The aim of the study was to establish relation between hemorheological disturbances and the degree of pathological changes in patients with ischaemic cerebral stroke as well as to examine the dynamics of changes in blood and plasma viscosity during hospitalization and treatment. The patients were divided into two groups according to ischaemic changes extent recognized on the basis of tomogram and clinical examination: group I--ten patients at the age of 64 +/- 11.8 years with hemiparesis and with hypodense cerebral foci several mm in diameter; group II--eight patients at the age of 65 +/- 10 years with hemiplegia and more severe course of disease. The hypodense foci in the brain were several centimetres Blood viscosity measurements were carried out by Brookfild's viscometer using cone-plate system and plasma viscosity by Ubbelohd's capillary viscometer at the temperature of 37 degrees C. Apart from rheological examinations, blood morphological measurements, ESR and biochemical examinations, such as sugar blood concentration, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides and total serum proteins were performed. It was found that in patients in the group II both viscosity of whole blood and plasma as well as corrected viscosity were significantly higher. What is more, degree of rheological disturbances of blood and plasma was related to severity of the course of the disease. Observation of the dynamics of changes in rheological parameters showed that rheological parameters of blood and plasma during hospitalization and treatment improved along with recovery.
Electrocardiographic abnormalities in patients with epilepsy are related to the presence of discharges in central autonomic structures and the effect of antiepileptic drugs. These patients are at risk for sudden unexpected death, and cardiac arrhythmias are one of the most probable causes related to it.The heart rate (HR) assessment recorded on electrocardiography (ECG) in the interictal period in patients with newly diagnosed and previously treated epilepsy, depending on the type of changes in electroencephalography (EEG) and the treatment option.Fifty patients with epilepsy were enrolled in the study: 22 comprised a non-treated patient (NTP) group with newly diagnosed epilepsy and 28 comprised a treated patient (TP) group that had been treated for more than 2 years. Resting ECG and EEG were performed in all patients.A significantly higher HR was recorded in the TP group compared to the NTP group (80±13 vs 67±15 bpm, p=0.00006). The tendency to higher HR was observed in polytherapy patients, carbamazepine patients and in patients with a focus in the right hemisphere.There is a relationship between the presence of the disorders related to bioelectric activities of the brain and the heart, therefore the ECG should be periodically monitored in epileptic patients.
In Poland, the prevalence of cardiovascular diseases is increasing. This might be associated with the constantly growing proportion of elderly people and inappropriate cardiovascular prevention. This study aimed to evaluate the frequency of use of oral antiplatelet (OAP) and oral anticoagulant (OAC) drugs among older people in Poland and to assess their association with cardiovascular risk factors. The study was based on data collected during the implementation of a multicentre, publicly funded research project called PolSenior. The study group consisted of 4,979 people with the average age of 79.35 ± 8.69 years. Among them, 1,787 people (35.9%) used at least one drug in the prevention of cardiovascular diseases. OAPs were used regularly by 1,648 (33.1%) elderly people and OACs were used by 165 elderly people (3.3%). Acetylsalicylic acid was used by 32.2% of elderly people. Use of drugs significantly depended on age (p < 0.01), sex (p < 0.01), place of residence (p < 0.001), level of education (p < 0.0001) and personal income (p < 0.0001). Among all the respondents treated with OAPs, therapy was applied as secondary cardiovascular prevention in 717 respondents (43.5%), and as primary prevention in 705 respondents (42.8%). Among the respondents treated with OACs, 117 (71%) elderly people had a history of atrial fibrillation. Secondary cardiovascular prevention should be considered in a further 482 respondents (15.1% of untreated elderly people), and primary cardiovascular prevention in 1,447 respondents (45.3%). Our study is the first to determine the frequency of use of OAP and OAC drugs among elderly people in Poland in relation to cardiovascular risk factors. The most commonly used drug for cardiovascular prevention is acetylsalicylic acid, but it appears that it is used too rarely in high-risk patients. Educational programs should be developed among general practitioners concerning current recommendations for pharmacological cardiovascular prevention.
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system with unclear pathogenesis. Among other clinical manifestations, sexual dysfunction (SD) is a common but still underreported and underdiagnosed symptom of the disorder. SD in MS patients may resultfrom a complex set of conditions and may be associated with multiple anatomic, physiologic, biologic, medical and psychological factors. SD arises primarily from lesions affecting the neural pathways involved in physiologic function. In addition, psychological factors, the side effects of medications and physical symptoms such as fatigue, muscular weakness, pain and concerns about bladder and bowel incontinence may also be involved. Since MS primarily affects young people, SD secondary to MS may have a great impact on quality of life.Thus, maintaining a healthy sexual life with MS is an important priority.
The relationship between the prevalence of multiple sclerosis (MS) and sunlight's ultraviolet radiation was proved. Oxidative stress plays a role in the pathogenic traits of MS. Melatonin possesses antioxidative properties and regulates circadian rhythms. Sleep disturbances in MS patients are common and contribute to daytime fatigue. The aim of study was to evaluate 5 mg daily melatonin supplementation over 90 days on serum total oxidant status (TOS), total antioxidant capacity (TAC) and its influence on sleep quality and depression level of MS patients. A case-control prospective study was performed on 102 MS patients and 20 controls matched for age and sex. The Kurtzke's Expanded Disability Status Scale, magnetic resonance imaging examinations, Athens Insomnia Scale (AIS), Beck Depression Inventory questionnaires were completed. Serum TOS and TAC levels were measured. We observed higher serum levels of TOS in all MS groups, while after melatonin treatment the TOS levels significantly decreased. The TAC level was significantly lower only in mitoxantrone-treated group and it increased after melatonin supplementation. A strong positive correlation between T1Gd(+) number lesions and TAC level in interferon-beta-1A group was observed. AIS group mean score above 6 defining insomnia were observed in interferon-beta-1B-group, glatiramer acetate-group and mitoxantrone-group: 6.62 ± 2.88, 8.45 ± 2.07, 11.1 ± 3.25, respectively. After melatonin treatment the AIS mean scores decrease in glatiramer acetate-group and mitoxantrone-group achieving 5.25 ± 1.14 and 7.08 ± 2.39, respectively (p < 0.05). Finding from our study suggest that melatonin can act as an antioxidant and improves reduced sleep quality in MS patients.
Mild head injury constitutes about 75% of all head injury cases. The post-concussion syndrome usually following a mild head injury is connected with numerous symptoms and not very severe signs. Research findings indicate that the symptoms related to mild head injuries persist for over 6 months in most patients. Accumulating evidence provided by neuropathological, physiological, psychological and neuroimaging studies pointing to an organic substrate of the postconcussion syndrome invalidates the "Hollywood head injury myth". No information is available on Doppler evaluation in patients with mild head injury. The aim of the study was to evaluate blood flow in selected precranial and intracranial vessels using Doppler ultrasonography in patients at various stages after mild head injuries. The dynamic assessment of blood flow velocity and pulsatility index was carried out in 51 patients on the day of the injury, on the third day, and the sixth day. Moreover, 22 patients were assessed at a follow-up six months to five years the injury. The control group consisted of 61 healthy volunteers. Obtained results show an increase in the blood flow velocity in the middle cerebral artery on the day of the injury and a decrease within the following days in younger patients (aged < 30 yrs). In older persons (aged > 30 yrs) and patients with injuries sustained in a distant past, the indices of blood flow velocity in precranial and intracranial arteries did not significantly differ from these in the control group of comparable age. In our opinion mild head injury affects the blood flow velocity in cerebral arteries. The haemodynamic disturbances noted in younger patients with mild head injuries seem to be connected with changes in the autonomous nervous system activity.
The aim of the study was to evaluate the prevalence of resistance to acetylsalicylic acid (ASA), used for secondary prevention of stroke, including the assessment of risk factors associated with the lack of ASA anti-aggregatory action.Patients after a transient ischaemic attack (TIA) or ischaemic stroke in the acute (n = 111) and chronic phase (n = 87) were enrolled in the study. The assessment of platelet function was performed by whole blood impedance aggregometry using a multi-channel platelet function analyser (Multiplate).A proper response to ASA was found in 121 patients (61.1%) (ASA responders), a partial response to ASA in 59 patients (29.8%) (ASA partial responders), and ASA resistance in 18 patients (9.1%) (ASA non-responders). Acetylsalicylic acid resistance was observed more frequently in the chronic phase. The mean low-density lipoprotein (LDL) concentration was higher in ASA non-responders (p = 0.02). The mean heart rate (p = 0.03) and the mean haematocrit (p = 0.03) were higher in the group of ASA partial responders and ASA non-responders. Angiotensin II receptor antagonists were more often used in the group of ASA partial responders and ASA non-responders (p = 0.04). Diuretics were more rarely used by ASA non-responders, whereas fibrates were more rarely used by ASA partial responders.The method enabled the detection of ASA resistance in some patients with cerebrovascular disease. The study revealed some possible risk factors of ASA resistance: long ASA therapy, increased heart rate, higher LDL concentration, and higher haematocrit value. The relationship between the effect of ASA and other medications (angiotensin II receptor blockers, fibrates, diuretics) requires further study. Platelet function monitoring should be considered in patients at a greater risk of ASA resistance.
Osteoporosis is a generalized skeletal disease characterized by low bone mass and leading to an increased fracture risk. It is classified by the World Health Organization as one of the main civilization diseases. Given the aging society, its significance is continuously increasing. There is also a number of neurological disorders predisposing to osteoporosis, such as poor mobility, exposure to corticosteroids, epilepsy and some rare congenital diseases. The present paper reviews literature concerning osteoporosis in the mentioned disorders and gives a diagnostic and therapeutic algorithm in chronic therapy with corticosteroids. Quoted studies show poor neurologists' vigilance regarding the possibility of osteoporosis in their patients and the need for improvement.
The Churg-Strauss syndrome (CSS) is a systemic vasculitis. The symptoms of CSS normally occur between the ages of 20 and 40. We present a case of a 60-year-old man with the CSS evolving in three phases. The initial symptoms included bronchial asthma and inflammation of the ethmoid sinuses. Later, the patient was diagnosed with peripheral blood eosinophilia, pulmonary changes, skin changes and neurological symptoms that progressed to multiple mononeuropathy. Electrophysiological tests confirmed progressive damage of the peripheral nervous system. An improvement of the patient's neurological state was observed after application of corticosteroids and rehabilitation. CSS is one of the causes of multiple mononeuropathy and should be taken into account in differential diagnosis. In patients with bronchial asthma, hypereosinophilia and progressive damage of many nerves, the syndrome is diagnosed in accordance with the criteria defined by the American College of Rheumatology.
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