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The aim of the study is to investigate the association between the prevalence of stroke, its risk factors, and occupational status, with a differentiation between voluntary and involuntary unemployment.This is a cross-sectional study, which included 3013 individuals aged 40 to 65 years. We compared the prevalence of stroke, comorbidities, self-reported stroke-like symptoms, healthy behaviors, and knowledge about stroke among the voluntarily and involuntarily unemployed versus the employed.Voluntary unemployment was associated with increased chances of stroke (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.05-3.57), hypertension (OR, 1.18; 95% CI, 1.06-1.32), diabetes (OR, 1.16; 95% CI, 1.01-1.35), and obesity (OR, 1.16; 95% CI, 1.05-1.29). Involuntary job loss was associated with increased odds of hypertension (OR, 1.69; 95% CI, 1.16-2.50) and more frequent self-reported stroke-like symptoms.We found higher chances of stroke among the voluntarily unemployed middle-aged adults, presumably because of increased prevalence of hypertension, diabetes, and obesity.

Study aim: To check if the short rehabilitation treatment (3 weeks) complemented by complex rehabilitation on advanced equipment improves the functional status of chronic stroke patients; and which clinical and objective parameters can be used to assess the efficacy of such treatment. Material and methods: 28 patients 3 to 6 months after the stroke. They participated in 3 weeks rehabilitation program in Rehabilitation Hospital. This program was supplemented by rehabilitation on: Zebris treadmill, ALFA and GAMMA platform, Biodex Balance System SD, the Balance Tutor treadmill. Their functional status was assessed by: Scandinavian Stroke Scale (SSS), Timed-Up-And-Go test (TUG), balance tests on Zebris, instrumented gait analysis on BTS system. Results: The positive changes of the patients’ functional status were found in time of TUG test, in case of balance test for 95% of the ellipsoid area, lengths of major and minor axes of the ellipsoid, average sway speed, sway path length, total ground reaction force for left and right leg, and Gillette Gait Index in case of the gait analysis. Conclusions: The improvement of the functional status of chronic stroke patients after relatively short rehabilitation treatment was achieved, due to the addition to the standard rehabilitation treatment the program on the advanced technologically equipment.

Stroke is the leading cause of adult disability in developed countries. As a result of damage to the central nervous system, the patient's independence in performing everyday activities is reduced, which often leads to dependence on the environment. The symptoms of syndromes affect many functions, including: speech, the upper limb, gait, balance and coordination disorders. These disorders lead to a decrease in the patient's quality of life. Many patients require knee braces to learn to walk. In this review article, the most commonly used scales used to assess the functional status of patients after stroke are discussed, with particular attention being paid to gait assessment. We described simple (basic ADL) and instrumental (extended) scales of activities of daily living (instrumental, extended ADL), methods of clinical gait and balance assessment, International Classification of Functioning, Disability and Health, ICF), as well as recommendations of the European Stroke Organisation (ESO, Neurorehabilitation Committee). These guidelines regard methods of evaluating the results of post-stroke rehabilitation for clinical use - Outcome Measures for Clinical Use, in which, among others, the Berg scale and the timed Up & Go test are recommended for the lower limb, the Barthel scale and the Functional Independence Measure for ADL, and the Stroke Impact Scale for the participation column in all 3 ICF domains. In the article, the current state of knowledge is presented regarding the impact of knee braces on the functional status of people after stroke. Mechanical knee and ankle orthoses are called KAFO (Knee Ankle Foot Orthosis). Their main tasks include immobilisation of the knee joint and aid in learning to walk.

The therapeutic effects of naproxen and its unique pharmacological properties allows it to use not only in the practice of primary care physicians, but also in specialist clinics. Naproxen is effective in relieving musculoskeletal pain of various origins, and additionally has anti-inflammatory and antipyretic properties. This enables its effective use in chronic diseases such as: RA, OA, AS, as well as for effective reduction of symptoms of classic infections, especially viral infections, reducing pain in muscles, joints, head and lowering fever.

Introduction: In rehabilitation, the symbol of the 21st century is the presence of new technologies related to the virtual world (VR), biofeedback, and rehabilitation robots. These trends are also observed in thermal treatment. The complexity of this form of treatment introduces therapies based on modern devices for balance exercises, body stability, gait re-education with biofeedback, and virtual reality. How do patients rate this new quality in the thermal station? Aim: The study aimed to collect the subjective opinions of patients undergoing treatment in a thermal and rehabilitation hospital on therapy using modern devices for balance exercises, stability with biofeedback, and virtual reality. Material and methods: The study included a group of 184 patients staying at the 21st Military Thermal and Rehabilitation Hospital in Busko-Zdrój as part of benef i ts reimbursed by the National Health Fund and as part of treatment and prophylactic stays with anti-stress training for soldiers returning from missions abroad fi nanced by the Minister of National Defense. Apart from traditional thermal treatment methods, the subjects performed an exercise program on stabilometric and dynamographic platforms and two types of treadmills during the treatment. Results: In the respondents’ opinion, therapy based on devices using modern technologies (virtual reality and biofeedback) was interesting, patient-friendly, and increased their motivation to exercise. The surveyed soldiers in all age groups and civilians aged 41-60 expressed their willingness to re-use the therapy on devices using modern technologies. The results were analyzed statistically. Conclusions: Thermal treatment in the 21st century is gaining a new quality, in which devices based on modern technologies of computer games, virtual reality, and biofeedback unquestionably participate in the therapy of patients. Patients, regardless of their age or type of stay, in a subjective opinion expressed a positive opinion about the therapy on devices using modern technologies.

The incidence of unruptured intracranial aneurysms (UIAs) amounts to 3.2% among adults. The annual risk of aneurysm rupture is 2–10% and it results in subarachnoid haemorrhage (SAH). The aim of this study is to assess changes in the incidence of unruptured intracranial aneurysms and subarachnoid haemorrhages in Poland between 2013 and 2021 and the cost associated with their in-hospital treatment in the acute phase. The analysis was based on the National Health Fund database. Patients diagnosed with UIA and SAH and hospitalised between 2013 and 2021 were chosen. The statistical analysis was performed with an assumed significance level of α = 0.05. The ratio between the prevalence of SAH and UIA diagnoses was 4:6. The proportion of women in relation to men was higher in both diagnoses. The highest proportions of patients with diagnoses SAH and UIA were found in highly urbanised provinces. The value of medical services in 2021 compared to 2013 increased by 81.8%. The highest values in this period were recorded in Mazowieckie province, and the lowest were recorded in Opolskie province. The overall number of patients hospitalised with diagnosis of UIA or SAH did not decrease, but the risk of aneurysm rupture probably decreased, which resulted in lower incidence of SAH in subsequent years of observation. The recorded changes in the dynamics of the value of medical services per patient or per hospitalisation largely coincided. However, it is difficult to speculate on expected value levels as not all provinces showed linear changes in the value of services provided.

AbobotulinumtoxinA (aboBoNT-A, Dysport®) is used in clinical practice as a well-tolerated and effective therapy for muscle spasticity. AboBoNT-A has been shown to reduce upper and lower limb spastic paresis in clinical trials, demonstrating improvements in muscle tone and limb function. This open-label, multicentre, observational, non-interventional study was the first to investigate aboBoNT-A's efficacy in adult patients with upper limb spasticity (ULS) in routine clinical practice in Poland. All enrolled patients received ≥1 aboBoNT-A injection cycles, per routine clinical practice (full analysis set, FAS), and ≥1 rehabilitation session. Patients attended a baseline visit (V1) and two follow-up visits (V2, V3) for retreatment, depending on the investigator's assessment of individual patient needs, with a mean interval (SD) between injections of 4.4 (1.4) and 4.5 (1.2) months. The primary effectiveness endpoint was patient- and physician-based evaluation using the Clinical Global Impression-Improvement Scale (CGII), a validated 7-point scale (1 = very much improved to 7 = very much worse) relative to baseline. CGI-I has not previously been used as a primary endpoint in studies evaluating ULS. Secondary endpoints included muscle tone in shoulder, elbow, carpal joint, and finger muscles, measured by the Modified Ashworth Scale (MAS), and muscle strength according to the Medical Research Council scale (MRC). Of 108 enrolled patients (FAS), 92 (85.2%) completed the study and 57 (52.8%) were included in the per protocol (PP) population. AboBoNT-A improved patient conditions in 96.4% and 98.6% at V2 and V3 (investigator assessment) and 92.8% and 98.6% (as reported by patient) of patients, respectively. Significant reductions in muscle tone from baseline were observed at both visits (p < 0.0001-0.0077) across muscle groups. Increased muscle strength by cumulative MRC was observed at V2 (p = 0.0566) and V3 (p = 0.0282) versus baseline. Safety was consistent with the known profile of aboBoNT-A. In conclusion, aboBoNT-A treatment is beneficial in patients with post-stroke ULS in routine clinical practice, assessed by patients and investigators.

Zespol ekspertow Polskiego Towarzystwa Neurologicznego opracowal zasady postepowania w leczeniu poszczegolnych objawow wystepujących u pacjentow ze stwardnieniem rozsianym. Rekomendacje opracowano na podstawie wynikow najnowszych badan klinicznych, zalecen zagranicznych towarzystw naukowych oraz wlasnego doświadczenia klinicznego autorow. Omowiono postepowanie w spastyczności, ataksji i drzeniu, zespole zmeczenia, w przypadku zaburzen zwieraczy drog moczowych i przewodu pokarmowego, zaburzen seksualnych oraz w zespolach bolowych wystepujących typowo w stwardnieniu rozsianym. Przedstawiono rowniez zasady postepowania w przypadku zaburzen psychicznych i zaburzen funkcji poznawczych. W dokumencie podsumowano mozliwości terapii objawowej w stwardnieniu rozsianym w warunkach polskich.

The growing number of Botulinum neurotoxin type A (BoNT/A) preparations on the market has resulted in a search for pharmacological, clinical and pharmacoeconomic differences. Patients are occasionally switched from one botulinum toxin formulation to another. The aim of this paper was to review studies that have made direct comparisons of the three major BoNT/A preparations presently on the market: ona-, abo- and incobotulinumtoxinA. We also review the single medication Class I pivotal and occasionally Class II-IV studies, as well as recommendations and guidelines to show how effective doses have been adopted in well-established indications such as blepharospasm, hemifacial spasm, cervical dystonia and adult spasticity. Neither direct head-to-head studies nor single medication studies between all preparations allow the formation of universal conversion ratios. All preparations should be treated as distinct medications with respect to their summary of product characteristics when used in everyday practice.

Botulinum neurotoxin type A (BoNT/A) formulations are widely used in clinical practice. Although they share a common mechanism of action resulting in presynaptic block in acetylocholine release, their structure and pharmacological properties demonstrate some similarities and many differences. Bioequivalence has been discussed since the onset of the clinical use of BoNT/A. In this review, we provide an update on the studies and compare the molecular structure, mechanisms of action, diffusion and spread, as well as immunogenicity and dose equivalence of onabotulinumtoxinA, abobotulinumtoxinA and incobotulinumtoxinA.

Family history of stroke increases stroke risk, however mechanisms underlying this association remain unclear. We investigated whether family history of stroke is related to increased prevalence of stroke risk factors, unhealthy behaviors and self-reported stroke symptoms in middle-aged adults.In a cross-sectional study conducted from November 2018 to January 2021 in 100 primary care facilities in Poland we evaluated adults aged 40-65 years (n = 2207, women 57.4%, median age 55 years) for stroke risk factors, healthy behaviors, family history of stroke, self-reported stroke symptoms and stroke knowledge using structured questionnaires. Patients were categorized based on family history of stroke defined as ≥1 first-degree relative with documented stroke.Family history of stroke was reported by 571 (25.9%) individuals who were older (median age 56 vs. 54 years, p = 0.00001) and after adjustment for age more frequently suffered from hypertension (61.5% vs. 53.7%, p = 0.024) and prior transient ischemic attack (2.1% vs. 0.9%, p = 0.019), but not other risk factors. However, they were less obese (34.5% vs. 39.1%, p = 0.03). Women, but not men, with family history of stroke (n = 339, 26.8%) had greater prevalence of atrial fibrillation (7.4% vs. 3.9%, p = 0.037). Family history of stroke was associated with higher prevalence of any self-reported stroke symptom (32.9% vs. 23.2%, p 0.00001), but not with unhealthy dietary behaviors or low level of knowledge about stroke.Family history of stroke is associated with greater prevalence of certain risk factors and self-reported stroke symptoms, which indicates the need for closer surveillance of middle-aged individuals at risk.

Background Post-stroke rehabilitation should begin immediately and continue while improvement is seen. After stroke, patients are at risk of developing medical complications, which can hinder optimal recovery. Objective We aimed to determine the incidence of complications occurring during early inpatient rehabilitation and to assess their influence on patients' functionality. Methods For 1075 patients (585 men), we recorded neurological deficits, activities of everyday living, functionality before and after rehabilitation, and the incidence of complications. The main measure of functional outcome was the discharge Barthel Index score. Results At least one complication was reported by 76.9% of patients, and 20% experienced three or more complications. The most common problems were: urinary tract infection (23.2%), depression (18.9%), falls (17.9%), unstable hypertension (17.6%), and shoulder pain (14.9%). Patients with a severe discharge disability were 2.5-fold more likely to experience complications than subjects with a mild disability. Conclusions Complications during the post stroke rehabilitation process had a significantly decreased chance for improvement. Knowledge of the most common type of complications, as well as their early prevention and treatment, may improve patient outcomes.

This article includes current information on the use of modern IT solutions and virtual-reality (VR)-based technologies in medical rehabilitation. A review of current literature on VR-based interventions and their indications, benefits and limitations in patients with nervous system diseases was conducted. The popularity of VR-based training as a tool used for rehabilitation of patients with acute and chronic deficits in both sensory-motor and cognitive disorders is increasing. Still, there is a need for large randomized trials to evaluate the efficacy and safety of VR-based rehabilitation techniques in different disease entities. .

Aim To test if circulating levels of markers of inflammation, endothelial function, and chronic infections, as well as association between these markers and carotid intima media thickness (CIMT), depend on the stage of atherosclerosis expressed as a history of a major vascular event. Methods The associations were analyzed separately in 75 healthy controls, 79 patients 3-6 months after the first-ever non-cardioembolic ischemic stroke (IS), and 37 patients 3-6 months after the first-ever myocardial infarction (MI). Data were collected prospectively in 2005. We measured high sensitivity C-reactive protein (hs-CRP), procalcitonin, E-selectin, intercellular adhesion molecule-1 (ICAM-1), serum level of immune complexes (IC), and identified antibodies against Herpes simplex virus type 1 (HSV), Cytomegalovirus, Chlamydia pneumonia, and Helicobacter pylori. Correlations with CIMT were determined using Pearson R and verified after adjustment for age, sex, hypertension, diabetes, and statin therapy. Results Median ICAM-1 concentration was significantly lower in controls than in post-IS patients (188 μg/L vs 215 μg/L), and significantly lower in post-IS patients than in post-MI patients (215 μg/L vs 260 μg/L). Control patients also had significantly lower IC level (0.03 U/L) and HSV antibody index (6.0) compared to both post-IS (0.6 U/L, 9.6) and post-MI (0.4 U/L, 9.2) patients. CIMT was correlated with age (Pearson R = 0.38, P = 0.001) in the control group, immune complexes (R = 0.26, P = 0.023) in the post-IS group, and with hs-CRP (R = 0.40, P = 0.017) in the post-MI group. These correlations were confirmed using multiple regression analysis. Conclusions Our study supports linear correlations between CIMT and IC and hs-CRP levels. However, these associations seem to depend on the type of vascular burden.

Background Despite estimates about general trends in stroke epidemiology worldwide, there are only a few reports of detailed longitudinal data and none of them reflects the economic transition that occurred in Central and Eastern Europe over the last two decades. The aim of this study was to investigate long term trends in risk factors and their pre-stroke control as well as acute stroke clinical presentation and etiology in Polish urban setting. Methods This is a retrospective registry-based analysis of consecutive acute stroke patients from a highly urbanized area (Warsaw, Poland) admitted to a single stroke center between 1995 and 2013. Patients were divided into four time periods: 1995–1999 (n = 529), 2000–2004 (n = 1253), 2005–2009 (n = 1320) and 2010–2013 (n = 871). Results During the study period 3973 first-ever stroke patients were admitted. The proportion of ischaemic strokes (88.2% to 90.9%) and male patients (45.2% to 46.2%) remained stable throughout the whole study period. Admitted patients became older (72, 73, 74 and 76 years, consecutive time periods), were more likely to be diagnosed with hypertension (from 61.1% to 72.8%) and disable (84.3% to 67.4%) prior to stroke. There was an increase in pre-stroke use of antihypertensives in patients with hypertension (from 77.8% to 90.5%), antiplatelets in patients with coronary artery disease (from 33.9% to 56.5%), vitamin K antagonists in patients with atrial fibrillation (from 6.3% to 39.8%) and statins (from 7.6% to 26.3%). There was a decrease in mean stroke severity (9, 11, 8 and 6 points on the National Institutes of Stroke Scale) on admission and the proportion of strokes attributed to small-vessel disease (22.0%, 20.0%, 10.6% and 8.3%). Conclusions Over the last two decades the profile of urban Polish stroke patients has changed significantly and it can be attributed to marked economic improvement in Poland since 1990s. Increasing age and better management of pre-existing vascular risk factors were accompanied by decreasing stroke severity and lower proportion of strokes attributed to small-vessel disease.

The aim of the present study was to assess the impact of 21-days comprehensive physiotherapy program on the functional condition of the spine and severity of pain in older people. To achieve this goal, physiotherapeutic procedures were performed on 100 elderly patients suffering from spinal disorders. The comprehensive therapy program consisted of: general improvement exercises, individual exercises with a physiotherapist, exercises in water and physical therapy treatments such as: TENS currents, galvanic current, iontophoresis, laser stimulation, magnetic field on the lumbar spine and hydro massage or mud compresses. Prior and post the therapy program: the Schober’s test - 1 (forward flexion), Schober’s test - 2 (extension), Ott’s test, fingertip-to-floor (FTF) test, pain Visual Analogue Scale (VAS) and the modified Oswestry low back pain questionnaire were evaluated. Statistically significant improvement (p0.001) in all tested parameters was shown at the end of therapy program. Age, height, body weight and body mass index (BMI) has no impact on results before and after the physiotherapy program in respective tests. In conclusion, the conducted study has shown the effectiveness of applied comprehensive physiotherapy program on the functional condition of the spine and improvement of the quality of life of the treated patients, regardless of their somatic conditions.

Background and purpose Haemorrhagic stroke is associated with substantial mortality and disability, thus prevention and appropriate treatment of acute intracerebral haemorrhage is crucial. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute haemorrhagic stroke in a real-world practice. Material and methods Haemorrhagic stroke patients hospitalized between 1 st March 2007 and 29 th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, authorized access, web-based questionnaire. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute haemorrhagic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency – modified Rankin Scale ≥ 3) at hospital discharge, while late outcomes covered one-year survival. Results A total of 3111 haemorrhagic stroke patients (mean age: 68.9 years; females: 46.7%) was reported. The analysis of pharmacotherapy showed low preventive use of hypotensive agents in hypertensive patients, high consumption of antibiotics and still overuse of vasoactive or neuroprotective compounds in acute haemorrhagic stroke. Regression models confirmed expected negative impact on stroke outcomes associated with oral anticoagulants but not antiplatelets and inconsistent impact of statins used prior to or in acute haemorrhagic stroke. Conclusions Preventive underuse of hypotensive compounds contribute substantially to haemorrhagic stroke risk. The high consumption of antibiotics and neuroprotective or vasoactive compounds in haemorrhagic acute stroke reflect the need to improved quality and evidence-based clinical practice.

Background and purpose According to the recommendations of stroke organizations, every stroke patient should be treated in a specialized stroke unit (SU). We aimed to evaluate the development of the SU network in Poland during the past decade. Material and methods In Poland, stroke is treated mainly by neurologists. A questionnaire evaluating structure and staff of neurological departments was sent to all neurological departments in 2003, 2005 and 2007. In 2010, we collected data based on information from the National Health Fund. We divided departments into categories: with a comprehensive SU, with a primary SU unit, and departments without an SU. Primary SUs were further divided into class A SUs (fulfilling criteria of the National Programme of Prevention and Treatment of Stroke Experts – eligible for thrombolysis), class B (conditionally fulfilling criteria), and class C (not fulfilling criteria). Results Final analyses included 87.4% of departments (194/222) in 2003, 85.5% of departments (188/220) in 2005, and 83.1% of departments (182/219) in 2007. According to the above-mentioned classification there were 20 class A SUs in 2003, 58 in 2005 and 5 comprehensive and 51 class A SUs in 2007. In 2012, based on information from the National Health Fund there were 150 SUs, all fulfilling criteria for thrombolysis, 9 of them comprehensive SUs. Conclusions The SU network in Poland is developing dynamically but thrombolysis and endovascular procedures are done too rarely. Now it is necessary to improve quality of stroke services and to make organizational changes in the in-hospital stroke pathways as well as to organize continuous education of medical staff.

Background and purpose Disparities in resources, access to the expertise and healthcare providers both at hospital and before admission, or patients’ awareness of stroke symptoms can cause differences in weekend and weekday stroke severity and prognosis. The aim of the study was to explore differences in baseline characteristics and outcomes of ischaemic stroke patients admitted on weekdays and weekends. Material and methods A questionnaire based on the WHO Step Stroke and Swedish Stroke Registry was used to collect data on patients admitted to centres participating in the POLKARD Hospital Stroke Registry between June 1 st , 2004 and May 31 st , 2005. To ensure the quality, only centres reporting at least 100 patients were analysed. Clinical characteristics and early outcomes (death rate and poor outcome defined as modified Rankin scale score of 3 or above) were compared between patients admitted on weekdays and weekends. Results A total of 19667 ischaemic stroke patients, including 5924 admitted during weekends, were reported by 72 stroke centres. Weekend patients were older, more often disabled prior to stroke and more commonly presented with atrial fibrillation and coronary heart disease. Weekend patients were more likely to present consciousness disturbances at admission. More patients admitted on weekends died during hospitalization or had poor outcome at discharge than weekday patients (15.9% and 59.8% vs. 14.1% and 55.3%, respectively). After adjusting for baseline severity of stroke and case-mix, the regression model showed that weekend ischaemic stroke patients had worse prognosis (odds of 1.137 and 1.147 for death and poor outcome, respectively). Conclusions Admissions on weekends are associated with higher mortality and poor outcome, and that can be only partially explained by differences in baseline characteristics of admitted patients.

Background: Pulse pressure (PP) in acute stroke may be related to the outcome. The link between PP in the first week following ischemic stroke and early outcome was assessed. Methods: We calculated mean PPs during the first 7 days after stroke onset in 1,677 patients. Poor outcome at hospital discharge was defined as a modified Rankin scale score of 3 or more points or death. Logistic regression was developed to evaluate PP as an independent predictor of early outcome. Results: For patients with poor outcomes the mean PP during the first week was higher than that for patients with non-poor outcomes. A logistic regression model confirmed that elevated mean PP was independently associated with poor outcome at discharge and 30-day mortality. Conclusion: Elevated PP during the acute phase of ischemic stroke is an independent predictor of poor early outcome at hospital discharge and 30-day mortality.

The Oxfordshire Community Stroke Project (OCSP) classification provides a simple means of classifying the clinical syndromes associated with acute stroke. The validity of the classification can depend on many factors. Accuracy and time of the clinical and radiological examination are very important. It was used in the International Stroke Trial (IST). The study was conducted in 467 hospitals in 34 countries. Our aim was to assess how well the OCSP classification could predict infarct site and size on computed tomography (CT) scan when performed in a trial within 48 h after the onset of stroke and the clinical assessment was carried out by different doctors in different hospitals. We examined data on the patients randomized in the IST by the seven participating hospitals in Poland. Patients admitted to the hospital were examined by the doctor on duty. Eight aspects of the neurological deficit present just before randomization were recorded. The computer system in the randomization centre employed a validated algorithm to assign the patient to one of the four infarct syndromes: lacunar syndrome (LACS), partial anterior circulation syndrome (PACS), total anterior circulation syndrome (TACS) and posterior circulation syndrome (POCS). We assessed the localization and extent of the recent infarction on available CT scans and correlated these with the computer-assigned OCSP category. CT scans were available for 558/759 (74%) of the patients randomized in Poland. In 458 (82%) of cases, CT was carried out in the first 24 h after the onset of stroke. In 444 (80%) scans, a recent infarct was visible. These radiological lesions were appropriate to the clinical classification in 56% of patients with TACS, 73% with PACS, 61% with LACS and 59% with POCS. In Polish centres in IST, amongst the patients with infarction visible on CT, the OCSP subtype predicted the size and site of the infarct in about two-thirds of cases. These data suggest that, provided its limitations are taken into account, the classification can be usefully applied in multicentre clinical trials (or epidemiological studies) and to aspects of the routine clinical care of patients with acute stroke.

Genetic factors, including gene polymorphisms, are promising in determining stroke rehabilitation outcome. Brain-derived neurotrophic factor (BDNF) is one of the most attractive because of its role in neuroplasticity and brain repair.The aim of present study was to assess the role of BDNF -196 G≯A (val66met) and -270 C≯T on clinical parameters and functional outcome in patients with ischemic and hemorrhagic stroke. Additional analyses according to sex and age (≤55 and ≯55 years) were performed.Three hundred thirty-eight patients (287 with ischemic and 51 with hemorrhagic stroke) were evaluated in terms of neurological deficit (National Institute of Heath Stroke Scale [NIHSS]), activities of daily living (Barthel Index [BI]), and everyday functionality (Rankin score [RS]) before and after rehabilitation. BDNF polymorphism genotyping was performed by polymerase chain reaction restriction fragment length polymorphism analysis.In multivariative analysis, unfavorable outcome of stroke rehabilitation (RS ≥2) was associated with independent factors: ischemic stroke (odds ratio [OR], 2.59; 95% CI, 1.03-6.47), female gender (OR, 2.80; 95% CI, 1.39-5.64), depression (OR, 4.24; 95% CI, 1.45-12.35), falls (OR, 2.61; 95% CI, 1.16-5.87), and BDNF -196 GG polymorphism (OR, 2.18; 95% CI, 1.09-4.35). The differences of functional parameters measured with BI and RS on admission and at discharge are apparent only for comparisons between patients ≤55 and ≯55 years old carrying BDNF -196 GA+AA genotypes but not in those carrying -196 GG genotype; the differences were evident in women but not in men.BDNF -196 G≯A polymorphism might affect functional outcome of stroke rehabilitation, but this hypothesis needs further verification.

Haemorrhagic stroke is associated with substantial mortality and disability, thus prevention and appropriate treatment of acute intracerebral haemorrhage is crucial. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute haemorrhagic stroke in a real-world practice.Haemorrhagic stroke patients hospitalized between 1st March 2007 and 29th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, authorized access, web-based questionnaire. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute haemorrhagic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency - modified Rankin Scale  3) at hospital discharge, while late outcomes covered one-year survival.A total of 3111 haemorrhagic stroke patients (mean age: 68.9 years; females: 46.7%) was reported. The analysis of pharmacotherapy showed low preventive use of hypotensive agents in hypertensive patients, high consumption of antibiotics and still overuse of vasoactive or neuroprotective compounds in acute haemorrhagic stroke. Regression models confirmed expected negative impact on stroke outcomes associated with oral anticoagulants but not antiplatelets and inconsistent impact of statins used prior to or in acute haemorrhagic stroke.Preventive underuse of hypotensive compounds contribute substantially to haemorrhagic stroke risk. The high consumption of antibiotics and neuroprotective or vasoactive compounds in haemorrhagic acute stroke reflect the need to improved quality and evidence-based clinical practice.

Background: Diffuse brain injury is a key component of post-cardiac arrest syndrome reported in 30–80% of survivors of out-of-hospital cardiac arrest (OHCA). It is responsible for a high mortality rate, and is a common cause of cognitive and neurological deficits and disability. Symptom variability and dynamics and the rehabilitation potential remain poorly understood. Aim: To investigate symptom prevalence, type, and severity and the natural course of recovery within 12 months after OHCA, and to estimate neurorehabilitation needs. Methods: Study participants were selected from OHCA survivors admitted consecutively to a cardiac intensive care unit (CICU) serving 250,000 of Warsaw’s inhabitants, according to the following inclusion criteria: first ever nontraumatic, normothermic cardiac arrest, age ≤ 75 years; cardiology ward survival until discharge, and no history of pre-existing brain disease. Patients’ cognitive and neurological status and disability were evaluated in the first days after onset and three, six and 12 months later. Neuropsychological assessment focused on attention, memory, executive, linguistic and visuo-spatial abilities. Neurological examination included assessment of cranial nerves, muscle strength and tone, deep tendon reflexes, cerebellar function, sensory function, and gait. The general psychophysical state was classified using the Disability Rating Scale. Patients’ neurorehabilitation needs were determined using data collected three months post-OHCA. This data was used to estimate future demands for such resources in Poland. Results: During a 28-month study period, of 69 OHCA patients admitted to the CICU, 29 met the study criteria (33 survived until discharge from cardiology unit; four did not meet further criteria). Severe consciousness disorders were most frequentin the early post-OHCA phase (28%); no unresponsive patients were identified 12 months later. Of responsive patients who were capable of at least minimal co-operation, 100% (early after OHCA) to 57% (12 months after OHCA) had cognitive impairment, usually with neurological symptoms. Memory impairment was the most common and severe problem, followed by executive, attentional, language and visuo-spatial dysfunctions. The prevalence of neurological deficits ranged from 88% (early after OHCA) to 43% (12 months after OHCA). Due to acquired deficits, between 71% (early post-OHCA) and 36% (12 months post-OHCA) of patients were significantly disabled and often dependent. Although dysfunctions tended to improve, over 50% of the patients remained impaired 12 months post-OHCA, and over 30% were significantly disabled. We estimated that about 800 OHCA survivors/year in Poland will develop symptoms requiring neurorehabilitation. Conclusions: Cognitive and neurological symptoms are common after cardiac arrest brain injury. Establishing specialised neurorehabilitation centres is essential for treating these patients.

Background and purpose Every stroke patient should undergo early rehabilitation. We aimed to evaluate accessibility, development and needs in early stroke inpatient rehabilitation in Poland. Material and methods A questionnaire evaluating rehabilitation departments was prepared and sent (in 2004 and 2008) to rehabilitation wards in Poland, where stroke patients are treated and undergo early rehabilitation. We divided departments into classes: class A – having comprehensive rehabilitation (physiotherapy minimum 60 minutes/day, speech therapy minimum 30 minutes/5 days/week, rehabilitation of other cognitive impairments minimum 30 minutes/5 days/week, group physiotherapy); B – having the possibility of all types of therapy, but done less frequently; C – physiotherapy and speech therapy; D – physiotherapy and cognitive rehabilitation; E – only physiotherapy. Results In 2004, we obtained responses from 115 of 172 (66.9%) rehabilitation departments. According to prespecified criteria there were 11 class A, 31 class B, 28 class C, 4 class D, and 41 class E wards. In 2008, we received response from 89 of 149 (59.7%) rehabilitation departments. According to prespecified criteria there were 17 class A, 40 class B, 22 class C, 0 class D, and 10 class E wards. In 2004, 159 beds and in 2008, 294 beds in class A departments were available for stroke patients. The minimal number of needed but lacking beds was 604 in 2004 and 469 in 2008. Conclusions Development of departments providing early comprehensive stroke rehabilitation from 2004 to 2008 is marked, but still insufficient. In 2008, 19% of rehabilitation departments could provide comprehensive stroke rehabilitation and this was 38.5% of beds actually needed.

Risk factors and a high stroke mortality rate are a heavy stroke burden on Central and Eastern European countries. The 1995 Helsingborg Declaration outlined the aim of the coming decade was to improve patient care. In Poland it led to the foundation of the National Stroke Prevention and Treatment Programme, (1998–2008) which later became part of the National Cardiovascular Disease Prevention and Treatment Programme. The aim: Improve acute and postacute management Implement innovative therapies Develop poststroke rehabilitation, and Monitor epidemiology. Establishing and equipping stroke units has raised their number from three to 111. Thrombolysis for stroke and carotid angioplasty and stenting procedures were supported and supervised. The needs in poststroke rehabilitation were assessed and services have improved due to the support of the programme. Continuous monitoring of patient care proved that the mortality and disability rates have decreased and the quality of treatment has improved. Stroke epidemiological data provided by the World Health Organization (WHO) from the 1970s and 1980s showed that mortality and early stroke fatality in Central and Eastern Europe is exceedingly high compared with other countries of the continent (1). It was confirmed by a Polish prospective study carried out in the years 1991–1992 (2). There was an urging need for change in management and prevention of stroke, which would allow reducing individual and social burden. The Helsingborg Declaration (1995) aimed at examining evidence-based knowledge in stroke and set aims for the next decade in organisation of care and research in Europe (3). Significant discrepancies were found between the Helsingborg Declaration and the everyday situation in Poland. Leaders in the field of Neurology and the Polish Ministry of Health took initiative and established the National Stroke Prevention and Treatment Programme (NPPiLUM) in 1998. The outcome was to achieve the aims outlined in Helsingborg. In 2003, the programme was incorporated into the National Cardiovascular Disease Prevention and Treatment Programme (POLKARD) and continued until the end of 2008 in its initial form. The strategic goals were to recognise and monitor stroke epidemiology and care lower stroke incidence by implementing effective primary and secondary prevention, and improve medical care in the acute stage and poststroke care. Monitoring of stroke care was an issue primarily due to the high mortality rate and significant differences in distribution of risk factors, in-hospital care and death, and poor outcome [modified

Atherosclerotic changes in carotid arteries are responsible for 10-20% of strokes. The aim of our study was to examine how the ultrasonic morphology of carotid arteries influences the occurrence of ischaemic stroke (IS).Ultrasonography of the carotid arteries was performed with a 7-MHz duplex-type scanner Acuson 128XP/10C. We examined 200 consecutive acute IS patients and 100 sex- and age-matched control subjects. Morphology of atheromatic plaques was evaluated with the assessment of degree of stenosis, surface regularity and echogenicity of the plaques. The predictive value of potential prognostic variables in the assessment of the risk of IS was tested using regression models.The most frequent site of atherosclerotic changes was the internal carotid artery (ICA) (right ICAs: 34.5% in IS group vs. 19% in controls, p=0.005; left ICAs: 26.5% vs. 16%, p=0.04). Plaques in ICAs were significantly more severe in IS patients than in controls. Echolucent plaques were observed in the IS group in 11% of right and 5.5% of left ICAs, whereas in controls we found echolucent plaques in only 2% in left ICAs. IS occurrence was independently predicted by: hypertension, congestive heart failure, current smoking status, haemodynamically significant and echolucent plaques in ICAs.Echolucent plaques in ICAs are an independent risk factor for ischaemic stroke even if they have no impact on haemodynamics of blood flow. Clear characterization of plaques in CAs, especially vulnerable plaques, together with estimation of the degree of stenosis, may improve the selection of patients for invasive secondary prevention methods.

OBJECTIVE In human genetic studies an effect of the apolipoprotein E gene (APOE) polymorphism on the risk, course and prognosis in chronic and acute nervous system disorders was established. We aimed to evaluate whether the APOE genotype is related to acute neurological impairments due to ischemic stroke (IS), and to outcomes (up to 1 year) indicated by severe functional disability, dependence in daily living or death. MATERIALS AND METHODS A total of 657 patients (326 men, 331 women), divided into the three groups: E2 (APOEepsilon2/epsilon3 subjects), E3 (APOEepsilon3/epsilon3 subjects), and E4 (APOEepsilon3/epsilon4 and epsilon4/epsilon4 subjects), were analyzed. RESULTS There was no association between the APOE genotype and baseline clinical characteristics, severity of neurological impairments during acute stroke, and 1-year outcome, when analyzing whole patient population. APOE gene interacted with gender in predicting severity of acute neurological deficit and post-stroke mortality within the period up to 1 year after the IS. Gender-stratified analysis indicated the E4 genotype as a significant independent positive predictor of death within 1 year after stroke incidence in men patients. CONCLUSION Ischemic stroke severity and outcome may be affected by complex interactions between gender and genetic factors that warrant further exploration.

According to the World Health Organization establishments and European Stroke Initiative recommendations, every patient with stroke should be treated by a specialized stroke team or in a specialized stroke unit. We aimed to evaluate the development of the stroke unit network in Poland and accessibility of stroke units in 2005.Questionnaires evaluating structure and staff of neurological departments were sent to all neurological departments in Poland in the second quarter of 2005. We divided departments into the following categories: those having a class A stroke unit (fulfilling criteria of experts of the National Programme of Prevention and Treatment of Stroke) class B stroke unit (conditionally fulfilling those criteria), class C stroke units (not fulfilling the criteria), and departments without stroke units. The classification was presented to the chief consultant in neurology of each voivodship in December 2005 for verification of the data.We received enquiries from 180 out of 220 (81.8%) departments. Consultants included data of a further 8 departments which did not respond to the questionnaire (188 - 85.5%). 105 departments declared having a stroke unit (58 class A units, 40 class B units, and 7 class C units). 83 other departments do not have stroke units. The most frequent problem that plays a role in classification of departments was the deficit of staff or lack of equipment. It is assessed that the supplementation of diagnostic equipment and staff in existing stroke units and the establishment of 27 new stroke units is required to satisfy current needs.The development of the stroke unit network in Poland is proceeding dynamically. There are 105 stroke units in Poland but 45% of them require additional diagnostic equipment and staff.

The apolipoprotein E gene (APOE) polymorphism may influence outcome in various forms of brain injury. The association between APOE genotype and long-term ischemic stroke (IS) outcome is controversial. We have examined the effect of stroke risk factors, clinical status at admission and APOE genotype on survival and dependency 1 year after IS.We investigated 496 consecutively subjects with IS. Information concerning risk factors and clinical data were collected prospectively. Functional dependency was estimated with modified Rankin scale (mRS) and defined as a score of 3-5. Each patient was offered a I year follow-up evaluation. APOE genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Multivariate regression models were used to analyse predictors of death and poor outcome (death or dependency) within 1 year after the stroke.The distribution ofAPOE genotypes was 69% with genotype E3/E3, 18% with genotype F3/ E4, 12% with genotype E2/13 and 1% with genotype F2/14. At year 1, 169 patients (38%) had died and 78 of the survivors (28%) were functionally dependent. The best predictors of death at year 1 were: age over 70 years, congestive heart failure, atrial fibrillation, disturbed consciousness and severe hand paresis. Poor outcome was independently predicted by: age over 70 years, congestive heart failure, pre-stroke mRSor =3, marked disturbance of consciousness and severe hand paresis.We did not find any impact of APOE genotype on mortality or poor outcome 1 year after IS.

According to European Stroke Initiative (EUSI) recommendations every stroke patient should undergo rehabilitation. We aimed to evaluate the needs of comprehensive stroke in-patient rehabilitation in Poland.We designed and distributed a questionnaire evaluating rehabilitation departments in Poland, where stroke patients undergo early rehabilitation. Comprehensive rehabilitation was defined as: kinesitherapy (minimum 60 minutes/day), speech therapy (minimum 30 minutes 5 days a week), rehabilitation of other cognitive impairments and group kinesitherapy. We separated rehabilitation departments where comprehensive post-stroke rehabilitation is conducted, and calculated the number of beds in these departments only for stroke patients. We estimated the number of acute stroke patients in Poland. We evaluated the number of patients requiring in-patient rehabilitation based on results from the 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, where all stroke patients who need in-patient rehabilitation have such a possibility. We estimated the number of beds required in rehabilitation departments for stroke patients in Poland.We obtained responses from 115 out of 172 (66.9%) rehabilitation departments. Comprehensive post-stroke rehabilitation is conducted in 11 departments. 159 beds in these departments are for stroke patients. From 64,896 acute stroke patients 9,927 will need in-patient rehabilitation. We need 604 more beds in rehabilitation departments for stroke patients in Poland.Only 10% of rehabilitation departments could provide comprehensive stroke rehabilitation in Poland. At present, the number of beds in rehabilitation departments for stroke patients covers about 20.8% of actual needs. An increased number of rehabilitation beds for stroke patients could result in a decreased number of disabled post-stroke patients.

The metabolic syndrome (MetSyn), especially diabetes or dyslipidaemias, predisposes to cardiovascular disease or stroke development. We aimed to evaluate the prevalence of MetSyn in a non-selected population of acute ischaemic stroke (IS) patients using three definitions.We analyzed 763 IS patients (426 women, 337 men) consecutively admitted to a tertiary referral hospital specializing in acute stroke care (1.01.2003-30.09.2005). MetSyn was diagnosed in the presence of three from five disturbances (alimentary or simple obesity, increased blood pressure, increased triglycerides, low HDL cholesterol, fasting hyperglycaemia) according to definitions of: National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), International Diabetes Federation (IDF), American Heart Association - National Heart, Lung and Blood Institute (AHA-NHLBI).MetSyn was diagnosed according to criteria NCEP-ATP III, IDF, AHA-NHLBI in 54.3, 60.8 and 63.5% of IS patients, respectively, with significantly higher prevalence in women than in men in all age groups. Hypertension was the most frequent disturbance (93.7%). Alimentary or simple obesity and low HDL cholesterol level were significantly more frequent in women than in men (visceral obesity: NCEP-ATP III - 60.7 vs. 26.6%, IDF - 82 vs. 55.8%, AHA-NHLBI - 63.1 vs. 28.2%, respectively; low HDL cholesterol: 56.8 vs. 42%).Over half of acute ischaemic stroke patients have MetSyn, but in the female population MetSyn is 1.5 times more frequent than in men. It is necessary to pay a special attention to the population with MetSyn because of the high risk of ischaemic stroke.

Thrombolysis for acute ischaemic stoke was introduced and licensed in Poland in 2003. The aim of the study was to assess the potential eligibility of patients for intravenous recombinant tissue plasminogen activator (rt-PA). We also investigated whether widespread information about stroke and organisational changes in the 2nd Department of Neurology influenced eligibility and the number of treated patients.An analysis of the 2nd Department of Neurology of the Institute of Psychiatry and Neurology database of stroke patients admitted in the years 1995-2003 and 2003-2005 was performed. Eligibility for rt-PA treatment was assessed using the criteria outlined by the SITS (Safe Implementation of Thrombolysis in Stroke) protocol. The number of patients eligible for thrombolysis was estimated and then compared with the number of treated patients.A total of 1541 patients with ischaemic stroke were admitted between 1 June 1995 and 1 November 2003, 18.7% within 2 hours of onset, 78% aged under 80. 4.6% of patients were found eligible for rt-PA. 552 ischaemic stroke patients were admitted between 1 November 2003 and 30 September 2005, 19.2% within 2 hours from onset, 71.6% under 80 years old. 6.9% were eligible for rt-PA, and 8.6% were treated.Age and time from onset to admission were the most common exclusion criteria. The number of actually treated patients was higher than estimated. After providing the information about stroke symptoms there was a trend in decreasing time from onset to admission. Organizational changes increased the number of treated patients.

Background: Results of experimental and clinical studies suggest that recombinant human interleukin 1 receptor antagonist (rhIL1ra) may be a good new therapeutic agent for acute stroke. In humans, IL1ra is encoded by the IL1RN gene located on chromosome 2. Objectives: To report on the association between different genotypes of the variable number tandem repeat (VNTR) polymorphism within IL1RN , and disease severity and 1-year outcome in patients with ischaemic stroke. Methods: IL1RN genotypes were evaluated using polymerase chain reaction in 391 patients with ischaemic stroke diagnosed according to the World Health Organization definition. The effects of IL1RN genotypes on severity of stroke at maximum impairment, and on the survival status and neurological and functional condition of patients at 7 days, 1 month, 3 months and 1 year after the onset, were evaluated. Results: No relationship was found between IL1RN genotypes and severity of symptoms at the time of maximum impairment. Homozygotes for the IL1RN *2 allele showed less severe neurological and functional impairments when assessed after the time period between 7 days and 1 year after stroke compared with carriers of the other two IL1RN genotypes. Patients with at least one copy of the IL1RN *2 allele had increased risk of death during the first week, and patients homozygotic for this allele had increased risk of death within the first month after stroke. Conclusion: IL1RN intron 2 variable number tandem repeats polymorphism influences the clinical outcome in patients with ischaemic stroke. It may possibly modify effects of treatment with rhIL1ra in patients with acute stroke.

Systemic thrombolysis treatment was approved in Poland in 2003 and should be performed in specialist stroke units (SU). We performed a survey to determine stroke service preparedness for thrombolysis treatment in Poland. We sent a questionnaire evaluating the neurological departments in Poland, where stroke patients are treated. We divided them into four categories: (i) class A SU (fulfilling criteria of the National Program for Stroke Prevention and Therapy and European Stroke Initiative guidelines), (ii) class B (conditionally fulfilling criteria), (iii) class C (not fulfilling criteria), and (iv) departments without SU. Only class A units are eligible for implementing thrombolysis. We obtained response from 194 of 222 (87.4%) departments; 90 (46.4%) declared having an SU. According to criteria, 20 class A, 56 class B, 14 class C. During one year, 71 208 patients were admitted to hospitals; 69,982 (98.2%) to neurological departments. A total of 10,959 (15.4%) were treated in class A SU, 23,650 (33.2%) in class B, 5153 (7.2%) in class C, whereas 30,220 (42.4%) in neurological departments without SU. Our survey showed that only 15.4% stroke patients in Poland are admitted to high-quality SU, where thrombolysis may potentially be administered. Improvement of SU quality in Poland is necessary for wide implementation of new methods of stroke therapy.

According to the European Stroke Initiative recommendations every stroke patient should undergo rehabilitation; its program should be tailored according to the individual needs of the patient. The aim of our study was to evaluate the accessibility of comprehensive early stroke rehabilitation at neurological departments in Poland.We have sent a questionnaire evaluating neurological and rehabilitation departments in Poland, where stroke patients are treated and undergo early rehabilitation. We divided them into 5 categories -- classes from A to F: class A -- having comprehensive rehabilitation (kinesitherapy minimum 60 minutes/day, speech therapy minimum 30 minutes for 5 days a week and rehabilitation of other cognitive impairments and group kinesitherapy at rehabilitation departments); B -- having the possibility of all types of therapy, but is done less frequently; C -- kinesitherapy and speech therapy; D -- kinesitherapy and cognitive rehabilitation; E -- only kinesitherapy. We also separated neurological departments without trained rehabilitation staff.We obtained responses from 191 of 215 (88.8%) neurological departments. According to criteria: 26 class A, 38 class B, 50 class C, 2 class D, 73 class E, 2 without specialized rehabilitation staff. We received filled questionnaires from 115 of 172 (66.9%) rehabilitation departments. According to criteria: 11 class A, 31 class B, 28 class C, 4 class D and 41 class E.Only 14% of all neurological departments and 10% of rehabilitation departments administered comprehensive early stroke rehabilitation in Poland. Improvement of comprehensive rehabilitation accessibility in Poland is necessary for lowering the number of disabled post-stroke patients.

The aim of our study was to investigate prevalence, characteristics and extensiveness of CA plaques in acute stroke using high-resolution B-mode USG.USG of CA was performed with a 7.0-MHz Duplex-type scanner Acuson 128 XP/10 C. We examined 149 patients aged 26-95 years, with acute ischemic stroke, consecutively admitted to our Department. Atheromatous plaques morphology was determined using the HSP Classification (H--Hemodynamic characteristics, S--Surface plaque, P--Plaque echogenics).An extracranial carotid disease (CCA, ICA, ECA) was found in 85 (57%) patients, while 67 (45%) patients had atheromatous changes in ICA. Bilateral ICA plaques were found in 22 (15%) patients, and unilateral--in 45 (30%) patients. In 17 (11%) patients plaques were associated with artery occlusion (in 16 cases ipsilateral to the stroke site, and in 1 case--contralateral). No bilateral occlusion of ICA was observed. In 6 (4%) patients stenosis (ranging from 60 to 99%) was found in only one ICA, while in 4 (2.7%) cases there was also contralateral stenosis60%. In 4 patients a contralateral occlusion was present. Ulcerated plaques were noted in 22 (15%) patients--in 18 cases ipsilateral to the stroke, and in the remaining 4--contralaterally. None of the patients had a bilateral ulceration.Atheromatous ICA changes were found in 45% of the patients under study. However, these plaques may be the cause of cerebral ischemia associated with a high-grade stenosis, occlusion or ulceration ipsilateral to the stroke site in 15.45% of the patients only.

The authors report a case of stroke in a young adult patient caused by intracranial internal carotid artery dissection--result of rapid neck movement. The patient developed hemiparesis, but all neurologic symptoms completely regressed after rehabilitation and now (18 months) after stroke there are no neurological symptoms.

The aim of this article is to present basic problems of new neuro-rehabilitation, its purposes and methods. This paper shows the newest methods of kinezytherapy and drugs used in improving the rehabilitation process. Authors present interdisciplinary rehabilitation teams dealing with neurologically disabled patients. They also show short programs of rehabilitation in multiple sclerosis and in stroke patients. That diseases are very popular in main population and are one of the main cause of disability in adult people.

This paper reports two cases of leptomeningitis carcinomatosa with progressive cranial nerves injury as the first clinical sign of disseminated disease. Neurological state, diagnostic procedure and treatment are described.