Segmental cavernous carotid ectasia in a patient with cluster-like headache

Introduction Cluster headache (CH) is a primary headache with severe, unilateral periorbital or temporal pain lasting 15–180min, accompanied with various cranial autonomic features. A diagnosis of cluster-like headache can be made whenever underlying cause of CLH is present. Methods and results We report a case where an ectatic cavernous segment of the internal carotid artery triggered CHL, most probably due to compression of the ophthalmic nerve within cavernous sinus. The pathological substrate of a vessel ectasia is degeneration of the tunica intima as a consequence of atherosclerosis and hypertension. On the other hand, cavernous sinus is unique space where parasympathetic, sympathetic and nociceptive fibers are in intimate relationship which is of great importance for understanding of CH pathophysiology. Conclusion Magnetic resonance imaging and MR angiography are mandatory imaging tools used for precise localization of pathological changes in the cavernous sinus, especially in the group of secondary headaches attributed to vascular disorders

Učinak liječenja relapsno-remitentne multiple skleroze interferonom beta-1b: rezultati trogodišnje studije praćenja

The aim of this prospective study was to evaluate therapeutic effects in a cohort of 32 patients with relapsing-remitting multiple sclerosis (RRMS) that were continuously treated with interferon beta-1b during a three-year period and to compare the results obtained with literature data available. Additionally, dropouts and side effects were assessed. The annual relapse rate at three years of treatment as the primary study end-point decreased by 60.5% compared with the relapse rate throughout the pretherapeutic course of disease (0.39±0.55 vs. 0.97±0.46; P<0.001) and by 71.3% compared with the relapse rate one year prior to treatment (0.39±0.55 vs. 1.34±0.65; P<0.001). The mean Extended Disability Status Scale (EDSS) increased significantly from 2.46±0.86 at baseline to 2.90±1.30 (P<0.01) at three years of treatment, whereas the mean progression index (EDSS/disease duration) decreased significantly from 0.76±0.50 prior to treatment to 0.43±0.24 (P <0.001), yielding a 56.6% improvement and proving the disease modifying effect of interferon beta-1b. Seventeen (53.12%) patients remained relapse-free during the course of therapy. Among patients that experienced disease relapse, the mean time to first exacerbation was 11.5±8.34 months. Our study results were consistent with similar studies performed worldwide, clearly indicating that Interferon beta-1b therapy decreased the disease activity and had a beneficial effect on the progression of RRMS, with low incidence and severity of serious side effects. This study has paved way for further long-term follow up studies at our institution.Cilj ove prospektivne studije bio je procijeniti učinkovitost terapije interferonom beta-1b u grupi od 32 bolesnika oboljela od relapsno-remitentne forme multiple skleroze liječenih tokom trogodišnjeg perioda, te dobivene rezultate usporediti sa rezultatima dostupnim u literaturi. Pacijenti kod kojih je iz različitih razloga obustavljena terapija također su detaljno obrađeni. Primarni pokazatelj, godišnja stopa egzacerbacije nakon tri godine terapije, pokazala je statistički značajan pad za 60,5% u odnosu na stopu egzacerbacije tokom cijelog trajanja bolesti (sa 0,97±0,46 na 0,39±0,55), odnosno za 71,3% u odnosu na godinu prije započinjanja terapije (sa 1,34±0.65 na 0,39±0,55; P<0,001). Prosječna vrijednost EDSS se značajno povećala od 2,46±0,86 prije započinjanja terapije do prosječnih 2,90±1,30 (P<0,01), ali je srednji indeks progresije bolesti (EDSS/ duljina trajanja bolesti) bio značajno niži nakon tri godine terapije (0,43±0,24) u odnosu na indeks progresije tokom cjelokupnog trajanja bolesti (0,76±0,50; P<0,001), što čini poboljšanje od 56,6% i ukazuje na pozitivan učinak interferona beta-1b u smislu modificiranja toka bolesti. Tokom provođenja terapije 53,17% (17 pacijenata) nije imalo egzacerbaciju bolesti. Prosječno vrijeme do prve egzacerbacije među pacijentima koji su imali egzacerbaciju bilo je 11,5±8,34 mjeseci. Rezultati ove studije su u suglasnosti sa rezultatima sličnih objavljenih prospektivnih studija i pokazuju da interferon beta-1b ima pozitivan efekt na aktivnost i progresiju multiple skleroze, kao i da se ozbiljna neželjena djelovanja lijeka rijetko javljaju. Ova studija otvara mogućnost za izvođenje dugoročnih studija praćenja

RELATIONSHIP BETWEEN LESION LOCATION AND COGNITIVE DOMAINS IN ACUTE ISCHEMIC STROKE PATIENTS

Localization of brain lesions in acute ischemic stroke has a significant effect on performance in various cognitive domains. The aim of the study was to determine whether there is association between different locations of ischemic brain lesions and different cognitive domains. The study included 40 acute ischemic stroke pati-ents (26 male and 14 female, aged 45-78 years, with 8-16 years of education). Lesi-on location was visualized using brain computerized tomography, whereas perfor-mance in different cognitive domains was assessed using an extensive neuropsychological test battery. The following domains were evaluated: executive function, language, immediate recall, delayed recall, attention, divergent reasoning, and visual-constructive performance in two dimensions. A series of categorical re-gression analyses were applied. The results showed a significant association between the domains of executive function and language and a set of predictors rela-ted to lesion location. Global brain atrophy was found to be a significant partial pre-dictor of performance in all cognitive domains, with higher degrees of global brain atrophy correlating with poorer performance in each of the studied domains. Combi-ned (cortical-subcortical) lesions and unilateral lesions were both found to be signi-ficant partial predictors for language, with a higher lesion load being associated with poorer language performance. Combined lesions were also a significant partial pre-dictor for delayed recall, with a higher lesion load correlating with poorer perfor-mance in the delayed recall domain

Paraneoplastic limbic encephalitis in a patient with non-Hodgkin’s lymphoma

Paraneoplastic limbic encephalitis is uncommon neurological side effect of cancer in the absence of direct effect of primary tumor or metastasis, side effects of treatment or metabolic dysfunctions (6). Non-Hodgkin's lymphoma triggers such side effect very rarely. We present a case of a young adult with complete clinical course of non- Hodgkin's lymphoma with an episode of behavioral disturbances and MRI features which were pathognomonic for paraneoplastic limbic encephalitis

Nonspecific perichondritis of the lumbar spine

WOS: 000243295900013PubMed ID: 17238876A teenage girl with soft tissue inflammation involving the L2-S1 region of the lumbar region is reported. Magnetic resonance (MR) imaging revealed high-signal lesions on T2-weighted images in association with contrast enhancement. Histology revealed nonspecific perichondritis with mononuclear inflammatory infiltration of the perichondrium and connective tissue. Six months after treatment, MR imaging was normal. No similar case of perichondritis with involvement of the lumbar region could be found in the current literature

Utjecaj depresije nakon moždanog udara na funkcionalni ishod i kvalitetu života

In spite of being a common and important complication of stroke, post stroke depression is often overlooked, so its impact on stroke outcome remains under recognized. The aim of the study was to determine the effect of depression on functional outcome and quality of life in stroke patients. The study included 60 patients treated for their first clinical stroke, 30 of them diagnosed with depression and 30 patients without depression. Testing was done in all patients two and six weeks after stroke. Depression was diagnosed according to the Mini International Neuropsychiatry Interview, DSM-IV diagnostic criteria, and depression severity was quantified by the Hamilton Depression Rating Scale; functional impairment was determined by the Barthel Index; and post stroke quality of life was assessed by the Short Form 36 (SF-36) questionnaires. The patients with depression had significantly more severe functional disability both at baseline and after rehabilitation treatment, although the potential for functional recovery in depressed patients was less than in non-depressed ones. The quality of life in patients with post stroke depression was impaired more severely in all SF-36 domains compared with non-depressed stroke patients, with the domains of the role of emotional functioning and social relations being most severely affected.Dijagnoza depresije nakon moždanog udara često se previdi, iako se radi o čestoj i važnoj komplikaciji moždanog udara, tako da je i njezin utjecaj na ishod moždanog udara zanemaren i podcijenjen. Cilj ovoga istraživanja je bio utvrditi utjecaj depresije na funkcionalni ishod i kvalitetu života bolesnika s moždanim udarom. Prospektivno istraživanje obuhvatilo je 60 bolesnika liječenih zbog klinički dijagnosticiranog prvog moždanog udara, od toga 30 bolesnika s dijagnosticiranom depresijom i 30 bolesnika bez depresije. Testiranja su provedena dva i šest tjedana nakon moždanog udara. Depresija je dijagnosticirana prema mini međunarodnom neuropsihijatrijskom intervjuu, DSM-IV dijagnostičkim kriterijima (MINI), a težina depresije kvantificirana je Hamiltonovom ljestvicom za procjenu depresivnosti. Funkcionalni status je procjenjivan pomoću Barthelova indeksa, a kvaliteta života nakon moždanog udara upitnikom Short Form 36 (SF-36). Značajno teža funkcionalna onesposobljenost zabilježena je u skupini bolesnika s depresijom, i to na početku kao i nakon završenog rehabilitacijskog tretmana. Potencijal za funkcionalni oporavak kod depresivnih bolesnika nije manji, iako je na kraju rehabilitacijskog tretmana stupanj funkcionalnih sposobnosti u ovoj skupini bio niži. Kvaliteta života depresivnih bolesnika značajno je smanjena u svim domenama upitnika SF-36 u odnosu na nedepresivne bolesnike, pri čemu je najteže oštećena uloga emocionalnog funkcioniranja te socijalni odnosi