Neurologia i neurochirurgia polska最新文献

Introduction: Multiple sclerosis (MS) is one of the most common chronic neurological diseases. It predominantly affects young adults. Recent advances in diagnostic and therapeutic approaches have led to increased recognition and reporting of the disease.

State of the art: Global MS prevalence varies significantly by region, and is influenced by environmental, genetic, and healthcare factors. Higher rates are observed in northern latitudes, which has been linked to reduced sunlight exposure and vitamin D deficiency. Advances in diagnostic tools, particularly MRI, have contributed to earlier detection and increased incidence rates.

Clinical implications: Gender and age differences in MS epidemiology highlight unique challenges in management. Women are more frequently affected, while men tend to experience a more severe disease course. Paediatric and late-onset MS forms require distinct diagnostic and treatment strategies.

Future directions: Research should prioritise understanding regional and demographic variability, the role of genetic-environmental interactions, and the long-term impact of new therapies. Improved global access to healthcare and advanced diagnostics is crucial for addressing disparities in MS management.

Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system (CNS) that is usually diagnosed between the ages of 20 and 40. Changes in the immune system also observed in cancer may suggest a higher prevalence of cancer in the MS patient population. In recent years, many highly effective immunosuppressive drugs have been introduced into disease-modifying therapy (DMT) which may be associated with a higher risk of cancer development in patients with MS. This paper presents current data on the oncological risk of individual drugs. In addition, it provides recommendations on the management for qualifying for DMT and monitoring the safety of the therapy from anoncological perspective.

Introduction: Acute kidney injury (AKI) is common in critically ill intensive care unit patients, including those with intracerebral hemorrhage (ICH). Spontaneous ICH (sICH) accounts for 10-15% of all strokes and is a significant cause of death and disability in people over 40 years of age worldwide, and the development of AKI in these patients might further worsen their outcomes. The aim of the study was to determine the incidence and risk factors for AKI, as well as short-term outcomes in patients with sICH.

Material and methods: In this single-center study, we retrospectively analyzed the data of consecutive patients diagnosed with sICH.

Results: Of the 237 patients with sICH included in the study, 13.5% developed AKI. Risk factors for AKI were as follows: severity of neurological deficit as measured by the National Institutes of Health Stroke Scale (NIHSS), larger hematoma volume, as well as higher baseline mean systolic and diastolic blood pressure. Furthermore, patients who developed AKI had higher levels of serum glucose, urea, and serum creatinine and lower estimated glomerular filtration rate (eGFR) on hospital admission. In addition, the overall and in-hospital mortality were much higher in patients with AKI than in those without AKI. Finally, adjusted regression analysis identified the in-hospital use of nephrotoxic antibiotics as a major risk factor, increasing the likelihood of AKI eightfold.

Conclusions: These findings highlight the importance of early identification of high-risk patients and careful management of nephrotoxic agents to reduce the incidence and adverse outcomes of AKI in ICH patients.

Aim of the study: This study aimed to evaluate the utility of speech acoustic analysis as a tool for diagnosing dysphagia in Parkinson's disease.

Clinical rationale for the study: Swallowing impairment is a common and potentially life-threatening symptom of Parkinson's disease (PD). Fiberoptic endoscopic examination of swallowing (FEES), considered the gold standard for dysphagia diagnosis, is often inaccessible in everyday clinical practice. Many studies highlight the link between speech and swallowing impairment in PD patients. Evaluating possible correlations between speech acoustic parameters and the presence or severity of dysphagia in PD could potentially indicate speech acoustic parameters for use in a non-invasive screening tool for swallowing impairment in PD patients.

Material and methods: This study included 40 patients with a clinical diagnosis of PD aged from 36 to 82 years. The disease duration varied from 1 to 25 years. All study participants were treated with oral medications, allowing them to achieve and maintain the best possible performance status. All study participants underwent a subjective and objective neurological examination, speech acoustic analysis, which was performed based on a standardized speech recording, and FEES, according to a specific study protocol. The obtained results were analyzed statistically.

Results: The presence of oropharyngeal dysphagia was confirmed among 92.5% of the analyzed patients. The FEES findings described in this study are consistent with the specific pattern of swallowing impairment characteristic of PD. The obtained results indicate the existence of multiple statistically significant correlations between the FEES findings and speech acoustic analysis parameters. The most important speech acoustic parameters in terms of swallowing impairment evaluation include the phonation time, efficiency coefficient, average efficiency, energy modulation depth, standard deviation of the length of the interval between segments, standard deviation of the length of the intervals between segments in the speech disfluency test, unharmonic-to-harmonic ratio (U2H), Yanagihara coefficient (YG), 1/Q, residual-to-harmonic ratio (R2H), and amplitude irregularity (APQ).

Conclusions: Speech acoustic analysis could be useful in everyday clinical practice for performing non-invasive dysphagia screening tests in PD patients, especially when an endoscopic examination is unavailable. Results obtained in the study require further validation in larger cohorts. However, if confirmed, this tool could be used to identify patients who potentially require an invasive examination of swallowing for individualized dysphagia management.

Introduction: The relationship between Parkinson's Disease (PD) and type 2 diabetes mellitus (T2DM) is attracting increasing research interest. Epidemiological data shows a remarkable association between these two age-related diseases. Evidence is emerging to suggest a common pathological pathway linking PD and T2DM, involving factors such as altered insulin signalling, insulin resistance, oxidative stress, mitochondrial dysfunction, neuroinflammation, and misfolded protein accumulation. The precise mechanisms underlying this interplay, however, remain less clear, and are likely to be bidirectional. The aim of this review was to examine the epidemiological association between PD and T2DM, summarise potential common mechanisms, and evaluate the role of antidiabetic medications in the treatment and prevention of PD progression.

Clinical implications: A deeper understanding of the shared pathophysiological pathways between PD and T2DM may pave the way for novel therapeutic approaches for patients with both diseases. Research into antidiabetic drugs, particularly GLP-1 receptor agonists, shows promise in potentially modifying the progression of PD.

Future directions: Investigation of the common pathophysiological mechanisms of PD and T2DM may lead to new treatment strategies for both diseases. Ongoing studies of the efficacy and safety of antidiabetic drugs in PD, particularly in larger populations, are essential to validate their long-term benefits and therapeutic potential.

Introduction: Parkinson's Disease (PD) is a highly heterogeneous entity in terms of clinical manifestations, progression, and treatment response. This variability has given rise to the hypothesis that different clinical subtypes of the disease exist.

State of the art: To date, several clinical subtypes have been described, mostly based on different clinical features, and sometimes with the support of biomarkers, either fluid, neuroimaging, or neurophysiological. The most homogeneous subtypes detected are a 'benign subtype', characterised by younger age at onset, mild non-motor symptoms, and a slower rate of disease progression, and a 'malignant subtype', which features an older age at onset, a higher burden of non-motor symptoms, and faster disease progression.

Clinical implications: Despite extensive research, none of the subtypes identified so far seem to be biologically supported, so clinical subtyping does not elucidate PD aetiology and does not allow for the prediction of prognosis or treatment response. This study was aimed to review the literature on this topic and to examine the studies on PD subtyping. We also reviewed the proposed biomarkers for a biological classification of PD, and outlined the role of genetics and pathology within this context.

Future directions: In light of the recent proposal of a biological classification of PD, which might overcome the limits of the clinical diagnosis, PD subtyping should hopefully shepherd researchers towards a biological approach, also aided by recent advances in the field of biomarkers.

Aim of study: The objective of this study was to identify cerebral regions specifically involved in speech comprehension for each sequentially acquired language (L1, L2, L3, L4) in multilingual individuals, and to explore the relationship between the sequence of language acquisition and its cortical representation.

Clinical rationale for study: Multilingualism is increasingly prevalent worldwide. However, the cortical representation of sequentially acquired languages remains inadequately explored. Currently, there are no established guidelines for the perioperative neurosurgical management of multilingual patients, presumably due to a lack of research on this topic.

Material and methods: Participants with a high communicative proficiency in at least three sequentially acquired foreign languages, learned after the age of three, were recruited. A passive listening paradigm was applied for this study. Brain anatomy was visualized using T1-weighted MRI, while functional brain activity (BOLD signal) was measured using echo-planar imaging. Cortical activity elicited by foreign languages (L2, L3, L4) was compared with native language (L1) and an 'unknown' (LN). Data processing and statistical analysis were conducted using SPM12 software.

Results: Twenty multilingual participants were included. A gradual decrease in left-hemisphere dominance was observed from L1 through L4. Compared to L1, L2 demonstrated increased cortical activation in the right middle temporal gyrus and left middle occipital gyrus, whereas L3 showed higher activation in the left fusiform gyrus. No areas of greater activation were identified for L4 compared to L1. Conversely, L1 showed numerous regions of heightened activation relative to subsequently acquired languages. When compared to LN, both L2 and L3 exhibited increased activity in the right insula. Additionally, L3 and L4 displayed elevated activity in the right hippocampus compared to LN.

Conclusions and clinical implications: Our study found distinct cortical localizations for sequentially acquired languages. We recommend routine perioperative cortical mapping for languages L2 and L3, in addition to L1. Mapping for L4 should be considered on a case-by-case basis. Further research into cortical areas involved in multilingual speech production is warranted.

Introduction: Pituitary metastases (PMs) are rare malignancy manifestations, generally deemed to have an extremely poor prognosis. Differential diagnosis from primary pituitary lesions is often difficult, as their features can mimic those of pituitary neuroendocrine tumours (PitNETs). This study aimed to report a single surgeon's experience in managing PMs and to gather the existing evidence on their clinical and neuroradiological presentation to build a model of 'red flags' that help raise the suspicion of PMs in the context of sellar lesions.

Material and methods: We retrieved an original 10-year surgical series of patients undergoing endoscopic transsphenoidal (TNS) surgery for suspected PitNETs, and we additionally conducted a systematic review of case reports or series of patients with PMs.

Results: The local series consisted of n = 6 PMs. The literature review yielded n = 149 works reporting n = 340 PMs. Overall, the clinical presentation and neuroradiological features of n = 346 PMs were analysed and compared to data retrieved from n = 361 PitNETs from our original cohort. Primary features associated with PMs were: the presence of headaches (OR 1.24, p = 0.001), visual field deficits (OR 1.19, p = 0.02), extraocular nerve palsies (OR 1.23, p = 0.001), diabetes insipidus (OR 2.13, p < 0.001), MRI features of pituitary stalk/infundibular involvement (OR 1.98, p = 0.001), cavernous sinus invasion (OR 1.57, p = 0.004), and T2w flow voids (OR 1.13, p = 0.001). An incidental diagnosis (OR 0.49, p < 0.001) and cystic changes (OR 0.77, p = 0.02) were less common among PMs. Secondary features involved an acute onset of symptoms (OR 1.25, p = 0.001), the presence of oncological history (OR 1.89, p = 0.001), sellar walls erosion (OR 1.55, p = 0.002), and gross appearance of a firm (OR 2.01, p < 0.001) and easily bleeding lesion (OR 1.99, p < 0.001). Sellar enlargement predicted a lower risk of PMs (OR 0.54, p = 0.001).

Conclusion: We have compiled a list of primary and secondary red flags, including clinical and neuroradiological features, to serve as a guiding tool for clinicians to raise suspicion of PMs and aid in the differential diagnosis of various lesions centered in the sella.