Pozadina i cilj: Premda je COVID-19 dominantno respiratorna bolest, često je praćen i brojnim neurološkim simptomima. U sklopu sindroma post-COVID-19 bilježimo pojavu različitih simptoma, među njima ...i vrtoglavice, na koje treba obratiti posebnu pozornost u današnjoj otoneurološkoj dijagnostici, jer post-COVID-19 vrtoglavice čine ne mali udio od 12,66% u ukupnom broju pacijenata oboljelih od poremećaja ravnoteže. Ispitanici i metode: U studiji smo obuhvatili 40 pacijenata s vrtoglavicom, razvijenom u sklopu kroničnog sindroma COVID-19, koji su se na pregled javili nakon prosječno oko dva mjeseca od završetka infekcije SARS-CoV-2. Prikazali smo utjecaj bolesti na rezultate laboratorijskih pretraga vestibularnog sustava, među njima na videonistagmografiju (VNG), video head impulse test (vHIT) i vestibularne evocirane mišićne potencijale (VEMP). Rezultati: Među pacijentima je očekivano bila najveća skupina onih s akutnom jednostranom perifernom vestibulopatijom (AUPVP). Značajan udio činili su pacijenti s benignom paroksizmalnom položajnom vrtoglavicom (BPPV), a zabilježeni su i slučajevi vestibularne migrene i Ménièreove bolesti. Laboratorijska vestibulološka dijagnostika pokazala je značajno veći udio patoloških nalaza u dvotoplinskom testu prema Fitzgerald-Hallpikeu učinjenom u sklopu VNG baterije testova, u odnosu na nalaze vHIT i VEMP. Zaključak: Pokazalo se da kalorički test prema Fitzgerald-Hallpikeu koji ispituje vestibularnu funkciju u najnižim dijelovima vestibularnoga frekvencijskog spektra najbolje korelira s različitim oblicima akutnih i kroničnih vestibularnih lezija post-COVID-19, u odnosu na vHIT i VEMP pretrage. Ovo upućuje na zaključak da se u dijagnostici post-COVID-19 vrtoglavica možemo osloniti na Fitzgerald-Hallpikeov kalorički test kao na najpouzdaniji izvor podataka o stanju vestibularnog osjetila.
: The COVID-19 pandemic had a profound impact on medical practice worldwide. In this study, we aimed to investigate the trends of elective spine surgery in our department before and during the ...pandemic.
: Total number of spine procedures due to disc herniation (DH) or spinal stenosis (SS) was collected during 2019-2021 in the Department of Neurosurgery, University Hospital Center Osijek, Croatia. In order to elucidate potential risk factors in the post-pandemic period, demographic data were collected for patients who underwent surgery during 2021.
: In 2020, there was a 22.1% decrease in the number of surgeries compared to 2019 (205 vs. 263), but during 2021 we observed an increase of 36.1% compared to 2020 (279 vs. 205). The mean age of patients in 2021 was 53.14 years (53.14 ± 13.05) with body mass index of 28.31 kg/m
(28.31 ± 4.89). There were 179 overweight patients (74%) and 103 smokers (42.6%). Although male and female patients were equally represented (121 each), there was a significant interaction of weight class and sex (
= 0.013). Patients younger than 65 were more likely to undergo surgery due to DH (
< 0.001), whereas older patients were more likely to suffer from SS (
< 0.001).
: The volume of elective spine surgeries decreased in the first year of the pandemic and increased the following year. Our results suggest that public health policies in the early pandemic period reduced elective surgical procedures, which was followed by a compensatory increase in the following period.
Treatment of glioblastoma is challenging due to its aggressive and highly invasive nature, and no significant advances in survival have been achieved recently. The aim of our retrospective study was ...identification of predictive factors and consequent survival outcome in patients who underwent surgical and oncologic treatment of glioblastoma. The study was conducted at the Department of Neurosurgery, Osijek University Hospital Centre. The authors designed a retrospective cohort study in 63 patients who underwent surgical and oncologic treatment between January 1, 2012 and December 31, 2017. Data were collected by reviewing medical records of the patients with histologically proven glioblastoma. Statistical analysis of study results revealed a significant impact of postoperative radiotherapy (p=0.002) and chemotherapy (p=0.016) on progression-free survival and overall survival (p=0.001 and p=0.009, respectively). Postoperative Karnofsky performance scale (p=0.027) was found to be significant in progression-free survival, and so was the interval between surgery and commencement of oncologic therapy (p=0.049). In conclusion, overall survival and prognosis in the treatment of glioblastoma remain poor, although prompt approach in postoperative adjuvant treatments improved progression-free survival.
We present the case of a 27‐year‐old male who presented with vertigo when pressing the entrance of his right auditory meatus and exposing his right ear to loud noise. A diagnostic procedure revealed ...bilateral labyrinth weakness, which was confirmed by caloric and rotational testing. The ocular vestibular evoked myogenic potentials investigation demonstrated a significant weakness of the right utriculus, whereas the cervical vestibular evoked myogenic potentials were normal, indicating preservation of the saccular response. Radiologic studies did not show evidence of labyrinthine dehiscence. We suspect the newly described association of this clinical syndrome with the previously described histopathology of vestibular atelectasis accounts for these findings.
Laryngoscope, 129:1685–1688, 2019
- A 45-year-old male patient was admitted to the emergency unit due to posterior stab wound of the neck. The knife was directed diagonally from the left to the right side of the neck in the ...dorsoventral axis. The patient was fully conscious upon admission with pain and paresthesia along the upper right extremity. The patient underwent computed tomography (CT) and CT angiography scan of the neck, which revealed the knife blade piercing the left sided neck muscles and through the intervertebral ligaments of the C IV/C V in direction to the contralateral internal carotid artery, vertebral artery and the C5 nerve root. The patient underwent an urgent surgery according to the radiographs. Electromyography was performed during the early postoperative care and revealed an acute lesion of the right-sided C5 nerve root. Postoperative follow-up magnetic resonance imaging revealed intact brachial plexus bundles at the site of injury. Symptoms of reduced muscle strength and limited range of motion of the upper right extremity prevailed. Penetrating neck injuries represent a rare entity of all trauma injuries. Meticulous preoperative radiographs revealed close proximity of the knife blade tip to the right-sided vertebral artery and common carotid artery. Limited abduction at the right shoulder during postoperative period correlated to the C5 nerve root injury.
The aim of our study was to examine the relationship between the mode of coping and health-related quality of life (HRQoL) in patients with migraine. We have also tried to examine the relationship of ...disease duration and the frequency of attacks with HRQoL and the ways of coping with stress. The research was done on a sample consisting of 106 participants (95 women and 11 men); mean age of 40 years (IQR 28–48) with the migraine lasting for 10 years (IRQ 5–20 years). The average number of attacks, over the last month, was two attacks (IRQ 1–3 attacks). Ways of coping questionnaire were used to estimate the mode of coping with stress and SF-36 questionnaire for HRQoL. The result showed the self-control as the most common way of coping with stress in patients with migraine. They also confirmed the existence of a significant connection of ways of coping with stress and HRQoL in people with migraine. There is a larger number of significant correlations of ways of coping connected with the domains of mental health than with the physical health. Escape/avoidance is significantly negatively correlated with the largest number of HRQoL domains, especially with existence of significant mental health (
ρ
= −0.447) and role limitation due to the emotional problems (
ρ
= −0.361). The number of migraine attacks has greater influence on HRQoL in patients with migraine than the disease duration. Our study showed the existence of significant correlations between the ways of coping with stress and HRQoL, especially with mental domains. In some domains, the correlation was even stronger than the one showing the disease duration and the number of attacks. The above-mentioned results suggest the directions in further formulation of psychological interventions that would be helpful for the additional treatment of migraine.
Benign paroxysmal positional vertigo is the most common cause of dizziness in the general population. It is a condition with potential impact of reduced levels of vitamin D on its recurrent attacks.
...The aim of this study was to measure the serum levels of 25-hydroxyvitamin D3 (25-OH D3) in patients with benign paroxysmal positional vertigo and determine whether there is a difference in the serum levels of vitamin D3 between patients with and without recurrence, as well as between the different clinical forms of benign paroxysmal positional vertigo.
The study included 40 patients who came to the regular medical examination, diagnosed with posterior canal-benign paroxysmal positional vertigo based on the positive Dix-Hallpike's test. All patients underwent Epley manoeuvre after the diagnosis. Patients were classified according to current guidelines for levels of vitamin D3 in the serum in three groups: the deficiency, insufficiency and adequate level.
The average serum level of 25-OH D3 among respondents was 20.78ng/mL, indicating a lack or insufficiency of the aforementioned 25-OH D3. According to the levels of 25-OH D3, most patients suffer from deficiency (47.5%). 7 (17.5%) respondents had adequate blood level of 25-OH D3, and 14 (35%) respondents suffer from insufficiency. A significant difference was not found in the serum level of 25-OH D3 between patients with and without benign paroxysmal positional vertigo recurrence. There was a significant difference in the serum levels of 25-OH D3 in comparison to the clinical form of the disease. Lower 25-OH D3 values were found in patients with canalithiasis compared to those with cupulolithiasis.
There were no significant differences in the vitamin D3 serum level in patients with and without recurrence. The study showed a low level of serum vitamin D3 in most patients, indicating the need for supplemental therapy.
Vertigem posicional paroxística benigna é a causa mais comum de tonturas na população em geral. É uma condição no qual níveis reduzidos de vitamina D podem ter um potencial impacto para o desenvolvimento de crises recorrentes.
O objetivo desse estudo foi medir os níveis séricos de 25-hidroxivitamina D3 (25-OH D3) em pacientes com vertigem posicional paroxística benigna e determinar se há diferença nos níveis séricos de vitamina D3 entre pacientes com e sem recorrência, bem como entre as diferentes formas clínicas de vertigem posicional paroxística benigna.
O estudo incluiu 40 pacientes submetidos a exame médico regular, diagnosticados com vertigem posicional paroxística benigna de canal posterior baseado no resultado positivo do teste de Dix-Hallpike. Todos os pacientes foram submetidos à manobra de Epley após o diagnóstico. Os pacientes foram classificados de acordo com as diretrizes atuais para os níveis de vitamina D3 sérica em três grupos: deficiência, insuficiência e nível adequado.
O nível sérico médio de 25-OH D3 entre os indivíduos avaliados foi de 20,78ng/mL, indicando falta ou insuficiência desta vitamina. De acordo com os níveis de 25-OH D3, a maioria dos pacientes apresentou deficiência (47,5%). Sete indivíduos (17,5%) entrevistados tinham nível sanguíneo adequado de 25-OH D3 e 14 (35%) apresentavam insuficiência. Não foi encontrada diferença significativa no nível sérico de 25-OH D3 entre pacientes com e sem recidiva de vertigem posicional paroxística benigna. Houve uma diferença significativa nos níveis séricos de 25-OH D3 de acordo com a forma clínica da doença. Baixos níveis de 25-OH D3 foram mais encontrados em pacientes com canalitíase em comparação com aqueles com cupulolitíase.
Não houve diferenças significativas no nível sérico de vitamina D3 em pacientes com e sem recorrência. O estudo mostrou um baixo nível de vitamina D3 sérica na maioria dos pacientes, indicando a necessidade de terapia suplementar.
Ocular vestibular evoked myogenic potentials (oVEMP) and cervical VEMP (cVEMP) are newer diagnostic methods, which allow an insight into the otolith senses. Our aim was to determine changes in ...certain parameters of the VEMP wave complex after successfully performed repositioning procedure, as an indicator of the state of recovery in patients with benign paroxysmal positional vertigo (BPPV). This may confirm the theory of otolith returning into the area of otolithic senses. The study included 48 patients with unilateral posterior semicircular canal BPPV. On their first arrival, otoneurological examinations, oVEMP and cVEMP tests were performed. The same were included in follow up check-ups scheduled at seven days and six months after successful implementation of Epley maneuvers. The initial measurement revealed a significantly reduced amplitude of oVEMP on the affected side. On the 7-day measurement, the amplitude increase was observed on the affected side, with significant reduction in the amplitude ratio (p=0.693), which reached statistical significance on the last measurement at 6 months (p=0.006). These findings confirmed the hypothesis of the return of otoconia into the utricular area.
Impaired cerebrovascular reactivity (CVR) is associated with stroke. Cerebrovascular diseases are common comorbidity in chronic obstructive pulmonary disease (COPD) patients. The aim of our study was ...to quantify CVR in the anterior and posterior cerebral circulation during voluntary breath-holding in COPD patients according to airflow limitation severity. In this cross-sectional study, we compared 90 COPD patients without previous cerebrovascular disease and 30 age- and sex-matched healthy volunteers (mean age 67 ± 7.9, 87 males). Using transcranial Doppler ultrasound and breath-holding index (BHI), we analysed baseline mean flow velocities (MFV) and CVR of middle cerebral artery (MCA) and basilar artery (BA). Our results demonstrated that COPD patients had lower baseline MFV of both MCA and BA than controls. COPD patients had significantly lower BHI
m
MCA and BHI
m
BA than controls (0.8 and 0.7 versus 1.24 and 1.07, respectively;
p
< 0.001). With the severity of airflow obstruction, there were significant declines of BHI
m
MCA and BHI
m
BA in mild (0.94 and 0.83), moderate (0.8 and 0.7) and severe to very severe COPD (0.7 and 0.6), respectively (
p
< 0.001). For all participants, we found a significant and positive correlation between forced expiratory volume in one second (FEV
1
) and BHI
m
MCA (Rho = 0.761,
p
< 0.001) and between FEV
1
and BHI
m
BA (Rho = 0.409,
p
< 0.001). COPD patients have impaired CVR in anterior and posterior cerebral circulation. Impairment of CVR increase with the airflow limitation severity. CVR is an appropriate marker to identify vulnerable COPD subjects at high risk to develop cerebrovascular disease. Prospective studies are needed for further evaluation.
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