Search

© European Stroke Organisation 2021, Purpose: Many daily-life clinical decisions in patients with cerebrovascular disease and cognitive impairment are complex. Evidence-based information sustaining these decisions is frequently lacking. The aim of this paper is to propose a practical clinical approach to cognitive impairments in patients with known cerebrovascular disease. Methods: The document was produced by the Dementia Committee of the European Stroke Organisation (ESO), based on evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. Findings: Many patients with stroke or other cerebrovascular disease have cognitive impairment, but this is often not recognized. With improvement in acute stroke care, and with the ageing of populations, it is expected that more stroke survivors and more patients with cerebrovascular disease will need adequate management of cognitive impairment of vascular etiology. This document was conceived for the use of strokologists and for those clinicians involved in cerebrovascular disease, with specific and practical hints concerning diagnostic tools, cognitive impairment management and decision on some therapeutic options. Discussion and conclusions: It is essential to consider a possible cognitive deterioration in every patient who experiences a stroke. Neuropsychological evaluation should be adapted to the clinical status. Brain imaging is the most informative biomarker concerning prognosis. Treatment should always include adequate secondary prevention.

Myalgic encephalomyelitis is a complex, multisystem disease with chronic course significantly affecting patients' quality of life. Physical and mental exertion intolerability, muscle pain, and sleep problems are the main features accompanied often with cognitive inefficacy and vegetative symptoms. Prevalence is 7-3000 per 100,000 adults. It is estimated that 90% of the patients are misdiagnosed. Pathogenesis is still only speculative but current research points to disturbances in the immunological system, inflammatory pathways, autonomic and central nervous system, muscle and mitochondria, as well as alterations of gut microbiota and gut permeability. The onset is typically acute, following an infectious disease. Exertional intolerance lasting for more than six months is an important diagnostic factor. The core features must be moderate to severe and present at least 50% of the time. Diagnostic criteria should be fulfilled and differential diagnosis should be made to exclude other potential pathological conditions or to diagnose comorbidities. Brain magnetic resonance imaging morphometry has shown gray matter atrophy in occipital lobes bilaterally, right angular gyrus, and the posterior division of the left parahippocampal gyrus, consistent with memory problems and potentially with impairment of visual processing. Treatment is still symptomatic and of partial benefit. Symptomatic treatment can include medications for controlling pain and sleep problems, graded exercise and cognitive behavioral therapy. Larger controlled trials are needed to shed more light on this challenging condition. Mijalgični encefalomijelitis je složeno, multisistemsko oboljenje sa hroničnim tokom koje značajno utiče na kvalitet života bolesnika. Slaba tolerancija na fizički i mentalni napor, bolovi u mišićima i problemi sa spavanjem glavne su odlike i često su praćene kognitivnom neefikasnošću i vegetativnim simptomima. Prevalencija je 7-3000 na 100.000 odraslih. Procenjuje se da je 90% ovih bolesnika pogrešno dijagnostikovano. Patogeneza je i dalje samo spekulativna, ali trenutna istraživanja ukazuju na poremećaje u imunološkom sistemu, inflamatornom odgovoru, autonomnom i centralnom nervnom sistemu, mišićima i mitohondrijama, kao i promene mikrobiote i propustljivosti creva. Početak bolesti je tipično akutan i prati infektivnu bolest. Netolerancija napora koja traje duže od šest meseci važan je dijagnostički kriterijum. Osnovne karakteristike moraju biti umerene do teške i prisutne najmanje 50% vremena. Isključivanje drugih mogućih patoloških stanja ili komorbiditetnih dijagnoza zahteva zadovoljavanje dijagnostičkih kriterijuma i diferencijalno dijagnostičko sagledavanje. Morfometrijska snimanja mozga magnetnom rezonancom pokazala su atrofiju sive mase u okcipitalnim režnjevima bilateralno, desnom angularnom girusu i posteriornom levom parahipokampalnom girusu, što može dovesti do problema sa pamćenjem i oštećenja vizuelne obrade informacija. Lečenje je i dalje simptomatsko i samo delimično uspešno. Simptomatski tretman može da uključuje lekove za kontrolu bola i problema sa spavanjem, doziranu fizičku aktivnost i kognitivno-bihevioralnu terapiju. Potrebne su veće studije da bi se razjasnilo ovo medicinsko stanje.

Omega 3 fatty acids are long-chain polyunsaturated fatty acids (LC-PUFAs). The basic molecule is the Alpha-linolenic acid (ALA) from which LC-PUFAs are formed: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). DHA is the predominant fatty acid in the brain especially in synaptic membranes, astrocytes, myelin and organelle membranes. LC-PUFAs lead to increased membrane fluidity and permeability, and most of the positive effects depend on immunomodulatory activities, via mechanisms of gene expression, cell signaling, and membrane organization. Previous studies in animal models have shown that LC-PUFAs are essential for normal dopaminergic, glutamatergic and serotonergic neurotransmission. Preclinical and clinical studies have demonstrated the role of PUFAs as an effective adjuvant therapy for unipolar and bipolar depression. Lack of omega 3 fatty acids plays a role in the onset of anxiety and aggression. Low omega 3 fatty acids in the prefrontal cortex of people with schizophrenia reduce dopaminergic neurotransmission, contributing to negative and neurocognitive symptoms, while subsequent disinhibition in the limbic system causes positive symptoms. Some evidence suggests that LC-PUFA may delay or even prevent the progression of particular psychotic disorders in high-risk children and adolescents. Epidemiological studies have shown a positive correlation between the relatively high intake of DHA and EPA and the lower relative risk of mild cognitive impairment and dementia or their progression. The recommended daily intake of EPA and DHA varies significantly: 300-500 mg/day as recommended by the World Health Organization (WHO), up to 1-2 grams/day in Norway. Daily intakes of EPA and DHA up to 3 grams are generally recognized as safe. EPA and DHA at doses greater than 3 grams per day can have side effects: an increase in bleeding frequency, oxidation of n-3PUFAs with the formation of biologically active oxidation products, and more.

Plants of the genus Crataegus , Rosaceae, are widely distributed and have long been used for food and in folk medicine for the treatment of various ailments. This study focused on HPLC-DAD-FLD identification of phenolic compounds of flowers, fruits, and leaves of hawthorn ( Crataegus pentagyna Willd.), on monitoring changes in the content of phenolic compounds during different harvesting periods, as well as on the in vitro testing of the antioxidant activity. Study results showed that neochlorogenic and chlorogenic acids (5.2 and 4.85 mg/g dry weight, respectively) were the most abundant phenolic compounds in the flowers. (-)-Epicatechin and procyanidin B2 were the most abundant phenolic compounds in leaves and fruits. The highest content of phenolic compounds was found in leaves harvested in the early maturity stages, with a tendency of declining in the later stages of maturity. On the other hand, in the case of fruits, the most noticeable changes were found in the content of flavan-3-ols. The highest content of (-)-epicatechin (21.1 mg/g fresh weight) in fruit was in August, and those of procyanidins B2 and B5 in September (10.6 and 3.74 mg/g fresh weight, respectively). Statistical analysis showed a strong correlation between the total phenolics content and the antioxidant activity. This study has demonstrated that there is seasonal variation in both the quantity and the type of phenolic compound as well as the antioxidant activity of different parts of hawthorn.

Digital images and video are the basic media for communication nowadays. They are used as authenticated proofs or corroboratory evidence in different areas like: forensic studies, law enforcement, journalism and others. With development of software for editing digital images, it has become very easy to change image content, add or remove important information or even to make one image combining multiple images. Thus, the development of methods for such change detection has become very important. One of the most common methods is copy-move forgery detection (CMFD). Methods of this type include change detection that occur by copying a part of an image and pasting it to another location within the image. We propose new method for detection of such changes using certain multifractal parameters as characteristic features, as well as common statistical parameters. Before the analysis, images are divided into non-overlapping blocks of fixed dimensions. For each block, the characteristic features are calculated. In order to classify observed blocks, we used metaheuristic method and proposed new semi-metric function for similarity analysis between blocks. Simulation shows that the proposed method provides good results in terms of precision and recall, with low computational complexity.

Purpose Practical suggestions on clinical decisions about vascular disease management in patients with cognitive impairment are proposed. Methods The document was produced by the Dementia Committee of the European Stroke Organisation (ESO) based on the evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. Findings Vascular risk factors and cerebrovascular disease are frequent in patients with cognitive impairment. While acute stroke treatment has evolved substantially in last decades, evidence of management of cerebrovascular pathology beyond stroke in patients with cognitive impairment and dementia is quite limited. Additionally, trials to test some daily-life clinical decisions are likely to be complex, difficult to undertake and take many years to provide sufficient evidence to produce recommendations. This document was conceived to provide some suggestions until data from field trials are available. It was conceived for the use of clinicians from memory clinics or involved specifically in cognitive disorders, addressing practical aspects on diagnostic tools, vascular risk management and suggestions on some therapeutic options. Discussion and conclusions The authors did not aim to do an exhaustive or systematic review or to cover all current evidence. The document approach in a very practical way frequent issues concerning cerebrovascular disease in patients with known cognitive impairment.

Remodelling of collagen fibers has been described during every phase of cancer genesis and progression. Changes in morphology and organization of collagen fibers contribute to the formation of microenvironment that favors cancer progression and development of metastasis. However, there are only few data about remodelling of collagen fibers in healthy looking mucosa distant from the cancer. Using SHG imaging, electron microscopy and specialized softwares (CT-FIRE, CurveAlign and FiberFit), we objectively visualized and quantified changes in morphology and organization of collagen fibers and investigated possible causes of collagen remodelling (change in syntheses, degradation and collagen cross-linking) in the colon mucosa 10 cm and 20 cm away from the cancer in comparison with healthy mucosa. We showed that in the lamina propria this far from the colon cancer, there were changes in collagen architecture (width, straightness, alignment of collagen fibers and collagen molecules inside fibers), increased representation of myofibroblasts and increase expression of collagen-remodelling enzymes (LOX and MMP2). Thus, the changes in organization of collagen fibers, which were already described in the cancer microenvironment, also exist in the mucosa far from the cancer, but smaller in magnitude.

Objectives Structural changes and metabolic stress have been reported on diffusion-weighted magnetic resonance imaging in the cornu ammonis 1 area of the hippocampus in patients with transient global amnesia (TGA), but a consensus on pathogenesis is still lacking. The aim of our study was to perform a comprehensive ultrasound analysis of the cerebrovascular circulation in our population of patients with TGA. Methods One hundred patients with TGA and 50 age- and sex-matched control participants underwent ultrasound examinations of the cervicocranial circulation. Results The most significant risk factor for TGA was arterial hypertension (P .05). Rarely detected microembolic signals or a right-left cardiopulmonary shunt excluded an emboligenic mechanism of TGA (P > .05). The internal jugular vein valves were incompetent in 54% of patients with TGA, and this condition was associated with an increased risk of TGA (odds ratio, 4.16; 95% confidence interval, 1.91–9.04). The mean values of the breath holding index and pulsatility index, as parameters of small-vessel function, were within normal ranges and without differences between the TGA and control groups (P > .05). Conclusions Our ultrasound examination did not detect significant structural atherosclerotic changes of cervicocranial arteries, and an emboligenic mechanism was excluded. Only a significant rise of blood pressure in TGA and significant valvular insufficiency of the internal jugular vein were established. New research should clarify whether these simultaneous functional circulatory changes have relevance for metabolic stress in the cornu ammonis of the hippocampus.

Stroke is the second largest cause of disability-adjusted life-years lost worldwide. The prevalence of stroke in women is predicted to rise rapidly, owing to the increasing average age of the global female population. Vascular risk factors differ between women and men in terms of prevalence, and evidence increasingly supports the clinical importance of sex differences in stroke. The influence of some risk factors for stroke — including diabetes mellitus and atrial fibrillation — are stronger in women, and hypertensive disorders of pregnancy also affect the risk of stroke decades after pregnancy. However, in an era of evidence-based medicine, women are notably under-represented in clinical trials — despite governmental actions highlighting the need to include both men and women in clinical trials — resulting in a reduced generalizability of study results to women. The aim of this Review is to highlight new insights into specificities of stroke in women, to plan future research priorities, and to influence public health policies to decrease the worldwide burden of stroke in women.

Introduction. Tolosa?Hunt syndrome (THS) is a rare entity, characterized by unilateral orbital pain associated with paresis of one or more of the oculomotor cranial nerves and caused by a granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. The low prevalence of THS with a broad spectrum of other disorders that could cause painful ophtalmoplegia resulted in a stricter diagnostic criteria of THS in the latest edition of the International Classification of Headache Disorders. Current criteria require demonstration of granuloma by magnetic resonance imaging or biopsy. The diagnosis could be difficult and the initiation of treatment delayed due to a high variablity of clinical presentation of TSH. Reducing the number of patients that, based on clinical presentation, could be classified as having THS, but do not fullfil all diagnostic criteria further complicates establishing of correct diagnosis. Case report. Hereby we presented eight patients diagnosed with and treated for THS. Inspite the exclusion of other causes of painful ophtalmoplegia, granuloma could not be demonstrated in a half of patients. Clinical presentation of THS in patients with and without shown granuloma, did not significantly differ concerning headache characteristics (localization, intensity, quality, duration preceding cranial nerve palsy, response to steroids), the affected cranial nerve, disease course and response to the treatment, as well as types of diagnostic procedures that were performed in ruling out other diseases from the extensive differential diagnosis of painful ophthalmoplegia. Conclusion. There is no significant difference between the THS patients with and without demonstrated granuloma.

Zahvajuci stalnom razvoju tehnologija, mobilnih telefona i digitalnih kamera, upotreba digitalnih fotografija je zastupljena u svakodnevnom životu. Koriste se kao izvori informacija, ali eesto i kao potrekpljujuci dokazi u forenziekim istraživanjima, kao dokazi na sudu, novinarstvu i slieno. Izmena sadržaja takvih slika je postala jako jednostavna, preko odreeenih softverskih alata, tako da ne možemo biti sigurni u originalnost slike. Promene nastaju tako sto se doda ili ukloni odreeeni sadržaj slike, ili se od vise slika pravi jedna slika, a sve u cilju pogresnog prenosa informacija. Iz tih razloga je znaeajno razvijati nove metode za detekciju takvih promena. Jedna od najvise zastupljenih promena jeste tkz. CMFD (Copy Move Forgery Detection). Promene nastaju tako sto se deo slike kopira i nalepi na neki drugi deo unutar iste slike. Takve promene se naknadno mogu skalirati, rotirati, visestruko kopirati i slieno. Obzirom da su kopirani i nalepljeni delovi sa iste slike, njihova detekcija postaje dodatno složenija, jer su karakteristike kopiranih i nalepljenih delova jako sliene (komponente suma, temperature boja, sjajnost, i slieno). Multifraktali kao i multifraktalni spektar su se pokazali dobro u samoj analizi slika, segmentaciji i izdvajanju odreeenih karakteristika slike. Mogu da opisiju signal lokalno, preko vrednosti odgovarajuceg Holder-ovog eksponenta, i globalno, preko vrednosti raspodele tih koeficijenata – multifraktalnog spektra. Stoga je predložena nova metoda za detekciju CMFD promena na slikama, zasnovana na odreeenim parametrima multifraktalnog spekra, kao i nekim statistiekim parametrima. Slika od interesa se deli na nepreklapajuce blokove fiksnih dimenzija. Svaki blok se opisuje karakteristienim vektorom, sastavljenim od parametara MF spektra i statistiekih paramatera. Za uparivanje blokova, pronalaženje duplikata i klasterovanje blokova u izmenjene i neizmenjene, predložena je nova semimetrika, zasnovana na metaheuristici. Preciznost predložene metode je potvreena eksperimentalno, testiranjem slika iz javno dostupnih baza slika, kao i testiranjem slika generisanih za potrebe istraživanja. Parametri preciznosti detekcije jesu procenat taene kao i procenat lažne detekcije, kao i preciznost i opoziv. Dobijeni rezultati pokazuju da predložena metoda daje znaeajno bolje rezultate u odnosu na rezultate koje su predstavili drugi autori. Takoee, predložena metoda ima manju kompleksnost raeunanja, u odnosu na ostale metode (karakteristieni vektor se sastoji od samo 7 deskriptora)..

Wild fruits grown in Serbia, i.e., elderberry (Sambucus nigra), hawthorn (Crataegus monogyna), cornelian cherry (Cornus mas), and blackthorn (Prunus spinosa), are rich in secondary metabolites. In this study, the polyphenolic composition of wild fruit extracts and their antioxidant capacity were investigated by in vitro assays. Elderberry was characterized by the presence of arbutin (a skin protector), and cornelian cherry by syringic and gallic acids. In blackthorn, at least 11 different phenolic compounds were reported for the first time, including vanillic acid and naringin, the metabolite present in the highest amount. Blackthorn extracts were the richest in polyphenols (11.24–18.70 g GAE/kg FW) and had the highest activity in the DPPH radical test (180.93–267.11 mMTE/mL), while cornelian cherry extracts showed the most effective ferric ion chelating (81.37–90.66%) and antityrosinase inhibition capacities (21.75–74.23%). No sample was able to scavenge NO. Using the principal component analysis, wild fruit samples were classified into four separate clusters due to distinctive phenolic profiles and antioxidant capacity. Our investigation showed how every fruit could be considered unique in terms of its phytonutrient content. Thus, Serbian wild fruits may be a great source of bioactive natural compounds and could be therefore considered particularly useful in food supplement production. Particularly, as a source of natural antioxidants, these species could be used to extend the shelf life of food products and replace synthetic antioxidants, avoiding potential health risks and toxicity. Supplementary material: [http://cherry.chem.bg.ac.rs/handle/123456789/3756]

Background: An increasing proportion of physicians are women, yet they still face challenges with career advancement. In 2014, the European Stroke Organisation established the goal of increasing the number and participation of women within the society using a Top Down and Bottom Up approach. The ‘Women’s Initiative for Stroke in Europe’ was created the same year by a group of women active within the organisation. We aimed to assess the current status of women in European Stroke Organisation, and to explore the change in sex differences after the introduction of focused approaches to address disparities in 2014. Methods: Using organisational records, we collected data on sex differences in core activities from 2008 up to 2017 including membership, participation in conferences, courses and in the official journal of the society, and positions of seniority and leadership. We estimated sex distribution differences in each of the activities from 2014 to date. Results: In 2017, the proportion of female members was 40%, while 24% of fellows, 22% of the executive board and 19% of the editorial board in the official journal of the society were women. From 2014 to 2017, there was a significant increase in the proportion of female members (p 1⁄4 0.0002) and in women participating in the annual conference as faculty (p 1⁄4 0.001). There was no significant change in the sex distribution among the faculty members in junior edu- cational activities (27%) or fellows. Interpretation: In 2017, the proportion of women holding positions of seniority and leadership is still significantly lower to the proportion of women attending educational activities. Transparent data on sex distribution will assist implementing tailored programmes to achieve progress against sex-based barriers.

Background Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism is a frequent complication in immobile patients with acute ischemic stroke. This guideline document presents the European Stroke Organisation guidelines for the prophylaxis of VTE in immobile patients with acute ischaemic stroke. Guidelines for haemorrhagic stroke have already been published. Methods A multidisciplinary group identified related questions and developed its recommendations based on evidence from randomised controlled trials using the Grading of Recommendations Assessment, Development, and Evaluation approach. This guideline document was reviewed within the European Stroke Organisation and externally and was approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee. Results We found mainly moderate quality evidence comprising randomised controlled trials and systematic reviews evaluating graduated compression stockings (GCS), intermittent pneumatic compression (IPC) and prophylactic anticoagulation with unfractionated (UFH) and low molecular weight heparins (LMWH) and heparinoids, but no randomised trials evaluating neuromuscular electrical stimulation (NES). We recommend that clinicians should use IPC in immobile patients, but that they should not use GCS. Prophylactic anticoagulation with UFH (5000U ×2, or ×3 daily) or LMWH or heparinoid should be considered in immobile patients with ischaemic stroke in whom the benefits of reducing the risk of VTE is high enough to offset the increased risks of intracranial and extracranial bleeding associated with their use. Where a judgement has been made that prophylactic anticoagulation is indicated LMWH or heparinoid should be considered instead of UFH because of its greater reduction in risk of DVT, the greater convenience, reduced staff costs and patient comfort associated single vs. multiple daily injections but these advantages should be weighed against the higher risk of extracranial bleeding, higher drug costs and risks in elderly patients with poor renal function associated with LMWH and heparinoids. Conclusions IPC, UFH or LMWH and heparinoids can reduce the risk of VTE in immobile patients with acute ischaemic stroke but further research is required to test whether NES is effective. The strongest evidence is for IPC. Better methods are needed to help stratify patients in the first few weeks after stroke onset, by their risk of VTE and their risk of bleeding on anticoagulants.

Introduction. Cerebral ischemic small-vessel disease (SVD), causing lacunar infarcts and white matter hyperintensities on brain magnetic resonance imaging (MRI), is a progressive disease associated with an increased risk of stroke, dementia and death. Increased arterial stiffness has been associated with ischemic stroke and cerebral SVD independently of common vascular risk factors. Objective. The aim of the study was to analyze arterial stiffness in our patients with symptomatic SVD. Methods. In a cross-sectional study design we included 30 patients with clinical and MRI evidence of cerebral SVD and 30 age-, gender- and risk factor-matched control subjects with no neurological diseases. Patients were evaluated at the Ultrasound Laboratory at the Neurology Clinic, Clinical Center of Serbia in Belgrade, during a three-month period (from September 1st to December 1st 2012). Baseline demographic and vascular risk factors were recorded. All patients underwent standard carotid ultrasound scans with measuring of intima-media thickness (IMT) and analysis of atheromatous plaques. Internal carotid artery stiffness was evaluated with the use of e-tracking option as beta stiffness index (BSI) value. Results. There were no differences between study groups in regard to degree of carotid stenosis and type of carotid plaques (p>0.05). Patients in SVD group had significantly higher mean IMT (p=0.0093) and mean BSI (p

Fresh wild blackberries were processed into sugar and sugar-low jams at high temperatures (90, 95, 100 and 105 °C). Total phenolic (TP), flavonoid (TF), anthocyanin (TA) contents and antioxidant activity, as well as the content of individual anthocyanins were significantly affected by the temperature, heating time and jam type, with the largest retention in the sugar-low jam prepared at 90 °C for 5 minutes and with the largest decrease in the sugar jam prepared at 105 °C for 30 minutes. Cyanidin- 3-rutinoside was found to be the most stable and cyanidin-3-malonylglucoside was found to be the least stable in sugar-low jam. In sugar jam, cyanidin-3-rutinoside and cyanidin-3-malonylglucoside have shown a relatively equable stability, while cyanidin-3-glucoside was the least stable. In the temperature interval from 90 oC to 105 oC, the degradation of total anthocyanins in both sugar and sugar-low jam types followed the first-order reaction, with activation energies (Ea) of 57.4 kJ/mol and 48.0 kJ/mol, respectively. The half-life values (t1/2) of total anthocyanins ranged from 6.6 to 15.9 minutes for the sugar jam and from 13.1 to 27.7 minutes for the sugar-low jam. The degradation of total anthocyanins is more susceptible to temperature elevation in the sugar jam compared to the sugar-low type.

Art and creativity originate in the brain and depend on normal brain functioning. Music is a multifacet phenomenon that exists as a universal heritage across all human societies and throughout the entire human history. There are numerous brain-based mechanisms involved in the cognitive processing of music, including music listening, performing, composing, reading, writing, as well as musical aesthetics and musical emotion. Music relates to many brain functions including perception, motor action, cognition, emotion, learning and memory. Various brain regions are associated with music processing and production, including the right anterior and posterior superior temporal lobe, the right inferior frontal cortex, the right prefrontal, bilateral premotor and bilateral parietal areas, the right anterior cerebellar lobe, language areas and limbic structures. In a diseased brain, after acquired brain injury, disorders in music perception or production have been described, although considered rare. Amusia or music-specific agnosia, a defective perception of music or its components is typically associated with temporal lobe lesions, and is more likely to occur with right-sided involvement. Etiology of acquired amusia comprise many diseases and conditions leading to brain injury, including traumatic brain injury, ischemic or hemorrhagic stroke, neoplasma, iatrogenic and epilepsy-related conditions, infections and degenerative diseases. Additionally, there are cases of congenital amusia, attributed to abnormality in neural networks for music, associated with structural variations in the frontal and temporal lobes. Umetnost i kreativnost potiču iz mozga i zavise od njegovog normalnog funkcionisanja. Muzika je multifacetni fenomen koji postoji kao univerzalno nasleđe u svim ljudskim društvima i kroz čitavu ljudsku istoriju. Postoje mnogobrojni moždani mehanizmi uključeni u kognitivnu obradu muzike, uključujući slušanje muzike, izvođenje, pisanje, čitanje, kao i muzičku estetiku i muzičke emocije. Muzika se odnosi na mnoge funkcije mozga, uključujući percepciju, motoriku, kogniciju, emocije, učenje i pamćenje. Različiti regioni mozga su povezani sa obradom i proizvodnjom muzike, uključujući prave prednje i zadnje superiorne temporalne režnje, desno inferiorni frontalni korteks, desno prefrontalni, bilateralni premotor i bilateralni parietalni prostori, desni anteriorni cerebelarni režanj, jezičke površine, limbičke strukture. U obolelom mozgu, nakon traume mozga, opisani su poremećaji u percepciji ili produkciji muzike, iako se smatraju retkim. Amuzija ili specifična muzička agnozija, narušena percepcija muzike ili njenih komponenti obično se povezuje sa lezijama temporalnog režnja i pretežno se javlja kod oštećenja desne polovine mozga. Etiologija stečene amusije obuhvata mnoge bolesti i stanja koji dovode do lezija mozga, uključujući traumatske povrede, ishemijski ili hemoragični moždani udar, neoplazme, jatrogena stanja, epilepsije, infekcije i degenerativne bolesti. Postoje i slučajevi kongenitalne amuzije, u vezi poremećaja neuronskih mreža za muziku, povezanih sa strukturnim varijacijama u frontalnom i temporalnom režnju.

INTRODUCTION The aim of this study was to analyze transcranial sonography (TCS) findings in genetically confirmed myotonic dystrophy type 2 (DM2) patients. METHODS Forty DM2 patients and 38 gender- and age-matched healthy controls (HCs) underwent TCS through the pre-auricular acoustic bone window. RESULTS Substantia nigra hyperechogenicity was found in 20% of DM2 patients compared with 3% of HCs. Brainstem raphe (BR) hypoechogenicity was more common in DM2 patients compared with HCs (56% vs. 10%, P

Objectives Patients with cerebral small vessel disease often present with various motor, cognitive, and emotional changes, including gait disturbances, parkinsonism, and depression. Substantia nigra hyperechogenicity, brain stem raphe hypoechogenicity, ventricle diameters, and sonographic characteristics of other brain structures on transcranial sonography have been increasingly used as biomarkers in a range of neurologic diseases. We aimed to explore the frequency and clinical correlates of transcranial sonographic findings in symptomatic patients with small vessel disease. Methods In a cross-sectional study, neurologic, cognitive, and emotional statuses and transcranial sonographic and magnetic resonance imaging findings were compared between 102 patients with small vessel disease and 45 healthy age- and sex-matched control participants. Results Compared to healthy controls, small vessel disease cases had more frequent brain stem raphe hypoechogenicity (55.9% versus 11.1%; P < .0001), substantia nigra hyperechogenicity (30.4% versus 11.1%; P = .022), and enlarged third ventricles (P < .0001). Substantia nigra hyperechogenicity correlated with gait disturbances, extrapyramidal features, and cognitive impairment. Brain stem raphe hypoechogenicity was associated with the diagnosis of depression. Enlargement of the third and lateral ventricles was more frequent in patients with cognitive impairment. Pathologic substantia nigra hyperechogenicity and enlarged ventricles were associated with the severity of cerebral ischemic lesions. Conclusions Transcranial sonography shows pathologic findings in a substantial number of patients with small vessel disease, probably reflecting disruption of frontostriatal pathways.

Objective Cerebral small vessel disease (SVD) is associated with late-onset depression and increases the risk for depression after stroke. We aimed to investigate baseline predictors of depression after long-term follow-up in patients with SVD, initially presenting with first-ever lacunar stroke, free of depression and cognitive impairment. Methods A total of 294 patients with SVD were evaluated 3–5 years after the qualifying event. We analyzed baseline demographic data, vascular risk factors, functional status expressed as a score on modified Rankin Scale (mRS), cognitive status, presence of depression, total number of lacunar infarcts and severity of white matter hyperintensities (WMH) on MRI with Age-Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular and deep subcortical scores. Results On follow-up, depression was registered in 117 (39.8%) SVD patients. At the baseline, patients with depression compared with non-depressed were older (64.4 vs 60.9 years; p = 0.007), had higher mRS score (2.8 ± 0.7 vs 1.5 ± 0.7; p 2 (HR 2.17, 95%CI 1.74–2.72; p

Background/Aim. The association between the right-to left shunt (RLS) and migraine with aura (MA) has been proven so far. The aim of this study was to determine if the presence of RLS detected as a result of transcranial doppler (TCD) bubble-test, makes any difference in clinical presentation, aura and headache in patients with MA. Methods. A single-group descriptive study was conducted on 153 patients diagnosed with MA. TCD bubble-test was performed on 135 of them. The recorded demographic and clinical features of patients were analyzed and compared with the results of the TCD bubble test. Results. In the group of 135 patients, 88 (65.2%) had positive TCD bubble-test. The difference in the investigated clinical features of patients of the patients and aura between the patients with and without RLS, was not found. Conclusion. The results of our study confirm a high prevalence of right-to-left shunt in patients with MA, but the clinical relevance of this association was not shown. [Projekat Ministarstva nauke Republike Srbije, br. 175022]

Summary While there is a large number of scientific papers reporting chemical composition and biological activities of Aronia melanocarpa, there is a lack information regarding the commercially available bagged tea. In order to supply new information on the antioxidant activity of the Aronia melanocarpa tea infusions, the aim of this study was to evaluate individual phenolic compounds which could be responsible for antioxidant activities of these beverages. Selected anthocyanins (cyanidin-3-O-galactoside, cyanidin-3-O-glucoside, cyanidin- 3-O-arabinoside, and cyanidin-3-O-xyloside), gallic acid, caffeic acid, rutin, morin, and protocatechuic acid were simultaneously detected from commercially available tea infusions using a High Performance Liquid Chromatographic (HPLC) method. The antioxidant activity was measured using five in vitro spectrophotometric methods: 1,1-diphenyl- 2-picrylhydrazyl radical scavenging activity (DPPH), 2,2'-azino-bis (3-ethylbenzthiazoline- 6-sulphonic acid) radical cation scavenging activity (ABTS), ferric reducing-antioxidant power (FRAP) and reduction power (RP)Fe(III) to Fe(II). Obtained results showed that anthocyanins, predominantly of cyanidin-3-O-galactoside, are the major class of polyphenolic compounds in tea infusions. Among phenolic acids the most abundant is caffeic acid. A significant correlation between DPPH and ABTS and FRAP and RP suggested that antioxidant components in these beverages were capable scavenging free radicals and reducing oxidants. Generally, these beverages had relatively high antioxidant capacities and could be important dietary sources of antioxidant phenolics for the prevention of diseases caused by oxidative stress.

Introduction. Leptomeningeal carcinomatosis (LC) is a serious complication occuring in solid cancer patients with rather poor prognosis. Case report. We presented a 47-yearold woman with the 6-month history of diffuse headache, nausea and visual obscuration. Initially, clinical status and brain magnetic resonance imaging (MRI) indicated syndrome of idiopathic intracranial hypertension. Due to clinical progression and high papillary stasis, cerebrospinal fluid (CSF) examination was performed only after ventriculoperitoneal shunt was implanted. This led to a significant although transient clinical improvement. Futher investigations led to the diagnosis of invasive lobular breast carcinoma and repeated CSF analysis revealed malignant breast carcinoma cells. In this case LC was an initial presentation of a malignant disease. Conclusion. In the presence of a high clinical suspicion of LC, in spite of initially negative findings, a clinician should persist in repeating relevant tests, such are MRI with larger amounts of gadolinium and high-volume cytological CSF analyses in order to make the diagnosis. [Projekat Ministarstva nauke Republike Srbije, br. 175022]

BACKGROUND: The vascular contributions to neurodegeneration and neuroinflammation may be assessed by magnetic resonance imaging (MRI) and ultrasonography (US). This review summarises the methodology for these widely available, safe and relatively low cost tools and analyses recent work highlighting their potential utility as biomarkers for differentiating subtypes of cognitive impairment and dementia, tracking disease progression and evaluating response to treatment in various neurocognitive disorders. ----- METHODS: At the 9th International Congress on Vascular Dementia (Ljubljana, Slovenia, October 2015) a writing group of experts was formed to review the evidence on the utility of US and arterial spin labelling (ASL) as neurophysiological markers of normal ageing, vascular cognitive impairment (VCI) and Alzheimer's disease (AD). Original articles, systematic literature reviews, guidelines and expert opinions published until September 2016 were critically analysed to summarise existing evidence, indicate gaps in current knowledge and, when appropriate, suggest standards of use for the most widely used US and ASL applications. ----- RESULTS: Cerebral hypoperfusion has been linked to cognitive decline either as a risk or an aggravating factor. Hypoperfusion as a consequence of microangiopathy, macroangiopathy or cardiac dysfunction can promote or accelerate neurodegeneration, blood-brain barrier disruption and neuroinflammation. US can evaluate the cerebrovascular tree for pathological structure and functional changes contributing to cerebral hypoperfusion. Microvascular pathology and hypoperfusion at the level of capillaries and small arterioles can also be assessed by ASL, an MRI signal. Despite increasing evidence supporting the utility of these methods in detection of microvascular pathology, cerebral hypoperfusion, neurovascular unit dysfunction and, most importantly, disease progression, incomplete standardisation and missing validated cut-off values limit their use in daily routine. ----- CONCLUSIONS: US and ASL are promising tools with excellent temporal resolution, which will have a significant impact on our understanding of the vascular contributions to VCI and AD and may also be relevant for assessing future prevention and therapeutic strategies for these conditions. Our work provides recommendations regarding the use of non-invasive imaging techniques to investigate the functional consequences of vascular burden in dementia.

Contains fulltext : 170402.pdf (Publisher’s version ) (Open Access) Post-stroke dementia (PSD) or post-stroke cognitive impairment (PSCI) may affect up to one third of stroke survivors. Various definitions of PSCI and PSD have been described. We propose PSD as a label for any dementia following stroke in temporal relation. Various tools are available to screen and assess cognition, with few PSD-specific instruments. Choice will depend on purpose of assessment, with differing instruments needed for brief screening (e.g., Montreal Cognitive Assessment) or diagnostic formulation (e.g., NINDS VCI battery). A comprehensive evaluation should include assessment of pre-stroke cognition (e.g., using Informant Questionnaire for Cognitive Decline in the Elderly), mood (e.g., using Hospital Anxiety and Depression Scale), and functional consequences of cognitive impairments (e.g., using modified Rankin Scale). A large number of biomarkers for PSD, including indicators for genetic polymorphisms, biomarkers in the cerebrospinal fluid and in the serum, inflammatory mediators, and peripheral microRNA profiles have been proposed. Currently, no specific biomarkers have been proven to robustly discriminate vulnerable patients ('at risk brains') from those with better prognosis or to discriminate Alzheimer's disease dementia from PSD. Further, neuroimaging is an important diagnostic tool in PSD. The role of computerized tomography is limited to demonstrating type and location of the underlying primary lesion and indicating atrophy and severe white matter changes. Magnetic resonance imaging is the key neuroimaging modality and has high sensitivity and specificity for detecting pathological changes, including small vessel disease. Advanced multi-modal imaging includes diffusion tensor imaging for fiber tracking, by which changes in networks can be detected. Quantitative imaging of cerebral blood flow and metabolism by positron emission tomography can differentiate between vascular dementia and degenerative dementia and show the interaction between vascular and metabolic changes. Additionally, inflammatory changes after ischemia in the brain can be detected, which may play a role together with amyloid deposition in the development of PSD. Prevention of PSD can be achieved by prevention of stroke. As treatment strategies to inhibit the development and mitigate the course of PSD, lowering of blood pressure, statins, neuroprotective drugs, and anti-inflammatory agents have all been studied without convincing evidence of efficacy. Lifestyle interventions, physical activity, and cognitive training have been recently tested, but large controlled trials are still missing.

We explored the relationship between acute ischaemic stroke (IS) early functional outcome and serum levels of homocysteine, vitamin B12, and D in a noninterventional prospective clinical study. We enrolled 50 patients with first-ever IS and performed laboratory tests and functional assessment at three time points: on admission and three and six months after stroke. Modified Rankin Scale (mRS), NIHSS scale, and Barthel index (BI) scores were assessed in all participants by trained examiner blinded to laboratory data. Patients did not receive treatment that might alter laboratory data. Admission NIHSS correlated with homocysteine levels (r=0.304,p<0.05), B12 level (r=-0.410,p<0.01), and vitamin D levels (r=-0.465,p<0.01). Functional outcome measures (BI and mRS) did not significantly correlate with homocysteine and vitamin D3 levels at 3 and 6 months. However, a positive correlation with vitamin B12 levels was detected for BI both at 3 and 6 months and mRS at 6 months. Higher serum vitamin B12 levels were associated with better functional outcome at follow-up.

Reading the Mind in the Eyes? test (RMET) is one of the most popular and widely used measures of individual differences in Theory of Mind (ToM) capabilities. Despite demonstrating good validity in differentiating various clinical groups exhibiting ToM deficits from unimpaired controls, previous studies raised the question of the RMET?s homogeneity, latent structure, and reliability. The aim of this study is to provide evidence on psychometric properties, latent structure, and validity of the newly adapted Serbian version of the RMET. In total, 260 participants (61.9% females) took part in the study. The sample consisted of both unimpaired controls (76.5%), and a clinical group of participants that are believed to demonstrate ToM deficits (23.5%), namely, persons diagnosed with schizophrenia and bipolar disorder (54.1% females). RMET has demonstrated fair psychometric properties (KMO = .723; ? = .747; H1 = .076; H5 = .465), successfully differentiating between clinical group and control [F (1,254) = 26.175, p

Introduction: In this study we analyzed transcranial sonography (TCS) in patients with myotonic dystrophy type 1 (DM1). Methods: This cross-sectional study included 66 DM1 patients and 55 matched healthy controls (HCs). Echogenicity of the brainstem raphe (BR) and substantia nigra (SN) and third ventricle width (DTV) were assessed by TCS. Results: BR hypoechogenicity was more common in DM1 patients than in HCs (37.7% vs. 7.8%, P

Summary Molecular genetic testing is part of modern medical practice. DNA tests are an essential part of diagnostics and genetic counseling in single gene diseases, while their application in polygenic disorders is still limited. Pharmacogenetics studies DNA variants associated with variations in drug efficacy and toxicity, and tests in this field are being developed rapidly. The main method for molecular genetic testing is the polymerase chain reaction, with a number of modifications. New methods, such as next generation sequencing and DNA microarray, should allow simultaneous analysis of a number of genes, even whole genome sequencing. Ethical concerns in molecular genetic testing are very important, along with legislation. After molecular genetic testing, interpretation of results and genetic counseling should be done by professionals. With the example of thrombophilia, we discuss questions about genetic testing, its possibilities and promises.

Vitamin D is a secosteroid hormon with pleiotrophic functions and essential for normal development and health throughout the entire life span. Vitamin D deficiency has epidemic proportions worldwide and interferes with important metabolic processes. Its prevalence is estimated in various populations of different etnicity and age from 50% up to 100% in certain groups. The main source of vitamin D for men is skin production by ultraviolet B radiation acting on 7-dehydrocholesterol. This is cholecalciferol or vitamin D3. Less than 20% is obtained from food. The active form, 1,25-dihydroxy-vitamin D (calcitriol) is synthesized in the kidney. Synthetic capacity declines with ageing. The main function of vitamin D is calcium homeostasis important for musculosceletal health, innate immunity, arterial integrity, endocrine function, antiinflamation, and various local processes (autocrine and epicrine functions) in more than 30 tissues where receptors exist. Vitamin D is also important for cognitive function, mainly executive in the frontal lobe. Normal vitamin D levels are above 75 nmol/L. Vitamin D deficiency is mostly due to the lack of sun exposure but can also be secondary to some individual characteristics. Deficiency during intrauterine development can lead to early and late negative consequences in bone growth, immune system, and cognition. The extreme deficiency causes rikets. In adults vitamin D deficiency has been suggested as a risk factor for infectious and autoimmune diseases, carcinomas (especially of the breast and colon), multiple sclerosis, falls, osteoporosis, bone fractures, cardiovacular and cerebrovascular diseases, diabetes mellitus type I and II, infertility, cognitive decline and dementia. Oral supplementation with serum level normalization can lead to reduction of these risks but even amelioration of some pathological states. Recomendation ranges form 400 IU of vitamin D in infants to 2000 IU in older population, but it should be guided by individual clinical circumstances. Key words : Vitamin D, cognition, immunity, ultraviolet B radiation

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary neurological disease accompanied by recurrent ischemic events, characterized by the presence of psychiatric disorders. The aim of this study was to examine the occurrence of depression and its severity among patients with CADASIL. Sixteen patients with diffuse white matter changes on MRI and clinical signs suggesting CADASIL were included in the study. Definitive diagnosis of CADASIL was obtained by electron microscopic analysis of skin biopsies. Testing of the patients’ affective status was primarily devoted to detecting depression. Electron microscopic examinations of all skin biopsies revealed numerous granular osmiophilic material (GOM) deposits embedded into the basal lamina around altered or degenerated vascular smooth muscle cells (VSMCs). Clinical symptoms of depression were present in a great number of examined CADASIL patients. The frequency of depression was higher than previously reported. Psychiatric disturbances might also represent the onset of CADASIL, especially in young patients, and should be evaluated by differential diagnosis. [Projekat Ministarstva nauke Republike Srbije, br. 41002]

Objective To evaluate long-term predictors of remission in patients with medication-overuse headache (MOH) by prospective cohort study. Background Knowledge regarding long-term predictors of MOH outcome is limited. Methods Two hundred and forty MOH patients recruited from 2000 to 2005 were included in a one-year follow-up study and then subsequently followed until 31 December 2013. The median follow-up was three years (interquartile range, three years). Predictive values of selected variables were assessed by the Cox proportional hazard regression model. Results At the end of follow-up, 102 (42.5%) patients were in remission. The most important predictors of remission were lower number of headache days per month before the one-year follow-up (HR-hazard ratio = 0.936, 95% confidence interval (CI) 0.884–0.990, p = 0.021) and efficient initial drug withdrawal (HR = 0.136, 95% CI 0.042–0.444, p = 0.001). Refractory MOH was observed in seven (2.9%) and MOH relapse in 131 patients (54.6%). Conclusions Outcome at the one-year follow-up is a reliable predictor of MOH long-term remission.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable cause of stroke and vascular dementia in adults. We present a family from Serbia presenting with stroke and depression in the lack of vascular risk factors, with brain MRI indicating CADASIL. A novel NOTCH3 Gly89Cys mutation was located in exon 3. This report illustrates that in the setting of a positive family history with typical clinical and MRI features, even with an atypical form of pedigree, a high suspicion of CADASIL should lead to genetic testing.

Omega-3 long-chain polyunsaturated fatty acids (ω-3 LC-PUFAs) are thought to be important for normal dopaminergic, glutamatergic and serotonergic neurotransmission. Depression is less prevalent in societies with high fish consumption, and depressed patients have significantly lower red blood cell ω-3 levels. Studies with ω-3 supplementation have led to controversial results. A significantly longer remission of bipolar symptomatology has been confirmed from a high-dose DHA and EPA mixture. Greater seafood consumption per capita has been connected with a lower prevalence of bipolar spectrum disorders. Reduced levels of ω-6 and ω-3 PUFAs were found in patients with schizophrenia. [Projekat Ministarstva nauke Republike Srbije, br. 175033 i br. 175022]

We have previously developed a Brain-computer interface (BCI) for neuromodulation based on movement related cortical potentials (MRCP). Since successful induction of plasticity is dependent on the attention of the user, the aim of this study was to analyze the changes in MRCPs during imposed attentional shifts in patients. We recorded EEG signals from Cz and its surrounding channels in seven chronic stroke patients, who were asked to attempt ankle dorsiflexion in two subsets of 30 repetitions. Each subset was separated from the other by an auditory oddball task comprised of three tones. Patients were asked to detect the target tone by pressing a button. Nine temporal features were extracted from single trial MRCPs and compared between the two subsets of dorsiflexion that were interspersed by the oddball task. The amplitude of the MRCP negativity, pre-movement slopes, pre-movement variability and movement detection latency and accuracy changed significantly when attention was diverted from the main task of dorsiflexion. This has significant implications for BCIs designed to induce plasticity since detection failure will result in inappropriate device control.

Cerebral ischemic small-vessel disease (SVD), causing lacunar infarcts and white matter hyperintensities on brain magnetic resonance imaging (MRI), is a progressive disease associated with an increased risk of stroke, dementia and death. Increased arterial stiffness has been associated with ischemic stroke and cerebral SVD independently of common vascular risk factors.The aim of the study was to analyze arterial stiffness in our patients with symptomatic SVD.In a cross-sectional study design we included 30 patients with clinical and MRI evidence of cerebral SVD and 30 age-, gender- and risk factor-matched control subjects with no neurological diseases. Patients were evaluated at the Ultrasound Laboratory at the Neurology Clinic, Clinical Center of Serbia in Belgrade, during a three-month period (from September 1st to December 1st 2012). Baseline demographic and vascular risk factors were recorded. All patients underwent standard carotid ultrasound scans with measuring of intima-media thickness (IMT) and analysis of atheromatous plaques. Internal carotid artery stiffness was evaluated with the use of e-tracking option as beta stiffness index (BSI) value.There were no differences between study groups in regard to degree of carotid stenosis and type of carotid plaques (p0.05). Patients in SVD group had significantly higher mean IMT (p = 0.0093) and mean BSI (p0.0001) than subjects in the control group. No significant correlation was detected between IMT and BSI in SVD group (r = 0.168; p = 0.376). Brain lesions severity correlated with BSI (r = 0.733; p0.0001).Arterial stiffness is increased in symptomatic patients with SVD, independently of vascular risk factors and IMT.

IF 2.415Research paperPost Author Corrections: April 14, 2016; International audience; Colorectal cancer (CRC) is becoming a major public health problem in the Republic of Serbia. Organized mass screening has been shown to decrease CRC mortality and even its incidence. The aim of this study was to assess the acceptability of a faecal immunochemical test for haemoglobin proposed by primary care physicians. From August to November 2013, a pilot study for CRC screening was organized in individuals aged 50 to 74 years. The study included 50 primary healthcare centres from all 25 administrative regions of Serbia. A qualitative immunochromatographic faecal immunochemical test for human haemoglobin detection was used. Overall, 50 894 individuals were invited. The participation rate was 67.8 and 3.4% of the tests were positive. Among individuals with a positive test, 69.7% agreed to undergo colonoscopy. The positive predictive value was 27.1% for adenoma and 14.6% for carcinoma. This was the first CRC screening project encompassing approximately one-third of primary healthcare facilities in all regions across the country. It showed a good response of the target population and satisfactory cooperation of the healthcare professionals involved.

Brain-computer interfaces (BCIs) have the potential to improve functionality in chronic stoke patients when applied over a large number of sessions. Here we evaluated the effect and the underlying mechanisms of three BCI training sessions in a double-blind sham-controlled design. The applied BCI is based on Hebbian principles of associativity that hypothesize that neural assemblies activated in a correlated manner will strengthen synaptic connections. Twenty-two chronic stroke patients were divided into two training groups. Movement-related cortical potentials (MRCPs) were detected by electroencephalography during repetitions of foot dorsiflexion. Detection triggered a single electrical stimulation of the common peroneal nerve timed so that the resulting afferent volley arrived at the peak negative phase of the MRCP (BCIassociativegroup) or randomly (BCInonassociativegroup). Fugl-Meyer motor assessment (FM), 10-m walking speed, foot and hand tapping frequency, diffusion tensor imaging (DTI) data, and the excitability of the corticospinal tract to the target muscle [tibialis anterior (TA)] were quantified. The TA motor evoked potential (MEP) increased significantly after the BCIassociativeintervention, but not for the BCInonassociativegroup. FM scores (0.8 ± 0.46 point difference, P = 0.01), foot (but not finger) tapping frequency, and 10-m walking speed improved significantly for the BCIassociativegroup, indicating clinically relevant improvements. Corticospinal tract integrity on DTI did not correlate with clinical or physiological changes. For the BCI as applied here, the precise coupling between the brain command and the afferent signal was imperative for the behavioral, clinical, and neurophysiological changes reported. This association may become the driving principle for the design of BCI rehabilitation in the future. Indeed, no available BCIs can match this degree of functional improvement with such a short intervention.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited vascular disorder caused by Notch3 gene mutations. The main histopathological hallmark is granular osmiophilic material (GOM) deposited in the close vicinity of vascular smooth muscle cells (VSMCs). The authors report the first 7 ultrastructurally and genetically confirmed cases of CADASIL in Serbia. Samples of skin and sural nerve were investigated by transmission electron microscopy. GOM deposits were observed around degenerated VSMCs in all the skin biopsies examined. Sural nerve biopsies revealed severe alterations of nerve fibers, endoneurial blood vessels with GOM deposits, endoneurial fibroblasts, and perineurial myofibroblasts. Total genomic DNA was extracted from peripheral blood leukocytes, and exons 2-6 of the Notch3 gene were amplified by PCR and subsequently sequenced. Four different mutations in exons 2 (Cys65Tyr), 3 (Gly89Cys and Arg90Cys), and 6 (Ala319Cys), which determine the CADASIL disease, were detected among all described patients. A novel missense mutation Gly89Cys involving exon 3 was detected. Due to the difficulties in the determination of the Notch3 mutations, these data suggest that electron microscopic analysis for GOMs in dermal vessel wall provides a rapid and reliable screening method for this disease.

nema

Objective Although typically linked to aging, small vessel disease (SVD) is also observed in younger adult patients, with common vascular risk factors (RF). We aimed to investigate features of SVD occurrence at an early adult age. Patients and methods Vascular RF, functional and cognitive status and severity of lesions on MRI expressed as total score on Age-Related White Matter Changes (ARWMC) scale were analyzed in 200 consecutive patients with cerebral SVD admitted to a tertiary neurological hospital. Variables were compared between younger (35–55 years) and older (>56 years) patients. Results In this study, 63 (31.5%) of patients were 55 years or younger. Both age groups had comparable RF profiles, but smoking emerged as an independent predictor for SVD at a younger age (OR 2.9; 95% CI 1.5–5.5; p =0.002). Younger patients had better functional (OR 1.8; 95% CI 1.3–2.5; p =0.0001) and cognitive ( χ 2 13.94; p =0.0009) status compared to older patients. However, two thirds of younger patients had some degree of cognitive deficit. Total score on ARWMC scale was lower in younger patients (mean 12.3 in younger versus 15.2 in older, OR 1.11; 95% CI 1.0–1.18; p =0.001). There was a strong correlation in both groups between functional score, cognitive status and ARWMC score ( p Conclusion In our dataset, younger patients with SVD shared common vascular RF with older patients. In the group aged ≤55, better functional and cognitive status and less severe MRI changes were noted. However, a substantial number of younger SVD patients presenting with TIA or ischemic stroke had various deficits.

The increased thickness of the carotid wall >1 mm is a significant predictor of coronary and cerebrovascular diseases. The purpose of our study was to assess the agreement between multidetector row computed tomography angiography (MDCTA) in measuring carotid artery wall thickness (CAWT) and color Doppler ultrasound (CD-US) in measuring intimae-media thickness (IMT). Eighty-nine patients (aged 35–81) were prospectively analyzed using a 64-detector MDCTA and a CD-US scanner. Continuous data were described as the mean value ± standard deviation, and were compared using the Mann–Whitney U test. A p value p < 0.01] obtained by paired T test), and limits of agreement from 0.04 to 0.104. Pearson correlation coefficient was 0.9997 (95% CI 0.9996–0.9998; p < 0.01). We conclude that there is an excellent correlation between CAWT and IMT measurements obtained with the MDCTA and CD-US.

Hallucinations are a psychopathological phenomenon with neuropsychological, neuroanatomical and pathophysiological correlates in specific brain areas. They can affect any of the senses, but auditory and visual hallucinations predominate. Verbal hallucinations reveal no gross organic lesions while visual hallucinations are connected to defined brain lesions. Functional neuroimaging shows impairments in modality specific sensory systems with the hyperactivity of the surrounding cerebral cortex. Disinhibition and expansion of the inner speech was noted with impaired internal monitoring in auditory verbal hallucinations. The subcortical areas and modal-specific associative cortex and cingulate cortex are essential for the occurrence of hallucinations.