Acute disseminated encephalomyelitis following spider bite

Akutni diseminirajući encefalomijelitis (ADEM) upalna je, demijelinizirajuća bolest središnjeg živčanog sustava koja se pojavljuje kao imunološki odgovor na virusnu ili bakterijsku infekciju ili cijepljenje. Prikazujemo bolesnika s kliničkom prezentacijom i radiološkim manifestacijama ADEM-a koji je nastao nakon ugriza pauka. Kortikosteroidna terapija nije postigla zadovoljavajući rezultat u liječenju. Bolesnik se oporavio nakon pet dana liječenja imunoglobulinima. Križna reaktivnost između paukovog toksina i mijelina mogla bi objasniti patofiziološki mehanizam demijelinizacije. O ADEM-u treba razmišljati kao mogućoj komplikaciji ugriza pauka.Acute disseminated encephalomyelitis (ADEM) is an inflammatory, demyelinating disease of the central nervous system that occurs as an immunological response to a viral or bacterial infection or an immunization. We describe a patient with clinical presentation and radiological features of ADEM that appeared after a spider bite. Corticosteroid therapy did not produce satisfied treatment response. The patient recovered after five days of immunoglobulin therapy. The cross-reactivity between spider toxin and myelin could explain pathophysiological mechanism of demyelination. ADEM should be considered as a possible complication of a spider bite

A case of „Spectacular Shrinking Deficit“ – case report and short review of elusive clinical phenomena

Spectacular Shrinking Deficit (SSD) is a term attributed by J.P. Mohr to a rare cerebrovascular event defined by a rapid and dramatic improvement of major hemispheric stroke syndrome. It is presumed to be caused by the migration of initially embolic occlusion of an internal carotid artery or middle cerebral artery to its distal branches. It is only reported in several case reports, and case series with differing criteria of what defies an SSD meaning that its presumed prevalence rate of 7-14% of major hemispheric stroke syndromes could be an overestimation. It is usually associated with the cardioembolic cause of stroke, and it has a higher prevalence rate in younger patients, males, and nondiabetics. Our case is a 58 – year old male who presented to our ER with a major hemispheric stroke syndrome (deviation of head and eyes on the right side, central facioparesis on the left, left hemiplegia, and left hemineglect, NIHSS 16) 30 min- utes after symptom onset. He was aggressive, insisting nothing was wrong with him. His initial brain CT showed acute ischemic changes in the right temporooccipital region with an inadequate filling of distal branches of the right MCA shown on CT brain angiography. His symptoms spectacularly improved in our ICU (NIHSS 0) 51 minutes from symptom onset negating the need for thrombolysis. Except for one positive Beta – 2 GPI test his detailed laboratory tests, 24h Holter ECG, TTE, carotid, and vertebral artery ultrasound were noneventful. He had no cognitive or neurological deficit. He denied the possibil- ity of performing TEE and prolonged cardiac monitoring. Control brain MRI 4 days and 4 months later confirmed moderate ischemic changes of the right insular, temporal, and occipital cortex. Studies report that spontaneous recanalization usually happens in 17% of patients but does not correlate with TIA. This is the first report of an SSD with moderate ischemic stroke and no leftover neurological deficit. Other case series report moderate ischemic stroke SSD with a small residual neurological deficit (NIHSS 2-4). Perhaps mood changes can be associated with selective neuronal loss found in animals and patients suf- fering transient occlusion of the brain artery. The cardioembolic cause can in certainty be excluded with TEE and prolonged cardiac monitoring

A case of „Spectacular Shrinking Deficit“ – case report and short review of elusive clinical phenomena

Spectacular Shrinking Deficit (SSD) is a term attributed by J.P. Mohr to a rare cerebrovascular event defined by a rapid and dramatic improvement of major hemispheric stroke syndrome. It is presumed to be caused by the migration of initially embolic occlusion of an internal carotid artery or middle cerebral artery to its distal branches. It is only reported in several case reports, and case series with differing criteria of what defies an SSD meaning that its presumed prevalence rate of 7-14% of major hemispheric stroke syndromes could be an overestimation. It is usually associated with the cardioembolic cause of stroke, and it has a higher prevalence rate in younger patients, males, and nondiabetics. Our case is a 58 – year old male who presented to our ER with a major hemispheric stroke syndrome (deviation of head and eyes on the right side, central facioparesis on the left, left hemiplegia, and left hemineglect, NIHSS 16) 30 min- utes after symptom onset. He was aggressive, insisting nothing was wrong with him. His initial brain CT showed acute ischemic changes in the right temporooccipital region with an inadequate filling of distal branches of the right MCA shown on CT brain angiography. His symptoms spectacularly improved in our ICU (NIHSS 0) 51 minutes from symptom onset negating the need for thrombolysis. Except for one positive Beta – 2 GPI test his detailed laboratory tests, 24h Holter ECG, TTE, carotid, and vertebral artery ultrasound were noneventful. He had no cognitive or neurological deficit. He denied the possibil- ity of performing TEE and prolonged cardiac monitoring. Control brain MRI 4 days and 4 months later confirmed moderate ischemic changes of the right insular, temporal, and occipital cortex. Studies report that spontaneous recanalization usually happens in 17% of patients but does not correlate with TIA. This is the first report of an SSD with moderate ischemic stroke and no leftover neurological deficit. Other case series report moderate ischemic stroke SSD with a small residual neurological deficit (NIHSS 2-4). Perhaps mood changes can be associated with selective neuronal loss found in animals and patients suf- fering transient occlusion of the brain artery. The cardioembolic cause can in certainty be excluded with TEE and prolonged cardiac monitoring

Ataxia as an initial presentation of Sporadic Creutzfeld – Jakob disease : an atypical case report and literature review

Sporadic Creutzfeldt Jakob disease is a rare, fast-progressing neurodegenerative disease with a fatal outcome. Even though its treatment options are scarce, and there is no cure for the disease, adequate diagnosis can help patients and their families come to terms with the disease on time, and give them valuable time to plan accordingly. We report a case of a patient presenting to our emergency depart- ment with a 2-week history of ataxia, and oscillopsia. Her initial neurological examination revealed subtle dysarthria, diplopia with left gaze, wide-based ataxic gait with occasional small steps, sinistro- pulsion in the Romberg position, and ataxia of the limbs, predominantly of the left arm. The patient at that time did not exhibit cognitive impairment, movement disorders, or other neurological signs. Her initial brain MSCT was without lesions or other pathomorphological supstrate. During hospitaliza- tion, treatable causes were firstly excluded with blood and CSF lab tests excluding metabolic, toxic, infectious, autoimmune, and paraneoplastic causes. Detailed medical history revealed subtle personal- ity changes, while cognitive testing revealed moderate cognitive impairment. Brain MRI and EEG 4 days after hospitalization reported typical changes seen with advanced prion disease surprisingly being the fact that the patient had a mild to moderate clinical picture. RtQuIC analysis of the CSF was per- formed to prove probable sCJD and was positive. The patient’s family were given instructions, while the wishes of the patient, and family members were fulfilled concerning planning future care. After- ward, the patient’s state deteriorated rapidly as per the tragic prognosis of sCJD resulting in akinetic mutism, and death. Ataxia without cognitive impairment, rigor, or movement disorders is an uncom- mon clinical presentation for a disease with a 1:1 000 000 incidence rate. Modern diagnostic methods in way of more advanced brain MRI capabilities, and RT-QuIC obviate the need for complicated, and potentially infectious brain biopsy in diagnosing sCJD. Alongside the case report, we present a short but comprehensive literature review of modern data regarding the sCJD. This case report and literature review serve to educate clinicians about this rare but devastating disease

Morfološka i kemijska analiza introduciranih sorti nektarine u Hercegovini

A 2-year study was done to compare fruit morphological and chemical composition of three nectarine cultivars grown in south Hercegovinia conditions. A high variability among and within cultivars was found and significant differences were observed among them in all properties analyzed. On the basis of evaluated data, the best fruit performance was registered in ‘Caldesi 2000’ and ‘Venus’ grown in the condition of this part of the Mediteran. This evaluation may help to select a set of nectarine cultivars with better fruit quality attributes, which in our growing conditions might be indicated in ‘Caldesi 2000’ and somewhat in ‘Venus’. The highest average of fruit width (61.18 mm) and fruit weight (148.24 g) was found in cultivar Caldesi 2000. As for friut thickness, also cultivar Caldesi 2000 had the highest value (55.39 mm). The results for the highest fruit length (60.48 mm) had Venus cultivar also fruit stone weight length, width and thickness. The contents sugars (glucose, fructose) total soluble dry matter, and total acids in fruits were found in cultivar Venus, but pH and sucrose were found in cultivar Sun Grand.Provedeno je dvogodišnje istraživanje kako bi se usporedio morfološki i kemijski sastav plodova tri sorte nektarine uzgojene u južnohercegovačkim uvjetima. Utvrđena je velika varijabilnost između i unutar sorti te su uočene značajne razlike među njima u svim analiziranim svojstvima. Na temelju procijenjenih podataka najbolji učinak ploda zabilježen je kod sorti \u27Caldesi 2000\u27 i \u27Venus\u27 uzgojenih u uvjetima ovog dijela Mediterana. Ova procjena može pomoći u odabiru niza sorti nektarina s boljim svojstvima kvalitete ploda, što bi u našim uvjetima uzgoja moglo biti označeno kao \u27Caldesi 2000\u27 i donekle \u27Venus\u27. Najveći prosjek širine ploda (61,18 mm) i mase ploda (148,24 g) ima sorta Caldesi 2000. Što se tiče debljine ploda, također je sorta Caldesi 2000 imala najveću vrijednost (55,39 mm). Rezultati za najveću duljinu ploda (60,48 mm) imala je sorta Venus kao i težinu, širinu i debljinu koštice ploda. Sadržaj ukupne topljive suhe tvari, šećera (glukoza, fruktoza) i ukupnih kiselina u plodovima utvrđen je kod sorte Venus, a pH i saharoza kod sorte Sun Grand