2015, Vol 15, No 4
Intracranial haemorrhage in the course of ischaemic stroke in patients receiving IV thrombolytic therapy – a study of 141 patients from Gliwice and its vicinity. An attempt to determine risk factors based on authors’ own experience
Aktualn Neurol 2015, 15 (4), p. 170–186
DOI: 10.15557/AN.2015.0023

Introduction: Systemic thrombolytic therapy using recombinant tissue plasminogen activator is a recognised method for the causative treatment of acute ischaemic stroke. The aim of this study was to determine the safety of thrombolytic treatment, the incidence of the most dangerous complication – intracranial haemorrhage and to assess its influence on the final therapeutic outcome. An additional aim was to identify risk factors. Material and methods: A total of 141 patients treated from January 2013 to June 2015 at the Stroke Unit were included in the analysis. The patients were assessed in terms of neurological deficit according to the National Institutes of Health Stroke Scale, their functional status using the modified Rankin Scale and Brunnstrom motor ability scale. A multivariate analysis of different risk factors for intracranial haemorrhage was performed. Results: Symptomatic intracranial haemorrhage occurred in 3.5% of cases, asymptomatic haemorrhage was reported in 7.1% of cases. A statistically significant difference was found in mortality rate (p = 0.0043) between the thrombolytic subgroup (5%) and the group not receiving causative therapy (13%). The neurological status in the subgroup with symptomatic intracranial haemorrhage deteriorated in the 2nd hour of treatment, then it remained stable and reached a high value of the National Institutes of Health Stroke Scale median – 23; it differed significantly compared to other patients (p = 0.009 in the 2nd hour; p = 0.001 on day 7). The functional status of patients with symptomatic intracranial haemorrhage did not improve; it was assessed at baseline and at the end of treatment and remained at the same level (modified Rankin Scale – median = 5 and 5). There was a significant increase in mobility, presenting as a 2 point drop in the median, in other patients. Conclusions: Thrombolytic treatment is a relatively safe procedure. Mortality during hospital treatment in the group treated using recombinant tissue plasminogen activator was significantly lower compared to patients not treated with systematic thrombolysis. The final therapeutic outcome in patients with symptomatic intracranial haemorrhage is significantly inferior compared to other patients.

Keywords: acute ischaemic stroke, symptomatic intracranial haemorrhage, thrombolysis, risk factors
Sudden neurological states encountered in the line of work of Emergency Medical Service in Rybnik
Aktualn Neurol 2015, 15 (4), p. 187–191
DOI: 10.15557/AN.2015.0024

Aim: Sudden neurologic states of various aetiology are the major reason for medical teams to be dispatched and often result in hospitalization of the patient. The purpose of this work was the analysis of the aforementioned neurologic states and pinpointing the type of patients the Emergency Medical Service teams have encountered in Rybnik with respect to the said states. Method: Analysed material consisted of Medical Emergency Action cards that were used by Emergency Medical Service Independent Public Healthcare District Hospital No. 3 in Rybnik in the year 2013. Five hundred and twenty-three cases were selected as consistent with sudden neurologic states. Result: A higher incidence of studied diseases was noted among male patients, whereas in females presenting with these states, the age was higher, with the exception of syncope. The analysis revealed the presence of characteristic symptoms in relevant emergency conditions. During the evaluation of psychomotor abilities, a prevalence of patients whose state qualified as normal, and in the case of stroke as “slowed down” was recorded. Brain damage in all states except for stroke was classified as mild. The study noted high blood glucose level disparities between measurements. Conclusion: Strokes occurred most often in patients over 60 years old. The observed signs were consistent with those described in the literature. Blood glucose test results in some patients allowed suspicion of diabetes, or ruled out hypoglycaemia. The majority of studied patients revealed mild brain injury. Alcohol had a significant effect on the incidence of head injuries and seizures.

Keywords: sudden neurologic states, Emergency Medical Service, stroke
Knowledge, attitude and practice regarding people with epilepsy among nurses
Aktualn Neurol 2015, 15 (4), p. 192–198
DOI: 10.15557/AN.2015.0025

Background: This work handled three aspects: to assess the nurses’ knowledge and practice with regard to patients with epilepsy, to study the outcome of training of nurses regarding epilepsy. Material and methods: The study conducted at the Department of Neurology at Assiut University Hospital. Data collected from all nurses (n = 35) working at the Department of Neurology. The following tools were used for data collection; a pre-/post-test questionnaire sheet for the assessment of the nurses’ knowledge of epilepsy, an observation checklist sheet for nurses, and the patient’s assessment sheet to assess the nurses’ practice. The work involved nine sessions, each about 30 minutes long, applied to teach nurses about all data necessary for the patients with epilepsy. Results: A good improvement in the mean knowledge and practice scores observed following the implementation of the designed nursing protocol. A significant decrease in complication rate which resulted from bad practice during fit following the implementation of the designed nursing protocol. A reduction in seizure-related complications reported after the training of nurses with the designed nursing protocol which acts as an additional advantage. Conclusion: Improving the nurses’ knowledge and practice with regard to patients with epilepsy will lead to the improvement the health and social conditions of patients with epilepsy.

Keywords: epilepsy, knowledge, nurse protocol, practice, Egypt
Multiple sclerosis and epilepsy – the complex relationship
Aktualn Neurol 2015, 15 (4), p. 199–204
DOI: 10.15557/AN.2015.0026

Multiple sclerosis is one of the most common chronic neurodegenerative diseases of the central nervous system with autoimmune background. The prevalence of epileptic seizures in patients with multiple sclerosis ranges from 0.5% to 10%, while in the general population it ranges from 0.5% to 1%. Clinical studies have proved that all types of epileptic seizures may occur in the course of multiple sclerosis. Yet, it needs to be remembered that not all seizure symptoms are consistent with epileptic seizures. Non-epileptic seizures include tonic spasms (paroxysmal dystonias), paroxysmal akinesias and paresthesias, and trigeminal neuralgia. According to the literature of the subject, the majority of the available antiepileptic drugs have been broadly used for management of seizures in multiple sclerosis patients. However, there is a group of medications registered for multiple sclerosis treatment, that can in isolated cases slightly lower the seizure threshold thus causing or strengthening episodes of epileptic seizures. They include 4-aminopyridine and baclofen used for supportive therapy of multiple sclerosis, and according to some sources also immunomodulatory drugs such as interferon beta. The latest research has shown sodium channel blockers such as lamotrigine and phenytoin to potentially assist neuroprotection by inhibiting axonal degeneration that underlies the impaired mobility in multiple sclerosis patients. Additionally, phenytoin has found its application in the therapy of optic neuritis, also in the course of multiple sclerosis. Multiple sclerosis is indisputably a disease whose course eludes clear prognosis, whereas the coexistence of epileptic seizures and the clinical multiple sclerosis symptoms frequently poses both diagnostic and therapy-related challenges for the treating physicians.

Keywords: epilepsy, multiple sclerosis, treatment
Selected aspects of the impact of functional asymmetry of the cerebral hemispheres on the cognitive and emotional functioning of the human being
Aktualn Neurol 2015, 15 (4), p. 205–209
DOI: 10.15557/AN.2015.0027

For many years, the asymmetry of the cerebral hemispheres was considered to be dichotomous with clear specialisation of each hemisphere. Researchers associated the left hemisphere exclusively with verbal functions, and the right hemisphere with non-verbal abilities. This division, however, is not exhaustive and definitely simplifies the subject of hemispheric specialisation. Recent reports indicate both cooperation and some interhemispheric independence in the daily functioning of the human being. Moreover, it is emphasised that functional differences exist, but they are much more subtle than expected at the beginning of research on this subject. In order to study the functional asymmetry of the cerebral hemispheres several models were developed that explain the mechanism of hemispheric specialisation and distinct styles of processing stimuli. Data supporting the existence of functional hemispheric asymmetry come mostly from reports of unilateral brain damage, corpus callosum agenesis as well as hemispherectomy and commissurotomy surgery. On the basis of the data, scientists conducted the analysis of cognitive and emotional functioning of patients. Certain regularities were detected regarding the differences and similarities in the functioning of the cerebral hemispheres in the area of visual perception, verbal functions, praxis, attention, memory, learning and executive functions. Lateralisation of emotions in the brain is an area of research that generates a lot of conflicting reports. There is a need for further well-designed studies to understand whether there is lateralisation of emotions in the brain, and if so, what aspects of them are involved. This paper presents views on the impact of hemispheric asymmetry on the cognitive, emotional and behavioural functioning of man.

Keywords: cerebral hemispheres, cognitive functions, emotional functions, depressive symptoms, schizophrenic disorders
Depression diagnosis in patients with Parkinson’s disease using various diagnostic tools
Aktualn Neurol 2015, 15 (4), p. 210–216
DOI: 10.15557/AN.2015.0028

Parkinson’s disease is a neurodegenerative disorder. Its main symptoms are those from the scope of motor and non-motor functions. Both groups of those symptoms considerably influence the patient’s health-related quality of life. Non-motor symptoms are frequently overlooked, and, as a consequence, poorly treated. It leads to complications in therapy and a decreased level of quality of life of both patients and their caretakers. One of the co-occurring disorders is depression. Many of the symptoms overlap with those of Parkinson’s disease. This presents additional requirements for the clinician/researcher and their psychometric tools. There are many clinical scales and self-report questionnaires successfully used for screening, diagnosis, or checking the progress in the treatment of depression. These include: Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Beck Depression Inventory (BDI), Inventory of Depressive Symptoms – Self-Rated (IDS-SR), Patient Health Questionnaire (PHQ), Unified Parkinson’s Disease Rating Scale (UPDRS-Part I), Hospital Anxiety and Depression Scale (HADS), Zung Self-Rating Depression Scale (SDS), Cornell Scale for the Assessment of Depression in Dementia (CSDD), Inventory of Depressive Symptoms – Clinician (IDS-C), Hamilton Depression Rating Scale (Ham-D), Montgomery–Åsberg Depression Rating Scale (MADRS). The most efficient tools in recognizing depression in Parkinson’s disease are clinical scales, especially Hamilton and Montgomery–Åsberg scales. Their usefulness and effectiveness is high for both the screening process and for measuring the severity of depressive symptoms. Beck Depression Inventory shows similar outcomes. Slightly less research in this area has been carried out on the Inventory of Depressive Symptoms – Clinician, yet this is a promising tool. Questionnaire version of this tool – Inventory of Depressive Symptoms – Self-Rated – does not live up to the expectations in the diagnosis of depression at an appropriate level in patients with Parkinson’s disease. Similar conclusions can be drawn with respect to Unified Parkinson’s Disease Rating Scale – Part I, and the Center for Epidemiologic Studies Depression Rating Scale. For screening purposes, Geriatric Depression Scale, Hospital Anxiety and Depression Scale, Patient Health Questionnaire and Zung Self-Rating Depression Scale are valid in depression in Parkinson’s disease. Cornell Scale for the Assessment of Depression in Dementia seems a promising tool for screening once it has been tested more.

Keywords: depression, Parkinson’s disease, diagnostic criteria, clinical scale, self-report questionnaire
Cerebral venous sinus thrombosis. Case report
Aktualn Neurol 2015, 15 (4), p. 217–221
DOI: 10.15557/AN.2015.0029

Introduction: Cerebral venous sinus thrombosis is a rare vascular disease affecting people regardless of their age. It is estimated that the disease is the cause of 1% of all cerebral strokes. Study design: The reported case has been described on the basis of the female patient’s medical record. Case study: The article describes a female patient, 47 years old, with arterial hypertension and metabolic syndrome who has been using hormonal contraceptives for 17 years. She sought medical attention due to headaches, the sensation of an alternate numbness in right and left extremities (for a month), vomiting (for a week) and high ESR levels. Upon admission, the patient underwent a neurological examination, yet apart from psychomotor retardation no pathology was detected. Computed tomography scan without contrast showed no lesions. Cerebral venous sinus thrombosis was confirmed only with additional examinations. Results: Despite the application of standard treatment methods, the patient’s condition did not improve. Focal and deficit symptoms that appeared during hospitalisation, resolved upon the inclusion of steroids in the treatment. Conclusion: The reported case testifies to difficulties in diagnosing and determining the aetiology of cerebral venous sinus thrombosis.

Keywords: psychomotor retardation, headaches, vomiting, numbness in extremities, factor VIII