2015, Vol 15, No 1
What does an isolated cerebrospinal fluid band mean: a tertiary centre experience
Aktualn Neurol 2015, 15 (1), p. 6–10
DOI: 10.15557/AN.2015.0001

Introduction: The presence of oligoclonal bands in cerebrospinal fluid of multiple sclerosis patients is now well established to support the clinical diagnosis. On the other hand, a single band response can represent the initial stage of an oligoclonal response, before the other antibody clones become visible. Method: The aim of the current study was to evaluate the presence of an isolated cerebrospinal fluid single immunoglobulin band, and to analyse the clinical and radiological diagnosis of the samples with a single immunoglobulin band. In this study, 3524 cerebrospinal fluid samples were re-examined using agarose gel isoelectric focusing, and ones with an isolated cerebrospinal fluid immunoglobulin band were detected. Results: A single band in cerebrospinal fluid was detected in 1.4% samples. A clinically isolated syndrome was diagnosed in 27.5%of them, relapsing remitting multiple sclerosis in 49%, secondary progressive multiple sclerosis in 11.8%, and radiologically isolated syndrome in 2%. No primary progressive multiple sclerosis patient was found. All Barkhoff criteria were met in 90.1% of them. The remaining were diagnosed with other inflammatory neurological diseases (9.8%). Conclusion: The presence of an isolated cerebrospinal fluid monoclonal immunoglobulin band is rare. Although most of the samples were diagnosed as multiple sclerosis according to both clinical and paraclinical (magnetic resonance imaging) parameters, they had only a single immunoglobulin band in cerebrospinal fluid. Not only oligoclonal bands, but also an isolated cerebrospinal fluid single band might be a cornerstone for the diagnosis of multiple sclerosis at least for some patients.

Keywords: cerebrospinal fluid, single band, multiple sclerosis
Application of the Trail Making Test in the assessment of cognitive flexibility in patients with speech disorders after ischaemic cerebral stroke
Aktualn Neurol 2015, 15 (1), p. 11–17
DOI: 10.15557/AN.2015.0002

The main aim of this study was to evaluate the level of cognitive flexibility in patients with speech disorders after ischaemic cerebral stroke. The study was conducted in a group of 43 patients (18 women and 25 men) who had experienced cerebral ischaemic stroke. The patients under study were divided into groups based on the type of speech disorders, i.e.: aphasia, lack of speech disorders and dysarthria. A Mini-Mental State Examination (MMSE) and a Clock Drawing Test (CDT) were applied for the general evaluation of the efficiency of cognitive functions. Cognitive flexibility – a component of executive functions, was evaluated with the use of a Trail Making Test (TMT). The results obtained prove that patients with aphasia show the lowest level of cognitive flexibility. Disorders of executive functions can be related to the dysfunction of the prefrontal cortex which has been damaged as a result of ischaemic cerebral stroke. Presumably, there are common functional neuroanatomical circuits for both language skills and components of executive functions. In the case of damage to the structures that are of key importance for both skills, language and executive dysfunctions can therefore occur in parallel. The presence of executive dysfunctions in patients with aphasia can additionally impede the functioning of the patient, and also negatively influence the process of rehabilitation the aim of which is to improve the efficiency of communication.

Keywords: aphasia, executive functions, cognitive flexibility, stroke, dysarthria
Impact of vascular diseases on the progression of mild cognitive impairment to Alzheimer’s disease
Aktualn Neurol 2015, 15 (1), p. 18–21
DOI: 10.15557/AN.2015.0003

Introduction: Mild cognitive impairment does not meet the criteria for the diagnosis of dementia, but reaching this diagnosis raises concern about the future state of a patient due to the possibility of the conversion to Alzheimer’s disease. Although the aetiology of Alzheimer’s disease is neurodegenerative, the impact of vascular diseases is also taken into consideration. The aim of this study was to assess the impact of vascular diseases in patients diagnosed with mild cognitive impairment on the conversion to Alzheimer’s disease. Material and methods: In each of 101 patients with a diagnosis of mild cognitive impairment, a detailed medical history was taken, taking into account: hypertension, ischaemic heart disease, arrhythmias, myocardial infarction, stroke, diabetes as well as thyroid diseases, head injuries, alcohol abuse, smoking, exposure to toxic substances, surgery under general anaesthesia and the family character of dementia. Clinical follow-ups were scheduled after 6, 12 and 24 months. Results: Amongst 101 patients with mild cognitive impairment, 17 (16.8%) converted to Alzheimer’s disease within two years of observation. The analysis of the distribution of independence tests showed that the conversion is significant for two variables: ischaemic heart disease and myocardial infarction.

Keywords: mild cognitive impairment, conversion, Alzheimer’s disease, myocardial infarction, ischaemic heart disease
Stop walking when talking – a relationship between cognitive functions and gait control
Aktualn Neurol 2015, 15 (1), p. 22–27
DOI: 10.15557/AN.2015.0004

Nowadays, more and more scientific reports highlight the importance of cognitive skills in motor control. It is believed that movement also engages higher mental processes such as executive functions, attention and working memory. Executive functions include cognitive processes, such as the ability to initiate, plan, modify and control behaviour. They play an integrative role in the processing of information, including both cognitive and behavioural elements, necessary for goal-directed and effective action. Executive functions play a key role in the regulation of gait in the case of taking new steps or modifying previously learned motor programmes. Neuroimaging studies show that there is a common pattern of neural activity for walking, executive functions and attention, involving the frontal cortex and cortico-subcortical neuronal network. Many studies have shown that the impairment of executive functions may contribute to gait disturbances and increased risk of falls. Executive functions allow movement patterns to be modified, and enable the introduction of adaptive compensatory strategies in response to changing internal and external environmental stimuli. Studies with dual-task paradigm also stress the importance of attention in maintaining the control over gait. The addition of a cognitive task slows gait in the elderly. The incidence of falls is higher in subjects with dementia. The identification of cognitive risk factors of falls may allow more effective diagnostic and therapeutic methods to be developed. The aim of this study was to elucidate the relationship between cognitive function, i.e. executive functions and attention, and the risk of falls.

Keywords: gait, executive functions, attention, working memory, fall risk
Role of androgens in the pathogenesis and clinical course of multiple sclerosis. New therapeutic possibilities
Aktualn Neurol 2015, 15 (1), p. 28–34
DOI: 10.15557/AN.2015.0005

Multiple sclerosis is an autoimmune disease that affects the central nervous system. An autoimmune reaction directed against myelin components leads to the degradation of sheaths surrounding axons of nerve cells, thus affecting the ability of the nerves to conduct electrical impulses to and from the brain. Despite extensive studies, the aetiology and pathogenesis of this disease is still not clear. It has been shown that the interplay between genetic and environmental factors is responsible for multiple sclerosis development. The average female-to-male ratio at a typical age of disease onset is around 2.0. It means that women suffer from multiple sclerosis twice as often as men. It has also been reported that the clinical course of the disease is different in women and men. Studies showing that the female-to-male ratio is not observed in paediatric patients, suggest that sex hormones play a role in the pathogenesis of multiple sclerosis and susceptibility to this disease. Numerous studies have reported that androgens affect neural and glial cell survival in vitro. In addition, the positive effect of both endogenous and exogenous testosterone on the clinical course of multiple sclerosis in animal models has been proven. Pilot studies concerning the treatment with testosterone and selective androgen receptor modulators have shown promising tolerance and no severe side effects, suggesting that they may be good candidates for a new therapy for multiple sclerosis patients.

Keywords: multiple sclerosis, androgens, testosterone, gender, therapy
Selected cognitive dysfunctions after brain stroke – clinical characteristics and diagnosis
Aktualn Neurol 2015, 15 (1), p. 35–40
DOI: 10.15557/AN.2015.0006

Patients after brain stroke are at a higher risk of developing cognitive dysfunctions. Clinical studies show that it is the cause of cognitive impairment in approximately two thirds of patients above 65 years of age. Deficits arising after stroke may include all areas of daily functioning. The factor that determines the type of clinical symptoms is the location and the area of brain damage. Cognitive impairment affects treatment and rehabilitation and, consequently, the quality of life. There are several neuropsychological tests and clinical trials, with different ranges of sensitivity, to measure cognitive function. Cognitive dysfunctions can affect many cognitive areas or their isolated aspects. The clinical course is often characterised by a mild form of cognitive impairment, or an advanced multisymptomatic form, such as vascular dementia. There is a need for general recommendations for the diagnosis and treatment of cognitive impairment in patients after stroke which would include healthy lifestyle and risk factors. The article presents the most important and most frequent cognitive dysfunctions that can arise after ischaemic stroke together with the clinical characteristics of symptoms and possibilities of their diagnosis. Also, the mutual influence of the basic mood and cognitive functioning is highlighted. In addition, the article describes the impact of key factors for cognitive functioning after stroke on prognosis. The clinical picture of cognitive impairment after stroke includes non-specific and specific symptoms. The non-specific symptoms are a response of the body to homoeostasis impairment by a sudden vascular incident. The characteristics of the specific symptoms depend on the location of organic damage.

Keywords: cognitive functions, brain stroke, clinical characteristics, diagnostic methods
The role of selected chemokines and their receptors in the pathogenesis and destabilisation of atheromatous plaques in the carotid arteries
Aktualn Neurol 2015, 15 (1), p. 41–46
DOI: 10.15557/AN.2015.0007

Chemokines are cytokines that act selectively on cells and are capable of inducing selective migration of cells in vitro and in vivo. The term was first coined at the 3rd International Symposium on Chemotactic Cytokines in 1992. The name “chemokine” is a contraction of “chemotactic cytokine,” meaning that these molecules combine features of both cytokines and chemotactic factors. They are a family of low-molecular-mass proteins acting on specific membrane receptors. A cell’s overall sensitivity to chemotaxis depends on the expression profile of chemokine receptors. Atherosclerosis is essentially an excessive inflammatory and proliferative response to the damage of arterial walls. It takes place within the wall and leads to the formation of unstable atherosclerotic plaques. Many chemokines have been studied in terms of their role in the pathogenesis of an atheromatous plaque in the carotid arteries, both in animal models and with the use of human tissue. It seems that molecules that are the most involved in the formation of atheromas in the carotid arteries include: CCL2, CCL3, CCL4 and CCL5. However, reports are sometimes contradictory, and more research is needed. Finding a marker that could help predict the destabilisation of an atheromatous plaque would be a valuable addition to the standard diagnostic panel of tests used in both the diagnosis and monitoring of vascular pathologies.

Keywords: chemokines, chemokine receptors, atheromatous plaque, mediators of inflammation