Search

The aim of this study was to analyze the management of headache patients presenting to the emergency room (ER) at a university hospital in Zagreb. Retrospective analysis of all patients with headache was carried out during 2007. Patients were analyzed according to the diagnoses, diagnostic procedures, treatment and further referral. Among 6225 patients, 1385 (22.3%) complained of headache; there were 894 (64.5%) women and 491 (35.5%) men. Migraine with or without aura, tension-type headache or "cervicogenic headache" had 1004 (72.5%) patients (women 67.5% and men 32.5%); secondary headache had 381 (27.5%) patients: 89 (6.4%) stroke or intracranial hemorrhage, 33 (2.4%) primary tumor, 54 (3.9%) metastatic tumor, 200 (14.4%) head trauma with or without hemorrhage, and 5 (0.4%) had an infectious disease. Diagnostic procedure was performed in 413 (29.8%) patients: 314 (22.7%) underwent computerized tomography scan of the brain, 85 (6.1%) electroencephalography and 70 (5%) ultrasound examination. Nonsteroidal antiinflammatory drugs (NSAIDs) and diazepam were the most commonly prescribed medications, followed by fluids, simple analgesics and antiemetics, whereas opioids were prescribed to 3.0% of patients. Among patients with primary headaches, diagnostic procedure was performed in 235 (23.2%) patients, while 40 (4.0%) patients were hospitalized. In conclusion, one-fifth of the patients presenting to neurological ER complain of headache and approximately three-quarters have primary headache. The majority of patients are treated with NSAIDs and a minority with opioids. Better treatment for these patients should be provided by general practitioners and neurologists in outpatient headache clinics.

Background Headaches are often under-diagnosed in adolescents. The aim of this study was to examine the one-year prevalence of primary headaches among high school students in the city of Zagreb, the capital of Croatia. Methods This was a population-based, cross-sectional study. A total of 2350 questionnaires consisting of questions on demographic data, the presence and clinical characteristics of headaches were distributed among students in eight high schools; 2057 (87.5%) questionnaires were eligible for analysis. Results The mean age of the students was 17.2 ± 1.2 years; 50.2% were female. The prevalence of recurrent headache was 30.1% (620/2057), girls 35.1%, boys 25.2%. Among students with headache, 291 (46.9%) had migraine, and 329 (53.1%) had tension-type headaches (TTHs). The mean frequency of headaches was 5.66 per month in girls and 4.42 in boys; mean duration of a headache attack was 8.94 hours in girls and 8.37 hours in boys (NS). Unilateral headache was present in 31.6%, throbbing quality in 22.6%, dull in 34.4% of students; 22.4% had severe intensity and 70.3% moderate. Nausea was present in 4.0% always and in 14.7% frequently (girls 18.8%), photophobia in 41.3%, phonophobia in 63.2%, osmophobia in 23.9% (NS among genders). Almost 30% of students were disabled and stayed at home, more frequently boys. Girls (33.4%) were more likely to take drugs for every attack; number per month was 3.7. The results of this study showed that the prevalence of migraine among adolescents in Croatia was 16.5% for girls and 11.8% for boys; the prevalence of TTH was 18.4% for girls and 13.4% for boys. Conclusions The prevalence of self-reported headache among high school students in Zagreb is relatively high. Significant gender differences in frequency and clinical characteristics were observed. Primary headaches among adolescents are an important public health problem and should receive more attention from school and health authorities.

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 periodontology department due to painful alveolar mucosa. On the basis of dental history, we concluded that the patient had a severe form of generalized aggressive periodontitis that led to complete edentulism. The patient was advised to undergo ultrasonography of carotid arteries with arterial stiffness measurements at neurology department. A diagnosis of the right internal carotid artery occlusion was established. Inflammatory periodontal disease may affect arterial hemodynamics and even lead to artery occlusion. It is advisable that patients with a severe form of periodontitis should be referred for carotid artery ultrasonography.

The aim of this study was to analyze the management of headache patients presenting to the emergency room (ER) at a university hospital in Zagreb. Retrospective analysis of all patients with headache was carried out during 2007. Patients were analyzed according to the diagnoses, diagnostic procedures, treatment and further referral. Among 6225 patients, 1385 (22.3%) complained of headache; there were 894 (64.5%) women and 491 (35.5%) men. Migraine with or without aura, tension-type headache or “cervicogenic headache” had 1004 (72.5%) patients (women 67.5% and men 32.5%); secondary headache had 381 (27.5%) patients: 89 (6.4%) stroke or intracranial hemorrhage, 33 (2.4%) primary tumor, 54 (3.9%) metastatic tumor, 200 (14.4%) head trauma with or without hemorrhage, and 5 (0.4%) had an infectious disease. Diagnostic procedure was performed in 413 (29.8%) patients: 314 (22.7%) underwent computerized tomography scan of the brain, 85 (6.1%) electroencephalography and 70 (5%) ultrasound examination. Nonsteroidal antiinflammatory drugs (NSAIDs) and diazepam were the most commonly prescribed medications, followed by fluids, simple analgesics and antiemetics, whereas opioids were prescribed to 3.0% of patients. Among patients with primary headaches, diagnostic procedure was performed in 235 (23.2%) patients, while 40 (4.0%) patients were hospitalized. In conclusion, one-fifth of the patients presenting to neurological ER complain of headache and approximately three-quarters have primary headache. The majority of patients are treated with NSAIDs and a minority with opioids. Better treatment for these patients should be provided by general practitioners and neurologists in outpatient headache clinics., Cilj ove studije bio je analizirati tretman bolesnika koji dolaze sa simptomom glavobolje u hitnu neurološku ambulantu u KB „Sestre milosrdnice“ u Zagrebu. Retrospektivno su analizirani svi bolesnici koji su tijekom 2007. godine pregledani u hitnoj neurološkoj ambulanti sa simptomom glavobolje te su razvrstani po dijagnozama. Analizirana je dijagnostička obrada, terapija i daljnji tretman bolesnika. Od ukupno 6225 pregledanih bolesnika, 1385 (22,3%) se žalilo na glavobolju; 894 (64,5%) žena i 491 (35,5%) muškarac. Migrenu s aurom ili bez nje, tenzijsku glavobolju ili „cervikogenu glavobolju“ je imalo 1004 (72,.5%) bolesnika (žene 67,5%, muškarci 32,5%); sekundarnu glavobolju je imalo 381 (27,5%) bolesnika: 89 (6,4%) moždani udar ili intrakranijsku hemoragiju 89 (6,4%), 33 (2,4%) primarni tumor, 54 (3,9%) metastatski tumor, 200 (14,4%) traumu glave s krvarenjem ili bez njega i 5 (0,4%) je imalo infektivnu bolest. Dijagnostička obrada je provedena kod 413 (29,8%) bolesnika: kod 314 (22,7%) kompjutorizirana tomografija mozga, kod 85 (6,1%)elektroencefalografija i kod 70 (5%) ultrazvučna obrada. Nesteroidni antireumatici (NSAR) i diazepam su bili najčešće propisivani lijekovi, potom infuzije, obični analgetici i antiemetici, dok su opioidi bili propisani kod 3,0% bolesnika. Kod bolesnika s primarnom glavoboljom dijagnostička obrada je provedena u 235 (23,2%) bolesnika, dok je 40 (4,0%) bolesnika bilo hospitalizirano. Zaključno, jedna petina bolesnika pregledanih u hitnoj službi se žalila na glavobolju, a tri četvrtine je imalo primarnu glavobolju. Većina bolesnika je liječena NSAR-ima, a manjina opioidima. Hitna služba ne bi smjela služiti kao mjesto za liječenje primarnih glavobolja; liječnici obiteljske medicine i neurolozi u ne-hitnoj ambulanti bi trebali pružiti bolji tretman bolesnika s primarnom glavoboljom.

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 of stroke and reorganization of health 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 5219 patients 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, ABCD2 scores and admission 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 +/- 11 years, 196 males) and 99 patients with TIA (mean age 67 +/- 14 years, 55 males). Parenchymal hemorrhage was diagnosed in 56 and subarachnoid hemorrhage in 49 patients, while 406 patients had nonspecific symptoms or other systemic or neurologic diseases. TIA preceded stroke in 29 (6.5%) patients and 197 (44%) patients were examined for worsening of stroke symptoms (133 within 24 hours, 47 within 48 hours, and 17 within 7 days). The mean ABCD2 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 (7%), but a relatively high percentage (44%) of stroke patients ignored initial symptoms and sought medical attention after persistence or worsening of the symptoms.

Hemodynamic changes can be noninvasively real-time monitored in stroke patients by means of transcranial Doppler sonography (TCD). The aim of this pilot study was to assess hemodynamic changes in both middle cerebral arteries (MCA) in aphasic stroke patients by means of TCD during verbal stimulation. Eight aphasic patients with stroke in the territory of the left MCA were tested by modified Boston Diagnostic Aphasia Examination (BDAE) within 3 days of stroke onset. Both MCA were monitored simultaneously by means of TCD with 2 MHz probes. Basic MCA mean blood flow velocity (MBFV) values were assessed and monitored during verbal stimulation. Verbal stimulation was performed with 30 photos of objects for daily usage, arranged by function. The same test was performed in 16 right-handed healthy controls. In stroke patients, the mean MBFV were 56 cm/s in the left MCA and 56 cm/s in the right MCA. A mean 30% increase was observed in the left MCA and 22% in the right MCA. In healthy controls, a mean 21.7% increase was observed in the left MCA and 18% in the right MCA. A trend toward higher percentage of MBFV increase was observed in the left MCA during verbal stimulations in aphasic patients as compared to control subjects.

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

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

Purpose: Depletion of serotonin and dopamine system is a frequent finding in the depressive state and deficient levels of serotonin are associated with suicide and depression. Recent transcranial sonography (TCS) studies showed that disruption of echogenic midbrain line might represent functional marker for the development of depression. We initiated this study to asses the usefulness of TCS recording in a group of major depressed patients (MDD) and in MDD patients with suicidal ideation, on the assumption that TCS might serve as a screening method for differentiating patients at risk of suicide. Material & Methods: Thirty six patients with MDD (DSM-IV) of whom 16 were suicidal and 30 controls where studied using TCS. Examination was performed by standardized semiquantitative protocol. Results: Reduced raphe echogenicity was found in 23 of 36 (64%) of the patients with MDD but only in 3 (10%) controls. 13 of 16 (81%) suicidal patients exhibit same reduced echogenicity, what was also in negative correlation with the severity of the illness cc 5 20.569, p 5 0.003. No correlation was found between raphe echogenicity and number of depressive episodes, age, gender or duration of the disease. (p , 0.05). Conclusion: Our results showed that alteration of RN is a frequent TCS finding in depressive states. That finding is rare in healthy subjects, however, in suicidal patients such alteration was even more pronounced. These data suggest that TCS might be a novel method for the detection of depressive disorders and might record patients with suicidal risk within.

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

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 of stroke and reorganization of health 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 5219 patients 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, ABCD2 scores and admission 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+11 years, 196 males) and 99 patients with TIA (mean age 67+14 years, 55 males). Parenchymal hemorrhage was diagnosed in 56 and subarachnoid hemorrhage in 49 patients, while 406 patients had nonspecific symptoms or other systemic or neurologic diseases. TIA preceded stroke in 29 (6.5%) patients and 197 (44%) patients were examined for worsening of stroke symptoms (133 within 24 hours, 47 within 48 hours, and 17 within 7 days). The mean ABCD2 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 (, Zamijećen je poboljšani ishod bolesnika s prolaznim ishemijskim napadajima (TIA) nakon što su primijenjene preporuke za zbrinjavanje moždanog udara te nakon različitih intervencija kao što su bile javne kampanje usmjerene na podizanje svijesti o moždanom udaru i reorganizaciju zdravstvenih usluga. Cilj ovoga istraživanja bio je opisati reorganizaciju bolničke službe za poboljšanje liječenja bolesnika kod kojih se sumnjalo na postojanje moždanog udara ili TIA i provjeriti valjanost ovih mjera na ishodu bolesti. Analizirani su podaci o 5219 bolesnika pregledanih između 1. siječnja i 31. prosinca 2008. u hitnoj neurološkoj ambulanti. Bolesnici su bili upućeni od liječnika opće medicine, liječnika hitne medicinske pomoći ili su dovezeni u pratnji rodbine bez prethodnog pregleda osoblja u zdravstvenoj službi. Hitna neurološka službe je organizirana tako da poboljša skrb za bolesnike s TIA, te da pruži kratku i standardiziranu kliničku procjenu i pokrene sveobuhvatni program prevencije moždanog udara. Analizirani su demografski podaci, čimbenici rizika, tipovi moždanog udara, prethodne epizode TIA, zbroj ABCD2 te stope prijma. Ukupno je pregledano 1057 bolesnika kod kojih se sumnjalo na dijagnozu moždanog udara ili TIA. Bilo je 447 bolesnika s ishemijskim moždanim udarom (srednja dob 73+11 godina, 196 muškaraca), 99 s TIA (srednja dob 67+14 godina, 55 muškaraca). Parenhimatozna krvarenja su dijagnosticirana kod 56, a subarahnoidno krvarenje u 49 bolesnika, dok je 406 bolesnika imalo nespecifične simptome ili druge sistemske i neurološke bolesti. TIA je prethodila moždanom udaru u 29 (6,5%) bolesnika, a 197 (44%) bolesnika je pregledano nakon pogoršanja simptoma povezanih s moždanim udarom (133 u roku od 24 sata, 47 u roku od 48 sati, a 17 u roku od 7 dana). Srednja vrijednost zbroja ABCD2 je bila 2,95. U svih pregledanih bolesnika započet je sveobuhvatni program prevencije moždanog udara, 427/447 (95%) bolesnika s moždanim udarom i 31/99 (31%) bolesnika s TIA je hospitalizirano u našoj Klinici za neurologiju. Četiri bolesnika s TIA su razvili moždani udar (4%) i bili hospitalizirani nakon toga, 3 bolesnika nakon 2 dana (zbroj ABCD2 3,4 i 5), a jedan nakon 7 dana (zbroj ABCD2 5). Preventivne mjere su rezultirale niskim brojem moždanih udara nakon preboljelog TIA (

The incidence of postoperative occlusion of carotid artery is low (0.5%-0.6%) and is rarely symptomatic. The aim of this study was to analyze the dynamics of the internal carotid artery (ICA) postoperative occlusion development. During one-year period, 8 000 patients were examined at Cerebrovascular Laboratory, University Department of Neurology. Among them, 33 patients (25 male and 8 female) with postoperative ICA occlusion were detected by color Doppler. We retrospectively analyzed the dynamics of ICA occlusion development from the first postoperative follow-up. The risk factors for atherosclerosis were analyzed. In 31 of 33 patients, postoperative ICA occlusion was recorded on the first follow-up examination, 3 months of carotid endarterectomy (18 right and 15 left). In 8 patients, combined occlusion of the common and ICA was detected (4 right and 4 left). One patient developed occlusion during the first year of follow-up, and in one patient it was detected 3 years after the surgery. Eight patients had also had surgery on the contralateral ICA and showed satisfactory findings. In 19 patients, mild atherosclerotic changes were found contralaterally, 5 had moderate stenosis, and 1 patient had subtotal ICA stenosis. The early onset of postoperative ICA occlusion most likely is not caused by atherosclerosis risk factors but by perioperative complications.

Although electroneuro- and electromyography are still the leading diagnostic methods for investigation of peripheral nerve function, they do not provide information on their morphology. This study was conducted to evaluate the suitability of ultrasonography in visualization of median nerve in healthy volunteers. Twenty-five asymptomatic volunteers (17 women and 8 men), age range 21-47 years, participated in the study. Body height was measured and handedness ascertained, as well as average time spent daily working on a computer. The device used was Aloka Prosound Alpha10 Premier with a 13-MHz probe, using custom preset for musculoskeletal sonography. The following dimensions of median nerve at the pisiform bone level were measured bilaterally: cross-sectional area (CSA), circumference, and longer and shorter diameter. Using the latter values, the flattening ratio (FR) was calculated. Median nerve and the surrounding soft tissue structures were easily depicted in all study subjects. The mean median nerve CSA was 9.70 mm2 (range 5-15 mm2, SD 2.25 mm2), mean FR (longer/shorter diameter) 4.04 (range 2.16-6.08), and median height 172.72 cm. Only one subject was left-handed. The mean time spent daily working on a computer (overall mean of 3.2 h/day) did not correlate with either CSA or FR for the dominant hand. In four subjects, an aberrant artery accompanying median nerve was visualized. High-resolution sonographic imaging is a fast and noninvasive method for assessment of various morphological properties of median nerve and can be used to enhance diagnostic efficiency.

Mirror illusion means that standing in front of a mirror placed in sagittal plane, with the head tilted on one side and one arm stretched forward, one side of the body is reflected as if it were the other side by mirror visual feedback. The aim of this study was to monitor blood flow changes in middle cerebral artery (MCA) by use of transcranial Doppler (TCD) in individuals during motor tasks and tasks using mirror visual feedback. Eight young healthy volunteers (four male and four female) were included in the study. TCD recording in MCA was done during each task consisting of various motor and visuomotor activities using mirror illusion. Both MCA mean blow flow velocity (MBFV) was measured while the subjects were seated in a comfortable chair. The MCA MBFV recordings are presented as baseline values. During the illusion of motor hand activation, when the subject was making right hand flexions and watching its reflection in the mirror, with the left hand immobile, an increase was observed the contralateral MCA MBFV (task 3, +4.5% baseline value; P = 0.017). Furthermore, when the subject made left hand flexions while watching the reflection of the immobile right hand in the mirror, there was an increase in the right MCA MBFV (+5.6% baseline value; P = 0.044), which was more pronounced than during the illusion of motor hand activation (task 3) and less than during direct vision of hand flexion (task 2, +6.3% baseline value; P = 0.005). Our data showed that visual illusion of action, as well as direct action observation could increase the MCA MBFV, which brings forward the possible usage of mirror illusion as a tool in motor neurorehabilitation.

Pineal cysts occur in all ages, predominantly in adults in the fourth decade of life. In series of magnetic resonance imaging (MRI) studies, the prevalence of pineal cysts ranged between 1.3% and 4.3% of patients examined for various neurologic reasons and up to 10.8% of asymptomatic healthy volunteers. The diagnosis of pineal cyst is usually established by MRI with defined radiological criteria to distinguish benign pineal cyst from tumors of this area. A recent study demonstrated the findings obtained by transcranial sonography to correspond to those obtained by MRI in the detection of both pineal gland cyst and pineal gland itself, and could be used in the future mainly as follow up examination. Pineal cysts usually have no clinical implications and remain asymptomatic for years. The most common symptoms include headache, vertigo, visual and oculomotor disturbances, and obstructive hydrocephalus. Less frequently, patients present with ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances, hypothalamic dysfunction of precocious puberty, and recently described occurrence of secondary parkinsonism. Symptomatic cysts vary in size from 7 mm to 45 mm, whereas asymptomatic cysts are usually less than 10 mm in diameter, although a relationship between the cyst size and the onset of symptoms has been proved to be irrelevant in many cases. There is agreement that surgical intervention should be undertaken in patients presenting with hydrocephalus, progression of neurologic symptoms, or cyst enlargement. Tissue sample of the pineal lesion can be obtained by open surgery, stereotaxy and neuroendoscopy.

The one-year incidence of carotid occlusion is 6/100 000 inhabitants in general population. Stroke incidence and mortality rate in these patients vary. Patients that underwent carotid endarterectomy (CES) are at a higher risk of progression of contralateral carotid stenosis. The aim of the study was to investigate the management and natural history of the contralateral internal carotid artery disease in patients with internal carotid artery occlusion (ICAO). During one year, 297 patients with ICAO were investigated. Follow up examinations were retrospectively analyzed and patients were divided into groups according to contralateral carotid disease. Out of 297 patients, only one investigation was performed in 90 patients with carotid occlusion. Thirty three patients were followed up due to postoperative ICAO. In 14 patients, ICAO developed during ultrasonographic follow up. In this group of patients, 9 had unchanged contralateral findings, whereas in 5 patients disease progression was observed. Out of 44 patients with ICAO and contralateral subtotal stenosis at initial investigation, 42 underwent carotid surgery. Postoperatively, 32 patients had normal findings, 6 developed mild carotid stenosis, 2 developed moderate carotid stenosis, and 2 had postoperative carotid occlusion. Two patients were followed-up without intervention. Nine patients with bilateral ICAO were followed-up for years. Follow up was continued in 106 patients with ICAO and contralateral mild to moderate changes. The finding was unchanged in 68 patients. In 21 (30%) patients the disease progressed to subtotal stenosis and 18 patients underwent carotid surgery. Accordingly, contralateral carotid disease progression was observed in one third of patients with carotid occlusion. Additional studies on the issue are needed.

Postoperative internal carotid artery (ICA) occlusion is a rare condition with few data on the risk factors. The aim of the study was to analyze risk factors and ischemic symptomatology in patients with postoperative ICA occlusion. During one year period, 33 patients with postoperative ICA occlusion were examined at Cerebrovascular Laboratory. Medical history, clinical findings and atherosclerosis risk factors were compared with data on 33 patients with satisfactory postoperative finding. Student's t-test was used on data comparison (P0.05). In 31 of 33 patients, ICA occlusion was recorded on the first postoperative examination, 3 months after carotid endarterectomy (18 right and 15 left). In 8 patients, combined occlusion of the common carotid artery and ICA was found (4 right, 4 left). One patient ICA developed occlusion during the first and third postoperative year each. Clinically, three patients presented with ischemic symptoms (one stroke and two transitory ischemic attacks (TIA)). The following risk factors were present in the group with postoperative ICA occlusion: hypertension in 18, smoking in 10, hyperlipidemia in 8, diabetes mellitus in 9, history of stroke in 13, TIA in 3, heart attack in 4 and coronary disease in 3 patients; the respective figures in the control group were as follows: 25, 11, 16, 7, 7, 3, 4 and 3. There was no significant between-group difference in the presence of risk factors. Study results suggested that postoperative ICA occlusion was not caused by atherosclerosis risk factors but by perioperative complications.

We have recently reported that transcranial sonography (TCS) is a method competitive to magnetic resonance neuroimaging (MRI) in the evaluation of pineal gland lesions. The aim of the present is study was to assess the usefulness of TCS in a larger patient sample during a two-year follow up. Twenty patients with incidental pineal gland cyst (PGC) detected by MRI scan of the brain and 40 healthy controls without any previous documented data on a disease related to pineal gland were evaluated by TCS and compared with MRI scans. There were no statistically significant differences in PGC size measured by TCS by two observers (p = 0.475), PGC size measured by TCS and MRI (first observer, p = 0.453; and second observer, p = 0.425), size of the pineal gland measured by TCS and MRI in control group (first observer, p = 0.497; and second observer, p = 0.370), and pineal gland size measured by TCS by two observers in control group (p = 0.473). Study results suggested TCS to be a suitable method in the evaluation of pineal gland lesions. Although its resolution cannot match the MRI resolution, its repeatability and accuracy might add to its practical value. We suggest that the repeat MRI scan of such lesions might be replaced by clinical and TCS follow up.

Although electroneuro- and electromyography are still the leading diagnostic methods for investigation of peripheral nerve function, they do not provide information on their morphology. This study was conducted to evaluate the suitability of ultrasonography in visualization of median nerve in healthy volunteers. Twenty five asymptomatic volunteers (17 women and 8 men), age range 21- 47 years, participated in the study. Body height was measured and handedness ascertained, as well as average time spent daily working on a computer. The device used was Aloka Prosound Alpha 10 Premier with a 13-MHz probe, using custom preset for musculoskeletal sonography. The following dimensions of median nerve at the pisiform bone level were measured bilaterally: cross-sectional area (CSA), circumference, and longer and shorter diameter. Using the latter values, the flattening ratio (FR) was calculated. Median nerve and the surrounding soft tissue structures were easily depicted in all study subjects. The mean median nerve CSA was 9.70 mm2 (range 5-15 mm2,SD2.25 mm2), mean FR (longer/shorter diameter) 4.04 (range2.16-6.08), and median height 172.72 cm. Only one subject was left-handed. The mean time spent daily working on a computer (overall mean of 3.2 h/day) did not correlate with either CSA or FR for the dominant hand. In four subjects, an aberrant artery accompanying median nerve was visualized. High-resolution sonographic imaging is a fast and noninvasive method for assessment of various morphological properties of median nerve and can be used to enhance diagnostic efficiency., Iako su elektroneuro- i elektromiografija još uvijek vodeće dijagnostičke metode u ispitivanju funkcije perifernih živaca, one ne pružaju informacije o njihovoj morfologiji. Cilj studije bio je procijeniti prikladnost visokorezolucijske ultrasonografije u slikovnom prikazivanju medijanog živca u asimptomatskih dobrovoljaca. U studiji je sudjelovalo 25 asimptomatskih dobrovoljaca u dobi od 21 do 47 godina. Na uređaju Aloka Prosound Alpha 10 Premier (sonda 13 MHz) izmjerene su obostrano slijedeće dimenzije medijanog živca (razina os pisiforme): površina presjeka (CSA, cross-sectional area), opseg, duži i kraci promjer, te je izračunat omjer stješnjenja (FR flattening ratio). Izmjerena je visina ispitanika, utvrđena dominantnost ruke, kao i prosječno vrijeme koje ispitanici provedu na dan radeći za računalom (moguć čimbenik za kompresiju živca u dominantnoj ruci). Prosječna CSA medijanog živca bila je 9.70 mm2 (raspon 5-15 mm2, standardna devijacija od 2.25 mm2). Srednji omjer stješnjenja (duži promjer/kraći promjer) bio je 4.04, raspona od 2.16 do 6.08. Srednja visina ispitanika bila je 172.72 cm i samo je jedan ispitanik bio ljevak, dok je ostalima (96%) desna ruka bila dominantna. Prosječno vrijeme rada za računalom na dan (ukupni prosjek 3,2 h/dan) nije koreliralo s CSA ili FR dominantne ruke. Nadalje, u jednog je ispitanika nađen podvojeni medijani živac (n. medianus bifidus), dok se u dvoje ispitanika prikazala anomalna arterija koja prati medijani živac (a. mediana). Sonografski prikaz visoke rezolucije omogućuje utvrđivanje različitih morfoloških karakteristika medijanog živca, uključujući njegove različite dimenzije i eho arhitekturu. Uz to, ultrazvučni prikaz je izrazito prikladan (dostupan, brz, relativno jeftin i neinvazivan) kao metoda procjene morfologije perifernog živčevlja i može se stoga rabiti u svrhu povećanja dijagnostičke sigurnosti.

The aim of the study was to assess differences in cerebrovascular reactivity in healthy subjects during orthostasis. Twenty healthy volunteers (11 men and 9 women) with no atherosclerotic risk factors were evaluated by use of transcranial Doppler. The breath holding index (BHI) was obtained in supine and upright posture using standardized procedure. Student's t-test was used on comparison of the mean blood flow velocities (MBFV) and BHI between supine and upright posture and between the left and right side of the body. The middle cerebral artery MBFV in supine posture was 66.6 cm/s on the right side and 68.5 cm/s on the left side and in upright posture 60.6 cm/s on the right side and 62.3 cm/s on the left side. There was no significant MBFV difference either between supine and upright posture or between male and female subjects. The mean BHI in supine posture was 1.59 on the right side, 1.65 on the left side, and in upright posture 1.63 on the right side and 1.7 on the left side, without significant sex difference. There was no statistically significant differences in BHI between supine and upright posture (P=0.81 and P=0.68 for the right and left side, respectively) or between the two sides of the body in supine (P=0.71) and upright posture (P=0.8). in conclusion, evaluation of cerebrovascular reactivity yielded no significant difference in BHI values during orthostatic stress., Cilj ovoga istraživanja bio je ispitati postojanje razlike cerebrovaskularne reaktivnosti u zdravih ispitanika tijekom ortostaze. Metodom transkranijskog doplera pregledano je 20 zdravih ispitanika (11 muškaraca i 9 žena) bez prisutnih čimbenika rizika za razvoj aterosklerotske bolesti. Vrijednosti indeksa zadržavanja daha (IZD) određene su u ležećem i stojećem stavu na standardiziran način. Studentov t-test primijenjen je za usporedbu srednjih brzina strujanja krvi i IZD između ležećeg i stojećeg stava te u odnosu strana. Srednja brzina strujanja krvi u srednjoj cerebralnoj arteriji u ležećem stavu ispitanika bila je 66,6 cm/s desno i 68,5 cm/s lijevo, a u stojećem stavu 60,6 cm/s desno i 62,3 cm/s lijevo. Nije bilo značajne razlike u vrijednosti brzine strujanja krvi između ležećeg i stojećeg stava ispitanika kao niti između spolova. Prosječna vrijednost IZD u ležećem stavu bila je 1,59 desno, 1,65 lijevo, a u stojećem stavu 1,63 desno te 1,7 lijevo, podjednaka za oba spola. Statističkom obradom nije nađena razlika u vrijednosti IZD uspoređujući ležeći i stojeći stav (P=0,81 za desnu stranu, P=0,68 za lijevu stranu), a niti uspoređujući dvije strane u ležećem (P=0,71) i stojećem stavu (P=0,8). Nisu zabilježene značajne razlike IZD u procjeni cerebrovaskularne reaktivnosti tijekom ortostatskog stresa.

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

Postoperative internal carotid artery (ICA) occlusion is a rare condition with few data on the risk factors. The aim of the study was to analyze risk factors and ischemic symptomatology in patients with postoperative ICA occlusion. During one year period, 33 patients with postoperative ICA occlusion were examined at Cerebrovascular Laboratory. Medical history, clinical findings and atherosclerosis risk factors were compared with data on 33patients with satisfactory postoperative finding. Student's t-test was used on data comparison (P, Poslijeoperacijska okluzija unutarnje karotidne arterije je rijetka komplikacija s nedovoljno poznatim rizičnim čimbenicima. Cilj ove studije bio je analizirati čimbenike rizika ateroskleroze i simptome ishemije kod bolesnika s okluzijom karotidne arterije nakon karotidne endarterektomije. Tijekom godine dana je u Cerebrovaskularnom laboratoriju pregledano 33 bolesnika s poslijeoperacijskom okluzijom unutarnje karotidne arterije. Uzeti su anamnestički podaci, analizirana je klinička slika, te čimbenici rizika ateroskleroze. Podaci su uspoređeni s podacima 33 bolesnika sa zadovoljavajućim poslijeoperacijskim nalazom. Podaci su uspoređeni Studentovim t-testom. U 31 od 33 bolesnika okluzija je ustanovljena tijekom prvog pregleda 3 mjeseca nakon karotidne endarterektomije, u troje bolesnika uz pojavu ishemijske simptomatologije. U 8 bolesnika zabilježena je poslijeoperacijska okluzija cijelog karotidnog stabla. U jednog je bolesnika okluzija nastala tijekom prve godine praćenja. dok je u jednog nastupila nakon tri godine. Čimbenici rizika ateroskleroze u skupini s poslijeoperacijskom okluzijom su bili: hipertenzija u 18, pušenje u 10, hiperlipidemija u 8, dijabetes melitus u 9, preboljeli moždani udar u 13, preboljela TIA u 3, infarkt miokarda u 4, angina pektoris u 3 bolesnika, dok su u skupini sa zadovoljavajućim poslijeoperacijskim nalazom to bili: hipertenzija u 25, pušenje u 11, hiperlipidemija u 16, dijabetes melitus u 7, preboljeli moždani udar u 7, preboljela TIA u 3, infarkt miokarda u 4, angina pektoris u 3 bolesnika. Nije bilo značajne razlike u prisutnim čimbenicima rizika. Dakle, rana poslijeoperacijska okluzija karotidne arterije najvjerojatnije nije uzrokovana uobičajenim čimbenicima rizika ateroskleroze, nego periproceduralnim komplikacijama.

Migraine is a primary episodic headache disorder characterized by a cascade of events that involve various combinations of neurologic, gastrointestinal and autonomic changes. Headache is probably caused by activation of meningeal and blood vessel nociceptors combined with an alteration in central pain modulation. Headache and its associated neuro-vascular changes are subserved by the trigeminal system. A link also exists between the migraine aura and headache. Cortical spreading depression (CSD) activates trigeminovascular afferents, causing a long-lasting increase in middle meningeal arterial blood flow and polypeptide release within the dura mater. The neuropeptides interact with the blood vessel wall, producing dilatation, plasma protein extravasation, and platelet activation. Neurogenic inflammation sensitizes nerve fibers (peripheral sensitization) that now respond to previously innocuous st imuli, such as blood vessel pulsations, causing, in part, the pain of migraine., Migrena je primarna glavobolja epizodnog karaktera karakterizirana nizom događaja koji uključuju kombinacije neuroloških, gastrointestinalnih i autonomnih promjena. Glavobolja je vjerojatno uzrokovana aktivacijom nociceptora u meningama i u stjenci krvnih žila, u kombinaciji s poremećajem u centralnoj modulaciji boli. Glavobolja i pridružene neurovaskularne promjene povezane su s trigeminalnim sustavom. Postoji također veza između migrenske aure i glavobolje. Kortikalna šireća depresija aktivira trigeminovaskularna aferentna vlakna, uslijed čega dolazi do dugotrajnog porasta protoka u srednjoj meningealnoj arteriji kao i u otpuštanju polipeptida unutar dure. Uslijed interakcije neuropeptida i stijenke krvne žile dolazi do dilatacije, ekstravazacije proteina plazme te aktivacije trombocita. Upala senzitizira živčana vlakna (periferna senzitizacija) te oni sad reagiraju na prethodno bezazlen podražaj, npr. pulzacije krvne žile, uzrokujući, barem djelomično, migrensku bol.

Mirror illusion means that standing in front of a mirror placed in sagittal plane, with the head tilted on one side and one arm stretched forward, one side of the body is reflected as if it were the other side by mirror visual feedback. The aim of this study was to monitor blood flow changes in middle cerebral artery (MCA) by use of transcranial Doppler (TCD) in individuals during motor tasks and tasks using mirror visual feedback. Eight young healthy volunteers (four male and four female) were included in the study. TCD recording in MCA was done during each task consisting of various motor and visuomotor activities using mirror illusion. Both MCA mean blow flow velocity (MBFV) was measured while the subjects were seated in a comfortable chair. The MCA MBFV recordings are presented as baseline values. During the illusion of motor hand activation, when the subject was making right hand flexions and watching its reflection in the mirror, with the left hand immobile, an increase was observed the contralateral MCA MBFV (task 3, +4.5% baseline value; P=0.017). Furthermore, when the subject made left hand flexions while watching the reflection of the immobile right hand in the mirror, there was an increase in the right MCA MBFV (+5.6% baseline value; P=0.044), which was more pronounced than during the illusion of motor hand activation (task 3) and less than during direct vision of hand flexion (task 2, +6.3% baseline value; P=0.005). Our data showed that visual illusion of action, as well as direct action observation could increase the MCA MBFV, which brings forward the possible usage of mirror illusion as a tool in motor neurorehabilitation., Iluzija zrcala očituje se time da stojeći ispred zrcala položenog u sagitalnu ravninu, gledajući na jednu stranu gdje nam je ispružena i jedna ruka, vidimo odraz kao da se radi o drugoj strani tijela zahvaljujući vizualnom zrcalnom povratu. Cilj ove studije bio je pokazati promjene brzine protoka krvi u srednjoj moždanoj arteriji (ACM) pomoću transkranijskog doplera (TCD) tijekom različitih motoričkih zadataka i zadataka s upotrebom zrcala. Osmoro mladih, zdravih dobrovoljaca (četiri muškarca i četiri žene) sudjelovalo je u ovom istraživanju. Pomoću TCD bilježile su se vrijednosti brzine protoka te promjene brzine u obje ACM, dok su ispitanici obavljali zadatke sjedeći u stolici. Snimljene vrijednosti prikazane su kao srednje vrijednosti. Tijekom iluzije o motoričkoj aktivnosti lijeve ruke pri pomicanju samo desne te gledanju njenog odraza u zrcalu zabilježeno je povećanje srednje brzine strujanja krvi u kontralateralnoj ACM (3. zadatak, porast za 4,5% u odnosu na bazalnu vrijednost, P=0,017). Nadalje, pri pomicanju lijeve ruke dok ispitanik promatra odraz nepomične desne također je došlo do porasta brzine u desnoj ACM (porast za 5,6% u odnosu na bazalnu vrijednost, P=0,044), koji je bio veći nego pri samoj iluziji motoričke aktivnosti (3. zadatak), a manji od porasta tijekom gledanja izravno u ruku koja se pomiče (2. zadatak, porast za 6,3%, P=0,005). Rezultati ovoga istraživanja pokazali su kako vizualna iluzija kretanja, kao i izravno promatranje aktivnosti povećava brzinu protoka krvi u ACM, što upućuje na mogućnost primjene iluzije zrcala u motoričkoj neurorehabilitaciji.

We have recently reported that transcranial sonography (TCS) is a method competitive to magnetic resonance neuroimaging (MRI) in the evaluation of pineal gland lesions. The aim of the present is study was to assess the usefulness of TCS in a larger patient sample during a two-year follow up. Twenty patients with incidental pineal gland cyst (PGC) detected by MRI scan of the brain and 40 healthy controls without any previous documented data on a disease related to pineal gland were evaluated by TCS and compared with MRI scans. There were no statistically significant differences in PGC size measured by TCS by two observers (p=0.475), PGC size measured by TCS and MRI (first observer, p=0.453; and second observer, p=0.425), size of the pineal gland measured by TCS and MRI in control group (first observer, p=0.497; and second observer, p=0.370), and pineal gland size measured by TCS by two observers in control group (p=0.473). Study results suggested TCS to be a suitable method in the evaluation of pineal gland lesions. Although its resolution cannot match the MRI resolution, its repeatability and accuracy might add to its practical value. We suggest that the repeat MRI scan of such lesions might be replaced by clinical and TCS follow up., Naša prethodna studija je pokazala da je transkranijska sonografija (TCS) moždanog parenhima kompetitivna metodi magnetske rezonancije (MRI) u procjeni pinealne žlijezde. Cilj ove studije bio je pokazati mogućnosti TCS u bilježenju signala pinealne žlijezde i njene cistične morfologije te pokazati korelaciju sa snimkama MRI na većem broju bolesnika kroz dvije godine praćenja. U studiju je bilo uključeno 20 bolesnika s novootkrivenom cistom pinealne žlijezde na MRI i 40 kontrolnih osoba. Snimanje TCS je provelo dvoje neovisnih istraživača na uređaju Aloka SSD-5500 i bez uvida u rezultate MRI. Pinealna cista je označena kao svaka hipoehogena struktura unutar hiperehogene zone žljezdanog tkiva ili hipoehogena lezija sa septumom ili bez njega, okružena tankom ehogenom linijom. širine žlijezde i lezije su izmjerene u latero-lateralnoj i antero-posteriornoj projekciji te uspoređene s rezultatima snimaka MRI. Podaci su obrađeni analizom ANOVA. Rezultati nisu pokazali statistički značajnu razliku između rezultata dvoje istraživača na TCS (p=0,475), veličine ciste mjerene pomoću TCS i MRI (prvi istraživač, p=0,453; drugi istraživač, p=0,425) i veličine pinealne žlijezde mjerene pomoću TCS u kontrolnoj skupini (p=0,473). Rezultati studije pokazuju mogućnosti TCS u otkrivanju pinealne regije uz dobru korelaciju s rezultatima MRI i značajnu podudarnost u rezultatima između dvoje neovisnih ispitivača. TCS se pokazala kao metoda kompetitivna metodi MRI u evaluaciji pinealnih cista, te ukazuje na mogućnost praćenja bolesnika kliničkim pregledom i pomoću TCS.