Primary central nervous system lymphoma (PCNSL) makes 1–2 % of all primary cerebral tumors. In contrast to lymphomas arising from nodal lymphatic tissues, PCNSL affect cerebral tissue. These tumors belong to a variety of non-Hodgkin lymphomas. Their occurrence is especially in immunocompromised patients. PCNSL is in principle good curable with chemotherapy and radiotherapy. The tumor sometimes does not show on follow-up imaging examination after intensive immunosuppressive therapy. Therefore, this tumor is also marked as a vanishing tumor. The diagnosis of PCNSL is verified by the immunohistochemical examinations which certify lymphoid tumor cells. If there are doubts between histological and imaging examination, problems will appear. These problems complicate the course of this disease. We treated a patient with this complicated course of disease in our clinic.

Ultrasound imaging is one of the most available perioperative imaging methods. Ultrasound imaging is based on registering of echo signals reflected by tissue. The basic modality of examination is two-dimensional (2D) imaging in various modes. In neurosurgery, the 2D imaging is succesfully used for intraoperative imaging. Nowadays, the use of ultrasound 3D imaging is spreading in neurological and neurosurgical practice. The three-dimensional imaging alike CT or MRI facititates delineation of pathological lesions. An improvement of perioperative imaging during neurosurgical procedures is expected. First experiences in 3D ultrasound imaging of the glioblastoma resection are presented in this short statement.

Migraine in women is a hormonal conditioned diseases and its prevalence changes during the course of life. Migraines typically occur during menses (menstrual migraine). Hormonal changes (pregnancy, lactation, perimenopause, menopause) influence their appearance significantly. Women with menstrual migraine can profit from continual use of combined oral contraception (COC). Migraines with aura in females is more likely to worsen due to COC and are higher at risk of migraine stroke, especially with those who smoke. Administration of hormone replacement therapy leaves the frequency of preexisting migraine in more than half women unchanged. Estrogen replacement can be provocative for migraines with aura or isolated aura. Continuous regimen is recommended in combined hormone replacement therapy.

The aim of the paper is to acquaint neurologists, psychiatrists, geriatricians, and other specialists with the options of and practical experience with the laboratory assessment of tau protein, phospho-tau protein, and beta-amyloid in the cerebrospinal fluid in Alzheimer's disease in particular. The rationale for the use of the three cerebrospinal fluid biomarkers is briefly summarized, the principle and the methodology of the cerebrospinal fluid test are explained in detail, including an evaluation of an own group of patients, and requirements for a proper sample collection technique are emphasized. When evaluating the three cerebrospinal fluid AD biomarkers in Alzheimer's disease, the sensitivity and specificity increase to 85–94 % and 83–100 %, respectively. Thus, patients with minimal cognitive deficit who are at a higher risk of developing Alzheimer's disease can be expected to benefit greatly from an evaluation of AD biomarkers.

Professional and Non-professional Intoxications with Lesion of the Central Nervous System in the Years 2005–2009 Reported by the Czech National Registry of Occupational Diseases and The Czech Toxicological Information Center The authors inform the readers on the number of professional and non-professional intoxications with lesion of central nervous system in the Czech Republic in years 2005–2009 (till 30. 10. 2009). The article is based on data reported by the Czech National Registry of Occupational Diseases, which is administered by the National Institute of Public Health in Prague, and by database of the Czech Toxicological Information Center in Prague. of Occupational Diseases, Czech Toxicological Information Center.

The goal of the general therapy for acute cerebral infarction is to prevent the progression of cerebral ischemia as well as to prevent and treat complications. It is of utmost importance to ensure adequate oxygenation and cerebral perfusion pressure. It is essential to maintain normothermia, to maintain optimum hydration and internal environment conditions, to initiate enteral nutrition early, and to provide prophylaxis against thromboembolic disease. In the acute phase of cerebral infarction, hypertension, tachycardia, and psychomotor agitation are commonly encountered and epileptic seizures may occur. Decompressive craniectomy can be a life-saving procedure in patients with a large cerebral infarction.

Clinical case report Glycogenosis type II (GSD II) is a lysosomal storage disorder caused by insufficient activity of acid α-glucosidase (acid maltase). This enzyme is responsible for the degradation of intralysosomal glycogen. Accumulation of glycogen in lysosomes leads to the cellular dysfunction and damage in many organs and tissues. GSD is inherited in autosomal recessive trait, the incidence is panethnic approximately 1 : 60 000 of live-born children, the gene for α-glucosidase is localised on chromosome 17 (17q23). We differentiate the classical infantile onset type with first symptoms within the first few months of life, with generalized muscle weakness and hypotonia (floppy baby), hepatomegaly, progressive cardiomyopathy and death in first two years and the late-onset form presentating anytime during childhood or adulthood with slow progression of muscle weakness of legs, arms, trunk and diaphragm, but without cardiac involvment. In biochemical assessment we find elevation of creatinkinase, AST (SGOT), ALT (SGPT), LDH, the glycide metabolismus is normal, in clinical test with muscle ischemia we observe normal elevation of lactate in venous blood. Electromyography is with typical pseudomyotonic changes but with normal nerve conduction velocity. In muscle biopsy we see increased amount of structural normal glycogen in lysosomes and also intracellular. Diagnosis of Pompe disease is confirmed by low or absent acid α-glucosidase activity in cultured skin fibroblasts, purified lymphocytes, leucocytes or muscle cells. In last year we can also use a non-invasive acarbose-based assay performed on dried blood-spots. Mutation analysis can help in final verification of Pompe diagnosis. Prenatal diagnosis is possible due to DNA analysis or enzymologic assay in amniocytes or chorion villi samples. The only effectual treatment is the enzyme replacement therapy (ERT). Myozyme (alglucosidase alfa) is purified recombinant enzyme administered beweekly in short intravenous infusion in recommended dosis 20 mg/kg. Other treatment options, used in lysosomals storage disorders, like haemopoetic stem cell transplantation, substrat inhibition therapy, chaperons or gene therapy, are not suitable for GSD II. Palliative care and symptomatic therapy like ventilation support and physical therapy can be effective in managing symptoms, but can not prevent the disease progression. The diet with low sugar for glycogenolysis stimulation and high protein intake are of questionable effect. In the case report we present our experience with ERT in 37-year old patient with confirmed GSD II diagnosis.

Botulinum toxin nowadays represents an important contribution to the treatment of several motor disorders – spasticity, dystonia, hyperkinetic syndromes, tremor. In a lesser extent botulinum toxin is used in smooth muscle dysfunction (e. g. urine bladder hyperfunctional syndromes, oesophagus achalazia) and in hyperfuctional autonomic syndromes (e.g. hyperhidrosis, hypersalivation). We suppose that the therapeutical use of botulinum toxin will include new indications of motor system hyperfunctional syndromes, in visceral disorders, dysfunctions of autonomic nervous system and new indications in various pain syndromes. In this review article we summarize the most up-to date indications, mechanisms of action and presumed future development of clinical use of botulinum toxin.

First, the author deals with the etymology of the word palliative for a better understanding of its meaning and defines its use in medicine. Next, he presents a list of the major symptoms accompanying brain tumours that make the lives of patients harder and focuses on their palliative management. He emphasizes the need for a multidisciplinary approach which should result in a most bearable quality of life of patients in their last months or years of life, which is not only about relieving the symptoms of disease. A similar approach is described also for malignant spinal cord tumours including terminal care.

assessment of embryotoxicity risk of pharmacotherapy based on previous experience Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system; it commonly affects women of childbearing age. Due to the chronic nature of the condition, treatment may be required even during pregnancy in some cases. Standard recommendations are used for MS and its treatment in pregnancy: patients are advised to plan their pregnancy during a stable phase of their disease when it is possible to discontinue the long-term treatment. If the condition has not stabilized optimally and in the case of a clinical attack, low doses of corticoids and/or intravenous immunoglobulins are recommended. Treatment with other agents, such as immunomodulators interferon beta and glatiramer acetate that are first-choice drugs outside of pregnancy, is not recommended during pregnancy. There are concerns stemming from the lack of information on their risk for the fetus or from a higher risk of miscarriage and growth retardation of the fetus reported by some studies. The paper provides an insight into MS and particularly its treatment in pregnancy based on previous experience and results of studies investigating teratology information services (ENTIS) that are concerned with embryotoxicity risk assessment. According to ENTIS, glatiramer acetate and interferon beta do not pose a significant risk to the fetus. The results of epidemiological studies suggest that, for normal fetal development, it is essential to keep the disease in remission, even at the expense of adequate treatment. When selecting medications, it is important to favor those with a well-known and low risk of embryotoxicity, ideally in monotherapy and at the lowest dose possible. The pregnancy has to be monitored closely by ultrasound with respect to structural defects and intrauterine growth retardation. The present review summarizes all available and recent experience with the agents used for the treatment of MS during pregnancy regarding their embryotoxicity risk. Information Services (ENTIS), Czech Teratology Information Service (CZTIS).

The relapsing-remitting and primary chronic progressive courses are distinguished in cerebrospinal multiple sclerosis. Both these types differ in the pathogenesis, immunology, therapeutic response, and prognosis. No laboratory diagnostic marker to distinguish these two disease subentities has been available to date. Our aim was to assess the intrathecal synthesis of specific IgG antibodies against the neurotropic measles, rubella, and herpes zoster viruses (the MRZ reaction) in the relapsing-remitting course and primary chronic progressive course and to establish its differential diagnostic significance. A cohort of 35 patients (n = 35) was investigated. The intrathecal synthesis of specific antibodies was expressed by the antibody index using Reiber‘s formula. The MRZ reaction was positive in 14 out of 25 patients with the relapsing-remitting course and in 2 out of 10 patients with the primary chronic progressive course of multiple sclerosis with sensitivities of 56 % and 20 %, respectively. The difference in the positivity of the MRZ reaction in both the courses supports the hypothesis of different pathogeneses, suggesting that the MRZ reaction may be used as a complementary marker in differential diagnosis.

Introduction: The author aimed at evaluating the course of treatment in migraine patients and determining whether their migraine was progressive. Methods: A group of 72 patients with migraine without aura, migraine with aura, chronic migraine and analgesic- and ergotamine-overuse headache was followed up retrospectively in the Regional Headache Centre in Brno for a mean period of 65 months. From October 1996 to July 2008, the following parameters were evaluated: the rate of attacks, severe pain intensity, degree of limitations in daily activities and efficacy of treatment both at one year of treatment at the Centre and at present and these were compared to the baseline values. Results: Improvement was achieved in 57.0 % of patients, 22.2 % deteriorated and 20.8 % were unchanged; the improvement was observed as early as one year of treatment. There was a clear decrease in patients with a high intensity of migraine attacks and a severe degree of limitations in daily activities. By contrast, the high frequency of pain remained unchanged and the number of patients with chronic migraine decreased only slightly. There was a significant change in the profile of both acute and prophylactic antimigraine treatment. Only 41.7 % of patients were familiar with triptans whereas now they are being used in almost 100 % and 88.7 % of patients are satisfied with triptan treatment. Of concern was the finding that 26.4 % of our patients overused triptans. Initially, prophylaxis was used in only 55.6 % of the group; currently, it is used by 81.9 % of patients with topiramate being the most commonly used agent followed by valproates, beta blockers and tricyclic antidepressants. Conclusion: Our retrospective follow-up showed very decent results in migraine treatment with a balanced combination of acute and prophylactic treatment and did not confirm the hypothesis that migraine must have a chronic-progressive course.

We have detected the 2 major trends in toxic neuropathies in our sample-set: i) professional toxic neuropathies incidence has decreased and ii) the number of drug-induced neuropathies has increased. It was proven that the axonal toxic neuropathies are the most frequent and long nerves are affected most severely. In clinical findings the lesion of sensory fibers prevails above the motor fibers lesion and above the signs of autonomic nerve dysfunction. The most important steps in the diagnostic process are the goal adhered history, the clinical picture, the neurophysiological investigation and blood and urine analysis. If the exposition to the industrial toxin occurred and is confirmed with the diagnostic process, the cooperation with Centre for occupational medicine is unavoidable. Symptomatic therapy is always prescribed, with the possible addition of targeted therapy in some toxic neuropathies, to terminate the neurotoxic medication or stopping the toxic exposition. The basic approach in toxic neuropathies is always the prevention.

Vascular dementia can be considered as a consequence of ischemic or hemorrhagic damage to brain tissue that manifests with alteration of cognitive function. Thus it is a very heterogenic group of various clinical syndromes-from focal injury of corresponding area of a larger size to multiple deficits of cognitive domains within the scope of multiinfarct dementia, across comparatively homogenic profile of dysexecutive syndrome with bradypsychism and frequently depressive mood in subcortical ischemic leucoencefalopathy. Mixed dementia, mostly combinations of vascular encephalopathy and Alzheimer disease, are quite common. At present there is no effective treatment of vascular dementia (VaD). The most important preventive measures include a rigorous control of arterial hypertension, modification of other vascular risk factors and their adequate treatment and secondary prevention of ischemic strokes (antiplatelet therapy). Clinical studies show effect of acetylcholinesterase inhibitors even in VaD.

Diabetes mellitus is one of the most common causes of polyneuropathy (PNP). Diagnostics of diabetic polyneuropathy is based on a neurological examination and auxilliary examination methods. It is crucial to diagnose PNP as soon as possible in order to prevent complications, such as the diabetic neuropathic foot. The diagnosis of diabetic PNP is a diagnosis „per exclusionem“, so even in diabetic patients it is necessary to exclude other possible causes of PNP, in particular when the clinical image and disease course show atypical symptoms.

The issues of speech disorders in Parkinson’s disease (PD) are discussed. The characteristic symptomatology in individual speech areas accompanying hypokinetic dysarthria (HD) is mainly dealt with. The symptomatology of HD is classified in terms of respiration, phonation, and facial musculature. The diagnostic and therapeutic procedures used in speech and language therapy are mentioned which are suitable in patients with PD and reported in the foreign literature as well as, and in particular, those used in our conditions. The Lee Silverman Voice Treatment (LSVT) method is dealt with in detail. Diagnosis and therapy of speech disorders is an integral part of a complex approach in PD treatment and may significantly improve the life and self-sufficiency of persons with PD. A lot of the symptoms of speech and communication disorders are common in Parkinson’s disease and a number of PD patients have an impaired quality of life due to impaired communication with others; still, only a small number of persons see a speech therapist for these complaints.

Cognitive impairment exists in Parkinson’s disease (PD) as a transitional state between cognitively intact and demented PD patients. It seems to be a risk factor for development of dementia in PD, but the precise criteria and “malignant” cognitive profile of mild cognitive impairment in PD (MCI in PD) have not yet been established. The concept may turn to be different from that in Alzheimer’s disease (AD) since we search for those already diagnosed PD patients who are at risk of developing dementia. In addition, clinical variables specific for PD also play role. Importantly, MCI possesses a metabolic basis in PD. Various biomarkers including particularly neuropsychological testing, brain imaging, and analysis of specific proteins in cerebrospinal fluid hold promise in identification of MCI in PD patients with unfavourable prognoses. Well-designed longitudinal studies in MCI-PD cohorts are needed to assess the sensitivity and specificity of the PD-MCI designation as far as dementia development is concerned.

Cognitive function impairment is common in patients with multiple sclerosis. Particularly affected are attention, speed of processing of information, and short-term memory. The cognitive deficits adversely affect social relations as well as quality of life and are the most common cause of job loss. The severity of the cognitive deficits correlates with the pathology seen on conventional magnetic resonance imaging (lesion extent, atrophy). Mostly mild forms are encountered, dementia is rare. Cognitive dysfunction may occur very early in the course of the disease and does not correlate with the physical impairment or the duration of the disease. The therapeutic options are discussed.