The article presents a current and comprehensive review of stroke mimics (SM), which represent a challenge for differential diagnosis due to their wide range of similar symptoms with strokes. It delves into the brief epidemiology, clinical features, and four predictive scales for SM diagnosis, which were identified on the basis of a literature search: TeleStroke Mimic Score (TSM), FABS, simplified FABS (sFABS), and Khan score. These validated tools might support rapid and efficient decision-making regarding treatment in an emergency department setting with the goal of minimizing delays in providing adequate care to patients with stroke. We would like to highlight the importance of correct identification of SM given the time sensitivity of revascularization treatment, with a focus on optimizing treatment and management of patients with acute onset of neurological symptoms.

An evidence-based treatment for a Multiple Sclerosis (MS) relapse is an intravenous administration of 3–5 g of Methylprednisolone. In case of insufficient effect or corticosteroids intolerance, the therapeutic plasma exchange (TPE) is indicated. To assess the clinical effect of TPE in treatment of relapse in patients with relapsing-remitting MS (RRMS), we enrolled 155 patients meeting the following criteria (study period: January 2011 to February 2021): (1) age > 18, (2) RRMS according to the McDonald´s 2017 criteria, (3) MS relapse and insufficient effect of corticosteroids/corticosteroids intolerance, (4) baseline EDSS < 8. Exclusion criteria: (1) progressive form of disease, (2) history of previous TPE. Following parameters were monitored: EDSS changes (before and after corticosteroid treatment, before and after TPE; EDSS after TPE was assessed at the next clinical follow-up at the MS Center), and improvement of EDSS according to the number of procedures and baseline severity of relapse. 115 females (74%) and 40 males (26%) were included. The median age was 41 years (IQR 33–47)—131 patients underwent the pulse corticosteroids treatment and TPE, while 24 patients underwent only TPE without any previous corticosteroid treatment. Median baseline EDSS was 4.5 (IQR 3.5–5.5), median EDSS after finishing steroids was 4.5 (IQR 4.0–5.5). EDSS prior to the TPE was 4.5 (IQR 4–6), EDSS after TPE was 4.5 (IQR 3.5–5.5). We observed a significant improvement in the EDSS after TPE (p < 0.001). Sex differences were seen in TPE effectiveness, with median improvement of EDSS in females being −0.5 (IQR 1–0) and in males being 0 (IQR −0.5 to 0), p = 0.048. There was no difference in EDSS improvement by age category: 18–30 years, 31–40 years, 41–50 years, > 50 (p = 0.94), nor by total TPE count (p = 0.91). In this retrospective study of patients with an aggressive relapse and insufficient effect of intravenous corticosteroid treatment, a significant effect of TPE on EDSS improvement was observed. There was no significant difference in TPE effectivity according to the number of procedures, age, nor severity of a relapse. In this cohort, TPE was more effective in females.

Background: Serum neurofilaments (sNfs), especially the most investigated serum neurofilament light chain (sNfL), are promising biomarkers in multiple sclerosis (MS). However, their clinical utility is still limited, given the availability and costs of accessible analytical methods. The gold standard for the detection of sNfs is rep-resented by the single molecule arrays (SIMOA). Recently, a high sensitivity enzyme-linked immunosorbent assay (hsELISA) has also been introduced. The objective of the study was to compare both assays for the determination of sNfL and neurofilament heavy chain (sNfH) concentrations in a defined MS cohort. The second objective was to identify contributing factors to sNfs concentrations determined by hsELISA.Methods: Serum samples were collected from MS patients attending the MS Centre, University Hospital Ostrava, Czech Republic. The levels of sNfs were detected using SIMOA and hsELISA assays. Results: The Spearman's rank correlation coefficient between the sNfL SIMOA and sNfL hsELISA and between the sNfH SIMOA and sNfH hsELISA was moderate rs= 0.543 (p = 0.001) and rs= 0.583 (p = 0.001), respectively. The Passing-Bablok regression analysis demonstrated bias between both methods. Equally significant bias between the methods was confirmed by the Bland-Altman plots. Furthermore, confounding factors affecting the sNfL levels were glomerular filtration rate (eGFR; 95% CI-2.34 to-0.04) and sex (95% CI-2.38 to-0.10). The sNfH levels were affected by age (95% CI 0.01 to 0.07), eGFR (95% CI-2.45 to-0.02), body mass index (BMI; 95% CI-0.31 to-0.05), and blood volume (95% CI 0.69 to 3.35).Conclusion: This analytical study showed significant differences between hsELISA and SIMOA methods, especially for the sNfH concentrations. We identified confounding factors for sNfs levels determined by hsELISA. The sNfs levels were influenced by renal function and sex, whilst sNfH levels were affected by age, BMI, and total blood volume.

Neurodegenerative diseases represent a large and heterogeneous group of disorders. Their common feature is the deposition of a certain pathological protein in brain tissue. The location and distribution of abnormally constituted alpha-synuclein deposits in central and peripheral nervous system define each respective disorder. The location and distribution of a-synuclein deposits define each respective disorder. Synucleinopathies currently include Parkinson's disease, Parkinson's disease with dementia, Lewy body dementia, multiple system atrophy, pure autonomic failure, and idiopathic REM sleep disorder. The detection of a-synuclein alone in these diseases has the effect in differentiating them from other neurodegenerative diseases; however, its specificity in the differential dia gnosis of individual synucleinopathies is relatively low. Therefore, it is necessary to look for other dia gnostic bio markers that would contribute to the early and accurate dia gnosis of individual diseases. At the same time, it is not just a matter of looking for new markers, but also of looking for more available bio logical samples or body fluids in which these bio markers can be eff ectively detected. In the introduction of this review there is a brief description of each disorder and subsequently there is a brief overview of mostly diagnostic laboratory biomarkers. We first present the cerebrospinal fl uid bio markers that refl ect the direct neuropathological changes, and then several bio markers found in peripheral tissues.

Aim: Robot-assisted gait training represents a modern concept of neurorehabilitation in stroke patients. Our randomized interventional study aims to assess the additive effect of robot-assisted gait rehabilitation in subacute ischemic stroke patients and to compare its effect with patients undergoing standard institutional protocol-defi ned rehabilitation. The primary endpoint is the functional ambulation category. The secondary endpoints include gait time parameters (10 Meter Walk Test, Timed Up and Go), changes in body composition, modifi ed Rankin scale, Barthel index, Berg balance scale, and a questionnaire Falls Efficacy Scale - International. Radiological sub study evaluates the dynamics of brain structural changes and atrophy using MRI. Methods: This is a prospective randomized open monocentric study enrolling patients within 6 weeks from the onset of the firs ischemic stroke. Both groups are treated with conventional rehabilitation (physiotherapy, occupational therapy and mechanotherapy) for 60 min 5 times a week, a total of 15 times for 3 to 4 weeks (a total of 1,200 min). The Lokomat group undergoes robot-assisted gait training using the interventional exoskeleton for 20-50 minutes 5 times a week for a total of 15 times for 3 to 4 weeks (a total of 1,800 min). Data collection takes place over four time periods: pre-intervention (T0), mid-intervention (T1; day 8), post-rehabilitation assessment (T2; day 15), and 3 months post-intervention (T3).

The results of multicenter randomized and controlled clinical trials, which were published in 2018 and 2019, showed the efficiency and safety of intravenous thrombolysis in the treatment of acute ischemic stroke in selected patients even beyond the standard therapeutic time window, and in those with unknown time of ischemic stroke onset. Based on this scientific evidence, the availability of specific antidotes for direct anticoagulants and the publication of new recommendations of the European Stroke Organisation and the American Heart Association/American Stroke Association, an update of the Czech national guidelines on the treatment of acute ischemic stroke with intravenous thrombolysis from the year 2014 became necessary. These recommendations do not substitute the valid legislative norms and represent a consensual statement of the Executive Committee of the Czech Stroke Society (a part of the Czech Neurological Society of the Czech Medical Association J. E. Purkyne).

Aim: The aim of a prospective multicenter study was to determine whether the risk of developing a new ischemic brain lesion on control MRI is dependent on some of the characteristics of atherosclerotic plaque detected by duplex sonography, MRI and CTA. Materials and methods: Patients with internal carotid artery stenosis (70-95%) indicated for carotid angioplasty and stenting (CAS) were consecutively included in the prospective observational study. All enrolled patients underwent neurological and physical examinations, duplex sonographic examination of the carotid arteries with evaluation of the structure of atherosclerotic plaque in the ultrasound B-mode, CTA of the cervical and cerebral arteries and MRI of the neck and brain. The univariate and multivariate logistic regression analyses were performed to identify factors affecting the risk of the onset of brain ischemia following CAS. Results: A total of 121 patients (93 males, age 70.5 +/- 7.6 years) were enrolled in the study. Within 30 days of the CAS, 4 patients suffered from stroke, 1 patient suffered from a transient ischemic attack and 1 patient died. A new ischemic lesion on control brain MRI was detected in 34 (28.1%) patients. Using univariate and multivariate logistic regression analysis, no predictor (atherosclerotic plaque characteristics, history data, CAS data) was found to influence the risk of the onset of new brain ischemia. Conclusion: Characteristics of atherosclerotic plaque in the area of the internal carotid artery stenosis does not affect the risk of developing brain ischemia detected by brain MRI following CAS.

For the fi rst time in cerebrovascular neurology there is an indisputable evidence of clinical eff ectiveness of mechanical recanalization in acute cerebral artery occlusion. Five randomized trials published in 2015 documented an unprecedented benefi t and safety of endovascular thrombectomy. The particular trials were: MR CLEAN, ESCAPE, SWIFT PRIME, EXTEND-IA and REVASCAT. It has been proven that endovascular treatment reduces morbidity and mortality of patients signifi cantly. The number needed to treat to result in one patient with good functional outcome was staggeringly low – only 3–7 patients. Age and defi cit severity do not constitute exclusionary criteria (MR CLEAN, ESCAPE and EXTEND-IA without age restrictions; SWIFT PRIME between 18–80 years and REVASCAT between 18–85 years of age). The principal imaging methods were predominantly native CT and CT angiography. Perfusion methods were used in EXTEND-IA and SWIFT PRIME. The objective of endovascular treatment was to achieve reperfusion within 60 min after groin puncture. An essential part of the trials was a performance evaluation system. We provide information on the results of thrombectomy trials, summarize management during thrombectomy (correction of blood pressure, use of anesthesia, concomitant medication) and propose indication criteria.