Brucellosis is a zoonosis with non-specific clinical symptoms involving multiple systems and organs. Its prevalence is low in most of EU countries, which can lead to the difficulties in laboratory and clinical diagnostic. Due to its relationship to the Ochrobactrum spp., it may be misclassified in rapid identification systems. We present a case of a 13-year-old immunocompetent girl who was examined several times for fever, fatigue, night sweats and weight loss; laboratory results showed mildly elevated C-reactive protein, anaemia and leukopenia. Four weeks before the onset of symptoms, she had been on a family holiday in Egypt. Given her symptoms, a haemato-oncological or autoimmune disease was considered more likely. The diagnosis of Brucella spondylitis was made after 4 months. The main reasons for this delay were as follows: low specificity of clinical symptoms, delay in completing the travel history, inconclusive initial serological results and misidentification of the blood culture isolate as Ochrobactrum sp. Even in countries with a low incidence of brucellosis, it is essential to educate healthcare professionals about the disease. Low specificity of symptoms and limited experience of laboratory staff may lead to late diagnosis with risk of complications and poor outcome. If Ochrobactrum spp. is detected in clinical specimens by rapid identification, careful re-evaluation must follow and all measures to prevent laboratory-acquired infections must be taken until Brucella spp. is unequivocally excluded.

• MeSH
• Bacteremia * diagnosis   microbiology   MeSH
• Brucella isolation & purification   classification   MeSH
• Brucellosis * diagnosis   microbiology   MeSH
• Diagnostic Errors * MeSH
• Gram-Negative Bacterial Infections diagnosis   microbiology   MeSH
• Fever * microbiology   etiology   MeSH
• Humans MeSH
• Adolescent MeSH
• Ochrobactrum * genetics   isolation & purification   MeSH
• Spondylitis microbiology   diagnosis   MeSH
• Check Tag
• Humans MeSH
• Adolescent MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Geographicals
• Egypt MeSH

INTRODUCTION: Late capsular bag distension syndrome (CBS) is a rare complication of the ^lcataract surgery. AIM: The aim is to present 9 cases with delayed presentation and describe their successful management with surgical approach. METHOD: A two-year retrospective review of 9 cases was undertaken. Anterior segment optical coherence tomography (AS-OCT) was used to confirm this diagnosis. Aspiration of the milky fluid with 26 gauge needle followed by capsular bag lavage was performed and aspirated fluid was examined. RESULTS: Patients showed signs of late CBS 6,56 ± 1,94 years after uncomplicated phacoemulsification with intraocular lens (IOL) implantation into the capsular bag. All 9 patients presented with a turbid fluid collection within the distended capsular bag. AS-OCT showed a hyper-reflective material in the space between the IOL and distended posterior capsule. CONCLUSION: Awareness of the manifestations of CBS and choice of the correct imaging modality may lead to regular diagnosis and successful treatment. Management with aspiration of the milky fluid and lavage of the capsular bag is technically safe and effective procedure. It has the advantage of microbial testing of the fluid. AS-OCT is useful tool to differentiate this condition clearly from IOL opacification and posterior capsule opacification.

• MeSH
• Phacoemulsification * MeSH
• Lens Implantation, Intraocular * MeSH
• Middle Aged MeSH
• Humans MeSH
• Lens Diseases diagnosis   etiology   surgery   MeSH
• Tomography, Optical Coherence * MeSH
• Postoperative Complications * MeSH
• Lens Capsule, Crystalline * surgery   diagnostic imaging   MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Syndrome MeSH
• Visual Acuity physiology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Wilson disease (WD) primarily presents with hepatic and neurological symptoms. While hepatic symptoms typically precede the neurological manifestations, copper accumulates in the brain already in this patient group and leads to subclinical brain MRI abnormalities including T2 hyperintensities and atrophy. This study aimed to assess brain morphological changes in mild hepatic WD. WD patients without a history of neurologic symptoms and decompensated cirrhosis and control participants underwent brain MRI at 3T scanner including high-resolution T1-weighted images. A volumetric evaluation was conducted on the following brain regions: nucleus accumbens, caudate, pallidum, putamen, thalamus, amygdala, hippocampus, midbrain, pons, cerebellar gray matter, white matter (WM), and superior peduncle, using Freesurfer v7 software. Whole-brain analyses using voxel- and surface-based morphometry were performed using SPM12. Statistical comparisons utilized a general linear model adjusted for total intracranial volume, age, and sex. Twenty-six WD patients with mild hepatic form (30 ± 9 years [mean age ± SD]); 11 women; mean treatment duration 13 ± 12 (range 0-42) years and 28 healthy controls (33 ± 9 years; 15 women) were evaluated. Volumetric analysis revealed a significantly smaller pons volume and a trend for smaller midbrain and cerebellar WM in WD patients compared to controls. Whole-brain analysis revealed regions of reduced volume in the pons, cerebellar, and lobar WM in the WD group. No significant differences in gray matter density or cortical thickness were found. Myelin or WM in general seems vulnerable to low-level copper toxicity, with WM volume loss showing promise as a marker for assessing brain involvement in early WD stages.

• MeSH
• White Matter pathology   diagnostic imaging   MeSH
• Adult MeSH
• Hepatolenticular Degeneration * pathology   diagnostic imaging   MeSH
• Liver pathology   diagnostic imaging   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging * MeSH
• Young Adult MeSH
• Brain * pathology   diagnostic imaging   MeSH
• Gray Matter pathology   diagnostic imaging   MeSH
• Case-Control Studies MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: Head tremor poses diagnostic problems, especially when present as an isolated or predominant symptom. OBJECTIVES: To assess how maneuvers activating upper limb postural tremor can help differentiate head tremor in essential tremor (ET) from dystonic tremor (DT) in cervical dystonia. METHODS: 48 patients with head tremor (25 ET, 23 DT), underwent clinical examination and accelerometric evaluation of head and upper limb tremor during routine tremor-inducing tasks. RESULTS: While accelerometric power and clinical scores of head tremor did not significantly differ between patient groups, task-induced variations revealed distinctions. ET patients exhibited increased head tremor power and clinical scores during forward outstretched and lateral wing-beating arm positions, unlike DT patients. Coherence between head and upper limb tremor remained consistent. Tremor stability index showed no significant differences. CONCLUSIONS: Task-induced changes in head tremor could aid in distinguishing between ET and DT. Further research is needed to refine diagnostic approaches for head tremor.

• MeSH
• Accelerometry instrumentation   methods   MeSH
• Diagnosis, Differential MeSH
• Adult MeSH
• Dystonia diagnosis   physiopathology   MeSH
• Essential Tremor * diagnosis   physiopathology   MeSH
• Head * physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Arm * physiopathology   MeSH
• Posture physiology   MeSH
• Aged MeSH
• Torticollis diagnosis   physiopathology   MeSH
• Tremor * diagnosis   physiopathology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Neurovascular conflict between the oculomotor nerve and a posterior circulation cerebral artery is a relatively frequent radiologic finding; however, it manifests minimally clinically (by slower photoreaction on the ipsilateral side). Sustained paresis of the oculomotor nerve that arose directly due to neurovascular conflict between the superior cerebral artery (SCA) and the oculomotor nerve, and resolved after microvascular decompression, is extremely rare and has not yet been published. METHODS: A 34-year-old female patient presented with an advancing ptosis and downward gaze on one side. Differential diagnostics ruled out all other causes of the oculomotor paresis. Magnetic resonance imaging showed significant compression of the oculomotor nerve by an aberrant SCA on the ipsilateral side. Neurovascular decompression performed microsurgically resulted in near complete resolution of the symptoms. RESULTS: This case report aims to present a case of a rare clinical condition caused by a generally common anatomical variation. This variation proved to be the only cause of the patient's symptoms, which resolved after microsurgical restoration of the neuroanatomy. CONCLUSIONS: Oculomotor nerve paresis caused directly by neurovascular conflict is an extremely rare diagnosis. Microvascular decompression should be considered in these cases, if other causes have been excluded.

• MeSH
• Adult MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Microvascular Decompression Surgery methods   MeSH
• Cerebellum * blood supply   MeSH
• Oculomotor Nerve Diseases * etiology   surgery   MeSH
• Oculomotor Nerve * surgery   MeSH
• Paresis * etiology   surgery   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Onemocnění covid-19, způsobené virem SARS-CoV-2, může mít ve své akutní i dlouhodobé (long-covid) fázi dopad na psychický stav pacientů. Virus může napadat centrální nervový systém přímou a nepřímou cestou. Mezi časté psychiatrické příznaky postcovidového syndromu patří úzkostné projevy. Přehledový článek prezentuje výsledky metaanalýz se zaměřením na postcovidové příznaky, rizikové faktory, prognózu a kvalitu života u těchto potíží. Dále shrnuje výsledky studií se zaměřením na postcovidové úzkosti.

COVID-19 disease, caused by the SARS-CoV-2 virus, can impact patients mental health during both acute and long-term (long COVID) phases. The virus can affect the central nervous system through direct and indirect pathways. Anxiety is a common psychiatric symptom of post-COVID syndrome. This review article presents the results of meta-analyses focusing on post-COVID symptoms, risk factors, prognosis, and quality of life for these conditions. It also summarizes the results of studies focusing on post-COVID anxiety.

Primární hypofyzitida je vzácné zánětlivé onemocnění podvěsku mozkového. Klinické projevy jsou variabilní a různě závažné. Nejčastěji se vyskytují bolesti hlavy, příznaky z deficitu hormonů předního laloku hypofýzy a příznaky nedostatku vazopresinu (polyurie a polydipsie). Na magnetické rezonanci má lymfocytární hypofyzitida typický obraz symetrického zvětšení hypofýzy s normálním signálem nativně; významným znakem může být ztluštění infundibula bez deviace. Diagnóza se opírá o klinické příznaky, laboratorní vyšetření a magnetickou rezonanci. Prezentujeme případ 41leté ženy s bolestmi hlavy, přechodnou polyurií s polydipsií a hyperprolaktinemií. Koncentrační test jednoznačně nepotvrdil diagnózu diabetu insipidu, zcela však nevyloučil možnost parciálního deficitu vazopresinu. Laboratorní vyšetření prokázalo opakovaně mírnou hyperprolaktinemii (maximální hodnota 2016 mIU/l), klinicky se projevila přechodnou galaktoreou a amenoreou trvající čtyři měsíce. Na magnetické rezonanci byl zjištěn nález svědčící pro lymfocytární hypofyzitidu, který v průběhu sledování spontánně regredoval. Na primární hypofyzitidu je potřeba pomýšlet v diferenciální diagnostice. Z důvodu rizika relabujícího průběhu a rizika rozvoje hypopituitarismu je doporučeno dlouhodobé sledování.

Primary hypophysitis is a rare inflammatory disease of the pituitary gland. Clinical symptoms are variable and of varying severity. Headache, symptoms of anterior pituitary deficiency and symptoms of vasopressin deficiency (polyuria with polydipsia) are the most common. On magnetic resonance imaging, lymphocytic hypophysitis typically shows a symmetrical pituitary enlargement with a normal native signal; the presence of thickening of the infundibulum without deviation may be an important feature. Diagnosis is based on clinical symptoms, laboratory examination and magnetic resonance imaging. We present the case of a 41-year-old woman with headache, transient polyuria with polydipsia and hyperprolactinemia. The water deprivation test did not confirm the diagnosis of diabetes insipidus, but did not completely exclude the partial vasopressin deficiency. Laboratory tests showed recurrent mild hyperprolactinemia (maximum 2016 mIU/l), clinically manifested by transient galactorrhoea and amenorrhoea lasting four months. Magnetic resonance imaging revealed findings consistent with lymphocytic hypophysitis, which resolved spontaneously during follow-up. Primary hypophysitis is a very rare disease and should be considered in the differential diagnosis. Long-term follow-up is recommended because of the risk of relapse and the risk of developing hypopituitarism.

Eozinofilní ezofagitida je chronické zánětlivé, imunologicky podmíněné onemocnění, charakterizované patologickou infiltrací sliznice jícnu eozinofilními granulocyty. Na vzniku nemoci se podílí genetická predispozice a faktory vnějšího prostředí. Stanovení správné diagnózy se u dětí opírá o klinické příznaky dysfunkce jícnu, zvracení, neprospívání a typický histologický nález. Velmi častou komorbiditou jsou alergická onemocnění. Cílem léčby je odstranit klinické příznaky onemocnění, potlačit infiltraci jícnu eozinofilními granulocyty a zabránit komplikacím, zejména přestavbě stěny (remodelace) a zúžení jícnu. U dětí je nezbytné zajistit správný růst a vývoj. Léčba je komplexní a zahrnuje empirickou eliminační dietu nebo kombinovanou farmakoterapii inhibitorem protonové pumpy nebo topickým kortikosteroidem (budesonid jako suspenze nebo rozpustná tableta). U nejtěžších případů je indikována celková farmakoterapie prednisonem a biologická léčba (dupilumabem). Kazuistika u chlapce ukazuje na úskalí diagnostiky eozinofilní ezofagitidy v kojeneckém věku a na nutnost mezioborové spolupráce nejen při stanovení správné diagnózy a zahájení adekvátní komplexní léčby za nezbytné spolupráce rodičů nemocného dítěte, ale i při dispenzární péči a včasném rozpoznání recidivy onemocnění.

Eosinophilic esophagitis is a chronic inflammatory immune-mediated disease characterized by pathological eosinophilic infiltration of the esophageal wall. Genetic predisposition and environmental factors contribute to the development of this illnes. Establishing the correct diagnosis in children is based on clinical symptoms of esophageal dysfunction, vomiting, failure to thrive and typical histological findings. Allergic diseases are very common comorbidities. The treatment aims to remove the clinical symptoms of the disease, suppress the infiltration of the esophagus by eosinophilic granulocytes, and prevent complications, especially the remodeling of the esophagus wall with its subsequent narrowing. Ensuring proper children's growth and development is essential. Treatment of eosinophilic esophagitis is comprehensive and includes empiric elimination diet, or pharmacotherapy with proton pump inhibitors, or topical corticosteroids. In the most severe cases, systemic pharmacotherapy with prednisone and biological treatment is indicated dupilumab. The presented case report illustrates the difficulties in diagnosing in infancy and the necessity of an interdisciplinary approach (pediatrician-gastroenterologist-allergist) not only in establishing the correct diagnosis and starting adequate treatment necessitating the cooperation of the chilďs parents but also in long-term care and early recognition of the possible disease recurrence.

V článku jsou prezentovány dvě kazuistiky pacientů s ischemickou cévní mozkovou příhodou a malým klinickým deficitem. V těchto případech jsou doporučené postupy stran indikace k mechanické trombektomii nejednoznačné. U každého pacienta byla individuálně zvážena tíže neurologického deficitu a rizika plynoucí z endovaskulární léčby. Oba pacienti byli indikování k mechanické trombektomii.

n this article we present two case reports of patients with ischmic stroke and mild deficit. Guidelines concerning mechanical thrombectomy in this cases are inconclusive. In each case severity of nerological symptoms and risk of endovascular treatment was considered. Both patients were in the end indicated for mechanical thrombectomy.

V revmatologické ambulanci se setkáváme s širokou paletou diagnóz. Pacienti přichází s příznaky zapadající spíše do degenerativních a funkčních poruch jako např. osteoartróza či osteoporóza. Setkáváme se ale i s pacienty se závažnými, někdy i život ohrožujícími nemocemi jako jsou systémové choroby pojiva, vaskulitidy či zánětlivé revmatické choroby. Předložené kazuistiky jsou z obou konců spektra pacientů v revmatologické ambulanci. První kazuistika je případ muže se subakutními bolestmi pohybového aparátu, hlavně ramenního kloubu, a únavovým syndromem. Druhý příběh popisuje pacientku s dlouhodobou diagnózou systémové sklerodermie. Obě kazuistiky popisují vliv psychosomatické intervence v akutní i dlouhodobé perspektivě a obě ilustrují, jak lze porozumět psychosociálnímu kontextu pacienta a jeho vlivu na somatické projevy

We detect a wide variety of diagnoses, in the rheumatology ambulancy,. Patients come with symptoms that fit more into degenerative and functional disorders such as osteoarthritis or osteoporosis. We also treat patients with serious systemic, sometimes life-threatening diseases such as connective tissue diseases, vasculitis or inflammatory rheumatic diseases. The presented case reports are from both ends of the spectrum of patients in the rheumatology clinic. The first case study is the case of a man with subacute musculoskeletal pain, shoulder joint especially and fatigue. The second case report describes a patient with a long-term diagnosis of systemic scleroderma. Both cases describe acute and long-term psychosomatic interventions. Detection of patient's psychosocial context may have an impact on somatic manifestations.