Primary Stroke Prevention

Moždani udar tradicionalno definiramo kao infarkt tkiva središnjega živčanog sustava. Prema definiciji Svjetske zdravstvene organizacije moždani udar je klinički sindrom vaskularne etiologije koji se očituje naglim nastankom žarišnoga ili difuznoga moždanog deficita trajanja dužeg od 24 sata, a koji može završiti smrću. Moždani udar jedan je od tri najčešća uzroka smrti u svijetu i vodeći uzrok trajnoga funkcionalnog oštećenja. Oko 85 % svih moždanih udara uzrokovano je ishemijom, a oko 15 % uzrokovano je hemoragijom. Mijenja živote ne samo onih koji dožive moždani udar već i njihovih obitelji i drugih skrbnika. Više od polovice osoba s komorbiditetima smatra da je veliki moždani udar gori od smrti upravo zbog posljedica: psihičkog, kognitivnog i tjelesnog invaliditeta. Unatoč pojavi reperfuzijskih terapija za odabrane pacijente s akutnim ishemijskim moždanim udarom, učinkovita prevencija ostaje i dalje najbolji pristup za smanjenje rizika od moždanog udara.Stroke is customarily defined as an infarction of the central nervous system. As defined by the World Health Organization, stroke is a clinical syndrome of vascular etiology that manifests itself in the sudden development of a focal neurologic deficit lasting more than 24 hours, and which can result in death. Stroke is one of the three most prevalent causes of death in the world and the leading cause of permanent functional impairment. About 85% of all strokes are caused by ischemia and about 15% are caused by hemorrhage. It transforms the lives not only of those who have suffered from it, but also that of their families and caregivers. More than half of those with comorbidities believe that a major stroke is worse than death because of its consequences: mental, cognitive and physical disability. Despite the development of reperfusion therapies for patients with acute ischemic stroke, proper prevention remains the best approach to reduce the risk of stroke

Primary Stroke Prevention

Moždani udar tradicionalno definiramo kao infarkt tkiva središnjega živčanog sustava. Prema definiciji Svjetske zdravstvene organizacije moždani udar je klinički sindrom vaskularne etiologije koji se očituje naglim nastankom žarišnoga ili difuznoga moždanog deficita trajanja dužeg od 24 sata, a koji može završiti smrću. Moždani udar jedan je od tri najčešća uzroka smrti u svijetu i vodeći uzrok trajnoga funkcionalnog oštećenja. Oko 85 % svih moždanih udara uzrokovano je ishemijom, a oko 15 % uzrokovano je hemoragijom. Mijenja živote ne samo onih koji dožive moždani udar već i njihovih obitelji i drugih skrbnika. Više od polovice osoba s komorbiditetima smatra da je veliki moždani udar gori od smrti upravo zbog posljedica: psihičkog, kognitivnog i tjelesnog invaliditeta. Unatoč pojavi reperfuzijskih terapija za odabrane pacijente s akutnim ishemijskim moždanim udarom, učinkovita prevencija ostaje i dalje najbolji pristup za smanjenje rizika od moždanog udara.Stroke is customarily defined as an infarction of the central nervous system. As defined by the World Health Organization, stroke is a clinical syndrome of vascular etiology that manifests itself in the sudden development of a focal neurologic deficit lasting more than 24 hours, and which can result in death. Stroke is one of the three most prevalent causes of death in the world and the leading cause of permanent functional impairment. About 85% of all strokes are caused by ischemia and about 15% are caused by hemorrhage. It transforms the lives not only of those who have suffered from it, but also that of their families and caregivers. More than half of those with comorbidities believe that a major stroke is worse than death because of its consequences: mental, cognitive and physical disability. Despite the development of reperfusion therapies for patients with acute ischemic stroke, proper prevention remains the best approach to reduce the risk of stroke

Treatment of posttraumatic epilepsy with new generation antiepileptic drugs (AEDs) – our experience

Aim To investigate influence of therapy with new generation antiepileptic drugs (AEDs) in fastening of posttraumatic epilepsy (PTE) remission comparing to therapy with standard AEDs, as well as the time to remission in the presence of psychiatric comorbidities. Methods The study was conducted during the 1988-2008 period and included 113 patients (47 females and 67 males) with PTE and 113 patients (93 females and 20 males) suffering from complex partial seizures (CPS) of temporal lobe origin. In both patient groups, epileptic seizure phenotype, brain magnetic resonance imaging (1.5 T and 3.0 T) and electroencephalogram were analyzed within 24 hours of epileptic seizure and after 5 years of treatment. Psychological testing was administered prior to therapy initiation. Results The patients treated with standard AEDs achieved remission in 82 (73%) cases as compared with 87 (77%) patients administered with a new generation AEDs; in the latter group, remission was achieved faster (1.85 vs. 1.6 months). In both patient groups, psychiatric comorbidity prolonged time to remission by 3.4 months. Conclusion Therapy with new generation AEDs enables achieving faster and complete remission in PTE patients

Giant Aneurysm of Basilar Artery

In the article we showed the patient, a woman with unruptured giant aneurysm of basilar artery, we showed the done examinations, and therapy dilemmas about what to do in the given case. We found in literature a number of examples which suggest operation treatment, but of embolisation too, some suggest conservative treatment

Jesmo li spremni za intravensku trombolizu u liječenju akutnog moždanog udara u našoj regiji?

Acute stroke is the leading cause of disability in modern society. Early treatment is crucial to maximize the benefit of stroke intervention. Effective thrombolytic therapy is dependent on timely intervention and guidelines for the recommended use of recombinant tissue plasminogen activator therapy within 3 hours after onset of stroke symptoms. The aim of the study was to assess whether we are ready for the introduction of thrombolysis in our region. We investigated retrospectively the time from symptom onset to hospital arrival (delay time) for patients with acute stroke in our region. Medical histories of all patients admitted to the Department in 2006 with acute stroke symptoms were studied. Statistical analysis was performed by use of the SigmaStat (version 2.0) software. Study results showed that a very high rate of patients presented after 24 hours of stroke onset (35%); 15% of all acute ischemic stroke (AIS) patients arrived within 3 hours of stroke onset. Due to other exclusion criteria established, only 4% of all AIS patients were eligible for intravenous thrombolysis. Most patients arrived in the hospital too late to get maximum benefit from the emerging stroke therapies. This may be due to the failure to recognize signs and symptoms or the lack of awareness of the potential treatment benefits. Our further efforts should be focused on increasing public awareness of the stroke signs and symptoms and on reducing delay time.Akutni moždani udar je vodeći uzrok invalidnosti u današnjem društvu. Rano liječenje je bitno za što veću učinkovitost akutnog liječenja. Učinkovita tromboliza rekombiniranim aktivatorom tkivnog plazminogena ovisi o vremenu i preporukama da se provede unutar 3 sata od nastanka simptoma moždanog udara. Cilj ove studije bio je utvrditi jesmo li spremni za uvođenje trombolize u našu regiju. Retrospektivno se promatralo vrijeme od nastanka simptoma do dolaska u bolnicu (vrijeme kašnjenja) bolesnika s akutnim moždanim udarom. Promatrale su se povijesti bolesti svih bolesnika primljenih u bolnicu u 2006. godini. U statističkoj obradi primijenjen je program SigmaStat (verzija 2.0). Utvrđen je vrlo visok postotak (35%) bolesnika koji su došli nakon 24 sata od nastanka moždanog udara; 15% svih bolesnika primljenih s akutnim ishemijskim moždanim udarom (AIMU) došlo je unutar 3 sata. Uzimajući u obzir i ostale kriterije isključivanja samo je 4% svih bolesnika primljenih s AIMU moglo primiti sistemsku trombolizu. Većina bolesnika je stigla prekasno da bi imala maksimalnu korist od hitne terapije moždanog udara. Uzrok je možda nepoznavanje znakova i simptoma ili nedovoljna saznanja o korisnosti ovog liječenja. Potrebno je i dalje se truditi i poboljšavati poznavanje znakova i simptoma moždanog udara, kao i smanjiti vrijeme kašnjenja

Head Trauma and Posttraumatic Epilepsy in Slavonski Brod, East Croatia, 1988-2008

Posttraumatic epilepsy is result of head trauma. The aim of our research was to establish how many patients after head trauma developed posttraumatic epilepsy (PTE). Retrospectively we analyzed 50 patients with head trauma different severity in period from 1989. to 2008., which we werified radiological, electroenfephalographic, and psychical changes were established according pto psychiatric examination. From 50 patient with head trauma, 40 developed seizures (3 in the firs 24 hours and 6 after first 24 hours to the end of first week, 31 after first week). By introducing antiepileptic therapy (AETh), 30 patients were seizure free, 10 patients had 1-2 epileptic seizure monthly (EPA/CPA), 10 patients got prophylactic AETh in period 6-12 months. 14 patients developed psychical changes which were verified by psychiatrist. The experience and literature show that posttraumatic epilepsy is good for treating with 1 or 2 antiepileptic, and remission is more difficult in case psychiatric comorbidity

Head Trauma and Posttraumatic Epilepsy in Slavonski Brod, East Croatia, 1988-2008

Posttraumatic epilepsy is result of head trauma. The aim of our research was to establish how many patients after head trauma developed posttraumatic epilepsy (PTE). Retrospectively we analyzed 50 patients with head trauma different severity in period from 1989. to 2008., which we werified radiological, electroenfephalographic, and psychical changes were established according pto psychiatric examination. From 50 patient with head trauma, 40 developed seizures (3 in the firs 24 hours and 6 after first 24 hours to the end of first week, 31 after first week). By introducing antiepileptic therapy (AETh), 30 patients were seizure free, 10 patients had 1-2 epileptic seizure monthly (EPA/CPA), 10 patients got prophylactic AETh in period 6-12 months. 14 patients developed psychical changes which were verified by psychiatrist. The experience and literature show that posttraumatic epilepsy is good for treating with 1 or 2 antiepileptic, and remission is more difficult in case psychiatric comorbidity

HOSPITALIZATION OF CHILDREN WITH TRAUMATIC BRAIN WOUNDS IN BROD - POSAVINA COUNTY

Traumatske ozljede mozga (TOM) su jedan od vodećih uzroka stečene nesposobnosti i smrti djece. Retrospektivnom analizom utvrđeno je 350 djece, 128 (36,6%) djevojčica i 222 (63,4%) dječaka, hospitalizirane zbog ozljeda neurokranija u 5-godišnjem razdoblju u Općoj bolnici «Josip Benčević» u Slavonskom Brodu. Najviše je ozlijeđene djece imalo istodobno kontuziju i komociju (46,8%), zatim samu kontuziju glave (12,5%), te frakture kosti lubanje (10,5%). Rjeđa su bila krvarenja i hematomi (epiduralni, subduralni, subarahnoidna hemoragija) (3,2%). Analiza obrade je pokazala da je u gotovo sve djece učinjena rentgenska pretraga (99,7%). Najčešće je učinjen RTG glave (kraniogram) i/ili vratne kralježnice, zatim CT, EEG, UZV, te NMR. Pojava komplikacija zabilježena je u samo 2% ozljeđene djece (epileptički napadi, sinkopa, febrilne konvulzije). Praćenje kirurških zahvata pokazalo je da je u većine djece (89,6%) liječenje provedeno konzervativno. Dužina liječenja ozlijeđene djece najčešće je iznosila 2 dana (34,5%) ili 3 dana (32,5%), dok je duže liječenje bilo rjeđe. S obzirom na dodatnu konzultaciju drugih specijalista (uz neurokirurga) najčešće je konzultiran pedijatar, kirurg/traumatolog, specijalist ORL/maksilofacijalne kirurgije, neuropedijatar, dječji kirurg, oftalmolog i dr. Može se reći da prognoza TOM u djece ovisi o dobi, neurološkom statusu i vrsti ozljede, te kvaliteti skrbi koja uključuje dostupnost neurokirurga i drugih specijalista.Traumatic brain injury (TBI) is the most common cause of acquired disability and death in children. Retrospective analysis showed 350 children, 128 (36.6%) girls and 222 (63.4%) boys who were hospitalized for injury of neurocranium in a 5 year-period in Dr. Josip Benčević General Hospital in Slavonski Brod. Most of them had both contusion and commotion (46.8%), followed by just contusion of the head (12.5%) and fractures of the skull (10.5%). The haemorrhages and hemathomas were less common (epidural, subdural, SAH) (3.2%). The procedures performed showed that in almost all children X-rays had been performed (99.7%). The most commonly X-rays performed were those of the head (craniogram) and/or cervical spine, followed by CT, EEG, ultrasound and NMR. The occurence of complications was recorded in only 2% of injured children (seizure, syncopa, febrile convulsions). Analysis of treatment methods showed that in most children (89.6%) therapy was conservative. The injured children were hospitalizated mostly for 2 days (34.5%) or 3 days (32.5%), while longer hospitalization was less common. Regarding extra consultation of other specialists (besides neurosurgeons), the most commonly consulted were pediatrician, surgeon/traumatologist, specialist of ENT/maxilofacial surgery, neuropediatrician, pediatric surgeon, ophthalmologist and others. It can be said that the prognosis of TBI in children depends on the age, neurological status and kind of injury, and on the quality of care, which involves availability of neurosurgeons and other specialists

Anksiozni i depresivni simptomi kod bolesnika s akutnim ishemijskim moždanim udarom

Inadequate attention is being paid to the anxiety and depressive symptoms in acute stroke, although these problems are known to influence the patients’ neurological outcome. The aim of our study was to assess the prevalence of anxiety and depressive symptoms in the acute stage of ischemic stroke and to identify the factors associated with such problems. Anxiety and depressive symptoms were evaluated using the Hospital Anxiety and Depression Scale in 40 patients with acute ischemic stroke admitted during a period of one month. Statistical analyses were performed by the SigmaStat (Version 2.0) software. Study results showed 55% of study patients to suffer from depressive symptoms and 40% from both anxiety symptoms and depressive symptoms. There was a correlation of depressive symptoms (HADS-D score) with MMSE (p<0.001), age (p=0.003) and BI (p<0.001), and of anxiety symptoms (HADS-A score) with MMSE (p<0.001) and BI (p=0.01). There was no significant association of HADS-A and HADS-D score with other patient characteristics. In conclusion, depressive symptoms were more frequent in the acute stage of ischemic stroke. Study patients had a high prevalence of both groups of symptoms. Therefore, attention should be paid to the anxiety and depressive symptoms in stroke units and try to relieve the patients’ emotional stress and personal suffering, which could improve their neurological outcome.Ne razmišlja se dovoljno o anksioznim i depresivnim simptomima kod bolesnika s akutnim moždanim udarom, iako se zna da ovi problemi utječu na neurološki ishod. Cilj studije bio je utvrditi učestalost anksioznih i depresivnih simptoma u akutnoj fazi ishemijskog moždanog udara te koji čimbenici utječu na ove probleme. Anksiozni i depresivni simptomi ocjenjivali su se pomoću Bolničke skale za anksioznost i depresiju kod 40 bolesnika s akutnim moždanim udarom primljenih tijekom jednog mjeseca. U statističkoj analizi primijenio se program SigmaStat (Version 2.0). Depresivni simptomi su bili prisutni kod 55%, a anksiozni simptomi kod 40% bolesnika, koji su svi istodobno imali i depresivne simptome. Nađena je korelacija depresivnih simptoma s MMSE (p<0,001), dobi (p=0,003) i BI(p<0,001), te anksioznih simptoma s MMSE (p<0,001) i BI (p=0,01). Nije bilo značajne povezanosti anksioznih i depresivnih simptoma s drugim osobinama bolesnika. Depresivni simptomi bili su češći u akutnoj fazi ishemijskog moždanog udara. Naši bolesnici imali su vrlo visoku učestalost obiju skupina simptoma. Znatno veću pozornost treba već u jedinicama moždanog udara posvetiti anksioznim i depresivnim simptomima i nastojati bolesnike osloboditi emocionalnog stresa i patnje, što će poboljšati njihov neurološki ishod

HOSPITALIZATION OF CHILDREN WITH TRAUMATIC BRAIN WOUNDS IN BROD - POSAVINA COUNTY

Traumatske ozljede mozga (TOM) su jedan od vodećih uzroka stečene nesposobnosti i smrti djece. Retrospektivnom analizom utvrđeno je 350 djece, 128 (36,6%) djevojčica i 222 (63,4%) dječaka, hospitalizirane zbog ozljeda neurokranija u 5-godišnjem razdoblju u Općoj bolnici «Josip Benčević» u Slavonskom Brodu. Najviše je ozlijeđene djece imalo istodobno kontuziju i komociju (46,8%), zatim samu kontuziju glave (12,5%), te frakture kosti lubanje (10,5%). Rjeđa su bila krvarenja i hematomi (epiduralni, subduralni, subarahnoidna hemoragija) (3,2%). Analiza obrade je pokazala da je u gotovo sve djece učinjena rentgenska pretraga (99,7%). Najčešće je učinjen RTG glave (kraniogram) i/ili vratne kralježnice, zatim CT, EEG, UZV, te NMR. Pojava komplikacija zabilježena je u samo 2% ozljeđene djece (epileptički napadi, sinkopa, febrilne konvulzije). Praćenje kirurških zahvata pokazalo je da je u većine djece (89,6%) liječenje provedeno konzervativno. Dužina liječenja ozlijeđene djece najčešće je iznosila 2 dana (34,5%) ili 3 dana (32,5%), dok je duže liječenje bilo rjeđe. S obzirom na dodatnu konzultaciju drugih specijalista (uz neurokirurga) najčešće je konzultiran pedijatar, kirurg/traumatolog, specijalist ORL/maksilofacijalne kirurgije, neuropedijatar, dječji kirurg, oftalmolog i dr. Može se reći da prognoza TOM u djece ovisi o dobi, neurološkom statusu i vrsti ozljede, te kvaliteti skrbi koja uključuje dostupnost neurokirurga i drugih specijalista.Traumatic brain injury (TBI) is the most common cause of acquired disability and death in children. Retrospective analysis showed 350 children, 128 (36.6%) girls and 222 (63.4%) boys who were hospitalized for injury of neurocranium in a 5 year-period in Dr. Josip Benčević General Hospital in Slavonski Brod. Most of them had both contusion and commotion (46.8%), followed by just contusion of the head (12.5%) and fractures of the skull (10.5%). The haemorrhages and hemathomas were less common (epidural, subdural, SAH) (3.2%). The procedures performed showed that in almost all children X-rays had been performed (99.7%). The most commonly X-rays performed were those of the head (craniogram) and/or cervical spine, followed by CT, EEG, ultrasound and NMR. The occurence of complications was recorded in only 2% of injured children (seizure, syncopa, febrile convulsions). Analysis of treatment methods showed that in most children (89.6%) therapy was conservative. The injured children were hospitalizated mostly for 2 days (34.5%) or 3 days (32.5%), while longer hospitalization was less common. Regarding extra consultation of other specialists (besides neurosurgeons), the most commonly consulted were pediatrician, surgeon/traumatologist, specialist of ENT/maxilofacial surgery, neuropediatrician, pediatric surgeon, ophthalmologist and others. It can be said that the prognosis of TBI in children depends on the age, neurological status and kind of injury, and on the quality of care, which involves availability of neurosurgeons and other specialists