Polymorphisms of paraoxonase 1 and 2 genes and the risk of multiple sclerosis in the Polish population.

BACKGROUND AND PURPOSE: The aim of this study was to test the hypothesis that polymorphisms of the paraoxonase genes PON1 and PON2 may be associated with increased risk of developing multiple sclerosis (MS) in the Polish population. MATERIAL AND METHODS: We studied the significance of the PON gene polymorphisms C311S, A162G, Q192R and L55M in 221 patients (including 145 women) with MS and in 661 healthy controls. In the MS population, mean Expanded Disability Status Scale score was 2.92, mean age was 36.8 years, and mean disease duration was 7.7 years. PON genotyping was determined using polymerase chain reaction and restriction enzyme digestion. RESULTS: According to our results, the PON1 and PON2 genotypes distribution did not differ between the MS patients and the controls. CONCLUSIONS: The polymorphisms of the PON genes studied are not related to increased risk of MS in the Polish population.

Incidence and case fatality rates of first-ever stroke - comparison of data from two prospective population-based studies conducted in Warsaw.

BACKGROUND AND PURPOSE: According to official statistics, the stroke mortality rate has remained high in Eastern European countries for a few decades. It has been shown that also in Poland stroke mortality failed to decline in the period 1984 to 1992. Since that time, stroke management in our country has changed, especially in the cities, where stroke units have been developed. The aim of the present study was to compare incidence and case fatality rates, estimated on the basis of two prospective population-based studies performed in Warsaw in 1991/1992 and 2005. MATERIAL AND METHODS: Incidence rates and case fatality rates for the first-ever-in-a-lifetime stroke have been estimated on the basis of two population-based studies: the Warsaw Stroke Registry (population 182 649) conducted in 1991 and 1992, and the European Register of Stroke (population 120 186) - registration in 2005. In both studies data were standardized to the European population by the direct methods. RESULTS: Contrary to the incidence rates, which did not change significantly between 1991/1992 and 2005, 30-day and 1-year case fatality rates decreased significantly from 43% to 14.9% and from 59.7% to 33.1%, respectively. CONCLUSIONS: Comparison of data from two population-based prospective stroke registries showed that stroke case fatality and mortality significantly decreased. This may be associated with the better management of patients in the acute phase of stroke and implementation of secondary prevention strategies for stroke.

Common carotid artery dissection in the course of acute aortic dissection De Bakey type I.

Extracranial artery dissection is a rare finding. It may be the result of acute aortic dissection. We present the case of a 50-year-old patient admitted to Department of Neurology CSK MSWiA with signs of transient ischaemic attack. Both computed tomography (CT) and magnetic resonance imaging revealed no ischaemic changes within the central nervous system. The ultrasonography revealed dissection of the right common carotid artery, brachiocephalic trunk and aorta. Acute aortic dissection De Bakey type I was confirmed on CT scans of the chest and abdomen. Emergency cardiosurgery was performed because of acute aortic valve insufficiency, threatening infarction in the territory of the right coronary artery and heart tamponade. During the surgery the false aortic lumen was closed and the ascending graft was implanted. Short- and long-term outcome was good. Neither neurological symptoms nor cardiovascular insufficiency was observed within 9 months of follow-up.

Serum kynurenic acid positively correlates with cardiovascular disease risk factor, homocysteine: a study in stroke patients.

KYNA, an antagonist of ionotropic glutamate receptors and alpha7 nicotinic receptors, has been found as well in the brain as in the periphery. The altered metabolism of KYNA, especially its deficiency, can lead to the enhanced glutamate-mediated excitotoxicity, and was suggested to be a factor contributing to the development of neurodegeneration and seizures. Elevated serum concentration of homocysteine is considered to be an independent risk factor of atherosclerosis and is an emerging risk factor of cognitive dysfunction and stroke. In the present study, serum level of KYNA, homocysteine and other biochemical parameters were assessed in patients at early (up to 24 h after infarct) stage of stroke. Serum KYNA and homocysteine levels were similar in control (N = 26) and stroke (N = 24) groups. KYNA level correlated positively with the level of homocysteine in control and in stroke group, with p = 0.018; r = 0.462 and p = 0.027; r = 0.451, respectively. In control group, KYNA correlated positively also with age (p = 0.007; r = 0.514) and with creatinine level (p = 0.002; r = 0.581). In stroke group, serum KYNA correlated positively with creatinine (p = 0.001; r = 0.644) and with urea level (p < 0.001; r = 0.716). Homocysteine level correlated inversely with folate level in control (p = 0.01; r = -0.499) but not in stroke group (p = 0.13; r = -0.317). Serum homocysteine in stroke group correlated positively also with age (p = 0.001; r = 0.6401), and with urea level (p = 0.017; r = 0.4813). Clinical significance of the association between serum KYNA and homocysteine levels requires further investigation.

Recurrent cerebral infarcts as the first manifestation of infection with the HIV virus.

There is an increased risk of stroke in patients with HIV infection. One of the mechanisms is production of anticardiolipin (aCL) antibodies, induced by the virus. Many studies have documented a high incidence of aCL antibodies in patients with HIV infection and the increased risk of stroke, although there is no such correlation with other viruses that also stimulate production of aCL antibodies. Probably the HIV virus also stimulates production of other serum proteins, which together with aCL antibodies make procoagulation complexes, similar to the primary anticardiolipin syndrome. We present a case of a 40-year-old patient, hospitalized three times in our department because of recurrent ischemic strokes. Diagnostic tests revealed a high titre of anticardiolipin antibodies and the early stage of HIV infection. Recurrent ischemic strokes were the first manifestation of HIV infection in this patient.

[Difficulties in the diagnosis in the case of subacute paraplegia in a woman with Addison-Biermer disease]. / Trudnosci diagnostyczne w przypadku podostrej paraplegii u kobiety z choroba Addisona-Biermera.

The following paper presents a case of presently rare serious and non-typical subacutely progressing neurological complications in Addison-Biermer disease in a period before the diagnosis, and effective treatment with vitamin B12 in the advanced process of the nervous system impairment. The patient was a 52-year-old woman with the following (increasingly severe) symptoms occurring over a period of 5 weeks, after an earlier non-related operation: paresis of lower limbs (up to paraplegia), slight paresis of upper limbs, sphincters disorder, numbness and the loss of sensation in the upper and lower limbs, and finally mental deterioration. The woman was admitted to a neurological clinic with the suspected Guillain-Bare syndrome. After an interview and medical examination, with the help of some additional tests and resulting clinical picture, it was diagnosed as the Addison-Biermer disorder. A typical treatment was started with vitamin B12 injections, with a neurological improvement within a week, and further gradual improvement over the following 5 weeks of treatment in the clinic (improvement in the strength, sensation in the limbs, functionality of the sphincters, and normalization of the cognitive functions). After 2 months of continuous pharmacological treatment and physical rehabilitation, the patient started to walk with the help of a walker, and after further 2 months, she was able to walk on her own with a crutch.

Plasma homocysteine level and the course of ischemic stroke.

Increased level of homocysteine (Hcy) in blood seems to influence negatively the course of ischemic stroke (IS), the possible mechanism of this action could be acceleration of oxidative stress. The aim of this study is to assess the influence of Hcy level in patients with IS on the prognosis 3 months after the stroke onset. 75 patients aged 68.27 +/- 12.62 years, with the diagnosis of first ever IS were examined. Patients with the symptoms corresponding with TACS at the beginning of stroke and with diminished level of consciousness were not included. The level of Hcy over 15 micromol/l was assessed as mild hiperhomocysteinemia (MHcy). 74 (98.7%) patients were assessed 3 months after IS onset in the Rankin scale. Recovery was assessed, according to Rankin Scale: good recovery (GR) 0-2, bad recovery (BR) 3-5 and death. MHcy was seen in 9 (14.5%) with GR and in 8 (66.7%) with BR (P = 0.0005). MHcy increases the risk of BR 11.78 times (95% CI 2.93-47.42).

CT angiography in the diagnosis of spontaneous extracerebral vertebral artery dissection.

Spontaneous vertebral artery dissection is an underrecognised cause of cerebral ischaemia, most often seen in young adult patients. For this diagnosis cerebral angiography is the most sensitive and specific method. We describe a 30-year-old, male, with cerebellar stroke, in whom spontaneous vertebral artery dissection was diagnosed. Our diagnosis was confirmed by cerebral angiography and CT angiography. In our case anticoagulation (in acute phase) was introduced subcutaneously and later continued orally. The outcome was very good with complete remission. CT angiography seems to be a promising non-invasive method for the diagnosis of vertebral artery dissection. The prognosis in the patient with this diagnosis is relatively good (if managed properly), but the disease must always be treated as serious and life-threatening.