Delirium is a clinical syndrome characterized by an acute attention deficit and cognitive dysfunction. It occurs frequently in hospitalized individuals, and its incidence rises with increasing age and severity of somatic condition. Diagnosis of delirium is based on history, clinical observation of behavior and testing of cognitive functions. The most common and important risk factor for development of delirium is the presence of dementia. In neurological practice, especially delirium occurs in dementia, as well as in stroke, CNS infections, tumors, etc.; administered drugs are also a frequent cause of delirium.

Delirium is a syndrome which, in geriatric patients, may lead to a significant functional impairment or even death. It is an acute, lifethreatening condition which occurs in elderly patients, particularly those in hospital. An elderly patient is extremely fragile and there is a high risk of delirium in patients with dementia, followed by those generally compromised, with the presence of an infection, or in postoperative states. It has been reported that up to 20% of all hospitalized patients over 65 years of age may develop complications during hospitalization as a result of delirium. A number of factors are involved in the development of delirium, the identification of which may often allow a causal therapeutic intervention. The present article provides an overview of the pathophysiology of delirium in the elderly as well as an overview of the diagnostic options and the treatment of the delirium syndrome in these patients.

Medication overuse headache belongs to the group of chronic daily headache (CDH). When some of the serious secondary headaches, such as brain tumour, cerebrovascular disease or other diseases caused by a structural lesion of the central nervous system, are ruled out, in typical migraine sufferers CDH may develop by transformation from episodic to chronic migraine, or it may be primary chronic tension- type headache, and/or the headache may result from overuse of medications (medication overuse headache, MOH). In the latter case, there is primarily an interaction between an excessively used acute analgesic drug and a predisposed type of patient. It has been shown that frequent and regular use of analgesic-antipyretic drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), ergotamine agents, triptans, opioids or combinations of these drugs may result in drug-induced headache, and not in pain relief. This condition can be managed by withdrawal of the overused medication, detoxification, and initiation of both adequate prophylaxis and appropriate acute treatment. Successful treatment requires the patient’s motivation and the physician’s persistent supervision and feedback. The article presents the opinion of an expert who deals with this problem in the practice and describes experience from the author’s workplace. ergotamine, treatment.

Sleep-Wake disturbances belong to the most common and disabling nonmotor symptoms of Parkinson‘s disease (PD) as they affect 50–95% patients. Etiology of impaired sleep and wakefulness in PD is multifactorial. Its most important causes are co-existent primary sleep disorders, medication side effects, overnight re-emergence of motor symptoms, psychiatric comorbidities and primary neurodegeneration of sleep regulating brain areas itself. To date, very few controlled studies are available to make a recommendation for their management, thus treatment of sleep-wake disturbances in PD must be tailored individually with respect to presence of comorbidities and patients preferences.

This article is dedicated to the problem of Lyme borreliosis, particularly to its later forms causing damage to the nervous system, and with an emphasis on the possibilities of its diagnosis and treatment. Lyme borreliosis occurs relatively often in the Czech Republic and patients are treated by doctors of various specializations. For the most part, it is the later forms of the disease that cause the biggest difficulties. Nevertheless, even these cases can be successfully treated, if in fact an active borreliosis infection is actually the cause of the symptoms.

Polymyositis is a rare disease manifesting with muscle weakness located particularly to proximal parts of extremities. A number of patients have also extramuscular manifestations, such as dysphagia, interstitial lung disease or arthritis. Muscle biopsy shows endomysial inflammatory infiltrate and MHC class I hyperexpression on muscle cells, EMG displays myogenic findings, and usually CK and/or other muscle enzyme levels are elevated. Detection of serum autoantibodies is diagnostically and prognostically helpful since some of them are specific for myositis and typical for particular clinical situations, such as antisynthetase syndrome. Many patients with PM respond to glucocorticoid or immunosuppressive treatment; full resistance prompts to diagnosis verification.

Myotonic dystrophy is the most common form of muscular dystrophy in adults. It is a multisystem disease characterized by slowly progressive weakness of skeletal muscles, myotonia, and multisystem involvement. Pain is a common and major symptom of the disease and its frequency is approximately 75 %. The pain is not same for all patients, it has a variable intensity, temporal pattern, localization, and character. In the majority of cases the pain has moderate intensity, long-term course, and fluctuates over time. The intensity or even presence of pain is usually not associated with the patient's age and severity of the disease. The most often reported localization of the pain is lower back, thighs, calf, arms, shoulders, and neck. Patients complain about various types of pain - pulling, stabbing, exhausting, and sore or just discomfort in muscles, such as tension, tightness, tenderness, burning, tingling, or cramping. The most frequently used treatment is medication.

Gluten-related disorders (GRD) is a term used to describe a spectrum of diseases related to the ingestion of the food containing gluten, a cereal protein contained in wheat, rye and barley. Celiac disease and non-celiac gluten sensitivity are the most prominent clinical units of this group with a high prevalence in general population and variable clinical manifestation in both the cases. Among others, they may present with neurological symptoms, mainly polyneuropathy, which is found in about 50 % of celiac patients. So called gluten neuropathy is usually symmetric chronic, sensory-motor and axonal. Asymetric forms as well as small fiber neuropathy can also be found in GRD patients. Besides medical history and clinical picture, diagnosis of GRD (particularly celiac disease) is confirmed by serological methods (evaluating the presence of antibodies against tissue transglutaminase, endomysium and gliadin, a part of gluten molecule), histology (confirming the inflammatory changes in duodenal mucosa biopsy samples) or evidence of the association with HLA II antigens. Confirmation may also be performed by evaluation of the effect of gluten-free diet, which represents a key therapeutical intervention in the prevention of development the clinical symptoms related to GRD. In gluten neuropathy, the diet leads to clinical stabilisation and prevention of the disease progession likely than to a clinical regression of the symptoms and signs.

Autism is one of the most serious, lifelong disorder of children's mental development, mostly requiring lifelong care of another person. The ability to predict the outcome (development of the disorders in adulthood and economic involvement of individuals in adulthood) of children with autism, so lets families plan the future of their children and create reasonable expectations. Studies, which follow up socio-economic status (SES) in adults through almost 50 years, are compared in this article. In addition we deal with scores, which can be used for outcome in adults, so single studies could be compared. We also think about factores, which influence SES in adult, like IQ, language skills or revalency of autistic symptoms. Last but not least, is in article mentioned, what is neccesery to be focused on in future.

Prion diseases are rare neurodegenerative conditions with a lethal course. These diseases are caused by deposition in the brain of a pathologically altered prion protein, leading to gradual neuronal degeneration and irreversible brain damage. Creutzfeldt-Jakob disease (CJD) is the best-known and most common human prion disease. It is clinically manifested by a wide range of symptoms, rapid progression, and poor prognosis. Early-onset rapidly progressive dementia is typical. We report a case of a 49-year-old man with presumed sporadic CJD that was confirmed by neuropathological investigation. It was shown to be a rare Heidenhain variant dominated by disorders of visual-spatial functions in the prodromal phase. In the Czech Republic, the diagnosis of CJD and other prion diseases is dealt with by the National Reference Laboratory for Human Prion Diseases.

Autoimmune syndromes of brainstem and cerebellum are usually of paraneoplastic origin. The diagnostics is based on the detection of onconeural antibodies and imaging methods. The early diagnostics enables effective treatment in some cases.

Glatiramer acetate and laquinimode are effective drugs for the treatment of multiple sclerosis.Glatiramer acetate and laquinimode exert significant not only anti-inflammatory effects but also important effects on remyelination and neuroprotection.

Proton MR spectroscopy provides the non-invasive assessment of metabolites in examined tissue, can be used to get intracranial neoplasms structural information, increases the specificity of structural magnetic resonance and may serve as an additional examination for evaluation of the response to treatment and decisions to change the treatment strategy as it is in diferentiation of posttreatment changes and recurrence after comlex oncologic treatment of glioma patients. Biochemic changes in glioma differ according to histology and tumor grading. The results of MR spectroscopy can be used for several indications in neurooncology. However, it is important to remember spectroscopy limitations and the necessity of an adequate institutional experience.

The varicella-zoster virus is the only virus that can cause two different diseases: chickenpox (varicella) and shingles (herpes zoster). Primary infection is characterized by a generalized vesicular eruption on an erythematous base of the skin and the mucosa. Endogenous infection is manifested by a vesicular eruption in a herpetiform pattern along the course of one or more nerve roots, the dermatomes. Primary infection is typical for childhood, causing chickenpox. It most commonly affects children aged three to six years. During the period of primary infection, the virus travels along the sensory nerve from the skin to the appropriate ganglion where it remains in a latent state. Herpes zoster occurs as a result of reactivation of latent viruses. It is an inflammatory disease of the posterior horns of the spinal cord or of brain cells with skin involvement. Postherpetic neuralgia that is often treatment resistant is the most frequent complication. The best way to prevent this complication is early diagnosis and treatment. Since April 2014, vaccine against herpes zoster has been available in the Czech Republic as the first among central and eastern European countries.

For more than 2,500 years, the medical profession has demonstrably had well-established rules to guide the approach and behaviour to the sick and suffering. However, in the last century in totalitarian regimes, professional failure occurred in many physicians – even the very educated and distinguished ones – that was manifested by the absence of adherence to centuries-old rules and by the support of or even active participation in the killing of the so-called "racially inferior". Even in the present day, a physician must overcome various pitfalls, in order not to betray his mission of being the one to help the sick with his knowledge and empathy in their difficult life situations. The article introduces some little-known or forgotten historical evidence, considers the causes for the above-mentioned professional failure, and seeks to find the reasons that used to lead, and still do, some physicians to act in ways that are the very opposite of the required ethical standards of their profession.

Neuropathic pain is one of the most difficult-to-treat pain conditions. Numerous common analgesics are not effective in treating it. Drugs from the groups of anticonvulsants, antidepressants, opioids with an increased affinity to neuropathic pain, and, recently, new topical dosage forms have been at the forefront of treatment. The occurrence of neuropathic pain increases exponentially with patient age; at the same time, however, tolerance of patients to antineuropathic treatment decreases. A major benefit in treating neuropathic pain has been the development of uniform EFNS guidelines based on which national guidelines are subsequently developed. The most common forms of neuropathic pain include polyneuropathy, trigeminal neuralgia, postherpetic neuralgia or central neurogenic pain.

Multiple sclerosis (MS) is a chronic potentially disabling disease of the central nervous system (CNS) with underlying focal and diffuse pathology. Current therapeutic options are based on administration of methylprednisolon during relapse and chronic treatment with disease modifying drugs (DMD). These drugs highly influence focal pathology represented by immune inflammation, but are less effective on diffuse pathology represented by neuro-degeneration and axonal loss which is however this part of MS pathophysiology that has major prognostic impact for MS patient. NEDA-4 concept (no evidence of disease activity) brings a new insight to MS treatment outcomes by introduction of the “freedom of the disease” principle (i.e. absence of disease activity and progression in both clinical and radiological point of view) and inclusion of assessment of brain atrophy which correlates with diffuse changes of the CNS. Achievement of long-term NEDA-4 is an important goal of MS treatment in individual patients.

Disorders of cognitive functions are among the main manifested symptoms of multiple sclerosis (MS)and, most commonly, their character is of a mild cognitive disorder; however, they impact essentiallyon the patients’ mental condition and social capacity. Recent studies have been aimed at the possibilityof using brain plasticity and its capacity of restructuring neural networks and, through cognitivetraining, restoring or at least maintaining cognitive functions in MS patients. In order for cognitivetraining to be eff ective, there must be not only targeted diagnosis (neuropsychological assessment,imaging techniques), but mainly a precisely designed training plan with suffi cient frequency andduration. The use of computer-assisted training is one of the possible options. A major advantageis the combination of training of cognitive functions with motor training.

Surgical treatment is necesery in vast majority of adult patients with acute or chronic hydrocephalus. There are three possibilities of hydrocephalus treatment: removing of the obstacle in the ventricular system (in the most cases removing of the tumor), shunt operation or endoscopic treatment. The type of the operation is determined based on the radiological investigation, today using magnetic resonance. The most freuently performed procedure is a shunt operation, which is however associated with high percentage of late complication. In the recent decade, endoscopic operation have been used increasingly. They are less invasive and no foreign material is implanted therein. After operation patient deserves regulary monitoring by neurosurgeon and neurologist.

Vasculitides are a very heterogeneous group of diseases with a wide range of clinical presentations. Due to inflammatory changes in the vessel wall, distal tissue is jeopardized by ischaemia (vascular occlusion, embolization) or, less frequently, vessel rupture and bleeding can occur at the site of the injury. Clinically, three basic presentations of CNS vasculitis manifestations can be specified: acute territorial ischaemic stroke, i.e. involvement of large arteries with a typical presentation consistent with the territory affected, but often with accompanying atypical symptoms in the medical history (cephalalgia, encephalopathy, or epileptic seizures); "atypical multiple sclerosis (MS-plus)" with involvement of small arteries, having a relapsing-remitting course with atypical MS symptoms (epileptic seizures, headaches); and acute encephalopathy with progressive disturbance of consciousness. In CNS vasculitides, immunosuppressive therapy always has to be supplemented by antiplatelet or anticoagulant therapy. Vascular risks are to be managed aggressively (high-dose statins, antihypertensive drugs, diabetes control). The diagnosis of CNS vasculitis should be taken into consideration despite its very low incidence, given the options of targeted therapy with a good chance of improving the prognosis in affected patients.

Physiotherapy has a key role in the multidisciplinary management of patients with functional motor disorder (FMD). Despite growing evidence that physiotherapy is an effective treatment, we still lack evidence-based guidelines on what physiotherapy for FMD should consist of. Here we present recommendations for approach towards patients with FMD and physiotherapy that have been successful in FMD and which are based on existing evidence and experience from leading experts in this field. Physiotherapy should address self-directed attention and abnormal habitual movement patterns through a process of education, movement retraining and self-management strategies.

Case report of a man, aged 52 years. He is staying in a residential care facility in a diffi cult life situation.Primary disease: multiple sclerosis; palliative; deteriorating health as well as mental condition.Anxiety; depressive states; repeated suicidal thoughts. Painful surgical procedures repeatedly overthe course of several years; lower limb amputation; decreasing self-suffi ciency.