Utjecaj CagA antigena bakterije Helicobacter pylori u razvoju aterosklerotske karotidne bolesti [Influence of CagA-positive Helicobacter pylori strains on atherosclerotic carotid disease]

Citotoxin-associated gene-A (CagA)-positive Helicobacter pylori strains have been associated with occurrence and destabilization of coronary atherosclerotic plaques. However, data on the relationship between CagA positive H. pylori infection and carotid artery instability are lacking. Thus, the role of CagA antigen in patients with symptomatic and asymptomatic carotid atherosclerotic plaques was investigated. A total of 64 patients with advanced carotid artery stenosis, including 33 patients with symptomatic and 31 patients with asymptomatic internal carotid artery stenosis, verified by duplex ultrasound, all undergoing carotid endarterectomy, were studied. The control group consisted of 65 subjects without a history or presence of vascular diseases. Serology for H. pylori and CagA antigen was assessed in all participants. Specimens of atherosclerotic plaques obtained from all patients during carotid endarterectomy were analyzed immunohistochemically using anti-CagA monoclonal antibodies. The ultrasonographic plaque characteristics were also estimated. CagA antibody titers were significantly higher in symptomatic patients (8.8; range, 5.8–32.7) compared to asymptomatic patients (4.7; range, 2.1–8.8; P = 0.005) and the control group (5.0; range 2.2–7.9; P<0.001). There was significant difference in echolucency (≥25% soft material) between the symptomatic and asymptomatic groups (P = 0.034) by ultrasonographic evaluation. Positive immunoreactivity between monoclonal CagA antibodies and antigens within atherosclerotic specimens was significantly higher among symptomatic patients compared to asymptomatic patients (97.0 vs. 74.2%; P = 0.009). The results of this study indicate that H. pylori may play a role in the pathogenesis of the atherosclerotic process due to autoimmune mechanisms and even contribute to destabilization of carotid atherosclerotic plaques

Acute disseminated encephalomyelitis following spider bite

Akutni diseminirajući encefalomijelitis (ADEM) upalna je, demijelinizirajuća bolest središnjeg živčanog sustava koja se pojavljuje kao imunološki odgovor na virusnu ili bakterijsku infekciju ili cijepljenje. Prikazujemo bolesnika s kliničkom prezentacijom i radiološkim manifestacijama ADEM-a koji je nastao nakon ugriza pauka. Kortikosteroidna terapija nije postigla zadovoljavajući rezultat u liječenju. Bolesnik se oporavio nakon pet dana liječenja imunoglobulinima. Križna reaktivnost između paukovog toksina i mijelina mogla bi objasniti patofiziološki mehanizam demijelinizacije. O ADEM-u treba razmišljati kao mogućoj komplikaciji ugriza pauka.Acute disseminated encephalomyelitis (ADEM) is an inflammatory, demyelinating disease of the central nervous system that occurs as an immunological response to a viral or bacterial infection or an immunization. We describe a patient with clinical presentation and radiological features of ADEM that appeared after a spider bite. Corticosteroid therapy did not produce satisfied treatment response. The patient recovered after five days of immunoglobulin therapy. The cross-reactivity between spider toxin and myelin could explain pathophysiological mechanism of demyelination. ADEM should be considered as a possible complication of a spider bite

Procjena indeksa zadržavanja daha tijekom ortostaze

The aim of the study was to assess differences in cerebrovascular reactivity in healthy subjects during orthostasis. Twenty healthy volunteers (11 men and 9 women) with no atherosclerotic risk factors were evaluated by use of transcranial Doppler. The breath holding index (BHI) was obtained in supine and upright posture using standardized procedure. Student\u27s t-test was used on comparison of the mean blood flow velocities (MBFV) and BHI between supine and upright posture and between the left and right side of the body. The middle cerebral artery MBFV in supine posture was 66.6 cm/s on the right side and 68.5 cm/s on the left side and in upright posture 60.6 cm/s on the right side and 62.3 cm/s on the left side. There was no significant MBFV difference either between supine and upright posture or between male and female subjects. The mean BHI in supine posture was 1.59 on the right side, 1.65 on the left side, and in upright posture 1.63 on the right side and 1.7 on the left side, without significant sex difference. There was no statistically significant differences in BHI between supine and upright posture (P=0.81 and P=0.68 for the right and left side, respectively) or between the two sides of the body in supine (P=0.71) and upright posture (P=0.8). in conclusion, evaluation of cerebrovascular reactivity yielded no significant difference in BHI values during orthostatic stress.Cilj ovoga istraživanja bio je ispitati postojanje razlike cerebrovaskularne reaktivnosti u zdravih ispitanika tijekom ortostaze. Metodom transkranijskog doplera pregledano je 20 zdravih ispitanika (11 muškaraca i 9 žena) bez prisutnih čimbenika rizika za razvoj aterosklerotske bolesti. Vrijednosti indeksa zadržavanja daha (IZD) određene su u ležećem i stojećem stavu na standardiziran način. Studentov t-test primijenjen je za usporedbu srednjih brzina strujanja krvi i IZD između ležećeg i stojećeg stava te u odnosu strana. Srednja brzina strujanja krvi u srednjoj cerebralnoj arteriji u ležećem stavu ispitanika bila je 66,6 cm/s desno i 68,5 cm/s lijevo, a u stojećem stavu 60,6 cm/s desno i 62,3 cm/s lijevo. Nije bilo značajne razlike u vrijednosti brzine strujanja krvi između ležećeg i stojećeg stava ispitanika kao niti između spolova. Prosječna vrijednost IZD u ležećem stavu bila je 1,59 desno, 1,65 lijevo, a u stojećem stavu 1,63 desno te 1,7 lijevo, podjednaka za oba spola. Statističkom obradom nije nađena razlika u vrijednosti IZD uspoređujući ležeći i stojeći stav (P=0,81 za desnu stranu, P=0,68 za lijevu stranu), a niti uspoređujući dvije strane u ležećem (P=0,71) i stojećem stavu (P=0,8). Nisu zabilježene značajne razlike IZD u procjeni cerebrovaskularne reaktivnosti tijekom ortostatskog stresa

Monotherapy with infusion therapies - useful or not?

Infusion pump-based therapies are an effective treatment option for patients with advanced Parkinson´s disease. Achieving monotherapy with infusion-based therapies could simplify the treatment regimen, provide better medication adherence, reduce adverse events and drug interactions. This review presents the literature data on the efficacy, safety, and achievability of monotherapy with all available infusion-based therapies, including apomorphine, levodopa-carbidopa-intestinal gel (LCIG), levodopa-entacapone-carbidopa intestinal gel (LECIG), and foslevodopa-foscarbidopa (LDp/CDp). In summary, monotherapy is achievable and effective in most patients on intestinal levodopa infusion therapy and in some patients on apomorphine infusion. There is a need for further investigation of monotherapy compared to polytherapy, especially in new pump treatment options (LECIG and LDp/CDp). Future research should reveal which patients on infusion-based therapies could benefit from monotherapy, including identification of potential baseline predictors of achieving monotherapy in patients treated with specific infusion-based therapies

Procjena indeksa zadržavanja daha tijekom ortostaze

The aim of the study was to assess differences in cerebrovascular reactivity in healthy subjects during orthostasis. Twenty healthy volunteers (11 men and 9 women) with no atherosclerotic risk factors were evaluated by use of transcranial Doppler. The breath holding index (BHI) was obtained in supine and upright posture using standardized procedure. Student\u27s t-test was used on comparison of the mean blood flow velocities (MBFV) and BHI between supine and upright posture and between the left and right side of the body. The middle cerebral artery MBFV in supine posture was 66.6 cm/s on the right side and 68.5 cm/s on the left side and in upright posture 60.6 cm/s on the right side and 62.3 cm/s on the left side. There was no significant MBFV difference either between supine and upright posture or between male and female subjects. The mean BHI in supine posture was 1.59 on the right side, 1.65 on the left side, and in upright posture 1.63 on the right side and 1.7 on the left side, without significant sex difference. There was no statistically significant differences in BHI between supine and upright posture (P=0.81 and P=0.68 for the right and left side, respectively) or between the two sides of the body in supine (P=0.71) and upright posture (P=0.8). in conclusion, evaluation of cerebrovascular reactivity yielded no significant difference in BHI values during orthostatic stress.Cilj ovoga istraživanja bio je ispitati postojanje razlike cerebrovaskularne reaktivnosti u zdravih ispitanika tijekom ortostaze. Metodom transkranijskog doplera pregledano je 20 zdravih ispitanika (11 muškaraca i 9 žena) bez prisutnih čimbenika rizika za razvoj aterosklerotske bolesti. Vrijednosti indeksa zadržavanja daha (IZD) određene su u ležećem i stojećem stavu na standardiziran način. Studentov t-test primijenjen je za usporedbu srednjih brzina strujanja krvi i IZD između ležećeg i stojećeg stava te u odnosu strana. Srednja brzina strujanja krvi u srednjoj cerebralnoj arteriji u ležećem stavu ispitanika bila je 66,6 cm/s desno i 68,5 cm/s lijevo, a u stojećem stavu 60,6 cm/s desno i 62,3 cm/s lijevo. Nije bilo značajne razlike u vrijednosti brzine strujanja krvi između ležećeg i stojećeg stava ispitanika kao niti između spolova. Prosječna vrijednost IZD u ležećem stavu bila je 1,59 desno, 1,65 lijevo, a u stojećem stavu 1,63 desno te 1,7 lijevo, podjednaka za oba spola. Statističkom obradom nije nađena razlika u vrijednosti IZD uspoređujući ležeći i stojeći stav (P=0,81 za desnu stranu, P=0,68 za lijevu stranu), a niti uspoređujući dvije strane u ležećem (P=0,71) i stojećem stavu (P=0,8). Nisu zabilježene značajne razlike IZD u procjeni cerebrovaskularne reaktivnosti tijekom ortostatskog stresa

A case of „Spectacular Shrinking Deficit“ – case report and short review of elusive clinical phenomena

Spectacular Shrinking Deficit (SSD) is a term attributed by J.P. Mohr to a rare cerebrovascular event defined by a rapid and dramatic improvement of major hemispheric stroke syndrome. It is presumed to be caused by the migration of initially embolic occlusion of an internal carotid artery or middle cerebral artery to its distal branches. It is only reported in several case reports, and case series with differing criteria of what defies an SSD meaning that its presumed prevalence rate of 7-14% of major hemispheric stroke syndromes could be an overestimation. It is usually associated with the cardioembolic cause of stroke, and it has a higher prevalence rate in younger patients, males, and nondiabetics. Our case is a 58 – year old male who presented to our ER with a major hemispheric stroke syndrome (deviation of head and eyes on the right side, central facioparesis on the left, left hemiplegia, and left hemineglect, NIHSS 16) 30 min- utes after symptom onset. He was aggressive, insisting nothing was wrong with him. His initial brain CT showed acute ischemic changes in the right temporooccipital region with an inadequate filling of distal branches of the right MCA shown on CT brain angiography. His symptoms spectacularly improved in our ICU (NIHSS 0) 51 minutes from symptom onset negating the need for thrombolysis. Except for one positive Beta – 2 GPI test his detailed laboratory tests, 24h Holter ECG, TTE, carotid, and vertebral artery ultrasound were noneventful. He had no cognitive or neurological deficit. He denied the possibil- ity of performing TEE and prolonged cardiac monitoring. Control brain MRI 4 days and 4 months later confirmed moderate ischemic changes of the right insular, temporal, and occipital cortex. Studies report that spontaneous recanalization usually happens in 17% of patients but does not correlate with TIA. This is the first report of an SSD with moderate ischemic stroke and no leftover neurological deficit. Other case series report moderate ischemic stroke SSD with a small residual neurological deficit (NIHSS 2-4). Perhaps mood changes can be associated with selective neuronal loss found in animals and patients suf- fering transient occlusion of the brain artery. The cardioembolic cause can in certainty be excluded with TEE and prolonged cardiac monitoring

A case of „Spectacular Shrinking Deficit“ – case report and short review of elusive clinical phenomena

Spectacular Shrinking Deficit (SSD) is a term attributed by J.P. Mohr to a rare cerebrovascular event defined by a rapid and dramatic improvement of major hemispheric stroke syndrome. It is presumed to be caused by the migration of initially embolic occlusion of an internal carotid artery or middle cerebral artery to its distal branches. It is only reported in several case reports, and case series with differing criteria of what defies an SSD meaning that its presumed prevalence rate of 7-14% of major hemispheric stroke syndromes could be an overestimation. It is usually associated with the cardioembolic cause of stroke, and it has a higher prevalence rate in younger patients, males, and nondiabetics. Our case is a 58 – year old male who presented to our ER with a major hemispheric stroke syndrome (deviation of head and eyes on the right side, central facioparesis on the left, left hemiplegia, and left hemineglect, NIHSS 16) 30 min- utes after symptom onset. He was aggressive, insisting nothing was wrong with him. His initial brain CT showed acute ischemic changes in the right temporooccipital region with an inadequate filling of distal branches of the right MCA shown on CT brain angiography. His symptoms spectacularly improved in our ICU (NIHSS 0) 51 minutes from symptom onset negating the need for thrombolysis. Except for one positive Beta – 2 GPI test his detailed laboratory tests, 24h Holter ECG, TTE, carotid, and vertebral artery ultrasound were noneventful. He had no cognitive or neurological deficit. He denied the possibil- ity of performing TEE and prolonged cardiac monitoring. Control brain MRI 4 days and 4 months later confirmed moderate ischemic changes of the right insular, temporal, and occipital cortex. Studies report that spontaneous recanalization usually happens in 17% of patients but does not correlate with TIA. This is the first report of an SSD with moderate ischemic stroke and no leftover neurological deficit. Other case series report moderate ischemic stroke SSD with a small residual neurological deficit (NIHSS 2-4). Perhaps mood changes can be associated with selective neuronal loss found in animals and patients suf- fering transient occlusion of the brain artery. The cardioembolic cause can in certainty be excluded with TEE and prolonged cardiac monitoring

Incidencija akutnih simptomatskih napadaja kod bolesnika s COVID-19: monocentrično istraživanje

The most common neurological symptoms in patients with SARS-CoV-2 infection are headache, myalgia, encephalopathy, dizziness, dysgeusia and anosmia, making more than 90 percent of neurological manifestations of COVID-19. Other neurological manifestations such as stroke, movement disorder symptoms or epileptic seizures are rare but rather devastating, with possible lethal outcome. The primary aim of this study was to estimate the prevalence of acute symptomatic seizures among COVID-19 patients, while secondary aim was to determine their possible etiology. Out of 5382 patients with COVID-19 admitted to Dubrava University Hospital from November 1, 2020 until June 1, 2021, 38 (seizure rate 0.7%) of them had acute symptomatic seizures. Of these 38 patients, 29 (76.3%) had new-onset epileptic seizures and nine (23.7%) patients with previous epilepsy history had breakthrough seizures during COVID-19. Although acute symptomatic seizures are an infrequent complication of COVID-19, seizure risk must be considered in these patients, particularly in the group of patients with a severe course of the disease. Accumulation of proinflammatory cytokines may contribute to the occurrence of seizures in patients with COVID-19, but seizures may also be secondary to primary brain pathology related to COVID-19, such as stroke or encephalitis.Najčešći neurološki simptomi kod bolesnika s infekcijom SARS-CoV-2 su glavobolja, mialgija, encefalopatija, vrtoglavica, disgeuzija i anosmija, a čine više od 90% neuroloških manifestacija ove bolesti. Ostala neurološka zbivanja poput moždanog udara, poremećaja pokreta ili epileptičkih napada nisu česta, ali su potencijalno teške komplikacije s mogućim smrtnim ishodom. Primarni cilj ove studije bio je procijeniti učestalost akutnih simptomatskih napadaja kod bolesnika s COVID-19, dok je sekundarni cilj bio utvrditi njihovu moguću etiologiju. Od ukupno 5382 bolesnika hospitaliziranih u Kliničkoj bolnici Dubrava od 1. studenoga 2020. godine do 1. lipnja 2021. njih 38 (0,7%) je imalo akutne simptomatske napadaje. Od tih 38 bolesnika 29 (76,3%) ih je imalo novonastale epileptičke napadaje bez ranije anamneze epilepsije, dok je njih 9 (23,7%) imalo anamnezu dobro kontrolirane epilepsije uz pojavu epileptičkih napadaja tijekom bolesti COVID-19. Iako su akutni simptomatski napadaji rijetka komplikacija bolesti COVID-19, treba razmišljati o epileptičkim napadajima kod ovih bolesnika, osobito kod onih s teškim oblikom bolesti. Nakupljanje proupalnih citokina može doprinijeti pojavi napadaja u bolesnika s COVID-19, ali napadaji mogu također biti posljedica primarnog zbivanja na mozgu uslijed bolesti COVID-19, poput moždanog udara ili encefalitisa