Zespół post-polio: Część II. Postępowanie terapeutyczne

The care of patients with post-polio syndrome ought to be carried out by a multidisciplinary team of specialists, including medical professionals, specialists of rehabilitation, psychologists and social workers. Many therapeutic strategies might be employed to reduce the late effects of polio. Today, the management of post-polio syndrome is based on non-pharmacological intervention, including lifestyle modification, decrease of physical activity, rest periods during the day and an individually tailored training program.     

Nerwiak osłonkowy nerwu strzałkowego wspólnego w obrębie dołu podkolanowego. Różnicowanie z torbielami zwyrodnieniowymi

The presented case concerns a patient with neuralgia of the common peroneal nerve and progressive neurological deficit caused by interfascicular growth of schwannoma. The ultrasound diagnostics identified the lesion as a popliteal cyst. Magnetic resonance imaging revealed features of atypical cyst location. Due to the clinical course, it was decided to decompress the nerve trunk. An interfascicular tumor was identified intraoperatively. Particular nerve bundles were separated microsurgically and the tumor of schwannoma morphology was removed. The postoperative course brought resolution of neuralgia and improvement of peroneal nerve function. In the case in question attention was focused on the differential diagnostics of processes located in the popliteal fossa. Imaging examination indicated an atypical cyst location rather than a morphologically solid tumor. The clinical course is essential for determining the nature of the lesion. Decompressing the common peroneal nerve in microsurgical technique allows the prevention of further neurological symptoms in the postoperative course.     

Udar kryptogenny – drożny otwór owalny – migrena z aurą: przypadkowa triada czy związek przyczynowo-skutkowy? Część I

In the first part of the paper we discuss the association between patent foramen ovale (PFO) and cryptogenic stroke. Patent foramen ovale is a remnant of the fetal circulation, found in about quarter of the general population. According to many authors, this common anatomical anomaly is of no or limited clinical significance. However, the results of some clinical studies suggest higher prevalence of PFO among subjects with either cryptogenic stroke or migraine with aura. To date, the answer to the question whether PFO is an independent risk factor for stroke remains equivocal. The purpose of this review is to discuss the role of PFO in pathophysiology of both symptomatic and asymptomatic ischaemic lesions and to analyze the coexisting factors that increase the risk of stroke. We also discuss the effectiveness of either pharmacological treatment or PFO closure in secondary stroke prevention.     

Zasady stosowania i mechanizm działania przezczaszkowej stymulacji prądem stałym w neurorehabilitacji: dane z badań kory ruchowej

Transcranial direct current stimulation (tDCS) is an emerging technique of non-invasive brain stimulation that has been found useful in facilitating treatment of various neurological disorders, especially stroke. Currently available criteria for single application of several minutes-long stimulation at 1–2 mA have been considered safe. However, knowledge regarding safety parameters of repeated and long-term electrical stimulation is so far limited. Studies on the use of tDCS focus predominantly on the motor cortex. They demonstrate that weak direct current is capable of eliciting cortical excitability changes which occur during and after stimulation. The nature of these changes is specific for current polarity – anodal stimulation enhances excitability, and cathodal reduces it. Studies indicate that tDCS effects are generated by polarity-driven alterations of membrane potentials and efficacy modulations of specific neuronal receptors. According to interhemispheric competition models, possible mechanisms underlying functional improvements due to stimulation in patients with stroke are attributed to tDCS-induced modification of inappropriate interhemispheric inhibition.     

Postępowanie w udarze mózgu – wytyczne Grupy Ekspertów Sekcji Chorób Naczyniowych Polskiego Towarzystwa Neurologicznego. Aktualizacja 2013: leczenie trombolityczne

Thrombolysis is the most effective therapy for ischaemic stroke. The current guidelines and approvals have limited its use to patients available for treatment within 4.5 hours of onset and those aged 80 or less. There are also a number of other limitations derived from clinical trial protocols, i.e. minor and major strokes. The available evidence has indicated its possible efficacy in patients treated within 6 hours of onset and not fulfilling other limitations.Last year, the results of the IST-3 (Third International Stroke Trial: Thrombolysis) and a meta-analysis of all available trials including IST-3 were published. They point out the possible benefit of thrombolysis in patients not meeting the current criteria, which has been acknowledged in the Polish guidelines for management of stroke.     

Neuropsykiatriska Föreningen i Finland: Dess 97:nde möte, 2. oktober 1948

Abstract

Background: Acute and transient psychotic disorder (ATPD; F23, ICD-10) is an acute, short-lived psychosis, which has variable prevalence worldwide and has not been extensively studied. Aims: To explore the first episode of ATPD in patients in Latvia by describing the clinical features, analyzing the longitudinal changes of diagnosis and associated socio-demographic characteristics. Material and Methods: Retrospective chart review of all first-time hospitalized patients fulfilling the ICD-10 criteria for ATPD treated at the Riga Centre of Psychiatry and Addiction Disorders, Latvia, during a 3-year period. Patients were followed-up and assessed using standardized instruments. Results: During a 3-year period, 294 patients were first-time hospitalized with a ATPD diagnosis; 54% were women. The average age at first psychotic episode was 35.7 ± 12.3 years for women, and 30.0 ± 10.8 years for men (P < 0.0001). Over an average of 5.6 years follow-up period, 51% of patients were not re-hospitalized. Later diagnosis was changed to schizophrenia in 73% of the re-hospitalized patients, mostly within the first 2 years of illness. The overall stability rate of ATPD diagnosis reached 58%. Typical polymorphic symptomatology, abrupt onset (i.e. within 48 h), less frequent anxiety, but more frequent hallucinations were observed in ATPD patients that later developed schizophrenia (P < 0.05). Stressful life events in the 6 months prior to the first episode were found in 44% of patients. Conclusions: Combining these assessments from first-episode ATPD patients in Latvia, with data from other countries may help to predict the development of disease and provide the possible basis for potential changes to ICD-11.     

Biological markers for anxiety disorders,OCD and PTSD – a consensus statement. Part I: Neuroimaging and genetics

Objectives: Biomarkers are defined as anatomical, biochemical or physiological traits that are specific to certain disorders or syndromes. The objective of this paper is to summarise the current knowledge of biomarkers for anxiety disorders, obsessive–compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).

Methods: Findings in biomarker research were reviewed by a task force of international experts in the field, consisting of members of the World Federation of Societies for Biological Psychiatry Task Force on Biological Markers and of the European College of Neuropsychopharmacology Anxiety Disorders Research Network.

Results: The present article (Part I) summarises findings on potential biomarkers in neuroimaging studies, including structural brain morphology, functional magnetic resonance imaging and techniques for measuring metabolic changes, including positron emission tomography and others. Furthermore, this review reports on the clinical and molecular genetic findings of family, twin, linkage, association and genome-wide association studies. Part II of the review focuses on neurochemistry, neurophysiology and neurocognition.

Conclusions: Although at present, none of the putative biomarkers is sufficient and specific as a diagnostic tool, an abundance of high-quality research has accumulated that will improve our understanding of the neurobiological causes of anxiety disorders, OCD and PTSD.