Our aim was to determine the frequency and characteristics of neurological post-COVID-19 syndrome and the diagnostic and therapeutic measures that were used for the treatment of these patients. Data ...were collected for 243 patients examined during the period of 11 May 2021 to 22 June 2022. The inclusion criteria were COVID-19 illness and neurological symptoms associated with COVID-19. The exclusion criteria were non-neurological symptoms, patients who did not suffer from COVID-19, and symptoms that occurred after vaccination against the SARS-CoV-2 virus. Data for 227 patients with neurological post-COVID-19 symptoms were analyzed. Most patients presented with multiple symptoms, most often headache, cognitive impairment, loss of smell, paresthesia, fatigue, dizziness, and insomnia. Patients were most often referred for consultative examinations, neuroradiological imaging, and EEG. The therapy was mostly symptomatic. Most patients had no change in their symptoms on follow-up visits (53.21%), while positive outcome was found in 44.95% of patients. This study found that neurological post-COVID-19 syndrome appears to be more common in women, and generally, the most common symptoms are headache and cognitive impairment. The gender distribution of symptoms was clearly visible and should be further investigated. There is a need for longitudinal follow-up studies to better understand the disease dynamic.
Cilj: Prikazati slučaj pacijenta s medikamentozno refrakternim esencijalnim tremorom kod kojega je duboka mozgovna stimulacija dovela do uspješne kontrole tremora i značajno popravila kvalitetu ...života unatoč starijoj dobi, izraženoj atrofiji mozga, perioperacijskim i poslijeoperacijskim komplikacijama. Prikaz slučaja: Muškarac u dobi od 72 godine došao je na drugo mišljenje zbog dugogodišnjeg bilateralnog tremora ruku, vođenog kao Parkinsonova bolest, koji mu je onemogućavao svakodnevno funkcioniranje. Fizikalnim i neurološkim pregledom utvrđen je posturalni i akcijski tremor, bez bradikineze i povišenog tonusa. Magnetska rezonancija mozga pokazala je atrofiju, a Dopamin Active Transfer scan i laboratorijske pretrage bili su uredni. Postavljena je dijagnoza esencijalnog tremora. Tijekom dvije godine pacijent je u terapiji uzimao propranolol, klonazepam, primidon te topiramate, što nije pokazalo učinka. Detaljnom evaluacijom multidisciplinarnog tima indicirana je duboka mozgovna stimulacija ventralne intermedijarne jezgre talamusa bilateralno. Međutim, dok je donosio odluku o zahvatu, u godinu dana pacijent se kognitivno pogoršao. Stanje se intraoperacijski kompliciralo visokim vrijednostima krvnog tlaka. Poslije operacije pacijent je bio smeten, s halucinacijama, što je najvjerojatnije uzrokovano hipertenzivnom encefalopatijom. Za vrijeme boravka na klinici modificirani su stimulacijski parametri i određena je kronična medikamentozna terapija. Unatoč pokazateljima da konačni ishod duboke mozgovne stimulacije možda neće biti dobar, tremor je manji i kvaliteta života ovog pacijenta značajno je bolja. Zaključak: U razmatranju pacijenta za duboku mozgovnu stimulaciju nužna je temeljita individualna multidisciplinarna evaluacija. Pažljivim perioperacijskim i poslijeoperacijskim praćenjem i prilagođavanjem stimulacija uz ispravno medikamentozno vođenje može se povoljno utjecati na ishode duboke mozgovne stimulacije kod rizičnih pacijenata. Za vrijeme operacije treba strogo kontrolirati krvni tlak jer on može uvelike zakomplicirati stanje.
Aim: To report a case of a patient with drug-refractory essential tremor to whom deep brain stimulation led to successful tremor control and significantly improved quality of life despite old age, brain atrophy, perioperative and postoperative complications. Case report: A 72-year-old man came for the second opinion due to a long-term bilateral hand tremor, run as Parkinson’s disease, that prevented him in daily functioning. Physical and neurological examination revealed postural and action tremor, without bradykinesis or increased muscle tone. Magnetic resonance imaging of the brain showed brain atrophy, Dopamin Active Transfer scan and laboratory tests were normal. Diagnosis of essential tremor was set. During the period of two years, the patient took propranolol, clonazepam, primidone and topiramate which showed no effect. After detailed evaluation performed by a multidisciplinary team, bilateral deep brain stimulation of nucleus ventralis intermedius of thalamus was indicated. However, while contemplating the procedure throughout one year, the patient deteriorated cognitively. The condition was complicated by intraoperatively high blood pressure. The patient was postoperatively in a disturbed state with hallucinations, most likely caused by hypertensive encephalopathy. During the patients' stay in clinic, stimulation parameters were modified, and chronic drug therapy was determined. Despite indications that the outcomes of deep brain stimulation may not be good, the tremor is reduced, and the quality of the patients' life is significantly better. Conclusion: Thorough individual multidisciplinary evaluation is necessary when considering patients for deep brain stimulation. Careful perioperative and postoperative monitoring and adjustment of stimulations with proper medication may have a beneficial effect on the outcomes of deep brain stimulation in at-risk patients. Blood pressure should be strictly controlled during surgery as this can greatly complicate the condition.
