Benigna angiopatija središnjeg živčanog sustava ili reverzibilni moždani vazokonstrikcijski sindrom

Benign angiopathy of the central nervous system is a subset of primary angiitis of the central nervous system characterized by “benign” course. It means that changes of cerebral vessels are reversible after treatment with corticosteroids and calcium channel blockers, so these abnormalities are believed to reflect vasospasm rather than true vasculitis. The diagnosis is made on the basis of clinical presentation, brain magnetic resonance imaging and cerebral angiography. We present a young man with acute onset of headache and neurologic impairment secondary to ischemic stroke with intracerebral and subarachnoid hemorrhage. Cerebral angiography showed characteristic findings of diffuse vasculitis but good response to treatment with corticosteroids and calcium channel blockers distinguish this benign angiopathy from the more aggressive form of the central nervous system vasculitis.Benigna angiopatija središnjeg živčanog sustava je podtip primarne upale krvnih žila središnjeg živčanog sustava (PACNS ) koju karakterizira „benigni“tijek. To znači da su promjene na krvnim žilama mozga reverzibilne nakon liječenja kortikosteroidima i blokatorima kalcijevih kanala pa se pretpostavlja da su promjene prije odraz vazospazma nego prave upale. Dijagnoza se postavlja na osnovi kliničke prezentacije, magnetske rezonance mozga i moždane angiografije. Prikazujemo mladića s naglo nastalom glavoboljom i neurološkim poremećajem na podlozi ishemijskog moždanog udara s intracerebralnim i subarahnoidnim krvarenjem. Cerebralna angiografija je pokazala promjene tipične za difuznu upalu krvnih žila, ali dobar odgovor na liječenje kortikosteroidima i blokatorima kalcijevih kanala razlikuje ovu benignu angiopatiju od agresivnijeg oblika vaskulitisa središnjeg živčanog sustava

CORRELATION OF BDNF, IL-6 AND OXIDATIVE STRESS MARKERS IN DEMYELINATING DAMAGE

BDNF, IL-6 i biljezi oskidacijskog stresa nedvojbeno imaju utjecaj na demijelinizacijski proces umultiploj sklerozi. Točni mehanizmi utjecaja na upalnu i neurodegenerativnu fazu nisu upotpunosti razjašnjeni. U ovo istraživanje je uključeno 60 ispitanika (19 muških i 41 ženskih)koji zadovoljavaju kriterije relapsno remitentne multiple skleroze (RRMS), i 66 zdravihkontrola (24 muških, 42 ženskih). Srednja dob oboljelih i zdravih je 43,5 godina. Iz krviispitanika određena je razina neurotrofina BDNF-a (proBDNF i mBDNF) i IL-6 ELISA testom,a biljega oksidacijskog stresa (MDA, GSH, katalaze i karboniliranih proteina)spektrofotometrijskom metodom, te ih se dodatno koreliralo s brojem demijelinizacijskihT1,T2/FLAIR i gadolinij imbibirajućih lezija. Utvrđena je i korelacija omjera navedenihfizioloških parametara sa stupnjem onesposobljenosti (EDSS), kognitivnim (MoCA test) idepresivnim deficitom (BDI-II upitnik). Dokazana je statistički značajna (P<0,001) negativnakorelacija serumskih razina biljega oksidacijskog stresa glutationa (GSH) na razvoj kognitivnihpromjena ispitanika s RRMS-om ispitanih MoCA testom. Ovo je prvo istraživanje ispitanika sRRMS-om temeljeno na istraživanju serumske razine glutationa na stupanj kongitivnogoštećenja ispitanog MoCA testom. Na razvoj kognitivnih promjena u ovom istraživanjuverificiranih MoCA testom, je statistički pozitivno značajno utjecao broj MR lezija(T1,T2,FLAIR) stupanj depresije, stupanj neurološke onesposobljenosti verificirane EDSSskalom, dob, te vrijednosti GSH. Ispitanici s višim vrijednostima MoCA testa su bili mlađi,imali manji stupanj neurološke onesposobljenosti, bili manje depresivni i imali su manjevrijednosti glutationa i manje demijelinizacijskih lezija na MR-u. Glutation bi mogao bitipotencijalni biljeg progresije kognitivnog deficita kod bolesnika s RRMS-om.BDNF, IL-6 and oxidative stress markers have a distinct role on the process of demyelination in multiple sclerosis. Distinct mechanisms of influence on inflammatory and neurodegenerative phase are not clarified. 60 subjects meeting the criteria for RRMS (19 men and 41 women) and 66 healthy control subjects (24 men, 42 women) were included in the study. The average age of patients and healthy people is around 43,5 years. The levels of the neurotrophin BDNF (proBDNF and mBDNF) and IL-6 were determined from the blood of the subjects by an ELISA test and oxidative stress markers (MDA, GSH, catalase and carbonylated proteins) were determined from subjects by the spectrophotometric method and correlated with the number of demyelinating T2/FLAIR lesions and gadolininium enhanced lesions. The correlation of the ratio of the mentioned physiological parameters with the degree of disability (EDSS), cognitive (MoCA test) and depressive deficit (BDI-II questionnaire) was determined. A statistically significant (P<0.001) negative correlation of serum markers of oxidative stress levels of glutathione (GSH) on the development of cognitive changes in subjects with RRMS tested with the MoCA test was shown. This is the first study of subjects with RRMS that performed the mentioned research of serum glutathione levels on the degree of congitive damage tested by the MoCA test. The development of cognitive changes in this study, verified by the MoCA test, was statistically significantly influenced by the positive number of MR lesions (T1, T2, FLAIR), degree of depression, EDSS, age, and GSH values. Subjects with higher MoCA test values were younger, had a lower degree of neurological disability, were less depressed and had lower glutathione values and fewer demyelinating lesions on MRI. Glutathione could be a potential marker of cognitive deficit progression in patients with RRMS

Treatment of relapsing multiple sclerosis - recommendations of the Croatian Neurological Society

Untreated multiple sclerosis (MS) irretrievably leads to severe neurological impairment. In European health care systems, patient access to disease modifying therapies (DMT) is often confined to more advanced stages of the disease because of restrictions in reimbursement. A discrepancy in access to DMTs is evident between West and East European countries. In order to improve access to DMTs for people with MS (pwMS) living in Croatia, the Croatian Neurological Society issued new recommendations for the treatment of relapsing MS. The aim of this article is to present these recommendations. The recommendations for platform therapies are to start DMT as soon as the diagnosis is made. If poor prognostic criteria are present (≥9 T2 or FLAIR lesions on the initial brain and spinal cord magnetic resonance imaging [MRI] or ≥3 T1 lesions with postcontrast enhancement on the initial brain and spinal cord MRI or Expanded Disability Status Scale after treatment of the initial relapse ≥3), high-efficacy DMT should be initiated. If pwMS experience ≥1 relapse or ≥3 new T2 lesions while on platform therapies, they should be switched to high-efficacy DMT. Further efforts should be made to enable early and unrestricted access to high-efficacy DMT with a freedom of choice of an appropriate therapy for expert physicians and pwMS. The improvement of access to DMT achieved by the implementation of national treatment guidelines in Croatia can serve as an example to national neurological societies from other Eastern European countries to persuade payers to enable early and unrestricted treatment of pwMS