Aterosklerotska karotidna bolest Aleksić Shihabi, Anka
Medicus (Zagreb, Croatia : 1992),
05/2022, Letnik:
31, Številka:
1 Moždani udar
Journal Article
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Aterosklerotska bolest arterija glave i vrata uzrokuje 15 % sveukupnih ishemijskih moždanih udara. Kod više od polovice preživjelih uzrokuje invaliditet zbog čega ova bolest predstavlja veliki ...financijski teret za zdravstveni sustav, a time i za cjelokupno društvo. Stoga je važno u liječenju naglasak staviti na proučavanje faktora rizika i prevenciju ove bolesti. Stenoza karotidnih arterija dijeli se prema stupnju na početnu stenozu (do 50 %), umjerenu stenozu (51 – 75 %), značajnu stenozu (76 – 95 %) i pseudookluziju (iznad 95 %). Također se dijeli na simptomatsku i asimptomatsku te se na temelju potonjih parametara određuje model liječenja. Terapija može biti peroralna (antiagregacijska), ali postoji i mogućnost karotidne endarterektomije (CEA) te endovaskularnog postavljanja stenta.
In this retrospective study, data on 3819 stroke patients, 1966 (51.5%) female and 1853 (48.5%) male, treated at Department of Neurology, Sibenik-Knin County General Hospital during the 1996-2005 ...period were analyzed. There were 3417 (89.5%) patients with ischemic stroke and 402 (10.5%) patients with hemorrhagic stroke. Analysis according to age decades revealed the 70-79 age group to account for the greatest number of both ischemic and hemorrhagic stroke patients per year. Stroke risk was found to rise significantly with each age decade irrespective of sex (chi2=7764.19; P=0.0000001). Rural and urban population accounted for 56.9% and 43.1% of all stroke cases, respectively (P=0.0000001). During the study period, the number of stroke cases steadily increased from 313 in 1996 to 422 in 2005 per 112,891 county population, yielding a rise in stroke incidence over years (chi2=24.63; P=0.003). The mean age of stroke patients increased from 72.5 years in 1996 to 74.6 years in 2005. The mean age of ischemic and hemorrhagic stroke patients was 73.2 and 66.7 years, respectively (P=0.0000). The stroke mortality rate increased from 75.2/100,000 in 1996 to 87.7/100,000 in 2000, and then decreased to 66.4/100,000 in 2005. The rate of hospital stroke mortality was reduced from 27.07% (95% CI, 21.62-33.47%) in 1996 to 17.44% (95% CI, 13.72-21.86%) in 2005 (P=0.005159), yielding a hospital mortality decrease by 9.63%. During the four-year study period, 808 patients died from stroke, showing a female predominance (F:M, 59.8% vs. 40.2%; P=0.000003092).
A very rare case of echinococcus cysts of the heart and brain in a 27-year-old man who worked as a butcher, lived on a farm, and had a dog before disease onset. The initial manifestation of hydatid ...disease was anaphylactic shock, the etiology of which remained unknown on initial hospitalization. On rehospitalization, the diagnosis of cardiac hydatidosis was made and the patient underwent surgery. Two years later, reoperation was required for hydatid cyst of the brain and cardiac cyst recurrence. There was no other organ involvement from the disease onset, which is rarely reported. Based on this case, we suggest that echocardiography be performed as a standard method in the diagnosis of anaphylactic reaction of obscure etiology in the areas endemic for hydatidosis, even in the absence of symptoms indicative of cardiac involvement. This especially applies to individuals with occupational or epidemiological exposure to the infection.
Schizophrenia spectrum psychosis is a chronic mental disorder, based on a range of genes whose expression can be altered by different environmental factors.
In this archival and demographic study of ...genetic isolate we show an incidence of schizophrenia spectrum psychosis in a minority population and transmission of schizophrenia spectrum psychosis through several generations of two families in an isolated rural area of Dalmatia from the second half of 19th and the first half of 20th century.
The incidence of schizophrenia spectrum psychosis was between 0.58 and 2.58 per 1000 inhabitants. The genogram of Family 1 shows that out of 182 descendants in six generations, there were 27 people with schizophrenia spectrum psychosis. Schizophrenia spectrum psychosis occurred in two men who were born from a relationship of a mother with her relative. The genogram of Family 2 shows that 19 out of 86 descendants in five generations suffered from schizophreniform psychosis.
The high occurrence of schizophrenia spectrum psychosis in an isolated village in central Dalmatia is in accordance with the results of earlier studies in that region. The fact that psychosis occurs in varying frequency, without obvious regularity, can be explained by the irregular expression of risk genes as well as by exogenous factors which may affect the activity of the key chromosome areas. Occurrence of psychosis in people born from incestuous relationships indicates the importance of genetic factors in the development of the disorder.
A 69-year-old woman, a diabetic, presented to emergency unit for severe back pain that occurred three weeks of her having sustained a fall and blow in the back. Upon admission, she developed elevated ...body temperature, urinary retention and severe paraparesis of lower extremities. Laboratory testing showed increased levels of erythrocyte sedimentation rate (93 mm/h), leukocyte count (18.3 x 10(3)/ mL), C-reactive protein (246.5 mg/L) and liver enzymes, and abundant bacteria in urine sediment. Penicillin-resistant Staphylococcus aureus was isolated in blood culture. Antibiotic therapy according to the antibiotic sensitivity report was introduced. Magnetic resonance of thoracic spine revealed epidural liquid collection compressing the spinal medulla from Th2 to Th7. The patient was transferred to neurosurgery for posterior laminectomy and decompression, along with antibiotic therapy. Microbiology confirmed Staphylococcus aureus in the intraoperative tissue specimen. The patient was discharged from the hospital with mild paraparesis and continuing antibiotic therapy recommended.
Radicular pain syndromes caused by disk herniation are often accompanied by incomplete central cord syndrome. Intensive pain is difficult to control with standard analgesics. Antiepileptics of new ...generation have shown significant efficacy in treating pain syndromes, trigeminal neuralgia, diabetic neuropathy, migraines, etc. The treatment of radicular pain with lamotrigine, a new generation antiepileptic, turned out to be effective in lumbar disk radicular conflicts, justifying its application for resistant pain in cervical segment. In our patient, pain intensity was significantly reduced with gradual titration of lamotrigine to a dose of 200 mg/day. Pain intensity measured by the visual analog scale significantly decreased from 100 to 20 mm during eight weeks of titration. The blood concentration of the drug measured by the method of high performance liquid chromatography was 13.65 micromol/L. The patient's quality of life improved greatly. It is necessary to further evaluate the efficacy of lamotrigine in the treatment of resistant radicular damage.
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.
Stroke is a medical emergency in neurology, and is one of the leading causes of death nowadays. At a recent time, a therapeutic method used in adequate conditions is thrombolysis, a treatment of an ...emerging clot in the brain vascular system by alteplase. The application of alteplase also has a high risk of life threatening conditions.
This is a brief report of a case with thrombolysis complication which manifested as a spleen rupture.
Tension-type headache is one of the most common and most significant primary headaches. Tension-type headache is a very heterogeneous disorder. It can be divided into episodic and chronic ...tension-type headache. The pain is a dull, pressing, tightening, typically band-like sensation. The pain is of non-pulsating quality, the location is bilateral, and there is no nausea, vomiting, phonophobia or photophobia. There are no prodromal symptoms or aura. The pain is mild to moderate and it does not aggravate with routine physical activities. Some patients have increased tenderness of pericranial muscles. Psychological factors are common in tension-type headache. Nitric oxide has an important role in the pathophysiology of chronic tension-type headache. Probably it promotes central sensitization and therefore increases nociception. In differential diagnosis of tension type-headache, all structural and metabolic diseases causing headache have to be ruled out, as well as all other primary headaches. All comorbid and coexistent states should also be considered. In the treatment of tension-type headache, pharmacological and non-pharmacological methods are employed. Analgesics, myorelaxants, anxiolytics and antidepressants are most commonly used, as well as physical therapy, massage, acupuncture, behavioral therapy and psychotherapy. Recently, the applications of botulinum toxin and acupuncture have been described in the treatment and prophylaxis of tension-type headache.
The aim of this study was to assess the efficacy of topiramate in the prevention of tension type headache. Tension type headache is the most common primary headache; the 1-year prevalence is 38%. ...Tension type headache often causes reduced quality of life.
In this study 51 patients were included; the dose of topiramate was gradually increased to 100 mg and patients were followed up for 6 months. The number of days and decrease in headache intensity were measured by the Visual Analog Scale (VAS) from 1 to 10 before and with therapy.
Study results showed a statistically significant decrease in the number of days with headache: the mean number of days before therapy was 13.25 and with therapy 8.65, (p=0,0001). A statistically significant decrease in headache intensity was also observed by VAS scale: before therapy 6.27 and with therapy 3.33 (p=0.0001).
This study showed topiramate to be efficient in the prevention of tension type headache.
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