Neurologia i neurochirurgia polska最新文献

{"title":"Blood-brain barrier-associated serum proteins as potential diagnostic biomarkers of epilepsy aetiology.","authors":"Elżbieta Bronisz, Agnieszka Cudna, Aleksandra Wierzbicka, Iwona Kurkowska-Jastrzębska","doi":"10.5603/pjnns.103864","DOIUrl":"10.5603/pjnns.103864","url":null,"abstract":"<p><strong>Aim of study: </strong>We aimed to assess serum levels of proteins associated with the blood-brain barrier (BBB) in two aetiological populations of patients with epilepsy in the interictal period: genetic and structural-metabolic epilepsy.</p><p><strong>Clinical rationale for study: </strong>Proteins associated with the BBB are emerging as potential indicators and/or inducers of pro-epileptogenic changes within the central nervous system (CNS). Dysfunction of BBB is known to contribute to the development of epilepsy, while on the other hand dysregulated BBB might be the result of seizures.</p><p><strong>Material and methods: </strong>Serum levels of MMP-9, MMP-2, TIMP-1, TIMP-2, S100B, CCL-2, ICAM-1, P-selectin, and TSP-2 were examined in a group of 100 patients who were seizure-free for a minimum of seven days and analysed by ELISA.</p><p><strong>Results: </strong>Serum level of TSP-2 was higher in patients with genetic epilepsy compared to structural-metabolic epilepsy (p < 0.05), while P-selectin was higher in patients with structural-metabolic epilepsy (p < 0.05). Additionally, generalised linear mixed models showed higher levels of MMP-9 and MMP-2 in patients with structural-metabolic epilepsy, and higher levels of TSP-2 in patients with genetic epilepsy. Levels of S100B, CCL-2, ICAM-1, TIMP-1 and TIMP-2 did not differ between the two groups.</p><p><strong>Conclusions and clinical implications: </strong>Serum levels of MMP-9, MMP-2, and P-selectin are elevated in patients with structural-metabolic epilepsy in the interictal period, which may indicate persistent impairment of the vascular part of the BBB. Serum level of TSP-2 was elevated in patients with genetic epilepsy, which may suggest its impact on synaptogenesis. Our study underlines the complexity of epilepsy, and indicates that different molecules participate in BBB disruption/restoration and neuroinflammation in different aetiological subgroups of epilepsy.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"221-230"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266858","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":"Neurological manifestations as first symptom of acute aortic syndrome: a case report.","authors":"Kamil Banasik, Joanna Pokrzywa, Dominika Kowalczyk, Rafał Celiński, Marcin Łubiarz","doi":"10.5603/pjnns.104959","DOIUrl":"10.5603/pjnns.104959","url":null,"abstract":"","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"300-301"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144079268","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":"Risk factors for complications in bolt-connected external ventricular drains.","authors":"Raquel Gutiérrez-González, Teresa Mediavilla, Celia Ortega-Angulo, Teresa Kalantari, Alvaro Zamarron","doi":"10.5603/pjnns.105168","DOIUrl":"10.5603/pjnns.105168","url":null,"abstract":"<p><strong>Introduction: </strong>This study was aimed at identifying risk factors for the main complications following bolt-connected external ventricular drain (EVD) insertion.</p><p><strong>Material and methods: </strong>This was a single-centre cohort study. All patients who underwent bolt-connected EVD placement between March 2015 and February 2024 were included. The complications analysed were infection, haemorrhage, misplacement, obstruction, and accidental pull-out. The need for EVD replacement was also recorded. Univariable and Cox regression multivariate analyses were performed.</p><p><strong>Results: </strong>A total of 119 procedures were analysed. The duration of ventriculostomy (OR 1.14; 95% CI 1.02-1.27) and the occurrence of cerebrospinal fluid leak (OR 409.86; 95% CI 1.36-12,353.36) or system obstruction (OR 31.44; 95% CI 2.04-484.85) were confirmed to be independent risk factors for infection. No risk factors were identified for misplacement or obstruction. Thicker catheters (OR 25.56; 95% CI 2.28-286.33) and antiplatelet or anticoagulant use (OR 7.29; 95% CI 1.75-30.41) were found to be independent risk factors for EVD-related haemorrhage. Men showed a 72% increased risk of accidental EVD pull-out. Finally, involuntary pull-out (OR 79.36; 95% CI 8.32-756.99), misplacement (OR 39.38; 95% CI 3.21-482.64), and obstruction (OR 31.55; 95% CI 2.70-368.40) were found to be independent risk factors for a new drain replacement.</p><p><strong>Conclusions: </strong>We have confirmed the duration of ventriculostomy, cerebrospinal fluid leak, and catheter obstruction to be independent risk factors for infection. Thicker catheters and antiplatelet or anticoagulant drug use were identified as independent risk factors for EVD-related haemorrhage. Male gender increased the risk for involuntary catheter pull-out. Finally, accidental removal, obstruction, and misplacement were confirmed as independent risk factors for re-inserting a new EVD. Neither surgeon's experience nor bedside placement in the intensive care unit increased the risk.</p><p><strong>Clinical implications: </strong>Our study has identified the risk factors for the most common complications associated with a specific type of ventricular catheter (bolt-connected EVDs), which allows the targeting of preventive measures. This is the first study to have analysed this specific group of drains, which are increasingly being used in clinical practice.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"420-430"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187431","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":"Age-related macular degeneration and risk of stroke and all-cause mortality.","authors":"Bhrugun Anisetti, Michael W Stewart, Daniela Markovic, Eric R Eggenberger, Nilufer Ertekin-Taner, James F Meschia, Michelle P Lin","doi":"10.5603/pjnns.98951","DOIUrl":"10.5603/pjnns.98951","url":null,"abstract":"<p><strong>Introduction: </strong>Age-related macular degeneration (AMD) is the most common degenerative disorder of the retina and choroid. Retinal vascular diseases have been associated with adverse cardiovascular outcomes, but an association between AMD and stroke has not been well established. We aimed to test the relationship between AMD, stroke, and age-adjusted mortality.</p><p><strong>Material and methods: </strong>Data was obtained from the US National Health and Nutrition Examination Surveys 2005 to 2008, with linked mortality through to 2015. Participants aged 40 or older with gradable AMD on fundus photographs were included. AMD was classified as either early or late. Independent relationships between AMD and stroke were assessed using multivariable logistic regression models. Risk of all-cause mortality was assessed using Cox regression models, before and after adjusting for covariates.</p><p><strong>Results: </strong>Of the 5,481 participants included, 49.8% were women, 56.5% white, 20.3% black, and 15.5% Hispanic. 425 (7.8%) had AMD. After adjusting for vascular risk factors, we found that AMD was associated with an increased risk of stroke (aOR 1.87, 95% CI 1.25-2.79, p = 0.002). There was a relationship between AMD and stroke depending on whether participants had early AMD (aOR 1.66, 95% CI 1.09-2.51) or late AMD (aOR 3.32, 95% CI 1.36-8.12). All-cause mortality was higher in those with AMD (HR 1.35, 95% CI 1.06-1.72) and late AMD (HR 2.18, 95% CI 1.33-3.58).</p><p><strong>Conclusions: </strong>Age-related macular degeneration is associated with stroke and all-cause mortality, independent of age and vascular risk factors. Our findings suggest potential non-vascular mechanisms related to the aetiology of AMD may increase the risk of stroke.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"413-419"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266857","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":"Predicting haemorrhagic transformation through serum biochemical indices for patients after endovascular treatment: a retrospective study.","authors":"Fang Wu, Qingyuan Wu, Qinji Zhou, Lina Zhang, Fei Yan, Yaping Xiao, Fanping Meng, Lei He, Zhenjie Yang, Chuyue Wu","doi":"10.5603/pjnns.97759","DOIUrl":"https://doi.org/10.5603/pjnns.97759","url":null,"abstract":"INTRODUCTION\u0000The aim of this study was to determine the serum biochemical markers that can predict the risk of haemorrhagic transformation (HT) before and after endovascular treatment (EVT).\u0000\u0000\u0000MATERIAL AND METHODS\u0000This study included patients with anterior circulation large vessel occlusion (ACLVO) who underwent EVT within six hours of symptom onset between September 2017 and September 2022. These patients were retrospectively categorised into two groups: an HT group and a No-HT group.\u0000\u0000\u0000RESULTS\u0000A total of 180 patients were included in the study, of whom 55 (30.6%) had HT. The monocyte count before EVT (p = = 0.005, OR = 0.694, 95% CI 0.536-0.898), the activated partial thromboplastin time before EVT (p = 0.009, OR = 0.186, 95% CI 0.699-0.952), and the eosinophil count after EVT (p = 0.038, OR = 0.001, 95% CI 0.000-0.018) were all found to be independent predictors of HT, with warning values of 6.65%, 22.95 seconds, and 0.035*10^9/L, respectively. When compared to prediction using only demographic data [AUC = 0.662,95% CI (0.545, 0.780)], adding biochemical indices before EVT [AUC = 0.719,95% CI (0.617, 0.821)], adding biochemical indices after EVT [AUC = 0.670,95% CI (0.566, 0.773)], and adding both [AUC = 0.778,95% CI (0.686, 0.870)], the prediction efficiency of HT was improved among all three combinations, with no statistical significance.\u0000\u0000\u0000CONCLUSIONS\u0000The levels of serum biochemical markers were found to show significant changes before and after EVT in ACLVO patients. A combination of demographic data and serum biochemical markers proved to be effective in predicting the occurrence of HT in patients with ACLVO who underwent EVT.","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":"31 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140656102","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":"Two cases of delayed onset, fully reversible cortical oedema and signal intensity on brain MRI without infarction caused by prolonged migraine aura.","authors":"Roaa Zayat, Olga P Fermo","doi":"10.5603/pjnns.98031","DOIUrl":"10.5603/pjnns.98031","url":null,"abstract":"","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"210-214"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049978","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":"Management of autoimmune temporal lobe epilepsy with GAD65 antibody: four case reports.","authors":"József Janszky, Beáta Bóné, Kázmér Karádi, Péter Barsi, Vera Juhos, Anikó Berta, Csilla Gyimesi, Dalma Tényi, Réka Horváth","doi":"10.5603/pjnns.98738","DOIUrl":"10.5603/pjnns.98738","url":null,"abstract":"<p><strong>Aim of study: </strong>Glutamate decarboxylase (GAD) enzyme can be a target intracellular antigen in autoimmune focal epilepsy. GAD65 antibody is in found patients diagnosed with drug-refractory temporal lobe epilepsy (TLE). We explore the clinical features of the disease and therapeutic options.</p><p><strong>Material and methods: </strong>We present the cases of four TLE patients, two of them with type 1 diabetes. All of them were drug-resistant and therefore underwent presurgical evaluation, which revealed GAD65 antibody positivity. We discuss the four GAD65 antibody positive temporal lobe epilepsy patients' electroclinical data, the treatments, and their effectiveness.</p><p><strong>Results: </strong>One of them became seizure-free after right anterior temporal lobe resection, two of them did not show significant improvement with immunmodulatory agents, and the fourth patient with the shortest duration of disease had significant improvement in seizure status and normalisation of cognitive status with IVIg therapy.</p><p><strong>Conclusions and clinical implications: </strong>Our cases show that the earlier a GAD65 antibody is detected, the greater the chance of achieving seizure freedom or improvements in both seizure and cognitive status with immunomodulatory agents. However, in some cases, surgery may also bring seizure freedom, but with a risk of cognitive deterioration.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"453-458"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875429","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":"Preoperative embolisation of head and neck paragangliomas - a single-centre experience.","authors":"Paweł Szmygin, Maciej Szmygin, Tomasz Roman, Andrzej Kucharski, Tomasz Jargiełło, Radosław Rola, Marcin Szymański","doi":"10.5603/pjnns.99637","DOIUrl":"10.5603/pjnns.99637","url":null,"abstract":"<p><strong>Introduction: </strong>Paragangliomas are neuroendocrine tumours commonly located in the abdomen, thorax, head and neck. The definitive treatment for these tumours is surgical resection, which in some cases can be very challenging due to the involvement of critical neurovascular structures and their high vascularity. Therefore, pre-operative embolisation may be performed to reduce the risk of complications. This study aimed to present our experience with endovascular embolisation of head and neck paragangliomas (HNP).</p><p><strong>Material and methods: </strong>In this single-centre study, we reviewed data from consecutive patients with HNP who underwent pre-operative embolisation from 2017 to 2023. The efficacy of embolisation, the method of embolisation, as well as the rate of complications, were noted.</p><p><strong>Results: </strong>A total of 27 patients (15 females) with an average age of 47 years underwent selective embolisation of HNP. Satisfactory embolisation, defined as occlusion of > 75% of the blood supply, was achieved in 22/27 cases (81.5%). The most commonly used embolic agents included coils and microspheres. With the exception of minor vessel dissections in two patients and embolic agent migration in two patients causing reversible occlusion of the intracranial vessels, there were no other complications associated with embolisation. No neurological deficits occurred in relation to the endovascular procedure.</p><p><strong>Conclusions: </strong>The results of our study indicate that endovascular embolisation of HNP prior to surgical resection is a safe and efficacious procedure, with a relatively low complication rate and associated morbidity.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"490-497"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446628","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":"Assessment of acute neuronal injury in critical illness: prognostication in septic shock patients - preliminary study in a Polish population.","authors":"Michał P Pluta, Piotr F Czempik, Joanna Natorska, Łukasz J Krzych","doi":"10.5603/pjnns.99042","DOIUrl":"10.5603/pjnns.99042","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis-associated brain dysfunction is a common organ dysfunction in sepsis. The main goal of this study was to verify whether the combined assessment of central nervous system injury markers (i.e. S100B, NSE, GFAP) and disease severity as per the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and Sequential Organ Failure Assessment (SOFA) classification systems, would increase the accuracy of death prediction in septic shock.</p><p><strong>Material and methods: </strong>Markers of neuronal damage were determined in 55 patients diagnosed with septic shock with no previous neurological disease. Clinical data was collected and the scores on the APACHE II, SAPS II and SOFA prognostic scales were calculated. Death before discharge from the Intensive Care Unit (ICU) was established as the endpoint.</p><p><strong>Results: </strong>Nineteen patients (35%) died before ICU discharge. Patients who died had significantly higher S100B and NSE values, and APACHE II, SAPS II and SOFA scores (P< 0.05 for all). At the time of septic shock diagnosis, NSE levels more accurately predicted the risk of death before ICU discharge than S100B. However, NSE had no better predictive value for short-term mortality than APACHE II, SAPS II and SOFA. Adding C-reactive protein (CRP) and S100B concentrations to the APACHE II score created a predictive model with 95% mortality accuracy (AUC = 0.95; 95%CI 0.85-0.99; P = 0.03).</p><p><strong>Conclusions: </strong>The assessment of acute neuronal injury plays an important role in prognostication in patients with septic shock. The concentration of S100B protein in combination with APACHE II score and concentration of CRP more accurately predicts mortality than the APACHE II alone.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"512-518"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889791","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 radiological consequences of delayed therapy escalation in patients with relapsing-remitting multiple sclerosis.","authors":"Małgorzata Popiel, Halina Bartosik-Psujek","doi":"10.5603/pjnns.97040","DOIUrl":"10.5603/pjnns.97040","url":null,"abstract":"<p><strong>Aim of the study: </strong>To evaluate the clinical and radiological consequences of delayed escalation of therapy in patients with relapsing-remitting multiple sclerosis (RRMS), in whom, despite finding platform therapy ineffective, high-efficacy drugs were introduced with a delay.</p><p><strong>Material and methods: </strong>We performed a single-centre, observational study evaluating patients with RRMS for ineffectiveness of disease-modifying therapies (DMTs). Depending on the time of therapy escalation to high-efficacy drugs, the patients were divided into an early escalation or a late escalation group, both of which were then observed for 48 months. All patients underwent a neurological examination every six months and a brain magnetic resonance imaging (MRI) every 12 months. The primary endpoint was a change in the Expanded Disability Status Scale (EDSS) score during the observation period. The secondary endpoint was the time to 6-month confirmed disability progression (6mCDP). In addition, we analysed the annualised relapse rate and the cumulative number of new Gd+ and T2 lesions on brain MRI.</p><p><strong>Results: </strong>165 patients were qualified for the analysis. On treatment initiation, mean age was 38 years (± 10.9), and mean EDSS was 1.41 ± 0.38. After 48 months, there was a statistically insignificant decrease in the EDSS score in the early escalation group (-0.17 ± 0.35; p > 0.05), while in the late escalation group there was an increase in the EDSS score. The highest increase was noted in the group in which the escalation was performed with a delay of more than two years (1.2 ± 0.63; p < 0.001), and moreover 80% of patients in this group met the 6mCDP criteria. The median time to 6mCDP was 4.6 years (LESC1) and 4.5 years (LESC2) in the late escalation groups. In the early escalation group, zero subjects met the 6mCDP criteria after 48 months of observation.</p><p><strong>Conclusions: </strong>In everyday practice, the long-term outcomes in patients with RRMS and disease activity, despite DMT being used, are more favourable after early implementation of high-efficacy drugs. Delaying therapy escalation results in the accumulation of permanent disability in patients with RRMS.</p>","PeriodicalId":19132,"journal":{"name":"Neurologia i neurochirurgia polska","volume":" ","pages":"84-93"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138808338","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}