Neurologia i neurochirurgia polska最新文献

{"title":"Small vessel disease - radiological feature and clinical implications.","authors":"Anetta Lasek-Bal, Michał Marek","doi":"10.5603/pjnns.109817","DOIUrl":"10.5603/pjnns.109817","url":null,"abstract":"<p><p>Cerebral small vessel disease (SVD) is commonly observed on neuroimaging among elderly individuals and is recognized as a risk factor for stroke, cognitive decline, gait impairment, and mood disturbance. Clinical features often vary in severity and presentation even among patients with similar SVD findings on brain imaging. The Standards for Reporting Vascular Changes on Neuroimaging (STRIVE) initiative (STRIVE 1 and 2) established standardized terminology for the radiological features of SVD and clarified their interrelationships. This article presents current knowledge about the effects of SVD on structural and functional brain connectivity, as well as the radiological and clinical implications of SVD, with particular attention to cognitive and behavioral disturbances.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"236-242"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-photon emission computed tomography 123I-ioflupane imaging in CSF1R mutation carriers.","authors":"Łukasz Milanowski, Jason R Young, Stephen Grill, Rodolfo Savica, Zbigniew K Wszolek","doi":"10.5603/pjnns.111575","DOIUrl":"10.5603/pjnns.111575","url":null,"abstract":"<p><strong>Aim of the study: </strong>CSF1R-related disorder (CSF1R-RD) is a rare, autosomal dominant microgliopathy characterized by leukoencephalopathy. While extrapyramidal symptoms are common, the underlying integrity of the presynaptic dopaminergic system in these patients remains poorly understood. The aim of our study was to analyze dopamine transporter availability using single-photon emission computed tomography (SPECT) 123I-ioflupane in patients with CSF1R mutations to differentiate the pathophysiology of their parkinsonism.</p><p><strong>Material and methods: </strong>We conducted a retrospective review of 112 electronic medical charts from a large tertiary referral medical center. Four patients (3.6%) with CSF1R variants underwent SPECT 123I-ioflupane imaging. Clinical data, MRI findings, and genetic pathogenicity were assessed.</p><p><strong>Results: </strong>SPECT 123I-ioflupane results were normal i n 3 patients, despite t he presence of parkinsonian symptoms, i ncluding tremor, rigidity, and bradykinesia. The only patient with an abnormal SPECT 123I-ioflupane result was a 70-year-old with a pathogenic CSF1R c.1924C > T, p.Gln642* variant and a clinical phenotype of classic Parkinson disease.</p><p><strong>Conclusions and clinical implications: </strong>Parkinsonism in CSF1R-RD may present with a normal SPECT 123I-ioflupane results, suggesting that motor deficits arise from white matter degradation and disrupted connectivity rather than primary nigrostriatal loss.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"355-359"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary optic nerve lymphoma masquerading as neuromyelitis optica spectrum disorder.","authors":"Maksymilian A Brzezicki, Jakub Moskal, Wojciech Wierzchołowski, Natalia Pawlak, Szymon Jurga, Radosław Kaźmierski","doi":"10.5603/pjnns.107023","DOIUrl":"10.5603/pjnns.107023","url":null,"abstract":"","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"373-375"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amyloid PET-guided anti-amyloid therapy in corticobasal syndrome associated with clinical improvement.","authors":"Shinsuke Fujioka, Yukiko Nagaishi, Tomohiro Imamura, Hiromu Minagawa, Kiku Uwatoko, Motohiro Yukitake, Jun-Ichi Kira, Yoshio Tsuboi","doi":"10.5603/pjnns.110307","DOIUrl":"10.5603/pjnns.110307","url":null,"abstract":"<p><strong>Aim of the study: </strong>Corticobasal syndrome (CBS), a heterogeneous clinical phenotype, can be associated with various underlying pathologies. Although neuropathological studies show that CBS cases can be attributed to Alzheimer's disease (AD), in vivo confirmation and subsequent disease-modifying therapy remain rarely reported. In our patients presenting with clinical features consistent with CBS, amyloid positron emission tomography (PET) facilitated the diagnosis of underlying AD pathology and enabled the initiation of anti-amyloid therapy.</p><p><strong>Material and methods: </strong>We retrospectively reviewed patients with probable corticobasal degeneration from two tertiary centers who underwent amyloid PET confirming AD, systematically collecting clinical, imaging, and treatment data.</p><p><strong>Results: </strong>Two patients were identified who fulfilled the inclusion criteria. In both patients, episodic memory was impaired, which was inconsistent with a typical corticobasal syndrome phenotype. Amyloid PET demonstrated widespread cortical and subcortical amyloid deposition, confirming underlying AD pathology. Based on these findings, anti-amyloid therapy was initiated, and clinical improvement was observed in both patients, although causality cannot be inferred from this uncontrolled retrospective observation.</p><p><strong>Conclusions: </strong>Corticobasal syndrome may be an atypical clinical presentation of AD pathology. Importantly, molecular imaging allowed an in vivo diagnosis of AD and facilitated the timely initiation of anti-amyloid therapy.</p><p><strong>Clinical implications: </strong>This novel report documents the clinical implementation of amyloid PET guided anti-amyloid therapy in patients presenting with CBS.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"477-481"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serotonin syndrome: understanding pathophysiological bases and managing a growing clinical challenge.","authors":"Filip Szałański, Mariusz Siemiński","doi":"10.5603/pjnns.106987","DOIUrl":"10.5603/pjnns.106987","url":null,"abstract":"<p><p>Serotonin syndrome (SS) is a potentially life-threatening condition resulting from excessive serotonergic activity often triggered by overdoses, drug interactions or inadequate polypharmacy. Serotonin syndrome is often underdiagnosed, and its documented prevalence worldwide is limited, however due to the growing global prescription of antidepressant agents for conditions ranging from psychiatric disorders to chronic pain and sleep disorders, the number of incidences is increasing. Serotonin syndrome presents with a wide spectrum of clinical manifestations, from mild agitation and hyperreflexia to severe hyperthermia, rigidity, and multi-organ failure. Its pathophysiology primarily involves 5-HT1A and 5-HT2A receptors, although other mechanisms may contribute. Current diagnostic frameworks, such as Hunter's criteria, provide guidance but have limitations, especially in cases of polypharmacy. Management strategies focus on early recognition, discontinuation of serotonergic agents, supportive care, and targeted treatments such as cyproheptadine, although its efficacy requires further study. Severe cases necessitate urgent interventions to control hyperthermia and prevent complications like rhabdomyolysis. This review highlights the clinical relevance of SS, its challenges in diagnosis and management, and the urgent need for increased awareness among healthcare providers. Future directions should aim to refine diagnostic criteria, explore novel therapeutic options, implementing preventive strategies and investigate the broader role of serotonin dysregulation in clinical practice to reduce morbidity and mortality associated with this condition.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"399-409"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restless legs syndrome treatment - gabapentinoids or dopamine agonists?","authors":"Vladimira Vuletić, Jarosław Sławek","doi":"10.5603/pjnns.109905","DOIUrl":"10.5603/pjnns.109905","url":null,"abstract":"<p><p>The pathogenesis of restless legs syndrome (RLS) is still poorly understood. Nevertheless, several medications are in clinical use, namely dopamine agonists (DA), gabapentinoids, opioids, and ferrum preparations, and their effectiveness has been confirmed in numerous clinical trials. In 2025 the American Academy of Sleep Medicine published new practice guidelines and changed the positioning of previously highly rated medications. The first-line treatment options with a \"strong recommendation\" are now gabapentinoids (gabapentin, gabapentin enacarbil, pregabalin) along with intravenous ferric carboxymaltose. Dopamine agonists previously classified at the same level have been moved to the category of \"conditional against\". This was based on the clinical data on the effectiveness of gabapentinoids but was not based on new clinical trials proving lower efficacy of DAs. In our opinion, this change is related to the potential side effects of DAs as augmentation and for impulse control disorder. Nevertheless, gabapentinoids are recommended in high doses vs. DAs, which are recommended in low doses. In older patients with co-morbidities in whom gabapentinoids are not well tolerated it results in relatively high rates of withdrawal. In this point of view paper, we present our personal views (supported by clinical data) on the need for both groups of medications in clinical practice because none of them is free of potential side effects and may still be useful.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"487-493"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of stroke-related disability assessment at discharge from a stroke unit.","authors":"Natalia Pożarowszczyk, Iwona Sarzyńska-Długosz, Hanna Ziąbska, Maciej Nowak, Iwona Kurkowska-Jastrzębska, Michał Karliński","doi":"10.5603/pjnns.106983","DOIUrl":"10.5603/pjnns.106983","url":null,"abstract":"<p><strong>Introduction: </strong>The modified Rankin Scale (mRS) score at discharge from the stroke unit (SU) is often used as a surrogate for the 3-month outcome, but the reliability of such an approach remains uncertain. Our aim was to investigate how mRS assessment at SU discharge compares with early post-discharge and 3-month post-discharge evaluation, considering discharge destination.</p><p><strong>Material and methods: </strong>We prospectively enrolled adult acute stroke patients discharged from a single tertiary SU with residual neurological deficit and mRS 1-4. Functional assessment was made by a single mRS-certified neurologist using the Rankin Focused Assessment (RFA) at SU discharge, and at 7-21 and 83-97 days post-discharge.</p><p><strong>Results: </strong>Of 116 enrolled patients, 109 completed the early post-discharge assessment and 104 the 3-month follow-up. The agreement between mRS at SU discharge and in the early follow-up was moderate overall (Krippendorff's alpha 0.71) and in patients discharged from the hospital (alpha 0.68) but poor in those transferred to the rehabilitation ward (RW) (alpha 0.41). Somewhat worse reliability was observed for the 3-month mRS (alpha 0.63, 0.53, and 0.26, respectively). Discharge assessments tended to overestimate dependency, particularly in RW-transferred patients (28.3% vs. 8.6% in discharges from the hospital).</p><p><strong>Conclusions: </strong>The modified Rankin Scale assessment reliability performed by an experienced neurologist at SU discharge is moderate and significantly poorer in RW-transferred patients. However, on the population level, it seems satisfactory for patients discharged from the hospital, even as a surrogate for the 3-month post-discharge mRS.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"432-439"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival and prediction of distant recurrence in glioblastoma.","authors":"Raquel Gutiérrez-González, Zulema Herrero, Enrique Rodriguez-Rubio, Alvaro Zamarron","doi":"10.5603/pjnns.108958","DOIUrl":"10.5603/pjnns.108958","url":null,"abstract":"<p><strong>Introduction: </strong>Glioblastoma is the most prevalent and aggressive primary tumor of the nervous system. The condition manifests with a high rate of recurrence, predominantly in a localized pattern. The impact of distant recurrence on survival and the associated factors are a controversial subject. This study aims to determine whether the pattern of distant recurrence exerts any influence on progression-free survival, survival after first progression, and overall survival in patients with de novo glioblastoma and low residual tumor volume (RTV) < 5 cc. It also aims to identify which factors predict distant recurrence.</p><p><strong>Material and methods: </strong>A retrospective single-center cohort study included patients aged 18 years or over with de novo glioblastoma and RTV < 5 cc after histological diagnosis, who were treated between 2017 and 2023 in our center. Kaplan-Meier curves were utilized for time-to-event analyses. Risk factors were assessed by univariable analysis and logistic regression.</p><p><strong>Results: </strong>The analysis encompassed 102 patients with a median survival period of 12.9 months. Distant recurrence was associated with a more extended progression-free survival (11.9 months; p = 0.003) and overall survival (21.5 months; p = 0.021) compared with the remaining patterns (6.1 and 12.7 months, respectively), with no significant impact on survival after the first progression. Epidermal growth factor receptor (EGFR) amplification (odds ratio [OR] = 3.42, 95% confidence interval [CI]: 1.14-10.60; p = 0.029) and Ki-67 < 30% (OR = 6.15, 95% CI: 1.12-33.67; p = 0.036) were identified as independent risk factors for distant recurrence.</p><p><strong>Conclusions: </strong>Distant recurrence in glioblastomas with low tumor burden after diagnosis is associated with superior progression-free survival and overall survival compared with other recurrence patterns. The EGFR amplification and Ki-67 < 30% were identified as independent risk factors for distant progression.</p><p><strong>Clinical implications: </strong>The study underscores the significance of incorporating molecular profiling into decision-making processes for patients with glioblastoma. Furthermore, stratification by recurrence patterns has the potential to enhance the efficacy of future clinical trials.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"440-448"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre- and post-void residual volume in Parkinson's disease patients with urinary urgency, incontinence or nocturia.","authors":"Edina Vitaszil, Emir Berberovic, Marita Thiel, Wolfgang H Jost","doi":"10.5603/pjnns.112228","DOIUrl":"10.5603/pjnns.112228","url":null,"abstract":"<p><strong>Introduction: </strong>Our aim was to identify Parkinson's disease (PD) patients with overflow incontinence and to observe trends between pre- and post-void residual volume (PVR) and urinary urgency, incontinence or nocturia in our sample.</p><p><strong>Material and methods: </strong>As part of our diagnostic evaluation, we measured PVR using a portable bladder scanner in patients with PD at our inpatient facility. The initial measurement was conducted upon admission, and, if increased (PVR > 50 mL), a control measurement was carried out on the same or following day. If the PVR was ≥ 150 mL at follow-up, further control measurements were made immediately before and after micturition. Data on urinary urgency, urinary incontinence and nocturia were retrieved from the non-motor symptoms (NMS) part of the standardized medical history taken at admission.</p><p><strong>Results: </strong>We identified 117 PD patients with increased PVR (≥ 150 mL) during the 8-month period. Due to limited mobility, cognitive impairment, lack of compliance, or early discharge, we were able to carry out the measurements in only 23 out of 117 patients. The investigated population consisted of these 23 PD patients. Further control measurements were carried out to exclude overflow incontinence. We identified no patients with overflow incontinence in our sample. We found that the voiding volume and the volume before voiding were the highest in the urinary urgency group (234.1 mL and 148.3 mL, respectively), while the PVR was the highest among patients with nocturia (91.9 mL vs. 85.8 mL in urgency and 86.6 mL in incontinence). Notable differences in pre-void, post-void, and voiding volumes were observed between men and women in all subgroups, in favor of male patients in our male-dominant sample. Urinary urgency was the most prevalent (78.3%) lower urinary tract symptom (LUTS), followed by nocturia (65.2%) and urinary incontinence (34.8%). We initially hypothesized a possible association between high PVR and urinary urgency in PD patients, but this could not be confirmed. Although the initial PVR was ≥ 150 mL, repeated controls showed lower values, underlining the importance of PVR controls in PD patients. The average age of the patients with nocturia was somewhat higher and they had higher UPDRS III scores than patients in the other subgroups. We only observed slight differences across the subgroups with regard to pre-void, post-void, and voiding volumes.</p><p><strong>Conclusion: </strong>The strength of the evaluation is limited by the relatively small sample size. Further studies are needed to clarify the characteristics and possible associations of LUTS subgroups (urgency, incontinence, and nocturia) in PD patients with high PVR.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"449-456"},"PeriodicalIF":3.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and EEG predictors of treatment response in pediatric absence epilepsy - a single-center experience.","authors":"Anna Lemska, Marta Zawadzka, Maria Mazurkiewicz-Bełdzińska","doi":"10.5603/pjnns.106693","DOIUrl":"10.5603/pjnns.106693","url":null,"abstract":"<p><strong>Aim of the study: </strong>Absence epilepsy, though primarily affecting children, can also emerge during adolescence or adulthood, showing a wide spectrum of clinical presentations and treatment responses. The aim of this study is to evaluate the clinical and electroencephalographic (EEG) characteristics of absence epilepsy and identify factors that influence treatment outcomes and long-term prognosis.</p><p><strong>Clinical rationale for the study: </strong>While childhood absence epilepsy (CAE) is often associated with favorable prognosis, a subset of patients experiences drug resistance and persistent seizures. Understanding the clinical and EEG predictors of treatment success or failure can support more effective, individualized therapeutic strategies and improve long-term management.</p><p><strong>Material and methods: </strong>This prospective study included 57 pediatric patients diagnosed with absence epilepsy. Clinical data and EEG findings were analyzed focusing on age of onset, seizure frequency, EEG patterns, family history, and treatment response. Patients were followed over a 12-month period to assess seizure outcomes and treatment efficacy.</p><p><strong>Results: </strong>Childhood absence epilepsy was the most common subtype, identified in 73.7 % of cases. A total of 85% of patients achieved seizure remission within six months of initiating treatment. A favorable prognosis was significantly associated with early age of onset, presence of typical 3-4 Hz spike-and-wave discharges on EEG, and rapid response to first-line anti-epileptic drugs (AEDs). In contrast, patients diagnosed with juvenile absence epilepsy (JAE), myoclonic absence seizures, or absence seizures with eyelid myoclonia often required more complex treatment regimens and demonstrated a higher risk of persistent seizures.</p><p><strong>Conclusions and clinical implications: </strong>Absence epilepsy encompasses a range of clinical syndromes, and outcomes are influenced by seizure type, age at onset, EEG characteristics, and initial treatment response. Early diagnosis and prompt initiation of appropriate therapy are critical for achieving seizure control. However, some patients, particularly those with atypical absence syndromes, may continue to experience therapeutic challenges, highlighting the need for tailored treatment approaches and long-term follow-up.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"60-66"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145605109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}