3 research outputs found
PoreÄenje dijagnostiÄkih kriterijuma kod bolesnika sa amiotrofiÄnom lateralnom sklerozom - doprinos elektromiografskih nalaza
Diagnosis of amyotrophic lateral sclerosis (ALS) is based on combination of clinical signs and electrophysiological correlates of pathological process which takes place in general. New electrophysiological criteria Awaji-Shima (AS) additionally qualify the complex fasciculations and neurogenically modified potentials of motor units as signs of active lesions of peripheral motor neuron, contrary to previously valid revised El Escorial criteria (rEE). The objective of this research was to determine the clinical significance and advantages of using the AS criteria in patients with ALS. Methods. Thirty patients (59.2 Ā± 10.9 years, 57% of them with spinal form of the disease) with clinically suspected ALS were monitored from the time of diagnosis until reaching the category of definitive diagnosis or death. The clinical evaluation and electromyographic (EMG) examinations were carried out at 3-month intervals. Results. By applying the AS criteria, the category of probable or definite diagnosis was achieved in all patients with ALS, except in one (96.6%), as contrary to the rEE (33.3%), after 6 months of the follow-up period. The subclinical affection in more than two body regions has been defined through detection of denervation potentials (80% of the patients by using the AS, or 67% by the rEE criteria). The complex fasciculations were registered particularly often in small muscles of the feet (37- 40%). Conclusion. Application of the AS criteria improve the achievment of category of probable or definite diagnosis of ALS by 2.7 months earlier compared to the rEE. This outcome is particularly affected by a higher frequency of positive EMG findings, when the AS criteria were employed. Early determination of diagnosis provides the better perspective and more frequent participation of the ALS patients in pharmacotherapy studies intended to establish new therapeutic options.Dijagnoza amiotrofiÄne lateralne skleroze (LS) zasniva se na kombinaciji kliniÄkih znakova i elektrofizioloÅ”kih korelata patoloÅ”kog procesa koji se odvija u osnovi. Novi elektrofizioloÅ”ki kriterijumi, Awaji-Shima (AS), dodatno kvalifikuju kompleksne fascikulacije i neurogeno izmenjene potencijale motornih jedinica kao znakove aktivnih lezija perifernog motornog neurona, nasuprot ranije važeÄim revidiranim El Escorial kriterijumima (rEE). Cilj ovog istraživanja bio je da se utvrdi kliniÄki znaÄaj i prednosti primene AS kriterijuma, kod obolelih od ALS. Metode. 30 bolesnika (59,2 Ā± 10,9 godina, od kojih 57% sa spinalnom formom bolesti) sa kliniÄki suspektnom ALS, praÄeno je od vremena postavljanja dijagnoze do postizanja kategorije definitivne dijagnoze ili smrtnog ishoda. Kod bolesnika su obavljane kliniÄka evaluacija i elektromiografski (EMG) pregledi u tromeseÄnim intervalima. Rezultati. Primjenom AS kriterijuma, nakon 6 meseci praÄenja, kategorija verovatne ili pouzdane dijagnoze postignuta je kod svih bolesnika sa ALS, izuzev jednog (96,6%), nasuprot rEE kriterijuma (33.3%). EMG nalazi bili su pozitivni u ā„ 2 telesna regiona kod 80% bolesnika primenom AS, odnosno 67% primenom rEE. Kompleksne fascikulacije zabeležene su posebno uÄestalo u malim miÅ”iÄima stopala (37-40%). ZakljuÄak. Primenom AS kriterijuma kategorija vjerovatne ili pouzdane dijagnoze ALS postiže se za 2,7 meseca ranije, u poreÄenju sa rEE, na Å”ta posebno utiÄe veÄa uÄestalost pozitivnih EMG nalaza. Ranije utvrÄivanje dijagnoze donosi perspektivu veÄe zastupljenosti obolelih u farmakoterapijskim studijama sa novim terapeutskim agensima
NaÅ”a iskustva s trombolitiÄkom terapijom ā preliminarno izvjeÅ”Äe
Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by acting on its cause using a very powerful weapon, thrombolytic therapy. The aim is to present a preliminary report of our experiences with thrombolytic therapy in patients with ischemic stroke. Results recorded in 20 patients who received thrombolytic therapy within three hours of stroke onset are presented. Nineteen patients survived and one patient died from therapy side effects, i.e. intracerebral hematoma. Seventeen of 19 patients were released from the hospital without any neurologic deficit, while two patients had Rankin score 2 (minimum disability) three months after stroke onset. Our experience confirms that thrombolytic therapy is the treatment of choice in patients with ischemic stroke if administered in accordance with precise protocols.Moždani udar je naglo nastali, akutni oblik fokalnog ili globalnog poremeÄaja moždane funkcije, koji traje duže od jednog sata, poremeÄaja koji nema drugog vidljivog uzroka osim vaskularnog. Predstavlja zavrÅ”nu fazu bolesti lokalizirane na moždanim arterijama, glavni je uzrok onesposobljenosti i drugi uzrok smrtnog ishoda. U danaÅ”nje vrijeme postoji moguÄnost veoma uspjeÅ”nog lijeÄenja ishemijskog moždanog udara primjenom moÄnog oružja, kauzalne trombolitiÄke terapije. Ovdje se daje preliminarni prikaz naÅ”ih iskustava u primjeni trombolitiÄke terapije kod bolesnika s ishemijskim moždanim udarom. U radu se prikazuju rezultati lijeÄenja 20 bolesnika koji su primili trombolitiÄku terapiju u prva tri sata od poÄetnih simptoma moždanog udara, od kojih je 19 preživjelo, a jedan bolesnik je umro od sporednih uÄinaka terapije, tj. intracerebralnog krvarenja. Kod 17 bolesnika doÅ”lo je do potpunog oporavka bez neuroloÅ”kog deficita, dok su dva bolesnika imala minimalnu onesposobljenost, Rankinov zbir 2, nakon tri mjeseca od dogaÄaja. TrombolitiÄka terapija je i prema naÅ”im prvim iskustvima terapija izbora u lijeÄenju ishemijskog moždanog udara, ako se primjenjuje strogo prema propisanim uputama
Funkcionalni ishod nakon lijeÄenja trombolizom
In this paper, we report our experience from a prospective study in 40 ischemic stroke patients admitted during the last two years at University Department of Neurology Stroke Unit, Banja Luka Clinical Center, in order to assess the safety and efficacy of thrombolytic therapy, the impact of age, sex and risk factors, and functional outcome at 6 months of intravenous tissue plasminogen activator treatment. According to the National Institutes of Health Stroke Scale, there were 5 mild, 22 moderate and 13 severe stroke cases in the study group. The outcome measures at 6 months of thrombolytic treatment were taken in 38 (100%) patients, yielding a Functional Independent Measure score ā„90 (good clinical outcome) in 21 (52.50%) and modified Rankin Score ā¤2 (good clinical outcome) in 22 (55%) patients. The rate of symptomatic intracerebral hemorrhage in tissue plasminogen activator treated patients was 5%, with a mortality rate of 17.50%. The outcomes were comparable with those found in the NINDS t-PA trial. Current guidelines recommend a ādoor-to needleā time of less than 60 minutes and emphasize that ātime is brainā.U radu iznosimo naÅ”a iskustva iz prospektivne studije kod 40 pacijenata sa ishemiÄnim moždanim udarom, lijeÄenih u Jedinici za moždani udar Klinike za neurologiju KliniÄkog Centra Banja Luka tokom posljednje dvije godine, da bi se procijenila pouzdanost i efikasnost trombolitiÄke terapije Å”est mjeseci nakon intravenske primjene aktivatora tkivnog plazminogena, kao i uticaj životne dobi, spola i faktora rizika na funkcionalni ishod nakon moždanog udara. MeÄu njima je, prema skali za moždani udar Nacionalnog instituta za zdravlje SAD, bilo pet blagih, 22 umjerena i 13 teÅ”kih oblika moždanog udara. Efikasnost terapije nakon Å”est mjeseci od trombolize kod 38 preživjelih pacijenata prezentirana je zbirom Nezavisnog funkcionalnog mjerenja ā„ 90 (dobar kliniÄki ishod) kod 21 (52,50%) pacijenta, te kao modificirani Rankinov zbir ā¤ 2 (dobar kliniÄki ishod) kod 22 (55%) pacijenta. UÄestalost intrakranijalne hemoragije bila je 5%, sa stopom smrtnosti od 17,50%. Rezultati funkcionalnog ishoda su usporeÄeni sa ishodom navedenim u studiji NINDS t-PA. VažeÄe preporuke savjetuju da vrijeme od āvrata do igleā bude kraÄe od 60 minuta, naglaÅ”avajuÄi izreku āvrijeme je mozakā