Case report: Unilateral paralysis of the hypoglossal nerve as the only clinical sign of clivus meningioma - a case report and literature review.

Introduction: Clivus meningiomas are benign tumors that occur at the skull base in the posterior cranial fossa. Symptoms usually progress several months or years before diagnosis and may include: headache, vertigo, hearing impairment, ataxia with gait disturbances, sensory problems. In the neurological findings, paralysis of the lower cranial nerves is most often seen, which in the later course can be accompanied by cerebellar and pyramidal signs until the development of a consciousness impairment. Case presentation: We presented the case of a patient who at the time of diagnosis had only unilateral hypoglossal nerve paralysis with dysarthria and mild dysphagia. After the neurosurgical procedure, pathohistological analysis confirmed meningothelial meningioma. Conclusion: Early recognition of clivus tumors, which include meningiomas, is necessary in order to implement an adequate therapeutic procedure and prevent further deterioration of the patient's condition.

Retinal ganglion cell/inner plexiform layer thickness in patients with Parkinson's disease.

Introduction: The aim of the paper was to analyze the changes in the macular ganglion cell layer and inner plexiform layer (GCL-IPL) thickness in patients with Parkinson's disease. Material and methods: The study enrolled 46 patients with established diagnosis of Parkinson's disease and 46 healthy subjects. Both groups were age- and gender-matched. An OCT protocol, namely standardized Ganglion Cell Analysis algorithm was used to measure the thickness of the macular GCL-IPL layer. The average, minimum, and six sectoral (superotemporal, superior, superonasal, inferonasal, inferior, inferotemporal) GCL-IPL thicknesses were measured from the elliptical annulus centered on the fovea. Results: The mean value of the clinical severity of Parkinson's disease was between 2 and 3, according to the Hoehn and Yahr scale. Statistically significant thinning of the GCL-IPL layer was registered in average and minimum GCL-IPL thickness, as well as in the sectoral layer thicknesses in patients with Parkinson's disease in comparison to the controls. There was no correlation between structural changes in the retina and disease duration or severity. A statistically significant difference in thickness between the different stages of the disease was registered only in the inferior sector. Conclusions: Parkinson's disease is accompanied by thinning of the GCL-IPL complex of macula even in the earliest stages. This may indicate a possible retinal dopaminergic neurodegeneration. There is no correlation between duration or severity of Parkinson's disease with thinning of the GCL-IPL complex. .

The Differences in the Cellular and Plasma Antioxidative Capacity Between Transient and Defined Focal Brain Ischemia: Does it Suggest Supporting Time-Dependent Neuroprotection Therapy?

There are many opened questions about the precocious role of oxidative stress in the physiopathology of the early stage of transitory ischemic attack (TIA) and defined focal brain ischemia, as well as about its correlation with clinical severity, short-lasting and clinical outcome prediction in these conditions. The study evaluates the values of glutathione (GSH), glutathione peroxidase, and superoxide dismutase (SOD) in hemolysates and total thiol content (-SH), advanced oxidation protein products (AOPP), SOD, and malondialdehyde (MDA) in plasma, in TIA and stroke patients in the early stage of their neurological onset. The results are interpreted in view of the potential relationship between tested parameters and clinical severity and clinical outcome prediction. Better hemolysates' and total antioxidant profile with higher values of AOPP were observed in TIA compared to stroke patients (p < 0.05). The stroke patients with initially better clinical presentation showed better antioxidant profile with lower values of AOPP (p < 0.05). In TIA patients, this was observed for GSH, -SH content, and AOPP (p < 0.05), which correlated with a short risk for stroke occurrence in this group (p < 0.01). Beyond MDA values, all tested parameters showed correlation with clinical outcome in stroke patients (p < 0.05). The measurement of oxidative stress in TIA and stroke patients would be important for identifying patients' subgroups which might receive supporting therapy providing better neurological recovery and clinical outcome. That approach might give us an additional view of a short-lasting risk of stroke occurrence after TIA, and its clinical outcome and prognosis.

The comparative analyses of the auditory evoked potentials and color Doppler sonography findings in patients diagnosed with vertebrobasilar insufficiency.

Auditory evoked potentials (AEP) represent an electrophysiological method used in the diagnostics of pathological changes of the brainstem. Patients with vertebrobasilar insufficiency (VBI) show changes in the AEP-caused ischemia of the brain structures that generate their responses. The aim of the study was to determine the diagnostic significance and correlation among the findings of AEP in patients with VBI established by color Doppler sonography. The cross-sectional and prospective research included 48 inpatients and outpatients treated at the Clinic of Neurology, Clinical Center Nis. Ultrasound Doppler of blood vessels in the neck included an examination of the carotid blood vessels, the outcome and all sonographically available parts of the vertebral artery (VA) with particular emphasis on the intravertebral segment (V2). The morphological and hemodynamic characteristics of VA in this segment were monitored, and it was important to test the systolic velocity in two adjacent intervertebral spaces. Auditory evoked potentials were used to monitor the amplitudes, absolute latencies of waves I, II, III, IV, and V, as well as interwave latencies (IWLs) I-III, III-V, and I-V. There is statistically significant difference in the more frequent pathological finding of AEP in patients with higher degree of the reduced flow of VA established by color Doppler (P < 0.05) compared to patients with less reduction in the flow. Pathological findings of AEP are well correlated with pathological findings of VBI in color Doppler, and it may be applied as an additional and useful marker in diagnosis of VBI.

[Blink and masseter inhibitory reflexes in Parkinson's disease].

BACKGROUND/AIM: Idiopathic Parkinson's disease (PD) is a chronic, progressive, neurodegenerative disorder with prevalence from 60 to 187 per 100 000 persons in general population. The aim of the study was to determine the abnormalities of the blink reflex (BR) and the masseter inhibitory reflex (MIR) in parkinsonian patients, as indices of the functional status of brainstem neuronal network, and abnormality level dependence on disease progression. METHODS: The investigation was conducted at the Clinic of Neurology, Clinical Center Nis, comprising a group of 60 subjects of both sexes, suffering from idiopathic Parkinson's disease in I-IV stages, according to the Hoehn and Yahr scale. The control group included 30 healthy subjects of both sexes and corresponding age. Testing of the patients was performed during the "on" phase by registering MIR and BR. RESULTS: Latency of polysynaptic R2 and R2' blink reflex responses and latency of polysynaptic S2 response, as well as a silent period of MIR, are linearly shortened in the subjects with PD, and more expressed in the subsequent stages of the disease compared to the control group. CONCLUSION: There is a positive correlation between the applied neurophysiological tests results and clinical stage of PD.

Diagnostic value of neurophysiological tests in the diagnosis of brain death--do we need changes in national guidelines?

For a final diagnosis of brain death one needs particular proof that the brain has fully stopped functioning. In this respect, diagnostic tests need to be used to confirm the clinical findings. Since in different countries there are various national guidelines for the determination of brain death, the aim of this study is to point to the diagnostic value of electroencephalography (EEG) and evoked potentials (EP) in verifying brain death. The need is emphasized for the two methods to be used in combination, and, accordingly, for the current national guidelines to be changed in our country and also in other countries round the world.