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Background. Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine, metabolic, and androgen excess disorders among reproductive age women. Globally, 46% of the adult population suffer from headache in general. PCOS and migraine pathogenesis are closely associated with insulin resistance. Studies on headache in women with PCOS are scarce. The objective of the study was to evaluate the frequency of headache, its association with metabolic parameters, and impact on daily activities in women with PCOS. Materials and methods. 114 women with PCOS (according to the Rotterdam criteria) and 80 age-matched control women with regular menses and no clinical or biochemical hyperandrogenism or polycystic ovaries were enrolled in the study. Data on age, height, weight, and blood pressure were collected, the body mass index (BMI) was calculated. Participants were tested for complete blood count, fasting glucose, fasting insulin, lipid profile, and comprehensive hormone panel. An ad-hoc questionnaire was given to the participants to obtain information on headache. Results. A total of 60.8% of studied women complained of headache attacks. Women with PCOS experienced headache more frequently than control subjects (68.4% vs. 50.0%, p=0.010). Having PCOS increased the odds ratio of headache by 2.17 (CI: 1.20-3.91, p=0.010). Being overweight or obese increased the odds ratio of having headache by 2.5 times for women with PCOS (OR 2.50, CI: 1.11-5.61, p=0.026). 24.6% of women with PCOS compared with 11.2% of control women reported that headache limited their daily housekeeping activities (p=0.020). 31.6% of women with PCOS compared with 18.8% of control women reported that headache had negative impact on their professional life (p=0.046). Conclusion. Women with PCOS (particularly overweight or obese) in Lithuania are often prone to suffer from headaches; the latter affect their professional life and everyday activities. [ABSTRACT FROM AUTHOR]

Deep brain stimulation for Parkinson disease is used for 30 years. This therapy is indicated for parkinsonian patients who have idiopathic Parkinson disease and side effects from L_DOPA therapy. Considering from symptoms Subthalamic nucleus or Globus pallidus internus might be stimulated. Patients are usually operated with stereotactic frame. Aim of this article to help recall neurologists about deep brain stimulation for Parkinson disease as an option to control Parkinson disease symptoms. There are parts in the article about indications, patient selection criteria, contraindications, surgical techniques and post operative neuromodulation strategy. At the end we give short results about STN DBS for Parkinson disease in Lithuania parkinsonian patients. Conclusion. The study provides evidence that STN DBS reduces L-dopa therapy dosage, reduces its motor complications and significantly improves motor functions in PD patients for an inspected period of one year after surgery. [ABSTRACT FROM AUTHOR]

Background and Objectives: Increased blood glucose levels atadmission are frequently observed in COVID-19 patients, even in those without pre-existing diabetes. Hyperglycaemia is associated with an increased incidence of severe COVID-19 infection. The aim of this study was to evaluate the association between hyperglycaemia at admission with the need for invasive mechanical ventilation (IMV) and in-hospital mortality in patients without diabetes who were hospitalized for COVID-19 infection., Materials and Methods: This retrospective observational study was conducted at Vilnius University Hospital Santaros Clinics, Lithuania with adult patients who tested positive for severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 and were hospitalized between March 2020 and May 2021. Depersonalized data were retrieved from electronic medical records. Based on blood glucose levels on the day of admission, patients without diabetes were divided into 4 groups: patients with hypoglycaemia (blood glucose below 4.0 mmol/L), patients with normoglycaemia (blood glucose between ≥4.0 mmol/L and <6.1 mmol/L), patients with mild hyperglycaemia (blood glucose between ≥6.1 mmol/L and <7.8 mmol/L), and patients with intermittent hyperglycaemia (blood glucose levels ≥7.8 mmol/L and <11.1 mmol/L). A multivariable binary logistic regression model was created to determine the association between hyperglycaemia and the need for IMV. Survival analysis was performed to assess the effect of hyperglycaemia on outcome within 30 days of hospitalization., Results: Among 1945 patients without diabetes at admission, 1078 (55.4%) had normal glucose levels, 651 (33.5%) had mild hyperglycaemia, 196 (10.1%) had intermittent hyperglycaemia, and 20 (1.0%) had hypoglycaemia. The oddsratio (OR) for IMV in patients with intermittent hyperglycaemia was 4.82 (95% CI 2.70-8.61, p < 0.001), and the OR was 2.00 (95% CI 1.21-3.31, p = 0.007) in those with mild hyperglycaemia compared to patients presenting normal glucose levels. The hazardratio (HR) for 30-day in-hospital mortality in patients with mild hyperglycaemia was 1.62 (95% CI 1.10-2.39, p = 0.015), while the HR was 3.04 (95% CI 2.01-4.60, p < 0.001) in patients with intermittent hyperglycaemia compared to those with normoglycaemia at admission., Conclusions: In COVID-19 patients without pre-existing diabetes, the presence of hyperglycaemia at admission is indicative of COVID-19-induced alterations in glucose metabolism and stress hyperglycaemia. Hyperglycaemia at admission in COVID-19 patients without diabetes is associated with an increased risk of invasive mechanical ventilation and in-hospital mortality. This finding highlights the importance for clinicians to carefully consider and select optimal support and treatment strategies for these patients. Further studies on the long-term consequences of hyperglycaemia in this specific population are warranted.

Background and Objectives : Vertebral artery hypoplasia (VAH) is a controversial risk factor for cerebral infarction. The aim of this study was to analyze the prevalence of vertebral artery hypoplasia and to evaluate its association with vertebrobasilar cerebrovascular accidents. Materials and Methods : The study was conducted in the Neurology Departments of the Republican Vilnius University Hospital from 2015 to 2020. Data of 742 subjects (133 patients with posterior circulation infarction or vertebral artery syndrome (PCI/VAS), 80 patients with anterior circulation infarction (ACI) and 529 control subjects with no symptoms of cerebrovascular accident) were analyzed. Ultrasound examination of the extracranial internal carotid and vertebral arteries (VA) was performed, risk factors were recorded. Results : The mean age of the subjects was 64.51 ± 13.02 years. In subjects with PCI/VAS the diameter of VA was smaller, and the prevalence of VAH was higher compared to those in subjects with ACI and in the control group. A higher degree of VAH in subjects younger than 65 years of age increased the risk of PCI/VAS. Subjects with non-dominant VA diameter of 2.7-2.9 mm had 2.21 times higher risk of PCI/VAS, subjects with non-dominant VA diameter of 2.5-2.6 mm had 2.36 times higher risk of PCI/VAS, and subjects with non-dominant VA diameter of 2.2-2.4 mm had 4.12 times higher risk of PCI/VAS compared with subjects with non-dominant VA diameter of ≥3 mm. Among patients with PCI/VAS those with VAH had lower rates of ischemic heart disease compared with patients with normal VA diameter. There was no difference in the rates of other risk factors between PCI/VAS patients with and without VAH. Conclusions : Vertebral artery hypoplasia is not a rare finding in individuals without symptoms of cerebrovascular accident, but more frequent in patients with vertebrobasilar cerebral infarction or vertebrobasilar artery syndrome. Vertebral artery hypoplasia can be considered a risk factor for posterior circulation infarction in subjects under 65 years of age.

Objective: The aim of this study was to explore the serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3), and to correlate the hormone levels among iNPH patients with their self-reported quality of life before and three months after the surgery., Methods: Twenty-five patients (52% women), mean age 63.5 (SD 9.5) years, were operated on by inserting a VP shunt. Patients with FT3 level ≤3.34 pmol/L were diagnosed as having low T3 syndrome., Results: The changes in thyroid hormones resulted in a U-shaped curve throughout the follow-up period. The significant changes occurred the next day after the surgery, including a decrease in TSH, FT3, and an increase in FT4. Additionally, the decrease occurred in mean FT3 for six patients with preoperative low T3 syndrome. Three months after the surgery, thyroid hormones were restored to their baseline and/or normal values. All six patients with preoperative low T3 syndrome had significant improvement in all SF-36 subscales (except for the role emotional and physical). Patients with preoperative normal high FT3 and low FT4 had increased FT3/FT4 ratio which was associated with deterioration in all SF-36 subscales 3 months after the surgery., Conclusion: Routine assessment of the FT3/FT4 ratio might be a simple and effective tool for the risk stratification of iNPH patients before VP shunt surgery.

Objectives: We aimed to quantitatively assess Evans index (EI) using ultrasonographic optic nerve sheath diameter (ONSD) measurements in supine and upright position in normal pressure hydrocephalus (NPH) patients., Methods: Ultrasonographically ONSD was measured in a supine and upright position before and 4-5 days after the ventriculoperitoneal shunt surgery. The changes of the ONSD between supine and upright positions were calculated as ∆ONSD = sONSD-uONSD and as the variation ONSD&#95;V = 100% × [(sONSD - uONSD)/sONSD]. Multiple linear regression analyses were conducted to assess associations between EI and the variation of ONSD. We derived the mathematical function to predict EI. Bland-Altman analysis was applied to evaluate the accuracy and precision of the EI prediction., Results: Thirteen adult patients (mean age 61.8 ± 11.1 (SD) years; 6 (46%) female) undergone VP shunt implantation for NPH. The mean EI was 0.432 (95% CI, 0.393-0.471) preoperatively and 0.419 (95% CI, 0.373-0.466) postoperatively (p = 0.066). There is a decrease of the ONSD during positional changes from supine to upright position and pre- and postoperative EI correlated with preoperative variation ONSD&#95;V1 (r =  - 0.610 and - 0.648, p < 0.05). The mathematical function for preoperative EI estimation was EI preop  = 0.504 - 0.022 × ONSD&#95;V1 + 0.101 × gender (M = 0; W = 1), (Durbin-Watson value = 1.94), and for postoperative was EI postop  = 0.487 - 0.022 × ONSD&#95;V1 + 0.117 × gender; (Durbin-Watson value 2.23)., Conclusions: Ultrasonographic ONSD measurements in supine and upright position provide a potential method to quantify EI that can be conducted at the bedside., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Objective: CT is able to precisely define the pathological process in COPD. There are a number of previous articles discussing the distribution of emphysema and its connection with pulmonary function tests. However, the results obtained by the researchers are not identical., Purpose: To assess relationships between emphysema and pulmonary function test parameters in COPD patients., Materials and Methods: Fifty-nine patients diagnosed to have COPD underwent chest CT examinations and pulmonary function tests.For the quantitative assessment, percentages of low attenuation volume LAV 950 HU (%) of a both lungs, the right lung, the left lung, and each lobe were obtained. Quantitative CT measurements were compared with forced expiratory volume in 1 s (FEV 1 ), the ratio of FEV 1 to forced vital capacity (FEV 1 /FVC), the diffusing capacity for carbon monoxide ( D Lco) and total lung capacity (TLC)., Results: Except for the right middle lobe and the right upper lobe, respectively, all the quantitative CT measurements showed weak to moderate negative correlations with diffusing capacity ( D Lco) ( r = -0.35 to -0.61, p < 0.05) and weak positive correlations with TLC ( r = 0.34 to 0.44, p < 0.05). Group analysis indicated that LAV -950 HU (%) values of both lungs, right lung, left lung, and each lobe, except for right middle lobe, were increased in patients with GOLD stages 3 and 4 of COPD compared to GOLD stages 1 and 2 ( p < 0.05)., Conclusion: CT measurements of emphysema are significantly related to pulmonary function tests results, particularly D Lco.

Aim: Treatment of craniopharyngiomas remains challenging. The aim of this study was to evaluate results of initial surgical management of craniopharyngiomas via the extended pterional approach., Material and Methods: Nineteen patients (10 female; median age of 23 years; ranging from 10 months to 67 years) undergone initial surgery for craniopharyngiomas through the extended pterional approach. Data were retrospectively collected by reviewing medical records, operative reports and imaging results., Results: The median size of craniopharyngiomas was 3.2 cm (range 1.3 - 4.8). Visual deterioration (n=12) and headache (n=10) were the most common symptoms on admission. After surgery, one patient died due to medical complications, 12 patients developed diabetes insipidus and eight patients developed anterior pituitary dysfunction. Median follow-up period was 9 years (range 2 - 13). Patients with progression of craniopharyngioma (n=5) when compared to patients without progression of craniopharyngioma (n=14) were significantly younger at the time of surgery, had less visual deterioration before surgery and had higher rates of not changed vision after surgery. Children had larger craniopharyngiomas when compared to adults., Conclusion: Initial surgery for craniopharyngioma via the extended pterional approach is a safe and effective treatment option with low postoperative mortality, and acceptable postoperative morbidity and recurrence rate.