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.
INTRODUCTION: The gold standard for serum neurofilament light chain (sNfL) determination is the single molecule array (SIMOA), the use of which is limited by availability and cost. The VEUS method is a fully automated, user-friendly diagnostic system requiring no sample preparation, with high reported sensitivity, multiplexing capability, and rapid diagnostics. The aim of this study was to compare the SIMOA and VEUS methods for determining sNfL levels in patients with multiple sclerosis (MS). METHODOLOGY: A single-centre cross-sectional study was conducted at the MS Centre of University Hospital Ostrava. Patients were enrolled in the study from January 18 to January 31, 2024. Inclusion criteria were: 1) diagnosis of MS according to the revised 2017 McDonald criteria, 2) age ≥18 years, and 3) signed informed consent. The NF-light V2 diagnostic kit (SIMOA, Quanterix) and the Singleplex Neurology assay kit (VEUDx, EZDiatech) were used to determine sNfL concentrations. The two methods were compared by use of Spearman correlation, Passing-Bablok regression, and Bland-Altman analysis. RESULTS: A total of 49 patients were included in the study, of whom 39 (79.6 %) were female. The median sNfL concentration was 7.73 (IQR 5.80-9.93) ng/L determined by SIMOA and 1.31 (IQR 1.18-1.65) ng/L by VEUS. We did not find a correlation between SIMOA and VEUS (rs = 0.025, p = 0.866). Passing-Bablok regression demonstrated a systematic and proportional difference between the two methods. A significant disagreement between them was also confirmed by the Bland-Altman plots. On average, sNfL values measured by SIMOA were 3.56 ng/L (95 % CI 0.78 to 6.34) higher than those measured by VEUS. CONCLUSION: Our investigation uncovered noteworthy disparities between the SIMOA and VEUS techniques in determining sNfL levels. Specifically, the VEUS technique systematically produces lower estimates of sNFL levels. This substantial variance emphasizes the importance of carefully evaluating assay methods when quantifying sNfL.
- MeSH
- biologické markery krev MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- neurofilamentové proteiny * krev MeSH
- průřezové studie MeSH
- roztroušená skleróza * krev diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
Magnetická rezonance (MR) hraje v managementu pacientů s roztroušenou sklerózou (RS) klíčovou roli – a to jak v diagnostice a určování prognostických markerů, tak při sledování časných signálů neefektivity terapie či bezpečnostních problémů. Pro maximální využití jejího potenciálu je však nezbytná standardizace napříč jednotlivými pracovišti. Zásadní je i úzká mezioborová komunikace mezi radiologem a neurologem zahrnující unifikaci žádanky a strukturovaného radiologického popisu. Za tímto účelem vychází s podporou České neuroradiologické společnosti a Sekce klinické neuroimunologie a likvorologie České neurologické společnosti tento konsenzus českého expertního radiologicko-neurologického panelu vycházející z mezinárodních doporučení MAGNIMS. Součástí doporučení je základní a rozšířený diagnostický protokol, protokol pro monitoraci aktivity a bezpečnostní protokol. V rámci standardizace je navržena i frekvence MR kontrol a jsou specifikovány nezbytné informace pro jejich plánování v čase. Implemen- tace tohoto konsenzu přinese vedle zlepšení péče o pacienty s RS i možnost sledování MR parametrů v rámci národního registru pacientů s RS a usnadní jednání s plátci zdravotní péče.
Magnetic resonance imaging (MRI) plays a key role in managing patients with multiple sclerosis (MS) – in diagnosis and determining prognostic markers, as well as in monitoring early signals of treatment ineffectiveness and safety problems. However, standardisation across sites is essential to maximise its potential. Close interdisciplinary communication between radiologists and neurologists and unification of the request form and structured radiological description are also essential. To this end, for this purpose, with the support of the Czech Society of Neuroradiology and the Section of the Clinical Neuroimmunology and Neurology Section of the Czech Neurological Society, this consensus of the Czech expert radiology-neurology panel, which is based on the international MAGNIMS recommendations, is published. The recommendations include a basic and extended diagnostic protocol, an activity monitoring protocol and a safety protocol. As part of the standardisation, frequencies of MRI examinations are proposed, and the necessary information for their timing is speci- fied. Implementing this consensus will not only improve the care of MS patients but also improve the monitoring of MRI parameters within the national registry of MS patients and facilitate negotiations with healthcare providers.
BACKGROUND AND OBJECTIVES: Nonconvulsive status epilepticus (NCSE) manifests as a change in mental status without a coma (NCSE proper) or comatose NCSE. Hypocretin-1/orexin-A (H/O) is involved in alertness and sleep maintenance. Sleep impairment and excessive daytime sleepiness (EDS) have a negative impact on cognitive functions and activities of daily living (ADL). METHODS: Patients meeting the NCSE criteria underwent cerebrospinal fluid and brain magnetic resonance imaging examinations, polysomnographies (PSG), multiple latency sleep tests (MSLT), and completed Epworth Sleepiness Scale (ESS). Montreal Cognitive Assessment was used to evaluate cognitive functions, and the Barthel Index was used to assess ADL in the acute phase (V1) and three months follow-up (V2). RESULTS: From May 2020 to May 2023, we enrolled 15 patients, eight (53.3 %) women, with a median age of 69 (14) years. The median H/O CSF concentration was 250 (63.6) pg/ml; however, only three CSF samples (20 %) decreased below the borderline concentration of 200 pg/ml. Fourteen out of 15 patients (93.3 %) completed the PSG study. The median of wakefulness after sleep onset was 167 (173.5) min, sleep efficiency (SE) was 62.9 (63) %, sleep latency (SL) was 6 (32) min, REM sleep was 2.85 (7.2) %, and REM first episode latency was 210.5 (196.5) minutes. The medians of the stages N1 NREM were 4.65 (15) %, N2 NREM 68.4 (29.9) %, and N3 NREM 21.8 (35.5) %. MSLT mean latency was 7.7 (12.6) minutes. A significant negative correlation exists between H/O CSF concentrations and the stage N1 NREM (rs = -0.612, p = 0.02), and the proportion of cumulative sleep time with oxygen saturation below 90 % in total sleep time (TST) t90 (rs = -0.57, p = 0.03). MSLT had significant negative correlation with TST (rs = -0.5369, p = 0.0478), with SE (rs = -0.5897, p = 0.0265), with apnea-hypopnea index (rs = -0.7631, p = 0.0002) and with deoxygenation index (rs = -0.8009, p = 0.0006). A positive correlation exists between MSLT and SL (rs = 0.6284, p = 0.0161) and between ESS and t90 (rs = 0.9014, p = 0.0004). The correlation between H/O CSF concentrations and EDS, cognitive performance, and ADL was not proved. CONCLUSIONS: Patients after NCSE exhibited sleep impairment and excessive daytime sleepiness. Hypocretin-1/orexin-A concentrations decreased only in 20 % of these cases.
- MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- orexiny * mozkomíšní mok MeSH
- polysomnografie * MeSH
- poruchy nadměrné spavosti * mozkomíšní mok MeSH
- průřezové studie MeSH
- senioři MeSH
- spánek fyziologie MeSH
- status epilepticus * mozkomíšní mok MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: To determine the added value of fetal magnetic resonance imaging (MRI) when clarifying a suspected anomaly detected by mid-trimester scan. METHODS: Women attending two centers of fetal medicine between January 2017 and December 2021 were identified. The centers carried out routine mid-trimester ultrasound scans to detect fetal anomalies. Those with a suspected anomaly which required further clarification were referred for fetal magnetic resonance imaging (MRI). The medical records of all referred women were examined to determine the anomalies found at scan, MRI and termination of pregnancy or delivery. A total of 9571 women had a routine mid-trimester scan and an anomaly was either diagnosed or suspected in 449 (4.7%); an MRI examination was made in 76 cases (0.79%). RESULTS: MRI confirmed the presence of an abnormality in 61 referrals (80%) and failed to yield a result in one case. Outcome information was available for 69 cases: the MRI confirmation rate was 89% (48/54) in those with abnormal outcome and 40% (6/15) if the outcome was normal, P.
- MeSH
- dospělí MeSH
- druhý trimestr těhotenství * MeSH
- lidé MeSH
- magnetická rezonanční tomografie * MeSH
- prenatální diagnóza metody MeSH
- těhotenství MeSH
- ultrasonografie prenatální * metody MeSH
- vrozené vady * diagnostické zobrazování MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Aim of this paper is to evaluate short and long-term changes in T2 relaxation times after radiotherapy in patients with low and intermediate risk localized prostate cancer. A total of 24 patients were selected for this retrospective study. Each participant underwent 1.5T magnetic resonance imaging on seven separate occasions: initially after the implantation of gold fiducials, the required step for Cyberknife therapy guidance, followed by MRI scans two weeks post-therapy and monthly thereafter. As part of each MRI scan, the prostate region was manually delineated, and the T2 relaxation times were calculated for quantitative analysis. The T2 relaxation times between individual follow-ups were analyzed using Repeated Measures Analysis of Variance that revealed a significant difference across all measurements (F (6, 120) = 0.611, p << 0.001). A Bonferroni post hoc test revealed significant differences in median T2 values between the baseline and subsequent measurements, particularly between pre-therapy (M0) and two weeks post-therapy (M1), as well as during the monthly interval checks (M2 - M6). Some cases showed a delayed decrease in relaxation times, indicating the prolonged effects of therapy. The changes in T2 values during the course of radiotherapy can help in monitoring radiotherapy response in unconfirmed patients, quantifying the scarring process, and recognizing the therapy failure.
- Publikační typ
- časopisecké články MeSH
