Neurologia i neurochirurgia polska (NEUROL NEUROCHIR POL )

Publisher: Polskie Towarzystwo Neurologiczne; Polskie Towarzystwo Neurolochirurgow


Polish Journal of Neurology and Neurosurgery, a bimonthly, publishes papers in the field of clinical neurology and neurosurgery understood broadly. It is intended for all interested in the results of scientific research in neurological sciences in Poland.

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    Polish Journal of Neurology and Neurosurgery website
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Publications in this journal

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    ABSTRACT: Background and purpose Accurate localization and adequate visualization of the superiorly or inferiorly located subperiosteal orbital abscesses or intraorbital abscess is difficult with transnasal endoscopic approach. Sonography is a well-known and effective tool for evaluation of orbital pathologies but no paper documenting intraoperative application of this method in orbital abscess surgery has been published to date. Material and methods We present a series of 12 patients in whom orbital abscesses were drained endoscopically with an aid of neuronavigation and intraoperative ultrasonography. The abscesses were localized subperiosteally in the medial (n = 6), superior (n = 2) or inferior (n = 1) part of the orbit whereas in 3 patients the abscess was localized in the intraconal space. Results According to intraoperative sonographic imaging complete drainage of the abscess was achieved in 11 out of 12 patients and no complications occurred. Intraoperative sonography helped to limit opening of the orbital wall in the medial subperiosteal abscesses, enabled check-up for completeness of drainage of the far extending pouches in the superior and inferior subperiosteal abscesses and enabled visualization of the tip of surgical instrument when reaching deeply located intraorbital abscesses. Conclusions Intraoperative ultrasonography facilitates the endoscopic management of orbital abscesses, especially those which are difficult to reach due to subperiosteal location in the superior and inferior parts of the orbit, or abscesses localized intraorbitally.
    Neurologia i neurochirurgia polska 08/2014;
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    ABSTRACT: We present our experience with surgery of jugular foramen schwannomas with special consideration of clinical presentation, surgical technique, complications, and outcomes.
    Neurologia i neurochirurgia polska 05/2014; 48(3):188-95.
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    ABSTRACT: To assess blood flow velocity in the middle cerebral artery (MCA) during transnasal endoscopic procedures performed with decreased hemodynamic parameters.
    Neurologia i neurochirurgia polska 05/2014; 48(3):181-7.
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    ABSTRACT: Supratentorial neurenteric cyst is a rare congenital lesion. We report here a case of a 33-year-old female who presented with seizures. A multicystic lesion in the left premotor cortex with moderate contrast enhancement was demonstrated with MRI. Microscopically, the lesion showed small cystic structures filled with a proteinaceous fluid. The wall of the cysts was lined with a single layer of ciliated columnar or cuboidal epithelium on a basement membrane. Glandular structures resembling gastrointestinal glands were also present. The cells of the cyst lining and glandular structures revealed strongly positive immunoreactions for epithelial markers (cytokeratin and epithelial membrane antigen).
    Neurologia i neurochirurgia polska 05/2014; 48(3):219-22.
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    ABSTRACT: A strikingly increasing number of obese patients causes a great interest in potential medical problems resulting from abnormal body weight. Many conditions are associated with obesity. The severity and risk of migraine may be connected with a body weight. We would like to assess a correlation between body mass index (BMI) and frequency and duration of migraine.
    Neurologia i neurochirurgia polska 05/2014; 48(3):163-6.
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    ABSTRACT: In this paper, we present some impressions and thoughts about CRPS which we found useful in our proceedings with CRPS patients. The clinical sub-types of the CRPS are presented and differences in their characteristics are discussed. The current pathophysiological concepts for CRPS are outlined. Diagnostic criteria are presented and critically discussed. Both classification and diagnosing have translation on research and clinical practice. Treatment modalities are provided, addressing separately acute/early and chronic forms of the syndrome. The "Szczecin" protocol of management of early CRPS is presented in details. Some information about prevention of the syndrome is given. We believe that the information presented may support doctors in resolving their diagnostic dilemmas associated with CRPS.
    Neurologia i neurochirurgia polska 05/2014; 48(3):200-205.
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    ABSTRACT: We present our experience with surgery of parasagittal and falcine meningiomas invading the superior sagittal sinus with special consideration of the surgical complications and the incidence of tumour recurrence.
    Neurologia i neurochirurgia polska 05/2014; 48(3):174-80.
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    ABSTRACT: Neurodegeneration with brain iron accumulation (NBIA) defines a heterogeneous group of progressive neurodegenerative disorders characterized by excessive iron accumulation in the brain, particularly affecting the basal ganglia. In the recent years considerable development in the field of neurodegenerative disorders has been observed. Novel genetic methods such as autozygosity mapping have recently identified several genetic causes of NBIA. Our knowledge about clinical spectrum has broadened and we are now more aware of an overlap between the different NBIA disorders as well as with other diseases. Neuropathologic point of view has also been changed. It has been postulated that pantothenate kinase-associated neurodegeneration (PKAN) is not synucleinopathy. However, exact pathologic mechanism of NBIA remains unknown. The situation implicates a development of new therapies, which still are symptomatic and often unsatisfactory. In the present review, some of the main clinical presentations, investigational findings and therapeutic results of the different NBIA disorders will be presented.
    Neurologia i neurochirurgia polska 05/2014; 48(3):206-213.
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    ABSTRACT: Wilson's disease (WD) is caused by excess of copper that leads to accumulation of copper mainly in the liver, brain and needs life-long decoppering therapy. However, overtreatment with anti-copper agents may lead to copper deficiency which may cause neurological and hematological symptoms. Copper is an important cofactor for many enzymes. This report describes three WD patients with diagnosed copper deficiency during zinc sulphate (ZS) treatment. After 5-16 years of therapy all patients developed leucopenia. Spinal cord injury was manifested in two of the patients. One of them also presented myopathy. In conclusion, copper deficiency may occur in different time after treatment onset, therefore regular copper metabolism and hematological monitoring is necessary.
    Neurologia i neurochirurgia polska 05/2014; 48(3):214-8.
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    ABSTRACT: General anesthesia (GA) is the most commonly used anesthetic technique for spinal surgery. This study aimed to compare spinal anesthesia (SA) and GA in patients undergoing spinal surgery, in terms of perioperative outcome and cost effectiveness.
    Neurologia i neurochirurgia polska 05/2014; 48(3):167-73.
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    ABSTRACT: Meige syndrome (MS) is characterized by blepharospasm, facial, oromandibular, and often cervical dystonia. The medical treatment of this condition is challenging and unsuccessful over long time. Recent case reports and small clinical series showed that bilateral deep brain stimulation (DBS) of globus pallidus pars interna (GPi) improves dystonic features of MS validated by Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS).
    Neurologia i neurochirurgia polska 05/2014; 48(3):196-9.
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    ABSTRACT: Mitoxantrone (MTX) has been shown to reduce progression of disability and number of clinical exacerbations in patients with progressive multiple sclerosis (MS). Prolonged administration of MTX, however, is limited by the risk of cardiotoxicity. Cardiac monitoring in MTX-treated patients includes usually measurement of left ventricular ejection fraction (LVEF) by means of echocardiography. The N-terminal pro-brain natriuretic peptide (NT-proBNP) represents a novel diagnostic tool in the assessment of heart failure. This study was aimed to evaluate the usefulness of NT-proBNP for early detection of MTX-induced cardiotoxicity in MS patients. We measured the NT-proBNP plasma levels in 45 MS patients who completed 24-month MTX therapy and in 37 MS patients of control group. The median NT-proBNP plasma value was 15.12pg/mL. In 12 MTX-treated patients (27%), NT-proBNP plasma values were elevated, though this subgroup of patients neither clinical showed evidence of myocardial damage nor had the LVEF value <50%. In five patients with normal NT-proBNP, we observed LVEF decline >10%. We did not observe correlations between the NT-proBNP levels and patient age, MS duration, relapses index, Extended Disability Status Scale (EDSS), MTX single dose and the total cumulative dose of MTX. In 8 patients (22%) from control group, NT-proBNP plasma levels were also elevated. The results of our study confirm that MTX therapy is safe for carefully selected and closely monitored MS patients. We believe that serial evaluation of NT-proBNP levels (before, during and after MTX therapy) can identify MS patients at high risk for MTX-induced cardiotoxicity.
    Neurologia i neurochirurgia polska 01/2014; 48(2):111-5.
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    ABSTRACT: Purpose The triple-H therapy is widely used for cerebral vasospasm (CV) prevention and treatment in patients after subarachnoid haemorrhage (SAH). However, this practice is based on low level evidence. Aim of this study was to evaluate errors in fluid administration, fluid balance monitoring and bedside charts completeness during a trial of triple-H therapy. Materials and methods An audit of the SAH patient charts was performed. A total of 508 fluid measurements were performed in 41 patients (6 with delayed cerebral ischaemia; DCI) during 14 days of observation. Results Underestimating for intravenous drugs was the most frequent error (80.6%; 112), resulting in a false positive fluid balance in 2.4% of estimations. In 38.6% of the negative fluid balance cases, the physicians did not order additional fluids for the next 24 h. In spite of that, the fluid intake was significantly increased after DCI diagnosis. The mean and median intake values were 3.5 and 3.8 l/24 h respectively, although 40% of the fluid balances were negative. The positive to negative fluid balance ratio was decreasing in the course of the 14 day observation. Conclusions This study revealed inconsistencies in the fluid orders as well as mistakes in the fluid monitoring, which illustrates the difficulties of fluid therapy and reinforces the need for strong evidence-based guidelines for hypervolemic therapy in SAH.
    Neurologia i neurochirurgia polska 01/2014;
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    ABSTRACT: To analyze the changes in spino-pelvic parameters after surgical treatment of lumbar isthmic spondylolisthesis. Sixty patients recruited from a group of consecutive series of 128 cases with isthmic spondylolisthesis operated on between 2002 and 2012 in the Department of Neurosurgery, Tarnow, Poland. All patients were operated on by the same surgeon (the first author). Spino-pelvic parameters: PI, SS, PT, LSA, and LL were measured manually on standing lateral view radiograms. Patients were divided according to Spinal Deformity Study Group classification which we modified for means of analysis: (A) low-grade group: subgroups with balanced pelvis and unbalanced pelvis (instead of normal and high PI subgroups), (B) high-grade group: subgroups with balanced and unbalanced pelvis. Twenty-nine patients had unbalanced pelvis before the operation. In 10 of them (34%), the procedure resulted in full correction of pelvis position meaning that they achieved balanced pelvis after the surgery. There were 6 patients with low-grade slip who had balanced pelvis preoperatively but showed unbalanced pelvis after the surgery but this loss of balanced pelvis did not affect the clinical outcome which overall was good among them. Patients with unbalanced pelvis presented changes towards restoration of spino-sacro-pelvic anatomy postoperatively: PT decreased while SS increased, although these changes were not statistically significant. Further studies are needed to confirm whether surgical correction of spino-pelvic parameters results in better clinical outcome in patients with isthmic spondylolisthesis.
    Neurologia i neurochirurgia polska 01/2014; 48(1):21-9.
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    ABSTRACT: We present a case of a 30-year-old Polish female who presented with increasing for about 2 years spastic paraparesis and urinary incontinence. She denied any risky sexual behaviors, drug abuse, there was no history of surgery or blood transfusions. MRI of the brain showed diffuse, hyperintensive in T2, poorly defined lesions in the white matter. About 3 months later paraparesis increased and control MRI showed progression of previously described lesions. She was then diagnosed with HIV infection. There was a suspicion of progressive multifocal leucoencephalopathy (PML) or vacuolar myelopathy in the course of HIV infection. Antiretroviral treatment was initiated leading, together with rehabilitation, to a progressive improvement of symptoms. Pathological lesions on brain MRI completely disappeared. In conclusion, HIV test should be done in every patient with neurological signs of unknown cause.
    Neurologia i neurochirurgia polska 01/2014;
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    ABSTRACT: Dilated Virchow-Robin spaces (dVRs) have been revealed by magnetic resonance imaging (MRI) in patients with various neurological disorders. However, their etiology and clinical importance have not been discovered yet. The aim of the study was to estimate dVRs occurrence in hospitalized children and determine dVRs localization and their association with different nervous system diseases. Contrast-enhanced brain MRI examinations with the use of 1.5T GE device were performed in children with different diseases of nervous system, who were hospitalized at Pediatric Neurology Department, Chair of Children and Adolescent Neurology, Jagiellonian University in the years 2010-2011. The mean age of examined children was 11.58 years, and the studied group included 27 boys and 26 girls. Within two years, MRI examinations of the brain were performed in 1348 children and dVRs were found in 53 of them (3.93%). Among children with dVRs, 15 were diagnosed with headache (28.3%) and 18 with epilepsy (33.96%). Other diagnoses were less frequent and occurred in 37.7%. Generalized dVRs and those localized in the subcortical nuclei were most frequently found. Higher incidence of dVRs was found in children with headache and epilepsy. No association was found between localization of dVRs and symptomatology of different nervous system diseases except for large dVRs probably due to the pressure on the surrounding tissues.
    Neurologia i neurochirurgia polska 01/2014; 48(1):39-44.
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    ABSTRACT: Nummular headache (NH) is a rarely recognized primary headache, the diagnostic criteria of which are contained in the appendix to the 2nd edition of the International Classification of Headache Disorders (code A13.7.1). We present the case of a 61-year-old female who suffers, regardless of NH, from right-sided occipital neuralgia. The applied treatment - gabapentin and mianserin - had no effect. Injection of bupivacaine twice to the right occipital region resulted in neuralgia resolution up to three months, with no effect on NH. This confirms the independence of two abovementioned head pain conditions.
    Neurologia i neurochirurgia polska 01/2014; 48(2):141-3.