The importance of scales for treating brain stroke

Prema Svjetskoj zdravstvenoj organizaciji, moždani udar je klinički sindrom definiran kao naglo nastali žarišni, ili rjeđe, globalni neurološki deficit koji traje dulje od 24 sata ili dovodi do smrti, a može se objasniti cerebrovaskularnim poremećajem. Razlikujemo ishemijski i hemoragijski moždani udar. Moždani udar je akutno stanje koje zahtjeva ranu intervenciju i hitno liječenja. Prema epidemiološkim podacima moždani udar je vodeći uzrok onesposobljenosti u odrasloj dobi u Sjedinjenim Američkim državama, treći je uzrok po smrtnosti u zemljama zapadne Europe, drugi uzrok smrtnosti u Hrvatskoj i prvi uzrok invalidnosti, a drugi vodeći uzrok smrti širom svijeta 2013. godine American Heart Association i American Stroke Association su izdale nove smjernice za rano zbrinjavanje pacijenata s ishemijskim moždanim udarom. 2015. godine učinjena je nadopuna smjernica iz 2013. godine za rano zbrinjavanje ishemijskog moždanog udara uključujući endovaskularno liječenje. Američka akademija za neurologiju priznala je ovu vrstu smjernica kao edukacijsku pomoć za liječnike neurologe. Ljestvice poput RACE (engl. Rapid arterial occlusion evaluation scale), FAST-ED (engl. Field assessment stroke triage for emergency destination), C-STAT (engl. Cincinnati stroke triage assessment tool) i LAMS (engl. Los angeles motor scale) su ljestvice koje imaju veliku važnost u ranom, hitnom otkrivanju akutnog zbivanja u procesu nastanka moždanog udara te se koriste od tada i pridonose bržem otkrivanju i zbrinjavanju pacijenata. Od kliničke važnosti za početak liječenja i praćenja tijekom liječenja bitna nam je i NIHSS (engl. National institutes of health stroke scale) ljestvica. Ljestvica NIHSS se koristi u procjeni pacijentova stanja za primjenu trombolitičke terapije u liječenju moždanog udara. Zaključno je bitno utvrditi važnost ljestvica koja se očituje u što ranijoj intervenciji te mogućnosti zbrinjavanja pacijenta u vanbolničkim i bolničkim uvjetima unutar zlatnog sata i postizanja boljih rezultata u liječenju moždanog udara i sprječavanju njegovih posljedica.According to the World Health Organization, stroke is a clinical syndrome defined as the sudden centered or (more rarely) global neurological deficit which lasts for more than 24 hours or leads to death, with the option of being explained through a cerebro-vaskular disease. It can be differentiated between 2 main types of stroke: ischemic and hemorrhagic. Stroke is an acute state which needs an early intervention and urgent treatment. Following the epidemiological data, stroke is the leading cause of the inabilities among the adults in the United States of America, as well as the third cause of death in the Western Europe. It is also the second cause of death in Croatia, alongside being the first cause of the disabilities, and the second death causator worldwide. In 2013 American Heart Association and American Stroke Association made new guidelines for the early menagement of patient with acute ishemic stroke. In 2015 Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment. The American academy of Neurology affirms the value of this guideline as an educational tool for neurologist. Those guideline addresses opportunities for optimal stroke care in the acute phase of the acute ishemic stroke. Scale like RACE (Rapid arterial occlusion evaluation scale), FAST-ED (Field assessment stroke triage for emergency destination), C-STAT (Cincinnati stroke triage assessment tool) and LAMS (Los angeles motor scale) are the scales which carry a great importance in early and urgent detection of the acute changes in the process that leads to stroke. Therefore, these scales are mostly used in this process and they contribute to faster and more precise results, as well as taking care of the patients. What is also very important in the clinical contet of the treatment is the National Institutes of Stroke Scale/Score scale (NIHSS). This score has been used in thrombolysis trials to include or exclude patients from active treatment. In conclusion, it is very important to point out the importance of these scales in as early diagnosis as possible, and furthermore treatment of the patients in hospital and out-of-hospital contexts within the golden hour, and all of this with the same aim to achieve faster and better treatments and prevetnion of stroke

Pathological and Non-pathological Irregularities of Nystagmus

Irregularities of nystagmus can be found almost in every electronystagmographic record, but only a few are pathological. In this investigation, the authors try to define the border line between pathological and nonpathological irregularities of nystagmus and according to this measure the diagnostic use of findings of irregularities of nystagmus

Frequency of early postoperative restenosis after carotid artery thrombendarterectomy

Cilj: Ustvrditi postotak pojavnosti poslijeoperacijske restenoze nakon operacijskog liječenja visokopostotne stenoze arterije karotis na godišnjoj razini te podatke usporediti s novijom svjetskom literaturom. Ispitanici i postupci: Podatci su dobiveni analizom ranih poslijeoperacij- skih kontrolnih nalaza dobivenih obojenim dupleks doplerom, izvršenih dva tjedna nakon zahvata trombendaterektomije karotidnog žilja, u laboratoriju za cerebrovaskularne bolesti, Klinike za neurologiju, KBC-a Rijeka, na 104 pacijenta operirana na Zavodu za torakovaskularnu kirurgiju, Kirurške klinike KBC-a Rijeka 2012. godine. Rezultati: U skupini od 104 operirana pacijenta poradi visokopostotne stenoze unutarnje karotidne arterije u ranom poslijeoperacijskom tijeku evidentirano je 11 pacijenata (10,5 %) s pojavom restenoze, no bez neuroloških simptoma. Dodatnim praćenjem naših pacijenata nakon tri i šest mjeseci primijetili smo da se stupanj restenotskog procesa nije povećavao u 8 pacijenata, no u trojice pacijenata (2,9 %) evidentirano je znatno povećanje stupnja restenoze, te su oni podvrgnuti endovaskularnoj tzv. stenting pro- ceduri. Zaključci: Trombendarterektomija karotidnog žilja je operacijski zahvat koji se u KBC-u Rijeka izvodi rutinski. Incidencija pojavnosti poslijeoperacijske restenoze je mala, no nije neuobičajena pojava, ali uz adekvatnu medikamentnu potporu gotovo nikad nije fatalna za pacijenta, te je reparabilna ako je to potrebno. Mnogi svjetski autori također izvještavaju u izvjesnom postotku o pojavnosti poslijeoperacijske restenoze unutarnje arterije karotis. Redovitim ultrazvučnim kontrolama pravovremeno se otkrivaju poslijeoperacijski restenotski procesi koji mogu biti od hemodinamskog značaja u neuroloških pacijenata. U postizanju dobrih kliničkih rezultata kod prevencije i liječenja neuroloških incidenata izuzetno je važna dobra i uska suradnja svih supspecijalističkih timova koji se bave problematikom cerebrovaskularnog inzulta.Aim: To determine the percentage of postoperative restenosis frequency on an annual level after the operative treatement of the high-percent carotid artery stenosis, and to compare the data with recent literature. Subject and methods: Data was obtained by analysing ear- ly postoperative Colour Duplex Doppler control tests, which were performed two weeks after thrombendarterectomy of carotid vesells in the Laboratory of cerebrovascular diseases, Neurology clinic, Clinical hospital centre Rijeka on 104 patients treated at the Thoracovascular insti- tute, Surgery clinic, Clinical hospital centre Rijeka in the year 2012. Results: In a group of 104 treated patients, because of high-percent stenosis of internal carotid artery there was an evi- dent restenotic process without neurological symptoms in the early postoperative stages in 11 patients (10,5 %). With additional follow-up care of our patients after 3 and 6 monts, the level of restenotic proces did not increase in 8 patients, but in 3 (29 %) of our patients there was an evident increase of restenosis and they were treated with stenting procedure. Conclusions: Carotid thrombendarterectomy is a routine operative procedure in our Thoracovascular institute, and has been performed for many years. Fortunately, the frequency of postoperative resteno- sis is small but not unusual, and with adequate drugs support is almost never fatal and treatable if needed. Numerous authors have also reported a certain percentage of postoperative restenosis of internal carotid artery. With frequent ultrasound controls, postoperative restenotic process can be discovered in time, which can be of hemodinamic importance in neurological patients. A good cooperation between all subspecialistic teams involved in the assessment of cerebrovascular stroke is of great importance for accomplishing good clinical results in prevention and treatement of neurological incidents

Voice Rehabilitation of Broca\u27s Aphasia Following Total Laryngectomy

Total laryngectomy, as a consequence of carcinoma of the larynx, results in loss of speech function. Cerebrovascular stroke is the leading cause of reduced speech production ability, and thereby communication difficulties. The case is presented of a 60-year-old male patient who suffered stroke five years after a total laryngectomy. Speech rehabilitation was hampered due to the depressive state of the patient. Although contraindicated, the secondary voice prosthesis was implanted. Only at that moment the patient showed willingness and motivation for speech rehabilitation. The aim of this presentation is to demonstrate that not all neurological disorders are contraindicated for implantation of voice prostheses

Frequency of early postoperative restenosis after carotid artery thrombendarterectomy

Cilj: Ustvrditi postotak pojavnosti poslijeoperacijske restenoze nakon operacijskog liječenja visokopostotne stenoze arterije karotis na godišnjoj razini te podatke usporediti s novijom svjetskom literaturom. Ispitanici i postupci: Podatci su dobiveni analizom ranih poslijeoperacij- skih kontrolnih nalaza dobivenih obojenim dupleks doplerom, izvršenih dva tjedna nakon zahvata trombendaterektomije karotidnog žilja, u laboratoriju za cerebrovaskularne bolesti, Klinike za neurologiju, KBC-a Rijeka, na 104 pacijenta operirana na Zavodu za torakovaskularnu kirurgiju, Kirurške klinike KBC-a Rijeka 2012. godine. Rezultati: U skupini od 104 operirana pacijenta poradi visokopostotne stenoze unutarnje karotidne arterije u ranom poslijeoperacijskom tijeku evidentirano je 11 pacijenata (10,5 %) s pojavom restenoze, no bez neuroloških simptoma. Dodatnim praćenjem naših pacijenata nakon tri i šest mjeseci primijetili smo da se stupanj restenotskog procesa nije povećavao u 8 pacijenata, no u trojice pacijenata (2,9 %) evidentirano je znatno povećanje stupnja restenoze, te su oni podvrgnuti endovaskularnoj tzv. stenting pro- ceduri. Zaključci: Trombendarterektomija karotidnog žilja je operacijski zahvat koji se u KBC-u Rijeka izvodi rutinski. Incidencija pojavnosti poslijeoperacijske restenoze je mala, no nije neuobičajena pojava, ali uz adekvatnu medikamentnu potporu gotovo nikad nije fatalna za pacijenta, te je reparabilna ako je to potrebno. Mnogi svjetski autori također izvještavaju u izvjesnom postotku o pojavnosti poslijeoperacijske restenoze unutarnje arterije karotis. Redovitim ultrazvučnim kontrolama pravovremeno se otkrivaju poslijeoperacijski restenotski procesi koji mogu biti od hemodinamskog značaja u neuroloških pacijenata. U postizanju dobrih kliničkih rezultata kod prevencije i liječenja neuroloških incidenata izuzetno je važna dobra i uska suradnja svih supspecijalističkih timova koji se bave problematikom cerebrovaskularnog inzulta.Aim: To determine the percentage of postoperative restenosis frequency on an annual level after the operative treatement of the high-percent carotid artery stenosis, and to compare the data with recent literature. Subject and methods: Data was obtained by analysing ear- ly postoperative Colour Duplex Doppler control tests, which were performed two weeks after thrombendarterectomy of carotid vesells in the Laboratory of cerebrovascular diseases, Neurology clinic, Clinical hospital centre Rijeka on 104 patients treated at the Thoracovascular insti- tute, Surgery clinic, Clinical hospital centre Rijeka in the year 2012. Results: In a group of 104 treated patients, because of high-percent stenosis of internal carotid artery there was an evi- dent restenotic process without neurological symptoms in the early postoperative stages in 11 patients (10,5 %). With additional follow-up care of our patients after 3 and 6 monts, the level of restenotic proces did not increase in 8 patients, but in 3 (29 %) of our patients there was an evident increase of restenosis and they were treated with stenting procedure. Conclusions: Carotid thrombendarterectomy is a routine operative procedure in our Thoracovascular institute, and has been performed for many years. Fortunately, the frequency of postoperative resteno- sis is small but not unusual, and with adequate drugs support is almost never fatal and treatable if needed. Numerous authors have also reported a certain percentage of postoperative restenosis of internal carotid artery. With frequent ultrasound controls, postoperative restenotic process can be discovered in time, which can be of hemodinamic importance in neurological patients. A good cooperation between all subspecialistic teams involved in the assessment of cerebrovascular stroke is of great importance for accomplishing good clinical results in prevention and treatement of neurological incidents

Cognitive impairment in patients with stenotic process of carotid artery supplying dominant brain hemisphere

Cilj: Stenoza karotidne arterije je progresivno suženje u procesu ateroskleroze koje se, kao i njezini rizici, smatra jednim od uzroka slabljenja kognitivnih sposobnosti. U radu smo ispitivali povezanost kognitivnog ispada sa stenotičkom promjenom karotidne arterije koja opskrbljuje dominantnu hemisferu mozga (lijeve unutarnje karotidne arterije kod dešnjaka te desne karotidne arterije kod lijevaka) zadužene za glavnu irigaciju moždanih hemisfera. Metode: U rad je uključeno 67 bolesnika (36 žena i 31 muškarac) koji u anamnezi nisu preboljeli moždani udar, tranzitornu ishemičku ataku te nisu imali karotidnu trombendarektomiju, a imaju asimptomatsku visokostupanjsku stenozu karotidne arterije koja opskrbljuje dominantnu hemisferu mozga. Kontrolnu skupinu od 30 bolesnika čine bolesnici bez stenotičkog procesa ekstrakranijalnog odsječka karotide slične dobi i spola. Kognitivni ispad mjeren je modificiranom mini mental skalom i BDI-MC testom (engl. blessed-dementia information-memory concentration test). Rezultati: Uočili smo da nema statistički značajne razlike kognitivnih ispada između skupina. Zaključak: Ispadi kognicije nisu povezani s visokim stenotičkim procesima unutarnje karotidne arterije koja opskrbljuje dominantnu hemisferu.Aim: Carotid artery stenosis is a progressive constriction in the process of atherosclerosis, which, as well as the attendant risks, is being considered as one of the reasons for reduction of cognitive capabilities. In this study we examined the connection between cognitive disorders and stenotic change of carotid artery supplying dominant brain hemisphere (left inner carotid artery in right handed persons and right carotid artery in left handed persons) being responsible for the primary irrigation of brain hemisphere. Methods: The study included 67 patients (36 women and 31 men), who according to their medical history did not suffer a stroke, transient ischemic attack and no carotid trombendarterectomy was performed on them, but they have an asymptomatic high level of stenosis of the dominant inner carotid artery. The control group of 30 patients consisted of patients without stenotic processes of extracranial parts of the carotid, age and sex approximately equally represented. Cognitive disorder was monitored by modified mental scale and BDI-MC test (blessed-dementia information- memory concentration test). Results: We found that there was no statistically significant difference in cognitive disorder between groups. Conclusion: Cognitive disorder is not connected to a high level of stenotic processes of the carotid arteries supplying dominant brain hemispheres

Nonfatal Systemic Air Embolism: A Grave Complication of Computed Tomography-Guided Percutaneous Transthoracic Needle Biopsy

Transthoracic computed tomography-guided core needle biopsy (TTNB) is a well-established method for diagnosing focal pulmonary lesions. However, the dangers associated with this method as well as the significant number of complications caused by it cannot be ignored. Systemic air embolism is a rare but potentially fatal complication that can accompany transthoracic needle biopsies of pulmonary lesions. In this study, we report nonfatal systemic air embolism as a complication of a transthoracic needle core biopsy of a subpleural nodule in the right upper pulmonary lobe of a patient with hemoptysis. Although extremely rare, the complication may result in a transient myocardial ischemia, which is presented with a transient depression of the ST segment

Management of primary intracerebral hemorrhage

Primarna moždana krvarenja predstavljaju značajni javnozdravstveni problem s obzirom na visok mortalitet i stupanj invalidnosti kod preživjelih bolesnika, što za posljedicu ima dugotrajno liječenje. Najznačajniji čimbenik rizika za nastanak moždanog krvarenja je arterijska hipertenzija, a njena regulacija kod bolesnika s primarnim moždanim krvarenjem predstavlja okosnicu liječenja. U bolesnika s poremećajem svijesti neophodno je liječenje povišenog intrakranijskog tlaka s ciljem sprječavanja sekundarnog oštećenja mozga održavanjem adekvatne moždane perfuzije mjerene cerebralnim perfuzijskim tlakom. Prema važećim smjernicama u liječenju primarnih moždanih krvarenja u nekim slučajevima potrebno je poduzeti i određene specifične mjere. Unatoč brojnim istraživanjima specifičnog lijeka za sada nema.Primary intracerebral hemorrhage is an important public health problem due to high mortality and level of disability among survivals leading to prolonged hospital management. The most important risk factor for primary intracerebral hemorrhage is arterial hypertension. Treatment of arterial hypertension is the main goal in intracerebral hemorrhage management. In the patients with a decreased level of consciousness management of high intracranial pressure is necessary to prevent secondary brain injury by maintaining optimal cerebral blood flow measured by cerebral perfusion pressure. According to current guidelines in intracerebral hemorrhage treatment in some cases specific measures are needed. In spite of the number of studies there is no specific therapy currently

Management of primary intracerebral hemorrhage

Primarna moždana krvarenja predstavljaju značajni javnozdravstveni problem s obzirom na visok mortalitet i stupanj invalidnosti kod preživjelih bolesnika, što za posljedicu ima dugotrajno liječenje. Najznačajniji čimbenik rizika za nastanak moždanog krvarenja je arterijska hipertenzija, a njena regulacija kod bolesnika s primarnim moždanim krvarenjem predstavlja okosnicu liječenja. U bolesnika s poremećajem svijesti neophodno je liječenje povišenog intrakranijskog tlaka s ciljem sprječavanja sekundarnog oštećenja mozga održavanjem adekvatne moždane perfuzije mjerene cerebralnim perfuzijskim tlakom. Prema važećim smjernicama u liječenju primarnih moždanih krvarenja u nekim slučajevima potrebno je poduzeti i određene specifične mjere. Unatoč brojnim istraživanjima specifičnog lijeka za sada nema.Primary intracerebral hemorrhage is an important public health problem due to high mortality and level of disability among survivals leading to prolonged hospital management. The most important risk factor for primary intracerebral hemorrhage is arterial hypertension. Treatment of arterial hypertension is the main goal in intracerebral hemorrhage management. In the patients with a decreased level of consciousness management of high intracranial pressure is necessary to prevent secondary brain injury by maintaining optimal cerebral blood flow measured by cerebral perfusion pressure. According to current guidelines in intracerebral hemorrhage treatment in some cases specific measures are needed. In spite of the number of studies there is no specific therapy currently