Autoimunitní encefalitidy jsou autoimunitně podmíněná onemocnění centrálního nervového systému s převážným postižením mozkové kůry. Jedná se o heterogenní skupinu stavů projevující se nově vzniklým neurologickým a psychiatrickým deficitem u dříve zdravých dětí. Tyto poruchy se odlišují závažností, klinickým průběhem a etiologií. Na rozdíl od dospělé populace u dětí převládají neparaneoplastické encefalitidy. V rámci prognózy a léčby je nejdůležitější identifikovat přítomnost antineuronálních protilátek. Rozlišujeme protilátky proti povrchovým antigenům nebo intracelulárním antigenům. Autoimunitní onemocnění příznivě reagují na imunoterapii, proto je nezbytná rychlá diagnostika a včasná léčba, která může vést k rychlejší úzdravě, snížení frekvence relapsů a kognitivního deficitu. Naše sdělení se zaměřuje na diagnostické a léčebné zkušenosti s nejfrekventovanějšími autoimunitními encefalitidami a protilátkami zprostředkovanými demyelinizačními syndromy v dětském věku ve Fakultní nemocnici Ostrava.

Autoimmune encephalitis is a group of autoimmune-related diseases of the central nervous system with the predominant involvement of the cerebral cortex. It is a heterogeneous group of conditions manifested by newly emerging neurological and psychiatric deficits in previously healthy children. These disorders differ in severity, clinical course, and aetiology. Unlike the adult population, non-paraneoplastic encephalitis is prevalent in children. Antineuronal antibodies are the most critical prognostic and therapeutic indicators. Antibodies are directed either against surface antigens or intracellular antigens. Autoimmune diseases respond favourably to immunotherapy. Therefore, rapid diagnosis and timely treatment are essential and can lead to faster recovery and lower rates of relapses and cognitive deficits. This article focuses on the diagnostic and therapeutic experience with the most common types of autoimmune encephalitis and antibody-mediated demyelinating syndromes in childhood at the University Hospital Ostrava.

• MeSH
• autoimunitní nemoci nervového systému * diagnóza   farmakoterapie   MeSH
• autoprotilátky analýza   imunologie   MeSH
• demyelinizační autoimunitní nemoci CNS diagnóza   farmakoterapie   MeSH
• dítě * MeSH
• imunoterapie metody   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• neurologické manifestace MeSH
• paraneoplastické syndromy etiologie   komplikace   MeSH
• Check Tag
• dítě * MeSH
• lidé MeSH

Perinatální asfyxie a její včasná diagnostika představuje kruciální problém současné neonatologie. Hypoxicko-ischemická encefalopatie (Hie) je nejzávažnější příčinou novorozenecké morbidity a mortality u donošených. incidence Hie je celosvětově přibližně 1–3 na 1000 živě narozených. nejtěžší formy Hie představují dle některých zdrojů až 60% riziko úmrtí. rychlá a včasná diagnostika zejména středních až těžkých forem, časný transport do perinatologického centra a indikace léčebné hypotermie mohou zmírnit a predikovat následky asfyktického poškození. cílem tohoto sdělení je vytvoření přehledu současných diagnostických možností Hie, tedy klinického a laboratorního vyšetření a zobrazovacích metod s důrazem na magnetickou rezonanci.

Hypoxic-ischemic encephalopathy (Hie) is the most serious cause of neonatal morbidity and mortality; it involves damage to the brain of a full-term newborn; in premature infants, it occurs in the form of periventricular leukomalacia. the incidence of Hie is approximately 1-3 per 1000 live births worldwide. the most severe forms of Hie, according to some sources, represent up to a 60 % risk of death, therefore rapid and timely diagnosis, especially of moderate to severe forms, early transport to a perinatological center and indication of therapeutic hypothermia can mitigate and predict the consequences of asphyxiation damage. this communication aims to create an overview of current diagnostic option for Hie, especially imaging methods focusing on magnetic resonance imaging.

• MeSH
• asfyxie novorozenců * diagnóza   etiologie   terapie   MeSH
• diagnostické zobrazování metody   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• mozková hypoxie a ischemie * diagnóza   etiologie   terapie   MeSH
• terapeutická hypotermie metody   MeSH
• Check Tag
• lidé MeSH

Ganglioneurom je vzácný, benigní, terminálně diferencovaný a pomalu rostoucí nádor autonomního nervového systému, který obvykle vzniká ze sympatických gangliových buněk. Většina z nich je asymptomatická a nachází se náhodně. Uvádíme poměrně vzácný případ ganglioneuromu zadního mediastina, který byl souběžně diagnostikován při vstupním zobrazovacím vyšetření 11leté dívky s akutní lymfoblastickou leukemií (ALL). Histopatologické a histochemické vyšetření bioptických vzorků potvrdily diagnózu ganglioneuromu. Vzhledem k asymptomatickému průběhu, bez propagace nádoru do páteřního kanálu byl zvolen neoperativní management sledováním pomocí zobrazovacích metod. Dívka s akutní leukemií je v celkové remisi, na udržovací léčbě podle protokolu AIEOP-BFM ALL 2017. Kontrolní vyšetření MR hrudníku po 10 měsících potvrdilo stacionární charakter GN bez progrese.

Ganglioneuroma is a rare, benign, terminally differentiated and slow-growing tumour of the autonomic nervous system, usually arising from sympathetic ganglion cells. Most are asymptomatic and found incidentally. We report a relatively rare case of a ganglioneuroma of the posterior mediastinum that was diagnosed simultaneously on initial imaging in an 11-year-old girl with acute lymphoblastic leukemia (ALL). Histopathological and histochemical examination of biopsy speci­mens confirmed the diagnosis of ganglioneuroma. Because of an asymptomatic course, without tumor propagation into the spinal canal, a non-operative mana­gement by imaging follow-up was chosen. The girl with acute leukemia is in complete remission, on maintenance treatment according to the AIEOP-BFM ALL 2017 protocol. The control chest MRI after 10 months confirmed the stationary character of GN without progression.

• MeSH
• akutní lymfatická leukemie * diagnóza   farmakoterapie   MeSH
• diagnostické zobrazování metody   MeSH
• dítě MeSH
• ganglioneurom * diagnostické zobrazování   diagnóza   klasifikace   patologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• management nemoci MeSH
• nádory mediastina diagnóza   klasifikace   MeSH
• souběh chronických nemocí klasifikace   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

OBJECTIVES: To determine the prognostic potential of S100B protein in patients with craniocerebral injury, correlation between S100B protein and time, selected internal diseases, body habitus, polytrauma, and season. METHODS: We examined the levels of S100B protein in 124 patients with traumatic brain injury (TBI). RESULTS: The S100B protein level 72 h after injury and changes over 72 h afterwards are statistically significant for prediction of a good clinical condition 1 month after injury. The highest sensitivity (81.4%) and specificity (83.3%) for the S100B protein value after 72 h was obtained for a cut-off value of 0.114. For the change after 72 h, that is a decrease in S100B value, the optimal cut-off is 0.730, where the sum of specificity (76.3%) and sensitivity (54.2%) is the highest, or a decrease by 0.526 at the cut-off value, where sensitivity (62.5%) and specificity (62.9%) are more balanced. The S100B values were the highest at baseline; S100B value taken 72 h after trauma negatively correlated with GCS upon discharge or transfer (r=-0.517, P<0.0001). We found no relationship between S100B protein and hypertension, diabetes mellitus, BMI, or season when the trauma occurred. Changes in values and a higher level of S100B protein were demonstrated in polytraumas with a median of 1.070 (0.042; 8.780) μg/L compared to isolated TBI with a median of 0.421 (0.042; 11.230) μg/L. CONCLUSION: S100B protein level with specimen collection 72 h after trauma can be used as a complementary marker of patient prognosis.

• MeSH
• biologické markery * krev   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• S-100 kalcium vázající protein G, podjednotka beta * krev   MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• traumatické poranění mozku * krev   diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND AND OBJECTIVES: Endovascular treatment of cerebral aneurysms has tremendously advanced over the past decades. Nevertheless, aneurysm residual and recurrence remain challenges after embolization. The objective of this study was to elucidate the portion of embolized aneurysms requiring open surgery and evaluate whether newer endovascular treatments have changed the need for open surgery after failed embolization. METHODS: All 15 cerebrovascular centers in Austria and the Czech Republic provided overall aneurysm treatment frequency data and retrospectively reviewed consecutive cerebral aneurysms treated with open surgical treatment after failure of embolization from 2000 to 2022. All endovascular modalities were included. RESULTS: On average, 1362 aneurysms were treated annually in the 2 countries. The incidence increased from 0.006% in 2005 to 0.008% in 2020 in the overall population. Open surgery after failed endovascular intervention was necessary in 128 aneurysms (0.8%), a proportion that remained constant over time. Subarachnoid hemorrhage was the initial presentation in 70.3% of aneurysms. The most common location was the anterior communicating artery region (40.6%), followed by the middle cerebral artery (25.0%). The median diameter was 6 mm (2-32). Initial endovascular treatment included coiling (107 aneurysms), balloon-assist (10), stent-assist (4), intrasaccular device (3), flow diversion (2), and others (2). Complete occlusion after initial embolization was recorded in 40.6%. Seventy-one percent of aneurysms were operated within 3 years after embolization. In 7%, the indication for surgery was (re-)rupture and, in 88.3%, reperfusion. Device removal was performed in 16.4%. Symptomatic intraoperative and postoperative complications occurred in 10.2%. Complete aneurysm occlusion after open surgery was achieved in 94%. CONCLUSION: Open surgery remains a rare indication for cerebral aneurysms after failed endovascular embolization even in the age of novel endovascular technology, such as flow diverters and intrasaccular devices. Regardless, it is mostly performed for ruptured aneurysms initially treated with primary coiling that are in the anterior circulation.

• MeSH
• dospělí MeSH
• endovaskulární výkony * metody   MeSH
• intrakraniální aneurysma * chirurgie   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrochirurgie metody   MeSH
• neurochirurgické výkony metody   MeSH
• neúspěšná terapie MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• terapeutická embolizace * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Česká republika MeSH
• Rakousko MeSH

The surgical treatment of paediatric thalamic gliomas has been burdened with high morbidity, and these lesions were often considered inoperable. With new approaches and intraoperative technologies, we can remove tumours once deemed inoperable. In our single centre, we have operated on 11 paediatric patients over the course of 8 years. We have performed eight GTR resections and three intended subtotal resections. The postoperative neurological deficit ranged from mild to very severe for motor weakness and none to severe for aphasia after surgery, with all of the patients improving at 3-month follow-up. Radicality in the surgical approach to thalamic gliomas in children has shown significant benefits when compared to more conservative approaches. For children with LGGs, extensive surgical resection is associated with improved prognosis and longer progression-free survival. However, it does not yield the same proportional benefit for HGGs due to its aggressive nature and worse outlook.

• Publikační typ
• časopisecké články MeSH

OBJECTIVES: To determine the treatment effect of corticosteroids in periradicular therapy (PRT) for radicular pain and to compare different types of corticosteroids and ozone. We also examined the effect in different indication groups for periradicular therapy for each type of treatment agent. BACKGROUND: Various studies have examined the therapeutic value of periradicular infiltration using treatment agents consisting of local anesthetic and corticosteroids or ozone application for radicular pain. This is the first study to compare different types of corticosteroids and ozone. METHODS: Eligible patients with radicular pain who failed conservative management were divided into five indication groups and prospectively followed to assess the PRT effect of corticosteroids or ozone application. PRT was performed under computer tomography (CT) monitoring. A set of three PRT applications in three weeks was applied and the outcome was evaluated using a visual analogue score for back and leg pain. The in-group and between-group treatment effect was tested using the Wilcoxon signed-rank test and the Kruskal-Wallis H-test with Dunn's post-hoc tests, respectively. The dependency between treatment effectiveness and indication for each group was tested using the Kruskal-Wallis H-test and Dunn's post-hoc tests. RESULTS: We prospectively followed 150 patients, randomized into three groups of 50 patients each. The follow-up rate was 100%. All three treatment agents showed a statistically significant treatment effect (P<0.001). The statistically significant effect was higher in betamethasone (Diprophos) versus methylprednisolone (Depomedrone) (P=0.019) and Diprophos versus ozone (P<0.001). Diprophos also showed the highest decrease of VAS after therapy versus VAS prior to therapy (median decrease = 4) compared to Depomedrone and ozone (median decrease = 3 and 2, respectively). The statistically significant outcome was better with the indication of spondylolisthesis and disc herniation (P=0.019) indication for the Diprophos group and between spinal stenosis and spondylolisthesis (P=0.022) and spondylolisthesis and disc herniation (P=0.016) for the ozone group. CONCLUSION: Clinical improvement occurred in all three groups but Diprophos showed the statistically best treatment effect compared to Depomedrone and ozone. Disc herniation resulting in radicular pain had a statistically significant better effect in comparison with spondylolisthesis in the Diprophos and ozone groups, but the ozone group showed heterogeneity depending on treatment effect and indication.

• MeSH
• bederní obratle MeSH
• betamethason terapeutické užití   MeSH
• bolest MeSH
• hormony kůry nadledvin terapeutické užití   MeSH
• lidé MeSH
• ozon * terapeutické užití   MeSH
• prospektivní studie MeSH
• spondylolistéza * MeSH
• výhřez meziobratlové ploténky * farmakoterapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Our study evaluates the sensitivity of papilledema as a sign of high intracranial pressure in children. Patients younger than 18 years old, diagnosed with increased ICP, and who had received dilated fundus examination between 2019 and 2021 were retrospectively reviewed. Factors including the patient's age, sex, aetiology, duration of signs or symptoms, intracranial pressure (ICP), and presence of papilledema were evaluated. We included 39 patients in this study, whose mean age was 6.7 years. The 31 patients without papilledema had a mean age of 5.7 years, and 8 patients (20%) with papilledema had a mean age of 10.4 (p < 0.037). The mean duration of signs or symptoms was nine weeks in patients without papilledema and seven weeks in those with papilledema (p = 0.410). The leading causes of increased ICP with papilledema were supratentorial tumor (12.5%), infratentorial tumor (33.3%), and hydrocephalus (20%) (p = 0.479). Papilledema was statistically significantly more common in older patients. We found no statistical significance between sex, diagnosis, and symptoms. The relatively low incidence of papilledema (20%) in our study shows that papilledema's absence does not ensure the absence of increased ICP, especially in younger patients.

• Publikační typ
• časopisecké články MeSH

Úvod: Dekompresivní kraniektomie (DK) je život zachraňující neurochirurgický výkon s několika technickými možnostmi provedení. Cíl: Cílem této studie bylo porovnat výsledky operační techniky DK s duroplastikou a bez provedené duroplastiky na dvou neurochirurgických pracovištích. Metodika: Retrospektivní bicentrická studie hodnotila výskyt komplikací (tj. infekční, likvorová píštěl, hematom) u jednotlivých technik. Výsledky: Ve studii nebyl prokázán statisticky signifikantně vyšší výskyt komplikací jako jsou infekce (p = 0,539), likvorová píštěl (p = 0,826) či hematom (p = 0,720). V obou sledovaných souborech po kranioplastice nebyly zaznamenány infekční komplikace nebo likvorová píštěl. Komplikace ve formě hematomu byla statisticky nevýznamná (p = 0,155). Byl zjištěn statisticky významný rozdíl v operačním čase kranioplastiky provedené po DK s duroplastikou (medián 53 min) a po DK bez provedené duroplastiky (medián 90 min; p = 0,006). Závěr: DK bez provedení duroplastiky je potenciální bezpečná varianta, která není zatížená vyšším výskytem komplikací ve smyslu infekce nebo vzniku likvorové píštěle a hematomu.

Background: Decompressive craniectomy (DC) is a life-saving neurosurgical procedure with several technical options. Aim: The aim of this study was to compare the results of the DC surgical technique with and without duroplasty performed at two neurosurgery departments. Methods: A retrospective bicentric study evaluated the occurrence of complications (i.e., infection, cerebrospinal fluid fistula, hematoma) in both compared techniques. Results: The study did not demonstrate a statistically significantly higher incidence of complications such as infection (P = 0.539), cerebrospinal fluid fistula (P = 0.826) or hematoma (P = 0.720). No infectious complications or cerebrospinal fluid fistula were recorded in both observed groups after cranioplasty. The complication in the form of hematoma was statistically insignificant (P = 0.155). A statistically significant difference was found in the operative time of cranioplasty performed after DC with duroplasty (median 53 min) and after DC without duroplasty (median 90 min; P = 0.006). Conclusion: DC without duroplasty is a potentially safe option that is not burdened by a higher incidence of complications in terms of infection or the formation of cerebrospinal fluid fistula and hematoma.

• Klíčová slova
• duroplastika, kranioplastika,
• MeSH
• dekompresní kraniektomie metody   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• traumatické poranění mozku * chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

Deep brain stimulation (DBS) is a beneficial procedure for treating idiopathic Parkinson's disease (PD), essential tremor, and dystonia. The authors describe their set of imaging modalities used for a frameless and fiducial-less method of DBS. CT and MRI scans are obtained preoperatively, and STN parcellation is done based on diffusion tractography. During the surgery, an intraoperative cone-beam computed tomography scan is obtained and merged with the preoperatively-acquired images to place electrodes using a frameless and fiducial-less system. Accuracy is evaluated prospectively. The described sequence of imaging methods shows excellent accuracy compared to the frame-based techniques.

• Publikační typ
• časopisecké články MeSH