Obustronny udar wzgórza z dysfunkcją podwzgórza

Unilateral thalamic lesions cause transient or permanent behavioral, sensory and oculomotor disturbances; bilateral lesions of thalamus result in more severe and longer lasting symptoms. We present an atypical case of bilateral paramedian thalamic infarct with concomitant hypothalamic dysfunction. The only risk factor of ischaemic stroke found in the patient was a short lasting episode of atrial fibrillation. Bilateral paramedian thalamic infarcts may result from occlusion of one paramedian thalamic artery, which arises from the posterior cerebral artery, either with separated or with a common trunk, thus supplying the thalamus bilaterally. Independently of anatomical variants of thalamus blood supply, the most probable cause of infarct in our patient was unilateral or bilateral occlusion of the posterior cerebral artery by cardioembolism, probably in the course of basilar artery occlusion. Hypothalamic dysfunction may accompany thalamic infarcts; thus hypothalamo-pituitary function should be routinely assessed in bithalamic infarcts.Jednostronne udary w obrębie wzgórza mogą być przyczyną przemijających lub trwałych zaburzeń zachowania, objawów czuciowych lub zaburzeń gałkoruchowych. Obustronne udary wzgórza skutkują zwykle bardziej nasilonymi i dłużej trwającymi objawami. W niniejszym artykule zaprezentowano przypadek obustronnego udaru wzgórza z jednoczesną dysfunkcją podwzgórza. Jedynym czynnikiem ryzyka udaru niedokrwiennego mózgu, jaki stwierdzono u pacjenta, był krótkotrwały epizod migotania przedsionków. Obustronne udary wzgórza mogą być wynikiem zamknięcia jednej tętnicy przyśrodkowej wzgórza, odchodzącej od tętnicy tylnej mózgu albo w postaci dwóch osobnych gałęzi, albo też jednego wspólnego pnia, zaopatrującego jednak wzgórze obustronnie. Niezależnie jednak od wariantów anatomicznych unaczynienia wzgórza najbardziej prawdopodobną przyczyną udaru niedokrwiennego u przedstawionego pacjenta było jednostronne lub też obustronne zamknięcie tętnicy tylnej mózgu przez materiał zatorowy, prawdopodobnie w przebiegu zamknięcia szczytu tętnicy podstawnej. Dysfunkcja podwzgórza może towarzyszyć udarom wzgórza, autorzy sugerują więc, aby funkcja układu podwzgórzowo-przysadkowe-go była rutynowo oceniana w przypadku obustronnych udarów wzgórza

Airplane headache – an underestimated problem?

The airplane headache is an incident of severe, clinically stereotypical pain during ascent or descent of an airplane. The entity is considered rare; however, growing numer of passengers in air transport results in better recognition of the problem. The airplane headache typically lasts less than 30 minutes and is unilateral, most often in fronto-orbital region and is connected with take-off or (more often) landing of the aircraft. The most important causative factor is sinus barotrauma attributed to changes in air pressure in passenger airliners during different phases of flight. So far there are only single cases or case series described in the literature. However, the problem can affect even a few percent of airline passengers. The condition is rare among children. The most effective treatment are triptans, but naproxen, paracetamol and nasal decongestants may play an important role either. There is an urgent need to conduct more researches on epidemology, pathogenesis and treatment of the headache attributed to airplane travel

Czynniki wpływające na występowanie mikrokrwawień mózgowych

Mikrokrwawienia mózgowe są efektem wynaczynienia krwi z patologicznie zmienionych naczyń. Produkty jej rozpadu, dzięki swoim charakterystycznym właściwościom, są wykrywane w polu magnetycznym i uwidaczniane jako małe, okrągłe ogniska hipointensywne w obrazach T2 badania rezonansu magnetycznego mózgu. Mechanizm powstawania mikrokrwawień jest złożonym zjawiskiem. Główną rolę odgrywają w nim angiopatia amyloidowa oraz angiopatia związana z nadciśnieniem tętniczym. Związek angiopatii z mikrokrwawieniami dotyczy różnorodnych czynników, do których zalicza się między innymi wiek, płeć, dietę, palenie tytoniu, choroby współistniejące oraz przyjmowane leki. W niniejszej pracy omówiono zależność między mikrokrwawieniami mózgowymi a czynnikami wpływającymi na ich rozpowszechnienie w populacji pacjentów

Symptomatic cavernous hemangioma of fronto-parietal region of the brain in a young female patient – a case report

Introduction: Cavernous hemangioma is a bening blood vessel malformation that can be located in the central nervous system. Although most patients who are found to have a CNS hemangioma are asymptomatic, the entity can cause a wide spectrum of symptoms including severe ones like epileptic seizures, stroke, diplopia, dysfasia or cognitive functions’ disorders. Case report: A 21-year-old female patient was admitted to the Department Of Neurology due to transient vision impairment, dysfasia, headache and tinnitus. Physical examination revealed no focal neurological signs. A brain MRI was performed. A cavernous hemangioma of 7-8 mm in size was found. The patient was examined by neurosurgeon as well, who did not qualify her for an immediate surgery. Discussion: Although cavernous hemangiomas are often asymptomatic, sometimes they can be a causative factor of different neurological symptoms. One should always take into account a possibility of cerebral hemangioma presence in young patients that suffer from headaches, tinnitis or have impaired vision

Transient ischemic attack of the brain as the first link in a decompensatory event chain of cerebro- and cardiovascular incidents in a 68-year-old female patient with radiological features of Fahr’s syndrome – a case report

Introduction: Transient ischemic attack (TIA) is a reversible episode of neurologic deficit, that symptomatically can be similar to stroke, but lasts shorter than 24 hours and does not cause any radiological changes in brain images. TIA is a major risk factor for subsequent ischemic stroke. Fahr’s syndrom is a rare, genetically conditioned incidence of calcified deposits in basal ganglia and cerebral cortex. Case report: A 68-year-old female patient was admitted to the Department of Neurology due to an incident of left limbs weakness and left mouth angle drop. The symptoms lasted 5 minutes. The initial brain CT revealed no acute ischemic foci, although the radiologist found characteristic features of Fahr’s syndrome. Carotid ultrasound showed stenosis of right internal carotid artery. The patient experienced an ischemic stroke in 6th day from initial symptoms. 4 days later a myocardial infarction occurred as well. Discussion: TIA is a major prognostic factor for an ischemic stroke with the greatest risk of incidence in the first week after initial symptoms. Proper imaging diagnostics and prophylactic treatment with aspirin and statins should be administered. Patients after TIA incident should stay under watchful neurological supervision during the first 3 months after the attack

Dementia with Lewy bodies and Parkinson’s disease dementia-two independent disorders or one clinical entity within a clinical spectrum of synucleinopathies?

Introduction: Introduction: Both dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) are important dementia syndromes that overlap in their clinical features and clinical course, neuropathological abnormalities, and also therapeutic approach. Nevertheless it is still unclear whether DLB and PDD are two different disorders that require differentiation or are one clinical entity within a spectrum of Lewy body disease. Currently these disorders are mainly distinguished on the basis of the relative timing of the onset of symptoms of dementia and parkinsonism. The present paper presents current concepts on the pathogenesis of both disorders and their possible overlap

Humoral response against myelin associated glycoprotein reflects oligodendroglial degeneration in Parkinson’s disease

Introduction Identification of disease-specific diagnostic and prognostic biomarkers which would enable early detection and follow-up of Parkinson’s disease (PD) is a crucial problem. Recently, we confirmed the presence of adaptive immune response against different glial-derived antigens in PD. Objective The aim of the study was to assess humoral response against myelin-associated glycoprotein (MAG) on a larger group of PD patients. IgM autoantibodies against MAG were measured by an ELISA system in 66 PD patients and 66 control subjects. Results The study confirmed a significantly increased production of anti-MAG IgM antibodies in parkinsonian patients (p 0.05). The results provide evidence for activation of humoral response against MAG in PD patients, but argue against the utility of anti-MAG antibodies as biomarkers of disease severity. The results additionally indicate the potential protective role of autoimmunity in maintaining the body’s homeostasis, which may involve the clearance of abnormal proteins. Further studies are necessary to confirm the role of anti-MAG antibodies as biomarkers of PD, especially in relation to other neurodegenerative disorders

Humoral response against small heat shock proteins in Parkinson's disease.

INTRODUCTION:In the light of evidence for the increased heat shock proteins (HSP) expression in neurodegenerative disorders, the presence of the adaptive humoral response of the immune system can be expected. The aim of the study was to check whether Parkinson's disease (PD) has the ability to elicit immune response against small heat shock proteins. METHODS:IgG and IgM autoantibodies against alpha B-crystallin were assessed in 26 PD patients 26 healthy subjects. For the assessment of anti-HSP IgG autoantibodies serum samples from 31 parkinsonian patients and 31 healthy control subjects were collected. Serum samples from PD patients and healthy control subjects were collected twice, at baseline and after mean of 13 months follow up. RESULTS:Both IgM and IgG autoantibodies against alpha ß-crystallin in PD patients were significantly higher compared to healthy controls (p<0.05). We also found statistically significant increase in antibodies titers against alpha ß-crystallin over the time of 13 months, both for IgG (p = 0.021) and for IgM (p<0.0001). Additionally, PD patients presented higher levels of anti-HSP IgG autoantibodies than healthy controls (p = 0.02). CONCLUSIONS:Increase of IgG and IgM autoantibodies against alpha B-crystallin in PD patients over time may suggest their involvement in the disease pathogenesis and progression. Further studies are required to confirm the role of this antibody as a biomarker of the disease progression

NMOSD&mdash;Diagnostic Dilemmas Leading towards Final Diagnosis

(1) Background: The emergence of white matter lesions in the central nervous system (CNS) can lead to diagnostic dilemmas. They are a common radiological symptom and their patterns may overlap CNS or systemic diseases and provoke underdiagnosis or misdiagnosis. The aim of the study was to assess factors influencing the underdiagnosis of neuromyelitis optica spectrum disorder (NMOSD) as well as to estimate NMOSD epidemiology in Lubelskie voivodeship, Poland. (2) Methods: This retrospective study included 1112 patients, who were made a tentative or an established diagnosis of acute or subacute onset of neurological deficits. The evaluation was based on medical history, neurological examination, laboratory and radiographic results and fulfilment of diagnosis criteria. (3) Results: Up to 1.62 percent of patients diagnosed with white matter lesions and up to 2.2% of the patients previously diagnosed with MS may suffer from NMOSD. The duration of delayed diagnosis is longer for males, despite the earlier age of onset. Seropositive cases for antibodies against aquaporin-4 have worse prognosis for degree of disability. (4) Conclusions: Underdiagnosis or misdiagnosis in NMOSD still remains a problem in clinical practice and has important implications for patients. The incorrect diagnosis is caused by atypical presentation or NMOSD-mimics; however, covariates such as gender, onset and diagnosis age may also have an influence