Ischemic stroke in a patient with giant fusiform aneurysm of dolichoectatic basilar artery and Covid-19 infection

Coronavirus disease (Covid-19) can manifest with numerous neurological disorders. We present a case of stroke in a patient with acute intraluminal thrombus in giant basilar tip fusiform aneurysm. A 71- year- old woman with past medical history of arterial hypertension and dilated cardiomyopathy was hospital- ized in intensive care unit (ICU) because of decreased consciousness (GCS 6) and a right- sided hemiple- gia which occurred twelve hours before admission. Five days earlier she was tested positive for Covid-19. ECG revealed new-onset atrial fibrillation (AF). She was intubated and mechanically ventilated. Brain CT and CT angiography of the head and neck vessels revealed dolichoectatic BA with giant fusiform an- eurysm of the tip of BA. BA lumen was partially filled with hyperdense, acute thrombus. Hypodensity of superior cerebellar artery (SCA) irrigation was consistent with acute ischemic stroke. She was treated with low molecular weight heparin, acetylsalicylic acid and corticosteroid therapy. During hospitalization her respiratory function deteriorated, and she died. To our knowledge this is the first case of stroke caused by acute thrombus in a giant tip of the BA aneurysm in patient with Covid-19 infection. It is important to increase prehospital stroke awareness since stroke in patients with Covid-19 is related to worse outcomes, and in appropriate time window can be treated with acute recanalization techniques

Ischemic stroke in a patient with giant fusiform aneurysm of dolichoectatic basilar artery and Covid-19 infection

Coronavirus disease (Covid-19) can manifest with numerous neurological disorders. We present a case of stroke in a patient with acute intraluminal thrombus in giant basilar tip fusiform aneurysm. A 71- year- old woman with past medical history of arterial hypertension and dilated cardiomyopathy was hospital- ized in intensive care unit (ICU) because of decreased consciousness (GCS 6) and a right- sided hemiple- gia which occurred twelve hours before admission. Five days earlier she was tested positive for Covid-19. ECG revealed new-onset atrial fibrillation (AF). She was intubated and mechanically ventilated. Brain CT and CT angiography of the head and neck vessels revealed dolichoectatic BA with giant fusiform an- eurysm of the tip of BA. BA lumen was partially filled with hyperdense, acute thrombus. Hypodensity of superior cerebellar artery (SCA) irrigation was consistent with acute ischemic stroke. She was treated with low molecular weight heparin, acetylsalicylic acid and corticosteroid therapy. During hospitalization her respiratory function deteriorated, and she died. To our knowledge this is the first case of stroke caused by acute thrombus in a giant tip of the BA aneurysm in patient with Covid-19 infection. It is important to increase prehospital stroke awareness since stroke in patients with Covid-19 is related to worse outcomes, and in appropriate time window can be treated with acute recanalization techniques

Povezanost posttraumatskog stresnog poremećaja i težine posljedica ishemičkog moždanog udara

Introduction: Although most often considered a consequence of a traumatic event, post-traumatic stress disorder (PTSD) occurs after illness as well. The aim of this study was to establish incidence of PTSD in patients with ischaemic stroke (IS) and its correlation to the degree of disability. Participants and Methods: The study included 161 patients with ischaemic stroke. PTSD was diag- nosed using a modified version of the PTSD Checklist specific for a stressor (PCL-S). Stroke severity was measured using the modified Rankin Scale (mRS). Demographic information including age and gender were collected from medical histories. Results: Of the 161 patients with IS, 21 (13.04%) fulfilled PCL-S criteria for PTSD. We found a posi- tive correlation between PTSD and higher degree of disability (Mann Whitney U test, P<0.001). Conclusion: Our results show that a significant number of IS patients develop PTSD after the incident. Determining correlates of post-stroke PTSD can help to identify those at higher risk for its development. If proven by additional large sample studies, early detection and treatment of PTSD symptoms may improve outcomes in stroke patients.Uvod: Iako se najčešće smatra posljedicom traumatskih događaja, PTSP se može pojaviti i nakon bolesti. Cilj ovog istraživanja je bio utvrditi incidenciju PTSP-a kod bolesnika s ishemičkim moždanim udarom (MU) te njegovu povezanost s stupnjem onesposobljenosti. Ispitanici i metode: U istraživanje je uključen 161 ispitanik s ishemičkim MU-om. PTSP je dijagnos- ticiran primjenom modificirane verzije PTSP liste specifične za stresor (PTSD Checklist Specific for a stressor (PCL-S)). Stupanj onesposobljenosti procjenjivan je korištenjem modificirane Rankin skale (mRS). Demografski podatci o dobi i spolu bolesnika prikupljeni su u razgovoru s pacijentima. Rezultati: Od 161 pacijenta s ishemičkim MU-om, njih 21 (13.04 %) je ispunilo PCL-S kriterije za PTSP. Našli smo pozitivnu povezanost između PTSP-a i većeg stupnja onesposobljenosti (Mann-Whit- neyjev U-test, P <0,001). Zaključak: Naši rezultati pokazaju da se PTSP pojavljuje u značajnog broja bolesnika s ishemičkim MU-om. Određivanje korelata PTSP-a nakon MU-a može pomoći identificirati bolesnike s većim rizikom za razvoj PTSP-a. Kada bi se ovi rezultati dokazali u studijama s većim brojem ispitanika, rana detekcija i liječenje simptoma PTSP-a mogli bi poboljšati ishode pacijenata s MU-om

Povezanost posttraumatskog stresnog poremećaja i težine posljedica ishemičkog moždanog udara

Introduction: Although most often considered a consequence of a traumatic event, post-traumatic stress disorder (PTSD) occurs after illness as well. The aim of this study was to establish incidence of PTSD in patients with ischaemic stroke (IS) and its correlation to the degree of disability. Participants and Methods: The study included 161 patients with ischaemic stroke. PTSD was diag- nosed using a modified version of the PTSD Checklist specific for a stressor (PCL-S). Stroke severity was measured using the modified Rankin Scale (mRS). Demographic information including age and gender were collected from medical histories. Results: Of the 161 patients with IS, 21 (13.04%) fulfilled PCL-S criteria for PTSD. We found a posi- tive correlation between PTSD and higher degree of disability (Mann Whitney U test, P<0.001). Conclusion: Our results show that a significant number of IS patients develop PTSD after the incident. Determining correlates of post-stroke PTSD can help to identify those at higher risk for its development. If proven by additional large sample studies, early detection and treatment of PTSD symptoms may improve outcomes in stroke patients.Uvod: Iako se najčešće smatra posljedicom traumatskih događaja, PTSP se može pojaviti i nakon bolesti. Cilj ovog istraživanja je bio utvrditi incidenciju PTSP-a kod bolesnika s ishemičkim moždanim udarom (MU) te njegovu povezanost s stupnjem onesposobljenosti. Ispitanici i metode: U istraživanje je uključen 161 ispitanik s ishemičkim MU-om. PTSP je dijagnos- ticiran primjenom modificirane verzije PTSP liste specifične za stresor (PTSD Checklist Specific for a stressor (PCL-S)). Stupanj onesposobljenosti procjenjivan je korištenjem modificirane Rankin skale (mRS). Demografski podatci o dobi i spolu bolesnika prikupljeni su u razgovoru s pacijentima. Rezultati: Od 161 pacijenta s ishemičkim MU-om, njih 21 (13.04 %) je ispunilo PCL-S kriterije za PTSP. Našli smo pozitivnu povezanost između PTSP-a i većeg stupnja onesposobljenosti (Mann-Whit- neyjev U-test, P <0,001). Zaključak: Naši rezultati pokazaju da se PTSP pojavljuje u značajnog broja bolesnika s ishemičkim MU-om. Određivanje korelata PTSP-a nakon MU-a može pomoći identificirati bolesnike s većim rizikom za razvoj PTSP-a. Kada bi se ovi rezultati dokazali u studijama s većim brojem ispitanika, rana detekcija i liječenje simptoma PTSP-a mogli bi poboljšati ishode pacijenata s MU-om

Analysis of Colon Cancer Features in Croatia

Qualitative and quantitative parametars were evaluated in 186 colorectal cancer patients. Quality of life was evaluated in subgroup of 84 patients. Correlation between Dukes stage of disease and qualitative (gender, blood type, marital status, region of Croatia from where patients were coming) and quantitative biological parametars (age, body mass index) was analysed. There was no statistically significant difference considering distribution of the patients disease stage and gender, blood type, marital status, region of Croatia from where patients were coming and body mass index (p> 0.05). Patients with Dukes D stage of colorectal cancer were statistically significantly younger in comparison to other stages (p<0.05). Quality of life was the best before surgery, significantly deteriorated immediately after and partially improved three months after the surgery without significant differences between investagted groups with different colorectal cancer stage and type of surgery

The reliability and validity of the mini-mental state examination in the elderly Croatian population

AIM: The aim of this study was standardization and validation of the Mini-Mental State Examination (MMSE) in the general Croatian aging population. ----- METHODS: Three-hundred and forty-four participants underwent the MMSE test, 217 cognitively healthy subjects without neurological and psychiatric disorders and 127 patients with mild cognitive impairment (MCI) or dementia. ----- RESULTS: The optimal cutoff point for screening of the general Croatian population (cognitively healthy vs. MCI and dementia) is 26/27; in the Croatian population aged ≥65 years, the cutoff point is 24/25, whereas for screening of highly educated persons (≥14 years of education) aged ≥65 years a higher cutoff point should be used (26/27). ----- CONCLUSIONS: MMSE results when standardized and validated in a certain population might better contribute to recognition of the individuals at risk that should be directed to dementia outpatient clinics

Single aortic clamping in coronary artery bypass surgery reduces cerebral embolism and improves neurocognitive outcomes

Aortic manipulation releases embolic material, thereby enhancing the probability of adverse neurologic outcomes following coronary artery bypass grafting (CABG). We prospectively evaluated 59 patients undergoing CABG. Patients in the single (SC, n = 37) and multiple clamp (MC, n = 22) groups were comparable in relation to age and operative risk (p > 0.05). Neurocognitive evaluation consisted of the Auditory Verbal Learning Test (AVLT), Color Trails Test A, the Grooved Pegboard test and the Mini-Mental State Examination. Data acquisition was performed preoperatively, early postoperatively and at the 4-month follow-up. Intraoperative transcranial Doppler (TCD) monitoring was used to quantify the embolic load in relation to different aortic clamping strategies. Preoperative neurocognitive results were similar between the groups (p > 0.05). The incidence of postoperative delirium was greater in the MC group but this failed to reach statistical significance (23% vs 8%, p = 0.14). SC patients had fewer embolization signals (270 ± 181 vs 465 ± 160, p < 0.0001). Early postoperative neurocognitive results were depressed in comparison to preoperative values in both groups (p < 0.05 for multiple comparisons). The magnitude of this cognitive depression was greater in the MC group (p < 0.05 for multiple comparisons). Preoperative levels of neurocognition were restored at follow-up in the SC group in all tests except the AVLT. A trend towards improvements in neurocognitive performances at follow-up was also observed in the MC group. Residual attention, motor skill and memory deficits were, however, documented with multiple tests. In conclusion, the embolic burden was significantly lower in the SC group. This TCD imaging outcome translated into fewer early cognition deficits and superior late restoration of function

Croatian study on COVID-19-positive stroke patients during the second wave of the pandemic

Aim: To investigate stroke characteristics in patients with concomitant coronavirus disease 2019 (COVID-19) infection in Croatia during the second wave of the COVID-19 pandemic. ----- Methods: This retrospective study investigated the characteristics of two groups of ischemic stroke patients: those who developed COVID-19 infection before stroke and those who developed the infection during the hospital stay after stroke onset. Stroke etiology was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. ----- Results: We analyzed data from 255 stroke patients from 12 Croatian hospitals. The two groups of ischemic stroke patients differed in stroke etiology (P=0.038). Patients with COVID-19 infection before stroke had fewer cardioembolic strokes (46% vs 29.1%), more cryptogenic strokes (32.5% vs 14.3%), and more strokes in multiple vascular territories (12.4% vs 1.8%). The percentage of large-vessel occlusions was high in both groups (49.6% and 44.4%). Median modified Rankin Scale score on discharge was 4 in both groups. Mortality was 36.4% in the group with stroke after COVID-19 and 33.3% in the group with COVID-19 after stroke. ----- Conclusion: Ischemic stroke after COVID-19 differs in etiology from ischemic stroke complicated by COVID-19 infection. Both patient groups are characterized by severe disability and high mortality. Raising the awareness of prehospital stroke and optimization of clinical workflow are important if we want to improve the stroke outcomes by acute recanalization techniques

The Interconnection between Carotid Intima–Media Thickness and Obesity: Anthropometric, Clinical and Biochemical Correlations

Background and Objectives: Carotid intima–media thickness (CIMT) and obesity are considered independent determinants of cardio- and cerebrovascular events. The aim of our study was to investigate the effect of obesity on CIMT and to define which traditional cardiovascular risk factors correlate the most with CIMT values in patients with obesity. Materials and Methods: Anthropometric measurements were collected for the whole study group, as well as body composition and blood pressure data, and biochemical blood analyses were also performed. Results: Although our study group was significantly older according to vascular compared with chronological age, the mean CIMT values were lower when compared with the reference values. We found a statistically significant correlation of CIMT with chronological and vascular age, systolic blood pressure, fasting glucose, total cholesterol and triglyceride levels, waist-to-hip ratio, waist circumference, body muscle mass and skeletal muscle mass index. Atherosclerotic Cardiovascular Disease (ASCVD) risk assessment and SCORE (Systematic COronary Risk Evaluation) showed significant positive correlations, but there was only a weak correlation of ASCVD with CIMT. Conclusions: To deduce, since no diagnostic tool currently includes body weight as an individual risk factor, further trials are highly needed to determine if SCORE, SCORE2, ASCVD risk assessment or CIMT would be the most accurate and relevant diagnostic tool for prediction of risk for future CV events in patients with obesity