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The most common neurological symptoms in patients with SARS-CoV-2 infection are headache, myalgia, encephalopathy, dizziness, dysgeusia and anosmia, making more than 90 percent of neurological manifestations of COVID-19. Other neurological manifestations such as stroke, movement disorder symptoms or epileptic seizures are rare but rather devastating, with possible lethal outcome. The primary aim of this study was to estimate the prevalence of acute symptomatic seizures among COVID-19 patients, while secondary aim was to determine their possible etiology. Out of 5382 patients with COVID-19 admitted to Dubrava University Hospital from November 1, 2020 until June 1, 2021, 38 (seizure rate 0.7%) of them had acute symptomatic seizures. Of these 38 patients, 29 (76.3%) had new-onset epileptic seizures and nine (23.7%) patients with previous epilepsy history had breakthrough seizures during COVID-19. Although acute symptomatic seizures are an infrequent complication of COVID-19, seizure risk must be considered in these patients, particularly in the group of patients with a severe course of the disease. Accumulation of proinflammatory cytokines may contribute to the occurrence of seizures in patients with COVID-19, but seizures may also be secondary to primary brain pathology related to COVID-19, such as stroke or encephalitis.

Spectacular Shrinking Deficit (SSD) is a term attributed by J.P. Mohr to a rare cerebrovascular event defined by a rapid and dramatic improvement of major hemispheric stroke syndrome. It is presumed to be caused by the migration of initially embolic occlusion of an internal carotid artery or middle cerebral artery to its distal branches. It is only reported in several case reports, and case series with differing criteria of what defies an SSD meaning that its presumed prevalence rate of 7-14% of major hemispheric stroke syndromes could be an overestimation. It is usually associated with the cardioembolic cause of stroke, and it has a higher prevalence rate in younger patients, males, and nondiabetics. Our case is a 58 – year old male who presented to our ER with a major hemispheric stroke syndrome (deviation of head and eyes on the right side, central facioparesis on the left, left hemiplegia, and left hemineglect, NIHSS 16) 30 min- utes after symptom onset. He was aggressive, insisting nothing was wrong with him. His initial brain CT showed acute ischemic changes in the right temporooccipital region with an inadequate filling of distal branches of the right MCA shown on CT brain angiography. His symptoms spectacularly improved in our ICU (NIHSS 0) 51 minutes from symptom onset negating the need for thrombolysis. Except for one positive Beta – 2 GPI test his detailed laboratory tests, 24h Holter ECG, TTE, carotid, and vertebral artery ultrasound were noneventful. He had no cognitive or neurological deficit. He denied the possibil- ity of performing TEE and prolonged cardiac monitoring. Control brain MRI 4 days and 4 months later confirmed moderate ischemic changes of the right insular, temporal, and occipital cortex. Studies report that spontaneous recanalization usually happens in 17% of patients but does not correlate with TIA. This is the first report of an SSD with moderate ischemic stroke and no leftover neurological deficit. Other case series report moderate ischemic stroke SSD with a small residual neurological deficit (NIHSS 2-4). Perhaps mood changes can be associated with selective neuronal loss found in animals and patients suf- fering transient occlusion of the brain artery. The cardioembolic cause can in certainty be excluded with TEE and prolonged cardiac monitoring.

Acute disseminated encephalomyelitis (ADEM) is an inflammatory, demyelinating disease of the central nervous system that occurs as an immunological response to a viral or bacterial infection or an immunization. We describe a patient with clinical presentation and radiological features of ADEM that appeared after a spider bite. Corticosteroid therapy did not produce satisfied treatment response. The patient recovered after five days of immunoglobulin therapy. The cross-reactivity between spider toxin and myelin could explain pathophysiological mechanism of demyelination. ADEM should be considered as a possible complication of a spider bite.

Non-motor symptoms (NMS) are an important determinant of Parkinson's disease (PD), both in clinical settings and for patients' quality of life. Some of these symptoms, such as hyposmia, rapid eye movement behavior sleep disorder, depression, and constipation, can precede the diagnosis of PD and could represent clinical biomarkers of developing PD. The NMS rise in frequency and severity with advancing PD as a result of troublesome motor complications. However, normal aging also manifests the occurrence of different NMS, including autonomic deficits, cognitive decline, sleep disorders, and pain. This review discusses the prevalence, pathophysiology, and advances in NMS of different PD stages compared with normal aging.

Akutni diseminirajući encefalomijelitis (ADEM) upalna je, demijelinizirajuća bolest središnjeg živčanog sustava koja se pojavljuje kao imunološki odgovor na virusnu ili bakterijsku infekciju ili cijepljenje. Prikazujemo bolesnika s kliničkom prezentacijom i radiološkim manifestacijama ADEM-a koji je nastao nakon ugriza pauka. Kortikosteroidna terapija nije postigla zadovoljavajući rezultat u liječenju. Bolesnik se oporavio nakon pet dana liječenja imunoglobulinima. Križna reaktivnost između paukovog toksina i mijelina mogla bi objasniti patofiziološki mehanizam demijelinizacije. O ADEM-u treba razmišljati kao mogućoj komplikaciji ugriza pauka., Acute disseminated encephalomyelitis (ADEM) is an inflammatory, demyelinating disease of the central nervous system that occurs as an immunological response to a viral or bacterial infection or an immunization. We describe a patient with clinical presentation and radiological features of ADEM that appeared after a spider bite. Corticosteroid therapy did not produce satisfied treatment response. The patient recovered after five days of immunoglobulin therapy. The cross-reactivity between spider toxin and myelin could explain pathophysiological mechanism of demyelination. ADEM should be considered as a possible complication of a spider bite.

BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) are common in individuals with Alzheimer disease (AD). Donepezil and memantine are both widely used for the treatment of moderate AD. OBJECTIVE To evaluate the effects of donepezil and memantine in relieving BPSD in individuals with moderate AD. METHOD We conducted a prospective, randomized, 6-month clinical trial involving 85 individuals with moderate AD divided into two groups: group 1 (n = 42) was treated with donepezil; group 2 (n = 43) was treated with memantine. We used the Neuropsychiatric Inventory (NPI) to assess the prevalence and severity of BPSD at baseline and after 6 months of treatment with donepezil or memantine. RESULTS The two groups' baseline characteristics, including age, sex, mean length of education, and disease duration, were comparable, as were their baseline Mini-Mental State Examination scores. The NPI Total score improved from baseline to month 6 in both groups (P < 0.0001). Analyses of the NPI subdomains revealed that both donepezil treatment and memantine treatment produced statistically significant improvement in all of the NPI domains except euphoria and apathy, for which no improvement was observed after memantine treatment. Both treatments were well tolerated, with mostly mild and transient adverse effects. CONCLUSION Specific drugs for AD, including donepezil and memantine, may be effective in treating BPSD in individuals with moderate AD, with a favorable safety profile.

Paroxismal non-kinesigenic dyskinesia (PNKD) is a rare movement disorder manifesting as choreatic/dystonic movements, usually lasting from minutes to up to 4 h, with perserved consciousness during attacks. Primary PNKD are idiopathic or genetic disorders while secondary PNKD are associated with various neurologic and medical conditions. We present a case with PNKD and right sided hemidystonia in association with celiac disease, responsive to gluten-free diet, not previously reported in available literature. In conclusion, diagnostic tests for celiac disease should be a part of etiological investigations in patients with otherwise unexplained movement disorders including PKND. Gluten free diet could produce a favorable clinical response in those patients.

Citotoxin-associated gene-A (CagA)-positive Helicobacter pylori strains have been associated with occurrence and destabilization of coronary atherosclerotic plaques. However, data on the relationship between CagA-positive H. pylori infection and carotid artery instability are lacking. Thus, the role of CagA antigen in patients with symptomatic and asymptomatic carotid atherosclerotic plaques was investigated. A total of 64 patients with advanced carotid artery stenosis, including 33 patients with symptomatic and 31 patients with asymptomatic internal carotid artery stenosis, verified by duplex ultrasound, all undergoing carotid endarterectomy, were studied. The control group consisted of 65 subjects without a history or presence of vascular diseases. Serology for H. pylori and CagA antigen was assessed in all participants. Specimens of atherosclerotic plaques obtained from all patients during carotid endarterectomy were analyzed immunohistochemically using anti-CagA monoclonal antibodies. The ultrasonographic plaque characteristics were also estimated. CagA antibody titers were significantly higher in symptomatic patients (8.8 ; range, 5.8-32.7) compared to asymptomatic patients (4.7 ; range, 2.1-8.8 ; P = 0.005) and the control group (5.0 ; range 2.2-7.9 ; P < 0.001). There was significant difference in echolucency (≥ 25% soft material) between the symptomatic and asymptomatic groups (P = 0.034) by ultrasonographic evaluation. Positive immunoreactivity between monoclonal CagA antibodies and antigens within atherosclerotic specimens was significantly higher among symptomatic patients compared to asymptomatic patients (97.0 vs. 74.2% ; P = 0.009). H. pylori may play a role in the pathogenesis of the atherosclerotic process due to autoimmune mechanisms and even contribute to destabilization of carotid atherosclerotic plaques.

Nonmotor symptoms (NMSs) are common in Parkinson disease (PD), affecting patient's quality of life. The prevalence and domains of NMSs in untreated de novo PD remains unclear, especially comparing to normal aging. The objective was to determine NMSs in untreated de novo PD patients. PATIENTS AND METHODS: We performed a cross-sectional study to evaluate the frequency and severity of NMSs in untreated de novo PD patients (n=71) and age- matched normal controls (n=60) using the Non- Motor Symptoms Scale (NMSS). The motor section of the Unified Parkisnon Disease Rating Scale (mUPDRS) and the Hoehn and Yahr (HY) stage were also obtained in PD patients RESULTS: The number of NMSs and the NMSS scores were significantly higher in the PD patients than in controls (p

The papillary carcinoma of the thyroid gland is the most common type of tumor of the thyroid gland with good prognosis and low incidence of distant metastasis. The brain metastases of thyroid gland carcinoma are extremely rare. We report a patient with multiple cystic brain lesions and satisfying criteria for diagnosis of neurocysticercosis. Brain biopsy revealed brain metastases from papillary thyroid carcinoma. The tumor originated from mediastinal thyroid tissue. Even in cases when neuroimaging suggests neurocysticercosis with great accuracy, it is important to exclude metastasis. Extensive brain metastases of primary papillary thyroid carcinoma are extremely rare.

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.