Posttraumatic visual agnosia and epilepsy as a consequence of gunshot injury to the head. Case report

Half million people in the world, each year have a gunshot injury to the head and eighty thousand of them are hospitalized. Gunshot injuries to the head have became in Poland second most frequent cause of death from head trauma, and in some countries during peace became the most frequent cause of death among patient with head injury. Glasgow Coma Scale (GCS) is a useful prognostic factor for patients with gunshot injury to the head. Injury to the eloquent regions of the brain, commotion and contusion of the brain, intracranial hematomas, subarachnoid hemorrhage, cerebro-vascular spasm, injuries to the major vessels, liquorrhea, infections, coagulopathies and epilepsy are the most important and influential factors in the clinical status of the patient with gunshot injury to the head. The operation is the preferred treatment to all patient, no matter of their clinical status at the moment of the admission. The report presents the history of treatment of a patient with gunshot injury to the head. During the treatment extremely infrequently occurring posttraumatic visual agnosia and posttraumatic epilepsy were observed. Twenty-two months after operation the patient is independent and professionally active.     

Familial occurrence of FXTAS caused by premutation in the FMR1 gene

The FMR1 gene premutation has recently been reported to be associated with a neurodegenerative syndrome, characterized by intention tremor, gait ataxia and cognition deficits in persons older than 50 years. We present a 74-year-old man with very severe intention tremor, slight postural tremor and gait ataxia. The molecular analysis revealed that he was a carrier of 91 CGG repeats in the FMR1 gene. His sister (68 years old), with head tremor, was found to be a carrier of 81 CGG repeats, while his younger brother, also with slight head and postural tremor, was a carrier of 98 CGG repeats. Molecular analysis of the proband's asymptomatic daughter revealed an expansion over 120 CGG. Her daughter, with mild intellectual disability, was a carrier of a full mutation. Thus, in the presented family with heterogeneous clinical presentation we found 4 premutations and one full mutation in the FMR1 gene.     

Subthalamic deep brain stimulation for the treatment of Parkinson disease

Background and purposeThe role of subthalamic nucleus deep brain stimulation (STN DBS) in the treatment of Parkinson disease (PD) is well established. The authors present a group of patients diagnosed with PD who were treated with STN DBS.Material and methodsBetween 2008 and 2009, 32 female and 34 male patients with PD were treated with STN DBS. Mean age at implantation was 57 ± 12 years. PD lasted from 6 to 21 years (mean 10 years). Patients were qualified for the surgery according to the CAPSIT-PD criteria. The STN was identified with direct and indirect methods. Macrostimulation and microrecording for STN identification were used in all cases. A unilateral STN DBS system was implanted in two cases and bilateral implantation was performed among rest of the group. Outcome was assessed six months after implantation.ResultsThe mean reduction of UPDRS III score among 51 patients who underwent follow-up was 45% (5-89%). Reduction of levodopa consumption varied from 15 to 100%. Infection forced the authors to remove the DBS system in one case four months after implantation. Skin erosion above the internal pulse generator was noted in four cases.ConclusionsCardinal symptoms of Parkinson's disease can be safely and effectively treated with STN DBS in selected group of patients.     

Spinal tumours: recommendations of the Polish Society of Spine Surgery,the Polish Society of Oncology,the Polish Society of Neurosurgeons,the Polish Society of Oncologic Surgery,the Polish Society of Oncologic Radiotherapy,and the Polish Society of Orthopaedics and Traumatology

Purpose

The purpose of these recommendations is to spread the available evidence for evaluating and managing spinal tumours among clinicians who encounter such entities.

Methods

The recommendations were developed by members of the Development Recommendations Group representing seven stakeholder scientific societies and organizations of specialists involved in various forms of care for patients with spinal tumours in Poland. The recommendations are based on data yielded from systematic reviews of the literature identified through electronic database searches. The strength of the recommendations was graded according to the North American Spine Society’s grades of recommendation for summaries or reviews of studies.

Results

The recommendation group developed 89 level A-C recommendations and a supplementary list of institutions able to manage primary malignant spinal tumours, namely, spinal sarcomas, at the expert level. This list, further called an appendix, helps clinicians who encounter spinal tumours refer patients with suspected spinal sarcoma or chordoma for pathological diagnosis, surgery and radiosurgery. The list constitutes a basis of the network of expertise for the management of primary malignant spinal tumours and should be understood as a communication network of specialists involved in the care of primary spinal malignancies.

Conclusion

The developed recommendations together with the national network of expertise should optimize the management of patients with spinal tumours, especially rare malignancies, and optimize their referral and allocation within the Polish national health service system.

     

Spinal cord stimulation for the treatment of refractory angina pectoris

Spinal cord stimulation (SCS) is a well known method of treatment used worldwide since the 80's of the last century. High efficiency of SCS was observed in the treatment of various types of pain. Promising clinical results were observed in the treatment of patients with refractory angina (RA). Reduction of angina attacks reduces doses of medications and improves quality of life. SCS efficacy in RA is comparable to that observed among patients treated with cardiac surgery (CABG) and percutaneous coronary intervention (PCI), with lower risk of complications and rehospitalisation. SCS is more cost effective compared to CABG and PCI. SCS might be considered for patients who did not respond to reperfusion therapy. The mechanism of action in RA is not well understood. It is known that SCS reduces the activity of the sympathetic nervous system, by which improves the coronary perfusion and oxygenation of the heart muscle. It is important that SCS does not mask the pain related to the infarct.     

Concentration of malonic dialdehyde in the cerebrospinal fluid as a measure of the intensity of lipid peroxidation processes in intracranial hypertension in small children

The authors analyzed the concentration of malonic dialdehyde (MDA) in the cerebrospinal fluid (CSF) of children with intracranial hypertension. For the control group an intracranial pressure (ICP) of 250 mm H₂O was taken as a reference point. The concentration of MDA was determined by a method using thiobarbituric acid. In a group of children with ICP values greater than the limiting value, the concentration of malonic dialdehyde was 0.629 mmol/mg protein, while in the control group with an ICP below 250 mm H₂O, this value was 0.610 mmol/mg protein. The differences between the two groups were not statistically significant, from the results obtained it can be concluded that the concentration of MDA, as an isolated parameter, does not constitute a good measure of intensity of the lipid peroxidation processes in central nervous system (CNS) tissues, taken as an indicator of their disintegration in cases of hydrocephalus with intracranial hypertension.     

Wpływ głębokiej stymulacji mózgowej jądra niskowzgórzowego na objawy autonomiczne obserwowane w chorobie Parkinsona

Dysfunctions of the autonomic nervous system (DA) are common in Parkinson's disease (PD). DA appear in the premotor phase of PD and may antedate cardinal motor symptoms by years or decades. DA significantly impair quality of life in the majority of PD patients. DA are related to accumulation of Lewy bodies in the central and peripheral nervous system. Progression of neurodegeneration and chronic dopaminergic therapy may increase DA as well. It is accepted that bilateral deep brain stimulation of the subthalamic nucleus (STN DBS) improves motor symptoms in PD. The effect of STN DBS on DA, such as cardiovascular symptoms and urinary, gastrointestinal and sexual dysfunction in PD, is not clear. STN DBS ameliorates some DA, but others might deteriorate at the same time.