Contrast-induced encephalopathy.

Contrast-induced encephalopathy (CIE) is a rare complication of the intravascular application of a contrast agent. CIE can be manifested by headache, cortical blindness, consciousness disorders, seizures, or focal neurological deficit. Neurological symptoms are typically transient with temporary abnormal findings on a brain scan. Urgent neuroimaging is important to obtain the correct diagnosis, especially in cases that require an acute management and treatment. We present a case of CIE after a digital subtraction angiography of the vertebral arteries in the patient with a symptomatic pre-occlusive stenosis of the posterior cerebral artery (Ref. 36). Text in PDF www.elis.sk Keywords: encephalopathy, iodixanol, contrast agent, cortical blindness, cerebral angiography.

The age at onset in Multiple Sclerosis is associated with patient's prognosis.

BACKGROUND: The causes of the individual differences in the rate of disability progression in multiple sclerosis (MS) are still not completely clear. According to the long-term prognosis of MS patients, the search for new valuable prognostic markers of "benign" or "malign" MS is necessary. OBJECTIVES: Our aim was to assess the possible association of MS onset age with the disease disability progression rate in Slovak patients with MS. METHODS: By the unique pattern of evaluation of disability progression rate using Multiple Sclerosis Severity Score (MSSS), each of 270 MS patients was defined as slow-progressing, mid-rate progressing or rapidly progressing. RESULTS: We found a significant differences in the age at onset between MS patients with different rate of disability progression (p(K-W)<0,00005). The faster was a disability progression assessed by MSSS score, the higher was the MS onset age. CONCLUSION: We showed for the first time in Central European Slovak population that MS onset age is an early marker that is in the positive correlation with disease disability progression rate, evaluated by MSSS score. We conclude that relapsing-remitting MS patients older at clinical onset have a higher risk of unfavorable prognosis (Tab. 2, Fig. 1, Ref. 21).

Hypothalamic damage in multiple sclerosis correlates with disease activity, disability, depression, and fatigue.

OBJECTIVES: Disturbances in the hypothalamo-pituitary axis are supposed to modulate activity of multiple sclerosis (MS). We hypothesised that the extent of HYP damage may determine severity of MS and may be associated with the disease evolution. We suggested fatigue and depression may depend on the degree of damage of the area. METHOD: 33 MS patients with relapsing-remitting and secondary progressive disease, and 24 age and sex-related healthy individuals (CON) underwent 1H-MR spectroscopy (1H-MRS) of the hypothalamus. Concentrations of glutamate + glutamin (Glx), cholin (Cho), myoinositol (mIns), N-acetyl aspartate (NAA) expressed as ratio with creatine (Cr) and NAA were correlated with markers of disease activity (RIO score), Multiple Sclerosis Severity Scale (MSSS), Depressive-Severity Status Scale and Simple Numerical Fatigue Scale. RESULTS: Cho/Cr and NAA/Cr ratios were decreased and Glx/NAA ratio increased in MS patients vs CON. Glx/NAA, Glx/Cr, and mIns/NAA were significantly higher in active (RIO 1-2) vs non-active MS patients (RIO 0). Glx/NAA and Glx/Cr correlated with MSSS and fatigue score, and Glx/Cr with depressive score of MS patients. In CON, relationships between Glx/Cr and age, and Glx/NAA and fatigue score were inverse. CONCLUSION: Our study provides the first evidence about significant hypothalamic alterations correlating with clinical outcomes of MS, using 1H-MRS. The combination of increased Glu or mIns with reduced NAA in HYP reflects whole-brain activity of MS. In addition, excess of Glu is linked to severe disease course, depressive mood and fatigue in MS patients, suggesting superiority of Glu over other metabolites in determining MS burden.

Tumefactive demyelination of the spinal cord: a case report.

STUDY DESIGN: Case report. OBJECTIVES: We report on a 52-year-old male patient with tumefactive demyelination of the spinal cord. SETTING: University Hospital and Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia. BACKGROUND: In contrast to relatively frequent tumefactive fulminant lesions in the brain, cases affecting the spinal cord in isolation have been reported less frequently. METHODS: Description of the case report. RESULTS: Clinical, neuroradiological and necropsy findings are described in a 52-year-old man with tumefactive fulminant demyelination of the spinal cord. Progression of the demyelination process produced paraplegia, mild paresis of the right upper limb, neurogenic bladder and sensitive loss over 2 weeks. MRI scans revealed several ovoid lesions in cervical segments and tumefactive T2-hyperintense signals with oedema and post-contrast enhancement located in thoracic segments Th3 to Th6. Cerebrospinal fluid (CSF) examination displayed lymphomonocytic pleocytosis with normal proteinorhachia, positive CSF oligoclonal IgG bands (OCB) and elevated IgG index (1.55). Serum anti-AQP4-Ab was not tested. Stored frozen CSF samples were later repeatedly examined with negative findings of anti-AQP4-Ab. Treatment with high-dose methylprednisolon and plasma exchange had limited effect. Immunosuppressive medication was interrupted because of an acute urinary infection. The patient died suddenly because of pulmonary embolism as a secondary complication. Histopathology of the spinal cord confirmed active demyelination. We considered that tumefactive demyelination could be a variant of neuromyelitis optica. CONCLUSION: Our case could be anti-AQP4-Ab-negative longitudinally extensive transverse myelitis, a variant of neuromyelitis optica.

Clinical correlations of proton magnetic resonance spectroscopy findings in acute phase after mild traumatic brain injury.

INTRODUCTION: Standard brain magnetic resonance imaging (MRI) is typically normal in most patients after mild traumatic brain injury (MTBI). Proton magnetic resonance spectroscopy (¹H-MRS) is more sensitive to detect subtle post-traumatic changes. The aim of the study was to evaluate the clinical correlations of these changes in the acute phase (within 3 days) after MTBI. METHODS: Twenty-one patients with MTBI and 22 controls were studied. Both groups underwent neuropsychological testing and single-voxel ¹H-MRS examination of both frontal lobes and upper brainstem. RESULTS: Significant decrease in NAA was found in both frontal lobes and in NAA/Cre ratio in the right frontal lobe (p < 0.05). Correlation analysis showed a correlation of NAA in the left frontal lobe with Backward Digit Span (p = 0.022) and Stroop test A (p = 0.0034) and a weak correlation with TMT B time (p = 0.046). The NAA/Cre in the right frontal lobe correlated with Stroop test A (p = 0.007) and with the total score of Digit Span (p = 0.016). Lower NAA was found in the upper brainstem (p = 0.0157) in the sub-group of patients with post-traumatic unconsciousness. CONCLUSIONS: This study found a correlation of ¹H-MRS metabolite changes with cognitive decline and presence or absence of loss of consciousness in the acute phase after MTBI.

[Risk factors for ischemic heart disease in the offspring of persons with a history of early onset of this disease]. / Rizikové faktory ischemické choroby srdecní v potomstvu osob anamnesticky zatízených casným výskytem této choroby.

The investigation was focused on assessment of the frequency of risk factors for the development of ischaemic heart disease (IHD)--hyperlipoproteinaemia, smoking, arterial hypertension and obesity--in the offspring of subjects suffering from the disease before the age of 55 years. Among grade I 126 offspring they recorded in 6.4% hyperlipoproteinaemia, in 29.4% smoking, in 2.4% arterial hypertension and in 16.7% obesity. The author draws attention to the fact that almost 40% of the offspring under 35 years of age of subjects with a history of early IHD have at least one risk factor for the development of the disease. These subjects are a high group which should be screened and followed up within the framework of primary prevention of cardiovascular diseases.

[Risk factors in persons with early manifestations of ischemic heart disease and in their offspring. I. Hyperlipoproteinemia]. / Rizikové faktory u osob s casnou manifestací ischemické choroby srdecní a u jejich potomku. I. Hyperlipoproteinémie.

In a group of 70 probands affected with ischaemic heart disease before the age of 55 years and in their 126 grade I and 8 grade II offspring the ratio of risk factors of the disease was assessed. In the first part of the investigation attention was focused on the frequency of hyperlipoproteinaemias. Elevated total cholesterol and/or triacylglycerols were found in 41% of the probands and 6.4% of the grade I offspring. The most frequently diagnosed type of hyperlipoproteinaemia in probands as well as their offspring was hypertriacylglycerolaemia. Twenty-five per cent of the hyperlipoproteinaemic probands had also a hyperlipoproteinaemic grade I offspring. The author emphasizes that early active screening of offspring of subjects suffering from ischaemic heart disease in young age is essential, in particular those where one of the risk factors is hyperlipoproteinaemia.

[Risk factors in persons with early manifestations of ischemic heart disease and in their offspring. II. Additional risk factors]. / Rizikové faktory u osob s casnou manifestací ischemické choroby srdecní a u jejich potomku. II. Dalsí rizikové faktory.

In a group of 70 probands treated on account of ischaemic heart disease manifested before the age of 55 years and in the grade I and II offspring the presence of other risk factors of the disease was assessed--smoking, arterial hypertension, obesity and diabetes mellitus. This part II is a continuation of the previous paper where the ratio of hyperlipoproteinaemias in the group was assessed. The probands comprised 62.9% smokers, 25.7% hypertonic subjects, 68.6% obese subjects and 20% diabetics. Risk factors were found only in grade I offspring--29.4% smokers, 2.4% hypertonic subjects and 16.7% obese subjects. The author emphasizes the fact that almost 40% of the offspring under 35 years of age with a family-history of early ischaemic heart disease have at least one risk factor of the disease.