The Town of Čabar, Croatia, Familiar Pseudocluster for Multiple Sclerosis – Descriptive Epidemiological Study

Previous descriptive surveys in the town of ^abar, Croatia carried out by our own epidemiological research group, have established that this area is at high risk for MS. To confirm the above assumption and to update MS frequency in this area we conducted a community-based intensive prevalence and incidence study. On December 31st 2001, the average prevalence was 205.7 per 100,000 with prevailing age-specific prevalence in the group of patients between 30 and 49 years of age. The average incidence (1948.–2004.) was 5.52/100.000 population per year (95% CI=3.27–8.72), average mortality in the year was 2.76/100 000 inhabitants (95% CI=1.26–5.24). Sexual index stood at 1:11, starting time was 10:04±28.53 in the year, and the average duration of the disease to the prevalence 11:11±27.26 years

The Town of Čabar, Croatia, Familiar Pseudocluster for Multiple Sclerosis – Descriptive Epidemiological Study

Previous descriptive surveys in the town of ^abar, Croatia carried out by our own epidemiological research group, have established that this area is at high risk for MS. To confirm the above assumption and to update MS frequency in this area we conducted a community-based intensive prevalence and incidence study. On December 31st 2001, the average prevalence was 205.7 per 100,000 with prevailing age-specific prevalence in the group of patients between 30 and 49 years of age. The average incidence (1948.–2004.) was 5.52/100.000 population per year (95% CI=3.27–8.72), average mortality in the year was 2.76/100 000 inhabitants (95% CI=1.26–5.24). Sexual index stood at 1:11, starting time was 10:04±28.53 in the year, and the average duration of the disease to the prevalence 11:11±27.26 years

The Town of Čabar, Croatia, a High Risk Area for Multiple Sclerosis – Analytic Epidemiology of Dietary Factors

Multiple sclerosis (MS) is demyelization disease of central nervous system of unidentified causes. Analytic epidemiological research of 19 patients, clinically approved cases of MS and 25 controls, autochthonic inhabitants of town of ^abar, Croatia, the high-risk zone for the disease, was made. The research plan included case-control investigation – the »door to door« questionnaire – about nutrition habits. An odds ratio (OR) was calculated for all the factors which were more frequently found in the patients than in the controls, and vice versa. The variables that were connected with significant risk for MS in the town of ^abar included: alcohol consumption (p=0.05), animal fats/dried meat products consumption (p=0.007), nitrate salting (p=0.03), strong spices (p=0.007), mixed bread (p=0.002), oat and oat products consumption (p=0.0075). No connection was found with regular consumption of vegetables and fruit (p=0.009), blue fresh fish (p=0.028), other fresh fish (p=0.03), freshwater fish (p=0.002), canned fish (p=0.004), dormouse meat (p=0.007), air-dried meat products (p=0.004) and using the water from water supply (p=0.011). In the town of ^abar nutritional customs, primarily food rich in animal fats, alcohol-abuse, and oat consumption could have an influence on MS pathogenesis in genetically inclined individuals

Dijagnostički izazov sindroma anti-GQ1b: diferencijalna dijagnoza između Miller-Fischerova sindroma i Bickerstaff ova encefalitisa moždanog debla

ABSTRACT – Miller Fisher syndrome (MFS) may be considered as a rare variant of Guillain-Barré syndrome (GBS). Together with GBS, Bickerstaff ’s brainstem encephalitis and acute ophthalmoparesis without ataxia, MFS is in the group of anti-GQ1b syndrome disorders (anti-GQ1b Sy). Among all GBS variants, MFS is distinctive, presenting with acute symptoms of ophthalmoparesis, ataxia and arefl exia, but without progressive limb weakness as the most characteristic symptom of GBS. MFS is a clinical entity based on typical clinical presentation and defi ned symptoms, and the fi nding of specifi c anti-GQ1b antibodies is not suffi cient for MFS diagnosis. Th e objective of this case report is to demonstrate the diversity of anti-GQ1b Sy clinical presentation. Here we describe a case of a male patient with acute bilateral ophthalmoparesis, mydriasis and unilateral right infranuclear facial nerve palsy, in whom muscle tendon refl exes were preserved and no ataxia was present. Serum antiganglioside antibody test was positive for anti-GQ1b antibody, confi rming the presupposed diagnosis of MFS. Although MFS is rare, it should be considered in patients with acute development of ophthalmoplegia. In rare cases of MFS with uncommon presentation, as it was in our case, positive serum antiganglioside antibody test will lead to the right diagnosisSAŽETAK – Miller Fisherov sindrom (MFS) može se smatrati rijetkom varijantom Guillain-Barréova sindroma (GBS). MFS, zajedno s GBS, Bickerstaff ovim encefalitisom moždanog debla (BBE) i akutnom o ft almoparezom (AO) bez ataksije, pripada skupini poremećaja unutar anti-GQ1b sindroma (anti-GQ1b Sy). Između svih varijanta GBS, MFS se manifestira na specifi čan način akutnim razvojem oft almoplegije, ataksije i arefl eksije, no bez progresivne slabosti mišića ekstremiteta kao karakterističnog znaka GBS. MFS je klinički entitet temeljen na tipičnoj kliničkoj slici i određenim simptomima, no nalaz specifi čnih anti-GQ1b protutijela nije dovoljan za dijagnozu MFS. Cilj je ovoga članka prikazati različitosti kliničke prezentacije anti-GQ1b sindroma. Opisujemo slučaj bolesnika s naglim razvojem obostrane oft almoplegije, midrijaze i unilateralne desnostrane infranuklearne pareze ličnog živca, bez ataksije te urednih miotatskih refl eksa. S obzirom na kliničku sliku i razvoj simptoma postavljena je sumnja na MFS, što je potvrđeno i pozitivnim nalazom serumskih anti-GQ1b protutijela. U zaključku, premda se rijetko pojavljuje, na MFS treba pomis liti u diferencijalnoj dijagnozi kod bolesnika s naglim razvojem oftalmoplegije. U rijetkim slučajevima neuobičajene prezentacije MFS-a, kao u našem slučaju, pozitivan nalaz antigangliozidnih protutijela omogućava postavljanje točne dijagnoz

Dijagnostički izazov sindroma anti-GQ1b: diferencijalna dijagnoza između Miller-Fischerova sindroma i Bickerstaff ova encefalitisa moždanog debla

ABSTRACT – Miller Fisher syndrome (MFS) may be considered as a rare variant of Guillain-Barré syndrome (GBS). Together with GBS, Bickerstaff ’s brainstem encephalitis and acute ophthalmoparesis without ataxia, MFS is in the group of anti-GQ1b syndrome disorders (anti-GQ1b Sy). Among all GBS variants, MFS is distinctive, presenting with acute symptoms of ophthalmoparesis, ataxia and arefl exia, but without progressive limb weakness as the most characteristic symptom of GBS. MFS is a clinical entity based on typical clinical presentation and defi ned symptoms, and the fi nding of specifi c anti-GQ1b antibodies is not suffi cient for MFS diagnosis. Th e objective of this case report is to demonstrate the diversity of anti-GQ1b Sy clinical presentation. Here we describe a case of a male patient with acute bilateral ophthalmoparesis, mydriasis and unilateral right infranuclear facial nerve palsy, in whom muscle tendon refl exes were preserved and no ataxia was present. Serum antiganglioside antibody test was positive for anti-GQ1b antibody, confi rming the presupposed diagnosis of MFS. Although MFS is rare, it should be considered in patients with acute development of ophthalmoplegia. In rare cases of MFS with uncommon presentation, as it was in our case, positive serum antiganglioside antibody test will lead to the right diagnosisSAŽETAK – Miller Fisherov sindrom (MFS) može se smatrati rijetkom varijantom Guillain-Barréova sindroma (GBS). MFS, zajedno s GBS, Bickerstaff ovim encefalitisom moždanog debla (BBE) i akutnom o ft almoparezom (AO) bez ataksije, pripada skupini poremećaja unutar anti-GQ1b sindroma (anti-GQ1b Sy). Između svih varijanta GBS, MFS se manifestira na specifi čan način akutnim razvojem oft almoplegije, ataksije i arefl eksije, no bez progresivne slabosti mišića ekstremiteta kao karakterističnog znaka GBS. MFS je klinički entitet temeljen na tipičnoj kliničkoj slici i određenim simptomima, no nalaz specifi čnih anti-GQ1b protutijela nije dovoljan za dijagnozu MFS. Cilj je ovoga članka prikazati različitosti kliničke prezentacije anti-GQ1b sindroma. Opisujemo slučaj bolesnika s naglim razvojem obostrane oft almoplegije, midrijaze i unilateralne desnostrane infranuklearne pareze ličnog živca, bez ataksije te urednih miotatskih refl eksa. S obzirom na kliničku sliku i razvoj simptoma postavljena je sumnja na MFS, što je potvrđeno i pozitivnim nalazom serumskih anti-GQ1b protutijela. U zaključku, premda se rijetko pojavljuje, na MFS treba pomis liti u diferencijalnoj dijagnozi kod bolesnika s naglim razvojem oftalmoplegije. U rijetkim slučajevima neuobičajene prezentacije MFS-a, kao u našem slučaju, pozitivan nalaz antigangliozidnih protutijela omogućava postavljanje točne dijagnoz

Intravenous Thrombolysis for Acute Ischemic Stroke – Our Experiences

Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the only available pharmacological therapy to improve the outcome of acute ischemic stroke. We compared 71 patients presenting with ischaemic stroke and given intravenous rt-PA (0·9 mg/kg total dose) within 3 h with 71 patients who present to the hospital more than 3 hours after stroke symptom onset. The primary endpoint was the modified Rankin scale (mRS) at 90 days, dichotomised for favourable and unfavourable (score 2–6). Outcome measures were symptomatic intracerebral haemorrhage within 36 h (haemorrhage associated with National Institutes of Health Stroke Scale [NIHSS] 4 points deterioration), and mortality at 3 months. More patients had favourable outcome with the rt-PA-treated group than with the control group (64.79% vs. 22.54%; p= 0.0001). The greater proportion of patients left with minimal or no deficit 90 days after rt-PA treatment, as compared with the control group. In the treated group symptomatic intracranial hemorrhage occurred in 1 patient who recovered to a level of functional independence, and asymptomatic intracranial hemorrhage was observed in 2 patients. Our experience of an acute stroke thrombolysis service shows that we are able to provide this treatment safely and in accordance with established treatment guidelines. We recommend thrombolytic treatment in acute ischemic stroke for selected population

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

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

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

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