Guillain-Barré syndrome (GBS) and neuroborreliosis may clinically manifest with symptoms related to acute polyradiculoneuritis. The aim and purpose of this study was analysis of clinical picture in ...patients with acute polyradiculoneuritis and their differential diagnosis into patients with GBS or meningoradiculoneuritis within the framework of neuroborreliosis. In this retrospective study, medical records of patients with acute polyradiculoneuritis hospitalized at University Department of Neurology, Sestre milosrdnice University Hospital Center during a 4-year period were analyzed. The study included data on 27 patients. Definitive diagnosis ofGBS was made in 23 patients and of neuroborreliosis in four (14.8%) patients. Acute inflammatory demyelinating polyneuropathy was recorded in 69% of GBS patients, Miller Fisher syndrome in four patients, and acute motor axonal neuropathy and/or acute motor and sensory axonal neuropathy in three patients. Clinically, patients with neuroborreliosis manifested flaccid tetraparesis, peripheral facial nerve paresis, bulbar paresis, ocular motility disorders, and sensory symptoms of radicular pain and paresthesias. Considering the relatively high prevalence of neuroborreliosis in north-west Croatia, it is important to exclude meningoradiculoneuritis caused by Borrelia burgdorferi on differential diagnosis of GBS in these patients.
Summary
While the mean increase in flow velocities in posterior cerebral artery (PCA) as a response to visual stimuli is well documented, the data on the reaction time as a measurement of the ...vasomotor response of the posterior part of the circle of Willis are still sparse. The aim was to assess the visual evoked response in PCA during white light stimulation by means of functional transcranial doppler in patients with severe internal carotid artery (ICA) stenosis, to introduce a real‐time haemodynamic changes as a measurement of the effect of severe carotid disease on the posterior circulation. The measurements were taken in 49 right‐handed patients with severe ICA stenosis or occlusion and 30 healthy volunteers, simultaneously in left and right PCA using 2‐MHz probes, successively in the dark and during the white light stimulation, during three consecutive repetitive periods of 1 min each. Mean values of mean blood flow velocities (MBFV) and mean reaction time (MRT) with and without visual stimuli were analysed. Linear regression analysis showed no statistically significant correlation between the age, MBFV and a degree of left and right carotid stenosis, and MRT in left and right PCA either in the group of healthy subjects or in the group of patients with severe carotid stenosis, in both test conditions. MRT could be an indicator of compromised cerebral circulation in the presence of haemodynamic significant carotid stenosis as well as an additional and independent haemodynamic parameter of the cerebral visual evoked response.
We assessed the visual evoked response and investigated side-to-side differences in mean blood flow velocities (MBFVs) by means of functional transcranial Doppler (fTCD) in 49 right-handed patients ...with severe internal carotid artery (ICA) stenosis and 30 healthy volunteers, simultaneously in both posterior cerebral arteries (PCAs) using 2 MHz probes, successively in the dark and during the white light stimulation. Statistically significant correlation (P=0.001) was shown in healthy and in patients (P<0.05) between MBFV in right PCA in physiological conditions and MBFV in right PCA during the white light stimulation and in the dark. The correlation between MBVF in right PCA and contralateral left PCA was not statistically significant (P>0.05). The correlation between ipsilateral left PCA was significantly higher than the one with contralateral right PCA (P<0.05). There is a clear trend towards the lateralisation of the visual evoked response in the right PCA.
A case is reported of a 72-year-old woman who presented with severe vertigo, vomit, and mild neck and occipital pain. She had a medical history of hypertension, angina pectoris, cholelithiasis, ...gastric ulcer, pyelonephritis and periodical mild dizziness. Neuroimaging revealed right vertebral artery occlusion, right cerebellar stroke and basilar impression. The therapeutic approach chosen in our patient was conservative, with non-steroid anti-inflammatory drugs and neck collar. Although our patient's prior risk factors for stroke supported a diagnosis of vertebrobasilar stroke, it is possible that the vertebral artery occlusion was the result of changes in the atlantoaxial anatomy and that cerebellar infarction was secondary to craniocervical anomaly. Although the presence of vertebral artery occlusion, cerebellar stroke and basilar impression in our patient may have been coincidental, we suggest that patients with basilar impression and craniocervical anomalies in general may be at an increased risk of vertebrobasilar vascular disease and vertebrobasilar stroke.
Neurogene orofaringealne disfagije su vrlo čest simptom i posljedica akutnih i kroničnih neuroloških bolesti, posebice cerebrovaskularnih, ekstrapiramidnih i demijelinizacijskih bolesti. Poremećaj ...gutanja uzrokuje niz sekundarnih komplikacija - malnutriciju, dehidraciju i aspiracijsku pneumoniju - ali i one suptilnije, često nedovoljno osviještene, psihološke i socijalne posljedice koje dugoročno utječu na kvalitetu života bolesnika. Prepoznavanje i liječenje bolesnika s poremećajem gutanja nerijetko je izazov, zato se cjelokupan postupak odvija u okviru multidisciplinarnog tima. Klinički logoped je sastavni dio multidisciplinarnog tima koji dijagnosticira i liječi poremećaje gutanja, svojim znanjem i kompetencijama utječe na povoljan rezultat liječenja. Logoped, kao član multidisciplinarnog tima, prilagođava konzistenciju hrane koju će uzimati bolesnik s neurogenom disfagijom i omogućuje sigurno hranjenje terapijskim postupcima. Logoped inicijalno provodi testove procjene gutanja, kojima prepoznaje bolesnike s rizičnim čimbenicima za aspiraciju. Ako je kod bolesnika uočen nesiguran obrazac gutanja, provodi se detaljna logopedska dijagnostika kojom se utvrđuje dalji način prehrane, kako bi se bolesniku omogućilo sigurno gutanje. Logoped odabire jednu ili više rehabilitacijskih tehnika koje će primijeniti, ovisno o bolesnikovu općem zdravstvenom stanju, suradljivosti i mogućnosti korištenja naučenim tehnikama nakon otpusta iz bolnice. Ovaj rad daje uvid u načine na koje se logoped brine o bolesnicima s poremećajem gutanja – od primitka do otpusta iz bolnice – i naglašava važnost logopeda u multidisciplinarnom timu, koji se bavi neurogenom disfagijom.
Neurogenic oropharyngeal dysphagia is a common symptom and the repercussion of acute and chronic
neurological diseases especialy cerebrovascular, extrapyramidal and demyelinating diseases. Swallowing
difficulties cause all kinds of secundary complications such as malnutrition, dehydration and pneumonia
caused by aspiration. They also affect patient's overall quality of life disturbing its psychological and
social well-being. Screening for patients with swallowing difficulties is often a challenge and therefore
diagnostics demands working in a multidisciplinary team. Clinical Speech and Language Pathologist
(SLP) should be a part of a multidisciplinary team that diagnoses and treats patients with dysphagia. By
doing that, SLPs help provide positive treatment outcomes with their specific knowledge and
competencies. As members of a multidisciplinary team, SLPs adjust food consistency that patients with
neurogenic dysphagia consume and enable safe feeding with therapeutic methods. The role of SLPs is to
provide that kind of nutrition. Initialy, SLPs do a brief swallowing screening that singles out patients with
risk factors for aspiration. If an unsafe swallowing pattern is recognised, SLPs perform overall
diagnostics to determine the way of future food and liquid intake to ensure safe swallowing. Moreover,
SLPs choose one or more rehabilitation techniques to use with patients according to their health
condition, cooperation and ability to use the technique outside of the hospital. This paper provides a
review of ways that Speech and Language Pathologists care for patients with swallowing difficulties from
the admission to the hospital till their discharge. Also, it emphasises the importance of SLPs in a
multidisciplinary team that deals with patients with neurogenic dysphagia.
These are evidence based guidelines for the management of medical complications in patients following aneurysmal subarachnoid hemorrhage, developed and endorsed by the Croatian Society of ...Neurovascular Disorders, Croatian Society of Neurology including Section for Neurocritical Care, Croatian Neurosurgical Society, Croatian Society for Difficult Airway Management and Croatian Medical Association. They consist of recommendations for best monitoring, medical treatment and interventions based on the literature, evaluation of the results of large international clinical trials, and collective experience of the authors.
Subarachnoid hemorrhage is a neurologic emergency and a detrimental cerebrovascular event with a high rate of death and complications. Recommendations have been developed and based on literature ...search, evaluation of the results of large international clinical trials, collective experience of the authors, and endorsed by the Croatian Society of Neurovascular Disorders, Croatian Society of Neurology including Section for Neurocritical Care, Croatian Neurosurgical Society, Croatian Society for Difficult Airway Management and Croatian Medical Association. The aim of these guidelines is to provide current and comprehensive recommendations and to assist physicians in making appropriate decisions in the management of subarachnoid hemorrhage. Evidence based information on the epidemiology, risk factors and prognosis, as well as recommendations on diagnostic work up, monitoring and management are provided, with regard to treatment possibilities in Croatia.
The goal of this study was to evaluate the visual evoked response in posterior cerebral artery (PCA) by means of functional transcranial doppler in patients with severe carotid disease and to ...determine the hemodynamic effect of severe carotid disease on posterior circulation. Measurements were performed successively in the dark and during the white light stimulation in 49 patients with high-grade (70-99%) internal carotid artery (ICA) stenosis or occlusion and compared with 30 healthy age and sex matched subjects. Mean blood flow velocities (MBFV) (cm/s +/- 2SD) and mean reaction time (MRT) (s +/- 2SD) during three consecutive repetitive periods of 1 minute each were analyzed. MBFV in PCA during the white light stimulation and in the dark between the two groups didn't differ. MRT in patients showed a significantly prolonged visual evoked response in both affected (light: patients 29.36 +/- 14.46, controls 19.67 +/- 11.25, respectively, p < 0.046; dark: patients 35.25 +/- 11.9 controls 21.89 +/- 10.31, respectively, p < 0.002 and unaffected side (dark: patients 33.13 +/- 11.12, controls 23.89 +/- 11.23, respectively, p < 0.032) of ICA. This data showed that MRT is the principal restrictive factor in the case of carotid stenosis suggesting the independence of cerebral vascular reserve capacity of the posterior part of Willis circle that is necessary to be considered separately.
The art: neuroscientific approach Bosnar-Puretić, Marijana; Roje-Bedeković, Marina; Demarin, Vida
Acta clinica Croatica (Tisak)
48, Issue:
3
Journal Article
Peer reviewed
Scientists have for centuries tried to localize and define artistic talent. Modern diagnostic techniques that enable visualization and measurement of brain morphology and function are positron ...emission tomography (PET), magnetic resonance imaging (MRI), functional transcranial Doppler (fTCD) and some biochemical methods. In the majority of people, the left hemisphere is dominant, but the right hemisphere is considered to be creative, visual, imaginative and intuitive. Right hemisphere is associated with musical skills and good three-dimensional orientation. It is also associated with good coordination and athletic skills. Creative people have less marked hemispheric dominance. Using the functional (fMRI) technique, the activation of visual cortex while watching different kinds of compositions was visible; the specific pattern of cortical activation was identified for looking at the landscapes, portraits, abstract compositions or different combination of colors. For music perception, the interplay of activity on both sides of the brain is necessary. In the right side, the centers for perceiving pitch, certain aspects of melody, harmony, timbre and rhythm are placed, and in the left side the processes of rapid changes in frequency and intensity, both in music and words are taking place. Adaptation of the brain, i.e. brain plasticity can arise upon listening or performing music. It is possible to use music, painting and dancing as an aid in the treatment of somatic, neurologic or psychiatric disorders.
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