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A prospective study was carried out in University Hospital Centre Zagreb to evaluate the relationship between epilepsy, antiepileptic drugs (AEDs) and quality of life (QoL) of patients with epilepsy (PE) and its association with the depressive symptoms and sexual dysfunction (SD). Quality of life in epilepsy-31 inventory (QOLIE-31) was used for evaluating QoL, Arizona Sexual Experiences Scale (ASEX) for SD and Hamilton Rating Scale for Depression (HAM- D17). 108 PE were included (63% women, 37% men ; mean age 39.54±15.91 years). 14.8% of patients had focal, 35.2% generalised and 40.7% both types of epilepsy. 44/108 patients had drug-resistant epilepsy (DRE) and in 27/44 vagus nerve stimulation (VNS) was implanted. Mean response on QOLIE-31 was 62.88±17.21 with no significant differences regarding gender, type of epilepsy and age. Statistically significantly lower QoL was found in the domain ‘Overall QoL’ (age group 35-55 years vs.

Background: Patients with epilepsy commonly report depressive symptoms. The main aim of this study was to evaluate the relationship between epilepsy, antiepileptic drugs (AEDs) and depression. We also wanted to evaluate possible association between depressive symptofigms in patients with epilepsy with the quality of life (QoL). Material and methods: This was a prospective cross-sectional study carried out at the tertiary teaching hospital (University Hospital Centre Zagreb, Croatia) with Ethics committee approval. Questionnaires evaluating depressive symptoms and QoL were administered to consecutive patients treated in the Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy. Depressive symptoms were evaluated using Hamilton Rating Scale for Depression (HAM-D17). Quality of life was assessed using Quality of life in epilepsy-31 inventory (QOLIE- 31) Background: Patients with epilepsy commonly report depressive symptoms. The main aim of this study was to evaluate the relationship between epilepsy, antiepileptic drugs (AEDs) and depression. We also wanted to evaluate possible association between depressive symptofigms in patients with epilepsy with the quality of life (QoL). Material and methods: This was a prospective cross-sectional study carried out at the tertiary teaching hospital (University Hospital Centre Zagreb, Croatia) with Ethics committee approval. Questionnaires evaluating depressive symptoms and QoL were administered to consecutive patients treated in the Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy. Depressive symptoms were evaluated using Hamilton Rating Scale for Depression (HAM-D17). Quality of life was assessed using Quality of life in epilepsy-31 inventory (QOLIE-31) Results: 108 patients (63% women, 37% men ; mean age 39.54±15.91 years, range 18-80 years) with epilepsy were included. 14.8% of patients had focal, 35.2% generalised and 40.7% both types of epilepsy. Majority of patients (65.74%) were on two and more AEDs and quarter was on monotherapy (25%) ; 42% were on newer, 19% on older and 39% on both AEDs. Mean total score on HAM-D17 was 9.94±8.18 (men - mean total score 10.16±8.85, women - mean total score 9.81±7.84). There were no significant differences on HAM-D17 regarding gender and age. We didn't find statistically significant differences regarding AEDs (older vs. newer AEDs, or both types AEDs) and results on HAM-D17, nor between the type of epilepsy and results on HAM-D17. We found strong negative correlation between the higher QoL and HAM-D17 (p=0.000). Conclusions: Results of this study evaluating depressive symptoms in patients with epilepsy demonstrate that our patients mainly experience mild depressive symptoms, with no significant differences on HAM-D17 regarding gender and age. Patients with epilepsy with less pronounced depressive symptoms were found to have higher QoL. We did not find statistically significant differences regarding the type of epilepsy and results on HAM-D17, nor between the AEDs (older vs. newer AEDs, or both types AEDs) and results on HAM-D17.

A prospective study was carried out at the Zagreb University Hospital Centre to evaluate the relationship between epilepsy, antiepileptic drugs (AEDs) and quality of life (QoL) in patients with epilepsy (PE), and its association with depressive symptoms and sexual dysfunction (SD). QoL was assessed by use of the Quality of Life in Epilepsy-31 Inventory (QOLIE-31), SD by the Arizona Sexual Experiences Scale (ASEX), and depressive symptoms by the Hamilton Rating Scale for Depression (HAM-D17). The study included 108 PE (women 63% and men 37% men), mean age 39.54±15.91 years. Focal type epilepsy was diagnosed in 14.8%, generalized type in 35.2%, and both types were present in 40.7% of study patients. Drug-resistant epilepsy (DRE) was present in 44/108 and vagus nerve stimulation (VNS) was implanted in 27/44 patients. The mean response on QOLIE-31 was 62.88±17.21 with no significant differences according to gender, type of epilepsy, and age. A statistically significantly lower QoL was found in the ‘Overall QoL’ domain (35-55 vs., Provedeno je prospektivno istraživanje u KBC-u Zagreb s ciljem procjene povezanosti epilepsije, antiepileptičkih lijekova (antiepileptic drug, AED) i kvalitete života (quality of life, QoL) u bolesnika s epilepsijom, kao i učestalosti depresije i seksualne disfunkcije (SD). QOLIE-31 (Quality of Life in Epilepsy-31 Inventory) je primijenjen za procjenu QoL-a, ASEX (Arizona Sexual Experiences Scale) za SD i HAM-D17 (Hamilton Rating Scale) za depresiju. Uključeno je 108 bolesnika s epilepsijom (63% žena, 37% muškaraca; srednja dob 39,54±15,91 godina). Žarišnu epilepsiju imalo je 14,8% i generaliziranu 35,2% bolesnika, dok je obje vrste epilepsije imalo 40,7% bolesnika. Farmakorezistentnu epilepsiju (drug-resistant epilepsy, DRE) imalo je 44/108 bolesnika, a kod njih 27/44 ugrađen je stimulator vagusnog živca (vagus nerve stimulation, VNS). Srednji odgovor na QOLIE-31 bio je 62,88±7,21 bez značajnih razlika u odnosu na spol, vrstu epilepsije i dob. Statistički značajno niži QoL nađen je u domeni ‘Sveukupni QoL’ (dobna skupina 35-55 godina u odnosu na dobnu skupinu

Background: Invasive neurosurgical treatment or minimally invasive neurosurgical treatment are methods of choice for the treatment of patients with drug resistant epilepsy. The aim of this study was to evaluate the impact of neurosurgical treatment and the quality of life of patients with drug resistant epilepsy and to determine what are the potential predictors of quality of life of patients with drug resistant epilepsy one year after neurosurgical treatment. Subjects and methods: The research was performed at the Referral Centre for Epilepsy, Department of Neurology, University Hospital Centre Zagreb from February 2015 to February 2020 with Ethics commitee approval. The study included 96 patients with drug resistant epilepsy who were examined for the quality of life before and one year after neurosurgical treatment using the form questionnaire "Quality of life in epilepsy" (QOILE-31) validated Croatian 1.0 version and the questionnaire to assess the degree of depression "Beck Depression Inventory I" (BDI-I) validated Croatian version. Results: Of 96 patients with drug resistant epilepsy one year after neurosurgical treatment 46 (47.9%) patients remained completely free from epileptis seizures. Wilcoxon equivalent pair test showed that the number of epileptic seizures one year after neurosurgical treatment was significantly lower (median before neurosurgical treatment is 10; and after neurosurgical treatment is 1, p

The primary objectives of this study were (1) to determine the presence of Borrelia burgdorferi infection in ticks removed from patients for the purpose of singling out sites with increased risk of Lyme borreliosis, and (2) to determine the presence of IgM and/or IgG antibodies against B. burgdorferi sensu lato (s. l.) complex in sera of patients who had ticks removed. From 108 ticks removed from patients, all were examined zoologically and a sub-sample of 91 ticks was tested using PCR analysis to determine the presence of DNA indicating B. burgdorferi infection. To detect anti-Borrelia IgM and/ or IgG antibodies in 61 patients bitten by ticks, we used line recombinant immunoblot test. The most common tick identified was Ixodes ricinus. B. burgdorferi s. l. was present in 37 of 91 tested ticks (40.7%). Seroconversion against B. burgdorferi s. l. antigen was detected in 12 of 61 patients (19.7%). Most of the infected ticks were from the province of Vojvodina (11 municipalities), with the city of Novi Sad proving to be the site with the highest number of infected ticks, 6 in total. Glavni cilj ove studije je bio da se ispita prisustvo B. burgdorferi infekcije u krpeljma uklonjenih sa pacijenata radi utvđivanja lokaliteta sa povećanim rizikom za obolevanje od lajm borelioze, kao i ispitivanje prisustva IgM i/ili IgG antitela usmerenih protiv B. burgdorferi s. l. kompleksa u serumu pacijenata infestiranih krpeljima. Sa pacijenata je prikupljeno i zoološki ispitano 108 krpelja. PCR analiza krpelja korišc'ena je za utvrđivanje prisustva B. burgdorferi s. l. kompleks kod 91 krpelja od ukupnih 108. Za otkrivanje IgM i/ili IgG antitela protiv B. burgdorferi s. l. korišćeni su linijski rekombinantni imunoblot testovi. Najčešc'i identifikovani krpelj je Ixodes ricinus. B. burgdorferi s. l. je bila prisutna u 37 od 91 testiranog krpelja (40,7%). Prisustvo IgM/IgG antitela protiv B. burgdorferi s. l. otkriveno je kod 12 od 61 pacijenta (19,7%). Najviše inficiarnih krpelja je sa teritorije AP Vojvodine (11 opština), gde je urbani deo Novog Sada lokalitet sa najvećim brojem inficiranih krpelja - 6.

Background and aims: Many factors influence quality of life (QoL) of patients with epilepsy. The aim of this study was to evaluate the relationship between epilepsy, antiepileptic drugs (AEDs) and QoL. Methods: Quality of life in epilepsy-31 (QOLIE-31) was used for evaluation of QoL, Arizona Sexual Experiences Scale (ASEX) for SD and Hamilton Rating Scale for depression (HAM-D17). Results: 108 patients with epilepsy were enrolled (68 (63%) women, 40 (37%) men ; mean age 39.54±15.91 ; 16 (14.8%) focal, 38 (35.2%) generalized and 44 (40.7%) combined type of epilepsy). Mean result on QOLIE-31 was 62.88±17.21 (women 63.31±16.51, men 62.18±18.51). No significant differences were found regarding gender, type of epilepsy and age, except in regard to the domain ‘Overall QoL’, where the age group 35-55 years was found to have statistically significantly lower QoL in comparison to those younger than 35 years. Patients taking both types of AEDs were found to have significantly lower QoL compared to those on newer AEDs. Lower QoL was found to be associated with more pronounced symptoms of SD (r=- 0.34, p=0.001) and depression (r=-0.71, p=0.000). Out of 44 patients with drug- resistant epilepsy, 27 were treated with vagus nerve stimulation (VNS), with statistically significant differences found between the 2 groups (p=0.041). Conclusion: Patients with epilepsy taking both types of AEDs were found to have lower QoL in comparison to those on newer AEDs. Furthermore, QoL and mood were found to improve following VNS implantation in patientswith drug-resistant epilepsy.

Vagus nerve stimulation (VNS) is a viable minimally invasive neurosurgical treatment option in drug resistant epilepsy and depression. In patients with drug resistant epilepsy, polytherapy is necessary, emphasizing the greater incidence of side effects which further impair the quality of life (QoL) at the physical, psychosocial and neurocognitive level. Patients with epilepsy oft en have depression, which can be the result of seizures, antiepileptic drugs (AEDs) or sociodemographic factors. In addition, epilepsy and depression share a similar neurobiologic basis that has been linked to biochemical changes, altered neurotransmission, hypothalamic-pituitary- adrenal axis abnormalities involved in chronic stress, inflammation, reduced neuroplasticity, and network dysfunction. However, the diagnosis of depression in patients with epilepsy, confirmed by psychiatric assessment, should be better understood when making a decision on early treatment with VNS. Selective serotonin reuptake inhibitors or psychotherapy should be considered as first line treatments for depression in patients with epilepsy, but these drugs can also compound cognitive and sedative side effects of antiepileptic agents. On the other hand, we should also consider side effects of VNS that can be implantation or stimulation associated. Considering the fact that QoL is known to be strongly linked to mood and improvement in the Beck Depression Inventory scores, and following published VNS studies in epilepsy that assessed QoL, we performed a study of QoL in a group of patients with drug resistant epilepsy treated at the Zagreb University Hospital Centre who had undergone VNS implantation. The study included 27 patients with drug resistant epilepsy with implanted VNS – case group (14 M and 13 F ; mean age 34.7±28.3 years) and 18 control patients with drug resistant epilepsy without implanted VNS (10 M and 8 F ; mean age 45.2±30.8 years). QoL was examined using the questionnaires Quality of life in Epilepsy (QoLIE-31 validated Croatian 1.0 version) and Beck Depression Inventory I (BDI I validated Croatian version). On statistical analysis, nonparametric Mann- Whitney test for independent samples was used. The study was approved by the Ethics Committee of the Zagreb University Hospital Centre. The Mann-Whitney test showed significant difference in the QoLIE-31 score between the case and control groups (p=0.041). In the case group, we noticed that younger patients had lower QoLIE-31 score and higher BDI-I score than the older ones. Our results showed positive influence on the QoL and mood improvement following VNS implantation in patients with drug resistant epilepsy.

Background and aim: Vagus nerve stimulation (VNS) is a viable treatment option in drug resistant epilepsy and depression. In patients with drug resistant epilepsy polytherapy is necessary that emphasizes greater incidence of side effects which further impair quality of life, on physical, psychosocial and neurocognitive level. Our study aimed to examine quality of life in patients with drug resistant epilepsy who had undergone VNS implantation. Patients and methods: The study included 27 patients with drug resistant epilepsy with implanted VNS – case group (14M, 13F ; mean age 34.7 +/- 28.3 years) and 18 controls – patients with drug resistant epilepsy without implanted VNS (10M, 8F ; mean age 45.2 +/- 30.8 years). The quality of life was examined using the questionnaires "Quality of life in epilepsy" (QOLIE-31 validated Croatian 1.0 version) and "Beck Depression Inventory I" (BDI I validated Croatian version). For statistical analysis nonparametric Mann-Whitney test for independent samples was used. The study was approved by the Ethical Committee of the University Hospital Centre Zagreb. Results and conclusion: The Mann- Whitney test showed significant difference in the QoLIE-31 score between the case and the control group (p=0.041). In the case group we have noticed that younger patients had lower score of QoLIE-31 and higher score of BDI-I then the older ones. Our results show positive influence on the quality of life and mood improvement following VNS implantation in patients with drug resistant epilepsy. VNS can be effective treatment when used early in patients with both seizures and depression.

Stavovi medicinskih sestara/tehničara o HIV-pozitivnim osobama

Između 25-30% bolesnika nema zadovoljavajuće kupirane epileptičke napadaje i pripada u skupinu farmakorezistentnih oblika epilepsija čineći ih kandidatima za neku od metoda neurokirurškog liječenja. U takvih je bolesnika potrebno učiniti ekstenzivnu preoperativnu dijagnostičku obradu. Jedna od novijih dijagnostičkih metoda koja se koristi u preoperativnoj obradi je BESA (Brain electric source analysis). BESA se temelji na složenim matematičkim procesima i služi za spaciotemporalno modeliranje strujnih izvora na temelju podataka dobivenih iz neinvazivnog površinskog EEG-a. Njezina svrha je identifikacija i lokalizacija ekvivalentnih strujnih izvora u mozgu koji su odgovorni za interiktalne šiljke te za početak samog napada ("seizure onset"). Također, važnu ulogu ima i određivanje vremenskog slijeda aktivacije pojednih izvora. Jedna od prednost ovog alata je u tome što BESA radi za podacima koji su dobiveni rutinskim neinvazivnim EEG površinskim snimanjem, čime se pridnosi povećanju iskoristivosti standardne EEG pretrage te nije potrebno pacijente izlagati dodatnim naporima. Rezultati dobiveni ovim alatom pružaju temeljitije informacije nužne za što precizniju lokalizaciju žarišta epileptičnih napadaja dodajući rutinskim EEG podacima novu dimenziju. Upotreba BESE u preoperativnoj obradi farmakrezistentnih epilepsija pridonosi kvaliteti same obrade i nudi brojne nove mogućnosti analize kortikalnih epileptičkih grafoelemenata.

Lance-Adams syndrome (LAS), first described in 1963, is a condition characterized by development of chronic post-hypoxic action myoclonus due to a temporary lack or inadequate brain supply of oxygen. A coagulative disorder should be suspected when an unexplained hemorrhage occurs. Patients with LAS show a favourable response to sodium valproate and clonazepam. The authors present a case of a 22-year-old young man, who was admitted to the Department of Neurology of the University Hospital Center Zagreb in January 2008, clinically presenting with headache, nausea, vomiting, mild right hemiparesis and truncal ataxia. Brain MRI revealed spontaneous atypical subdural hematoma in the region of the right middle cerebellar peduncle, vermis and left cerebellar hemisphere. Laboratory findings revealed deficiency in coagulation Factor XIII. Two weeks after admission patient developed spontaneous subdural hematoma in the right frontoparietal region. In the meantime he clinically also presented with generalized action myoclonus that was, according to our beliefs, a part of chronic posthypoxic action myoclonus - Lance-Adams syndrome (secondary to intracranial hemorrhage). He had a complete regression of myoclonus after an oral administration of sodium valproate and clonazepam, and after normalization of coagulation Factor XIII concentration following replacement therapy.

Oko 1% opće populacije boluje od epilepsije, a unatoč pojavi novih antiepileptika i njihovoj širokoj primjeni između 25-30% bolesnika nema zadovoljavajući kupirane epileptičke napade i spada u grupu farmakorezistentnih oblika epilepsija čineći te bolesnike kandidatima za neku od metoda neurokirurškog liječenja. Jedna od metoda minimalno invazivnog neurokirurškog liječenja farmakorezistentnih oblika epilepsije je implantacija vagusnog stimulatora (VNS), kojom se postiže redukcija epileptičkih napada za 60-70%, a referirani su i slučajevi sa kompletnom remisijom bolesti. Jedna od rijetkih ranih nuspojava ove metode liječenja u bolesnika oboljelih od bronhalne astme ili opstruktivne bolesti pluća je bronhokonstrikcija čija je pojavnost u korelaciji s jačinom stimulacije. Prikazujemo slučaj bolesnice s premorbidnom anamnezom bronhalne astme i farmakorezistentne epilepsije kod koje je nakon implantacije VNS na vrijednostima stimulacije 0, 75 mA došlo do pogoršanja simptoma bronhalne astme i razvoja znakova globalne respiratorne insuficijencije.

One percent of the general population is affected with epilepsy and close to thirty percent of epilepsy patients are intractable to medications in spite of a recent increase in the number of new available antiepileptic drugs. Resection epilepsy surgery is an alternative, but not every patient with pharmacoresistant epilepsy is a good candidate for this type of surgery. Vagus-nerve stimulation (VNS) is a relatively new device that is finding increased use in the non-pharmacologic management of refractory epilepsy. Vagus nerve stimulators are implanted in the subcutaneus tissues of the chest, with a wire lead inserted around the left vagus nerve to deliver regularly timed cycles of electrical pulses that suppress epileptogenic foci. Adverse events related to VNS include voice alteration and a tingling sensation in the throat, but the intensity of the symptoms decreases over the next few weeks. Coughing during stimulation occurrs normally when therapy is initiated and shortness of breath occurrs mainly during physical activity, but dyspnea and bronchoconstriction are very rare. We report a case of a 37-year old woman with a 27-year history of pharmacoresistant simple partial sensomotor seizures, cortical dysgenesis of precentral gyrus (Taylor) and a 19-year history of bronchial asthma. In March 2009, one year after VNS implantation, she experienced dyspnea associated with the activation of device, and was found to temporally correlate with worsening of asthma - bronchoconstriction as demonstrated by pulmonary function assessments. Following therapy with antibiotics, bronchodilatators and corticosteroids her condition improved. In patients with bronchial asthma and implanted VNS by experience there is a difficulty in achievement of regression of asthma symptoms, probably because of the continuous activation of the parasympathetic nervous system.

Lance-Adams syndrome, first described in 1963, is a condition characterized by development of chronic post-hypoxic action myoclonus due to a temporary lack or inadequate supply of oxygen to the brain. It clinically presents mainly by action myoclonus, associated with cerebellar ataxia and very mild intellectual deficit. Occurrence of Lance-Adams syndrome is rare - 122 cases have been reported in the literature so far. Pathohistologically there are structural changes - prominent astrocytosis in nuclei of the mesencephalic gray matter, loss of neurons and changes in the periaqueductal gray matter of brainstem and dorsolateral gray matter of mesencephalis tegmentum (3rd mediator system of epileptogenesis). Generator of myoclonus is the caudal part of medulla oblongata and upper part of cervical spinal cord, as well as cerebral cortex. Patients with LAS show a favourable response to sodium valproate and clonazepam. The authors present a case of a 22-old man, who was admitted at the Department of Neurology of the University Hospital Center Zagreb in January 2008, clinically presenting with headache, nausea, vomiting, mild right hemiparesis and truncal ataxia. Brain MRI revealed spontaneus intracerebellar hematoma in the region of the right middle cerebellar peduncle, vermis and left cerebellar hemisphere. Cerebral digital subtraction angiography was negative. Laboratory findings revealed probably congenital deficiency in coagulation Factor XIII. Two weeks after admission patient developed spontaneous subdural hematoma in the right frontoparietal region. In the meantime he clinically also presented with generalized action myoclonus that was, according to our beliefs, a part of chronic posthypoxic action myoclonus - Lance-Adams syndrome (secondary to intracranial hemorrhage). Electroencephalography showed polyspikes and complex of polyspikes-slow waves, synchronized with myoclonus. He had a complete resolution of myoclonus after an oral administration of sodium valproate and clonazepam, and after normalization of coagulation Factor XIII concentration following replacement therapy. His neurological status also improved. A coagulation disorder should be suspected when an unexplained intracranial hemorrhages occur. The incidence of Factor XIII deficiency is estimated at one in five million births, and is inherited in an autosomal recessive fashion. Congenital deficiency in coagulation Factor XIII can be a possible cause of unexplained intracranial hemorrhages in young adults. Ongoing factor replacement therapy is recommended to prevent further bleeding episodes. The authors indicate the importance of the correct diagnosis and proper treatment. According to our knowledge and literature data, this is a first reported case of Lance -Adams syndrome in Croatia.

Transverzalni mijelitis (TM) je rijedak klinički sindrom karakteriziran fokalnom inflamacijom, demijelinizacijom i aksonalnim oštećenjem unutar kralješnične moždine. TM se može javiti kao izolirani, idiopatski entitet, može biti povezan s multifokalnim bolestima središnjeg živčanog sustava (npr. multipla skleroza), ili sa sistemnim bolestima vezivnog tkiva (npr. SLE, Sjögrenov sindrom). Prema podacima iz literature TM se u potonjih javlja u oko 1% slučajeva, a kao inicijalni simptom opisan je samo u prikazima slučajeva. U Kliniku za neurologiju KBC-a Zagreb u rujnu 2006. zaprimljena je 49-godišnja bolesnica zbog akutno nastale motoričke slabosti donjih udova, uz osjetni nivo od Th11 prema distalno te retenciju mokrenja. MR-om su pokazane dvije demijelinizacijske lezije koje su zahvaćale manje od 50% površine presjeka torakalne kralješnične moždine, u segmentu Th10 lijevo i Th11 desno. U likvoru su nađeni blaže povišeni proteini (45 mg/dl), 4 limfocita mm-3, oligoklonske trake su bile negativne. Imunološka ispitivanja pokazala su pozitivan ANF titar. Bolesnica je liječena pulsnom kortikosteroidnom terapijom tjedan dana, a u nastavku peroralnim kortikosteroidima (taper), uz dobar klinički odgovor. U studenom 2006. razvija duboku vensku trombozu lijeve noge. Klinički imunolog postavlja dg. Collagenosis non determinata te u terapiju uvodi metotreksat. Na kontrolnom MR-u kralješnične moždine učinjenom u svibnju 2007. demijelinizacijskih lezija više nije bilo. Slučaj prikazane bolesnice jedan je od rijetkih koji su primljeni u našu Kliniku s akutno nastalnom spinalnom simptomatologijom, gdje se kasnijom obradom utvrdilo da boluje od sistemske imunološke bolesti. Naše iskustvo sugerira primjenu kortikosteroidne terapije i dijagnostički postupak sukladno Algoritmima za dijagnozu i liječenje transverzalnog mijelitisa (Kaplin i sur., 2005).

Transverse myelitis (TM) is a monofocal inflammatory disorder of the spinal cord in which an immune-mediated process results in neural injury. It may exist as an idiopathic entity, as a part of a multifocal diseases of the central nervous sistem, or a multisystemic connective tissue disease. Transverse myelitis as a manifestation of an autoimmune disorder occurs in approximately 1% of patients, and as initial symptom it is described only in a case reports. A 49-year-old woman was admitted to the Department of Neurology of the University Hospital Center Zagreb in September 2006, due to sudden development of weakness in legs, accompanied with Th11 sensory level and urinary retention. Magnetic resonance imaging (MRI) of the caudal part of the spinal cord revealed two spacky T2 hyperintensive demyelinating lesions which comprise less then 50% of the surface, in the lateral parts of thoracal spinal cord, in the Th10 segment on the left and Th11 on the right. Cerebrospinal fluid (CSF) analysis showed little increase of total protein (45 mg/dl), oligoclonal bands were negative, and there were 4 lymphocytes mm-3. She had positive antinuclear antibody (ANA) titer. Patient was treated with pulse glucocorticoid therapy during 7 days, followed by peroral glucocorticoid therapy (taper) with improvement of her symptoms. In the following few monts patient developed clinical signs and symptoms (episodes of polyarthritis, febrile episodes, and skin photosensitivity), that, together with positive ANA titer, led the clinical immunologist to the diagnosis of probable systemic lupus erythematosus (SLE). Patient showed good clinical response to chronic oral immunosuppresive therapy (methotrexate). On control MRI performed in November 2008 formerly described demyelinating lesions disappeared. This case report is one of rare cases with acute spinal symptomatology as an initial manifestation of the connective tissue disease in our Department. Our experience suggest the glucocorticoid therapy and diagnostic procedures recommended by the Algorithm for the diagnosis and treatment of transverse myelitis.