2010, Vol 10, No 1
Clinical picture of cervical myelopathy
AKTUALN NEUROL 2010, 10 (1), p. 12-18
ABSTRACT

The cervical myelopathy (CM) belongs to the civilization diseases connected to age. The symptoms of the disease were well known from many years after yet the neuroradiological examinations (CT or NMR) can confirmed the diagnosis of cervical myelopathy. In 1928 year Stookey presented the theory of CM aetiology, since other authors have formed their opinions or modified Stookey’s theory. Now is established that the cervical myelopathy is the effects from following abnormalities: 1) the direct pressure of the bone, osteochondrosis or its calcifications changes to spinal cord; 2) the ischaemic changes to cause by pressure to the spinal cord vessels; 3) repetitive microtraumas connected whit the flexion or extension movements of the neck. It is considered that CM develops when the diameter of canal vertebralis narrows by 30%. The spinal cord gets flattened in the anterior-posterior size. Few anatomopathological investigations have shown that on the level of the lesions were observed gliosis or demyelination of the spinal cord. The lateral columns of the spinal cord are more prone to the pressure than anterior or posterior one. The osteochondrosis as the osteophytes are present in 90% of people over 60 years. The initial symptoms of CM are headache or pain of the neck. Later the pain is radiated to shoulders or brachium, the upper limbs weaken, the patient is feeling paresthesias mostly in palms. After some time the lower limbs were found less efficiency and spastic rigidity. The gait to turn slowly and clumsy. The disturbances with continence of urine was also appeared. The muscles atrophy, mainly hands, have been observed as well as impaired deep sensation or vibration. Is characterized the hyperreflexia in upper and lower limbs. Sometimes is appeared a patellar clonus as well as the Lhermitte’s sign. In the differential diagnosis should be taken under consideration many diseases, but the results of the neuroradiological examination should be a decisive factor. We should remember also that the examination of the cerebrospinal fluid is normal. The CM is disease of the slowly progressive course. The surgical treatment of the disease might give better results in the initial stage of the disease – 30% of patients reported the improvements in their condition. In 2 to 3 years after the surgery the symptoms reoccur and the neurological status of the patients is similar to those who have been treated in the conservative way.

Keywords: cervical myelopathy, pathogenesis, diagnosis, treatment, neuroimaging, prognosis
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Comparative analysis of caloric nystagmus test results obtained using the method of ENG and VNG in healthy subjects
AKTUALN NEUROL 2010, 10 (1), p. 51-54
ABSTRACT

Introduction: Nystagmus test is the most important and objective method of assessing balance disorders. The caloric test, as the sole test illustrates the excitability of individual labyrinths, enabling the assessment of each of them separately. The aim of the study is a comparative analysis of results of caloric nystagmus test obtained using the method of ENG and VNG in healthy subjects. Material and methods: The study included a group of 20 healthy people, including 10 women and 10 men aged 22-26 years. In all patients were performed medical interview and subject otoneurologic examination. Subsequently, among all subjects the ENG and after 7 days the VNG were performed tests with calibration, evaluation of spontaneous nystagmus and attempts by Hallpike caloric test. The caloric test was conducted by means of HOMOTH air calorimeter in the air temperatures of 30°C and 44°C, and the exposure of the ear lasting 40 sec. Results: In the caloric tests there were no canal paresis that goes beyond the boundaries of accepted norms in any of examined persons. It was observed that averages of slow phases velocities (SPV) were lower in ENG than VNG. The VNG also allow to designate value of absolute directional preponderance of nystagmus and labyrinths excitability. Conclusions: The obtained results show that the VNG test for ENG test is more precise and allows to better describe Hallpike caloric test. The value of Hallpike’s caloric test was significantly increased by the analysis of absolute directional preponderance in VNG.

Keywords: nystagmus, videonystagmography, electronystagmography, caloric test
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Neurological complications coexisting with renal failure
AKTUALN NEUROL 2010, 10 (1), p. 42-50
ABSTRACT

Neurological complications both due to uraemia or its management are related to the central and peripheral nervous system and muscle tissue and are the reason for increased mortality in patients with renal failure. There is the high risk of the uraemic encephalopathy, hypertensive encephalopathy, cerebrovascular diseases, and dementia in the subjects with renal failure. In the group of uraemic patients the mononeuropathies and polyneuropathies are rather common and the pathology of kidney may results in the restless legs syndrome. Despite continuous therapeutic advances many complications like uraemic encephalopathy, atherosclerosis, neuropathies and myopathy fail to fully respond to the routine treatment. Moreover, the dialytic therapy even induce new complications like dialysis dementia, intracranial haemorrhages, dialytic disequilibrium syndrome, Wernicke’s encephalopathy and osmotic myelinolysis. The use of immunosuppressive drugs in renal disease and after renal transplantation can cause opportunistic infections, the proliferative disorders within central nervous system or posterior reversible encephalopathy syndrome. In order to decrease the mortality and improve the quality of life in patients with renal failure, both nephrologists and neurologists should be familiar with neurological complications of uraemia and should collaborate. The disorders resulting in renal failure (connective tissue diseases, diabetes) may be directly related to the neurological complications.

Keywords: renal failure, uraemic encephalopathy, uraemic polyneuropathy, dialytic dementia, dialytic disequilibrium syndrome, restless legs syndrome
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Free radicals, selenium and epilepsy in children
AKTUALN NEUROL 2010, 10 (1), p. 37-41
ABSTRACT

Here we present the results of our study and give the review of the literature data concerning the role of free radicals, selenium and zinc ions in children’s epilepsy and febrile seizures. Newborns and infants are at the high risk of oxidative stress and are very susceptible to imbalance between antioxidants and free radical generation system. During the phase of ischaemia and reperfusion of perinatal asphyxia, the activity of membrane Na+/K+-ATP-ase is impaired. This leads to persistent membrane depolarisation and glutamate (major excitotoxic agent) release. In 25% cases of hypoxic-ischaemic encephalopathy (HJE) cerebral palsy is diagnosed. In this condition the epilepsy coexists with cerebral palsy in 15% to 40% of cases. We have shown that the blood selenium concentration is decreased in the group of children with epilepsy treated with carbamazepine in comparison to the control group treated with valproate. This results in impairment of the oxidants and antioxidants balance. This results are concordant with literature data. In the groups of children with febrile seizures also zinc concentration were decreased. The above results suggest that the presence of seizures diminish zinc and selenium concentration but the exact mechanism of the influence of these microelements in pathogenesis and the course of epilepsy in children is not fully described.

Keywords: newborn, children, HJE, antioxidant-oxidant status, selenium, zinc, epilepsy
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Value of homocysteine concentration in epilepsy patients
AKTUALN NEUROL 2010, 10 (1), p. 31-36
ABSTRACT

Epilepsy is usually a chronic disease. It often starts in childhood and sometimes taking anticonvulsant drugs lasts for a whole life. In the last decade the attention was paid on the role of homocysteine in pathogenesis of some neurological diseases. First it was proven that homocysteine high level is a risk factor for ischaemic heart disease, vascular diseases of brain (especially ischaemic stroke), also Parkinson disease, migraine and others. It was also found that patients taking anticonvulsant drugs have higher homocysteine level. It is thought that higher homocysteine level might be connected with taking epileptic drugs, which are the inducers of cytochrome P450. The aim of the study was to measure the plasma homocysteine level at 112 patients with cryptogenic epilepsy. The exclusion criteria were symptomatic epilepsy, diseases of thyroid, renum, liver, vascular diseases of brain. The level of homocysteine in serum was measured by using fluorescence polarization immunoassay method. We also measured the level of vitamin B12 and folic acid. Mean homocysteine level was significantly higher in studied group than in control one, there was not found such a difference as far as folic acid and vitamin B12. Patients on polytherapy had significantly higher level of homocysteine than control group and patients after the first epileptic seizure. The level of folic acid was lower in patients on polytherapy than in controls, there was no such a difference in vitamin B12.

Keywords: epilepsy, homocysteine, anticonvulsant drugs, hyperhomocysteinemia, metabolism
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Etiology and risk factors of stroke attack in patients treated in the Department of Neurology Medical University in Bialystok
AKTUALN NEUROL 2010, 10 (1), p. 26-30
ABSTRACT

Background: Polish epidemiological studies reported high ratio of morbidity and mortality on first in life stroke attack, lasting for several years increased with age. We can decrease those indicators significantly after identifying the risk factors and introducing prevention of stroke. The aim of the study was epidemiological analysis of patients hospitalised in the Department of Neurology Medical University in Bialystok. We have concentrated on aetiology with risk factors and mortality, depending on the age and sex of our patients. Material and methods: We recorded all cases of stroke in patients hospitalised in the Department of Neurology, Medical University in Bialystok during one year. We collected data using questionnaires from POLKARD (National Programme of Prophylaxis and Treatment of Cardiovascular Diseases). Results: We studied 408 patients – 185 (45.3%) women and 223 (54.7%) men with subarachnoid haemorrhage in 6.9%, intracerebral haemorrhage in 12.5% and ischaemic stroke in 80.6% cases. The most often observed risk factors were hypertension (81.2% cases), aerial fibrillation and morbus coronarius (38%). We observed case fatality rates in 11.6% patients with ischaemic stroke and in 21.5% with haemorrhagic stroke. Average mortality in the Department of Neurology Medical University in Bialystok was 13.5%. Conclusions: Hypertension is the most frequent risk factor of stroke attack and we often observed a few risk factors in one patient. Conducting treatment in stroke units can decrease early mortality in stroke.

Keywords: stroke, epidemiology, risk factors, case fatality rate
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Indications for surgical treatment in acute stroke
AKTUALN NEUROL 2010, 10 (1), p. 19-25
ABSTRACT

Stroke is an emergency state requiring immediate diagnosis and treatment. It is recommended that all acute stroke patients should be treated in a stroke unit. Thrombolytic therapy proved to be the most effective treatment. Although intravenous thrombolysis is available, only 10% of the patients are treated with recombinant tissue plasminogen activator (rt-PA) in the best Polish centres. Statistically, in scale of the country, the percentage of patients treated that way is no more than 1. Recently there has been a dynamic development of surgical neurology, which aims at surgical treatment of ischemic stroke including intraarterial thrombolysis, mechanical recanalisation of arteries (embolectomy), carotid endarectomy, remodeling, angioplasty and stenting. There is, however, lack of reliable research results confirming efficiency of these methods. According to recommendations of experts from the National Programme of Prevention and Treatment of Stroke POLKARD surgical stroke care is rarely advised. Surgical treatment is recommended in specific cases of ischemic stroke (malignant middle cerebral artery infarct, large spaceoccupying cerebellum infarct) and in some cases of intracerebral hemorrhage. Surgical treatment is restricted to patients with superficial intracerebral hematoma (cases with localization in basal ganglia), cases of rapid decrease of consciousness or neurological deterioration. Another issue is treatment of subarachnoid hemorhage connected with arteriovenous malformation where neurosurgical operations are more advised. In cases of aneurismal rupture neurosurgical clip is the method of choice.

Keywords: stroke, non-invasive treatment, thrombolysis, surgical treatment, indications
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Coexistence of neurofibromatosis type 1 and optic chiasm glioma – case report
AKTUALN NEUROL 2010, 10 (1), p. 55-59
ABSTRACT

Neurofibromatosis type 1 (NF1, von Recklinghausen’s disease) is known to be the neurocutaneous disease, called phacomatoses. It is one of the most common inherited autosomal dominant disorder, occurring with a frequency of approximately 1:3000 births. The typical symptoms of NF1 are café au lait spots, axillary, groin freckling, neurofibromas and Lisch nodules on the irises. In patients also more frequently than in the general population is observed occurrence of benign and malignant tumours. The most common tumour in the case of NF1, approximately in 15-20% of patients, is visual pathway glioma, known as capillary astrocytoma, which involves visual nerves and/or the optic chiasm and leads to visual field loss. The visual pathway gliomas grow slowly, sometimes can be asymptomatic and rarely take an aggressive form, and only one third of patients require surgery. Among other cancers in patients with NF1 we also have: sarcoma of peripheral nerves, striated cell sarcoma, a pheochromocytoma, carcinoid of the duodenum, nonlymphocytic leukaemia. Other symptoms of NF1 include dysplasia and bone deformities, macrocephaly, short height, mental retardation, impaired visual-spatial orientation, poorer memory, dyslexia, and epilepsy. We present a case of 19-year-old patient diagnosed with neurofibromatosis type 1 with coexisting optic chiasm glioma and drug resistant epilepsy.

Keywords: neurofibromatosis type 1, von Recklinghausen’s disease, phacomatoses, optic chiasm glioma, epilepsy
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