Risk factors for death by acute ischaemic stroke in patients from West-Pomerania, Poland

Aim and clinical rationale for study. In Poland, it is widely believed that the outlook for ischaemic stroke patients is gradually improving due to the development of a network of stroke wards and other dedicated hospital units throughout the country. However, a study by Shah et al., reporting a significant increase in mortality from ischaemic stroke in several European countries including Poland, contradicts this belief. Therefore, the aim of this study was to determine the risk factors for death in patients with recent ischaemic stroke among a population of patients from Western Pomerania, a region in north-western Poland.Materials and methods. This retrospective study involved 2,374 patients with recent ischaemic stroke. Mortality was defined as death within 30 days of admission to hospital. Patients who died in hospital during this period were defined as deceased, while those who survived beyond this time were classified as alive.Results. We found that compared to ischaemic stroke patients who survived, the group of ischaemic stroke patients who died included a higher number of patients who smoked cigarettes (OR = 6.08 in univariable model; OR = 6.22 in adjusted model), had hypertension (OR = 2.57; OR = 1.85), had a history of previous stroke (OR = 2.63; OR = 2.14), had coronary heart disease (OR = 1.78; OR=1.36), and were older (OR = 1.06; OR = 1.05). For all these factors, p-value was lower than 0.001. Females had a higher risk of death (OR = 1.48, p < 0.001; OR = 1.35, p = 0.01). For dyslipidemia, only univariable model was statisticallysignificant (OR = 1.38, p < 0.001).Conclusion and clinical implications. Older age, female sex, dyslipidemia, hypertension, coronary heart disease, and smoking are not only recognised risk factors for ischaemic stroke, but also risk factors associated with an unfavourable prognosis following stroke

Zwyrodnienie korowo-podstawne

Zwyrodnienie korowo-podstawne (CBD, corticobasal degeneration) jest rzadkim, heterogennym klinicznie i neuropatologicznie schorzeniem zwyrodnieniowym układu nerwowego zaliczanym do parkinsonizmów atypowych. Do najbardziej typowych dla tego zespołu objawów klinicznych należą: wyraźnie asymetryczny (przynajmniej na początku choroby) parkinsonizm, sztywność i dystoniczne ułożenie kończyny górnej, mioklonie, apraksja, zjawisko obcej kończyny, zaburzenia chodu z powtarzającymi się upadkami i korowe zaburzenia czucia. W późniejszym okresie pojawiają się: zaburzenia neuropsychiatryczne, odhamowanie, zespół czołowy, otępienie. Asymetria objawów klinicznych przekłada się na również asymetryczny, przeciwstronny do objawów ruchowych, zanik czołowo-skroniowy i podkorowy widoczny w badaniach neuroobrazowych (TK/MR) oraz hipoperfuzji/metabolizmu w obrazie SPECT/PET. Schorzenie pozostaje nieuleczalne. Terapia sprowadza się do prób leczenia objawowego

Charakter zaburzeń mowy w chorobie Parkinsona

Streszczenie Celem pracy było omówienie fizjologii i patologii mowy oraz dokonanie przeglądu piśmiennictwa dotyczącego badań nad zaburzeniami mowy w chorobie Parkinsona. Ponadto wskazano najskuteczniejsze metody diagnostyki zaburzeń mowy w tym schorzeniu. Omówiono czynniki wpływające na nasilenie zaburzeń mowy: artykulacyjne, oddechowe, akustyczne oraz pragmatyczne. Opisano najważniejsze metody stosowane w terapii mowy: farmakologiczne i behawioralne. Szczególnie podkreślono rolę programu Lee Silverman Voice Treatment w terapii mowy w chorobie Parkinsona

Simultaneous acute shoulder arthritis and multiple mononeuropathy in a newly diagnosed type 2 diabetes patient – First case report

Diabetes is a common disorder that leads to the musculoskeletal symptoms such as the shoulder arthritis. The involvement of peripheral nervous system is one of the troublesome for the patients as it provokes chronic sensory symptoms, lower motor neuron involvement and autonomic symptoms. In the course of the disease there has been several types of neuropathies described. A 41-year-old male patient was admitted to the internal medicine department because of the general weakness, malaise, polydypsia and polyuria since several days. The initial blood glucose level was 780mg/dl. During the first day the continuous insulin infusion was administered. On the next day when he woke up, the severe pain in the right shoulder with limited movement, right upper extremity weakness and burning pain in the radial aspect of this extremity appeared. On examination right shoulder joint movement limitation was found with the muscle weakness and sensory symptoms in the upper limbs. The clinical picture indicated on the right shoulder arthritis and the peripheral nervous system symptoms such as the right musculocutaneous, supraspinatus, right radial nerve and left radial nerve damage. We present a first case report of simultaneous, acute involvement of the shoulder joint and multiple neuropathy in a patient with newly diagnosed type 2 diabetes, presumably in the state of ketoacidosis

Potential role of statins in the intracerebral hemorrhage and subarachnoid hemorrhage

Statins are used in primary and secondary prevention of cardiovascular episodes. Most of recent studies regard ischemic stroke. There are more emerging results of studies suggesting usefulness of these drugs in the other types of stroke e.g. intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Searching for new methods of treatment is important, because both ICH and SAH lead to poor prognosis and severe psychomotor disability. The unquestionable role of inflammatory factors in the pathogenesis of these disorders justifies considering statin treatment. Previous results are contradictory, thus in present study we review results of studies and try to explain the potential pathomechanism of statin use in hemorrhagic strokes

The emotional stress and risk of ischemic stroke

Stroke is the second leading cause of death worldwide, and the leading cause of acquired disability in adults in most regions. There have been distinguished modifiable and non-modifiable risk factors of stroke. Among them the emotional stress was presented as a risk factor. The aim of this review was to present available data regarding the influence of acute and chronic mental stress on the risk of ischemic stroke as well as discussing the potential pathomechanisms of such relationship. There is an evident association between both acute and chronic emotional stress and risk of stroke. Several potential mechanisms are discussed to be the cause. Stress can increase the cerebrovascular disease risk by modulating symphaticomimetic activity, affecting the blood pressure reactivity, cerebral endothelium, coagulation or heart rhythm. The emotional stress seems to be still underestimated risk factor in neurological practice and research. Further studies and analyses should be provided for better understanding of this complex, not fully known epidemiological problem

Atrial fibrillation and stroke – Coexistence and attitude to preventive therapy on the basis of Szczecin and Szczecin region patients

Atrial fibrillation (AF) is an independent factor increasing the risk of an ischemic stroke (IS) fivefold. The objective of the study was to evaluate the frequency of coexistence of non-valvular AF and IS during the acute stroke and to analyze the attitude of AF patients to treatment. The study included 3712 successive patients presenting either an IS or a transient ischemic attack. The analysis revealed a significant increase in the rate of patients with AF and IS in the years 2010–2013 (31.9%) compared with 2002–2005 (20.2%). A rise in the proportion of AF and IS patients was recorded over the course of consecutive years in group II. The proportion of newly detected AF cases during hospital stay differed significantly between the groups (16.9% vs. 31.9%). Group I and II patients differed essentially with regards to hypertension incidence and female rates. Antiplatelet medications or OACs were taken by a significantly greater number of AF patients in group II. Low number of therapeutic levels of INR was recorded in both groups. IS and AF coexist more frequently than indicated by previous assessments and demographic data from other countries. Increase in the number of IS and AF patients may result from higher detectability of AF and older age of patients affected with stroke, women in particular. Despite a well grounded knowledge about the benefits of OACs use in the prophylaxis of thrombotic-embolic events in AF patients, they are rarely used. A surprisingly low proportion of patients taking OACs reaches a therapeutic INR level

Risk factors of stroke and −717A>G (rs2794521) CRP gene polymorphism among stroke patients in West Pomerania province of Poland

Background and purpose Some of the risk factors of ischaemic stroke influence the development of atherosclerosis, which is a significant cause of vascular incidents. An inflammatory component plays a role in pathogenesis of both atherosclerosis and atrial fibrillation, the most important risk factor of embolic strokes. C-reactive protein (CRP) concentration in blood reflects the inflammatory process. Concentration of this protein depends on the CRP gene polymorphism. The aim of the study was to assess the relationship between selected risk factors of stroke and variant of −717A>G (rs2794521) CRP gene polymorphism in population of West Pomerania Province of Poland. Materials and methods There were 125 consecutive patients with ischaemic stroke analysed, who met the inclusion and exclusion criteria. In all patients, −717A>G CRP gene polymorphism was genotyped and analysed in relation to selected stroke risk factors. Results Prevalence of type 2 diabetes was lower in patients with AA genotype of −717A>G CRP gene polymorphism than in patients with other alleles (p=0.017). Subjects with GG genotype had significantly higher concentration of CRP comparing to AG genotype (p=0.023). No correlation was found between −717A>G CRP gene polymorphism and the lipid profile and other selected risk factors of stroke. Conclusions In patients with ischaemic stroke in West Pomerania Province, the GG genotype of −717A>G CRP gene polymorphism is associated with significantly higher CRP concentration in relation to AG genotype. Patients with AA genotype may be characterised by lower prevalence of type 2 diabetes

The role of brain-derived neurotrophic factor and its single nucleotide polymorphisms in stroke patients

Stroke is the main cause of motoric and neuropsychological disability in adults. Recent advances in research into the role of the brain-derived neurotrophic factor in neuroplasticity, neuroprotection and neurogenesis might provide important information for the development of new poststroke-rehabilitation strategies. It plays a role as a mediator in motor learning and rehabilitation after stroke. Concentrations of BDNF are lower in acute ischemic-stroke patients compared to controls. Lower levels of BDNF are correlated with an increased risk of stroke, worse functional outcomes and higher mortality. BDNF signalling is dependent on the genetic variation which could affect an individual's response to recovery after stroke. Several single nucleotide polymorphisms of the BDNF gene have been studied with regard to stroke patients, but most papers analyse the rs6265 which results in a change from valine to methionine in the precursor protein. Subsequently a reduction in BDNF activity is observed. There are studies indicating the role of this polymorphism in brain plasticity, functional and morphological changes in the brain. It may affect the risk of ischemic stroke, post-stroke outcomes and the efficacy of the rehabilitation process within physical exercise and transcranial magnetic stimulation. There is a consistent trend of Met alleles’ being connected with worse outcomes and prognoses after stroke. However, there is no satisfactory data confirming the importance of Met allele in stroke epidemiology and the post-stroke rehabilitation process. We present the current data on the role of BDNF and polymorphisms of the BDNF gene in stroke patients, concentrating on human studies

Articulation disorders and duration, severity and l-dopa dosage in idiopathic Parkinson's disease

Background Parkinson's disease (PD) is one of the most common diseases of the central nervous system (CNS). It is frequently heralded by speech disturbances, which are one of its first symptoms. Aim The aim of this paper is to share our own experience concerning the correlation between the severity of speech disorders and the PD duration, its severity and the intake of l-dopa. Material and methods The research included 93 patients with idiopathic PD, aged 26–86 years (mean age 65.1 years). Participants were examined neurologically according to the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr Scale. They were also assessed by Frenchay Dysarthria Assessment. Results Considerable and severe disorders were concurrent with impairments in the mobility of the tongue, lips, the jaw as well as the pitch and loudness of the voice. The strongest correlation but at a moderate level was found to exist between the severity of labial impairment, voice loudness and the length of the disease. There was also a positive correlation between lip movement while the motions were being diversified, lip arrangement while speaking and the intake of l-dopa. Conclusions As PD progresses a significant decline in vocal articulation can be observed, which is due to reduced mobility within the lips and the jaw. Exacerbation of articulation disorders resulting from progression of the disease does not materially influence the UPDRSS scores. l-dopa has been found to positively affect the mobility of the lips while the patient is speaking and their arrangement at rest