Search

An abstract of the article "Cognitive dysfunctions after ischemic stroke with transient neurological deficit," by D. Janculjak and colleagues is presented.

The intima-media thickness (IMT) of carotid arteries is a marker of subclinical atherosclerosis associated with risk factors for atherosclerosis and a predictor of vascular disease. The aim of the research was to determine the correlation of IMT and age, and above normal IMT values in healthy adults in Slavonia (eastern Croatia). The study included 275 subjects of both sexes, aged between 20 and 79, who had no clinical manifestations of vascular disease or presence of major risk factors for atherosclerosis (hypertension, hypercholesterolemia, diabetes mellitus, cigarette smoking). Ultrasonic measurement of IMT in the B-mode was performed on far walls of the carotid arteries on both sides at three locations (common and internal carotid artery, carotid bifurcation). At all three sites of measurement a high correlation between the IMT values and age was found in both sexes, including the maximum for IMT of carotid bifurcation (men r=0.92, women 0.91). Upper normal values (75th percentile) IMT of common carotid arteries were determined for the ten year age groups. It is the same for both men and women in age groups both 20-29 and 30-39 (0.41, 0.46 mm). On the other hand, in age groups 40-49, 50-59, 60-69 and 70-79 upper normal values for men are 0.57, 0.62, 0.77 and 0.96 mm, and for women 0.50, 0.57, 0.71 and 0.81 mm. Our study in healthy adults in Slavonia (eastern Croatia) established a clear con- nection between carotid IMT and age, which implies a need for taking the age as an essential factor into account when conducting researches that involve the IMT.

A 46-year-old female patient with a large slow-growing craniocervical junction tumor is presented. Her complaints began 6 months before with sensory and painful sensations, sphincter impairment, and motor events (spastic tetraparesis, more pronounced on the left extremities). Magnetic resonance of the head revealed a rounded tumor of 2.5 cm in diameter, by its characteristics corresponding to meningioma, at the level of C1 vertebra and craniocervical junction, with the base at spinal canal anterior wall, occupying most of the craniocervical junction, compressing spinal cord and medulla oblongata. Intracerebral computed tomography angiography showed spared lumen and a satisfactory image of vertebral arteries bypassing the expansive growth at the occipital foramen, confirming slow tumor growth. Antiedematous therapy led to transient improvement in extremity strength and partial recovery of neurologic deficit, which resolved completely upon neurosurgical operation and rehabilitation. This case report exemplifies brain adaptability to slowly growing expansive neoplasms, based on its volume reduction up to the moment when further adaptation is not possible anymore, i.e. breaking of the mechanism of adaptation. Because of brain adaptability, such slowly growing tumors may stay asymptomatic for a long time. Brain plasticity also includes adaptation and autoregulation of the circulation, thus ensuring stable blood flow.

These guidelines have been developed to assist the physician in making appropriate choices in work-up and treatment of patients with headaches. The specific aim of the Evidence Based Guidelines for Treatment of Primary Headaches--2012 Update is to provide recommendations for establishing an accurate diagnosis and choose the most appropriate therapy in the group of patients with primary headaches, based on a comprehensive review and meta-analysis of scientific evidence with regard to treatment possibilities in Croatia. These data are based on our previous Evidence Based Guidelines for Treatment of Primary Headaches published in 2005 and other recommendations and guidelines for headache treatment.

Aim: To evaluate the characteristics of cognitive disturbances in patients with parkinsonism and to point out the need of following up those changes by highly specific tests., Methods: The first group consisted of patients with Parkinson's disease, and the second group of patients with vascular parkinsonism. The neuropsychological assessments were performed with mini mental state examination (MMSE) and the Raven progressive matrices., Results: The MMSE has shown a higher percentage of patients with vascular parkinsonism who had dementia. For evaluating the nonverbal possibilities, the aim of understanding the complex situation and the visual perception, the Raven's progressive matrices were used showing that in both groups of the patients those specific changes were highly present., Conclusions: It was concluded that MMSE and Raven's progressive matrices have to be obtained in early phases of the disease, and have to be repeated to follow up the therapy effect.

It presents a case of a 39-year old woman with acute symptomatic occlusion of basilar artery proximal segment, which was manifested by severe neurological symptomatology and deficits. The patient was treated conventionally (anticoagulant, then antiplatelet agent therapy) with excellent short-term and long-term outcome. In spite of serious acute neurological symptomatology of basilar artery occlusion, proximal localization of the occlusion, fluctuating symptomatology flow, younger age and development of collateral circulation can suggest a good outcome in conventionally treated patients.

The purpose of this investigation was to determine the atherosclerotic changes in patients with vascular parkinsonism and in patients with idiopathic Parkinson's disease, in order to evaluate the possible influence of the extracranial pathology of carotid arteries in developing lacunar cerebral infarcts. Degree of stenosis and plaque morphology of the extracranial part of carotids in both group of patients were evaluated by color Doppler flow imaging ultrasound investigation and the results were compared. We selected two matched groups of patients with parkinsonism: 22 patients with vascular parkinsonism, and 28 with idiopathic Parkinson's disease.The atherosclerotic changes found in patients with Parkinson's disease showed mild carotid lesions with mostly stable calcified plaques and lesser risk for embolic cerebral intravascular events contrary to the higher degree of carotid stenosis found in patients with vascular parkinsonism with mostly mixed plaques prone to embolization. Therefore, we suggest performing ultrasonographic examination of the extracranial part of carotid arteries in all patients with parkinsonism to assess risk of vascular accidents originating from carotid lesions. That would enable adequate treatment of parkinsonism and prevent further occurrence of intracranial vascular changes.

Background/aim: Population-based epidemiological studies about headaches, especially migraine, have been carried out in many countries. The aim of this study was to assess the 1-year prevalence of migraine, probable migraine and tension-type headache (TTH) in the Croatian population., Methods: The design of the study was a cross-sectional survey of an adult population sample using a self-completed questionnaire., Results: The 1-year crude prevalence of migraine without and with aura in this study was 7.5%, of probable migraine 11.3%, and of TTH 21.2%. The 1-year age- and sex-adjusted prevalence of migraine was 6.2%, of probable migraine 8.8%, and of TTH 20.7%; the prevalence of migraine combined with probable migraine was 15.0%. Total crude prevalence of headache (combination of migraine, probable migraine and TTH) was 39.9%. Prevalence of migraine was higher in continental than in Mediterranean areas of Croatia. Multivariate regression analysis showed that the highest risk of suffering from any kind of headache is observed for the following people: living in Dubrovnik, being female, having elementary or high school education, being married, employed and living in an urban or suburban area., Conclusion: The prevalence of migraine and probable migraine is similar as in other Western countries. Certain demographic characteristics differ among patients with and without headache., (Copyright 2010 S. Karger AG, Basel.)

Background: Chronic post-traumatic headache (CPH) is a complex clinical entity. The clinical features of CPH are variable and may resemble those of primary headaches (migraine, tension-type headache or cluster headache), as well as of cervicogenic headache. Therefore, the treatment must be individualized according to the headache type. There were few studies addressing the effectiveness of pharmacological treatment in patients with CPH., Aim: The aim of the present study was to analyze the efficiency of pharmacological treatment with analgesic drugs and concomitant psychotropic drugs in outpatients with CPH., Methods: We studied 59 outpatients with CPH (39 males and 20 females, mean age 36+/-13 years) who were taking analgetic monotherapy for their headache (simple analgesics, NSAIDs, atypic analgesics and triptans in subjects with migraine) and in case of comorbid psychic disorders some of them were taking psychotropic drugs. The efficiency of drug therapy was evaluated by the outcome scale based on the patients' headache diaries (outcome graded as improved, unchanged or worsened)., Results: Most of the study patients reported that their CPH was unchanged. The improvement was greater in the subgroup of cervico-occipital headache sufferers, but it was not statistically significant when compared to other subgroups. Post-traumatic migraine was the type of headache most refractory to drug therapy. The patients who took analgesics without psychotropic drugs had a reliably (p<0.05) better improvement of their headache., Conclusion: Analgesic drug monotherapy did not produce favorable therapeutic response in patients with CPH. Appropriate psychopharmacotherapy should be prescribed to CPH patients with psychiatric comorbidity.

Some patients suffering from headache require neurologic examination. The objective of the guidelines for the treatment of headaches is to help physicians in their daily care for headache patients. In most patients, the diagnosis of migraine has not been made by a physician and they have not received appropriate care to treat migraine attacks. New therapeutic methods (for acute and preventive treatment) have been introduced in the past fifteen years. Triptans should be offered to patients that fail to respond to usual analgesics, those with moderate to severe migraine in particular. Depending on comorbidity, preventive therapy should be recommended to individuals with frequent or prolonged migraine attacks. In patients with tension headaches, organic causes underlying the headache should be ruled out, while the treatment includes pharmacological and non-pharmacological measures. Although rare, patients with cluster headaches suffer severe pain; oxygen inhalation or triptans are recommended for acute attack, and preventive therapy may be indicated in some cases. The guidelines provide classification, diagnostic criteria and therapeutic principles for primary headaches. All recommendations listed in the guidelines are based on meta-analyses and recommendations from the world literature, with special reference to therapeutic options available in Croatia.

Knowledge of post-traumatic cerebral haemodynamic disturbances might be beneficial for predicting the management outcome when measuring the basal cerebral arteries blood flow velocity by ultrasonic transcranial Doppler device immediately after severe head injury. Thirty patients who sustained severe brain injury underwent an early blood velocity measuring by transcranial Doppler ultrasonography during a 1-year period of study. The standard technique of measuring the mean blood flow velocity in the middle cerebral artery was applied. The outcome was assessed at 6-month follow-up by the Glasgow Outcome Score. The middle cerebral artery low blood flow velocity, and the increased values of the pulsatility index significantly correlated to an unfavourable outcome. Transcranial Doppler ultrasonography for measuring the middle cerebral artery blood flow velocity has been proved worthy as a possible predictor of severe head injury management outcome. This non-invasive and simple procedure could be engaged in the daily management of severely brain-injured patients.

Primary Objective: To investigate the potential of transcranial Doppler ultrasonography in estimating post-traumatic intra-cranial pressure early after severe traumatic brain injury., Research Design: The group of 24 patients was analysed for the observation of an early post-traumatic cerebral haemodynamic by middle cerebral artery blood velocity measuring., Methods and Procedures: The standard method of measuring the mean blood middle cerebral artery velocity by transcranial Doppler ultrasonic device was performed., Main Outcomes and Results: The increased duration of intra-cranial hypertension correlated to the middle cerebral artery low blood velocity (p = 0.042; r = -0.498) (n = 17) and to elevated pulsatility indices (p = 0.007; r = 0.753) (n = 11) significantly. The increased duration of lowered cerebral perfusion pressure correlated to the middle cerebral artery low blood velocity significantly (p = 0.001; r = -0.619) (n = 24)., Conclusions: The significance of transcranial Doppler ultrasonography as a method to estimate an early post-traumatic intra-cranial pressure after severe brain injury was confirmed. This simple and non-invasive technique could be easily used in daily clinical practice and precede intra-cranial pressure monitoring in selected patients.

A rare case of sudden death due to cerebral embolization of trophoblastic tissue and concomitant massive pulmonary embolization following artificial abortion in a 42-year-old woman with poorly regulated hypertension and chronic smoking is described. Histopathological analysis showed syncytiotrophoblast cells, positive on hPL immunostaining, obstructing vascular lumina in the small perforating arteries irrigating the diencephalon. There was no trophoblast invasion of capillary walls. Severe perivascular edema and lymphocytic infiltration were observed. No trophoblastic cells were found in the pulmonary circulation., (Copyright (c) 2005 S. Karger AG, Basel.)

Most evaluation scales used in the follow up of war victims with traumatic brain injury used to date have been focused on physical disability rather than psychological and social dimensions of the handicap. The aim of this study was to assess the applicability of the European Head Injury Evaluation Chart (EHIEC) in the follow up of traumatic brain injury in patients attending the War Veterans Rehabilitation Center in Osijek. The study included 20 patients with traumatic brain injury sustained during the war in Croatia and their families. The EHIEC form was filled out by a professional examiner using data from the patient's medical records and those obtained by evaluation of the patient's physical, mental and social status on his first visit to the Center. Study results showed the majority of these patients to suffer relatively moderate disability consequential to traumatic head injury (mild to moderate hemiparesis, moderate chronic pain, attention impairment, and frequent affective disorder such as depression and anxiety). The patients had significantly reduced capacity for work and impaired community adaptation. However, EHIEC questionnaire was found to suffer from some shortcomings, including time-consuming procedure, problems with interpretation of answers, and inadequate adaptability to local social service. Additional studies are needed to evaluate the questionnaire applicability to outpatient follow up of individuals with traumatic head injury.

In this study we compared the performance of 39 multiple sclerosis (MS) patients with 28 age-, sex- and education-matched controls on both the Mini-Mental State Examination, a global cognitive assessment tool, and the Sternberg Short-Term memory scanning task, a standardized test of short-term memory (STM) processes. While the STM span of our MS patients did not differ from that of our controls, STM scanning time of the MS group was reliably slower than that of the controls and a significant correlation was observed between STM scanning time and duration but not severity of illness. Our results suggest that processing stages other than the manipulation of data within the STM buffer are also affected by MS., (Copyright 1999 Lippincott Williams & Wilkins)