Neurology for Practice, 2024, issue 6
Main topic
Vaskulárna problematika
doc. MUDr. Vladimír Nosáľ, PhD., FESO
Neurol. praxi. 2024;25(6):425
Anticoagulation therapy in patients with AF atrial fibrilation after ischemic stroke
MUDr. Lucia Babálová, PhD., prof. MUDr. Egon Kurča, PhD., FESO, doc. MUDr. Vladimír Nosáľ, PhD., FESO
Neurol. praxi. 2024;25(6):427-432 | DOI: 10.36290/neu.2024.067
A consistent approach to anticoagulant therapy is a crucial factor influencing the success of primary and secondary prevention of ischaemic stroke. In clinical practice, neurologists deal with anticoagulant treatment mainly in patients who have experienced a stroke, whether it occurred during anticoagulant therapy or in those without such treatment but an etiological factor requiring anticoagulation was identified during the diagnostic process. Deciding on the timing of anticoagulant therapy after stroke is particularly challenging. Equally important is the choice of a drug, its dosage, and consideration of individual risk factors.
Spontaneous intracerebral hemorrhage -what should the management be in 2024?
prof. MUDr. Roman Herzig, Ph.D., FESO, FEAN, MUDr. Martin Šrámek, Ph.D.
Neurol. praxi. 2024;25(6):434-439 | DOI: 10.36290/neu.2024.080
Spontaneous intracerebral hemorrhages (SICH) are associated with a number of risk factors, which can be divided into controllable and uncontrollable factors. Their most important risk factor is arterial hypertension. The care for patients with SICH must be complex and multidisciplinary. In the acute phase, it becomes imperative to try to correct arterial hypertension and reverse the effect of anticoagulant therapy as quickly as possible. In the future, a better clinical outcome can recently be expected in selected patients with supratentorial (mainly lobar) SICH operated on within 24 h using minimally invasive parafascicular surgery.
Tenecteplase in ischemic stroke treatment
doc. MUDr. Vladimír Nosáľ, PhD., FESO
Neurol. praxi. 2024;25(6):441-444 | DOI: 10.36290/neu.2024.066
Ischemic stroke is a common and serious condition. Timely restoration of cerebral perfusion is crucial for improving patient outcomes and reducing economic impacts. For three decades, alteplase has been the only established pharmacological treatment, often combined with endovascular therapy. Tenecteplase, a newer generation of fibrinolytic therapy, is recommended by the ESO 2023 guidelines as a suitable alternative to alteplase, particularly if treatment is initiated within 4.5 hours of symptom onset. Tenecteplase offers higher fibrin specificity, lower binding to PAI-1, and a longer plasma half-life compared to alteplase, allowing for single bolus...
Vertebrobasilar ischemic stroke
MUDr. Miroslav Mako, PhD.
Neurol. praxi. 2024;25(6):446-449 | DOI: 10.36290/neu.2024.063
Ischemic strokes in the posterior circulation represent 20 % to 25 % of all ischemic strokes. Making the diagnosis could be difficult, especially with a non-specific and less serious clinical picture. Low sensitivity of CT examination in the acute phase of stroke can complicate diagnosis. Incorrect or delayed diagnosis puts patients at high risk of early recurrence and worsens their clinical condition. The general principles of treatment are the same as for patients with lesions of the anterior cerebral circulation. Intravenous thrombolysis improved the prognosis of patients without an increased risk of complications. Endovascular treatment of basilar...
Sleep disorders and stroke
doc. MUDr. Pavel Šiarnik, PhD., MUDr. Michal Poddaný, prof. MUDr. Branislav Kollár, PhD.
Neurol. praxi. 2024;25(6):450-453 | DOI: 10.36290/neu.2024.057
Sleep disorders represent a common comorbidity in patients with stroke. Their relationships are complex and bidirectional. Sleep disorders can act as a risk factor for the development of stroke. On the other hand, lesions in the central nervous system can lead to sleep disturbances. Sleep disorders and their treatment can significantly modify the recovery process of the patient and also affect the risk of stroke recurrence. In the following text, we present the mentioned topic. We focus not only on the well-studied sleep apnea but also explain the role of sleep-related movement disorders and insomnia. The interactions of stroke with hypersomnias, circadian...
Management of patient with post-stroke cognitive impairment
MUDr. Dominik Koreň, PhD., Mgr. Miriam Slavkovská, PhD., prof. MUDr. Zuzana Gdovinová, PhD., FESO, FEAN
Neurol. praxi. 2024;25(6):455-464 | DOI: 10.36290/neu.2024.087
Cognitive impairment (CI) after stroke is a frequent phenomenon. In some patients, CI can persist for a long time after overcoming stroke, which is referred to in the English literature as PCSI - post stroke cognitive impairment. It is a special nosological entity that needs to be diagnosed already during hospitalization, but a definitive diagnosis can only be made subsequently by a control examination of cognitive functions six months after stroke. The following article provides an up-to-date overview of the diagnosis, prediction and therapy of PSCI as a special nosological unit.
Review articles
Gepants - new moleculs in migraine treatment
MUDr. Petra Migaľová
Neurol. praxi. 2024;25(6):466-469 | DOI: 10.36290/neu.2024.073
Migraine is a frequent disabling disease. The worldwide prevalence of migraine is estimated to be between 10-15 %. Migraines often start already in childhood, when the ratio of girls to boys tends to be higher in boys, and during puberty the numbers even out. As age continues, the ratio leans more towards the female sex. However, it mostly affects adults of working age, where women already significantly outnumber men. There are more than a million migrainers in the Czech Republic. Most of them suffer from episodic migraine, while at least twenty percent of them suffer from the chronic form, which significantly affects the quality of life of the patient...
Ravulizumab in treatment of AQP4-IgGpos Neuromyelitis Optica Spectrum Disorder
MUDr. Petra Nytrová, MUDr. Ingrid Menkyová, Ph.D.
Neurol. praxi. 2024;25(6):470-476 | DOI: 10.36290/neu.2024.068
Ravulizumab is a humanized monoclonal antibody targeting the complement C5 protein. This drug has been approved by different regulatory agencies worldwide for the treatment of AQP-4 seropositive NMOSD based on the results of the CHAMPION-NMOSD trial. Similar to eculizumab, ravulizumab offers highly effective prevention of NMOSD relapses. Both molecules demonstrated more than 90% reduction in relapse risk compared to the placebo group. Ravulizumab has a longer half-life allowing extending interval dosing from two to eight weeks compared to eculizumab. Patients taking C5 complement inhibitors have an increased risk of serious meningococcal infections,...
Chronic pain management, atypical opioids
MUDr. Marek Hakl, Ph.D.
Neurol. praxi. 2024;25(6):478-481 | DOI: 10.36290/neu.2024.071
Chronic pain is a major society-wide socio-economic problem. It significantly contributes to the population disability rate in developed countries and adversely affects the quality of life. The strategy of chronic pain management is multimodal, involving pharmacotherapy, rehabilitation therapy, psychotherapy, invasive methods, and some other therapeutic options. The basic pain management strategy is based on the WHO three-step analgesic ladder. Non-opioid analgesics are the mainstay of chronic pain management, combined with weak or strong opioids depending on the intensity of pain. This treatment can be supplemented with adjuvant analgesic medication....
Drug-induced excessive sleepiness
MUDr. Kateřina Seltenreichová, Ph.D.
Neurol. praxi. 2024;25(6):482-484 | DOI: 10.36290/neu.2024.041
Excessive daytime sleepiness (EDS) is a serious issue, with one of the most tragic potential consequences being traffic and other accidents. This review article particularly deals with drug-induced EDS that cannot be explained by negative effects on nocturnal sleep quality and architecture or by inducing nocturnal insomnia and/or the occurrence of parasomnia. It is focused on EDS induced by drugs in themselves; however, the distinction between various pharmacogenetic causes of EDS is not always clear cut. The main emphasis is placed on anti-seizure medications, anxiolytics, antipsychotic drugs, antidepressants, antiparkinsonian drugs, muscle relaxants,...
From the boundary of neurology
Communication strategies for neurologists when interviewing patients with multiple sclerosis when the diagnosis deteriorates
PhDr. Eva Růžičková
Neurol. praxi. 2024;25(6):486-490 | DOI: 10.36290/neu.2024.052
The article focuses on communication strategies for neurologists when talking to multiple sclerosis (MS) patients as their diagnosis deteriorates. Breaking of bad news is difficult and often insufficiently covered in medical education, which can lead to emotional detachment of physicians from patients and burnout. Targeted communication skills training improves the physician-patient relationship. Recommended communication strategies to enhance the compliance include: preparation of the environment, structured interview process, ascertaining the patient's awareness, building a therapeutic relationship, honest and empathetic communication of the diagnosis,...
Case report
Ponesimod as a suitable high-efficacy treatment for multiple sclerosis
MUDr. Mgr. Matouš Rous
Neurol. praxi. 2024;25(6):492-495 | DOI: 10.36290/neu.2024.074
This case report describes the treatment of a patient with relapsing-remitting multiple sclerosis (RR-RS) who also suffers from Crohn's disease. After initial therapy with glatiramer acetate and interferon beta-1a, the patient had ongoing disease activity that required a change in treatment. Considering the need for highly effective therapy and the patient's preference for less frequent visits to the medical facility, treatment with ponesimod was started in April 2022. After more than two years of treatment, the patient remains clinically stable, without new relapses or disease progression, and Crohn's disease is in remission. The patient tolerates...
Information
Zpráva z podzimního setkání epileptologů a klinických neurofyziologů
prof. MUDr. Ing. Petr Hluštík, Ph.D.,, prof. MUDr. Pavel Kršek, Ph.D.,, MUDr. David Krýsl, Ph.D.
Neurol. praxi. 2024;25(6):497-498
Obituary
Kaddiš za Pavla Traubnera (1941–2024)
prof. MUDr. Petr Kaňovský, CSc., FEAN, prof. MUDr. Egon Kurča, Ph.D., FESO, doc. MUDr. Marek Baláž, Ph.D.
Neurol. praxi. 2024;25(6):496