2014, Vol 14, No 1
Gestational insolation and risk of multiple sclerosis in offspring
AKTUALN NEUROL 2014, 14 (1), p. 16–24
DOI: 10.15557/AN.2014.0001

Introduction: The exposure of gestating mothers to physicochemical factors may be associated with increased risk of multiple sclerosis (MS) in offspring. Method: The aim of this study was to determine whether solar radiations (SOR), ultraviolet B (UVB) rays, total ozone concentration in the atmosphere (TOCA) and air temperature (AT) during pregnancy are associated with MS developing in offspring. Demographic and diagnostic data including month of birth of 436 MS offspring (M – 171, F – 265), deceased in the year 2007 were derived from the Central Statistical Office in Warsaw. Information on previous SOR, UVB, TOCA and AT in Poland in the scattered years (1931–2007) was obtained from the Institute of Meteorology. Results: Longer exposure to SOR and higher level of UVB during maternal gestation were associated with the smaller number of MS offspring; linear regression test: r = –0.598, p = 0.040 and r = –0.587, p = 0.035. TOCA and AT during gestation were not significantly correlated with the number of MS offspring: r = –0.280 (p = 0.830) and r = –0.437 (p = 0.104). However, decreased TOCA during birth month of offspring was significantly associated with the smaller number of children destined to develop MS: r = +0.631, p = 0.028. Conclusions: Longer gestational exposure to SOR and more intense UVB were associated with lower risk of MS in offspring. Reduced risk of the disease was also correlated to decreased TOCA during month of offspring birth.

Keywords: solar radiation, maternal gestation, multiple sclerosis, offspring
Pregnancy and childbirth in women with multiple sclerosis
AKTUALN NEUROL 2014, 14 (1), p. 25–29
DOI: 10.15557/AN.2014.0002

Multiple sclerosis (MS) is the main cause of disability in young adults and, as most autoimmune diseases, more commonly affects women. The relationship between pregnancy and MS has been an issue of significance for many years and has recently become the subject of multicentre studies. Usually, pregnancy is a period of relative wellness for patients and most commonly is a period without relapse. This boost of health involves the change of immune reactivity to anti-inflammation associated with Th2 lymphocytes and anti-inflammatory cytokines (interleukin 4, 5, 6, 10, TGF-β). After giving birth, a woman’s immune system returns to its original level of activity and disease susceptibility increases. Most studies have shown no overall negative impact of pregnancy on longterm disability associated with MS, and MS does not have negative impacts on pregnancy, childbirth or the child’s condition. Women with MS can plan to have children. The disease does not increase the risk of pregnancy/ childbirth complications or birth defects compared to the general population. Each immunomodulatory therapy is contraindicated in pregnancy. If a patient wishes to become pregnant, discontinuation of the therapy much before planned pregnancy is recommended. The work summarizes available information on clinical problems associated with pregnancy and childbirth in patients with MS and analyses risks to the child associated with the administration of drugs.

Keywords: multiple sclerosis, pregnancy, childbirth, cytokines anti-inflammatory, magnetic resonance imaging
Post-stroke involuntary movements in a patient with chronic respiratory failure
AKTUALN NEUROL 2014, 14 (1), p. 30–33
DOI: 10.15557/AN.2014.0003

Introduction: Movement disorders in the form of involuntary movements are a rare complication of stroke, found in approximately 4% of patients. Material and methods: This case is presented on the basis of medical records of the patient. Case study: This paper presents the case of a 73-year-old patient with chronic obstructive pulmonary disease, a history of an ischaemic stroke, who was treated repeatedly at the Department of Neurology due to poststroke involuntary movements involving the left upper extremity, head and tongue. Computed tomography of the head revealed: bilateral vascular focal lesions in the projection of basal ganglia. Frequently, the decrease in oxygen saturation (SpO2) levels below 90% was observed in the patient, when involuntary movements intensified. When the patient was saturated with oxygen, involuntary movements were remitted, and reappeared after some time but their amplitude was significantly narrower. Involuntary movements completely regressed after new cerebral ischaemic accidents in the right frontal lobe. Results and discussion: Chorea-ballism and dystonic movements are associated with damage to the basal ganglia, most commonly developed as a result of lesions of a vascular origin. In the case of our patient, vascular lesions were confirmed by a computed tomography scan. Conclusions: In the presented case massive involuntary movements intensified when saturation levels dropped below 90%. This can be associated with the adverse effect of hypoxia in focal ischaemia involving the brain. Remission of involuntary movements may have been caused by the development of a new ischaemic lesion in the right frontal lobe.

Keywords: chorea-ballism, basal ganglia, hypoxia, saturation, ischaemic stroke
Uncommon – monogenetic – causes of small-vessel stroke
AKTUALN NEUROL 2014, 14 (1), p. 34–42
DOI: 10.15557/AN.2014.0004

A brain stroke is the most common cause of disability and the third cause of mortality among adults. Every year 6.15 million people in the world die of stroke. According to a current and commonly used WHO definition, the stroke is a rapid occurrence of focal or global neurological deficit of strictly cerebrovascular cause that persists beyond 24 hours. It is estimated that even up to 85–90% of strokes is caused by an ischaemic aetiology, the remainder by haemorrhagic or subarachnoid bleeding. The aim of the paper is to acquaint clinicians with rare, nevertheless occurring in practice genetic causes of strokes connected with single gene mutation. The mentioned disorders are included in a wide spectrum of so called nonhypertensive, cerebral small-vessel diseases. Commonly they occur with concomitant syndromes such as progressive cognitive disturbances or spinal chronic pain syndromes. The multitude of disorders of theoretically unrelated organs also should be alarming although, according to the literature, there are known some oligosymptomatic cases. Additionally, in many cases, unclear radiological image seems to suggest the need for further investigations. After reading this article, clinicians should keep in mind that they especially inquisitively need to search for the reason of stroke in young patients without obvious hypertension in anamnesis, with recurrent vascular episodes, with abnormalities on physical examination that suggest the presence of certain complex of syndromes. Simultaneously, coexistence of typical risk factors such as using drugs affecting thrombosis, arterial hypertension or metabolic disorders should not excuse ignoring the rare diseases. An interdisciplinary team-work of specialists of cardiology, nephrology, dermatology or genetics seems to be invaluable for establishing the diagnosis in this cases.

Keywords: brain stroke, small vessel disease, monogenetic disorders, CADASIL, CARASIL, Fabry’s disease, microangiopathy related with COL4A1 gene mutation, amyloid angiopathy
The formation of atherosclerotic plaque, its destabilisation and diagnostics
AKTUALN NEUROL 2014, 14 (1), p. 43–53
DOI: 10.15557/AN.2014.0005

According to the established medical knowledge, the atheromatous lesions occur in the arteries of large and medium diameter. Their presence in the aorta, arteries of extremities as well as extracerebral and coronal arteries is clinically relevant. The evolution of atherosclerotic plaques probably starts in the prenatal development, what may be proved by the presence of the fatty streaks in endothelium of coronal arteries in some newborns. Then it evolves through lipid accumulation, media inflammatory response, vasa vasorum proliferation, fibrination and calcification of plaques. Researches proved that the matter of atherosclerosis is exaggerated inflammatory proliferative reaction to the arterial wall damage. The oxidative stress phenomenon and infections with common pathogens play an undoubtful role in this process. Ultimately the direct damage is an effect of immune response cells infiltration and secretion of cytokines and proinflammatory factors. Among the cells of immune system responsible for formation and development of atheromatous plaque are considered: macrophages, dendritic cells, T and B lymphocytes, monocytes. Attention was also paid to the inflammatory mediators and growth factors. Scientist are interested in unstable atherosclerotic plaque and accompanying inflammatory process within the artery wall for a long time. Meanwhile, there are conducted researches on inflammation markers underlying the destabilisation of plaques. Revealing the role of these cells in evolution of atherosclerosis would enable more complex understanding of the mechanism of lesions development. Then it would facilitate an introduction of the new and upgraded methods of treatment and prevention. Also the progress of imaging examinations is meaningful for diagnostics and treatment. It is contributory to the choice of therapeutic strategy and assessment of surgical intervention urgency. In the clinical practice there are recognized standards of imaging the morphology of atheromatous plaque. Development of diagnostics aims the indirect assessment of possible dynamics of lesions progression. Targeting the complex plaque analysis is based on excellence of established standards such as ultrasound examination or computed tomography.

Keywords: atherosclerosis, atheromatous/atherosclerotic plaque, inflammation, mediator, immune response cells, unstable plaque, diagnostics, imaging
Memantine in mild cognitive impairment and mild dementia of Alzheimer’s disease: theoretical background, clinical trials and recommendations
AKTUALN NEUROL 2014, 14 (1), p. 54–60
DOI: 10.15557/AN.2014.0006

Memantine, uncompetitive antagonist of NMDA receptor, is currently registered worldwide for the treatment of moderate to advanced dementia in the course of Alzheimer’s disease and is used either in monotherapy or in combination with cholinesterase inhibitor. Memantine’s efficacy has been documented in several clinical trials within cognition, behaviour and activities of daily living domains; the more advanced dementia the bigger effect size is usually seen. Adding memantine to an ongoing cholinesterase inhibitors exerts augmentation. Memantine efficacy in less advanced stages of Alzheimer’s dementia is the matter of controversy. It is highly unlikely to see an evident clinical benefit in the group of patients with initial MMSE above 20. Early treatment with memantine is thought to exert long-term consequences as probable disease-modifying effect may come to action. Data supporting this view (and, as a result, early treatment with memantine) is mainly of clinical nature and need to be confirmed with the use of validated disease progression biomarkers. Patients with mild dementia of Alzheimer’s type may be rationally treated with memantine monotherapy, even considering probable lack of symptomatic effect, when cholinesterase inhibitors are contraindicated or poorly tolerated. Data supporting the use of memantine in mild cognitive impairment are currently insufficient.

Keywords: Alzheimer’s disease, dementia, mild cognitive impairment, treatment, memantine
Hearing disturbances in neurologist clinical practice
AKTUALN NEUROL 2014, 14 (1), p. 61–69
DOI: 10.15557/AN.2014.0007

Hearing is one of the most important human senses closely associated with the organ of hearing and balance. Patients with sudden hearing loss sometimes report ear fullness, tinnitus or vertigo. Hearing disturbances is a very unpleasant sensation lowering the quality of life. Sudden hearing loss is mostly caused by otologic diseases but also disturbances of brain circulation, brain injury, viral (mumps, rubella, herpes zoster) and bacterial infections, bone diseases, bone tumours, 8th nerve tumours, genetic disorders, autoimmune diseases (e.g. multiple sclerosis), ototoxic medications and many others. Hearing disorders are generally divided into central and peripheral, the latter divided into conductive and perceptive. Deafness is a worrying symptom not only for the patient but also for a clinical neurologist. Diagnosis is based on the past history, physical examination, both otolaryngological and neurological, diagnostic investigations, audiological investigation, atrial excitability testing (caloric tests, electronystagmography) depending on clinical indications, neuroradiological investigations, brainstem auditory evoked potentials, blood tests and others, which enables instituting a proper treatment.

Keywords: hearing impairment, cerebrovascular disease, sudden sensorineural hearing loss, pontine angle tumours-brain, bone disease, infectious disease, multiple sclerosis, brain injury, barotrauma, genetic disease, Meniere’s disease, ototoxic drugs
An assessment of surgical treatment using hemilaminectomy in patients with degenerative lumbar stenosis
AKTUALN NEUROL 2014, 14 (1), p. 70–74
DOI: 10.15557/AN.2014.0008

Degenerative stenosis of a lumbar segment relates in particular to older people. The most often method, bringing satisfying results is surgical treatment consisting primarily on decompression of vertebral canal. Conservative treatment is rarely used therapy in this disease. One hundred and twenty patients were subjected to retrospective researches, men and women, in whom was diagnosed degenerative stenosis of a lumbar segment. Sixty patients in one group was threaten surgically by hemilaminectomy, and next was analyzed postsurgical results. In similar comparative group was applied conservative treatment. In postsurgical evaluation among patients was proven significant increase of distance of neurogenic claudication and increase of postoperative result, 51 patients was satisfied of treatment. In comparative group fraction of patients satisfied of applied treatment was significantly smaller. Distance of neurogenic claudication was increase significantly in research group where was used surgical treatment. While in patients of comparative group treated rehabilitation method, distance of neurogenic claudication didn’t change. Postoperative result was significantly better, than after conservative treatment The result of operation was that dimension A-P of spinal canal was increased. A removal of vertebral arches which extraction of adjacent yellow ligaments and overgrown elements of joint is proper method of laminectomy and doesn’t expose patient for increment of complications connected with surgical treatment. Hemilaminectomy was used by Poletti and Yong-Cheol et al. also. Surgical treatment clearly exceeds rehabilitation methods at patients with degenerative stenosis of a lumbar segment.

Keywords: degenerative stenosis, lumbar spine, stenosis, hemilaminectomy, neurogenic claudication