K okluzi centrální retinální tepny může dojít na podkladě embolizace z nestabilního aterosklerotického plátu arteria carotis interna. V naší kazuistice byla ztráta monokulárního vidění prvním příznakem závažného průběhu ischemické cévní mozkové příhody, kterou bylo nutné urgentně řešit mechanickou trombektomií. Cílem sdělení je poukázat na často podceňovanou závažnost tohoto stavu. Okluze centrální retinální arterie by dle našeho názoru měla být řešena v akutním režimu, bez prodlení a se zapojením zdravotnické záchranné služby jako každá jiná cévní mozková příhoda. I přes debatu jak v české, tak ve světové odborné veřejnosti, není dosud k dispozici konsenzus v přístupu k této klinické jednotce.

Central retinal artery occlusion can occur secondary to embolism from an unstable atherosclerotic plaque of the internal carotid artery. In our case report, monocular visual loss was the initial presentation of a severe course of ischaemic stroke which required urgent management with mechanical thrombectomy. The aim of the paper is to highlight the often underestimated severity of this condition. In our opinion, central retinal artery occlusion should be managed in an acute mode, without delay, and with the involvement of emergency medical services, just like any other stroke. In spite of the debate in both the Czech and worldwide professional community, no consensus has so far been available on the approach to this clinical entity.

• MeSH
• arteria centralis retinae patologie   MeSH
• ischemická cévní mozková příhoda * diagnóza   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mechanická trombolýza metody   MeSH
• okluze retinální arterie diagnóza   terapie   MeSH
• trombolytická terapie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• eutanazie * MeSH
• Publikační typ
• úvodníky MeSH

Parestezie jsou typické pozitivní senzitivní příznaky, které vznikají v důsledku poškození nebo poruchy somatosenzorického systému. Jsou častým subjektivním steskem uváděným pacienty různého věku. Mohou se vyskytovat jak u zdravých osob, tak u pacientů s nejrůznějšími nemocemi. Parestezie jsou častým symptomem řady neurologických i interních chorob. Vyskytují se u heterogenní skupiny poruch, které postihují centrální i periferní nervový systém. V následujícím přehledu je uvedena diagnostika i diferenciální diagnostika parestezií s důrazem na závažná akutní onemocnění.

Paresthesias are sensory symptoms that typically arise from damage or disorder of the somatosensory system. Patients of different age groups frequently report these symptoms as subjective issues. They can occur in healthy individuals as well as in people with various diseases. Paresthesias are a frequent symptom of a number of neurological and internal diseases. They occur in a heterogeneous group of disorders that affect both the central as well as peripheral nervous systems. In the following review, we present the diagnosis and differential diagnosis of paresthesias with an emphasis on severe acute diseases.

• MeSH
• diferenciální diagnóza MeSH
• lidé MeSH
• parestezie * diagnóza   etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

INTRODUCTION: There are today two models of transporting patients with acute ischaemic stroke because of large artery occlusion (AIS-LVO): mothership (MS) and drip-and-ship (DS). Our aim was to evaluate our ongoing transport strategy (OT), which is an MS/DS hybrid. In our OT, the patient is transported directly to the CT of the Primary Stroke Centre (PSC), where intravenous thrombolysis (IVT) is administered. The patient then continues without delay to a Comprehensive Stroke Centre (CSC) with the same medical rescue team (MRT). The distance between our centres is 73 km. MATERIAL AND METHODS: We retrospectively analysed data of 100 consecutive AIS-LVO patients treated with mechanical thrombectomy (MT) between January 2017 and October 2019. OT, MS and DS groups were compared. 31 patients were transported as MS, 32 as DS, and 37 as OT. RESULTS: DS had significantly longer time to groin puncture (185 min) compared to OT and MS (p < 0.0001). OT shortened time almost to MS level (OT 124 min, MS 110 min, p = 0.002. Time to IVT administration (from MRT departure) differed statistically significantly in favour of OT (OT 27 min, MS 63 min, p < 0.0001). Logistical change in PSC had a significant effect on decreasing the door-to-needle time (DNT) median from 37 min to 11 min (p < 0.0001). DNT reduction also occurred in patients with AIS and without an indication for MT. CONCLUSIONS: OT is highly effective, significantly reducing the time to IVT administration, and combining all the benefits, while eliminating all the disadvantages, of DS and MS. The OT concept gives all indicated patients a chance for MT to be performed, and does not overload the performing centre.

• MeSH
• cévní mozková příhoda * farmakoterapie   etiologie   MeSH
• ischemická cévní mozková příhoda * MeSH
• ischemie mozku * farmakoterapie   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• trombektomie škodlivé účinky   MeSH
• trombolytická terapie škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND AND PURPOSE: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. METHODS: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). RESULTS: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. CONCLUSIONS: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

• Publikační typ
• časopisecké články MeSH

Background The benefit of intravenous thrombolysis is time dependent. It remains unclear, however, whether dramatic shortening of door-to-needle time (DNT) among different types of hospitals nationwide does not compromise safety and still improves outcome. Methods and Results Multifaceted intervention to shorten DNT was introduced at a national level, and prospectively collected data from a registry between 2004 and 2019 were analyzed. Generalized estimating equation was used to identify the association between DNT and outcomes independently from prespecified baseline variables. The primary outcome was modified Rankin score 0 to 1 at 3 months, and secondary outcomes were parenchymal hemorrhage/intracerebral hemorrhage (ICH), any ICH, and death. Of 31 316 patients treated with intravenous thrombolysis alone, 18 861 (60%) had available data: age 70±13 years, National Institutes of Health Stroke Scale at baseline (median, 8; interquartile range, 5-14), and 45% men. DNT groups 0 to 20 minutes, 21 to 40 minutes, 41 to 60 minutes, and >60 minutes had 3536 (19%), 5333 (28%), 4856 (26%), and 5136 (27%) patients. National median DNT dropped from 74 minutes in 2004 to 22 minutes in 2019. Shorter DNT had proportional benefit: it increased the odds of achieving modified Rankin score 0 to 1 and decreased the odds of parenchymal hemorrhage/ICH, any ICH, and mortality. Patients with DNT ≤20 minutes, 21 to 40 minutes, and 41 to 60 minutes as compared with DNT >60 minutes had adjusted odds ratios for modified Rankin score 0 to 1 of the following: 1.30 (95% CI, 1.12-1.51), 1.33 (95% CI, 1.15-1.54), and 1.15 (95% CI, 1.02-1.29), and for parenchymal hemorrhage/ICH: 0.57 (95% CI, 0.45-0.71), 0.76 (95% CI, 0.61-0.94), 0.83 (95% CI, 0.70-0.99), respectively. Conclusions Ultrashort initiation of thrombolysis is feasible, improves outcome, and makes treatments safer because of fewer intracerebral hemorrhages. Stroke management should be optimized to initiate thrombolysis as soon as possible optimally within 20 minutes from arrival to a hospital.

• MeSH
• cerebrální krvácení komplikace   MeSH
• cévní mozková příhoda * terapie   MeSH
• fibrinolytika škodlivé účinky   MeSH
• intravenózní podání MeSH
• ischemie mozku * komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tkáňový aktivátor plazminogenu MeSH
• trombolytická terapie škodlivé účinky   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND AND AIMS: Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by disease-associated variants in the alpha-galactosidase A gene (GLA). FD is a known cause of stroke in younger patients. There are limited data on prevalence of FD and stroke risk in unselected stroke patients. METHODS: A prospective nationwide study including 35 (78%) of all 45 stroke centers and all consecutive stroke patients admitted during three months. Clinical data were collected in the RES-Q database. FD was diagnosed using dried blood spots in a stepwise manner: in males-enzymatic activity, globotriaosylsphingosine (lyso-Gb3) quantification, if positive followed by GLA gene sequencing; and in females GLA sequencing followed by lyso-Gb3. RESULTS: 986 consecutive patients (54% men, mean age 70 years) were included. Observed stroke type was ischemic 79%, transient ischemic attack (TIA) 14%, intracerebral hemorrhage (ICH) 7%, subarachnoid hemorrhage 1% and cerebral venous thrombosis 0.1%. Two (0.2%, 95% CI 0.02-0.7) patients had a pathogenic variant associated with the classical FD phenotype (c.1235_1236delCT and p.G325S). Another fourteen (1.4%, 95% CI 0.08-2.4) patients had a variant of GLA gene considered benign (9 with p.D313Y, one p.A143T, one p.R118C, one p.V199A, one p.R30K and one p.R38G). The index stroke in two carriers of disease-associated variant was ischemic lacunar. In 14 carriers of GLA gene variants 11 strokes were ischemic, two TIA, and one ICH. Patients with positive as compared to negative GLA gene screening were younger (mean 60±SD, min, max, vs 70±SD, min, max, P = 0.02), otherwise there were no differences in other baseline variables. CONCLUSIONS: The prevalence of FD in unselected adult patients with acute stroke is 0.2%. Both patients who had a pathogenic GLA gene variant were younger than 50 years. Our results support FD screening in patients that had a stroke event before 50 years of age.

• MeSH
• alfa-galaktosidasa krev   genetika   MeSH
• cévní mozková příhoda krev   komplikace   epidemiologie   genetika   MeSH
• exprese genu MeSH
• Fabryho nemoc krev   komplikace   epidemiologie   genetika   MeSH
• genetické testování MeSH
• glykolipidy krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mutace MeSH
• prevalence MeSH
• prospektivní studie MeSH
• senioři MeSH
• sfingolipidy krev   MeSH
• test suché kapky krve MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

Syfilis je chronické systémové onemocnění, které se projevuje pestrou škálou příznaků především na pohlavních orgánech, ale postiženy bývají i systémy kardiovaskulární, nervový, kožní nebo pohybový. K postižení centrální nervové soustavy může dojít kdykoliv během primárního, sekundárního nebo terciárního stadia syfilis. Časné formy neurosyfilis v současné době převažují, pozdní parenchymomatózní komplikace se vyskytují vzácně. Meningovaskulární syfilis se zpravidla manifestuje 5-7 let po primárním stadiu a představuje jednu z vzácných příčin cerebrovaskulárních onemocnění u mladších osob. V diagnostice má stěžejní význam nejen vyšetření mozku a mozkových tepen zobrazovacími metodami, ale také komplexní rozbor mozkomíšního moku. Základním lékem je benzylpenicilin. Prezentujeme případ 52letého muže s neurosyfilis, která se projevila akutní ischemickou cévní mozkovou příhodou ve vertebrobazilárním povodí při obliteraci bazilární tepny.

Syphilis is a chronic systemic disease which is manifested by a wide range of signs and symptoms, particularly in the sex organs, but it also affects the cardiovascular, nervous, integumentary, or musculoskeletal systems. An involvement of the central nervous system may occur at any point of the primary, secondary, or tertiary stages of syphilis. Early forms of neurosyphilis currently prevail, with late parenchymal complications occurring rarely. Meningovascular syphilis typically presents five to seven years after the primary stage, and is among the rare causes of cerebrovascular disease in younger individuals. Imaging of the brain and cerebral arteries as well as a comprehensive cerebrospinal fluid analysis are of crucial importance for the diagnosis. Benzylpenicillin is the principal drug. A case report is presented of a 52-year-old man with neurosyphilis manifested by acute ischaemic stroke in the vertebrobasilar territory in the setting of basilar artery occlusion.

• Klíčová slova
• obliterace bazilární tepny,
• MeSH
• ischemická cévní mozková příhoda * diagnóza   etiologie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• neurosyfilis * diagnóza   komplikace   terapie   MeSH
• syfilis diagnóza   komplikace   terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH