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.
Foot drop represents a very common reason for a neurologist referral and is often first seen in emergency departments or by a general practitioner. This condition is defined as weakness of ankle ...dorsiflexion (mainly through tibialis anterior muscle weakness). The most common causes include lower motor neuron lesion, with L4-L5 radiculopathy and peroneal neuropathy being the most frequent ones. Classical diagnostic pathway includes a thorough medical history, detailed neurological examination, radiological studies (MRI of the lumbosacral spine), EMG and nerve conduction studies, and a battery of laboratory tests. The absence of abnormal radiological and neurophysiological findings when searching for the most common causes of foot drop, should raise a red flag and broaden the diagnostic yield for central nervous system pathology (upper motor neuron, UMN) as a possible cause of foot drop. Central causes of isolated foot drop are very rare, with less than 20 cases reported in literature so far, and seven of them being a meningioma. We present a case of a 79-year-old female patient with an isolated foot drop (with no UMN signs on the initial examination) and parasagittal meningioma. Central causes of foot drop should be suspected when foot drop is associated with UMN signs on examination (hyperreflexia of the patellar or ankle jerk and extensor plantar reflex) and when standard diagnostic work-up (MRI of the lumbar spine, EMG and NCS, standard laboratory screening for most common causes of foot drop) is negative or inconclusive. Although very rare, central lesions present a far more serious cause of foot drop and require a more urgent diagnostic work up and a potential neurosurgical referral and treatment. Keeping in mind the possible central causes of foot drop would eliminate unnecessary diagnostic work up and avoid delayed diagnosis and treatment.
Neurosyphilis: The shape of a rising threat Blažeković, Antonela; Ozretić, David; Habek, Mario ...
International journal of infectious diseases,
November 2018, 2018-Nov, 2018-11-00, 2018-11-01, Volume:
76
Journal Article
Peer reviewed
Open access
•Identifying the cause of neuropsychiatric symptoms at an early stage is crucial.•Neurosyphilis should be considered in subjects with neuropsychiatric manifestations.•The diagnosis is challenging due ...to non-specific symptoms and unclear laboratory results.•The role of neuroimaging methods in the diagnosis of unclear dementia is increasing.•Neurosyphilis should be considered in cases of dural thickening.
This report describes a case of neurosyphilis presenting with memory disturbances, attention deficit, and acute psychotic decompensation in an immunocompetent man. Despite the known connection of neurosyphilis with psychiatric symptoms, this cause often remains unrecognized. This report emphasizes the importance of maintaining a suspicion for the disease in patients with vague symptoms and describes the diagnostic difficulties.
Intracranial aneurysms have a prevalence of about 2% of the population. They are a common incidental finding of noninvasive neuroimaging methods, raising the question of the necessity of treatment of ...patients with an asymptomatic intracranial aneurysm. For long, the only treatment option was surgical clipping of aneurysm neck. In the last 25 years, endovascular techniques have been developed as an alternative solution for patients who are not eligible for neurosurgical procedures. Research has shown better results of embolization procedures with lower rates of complications, but a higher rate of recanalization is still a major drawback of endovascular coiling. There are no strict protocols and the treatment of choice for intracranial aneurysms should be agreed upon by both the physician and the patient. This review aims to provide an insight into the management of intracerebral aneurysms with emphasis on the decision making problems faced by clinicians.
Anderson-Fabryjeva bolest metabolička je bolest nakupljanja glikolipida u lizosomima. Multidisiciplinarni pristup neophodan je za rano prepoznavanje, liječenje i prevenciju komplikacija u oboljelih. ...Ove smjernice nadopuna su smjernica publiciranih u ime Referentnog centra za rijetke i metaboličke bolesti 2014. godine u Liječničkom vjesniku s obzirom na nove dijagnostičke postupke, biljege i terapijske opcije, suradnjom specijalista iz centara izvrsnosti te multidisciplinarnog tima Referentnog centra za rijetke i metaboličke bolesti odraslih Ministarstva zdravstva Republike Hrvatske. Smjernice su prezentirane na godišnjem sastanku Hrvatskog društva za rijetke bolesti Hrvatskoga liječničkog zbora te su jednoglasno prihvaćene.
•Isolated hypoglossal nerve palsy (HNP) is a rare condition.•Causes of isolated HNP include tumours, trauma, stroke, surgery and infections.•Isolated HNP typically resolves spontaneously within ...months.•Extended work-up is necessary to rule out reversible and treatable causes of HNP.•This case report highlights a potential link between tongue angioedema and HNP.
We aimed to provide insights into transverse myelitis (TM) following COVID-19 by analyzing cases treated at tertiary care neurology centers and a systemic review of the literature.
The retrospective ...observational multi-center study was conducted at the four university neurology departments in Croatia, Slovenia, Serbia, and Austria. We searched for acute myelitis cases that occurred during or after COVID-19. A systemic review of the literature on COVID-19 and transverse myelitis was performed.
We identified 76 persons with TM associated with COVID-19, 13 from the multi-center study and 63 from the literature review. Most of the participants (55.6%) had an intermediate latency, 25.4% had short and 19% long latency from COVID-19 symptoms to TM. The clinical presentation consisted of the typical TM signs. More than half of the participants had inflammatory changes in the CSF, with rare patients having intrathecal OCB synthesis and positive serology for anti-MOG or anti-AQP4 antibodies. Persons with autonomic symptoms and CSF pleocytosis were significantly more common to have an intermediate latency of 8 to 21 days from COVID-19 to TM (p = 0.005 and p = 0.003; respectively). According to logistic regression analysis, only participants with lesions evident on spinal cord MRI compared to normal spinal cord MRI had reduced risks for poor recovery. >80% of participants were treated with a combination of corticosteroids and intravenous immunoglobulins or plasma exchange with 73% having incomplete recovery.
Our study further characterizes clinical, laboratory, and MRI features, as well as treatment of TM associated with COVID-19.
•Inflammatory changes in the CSF are present in up to half of persons with TM following COVID-19.•Intrathecal OCB synthesis and positive serology for anti-MOG or anti AQP4 antibodies are rare.•Spinal cord MRI may be normal in up to 30% of persons with TM following COVID-19and these patients have a poorer prognosis.
Coronavirus disease 2019 (COVID-19) vaccines have been reported as possible triggers of the production of antibodies pathogenic to the peripheral nerve and neuromuscular junction. We report on a ...patient who experienced vertical diplopia three weeks after the booster dose of the Pfizer-BioNTech vaccine (Comirnaty®). The diagnosis of myasthenia gravis (MG) was established based on highly positive antibodies to the nicotinic acetylcholine receptor (nAChR). Treatment with pyridostigmine and prednisone was started with gradually raising doses. On a follow-up exam two months after treatment initiation, clinical improvement was noted with an almost normal bulbomotor examination. The occurrence of diplopia following COVID-19 vaccination should raise suspicion of new-onset ocular MG and testing for anti-nAChR antibodies is advised.
•a new system to detect early mild cognitive impairment (MCI) is introduced.•the system is based on a hidden goal task (HGT) test.•HGT testing consists of egocentric, allocentric, and combined ...variants.•significant differences were observed between MCI and healthy controls.•high negative predictive values suggested strong screening potential for HGT.
There is a need for highly sensitive and specific tests and biomarkers that would allow preclinical diagnosis of mild cognitive impairment (MCI) and Alzheimer's disease (AD), which would also enable timely intervention.
We have developed a new system (ALZENTIA) to help detect early MCI, mainly caused by AD. The system is based on a hidden-goal task (HGT) in which the human subject has to find a target that is not visible; as such, the navigation is based on a previously memorized target position, in relation to the starting position (egocentric variant) and/or other navigational landmarks (allocentric variant of the task). We present our preliminary results obtained in 33 patients with MCI and 91 healthy controls (HC).
Between-group differences in the average error measured in allocentric, egocentric, and combined allocentric-egocentric subtests were statistically significant in MCI compared to HC. The high negative predictive values suggested high discriminative capacity and diagnostic potential for the HGT test as a tool to detect subjects in healthy population who will progress to MCI. Considering the low sensitivity of the Mini-Mental Status Examination and Montreal Cognitive Assessment tests, we believe that HGT can improve early identification of MCI patients who will progress to AD.
The HGT carried out with the ALZENTIA system proved to be a reliable screening test to identify individuals with MCI from an aging cohort.
Chronic graft-versus-host disease (GVHD) can be associated with significant morbidity, in part because of nonreversible fibrosis, which impacts physical functioning (eye, skin, lung manifestations) ...and mortality (lung, gastrointestinal manifestations). Progress in preventing severe morbidity and mortality associated with chronic GVHD is limited by a complex and incompletely understood disease biology and a lack of prognostic biomarkers. Likewise, treatment advances for highly morbid manifestations remain hindered by the absence of effective organ-specific approaches targeting "irreversible" fibrotic sequelae and difficulties in conducting clinical trials in a heterogeneous disease with small patient numbers. The purpose of this document is to identify current gaps, to outline a roadmap of research goals for highly morbid forms of chronic GVHD including advanced skin sclerosis, fasciitis, lung, ocular and gastrointestinal involvement, and to propose strategies for effective trial design. The working group made the following recommendations: (1) Phenotype chronic GVHD clinically and biologically in future cohorts, to describe the incidence, prognostic factors, mechanisms of organ damage, and clinical evolution of highly morbid conditions including long-term effects in children; (2) Conduct longitudinal multicenter studies with common definitions and research sample collections; (3) Develop new approaches for early identification and treatment of highly morbid forms of chronic GVHD, especially biologically targeted treatments, with a special focus on fibrotic changes; and (4) Establish primary endpoints for clinical trials addressing each highly morbid manifestation in relationship to the time point of intervention (early versus late). Alternative endpoints, such as lack of progression and improvement in physical functioning or quality of life, may be suitable for clinical trials in patients with highly morbid manifestations. Finally, new approaches for objective response assessment and exploration of novel trial designs for small populations are required.
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