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Although inflammatory periodontal disease has been proven to be related to carotid intima media thickness, it has been recently suggested that even an alteration of carotid hemodynamics might contribute to atherosclerosis in patients with periodontal disease. A 52-yearold female patient was referred to periodontology department due to painful alveolar mucosa. On the basis of dental history, we concluded that the patient had a severe form of generalized aggressive periodontitis that led to complete edentulism. The patient was advised to undergo ultrasonography of carotid arteries with arterial stiffness measurements at neurology department. A diagnosis of the right internal carotid artery occlusion was established. Inflammatory periodontal disease may affect arterial hemodynamics and even lead to artery occlusion. It is advisable that patients with a severe form of periodontitis should be referred for carotid artery ultrasonography., Iako je dokazano da parodontna bolest može biti povezana s debljinom intime-medije, tek je u novije vrijeme uočeno da i promjene u arterijskoj hemodinamici mogu doprinijeti aterosklerozi kod pacijenata s parodontitisom. Pedesetdvogodišnja pacijentica je upućena na odjel parodontologije zbog bolne alveolarne mukoze. Na temelju stomatološke anamneze zaključeno je da je pacijentica bolovala od generaliziranog agresivnog parodontitisa koji je doveo do potpune bezubosti. Pacijentici je predložen ultrazvučni pregled karotidnih arterija i određivanje arterijske krutosti na odjelu neurologije. Postavljena je dijagnoza okluzije desne unutarnje karotidne arterije. Upalna parodontna bolest može utjecati na arterijsku hemodinamiku i dovesti do arterijske okluzije. Preporučljivo je da se pacijenti s uznapredovalim oblikom parodontitisa upute na ultrazvučni pregled karotidnih arterija

Hemodynamic changes can be noninvasively real-time monitored in stroke patients by means of transcranial Doppler sonography (TCD). The aim of this pilot study was to assess hemodynamic changes in both middle cerebral arteries (MCA) in aphasic stroke patients by means of TCD during verbal stimulation. Eight aphasic patients with stroke in the territory of the left MCA were tested by modified Boston Diagnostic Aphasia Examination (BDAE) within 3 days of stroke onset. Both MCA were monitored simultaneously by means of TCD with 2 MHz probes. Basic MCA mean blood flow velocity (MBFV) values were assessed and monitored during verbal stimulation. Verbal stimulation was performed with 30 photos of objects for daily usage, arranged by function. The same test was performed in 16 right-handed healthy controls. In stroke patients, the mean MBFV were 56 cm/s in the left MCA and 56 cm/s in the right MCA. A mean 30% increase was observed in the left MCA and 22% in the right MCA. In healthy controls, a mean 21.7% increase was observed in the left MCA and 18% in the right MCA. A trend toward higher percentage of MBFV increase was observed in the left MCA during verbal stimulations in aphasic patients as compared to control subjects., Promjene moždane hemodinamike u srednjoj moždanoj arteriji (SMA) u bolesnika s moždanim udarom u irigacijskom području lijeve moždane arterije, te s posljedičnom afazijom mogu se neinvazivno pratiti pomoću funkcionalne transkranijske dopler sonografije (fTCD). Pritom se kao funkcionalni podražaj može koristiti stimulacija govora u obliku logopedskih vježbi. Da bismo procijenili aktivaciju SMA tijekom receptivne i ekspresivne verbalne stimulacije, ispitivanje afazije proveli smo modificiranim bostonskim dijagnostičkim testom u irigacijskom području lijeve SMA kod 8 bolesnika s moždanim udarom unutar 3 dana od nastanka ishemičnog moždanog udara. U obje smo SMA praćenje TCD-om proveli istodobno pomoću 2 ultrazvučne sonde frekvencija 2 MHz. Srednje brzine strujanja krvi (SBSK) u SMA procjenjivali smo i pratili prije i tijekom govorne stimulacije. Stimulaciju govorom proveo je logoped baterijom logopedskih vježbi, te zadacima imenovanja uz pomoć 30 fotografija predmeta svakodnevne uporabe grupiranih prema funkcijama. Isto ispitivanje je provedeno u 16 zdravih dešnjaka. Srednje brzine strujanja krvi bile su: 56 cm/s u lijevoj ACM, te 56 cm/s u desnoj SMA. U lijevoj je SMA tijekom stimulacije govora zabilježen srednji 30%-tni rast SBSK, a u desnoj SMA 22%-tni rast u odnosu na mirovanje. U zdravih kontrolnih osoba u lijevoj je SMA zabilježen porast SBSK od 21,7%, a u desnoj SMA od 18%. Uočen je trend rasta SBSK u lijevoj SMA tijekom stimulacije govora u afatičnih bolesnika u usporedbi sa zdravim kontrolnim osobama.

Purpose: Prevalence of type 2 diabetes mellitus (DM) is increasing. DM is a major risk factor for cerebrovascular diseases. Assessment of arterial structure and function, by non-invasive methods, can be used in early detection of vascular complications. Besides intima-media thickness (IMT), beta stiffness index (BSI) was recently recognized as a surrogate marker of atherosclerosis. The aim of this study was to explore BSI in patients with type 2 DM. Material & Methods: Patients with type 2 DM were examined in our Stroke prevention centre by means of ultrasound with a high-resolution echo-tracking system, on Aloka Prosound alpha 7 system equipped with 8MHz probe. IMT of common carotid artery was measured by highresolution B- mode ultrasound imaging. Results: Altogether 32 DM patients (16 female) were examined (mean age 65, 9₠i, 68, 7 years). Most of patients (26) were hypertensive (142₠i, 621 over 86₠i, 69 mmHg) and had increased BMI (31, 1₠i, 64, 8 kg/m2). Average IMT was 0, 72₠i, 60, 15 (right CCA) and 0, 76₠i, 60, 15 (left CCA). Average BSI was 11, 6₠i, 65, 5 (right CCA) and 11, 8₠i, 63, 8 (left CCA). IMT was significantly correlated with waist circumference and age, while BSI correlated with systolic blood pressure, waist circumference and heart beat rate. Conclusion: Increased carotid IMT and BSI in type 2 DM patients were registered. Further studies are needed to assess the impact of these parameters on stroke risk and outcome.

The one-year incidence of carotid occlusion is 6/100 000 inhabitants in general population. Stroke incidence and mortality rate in these patients vary. Patients that underwent carotid endarterectomy (CES) are at a higher risk of progression of contralateral carotid stenosis. The aim of the study was to investigate the management and natural history of the contralateral internal carotid artery disease in patients with internal carotid artery occlusion (ICAO). During one year, 297 patients with ICAO were investigated. Follow up examinations were retrospectively analyzed and patients were divided into groups according to contralateral carotid disease. Out of 297 patients, only one investigation was performed in 90 patients with carotid occlusion. Thirty three patients were followed up due to postoperative ICAO. In 14 patients, ICAO developed during ultrasonographic follow up. In this group of patients, 9 had unchanged contralateral findings, whereas in 5 patients disease progression was observed. Out of 44 patients with ICAO and contralateral subtotal stenosis at initial investigation, 42 underwent carotid surgery. Postoperatively, 32 patients had normal findings, 6 developed mild carotid stenosis, 2 developed moderate carotid stenosis, and 2 had postoperative carotid occlusion. Two patients were followed-up without intervention. Nine patients with bilateral ICAO were followed-up for years. Follow up was continued in 106 patients with ICAO and contralateral mild to moderate changes. The finding was unchanged in 68 patients. In 21 (30%) patients the disease progressed to subtotal stenosis and 18 patients underwent carotid surgery. Accordingly, contralateral carotid disease progression was observed in one third of patients with carotid occlusion. Additional studies on the issue are needed., Godišnja incidencija okluzije unutarnje karotidne arterije (ACI) u općoj populaciji je 6/100.000 stanovnika. Godišnja razina moždanih udara i smrti vezanih uz okluziju ACI varira. U bolesnika u kojih je učinjena karotidna endarterektomija postoji povećani rizik progresije kontralateralne karotidne stenoze. Cilj ove studije bio je prikazati stanje kontralateralne karotidne bolesti u bolesnika s karotidnom okluzijom. U jednogodišnjem razdoblju u Cerebrovaskularnom laboratoriju Klinike za neurologiju pregledano je 8.000 bolesnika obojenim doplerom karotidnih arterija prema protokolu. Zabilježeno je 297 bolesnika s okluzijom ACI. Retrospektivno su analizirani nalazi doplera te su bolesnici prema nalazu na kontralateralnoj karotidnoj arteriji svrstani u 6 skupina. Okluzija ACI otkrivena je na prvom pregledu u 90 od 297 bolesnika. Poslijeoperacijski se okluzija razvila u 33 bolesnika. U 14 bolesnika okluzija je nastala tijekom praćenja. Kontralateralno je 9 bolesnika iz ove skupine imalo nepromijenjen nalaz, dok je u 5 zabilježena progresija bolesti. Operirana su 42 od 44 bolesnika s okluzijom ACI i subtotalnom stenozom kontralateralno na prvom pregledu. Poslijeoperacijski je 32 bolesnika imalo uredan nalaz, 6 je razvilo početnu stenozu, 2 umjerenu stenozu, a 2 poslijeoperacijsku okluziju ACI. Dvoje bolesnika je dalje praćeno bez intervencije. Devetoro bolesnika s obostranom okluzijom ACI praćeno je 4,9 godina. Praćenje je nastavljeno i u 106 bolesnika s okluzijom ACI te kontralateralno početnim do umjerenim promjenama. Nalaz je bio nepromijenjen u 68 bolesnika. U 21 (30%) bolesnika stenoza je napredovala do subtotalne, a 18 bolesnika je operirano. Dakle, progresija kontralateralne karotidne bolesti nastupila je u trećine bolesnika s okluzijom ACI.