9 research outputs found
Repeated intravenous thrombolytic therapy with rt-PA alteplase in treatment of early recurrent ischemic stroke
The 2019 year guidelines (American Heart Association / American Stroke Association ā AHA/ASA) do not recommend treating recurrent acute ischemic stroke with alteplase in patients who had previ- ous stroke in last 3 months (1,9). According to the European Stroke Organisation`s (ESO) guidelines (year 2021), there is no clear consensus. The risk of reocclusion occurs in 14-34% of patients in whom recanalisation with alteplase has been achieved (1). In this paper we present the case of our 70-year old patient with early stroke recurrence and repeated thrombolytic therapy 9 hours after the first dose of alteplase
SporadiÄni oblik Creutzfeldt-Jakobove bolesti u bolesnice s ispadima nekonvulzivnog epileptiÄnog statusa: prikaz sluÄaja
Creutzfeldt-Jakob disease is the most common form of human prion diseases. A 57-year-old woman was transferred to our Department from a local hospital, where she had been treated for two weeks due to consciousness disorders and convulsive epileptic attacks that progressed to refractory status epilepticus. Electroencephalography showed diffuse spike-wave complex discharges and development of nonconvulsive status epilepticus. The causes of metabolic encephalopathy and paraneoplastic syndrome were ruled out. A combination of clinical features and findings of diagnostic procedures including electroencephalography, biomarkers in the cerebrospinal fluid and magnetic resonance imaging suggested with great probability that the patient was affected with sporadic Creutzfeldt-Jakob disease.Creutzfeldt-Jakobova bolest je najÄeÅ”Äi oblik prionske bolesti u ljudi. Prikazuje se sluÄaj bolesnice koja je prevezena u naÅ”u Kliniku iz manje bolnice, gdje je bila lijeÄena dva tjedna zbog poremeÄaja stanja svijesti i konvulzivnih epileptiÄnih napadaja koji su progredirali do epileptiÄnog statusa koji je bio refraktoran na primijenjenu terapiju. Elektroencefalografija je prikazala difuzna izbijanja kompleksa Å”iljak-val i razvoj nekonvulzivnog epileptiÄnog statusa. KoristeÄi kombinaciju kliniÄkih znaÄajka i nalaza dijagnostiÄkih pretraga ukljuÄujuÄi elektroencefalografiju, biomarkere u cerebrospinalnoj tekuÄini i nalaze magnetske rezonance zakljuÄeno je s velikom vjerojatnoÅ”Äu da se radi o sporadiÄnom obliku Creutzfeldt-Jakobove bolesti
Uloga komplementarne i alternativne medicine u terapiji multiple skleroze
The National Center for Complementary and Alternative Medicine defines complementary and alternative medicine as a group of diverse medical and health care systems, practices and products that are not generally considered part of conventional medicine. Multiple sclerosis (MS) is a chronic disabling disease of the central nervous system that affects people during early adulthood. In spite of many approved medications, the treatment options in MS are limited. Many
people with MS explore complementary and alternative medicine (CAM) treatments to help control their MS and treat their symptoms. Surveys suggest that up to 70% of people with MS have tried one or more CAM treatment for their MS. People with MS using CAM generally report deriving some benefit from therapies. The CAM therapies most frequently used include diet, omega-3 fatty acids and antioxidants. The therapies with highest potential among CAM therapies that warrant further investigation are low-fat diet, omega-3 fatty acids, lipoic acid, and vitamin D supplementation as potential anti-inflammatory and neuroprotective agents in both relapsing and progressive forms of MS. There are very limited researches evaluating the safety and efficacy of CAM in MS. However, in recent years, the USA National Institutes of Health and the National Multiple Sclerosis Society have been actively supporting the researches in this very important area.Nacionalni centar za komplementarnu i alternativnu medicinu u Sjedinjenim AmeriÄkim Državama definira komplementarnu i alternativnu medicinu kao skupinu razliÄitih medicinskih i zdravstvenih sustava, praksa i proizvoda koji se opÄenito ne smatraju dijelom konvencionalne medicine. Multipla skleroza je kroniÄna onemoguÄavajuÄa bolest srediÅ”njeg živÄanog sustava koja se javlja u mlaÄoj odrasloj dobi. UnatoÄ mnogim istraženim i odobrenim lijekovima moguÄnosti lijeÄenja multiple skleroze su ipak ograniÄene. Zbog toga mnogi bolesnici koji boluju od multiple skleroze istražuju djelovanja metoda iz okvira komplementarne i alternativne medicine ne bi li postigli bolju kontrolu bolesti te smanjili simptome iste. Istraživanja ukazuju na to da je do 70% bolesnika oboljelih od multiple skleroze u tijeku lijeÄenja bolesti isprobalo jednu ili viÅ”e metoda iz okvira komplementarne i alternativne medicine. VeÄina oboljelih od multiple skleroze koji su koristili metode komplementarne i alternativne medicine navodi da su iskusili neke povoljne uÄinke. NajÄeÅ”Äe koriÅ”tene metode komplementarne i alternativne medicine su dijeta, omega-3 masne kiseline i antioksidansi. MeÄu metode koje bi mogle imati najviÅ”e potencijala u terapiji multiple skleroze, a za koje su potrebna daljnja istraživanja, ubrajaju se dijeta s malim udjelom masnoÄe, omega-3 masne kiseline, lipoiÄna kiselina i nadomjesci vitamina D kao sredstva s protuupalnim i neuroprotektivnim djelovanjem kako u relapsnom, tako i u progresivnom obliku multiple skleroze. Dosad je provedeno nedovoljno istraživanja koja su za cilj imala procjenu sigurnosti i uÄinkovitosti komplementarne i alternativne medicine u lijeÄenju multiple skleroze. Upravo zbog toga posljednjih nekoliko godina Nacionalno druÅ”tvo za multiplu sklerozu aktivno podupire istraživanja u ovom vrlo važnom podruÄju
Tumefaktivni oblik multiple skleroze
Multiple sclerosis is a chronic demyelinating disease of the central nervous system. Tumor-like manifestation of multiple sclerosis is one of the rare clinical variants and it is frequently misdiagnosed. This is a report on a 45-year-old man who presented with right-sided hemiparesis. Initial computed tomography and magnetic resonance imaging studies of the brain revealed a large hyperintense signal lesion in the left hemisphere surrounding the cerebral edema. Low grade glioma was among the likely differential diagnoses. The patient underwent surgery. Brain biopsy showed demyelination. Lumbar puncture was performed and cerebrospinal fluid was positive for intrathecal synthesis of immunoglobulins. Other findings were compatible with the unusual form of multiple sclerosis. This case report illustrates a demyelinating process mimicking tumor lesions of the brain and it is of high importance to consider the diagnosis of multiple sclerosis on differential diagnosis of a tumor-like lesion of the central nervous system.Multipla skleroza je kroniÄna demijelinizacijska bolest srediÅ”njega živÄanog sustava. Pojava tumefaktivnog oblika multiple skleroze je jedna od rijetkih kliniÄkih varijanta i Äesto je pogreÅ”no dijagnosticirana. Ovo je prikaz sluÄaja 45-godiÅ”njeg muÅ”karca s desnostranom hemiparezom. PoÄetna kompjutorizirana tomografija i magnetska rezonanca mozga prikazale su veliku hiperintenzivnu leziju lijeve hemisfere mozga okruženu cerebralnim edemom. Diferencijalno dijagnostiÄki nalaz je upuÄivao na nisko diferencirani glioblastom mozga. Bolesnik je podvrgnut kirurÅ”kom zahvatu. Biospija mozga potvrdila je demijelinizaciju. UÄinjena je lumbalna punkcija i nalaz likvora ukazao je na intratekalnu sintezu imunoglobulina. Drugi su nalazi dijagnostiÄke obrade bili u skladu s rijetkim oblikom multiple skleroze. Ovaj prikaz sluÄaja ilustrira demijelinizacijski proces koji se prikazao kao tumoska lezija mozga i od iznimne je važnosti razmotriti dijagnozu multiple skleroze kao diferencijanu dijagnozu tumefaktivne lezije srediÅ”njega živÄanog sustava
Kvaliteta života u bolesnika s multiplom sklerozom
Multiple sclerosis is a chronic, immune-mediated disease of the central nervous system that typically strikes young adults. It is often associated with a wide range of functional deficits and progressive disability. Common symptoms of multiple sclerosis include vision problems, spasticity, weakness, ataxia, bladder and bowel dysfunctions, fatigue, pain syndromes, tremors, vertigo, cognitive impairment, and mood disorders. Multiple sclerosis has a major negative impact on patient health-related quality of life (HRQoL). Quality of life (QoL) is a multidimensional construct composed of functional, physical, emotional, social and spiritual well-being. Researches have reported that individuals with multiple sclerosis have lower QoL than non-diseased and diseased populations. The inclusion of HRQoL questionnaires in the patient follow-up is a relevant issue to optimize treatment, facilitate treatment decisions and improve adherence, as well as to reduce the inconveniences derived from medication such as side effects.Multipla skleroza je kroniÄna, imuno posredovana bolest srediÅ”njega živÄanog sustava, koja obiÄno pogaÄa odrasle ljude mlaÄe životne dobi. Äesto je povezana sa Å”irokim rasponom funkcionalnog deficita i progresivne nesposobnosti. UobiÄajeni simptomi multiple skleroze su smetnje vida, spastiÄnost, slabost, ataksija, smetnje kontrole mokrenja i stolice, umor, bolni sindromi, tremor, vrtoglavica, pogorÅ”anje kognitivnih funkcija i poremeÄaji raspoloženja. Multipla skleroza ima znaÄajan negativan utjecaj na kvalitetu života oboljelih od ove bolesti. Kvaliteta života je multidimenzionalna formulacija sastavljena od funkcionalnih, fiziÄkih, emocionalnih, socijalnih i duhovnih Äimbenika zdravlja. Istraživanja su pokazala da oboljeli od multiple skleroze imaju nižu kvalitetu života od zdrave populacije i oboljelih od nekih drugih kroniÄnih bolesti. UkljuÄivanje upitnika o kvaliteti života u praÄenju bolesnika je važno u optimiziranju lijeÄenja, odreÄivanju i odluÄivanju o vrsti lijeÄenja i poboljÅ”anju suradljivosti, kao i u smanjenju neugodnosti koje proizlaze iz lijeÄenja, kao Å”to je primjerice pojava nuspojava primijenjenih lijekova