Differences in the Knowledge of Stroke Symptoms between Urban and Rural Population

Visoke stope smrtnosti od moždanog udara uzrokovane su nedostatnim znanjem stanovništva o moždanom udaru koji nastaje kao posljedica načina života i nedovoljne kontrole rizičnih čimbenika za tu bolest. Poznavanje simptoma moždanog udara ispitivalo se među gradskim i seoskim stanovništvom u županiji Šibensko-kninskoj. Ispitivanje je obuhvatilo ukupno 448 osoba uz jednak udio ispitanika iz gradskih i seoskih sredina. Uz to je ispitano i liječenje moždanog udara, te razina obrazovanja ispitanika. Studija je provedena kao anketa s razgovorima i anketnim upitnicima koji su sadržavali višestruke ispravne i krive odgovore na pitanja. Rezultati su pokazali kako gradsko stanovništvo bolje poznaje simptome moždanog udara od osoba koje žive na selu, a obje su skupine prepoznale poremećaje govora kao najčešći simptom moždanog udara (63,64% gradskih i 50,44% seoskih ispitanika; p=0,005), nakon kojega slijedi slabost jedne strane tijela (61,82% gradskih i 46,93% seoskih ispitanika; p=0,002) i disestezije (trnci) u jednoj strani tijela (60,0% gradskih i 44,74% seoskih ispitanika; p=0,001). Obje skupine misle kako se moždani udar može uspješno liječiti. To bi moglo biti zbog razlike u razini obrazovanja, jer je u usporedbi sa skupinom gradskog stanovništva skupina ispitanika sa sela imala veći broj osoba s osnovnom školom ili manje od toga, a manje onih sa srednjim i visokim obrazovanjem, te slijedom toga različit način života i bolju kontrolu rizičnih čimbenika za moždani udar kod gradskog stanovništva.High mortality rates of stroke are due to insufficient knowledge of stroke among the population, which is the consequence of lifestyle and inadequate control of stroke risk factors. The knowledge of stroke symptoms was assessed in urban and rural population from the Šibenik-Knin County. A total of 448 subjects were studied, with equal numbers of urban and rural participants. In addition, the treatment of stroke and educational level of the subjects were recorded. The study was conducted as a survey comprising interviews and questionnaires with multiple right and wrong answers. The results showed that urban subjects had better knowledge of stroke symptoms than rural subjects, and both groups recognized speech disturbances as the most common stroke symptom (63.64% of urban and 50.44% of rural subjects; p=0.005), followed by weakness affecting one side of the body (61.82% of urban and 46.93% of rural subjects; p=0.002), and dysesthesias (pins and needles) affecting one side of the body (60.0% of urban and 44.74% of rural subjects; p=0.001). Both groups of subjects thought that stroke could be treated successfully. This could be due to differences in educational level because the group of rural population included more subjects with less than primary school or primary school education, and less subjects with high school and university education as compared with urban population, resulting in different lifestyle and better control of stroke risk factors in the latter

Carotid Atherosclerosis

Aterosklerotska bolest arterija glave i vrata uzrokuje 15 % sveukupnih ishemijskih moždanih udara. Kod više od polovice preživjelih uzrokuje invaliditet zbog čega ova bolest predstavlja veliki financijski teret za zdravstveni sustav, a time i za cjelokupno društvo. Stoga je važno u liječenju naglasak staviti na proučavanje faktora rizika i prevenciju ove bolesti. Stenoza karotidnih arterija dijeli se prema stupnju na početnu stenozu (do 50 %), umjerenu stenozu (51 – 75 %), značajnu stenozu (76 – 95 %) i pseudookluziju (iznad 95 %). Također se dijeli na simptomatsku i asimptomatsku te se na temelju potonjih parametara određuje model liječenja. Terapija može biti peroralna (antiagregacijska), ali postoji i mogućnost karotidne endarterektomije (CEA) te endovaskularnog postavljanja stenta.Atherosclerotic disease of the arteries of the head and neck causes 15% of all ischemic strokes. More than half of the survivors face post-stroke disability, which is why this disease is a great financial burden for the entire health system, and thus for society as a whole. Therefore, it is very important in terms of treatment to focus on the study of risk factors and prevention of this disease. Carotid artery stenosis is divided according to degree into initial stenosis (up to 50%), moderate stenosis (51 – 75%), significant stenosis (76 – 95%) and pseudoocclusion (above 95%). It is also divided into symptomatic and asymptomatic, and the treatment model is determined based on the latter parameters. Therapy includes peroral therapy (antiplatelet), but there is also the possibility of carotid endarterectomy (CEA) and endovascular stent placement

Retrospective Analysis of Stroke Patients Treated at the Department of Neurology of the Šibenik-Knin County General Hospital from 1996 to 2015

U razdoblju od 1996. do 2015. godine na Odjelu neurologije OB-a Šibensko-kninske županije liječeno je 15.530 pacijenata, a od toga 7948 od moždanog udara (MU). Ishemijski MU imalo je 6246 (79,2%) pacijenata, 740 (9,4%) hemoragijski MU, a 900 (11,4%) ih je liječeno pod dijagnozom TIA-e. Od ukupnog broja pacijenata koji su doživjeli MU njih 3857 (48,5%) bilo je muškog spola, a 4091 (51,5%) ženskoga. Srednja dob pacijenata bila je 72,5 godina 1996. i povisivala se do 75,5 godina 2015. godine. Broj liječenih od MU-a povećavao se tijekom godina, tako da je 1996. od MU-a liječeno 308, a 2015. 438 osoba. Statistički, incidencija MU-a povisivala se s godinama. Stopa smrtnosti oboljelih od MU-a, a liječenih na našem odjelu u tom razdoblju, rasla je od 75,2/100.000 1996. godine do 87,7/100.000 2000. godine kada je bio najveći broj umrlih (100). Nakon toga pada do 48,5/100.000 2015. godine (r2 = 0,579, 57,9% sume kvadrata, empirijska signifikantnost približno 0,00%, standardizirani koeficijent -0,761 < 0). Najmanji broj umrlih bio je 2011. godine i iznosio je 42 (43,9/100.000). Na odjelu je u tom periodu od MU-a umrlo 1470 osoba, a postotak umrlih padao je s 28,9% 1996. na 12,1% 2015. godine.In the period from 1996 to 2015, a total of 15,530 patients were treated at the Department of Neurology of the Šibenik-Knin County General Hospital. From this number 7,948 were treated for stroke. There were 6,246 (79.2%) patients with ischemic stroke and 740 (9.4%) with haemorrhagic stroke, while 900 (11.4%) patients were treated for transient ischemic attack (TIA). From the total number of patients who suffered stroke, 3,857 patients were male (48.5%) and 4,091 were female (51.5%). In 1996, the mean age of patients was 72.5, which increased to 75.5 in 2015. The number of treated stroke patients increased over this time period, from 308 patients in 1996 to 438 in 2015. Statistically, stroke incidence rose over the years. The mortality rate of stroke patients treated at our department during this time period increased from 75.2/100.000 in 1996 to 87.7/100.000 in 2000, when the highest number of deaths (100) was recorded. The mortality rate decreased to 48.5/100.000 in 2015 (r2=0.579, 57.9% of the sum of squares, empirical significance approx. 0.00%, standardized coefficient -0.761 < 0). The lowest recorded number of deaths was 42 (43.9/100.000) in 2011. During this period, 1,470 patients admitted to the Department of Neurology died from stroke, while the percentage of deaths steadily decreased from 28.9% in 1996 to 12.1% in 2015

SCHIZOPHRENIA SPECTRUM PSYCHOSIS IN A CROATIAN GENETIC ISOLATE: GENEALOGICAL RECONSTRUCTIONS

Background: Schizophrenia spectrum psychosis is a chronic mental disorder, based on a range of genes whose expression can be altered by different environmental factors. Subjects and methods: In this archival and demographic study of genetic isolate we show an incidence of schizophrenia spectrum psychosis in a minority population and transmission of schizophrenia spectrum psychosis through several generations of two families in an isolated rural area of Dalmatia from the second half of 19th and the first half of 20th century. Results: The incidence of schizophrenia spectrum psychosis was between 0.58 and 2.58 per 1000 inhabitants. The genogram of Family 1 shows that out of 182 descendants in six generations, there were 27 people with schizophrenia spectrum psychosis. Schizophrenia spectrum psychosis occurred in two men who were born from a relationship of a mother with her relative. The genogram of Family 2 shows that 19 out of 86 descendants in five generations suffered from schizophreniform psychosis. Conclusion: The high occurrence of schizophrenia spectrum psychosis in an isolated village in central Dalmatia is in accordance with the results of earlier studies in that region. The fact that psychosis occurs in varying frequency, without obvious regularity, can be explained by the irregular expression of risk genes as well as by exogenous factors which may affect the activity of the key chromosome areas. Occurrence of psychosis in people born from incestuous relationships indicates the importance of genetic factors in the development of the disorder

Vertigo in Neurological Practice

Vrtoglavica je učestali problem u neurološkoj praksi uzrokovan nizom patomorfoloških i patofizioloških supstrata. Cilj istraživanja bio je utvrditi učestalost pojedinih uzroka vrtoglavice u neurološkoj praksi. Provedeno je prospektivno istraživanje uzroka vrtoglavice u bolesnika obrađivanih u neurološkoj ambulanti. U statističkoj obradi rabili smo χ²-test, t-test, analizu varijance i post hoc LSD test. Srednja životna dob oboljelih muškaraca bila je 55,45±14,8 godina, a žena 52,9±15,1 godinu. Utvrdili smo da podjednako obolijevaju muškarci i žene (t=0,92; p=0,36). Najčešći uzrok vrtoglavice bila je vertebrobazilarna insuficijencija i tranzitorna ishemijska ataka vertebrobazilarnog sliva (36,5%), a slijedili su prema učestalosti vestibularni neuritis (23,5%) i moždani udar (14,8%) te tranzitorna ishemijska ataka uzrokovana značajnim stenozama karotidnih arterija (9,6%). Ostali znatno rjeđi uzroci vrtoglavice u neurološkoj praksi bili su benigna paroksizmalna pozicijska vrtoglavica, multipla skleroza, upalni procesi srednjeg uha, tumori mozga i akustični neurinomi. Utvrđena je statistički značajna razlika uzroka vrtoglavice s obzirom na patomorfološki supstrat prema dobi bolesnika (f=3,55; p=0,017). Oboljeli od moždanog udara i oni s tranzitornom ishemijskom atakom uzrokovanom značajnom stenozom karotidnih arterija bili su značajno starije životne dobi. Posebna pomoć u dijagnostici pojedinih uzroka vrtoglavice uz dijagnostičke metode su pridruženi simptomi te težina, trajanje i tijek vrtoglavice, o čemu treba voditi računa pri procjeni mogućih uzroka vrtoglavice.Vertigo is a common problem in neurological practice, caused by a number of pathomorphological and pathophysiological substrates. The aim of the study was to assess the incidence of particular causes of vertigo in neurological practice. This prospective study included patients treated for vertigo at neurology outpatient clinic. On statistical analysis, χ2-test, t-test, analysis of variance and post hoc LSD test were used. The mean age was 55.45±14.8 years in male patients and 52.9±15.1 years in female patients. The incidence of vertigo was comparable in the two sexes (t=0.92, p=0.36). The most common cause of vertigo was vertebrobasilar insufficiency and transient ischemic attack of the vertebrobasilar circulation (36.5%), followed by vestibular neuritis (23.5%), stroke (14.8%) and transient ischemic attacks caused by significant carotid artery stenosis (9.6%). Other, more infrequent causes of vertigo in neurology practice were benign paroxysmal positional vertigo, multiple sclerosis, inflammation processes in the middle ear, brain tumors and acoustic neuroma. There was a statistically significant difference in the causes of vertigo according to pathomorphological substrate and patient age (f=3.55; p=0.017). The patients that had suffered a stroke and those with transient ischemic attacks caused by significant carotid artery stenosis were significantly older. Besides established diagnostic methods, associated symptoms, severity, duration and course of vertigo are of great help in the diagnosis of particular causes of vertigo, which should be taken in consideration on assessing the possible causes of vertigo

Lamotrigin u liječenju rezistentne akutne boli pri radikularnom oštećenju vratnog segmenta: prikaz slučaja

Radicular pain syndromes caused by disk herniation are often accompanied by incomplete central cord syndrome. Intensive pain is difficult to control with standard analgesics. Antiepileptics of new generation have shown significant efficacy in treating pain syndromes, trigeminal neuralgia, diabetic neuropathy, migraines, etc. The treatment of radicular pain with lamotrigine, a new generation antiepileptic, turned out to be effective in lumbar disk radicular conflicts, justifying its application for resistant pain in cervical segment. In our patient, pain intensity was significantly reduced with gradual titration of lamotrigine to a dose of 200 mg/day. Pain intensity measured by the visual analog scale significantly decreased from 100 to 20 mm during eight weeks of titration. The blood concentration of the drug measured by the method of high performance liquid chromatography was 13.65 µmol/L. The patient.s quality of life improved greatly. It is necessary to further evaluate the efficacy of lamotrigine in the treatment of resistant radicular damage.Radikularni bolni sindromi uzrokovani hernijacijom diska obično su udruženi s nepotpunim sindromom kralježnične moždine. Intenzivna bol se teško kontrolira standardnim analgeticima. Antiepileptici nove generacije pokazuju značajan učinak u liječenju bolnih sindroma, neuralgije trigeminusa, dijabetične neuropatije, migrene itd. Liječenje radikularne boli lamotriginom, antiepileptikom nove generacije, pokazalo se učinkovitim u lumbarnom disk-radikularnom konfliktu pa smo ga pokušali primijeniti i u rezistentnoj boli vratnoga segmenta. Postupnom titracijom lamotrigina do doze od 200 mg/dan intenzitet boli značajno se smanjio. Intenzitet boli mjeren ljestvicom VAS smanjio se sa 100 na 20 mm kroz razdoblje od osam tjedana titracije lijeka. Razina lijeka u krvi određena pomoću metode HPLC bila je 13,65 µmol/L. Kvaliteta života naše bolesnice značajno se poboljšala. Potrebno je procijeniti učinkovitost lamotrigina u liječenju rezistentne radikularne boli

UPDATE ON GUIDELINES FOR ACUTE STROKE TREATMENT BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND THE CROATIAN STROKE SOCIETY

Cilj ovih smjernica bio je predati najnovije, sistematizirane spoznaje kliničarima koji se bave zbrinjavanjem odraslih bolesnika s akutnim ishemijskim moždanim udarom. Preveli smo Američke smjernice za liječenje akutnog ishemijskog moždanog udara, koje su izdane 2018. godine od American Heart Association (AHA) i American Stroke Association (ASA) s ciljem prilagodbe hrvatskom zakonodavstvu i zdravstvenom sustavu. Članovi radne skupine Hrvatskog društva za neurovaskularne poremećaje Hrvatskog liječničkog zbora i Hrvatskog društva za moždani udar usmjerili su posebnu pozornost na pregled dosadašnjih spoznaja i prilagodili ih aktualnom stanju u nacionalnom zdravstvenom sustavu kako bi se postiglo optimalno zbrinjavanje bolesnika s akutnim ishemijskim moždanim udarom u Hrvatskoj. Ove smjernice obuhvaćaju prehospitalnu skrb, hitnu evaluaciju te liječenje intravenskom i intraarterijskom terapijom uključujući mjere sekundarne prevencije prigodom inicijalne hospitalizacije u odraslih pacijenata s akutnim moždanim udarom.The aim of these guidelines is to provide an update and comprehensive review of the recent literature for clinicians treating adult patients with acute stroke. We translated American guidelines for the acute ischemic stroke treatment, published in 2018 by the American Heart Association and American Stroke Association, and adapted these guidelines to the Croatian legislation, health insurance policy and standards of health care in Croatia. Members of the Croatian Society for Neurovascular Disorders of the Croatian Medical Association and the Croatian Stroke Society writing group evaluated and adjusted American guidelines to specifi cities of the Croatian health care system in order to improve the quality of stroke management in Croatia. These guidelines include pre-hospital care, urgent evaluation and treatment with intravenous and intra-arterial therapy, as well as the secondary prevention measures during initial hospitalization in adult acute stroke patients

UPDATE ON GUIDELINES FOR ACUTE STROKE TREATMENT BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND THE CROATIAN STROKE SOCIETY

Cilj ovih smjernica bio je predati najnovije, sistematizirane spoznaje kliničarima koji se bave zbrinjavanjem odraslih bolesnika s akutnim ishemijskim moždanim udarom. Preveli smo Američke smjernice za liječenje akutnog ishemijskog moždanog udara, koje su izdane 2018. godine od American Heart Association (AHA) i American Stroke Association (ASA) s ciljem prilagodbe hrvatskom zakonodavstvu i zdravstvenom sustavu. Članovi radne skupine Hrvatskog društva za neurovaskularne poremećaje Hrvatskog liječničkog zbora i Hrvatskog društva za moždani udar usmjerili su posebnu pozornost na pregled dosadašnjih spoznaja i prilagodili ih aktualnom stanju u nacionalnom zdravstvenom sustavu kako bi se postiglo optimalno zbrinjavanje bolesnika s akutnim ishemijskim moždanim udarom u Hrvatskoj. Ove smjernice obuhvaćaju prehospitalnu skrb, hitnu evaluaciju te liječenje intravenskom i intraarterijskom terapijom uključujući mjere sekundarne prevencije prigodom inicijalne hospitalizacije u odraslih pacijenata s akutnim moždanim udarom.The aim of these guidelines is to provide an update and comprehensive review of the recent literature for clinicians treating adult patients with acute stroke. We translated American guidelines for the acute ischemic stroke treatment, published in 2018 by the American Heart Association and American Stroke Association, and adapted these guidelines to the Croatian legislation, health insurance policy and standards of health care in Croatia. Members of the Croatian Society for Neurovascular Disorders of the Croatian Medical Association and the Croatian Stroke Society writing group evaluated and adjusted American guidelines to specifi cities of the Croatian health care system in order to improve the quality of stroke management in Croatia. These guidelines include pre-hospital care, urgent evaluation and treatment with intravenous and intra-arterial therapy, as well as the secondary prevention measures during initial hospitalization in adult acute stroke patients