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ABSTRACT: Although inflammatory periodontal disease has been proven to be related to carotid intima media thickness, it has been recently suggested that even an alteration of carotid hemodynamics might contribute to atherosclerosis in patients with periodontal disease. A 52-year-old female patient was referred to periodontology department due to painful alveolar mucosa. On the basis of dental history, we concluded that the patient had a severe form of generalized aggressive periodontitis that led to complete edentulism. The patient was advised to undergo ultrasonography of carotid arteries with arterial stiffness measurements at neurology department. A diagnosis of the right internal carotid artery occlusion was established. Inflammatory periodontal disease may affect arterial hemodynamics and even lead to artery occlusion. It is advisable that patients with a severe form of periodontitis should be referred for carotid artery ultrasonography.
Acta clinica Croatica 09/2012; 51(3):441-4. · 0.25 Impact Factor
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ABSTRACT: Hemodynamic changes can be noninvasively real-time monitored in stroke patients by means of transcranial Doppler sonography (TCD). The aim of this pilot study was to assess hemodynamic changes in both middle cerebral arteries (MCA) in aphasic stroke patients by means of TCD during verbal stimulation. Eight aphasic patients with stroke in the territory of the left MCA were tested by modified Boston Diagnostic Aphasia Examination (BDAE) within 3 days of stroke onset. Both MCA were monitored simultaneously by means of TCD with 2 MHz probes. Basic MCA mean blood flow velocity (MBFV) values were assessed and monitored during verbal stimulation. Verbal stimulation was performed with 30 photos of objects for daily usage, arranged by function. The same test was performed in 16 right-handed healthy controls. In stroke patients, the mean MBFV were 56 cm/s in the left MCA and 56 cm/s in the right MCA. A mean 30% increase was observed in the left MCA and 22% in the right MCA. In healthy controls, a mean 21.7% increase was observed in the left MCA and 18% in the right MCA. A trend toward higher percentage of MBFV increase was observed in the left MCA during verbal stimulations in aphasic patients as compared to control subjects.
Acta clinica Croatica 09/2011; 50(3):323-8. · 0.25 Impact Factor
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ABSTRACT: Improved outcomes were observed in transient ischemic attack (TIA) patients after implementation of recommendations for stroke management and after multiple interventions such as public campaigns focused on raising awareness of stroke and reorganization of health services. The aim of this study was to describe reorganization of in-hospital services to improve the management of patients suspected of having TIA or stroke, and to validate these measures with patient outcomes. Data on 5219 patients examined between January 1 and December 31, 2008 at emergency neurology outpatient department were analyzed. Patients were referred by general practitioners, emergency physicians, or were brought by relatives without being previously seen by health services staff. The emergency services department is intended to improve care for TIA patients, providing a short standardized clinical assessment followed by initiation of a comprehensive stroke prevention program. Demographic data, risk factors, stroke type, previous TIA history, ABCD2 scores and admission rates were analyzed. A total of 1057 patients suspected of having stroke or TIA were examined. There were 447 patients with ischemic stroke (mean age 73 +/- 11 years, 196 males) and 99 patients with TIA (mean age 67 +/- 14 years, 55 males). Parenchymal hemorrhage was diagnosed in 56 and subarachnoid hemorrhage in 49 patients, while 406 patients had nonspecific symptoms or other systemic or neurologic diseases. TIA preceded stroke in 29 (6.5%) patients and 197 (44%) patients were examined for worsening of stroke symptoms (133 within 24 hours, 47 within 48 hours, and 17 within 7 days). The mean ABCD2 score was 2.95. In all examined patients, a comprehensive stroke prevention program was started; 427/447 (95%) strokes and 31/99 (31%) TIAs were hospitalized at neurology department. Four (4%) TIA patients developed stroke and were hospitalized, three of them after 2 days (ABCD2 score 3.4 and 5) and one after 7 days (ABCD2 score 5). Preventive measures resulted in a low number of strokes after TIA (< 7%), but a relatively high percentage (44%) of stroke patients ignored initial symptoms and sought medical attention after persistence or worsening of the symptoms.
Acta clinica Croatica 09/2011; 50(3):367-73. · 0.25 Impact Factor
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ABSTRACT: The incidence of postoperative occlusion of carotid artery is low (0.5%-0.6%) and is rarely symptomatic. The aim of this study was to analyze the dynamics of the internal carotid artery (ICA) postoperative occlusion development. During one-year period, 8 000 patients were examined at Cerebrovascular Laboratory, University Department of Neurology. Among them, 33 patients (25 male and 8 female) with postoperative ICA occlusion were detected by color Doppler. We retrospectively analyzed the dynamics of ICA occlusion development from the first postoperative follow-up. The risk factors for atherosclerosis were analyzed. In 31 of 33 patients, postoperative ICA occlusion was recorded on the first follow-up examination, 3 months of carotid endarterectomy (18 right and 15 left). In 8 patients, combined occlusion of the common and ICA was detected (4 right and 4 left). One patient developed occlusion during the first year of follow-up, and in one patient it was detected 3 years after the surgery. Eight patients had also had surgery on the contralateral ICA and showed satisfactory findings. In 19 patients, mild atherosclerotic changes were found contralaterally, 5 had moderate stenosis, and 1 patient had subtotal ICA stenosis. The early onset of postoperative ICA occlusion most likely is not caused by atherosclerosis risk factors but by perioperative complications.
Acta medica Croatica: c̆asopis Hravatske akademije medicinskih znanosti 12/2009; 63 Suppl 3:61-4.
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ABSTRACT: The one-year incidence of carotid occlusion is 6/100 000 inhabitants in general population. Stroke incidence and mortality rate in these patients vary. Patients that underwent carotid endarterectomy (CES) are at a higher risk of progression of contralateral carotid stenosis. The aim of the study was to investigate the management and natural history of the contralateral internal carotid artery disease in patients with internal carotid artery occlusion (ICAO). During one year, 297 patients with ICAO were investigated. Follow up examinations were retrospectively analyzed and patients were divided into groups according to contralateral carotid disease. Out of 297 patients, only one investigation was performed in 90 patients with carotid occlusion. Thirty three patients were followed up due to postoperative ICAO. In 14 patients, ICAO developed during ultrasonographic follow up. In this group of patients, 9 had unchanged contralateral findings, whereas in 5 patients disease progression was observed. Out of 44 patients with ICAO and contralateral subtotal stenosis at initial investigation, 42 underwent carotid surgery. Postoperatively, 32 patients had normal findings, 6 developed mild carotid stenosis, 2 developed moderate carotid stenosis, and 2 had postoperative carotid occlusion. Two patients were followed-up without intervention. Nine patients with bilateral ICAO were followed-up for years. Follow up was continued in 106 patients with ICAO and contralateral mild to moderate changes. The finding was unchanged in 68 patients. In 21 (30%) patients the disease progressed to subtotal stenosis and 18 patients underwent carotid surgery. Accordingly, contralateral carotid disease progression was observed in one third of patients with carotid occlusion. Additional studies on the issue are needed.
Acta clinica Croatica 09/2009; 48(3):241-6. · 0.25 Impact Factor
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ABSTRACT: Postoperative internal carotid artery (ICA) occlusion is a rare condition with few data on the risk factors. The aim of the study was to analyze risk factors and ischemic symptomatology in patients with postoperative ICA occlusion. During one year period, 33 patients with postoperative ICA occlusion were examined at Cerebrovascular Laboratory. Medical history, clinical findings and atherosclerosis risk factors were compared with data on 33 patients with satisfactory postoperative finding. Student's t-test was used on data comparison (P < 0.05). In 31 of 33 patients, ICA occlusion was recorded on the first postoperative examination, 3 months after carotid endarterectomy (18 right and 15 left). In 8 patients, combined occlusion of the common carotid artery and ICA was found (4 right, 4 left). One patient ICA developed occlusion during the first and third postoperative year each. Clinically, three patients presented with ischemic symptoms (one stroke and two transitory ischemic attacks (TIA)). The following risk factors were present in the group with postoperative ICA occlusion: hypertension in 18, smoking in 10, hyperlipidemia in 8, diabetes mellitus in 9, history of stroke in 13, TIA in 3, heart attack in 4 and coronary disease in 3 patients; the respective figures in the control group were as follows: 25, 11, 16, 7, 7, 3, 4 and 3. There was no significant between-group difference in the presence of risk factors. Study results suggested that postoperative ICA occlusion was not caused by atherosclerosis risk factors but by perioperative complications.
Acta clinica Croatica 09/2009; 48(3):247-51. · 0.25 Impact Factor
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ABSTRACT: Although electroneuro- and electromyography are still the leading diagnostic methods for investigation of peripheral nerve function, they do not provide information on their morphology. This study was conducted to evaluate the suitability of ultrasonography in visualization of median nerve in healthy volunteers. Twenty-five asymptomatic volunteers (17 women and 8 men), age range 21-47 years, participated in the study. Body height was measured and handedness ascertained, as well as average time spent daily working on a computer. The device used was Aloka Prosound Alpha10 Premier with a 13-MHz probe, using custom preset for musculoskeletal sonography. The following dimensions of median nerve at the pisiform bone level were measured bilaterally: cross-sectional area (CSA), circumference, and longer and shorter diameter. Using the latter values, the flattening ratio (FR) was calculated. Median nerve and the surrounding soft tissue structures were easily depicted in all study subjects. The mean median nerve CSA was 9.70 mm2 (range 5-15 mm2, SD 2.25 mm2), mean FR (longer/shorter diameter) 4.04 (range 2.16-6.08), and median height 172.72 cm. Only one subject was left-handed. The mean time spent daily working on a computer (overall mean of 3.2 h/day) did not correlate with either CSA or FR for the dominant hand. In four subjects, an aberrant artery accompanying median nerve was visualized. High-resolution sonographic imaging is a fast and noninvasive method for assessment of various morphological properties of median nerve and can be used to enhance diagnostic efficiency.
Acta clinica Croatica 09/2009; 48(3):265-9. · 0.25 Impact Factor
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ABSTRACT: The aim of the study was to assess differences in cerebrovascular reactivity in healthy subjects during orthostasis. Twenty healthy volunteers (11 men and 9 women) with no atherosclerotic risk factors were evaluated by use of transcranial Doppler. The breath holding index (BHI) was obtained in supine and upright posture using standardized procedure. Student's t-test was used on comparison of the mean blood flow velocities (MBFV) and BHI between supine and upright posture and between the left and right side of the body. The middle cerebral artery MBFV in supine posture was 66.6 cm/s on the right side and 68.5 cm/s on the left side and in upright posture 60.6 cm/s on the right side and 62.3 cm/s on the left side. There was no significant MBFV difference either between supine and upright posture or between male and female subjects. The mean BHI in supine posture was 1.59 on the right side, 1.65 on the left side, and in upright posture 1.63 on the right side and 1.7 on the left side, without significant sex difference. There was no statistically significant differences in BHI between supine and upright posture (P = 0.81 and P = 0.68 for the right and left side, respectively) or between the two sides of the body in supine (P = 0.71) and upright posture (P = 0.8). In conclusion, evaluation of cerebrovascular reactivity yielded no significant difference in BHI values during orthostatic stress.
Acta clinica Croatica 09/2009; 48(3):299-304. · 0.25 Impact Factor
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ABSTRACT: Mirror illusion means that standing in front of a mirror placed in sagittal plane, with the head tilted on one side and one arm stretched forward, one side of the body is reflected as if it were the other side by mirror visual feedback. The aim of this study was to monitor blood flow changes in middle cerebral artery (MCA) by use of transcranial Doppler (TCD) in individuals during motor tasks and tasks using mirror visual feedback. Eight young healthy volunteers (four male and four female) were included in the study. TCD recording in MCA was done during each task consisting of various motor and visuomotor activities using mirror illusion. Both MCA mean blow flow velocity (MBFV) was measured while the subjects were seated in a comfortable chair. The MCA MBFV recordings are presented as baseline values. During the illusion of motor hand activation, when the subject was making right hand flexions and watching its reflection in the mirror, with the left hand immobile, an increase was observed the contralateral MCA MBFV (task 3, +4.5% baseline value; P = 0.017). Furthermore, when the subject made left hand flexions while watching the reflection of the immobile right hand in the mirror, there was an increase in the right MCA MBFV (+5.6% baseline value; P = 0.044), which was more pronounced than during the illusion of motor hand activation (task 3) and less than during direct vision of hand flexion (task 2, +6.3% baseline value; P = 0.005). Our data showed that visual illusion of action, as well as direct action observation could increase the MCA MBFV, which brings forward the possible usage of mirror illusion as a tool in motor neurorehabilitation.
Acta clinica Croatica 09/2009; 48(3):305-10. · 0.25 Impact Factor
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ABSTRACT: Pineal cysts occur in all ages, predominantly in adults in the fourth decade of life. In series of magnetic resonance imaging (MRI) studies, the prevalence of pineal cysts ranged between 1.3% and 4.3% of patients examined for various neurologic reasons and up to 10.8% of asymptomatic healthy volunteers. The diagnosis of pineal cyst is usually established by MRI with defined radiological criteria to distinguish benign pineal cyst from tumors of this area. A recent study demonstrated the findings obtained by transcranial sonography to correspond to those obtained by MRI in the detection of both pineal gland cyst and pineal gland itself, and could be used in the future mainly as follow up examination. Pineal cysts usually have no clinical implications and remain asymptomatic for years. The most common symptoms include headache, vertigo, visual and oculomotor disturbances, and obstructive hydrocephalus. Less frequently, patients present with ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances, hypothalamic dysfunction of precocious puberty, and recently described occurrence of secondary parkinsonism. Symptomatic cysts vary in size from 7 mm to 45 mm, whereas asymptomatic cysts are usually less than 10 mm in diameter, although a relationship between the cyst size and the onset of symptoms has been proved to be irrelevant in many cases. There is agreement that surgical intervention should be undertaken in patients presenting with hydrocephalus, progression of neurologic symptoms, or cyst enlargement. Tissue sample of the pineal lesion can be obtained by open surgery, stereotaxy and neuroendoscopy.
Acta clinica Croatica 09/2009; 48(3):355-8. · 0.25 Impact Factor
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ABSTRACT: We have recently reported that transcranial sonography (TCS) is a method competitive to magnetic resonance neuroimaging (MRI) in the evaluation of pineal gland lesions. The aim of the present is study was to assess the usefulness of TCS in a larger patient sample during a two-year follow up. Twenty patients with incidental pineal gland cyst (PGC) detected by MRI scan of the brain and 40 healthy controls without any previous documented data on a disease related to pineal gland were evaluated by TCS and compared with MRI scans. There were no statistically significant differences in PGC size measured by TCS by two observers (p = 0.475), PGC size measured by TCS and MRI (first observer, p = 0.453; and second observer, p = 0.425), size of the pineal gland measured by TCS and MRI in control group (first observer, p = 0.497; and second observer, p = 0.370), and pineal gland size measured by TCS by two observers in control group (p = 0.473). Study results suggested TCS to be a suitable method in the evaluation of pineal gland lesions. Although its resolution cannot match the MRI resolution, its repeatability and accuracy might add to its practical value. We suggest that the repeat MRI scan of such lesions might be replaced by clinical and TCS follow up.
Acta clinica Croatica 01/2009; 47(4):205-10. · 0.25 Impact Factor
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ABSTRACT: We have recently reported that transcranial sonography (TCS) is a method competitive to magnetic resonance neuroimaging (MRI) in the evaluation of pineal gland lesions. The aim of the present is study was to assess the usefulness of TCS in a larger patient sample during a two-year follow up. Twenty patients with incidental pineal gland cyst (PGC) detected by MRI scan of the brain and 40 healthy controls without any previous documented data on a disease related to pineal gland were evaluated by TCS and compared with MRI scans. There were no statistically significant differences in PGC size measured by TCS by two observers (p=0.475), PGC size measured by TCS and MRI (first observer, p=0.453; and second observer, p=0.425), size of the pineal gland measured by TCS and MRI in control group (first observer, p=0.497; and second observer, p=0.370), and pineal gland size measured by TCS by two observers in control group (p=0.473). Study results suggested TCS to be a suitable method in the evaluation of pineal gland lesions. Although its resolution cannot match the MRI resolution, its repeatability and accuracy might add to its practical value. We suggest that the repeat MRI scan of such lesions might be replaced by clinical and TCS follow up.
Acta Clinica Croatica; Vol.47 No.4.
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ABSTRACT: Migraine is a primary episodic headache disorder characterized by a cascade of events that involve various combinations of neurologic, gastrointestinal and autonomic changes. Headache is probably caused by activation of meningeal and blood vessel nociceptors combined with an alteration in central pain modulation. Headache and its associated neuro-vascular changes are subserved by the trigeminal system. A link also exists between the migraine aura and headache. Cortical spreading depression (CSD) activates trigeminovascular afferents, causing a long-lasting increase in middle meningeal arterial blood flow and polypeptide release within the dura mater. The neuropeptides interact with the blood vessel wall, producing dilatation, plasma protein extravasation, and platelet activation. Neurogenic inflammation sensitizes nerve fibers (peripheral sensitization) that now respond to previously innocuous st imuli, such as blood vessel pulsations, causing, in part, the pain of migraine.
Rad. Medical sciences; No.504=33.
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ABSTRACT: Pineal cysts occur in all ages, predominantly in adults in the fourth decade of life. In series of magnetic resonance imaging (MRI) studies, the prevalence of pineal cysts ranged between 1.3% and 4.3% of patients examined for various neurologic reasons and up to 10.8% of asymptomatic healthy volunteers. The diagnosis of pineal cyst is usually established by MRI with defined radiological criteria to distinguish benign pineal cyst from tumors of this area. A recent study demonstrated the findings obtained by transcranial sonography to correspond to those obtained by MRI in the detection of both pineal gland cyst and pineal gland itself, and could be used in the future mainly as follow up examination. Pineal cysts usually have no clinical implications and remain asymptomatic for years. The most common symptoms include headache, vertigo, visual and oculomotor disturbances, and obstructive hydrocephalus. Less frequently, patients present with ataxia, motor and sensory impairment, mental and emotional disturbances, epilepsy, circadian rhythm disturbances, hypothalamic dysfunction of precocious puberty, and recently described occurrence of secondary parkinsonism. Symptomatic cysts vary in size from 7 mm to 45 mm, whereas asymptomatic cysts are usually less than 10 mm in diameter, although a relationship between the cyst size and the onset of symptoms has been proved to be irrelevant in many cases. There is agree-ment that surgical intervention should be undertaken in patients presenting with hydrocephalus, progression of neurologic symptoms, or cyst enlargement. Tissue sample of the pineal lesion can be obtained by open surgery, stereotaxy and neuroendoscopy.
Acta Clinica Croatica; Vol.48 No.3.
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ABSTRACT: Migraine is a primary episodic headache disorder characterized by a cascade of events that involve various combinations of neurologic, gastrointestinal and autonomic changes. Headache is probably caused by activation of meningeal and blood vessel nociceptors combined with an alteration in central pain modulation. Headache and its associated neuro-vascular changes are subserved by the trigeminal system. A link also exists between the migraine aura and headache. Cortical spreading depression (CSD) activates trigeminovascular afferents, causing a long-lasting increase in middle menin-geal arterial blood flow and polypeptide release within the dura mater. The neuropep-tides interact with the blood vessel wall, producing dilatation, plasma protein extravasa-tion, and platelet activation. Neurogenic inflammation sensitizes nerve fibers (peripheral sensitization) that now respond to previously innocuous st imuli, such as blood vessel pulsations, causing, in part, the pain of migraine.
