Isolated abducens nerve palsy following lumbar puncture is a rare complication. In scientific literature, it has been mostly described after performing spinal anesthesia in anesthesiology literature ...rather than in neurological literature. Isolated abducens nerve palsy usually occurs from one to three weeks after performing lumbar puncture and it is important to connect it with this procedure and exclude other possible etiologies. The actual incidence of this complication is unknown. We describe a 32-year-old male patient who presented with unspecific headache attributed to cavernous malformation and two developmental venous anomalies. While searching for headache etiology, lumbar puncture was performed. Two days after lumbar puncture, the patient presented with isolated abducens palsy of the right eye. Our planned diagnostic evaluation included measuring intracranial pressure by noninvasive optic sheath nerve sonography and repeating brain magnetic resonance imaging. We also planned to treat the patient with epidural blood patch, which is usually successful when performed as soon as the diagnosis is established. Unfortunately, our patient refused diagnostic and therapeutic proposal, so it was impossible to know final outcome. In conclusion, we want to highlight these complications, especially to young doctors and specialists who might see it rarely.
Spinal subdural hematoma caused by lumbar puncture is a rare state of acute blood clot in spinal subdural space, and in some cases, it can be the cause of local compression and consecutive ...neurological symptoms. We present a 36-year-old female patient who was hospitalized due to persistent headache despite pharmacological therapy. Therefore, we performed lumbar puncture in order to measure intracranial pressure and evaluate cerebrospinal fluid. After lumbar puncture, the patient was complaining of pain in the lumbar region. Emergency magnetic resonance imaging (MRI) of the lumbosacral (LS) region was performed to show acute subdural hematoma of up to 7.3 mm in the dorsal part of the spinal canal at the level of L1 vertebra to the inferior endplate of L4 vertebra. Repeat LS MRI after 3 hours showed unchanged finding. The patient reported gradual regression of pain in the LS region over the next few days, therefore conservative treatment was applied. Patients with a previously known blood clotting disorder and patients on anticoagulation therapy have worse outcome as compared with patients without such disorders. During treatment, it is necessary to monitor patient clinical state and consider the need of surgical treatment.
Numerous adverse factors are acting in the prenatal, perinatal and postnatal period
of life and may be the cause of later mild or severe deviations from normal psychomotor development.
Therefore, it ...is crucial to identify infants with neurological risk factors and infants that already have a
delay from orderly development, in order to immediately initiate the rehabilitation process. The aim of
this study was to determine whether there is difference in the assessment of psychomotor development
in neurological risk children based on the psychomotor development test (Croatian, Razvoj
psihomotorike, RPM test) and clinical evaluation of neuromotor development. RPM test is designed
for rough estimate of psychomotor development in children in the first two years of life. The study
included 15 full term children (8 male and 7 female) with clinical diagnosis of mild paraparesis and
mild deviation from normal psychological and social development, and 15 full term children (8 male
and 7 female) without neurological risk factors and deviations from normal psychomotor development,
all at the age of 12-24 months. Of the 15 children diagnosed with mild paraparesis, none had
delayed psychomotor development, 6.7% had suspect development and 93.3% had normal development
on RPM test. All children in the control group had normal development on RPM test. According
to the results, the RPM test is not sensitive enough to detect mild neurodevelopmental disorders.
Background In young individuals, a genetically predisposing hypercoagulability and classic modifying risk factors can act synergistically on the ischemic stroke risk development. The aim of the study ...was to compare the prevalence of classic vascular risk factors and polymorphisms of the G20210A coagulation factor II (prothrombin), Arg506Glu coagulation factor V Leiden, C677T methylenetetrahydrofolate reductase (MTHFR), and 4G/5G plasminogen activator inhibitor-1 (PAI-1) and the impact of these gene mutations and classic vascular risk factors on the overall stroke risk in individuals aged 55 years or younger. Methods The study included 155 stroke patients aged 55 years or younger and 150 control subjects. Stroke prevalence and odds ratio (OR) were assessed for the following parameters: G20210A prothrombin, Arg506Glu factor V Leiden, C677T MTHFR, and 4G/5G PAI-1 polymorphisms; total number of study polymorphisms in a particular subject (genetic sum); and classic vascular risk factors of hypertension, obesity, diabetes mellitus, cigarette smoking, hypercholesterolemia, hypertriglyceridemia, and elevated levels of low-density lipoprotein (LDL) cholesterol and very low–density lipoprotein cholesterol. Results The prevalence of hypertension ( P < .001), smoking ( P < .001), decreased HDL cholesterol levels ( P < .001), obesity ( P = .001), elevated LDL cholesterol ( P = .036), C677T MTHFR polymorphism ( P < .001), and genetic sum was significantly higher in the group of stroke patients. The following parameters were found to act as independent risk factors for ischemic stroke: decreased HDL cholesterol level ( P < .001; OR 4.618; 95% confidence interval CI 2.381-8.957); hypertension ( P = .001; OR 2.839; 95% CI 1.519-5.305); obesity ( P = .040; OR 2.148; 95% CI 1.036-4.457); smoking ( P = .001; OR 2.502; 95% CI 1.436-4.359); and genetic sum as a continuous variable ( P < .01; OR 2.307; 95% CI 1.638-3.250). Conclusions Gene mutations of the procoagulable and proatherosclerotic factors investigated exerted a synergistic action in the development of overall risk of ischemic stroke in young and middle-aged individuals.
Multiple sclerosis (MS) is one of the most common diseases of the central nervous system and usually occurs at the age when people would be expected to be in the prime of their sexual lives. In ...everyday practice, sexual dysfunction is underestimated because clinicians mostly concentrate
on the classic neurologic deficits and often overlook symptoms that can seriously affect the quality of life. Our study included 98 patients (42 men and 56 women, mean age 35±12 years) with relapse from our MS register, with established diagnosis of relapsing remitting multiple sclerosis according
to McDonald criteria. Patients completed the questionnaires (Sexual Satisfaction Scale, SSS and Beck Depression Scale BDS), and underwent neurological assessment (Expanded Disability Status Scale, EDSS). All patients were in the group with EDSS 2 to 4 points (mobile patients). There
was no statistically significant difference in BDS and SSS values according to EDSS score. Correlation coefficients were calculated (BDS and SSS) for men (p=0.42) and women (p=0.44), yielding positive correlation. There was no statistically significant difference in BDS and SSS values according
to gender, disease duration or immunomodulatory therapy. In our group of patients, despite low EDSS score (fully ambulatory without aid, self sufficient patients) we found positive correlation between sexual dysfunction and depression, showing that even in such patients the quality of life can be
decreased. In conclusion, sexual dysfunction and depression are mostly under-recognized by neurologists because they are not part of routine testing; therefore, some additional questionnaires should be used in the evaluation in MS patients, even those with low EDSS score, in order to improve their
quality of life.
- Fabry disease is a rare X-linked inherited lysosomal storage disease affecting multiple organ systems, presenting in the central nervous system (CNS) as white matter lesions with underlying ...cerebral vasculopathy and autoinflammatory changes of the choroid plexus and leptomeninges. We present a young female patient (age 36 years) admitted to our department due to visual loss on the left eye. Magnetic resonance imaging (MRI) showed demyelinating lesions in the frontal and parietal lobe, periventricularly, in mesencephalon and right cerebellar hemisphere, and left optic neuritis; MR angiography was normal. Her medical history revealed renal dysfunction, hypothyroidism, and miscarriage in the 6
month of pregnancy due to eclampsia and Fabry disease in the family (mother). Cerebrospinal fluid analysis showed mild pleocytosis, normal blood brain barrier function and oligoclonal bands type 3. Visual evoked potentials showed prechiasmal dysfunction of the left optic nerve. Genetical testing for Fabry disease was positive (two heterozygous mutations), with decreased alpha galactosidase activity values and increased Lyso GB3 values. The patient received corticosteroid therapy (methylprednisolone) 1 g for 5 days, which led to regression of visual disturbances on the left eye. After this acute treatment, there was a question of definitive diagnosis and further treatment of the underlying cause. Considering renal dysfunction, miscarriage, arterial hypertension, positive genetic and biochemical testing for Fabry disease, as well as MRI findings showing lesions in posterior circulation, we concluded that the patient probably had Fabry disease with autoinflammatory changes in the CNS and should be treated with enzyme replacement therapy. Still, there was a question of optic neuritis on the left eye and positive oligoclonal bands favoring the diagnosis of multiple sclerosis. Therefore, further clinical and neuroradiological follow up was needed to distinguish multiple sclerosis and Fabry disease in this patient.
Stroke is the second leading cause of death and the most important cause of adult disability worldwide and in Croatia. In the past, stroke was almost exclusively considered to be a disease of the ...elderly; however, today the age limit has considerably lowered towards younger age. The aim of this study was to determine age and gender impact on stroke patients in a Croatian urban area during one-year survey. The study included all acute stroke patients admitted to our Department in 2004. A compiled stroke questionnaire was fulfilled during hospitalization by medical personnel on the following items: stroke risk factors including lifestyle habits (smoking and alcohol), pre-stroke physical ability evaluation, stroke evolution data, laboratory and computed tomography findings, outcome data and post-stroke disability assessment. Appropriate statistical analysis of numerical and categorical data was performed at the level of p < 0.05. Analysis was performed on 396 patients, 24 of them from the younger adult stroke group. Older stroke patients had worse disability at hospital discharge and women had worse disabilities at both stroke onset and hospital discharge, probably due to older age at stroke onset. Younger patients recovered better, while older patients had to seek secondary medical facilities more often, as expected. The most important in-hospital laboratory findings in young stroke patients were elevated lipid levels, while older patients had elevated serum glucose and C-reactive protein. Stroke onset in younger patients most often presented with sudden onset headache; additionally, onset seizure was observed more frequently than expected. Stroke risk factor analysis showed that women were more prone to hypertension, chronic heart failure and atrial fibrillation, whereas men had carotid disease more frequently, were more often smokers and had higher alcohol intake. Additionally, age analysis showed that heart conditions and smoking were more prevalent among older stroke patients. In conclusion, considerable differences were established between age and gender stroke patient groups, confirming the need of permanent national stroke registry and subsequent targeted action in secondary care, and prevention with education on risk factors, preferably personally tailored.
Migraine and tension type headache are the most common disabling primary
headache disorders. Epidemiological studies have documented their high prevalence and high socioeconomic
and personal impacts. ...According to recent data, migraine ranks as the third most prevalent
disorder and seventh-highest specific cause of disability worldwide. Tension-type headache has lifetime
prevalence in the general population ranging between 30% and 78% in different studies. According
to the International Classification of Headache Disorders, 3rd edition, there also are many other
headaches but their incidence in general population is lower than the previously mentioned headaches.
Trigeminal nerve and upper cervical segments (C1-C3) are included in pain control of the head region
and often evaluated in headache studies in order to improve differential diagnosis and headache treatment.
In our study, we evaluated the potential role of electromyographic (EMG) blink reflex in establishing
diagnosis of headache and evaluation of trigeminal nerve dysfunction as the possible underlying
pathomorphological headache mechanism. Our study included 60 patients with different types of
primary headaches and 30 control subjects. Statistical analysis was performed by use of χ2-test and
statistical significance was set at p<0.001. Study results showed that patients with trigeminal dysfunction
in EMG blink reflex had a 5.6-fold higher risk of developing headache in comparison to subjects
with normal EMG blink reflex finding.
Each sleep phase is characterized by specific chemical, cellular and anatomic events
of vital importance for normal neural functioning. Different forms of sleep deprivation may lead to a
decline of ...cognitive functions in individuals. Studies in this field make a distinction between total sleep
deprivation, chronic sleep restriction, and the situation of sleep disruption. Investigations covering the
acute effects of sleep deprivation on the brain show that the discovered behavioral deficits in most cases
regenerate after two nights of complete sleep. However, some studies done on mice emphasize the
possible chronic effects of long-term sleep deprivation or chronic restriction on the occurrence of neurodegenerative
diseases such as Alzheimer’s disease and dementia. In order to better understand the acute
and chronic effects of sleep loss, the mechanisms of neural adaptation in the situations of insufficient
sleep need to be further investigated. Future integrative research on the impact of sleep deprivation on
neural functioning measured through the macro level of cognitive functions and the micro molecular and
cell level could contribute to more accurate conclusions about the basic cellular mechanisms responsible
for the detected behavioral deficits occurring due to sleep deprivation.
Isolated abducens nerve palsy following lumbar puncture is a rare complication. In scientific literature, it has been mostly described after performing spinal anesthesia in anesthesiology literature ...rather than in neurological literature. Isolated abducens nerve palsy usually occurs from one to three weeks after performing lumbar puncture and it is important to connect it with this procedure and exclude other possible etiologies. The actual incidence of this complication is unknown. We describe a 32-year-old male patient who presented with unspecific headache attributed to cavernous malformation and two developmental venous anomalies. While searching for headache etiology, lumbar puncture was performed. Two days after lumbar puncture, the patient presented with isolated abducens palsy of the right eye. Our planned diagnostic evaluation included measuring intracranial pressure by noninvasive optic sheath nerve sonography and repeating brain magnetic resonance imaging. We also planned to treat the patient with epidural blood patch, which is usually successful when performed as soon as the diagnosis is established. Unfortunately, our patient refused diagnostic and therapeutic proposal, so it was impossible to know final outcome. In conclusion, we want to highlight these complications, especially to young doctors and specialists who might see it rarely. Key words: Abducens palsy; Lumbar; Duralpuncture; Complication Izolirana lezija abducensa nastala nakon lumbalne punkcije je rijetka komplikacija ovog postupka. U znanstvenoj literaturi izolirana lezija abducensa nakon lumbalne punkcije se cesce opisuje nakon spinalne anestezije u anestezioloskim casopisima. Izolirana lezija abducensa obicno se javlja nakon jednog do tri tjedna od lumbalne punkcije te ju je vazno povezati sa samim postupkom punkcije i iskljuciti ostale potencijalne etiologije. Tocna incidencija je nepoznata. Prikazujemo slucaj 32-godisnjeg muskarca koji se prezentirao nespecificnom glavoboljom koja je bila uzrokovana kavernomom i dvjema razvojnim venskim anomalijama. Tijekom trazenja etiologije glavobolje ucinjena je lumbalna punkcija. Dva dana nakon lumbalne punkcije bolesnik se prezentirao s izoliranom lezijom abducensa desnog oka. Oas planiran dijagnosticki algoritam ukljucivao je mjerenje intrakranijskog tlaka neinvazivnom metodom sonografijom ovojnice optickog zivca i ponavljanjem magnetne rezonancije mozga.Takoder smo planirali bolesnika lijeciti krvnom zakrpom, sto je inace uspjesno ako se provede sto ranije nakon postavljanja dijagnoze. Nazalost, bolesnik je odbio daljnji dijagnosticki i terapijski prijedlog, tako da je bilo nemoguce saznati krajnji ishod. U zakljucku, zeljeli smo istaknuti ovu komplikaciju, osobito za mlade lijecnike i specijaliste koji se mozda rijetko s njom susrecu. Kljucne rijeci: Lezija; Abducens; Lumbalna punkcija; Komplikacija
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