Epidemiology of stroke KADOJIĆ, DRAGUTIN; DIKANOVIĆ, MARINKO; BITUNJAC, MILAN ...
Periodicum biologorum,
09/2012, Letnik:
114, Številka:
3
Journal Article
Odprti dostop
The epidemiology of stroke may be changing over time as a result of a
number of factors, including an aging population and advances in the prevention and treatment of stroke. Epidemiological ...indicators and research of stroke have great significance in estimating the impact of this disease on the population. Such research states the distribution of this illness and factors by which it is influenced, follows short-term and long-term consequences, as well as socio-economic burden of stroke for the whole community.
Data on stroke prevalence is important for creating the right strategies for health care in a specific area. Stroke-relatedmortality in any population is dependent upon three main factors: the incidence of stroke in the population, quality ofmedical care available, and the prevalence of cardiovascular diseases and comorbidities that can affect the likelihood of surviving stroke events. The quality of medical care available influences both the number of individuals suffering from stroke and the proportion of case-fatality among them.
Epidemiological data shows that stroke is one of the leading causes of
death and long-term disability in most industrialized populations, and the
same is true for Croatia. The existing systemof health care for stroke patients does not meet the needs and is not in accordance with latest trends in developed countries.Hence, there is a need for its reorganization and design of the national project for stroke prevention and treatment similar to those in European countries with favorable epidemiological data.
Cognitive abilities have great impact on rehabilitation program in stroke patients. Therefore, fast and practical psychometric assessment as an indicator of individual rehabilitation program is of ...great importance. The aim of this study was to analyze and compare motor and cognitive impairment in stroke patients in acute, subacute and chronic phase of the disease, taking age, sex, education, stroke risk factors, lateralization and type of stroke in consideration. The study included 50 stroke patients, 33 male and 17 female. Ischemic stroke was diagnosed in 78% and hemorrhagic stroke in 22% of patients. Hypertension was the leading stroke risk factor in 82% of patients. Cognitive impairment in acute, subacute and chronic phase of the disease was noticed in 12% of stroke patients with ischemia in the left brain hemisphere, mMMSE average score 31 and SKT score 19, IQ under 90. Better motor recovery in acute and subacute phase of stroke was followed by better cognitive status. All cognitively impaired stroke patients had low level of education, some had accomplished elementary education and others had not, all much below the dementia risk age of 75 years. Exclusion of patients with severe stroke from the study led to overestimation of the results. Finally, a coherent algorithm for somatic and cognitive stroke assessment in stroke patients poses itself as an imperative as a guideline for plastic, individualized and appropriate rehabilitation.
Multiple sclerosis is a chronic, immune-mediated disease of the central nervous system that typically strikes young adults. It is often associated with a wide range of functional deficits and ...progressive disability. Common symptoms of multiple sclerosis include vision problems, spasticity, weakness, ataxia, bladder and bowel dysfunctions, fatigue, pain syndromes, tremors, vertigo, cognitive impairment, and mood disorders. Multiple sclerosis has a major negative impact on patient health-related quality of life (HRQoL). Quality of life (QoL) is a multidimensional construct composed of functional, physical, emotional, social and spiritual well-being. Researches have reported that individuals with multiple sclerosis have lower QoL than non-diseased and diseased populations. The inclusion of HRQoL questionnaires in the patient follow-up is a relevant issue to optimize treatment, facilitate treatment decisions and improve adherence, as well as to reduce the inconveniences derived from medication such as side effects.
A case is described of a 72-year-old woman that presented to our outpatient neurology clinic complaining of relapsing attacks of severe pain in and around the left ear and ipsilateral side of the ...face, accompanied by objectively visible cutaneous erythema with burning sensation throughout the attack. There was no alteration in her neurologic status. Comprehensive tests were done to exclude the possible primary diseases. The findings were within the limits of physiological values. Attempts at treating the pain with various analgesics and a combination of analgesics and first generation anticonvulsants did not prove effective. The pain was slightly relieved with pregabalin in maximum dosage. Because of various potential pathophysiological mechanisms, literature does not indicate any unique potential treatment approach, and some patients are resistant to any kind of therapy.
SAŽETAK
Međunarodne smjernice za farmakološko liječenje epilepsija općenite su, sveobuhvatne i ne prepoznaju lokalne specifičnosti poput ekonomskih i tehničkih mogućnosti u pojedinim državama, ...dostupnosti pojedinih antiepileptika ili drugih metoda liječenja i slično. Stoga se nameće potreba izrade nacionalnih smjernica, čiji su zapravo temelj međunarodne smjernice Internacionalne lige protiv epilepsije. Hrvatske smjernice za farmakološko liječenje epilepsija plod su suradnje svih relevantnih stručnih društava i referentnih centara u RH, na čelu s Hrvatskom ligom protiv epilepsije te Hrvatskim neurološkim društvom i Hrvatskim društvom za dječju neurologiju Hrvatskoga liječničkog zbora, a odražavaju aktualne socioekonomske i regulatorne specifičnosti u našoj zemlji, najnovije spoznaje farmakoloških profila i učinkovitosti pojedinih antiepileptika kao i ekspertna mišljenja. Antiepileptička terapija se uvodi nakon postavljanja dijagnoze epilepsije, stoga profilaktička primjena nije opravdana. Nakon postavljanja dijagnoze potrebno je bolesnika informirati o prognozi bolesti, mogućnostima liječenja i samopomoći, životnim ograničenjima te mogućim neželjenim događajima. Ciljevi farmakoterapije epilepsija su potpuna kontrola napada uz izbjegavanje nuspojava te održavanje ili poboljšanje kvalitete života. Zlatni standard liječenja je monoterapija odnosno primjena adekvatnog antiepileptika u adekvatnoj dozi. Izbor i titracija lijeka su individualni, a temelje se na smjernicama za liječenje pojedinih vrsta napada, karakteristikama bolesnika i regulatorno specifičnim čimbenicima. Nakon neuspjeha inicijalne monoterapije, potrebna je reevalucija anamnestičkih i dijagnostičkih podataka te potom postupna i spora zamjena antiepileptika. Racionalna politerapija podrazumijeva kombinaciju dvaju antiepileptika različitih mehanizama djelovanja, prvog ili eventualno drugog izbora za postavljenju dijagnozu, niskoga interakcijskog potencijala, različitog profila nuspojava i sinergističkog ili aditivnog djelovanja. Zamjena generičkih ili originalnog i generičkog oblika lijeka nije preporučljiva, a poglavito nakon postizanja remisije ili prilikom uzimanja visokih doza lijeka. Ukidanje antiepileptičke terapije treba biti postupno i sporo, u slučaju politerapije jedan po jedan lijek, a u donošenju odluke o ukidanju, kao i o uvođenju antiepileptika, mora biti uključen bolesnik i njegova obitelj.
The aim of our study was to assess cerebral vasoreactivity (CVR) in type 2 diabetes mellitus (DM2) and factors which may influence on it. According to previous studies, evaluating CVR in DM2 on the ...similar way, the results were dubious. For the evaluation CVR we used breath holding index (BHI) and transcranial Doppler ultrasound (TCD) in 50 patients with DM2 and 50 sex- and age-matched healthy controls. We observed epidemiologic and clinic data, other vascular risk factors and laboratory parameters. We found statistically significant difference in BHI between patients with DM2 (BHI = 0.69 +/- 0.31) and age- and sex-matched healthy controls (BHI = 1.33+/-0.28) (p < 0.05 ). Because of a significant correlation between BHI and age (p < 0.001) in healthy controls we made an adjustment of BHI for age before further analyses (BHIadj). In DM2 group we found a significant correlation between BHIadj and age (p = 0.0004), fasting glycemia (p = 0.04), and albuminuria (p = 0.04) (creatinine clearance in multivariate analysis (p = 0.007)). Our study has shown that CVR is impaired in DM2 patients and that it's severity was associated with age, fasting glycemia and renal function. Functional TCD is a very good screening method for detection and monitoring of cerebral microangiopathic changes in DM2 patients.
The aim of the study was to assess the possible correlation between catecholamine and cortisol levels and changes in cerebral hemodynamics in patients with chronic posttraumatic stress disorder ...(PTSD). The study included 50 patients with chronic PTSD first ever hospitalized for psychiatric treatment and 50 healthy control subjects. All study subjects were aged 30-50. In PTSD patients, 24-h urine levels of the epinephrine and norepinephrine metabolites vanillylmandelic acid (VMA) and cortisol were determined and transcranial Doppler ultrasonography was performed on day 1 of hospital stay and repeated after 21-day psychiatric medicamentous treatment. On initial testing, increased level of 24-h VMA, decreased cortisol level and elevated mean blood flow velocity (MBFV) in the circle of Willis vessels were recorded in 25 (50.00%) patients. Repeat findings obtained after 21-day psychopharmaceutical therapy showed increased 24-h VMA, decreased cortisol and elevated MBFV in the circle of Willis vessels in seven (14.00%) patients (initial vs. repeat testing, P = 0.0002). Such parameters were not recorded in any of the control subjects (initial PTSD patient testing vs. control group, P = 0.0000). Study results pointed to a significant correlation between increased catecholamine levels, decreased cortisol level and elevated MBFV in the circle of Willis vessels caused by cerebral vasospasm. Psychiatric medicamentous therapy administered for three weeks significantly reduced the proportion of patients with concurrently altered cerebral hemodynamics, increased levels of catecholamine metabolites and decreased level of cortisol.
Multipla skleroza je kronična, imuno posredovana bolest središnjega živčanog sustava, koja obično pogađa odrasle ljude mlađe životne dobi. Često je povezana sa širokim rasponom funkcionalnog deficita ...i progresivne nesposobnosti. Uobičajeni simptomi multiple skleroze su smetnje vida, spastičnost, slabost, ataksija, smetnje kontrole mokrenja i stolice, umor, bolni sindromi, tremor, vrtoglavica, pogoršanje kognitivnih funkcija i poremećaji raspoloženja. Multipla skleroza ima značajan negativan utjecaj na kvalitetu života oboljelih od ove bolesti. Kvaliteta života je multidimenzionalna formulacija sastavljena od funkcionalnih, fizičkih, emocionalnih, socijalnih i duhovnih čimbenika zdravlja. Istraživanja su pokazala da oboljeli od multiple skleroze imaju nižu kvalitetu života od zdrave populacije i oboljelih od nekih drugih kroničnih bolesti. Uključivanje upitnika o kvaliteti života u praćenju bolesnika je važno u optimiziranju liječenja, određivanju i odlučivanju o vrsti liječenja i poboljšanju suradljivosti, kao i u smanjenju neugodnosti koje proizlaze iz liječenja, kao što je primjerice pojava nuspojava primijenjenih lijekova.
Cilj ovih smjernica bio je predati najnovije, sistematizirane spoznaje kliničarima koji se bave zbrinjavanjem odraslih bolesnika s akutnim ishemijskim moždanim udarom. Preveli smo Američke smjernice ...za liječenje akutnog ishemijskog moždanog udara, koje su izdane 2018. godine od American Heart Association (AHA) i American Stroke Association (ASA) s ciljem prilagodbe hrvatskom zakonodavstvu i zdravstvenom sustavu. Članovi radne skupine Hrvatskog društva za neurovaskularne poremećaje Hrvatskog liječničkog zbora i Hrvatskog društva za moždani udar usmjerili su posebnu pozornost na pregled dosadašnjih spoznaja i prilagodili ih aktualnom stanju u nacionalnom zdravstvenom sustavu kako bi se postiglo optimalno zbrinjavanje bolesnika s akutnim ishemijskim moždanim udarom u Hrvatskoj. Ove smjernice obuhvaćaju prehospitalnu skrb, hitnu evaluaciju te liječenje intravenskom i intraarterijskom terapijom uključujući mjere sekundarne prevencije prigodom inicijalne hospitalizacije u odraslih pacijenata s akutnim moždanim udarom.
Kako kognitivne sposobnosti u velikoj mjeri utječu na rehabilitacijski program bolesnika s moždanim udarom (MU), veliko je značenje brze i praktične psihometrijske prosudbe kao indikatora ...individualnog rehabilitacijskog programa. Cilj istraživanja je bio analizirati i usporediti motorički i kognitivni deficit u bolesnika s MU u akutnoj, subakutnoj i kroničnoj fazi bolesti, uvažavajući pritom dob, spol, obrazovanje, čimbenike rizika za MU, lateralizaciju i vrstu MU. Istraživanje je obuhvatilo 50 bolesnika s MU, 33 muškarca i 17 žena. Nađeno je 78% bolesnika s ishemijskim MU i 22% s hemoragijskim MU. Hipertenzija se pokazala vodećim čimbenikom rizika za MU (82%). Kognitivni deficit u akutnoj, subakutnoj i kroničnoj fazi zabilježen je u 12% bolesnika s ishemijskim MU u lijevoj moždanoj hemisferi, s prosječnim zbirom na ljestvici mMMSE 31 i na ljestvici SKT 19, IQ ispod 90. Nakon boljeg motoričkog oporavka u akutnoj i subakutnoj fazi MU uslijedilo je poboljšanje kognitivnog statusa. Svi bolesnici s kognitivnim oštećenjem bili su niske naobrazbe sa završenim i nezavršenim osnovnim obrazovanjem, znatno mlađi od rizične dobi za mogući razvoj demencije (75 godina). Isključenje iz istraživanja najtežih bolesnika s MU svakako je utjecalo na precijenjenost rezultata. U konačnici nameće se neophodnost koherentnog algoritma somatske i kognitivne procjene statusa bolesnika s MU, koja bi plastično oblikovala kvalitetnu rehabilitaciju.
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