Cilj: Autori prikazuju dva medicinski zanimljiva portreta poznatoga hrvatskog slikara Mata Celestina Medovića, s ciljem rasprave o mogućnostima dijagnosticiranja obostrane blefaroptoze prikazanih ...osoba. Materijal i metode: Portreti su analizirani u skladu s postulatima ikonodijagnostike. S diferencijalno-dijagnostičkog aspekta prikazani su hipotetski uzroci stečene, obostrane blefaroptoze. Također je analiziran prikaz ovog kliničkog znaka na djelima
poznatih europskih slikara 14. – 20. stoljeća te hrvatskih slikara 19. – 20. stoljeća. Rezultati: Mogući uzrok ptoze na Portretu starice mogao bi biti aponeurotski, uzrokovan atrofijom mišića gornje vjeđe. Ne može se sa sigurnošću isključiti niti okularni oblik miastenije gravis. Mogući uzrok blefaroptoze na Portretu Konavoke je miastenija gravis s pozitivnim antitijelima na mišić-specifičnu tirozin kinazu, s obzirom na evidentnu atrofiju lijevog m. massetera. U oba slučaja može se raditi i o miogenoj blefaroptozi uzrokovanoj okularnom miopatijom ili okulofaringelanom mišićnom distrofijom. Ostali mogući uzroci blefaroptoze kod portretiranih žena isključeni su s većom ili manjom sigurnošću. Analogno principima medicine temeljene na dokazima, zaključci ikonodijagnostičke analize klasificiraju se u skupine: A (gotovo sigurno), B (vjerojatno), C (nesigurno), D (nevjerojatno) i E (nemoguće). Zaključak prikazane analize pripadao bi skupini B, što znači da su naša zapažanja „vjerojatno točna“, uzevši u obzir da se ista temelje isključivo na kliničkim zapažanjima, bez uvida u povijesne okolnosti ili dokumente koji bi to mogli potvrditi. Komparativnom analizom prisutnosti kliničkog znaka ptoze na djelima poznatih europskih slikara od 14. do 20. stoljeća isti smo detektirali na ukupno jedanaest slika. Na djelima hrvatskih majstora 19. i 20. stoljeća ptoza je detektirana na četiri slike i jednoj
brončanoj bisti. Zaključak: Ovaj rad nas podsjeća na važnost poznavanja kliničke propedeutike, nasuprot danas prevladavajućem medicinsko-tehnološkom pristupu koji favorizira brojne, često nepotrebne procedure u procesu postavljanja dijagnoze. Možda tzv. „muzejske vizite“, s ciljem poboljšanja sposobnosti uočavanja kliničkih znakova na umjetničkim slikama od strane studenata medicine, jednom postanu i dio nastavnog programa na hrvatskim sveučilištima.
Dear Editor, Although some of my colleagues may find this surprising, as a neurologist, I have noticed many connections between dermatology and neurology. Neurological and dermatological signs and ...symptoms are common in many clinical entities, especially in the so-called phakomatoses or neurocutaneous syndromes (Von Recklinghausen's disease type 1 and 2, Bourneville-Pringle syndrome, Sturge-Weber syndrome, Von Hippel-Lindau syndrome, Louis-Bar syndrome) (1). The terms "neurodermatitis" and "neurodermatology" also confirm the above. Inspection is the basis of every clinical examination and an integral part of both dermatological and neurological propaedeutics. Therefore, I would like to remind your readers of Frank's sign, another link between dermatology and neurology. Frank's sign is a diagonal earlobe crease (DELC) that extends backwards from the tragus at a 45-degree angle across the lobule to the auricular edge of the ear (Figure 1). It has been described as a dermatological marker for atherosclerosis. Frank's sign is named after Dr. Sanders T. Frank, who observed this crease in 20 patients with coronary artery disease and published his findings in The New England Journal of Medicine in 1973 (2). Although this sign has been known for more than 50 years, it is still not routinely employed in clinical practice. Histopathological examination of DELC-positive earlobes revealed myoelastofibrosis in the arterial vessel at the base of the earlobe, indicating that DELC is not a coincidental finding but is directly related to atherosclerosis (3). Following the finding of DELC in patients with coronary artery disease, numerous studies have confirmed the presence of DELC in peripheral vascular disease as well as cerebrovascular disease. I encountered the description of this sign as a student in the textbook of Internal Medicine in 1991 (4). This sign was also the subject of research by Croatian authors. In 1998, Mirić et al. found that a positive Frank's sign carried a higher risk of heart attack (5,6). In 2008, Glavić et al. found a statistically significant association between Frank's sign and an increase in intima media thickness (IMT) of the common carotid artery as a surrogate marker of atherosclerosis, thus confirming the hypothesis that Frank's sign is an uncontrollable risk factor for cerebrovascular disease (such as gender or age) (7). In clinical practice, earlobe inspection should be considered an integral part of the physical examination. In the case of a positive Frank's sign, a color Doppler ultrasound examination of the neck arteries and a cardiologist's examination are recommended. The determination of Frank's sign can be used as a method of primary prevention for cardiovascular and cerebrovascular diseases.
Even though the classical clinical concept supports the clear difference between diseases affecting the central and peripheral nervous systems, this difference is becoming less rigid. Here, we report ...the case of a 50-year-old male patient who presented with acroparaesthesia, headache, and flaccid tetraparesis after febrile diarrhea. Nerve conduction studies indicated action potentials with low amplitudes, which are typical in acute motor and sensory axonal neuropathy. Magnetic resonance revealed a round lesion in the splenium consistent with a diagnosis of reversible splenial lesion syndrome. A polyclonal antiganglioside antibody response was detected. The patient was successfully treated with intravenous immunoglobulins. The coexistence of reversible splenial lesion syndrome and acute motor and sensory axonal neuropathy has not been described in the literature so far. We discuss our diagnostic dilemmas and the possible role of antiganglioside antibodies in the occurrence of simultaneous lesions of the central and peripheral nervous systems.
•Reversible splenial lesion syndrome is characterized by transient cytotoxic lesions.•Antiganglioside antibodies are positive in the axonal form of Guillain-Barré syndrome.•Guillain-Barré syndrome may affect the peripheral and central nervous systems.
Uloga EMNG-a u neurološkoj praksi Čerimagić, Denis
Medicus (Zagreb, Croatia : 1992),
02/2019, Letnik:
28, Številka:
1 Neurologija
Journal Article
Recenzirano
Odprti dostop
Elektromioneurografija je dijagnostička metoda sastavljena od dvije komponente: elektromiografije i elektroneurografije. Elektroneurografijom određujemo brzine provodljivosti ispitivanih živaca, a ...elektromiografijom registriramo mišićnu aktivnost. Ova je metoda „zlatni standard“ u dijagnostici različitih neuroloških poremećaja. Klinička elektromioneurografija ne može se standardizirati poput EKG-a ili EEG-a, jer se temelji na detaljnome prethodnom kliničkom neurološkom pregledu te na razmatranju različitih diferencijalnodijagnostičkih mogućnosti koje iz njega proizlaze. Interpretacija rezultata elektromioneurografske obrade podrazumijeva dobro poznavanje neuroanatomije i kliničko iskustvo iz područja neuromuskularnih bolesti.
Complex regional pain syndrome type I (CRPS I) is a disorder of one or more extremities characterized by pain, abnormal sensitivity (allodynia), swelling, limited range of motion, vasomotor ...instability, fatigue and emotional distress. The symptoms may be aggravated by even minor activity or weather change. It is usually provoked by injury, surgery or injection but in a small proportion of patients CRPS I develops without a clear causative event. There are several literature reports on CRPS after rubella and hepatitis B vaccination. We present a case of CRPS I affecting the left arm after diphtheria and tetanus (Di-Te) vaccination in the left deltoid muscle in a young girl having experienced profound emotional stress before the vaccination procedure. History data on previous minor trauma at the site of vaccination or emotional stress may necessitate temporary vaccination delay due to their proneness to impaired local or systemic immune response and CRPS as a complication of vaccination. If a child or an adult has prominent swelling and severe pain after vaccination, the diagnosis of CRPS I should be considered and if confirmed, the multidisciplinary treatment should start as soon as possible.
Neurological ZOO Čerimagić, Denis; Bilić, Ervina; Kuliš, Borka
Rad Hrvatske akademije znanosti i umjetnosti (1991). Medicinske znanosti,
06/2021, Letnik:
547, Številka:
54-55
Journal Article
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