Main causes od intracerebral hemorrhage (ICH) are described, and include: acute and chronic hypertension, small vessel disease, amyloid angiopathy, arterial aneurysms, arteriovenous malformations, cavernomas, venous angiomas, teleangiectasias, dural arteriovenous fistulae, traumatic ICH, hemorrhage into metastatic tumors, vasculitis, septic arteritis and mycotic aneurysms, moya moya, arterial dissections, carotidocavernous fistula, anticoagulant and antiaggregation therapy, thrombolytic therapy and others. Important clinically relevant issues are mentioned. Variations of clinical presentations and differential diagnostics are described with special emphasis on differentation between spontaneous and traumatic ICH, and on hemorrhagic manifestations in intracranial venous thrombosis.

The ketogenic diet is an established non-pharmacologic treatment for childhood intractable epilepsy. It is a high-fat, adequate-protein, low- -carbohydrate diet. Efficacy and safety of ketogenic diet has been proven in many clinical trials. If ketogenic diet was previously considered as an alternative medical procedure of „last choice“ nowadays its indications changed. For some epilepsies or epileptic syndromes is recommended after failure of two or three AEDs.

Myoclonus is a fast, jerky involuntary movement caused by a muscle contraction or inhibition. It is classified according to the clinical characteristics, anatomical origin or its etiology. Myoclonus is either physiological or it can be a symptom of various neurological disorders. Neurophysiological diagnostics is widely used, besides history and meticulous clinical examination. Therapy is empirical, with clonazepam as one of the most often administered drugs. It appears that the combination therapy with several drugs is more successful.

Alcohol consumption is very high in the Czech Republic and this gives rise to a considerable public health problem. The link between epilepsy and alcohol consumption is definite. Epileptic seizures are three times more frequent in abusers and increase with the amount per day of alcohol consumed. Both intoxication and withdrawal are recorded as the risk factors, but the withdrawal seizures attracts the most of attention. Long-term alcohol abuse impairs regulation of the NMDA and GABA-A receptors. The sudden deficit of alcohol results in alcohol withdrawal seizures. A manifestation of alcoholic epilepsy varies with respect to length of abuse. There are seizures related to withdrawal period at the first stage, seizures appearance in both withdrawal phase and consumption phase at the second stage and finally irreversible third stage of alcoholic epilepsy (Bartolomei, 2006). Epilepsy suffered by alcohol abusers can also have the same kinds of etiology as it has in general population (e.g.post-traumatic, post-stroke etc.) The chronic alcohol abuse influences also the metabolism of an AED that reduces level of the AED within the blood plasma. The repeatedly abstaining abusers (may be for the treatment of abuse) should be observed carefully. Recent studies conclude the antiepileptic treatment of alcohol abusers is necessary. However, the epilepsy and alcohol abuse treatment should be linked together.

Thyroid gland dysfunction is beside diabetes mellitus the most common endocrinopathy. Both hypothyroidism and hyperthyroidism may cause signs and symptoms of neuromuscular dysfunction. Hypothyroidism is associated with clinical neuromuscular features in 79 % and hyperthyroidism in 67 % patients. Proximal myopathy, sensorimotor axonal neuropathy and carpal tunnel syndrome are the most common disorders in hypothyroidism. Hyperthyroidism (Graves Basedow disease) may cause hyperthyroid myopathy, thyrotoxic periodic paralysis and thyroid-associated ophtalmopathy. Peripheral sensorimotor neuropathy is rare. Neuromuscular symptoms and signs usually recover completely when thyroid gland dysfunction is corrected.

Alemtuzumab (Lemtrada®) is a humanized monoclonal antibody indicated for the treatment of highly active relapsing-remitting multiple sclerosis (RRMS).Alemtuzumab causes cytolysis of circulating B and T lymphocytes by binding to their surface marker, CD52. The newly achieved repopulation of lymphocytes subsequently leads to a rebalancing of the immune system. In clinical trials with active comparator (IFN-beta-1a -Rebif 44) demonstrated alemtuzumab superior efficacy when evaluating the annualized relapse rate, progression of disability, the number of new or enlarging lesions on magnetic resonance imaging (MRI) and increasing brain atrophy. Data from clinical trial extensions confirm the long-term effect of alemtuzumab. Its advantage is the low frequency of administration - 5 infusions over 5 days at the start of treatment, and additional 3 infusions per year with the expected efficacy of the treatment scheme for the next 5 years.

Interferon beta 1b (Betaferon) has been the longest used disease-modifying drug in multiple sclerosis. Its side effects include, among other things, elevated liver aminotransferases, which reflects hepatocellular injury. It is, however, unclear what exact changes in the liver parenchyma occur. Data are available only from liver biopsies of patients with fulminant hepatic failure, resulting from another underlying cause. Our case report presents a patient treated with Betaferon since 1999 who had developed elevation of liver enzymes with a gradual increase as early as the first year of treatment and, transiently, third-degree toxicity was reached. Given the long-term clinical and radiological stabilization and the patient's negative attitude to a possible treatment switch, the decision was made based on the liver biopsy results to continue the treatment with interferons despite persistently elevated liver enzyme levels.

Limbic encephalitis (LE) is a condition affecting the limbic system that typically presents with memory disorders, with recent memory being most affected; concurrently, epileptic seizures and psychiatric symptoms can occur. Paraneoplastic limbic encephalitis (PLE) and non-paraneoplastic limbic encephalitis (NLE) are distinguished. Recently, an association of NLE with anti-LGI1 antibodies has been described. We report a case of a 45-year-old female patient with LE and positivity of anti-LGI1 antibodies. The differential diagnosis and treatment of this disease are also discussed.

Polymorbid patient with pain is a difficult problem for physicians. It is usually more of the diseases that are accompanied by various types of pain, and is treated with medicaments which have different pharmacologic properties and adverse effects (Slíva, 2011). In these cases it is very important detailed examination of pain etiology and rational use of analgesic treatment (Ambler, 2012). In our case report, we present example of polymorbid middle-aged patient who suffers from serious illnesses, underwents radical surgery on the musculoskeletal system and has a long-term chronic medication therapy, including corticosteroids. Patient is treated with several analgesics, despite its multiple pain are not sufficiently covered. Etiology of pain is mixed. Nociceptive component dominates, but is combined with a neuropathic component. In our department was adjusted pharmacotherapy emphasizing the influence component of neuropathic pain. At the control examination, we noticed reduce pain, lower incidence of adverse events of drugs and signs of improvement in quality of life.

Lumbar spinal stenosis (LSS) is a frequent disease of older age that contributes to impaired mobility of patients, but that is often underdiagnosed. Diagnostics and therapy of patients with LSS are multidisciplinary issue with contribution of neurologist, spine surgeon and radiologist. This article summarizes recent findings about clinical manifestation, diagnostics, differential diagnostics and choice of optimal therapy for patients with LSS.

We report a case of 34-year-old man with multiple sclerosis with recurrent hepatopathy of toxicity grade 3 after Gilenya treatment in the first 6 months of our treatment. We must twice discontinue treatment with Gilenya due to hepatopathy. There was no episode of recurrent hepatopathy in the next 1,5 year. Our patient is clinically and radiologically stabilized.

Instrumental methods of investigation, such as positron emission tomography, functional magnetic resonance imaging, electroencephalography and evoked potential measurement, yield a lot of information useful for differential diagnosis and for determining the prognosis of patients in a vegetative state. Consequently, they also allow for a better understanding of how the brain of a patient in a vegetative state works.

Back pain in pregnancy is a common condition which can be easily trivialized by treating physicians. We present a case series where the back pain was the major or the only clinical sign of a life-threatening condition. We provide an overview of recent knowledge about these conditions from the neurological point of view. We also point out warning signs and a set of examinations that should not be missed out in any pregnant patient with a back pain.

Riding a bicycle is the most popular and very widespread sports activity that leads to improved physical and mental performance. However, improper choice of a bicycle, incorrect posture and riding technique can result in deterioration of physical condition, particularly manifested by pain in the neck or lower back. The article highlights the most common health issues associated with riding a bicycle and the options of managing them in order to better enjoy bicycle riding.

Acute polyradiculoneuritis is an autoimmune-based neuropathy and represents an important diagnostic and therapeutic problem. In Europe demyelinating forms prevail (more than 80 %), whereas in China and in Middle and Southern America the axonal forms represent more important portion. During diagnosis setting there is necessary to evaluate clinical finding and a course of disease, then laboratory analysis of blood and urine follow, further electrophysiological investigations (motor and sensory neurography, F-waves, H-reflex) and withdrawal of cerebrospinal fluid. During differential diagnostic process there is to evaluate and differentiate a couple of various disoders. dissociation.

Molecular genetic diagnostic methods have recently very quickly advanced, their yield has simultaneously increased and the cost decreased. Both physicians and common population have become more aware of possible genetic reasons for epilepsy and demands for genetic testing of patients with epilepsy have increased too. But despite the progress in identification of genes contributing to different epileptic syndromes the utility of genetic tests in clinical epileptology is often controversial. In genetic counselling physicians should be familiar not only with the mode of inheritance of disorders, but must be also aware of frequent genetic and phenotype heterogenicity and clinical utility of the tests. The overview of idiopathic epileptic syndromes and epileptic encephalopathies with identified genetic aetiology, possibilities of genetic testing and current opinion on the clinical utility of genetic testing in specific syndromes is provided.

Detailed neurological and functional examination is fundamental for the evaluation of the development after spinal cord injury. European Multicenter Study about Spinal Cord Injury (EMSCI) has significantly contributed to standardization of processes of investigation. Their widening is going on in the Czech Republic in form of courses on the examination of a spinal cord injured patient organised by the Spinal Cord Unit Prague, University Hospital Motol. Electronic forms could help to simplify processing of obtained information, unify outputs and make the medical documentation better arranged.

In the introduction, the author describes the history of the Czech Headache Society which has played an important role in developing the knowledge of headaches in the Czech Republic. Next, the IHS headache classification is briefly mentioned and an overview is given of the most commonly occurring primary as well as secondary headaches – migraine, tension headache, cluster headache syndrome, headaches related to head and/or neck injury, headaches related to cerebrovascular disease, headaches related to intracranial involvement of other than vascular aetiology, headaches related to the use or discontinuation of a pharmacologically active substance, and cervicogenic headaches. For each type of headache, the clinical presentation and therapy are described.

Diabetic neuropathy, a common complication of diabetes mellitus type 1 and type 2, represents clinically heterogeneous syndrome with various involvement of peripheral, cranial and autonomic nerves. The progression is usually slow and patients may stay for a long time asymptomatic. Prevalence of diabetic neuropathy is estimated between 13 and 54 % according to the duration of the disease. Two main clinical types of diabetic neuropathy – generalized and focal – can be distinguished by clinical examination. The basic diagnostic tool is electromyography. The symptomatic treatment is focused on neuropathic pain. As the effective treatment is still unavailable diabetic neuropathy represents a high risk for development of diabetic foot. It is very important to differentiate other causes leading to neuropathy in diabetic patient as this may lead to causative and usually more effective therapy.

Huntington’s disease is a hereditary neurodegenerative disease primarily affecting striatal neurons, manifested mostly in adulthood by a combination of neurological and psychiatric symptoms, most typically by choreatic hyperkinesias and development of dementia. We report a case of a female patient with Huntington’s disease presenting as multisystem atrophy (MSA) with delayed manifestation of chorea. Unlike a typical MSA presentation, asymmetry in manifestations of Parkinson’s syndrome and responsiveness to levodopa were evident.

The risk of the central nervous system damage in terms of a chronic toxic encephalopathy caused by long-term low-level exposure to organic solvents is constantly in the focus of interest of the occupational neurology. Clinical manifestation of such a disease involves subjective neurasthenic complaints and subtle non-focal signs in the physical neurological examination. To assess the severity of impairment, two international classification systems are available. The boom of interest in the issue culminated in the 1970s, especially in the Scandinavian countries. Currently, it experiences a revival in connection with reports on findings in the neuroimaging methods, documenting some structural brain changes in the patients, such as the multifocal toxic leukoencephalopathy on MRI. Attempts at the international standardization of diagnosis based mainly on the results of a neuropsychological examination are in progress, to be used especially in the framework of recognition as an occupational disease. However, the number of such cases reported in the Czech Republic is quite low.

Painful diabetic neuropathy developes in 16 % of all diabetics and in 40–50 % of diabetics with previously diagnosed diabetic neuropathy. Various medicaments are used in treatment of neuropatic pain in painful diabetic neuropathy: antidepressants, anticonvulsants, opioids, topically administered drugs, other medicaments and non-pharmacological procedures. According to evidence of pain-relieving effects in painful diabetic neuropathy there were evaluted more than 2000 citations, the titles and abstracts of which 79 were chosen, that fulfilled all the criteria of evaluating panel (from AAN – American Academy of Neurology). The highest level of recommendation (level A) reached pregabalin, then duloxetine (with respect to its adverse events, level B), then venlafaxine, tricyclic antidepressants, gabapentin, opioids, capsaicin. The combination of drugs is successful (e.g. with opioids).

Therapy of myasthenia gravis is based on two parts: symptomatic and disease modifying procedures. Among cholinestrase inhibitors (symptomatic therapy) pyridostigmine is widely used. This medication is administered in patients with the ocular or very mild form of myasthenia. In other patients immunosuppressive medication should be introduced. The key role plays prednisone and/or other steroid sparing drugs as azathioprine, cyclosporine, or mycophenolate mophetil. Plasma exchange or intravenous immunoglobulin is indicated in patients with myasthenic crisis or other severe resistant symptoms.

Painful diabetic neuropathy is common and is associated with significant reduction in quality of life. A distal and symmetric peripheral neuropathy is the most frequent form, and small fiber damage is thought to result in painful symptoms. The much less common though well recognized are acute painful and atypical neuropathies. Management of the patient with painful neuropathy is difficult, must be tailored to individual requirements, taking into consideration comorbidities and other factors. Pharmacological management represents the most important therapeutic option for chronic neuropathic pain. Current first-line agents with proven efficacy for painful neuropathies are tricyclic antidepressants (amitriptyline, nortriptyline), serotonin-norepinephrine reuptake inhibitors (SNRI – duloxetine and venlafaxine) and the anticonvulsants pregabalin and gabapentin. Second line approaches include use of opioids, thioctic acid and sodium valproate.

The author discusses the pitfalls of differential diagnosis between migraines, particularly those with aura, and idiopathic focal (partial) epilepsies, particularly benign, age-related ones. These diagnoses are among the most common in the outpatient practice of a paediatric neurologist. The author points out to the similarity of both entities in terms of medical history data, clinical presentations, and normal results of auxiliary examinations, including structural brain imaging, and highlights the similar therapeutic strategies and prognostic aspects. EEG remains a decisive examination tool for distinction; nevertheless, correct interpretation of findings in terms of electroclinical correlation may not always be unequivocal. The author also emphasizes that diagnostic considerations may be greatly complicated by their concurrent presence or mutual transitions over time in the same patient, or by possible combinations with other non-epileptic seizures, which is not an uncommon occurrence in paediatric age. The above applies not only to clinical presentations that, particularly in the lowest age groups, are often atypical, with children being frequently unable to describe their complaints in a relevant way, but also to EEG patterns.