Prognostička vrijednost radioloških deskriptivnih pokazatelja u prosudbi oporavka bolesnika s primarnim intracerebralnim krvarenjem

Uvod: Spontano intracerebralno krvarenje definirano je kao krvarenje unutar moždanog parenhima, predstavlja za život ugrožavajuće stanje i povezano je s visokim morbiditetom i mortalitetom. Primarno oštećenje mozga uslijed ovakvog krvarenja proizlazi iz karakteristika samog hematoma, kao što su njegova lokalizacija i volumen, što utječe na funkcionalni oporavak bolesnika i ishod liječenja. Cilj: U retrospektivnom preglednom istraživanju ispitati povezanost lokalizacije i volumena hematoma te prodora krvi u moždane klijetke s oporavkom i prognozom liječenja bolesnika s primarnim spontanim intracerebralnim krvarenjem. Metode: Tijekom petogodišnjega retrospektivnog istraživanja provedenog u Sveučilišnoj kliničkoj bolnici Mostar na uzorku od 267 odraslih bolesnika sa spontanim intracerebralnim krvarenjem statistički su analizirani demografski podaci i osnovne prediktivne varijable radioloških deskriptivnih pokazatelja. Provjeravana je povezanost lokalizacije i volumena hematoma te intraventrikulskog krvarenja s ishodom liječenja. Razina statističke značajnosti iznosila je p > 0,05. Rezultati: Razlika u lokalizaciji hematoma između preživjelih i umrlih bolesnika nije bila statistički značajna (p = 0,226). Razlika u volumenu hematoma između istraživanih skupina bila je visoko statistički značajna (p < 0,001), kao i razlika u odnosu na prodor krvi u moždane klijetke (p = 0,001). Zaključak: Rezultatima provedenog istraživanja potvrđeni su radiološki deskriptivni pokazatelji volumena hematoma s prodorom krvi u moždane klijetke kao pouzdani negativni prediktori oporavka bolesnika s primarnim spontanim intracerebralnim krvarenjem

Trends in stroke thrombolysis rate in Bosnia and Herzegovina: a hospital-based observation study

Aim To assess trends in thrombolysis rates and door-to-needle times in University Hospital Mostar. Methods Data from the University Hospital Mostar Registry were used. Information on the number of ischaemic stroke patients, intravenous thrombolysis rates and „door-to-needle times“ (DNT) were collected between January 2013 and December 2021. Results Out of the total of 3100 ischaemic stroke patients, alteplase was given to 130 patients giving a thrombolysis rate of 4.2%. The mean hospital thrombolysis rate increased from 2.4% in 2013 to 10.6% in 2021. Conclusion Although the hospital thrombolysis rate more than quadrupled, there is still a low proportion of acute ischaemic stroke patients who received intravenous thrombolysis therapy. Education and interventions indicating the importance of recognition and treatment of acute ischemic stoke are necessary for all physicians

Neurological Complications of COVID-19

Koronavirusna bolest u 2019. godini (COVID-19) uzrokovana je novootkrivenim korona virusom tipa 2 koji uzrokuje teški akutni respiratorni sindrom (SARS-CoV-2). Virus je otkriven u prosincu 2019. godine, a od strane Svjetske zdravstvene organizacije je, zbog broja oboljelih i proširenosti širom svijeta, proglašena pandemija. Klinička prezentacija COVID-19 varira od asimptomatskog do teškog oblika i smrtnog ishoda. Iako kliničkom slikom dominiraju respiratorne smetnje, mnogobrojne studije ukazuju na pojavu akutnih i kroničnih neuroloških komplikacija u skoro trećine oboljelih. Najčešći neurološki simptomi akutne faze COVID-19 su glavobolja, gubitak njuha i okusa, poremećaji stanja svijesti, encefalopatije, encefalitisi, moždani udar, bolovi u mišićima, epileptički napadaji, poliradikulopatije (GBS) te pojačan umor i netolerancija napora, poremećaji vegetativnih funkcija, kognitivne i psihičke smetnje u postinfekcijskoj fazi oboljenja. Potencijalni patofiziološki mehanizam nastanka neuroloških poremećaja u akutnoj fazi uključuje koagulopatije s udruženim hipoksično-ishemijskim oštećenjima, poremećajem krvno-moždane barijere, endoteliopatijama i neuroinvazijom virusa, udruženom s neuro-imunim odgovorom. Cilj ovog članka je prikazati najčešće akutne i kronične neurološke poremećaje vezane uz COVID-19 kod odraslih bolesnika kao i potencijalni patofiziološki mehanizam nastanka neuroloških poremećaja, a buduće epidemiološke studije o bolesnicima s COVID-19 bi trebali utvrditi pravu incidenciju neuroloških komplikacija COVID-19, razgraničiti specifične neurološke sindrome, postaviti dijagnostičke i terapijske protokole ta razjasniti mehanizam nastanka poremećaja.Coronavirus disease in 2019 (COVID-19) is caused by the newly discovered coronavirus type 2 which causes severe acute respiratory syndrome (SARS-CoV-2). The virus was discovered in December 2019, and the World Health Organization has declared a pandemic due to the number of cases and the spread around the world. The clinical presentation of COVID-19 varies from asymptomatic to severe and lethal outcome. Although the clinical picture is dominated by respiratory disorders, numerous studies indicate the occurrence of acute and chronic neurological complications in almost a third of patients. The most common neurological symptoms of the acute phase of COVID-19 are headache, loss of smell and taste, disturbances of consciousness, encephalopathies, encephalitis, stroke, muscle pain, epileptic seizures, polyradiculopathy (GBS) and increased fatigue and intolerance to stressful and mental disorders in the postinfectious phase of the disease. Potential pathophysiological mechanisms of the development of neurological disorders in the acute phase include coagulopathies with associated hypoxic-ischemic damage, blood-brain barrier disorder, endotheliopathies and neuroinvasion of viruses with associated neuro-immune response. The objective of this paper is to present the most common acute and chronic neurological disorders related to COVID-19 in adult patients as well as the potential pathophysiological mechanism of neurological disorders, and future epidemiological studies on patients with COVID-19 should determine the true incidence of specific neurological syndromes, to establish diagnostic and therapeutic protocols and to clarify the mechanism of disorder development

Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework

Purpose: To propose a consensus-based definition and framework for motor rehabilitation after stroke. Methods: An expert European working group reviewed the literature, attaining internal consensus after external feedback. Findings: Motor rehabilitation is defined as a process that engages people with stroke to benefit their motor function, activity capacity and performance in daily life. It is necessary for people with residual motor disability whose goal is to enhance their functioning, independence and participation. Motor rehabilitation operates through learning- and use-dependent mechanisms. The trajectory of motor recovery varies across patients and stages of recovery. Early behavioral restitution of motor function depends on spontaneous biological mechanisms. Further improvements in activities of daily living are achieved by compensations. Motor rehabilitation is guided by regular assessment of motor function and activity using consensus-based measures, including patient-reported outcomes. Results are discussed with the patient and their carers to set personal goals. During motor rehabilitation patients learn to optimize and adapt their motor, sensory and cognitive functioning through appropriately dosed repetitive, goal-oriented, progressive, task- and context-specific training. Motor rehabilitation supports people with stroke to maximize health, well-being and quality of life. The framework describes the International Classification of Functioning, Disability and Health in the context of stroke, describes neurobiological mechanisms of behavioral restitution and compensation, and summarizes recommendations for clinical assessment, prediction tools, and motor interventions with strong recommendations from clinical practice guidelines (2016–2022). Conclusions: This definition and framework may guide clinical educators, inform clinicians on current recommendations and guidelines, and identify gaps in the evidence base