[Internal carotid artery dissection in the neurologist's practice - a case study]. / Rozwarstwienie tetnicy szyjnej wewnetrznej w praktyce neurologa ­ opis przypadku.

Dissection of the interior carotid artery is rare in the general population. It can however be a potentially life-threatening condition. In the group of patients below 45 years of age, it constitutes a fairly common cause of cerebral stroke. A CASE REPORT: The study describes the case of a patient with the right interior carotid artery dissection, sustained most probably in the course of work. The patient was admitted to hospital for a severe headache of a few days' duration accompanied by Horner's syndrome on the right side. Promptly undertaken diagnostic procedures allowed for immediate diagnosis and application of the right treatment. The check-up examinations performed showed a healed artery and withdrawal of the neurological syndrome. CONCLUSIONS: The case emphasizes the role of prompt diagnosis and treatment in preventing the development of more serious complications. The article refers also to the standards of treating the dissection of the interior carotid artery which still arouse controversies.

Prevalence and extent of right-to-left shunt on contrast-enhanced transcranial Doppler in patients with chronic hyperventilation syndrome: results of a case-control study.

AIM: Chronic hyperventilation syndrome (CHVS) represents a frequent but poorly understood breathing pattern disorder. In a previous small pilot study, we reported a higher prevalence of right-to-left shunt (RLS) in CHVS patients than in healthy subjects. The aim of this study was to confirm those previous results from this larger and matched case-control study, and to evaluate the prevalence and grade of RLS in patients with CHVS in whom organic and psychiatric causes were excluded. CLINICAL RATIONALE FOR THE STUDY: Determining other types of CHVS triggers not related to organic or psychiatric causes which could be clinically useful. MATERIAL AND METHODS: 100 subjects (mean age 34 ± 6 years; 80% females), including 50 patients with CHVS and 50 age- and sex-matched healthy controls (CG), were prospectively recruited into this single-centre study. Vascular RLS was diagnosed using contrast-enhanced transcranial Doppler (c-TCD). RESULTS: RLS prevalence significantly increased in the CHVS group (n = 23) compared to the CG group (n = 8) (46% vs 16%; p < 0.01). Patients with CHVS and RLS tended to have more frequent permanent shunts compared to the CG (60% vs 25%; p = 0.08), but there was no difference regarding RLS grading between the groups. CONCLUSIONS AND CLINICAL IMPLICATIONS: This study confirmed our previous findings in which the prevalence of RLS in patients with CHVS was significantly higher than in an age- and sex-matched healthy control group. However, we could not confirm the results of our prior study, where RLS was larger in CHVS than in CG. The tentative association between RLS and CHVS needs to be further examined.

State-of-the-art approach towards magnetic resonance imaging of the nervous system structures in patients with cardiac implantable electronic devices.

INTRODUCTION: MRI generated forces are the source of potential complications in patients with cardiac implantable electronic devices (CIED). The technological progress, and growing clinical evidence concerning the operation of the contemporary MR non-conditional CIEDs during MRI, have started to significantly change our every-day clinical practice. Nevertheless, a lot of patients who could have an MRI performed safely, still have been refused the examination. STATE-OF-THE-ART: In many clinical situations, an MRI examination in a patient with a CIED is reasonable, and is linked to a negligible risk of complications if performed under strict precautions. The MagnaSave Registry that evaluated the influence of nonthoracic MRI on the function of MR non-conditional CIEDs, and numerous studies involving thoracic and non-thoracic MRIs in patients with legacy CIEDs, have confirmed the feasibility and safety of such examinations. In this article, practical tips aimed towards improving the safety of MRI in MR conditional and non-conditional CIED patients are largely based on the very recently released (2017) HRS expert consensus statement. CLINICAL IMPLICATIONS: Clinical data emphasize the necessity of making the MRI more accessible to CIED patients, also in the case of MR non-conditional systems or when the thorax MR imaging is clinically reasonable. This goal should be achieved by increasing the number of centers complying with respective recommendations and applying protocols that would guarantee the highest safety level. FUTURE DIRECTIONS: Further studies are warranted to assess safety issues related to the main current contraindication to MRI, i.e., the presence of abandoned leads.

Post-polio syndrome. Cases report and review of literature.

It is estimated that around 15 million people survived polio infection worldwide since early twentieth century. In 1950 effective vaccination was used for first time. Since that time number of affected people decreased. The last epidemic of Haine-Medine disease in Poland was in 1950s. Another rare cases of infections were observed till 1970s. About at least 15 years after polio virus infection, slowly progressive muscle limbs paresis with muscle atrophy, joints pain, paresthesia were observed in polio survivors. That constellation of symptoms was called post-polio syndrome (PPS). PPS frequency among people after paralytic and nonparalytic polio infectious is ranged from 30% to 80%. Fatigue that leads to physical and mental activity deterioration is another important symptom that is observed in 90% of patients with PPS. Etiology of disease remains elusive. Probably it is an effect of spine frontal horns motoneurons damage during acute virus polio infection that leads to overloading and degeneration of remaining ones. The most important risk factors of PPS are female sex and respiratory symptoms during acute polio infection. Electromyography is an important part of PPS diagnostic process. Electrophysiological abnormalities are seen in clinically affected and unaffected muscles. The most frequent are fasciculations and fibrillations during rest activity, extension of motor unit area, time duration and amplitude. In this study we described three cases of people who developed PPS years after Haine-Medine disease and correlation between their EMG results and clinical status. We also analyzed electromyography results both after one month since first PPS signs occurred as well as after few years. Presentation of dynamic changes in EMG was the most important aim of that study.

[Patient with Creutzfeld-Jakob disease - a case report]. / Patient with Creutzfeld-Jakob disease ­ a case report.

Creutzfeldt-Jakob disease (CJD) is a rare syndrome of central nervous system caused by infectious protein called prion. There are four types of CJD: sporadic (sCJD), familial (fCJD), jatrogenic (jCJD) and variant (vCJD). The most frequent symptoms are rapidly progressing dementia, mioclonias, akinetic mutism and signs of cerebellum dysfunction. In sCJD, MRI often shows high signal intensity in the putamen and caudate nucleus on T2-weighted images while in vCJD pulvinar sign is often observed. 70% patients with CJD often has characteristic generalized periodic sharp wave pattern in electroencephalography. In case of 90% patients with CJD 14-3-3 protein is present in cerebrospinal fluid. Neuropathological studies play an important role in disease diagnosis. CJD incidence is 0.5-1 on 1000000 people but some cases can be undiagnosed. Presented study is a description of woman with sCJD confirmed with histopathological study. Since childhood patient had psychotic symptoms and behavior disturbances. Patient wasn't diagnosed due to this symptoms. Few months before admission to hospital her condition was getting worse. Symptoms of cerebellum, pyramidal and extrapyramidal system occurred. In cerebrospinal fluid 14-3-3 protein was detected. In EEG and MRI changes specific for sCJD was observed. After three months patient died.

Limbic encephalitis - a report of four cases.

Usually limbic encephalitis (LE) is a paraneoplastic neurologic syndrome. LE symptoms can precede cancer even by a few years. Almost 50% of LE cases are connected with small cell lung carcinoma. Testis and breast cancers, granulomatous disease, thymoma, and teratomas are also often connected with LE. Other cases have infectious and autoimmunological aetiology. In LE limbic system dysfunction is observed, and it is accompanied by cerebellum and brain stem abnormalities as well as polyneuropathy. Paraneoplastic limbic encephalitis is sometimes a part of larger syndrome in which brain stem and spinal cord are involved in an inflammatory process called paraneoplastic encephalomyelitis. The main LE symptoms are: impairment of cognitive functions with subacute beginning, partial and generalised seizures, mental distress, disturbances of consciousness, and limb paresis. In MRI study hyperintensive lesions in the medial part of the temporal lobes in T2 and FLAIR sequences are present. Sharp and slow waves in electroencephalography in the temporal area are also frequent. In cerebrospinal fluid pleocytosis, elevation of protein level, intensification of immunoglobulin synthesis, and oligoclonal bands can be detected. The majority of patients with paraneoplastic LE have onconeural antibodies in the blood. The presented study is a description of the clinical course of the disease in four patients diagnosed with LE.

BLOOD COUNT IN PATIENTS WITH MULTIPLE SCLEROSIS TREATED WITH MITOXANTRONE IN SHORT TIME OBSERVATION.

Multiple sclerosis (MS) is an inflammatory, demyelinating disease that affects the central nervous system. Etiology of MS is undiscovered but it is assumed that both genetic and environmental triggers play an important role in disease pathogenesis. Mitoxantrone (MTX) is an antracycline antibiotic that is used in oncologic treatment of breast, prostate, liver, ovarian and stomach cancer. MTX is also effective in treatment of primary and secondary progressive multiple sclerosis and in relapsing - remitting subtype of disease with no reaction for other drugs therapy. In treatment of MS drug is given intravenously in a dose of 12 mg/m2 in three months intervals to maximal dose of 120-140 mg/m² of body surface. MTX treatment can cause transient reduction of leukocyte, erythrocyte and thrombocyte number in blood but the most dangerous side effect of MTX treatment is therapy related acute leukemia (TRAL). The aim of this study was to evaluate influence of MTX treatment on complete blood count in multiple sclerosis patients. Seventy two patients with multiple sclerosis treated with mitoxantrone from 2002 to 2014 took part in this study. Control group comprised 60 patients with multiple sclerosis who weren't given immunomodulatory treatment. In this study, amount of leukocytes, erythrocytes and thrombocytes after MTX treatment was compared to those before treatment and in control group. Six patients were withdrawn from the study because of leucopenia. A decrease of leukocytes, erythrocytes and thrombocytes number after MTX treatment was observed in comparison to control group and value before treatment. The decrease of erythrocytes number after MTX treatment was statistically significant. The most frequent side effect of mitoxantrone treatment is transient, asymptomatic leucopenia. Therapy related acute leukemia and other life-threatening complications weren't observed in the study group.

[Cervical dystonia treatment with botulin toxin]. / Cervical dystonia treatment with botulin toxin.

Cervical dystonia is the most common form of dystonia in adult age. It is characterized by involuntary muscle contractions that cause abnormal movements and positioning of the head and neck. Symptoms of it are often associated with pain. This distinguishes this form from other dystonia. The drug of choice is botulinum toxin. It effectively reduces both pain and abnormal excessive muscle activity. In some cases, particularly where there is not obtained the full recovery after treatment botulinum toxin we used drugs for systemic effect. To increase the effectiveness and reduce the side effects of botulinum toxin more commonly we used administration of toxin under the EMG and ultrasound control.

[Mitoxantrone role in treatment of primary progressive multiple sclerosis]. / Role mitoksantronu w leczeniu postaci pierwotnie postepujacej stwardnienia rozsianego.

Multiple sclerosis is a chronic, autoimmunological disease of central nervous system in which axonal damage in brain and spinal cord is observed. It is second most common cause of disability in young adults in West Europe and North America after injuries. There is 2.5 million people suffered from multiple sclerosis worldwide. The worse prognosis is connected with primary progressive MS in which recovery after first symptoms of central nervous system damage isn't observed. That subtype of disease is seen in case of 10-20% people with MS. MTX is a synthetic antracycline with antineoplastic, immunomodulatory and anti-inflammatory effects. Drug was allowed to treatment of leukemia. It is also used in treatment of breast, prostate, ovarian, stomach and liver cancer. Additionally MTX is used in treatment of secondary progressive SM and relapsing - remitting subtype of disease with no respond to treatment with interferon beta and glatiramer acetate. MTX inhibits topoisomerase II activity, matches to DNA molecule and damage her structure. Drug inhibits limphocyte T, B and macrophages activity and antibodies synthesis. The most dangerous side effects of MTX treatment are cardiotoxicity and induction of leukemia. There is lack of studies describing MTX effectiveness and safety in treatment of primary progressive SM.

[Evaluation of repetitive transcranial magnetic stimulation effectiveness in treatment of psychiatric and neurologic diseases]. / Ocena skutecznosci powtarzalnej przezczaszkowej stymulacji magnetycznej w leczeniu chorób psychiatrycznych i neurologicznych.

Repetitive transcranial magnetic stimulation (rTMS) is a treatment option with proved effectiveness especially in drug resist depression. It is used in functional brain mapping before neurosurgery operations and diagnostic of corticospinal tract transmission. Many studies are performed to evaluate rTMS using in treatment of obsessive - compulsive disorder, schizophrenia, autism, strokes, tinnitus, Alzheimer and Parkinson diseases, cranial traumas. Moreover rTMS was used in treatment of multiple sclerosis, migraine, dystonia. Electromagnetical field generated by rTMS penetrate skin of the scalp and infiltrate brain tissues to a depth of 2 cm, cause neurons depolarization and generating motor, cognitive and affective effects. Depending on the stimulation frequency rTMS can stimuli or inhibit brain cortex. rTMS mechanism of action remains elusive. Probably it is connected with enhancement of neurotransmitters, modulation of signals transductions pathways in Central Nervous System, gene transcription and release of neuroprotective substances. Studies with use of animals revealed that rTMS stimulation can generate brain changes similar to those seen after electric shock therapy without provoking seizures. The aim of presenting study was to analyze actual researches evaluating rTMS use in treatment of psychiatric and neurological diseases.

[Post-polio syndrome - a case report]. / Zespól post-polio - opis przypadku.

Post-polio syndrome occurs 30-40 years after polio virus infection. The main symptoms of PPS are slowly progressive muscle limbs paresis with muscle atrophy, joints pain, paresthesia. In 90% of patients the main symptom is fatigue that leads to physical and mental activity deterioration. The cause of disease remains unknown. Probably it is an effect of motoneurons damage during acute virus polio infection, their overloading and degeneration of remaining ones. In this study we described a case of man who developed PPS 36 years after Heine-Medin disease. The main symptom was intensification of right limb paresis and muscle atrophy. In electromyography there were damage features of muscle clinically affected and unaffected. Changes in lifestyle made possible to continue occupational activity.

[Amyothropic neuralgy of lumbosacral plexus - case report]. / Neuralgia amiotroficzna splotu ledzwiowo-krzyzowego - opis przypadku.

Amyothropic neuralgy is a rare disease witch unknown etiopathogenesis. The main popular theory says that inflammatory and immunomodulatory process is connected with that disease. Diagnosis is made after exclusion of other causes of plexus lumbosacralis damage. The main symptom is neuropathic pain after which there is observed muscle weakness and atrophy. ENG/EMG study and MRI are made to confirm the diagnosis. In this study we described a case of 52 years old female with lower limbs paresis, who was diagnosed few years after first symptoms. Limb paresis was preluded by lumbar pain. MRI study revealed central spinal disc herniations on L1-2, L2-3, L3-4 levels with dura matter compression, L4-5 spinal disc right lateral herniation and synovial cyst. MRI of both lumbar plexuses was also normal. EMG study revealed features of bilateral, chronic damage of lower legs nerves on lumbar plexus level. Patient was treated with physiotherapy and gabapentin with dose of 2x600mg per day.

The occurrence of tumors of the central nervous system in a clinical observation.

UNLABELLED: Brain tumor is an abnormal growth of cells in central nervous system (CNS). The most common primary brain tumors are: gliomas, meningiomas, pituitary adenomas and craniopharyngiomas. The secondary group are metastatic tumors. About 25% patients with cancers have metastasis to CNS. AIM: The aim of this study was to evaluate the most common symptoms and localization of brain tumors, time from first symptoms to diagnosis and patients' survival rate. MATERIALS AND METHODS: In this retrospective study 106 patients with primary and metastatic brain tumors hospitalized in Military Institute of Medicine from 2007 to 2012 year were investigated. RESULTS: The most common cause of metastases to brain is non-smallcell lung carcinoma. The most frequent symptom of brain tumor is headache but very often patients have seizures, vomits, arms and legs weakness. The mean time of life for patients with gliomas was 9 month and 13 days for patients with brain metastases. CONCLUSIONS: It occurred that patients with primary and secondary brain tumors lived shorter than it is described in literature. In group of patients with metastases to brain 60% had one or two brain tumors so they could be treated with surgery and prognosis for them was better.

[Stiff person syndrome--case report]. / Zespól sztywnosci uogólnionej--opis przypadku.

Stiff person syndrome (SPS) is the rare disease and cause great inefficient. It is characterized by progressive stiffness muscles of trunk and the limbs on which the cramps of muscles overlap. In the electrophysiological investigation of the patients the involuntary discharge of motor unit potentials find and also simultaneous contraction agonistic and antagonistic muscles. SPS is presented with insulin-dependent diabetes mellitus often or is the symptom of the paraneoplastic syndrome. It is commonly associated with high anti-glutamic acid decarboxylaze (GAD) antibody titters in the serum of the blood of patients. Establishing the diagnosis can cause difficulties. We observed the patient in the last period about the atypical course the disease. The diagnosis was confirmed occurrences of the high titters of antibodies anti-GAD, the discharge of motor unit potential in paraspinal muscles in the rest and good response the treatment with diazepamem.

[The duration of the symptoms of carpal tunnel syndrome to the diagnosis]. / Czas trwania objawów zespolu ciesni kanalu nadgarstka do postawienia rozpoznania.

UNLABELLED: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Efficacy of the surgical treatment is dependent on the severity of median nerve injury. THE AIM OF STUDY: To determine the average duration of symptoms to diagnosis CTS. MATERIAL AND METHODS: Survey study conceming the duration of symptoms of CTS to establishing the diagnosis was conducted between 192 consecutive patients with CTS referred to the Electrophysiology Laboratory of the Military Institute of Medicine for the confirmatory EMG testing. The questionnaire included question concerning the duration of symptoms of neuropathy of the median nerve and the selected epidemiological data, i.e., gender, age, place of residence, profession, comorbidities, specialization of referring physician. Nerve conduction parameters of median and ulnarnerves were assessed by means of study ENG/EMG (amplitude, conduction velocity and final latency in motor fibers). Some of the patients had performed comparative tests of the median nerve and ulnar or radial nerves. On the basis of these values the severity of carpal tunnel syndrome was determined according to the Padua's classification. RESULTS: In the group of women surveyed duration of symptoms until diagnosis was on average 39,6 months (from 1 month to 20 years), while in men this time was on average 37.4 months (from I month to 7 years). CONCLUSIONS: The results of this study indicate that the average duration of symptoms CTS until diagnosis is long and can have a negative impact on the results of treatment.

Evaluation of motor unit potential wavelet analysis in the electrodiagnosis of neuromuscular disorders.

INTRODUCTION: Electrophysiological studies of human motor units can use various electromyographic techniques. Together with the development of new techniques for analysis and processing of bioelectric signals, motor unit action potential (MUAP) wavelet analysis represents an important change in the development of electromyographic techniques. METHODS: The proposed approach involves isolating single MUAPs, computing their scalograms, taking the maximum values of the scalograms in 5 selected scales, and averaging across MUAPs to give a single five-dimensional feature vector per muscle. After Support Vector Machine analysis, the feature vector is reduced to a single decision parameter that allows the subject to be assigned to 1 of 3 groups: myogenic, healthy, or neurogenic. The software is available as freeware. RESULTS: MUAP wavelet analysis yielded consistent results for the diagnostic index and muscle classification, with only 7 incorrect classifications out of a total of 1,015 samples. CONCLUSIONS: This proposed approach provides a sensitive and reliable method for evaluating and characterizing MUAPs.

[Fulminant adhesive arachnoiditis]. / Zlepne zapalenie pajeczynówki o piorunujacym przebiegu.

Adhesive arachnoiditis is a rare disease with insidious course. It causes damage of the spinal cord and nerve roots. The causes of adhesive arachnoiditis include earlier traumatic injury of the spinal cord, surgery, intrathecal administration of therapeutic substances (e.g. anaesthetics, chemotherapy) or contrast media, bleeding, and inflammation. It can also be idiopathic or iatrogenic. We present the case of a 42-year-old patient with fulminant adhesive arachnoiditis which was provoked by spinal surgery and caused severe neurological disability with profound, progressive, flaccid paraparesis and bladder dysfunction. The electromyography (EMG) showed serious damage of nerves of both lower limbs at the level of motor roots L2-S2 and damage of the motor neuron at the level of Th11-Th12 on the right side. Magnetic resonance imaging of the lumbosacral and thoracic part of the spinal cord demonstrated cystic liquid spaces in the lumen of the dural sac in the bottom part of the cervical spine and at the Th2-Th10 level, modelling the lateral and anterior surface of the cord. Because of the vast lesions, surgery could not be performed. Conservative treatment and rehabilitation brought only a small clinical improvement.

[Myopathy in the course of carnitine palmitoyltransferase II deficiency]. / Miopatia w przebiegu niedoboru palmitylotransferazy karnityny II.

Congenital deficiency of carnitine palmitoyltransferase (CPT) II is a disease with an autosomal recessive inheritance of phenotypic variability which depends on age at the onset of symptoms. Three entities associated with deficiency of CPT II are known: the perinatal, the infantile and the adult form. The perinatal disease is the most severe form and is invariably fatal. On the other hand, the adult CPT II clinical phenotype is benign and requires additional external triggers such as high-intensity exercise to provoke myopathic symptoms. We report a case of adult CPT II deficiency presenting with the subtle symptoms of myopathy. A 32-year-old man was admitted to the hospital complaining of muscle pain after exercise. Athletic appearance drew attention, because the patient denied practicing sport. Neurological examination revealed marked tiredness during the single-leg hop test without other abnormalities. Electromyography (EMG) and serum biochemistry were not typical for myopathy. Routine histopathological examination did not reveal any abnormalities of structure of muscle fibers. Diagnosis was established after ultrastructural and biochemical analysis which revealed changes typical for CPT II deficiency.

[The damage of the ulnar nerve on the level Guyon's canal--four cases report]. / Uszkodzenie nerwu lokciowego na poziomle kanalu Guyona- -opis czterech przypadków.

The damage of the ulnar nerve on a level Guyon's canal is a rare occur in clinical practice. The presence of pathology mass, injury or long-lasting pressure the most often be caused. The authors represent four patients from this syndrome, in three cases the damage the long-lasting pressure of nerve was caused in neighborhood Guyon's canal, and in one injury of neighborhood of wrist. In therapeutic-rehabilitation management was recommended the avoidance the loading of adjacent of wrist. In two cases in catamnestic examination after retreat provocative factor, the symptoms of damage of ulnar nerve revealed. The principles of diagnosis and treatment in adjacent of wrist the damages of ulnar nerve in article were presented.

[Personage-Turner syndrome--case report]. / Zespól Personage-Turnera--opis przypadku.

Personage-Turner syndrome or acute brachial radiculitis is rare syndrome. In typical cases it was manifested by strong pain of shoulder region and the weakness of muscles which are supplies by individual nerves or part of brachial plexus and in longer time with atrophy. Aetiology of this disease is unknown, probably on the autoimmuno-inflammatory background. Diagnosis is made on the typical clinical picture and in exclusion many illness with impairment brachial plexus. In presented case the course of disease as well as executed investigations suggested that discopathy could be the reason of paresis, however renewed estimation caused the change of the diagnosis.