Analiza srednjih brzina krvnog protoka u bazalnim moždanim arterijama pomoću transkranijskog dopplera tijekom vidne stimulacije

Changes of mean blood flow velocities (MBFV) in the posterior cerebral arteries (PCA) during visual stimulation were recorded in a group of 51 healthy, right-handed volunteers. There were 27 (52.9%) males and 24 (47.1%) females aged from 20 to 59 (mean age 36.98) years. Measurements were performed with a hand-held 2 MHz transcranial Doppler (.I.CD) probe through temporal window, while the subjects had their eyes open, closed, and when looking at white light. In half of the subjects, the right PCA was insonated first and then the left PCA, while in the other half a reverse procedure was used. Statistical analysis was performed using Wilcoxon.s matched-pair signed-rank test. In the left PCA, MBFV was 41.2±8.6 cm/s (mean ± SD) with eyes open, 27.8±8.5 cm/s with eyes closed, and 42.3±9.1 cm/s while looking at white light. In the right PCA, MBFV was 41.7±8.9 cm/s with eyes open, 28.2±9.1 cm/s with eyes closed, and 42.4±8.8 cm/s while looking at white light. In the left PCA, differences between eyes open and closed, and between eyes open and while looking at white light were statistically significant (p<0.001, z=-6.2146, and p<0.001, z=-3.4836, respectively). In the right PCA, a statistically significant difference was found between eyes open and closed (p<0.001, z=-6.2146 and p<0.001, z=-3.6928), but not between eyes open and looking at white light (p=0.03, z=-2.1693). Study results demonstrated that straightforward visual stimulation had an effect on blood flow velocities in PCA and that it could be measured with TCD.Promjene srednjih brzina krvnog protoka (MBFV) u stražnjim moždanim arterijama (PCA) bilježene su tijekom vidne stimulacije u skupini od 51 zdravog desnorukog dobrovoljca. Skupina se sastojala od 27 (52,9%) muških i 24 (47,1%) ženskih ispitanika u dobi od 20 do 59 (srednja dob 36,98) godina. Mjerenja su se izvodila pomoću ručne sonde od 2 MHz za transkranijski Doppler (TCD) kroz temporalni prozor, dok su ispitanici oči držali otvorenima, zatvorenima i dok su gledali u bijelo svjetlo. U polovice ispitanika najprije je ispitana desna PCA, a potom lijeva PCA, a u druge polovice primijenjen je obrnuti postupak. Statistička analiza je provedena pomoću Wilcoxonova parnog rank testa. U lijevoj PCA je MBFV bila 41,2±8,6 cm/s (srednja vrijednost ± SD) uz otvorene oči, 27,8±8,5 cm/s uza zatvorene oči i 42,3±9,1 cm/s dok su gledali u bijelo svjetlo. U desnoj PCA je MBFV bila 41,7±8,9 cm/s uz otvorene oči, 28,2±9,1 cm/s uza zatvorene oči i 42,4±8,8 cm/s dok su gledali u bijelo svjetlo. Razlike u MBFV između zatvorenih i otvorenih očiju, te između otvorenih očiju i gledanja u bijelo svjetlo bile su statistički značajne za lijevu PCA (p<0,001, z=-6,2146, odnosno p<0,001, z=-3,4836). U desnoj PCA je razlika u MBFV bila statistički značajna između otvorenih i zatvorenih očiju (p<0,001, z=-6,2146, odnosno p<0,001, z=-3,6928), ali ne između otvorenih očiju i gledanja u bijelo svjetlo (p=0,03, z=-2,1693). Rezultati su pokazali da izravna vidna stimulacija utječe na brzinu krvnog protoka u PCA te da se to može mjeriti pomoću TCD

The effect of delayed anti-NMDAR encephalitis recognition on disease outcome

Anti-NMDA receptor encephalitis is an acute form of brain inflammation that is potentially lethal but has a high probability for recovery with treatment. Although the clinical picture of anti-NMDAR encephalitis is usually recognizable due to its relatively well-known symptoms, the disorder can sometimes present itself in an unpredictable and atypical way. In this case report, we wish to present the influence of different delay times prior to the establishment of diagnosis. Thus, our first patient was diagnosed with anti-NMDAR encephalitis 4 years after the initial symptoms, the second one after 8 years, and the third one after 13 months. The outcomes of the three presented patients indicate the importance of being aware of many clinical presentations of this disorder, as its early diagnosis greatly affects the outcome and may reduce permanent damage, especially in cognitive functions

Seizure freedom with vagus nerve stimulation in neurofibromatosis type 1: A case report

Epileptic seizures in neurofibromatosis type 1 (NF1) have been a subject of investigation of numerous studies, however, their etiology has not yet been elucidated. They are usually well controlled with an- tiseizure medications (ASMs), but in some pharmacoresistant patients, vagus nerve stimulation (VNS) might present a complementary treatment modality. We present a 24-year-old male patient with NF1 who had temporal lobe seizures - focal autonomic seizures with impaired awareness and oroalimentary automatisms, as well as focal motor seizures with retained awareness, in addition to moderate intel- lectual disability. The most significant magnetic resonance (MRI) abnormalities included infiltrative changes of medulla oblongata, pons and cerebellum, as well as signal intensity changes with mild com- pression in the apex of the temporal lobes, insular cortex, putamen and medial part of the frontal lobe, all more prominent on the right, along with right mesial temporal sclerosis. Interictal electroencepha- logram (EEG) showed two independent epileptic foci – one in the right frontocentrotemporal region and the other in the left centrotemporal region. Throughout the years, he had been treated with several ASMs in monotherapy or polytherapy without success in seizure control. After an extensive preoperative evaluation, VNS implantation was performed and the patient has been seizure free for almost two years. Al- though a palliative intervention, VNS could be a powerful tool in the treatment of these patients and even lead to seizure freedom. To the best of our knowledge, this is the first case report where seizure freedom was achieved in a patient with NF1 following VNS implantation

Seizure freedom with vagus nerve stimulation in neurofibromatosis type 1: A case report

Epileptic seizures in neurofibromatosis type 1 (NF1) have been a subject of investigation of numerous studies, however, their etiology has not yet been elucidated. They are usually well controlled with an- tiseizure medications (ASMs), but in some pharmacoresistant patients, vagus nerve stimulation (VNS) might present a complementary treatment modality. We present a 24-year-old male patient with NF1 who had temporal lobe seizures - focal autonomic seizures with impaired awareness and oroalimentary automatisms, as well as focal motor seizures with retained awareness, in addition to moderate intel- lectual disability. The most significant magnetic resonance (MRI) abnormalities included infiltrative changes of medulla oblongata, pons and cerebellum, as well as signal intensity changes with mild com- pression in the apex of the temporal lobes, insular cortex, putamen and medial part of the frontal lobe, all more prominent on the right, along with right mesial temporal sclerosis. Interictal electroencepha- logram (EEG) showed two independent epileptic foci – one in the right frontocentrotemporal region and the other in the left centrotemporal region. Throughout the years, he had been treated with several ASMs in monotherapy or polytherapy without success in seizure control. After an extensive preoperative evaluation, VNS implantation was performed and the patient has been seizure free for almost two years. Al- though a palliative intervention, VNS could be a powerful tool in the treatment of these patients and even lead to seizure freedom. To the best of our knowledge, this is the first case report where seizure freedom was achieved in a patient with NF1 following VNS implantation

DEPRESSION AND QUALITY OF LIFE IN PATIENTS WITH EPILEPSY - SINGLE CENTRE EXPERIENCE

Background: Patients with epilepsy commonly report depressive symptoms. The main aim of this study was to evaluate the relationship between epilepsy, antiepileptic drugs (AEDs) and depression. We also wanted to evaluate possible association between depressive symptofigms in patients with epilepsy with the quality of life (QoL). Material and methods: This was a prospective cross-sectional study carried out at the tertiary teaching hospital (University Hospital Centre Zagreb, Croatia) with Ethics committee approval. Questionnaires evaluating depressive symptoms and QoL were administered to consecutive patients treated in the Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy. Depressive symptoms were evaluated using Hamilton Rating Scale for Depression (HAM-D17). Quality of life was assessed using Quality of life in epilepsy-31 inventory (QOLIE-31) Results: 108 patients (63% women, 37% men; mean age 39.54±15.91 years, range 18-80 years) with epilepsy were included. 14.8% of patients had focal, 35.2% generalised and 40.7% both types of epilepsy. Majority of patients (65.74%) were on two and more AEDs and quarter was on monotherapy (25%); 42% were on newer, 19% on older and 39% on both AEDs. Mean total score on HAM-D17 was 9.94±8.18 (men - mean total score 10.16±8.85, women - mean total score 9.81±7.84). There were no significant differences on HAM- newer AEDs, or both types AEDs) and results on HAM-D17, nor between the type of epilepsy and results on HAM-D17. We found strong negative correlation between the higher QoL and HAM-D17 (p=0.000). Conclusions: Results of this study evaluating depressive symptoms in patients with epilepsy demonstrate that our patients mainly experience mild depressive symptoms, with no significant differences on HAM-D17 regarding gender and age. Patients with epilepsy with less pronounced depressive symptoms were found to have higher QoL. We did not find statistically significant differences regarding the type of epilepsy and results on HAM-D17, nor between the AEDs (older vs. newer AEDs, or both types AEDs) and results on HAM-D17