Bučaitė, Dovilė

COVID-19 yra liga, kurią sukelia virusas, vadinamas sunkaus ūminio respiracinio sindromo koronavirusu 2 (SARS-CoV-2). Didelei žmonių populiacijai susidūrus su infekcija buvo pastebėta, kad užsikrėtus virusu pro­gresuoja ne tik ligai būdingi simptomai, bet stebimas ir autoimuninių ligų, kaip autoimuninis encefalitas (AE), pasireiškimas. Nagrinėjant AE patogenezę po COVID-19 išsiaiškinta, kad sisteminio uždegiminio atsako sindro­mas (SIRS) sutrikdo organizmo imuninės sistemos savų struktūrų atpažinimą, daro įtaką autoimuninio proceso at­siradimui, ligos pasireiškimui, eigai. AE klinikinė raiška progresuoja greitai ir gali pasireikšti jau po 1-12 dienų nuo pirmųjų COVID-19 infekcijos simptomų. Stebimi dažnesni, sudėtingesnio gydymo reikalaujantys epilep­sijos priepuolių atvejai nei po kitų infekcijų, galinčių išprovokuoti autoimuninio proceso atsiradimą. Tyrimo tikslas – apžvelgti literatūros duomenis ir aptarti COVID-19 infekcijos sukelto AE etiologiją, patogenezę, klinikinę raišką, diagnostiką ir gydymą.

Introduction. During the pandemic, vaccination against COVID-19 has become one of the most important ways to prevent severe infection. However, a lack of trust in vaccines among the population, including people with multiple sclerosis (MS) has been identified. In Lithuania, the specific reasons for vaccine hesitancy among people with MS have not been described. We conducted a survey to determine the attitude of people with MS towards vaccination against COVID-19 infection. Methods. An original anonymous questionnaire was created. The survey included the following aspects: patient demographics, MS exacerbation, COVID-19 vaccination status, and attitudes towards the vaccination process. The survey was conducted between November 2021 and February 2022. Data were analyzed using IBM SPSS Statistics 27.0 with Chi-square and Mann-Whitney U tests and p-value (statistically significant at <0.05) for each hypothesis. Results. Of the 80 MS patients, 82.5% (n=66) were vaccinated and only 17.5% (n=14) were not vaccinated. The most popular positive opinions about vaccination were: “COVID-19 vaccines have more benefits than harm” (71.6%) and “the desire to prevent severe symptoms/hospitalization caused by COVID-19 infection” (79.1%), while mostly agreed negative opinion was “fear of side effects of the vaccine” (84.6%). Intended uptake of COVID-19 vaccines was strongly associated with younger age (p=0.021), higher education level (p=0.008), and employment status (p=0.028). There was no further link between other demographic factors such as gender, residency, and even exacerbation of MS between January 1, 2020 and February 1, 2022 (p>0.05). Conclusion. Although there was some hesitancy about the COVID-19 vaccination, people with MS were more likely to take the COVID-19 vaccine due to their positive attitude towards the process.

Parkinsono liga (PL) dažniausiai serga vyresni nei 60 metų asmenys. Jei klinikiniai šio sutrikimo simptomai pasireiškia iki 21 metų, diagnozuojamas jaunatvinis parkinsonizmas (JP). Patogeniniai PRKN geno variantai yra viena dažniausių genetinių JP priežasčių. JP būdingi atipiniai simptomai, todėl ši PL forma dažnai klaidingai diagnozuojama (pvz., levodopai jautri distonija). Šiame straipsnyje pristatome JP atvejį 36 m. pacientei su netipiniais simptomais, kuriai pirmiausiai įtarta idiopatinė nešeiminė distonija. Moteriai pasireiškė kairės kūno pusės spastika, pasunkėjusi eisena, mėšlungis. Dėl simptomų pagerėjimo po levodopos skyrimo, patikslinta kaip levodopai jautri distonija. Blogėjant klinikinei būklei, pacientei jau daugelį metų koreguojamas medikamentinis gydymas, prireikė ir giliosios smegenų stimuliacijos sistemos implantavimo. Galiausiai naujos kartos genų sekoskaitos metodu moteriai buvo nustatyta PKRN geno mutacija ir diagnozuotas JP.

Introduction (Case Reports Only) In clinical practice, there are 2 main types of exudative age-related macular degeneration (AMD): classic and occult. Meanwhile the scientific literature describes a total of 3, including retinal angiomatous proliferation (RAP). This neovascularization specifically starts at the retina and progresses posteriorly into sub retinal space. RAP is difficult to diagnose because it is a rare pathology (about 20% cases of AMD). Case Description (Case Reports Only) A 64-year-old white man presented to the Ophthalmology Outpatient Department with decreased vision in his left eye. Clinical examination revealed visual acuity (VA) (Snellen chart) VOD = 1.0, VOS = 0.8, normal intraocular pressure. Routine and instrumental examinations were performed: OCT, OCT-A, FA. The findings included choroidal neovascularization (CNV), intraretinal fluid, subretinal fluid, hemorrhage, drusen, paracentral areas of retinal pigment epithelium atrophy, and swollen retina in the left eye. After long discussions about the results of the examinations the final diagnosis was made of exudative AMD - RAP. After 3 weeks the treatment was started with ranibizumab, an anti-VEGF intravitreal injection (IVT). The efficacy of the treatment was monitored by VA testing and OCT examination. After the first dose of IVT, VA improved to VOS = 0.7, after the second, third and fourth doses improved to VOS = 1.0. After the 4th IVT, the OCT examination showed changes: OS macular parafoveal CNV with mild scarring and reduced retinal swelling. 4 months after the start of the treatment the patient's condition has improved, and further follow-up is prescribed. Summary (Case Reports Only) A 64-year-old patient experienced a decreased vision in the left eye, after a rare diagnosis of RAP IVT were performed and his condition successfully improved. Conclusions While it is challenging to diagnose RAP, this case report represents the importance of applying appropriate evaluations and interventions to diagnose and treat this rare pathology.

Introduction (case reports only) Parkinson’s disease (PD) is one the most common neurodegenerative movement disorders. The mean age of onset of disease is in the early-to-mid 60s manifesting with bradykinesia, rigidity and tremor. However, there are some difficulties to diagnose PD for young patients. Case description (case reports only) A 36-year-old woman was admitted to Neurology Outpatient unit due to deterioration of gait, stiffness of left side of the body, muscle cramps and inversion of the right foot. Her mental status was found normal. Similar symptoms have been shown since the age of 15. In the year of 2010 CT and MRI were performed - no structural causes were found. As the symptoms persisted, in 2011 the patient was diagnosed with levodopa-sensitive idiopathic familial dystonia, due to 30% improvement in the motor portion of the Unified Parkinson Disease Rating Scale after taking Levodopa/Benserazide test. For treatment she used Levodopa/Benserazide prolonged release form with gradually increased dosage until 2018. After reported side effects it was changed to Levodopa/Carbidopa and Trihexyphenidylum sustained-release form. Regarding the possibility of familial dystonia genetic tests were performed - no mutations in TOR1A gene were found. In 2020 neurosurgeons implanted the globus pallidus internus (GPi) deep brain stimulation (DBS) bilaterally, however, recurrent symptoms require changes in parameters and medical treatment till this day. In 2022 09, following genetic tests, a mutation in PRKN gene was found and finally she was diagnosed with juvenile PD, type 2. Summary (case reports only) A 36-year-old patient with rapidly progression of atypical signs and symptoms such as dystonic posture and muscle cramps and a requirement of different treatment is presented. After a delayed diagnosis, finally genetically inherited PD form was diagnosed. Conclusions Although the clinical diagnostic criteria for PD is validated, an accurate diagnosis of PD remains a challenge because clinical features can overlap with those of other movement disorders.

Įvadas. Ptozė – viršutinio voko nusileidimas žemiau įprastinės padėties (> 2 mm). Atsižvelgiant į išsivystymo laiką, ptozės skirstomos į įgytas bei įgimtas. Pastarosios dažniausiai pasireiškia vaikams, gali būti paveldimos, pasireikšti vienoje ar abejose akyse kaip izoliuotas sutrikimas arba kartu su kitomis sisteminėmis ligomis. Manoma, kad šio sutrikimo patogenezę lemia ne tik raumenų vystymosi sutrikimas, bet ir jų inervacijos pažaida. Kita vertus, šiuo metu tikslaus įgimtos vokų ptozės patogenezės apibūdinimo dar nėra. Tikslas. Pristatyti pagrindines įgimtų ptozių klinikines išraiškas tam, kad būtų pasirenkamas ankstyvas ir tikslus ligos gydymas. Medžiaga ir metodai. Literatūros apžvalga buvo atlikta „PubMed“ duomenų bazėje, naudojant terminą „įgimta ptozė“ kartu su „miogeninė įgimta ptozė“, ,,neurogeninė įgimta ptozė“ nuo 2010 – 2023 m. Į literatūros apžvalgą įtraukti straipsniai, atitinkantys paieškos kriterijus. Rezultatai. 1) Miogeninės ptozės atsiradimo mechanizmas yra susijęs su viršutinio voko keliamojo raumens vystymosi pažaida, kai raumens skaidulos pakeičiamos kitu audiniu. Jai būdingi dažniausi klinikiniai pasireiškimai: izoliuota įgimta ptozė ir blefarofimozės - ptozės - inversinio epikanto sindromas. 2) Neurogeninė įgimta ptozė atsiranda esant voko keliamųjų raumenų inervacijos sutrikimui. Jos kilmę lemia didesnė grupė ligų, priskiriamų įgimtai kaukolės inervacijos sutrikimų grupei: įgimta ekstraokulinių raumenų fibrozė, Markuso - Guno, Duano, Mebiuso sindromai, paveldima įgimta veido parezė, Hornerio sindromas bei įgimtas III galvinio nervo paralyžius. Išvados. Įgimtos ptozės etiologija įvairi, tačiau miogeninės ir neurogeninės kilmės įgimtos ptozės literatūroje aprašomos dažniausiai, o jų pasireiškimas didesnis vaikų amžiuje. Pagrindinis įgimtos ptozės etiopatogenezės mechanizmas išlieka neaiškus.

Introduction Delayed cerebral ischemia (DCI) is a major predictor of poor outcomes in patients with SAH [1]. This occurs in about one-third of patients after SAH and poses substantial risks for mortality. Inpatients who experience DCI, about 20% have fatal outcomes [2, 3]. While it is important to detect early signs of DCI, patients with a high risk of DCI are difficult to identify. Therefore, this study aimed to identify risk factors of DCI and clarify their clinical impact on outcome and the disease course. Aim To evaluate the most important risk factors causing the development of late ischemia after cerebral vascular aneurysm rupture and the outcome of patients with DCI. Methods The study was approved by the Bioethics center of Lithuanian University of Health Sciences(LUHS) (BEC-MF-02). It was a single-centre retrospective analysis of 165 patients during the period of 2020.09 to 2021.12 in LUHS KC Neurosurgery Intensive care Unit. Inclusion criteria were: age ≥ 18, patients diagnosed with ruptured cerebral artery aneurysm. Medical history was analyzed. Statistical analysis was performed with IBM SPSS Statistics 27.0 and MS Excel 2016programs. To carry out research objectives Mann-Whitney test, Chi-Square and p-value criteria were used (statistically significant if p<0.05). The statistical strength and direction of association between two variables were counted with Spearman’s correlation coefficient (R). Results Of all 165 patients with SAH, 27.88% (n=46) developed DCI (diagnosed by CT findings and worsened neurological condition after >48 hours): 43.50% (n=20) men and 56.50% (n=26)women. The average age of the patients was 57.61±12.39 years (range 34-86 years), the majority were >50 years (73.90%). 47.80% of the patients had previously been diagnosed with arterial hypertension, diabetes mellitus, or both and even 52.20% had no comorbidities. The most common site of rupture was the anterior communicating artery (39.10%). Although the patients' initial blood glucose level and leukocyte count were not statistically significant for patients with DCI outcomes, these results were increased (7.74±1.66, p=0,48 and 13.58±5.51, p=0,69). According to the GOS scale, outcomes of the patients with DCI were: death (39.10%), vegetative state (15.20%), severe disability (28.30%), moderate disability (8.70%) and good recovery(8.70%). Outcomes after developing DCI were not associated with gender (p=0.96) and age(p=0.12). Moreover, comorbidities, the site of an aneurysm, and the amount of SAH (e.g. Fisher scale) did not correlate with outcomes after DCI (p>0.05). Conclusions This study showed that DCI was not associated with such risk factors as age, gender and comorbidities, initial glucose level, leukocyte count, and even with the site of an aneurysm. Furthermore, according to the GOS scale, death was the most common outcome in patients with DCI.

Migrena ir neramių kojų sindromas (NKS) – tai ligos, sutrikdančios normalią žmogaus gyvenimo kokybę, o jų komorbidiškumas nulemia dar sunkesnę pacientų būklę. Migrenai yra būdingas pulsuojantis, vienpusis, priepuolinis galvos skausmas, kurį lydi pykinimas, vėmimas, fotofobija ir fonofobija. Žinoma, kad, sutrikus miegui, gali padažnėti migrenos priepuoliai. Miego sutrikimai gali pasireikšti įvairiomis klinikinėmis išraiškomis, viena jų – NKS. Jis apibūdinamas kaip neurosensorinis pakenkimas, kurio metu atsiranda nenumaldomas noras judinti galūnes ramybėje. Dėl šios priežasties pacientai gali skųstis suprastėjusiu miegu. Nors migrenos ir NKS ryšys bei jų patofiziologija nėra iki galo ištirti, dabartinių tyrimų duomenimis, šios ligos gali turėti sąsajų. Asmenims, sergantiems NKS, tikimybė pasireikšti migrenos priepuoliams padidėja nuo 1,23 iki 2,65 karto. Manoma, kad abiejų ligų atsiradimą lemia keli patofiziologiniai veiksniai, tokie kaip dopaminerginės sistemos aktyvumas, geležies stoka, genetinis polinkis ir pilkosios smegenų medžiagos pokyčiai. Nors sąsaja tarp NKS ir migrenos yra tyrinėjama, vyraujantys patofiziologiniai pokyčiai kol kas nėra nustatyti. Atskirai šių ligų gydymas jau seniai yra žinomas. Migrenos gydymo principas – slopinti skausmą ir retinti priepuolių dažnį. NKS gydymas remiasi simptomų malšinimu. Deja, bendras abiejų ligų gydymas nėra patvirtintas. Dėl panašios šių sutrikimų patofiziologijos, šiuo metu tyrinėjami vaistai, veikiantys dopaminerginę sistemą (pvz., pramipeksolis) ir galintys lengvinti NKS simptomus bei migrenos priepuolius.

Introduction During the COVID–19 pandemic, vaccination became an important tool to prevent severe illness [1]. COVID–19 vaccines are safe and effective for people with multiple sclerosis (MS) [2]. However, coronavirus outbreak has also raised awareness of vaccine skepticism. In the US and other countries, some studies evaluated the link between willingness to get vaccinated against COVID–19 and sociodemographic factors or MS exacerbation [3–6]. In Lithuania, specific reasons for vaccine hesitancy among people with MS have not been described. We created a survey from 1 November 2021 to 1 February 2022 to estimate positive and negative attitudes of COVID-19 vaccination among patientswith MS. Aim To evaluate the peculiarities of vaccination against COVID-19 infection in patients with MS and their attitude towards vaccination. Methods The study was approved by Bioethics center of Lithuanian University of Health Sciences (LUHS) (BEC-MF-153). The research was performed at LUHS Kaunas Clinics Neurology unit and Diseases of Nervous System Outpatient unit. 100 people with MS were asked to fill an original questionnaire, in total 80 patients responded. Survey was about patients’ sociodemographic aspects, MS exacerbation, COVID-19 vaccination and their attitudes towards this process. Data was analyzed with IBM SPSS Statistics 27.0, with calculation of the Qui-square and Mann – Whitney U test and p-value (statistically significant if < 0.05) for each hypothesis. Results Among 80 respondents, 63.1% were female and 32.1% were male. Mean respondents age was 39 ± 9.8 years. 78.6% (n=66) of patients were vaccinated and only 16.7 % (n=14) were not. Vaccinated respondents age median - 37 ± 9.9 years, nonvaccinated age median – 47 ± 8.0 years.. […].