Medication Overuse Headache

Glavobolja uzrokovana prekomjernim uzimanjem lijekova je sekundarna glavobolja kod bolesnika s prethodno prisutnom primarnom glavoboljom koja je prisutna 15 i više dana mjesečno, a nastaje kao posljedica prekomjerne redovite uporabe akutne i/ili simptomatske terapije za glavobolje 10 ili 15 dana na mjesec i više, ovisno o uzimanom lijeku tijekom više od tri mjeseca. Glavobolja uzrokovana prekomjernom uporabom lijekova predstavlja veliki medicinski problem s obzirom na to da je sve učestalija i predstavlja terapijski izazov, ali i socioekonomski problem jer narušava kvalitetu života bolesnika i prouzrokuje značajne troškove samom bolesniku, no i društvu u cjelini. U prevenciji nastanka važno je educirati bolesnike, ali i liječnike i ljekarnike o opasnosti prekomjernog uzimanja lijekova koje može dovesti do novonastale glavobolje, dok je u liječenju najvažnije reducirati ili potpuno prekinuti uzimanje lijeka koji je doveo do glavobolje, a često je važno i uvesti profilaktičku terapiju za primarnu glavobolju u podlozi. Nakon uspješnog liječenja važno je daljnje praćenje bolesnika radi prevencije recidiva.Medication overuse headache is a secondary headache occurring 15 or more days/month in a patient with a pre-existing primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication (10 to 15 or more days/month, depending on the medication) for more than 3 months. Medication overuse headache is a grave medical problem since it becomes more and more frequent, but it also represents a serious socioeconomic problem since it negatively affects patient quality of life and is a substantial financial burden not just for the patient but for the economy in general. Medication overuse headache can be prevented by education of patients as well as doctors and pharmacists about the headache as a consequence of medication overuse. The most important step in therapy is reduction or complete withdrawal of medication that caused the medication overuse headache. Introducing prophylactic therapy for primary headache is also very useful. Close follow-up of patients after therapy warrants prevention of relapses

Medication Overuse Headache

Glavobolja uzrokovana prekomjernim uzimanjem lijekova je sekundarna glavobolja kod bolesnika s prethodno prisutnom primarnom glavoboljom koja je prisutna 15 i više dana mjesečno, a nastaje kao posljedica prekomjerne redovite uporabe akutne i/ili simptomatske terapije za glavobolje 10 ili 15 dana na mjesec i više, ovisno o uzimanom lijeku tijekom više od tri mjeseca. Glavobolja uzrokovana prekomjernom uporabom lijekova predstavlja veliki medicinski problem s obzirom na to da je sve učestalija i predstavlja terapijski izazov, ali i socioekonomski problem jer narušava kvalitetu života bolesnika i prouzrokuje značajne troškove samom bolesniku, no i društvu u cjelini. U prevenciji nastanka važno je educirati bolesnike, ali i liječnike i ljekarnike o opasnosti prekomjernog uzimanja lijekova koje može dovesti do novonastale glavobolje, dok je u liječenju najvažnije reducirati ili potpuno prekinuti uzimanje lijeka koji je doveo do glavobolje, a često je važno i uvesti profilaktičku terapiju za primarnu glavobolju u podlozi. Nakon uspješnog liječenja važno je daljnje praćenje bolesnika radi prevencije recidiva.Medication overuse headache is a secondary headache occurring 15 or more days/month in a patient with a pre-existing primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication (10 to 15 or more days/month, depending on the medication) for more than 3 months. Medication overuse headache is a grave medical problem since it becomes more and more frequent, but it also represents a serious socioeconomic problem since it negatively affects patient quality of life and is a substantial financial burden not just for the patient but for the economy in general. Medication overuse headache can be prevented by education of patients as well as doctors and pharmacists about the headache as a consequence of medication overuse. The most important step in therapy is reduction or complete withdrawal of medication that caused the medication overuse headache. Introducing prophylactic therapy for primary headache is also very useful. Close follow-up of patients after therapy warrants prevention of relapses

Differential diagnostic relevance of high resolution magnetic resonance in patients with possible multiple system atrophy (MSA) – a case report [Važnost uporabe magnetne rezonancije visoke rezolucije u dijagnostici moguće multiple sistemske atrofije - prikaz slučaja]

Multiple system atrophy (MSA) is sporadic, progressive neurodegenerative disorder characterized clinically by autonomic dysfunction, Parkinsonism (MSA-P), and cerebellar ataxia (MSA-C) in any combination. Parkinsonism is present in the majority of patients (80%). Early in the course of the disease autonomic dysfunctions are present in approximately 40% of patients, while the domination of cerebellar symptoms is present in 20% of all patients1,2. According to second consensus statement on diagnosis of MSA, to make the diagnosis of possible MSA, except Parkinsonism or a cerebellar syndrome, there must be one feature involving autonomic dysfunction plus one other additional that can include findings on history, clinical examination or changes in structural or functional imaging3. We present a case of 60-year old male with Parkinsonism and cerebellar symptoms accompanied with signs of autonomic nervous system involvment. Level of autonomic dysfunction was not the level required for the diagnosis of probable MSA. On initially performed 1.5T MRI, the most prominent neurodegenerative feature of brain stem, cerebellum and basal ganglia was atrophy, however features like »hot-cross bun« sign, »slit-like« putaminal rim and middle cerebellar peduncle hyperintensities were detected only after MR imaging on higher resolution (3T) device4. Our case points to the possibility that some typical structural changes that can help in diagnostic process may not be clearly visible on 1.5 T MRI devices. In such cases we suggest using 3T MRI device, if feasible, in order to demonstrate findings that may help in establishing the diagnosis of possible MSA

HES solutions in critical illness, trauma and perioperative period

In the last few years, many studies and meta-analyses have demonstrated that hydroxyethyl starch (HES) solutions increase the risk of acute renal failure and mortality in critically ill patients. Some studies suggest complete avoidance of HES solutions in patients of all categories. On the other hand, recent studies and analyses suggest that HES solutions may be used in hypovolemic critically ill patients and in the perioperative setting. The main problem in everyday clinical practice and in a rational fluid management approach is that treatment with alternatives to HES solutions is not always pathophysiologically justified (crystalloids) or confirmed in randomised controlled trials (gelatins, albumins)

Differential Diagnostic Relevance of High Resolution Magnetic Resonance in Patients with Possible Multiple System Atrophy (MSA) – A Case Report

Multiple system atrophy (MSA) is sporadic, progressive neurodegenerative disorder characterized clinically by autonomic dysfunction, Parkinsonism (MSA-P), and cerebellar ataxia (MSA-C) in any combination. Parkinsonism is present in the majority of patients (80%). Early in the course of the disease autonomic dysfunctions are present in approximately 40% of patients, while the domination of cerebellar symptoms is present in 20% of all patients1,2. According to second consensus statement on diagnosis of MSA, to make the diagnosis of possible MSA, except Parkinsonism or a cerebellar syndrome, there must be one feature involving autonomic dysfunction plus one other additional that can include findings on history, clinical examination or changes in structural or functional imaging3. We present a case of 60-year old male with Parkinsonism and cerebellar symptoms accompanied with signs of autonomic nervous system involvment. Level of autonomic dysfunction was not the level required for the diagnosis of probable MSA. On initially performed 1.5T MRI, the most prominent neurodegenerative feature of brain stem, cerebellum and basal ganglia was atrophy, however features like »hot-cross bun« sign, »slit-like« putaminal rim and middle cerebellar peduncle hyperintensities were detected only after MR imaging on higher resolution (3T) device4. Our case points to the possibility that some typical structural changes that can help in diagnostic process may not be clearly visible on 1.5 T MRI devices. In such cases we suggest using 3T MRI device, if feasible, in order to demonstrate findings that may help in establishing the diagnosis of possible MSA

Arylsulfatase a Gene Polymorphisms in Relapsing Remitting Multiple Sclerosis: Genotype-Phenotype Correlation and Estimation of Disease Progression

Arylsulfatase A (ASA) is a lysosomal enzyme involved in catabolism of cerebroside-sulfate, major lipid constituent of oligodendrocyte membranes. Various polymorphisms in ASA gene have been described, leading to different levels of enzyme deficiency. Progressive demyelination occurs in metachromatic leukodystrophy (MLD), while the condition of ASA-pseudodeficiency (ASA-PD) is suggested to contribute to complex pathogenesis of multiple sclerosis (MS). This work presents usefulness of genotype-phenotype correlation in estimation of disease severity and progression. The presence of two most common mutations associated with ASA-PD was analyzed in 56 patients with diagnosis of relapsing-remitting multiple sclerosis, by polymerase chain reaction restriction fragment length polymorphism method. In MS patients confirmed as ASA-PD mutations carriers, arylsulfatase activity was determined in leukocyte homogenates by spectrophotometry. To determine whether there is a difference between disability level and/or disease progression in patients with or without mutations we have estimated disability level using Expanded disability status scale (EDSS) and disease progression using Multiple sclerosis severity score (MSSS). Correlation of genotypes and disease progression was statistically analyzed by Kruskal-Wallis test. Patients showing higher MSSS score and found to be carriers of both analyzed ASA-PD mutations were additionally examined using conventional magnetic resonance (MR) techniques. The presence of either one or both mutations was determined in 13 patients. Lower ASA activities were observed in allMS patients carrying the mutations. Nine of the mutations carriers had mild disability (EDSS=0–4.0), 1 had moderate disability (EDSS=4.5–5.5), and 3 had severe disability (EDSS6.0). On the other hand, only 3 MS patients who were mutation carriers showed MSSS values lower than 5.000 while in other MS patients-mutation carriers the MSSS values ranged from 5.267 to 9.453. Comparison of MR findings between MS patients, mutations carrier vs. non-carrier, matched for sex, age and disease duration, showed that the total number of lesions and the number of hypointense lesions on T1-weighted images was greater in MS patient carrying the ASA-PD mutations. Our results on genotype-phenotype correlation analysis indicate a possible contribution of detected arylsulfatase A gene polymorphisms to the clinical severity of multiple sclerosis, estimated by EDSS, MSSS and MR findings. The MSSS proved to be more appropriate indicator of disease progression and should be more frequently used in clinical practice especially for comparison of disease progression in different groups of patients and identification of factors that may influence disease progression such as the presence of gene polymorphisms

Distrofična bulozna epidermoliza s kožnim karcinomom – utjecaj na anesteziju – prikaz slučaja

We report a patient with recessive dystrophic epidermolysis bullosa who developed multiple skin cancer on the upper arm. She was scheduled for arm amputation. Skin and mucosa lesions render more difficulty in anesthetic management, especially monitoring, positioning and airway instrumentation. General anesthesia based on ketamine enables us to avoid some of the problems.Opisujemo bolesnicu s distrofičnim oblikom buloznog dermatitisa u koje su se razvili multipli kožni karcinomi nadlaktice. Bolesnica je predviđena za amputaciju ruke. Kožne promjene i promjene sluznice otežavaju vođenje anestezije, a osobito promatranje, namještanje i pristup dišnom putu. Opća anestezija ketaminom omogućila nam je da izbjegnemoneke od navedenih problema