. praxi. 2021;22(6):519-522 | DOI: 10.36290/neu.2021.112  

Sporadic Creutzfeldt-Jacob disease (sCJD) is rare, prion and incurable disease. It is characterized by the rapid development of dementia and other focal symptoms. Typical signs of CJD are found in the MR examination of the brain, in the EEG and in the examination of cerebrospinal fluid. The definitive diagnosis is determined by neuropathological examination of brain tissue. We present the case of an elderly man with sudden onset and rapidly progressing dementia and characteristic findings in auxiliary examination methods. Neuropathological changes in the brain eventually demonstrated changes typical of Creutzfeldt-Jakob disease, but also of frontotemporal...

Segawa syndrome, dopa-responsive dystonia

MUDr. Michal Pavlovič, doc. MUDr. Miriam Kolníková, PhD., MUDr. Ivana Paučinová, MUDr. František Cisárik, CSc.

Neurol. praxi. 2021;22(6):525-528 | DOI: 10.36290/neu.2021.114  

Segawa syndrome is an autosomal dominant type of dystonia, first described by Dr. Segawa in 1971. The onset of dystonia is usually in childhood, and is mostly misdiagnosed as cerebral palsy. Characteristics features include lower limb dystonia, young onset, worsening of the symptoms during the day and dramatic response to levodopa therapy. The disease is caused by a deficiency of GTP-cyclohydrolasis, and the diagnosis is established by genetical proof for GCH1 mutation. We would like to present a case-report of a 12-year-old girl, diagnosed with dopa-responsive dystonia, which has been initially misdiagnosed as cerebral palsy.

Nová bezpečnostní data glatiramer acetátu (Copaxone 20 nebo 40 mg/ml)

Ciplea AI, Kurzeja A, Thiel S, Haben S, Alexander J, Adamus E, Hellwing K.

Neurol. praxi. 2021;22(6):530  

Towards the roots of deep brain stimulation

doc. MUDr. Marek Baláž, Ph.D., Anastassiya Kozlovskaya, doc. MUDr. Jan Chrastina, Ph.D.

Neurol. praxi. 2021;22(6):532-534 | DOI: 10.36290/neu.2021.115  

The study aims to present the less widely known pioneering work of Prof. Natalyia Petrovna Bechtereva from the Leningrad Institute of Experimental Medicine utilising electrical stimulation of defined deep brain structures (thalamic nuclei, basal ganglia) by means of long - term externalised intracerebral electrodes for the treatment of some neurological diseases (Parkinson's disease, phantom limb pain, dystonia). Together with the surprisingly long lasting good results some data suggesting the potential abuse of brain stimulation techniques must be noted.

CLIPPERS - vzácné zánětlivé onemocnění s typickým MR obrazem

MUDr. Veronika Vachálková, MUDr. Jiří Keller, doc. MUDr. Robert Rusina, Ph.D.

Neurol. praxi. 2021;22(6):523-524 | DOI: 10.36290/neu.2021.113  

MUDr. Jiří Polívka, CSc., slaví sedmdesátiny

Jitka Rokytová a spolupracovníci

Neurol. praxi. 2021;22(6):529