Znanstveni pristup migreni

Migraine is a common episodic headache disorder; prevalence of migraine in most western countries is 10-12%. The mechanism of migraine pain development is not fully understood. The theory of neurogenic inflammation proposes that the main event is the inflammation in the vessel wall which leads to leakage of nociceptive substances, causing thickening of the vessel wall and dilatation of vascular smooth muscles. The release of vasoactive neuropeptides causes depolarization of trigeminal perivascular axons, thus causing pain. Triptans are recommended for acute migraine attacks; studies have shown that their use increases productivity at work and improves the quality of life. Preventive therapy is recommended in migraine patients with frequent, severe, long-lasting attacks, in cases where acute therapy is not efficient, if there is a contraindication to the drug, failure or unbearable side-effects from acute treatments, overuse of acute medications or in special cases such as hemiplegic migraine. Beta-blockers and tricyclic antidepressants were often used as first line therapy for migraine prevention. Other p reventive drugs include pizotifen, flunarizine, and anticonvulsives. Migraine is often associated with a number of commorbid diseases: allergies, hypotension, epilepsy, fatigue sy, gastritis, iritabile colon disease, vertigo; therefore, preventive and acute therapy should be tailored individually.Migrena je česta glavobolja čija se prevalencija kreće u zapadnim zemljama između 10- 12%. Mehanizam boli kod migrene nije sasvim razjašnjen. Po teoriji neurogene upale glavno zbivanje je upala stijenki krvnih žila koja dovodi do istjecanja nociceptivnih supstanci što uzrokuje zadebljanje zida arterija te dilataciju glatkih mišićnih stanica. Otpuštanje vazoaktivnih neuropeptida uzrokuje depolarizaciju trigeminalnih aksona što dovodi do pojave boli. Triptani se preporučaju u akutnim napadajima migrene; istraživanja su pokazala da se njihovom upotrebom u akutnom napadaju migrene povećava produktivnost na poslu i poboljšava kvaliteta života. Preventivna terapija se preporuča kod osoba s učestalim jakim i dugotrajnim napadajima, te u slučajevima kada akutna terapija nije učinkovita, ukoliko postoji kontraindikacija ili su izražene nuspojave za primjenu akutne terapije, te u slučajevima kada se radi o obiteljskoj hemiplegijskoj migreni. U preventivnoj terapiji preporučaju se beta blokatori i triciklički antidepresivi a od ostalih lijekova se preporučaju pizotifen, flunarizin te antiepileptici. Migrena je često udružena s komorbidnim bolestima poput alergija, hipotenzije, epilepsija, sindromom kroničnog umora, iritabilnim kolonom, gastritisom i vertigom; stoga se akutna i profilaktička terapija moraju individualno određivati

Neurological Manifestation of Fabry Disease – A Case Report

Fabry disease is an X-linked recessive glycolipid storage disease. It is caused by deficiency of the lysosomal enzyme a-galactosidase A and leads to the accumulation of the enzyme substrate, globotriasylceramide (Gb3) in many tissues including endothelial cells, pericytes and smooth muscle cells of blood vessels, renal epithelial cells, cardiac myocytes and numerous neuronal cells. In this report, we present 20-year-old male patient with ischemic stroke in pons. The case had previously been misdiagnosed as polimyositis and vasculitis. Angiokeratomas, neuropathic pain and ischemic stroke in young age suggested a Fabry disease. The diagnosis was confirmed biochemically and genetically. All young adults with stroke, especially if they have additional symptoms like angiokeratomas, proteinuria, neuropathic pain in toes and fingers should be tested for Fabry disease

Zastupljenost moždanog udara u Dubrovačko-neretvanskoj županiji u 2008. godini

Data on all patients admitted in 2008 to the Department of Neurology, Dubrovnik General Hospital, were retrospectively analyzed. In a total of 663 patients, there were 247 (37.25%) stroke patients. Ischemic stroke was diagnosed in 217 (87.85%) and hemorrhagic stroke in 30 (12.15%) patients. In the cohort of stroke patients, there were 136 (55.00%) women and 111 (45.00%) men. The group of patients with ischemic stroke consisted of 124 (57.15%) women and 93 (42.85%) men, and the group of those with hemorrhagic stroke of 12 (40%) women and 18 (60%) men. The majority of patients with ischemic stroke (89.86%) and hemorrhagic stroke (76.66%) were over 60 years of age. Only 9 (4.14%) patients with ischemic stroke and 5 (16.66%) patients with hemorrhagic stroke were employed. The mortality rate was 20.24% in the overall stroke group and 19.35% in the ischemic stroke group. In the group of patients with hemorrhagic stroke, 26.66% of patients died at our Department, however, additional 20% of patients with this type of stroke were transferred to the Hospital Intensive Care Unit or to Departments of Neurosurgery in Split and Zagreb, so precise data on the disease outcome in these patients were missing. Eighteen (7.29%) patients were from other countries, mostly from Bosnia and Herzegovina. The majority of them had ischemic stroke (83.33%) and 12 (66.66%) patients were over 60 years of age.Retrospektivnom analizom obuhvaćeni su podaci o svim bolesnicima liječenim na Neurološkom odjelu Opće bolnice Dubrovnik tijekom 2008. godine. U tom razdoblju hospitalizirano je 663 bolesnika, od čega 247 (37,25%) s moždanim udarom. Ishemijski moždani udar imalo je 217 (87,85%), a hemoragijski moždani udar 30 (12,15%) bolesnika. U ukupnom broju bolesnika s moždanim udarom bilo je 136 (55,00%) žena i 111 (45,00%) muškaraca. U skupini ishemijskih moždanih udara bile su 124 (57,15%) žene i 93 (42,85%) muškarca, a u skupini s hemoragijskim moždanim udarom 12 (40%) žena i 18 (60%) muškaraca. Većina bolesnika s ishemijskim (89,6%) i hemoragijskim (76,66%) moždanim udarom bili su stariji od 60 godina. Samo 9 (4,14%) bolesnika s ishemijskim moždanim udarom i 5 (16,66%) bolesnika s hemoragijskim moždanim udarom su bili zaposleni. Stopa smrtnosti je ukupno iznosila 20,24%; 19,35% za ishemijski i 26,66% za hemoragijski moždani udar. Također, 20% bolesnika s hemoragijskim moždanim udarom premješteno je na Odjel intenzivnog liječenja naše bolnice ili na neurokirurške klinike u Splitu i Zagrebu, pa nisu bili dostupni podaci o ishodu liječenja tih bolesnika. Isto tako, 18 (7,29%) bolesnika je bilo iz drugih zemalja, najviše iz Bosne i Hercegovine. Većina ih je imala ishemijski moždani udar (83,33%), a 12 (66,66%) bolesnika je bilo starije od 60 godina

Metabolički sindrom u bolesnika sa shizofrenijom

SAŽETAK Komorbiditet tjelesnih i psihičkih bolesti je uz istraživanje etiologije psihijatrijskih poremećaja vodeći znanstveni izazov u suvremenoj psihijatriji. Metabolički sindrom jedan je od najčešćih metaboličkih poremećaja povezanih s razvojem rane ateroskleroze, cerebrovaskularih, kardiovaskularnih bolesti i šećerne bolesti tipa 2. Kraći životni vijek shizofrenih bolesnika nego u zdravoj populaciji, jedna je od hipoteza koje povezuju shizofreniju i metabolički sindrom. Holistički pristup shizofrenim bolesnicima treba biti pravilo, a svijest o visokoj učestalosti komorbidnih tjelesnih bolesti i upotreba smjernica za praćenje metaboličkog stanja te otkrivanje somatskih bolesti mora biti jedna od temeljnih odrednica u svakodnevnome kliničkom radu na svim razinama zdravstvene zaštite psihijatrijskih bolesnika.

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

Bol u multiploj sklerozi

Multiple sclerosis (MS) is a disease of the central nervous system (CNS), beginning most often in late adolescence and early adult life and expressing itself by reccurrent attacks of spinal cord, brainstem, cerebellar, optic nerve and cerebral dysfunction, the result of foci of destrucion of myelinated fibers. Neuropathic pain, such as trigeminal neuralgia might be one of the first symptoms of multiple sclerosis. In this retrospective study we evaluated 290 patients who have been hospitalised at Department of neurology in last three years. According to the results of our study 70% had either an acute or chronic pain syndrome at some time during their disease. Between them 2.7% with acute pain syndroms had episodes of paroxismal pain attacks in distribution of trigeminal nerve. Chronic pain syndromes, occured in 58% of patients and included headache (25%), low back pain (35%) and painful leg spasms in 20% of patients. Our patients were treated with nesteroid antireumatic drugs in case of nociceptive pain, but neuropathic pain was treated with combination of antidepressive and antiepileptic drugs.Multipla skleroza je kronična, demijelinizirajuća bolest koja se najčešće javlja u osoba mlađe životne dobi. Smatra se da je pojava multiple skleroze rezultat međudjelovanja genetskih i čimbenika okoliša. Dugo se smatralo da multipla skleroza nije povezana s pojavom boli, iako su rezultati istraživanja pokazali da neuropatska bol, poput neuralgije trigeminusa može biti jedan od prvih simptoma bolesti. Cilj ovog istraživanja bio je utvrditi prevalenciju i periodu bolnih stanja u bolesnika oboljelih od MS-a, a koji su bili liječeni na Klinici za neurologiju, KB «Sestre milosrdnice». U vremenskom periodu od tri godine obuhvatili smo 290 bolesnika. Od akutnog ili kroničnog bolnog sindroma patilo je 70% pacijenata. Dvanaest pacijenata (2.7%) s akutnim bolnim stanjem imalo je paroksizmalne bolne atake u području trigeminalnog živca. Kronični bolni sindrom dijagnosticiran je u 58% bolesnika i uključivao je razne oblike glavobolje (20%), bol lumbosakralnom dijelu kralježnice (20%) te bolne spazme u 4% bolesnika. Bolesnici su liječni nesteroidnim antireumaticima u slučaju nociceptivne boli. Neuropatska bol je liječena adjuvantnim lijekovima, najčešće kombinacijom antiepileptika i antidepresiva. Na temelju rezultata ove retrospektivne studije vidljivo je da su akutni i kronični bolni sindromi prisutni u velikom broju bolesnika oboljelih od MS-e te da terapija svakog bolesnika mora biti individualizirana