With a subarachnoid haemorrhage, the outcome is never enough

Introduction. In the current edition, Nastasovic et al. present the results of a prospective study on patients with aneurysm subarachnoid haemorrhage (SAH) regarding the association of selected variables and outcomes three months after the incident.Clinical reflections. The independent predicting factors of an unfavourable aneurysm SAH outcome are aneurysm re-rupture, high systolic blood pressure (SBP), and increased heart rate.Clinical implications. The article findings confirm easily monitored parameters that could be potentially useful in clinical approaches to this critical illness

Zastosowanie ultrasonografii przezczaszkowej typu duplex w diagnostyce chorób pozapiramidowych

Streszczenie Rutynowo stosowane metody obrazowania układu nerwowego, takie jak tomografia komputerowa i tomografia rezonansu magnetycznego, służą głównie do wykluczania wtórnych przyczyn schorzeń pozapiramidowych. Nie są jednak istotnie przydatne w wykrywaniu zmian w obrębie jąder podstawy i pnia mózgu, szczególnie we wczesnym okresie wystąpienia objawów idiopatycznych postaci tych chorób. Ostatnio podjęto próby stosowania przezczaszkowej ultrasonografii metodą duplex w diagnostyce obrazowej jąder podstawy. Metoda ta, z powodzeniem wykorzystywana w chorobach naczyń mózgu, pozwala także uwidocznić niektóre struktury miąższowe mózgowia. W pracy przedstawiono najważniejsze odkrycia dotyczące obserwowanych w badaniu ultrasonograficznym zaburzeń określonych struktur, w szczególności hiperechogeniczności w obrębie istoty czarnej towarzyszącej chorobie Parkinsona

An evaluation of the reproducibility of the measurement of the intima-media thickness of carotid arteries

The intima-media thickness (IMT) of carotid arteries was demonstrated to be a reliable measure for early stages of atherosclerosis. B-mode ultrasound may be used to measure carotid IMT. The measurements of the IMT of the carotid artery (CA) conducted by different investigators can be comparable and enable the implementation of clinical trial successfully while maintaining a high reproducibility value. The objective of the study was to evaluate the reproducibility of the measurements made by the same investigator on two separate occasions (intraobserver variability) and the reproducibility of the off-line measurements between four sonographers in our laboratory (interobserver variability). The IMT of CA in 25 subjects (15 post stroke and 10 healthy persons) was investigated with the use of high-resolution ultrasonography. The CA subdivided into the common, bulbs and internal segments were scanned twice with a 3-week interval. Additionally three other readers with different levels of experience and skills in ultrasonography were asked to perform the same measurements in duplicate with at least a 3-week interval between. A high concurrence for intraobserver variability was detected with a correlation coefficient ranging from 0.92 to 0.95; p < 0.0001, and maximal bias 0.019 mm. Interobserver variability for all four readers also demonstrated a high correlation coefficient ranging from 0.72 to 0.83; p < 0.0001, and the maximal bias of measurements did not exceed 0.08 mm. The analogue measurements performed by the team demonstrate a reliable reproducibility in terms of the results of morphologic measurements. The differences obtained in the study were less than the error of the method (i.e. 0.1 mm) and should not influence clinical decision-making. Additionally, this study demonstrated that interobserver concurrence increases with the increasing experience of the investigators

Free thyroxine and TSH interact with secreted protein acidic and rich in cysteine-like 1 in ischemic stroke

The role of the thyroid gland in ischemic stroke pathology is not well understood. As thyroid hormones modulate the extracellular matrix, we explored the possible link between them and secreted protein acidic and rich in cysteine like 1 (SC1) – one of the extracellular matrix molecules. In the 81 patients with acute ischemic stroke, serum SC1 levels were much higher compared with 30 control subjects: 4.47 vs 2.43ng/mL (p&lt;0.001). Serum levels of free thyroxine (fT4) were higher in stroke subjects compared to those of controls (p=0.03). In stroke patients, TSH concentration was lower than in the control group (p=0.03). SC1 levels positively correlated with fT4 levels (p=0.02) and negatively with TSH (p=0.03) in stroke patients. Our results confirmed the association between thyroid hormones and SC1 – extracellular matrix protein

Structural bases of aphasia in the light of functional neuroimaging

W artykule zawarto rys historyczny pojęcia afazji i jej współczesne rozumienie. Opisano zarówno klasyczne - korowe typy afazji: motoryczną, sensoryczną, nominalną, transkorową i kondukcyjną, jak i dyskusyjne pod względem nozologicznym typy afazji podkorowej - wzgórzową i móżdżkową. Rozważane są odniesienia lokalizacyjne wymienionych zaburzeń komunikacji słownej oraz jej odzwierciedlenie w czynnościowych badaniach neuroobrazowych (SPECT [single photon emission computed tomography ], fMRI [functional magnetic resonance imaging], PET [positron emission tomography]).In the article the authors describe the history of concept of aphasia and its contemporary meaning. The different types of classical speech disorders are described: Broca&#8217;s and Wernicke&#8217;s aphasia, anomia, transcortical and central conductive aphasias. Non-classical speech disorders such as subcortical and cerebellar aphasias are described. The authors consider also topographic bases of central, verbal communication disturbances and the role of functional neuroimaging studies (SPECT, fMRI, PET) in their diagnosis

The impact of disease modifying therapies on cognitive functions typically impaired in multiple sclerosis patients: a clinician’s review

ObjectiveOver the last few decades clinicians have become aware that cognitive impairment might be a major cause of disability, loss of employment and poor quality of life in patients suffering from multiple sclerosis [MS].The impact of disease modifying therapies [DMTs] on cognition is still a matter of debate. Theoretically, DMTs could exert a substantial beneficial effect by means of reducing neuroinflammation and brain atrophy, which are established correlates of cognitive dysfunction. The aim of the study was to review the evidence concerning the effect of DMTs on cognitive functions.MethodsPubMed, Scopus, and the European Committee for Treatment and Research in Multiple Sclerosis [ECTRIMS] Library were searched for articles concerning the pediatric and adult populations of patients with multiple sclerosis, including clinical trials and RWD, where psychometric results were analyzed as secondary or exploratory endpoints.ResultsWe reviewed a total of 44 studies that were found by our search strategy, analyzed the psychological tests that were applied, the length of the follow-up, and possible limitations. We pointed out the difficulties associated with assessing of DMTs’ effects on cognitive functions, and pitfalls in cognitive tools used for evaluating of MS patients.ConclusionThere is a need to highlight this aspect of MS therapies, and to collect adequate data to make informed therapeutic decisions, to improve our understanding of MS-related cognitive dysfunction and provide new therapeutic targets

Prevalence and prognostic value of prodromal symptoms in relapsing-remitting multiple sclerosis

Introduction. Several studies have suggested the possibility that disease prodromes might occur months or even years before a multiple sclerosis diagnosis. Objectives. To describe the profile of prodromal symptoms and the possible relationship between the occurrence of individual symptoms and clinical course characteristics in patients with relapsing-remitting multiple sclerosis (RRMS), and to assess their role as predictors of further disease course. Material and methods. The cohort included 564 patients with RRMS. Patients were stratified based on their current EDSS score, and the annual EDSS growth rate was calculated. Logistic Regression Analysis was used to study the relationship between prodromal symptoms and disease progression. Results. The most commonly reported prodromal symptom was fatigue (42%). The following symptoms were significantly more common in women than in men: headache (39.7% vs. 26.5%, p &lt; 0.05), excessive sleepiness (19.1% vs. 11.1%, p &lt; 0.05) and constipation (18.0% vs. 11.1%, p &lt; 0.05). Prodromal urinary and cognitive disturbances, fatigue and pain complaints were significantly more common in patients with the highest annual EDSS increase (p &lt; 0.05). Multivariate analysis revealed some potential predictors of long-term disability progression: hesitancy in starting urination predicted EDSS increase by 0.6 point (p &lt; 0.05), while deterioration in everyday functioning because of cognitive disturbances, and pain complaints, were associated with an EDSS increase of 0.5 (p &lt; 0.05), and 0.4 (p &lt; 0.05), respectively. Conclusions. Prodromal pain, urinary and cognitive complaints (especially when these lead to deterioration of everyday functioning) were associated with a higher EDSS increase rate, and may thus be regarded as possible predictors of worse clinical outcomes in RRMS patients

The Early Effect of Carotid Artery Stenting on Antioxidant Capacity and Oxidative Stress in Patients with Carotid Artery Stenosis

The treatment of carotid artery stenosis is associated with the risk of complications, which may include stroke after carotid artery stenting (CAS) and myocardial infarction after carotid endarterectomy (CEA). The imbalance between prooxidative mechanisms and antioxidant capacity creates a milieu of factors, which may increase the risk of complications after endovascular procedures. We have examined 43 consecutive patients with carotid artery stenosis. Sera were analyzed for the activity of paraoxonase (PON) and arylesterase (ARE), sulfhydryl groups (SG), malondialdehyde (MDA), and conjugated dienes (CD) concentrations by means of spectrophotometric methods before and next day after CAS. We have found lowered PON (P=0.0032), increase in ARE activity (P=0.0058), and decrease in sulfhydryl groups concentration (P=0.0267). No effect on absolute MDA and CD concentrations was observed. The degree of carotid artery stenosis correlated negatively with PON/ARE ratio after CAS (rS = −0.507, P=0.0268). To conclude, CAS influences both enzymatic (differently, PON and ARE activity) and nonenzymatic antioxidant defense. Females are more susceptible to lipid peroxidation after CAS. PON/ARE ratio after CAS correlated with the degree of carotid artery stenosis. The changes (deltas) in ARE activity, SG, and MDA concentrations correlated with the severity of neurological deficit and disability

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: Current Insights into the Disease Pathophysiology, Diagnosis and Management

Myelin oligodendrocyte glycoprotein (MOG)-associated disease (MOGAD) is a rare, antibody-mediated inflammatory demyelinating disorder of the central nervous system (CNS) with various phenotypes starting from optic neuritis, via transverse myelitis to acute demyelinating encephalomyelitis (ADEM) and cortical encephalitis. Even though sometimes the clinical picture of this condition is similar to the presentation of neuromyelitis optica spectrum disorder (NMOSD), most experts consider MOGAD as a distinct entity with different immune system pathology. MOG is a molecule detected on the outer membrane of myelin sheaths and expressed primarily within the brain, spinal cord and also the optic nerves. Its function is not fully understood but this glycoprotein may act as a cell surface receptor or cell adhesion molecule. The specific outmost location of myelin makes it a potential target for autoimmune antibodies and cell-mediated responses in demyelinating processes. Optic neuritis seems to be the most frequent presenting phenotype in adults and ADEM in children. In adults, the disease course is multiphasic and subsequent relapses increase disability. In children ADEM usually presents as a one-time incident. Luckily, acute immunotherapy is very effective and severe disability (ambulatory and visual) is less frequent than in NMOSD. A critical element of reliable diagnosis is detection of pathogenic serum antibodies MOG with accurate, specific and sensitive methods, preferably with optimized cell-based assay (CBA). MRI imaging can also help in differentiating MOGAD from other neuro-inflammatory disorders. Reports on randomised control trials are limited, but observational open-label experience suggests a role for high-dose steroids and plasma exchange in the treatment of acute attacks, and for immunosuppressive therapies, such as steroids, oral immunosuppressants and rituximab as maintenance treatment. In this review, we present up-to-date clinical, immunological, radiographic, histopathological data concerning MOGAD and summarize the practical aspects of diagnosing and managing patients with this disease