[Show abstract][Hide abstract] ABSTRACT: A case of a 45-year-old woman with untreated panhypopituitarism is presented. Hypopituitarism is a rare disorder consisting of multiple deficiencies of hormones originating from the adenohypophysis. It is divided into primary and secondary. Primary disorders manifest at the pituitary level, whereas secondary hypopituitarism implies hypothalamic affection. Partial or total loss of all pituitary hormones is called panhypopituitarism. Hypopituitarism can be slow and insidious or severe and life-threatening. The expression of symptoms largely depends on the patient's age and the hormones involved. The leading symptom is growth retardation when the disorder develops in childhood or puberty. Sometimes years may elapse without accurate diagnosis, as in the case described. To date, only a few cases of untreated hypopituitarism have been published. In our patient, clinical examination revealed short stature and weak osteomuscular constitution, primary amenorrhea and lack of development of secondary sex characteristics. The patient's clinical history revealed signs of hypopituitarism from childhood, which had been untreated until she presented to our clinic. The results of complete testing showed the lack of all pituitary hormones and antidiuretic hormone, which was consistent with panhypopituitarism, including central diabetes insipidus.
[Show abstract][Hide abstract] ABSTRACT: Vertebrobasilar occlusion is a life-threatening event that requires prompt diagnostic evaluation and subsequent therapy. Advanced magnetic resonance imaging (MRI) methods, including diffusion-weighted imaging and magnetic resonance angiography (MRA), are highly sensitive for the detection of ischemic tissue injury, and for the detection and localization of intracranial arterial occlusion and stenosis. In the era of thrombolytic therapy, MRI and MRA provide useful information for therapeutic decision making in the early stage of stroke evaluation. This retrospective review included patients with posterior circulation symptomatology examined at our Department between July 2002 and January 2005, 8 female and 11 male, mean age 54.9 years. The aim was to present the possibilities of MRI and MRA in the management of patients with ischemic stroke in posterior circulation. In 19 patients with an ischemia in the vertebrobasilar circulation detected by MRI of the brain, MRA identified 8 cases of basilar artery occlusion, 4 cases of basilar artery stenosis, 3 cases of multiple atherosclerotic stenoses of the vertebral arteries with 2 cases of concurrent vertebral artery occlusion, 2 cases of vasculitis in the posterior circulation, 1 case of proximal posterior cerebral artery occlusion, and 1 case of posterior cerebral artery stenosis. In 8 patients with basilar artery occlusion, the site of occlusion was proximal in 3 cases, proximal and middle in 2 cases, middle and distal in 2 cases, and distal in 1 case. MRI is a powerful tool to detect ischemic changes in stroke immediately upon stroke onset, while MRA is highly sensitive for the detection of occlusive disease in large intracranial arteries as well as in posterior circulation. In the acute stroke setting, MRI and MRA are useful for: 1) early and reliable identification of ischemic stroke; 2) improved choice of treatment modality by helping exclude from thrombolysis patients at high risk of hemorrhage and by identifying those patients most likely to benefit from it; 3) pinpoint the vascular origin of ischemic stroke; 4) determination of neurologic consequences of stroke, including final infarct size, clinical outcome and hemorrhagic risk.
[Show abstract][Hide abstract] ABSTRACT: Two cases of intracranial venous angiomas, one in a 42-year-old woman and another one in a 27-year-old-man, are presented. Intracranial venous angiomas, also known as developmental venous anomalies, represent one of four cerebral vascular malformations. Usually they are incidentally discovered on cerebral imaging. These lesions have a characteristic appearance in the venous phase of angiography, a starburst pattern or umbrella sign, described as caput medusae. Most of the lesions are clinically silent, however, they can be symptomatic with clinical presentation including seizures, headache, dizziness and focal neurologic deficits. They are sometimes associated with cerebral hemorrhage. In general, no treatment is required. Surgery is only indicated if seizures attributed to the lesion or hemorrhage occur.
[Show abstract][Hide abstract] ABSTRACT: The objective of the study was evaluation and radiologic - clinical correlation of brain computed tomography (CT) scans performed at emergency service. The relation between the number of urgent and total CT scans performed during a 2-year period (January 1, 2001 - December 31, 2002) was analyzed. Emergency brain CT scans were especially investigated according to clinical indications, requests from particular clinical specialties, and need of anesthesiologist's assistance. CT scans were correlated with clinical examinations and diagnoses as well as with literature data. During the study period, 15,933 CT scans were performed at our department, 3132 (19.66%) of them at emergency service (1757 male and 1375 female, mean age 56.97 years), and 2576 (82.25%) of the latter emergency brain CT scans (1398 male and 1178 female, mean age 57.80 years). Data analysis showed the following distribution of emergency brain CT scans according to hospital departments: neurology 1441 (55.94%), neurosurgery 632 (24.53%), internal medicine 186 (7.22%), surgery 138 (5.36%), other departments 150 (5.82%), and other institutions 29 (1.13%). Clinical diagnoses for emergency brain CT scanning were as follows: stroke 905 (35.13%), subarachnoid hemorrhage 128 (4.97%), head injury 617 (23.95%), consciousness disorders and convulsions 389 (15.10%), intracranial expansive lesions 234 (9.08%), headache and/or vertigo 141 (5.47%), cerebrovascular insufficiency 50 (1.94%), infectious disease 46 (1.79%), hydrocephalus 12 (0.47%), metabolic disorders 2 (0.08%), and lost or unavailable data at the time of the study 52 (2.02%). Anesthesiologist's assistance during emergency brain CT scanning was needed in 234 (9.08%) cases. Correlation of CT findings with clinical diagnosis yielded the following results: 96 (3.73%) lost or unavailable data at the time of the study, 639 (25.77%) normal findings, and 1841 (74.23%) pathologic findings. Study results showed the number of emergency brain CT scans to be quite high with a tendency of continuous growth (cerebrovascular disorders, new therapeutic approaches, head injury). Difficulties encountered on brain CT scanning because of the patient's state, and delicacy of the emergency interpretation of CT scans impose the need of higher availability of a neuroradiologist within the frame of the emergency state algorithm.
[Show abstract][Hide abstract] ABSTRACT: Magnetic resonance imaging (MRI) is an important imaging technique for evaluation of cerebral ischemic changes. Using magnetic resonance angiography (MRA), both large and medium sized intracranial arteries and veins can be visualized by selecting appropriate imaging parameters. The aim of this retrospective study was to evaluate our own results in the diagnosis of cerebrovascular diseases with MRI and MRA, and to compare them with literature data. Data on 278 patients with cerebrovascular symptomatology (158 female and 120 male, mean age 45-54 years), examined between April 2001 and November 2002, were analyzed. MRA was performed in all 278 and both MRA and MRI in 231 patients. On MRA, 90 pathologic alterations of intracranial arteries (69 aneurysms and 21 vascular malformations), 13Rintracranial arterial occlusions, 19 intracranial arterial stenoses, and 14 cases of intracranial arteriosclerotic changes were identified. On MRI, 114 strokes (73 brain infarctions, 22 cerebral hemorrhages and 19 sub-arachnoid hemorrhages), 14 vascular malformations and 14 cases of small vessel disease were detected. MRI was found to be a powerful tool to detect ischemic lesions immediately upon stroke onset. MRA is highly sensitive for the detection of occlusive disease in large intracranial arteries. For cerebral venous and sinus thrombosis, MRI and MRA are first line studies. MRA of extracranial and intracranial vessels alone or in combination with transcranial color-coded duplex sonography (TCCD) as well as computed tomography angiography (CTA) may eliminate the need of intra-arterial digital subtraction angiography (DSA) in most patients studied for occlusive cerebrovascular disease. DSA may be reserved for those patients in whom there is a disagreement among the results obtained by use of noninvasive techniques, and for the diagnosis of arteriovenous malformations, whereas MRA can prove useful on follow-up examinations.
[Show abstract][Hide abstract] ABSTRACT: We describe a case of hyperacute subarachnoid and intraventricular hemorrhage from a ruptured aneurysm, which occurred while the patient was undergoing MR imaging. Compared with CSF, the blood in the subarachnoid space had slightly lower signal intensity on T2*-weighted gradient-echo images and increased signal intensity on T2-weighted spin-echo images. This finding differs from the generally accepted MR appearance of intracranial hemorrhage and should be recognized to ensure proper patient care.
No preview · Article · Apr 2003 · American Journal of Neuroradiology
[Show abstract][Hide abstract] ABSTRACT: We herein describe a case of an isolated multilocular hydatid cyst occurring in the basilar cisterns, with nondependent levels of different signal intensities shown on MR images. Three portions were visualized on T1-weighted images: the hyperintense inferior aspect, the isointense central part, and the superior aspect of lower signal intensity. The inferior portion was hypointense on T2-weighted images. This unusual appearance was caused by layering of hydatid sand and may represent a characteristic feature of hydatid disease.
Full-text · Article · Feb 2003 · American Journal of Neuroradiology
[Show abstract][Hide abstract] ABSTRACT: Despite the enormous progress done in the course of last years in diagnosis, treatment and rehabilitation of stroke patients, prevention is still main strategy in approaching the stroke. After the comprehensive review of the organization of stroke care, treatment and neurorehabilitation of stroke patients, this part shows the recommendations of the Croatian Society for Neurovascular Disorders of the Croatian Medical Association and the Croatian Stroke Society for primary and secondary prevention of stroke.
No preview · Article · Jan 2003 · Lijec̆nic̆ki vjesnik
[Show abstract][Hide abstract] ABSTRACT: Background
Seven cases of neurocysticercosis and three cases of neuroechinococcosis with symptoms of elevated intracranial pressure requiring urgent neurosurgical treatment are described. No neuroradiologic procedure established exact diagnosis preoperatively; this was achieved by pathohistologic analysis of bioptic material.
No preview · Article · Nov 2002 · Archives of Medical Research
[Show abstract][Hide abstract] ABSTRACT: Seven cases of neurocysticercosis and three cases of neuroechinococcosis with symptoms of elevated intracranial pressure requiring urgent neurosurgical treatment are described. No neuroradiologic procedure established exact diagnosis preoperatively; this was achieved by pathohistologic analysis of bioptic material.
Ten patients with duration of clinical symptoms ranging from 1 week to 1 month were operated on at the Department of Neurosurgery of Sestre Milosrdnice University Hospital in Zagreb, Croatia during the period 1988-2000. On receipt, bioptical material was examined pathohistologically at the Ljudevit Jurak Clinical Department of Pathology of the same hospital. We compared our data with facts collected by reviewing the pertinent literature over the past 10 years.
The most common localization of parasitic cysts in our study was posterior cranial fossa, i.e., subtentorial, which, according to the literature, is a rare localization. Due to this unusual localization, dominant clinical symptoms included elevated intracranial pressure, requiring urgent surgical removal of parasitic cysts.
With the exception of the epidemiologic aspect, cerebral cysticercosis and echinococcosis are important as a true diagnostic and therapeutic problem. These human parasitic zoonoses are rarely diagnosed preoperatively despite newly developed neuroradiologic and serologic methods, especially in cases of primary appearance in brain when exact diagnosis reveals adequate surgical removal with subsequent complete recovery.
No preview · Article · Jan 2002 · Archives of Medical Research
[Show abstract][Hide abstract] ABSTRACT: Acute stroke in the leading cause of disability in the modern society. In developed countries, stroke is the second cause of death, and in Croatia it is the leading cause of death. Due to modification of life-style and risk factors, better stroke management, the incidence of stroke in developed countries has decreased and mortality has been reduced. Over the past year, there have been published several recommendations for stroke management. In this paper an overview of the already accepted therapeutic strategies for stroke management and an evaluation of the evolving new ones is provided.
Full-text · Article · Jan 2001 · Neurologia croatica: glasilo Udruzenja neurologa Jugoslavije = official journal of Yugoslav Neurological Association
[Show abstract][Hide abstract] ABSTRACT: A majority of growth hormone secreting pituitary adenomas respond well to somatostatin and somatostatin analogues. The acute action of octreotide, a synthetic somatostatin analogue, on growth hormone secretion was assessed in 42 patients with clinically and laboratory verified acromegaly. Octreotide was administered subcutaneously in a dose of 50 mg. Blood sampling was performed at 1-hour intervals during 6 hours of testing. The mean basal values of growth hormone (c±SE) was 26.3±4.5 ng/ml (range 6.1-66.6 ng/ml), and of IGF-I 2940±171.7 IU/l (range 2350-4856 IU/l). Reduction in growth hormone values below 5 ng/ml was recorded in 31 (73.8%), suppression by more than 50% in 5 (11.9%) and by more than 45% in 3 (7.1%) patients. Maximal suppression was noticed in the first two hours of testing. In 3 (7.1%) patients, resistance to octreotide with no change in growth hormone values was observed. In conclusion, octreotide reduces growth hormone values in most acromegalic patients. A small proportion of acromegalic patients do not respond well to octreotide, probably due to the lack of somatostatin receptors on tumor cells. We consider the acute octreotide test as a very useful tool in triage of acromegalic patients eligible for medicamentous treatment.
[Show abstract][Hide abstract] ABSTRACT: Reactivity of Ki-67 antigen was tested in six choroid plexus tumors (three papillomas and three carcinomas, including a case of triple recurrence of choroid plexus carcinoma) in order to evaluate the proliferative potential of each tumor. All tumors were diagnosed in male children aged several months to 12 years, except for one choroid plexus papilloma diagnosed in a 23-year- old female. Retrospective immunohistochemical characterization and evaluation of the proliferative potential in those three choroid plexus papillomas and three carcinomas was performed by reaction to Ki-67 antigen using the Strept AB Complex/HRP duet visualization system. The DAKO Rabbit Anti-Human Ki-67 antigen on paraffin sections was used. The purpose of this evaluation was to determine and to quantify the proliferative potential in each choroid plexus papilloma, and to compare the proliferative potential of papillomas and carcinomas. Authors' results showed significant differences in the number of positive immunoreactive cells in choroid plexus papillomas and especially in choroid plexus carcinomas. Quantitative differences of Ki-67 antigen nuclear reactivity may prove as a useful clinical indicator for the prognosis of progression and recurrence of choroid plexus tumors.
[Show abstract][Hide abstract] ABSTRACT: The best operative intervention for children with intracranial arachnoid cysts remains a subject of controversy. Treatment options for intracranial arachnoid cysts are either craniotomy and fenestration of the cyst into the cerebrospinal fluid (CSF) spaces or shunting of the cysts content extracranially. To determine which treatment provides the greatest benefit with fewest complications, records of 42 children with arachnoid cysts treated at the Department of Neurosurgery from 1988 to 1996 were reviewed. There were 42 patients (25 males and 17 females) with 42 cysts. The mean age of the patients was 7.3 years, with a range from 4 months to 15 years. The cysts were most commonly supratentorially (middle fossa) located. The diagnostic procedures were: transfontanellar ultrasonography (4 patients), CT scan (35 patients) and MRI scan (7 patients). In the treatment of arachnoid cysts, the cystoperitoneal (CP) shunt was the most common procedure. Fenestration of the cysts was performed in only 6 patients. Twenty-five patients were treated by cyst shunting initially and 4 patients after fenestration. In 3 patients the fenestration and shunt were performed simultaneously, and in 8 patients the cysts and hydrocephalus were shunted by a 3-way connector. The follow-up period in these 42 patients ranged from 6 months to 5 years. Thirty-four of 39 treated cysts were reduced in size on follow-up studies (in 3 patients no neuroradiologic studies were performed). Twenty-four (57%) patients achieved full recovery, 9 (21%) patients showed clinical improvement, in 7 (17%) patients the symptoms remained the same, and in 2 (5%) patients the statement worsened. There were 5 complications in 5 patients, excluding shunt malfunctions and infections.
No preview · Article · Jan 1998 · Neurologia croatica: glasilo Udruzenja neurologa Jugoslavije = official journal of Yugoslav Neurological Association
[Show abstract][Hide abstract] ABSTRACT: Cerebral and spinal column computed tomography (CT) was performed in 53 patients wounded during war in the Republic of Croatia from June through December 1992. Of these, 36 (67%) suffered craniocerebral injuries; 10 (18%) sustained facial, neck, and paranasal sinus wounds; and 7 (13%) had vertebral andjor paravertebral lesions. Twenty-five (70%) of the patients with craniocerebral injuries had penetrating wounds with diffuse and multiple, predominantly hemorrhagic lesions of cortical and subcortical structures, with basal ganglia lesions in 15 (43%) and brainstem lesions in 6 (20%). Of the 7 vertebral studies. 4 showed paravertebral tissue damage to the spinal column and cord.
No preview · Article · Jul 1993 · Journal of neuroimaging: official journal of the American Society of Neuroimaging
[Show abstract][Hide abstract] ABSTRACT: On computed tomography (CT) layers through the tumor the quality of picture depends upon the tumoral tissue structure, i.e., upon its histological appearance. In the formation of this histological appearance to a greater or lesser extent a series of various elements are involved, which are responsible for the density on CT scan, e.g., blood vessels, fatty tissue, calcium, connective tissue, collagen, etc. For some tumors the most important characteristic is specific organization of tissues in the volume, which can be clearly seen on high-quality CT scan. Possible limitations are due to technical capabilities of a CT apparatus. In our study we have obtained the most valuable results by analyzing the quality of picture of neurinomas on the so-called native CT scans, and by evaluating the way in which the picture of the tumoral tissue changed by opacification after an intravenous injection of contrast medium. Our study included 23 intracranial neurinomas. Twenty of them were neurinomas of the statoacoustic nerve, 1 of the orbit, 1 of the Gasser's gaglion and 1 was in the parasagittal region. For each particular tumor on histological specimens Antoni A and Antoni B types of tissue were semiquantitatively identified. In our study we have chosen only those cases for which we had a plenty of tumoral tissue suitable for semiserial analysis. The results of the histological analysis were compared with the results of the CT assessment of the tumoral tissue. Larger necrotic areas and cystic formations within tumoral tissue, which we could not analyze on our histological specimens, were excluded from the evaluation of CT scans of these tumors. Our results indicate a positive correlation between the histological appearance of neurinomas and their CT scans. This correlation between the histological properties of the tumoral tissue and the CT scan was almost 100% in those cases in which one histological type of neurinomas significantly prevailed. The prevalence of one type of neurinoma tissue was found in 74% of cases. In almost 61% of neurinomas in the histological appearance Antoni A type of tissue prevailed, what was clearly seen on CT in the form of hyperdense areas of the tumor. Antoni B type of tissue was histologically found in about 13% of neurinomas. These tumors had a marked hypodense picture of the tumoral tissue. The rest of neurinomas had mixed types of tissue. In this group of tumors we could not use the CT findings as an indicator in preoperative analysis of histopathological tissue characteristics.
No preview · Article · Feb 1991 · Neurologia croatica: glasilo Udruzenja neurologa Jugoslavije = official journal of Yugoslav Neurological Association
[Show abstract][Hide abstract] ABSTRACT: Subdural hematoma (SDH) develops as a result of bleeding in the subdural space. According to nowadays accepted division, three groups of subdural hematomas can be differentiated: acute, subacute and chronic. The time elapsed from the moment of the occurrence of the hematoma to the moment when it was diagnosed is the main factor for determining the stage of SDH. However, for the above-mentioned types of SDH, this time differs depending on the author reporting it. Subdural hematoma is most often diagnosed by means of computerized tomography (CT). This method is safe and reliable, giving the exact diagnosis in more than 90% of cases. According to the basic principle of the concept of "living pathology", the knowledge of histological appearance of an investigated lesion is essential for the diagnostic interpretation of this lesion in neuroimaging methods. Very few authors studied the histological picture of subdural hematoma. The only structure which was histologically examined in details was the subdural neomembrane. Studies correlating histological picture of SDH and its appearance on CT scans have not been carried out until now. In this work such a correlation was made, and some regularities connecting these two methods were pointed out. Hyperdense picture of SDH on CT scans represents a hematoma containing almost only erythrocytes and erythrocyte-fibrin component being formed. Hypodense picture of SDH on CT scans represents a hematoma containing fibrin and inflammatory cells. Hematomas of mixed density on CT scan in all cases contained a neomembrane. Obvious histological differences between the mentioned types of subdural hematoma have led to the conclusion that chronic subdural hematoma is not the last stage of an "old" acute SDH. Chronic and acute subdural hematomas are different entities, considering their etiopathogenetic and clinical picture, and especially their CT and histopathological appearances.
No preview · Article · Feb 1991 · Neurologia croatica: glasilo Udruzenja neurologa Jugoslavije = official journal of Yugoslav Neurological Association
[Show abstract][Hide abstract] ABSTRACT: A case of neuro-cutaneous melanoma, in the course of which a bifocal melanoma of the cerebral hemisphere had developed, was used as a natural model for the study of the relation between tumorous and non-tumorous elements. The need is pointed out for the definition of such a cutaneous-meningeal syndrome before the development of a neoplasm. As tumours develop from the cells defining leptomeningeal melanosis, the possibility of a neuroradiological diagnosis of this process is accentuated, primarily by a minute examination of the sites characteristic of the disease. A premorbid detection of all such cases is imperative in order to introduce an early anti-tumour treatment.
No preview · Article · Feb 1990 · Acta medica Iugoslavica