Aim: The aim of the projeck is to integrate early neurorehabilitation into the healthcare system for patients with acquired severe brain injury in the Czech Republic.Objectives. Methods: The intensive neurorehabilitation (NINR) pilot project implements phase B1 of the neurorehabilitation phase model, which is defined as the early rehabilitation phase. During this phase, intensive care must be provided if necessary, including the possibility of artificial pulmonary ventilation. Patients indicated for admission to the NINR facility are conditiontransferred from intensive or acute neurosurgical care units, such as traumatic brain injury, inflammatory brain dis ease, brain tumor, cerebral stroke or impaired cerebrospinal fluid production, flow and resorption. Admission is possible within one month of the onset of the condition, according to admission criteria. The maximum duration of care provided to one patient at NINR facility is 12 weeks. If necessary, the length of stay at an NINR facility can be prolonged due to a deferred prognosis; in such cases, an ,indication seminar` is held with representatives of the health insurance company in attendance, where justification for such a proposal is assessed and further actions are recommended. A stay at the NINR facility will end if there has been no improvement for an uninterrupted period of up to six weeks, or ifa Barthel Index value of 30 has been achieved at anytime during the stay. Under the NINR program, patients receive up to 12 weeks of 3 to 4 h of intensive therapy per day. Results: The project is currently operating at three locations in the Czech Republic. As of the end of June 2025, early neurorehabilitation as part of the project had been completed in 122 patients, who were admitted on average 18 days after the onset of acute illness. The average hospitalization time at NINR facility was 45.8 days. Upon admission, 53.6% of patients were on mechanical ventilation, compared to 9.7% at discharge. Of those admitted with tracheostomy (79.5%), 29.5% remained upon discharge. A Barthel Index score of 30 or more was achieved by 75 (61.5%) patients at discharge. 38% were able to progress to the next phase of rehabilitation, 30% were transferred to fol lowor longintensive care units, and 11%were released to home care. Conclusion:The project results demonstrate the feasibility of successfully implementing this approach into the healthcare system in the Czech Republic. Following the completion of the project, we hope to extend this care to other facilities.
Introduction: Herniated disc is a common cause of lumbar radiculopathy. Full endoscopic discectomy is a minimally invasive alternative to microdiscectomy. The aim of the study was to evaluate the results and complications of endoscopic procedures and to compare the transforaminal and interlaminar approaches. Methods: A retrospective analysis included 64 patients (40 men, 24 women; mean age 51.2 years). Transforaminal approach was performed in 12 patients and interlaminar in 52 patients. In both groups, we evaluated the duration of surgery, X-ray exposure, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) (before the procedure, at discharge, 3 and 12 months after surgery), postoperative complications, and the frequency of postoperative recurrence of herniated disc. Results: The mean duration of surgery was 62 min. X-ray exposure was longer with the transforaminal approach (43 s) than with the interlaminar approach (22 s; P < 0.001). VAS decreased from 7.4 +/- 1.2 to 1.3 +/- 0.8 at 12 months (P < 0.0001), and ODI from 56% +/- 13% to 14% +/- 9% (P < 0.0001). No significant difference was found between the transforaminal and translaminar approaches in VAS and ODI. The results are valid for the entire group of patients. The overall complication rate was 14.0%. We recorded dural sac injuries twice (3.1%) without the need for surgical revision. Recurrence of disc herniation was recorded in 7 patients (10.9%). Conclusion: Transforaminal and translaminar endoscopic extirpation of intervertebral disc herniation is an effective and safe method with rapid recovery and low morbidity. The translaminar approach is suitable for centrolateral herniations, where it allows a more direct and anatomically clearer approach to the pathology with better control of the dural sac and nerve root and is associated with lower technical demands. The transforaminal approach is used for medial and laterally localized intervertebral disc herniations. The advantage is the preservation of the integrity of the spinal canal with minimal manipulation of the dural sac. However, it is technically more demanding and the result depends on the experience of the surgeon.
Academician Kamil Henner ranks among the most prominent figures in 20th-century Czechoslovakian neurology.This article outlines not only his exceptional professional contributions, but also the key milestones of his life and his personality. Henner began his career at the First Department of Internal Medicine under Ladislav Syllaba, where he gradually established himself as a neurologist and built his own school of disciples. In 1937, he became the head of the Neurology Department at the General Hospital, but his early tenure was significantly affected by the events of World War II, during which Henner and his colleagues became actively involved in the resistance. After World War II, Henner succeeded in transforming the department into a leading center for neurology. Henner's scientific work was remarkably broad and productive; he authored more than 300 publications. His pedagogical influence was equally important-both at the undergraduate level, where he improved the quality of neurological education, and at the postgraduate level, where he trained an entire generation of neurologists, many of whom later achieved the highest academic positions. His death marked the end of an era in Czechoslovakian neurology.
Background: Parkinson's disease is a neurodegenerative disorder that not only affects motor functions, but also speech and voice production. Music therapy represents a promising non-pharmacological approach to support communication in this population. Objectives: This interventional studyaimed to evaluate the impact ofan original structured music therapy program on speech intelligibility, voice quality, and spontaneous speech production in individuals with Parkinson's disease. Methods: Study participants (N = 17) participated in an eight-week structured group program focused on voice, breathing, articulation, and singing. Pre-and post-intervention assessments included the GRBAS scale, a speech intelligibility test, and the Analysis ofSpontaneous Speech (ASpoR) tool to evaluate spontaneous speech. Data were analyzed statistically using descriptive and inferential methods with effect size calculation. Results: Participants demonstrated consistent improvement in overall speech intelligibility, with a significant gain in the combined score (P = 0.0099, d = 0.71). GRBAS scores improved descriptively, though not significantly, with large effect sizes for breathiness (r = 0.83) and strain (r = 0.67). While fluency and error rates in spontaneous speech showed no significant change, the intervention significantly enhanced self-monitoring, as evidenced by a higher percentage of corrected errors relative to total errors (P = 0.00097, r = 0.87), and a reduced ratio of uncorrected to corrected errors (P = 0.00049, r = 0.87). Conclusion: The program improved several aspects of communication, suggesting the therapeutic potential of music therapy for this population.
Backgroundandobjective:Although intravenous thrombolysis(IVT) isa recommended recanalization therapy for ischemic stroke, it is associated with a risk of symptomatic intracranial hemorrhage. This academic clinical study aims to evaluate the relationship between fibrinogen levels and their drop measured at 6 and 24 h after IVT and the risk of intracranial hemorrhage, specifically parenchymal hematoma, which is the most clinically significant type of intracranial hemorrhage. Methods: Seven primary stroke centers and comprehensive stroke centers in the Czech Republic will be involved in the multicenter retrospective study. The estimated total number of patients enrolled in the observation and control groups is 300, with defined entry parameters maintained. The parameters monitored include personal and pharmacological history, laboratory parameters, neurological findings, and imaging results. Results: The study will evaluate the degree of association between fibrinogen levels and their drop measured at 6 and 24 h after IVT and the risk of parenchymal hematoma. Conclusion: Evidence of an association between the development of parenchymal hematoma and a decrease in fibrinogen levels in patients with ischemic stroke treated with IVT may be used to design an interventional study with fibrinogen replacement to prevent bleeding.
Aim: This article explores brain death assessment according to neurological criteria and evaluates a nationwide survey on diagnostic procedures. It also examines awareness among healthcare professionals. Methods: An online survey was conducted from January 7 to March 3, 2025, targeting 115 healthcare facilities. The questionnaire collected demographic data, specialties, and frequency of brain death assessments and examination of individual reflexes. Results: 523 respondents participated in the questionnaire survey, with 38% having experience in brain death assessment. A total of 187 physicians regularly examine brain death, with 74% of them performing fewer than five examinations per year. The most common specialists were anesthesiologists (48%) and neurologists (27%). Most physicians (50%) follow the IKEM "& Zcaron;ivot2" manual. The main reason for the examination (61%) was the donor program. The apnea test is performed by 81% of respondents, 90% of them only after a clinical examination. The most commonly used confirmatory method is CTA (26%), while 43% of physicians indicate confirmatory testing only in the case of a donor program. Conclusion: A questionnaire survey revealed the existence of interindividual differences in the investigative procedure for clinical determination of brain death in the Czech Republic. The consistency of clinical examinations is insufficient in patients referred to the donor program. In contrast, the apnea test is unnecessarily overused in examinations conducted as part of the decision-making process regarding futile care limitations. The findings emphasize the need for enhanced education on brain death assessment, particularly those who rarely encounter this diagnosis. It is also crucial to understand the concept of brain death and how it is communicated both among healthcare professionals and to the public.
Ladislav Haskovec was the central founding figure in the field of neurology in the Czech lands. For three decades, he advocated the recognition of neurology as an independent teaching and clinical discipline; however, it was not until 1926 that he succeeded in establishing the "University Department for Nervous Diseases" at the Faculty of Medicine of Charles University. He was then granted only ten years to lead the department. A persistent motive of his career was not merely the scientific development of the field, but also a sustained struggle for beds, outpatient facilities, laboratories, and personnel-in other words, for the "infrastructure" of the discipline. The article tracesHaskovec 's professional trajectory from his habilitation in neuropathology in 1896, through the establishment of the first neurological outpatient clinic and ward at Na Franti & scaron;ku Hospital, to the institutional consolidation of the department in the former monastery at Karlov. Drawing on archival sources, it analyses the circumstances of its foundation, its staffing conditions, and the role of Haskovec `s collaborators and pupils. The study also addresses the question of his priority among habilitated neurologists in the Czech lands and situates his work within the broader Central European context of the emergence of modern neurology.
Objective: The study compares the health status of pediatric patients after prenatal and postnatal surgical treatment of open neural tube defects in order to determine the success of the above approaches in the treatment of patients. Methods: The retrospective study analyzes the health status of 12 prenatally and 17 postnatally operated patients between 2016 and 2024. Fetal procedures were performed at the Spina Bifida Center at the Children's Hospital in Z & uuml;rich, Switzerland, and postnatal surgeries were performed at National Institute of Childrens Diseases in Bratislava, Slovakia. Results: We recorded the following values in prenatally and postnatally operated patients-the incidence of shunt-dependent hydrocephalus was 33.33% and 47.06%; psychomotor development was slowed down in 25% and 23.53%;41.67%and 52.94%were able to walk independently, or walk independently with orthopedic aids; neurogenic bladder was present in 66.67% and 58.88%; and neurogenic obstipation was found in 41.67% and 41.18% of patients, respectively. Arnold-Chiari malformation type II occured in 91.67%of patients after prenatal surgery and in 100% of patients after postnatal surgery. Conclusion: We consider prenatal correction of open neural tube defects to be effective and beneficial due to the lower rate of need for surgical interventions for hydrocephalus and the lower number of children whose mobility depends on another person or a wheelchair.
Spontaneous intracerebral hemorrhage (SICH) represents a significant subtype of acute stroke with high morbidity and mortality. Comprehensive SICH management aims to increase survival rates and improve clinical outcomes of patients with this disease. The guidelines cover the areas of care organization, diagnosis, medical treatment (acute blood pressure lowering and hemostatic treatment), surgical treatment, prevention and treatment of complications, secondary prevention, prediction of the final clinical condition and care goals, rehabilitation and neurobehavioral complications, quality control, and discharge report requirements. The presented guidelines for the management of SICH in adult patients represent a consensus opinion of the committees of the Czech Neurological Society of the Czech Medical Association JEP, and the Czech Neurosurgical Society of the Czech Medical Association JEP.
