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

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

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

Dilemma of Antiepileptic Drugs Withdrawal in Symptomatic Epilepsy

A successful treatment of epilepsy depends on numerous factors such as etiology, genetics and environmental impact. An exact diagnosis, treatment and an adequate selection of antiepileptic drugs (AED) are important from the very beginning. The patient with symptomatic epilepsy caused by the brain tumor (low-grade astrocytoma in the left parietal lobe, surgically removed 17 years after the first manifestation of illness) is presented in this study. He has been seizure free for 6 years. The represented case study deals with the risk-benefit analysis of the discontinuation of the prescribed antiepileptic treatment that has lasted for 23 years

Systemic thrombolysis for acute ischemic stroke treatment

Unatoč činjenici da je ishemijski moždani udar zbog visoke smrtnosti i invalidnosti velik javnozdravstveni problem, do pojave trombolitičke terapije nije postojao specifičan lijek za rekanalizaciju okludirane krvne žile. Tromboliza rekombiniranim tkivnim aktivatorom plazminogena (rt-PA) dokazala je svoju učinkovitost u nizu studija i za sada je jedini odobreni lijek za liječenje ishemijskog moždanog udara. Radi poboljšanja ishoda liječenja potrebno je liječenje provoditi u specijaliziranim odjelima – jedinicama za liječenje moždanog udara, koje uz pravovremeno prepoznavanje moždanog udara i žurno postavljanje dijagnoze predstavljaju preduvjet za brzo započinjanje terapije u cilju rane rekanalizacije krvne žile i reperfuzije moždanog parenhima. Ovakav pristup zbrinjavanju bolesnika s ishemijskim moždanim udarom omogućava ponovno uspostavljanje cirkulacije u ishemijskom području mozga, dok je oštećenje neurona reverzibilno, što u konačnici poboljšava ishod liječenja.In spite of the fact that ischemic stroke is an important public health problem because of high mortality and disability, until thrombolysis was established as a standard treatment for ischemic stroke there was no specific therapy for recanalization of occluded blood vessels. Efficacy of thrombolysis with recombinant tissue plasminogen activator (rt-PA) has been proven in a number of studies and currently is only approved therapy for acute ischemic stroke treatment. In order to improve outcome, ischemic stroke patients need to be treated in specialized units – stroke units. After early recognitions of stroke symptoms and urgent diagnosis these units are a prerequisite for an urgent start of therapy with purpose of early recanalization of blood vessels and reperfusion of brain parenchyma. This approach in management of ischemic stroke patients makes it possible for circulation to be restored in the ischemic region of the brain while neurons are still reversible damaged leading to an improved outcome at the end

Make Love to Forget: Two Cases of Transient Global Amnesia Triggered by Sexual Intercourse

Transient global amnesia (TGA) is characterized by a sudden onset and by a typical resolution within several hours. Several precipitating events have been proposed: physical exertion, emotional experiences, etc. The aim of this paper was to present two cases of TGA triggered by sexual intercourse and to suggest a possible mechanism for the development of TGA. In both patients, clinical examination revealed elevated blood pressure. Laboratory examinations and brain CTs were normal. EEG demonstrated diffuse dysrhythmia and slow spike-waves, respectively. SPECT revealed hypoperfusion in the left frontal and right medial temporal regions. Various explanations of the mechanism of TGA are discussed. Based on the observed hypoperfusion in the medial temporal regions, a new hypothesis is advanced, suggesting the possibility that TGA occurs due to a pathologically changed or less adaptable anterior chorioid artery, initially constricted by hypotension following a blood shift from the center towards periphery

Dilemma of Antiepileptic Drugs Withdrawal in Symptomatic Epilepsy

A successful treatment of epilepsy depends on numerous factors such as etiology, genetics and environmental impact. An exact diagnosis, treatment and an adequate selection of antiepileptic drugs (AED) are important from the very beginning. The patient with symptomatic epilepsy caused by the brain tumor (low-grade astrocytoma in the left parietal lobe, surgically removed 17 years after the first manifestation of illness) is presented in this study. He has been seizure free for 6 years. The represented case study deals with the risk-benefit analysis of the discontinuation of the prescribed antiepileptic treatment that has lasted for 23 years

Silent brain infarct

Akutni infarkt mozga svojim nastupom i simptomima uzrokuje relativno jasnu i prepoznatljivu kliničku sliku, no postoje kronične pojedinačne i/ili difuzne ishemične lezije mozga koje su klinički asimptomatske i duže vremena se ne prepoznaju. Termin tihi infarkt mozga često se koristi za opis infarkta mozga koji se slučajno utvrdi u osoba koje nikad ranije u svojoj povijesti bolesti nisu imale kliničke simptome tranzitorne ishemijske atake ili moždanog udara. Može ga se utvrditi obdukcijom ili neuroradiološkim pretragama, kompjutoriziranom tomografijom i magnetskom rezonancijom mozga. Radi se najčešće o malom infarktu u dubokim subkortikalnim regijama mozga i morfološki je sličan simptomatskom lakunarnom infarktu. Lakunarna ishemična lezija mozga posljedica je okluzije duboke, penetrantne arterije u čijoj se osnovi uglavnom nalazi hipertenzivna moždana mikroangiopatija. Tihom infarktu mozga posljednje se desetljeće pridaje velika pažnja jer su studije pokazale da prisutnost tihog infarkta mozga dvostruko povećava rizik nastanka simptomatskog moždanog udara i demencije. U ovom preglednom članku prikazujemo epidemiologiju, patofiziološka obilježja, čimbenike rizika i moguće posljedice tihog infarkta mozga.With its onset and symptoms the acute brain stroke causes relatively clear and recognizable clinical features. However, there are chronic, single and/or diffuse ischemic brain lesions which are clinically asymptomatic and which take longer to recognize. The term ”silent brain infarct” is frequently used to describe the brain infarct which is determined with the autopsy by chance or which could be determined with computerized tomography. Such brain infarct could also be determined using the brain magnetic resonance imaging on people who never before had clinical symptoms transient ischemic attack or brain stroke in their lives. For the most of the time this is about small infarct in deep sub-cortical brain regions. It is morphologically similar to symptomatic lacunar infarct. Lacunar ischemic brain lesion is the consequence of the deep, perforating artery occlusion. Its base is mainly the hypertensive brain microangiopathy. The silent brain infarct is given great attention in the last decade because the studies show the silent brain infarct presence doubles the symptomatic brain stroke and dementia risk. In this review we show the epidemiology, the pathophysiologic attributes, the risk factors and possible silent brain infarct consequences