Neurologia i neurochirurgia polska最新文献

{"title":"Neurotoxoplasmosis - a deceptive infection.","authors":"Joanna Zajkowska","doi":"10.5603/pjnns.112204","DOIUrl":"https://doi.org/10.5603/pjnns.112204","url":null,"abstract":"","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777319","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":"Alteplase before mechanical thrombectomy: which patients benefit from this bridging therapy?","authors":"Sandra Pyza, Wojciech Poncyliusz, Przemysław Nowacki, Wioletta Pawlukowska, Marcin Sawicki, Krystian Mross, Piotr Bąk, Edyta Korczak-Dolecka, Agata Krajewska, Anna Bajer-Czajkowska, Marta Masztalewicz","doi":"10.5603/pjnns.109188","DOIUrl":"https://doi.org/10.5603/pjnns.109188","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of death and disability. In patients with ischemic stroke caused by large intracranial artery occlusion, treatment options include intravenous thrombolysis and mechanical thrombectomy. While tenecteplase is gaining favor, alteplase remains widely used, and its role as bridging therapy (BT) before thrombectomy is still debated. To identify which patients with ischemic stroke benefit most from intravenous alteplase prior to mechanical thrombectomy, focusing on functional recovery and mortality within 90 days.</p><p><strong>Material and methods: </strong>We analyzed prospectively collected observational data from 292 patients with large-vessel ischemic stroke treated with thrombectomy at University Clinical Hospital No. 1 of the Pomeranian Medical University in Szczecin between May 2019 and December 2021. Of these, 164 received bridging intravenous alteplase and 128 underwent thrombectomy alone. Clinical, demographic, and procedural characteristics were compared. Primary outcomes were functional independence (modified Rankin Scale [mRS] ≤ 2) at discharge, 30 days, and 90 days. Secondary outcomes included neurological recovery (National Institutes of Health Stroke Scale [NIHSS]) and mortality at 90 days.</p><p><strong>Results: </strong>Patients receiving alteplase were significantly younger and had fewer comorbidities compared to those treated with thrombectomy alone. Functional outcomes favored the alteplase group: 42.7% regained independence by 90 days versus 39.1% in the thrombectomy-only group, but the difference was not statistically significant. Neurological deficit improved in both groups with comparable trajectories. Subgroup analyses indicated that patients < 80 years old and those treated with alteplase within 3 hours of symptom onset had significantly higher rates of independence at 90 days. Smoking and alcohol abuse were unexpectedly associated with improved outcomes, while atrial fibrillation tended to predict poorer recovery. Mortality rates were similar between groups (39.6% vs. 37.5%, p = 0.66), with no excess risk of in-hospital or early death from alteplase administration.</p><p><strong>Conclusions: </strong>Bridging therapy with alteplase before thrombectomy was safe and associated with a modest improvement in functional outcomes compared with thrombectomy alone. The greatest benefit was observed in patients under 80 years old and in those treated within 3 hours of symptom onset. These findings support the continued selective use of alteplase in BT without increasing mortality risk.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777173","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":"Toxoplasma gondii seroprevalence in people newly diagnosed with HIV in Poland: implications for neurotoxoplasmosis risk assessment.","authors":"Carlo Bieńkowski, Agata Skrzat-Klapaczyńska, Bartosz Matłosz, Ewa Firląg-Burkacka, Regina B Podlasin, Justyna D Kowalska","doi":"10.5603/pjnns.110126","DOIUrl":"https://doi.org/10.5603/pjnns.110126","url":null,"abstract":"<p><strong>Introduction: </strong>Toxoplasma gondii (T. gondii) remains the primary pathogen causing focal cerebral lesions in human immunodeficiency virus (HIV)-positive persons, despite the general reduction of the incidence of opportunistic infections with the wide rollout of antiretroviral therapy. Therefore, serology testing at baseline remains a standard of HIV care. The aim of our study was to investigate the prevalence of T. gondii immunoglobulin G (IgG) and IgM antibodies among people who have been newly diagnosed with HIV.</p><p><strong>Material and methods: </strong>A retrospective analysis of medical records of individuals newly registered in Warsaw's HIV Outpatient Clinic from January 1, 2021, to April 4, 2023, was performed. Demographics, transmission mode, and HIV status data were analyzed. Toxoplasma IgM and IgG antibodies were assessed using VIDAS® (bioMérieux, Lyon, France). Stratification was based on IgG antibody presence and chi-square test used for group comparison using Quick Statistics Calculators (https://www.socscistatistics. com/, accessed on November 10, 2023).</p><p><strong>Results: </strong>Among 464 healthcare clients, 92.0% were male, with men who have sex with men (MSM) as the main HIV transmission mode (76.1%). Toxoplasma IgM antibodies were present in one (0.2%) and IgG antibodies were present in 142 (30.6%) persons. The median age was 32 years [interquartile range (IQR): 26.25-40.0], median CD4+ count was 365.5 cells/μL (IQR: 263-506), and median HIV viral load 46,576 copies/mL (IQR: 8,762.25-187,585.25). Persons with Toxoplasma IgG present were more likely to be female (13.4% vs. 5.6%, p = 0.0043), ≥ 30 years old (69.0% vs. 56.5%, p = 0.0112), acquiring HIV through heterosexual contacts (23.9% vs. 11.8%, p = 0.0013), and through intravenous drug injections (2.8% vs. 0.0%, p = 0.0085). No significant differences in T. gondii IgG prevalence were observed in persons regarding CD4 count and HIV viral load.</p><p><strong>Conclusions: </strong>Positive T. gondii IgG antibodies were present in 30.6% of newly registered healthcare clients and IgM in one person. This reflects trends in the general population. Factors correlated with positive T. gondii IgG antibodies were female sex, older age, heterosexual contacts, and intravenous drug injection modes of HIV acquisition.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723318","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":"Insufficient immunosuppressive treatment in patients with myasthenia gravis in the context of the possibility of new therapies - a single center experience.","authors":"Aleksander Rajczewski, Karolina Kania, Wojciech Kozubski, Sławomir Michalak, Wojciech Ambrosius","doi":"10.5603/pjnns.107882","DOIUrl":"https://doi.org/10.5603/pjnns.107882","url":null,"abstract":"<p><strong>Aim of the study: </strong>The authors aimed to characterize the population with myasthenia gravis (MG), focusing on their eligibility for a therapeutic program with terminal complement protein C5 inhibition (ravulizumab), neonatal Fc receptor (FcRn) modulation (efgartigimod), and with anti-cluster of differentiation 20 (anti-CD20) monoclonal antibody rituximab reimbursed by the Polish National Health Fund (NFZ), and also to create a database with clinical and epidemiological details of a large MG population.</p><p><strong>Clinical rationale for the study: </strong>Myasthenia gravis is a rare, life-threatening autoimmune neurological disease and, as such, is usually treated with traditional immunosuppressants. The therapeutic program enables the use of advanced agents, but the eligibility criteria are highly restrictive. It is not known how many patients may be eligible for treatment with advanced therapies since the available data is sparse.</p><p><strong>Material and methods: </strong>The authors reviewed the clinical files of all 82 hospitalizations (of 65 patients) due to MG at the Department of Neurology of Poznan University Hospital between January 2023 and May 2025. Collected data included: age, gender, reason for admission, treatment before and after hospitalization with doses, The Myasthenia Gravis-Activities of Daily Living scale (MG-ADL), and Myasthenia Gravis Foundation of America (MGFA) scores on admission, treatment with intravenous immunoglobulin (IVIG)/plasmapheresis during hospitalization, data describing the autoimmunologic and comorbidities profile of each patient. Furthermore, the authors explored whether patients fulfilled the therapeutic program enrollment criteria: 1) history of glucocorticoids (GCS) therapy for at least 6 months (at least 3 months of 30 mg of prednisone daily); 2) history of using two drugs from the class of non-steroidal immunosuppressive drugs, including one for at least 12 months and the other for at least 6 months. Statistical analyses were conducted using JASP software (University of Amsterdam, the Netherlands).</p><p><strong>Results: </strong>Among 65 patients, the median age was 64 years, 57% were women, and 94% had at least one comorbidity. During 82 hospitalizations, the authors used IVIG 23 times, plasmapheresis 8 times, and a combination of these therapies 3 times. In only 6.1% of hospitalized patients, there was a proven history of adequate oral steroid therapy, and no patient fulfilled definitively the criterion for a history of treatment with two non-steroidal immunosuppressive drugs.</p><p><strong>Conclusions and clinical implications: </strong>Only a small percentage of patients are eligible for the therapeutic program as an indication of insufficient immunosuppressive treatment of MG before hospitalization.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147675287","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":"Central retinal artery occlusion - to thrombolyze or not to thrombolyze?","authors":"Anetta Lasek-Bal","doi":"10.5603/pjnns.111986","DOIUrl":"https://doi.org/10.5603/pjnns.111986","url":null,"abstract":"","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147675264","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":"Consciousness impairment as a primary manifestation of neurosarcoidosis.","authors":"Dominika Jakubowicz-Lachowska, Katarzyna Kapica-Topczewska, Dorota Halicka, Monika Chorąży, Alina Kułakowska","doi":"10.5603/pjnns.110614","DOIUrl":"https://doi.org/10.5603/pjnns.110614","url":null,"abstract":"","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593097","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":"Neurophysiological assessment of F-, M-waves and cutaneous silent period in patients with caput patterns of cervical dystonia in the waning phase of botulinum toxin therapy.","authors":"Artur Drużdż, Małgorzata Dudzic, Anna Sowińska, Szymon Jurga, Natalie Górna, Radosław Kaźmierski","doi":"10.5603/pjnns.109338","DOIUrl":"https://doi.org/10.5603/pjnns.109338","url":null,"abstract":"<p><strong>Aim of the study: </strong>Evaluate and compare F‑wave and cutaneous silent period (CSP) parameters in caput‑pattern idiopathic cervical dystonia (CD) in the waning phase of botulinum toxin therapy vs. healthy controls to identify alterations in segmental excitability and spinal inhibition.</p><p><strong>Clinical rationale for the study: </strong>Cervical dystonia likely reflects sensorimotor network dysfunction. Objective neurophysiological markers of spinal and supraspinal inhibition could clarify pathophysiology, improve diagnostic accuracy versus pseudodystonia and offer candidate biomarkers for monitoring and therapeutic studies.</p><p><strong>Material and methods: </strong>A control study enrolled 21 patients with focal caput‑pattern CD (18 female, 3 male, mean age 53.5 ± ± 7.9 years) and 21 matched healthy volunteers (18 female, 3 male, mean age 51.6 ± 9.2 years). The standard F‑wave protocol, including F‑wave minimal latency (Fmin), chronodispersion (Fchronosp), persistence (Fpersistence), amplitude (Fampl), F/M amplitude ratio (F/Mampl), F‑wave maximal latency (Fmax), mean latency (Fmean), F/M latency ratio (F/Mlat ratio) and conduction velocities (CV1, CV2). Similarly, the CSP measurement protocol, which typically includes CSP onset latency (CSPo), CSP end latency (CSPe), CSP duration (CSPd), was expanded with CSP onset minimal latency (CSPom) and velocities CV3, CV4 and CV5. Because conduction velocity depends on anatomical distance and CSP latencies, incorporating precise distances enables a more reliable and accurate evaluation of both afferent and efferent overall neural pathway efficiency than latency measures alone.</p><p><strong>Results: </strong>Compared with controls, patients with caput‑pattern CD demonstrated prolonged Fmax and Fmean (p = 0.012 and p = = 0.019 respectively), increased Fchronosp (p = 0.004) and Fampl (p = 0.043), increased F/Mlat ratio (p = 0.037), shortened CSPd and CSPe (p < 0.0001 and p = 0.0001), and altered (generally increased) CSP‑related conduction velocities: CV4 (p < 0.0001) and CV5 (p = 0.007). The most sensitive measures were CSPd, CSPe and CV4.</p><p><strong>Conclusions and clinical implications: </strong>Cervical dystonia is associated with impaired inhibition and altered conduction velocities (CV4, CV5). CSPd, CSPe and CV4 are candidate markers to aid diagnosis, differentiate pseudodystonia, and monitor disease or treatment effects. These measures may also inform studies of other motor‑control disorders.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593489","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":"Semiology matters: diagnosing functional seizures beyond the EEG.","authors":"Brin Freund","doi":"10.5603/pjnns.111313","DOIUrl":"https://doi.org/10.5603/pjnns.111313","url":null,"abstract":"<p><p>Not available.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444357","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":"Blood glucose-to-potassium ratio and 90-day outcome in acute ischemic stroke patients of Caucasian origin treated by mechanical thrombectomy.","authors":"Małgorzata Dec-Ćwiek, Joanna Słowik, Magdalena Bosak, Paweł Czechowicz, Maciej T Małecki","doi":"10.5603/pjnns.109571","DOIUrl":"https://doi.org/10.5603/pjnns.109571","url":null,"abstract":"<p><strong>Introduction: </strong>Existing evidence suggests that a high glucose-to-potassium ratio (GPR) is associated with poor outcomes in various conditions: acute, critical, and urgent. This study investigated the association of the GPR with 3-month functional outcomes in Caucasian patients with acute ischemic stroke (AIS), who underwent mechanical thrombectomy (MT), as well as its potential as a biomarker.</p><p><strong>Material and methods: </strong>In a prospective study, 20 commonly available parameters in 464 patients with AIS were analyzed. Of these patients, 309 achieved a good outcome, defined as a modified Rankin Scale (mRS) score of 0-2, while 155 experienced an unfavorable outcome (mRS 3-6) at day 90.</p><p><strong>Results: </strong>Both, univariate model and multivariate logistic regression model adjusted for age and sex, indicated that GPR was associated with an unfavorable outcome [odds ratio (OR) = 1.78; 95% confidence intervals (CI): 1.34-2.40, p < 0.001, OR = 1.68, 95% CI: 1.26-2.26, p < 0.001; respectively]. A further multivariate logistic regression model, adjusted for parameters with a significance threshold of 0.05 in univariate analysis, showed that an increased GPR (OR = 2.38, 95% CI: 1.48-3.90, p < 0.001) was linked to an unfavorable outcome. Additionally, factors such as older age (OR = 1.06, 95% CI: 1.03-1.10, p < 0.001), longer intervention duration (OR = 1.46, 95% CI: 0.99-2.13, p = 0.037), higher initial National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.15, 95% CI: 1.09-1.23, p < 0.001), hemorrhagic transformation (HT) on computed tomography 24 h post-stroke onset (OR = 2.04, 95% CI: 1.08-3.86; p = 0.029), larger initial ischemic core volume on perfusion computed tomography (CT) (OR = 1.01, 95% CI: 1.00-1.02, p = 0.05), successful reperfusion (OR = 0.20, 95% CI: 0.08-0.49, p < 0.001), and higher C-reactive protein (CRP) levels (OR = 1.01, 95% CI: 1.00-1.03, p = 0.029) were also associated with an unfavorable outcome. Similar results were obtained when GPR was analyzed as a categorical variable. The relationship between GPR and the 90-day outcome was demonstrated to be linear. Receiver operating characteristics (ROC) analysis indicated an area under the curve (AUC) of 0.634 (95% CI: 0.580-0.688, p < 0.001) with sensitivity and specificity being 52.3% and 70.6%, respectively for GPR in predicting an unfavorable outcome at day 90.</p><p><strong>Conclusions: </strong>It was confirmed that GPR was associated with unfavorable outcome at day 90 in AIS patients who received MT.</p><p><strong>Clinical implications: </strong>Further studies on the significance of predictive value of GPR are required across various clinical scenarios, including different populations and outcome measures. Additionally, enhancing the predictive power of GPR by incorporating definitive disease biomarkers should be considered.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434411","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":"First report of combined central and peripheral demyelination from Central and Eastern Europe: a case series.","authors":"Szymon Andrusiów, Edyta Dziadkowiak, Anna Zimny, Magdalena Koszewicz","doi":"10.5603/pjnns.109643","DOIUrl":"https://doi.org/10.5603/pjnns.109643","url":null,"abstract":"","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434368","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}