[Show abstract][Hide abstract] ABSTRACT: To determine the prevalence, number, and location of multiple (≥2) T2-hyperintensities on brain magnetic resonance imaging (MRI) in children with neurofibromatosis type 1 (NF1) and their correlation with age, and to establish their sensitivity, specificity, and accuracy for the diagnosis of NF1 in children, especially in the early age (2-7 years).
We performed a cross-sectional study of 162 patients with NF1 from Croatian Neurofibromatosis Association Database and 163 control children between the ages of 2 and 18 years who underwent brain MRI between 1989 and 2009.
Multiple T2-hyperintensities were present in 74% of NF1 patients and 1.8% of controls. They were mainly located in the basal ganglia, brainstem, and cerebellum and were significantly decreased in prevalence and number in the older age. T2-hyperintensities had excellent diagnostic accuracy with the area under the receiver operating characteristic (ROC) curve of 0.849 and 95% confidence interval (CI) of 0.805-0.886. The diagnostic sensitivity, specificity, and accuracy rate of T2-hyperintensities for NF1 were highest in the youngest age (2-7 years): 81% (95% CI 71%-89.1%), 99% (95% CI 92.3%-100%), and 85.8 (95% CI 83.3-93.8), respectively.
This study strongly suggests the inclusion of T2-hyperintensities on brain MRI on the list of diagnostic criteria for NF1, especially in children of early age, when the clinical penetration of the NF1 gene has not yet been completely finished.
Croatian Medical Journal 08/2011; 52(4):488-96. DOI:10.3325/cmj.2011.52.488 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Psychopharmaca are used in treatment of psychiatric illnesses and disorders, among other therapeutic possibilities. The choice of the psychopharmaca is determined by the specific psychopathology of the patient, within the diagnostic categories, according to the current classification of diseases and disorders. With the advances in pharmaco industry, the range of drugs used in the everyday clinical practice is occurring at a very rapid pace. Antipsychotic medications are used in treatment of mainly psychotic disorders. However, the new generation of antipsychotics, due to their specific receptor affinities, is sometimes used in treatment of affective disorders as well. We are reporting a case of a female patient who was hospitalized several times. Amisulpride was introduced in the treatment and due to a series of unfortunate events and changes that followed (i. e. frequent hospitalizations and changes of therapists, different mental institutions) dose of amisulpride was gradually increased to its antipsychotic doses, which did not help achieve therapeutic benefits, but serious side effects.
[Show abstract][Hide abstract] ABSTRACT: The treatment of dysthymia in itself poses a problem in the everyday psychiatric practice and it can be further hindered when accompanied by pronounced personality traits (which are indicative of disorder). Due to its pathology and duration dysthymia interferes with the patient's quality of life and the ability to function in some segments of everyday life. These interferences enticed our patient to opt for psychiatric treatment. During a three-year period, despite all the efforts made by psychiatrists in this comprehensive and challenging dysthymia treatment (psychotherapy, group psychotherapy, psychopharmacotherapy), the expected outcomes of the treatment did not occur. The patient's goals and expectations included lifestyle change, achieving life satisfaction and mood improvement. The patient was refusing suggested psychopharmaca until confronted, in psychotherapy, with the fact that she is the one prolonging her own helplessness and directing her passive agression at the members of the group. In the end the patent agreed to take psychopharmaca. Therefore, sertraline was introduced in the treatment, but the patient experienced a severe allergic reaction (Qiuncke's oedema). After four months the second attempt was made and escitaloptam was introduced, which resulted in urticaria. Due to these allergic reactions to antidepressants, the patient decided not to pursue the psychopharmacological treatment.
[Show abstract][Hide abstract] ABSTRACT: Epilepsy often occurs in comorbidity with mental diseases and disorders. Early detection and/or treatment of such disorders in patients affected by epilepsy, as well as their socialisation are crucially important since epileptic patients tend to suffer more due to lack of social support than to frequent epileptic seizures. Prevalence of psychiatric disorders is higher in patients with epilepsy than in general population, the most frequent being: anxiety, depression, panic attacks, behavioural disorders as well as psychotic states with paranoid elements. The efficacy of AE treatment of patients affected by epilepsy and mood disorders has also directed clinicians to investigate possible AE benefits in treating other mental disorders such as anxiety states, depression and bipolar disorder. The examined case displays complex partial epilepsy and comorbid mental disorder. The use of lamotrigine, a fourth-generation antiepileptic, which is also a mood stabilizer, has assured a favourable remission of symptoms related to both epilepsy and mood disorders. Side-effects caused by lamotrigine were only temporary and dose reduction was sufficient to eliminate their symptoms.
[Show abstract][Hide abstract] ABSTRACT: According to current medical opinion chronic mental diseases such as schizophrenia require life-long treatment. The choice of antipsychotics is an important treatment factor, since their side-effects often influence patients' compliance with treatment. Severe side-effects may cause the patients to reject such treatment, the latter being their right. In case a psychiatrist does not agree with the patient's decision to interrupt his antipsychotic treatment regardless its serious side-effects, the former should be persistent in convincing the patient to replace such drug with a more appropriate therapy.
[Show abstract][Hide abstract] ABSTRACT: Rapid weight gain among patients with mental disorders can further compound psychological distress and negatively influence compliance. Weight gain associated with treatment with atypical antipsychotic medication has been widely recognized as a risk factor for the development of diabetes type II and cardiovascular diseases. This paper describes a 33-year old female patient treated for schizoaffective disorder. Within two months after introducing quetiapine the patient experienced considerable weight gain amounting to 19 kg. The replacement of antipsychotic during inpatient psychiatric care resulted in weight loss.
[Show abstract][Hide abstract] ABSTRACT: We report clinically rare and serious adverse reactions that occurred after the co-administration of ranitidine, ibuprofen and ciprofloxacin: completely reversible aseptic meningitis and irreversible bilateral sensorineural hearing loss, tinnitus, and vestibulopathy. Recurrent urinary inflammations treated with antibacterials, classic familial migraine, and allergy to trimethoprim-sulfamethoxazole and chromium were favourable predisposing factors for the adverse event in this patient. A close chronological relation between administration of drugs (especially ibuprofen) and adverse reactions was noted. No evidence of infection and/or autoimmune disease was found. The mechanism of these serious events may be explained as a hypersensitive reaction affecting the meninges and, partially, cochlea.
Collegium antropologicum 09/2010; 34(3):1101-4. · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Psychophysical dermatitis is frequently manifested in patients that suffer from psychiatric illnesses and disorders as well as in patients that suffer from depressive disorders. These diseases occur or worsen after acute stress that may trigger them. Difficulties in expressing feelings or impossibility to verbalise them are connected to somatic diseases. In order to emphasize their importance, we will present a case of a 58 years old woman who has been suffering from alopecia areata that developed after her husband's death. The patient doesn't function well since then - she is socially isolated, she has lost self confidence and self esteem. As she has realised it was impossible to live like that, she decided to seek psychiatric help. The patient should be examined through the prism of the interdisciplinary treatment and as an integral structure of the mind and body.
[Show abstract][Hide abstract] ABSTRACT: This article reports the case of a patient with partial agenesis of the corpus callosum manifested with corpus callosum syndrome together with signs of brain hemispheres dysfunction: mental impairment, epilepsy and pyramidal signs. The patient's malformation is combined with left-handedness while signs of callosal disconnection are not present. Mild cognitive impairment and late epilepsy onset require a multidisciplinary approach since the patient also displays elements of central nervous system malformations.
[Show abstract][Hide abstract] ABSTRACT: A case report of a minor, pregnant girl with epilepsy caused by a brain tumour is presented. There are several aspects which make the presented case complex from medical, but also from the bioethical point of view. The decision about keeping the pregnancy or not is the most important bioethical dilemma for the patient and family. A detailed medical multidisciplinary approach and later balanced explanation of the medical situation to the patient are of extreme value for helping the patient's decision. It is also important to enhance the activities in pregnancy counselling for a woman with epilepsy which will result in a planned pregnancy as a prerequisite for a positive pregnancy outcome.
Collegium antropologicum 03/2010; 34 Suppl 1:311-3. · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of our study was to analyse the antiepileptic drugs (AEDs) usage in pregnant women with epilepsy, and to evaluate possible complications of this therapy during pregnancy and delivery as well as fetal effects of there drugs.
This retrospective study was conducted in the University Hospital Center Rijeka, Croatia, during the ten-year period (Jan 1, 1993-Dec 31, 2002). The study included 151 pregnant women with epilepsy. Data were entered in a structured form for evaluation of patient general data and data on antiepileptic therapy and neonatal outcome according to the use of AEDs.
During the study period, 185 children (male 95) were born. Twenty-four miscarriages were recorded in women with the diagnosis of epilepsy in their medical history. In 117 of women, the onset of epilepsy occurred before the age of 20 years. AEDs were used in 111 of patients, in 77% of them as monotherapy. The most frequently used AEDs were carbamazepine (36.2%), valproate (29.3%), phenobarbitone (24.1%). Folic acid was used in 25 pregnancies only, however, during 2002 folic acid was used in 15 pregnancies (yielding 22 in total). Apgar score was equal or higher than 8/8 in 96% of children. No specific teratogenic effects were observed.
Study results showed standard AEDs to be most commonly used in the study population, entailing no major birth defects, thus the potential risk probably being rather low. In the study population of pregnant women with epilepsy, the use of folic acid improved in 2002 in comparison to the previous period.
Acta medica Croatica: c̆asopis Hravatske akademije medicinskih znanosti 02/2005; 59(1):55-8.
[Show abstract][Hide abstract] ABSTRACT: The careful monitoring of the trigger factors of headache could be an important step in treatment, because their avoidance may lessen the frequency and severity of attacks. Furthermore, they may provide a clue to the aetiology of headache. The aim of the present study was to estimate the prevalence of tension-type headache (TTH) and to establish the frequency of precipitating factors in subjects with migraine and TTH in the adult population of Bakar, County of the Coast and Gorski Kotar, Croatia. Another important purpose of the study was to examine the relationship of the precipitating factors with migraine and TTH, and with migraine subtypes: migraine with aura (MA) and migraine without aura (MO). We performed a population-based survey using a 'face-to-face door-to-door' interview method. The surveyed population consisted of 5173 residents aged between 15 and 65 years. The 3794 participants (73.3%) were screened for headache history according to the International Headache Society (IHS) criteria. Headache screen-positive responders, 2475 (65.2%), were interviewed by trained medical students with a structured detailed interview focused on the precipitating factors. The following precipitating factors in lifetime migraineurs and tension-type headachers have been assessed: stress, sleep disturbances, eating habits, menstrual cycle, oral contraceptives, food items, afferent stimulation, changes in weather conditions and temperature, frequent travelling and physical activity. A total of 720 lifetime migraineurs and 1319 tension-type headachers have been identified. The most common precipitants for both migraine and TTH were stress and frequent travelling. Stress (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.17, 1.69) was associated with migraine, whereas physical activity (OR 0.72, 95% CI 0.59, 0.87) was related to TTH. Considering MA and MO, frequent travelling (OR 2.2, 95% CI 1.59, 2.99), food items (OR 2.2, 95% CI 1.35, 3.51) and changes in weather conditions and temperature (OR 1.75, 95% CI 1.27, 2.41) exhibited a significant positive association with MA. The present study demonstrated that precipitant-dependent attacks are frequent among both migraineurs and tension-type headachers. Lifetime migraineurs experienced headache attacks preceded by triggering factors more frequently than tension-type headachers. MA was more frequently associated with precipitating factors than MO. We suggest that some triggering factors may contribute to the higher occurrence of precipitant-dependent headache attacks in susceptible individuals.
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to estimate the prevalence of migraine among Croatian adults. This is the first epidemiological study of migraine in Croatia in which the operational diagnostic criteria of the International Headache Society have been applied.
The study population consisted of all residents (aged 15 to 65 years) of Bakar, County of The Coast and Gorski Kotar, Croatia. A population-based survey was undertaken using a "face-to-face, door-to-door" interview
The participation rate was 73.3%. All participants were screened for headache history according to the International Headache Society criteria. Headache screen positive responders (65.7%) were interviewed by trained medical students with a structured detailed interview focused on migraine.
A total of 720 lifetime migraineurs were identified. The lifetime prevalence of migraine was 22.9% (95% confidence interval, 20.9 to 25.1) in women, 14.8% (95% confidence interval, 13.1 to 16.8) in men, and 19% (95% confidence interval, 17.6 to 20.5) in both sexes. The highest lifetime prevalence of migraine was in women in the age group 40 to 49 years (38.1%). Among 636 active migraineurs, 399 (62.7%) were women and 237 (37.3%) were men; 55.8% had migraine without aura, 35.2% migraine with aura, and 6.9% migraine both with and without aura. The 1-year prevalence of migraine, migraine without aura, migraine with aura, and migraine both with and without aura in women was 18%, 11.3%, 8.6%, and 2.2%, respectively. In men, the 1-year prevalence of migraine, migraine without aura, migraine with aura, and migraine both with and without aura was 12.3%, 7.3%, 3%, and 0.7%, respectively.
The prevalence of migraine in this Croatian population showed rates quite similar to those reported in neighboring countries, such as Italy and France. Further studies are needed to estimate the prevalence rates of migraine in the total Croatian population.
Headache The Journal of Head and Face Pain 10/2001; 41(8):805-12. DOI:10.1046/j.1526-4610.2001.01147.x · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Almost all the neurological diseases can imitate multiple sclerosis. No strictly specific laboratory test has become as yet available for its diagnosis. Information obtained by clinical examination of the patient--dissemination of different symptoms at the same time and the same symptom in various periods--supplemented by neuroradiological, neurophysiological and biological supplementary tests allow making diagnosis of multiple sclerosis with about hundred percent certainty.
[Show abstract][Hide abstract] ABSTRACT: An analysis was made of the possible influence of nutritional factors on the etiology of multiple sclerosis in Gorski Kotar (Croatia), a high-risk zone for this disease. A total of 46 MS patients and 92 controls, native-born residents of the area studied, participated in a case-control study. The questionnaire comprised 51 questions concerning dietary habits. An odds ratio (OR) estimate was obtained for all the factors which were more frequently found in the patients than in the controls. Large differences were found in the daily consumption of different quantities of full fat unskimmed milk (OR 21.7; chi 2 42.34; LL 7.12), potatoes with lard and fresh or smoked meat (OR 20.7; chi 2 15.52; LL 2.72), and new potatoes (OR 20.7; chi 2 15.52; LL 2.72). The consumption of unpasteurized milk, animal fat, smoked meat and potatoes are nutritional risk factors which could have an influence on the severity of primary demyelinization in a high-risk area for multiple sclerosis.
[Show abstract][Hide abstract] ABSTRACT: A patient, young fisherman, with a locked-in syndrome is reported, in whom intact consciousness, quadriplegia of spastic type, voluntary eye blinking, (de)sursumvergence and anarthria were observed. Thrombosis of the basilar artery and slightly disturbed bioelectrogenesis of the cerebral cortex were proved by clinical examination. The patient died after 41 days. At the autopsy thrombosis a. basilaris and ventrobasal pontine infarction were confirmed. Differential diagnosis of this and similar syndromes has been discussed.
Neurologia croatica: glasilo Udruzenja neurologa Jugoslavije = official journal of Yugoslav Neurological Association 02/1992; 41(3):157-61.
[Show abstract][Hide abstract] ABSTRACT: The results of some immunological analyses in 12 patients with the acute Guillain-Barré syndrome (GBS) are presented. The mean cerebrospinal fluid (CSF) concentrations of IgG and IgA were significantly increased. A longitudinal study of CSF IgG concentrations in 5 patients shows that the recovery period of the disease is not regularly accompanied by a decline of the IgG level. The finding of significantly reduced percentages of active T cells in the peripheral blood of patients with the acute GBS in comparison with the controls supports the view of the cellular immunity role in the pathogenesis of the disease. With the exception of HLA--B5 and HLA--B15, no other individual antigen was significantly more present in either the cases or controls.
[Show abstract][Hide abstract] ABSTRACT: Epidemiologic study of Huntington's disease (HD) in the Rijeka district represents the first research of its kind carried out in Yugoslavia. After a detailed investigation of all available sources of health information, ten families, with a total number of 24 HD patients, were found. The prevalence rate of HD on March 31, 1981, was 4.46/100,000 population. Most of the patients involved were members from the second or third familial generation. The age at recognition of disease was 41.6 years, with earlier onset among the males. Involuntary movements frequently appeared as the initial symptomatology (45.8%). Duration of the disease from initial symptomatology to death averaged at 10.6 years. Six of nine patients who died had committed suicide. It took physicians of primary care, neurologists, and psychiatrists 5.3 years (1-12 years) to make a definite diagnosis. Nine of the affected families from Rijeka district were autochthonic households. Six of these families immigrated from Saxony, Slovakia and Upper Carinthia during the reign of the Habsburg dynasty (1619-1780).