Neurology for Practice - Latest articles
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Cognitive dysfunction in secondary progressive multiple sclerosisReview articles
MUDr. Radek Ampapa
Neurol. praxi. 2022;23(3):221-226 | DOI: 10.36290/neu.2021.094 
Cognitive dysfunction is among the less frequently investigated and diagnosed signs in multiple sclerosis (MS). Standard diagnostic processes used in routine neurological practice fail to sufficiently consider cognitive impairment. Cognitive dysfunction is more common in progressive MS variants and can have a significant impact on the patient's quality of life. Secondary progressive MS is a difficult-to-treat condition. Siponimod is the first drug which, in patients with secondary progressive MS, has been shown to reduce the progression of disability while having a positive effect on cognitive functions. Cognitive monitoring can prospectively be a...
Breastfeeding and multiple sclerosisReview articles
MUDr. Eva Meluzínová
Neurol. praxi. 2022;23(3):217-220 | DOI: 10.36290/neu.2022.033
Multiple sclerosis (MS) is a chronic autoimmune and neurodegenerative disease affecting the brain and spinal cord. Most often the disease begins between the ages of 20-30 and occurs three times as often in women. Treatment is initiated early, preferably after the first symptom of the disease. In patients of childbearing age, it is advisable to choose a drug that is safe after conception. The period of pregnancy has a favourable effect on the course of the disease, with a decrease in activity in most cases. In stable patients, therapy is discontinued. If patients have unplanned pregnancy and the disease is not stable, therapy with certain drugs can...
Sleep related breathing disorder in neuromuscular diseasesReview articles
doc. MUDr. David Kemlink, Ph.D.
Neurol. praxi. 2022;23(3):211-216 | DOI: 10.36290/neu.2022.038
Numerous conditions from the group of neuromuscular diseases lead at some point to weakness of respiratory or upper airway musculature, which is most prominent in supine position. These conditions most frequently result in obstructive sleep apnea or sleep related hypoventilation, central sleep apnea is diagnosed less often. Most typical daytime symptoms are excessive daytime sleepiness, cognitive problems, or body weight changes, whereas nighttime symptoms are dominated by periodic snoring, sleep fragmentations and morning headache. The precise identification of the disorder frequently requires polysomnographic investigation. Most frequent therapeutic...
Paroxysmal sleep-related eventsMain topic
MUDr. Petr Bušek, Ph.D., MUDr. Jitka Bušková, Ph.D.
Neurol. praxi. 2022;23(3):203-210 | DOI: 10.36290/neu.2022.007
There is a wide range of different paroxysmal motor events with various aetiology during sleep. The most important issue in their evaluation is to distinguish epileptic seizures from other sleep disorders. Sleep-related epileptic seizures are relatively frequent and they may occur predominantly or exclusively during sleep in approximately 12 %. The most frequent seizure type during sleep is a focal hyperkinetic seizure in the frame of the sleep-related hypermotor epilepsy (SHE), previously known as nocturnal frontal lobe epilepsy, which is a heterogeneous group in terms of aetiology and localization of epileptic focus. The differentiation of SHE from...
Continuous positive airway pressure (CPAP) - 40 years of effective conservative obstructive sleep apnea treatmentMain topic
prof. MUDr. Karel Šonka, DrSc., MUDr. Simona Dostálová, Ph.D., MUDr. Jana Vyskočilová
Neurol. praxi. 2022;23(3):198-202 | DOI: 10.36290/neu.2022.005
Continuous positive airway pressure (CPAP) is an effective treatment for moderate and severe obstructive sleep apnea (OSA) that improves OSA symptoms, reduces the health consequences of OSA, and improves the patient's quality of life. Sufficient compliance and proper CPAP settings are required to achieve the therapeutic effect of CPAP. This treatment should be supplemented with other methods of OSA treatment, especially weight reduction. The principle of CPAP was described by Colin Sullivan in 1981, and many technical improvements have subsequently been made to facilitate its application and improve compliance. The discovery of CPAP is one of the milestones...
Daytime sleepiness in a neurologist's officeMain topic
doc. MUDr. Eva Feketeová, PhD.
Neurol. praxi. 2022;23(3):192-197 | DOI: 10.36290/neu.2022.010
Daytime sleepiness (DS) poses a serious risk to the affected individual in the form of difficult employment and reduced quality of life and, depending on its cause, also metabolic and cardiovascular consequences. The work analyzes the nature of sleepiness depending on its cause, diagnostic procedures and therapeutic options. On the example of five case reports points out the differences in clinical manifestation of sleepiness in narcolepsy type 1, Klein-Levin syndrome, epilepsy, multiple sclerosis and osmotic demyelinating syndrome, it demonstrates the application of diagnostic and therapeutic options in clinical practice.
Sleep apnea in patients with ischemic strokeMain topic
doc. MUDr. Pavel Šiarnik, PhD., prof. MUDr. Branislav Kollár, PhD.
Neurol. praxi. 2022;23(3):188-191 | DOI: 10.36290/neu.2022.006
Sleep-disordered breathing is a significant risk factor for cerebrovascular diseases. Sleep apnea syndrome is common among patients with stroke and negatively influences outcomes of patients. However, most cases of sleep apnea in patients with stroke remain undiagnosed and patients are losing potential benefits of positive airway pressure therapy. In this article, we focus in detail on the specific aspects of epidemiology, etiopathogenesis, diagnostic process, and therapy of sleep apnea syndrome in stroke patients. We also deal with the relationships and connections between these two separate nosological units.
Poruchy spánku a neurologická onemocněníMain topic
prof. MUDr. Karel Šonka, DrSc.
Neurol. praxi. 2022;23(3):187 | DOI: 10.36290/neu.2021.079
Hemostyptika u pacientů s rupturou aneuryzmatu
NE!Controversy
doc. MUDr. Aleš Hejčl, Ph.D., prof. MUDr. Martin Sameš, CSc.
Neurol. praxi. 2022;23(2):176-178 | DOI: 10.36290/neu.2022.025
Hemostyptika u pacientů s rupturou aneuryzmatu
ANO!Controversy
MUDr. Jan Vinklárek, prof. MUDr. Robert Mikulík, Ph.D.
Neurol. praxi. 2022;23(2):174-175 | DOI: 10.36290/neu.2022.024
Uncommon association of two anatomical variants of cerebral circulation: fetal-type posterior cerebral artery and Percheron artery as the cause of paramedian thalamomesencephalic strokeCase report
MUDr. Milan Maretta, MUDr. Norbert Leško, prof. MUDr. Zuzana Gdovinová, CSc., FESO, FEAN
Neurol. praxi. 2022;23(2):171-173 | DOI: 10.36290/neu.2020.080
Paramedian bilateral thalamic ischemia often leads to different clinical presentation, the differential diagnosis of which includes several possible causes. The major features are unconsciousness, hypersomnia, ocular and neuropsychiatric disorders. In addition to the clinical manifestations, neuroradiological findings can also lead to diagnosis. Thrombosis of so-called Percheron artery is presumed cause. In this case report we would like to present a patient with clinical and radiological diagnosis of bilateral paramedian thalamic stroke due to thrombosis of Percheron artery in coincidence with an anatomical vascular anomaly of the posterior cerebral...
A long way to a right diagnosisCase report
MUDr. Iveta Koščová, MUDr. Zuzana Gregová, MUDr. Miloslav Dvorák, PhD.
Neurol. praxi. 2022;23(2):166-170 | DOI: 10.36290/neu.2020.102
We present a case report of a 64-year-old patient with cervical myelopathy who was transferred to our department from the Department of Neurosurgery for appearance of left-sided internuclear ophthalmoplegia and facial palsy. The following MR of the brain excluded a possible stroke. Laboratory samplings and lumbar punctures performed repeatedly during hospitalization together with paraclinic examinations, which helped us to reach out the final diagnosis of neuroborreliosis.
Sentinel lesion and significance of rebiopsy: a case of primary CNS lymphomaCase report
MUDr. Dominik Drobisz, MUDr. Petr Skalický, MUDr. Adam Pavličko, prof. MUDr. Radoslav Matěj, Ph.D., MUDr. Kateřina Benešová, CSc., prof. MUDr. David Netuka, Ph.D., doc. MUDr. Robert Rusina, Ph.D.
Neurol. praxi. 2022;23(2):161-165 | DOI: 10.36290/neu.2020.052
We show a case study of a 72-years old woman who firstly presented with left side brachiofacial paresis, dysarthria and headache. MR brain scan revealed a lesion in right frontal lobe with radiological findings typical for a brain lymphoma. Biopsy of this lesion was diagnostically inconclusive with unspecific inflammatory changes. MR scan performed after the biopsy showed substantial regression of the firstly found lesion and 2 new lesions, with similar radiological characteristics as the one which regressed, each one in a different hemisphere. We therefore present a case of a sentinel lesion. In our case no corticoid therapy was given before the surgery....
Autistic patient in a (paediatric) neurologist's practiceCase report
MUDr. Alena Zumrová, Ph.D.
Neurol. praxi. 2022;23(2):155-160 | DOI: 10.36290/neu.2021.001
Autism spectrum disorders (ASDs) are manifested in the area of social interactions, communication, and behaviour. The diagnosis of autism is to be made by an experienced psychologist or psychiatrist who has had long expertise in this field, using a specialized psychological-psychiatric testing which involves at least two standardized methods. However, every ASD patient should undergo comprehensive evaluation in order to ascertain either the aetiology of the symptoms or the comorbidity obscured by autistic symptomatology. The diverse diagnoses that can cause autistic symptoms in a patient are documented by three entirely different case reports from...
Fingolimod treatment of multiple sclerosis at any ageReview articles
doc. MUDr. Radomír Taláb, CSc., MUDr. Marika Talábová
Neurol. praxi. 2022;23(2):146-154 | DOI: 10.36290/neu.2021.045
Fingolimod was approved in Europe until the 2nd line of treatment for relapsing multiple sclerosis in children and adult patients. It is also recommended in the first line for a highly active form of multiple sclerosis. The results of phase 2, phase 3 (TRANSFORMS, FREEDOMS) and phase 3b (LONGTERMS) clinical trials are presented, which evaluate longitudinal efficacy, safety and MR data of fingolimod in real clinical practice. The fundamental benefit of long-term collection of clinical data from real clinical practice is highlighted, which complemented data on the efficacy and safety of fingolimod and the reduction of the most common adverse...
The significance of correct algorithm of the diagnostics and treatment of migraine in the prophylactic treatment against calcitonin gene-related peptideReview articles
MUDr. Rudolf Kotas, Ph.D., MUDr. Ondřej Slach, MUDr. František Jelínek, MUDr. Jolana Mračková, Ph.D.
Neurol. praxi. 2022;23(2):138-145 | DOI: 10.36290/neu.2022.018
The paper describes the algorithm of the diagnostics and treatment of migraine which in indicated cases will lead to the initiation of modern prophylactic treatment directed against calcitonin gene-related peptide (anti-CGRP therapy). At first it is necessary to perform the correct differential diagnosis of migraine attacks from other acute primary or secondary headaches. In the next part the algorithm of the treatment of migraine is described. In few frequent uncomplicated migraine attacks the care of general practitioner is sufficient who should except prescription of acute antimigraine drugs actively follow the frequency of attacks and consumption...
Benign fasciculation syndromeReview articles
MUDr. Petr Ridzoň
Neurol. praxi. 2022;23(2):133-136 | DOI: 10.36290/neu.2021.075
Fasciculations are one of the uncommon but potentially serious neurological symptoms and can occur in a variety of neurological and other diseases or conditions. They can arise for many different reasons: from metabolic-endocrine (calcium and magnesium metabolism disorder, hyperthyroidism), through drug side effects (succinylcholine, depolarizing muscle relaxants, acetylcholin inhibitors, salbutamol) to serious neurological diseases (ALS/MND, neuropathy, root syndromes, borreliosis). They are often the result of increased neuromuscular irritability during excessive use of stimulants (caffeine, tein) or increased anxiety, or after sudden physical overload....
Treatable lysosomal storage disorders with movement disorder manifestationsMain topic
MUDr. Alexandra Lacková, doc. MUDr. Matej Škorvánek, PhD.
Neurol. praxi. 2022;23(2):124-131 | DOI: 10.36290/neu.2022.022
Lysosomal storage disorders are a group of inherited metabolic disorders caused by mutations in genes encoding soluble lysosomal hydrolases, leading to the progressive accumulation of undegraded macromolecules in vital organs and tissues. Phenotypically, these disorders are characterised by a wide range of clinical symptoms with a combination of visceral, ocular, haematological, skeletal and neurological manifestations, with involvement of the extrapyramidal system being particularly common. Significant progress has been made in the treatment of these diseases in recent years, focusing on various innovative therapeutic approaches. The aim of this review...
GLUT1-deficiency syndromeMain topic
MUDr. Ján Necpál, MUDr. Bibiána Jeleňová
Neurol. praxi. 2022;23(2):120-123 | DOI: 10.36290/neu.2021.076
GLUT1-deficiency syndrome is a rare neurometabolic brain disorder caused by disruption of glucose transport across the blood-brain barrier. As brain almost completely depends on glucose supply as the main source of energy, and the GLUT-1 represents the main transporter of glucose across the blood-brain barrier, the classic form of the disease manifests by severe consequences of neuroglycopenia: early neurodevelopmental encephalopathy with seizures, acquired microcephaly, cognitive deficit and various persistent or paroxysmal motor (often complex in nature) features such as ataxia, spasticity or dystonia. The evidence of low glucose cerebrospinal fluid...
Treatable CNS disorders with brain metal accumulationMain topic
MUDr. Petr Dušek
Neurol. praxi. 2022;23(2):115-119 | DOI: 10.36290/neu.2021.084
Some neurological diseases caused by accumulation of iron in CNS are treatable. If the initiation of treatment is early, neurological symptoms may be reversibile. The best results are achieved when the treatment is started before the manifestation of neurological symptoms. In this chapter we summarize the clinical features, diagnosis and treatment strategies in treatable diseases with the accumulation of copper (Wilson's disease), calcium (hypoparathyroidism), manganese (SLC30A10 and SLC39A14 transporter deficiency) and iron (aceruloplasminaemia).
Treatable inherited metabolic disorders with extrapyramidal manifestation in childrenMain topic
doc. MUDr. Miriam Kolníková, PhD., MUDr. Dominika Kovárová, MUDr. Patrícia Balážová, MUDr. Silvia Radová
Neurol. praxi. 2022;23(2):108-112 | DOI: 10.36290/neu.2021.082
Inherited metabolic disorders are often manifested by movement disorders that are more or less expressed in the clinical presentation. They can be hyperkinetic: dystonia, chorea, athetosis, myoclonus, tremor stereotypies or hypokinetic: hypokinetic-rigid syndrome. Diagnosis of these diseases is often very difficult, because of the fact that the same movement disorder can be caused by various diseases. To our current knowledge, more than two hundred inherited metabolic disorders associated with movement disorders have been registered so far. In half of these diseases two or more symptoms are present, the most common of which are ataxia and dystonia....
Liečiteľné vzácne extrapyramídové ochoreniaMain topic
MUDr. Ján Necpál
Neurol. praxi. 2022;23(2):107 | DOI: 10.36290/neu.2021.081
Slovo úvodemEditorial
Prof. MUDr. Ivan Rektor, CSc.
Neurol. praxi. 2022;23(2):103 | DOI: 10.36290/neu.2022.021
Slovo úvodemEditorial
prof. MUDr. Ivan Rektor, CSc., FCMA, FANA, FEAN
Neurol. praxi. 2022;23(1):3
MUDr. Jan Hromada Obituary
Ivan Rektor
Neurol. praxi. 2022;23(1):98
Prof. MUDr. Zdeněk Kadaňka, CSc., osmdesátiletýLaudatio
Josef Bednařík
Neurol. praxi. 2022;23(1):97
Hereditary chorea with a tendency to insanity and adult onset: 150 years since George Huntington and his diseaseFrom the History of Neurology
MUDr. Ján Necpál, MUDr. Michal Patarák, PhD.
Neurol. praxi. 2022;23(1):93-96 | DOI: 10.36290/neu.2022.015
Huntington's disease is a rare autosomal dominant incurable neurodegenerative disease, manifested by dementia, behavioral symptoms, chorea and other motor features. The disease bears his name after George Huntington (1850-1916), representing the third generation physician of Huntington´s family, working in East Hampton on the east part of Long Island, New York. Here, since his childhood, he could see several patients with a hereditary disease, described by him in a paper entitled "On chorea", published in The Medical and Surgical Reporter in 1872. In this article, he characterized chorea from the clinical point of view, and also the three main features...
Neck-tongue syndromeCase report
MUDr. Michael Pipka, MUDr. Pavel Mencl
Neurol. praxi. 2022;23(1):90-92 | DOI: 10.36290/neu.2020.083
Neck-tongue syndrome is a rarely occurring disease which is included and defined in the International Classification of Headache Disorders (ICHD-3). The clinical manifestations of neck-tongue syndrome (NTS) are sudden-onset headache at the back of the neck and sensory-motor signs due to impairment of tongue innervation, occurring as a result of vigorous head movement. In the clinical practice, the diagnosis is made by exclusion, that is after ruling out more frequent and potentially more serious conditions, particularly vascular pathologies (pre/intracerebral artery dissection and subarachnoid haemorrhage). The treatment predominantly involves nonpharmacological...
Rehabilitation in post-Covid-19 patients (specifically those with multiple sclerosis)From the boundary of neurology
Mgr. Klára Novotná, Ph.D., MUDr. Ingrid Menkyová, prof. MUDr. Eva Kubala Havrdová, CSc.
Neurol. praxi. 2022;23(1):84-89 | DOI: 10.36290/neu.2022.004
The article introduces the options of rehabilitation interventions that can be used to restore function and fitness after Covid-19 disease in patients with a chronic neurological disease - multiple sclerosis. Two individual case reports of patients are included to discuss the use of respiratory physiotherapy as well as the issue of restoring mobility and increasing fitness in post-Covid-19 patients.
Analgesics in neurology, their specific fealures and adverse effectsReview articles
MUDr. Dana Halbichová
Neurol. praxi. 2022;23(1):76-83 | DOI: 10.36290/neu.2021.093
Each one of us has a lot of experience with pain management and painkillers, both professional and personal. The goal of this article is therefore to only point out what the specifics, advantages, risks and interactions of the representatives of individual groups are. It is not possible to encompass a complete summary of those - some of them are even not registered in the Czech Republic (flupirtine, nefopam) for pain management. In our country, methadon is a newly approved drug for the treatment of severe pain which cannot be influenced by non-narcotic painkillers. Co-analgetics are mentioned only peripherally, despite the fact that they are an inseparable...