Stroke-like episodes (SLEs) are significant clinical manifestations of metabolic disorders affecting the central nervous system. Morphological equivalents presented in neuroimaging procedures are described as stroke-like lesions (SLLs). It is crucial to distinguish SLEs from cerebral infarction or intracerebral hemorrhage, mainly due to the variety in management. Another significant issue to underline is the meaning of the main pathogenetic hypotheses in the development of SLEs. The diagnostic process is based on the patient’s medical history, physical and neurological examination, neuroimaging techniques and laboratory and genetic testing. Implementation of treatment is generally symptomatic and includes L-arginine supplementation and adequate antiepileptic management. The main aim of the current review was to summarize the basic and actual knowledge about the occurrence of SLEs in various inherited neurometabolic disorders, discuss the possible pathomechanism of their development, underline the role of neuroimaging in the detection of SLLs and identification of the electroencephalographic patterns as well as histological abnormalities in inherited disorders of metabolism.

Introduction. Results of cocaine intake can be such cardiovascular complications as hypertension, myocardial infarction, arrhythmia, and cardiomyopathy. Anabolic androgenic steroids use is related to hypertension, cardiomyopathy and lipid metabolism derangements.Case report. On admission to the cardiology department a 37-year-old man presented prolonged pain at rest located in the middle part of the chest, which occurred 2 days earlier. He was after the use of cocaine, tetrahydrocannabinol, and alcohol. Smoking and using the growth hormone and anabolic androgenic steroids (AAS) in the past were present in the patient's medical history. Physical examination with no deviation, heart rate 72/min, and blood pressure 130/90 mm Hg. Features of anterior wall myocardial infarction (MI) were present in electrocardiogram -ST-elevation up to 3 mm in V2-V5. In laboratory tests, troponin T rise (1.99 ng/mL) and D-dimer (503 ng/mL) were observed. In echocardiography -apex hypokinesis and concentric left ventricular hypertrophy -max. thickness: 19 mm. No significant abnormalities were detected in an immediate coronary angiography. Heart damage of vascular aetiology involving an apical region and partial interventricular septum were confirmed in magnetic resonance imaging. No significant arrhythmias are present in electrocardiogram Holter monitoring. Conservative treatment was prescribed: beta blockers, atorvastatin, enoxaparin, captopril, acetyl salicylic acid (ASA), electrolytes i.v. and was released from hospital after 4 days. On discharge in a good general condition with a recommended further treatment.Conclusions. The presented case is an example of ST-elevation myocardial infarction (STEMI) in a young patient with left ventricular hypertrophy of multifactorial aetiology (hypertrophic cardiomyopathy, athlete's heart, hypertrophy due to anabolic steroids, and growth hormone intake). Immediate coronary angiography showed no significant abnormalities. The patient during STEMI was after ingestion of cocaine and other stimulants which, apart from pulmonary embolism, vasospastic angina, and Takotsubo cardiomyopathy, can be an aetiology factor. Elimination of all modifiable risk factors is the key factor influencing successful therapy in this case.

One of the most common epileptic disorders in the pediatric population is Panayiotopoulos syndrome. Clinical manifestations of this idiopathic illness include predominantly autonomic symptoms and dysfunction of the cardiorespiratory system. Another feature constitutes prolonged seizures that usually occur at sleep. It is crucial to differentiate the aforementioned disease from other forms of epilepsy, especially occipital and structural epilepsy and non-epileptic disorders. The diagnostic process is based on medical history, clinical examination, neuroimaging and electroencephalography—though results of the latter may be unspecific. Patients with Panayiotopoulos syndrome (PS) do not usually require treatment, as the course of the disease is, in most cases, mild, and the prognosis is good. The purpose of this review is to underline the role of central autonomic network dysfunction in the development of Panayiotopoulos syndrome, as well as the possibility of using functional imaging techniques, especially functional magnetic resonance imaging (fMRI), in the diagnostic process. These methods could be crucial for understanding the pathogenesis of PS. More data arerequired to create algorithms that will be able to predict the exposure to various complications of PS. It also concerns the importance of electroencephalography (EEG) as a tool to distinguish Panayiotopoulos syndrome from other childhood epileptic syndromes and non-epileptic disorders.