Schwannoma as an extracranial nerve sheath tumor rarely affects brachial plexus. Due to the fact that brachial plexus schwannomas are a rare entity and due to the brachial plexus anatomic complexity, ...schwannomas in this region present a challenge for surgeons. We present a case of a 49-year-old female patient with a slow growing painless mass in the right supraclavicular region that was diagnosed as schwannoma and operated at our department. The case is described to remind that in case of supraclavicular tumors, differential diagnosis should take brachial plexus tumors, i.e. schwannomas, in consideration. Extra caution is also required on fine needle aspiration procedures or biopsies of schwannomas due to the possible iatrogenic injury of the nerve and adjacent structures. On operative treatment of schwannoma, complete tumor resection should be achieved while preserving the nerve.
The BNT162b2 (Pfizer BioNTech) mRNA vaccine is an effective vaccine against COVID-19 infection. Here, we report an adverse event following immunization (AEFI) in a 48-year-old female patient who ...presented with fasciculations, migraine auras without headaches and in an increased discomfort of previously present palpitations, as well as excitation and insomnia. Her fasciculations were intermittently present until the time this paper was written, starting from the 6th day post-vaccination; they changed localization and frequency, but most commonly they were generalized, affecting almost all muscle groups. The patient also suffered from two incidents of migraine auras with visual kaleidoscope-like phenomena without headaches a few months after the vaccination. These symptoms were considered to be AEFI and no causal relation with the vaccine could be proven.
The aim of this study was to estimate the role of transcranial sonography in detecting basal ganglia changes as structural biomarkers in migraine. Transcranial sonography was performed on Aloka ...prosound
α
-10. Semiquantitative and planimetric methods were applied when basal ganglia changes were detected. Comparison between groups was performed by unpaired Student’s
t
test and Spearman’s correlation test. We analyzed 30 migraine patients and 30 age-/sex-matched controls. Substantia nigra hyperechogenicity was detected in 36.7% migraineurs and in 13.3% controls (
t
test,
p
= 0.036888). Hyperechogenic substantia nigra was found in 70% aura patients and in 20% patients without aura (
p
= 0.007384). Mean substantia nigra echogenic size of all migraine patients was 0.16 ± 0.07 and 0.12 ± 0.043 cm
2
in controls (
t
test,
p
= 0.0011). Lentiform nucleus hyperechogenicity was seen in 50% migraine patients and 13.3% controls (
t
test,
p
= 0.002267). Mean lentiform nucleus echogenic size of all migrenous patients was 0.34 ± 0.08 cm
2
and in controls 0.20 ± 0.008 cm
2
(
t
test,
p
= 0.0021). Caudate nucleus hyperechogenicity was found in 26.7% migraine patients and in 6.6% controls (
t
test,
p
= 0.037667). Mean frontal horn width in migraine patients was 8.73 ± 1.76 mm and in controls 7.10 ± 1.71 (
t
test,
p
= 0.0006). Substantia nigra hyperechogenicity correlated with disease duration (rho = −0.35521,
p
= 0.05467) and third ventricle width (rho = −0.68221,
p
= 0.02976). No other differences between migraineurs and controls were found. Our study has revealed differences in transcranial findings between migraineurs and controls, but overall significance of those findings are still to be evaluated.
Abstract Background Previous studies have shown that after coronary artery bypass grafting (CABG), heart rate variability (HRV) becomes decreased, even more significantly than in patients after ...myocardial infarction (MI). According to some reports, unlike in patients after MI, decreased postoperative HRV does not increase mortality in CABG patients. The aim of this study was to compare differences in mortality rate in CABG patients with normal vs. decreased postoperative HRV. Methods This study included 206 consecutive patients who underwent CABG. During stationary rehabilitation, 24-hours Holter ECG was performed on all the patients, and HRV was analyzed from its recordings. After leaving cardiac rehabilitation, all patients were contacted in writing to provide data on their health in the follow-up period. In the analysis of survival rate depending on HRV findings log-rank analysis and Kaplan–Meier method were used. Results Seventy four CABG patients (36%) had SDNN < 93 ms while 132 patients (64%) had normal overall HRV (SDNN ≥ 93 ms). The average time of follow-up period was 3.0 ± 1.8 years. In the follow up period 16 (7.8%) adverse coronary events were recorded. Out of the 16 CABG patients, 13 patients had decreased HRV and 3 had normal HRV ( p = 0.001). Conclusions Contrary to previous reports, results of this study show that the CABG patients with postoperative decreased HRV have a higher mortality rate than patients with normal HRV.
Background Data regarding the autonomic control of heart rate in multiple sclerosis (MS) patients depending on the disease duration are lacking in the literature. The goal of this study was to ...evaluate differences in heart rate variability (HRV) in patients with MS according to the duration of the disease. Methods The study included 39 patients (23 female and 16 male; median age 42 years, range 34–53 years) with relapsing-remitting MS (RRMS) in stable phase and 39 age- and sex-matched healthy controls. RRMS patients were divided into two groups: group 1 with 21 patients within 5 years and group 2 with 18 patients with >5 years from the diagnosis of MS. HRV analysis was done with 24-h Holter ECG. Results Patients with RRMS had a significantly lower overall HRV than controls: SDNN 91 ± 18 msec vs. 135 ± 24 msec, p <0.001. RRMS patients with lower duration of disease (Group 1) had all higher HRV parameters except LF/HF ratio compared with RRMS patients with >5 years from the diagnosis of MS (Group 2): SDNN 94 ± 24 vs. 88 ± 21 msec, p = 0.008; TP 2028 ± 1326 vs. 1683 ± 1017 ms2 , p = 0.006. Conclusions Results of the study suggested that the autonomic control of heart rate depends on the disease duration in RRMS patients. Longer disease duration led to progressive impairment of cardiac autonomic balance in MS patients.
In a patient with a deficit of ocular movement that goes beyond any anatomically specific pattern one must always bear in mind the role of thalamic nuclei in ocular motor function. We present three ...case reports depicting manifestations of infarction in the vascular territories of arteries that supply thalamus. The first case presented with a complete, ipsiversive ocular tilt reaction and the second case presented with Parinaud's syndrome as a result of a paramedian thalamic infarction extending into the rostral midbrain. The third one presented as a left eye ptosis with Korsakoff-like amnestic syndrome due to anteromedian thalamic infarction, which can be a result of both tuberothalamic and paramedian artery infarction. An unusual presentation of ocular movement disorders without an unequivocal anatomical correlation or an ocular movement disorder coupled with an amnestic syndrome should raise suspicion for possible infarction in one of the thalamic arteries.
Heart rate variability is a physiological feature indicating the influence of the autonomic nervous system on the heart rate. Association of the reduced heart rate variability due to myocardial ...infarction and the increased postinfarction mortality was first described more than thirty years ago. Many studies have unequivocally demonstrated that coronary artery bypass grafting surgery generally leads to significant reduction in heart rate variability, which is even more pronounced than after myocardial infarction. Pathophysiologically, however, the mechanisms of heart rate variability reduction associated with acute myocardial infarction and coronary artery bypass grafting are different. Generally, heart rate variability gradually recovers to the preoperative values within six months of the procedure. Unlike the reduced heart rate variability in patients having sustained myocardial infarction, a finding of reduced heart rate variability after coronary artery bypass surgery is not considered relevant in predicting mortality. Current knowledge about changes in heart rate variability in coronary patients and clinical relevance of such a finding in patients undergoing coronary artery bypass grafting are presented.
Abstract
Background
Heterophile antibodies are one of the most common causes of false-positive troponin.
Case summary
We report a case of a 53-year-old woman with false-positive troponin elevation ...and a clinical presentation understood and treated as non-ST-elevation acute coronary syndrome. Because of chronic basal elevation of troponin (at a ‘plateau’ level) and chest pain, the patient underwent several invasive coronary angiograms until false-positive increase of troponin due to heterophile antibodies was suspected. Borderline stenosis of a left circumflex coronary artery found on first coronary angiogram was a coincidental finding and heterophile antibodies in the patient’s serum were confirmed.
Discussion
This interesting case report aims to remind the clinicians about the possibility of false-positive troponin level due to laboratory analytical interference caused by heterophile antibodies. In this case, it is important to suspect false-positive troponin elevation, even when coronary artery disease is found. This rare and less mentioned and/or recognized cause of troponin elevation may lead to unnecessary invasive diagnostics and aggressive treatment of patients.
These guidelines have been developed to assist the physician in making appropriate choices in work-up and treatment of patients with headaches. The specific aim of the Evidence Based Guidelines for ...Treatment of Primary Headaches--2012 Update is to provide recommendations for establishing an accurate diagnosis and choose the most appropriate therapy in the group of patients with primary headaches, based on a comprehensive review and meta-analysis of scientific evidence with regard to treatment possibilities in Croatia. These data are based on our previous Evidence Based Guidelines for Treatment of Primary Headaches published in 2005 and other recommendations and guidelines for headache treatment.
Aims
To assess the prevalence of left ventricular diastolic dysfunction in a population of patients with type 2 diabetes mellitus; to determine correlation of diastolic dysfunction with heart rate ...and its variability.
Methods
The study included 202 patients with type 2 diabetes mellitus. Echocardiography was performed with special reference to diastolic function, and heart rate variability was analysed using standard deviation of normal RR intervals, root mean square of successive differences and percentage of successive R–R intervals greater than 50 ms (pNN 50 %) in a 24-h electrocardiogram recording.
Results
Diastolic dysfunction is present in 79 % of type 2 diabetes mellitus patients: grade 1 in 52 %, grade 2 in 26 % and grade 3 in 1 % of patients. The subjects with grade 1 diastolic dysfunction had a statistically significantly higher heart rate variability compared with those with grade 2 diastolic dysfunction (LSD, post hoc test,
p
= 0.001). In the group with diastolic dysfunction, grade 2 reduced heart rate variability was recorded in 83 % of patients (37 and 7 % for grade 1 and normal diastolic function). An increase in the severity of diastolic dysfunction was associated with decreased heart rate variability and increased heart rate.
Conclusion
Progression of diastolic dysfunction is associated with a significantly greater prevalence of reduced heart rate variability, which is accompanied by increased heart rate.
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