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Cognitive abilities and serum testosterone levels naturally decline with age. Low serum testosterone levels are known to be associted with increased vascular risk and musculoscteletal, but also with neurological and psychiatric cognitive consenquences.Patients with locally advanced prostate cancer, which is hormone sensitive/dependent, are often treated using antiandrogene therapy, which artificially further lowersserum testosterone levels until castration levels are reached.Our aim was to evaluate the relationship of cognitive changes and serum testosterone levels in patients with prostate cancerreceiving antiandrogene therapy.Although indications for antiandrogene therapy in patients with prostate cancer are nowadays expanding, clinicians need to be well-aware of its side-effects, including cognitive impairment.MoCA can be used as a practical tool for evaluation and follow-up of cognitive changes in those patients.

Cervical artery dissection (CAD) can occur at any age, but is considered one of the most common causes of stroke in young adults. There is an association between migraine and stroke. Several small to medium sized studies indicated a link between CAD and migraine. AIM: To assess the incidence of vascular risk factors in consecutive patients with CAD. During one year 20 consecutive patients (18/20 50% difference in blood flow velocity (BFV) compared to the unaffected side(60%) and intracranial collateral flow(35%).Head and neck MR, MRA or CTA confirmed the diagnosis.Multivessel involvement was present in 4 patients, affection of one carotid artery in 9 and one vertebral artery in 7 patients. Hyperlipidemia was present in 11, arterial hypertension and migraine in 7, diabetes mellitus in 3, heart disease in 4 and smoking in 2 patients.Head or neck pain was the dominant symptom in 19/20 patients, followed by ischemic symptomatology in 17/20 (15 patients presented with ischemic stroke and 2 had TIA ), only one patient had intracranial hemorrhage. Follow up during one year showed recanalization rate: 10/20, while recurrence rate was 0/2 Conclusion: In this cohort of patients with CAD hyperlipidemia and arterial hypertension apper to be the most common risk factors, followed by heart disease and diabetes. Also, the migraine was present more common than in general population.

Cervical artery dissection (CAD) is at the most common single etiology of stroke in young adults. There is an association between migraine and stroke. Several small to medium sized studies indicated a link between CAD nad migraine. The aim of this study was to asses the incidence of migraine and ozher risk factors in consecutive patients with CAD. The incidence of migraine was higher in patients with CAD than in the general population.

Craniocervical artery dissection(CCAD) appears to be the most common etiology of a stroke in young adults. There is an association between migraine and stroke. Several small- to medium- sized studies indicated a link between CAD and migraine. The aim of this study was assess the incidence of vascular risk factors in consecutive patients with CAD. The data of 20 consecutive patients with CAD diagnosed from january 1 to december 31, 2012.In this cohort of patients with CAD , hiperlipidemia and arterial hypertension appeared to be the most common risk factors , followed by heart disease and diabetes. Also, migraine was present more often than in general population.

Recent studies showed correlation between increased intracranial pressure (ICP) and ultrasonography of the optic nerve sheath diameter (ONSD). Limit range of ONSD from 5.0-5.86 mm correlates with raised ICP (>20 cmH2O). The aim of this study was to asses the usefulness of ONSD ultrasonography in patients with brain death.

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-year-old female patient was referred to the periodontology department, due to a painful alveolar mucosa. On the basis of the dental history we concluded that the patient had had a severe form of generalized aggressive periodontitis that led to complete edentulism. An ultrasound examination of carotid arteries at neurology department was suggested to the patient, including arterial stiffness measurements. A diagnosis of right internal carotid artery occlusion was established. Inflammatory periodontal disease may affect arterial hemodynamic, and even lead to artery occlusion. It is advisable that the patients with severe form of periodontitis are referred to the carotid artery ultrasound.

The exposure to chronic inflammation, such as periodontal disease, is recognized as a risk factor for atherosclerotic cardiovascular disease. The aim of this research was to investigate the relationship between carotid arterial stiffness indices and periodontal condition, compared to the periodontally healthy subjects. The study was conducted on 23 patients with untreated chronic periodontitis (test group, 11 men and 12 women, mean age 57.4 ± 10.6 years) and 20 periodontally healthy volunteers (control group, 8 men and 12 women, mean age 59.3 ± 8.6 years). Periodontal condition was assessed in terms of clinical attachment level. Arterial stiffness measurements on common carotid artery (CCA) were performed using Aloka ProSound ALPHA 10 with 13 MHz linear probe. In comparison with the control group, test group showed statistically significant difference (p

background: Vascular risk factors (VRFs) are recognized as important contributors in the pathogenesis of both vascular and Alzheimer’s dementia. The same VRFs influence arterial mechanics and consequently cerebrovascular perfusion, thus predisposing to evolution of cerebral vascular incidents. Our aim was to further investigate vascular function in patients with cognitive decline, using non-invasive neurosonology techniques. methods: In all, 15 patients diagnosed with Alzheimer’s disease (AD), 15 patients with vascular dementia (VAD) and 20 patients diagnosed with mild cognitive impairment (MCI) were recruited. E-tracking was performed using Aloka ProSound Alpha 10 with 13 MHz linear probe. Parameters of arterial stiffness (beta stiffnes index, augmentation index [AI] and pulse wave velocity [PWV]) were analysed, and IMT was measured. Inter-group comparison was performed. results: When compared to patients with VAD, patients with AD showed statistically significant difference (p

Background: Inflammatory periodontal disease is recognized as a risk factor for the development of atherosclerosis. The aim of this study was to assess the relationship between periodontal condition and arterial stiffness, compared to the periodontally healthy subjects. Methods: The study included 20 patients with chronic periodontitis (test group, 9 men and 11 women, mean age 57.5 ± 11.0 years) and 18 patients with healthy periodontium (control group, 7 men and 11 women, mean age 58.4 ± 8.2 years). Periodontal condition was assessed in terms of clinical attachment level with a periodontal probe. Arterial stiffness measurements on common carotid artery (CCA) were performed using Aloka ProSound ALPHA 10 with 13 MHz linear probe. Results: In comparison with the control group, test group showed statistically significant difference (p < 0.01) in the mean beta stiffness (11.06 ± 3.96), augmentation index (14.93 ± 11.36) and pulse wave velocity (7.48 ± 1.33), but only when measured on left CCA. Test group also showed statistically significant difference (p < 0.05) in the mean beta stiffness and pulse wave velocity when measured on the left and right CCA, respectively. No statistically significant differences were observed among groups regarding body mass index, blood pressure, pulse pressure and intima media thickness. Conclusions: Our results demonstrate that inflammatory periodontal disease can affect arterial haemodynamics, regardless alterations of intima media thickness. Further investigation with a larger patient sample is required in order to more accurately assess the arterial stiffness in patients with periodontitis.

Background: Evaluation of optic nerve sheath by means of optic nerve ultrasonography (ONUS) is a reliable tool for assessment of patients with increased intracranial pressure. The aim of this study was to present the usefulness of optic nerve sheath ultrasonography in patients with brain death.Methods: Ten patients with brain death as a result of traumatic or non-traumatic causes were evaluated by ONUS. Optic nervesheath diameter (ONSD) was measured with a 12 MHz linear ultrasound probe (Terason T3000, Teratech Corporation, USA).The probe was adjusted to give a suitable angle for displaying the entry of the optic nerve into the globe, at the depth of 3mm behind the globe. For each optic nerve four measurements were made, twice in transversal and twice in the sagittal plane, by rotating the probe clockwise. Mean ONSD for brain death patients were compared with mean ONSD of 17 healthy controls. Results: Ten inviduals (7 males) with confirmed brain death (5 due to neurotrauma, 2 due to subarachnoid hemorrhage, 2 as a result of ischemic strokes and one of parenchymal hemorrhage), were evaluated. On the left mean ONSD was 0, 71+0.06 cm on transversal plane and 0.72+0.04 cm on sagittal plane. On the right mean ONSD was 0.73+0.05 cm on transversal plane and 0.73+0.06 on sagittal plane. In controls left mean ONSD was 0, 51+0.05 cm on transversal plane and 0.55+0.06 cm on sagittal plane. On the right mean ONSD was 0.52+0.05 cm on transversal plane and 0.54+0.07 on sagittal plane. Mean ONSD in brain death was 0.72+0.05cm and 0.53+0.06 cm in controls (p

Testing of middle cerebral artery (MCA) by verbal stimulation in patients with stroke and aphasia can be noninvasivly monitored by means of transcranial Doppler sonography (TCD). In order to assess MCA activation during receptive and expresive verbal stimulation, 10 patients with MCA stroke within 3 days of onset and aphasia were tested by modifi ed Boston Diagnostic Aphasia Examination. Both MCA were monitored simultaneously by means of TCD with 2 MHz probes. Basic mean blood fl ow velocies (BFV) MCA values were assessed and monitored during verbal stimulation. Verbal stimulation was performed with 30 photos of objects for daily usage, arranged by function. Same test was performed in 10 healthy controls. Ten stroke patients (9 males, 1 female), mean age 53+17 years, were tested. Mean MBFV were 55 cm/s in the left MCA, and 56 cm/s in the right MCA. Mean 29% increase was observed in the left MCA, and 18% in the right MCA. In healthy controls mean 24% increase was observed in left MCA, and 21% in right MCA. A trend toward higher percentage of MBFV increase was observed in left MCA during verbal stimulations in aphatic patients compared to controls.

Vascular risk factors have an important role not only in the in the development of stroke, but also of cognitive decline. Advanced stenosis or occlusion of the internal carotid artery (ICA s/o) is known to be associated with vascular risk but also with cognitive decline. We therefore evaluated cognitive functions in patients with vascular risk factors with and without advanced carotid disease. Cognitive status of 42 patients with vascular risk factors, diagnosed with mild cognitive impairment (MCI) and with advanced ICAs/o (PG) was compared with age and gender matched control group of 42 MCI patients with vascular risk but without ICAs/o (CG). Cognitive testing was performed using MMSE and Montreal Cognitive Assessment (MoCA). Cognitive performance on both tests and on cognitive domains covered by MoCA was correlated with vascular risk profile. Compared to MCI patients without concomitant advanced ICA s/o, MCI patients with ICA s/o scored significantly worse on MoCA (p=0, 049) and on the short-term memory domain MoCA subtest (p=0, 026). MMSE cognitive scores did not differ significantly between groups. Analysis of cognitive domains covered by MoCA in subgroups of participants with different vascular risk factors showed significant association of impaired attention with hypertension, diabetes, hyperlipidaemia, smoking and with multiple risk factors (>2). Diabetes was also significantly associated with the impaired language domain (p< 0, 05). Patients with vascular risk factors and concomitant advanced carotid disease seem to be at increased risk of developing cognitive decline. The pattern of cognitive impairment could be easily revealed when MoCA subtests scores are analysed.

Vascular cognitive impairment (VCI) is nowadays deemed the most common form of cognitive decline that can potentially be prevented or ameliorated. Besides well known vascular risk factors that have a key role in the development of VCI, concomitant advanced stenosis or occlusion of the internal carotid artery (ICA s/o) could further increase the risk of cognitive decline due to chronic hypoperfusion. We therefore evaluated cognitive functions in patients with vascular risk factors with and without advanced carotid disease. Cognitive status of 42 patients with vascular risk factors, diagnosed with mild cognitive impairment (MCI) and with advanced ICAs/o (PG) was compared with age and gender matched control group of 42 MCI patients with vascular risk but without ICAs/o (CG). Cognitive testing was performed using MMSE and Montreal Cognitive Assessment (MoCA). Cognitive performance on both tests and on cognitive domains covered by MoCA was correlated with vascular risk profile. Compared to MCI patients without concomitant advanced ICA s/o, MCI patients with ICA s/o scored signifi cantly worse on MoCA (p=0, 049) and on the short-term memory domain MoCA subtest (p=0, 026). MMSE cognitive scores did not diff er signifi cantly between groups. Analysis of cognitive domains covered by MoCA in subgroups of participants with diff erent vascular risk factors showed signifi cant association of impaired attention with hypertension, diabetes, hyperlipidaemia, smoking and with multiple risk factors (>2). Diabetes was also signifi cantly associated with the impaired language domain (p< 0, 05). Patients with vascular risk factors and concomitant advanced carotid disease seem to be at increased risk of developing cognitive decline. Th e pattern of cognitive impairment could be easily revealed when MoCA subtests scores are analysed.

Background: As the result of public campaigns focused on the awareness of the stroke, published recommendations for stroke management and reorganisation of services, improvement outcome of TIA patients was observed. The aim was to validate the measures that improved management of patients with cerebral ischemic symptoms. Methods: One year data of 5219 patients examined in emergent neurological outpatient department were analyzed. Patients were referred from general practitioner, emergency physician or were brought by relatives without being previously seen by a health service. The service is organized to improve care for TIA patients, providing a short and standardized clinical assessment followed by initiation of a comprehensive stroke prevention program. Demographic data, risk factors, stroke type, preceding TIA, ABCD2 score and admittance rate are analyzed. Results: Between 1th January and 31th December 2008, 1057 patients suspected to have stroke or TIA were examined. There were: 447 ischemic strokes, 99 TIA, 56parenchymal hemorrhages, 49 subarachnoid hemorrhages and 406 patients with nonspecific symptoms, other systemic or neurological illness. Out of 447 ischemic strokes (73+11 years) 196 were males. TIA preceded stroke in 29 patients (6, 5%), and 197 (44%) patients were examined after worsening of stroke syndromes (133 within 24 hours, 47 within 48 hours, and 17 within 7 days). Out of 100 TIA (67+14 years) patients 55 were males. Mean ABCD2 score was 2, 95. In all patients comprehensive stroke prevention program was started, 427/447 (95%) strokes and 31/99 (31%) TIA's were hospitalized in Neurology clinic. Four TIA patients developed stroke (4%) and were hospitalized, 3 patients after 2 days (ABCD2 score 3, 4 and 5), and one after 7 days (ABCD2 score 5). Conclusion: Preventive measures resulted in a low number or strokes after TIA (

The recovery of aphasia in left middle ceebral artery (MCA) stroke is mediated by activation of both cerebral hemispheres. In order to assess MCA activation during receptive and expresive verbal stimulation, 10 patients with MCA stroke within 3 days of onset and aphasia were tested by modified Boston Diagnostic Aphasia Examination. Both MCA were monitored simultaneously by means of transcranial Doppler sonography with 2 MHz probes. Basic mean blood flow velocies (BFV) MCA values were assessed, and monitored during verbal stimulation. Verbal stimulation was performed with 30 photos of objects for daily usage, arranged by function. Same test was performed in 10 healthy controls. Ten patients (9 males, 1 female), mean age 53+17 years, were tested. Mean MBFV were 55 cm/s in the left MCA, and 56 cm/s in the right MCA. Mean 29% increase was observed in the left MCA, and 18% in the right MCA. In healthy controls mean 24% increase was observed in left MCA, and 21% in right MCA. A trend toward higher percentage of MBFV increase was observed in left MCA during verbal stimulations in aphatic patients compared to controls.

Background The exposure to inflammatory periodontal disease represents a risk factor for the development of atherosclerosis. The aim of this research was to assess the relationship between carotid elastic properties and periodontal condition in patients with aggressive periodontitis. Methods The study was conducted on 30 subjects with untreated aggressive periodontitis (test group, 13 men and 17 women, mean age 34.7±6.3 years) and 34 periodontal healthy volunteers (control group, 15 men and 19 women, mean age 27.7±5.7 years). Periodontal parameters were assessed in terms of clinical attachment level using a periodontal probe. Arterial stiffness measurements on common carotid artery (CCA) were performed using Aloka ProSound ALPHA 10 with 13 MHz linear probe. Results In comparison with the control group, test group showed statistically significant difference (p0.05). Conclusion The present results demonstrate that aggressive periodontitis may affect carotid artery hemodynamics, despite normal intima media thickness values. Assessment of atherosclerosis by arterial stiffness measurements represents a valuable diagnostic tool that might reveal a potential role of periodontitis in the earliest stages of atherosclerosis.

Improved outcomes were observed in transient ischemic attack (TIA) patients after implementation of recommendations for stroke management and after multiple interventions such as public campaigns focused on raising awareness ofstroke and reorgantzation ofhealth services. The aim of this study was to describe reorganization of in-hospital services to improve the management of patients suspected of having TIA or stroke, and to validate these measures with patient outcomes. Data on 5279 patiets examined between January 1 and December 31, 2008 at Emergency Neurology Outpatient Department were analyzed. Patients were referred by general practitioners, emergency physicians, or were brought by relatives without being previously seen by health services staff. The Emergency Services Department is intended to improve care for TIA patients, providing a short standardized clinical assessment followed by initiation of a comprehensive stroke prevention program. Demographic data, risk factors, stroke type, previous TIA history, ABCD, scores and adimission rates were analyzed. A total of 1057 patients suspected of having stroke or TIA were examined. There were 447 patients with ischemic stroke (mean age 73, 7 years, 796 males) and 99 patients with TIA (mean age 67, 4 years, 55 males). Parenchymal hemorrhage was diagnosed in 56 and subarachnoid hemorrhagein 49 patients, while 406 patients had nonspecific symptoms or other systemic or neurologic diseases. TIA preceded stroke in 29 (6.5 %) patients and797 (44%) patients were examined for worsening of stroke symptoms (133 within 24 hours, 47 within 48 hours, and 17 within 7 days). The mean ABCD'z score was 2.95. In all examined patients, a comprehensive stroke prevention program was started ; 427/447 (95%) strokes and 31/99 (31%) TIAs were hospitalized at Neurology Department. Four (4%) TIA patients developed stroke and were hospitalized, three of them after 2 days (ABCD2 score 3.4 and 5) and one after 7 days (ABCD2 score 5). Preventive measures resulted in a low number of strokes after TIA (