Bogusław Paradowski

Evaluation of CSF-Chlamydia pneumoniae, CSF-tau, and CSF-Abeta42 in Alzheimer’s disease and vascular dementia

The potential role of microbiological factors such as Chlamydia pneumoniae (ChP) in the pathogenesis of neurodegenerative disorders, including Alzheimer’s disease (AD) and vascular dementia (VD), has been suggested, but the correctness of this hypothesis still needs to be tested. In this study the appearance of ChP in the cerebrospinal fluid (CSF) of 57 AD and 21 VD patients and in 47 controls (CG) as well as the influence of ChP on the levels of tau protein and Aβ42 were investigated. The frequency of ChP occurrence in the AD patient group (43.9%) was significantly higher (p < 0.001) than in the control group (10.6%). In the case of VD patients, 9.5% of this group was positive for ChP. The presence of ChP DNA in the CSF of patients with AD significantly increases the occurrence of this disease (odds ratio = 7.21). Cerebrospinal fluid Aβ42 levels were significantly lower in patients with AD than in the CG (p < 0.001). Cerebrospinal tau protein was significantly higher in AD vs. CG (p = 0.007). However, no relationships between the presence of the bacterium in CSF and the level of either tau or Aβ42 protein were observed. In conclusion, we may suspect that testing for the presence of ChP in CSF, along with the tau and Aβ42 markers, may be used in the clinic diagnosis of AD.

Intraosseous hemangioma in parietal bone

A 35-year-old woman, with headaches for 6 years, was admitted to our Department of Neurology. X-ray showed an osteolytic lesion in the parietal bone, suggesting the presence of hemangioma. CT and MRI (figure) confirmed the tumor, of honeycomb-like internal structure, pressing the adjacent cortex. Neurosurgery of the tumor involved total …

The Usefulness of the TOAST Classification and Prognostic Significance of Pyramidal Symptoms During the Acute Phase of Cerebellar Ischemic Stroke.

Cerebellar stroke is a rare condition with very nonspecific clinical features. The symptoms in the acute phase could imitate acute peripheral vestibular disorders or a brainstem lesion. The aim of this study was to assess the usefulness of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification in cerebellar stroke and the impact of clinical features on the prognosis. We retrospectively analyzed 107 patients with diagnosed ischemic cerebellar infarction. We studied the clinical features and compared them based on the location of the ischemic lesion and its distribution in the posterior interior cerebellar artery (PICA), superior cerebellar artery (SCA), and anterior inferior cerebellar artery (AICA) territories. According to the TOAST classification, stroke was more prevalent in atrial fibrillation (26/107) and when the lesion was in the PICA territory (39/107). Pyramidal signs occurred in 29/107 of patients and were more prevalent when the lesion was distributed in more than two vascular regions (p = 0.00640). Mortality was higher among patients with ischemic lesion caused by cardiac sources (p = 0.00094) and with pyramidal signs (p = 0.00640). The TOAST classification is less useful in assessing supratentorial ischemic infarcts. Cardioembolic etiology, location of the ischemic lesion, and pyramidal signs support a negative prognosis.

Plexiform neurofibromas of the brachial plexuses

A 47-year-old woman was admitted to our Neurology Department with a 13-year history of slowly progressing atrophy and weakness of the upper extremities, and numerous masses in the supraclavicular regions. MRI examination (figure) revealed plexiform neurofibromas of …

Vertebral artery dissection and stroke after scuba diving

Sir, A 27‐year‐old man without past medical history developed vertigo and gait imbalance two hours after diving in cold water. The magnetic resonance imaging revealed ischemic lesion in the right side of medulla oblongata in the area of right posterior inferior artery (PICA). Computerized tomography‐angiography (CTA) showed right vertebral artery (VA) dissection [Figure 1a and b]. Six months later patient had no symptoms and the neurological examination was normal. The follow‐up magnetic resonance examination showed partial regression of the previous ischemic lesion and the CTA revealed normal right VA [Figure 1c and d]. The association An unusual cause of low backache: Lumbar interspinous bursitis

Three Cases with Visual Hallucinations following Combined Ocular and Occipital Damage

Charles Bonnet syndrome is an underrecognized disease that involves visual hallucinations in visually impaired patients. We present the cases of three patients who experienced complex visual hallucinations following various pathomechanisms. In two cases, diagnosis showed coexistence of occipital lobe damage with ocular damage, while in the third case it showed occipital lobe damage with retrobulbar optic neuritis. Theories of pathogenesis and the neuroanatomical basis of complex visual hallucinations are discussed and supported by literature review.

Cognitive Impairment in Parkinson s Disease

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder with characteristic clinical motor features combined with non-motor symptoms. Cognitive impairment has a very significant impact on the patient’s quality of life. The risk of developing dementia is six times higher in PD patients than in general population and increases with longer duration of the disease. Objectives: The aim of this study is to assess cognitive impairment in PD patients and its characteristics and to explore the correlation between duration of the disease, its stage, and neuroimaging of the brain. Material and methods: The study involved 64 patients with clinical diagnosis of PD established on the basis of the UKPDS BB criteria. Patients with PD were subdivided into two groups: patients with disease duration under five years and over five years. Participation in the study included taking medical history, collecting information on the course of the disease and its treatment, identification of comorbidities, and neurological examination. A neuropsychological assessment was carried out for all the patients and included: MMSE, CDT, verbal fluency test (both semantic and phonemic tasks) and, in part, the ADAS-cog test. The examination also included the BDI (Beck Depression Inventory) test. CT and MRI scans were performed of PD patients in order to assess atrophy of the brain and hippocampus. Results: Most of the PD patients suffer from visuospatial and semantic fluency dysfunctions. The level of cognitive impairment in PD is dependent on the patient’s age and the motor symptom severity assessed using the H-Y scale. We observed a clear relationship in PD between cognitive impairment and atrophy of the hippocampus, temporal and parietal lobes, and vascular lesion. Conclusion: Cognitive function impairment appears in Parkinson’s patients without diagnosed dementia. The executive functions are especially affected with the level of impairment dependent on the patient’s age and the degree of movement impairment.

Cerebral venous thrombosis as a diagnostic challenge: Clinical and radiological correlation based on the retrospective analysis of own cases

BACKGROUND Cerebral venous thrombosis (CVT) is a rare condition which constitutes 0.5-1% of all strokes. The clinical and radiological picture of CVT is non-specific and can mimic other disorders. OBJECTIVES The aim of the study was to retrospectively evaluate and correlate clinical and radiological symptoms presented by patients with CVT, both in the initial and follow-up neurological and neuroimaging examinations, with a special emphasis on diagnostic difficulties. MATERIAL AND METHODS Material consisted of 11 patients with CVT (7 women, 4 men). The average age was 43.5, ranging from 23 to 69 years. Clinical symptoms, laboratory findings, risk factors and the results of neuroimaging examinations including CT, MRI and DSA were retrospectively analyzed and correlated. RESULTS All subjects developed superficial CVT and 1 also deep CVT, with no parenchymal lesions in 2 cases, non-hemorrhagic infarctions in 3 and hemorrhagic lesions in 6 subjects. The most frequent symptoms were headache, seizures and hemiparesis. The major risk factors were hormonal therapies in women and congenital thrombophilia. Factors influencing the clinical course and outcome the most were location and type of brain lesions, with hemorrhagic cortical infarctions bringing the worst prognosis and being associated with the highest rate of persistent neurological deficits, despite the rate of vessel recanalization. CONCLUSIONS In our opinion, quick diagnosis before parenchymal hemorrhagic lesions are visible on CT is of crucial importance and requires a constant alertness and good cooperation of neurologists and radiologists, especially in emergency settings.