Neurology for Practice, 2023, issue 6

Editorial

Slovo úvodem

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

Neurol. praxi. 2023;24(6):407

Main topic

Neurosonologie

prof. MUDr. David Školoudík, Ph.D., FESO, FEAN

Neurol. praxi. 2023;24(6):411

Neuro-POCUS - neurosonological examination performed at the patient's bedside

prof. MUDr. David Školoudík, Ph.D., FESO, FEAN, Mgr. David Pakizer

Neurol. praxi. 2023;24(6):412-414 | DOI: 10.36290/neu.2023.029

Due to its non-invasiveness and relatively low cost, ultrasound examination has become an integral part of medical practice. Thanks to the pressure for faster and more accurate diagnosis in the last decade, especially for acute diseases, a new concept of ultrasound examination is being developed directly at the point of care of the patient using mobile ultrasound devices. This new concept was named point-of-care ultrasound or POCUS, and it has also been extended to neurology in recent years under the name Neuro-POCUS. Neuro POCUS is defined as a targeted ultrasound examination of the head, neck, orbit, or musculoskeletal system performed at the patient's...

Transcranial sonography in Parkinson's disease

prof. MUDr. David Školoudík, Ph.D., FESO, FEAN, Mgr. Jiří Kozel, Mgr. Patricie Michalčová

Neurol. praxi. 2023;24(6):415-418 | DOI: 10.36290/neu.2023.036

Transcranial sonography is one of the modalities of transcranial sonographic examination, which enables to visualize intracranial structures in ultrasound B Mode. Using this examination, it is possible to evaluate changes in echogenicity or dimensions of selected brain structures, e.g. substantia nigra, ncl. raphe, ncl. lentiformis, ncl. caudate, insula, mediotemporal lobe or ventricular system. Thanks to this, transcranial sonography can be used as an auxiliary examination in the diagnosis and differential diagnosis of neurodegenerative and other neurological and psychiatric diseases of the central nervous system. A typical finding in Parkinson's...

Ultrasonographic diagnostics of the subclavian steal syndrome and their practical use

MUDr. Ondřej Škoda, Ph.D., FESO

Neurol. praxi. 2023;24(6):420-425 | DOI: 10.36290/neu.2023.027

Color duplex sonography is a suitable and accurate imaging method for the diagnostics of the subclavian steal syndrome in all its hemodynamic degrees, aswell as for the detection of stenoses or occlusions of the subclavian and anonymous artery. In this overview article I describe methodology of examination of the subclavian and brachiocephalic arterial stenoses, classification of the steal degrees and assessment of all collateral resources, which are involved in blood supply of the impaired subclavian artery region, including supposed impact for the brain blood perfusion. In the final part of this article some aspects of practical use are mentioned,...

Musculoskeletal ultrasound in neurological practice

MUDr. Martin Kuliha, Ph.D.

Neurol. praxi. 2023;24(6):426-432 | DOI: 10.36290/neu.2023.028

Musculoskeletal (MSK) ultrasound is very useful tool for imaging musculoskeletal body structures- muscles, tendons, joints, bones, peripheral nerves and vessels. In last decade becoming MSK ultrasound common diagnostic tool in neurological practices and amount of publications and studies which prove ultrasound as a useful diagnostic tool in neurological diseases increase. Other important field for ultrasound application are interventional procedures in neurology- peripheral nerve injection, nerve block, vessel puncture, lumbar puncture, muscle biopsy. Ultrasound diagnosing is quick, widely available, relatively cheap, non-invasive and for patient comfortable...

Today's role of duplex sonography in the diagnostics of atherosclerosis of brain supplying arteries

MUDr. Dagmar Součková

Neurol. praxi. 2023;24(6):435-439 | DOI: 10.36290/neu.2023.038

The role of sonography is being changed nowadays due to the progress and logistic changes in acute diagnostics in stroke care. In the acute phase of stroke, CT angiography is basic to enable start treatment as soon as possible. Nevertheless, sonographic examination has a lot to offer, not only in the acute, but also subacute period of stroke treatment. Neurosonology is irreplaceable in secondary prevention, as well as in primary prevention of stroke. We summarize contemporary clinical importance of the examination in all phases of stroke care.

Current possibilities of using transcranial duplex sonography in vascular neurology

MUDr. Petra Kešnerová, Ph.D.

Neurol. praxi. 2023;24(6):441-446 | DOI: 10.36290/neu.2023.048

Transcranial color-coded duplex sonography (TCCS) is widely accepted, noninvasive method providing hemodynamic data in real time imaging and therefore is an ideal tool for examination of cerebrovascular pathologies. In this review basic principles of the method, reference limits of detected parameters and its principal abnormities are described. Subsequently, an overview of an important vascular pathologies and its specific findings on TCCS is given: stenosis and occlusions of cerebral arteries, specifics of collateral pathways, changes in intracerebral hemorrhage including vascular malformations and subarachnoid hemorrhage, findings in vasculitis,...

Review articles

A multidisciplinary approach to cognitive deficit in patients with multiple sclerosis

MUDr. Iva Šrotová, Ph.D., MUDr. Martina Petrášová, MUDr. Sabina Flašarová, PhDr. Radka Michalčáková Neužilová, Ph.D., MUDr. Pavla Hanzlíková, Ph.D., MBA

Neurol. praxi. 2023;24(6):449-452 | DOI: 10.36290/neu.2023.072

Multiple sclerosis (MS) is an immune-based neurodegenerative disease that often leads to cognitive deficit in addition to other symptoms. The decline in cognitive functions has a various prevalence in the respective forms of MS, whereas it occurs more often in progressive variants, however, it always reduces the patient's quality of life. Cognition in patients with MS should be examined as a part of the routine follow-up and coincident diseases, such as depression or anxiety, which can further impair the patient's cognitive abilities, should be also addressed adequately.

Migraine and multiple sclerosis

MUDr. Rudolf Kotas, Ph.D., MUDr. Marta Vachová

Neurol. praxi. 2023;24(6):453-457 | DOI: 10.36290/neu.2023.067

The association of headaches and multiple sclerosis (MS) has been found in the last years in more studies. Most of them are of migrainous type. The prevalence of migraine in MS patients is significantly higher (46%) than in general population (10-15%). This association is considered in clinical practice usually as a comorbidity of two independent diseases. Some facts however indicate, that headaches, especially of migrainous type, could be also the symptom of MS. Then they would belong to the secondary headaches. The headache occurs with increased frequency especially in the initial stage of MS. A prospective multicenter study has revealed the occurrence...

Epidemiology and genetics of multiple sclerosis

MUDr. Mgr. Matouš Rous

Neurol. praxi. 2023;24(6):458-463 | DOI: 10.36290/neu.2023.055

Multiple sclerosis (MS) is an autoimmune disease in which multiple factors contribute to its development. Currently, more and more studies are devoted to the role of genetics in the development of MS. Studies that mapped large sets of MS patients and controls identified 236 independent genetic variants associated with an increased risk of developing MS. None of these variants are found exclusively in MS patients. MS is primarily mediated by mild changes in gene regulation that result in changes in the functions of peripheral and tissue-bound cells of the immune system. Each genetic risk factor alone represents a small risk, the combination of which...

From the boundary of neurology

Long‑term treatment for depression in neurologic diseases

prof. MUDr. Eva Češková, CSc.

Neurol. praxi. 2023;24(6):464-468 | DOI: 10.36290/neu.2023.068

Depression belongs to frequent comorbidities in neurological diseases. There are some common etiopathogenetic factors and depression negatively influences the course of neurologic disorders. Diagnostics and treatment of comorbid depression is usually carried out by neurologist, however, in the case of severe and/ or unsuccessful treated depression psychiatric consultation is necessary. The paper deals in more details with pharmacotherapy for chosen long-term neurological disorders and is focused on the newest information and specifics in individual diseases.

Case report

Early high efficacy mulitple sclerosis treatment: therapeutic success despite safety barriers

MUDr. Dominika Šťastná, Ph.D., prof. MUDr. Manuela Vaněčková, Ph.D., doc. MUDr. Dana Horáková, Ph.D.

Neurol. praxi. 2023;24(6):469-473 | DOI: 10.36290/neu.2023.074

The presented case report illustrates the use of high-efficacy therapy in the early stages of multiple sclerosis as an effective strategy. Numerous studies from real clinical practice confirm the superior effectiveness of this approach. However, in addition to the effectiveness of the therapy, it is crucial to monitor side effects and to intervene early. With the expanding range of disease-modifying therapies (DMT), the appropriate sequencing of individual drugs is another pressing issue. For patients treated with some DMT (S1P modulators, natalizumab) the risk of rebound phenomenon should also be considered when looking for subsequent therapy. One...

Central retinal artery occlusion as an underestimated form of ischaemic stroke

MUDr. Ing. David Černík, MBA, Ph.D., MUDr. Jiří Neumann, FESO, MUDr. Jarmila Neradová

Neurol. praxi. 2023;24(6):474-476 | DOI: 10.36290/neu.2023.063

Central retinal artery occlusion can occur secondary to embolism from an unstable atherosclerotic plaque of the internal carotid artery. In our case report, monocular visual loss was the initial presentation of a severe course of ischaemic stroke which required urgent management with mechanical thrombectomy. The aim of the paper is to highlight the often underestimated severity of this condition. In our opinion, central retinal artery occlusion should be managed in an acute mode, without delay, and with the involvement of emergency medical services, just like any other stroke. In spite of the debate in both the Czech and worldwide professional community,...

Pompe's disease - when nothing standard applies

MUDr. Viera Holecová, MUDr. Laura Grossmanová, MUDr. Ján Kothaj, MUDr. Martina Martiníková, MUDr. Anna Hlavatá, PhD., MPH, doc. MUDr. Robert Vyšehradský, PhD., RNDr. Slavomíra Mattošová, PhD., MUDr. Pavol Ďurina

Neurol. praxi. 2023;24(6):477-480 | DOI: 10.36290/neu.2023.069

We present the case report of a patient with acute respiratory insufficiency, long-term dependent on artificial pulmonary ventilation with generalized muscle weakness of unclear origin. The patient underwent a series of examinations, which ultimately led to the correct diagnosis and subsequent treatment of Pompe disease despite the non-specific clinical picture and the non-specific result of the first EMG examination and the negativity of muscle enzymes.

Video case reports

Adult form of Tay-Sachs disease: a video case report

MUDr. Zuzana André, MUDr. Martina Chovancová, MUDr. Michaela Pietrzyková, MUDr. Alice Martinkovičová, PhD., prof. MUDr. Peter Valkovič, PhD., doc. MUDr. Zuzana Košutzká, PhD.

Neurol. praxi. 2023;24(6):481-483 | DOI: 10.36290/neu.2023.049

Tay-Sachs disease is a rare autosomal recessive disorder caused by β-hexosaminidase A (HexA) enzyme deficiency. There is accumulation of GM2 gangliosides in neuronal lysosomes, which potentiates their toxic effect, thus inducing gradual neurodegeneration. The exact mechanism triggering neuronal death is still unknown. Due to the preserved residual HexA enzyme activity, the adult form of the disease tends to have a milder course than the infantile form. The clinical presentation is non-specific; hence, the disease is significantly underdiagnosed. Our video case report presents a 49-year-old patient with a genetically confirmed diagnosis of adult...