Significance of de-novo IgD and IgM synthesis in CSF of patients with relapsing-remitting form of disseminated demyelinating disease of CNS.

Disseminated demyelinating disease of the central nervous system (DDD CNS) is immunologically mediated, with confirmed significant intrathecal immunoglobulin production. According to recently known immunopathogenic occurrences and activation of humoral immune response, we have assumed that the presence of oligoclonal immunoglobulins of M and D classes can be confirmed in cerebrospinal fluid (CSF) of patients with DDD CNS. With the aim of its further determination in CSF of relapsing-remitting DDD CNS patients in either remission and relapse phase, respectively, we have confirmed the presence of oligoclonal IgD and IgM bands, the association of this production and the presence of new demyelinating zones found by MRI of endocranium, as the time elapsed from the last relapse until the obtaining of CSF for further analyses. Method of isoelectric focusing with Western blott procedure was used for the confirmation of oligoclonal IgM and IgD bands presence in CSF. Significant presence of intrathecally synthetized oligoclonal IgM and IgD in patients with DDD CNS in exacerbation phase was presented. Almost in all patients in this phase was found at least one indicator of acute phase (positive MRI finding, presence of oligoclonal IgM or IgD bands). Significant decrease of positive findings of oligoclonal Ig bands in CSF was correlated with the time elapsed from the onset of relapse until the obtaining of CSF for the analysis due to short half-life of those Ig in CSF.

[Significance of proteinuria in patients with acute ischemic brain disease]. / Znacaj proteinurije kod bolesnika sa akutnom ishemijskom bolescu mozga.

Brain vascular diseases are ranked the third as the cause of morbidity and mortality in majority of the countries of the world. In about 80% of the cases of vascular brain diseases, it is ischemic brain disease (IBD). Atherosclerosis of main cerebral arteries is most frequently responsible for the occurrence and development of IBD. In recent years it was reported for the first time of the association of atherosclerosis and/or its complications and proteinuria. Assuming that there exists the significant association between the degree of proteinuria and clinical parameters of IBD, the aim of this study was to investigate the frequency and patterns of the association of proteinuria and clinical IBD parameters. The study was performed in 180 patients with IBD of atherothrombotic origin and 60 patients with the diseases of non-vascular origin, as the control group. In all patients quantitative determination of proteinuria was performed, and in the patients with IBD was determined the degree of IBD and afterwards the degree of functional and neurologic impairment prior to and at the end of treatment in acute phase using the standardized scales. The results of the study revealed the existence of significant frequency of proteinuria in the patients with IBD, as well as the significant association between the degree of proteinuria and severity of IBD. It was concluded that proteinuria in patients with IBD was probably associated with the atherogenic processes and physiopathologic processes of IBD, respectively, which could have predictive value for the outcome of the disease in the early stage.

[Convulsion-conversion epilepsy--a problem in differential diagnosis]. / Konvulzijsko-konverzijska epilepsija--diferencijalnodijagnosticki problem.

Epilepsy is chronic, multietiologic disease of the cerebrum, with different clinical features and with frequent occurrence of emotional and psychic disorders. In this report, we presented the case of female patient, 16 years old, examined in our Clinic twice. The diagnosis of epilepsy was established on the basis of the following examinations (EEG, Holter EEG, MR of the head) and Carbamazepine was included in the therapy. Afterwards, in the patient, instead of grand mal seizures, occurred atypical nonconvulsive prolonged seizures, without postictal phenomena, and after the repeated observation, psychological confrontation and according to the bizarreness of certain seizures the case of conversional-convulsive epilepsy was confirmed, and for that reason we decided to publish this report.

[The Fahr syndrome]. / Farov sindrom.

Fahr's syndrome is a rare clinical entity consisting of certain metabolic, biochemical, neuroradiologic and neuropsychologic phenomena in which extrapyramidal phenomenology clinically dominates. In this report, primarily from educational reasons, we have presented a female patient, who was before admittance to our clinic examined in one Belgrade hospital for headache, stiffness of trunk and extremities and the diagnosis was migraine with depressive reactions. However, as the discomforts were persistent, she was admitted to our clinic and after the investigation, especially for the presence of extrapyramidal clinical phenomenology with dominantly pronounced increase of tonus with the presence of amorphous calcifications in basal ganglia on both sides it was concluded that she was suffering from Fahr's syndrome.

[Neurologic disorders in a patient with autoimmune hemolytic anemia]. / Neuroloski poremecaji kod bolesnika sa autimunskom hemolitickom anemijom.

Completely different entities might be with the same possibility in the baseline of interweaving of symptoms and signs of nervous system damage. One of them, the deficiency of vitamin B12 very frequently causes megaloblastic anemia and funicular myelosis. In the case of our patient, after the clinical picture of hemolytic anemia was revealed, by slow-progressive course was developed neurologic deficiency that, according to its features, could have the deficiency of cobalamin and folic acid in its etiologic background. On the basis of disease course, clinical finding, numerous clinical investigations so as the reaction to applied therapy it was assumed that the patient had besides confirmed autoimmune hemolytic anemia the pernicious anemia as the associated cause of anemic syndrome and the basic reason of the development of neurologic deficiency. Described is the frequent associated occurrence of pernicious anemia and antiglobulin positive hemolytic anemia, so as the significant association of pernicious anemia with the deficiency of immunoglobulins that was otherwise observed in our patient as the permanent IgA deficiency.

Oxidative and antioxidative activity in the patients with disseminated demyelinating disease of central nervous system.

Considering the basic pathologic process and current knowledge of the physiopathologic mechanisms in the active phase of disseminated demyelinating disease of central nervous system, the increase of oxidative processes was assumed in the patients with that disease in the phase of clinical impairment. The aim of the research was to study some indices of oxidative processes and activity of antioxidative enzymes in such patients. The research was performed on blood samples (erythrocyte hemolysate and plasma) and cerebrospinal fluid of 30 patients with disseminated demyelinating disease of central nervous system during the clinical impairment and during the increase of immunologic activity in intrathecal space. The patients were of younger age, in the acute phase or with the shorter disease duration (up to 3 years). Control group was formed of 12 patients examined for lesions of intervertebral disks in lumbosacral region. The research results demonstrated the increase of superoxide anion production, the elevation of lipid peroxidation followed by the increase of superoxide dismutase and glutathione reductase activation. It was concluded that the signs of simultaneous increase of oxidative processes and antioxidative activity, but also the oxidative impairment of lipid structures existed in the studied patients during the acute phase.