Klinički ishod u bolesnika nakon operacije hernije intervertebralnog diska pomoću proteze za rekonstrukciju defekta anulusa: rezultati dvogodišnjeg praćenja

Annular Reinforcement Device represents a modification of operative treatment of intervertebral disk herniation. It is a prosthesis that is anchored into the body of the vertebra. The intradiscal part of the implant is placed in the inner part of the annulus fibrosus defect. The aim of this technique is to reduce the incidence of reherniation and the degree of intervertebral space collapse, which is the most frequent adverse effect of diskectomy. Clinical outcomes of the treatment group indicated a statistically significant improvement with respect to the control group. Furthermore, over the period of two years, no cases of symptomatic reherniation were recorded. Considering that no serious complications occurred during the procedures, it would appear that this is an implant that, given its encouraging results, should be further verified in carefully designed future studies.Ugradnja proteze za rekonstrukciju defekta anulusa čini modifikaciju operacijskog liječenja hernije intervertebralnog diska. Radi se o protezi koja se ugrađuje (usidri) u korpus kralješka. Intradiskalni dio implantata postavlja se s unutarnje strane defekta anulusa fibrozusa. Cilj navedene tehnike je smanjivanje incidencije rehernijacija te smanjivanje stupnja kolapsa intervertebralnog prostora kao najčešćih neželjenih posljedica diskektomije. Klinički ishod ispitivane skupine pokazao je statistički značajan napredak u odnosu na kontrolnu skupinu. Također tijekom dvije godine nije zabilježen nijedan slučaj simptomatske rehernijacije. S obzirom na to da nije bilo ozbiljnih komplikacija tijekom samog zahvata, smatramo da se radi o implantatu čiji početni rezultati ohrabruju te se moraju potvrditi u slijedećim dobro dizajniranim prospektivnim studijama

Morphological Manifestations of the Dandy-Walker Syndrome in Female Members of a Family

The Dandy-Walker syndrome (DWS) is a hereditary disorder, appearing somewhat more frequently in women. The most important characteristics of the DWS are the lack of the cerebellar vermis, varying from a partial lack to a complete agenesis, and enlargement of the cerebrospinal spaces, especially in the fourth ventricle. The above mentioned morphological changes clinically manifest in ataxia, increased intracranial pressure and hydrocephalus. Here is presented a family with DWS, where the disease is contracted only by female members, in two generations, whereas no signs of DWS have been noticed in male family members. DWS is clinically manifested from early childhood to middle age, with the morphological changes varying from hypoplastic cerebellar vermis to widening of the brain ventricles and hydrocephalus and arachnoid cyst in the occipital part

CT Perfusion and Noncontrast CT in Acute Ischemic Stroke Diagnosing – Is there Influence on early Thrombolytic Therapy Outcome?

The objective of this study was to compare noncontrast computed tomography (NCCT) and computed tomography perfusion (CTP) in early diagnosis of acute ischemic stroke and to define influence of these diagnostic procedures on early outcome of thrombolytic therapy (TLTH). The study included 45 patients, 35 patients submitted to NCCT and CTP and 10 patients who underwent only NCCT, before CTP was introduced. Based on the National Institute of Health Stroke Scale (NIHSS) score we compared early outcome of patients who received TLTH after NCCT only (group 1) with the early outcome of patients who received TLTH following NCCT and CTP (group 2). Statistically significant difference was found in acute stroke diagnosing between CTP and NCCT (p=0.002). There were no statistically significant differences in TLTH early outcome between group 1 and group 2. In conclusion, CTP should be done regulary in patients presenting with acute ischemic stroke symptoms. More research needs to be done in defining exact influence of CTP implementation on the TLTH outcome

Subarachnoid haemorrhage

Spontano subarahnoidealno krvarenje (SAH) u najveæem broju sluèajeva nastaje kao posljedica rupure aneurizme, najèešæe unutarnje karotidne arterije, prednje komunikantne ili srednje cerebralne arterije. Velièina i lokalizacija aneurizme su znaèajni neovisni prognostièki èimbenici. Prema smještaju na krvnim žilama mozga aneurizme se dijele na aneurizme prednje i stražnje moždane cirkulacije (odnosno karotidnog i vertebrobazilarnog sliva). Ishodi lijeèenja su bitno nepovoljniji u bolesnika s aneurizmama stražnje cirkulacije zbog relativne kirurške nedostupnosti i blizine moždanog debla. Klinièki se SAH manifestira naglim nastupom jake glavobolje, poremeæajima svijesti uz znakove povišenog intrakranijskog tlaka, te koèenjem šije. Dijagnostièke metode izbora su raèunalna tomografija i cerebralna angiografija koja je zlatni standard u dokazivanju aneurizmatskog proširenja. Lijeèenje može biti kirurško ili endovaskularno, a ovisi o stanju bolesnika, anatomskom smještaju aneurizme i sposobnostima kirurga. Kirurški pristup ovisi o lokalizaciji aneurizme.Spontaneous subarachnoid hemorrhage (SAH) is usually caused by a ruptured intracranial aneurysm, most frequently the aneurysm of internal carotid artery, anterior communicating artery or middle cerebral artery. Significant prognostic factors include the localization and size of the aneurysm. Intracranial aneurysms can be divided according to their anatomical location to aneuryms of anterior and posterior brain circulation (i.e. aneurysm of the carotid and vertebrobasilar circulation). Due to the localization and closeness to the brain stem, patients with aneurysms of the posterior circulation have a poor outcome. The most common clinical symptom of SAH is sudden and severe headache, reduced level of consciousness, signs of increased intracranial pressure and nuchal rigidity. Diagnostic methods of choice are computerized tomography scans and cerebral angiography which represent the gold standard. The treatment of SAH can be surgical or endovascular and the choice depends on patient status, anatomical localization of the aneurysm and surgeon competencies. The surgical approach depends on the anatomical localization of the aneurysm

Subarachnoid haemorrhage

Spontano subarahnoidealno krvarenje (SAH) u najveæem broju sluèajeva nastaje kao posljedica rupure aneurizme, najèešæe unutarnje karotidne arterije, prednje komunikantne ili srednje cerebralne arterije. Velièina i lokalizacija aneurizme su znaèajni neovisni prognostièki èimbenici. Prema smještaju na krvnim žilama mozga aneurizme se dijele na aneurizme prednje i stražnje moždane cirkulacije (odnosno karotidnog i vertebrobazilarnog sliva). Ishodi lijeèenja su bitno nepovoljniji u bolesnika s aneurizmama stražnje cirkulacije zbog relativne kirurške nedostupnosti i blizine moždanog debla. Klinièki se SAH manifestira naglim nastupom jake glavobolje, poremeæajima svijesti uz znakove povišenog intrakranijskog tlaka, te koèenjem šije. Dijagnostièke metode izbora su raèunalna tomografija i cerebralna angiografija koja je zlatni standard u dokazivanju aneurizmatskog proširenja. Lijeèenje može biti kirurško ili endovaskularno, a ovisi o stanju bolesnika, anatomskom smještaju aneurizme i sposobnostima kirurga. Kirurški pristup ovisi o lokalizaciji aneurizme.Spontaneous subarachnoid hemorrhage (SAH) is usually caused by a ruptured intracranial aneurysm, most frequently the aneurysm of internal carotid artery, anterior communicating artery or middle cerebral artery. Significant prognostic factors include the localization and size of the aneurysm. Intracranial aneurysms can be divided according to their anatomical location to aneuryms of anterior and posterior brain circulation (i.e. aneurysm of the carotid and vertebrobasilar circulation). Due to the localization and closeness to the brain stem, patients with aneurysms of the posterior circulation have a poor outcome. The most common clinical symptom of SAH is sudden and severe headache, reduced level of consciousness, signs of increased intracranial pressure and nuchal rigidity. Diagnostic methods of choice are computerized tomography scans and cerebral angiography which represent the gold standard. The treatment of SAH can be surgical or endovascular and the choice depends on patient status, anatomical localization of the aneurysm and surgeon competencies. The surgical approach depends on the anatomical localization of the aneurysm

Internal Watershed Infarction as an Imaging and Clinical Challenge: a Case Report

We presented the case of a patient with internal watershed infarction with a nonspecific clinical presentation including hemiplegia, hemisensory deficit, and speech disturbance. Neuroimaging and ultrasound diagnostic procedure are important tools for diagnosis of these rare ischemic events that count for about 6% of all strokes.  Specific therapy is mandatory for the diagnosis of watershed infarction and different from the therapeutical measures than can be taken for embolic and atherothrombotic strokes. Our patient was a 69-year-old, right-handed Caucasian woman who presented to our facility with acute right side weakness and speech disturbance. He had hypothyroidism, permanent atrial fibrillation, diabetes mellitus and she was hypotensive. She reported dizziness few days before the accident. Imaging studies revealed internal watershed infarction. Therapeutic procedures were taken to restore low cerebral blood flow. Internal watershed infarction is rare (less than 10% of all strokes) but well recognized a clinical feature of stroke. Specific pathophysiology generally is connected with hypoperfusion and hemodynamic mechanisms. Specific therapy is mandatory for these conditions