Neurologia i Neurochirurgia Polska

Professor Zbigniew K. Wszolek, Co-Editor-in-Chief of Polish Journal of Neurology and Neurosurgery 2017–2025

2026-02-28

Jarosław Sławek

Clinical, serological, and electrophysiological differences in chronic inflammatory demyelinating polyradiculoneuropathy patients with and without malignancy — real-life evidence

2026-02-26

Polina Nekrasova, Magdalena Koszewicz, Małgorzata Wieczorek, Patrycja Kłębek-Targowska, Sławomir Budrewicz, Edyta Dziadkowiak

Introduction. Malignancies may coexist in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), possibly indicating shared immune mechanisms or risk factors. This study aimed to assess the frequency of cancer in patients with CIDP and the clinical characteristics of CIDP subgroups with and without cancer. Material and methods. The study included 61 patients with CIDP (mean age 61.6 ± 11.8 years). Cancer was diagnosed after CIDP in 14 cases (23%). Diagnostic parameters: clinical, biochemical and electrophysiological, and their correlations were analyzed in patients with and without cancer. Results. At chronic inflammatory demyelinating polyradiculoneuropathy diagnosis, the mean inflammatory neuropathy cause and treatment (INCAT) score was 2.29 ± 1.68 in the cancer group and 2.21 ± 1.81 in the non-cancer group (p = 0.891). At cancer diagnosis, the scores were 2.79 ± 1.81 vs. 2.40 ± 1.73, respectively (p = 0.489). Immunoglobulin levels were more variable in cancer patients, especially immunoglobulin M (IgM), although the differences were not significant. Cerebrospinal fluid (CSF) protein levels averaged 102.04 mg/dL in cancer patients and 92.67 mg/dL in those without cancer. In CIDP patients with cancer, a strong negative correlation was found between peroneal nerve motor latency and the INCAT score (r = –0.58). In those without cancer, CSF protein levels positively correlated with compound muscle action potentials (CMAP) latency and negatively with conduction velocity in both the ulnar and peroneal nerves. Conclusions. While not statistically significant, trends indicate that malignancy in CIDP may be linked to a more aggressive disease course, distinct immune profiles, and alternative pathogenic mechanisms, warranting further investigation into targeted therapies.

Gut and skin microbiome profiles as promising biomarkers in Parkinson’s disease — preliminary results

2026-02-26

Anna Jakubczyk-Słabicka, Jakub Kasprzak, Karolina Skonieczna-Żydecka, Jarosław Sławek, Magdalena Górska-Ponikowska

Blood-brain barrier-associated serum proteins in epilepsy — clinical and diagnostic implications

2026-02-26

Elżbieta Bronisz, Agnieszka Cudna, Aleksandra Wierzbicka, Iwona Kurkowska-Jastrzębska

Association of mercury exposure with neurodegenerative diseases — a reality or a misconception?

2026-02-26

Soghra Bagheri, Ali A. Saboury, Owais Ahmad, Rizwan Hasan Khan, Ireneusz Ryszkiel, Agata Stanek

Introduction. Exposure to heavy metals has long been considered a potential risk factor for neurodegenerative diseases. State of the art. Most existing studies include in vitro and animal models, and research involving human subjects has yielded conflicting results, obscuring the overall understanding of this topic. Aims of the study. In this article, the aim is to clarify the situation by carefully reviewing and categorizing the available body of knowledge in this field. Specifically, the focus is on research that explores the relationship between mercury exposure and common neurodegenerative diseases. Conclusions. Despite its neurotoxic properties, results show that mercury is not associated with frequent neurodegenerative disorders.

Non-invasive versus continuous invasive blood pressure monitoring during endovascular treatment of acute ischemic stroke under general anesthesia — a pilot study

2026-02-26

Marcin Wiącek, Katarzyna Koszarska, Aleksandra Kotlińska, Katarzyna Wąchała, Sylwia Lepak, Katarzyna Jucha, Halina Bartosik-Psujek

Aim of the study. To assess the agreement between continuous invasive (IBP) and intermittent non-invasive blood pressure (NIBP) monitoring during endovascular treatment (EVT) of acute ischemic stroke (AIS) under general anesthesia, and to evaluate the frequency of clinically relevant discrepancies between both methods and the potential impact of IBP use on treatment initiation times. Clinical rationale for the study. Intraprocedural hypotension during mechanical thrombectomy (MT) is associated with worse outcomes in AIS patients. While continuous IBP monitoring is frequently used during procedures with high-risk of hypotension, it is not universally adopted in stroke EVT. Accurate, real-time hemodynamic monitoring may be essential to guide timely therapeutic interventions and optimize outcomes. Materials and methods. In this prospective observational study, 30 AIS patients undergoing MT under general anesthesia were included. Simultaneous IBP and NIBP measurements were recorded throughout the procedure. Non-invasive blood pressure was measured every 5 minutes on one arm, while IBP was continuously recorded from a radial arterial catheter in the contralateral upper extremity. Paired readings were analyzed using Bland–Altman plots. The proportion of time with clinically relevant discrepancies between measurements was calculated. Additionally, door-to-groin (DTG) times were compared between patients with and without intended IBP monitoring. Results. A total of 481 paired IBP and NIBP readings were analyzed. While mean differences for systolic blood pressure (SBP) and mean arterial pressure (MAP) were small (–0.64 mm Hg and –0.99 mm Hg, respectively), limits of agreement were wide (SBP: –40.6 to 39.4 mm Hg; MAP: –28.5 to 26.5 mm Hg). Diastolic blood pressure (DBP) showed poor agreement with a mean bias of –7.64 mm Hg. Discrepancies of ≥ 20 mm Hg for SBP occurred in 41.0% (IQR = 28.0–59.4%) of the procedure time, and discrepancies > 15 mm Hg for MAP in 29.6% (IQR = 22.8–58.5%). DTG times did not differ significantly between the IBP and NIBP groups (median: 41 vs. 38 minutes, p = 0.217). Conclusions and clinical implications. Non-invasive blood pressure may show limited agreement with IBP and miss clinically relevant hemodynamic changes due to its intermittent nature and overestimation of blood pressure during hypotensive episodes. Invasive monitoring does not appear to delay treatment initiation and may improve blood pressure control in AIS patients undergoing EVT under general anesthesia. These findings, from a pilot study, should be interpreted with caution but provide a basis for larger prospective investigations.

Artificial intelligence-based software to support mechanical thrombectomy transfer decision in low-volume primary stroke centers: a multicenter, retrospective study

2026-02-26

Marcin Wiącek, Katarzyna Koszarska, Aleksandra Kotlińska, Katarzyna Wąchała, Sylwia Lepak, Katarzyna Jucha, Rafał Kaczorowski, Halina Bartosik-Psujek

Introduction. To assess the potential benefit of artificial intelligence (AI) based imaging software in supporting mechanical thrombectomy (MT) transfer decisions in patients with acute ischemic stroke (AIS) referred from low-volume primary stroke centers (PSCs). Clinical rationale for the study. Many MT-eligible patients are initially managed in PSCs, which often lack advanced imaging capabilities, stroke imaging expertise, and efficient interhospital image transfer systems. Artificial intelligence-based tools for automated large vessel occlusion (LVO) detection have shown promising results in improving stroke workflow metrics, yet data from low-volume PSCs remain limited. Material and methods. This study presents a multicenter, retrospective analysis of 109 AIS patients transferred for anterior circulation LVO MT from five low-volume PSCs in Poland over a 53-month period (≤ 1 MT transfer/center/month). Standard imaging was retrospectively assessed using Brainomix 360 (Brainomix USA Inc., Chicago, USA) to assess early ischemic changes, collateral status, and LVO location. Two blinded vascular neurologists independently simulated transfer decisions based on post-processed imaging. Large vessel occlusion detection sensitivity and potential changes in transfer eligibility were analyzed. The workflow time parameters were compared to the comprehensive stroke center (CSC) cohort with a routine AI-assisted evaluation (n = 69). The maximal expected time benefit from AI implementation was also estimated. Results. Artificial intelligence-based sensitivity for anterior circulation LVO detection was 83.5% [95% confidence interval (CI) 76.5–90.5], significantly higher for M1 than for internal carotid artery (ICA) occlusions (95.2% vs. 63.9%, p < 0.01). Among included patients, 78.9% (95% CI 70.3–85.5) were simulated as eligible and could potentially benefit from shorter workflow times. This is supported by the significantly shorter computed tomography angiography (CTA) to endovascular treatment (EVT) notification time in the CSC cohort with routine AI-assisted imaging compared with the low-volume PSC (11 vs. 48 min, p < 0.01). The median maximal potential reduction in door-in–door-out (DIDO) time was estimated at 30 min [interquartile range (IQR) 4–45). In contrast, 4.6% (95% CI 2.0–10.3) individuals were reclassified as ineligible due to extensive early ischemic changes and poor collaterals, potentially avoiding futile transfer. Conclusions. Artificial intelligence-assisted imaging may significantly improve transfer decisions and workflow efficiency in low-volume PSCs, particularly in settings without real-time radiological interpretation. Its broader adoption may strengthen MT eligibility assessment within regional stroke networks.

Clinical and EEG predictors of treatment response in pediatric absence epilepsy — a single-center experience

2026-02-26

Anna Lemska, Marta Zawadzka, Maria Mazurkiewicz-Bełdzińska

Aim of the study. Absence epilepsy, though primarily affecting children, can also emerge during adolescence or adulthood, showing a wide spectrum of clinical presentations and treatment responses. The aim of this study is to evaluate the clinical and electroencephalographic (EEG) characteristics of absence epilepsy and identify factors that influence treatment outcomes and long-term prognosis. Clinical rationale for the study. While childhood absence epilepsy (CAE) is often associated with favorable prognosis, a subset of patients experiences drug resistance and persistent seizures. Understanding the clinical and EEG predictors of treatment success or failure can support more effective, individualized therapeutic strategies and improve long-term management. Material and methods. This prospective study included 57 pediatric patients diagnosed with absence epilepsy. Clinical data and EEG findings were analyzed focusing on age of onset, seizure frequency, EEG patterns, family history, and treatment response. Patients were followed over a 12-month period to assess seizure outcomes and treatment efficacy. Results. Childhood absence epilepsy was the most common subtype, identified in 73.7 % of cases. A total of 85% of patients achieved seizure remission within six months of initiating treatment. A favorable prognosis was significantly associated with early age of onset, presence of typical 3–4 Hz spike-and-wave discharges on EEG, and rapid response to first-line anti-epileptic drugs (AEDs). In contrast, patients diagnosed with juvenile absence epilepsy (JAE), myoclonic absence seizures, or absence seizures with eyelid myoclonia often required more complex treatment regimens and demonstrated a higher risk of persistent seizures. Conclusions and clinical implications. Absence epilepsy encompasses a range of clinical syndromes, and outcomes are influenced by seizure type, age at onset, EEG characteristics, and initial treatment response. Early diagnosis and prompt initiation of appropriate therapy are critical for achieving seizure control. However, some patients, particularly those with atypical absence syndromes, may continue to experience therapeutic challenges, highlighting the need for tailored treatment approaches and long-term follow-up.

The association between smoking and Huntington’s disease symptom onset and progression — results from Enroll-HD: The observational cohort study of people with Huntington’s disease

2026-02-26

Grzegorz Witkowski, Daniel Zielonka, Rafał Rola, Halina Sienkiewicz-Jarosz

Aim of the study. To assess the impact of tobacco smoking on the onset of Huntington’s disease (HD) and the progression of its motor and cognitive symptoms. Clinical rationale of the study. HD is an incurable neurodegenerative disorder. Therefore, identifying lifestyle factors with an impact of its progression is of particular interest. Tobacco smoking influences the course of neurodegenerative disorders. It has been shown to be a risk factor for dementia, but, on the contrary, seems to have a protective role in Parkinson’s disease. Material and methods. This study used Periodic Dataset 4 of the Enroll-HD database, from which a cohort of 2,438 HD subjects (799 presymptomatic) with four consecutive annual visits (three years of observation) was extracted. Logistic regression models were used to assess the effect of lifetime smoking on progression to the symptomatic phase. In the premanifest, Cox proportional regression model was applied to estimate the hazard ratio of HD diagnosis for smokers and nonsmokers during the three-year observation period. Multivariate linear regression models were used to investigate the relationship between smoking and the progression of HD clinical measures. Results. It was found that current female smokers were at a higher risk of progressing to the symptomatic phase of HD than nonsmokers [hazard ratio (HR): 1.35, p = 0.023, 95% confidence interval (CI): 1.04–1.56]. For the symptomatic HD cohort, regardless of sex, smoking was associated with faster progression of motor symptoms, as measured by the Total Motor Score (p = 0.035, 95% CI: 0.04–0.9), as well as cognitive impairment, as measured by the Stroop Word Reading test (p = 0.04, 95% CI: 0.1–0.9). Conclusions and clinical implications. It was presented that lifetime and current smoking are environmental factors that may be associated with an increased risk of HD progression, particularly in female HD gene carriers. This supports the recommendation that HD mutation carriers avoid smoking.