Slovo úvodem

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

Neurol. praxi. 2023;24(2):83  

Neuro­‑oftalmologie

MUDr. Jana Lízrová Preiningerová, Ph.D.

Neurol. praxi. 2023;24(2):87  

Optic disc edema - a shared topic of ophthalmologists and neurologists

MUDr. Jan Rambousek, MUDr. Jana Lízrová Preiningerová, Ph.D., MUDr. Marie Česká Burdová, Ph.D., MUDr. Martin Hložánek, Ph.D., FEBO

Neurol. praxi. 2023;24(2):88-93 | DOI: 10.36290/neu.2022.074  

Optic disc swelling is a potentially life- and sight-threatening symptom and its diagnostic procedure often requires the cooperation of a neurologist and an ophthalmologist. A good knowledge of individual optic nerve diseases, including findings that mimic optic disc swelling but do not require immediate investigation, is essential for a correct and effective differential diagnosis of this finding. In this article, we summarize the basic causes according to the mechanism of involvement (inflammatory changes, vascular changes, increased pressure and systemic disorders) and the specific diagnoses leading to optic disc swelling.

Ocular complications of peripheral facial nerve palsy and their therapeutic possibilities

MUDr. Aneta Klímová, Ph.D., MUDr. Jan Bydžovský, MUDr. Pavlína Skalická, Ph.D.

Neurol. praxi. 2023;24(2):94-97 | DOI: 10.36290/neu.2022.069  

Peripheral lesion of the facial nerve leads to ipsilateral palsy of facial muscles. Weakening of the orbicularis oculi muscle results in inability to close the eyelids, i.e., lagophtalmos. As a result of lagophtalmos, the lower parts of the eye surface dry and cause a formation of exposure keratopathy of variable severity. Chronic corneal changes lead to development of vascularized corneal scar, which permanently deteriorates the visual acuity. Immediately after the diagnosis of peripheral facial nerve palsy by the neurologist, frequent application of ophthalmic lubricants and an early ophthalmological examination are recommended. The treatment of...

Ocular manifestations of disease associated with the presence of antibodies to myelin oligodendrocyte glycoprotein

MUDr. Barbora Beroušková, MUDr. Kateřina Myslík Manethová, Ph.D., FEBO

Neurol. praxi. 2023;24(2):98-102 | DOI: 10.36290/neu.2022.073  

Myelin oligodendrocyte glycoprotein antibody-positive disease (MOGAD) is a relatively new diagnostic entity that has emerged from the spectrum of neuromyelitis optica disorder (NMOSD), formerly also known as Devic's disease. This inflammatory autoimmune demyelinating disease affects the optic nerve, spinal cord and some other structures of the central nervous system. One of the cardinal manifestations in adult patients is optic neuritis. In children, the disease manifests as acute demyelinating encephalomyelitis (ADEM). The main diagnostic criteria are visible signs of CNS demyelination and detection of serum MOG-IgG antibodies. An attack of optic...

Value of OCT­‑A in patients with multiple sclerosis

MUDr. Miriama Skirková, PhD., MUDr. Monika Moravská, MUDr. Marek Horňák, MUDr. Jozef Szilasi, doc. MUDr. Jarmila Szilasiová, PhD.

Neurol. praxi. 2023;24(2):103-110 | DOI: 10.36290/neu.2022.070  

Optical coherence tomography angiography (OCT-A) is a novel, non-invasive, fast, repeatable, 3D imaging method for retinal, choroidal, and optic nerve vessels. OCT-A has the potential to become a new biomarker of various ophthalmological (e.g. glaucoma, diabetic retinopathy, age-related macular degeneration) and neurological disorders. Retinal microcirculation share similar features with cerebral small blood vessels, thus OCT-A may be considered a "window" for the detection of microvascular changes which are associated with neurodegenerative disorders, such as multiple sclerosis. In this review, we summarize recent findings regarding the utility of...

COVID-19 in patients with multiple sclerosis treated with ofatumumab

MUDr. Eva Recmanová

Neurol. praxi. 2023;24(2):111-115 | DOI: 10.36290/neu.2022.075  

When the global COVID-19 pandemic began in 2019, there were concerns about the course among patients with multiple sclerosis (MS). It seems that the course of this infection in MS patients is similar to the general population, given the same risk factors. Patients with comorbidities, patients on anti-CD20 therapy and after recent administration of corticosteroids progress to more clinically severe forms. Ofatumumab is a fully human anti-CD20 monoclonal antibody approved for treatment of adult patient with active relapsing-remitting MS (RR MS). The most recently published results from the open-label ALITHIOS study do not indicate that patient treated...

Migraine and hormonal contraception

MUDr. Ingrid Niedermayerová

Neurol. praxi. 2023;24(2):116-120 | DOI: 10.36290/neu.2023.004  

The use of hormonal contraception (HC) has been increasing in recent decades. In women with migraine, the use of HC can significantly positively as well as negatively affect the course of the disease. In women with vascular risks, the use of inappropriate HC can make them more likely to develop ischaemic stroke. In migraine without aura, it is possible to prescribe both combined and gestagen-only HC; in migraine with aura, it is the gestagen-only type only. In menstrual migraine, in order to reduce menstruation-related migraine attacks, extended-cycle or continuous-cycle combined oral contraceptives (COCs), or gestagen-only HC can be administered....

The expedited version of international standards for neurological classification of spinal cord injury (E­‑ISNCSCI)

doc. MUDr. Jiří Kříž, Ph.D., Bc. Kristýna Šedivá, MUDr. Veronika Hyšperská, Bc. Lenka Špačková

Neurol. praxi. 2023;24(2):122-126 | DOI: 10.36290/neu.2023.008  

The International standards for neurological classification of spinal cord injury are the most widely used tools for the evaluation of sensorimotor deficit after spinal cord injury. Nevertheless, the examination is time-consuming, even for an experienced therapist. Frequently, mainly in the acute phase, it is replaced by nonstandardized examination which is unable to make a proper classification. Therefore, the Committee of the American Spinal Injury Association developed the expedited version of international standards, which allows to define the neurological level of injury and its severity with the least amount of exam items.

Genetic factors influencing age of onset of Huntington's disease and markers of its prediction

Petr Roudenský, MSc.

Neurol. praxi. 2023;24(2):127-131 | DOI: 10.36290/neu.2022.064  

Huntington's disease is an autosomal dominant neurodegenerative disorder with progressive motor, cognitive and behavioural impairment. The disease is caused by a mutation in the HTT gene, which results in an abnormal expansion of CAG repeats. Although the usual age of clinical onset of the disease is around 40 years, its range extends from childhood to the eighth decade. The main factor influencing this variability is the number of repeats of the expanded allele, on which the age of onset of the disease is inversely dependent, especially between 55 and 80 repeats, but genetic modifiers identified mainly in genome-wide association studies also play...

Covid-19 and its impact on (chronic) pain - observations from experience

MUDr. Jan Procházka, Ph.D.

Neurol. praxi. 2023;24(2):132-139 | DOI: 10.36290/neu.2022.062  

Pain is a common symptom accompanying the coronavirus disease COVID-19 caused by coronavirus SARS-CoV-2. In addition to acute headache, myalgia and arthralgia or neuropathic pain in context of acute viral illness, chronic pain can be worsened as well. This can be due to post-viral syndrome, direct affection of nervous system by viral penetration, or as a consequence of psychological distress due to limited health care, social isolation, fear of infection and so on. When proceeding of the interventional procedures in patients with COVID-19 disease we should take general precautions for personal protection and consider a dose of corticoids and undergoing...

Molecular and cellular biology of multiple sclerosis

RNDr. Kateřina Klíčová, prof. MUDr. Jan Mareš, Ph.D., MBA, MUDr. Jiří Bučil

Neurol. praxi. 2023;24(2):140-144 | DOI: 10.36290/neu.2022.059  

Multiple sclerosis is a chronic autoimmune inflammatory disease of the central nervous system with an unclear prognosis, mainly affecting young adults. It is a disease that is highly heterogeneous. The causes are multifactorial and include genetic predisposition along with environmental factors. Specific epigenetic modifications such as DNA methylation can affect the pathophysiology and key aspects of multiple sclerosis. Processes at the molecular level could be helpful in understanding the nature of the disease and setting up appropriate treatment for patients.

Left­‑sided hemicrania - not a migraine!

MUDr. Petr Hollý, MUDr. Ivana Slámová, MUDr. Svatopluk Ostrý, Ph.D.

Neurol. praxi. 2023;24(2):146-150 | DOI: 10.36290/neu.2023.002  

Headache is a very common symptom that a patient presents with in the acute outpatient clinic. Repeated migraine-like headache can be misleading and lead to partial downplaying of the difficulty, but it is of course appropriate to perform an imaging examination if this has not already been done. We present here an example of a young patient who visited our outpatient clinic in similar circumstances with very surprising findings on neuroimaging, her diagnosis, treatment, and evolution over time. We demonstrate here the importance of assessing the sensitivity of individual tests and, even if the diagnostic criteria were not met, the high suspicion of...

Cerebral venous sinus thrombosis cause of stroke in a 70-year­‑old patient

MUDr. Michaela Roláková

Neurol. praxi. 2023;24(2):151-153 | DOI: 10.36290/neu.2022.026  

Although cerebral venous thrombosis is rare, it is a serious and often overlooked diagnosis. Due to the wide range of non-specific clinical symptoms, diagnosis is often difficult. In the last decade, patient mortality has been significantly reduced by improvements in treatment and diagnosis techniques and higher awareness of this diagnosis. In our case, we present a 70-year-old patient in whom cerebral venous thrombosis first manifested as a symptomatic epileptic seizure and was diagnosed thanks to anamnestic data, clinical symptoms and neuroimaging methods. The patient's conditions improved after anticoagulant therapy and treatment of the epileptic...

Autoimmune meningoencephalitis associated with anti­‑GFAP antibodies - a case study

MUDr. Hana Mojžišová, MUDr. Martin Elišák, Ph.D., RNDr. Jitka Hanzalová, MUDr. David Krýsl, Ph.D., prof. MUDr. Petr Marusič, Ph.D.

Neurol. praxi. 2023;24(2):155-157 | DOI: 10.36290/neu.2022.076  

Glial fibrillary acidic protein (GFAP) astrocytopathy, first described in 2016, belongs to the group of autoimmune diseases of the central nervous system. This disease typically manifests around 50 years of age, without sex predilection. Clinical picture is variable, but typically is that of meningoencephalitis. In approximately one fifth of cases, the patient suffers from another autoimmune disease and has a malignancy. Diagnosis is supported with typical findings on brain MRI - T2 hyperintense lesions and perivenular radial enhancement in contrast-enhanced T1 sequence. The disease responds well to immunotherapy, particularly corticosteroids. Relapses...

Profesorka Ivana Štětkářová – kulaté výročí

Edvard Ehler

Neurol. praxi. 2023;24(2):158