Magnetska rezonanca mozga i magnetska angiografija u zbrinjavanju bolesnika s ishemijskim moždanim udarom u vertebrobazilarnoj cirkulaciji

Vertebrobasilar occlusion is a life-threatening event that requires prompt diagnostic evaluation and subsequent therapy. Advanced magnetic resonance imaging (MRI) methods, including diffusion-weighted imaging and magnetic resonance angiography (MRA), are highly sensitive for the detection of ischemic tissue injury, and for the detection and localization of intracranial arterial occlusion and stenosis. In the era of thrombolytic therapy, MRI and MRA provide useful information for therapeutic decision making in the early stage of stroke evaluation. This retrospective review included patients with posterior circulation symptomatology examined at our Department between July 2002 and January 2005, 8 female and 11 male, mean age 54.9 years. The aim was to present the possibilities of MRI and MRA in the management of patients with ischemic stroke in posterior circulation. In 19 patients with an ischemia in the vertebrobasilar circulation detected by MRI of the brain, MRA identified 8 cases of basilar artery occlusion, 4 cases of basilar artery stenosis, 3 cases of multiple atherosclerotic stenoses of the vertebral arteries with 2 cases of concurrent vertebral artery occlusion, 2 cases of vasculitis in the posterior circulation, 1 case of proximal posterior cerebral artery occlusion, and 1 case of posterior cerebral artery stenosis. In 8 patients with basilar artery occlusion, the site of occlusion was proximal in 3 cases, proximal and middle in 2 cases, middle and distal in 2 cases, and distal in 1 case. MRI is a powerful tool to detect ischemic changes in stroke immediately upon stroke onset, while MRA is highly sensitive for the detection of occlusive disease in large intracranial arteries as well as in posterior circulation. In the acute stroke setting, MRI and MRA are useful for: 1) early and reliable identification of ischemic stroke; 2) improved choice of treatment modality by helping exclude from thrombolysis patients at high risk of hemorrhage and by identifying those patients most likely to benefit from it; 3) pinpoint the vascular origin of ischemic stroke; 4) determination of neurologic consequences of stroke, including final infarct size, clinical outcome and hemorrhagic risk.Vertebrobazilarna okluzija je za život opasno stanje koje zahtijeva brzu dijagnostičku obradu i terapiju. Suvremene metode magnetske rezonance (MR) mozga, uključujući difuzijski mjerenu sliku i magnetsku angiografiju (MRA), imaju visoku osjetljivost u otkrivanju ishemijske lezije moždanog parenhima, te u otkrivanju i lokalizaciji okluzije i stenoze intrakranijskih arterija. U doba trombolitične terapije MR mozga i MRA daju korisne podatke bitne za donošenje odluke o izboru terapije u procjeni ranog stadija ishemijskog moždanog udara. Proveden je retrospektivni pregled bolesnika sa simptomatologijom stražnje cirkulacije koji su na našem Zavodu pregledani u razdoblju od srpnja 2002. do siječnja 2005. godine, 8 žena i 11 muškaraca srednje životne dobi od 54,9 godina. Cilj je bio pokazati mogućnosti MR mozga i MRA u zbrinjavanju bolesnika s ishemijskim moždanim udarom stražnje cirkulacije. U 19 bolesnika s ishemijskim moždanim udarom vertebrobazilarnog sliva, koji je dokazan pomoću MR mozga, MRA je otkrila 8 okluzija bazilarne arterije, 4 stenoze bazilarne arterije, 3 slučaja višestrukih aterosklerotskih stenoza vertebralnih arterija s 2 slučaja istodobne okluzije vertebralne arterije, 2 vaskulitisa u stražnjoj cirkulaciji, 1 okluziju proksimalnog dijela i 1 stenozu stražnje moždane arterije. Među 8 bolesnika s okluzijom bazilarne arterije mjesto okluzije bilo je proksimalni dio arterije u 3, proksimalni i srednji dio u 2, srednji i distalni dio u 2 slučaja i distalni dio bazilarne arterije u 1 slučaju. MR mozga je moćno sredstvo u otkrivanju ishemijskih promjena neposredno nakon nastupa moždanog udara, dok MRA ima visoku osjetljivost za otkrivanje okluzivne bolesti velikih intrakranijskih arterija. Kod zbrinjavanja akutnog moždanog udara MR mozga i MRA su korisne zbog: 1) brzog i sigurnog otkrivanja ishemije; 2) sigurnijeg izbora oblika terapije pomažući da se tromboliza ne primijeni kod bolesnika s visokim rizikom za razvoj krvarenja te da se otkriju bolesnici koji će imati najviše koristi od iste; 3) mogućnosti točnog određivanja vaskularnog podrijetla ishemijskog moždanog udara; 4) određivanja neuroloških posljedica moždanog udara uključujući konačnu veličinu ishemijske lezije, klinički ishod i rizik od krvarenja

Nerazmjer između podataka za intrakranijski i cerebralni perfuzijski tlak te neuroloških nalaza u bolesnika s teškom ozljedom glave: prikaz slučaja

A 48-year-old man with relative hepatic impairment, thrombocytopenia and chronic alcoholism was admitted to intensive care unit six hours after head trauma. Computed tomography (CT) scan at admission indicated cerebral edema and subdural hematoma. Glasgow Coma Score (GCS) was 5, and his pupils were 4 mm in diameter without response. Decompression craniotomy with evacuation of hematoma was performed, and a ventricular catheter was introduced for intracranial pressure (ICP) monitoring. After the operation, there was no change in the neurologic status. ICP/CPP and jugular vein oxygen saturation (SvjO2) were continuously monitored and data were collected in hour-to-hour manner. Therapeutic goal was to optimize ICP and cerebral perfusion pressure (CPP) in accordance with the Guidelines for the Management of Severe Head Injury. Mannitol and barbiturates were not used in therapeutic procedures. Normocapnic values of PCO2 were maintained. During the first six hours postoperatively, the patient was stabilized hematologically and hemodynamically. At 24 hours postoperatively, there was no improvement in the neurologic status in spite of optimal values of ICP/CPP and SvjO2: GCS 5, pupils 4 mm with no response. The reason for this was detected on 24-hour CT scan, which revealed thalamic and pontine hemorrhage (mesencephalon lesion) with ischemia in the occipital region.Muškarac star 48 godina s relativnim oštećenjem jetre, trombocitopenijom i kroničnim alkoholizmom u anamnezi primljen je u jedinicu intenzivnog liječenja šest sati nakon ozljede glave. Nalaz kompjutorizirane tomografije (CT) kod prijma pokazao je subduralni hematom i edem mozga. Kod primitka, Glasgow Coma Score (GCS) bio je 5, zjenice 4 mm izokorične i nereaktivne. Učinjena je dekompresijska kraniotomija s evakuacijom hematoma, te je postavljen kateter za mjerenje intrakranijskog tlaka (ICP). Kontinuirano su mjereni ICP, cerebralni perfuzijski tlak (CPP), zasićenje jugularne vene kisikom (Svj O2) i CO2. Nakon 24 sata nije došlo do neurološkog poboljšanja unatoč tome što su postignute željene terapijske vrijednosti svih praćenih parametara. Kontrolni CT mozga pokazao je krvarenje u ponsu i talamusu, te ishemiju okcipitalno, zbog čega je izostalo poboljšanje neurološkog statusa. Kasna dijagnostika i nedostupnost za terapiju dubokih i infratentorijalnih ozljeda mozga problem su u svakodnevnom liječenju ovih bolesnika

Procjena cerebrovaskularne bolesti magnetskom rezonancijom mozga i magnetskom angiografijom

Magnetic resonance imaging (MRI) is an important imaging technique for evaluation of cerebral ischemic changes. Using magnetic resonance angiography (MRA), both large and medium sized intracranial arteries and veins can be visualized by selecting appropriate imaging parameters. The aim of this retrospective study was to evaluate our own results in the diagnosis of cerebrovascular diseases with MRI and MRA, and to compare them with literature data. Data on 278 patients with cerebrovascular symptomatology (158 female and 120 male, mean age 45-54 years), examined between April 2001 and November 2002, were analyzed. MRA was performed in all 278 and both MRA and MRI in 231 patients. On MRA, 90 pathologic alterations of intracranial arteries (69 aneurysms and 21 vascular malformations), 13Rintracranial arterial occlusions, 19 intracranial arterial stenoses, and 14 cases of intracranial arteriosclerotic changes were identified. On MRI, 114 strokes (73 brain infarctions, 22 cerebral hemorrhages and 19 sub-arachnoid hemorrhages), 14 vascular malformations and 14 cases of small vessel disease were detected. MRI was found to be a powerful tool to detect ischemic lesions immediately upon stroke onset. MRA is highly sensitive for the detection of occlusive disease in large intracranial arteries. For cerebral venous and sinus thrombosis, MRI and MRA are first line studies. MRA of extracranial and intracranial vessels alone or in combination with transcranial color-coded duplex sonography (TCCD) as well as computed tomography angiography (CTA) may eliminate the need of intra-arterial digital subtraction angiography (DSA) in most patients studied for occlusive cerebrovascular disease. DSA may be reserved for those patients in whom there is a disagreement among the results obtained by use of noninvasive techniques, and for the diagnosis of arteriovenous malformations, whereas MRA can prove useful on follow-up examinations.Magnetska rezonancija (MR) mozga je važna tehnika prikazivanja u procjeni ishemijskih promjena moždanoga parenhima. Magnetskom angiografijom (MRA) se birajući odgovarajuće parametre prikaza mogu pokazati i velike i male intrakranijske arterije i vene. Cilj ove retrospektivne studije bila je procjena vlastitih rezultata u dijagnostici cerebrovaskularnih bolesti pomoću MR mozga i MRA, te njihova usporedba s literaturnim podacima. Analizirani su podaci 278 bolesnika (158 žena i 120 muškaraca srednje životne dobi od 45,54 godine), koji su bili pregledani u razdoblju od travnja 2001. do studenoga 2002. Učinjeno je 278 postupaka MRA, a u 231 bolesnika učinjena je i MR mozga. MRA je otkrila 88 patološki promijenjenih intrakranijskih krvnih žila (69 aneurizma i 21 vaskularnu malformaciju), 13 okluzija intrakranijskih arterija, 19 stenoza intrakranijskih arterija, te 14 slučajeva arteriosklerotskih promjena intrakranijskih arterija. MR mozga otkrila je 114 cerebrovaskularnih inzulta (73 cerebralne ishemije, 22 intracerebralne hemoragije i 19 subarahnoidnih hemoragija), 14 vaskularnih malformacija, te 14 slučajeva "patologije malih krvnih žila". MR mozga je moćno sredstvo u otkrivanju ishemijskih promjena neposredno nakon nastupa moždanog inzulta. RMRA ima visoku osjetljivost za otkrivanje okluzivne bolesti velikih intrakranijskih arterija. MR mozga i MRA su osnovne pretrage za dijagnozu tromboze moždanih vena i sinusa. Samo se pomoću MRA ekstrakranijskih i intrakranijskih krvnih žila ili u kombinaciji s obojenom dupleks sonografijom krvnih žila glave i vrata (TCCD) te kompjutoriziranom tomografijskom angiografijom (CTA) može isključiti potreba za intraarterijskom digitalnom subtrakcijskom angiografijom (DSA) u većine bolesnika pregledanih zbog okluzivne cerebrovaskularne bolesti. DSA može biti rezervirana za one bolesnike kod kojih postoji neslaganje između nalaza neinvazivnih metoda pregleda, te za dijagnozu arteriovenskih malformacija, dok se MRA može rabiti za daljnje praćenje

Vrijednost CT-a mozga u hitnoj službi: retrospektivna analiza

The objective of the study was evaluation and radiologic - clinical correlation of brain computed tomography (CT) scans performed at emergency service. The relation between the number of urgent and total CT scans performed during a 2-year period (January 1, 2001 - December 31, 2002) was analyzed. Emergency brain CT scans were especially investigated according to clinical indications, requests from particular clinical specialties, and need of anesthesiologist\u27s assistance. CT scans were correlated with clinical examinations and diagnoses as well as with literature data. During the study period, 15,933 CT scans were performed at our department, 3132 (19.66%) of them at emergency service (1757 male and 1375 female, mean age 56.97 years), and 2576 (82.25%) of the latter emergency brain CT scans (1398 male and 1178 female, mean age 57.80 years). Data analysis showed the following distribution of emergency brain CT scans according to hospital departments: neurology 1441 (55.94%), neurosurgery 632 (24.53%), internal medicine 186 (7.22%), surgery 138 (5.36%), other departments 150 (5.82%), and other institutions 29 (1.13%). Clinical diagnoses for emergency brain CT scanning were as follows: stroke 905 (35.13%), subarachnoid hemorrhage 128 (4.97%), head injury 617 (23.95%), consciousness disorders and convulsions 389 (15.10%), intracranial expansive lesions 234 (9.08%), headache and/or vertigo 141 (5.47%), cerebrovascular insufficiency 50 (1.94%), infectious disease 46 (1.79%), hydrocephalus 12 (0.47%), metabolic disorders 2 (0.08%), and lost or unavailable data at the time of the study 52 (2.02%). Anesthesiologist\u27s assistance during emergency brain CT scanning was needed in 234 (9.08%) cases. Correlation of CT findings with clinical diagnosis yielded the following results: 96 (3.73%) lost or unavailable data at the time of the study, 639 (25.77%) normal findings, and 1841 (74.23%) pathologic findings. Study results showed the number of emergency brain CT scans to be quite high with a tendency of continuous growth (cerebrovascular disorders, new therapeutic approaches, head injury). Difficulties encountered on brain CT scanning because of the patient\u27s state, and delicacy of the emergency interpretation of CT scans impose the need of higher availability of a neuroradiologist within the frame of the emergency state algorithm.Cilj ove studije bila je evaluacija i radiološko-klinička korelacija CT pretraga mozga u hitnoj službi. Tijekom dvogodišnjeg razdoblja (1. siječnja 2001. - 31. prosinca 2002.) analiziran je odnos hitnih i sveukupnih CT pretraga. Posebno su obrađeni hitni CT pregledi mozga prema kliničkim indikacijama, zastupljenosti pojedinih kliničkih struka i potrebi anesteziološke asistencije. CT nalazi su korelirani s kliničkim upitima i dijagnozama, te uspoređeni s literaturnim podacima. Tijekom 24 mjeseca na Kliničkom zavodu su izvedene 15.933 CT pretrage, od čega 3132 (19,66%) u hitnoj službi (1757 muškaraca i 1375 žena srednje dobi od 56,97 godina). Čak 2576 (82,25%) svih hitnih CT pretraga bile su hitne CT pretrage mozga (1398 muškaraca i 1178 žena srednje dobi od 57,80 godina). Raspoređenost hitnih CT pretraga mozga prema klinikama bila je slijedeća: neurologija 1441 (55,94%), neurokirurgija 632 (24,53%), interna medicina 186 (7,22%), kirurgija 138 (5,36%), ostale klinike 150 (5,82%) i vanjske ustanove 29 (1,13%). Kliničke indikacije za hitnu CT pretragu mozga bile su slijedeće: moždani udar 905 (35,13%), subarahnoidno krvarenje 128 (4,97%), trauma glave 617 (23,95%), poremećaj svijesti i konvulzije 389 (15,10%), intrakranijska ekspanzija 234 (9,08%), glavobolja i/ili vrtoglavica 141 (5,47%), cerebrovaskularna insuficijencija 50 (1,94%), infekcija 46 (1,79%), hidrocefalus 12 (0,47%), metabolične promjene 2 (0,08%) i nedostupni podaci u vrijeme studije 52 (2,02%). Anesteziološka asistencija pri hitnom CT pregledu mozga bila je potrebna u 234 (9,08%) slučaja. Korelacija CT nalaza s kliničkom dijagnozom (kliničkim upitom) pokazala je kako je 96 (3,73%) podataka bilo nedostupno u vrijeme studije, dok je od 2480 preostalih nalaza hitnih CT pregleda mozga bilo 639 (25,77%) normalnih i 1841 (74,23%) patoloških. Provedena je i usporedba s podacima iz literature. Zaključeno je kako je velik broj hitnih CT pretraga mozga s tendencijom stalnog porasta (cerebrovaskularne bolesti, novi terapijski pristupi, trauma glave). Otežano izvođenje pretrage zbog teškog stanja bolesnika i osjetljivost hitne interpretacije nalaza nameću potrebu veće dostupnosti neuroradiologa uz pridržavanje algoritma pretraga u hitnim stanjima

Vrijednost CT-a mozga u hitnoj službi: retrospektivna analiza

The objective of the study was evaluation and radiologic - clinical correlation of brain computed tomography (CT) scans performed at emergency service. The relation between the number of urgent and total CT scans performed during a 2-year period (January 1, 2001 - December 31, 2002) was analyzed. Emergency brain CT scans were especially investigated according to clinical indications, requests from particular clinical specialties, and need of anesthesiologist\u27s assistance. CT scans were correlated with clinical examinations and diagnoses as well as with literature data. During the study period, 15,933 CT scans were performed at our department, 3132 (19.66%) of them at emergency service (1757 male and 1375 female, mean age 56.97 years), and 2576 (82.25%) of the latter emergency brain CT scans (1398 male and 1178 female, mean age 57.80 years). Data analysis showed the following distribution of emergency brain CT scans according to hospital departments: neurology 1441 (55.94%), neurosurgery 632 (24.53%), internal medicine 186 (7.22%), surgery 138 (5.36%), other departments 150 (5.82%), and other institutions 29 (1.13%). Clinical diagnoses for emergency brain CT scanning were as follows: stroke 905 (35.13%), subarachnoid hemorrhage 128 (4.97%), head injury 617 (23.95%), consciousness disorders and convulsions 389 (15.10%), intracranial expansive lesions 234 (9.08%), headache and/or vertigo 141 (5.47%), cerebrovascular insufficiency 50 (1.94%), infectious disease 46 (1.79%), hydrocephalus 12 (0.47%), metabolic disorders 2 (0.08%), and lost or unavailable data at the time of the study 52 (2.02%). Anesthesiologist\u27s assistance during emergency brain CT scanning was needed in 234 (9.08%) cases. Correlation of CT findings with clinical diagnosis yielded the following results: 96 (3.73%) lost or unavailable data at the time of the study, 639 (25.77%) normal findings, and 1841 (74.23%) pathologic findings. Study results showed the number of emergency brain CT scans to be quite high with a tendency of continuous growth (cerebrovascular disorders, new therapeutic approaches, head injury). Difficulties encountered on brain CT scanning because of the patient\u27s state, and delicacy of the emergency interpretation of CT scans impose the need of higher availability of a neuroradiologist within the frame of the emergency state algorithm.Cilj ove studije bila je evaluacija i radiološko-klinička korelacija CT pretraga mozga u hitnoj službi. Tijekom dvogodišnjeg razdoblja (1. siječnja 2001. - 31. prosinca 2002.) analiziran je odnos hitnih i sveukupnih CT pretraga. Posebno su obrađeni hitni CT pregledi mozga prema kliničkim indikacijama, zastupljenosti pojedinih kliničkih struka i potrebi anesteziološke asistencije. CT nalazi su korelirani s kliničkim upitima i dijagnozama, te uspoređeni s literaturnim podacima. Tijekom 24 mjeseca na Kliničkom zavodu su izvedene 15.933 CT pretrage, od čega 3132 (19,66%) u hitnoj službi (1757 muškaraca i 1375 žena srednje dobi od 56,97 godina). Čak 2576 (82,25%) svih hitnih CT pretraga bile su hitne CT pretrage mozga (1398 muškaraca i 1178 žena srednje dobi od 57,80 godina). Raspoređenost hitnih CT pretraga mozga prema klinikama bila je slijedeća: neurologija 1441 (55,94%), neurokirurgija 632 (24,53%), interna medicina 186 (7,22%), kirurgija 138 (5,36%), ostale klinike 150 (5,82%) i vanjske ustanove 29 (1,13%). Kliničke indikacije za hitnu CT pretragu mozga bile su slijedeće: moždani udar 905 (35,13%), subarahnoidno krvarenje 128 (4,97%), trauma glave 617 (23,95%), poremećaj svijesti i konvulzije 389 (15,10%), intrakranijska ekspanzija 234 (9,08%), glavobolja i/ili vrtoglavica 141 (5,47%), cerebrovaskularna insuficijencija 50 (1,94%), infekcija 46 (1,79%), hidrocefalus 12 (0,47%), metabolične promjene 2 (0,08%) i nedostupni podaci u vrijeme studije 52 (2,02%). Anesteziološka asistencija pri hitnom CT pregledu mozga bila je potrebna u 234 (9,08%) slučaja. Korelacija CT nalaza s kliničkom dijagnozom (kliničkim upitom) pokazala je kako je 96 (3,73%) podataka bilo nedostupno u vrijeme studije, dok je od 2480 preostalih nalaza hitnih CT pregleda mozga bilo 639 (25,77%) normalnih i 1841 (74,23%) patoloških. Provedena je i usporedba s podacima iz literature. Zaključeno je kako je velik broj hitnih CT pretraga mozga s tendencijom stalnog porasta (cerebrovaskularne bolesti, novi terapijski pristupi, trauma glave). Otežano izvođenje pretrage zbog teškog stanja bolesnika i osjetljivost hitne interpretacije nalaza nameću potrebu veće dostupnosti neuroradiologa uz pridržavanje algoritma pretraga u hitnim stanjima

Magnetska rezonanca mozga i magnetska angiografija u zbrinjavanju bolesnika s ishemijskim moždanim udarom u vertebrobazilarnoj cirkulaciji

Vertebrobasilar occlusion is a life-threatening event that requires prompt diagnostic evaluation and subsequent therapy. Advanced magnetic resonance imaging (MRI) methods, including diffusion-weighted imaging and magnetic resonance angiography (MRA), are highly sensitive for the detection of ischemic tissue injury, and for the detection and localization of intracranial arterial occlusion and stenosis. In the era of thrombolytic therapy, MRI and MRA provide useful information for therapeutic decision making in the early stage of stroke evaluation. This retrospective review included patients with posterior circulation symptomatology examined at our Department between July 2002 and January 2005, 8 female and 11 male, mean age 54.9 years. The aim was to present the possibilities of MRI and MRA in the management of patients with ischemic stroke in posterior circulation. In 19 patients with an ischemia in the vertebrobasilar circulation detected by MRI of the brain, MRA identified 8 cases of basilar artery occlusion, 4 cases of basilar artery stenosis, 3 cases of multiple atherosclerotic stenoses of the vertebral arteries with 2 cases of concurrent vertebral artery occlusion, 2 cases of vasculitis in the posterior circulation, 1 case of proximal posterior cerebral artery occlusion, and 1 case of posterior cerebral artery stenosis. In 8 patients with basilar artery occlusion, the site of occlusion was proximal in 3 cases, proximal and middle in 2 cases, middle and distal in 2 cases, and distal in 1 case. MRI is a powerful tool to detect ischemic changes in stroke immediately upon stroke onset, while MRA is highly sensitive for the detection of occlusive disease in large intracranial arteries as well as in posterior circulation. In the acute stroke setting, MRI and MRA are useful for: 1) early and reliable identification of ischemic stroke; 2) improved choice of treatment modality by helping exclude from thrombolysis patients at high risk of hemorrhage and by identifying those patients most likely to benefit from it; 3) pinpoint the vascular origin of ischemic stroke; 4) determination of neurologic consequences of stroke, including final infarct size, clinical outcome and hemorrhagic risk.Vertebrobazilarna okluzija je za život opasno stanje koje zahtijeva brzu dijagnostičku obradu i terapiju. Suvremene metode magnetske rezonance (MR) mozga, uključujući difuzijski mjerenu sliku i magnetsku angiografiju (MRA), imaju visoku osjetljivost u otkrivanju ishemijske lezije moždanog parenhima, te u otkrivanju i lokalizaciji okluzije i stenoze intrakranijskih arterija. U doba trombolitične terapije MR mozga i MRA daju korisne podatke bitne za donošenje odluke o izboru terapije u procjeni ranog stadija ishemijskog moždanog udara. Proveden je retrospektivni pregled bolesnika sa simptomatologijom stražnje cirkulacije koji su na našem Zavodu pregledani u razdoblju od srpnja 2002. do siječnja 2005. godine, 8 žena i 11 muškaraca srednje životne dobi od 54,9 godina. Cilj je bio pokazati mogućnosti MR mozga i MRA u zbrinjavanju bolesnika s ishemijskim moždanim udarom stražnje cirkulacije. U 19 bolesnika s ishemijskim moždanim udarom vertebrobazilarnog sliva, koji je dokazan pomoću MR mozga, MRA je otkrila 8 okluzija bazilarne arterije, 4 stenoze bazilarne arterije, 3 slučaja višestrukih aterosklerotskih stenoza vertebralnih arterija s 2 slučaja istodobne okluzije vertebralne arterije, 2 vaskulitisa u stražnjoj cirkulaciji, 1 okluziju proksimalnog dijela i 1 stenozu stražnje moždane arterije. Među 8 bolesnika s okluzijom bazilarne arterije mjesto okluzije bilo je proksimalni dio arterije u 3, proksimalni i srednji dio u 2, srednji i distalni dio u 2 slučaja i distalni dio bazilarne arterije u 1 slučaju. MR mozga je moćno sredstvo u otkrivanju ishemijskih promjena neposredno nakon nastupa moždanog udara, dok MRA ima visoku osjetljivost za otkrivanje okluzivne bolesti velikih intrakranijskih arterija. Kod zbrinjavanja akutnog moždanog udara MR mozga i MRA su korisne zbog: 1) brzog i sigurnog otkrivanja ishemije; 2) sigurnijeg izbora oblika terapije pomažući da se tromboliza ne primijeni kod bolesnika s visokim rizikom za razvoj krvarenja te da se otkriju bolesnici koji će imati najviše koristi od iste; 3) mogućnosti točnog određivanja vaskularnog podrijetla ishemijskog moždanog udara; 4) određivanja neuroloških posljedica moždanog udara uključujući konačnu veličinu ishemijske lezije, klinički ishod i rizik od krvarenja

Sporadični oblik Creutzfeldt-Jakobove bolesti u bolesnice s ispadima nekonvulzivnog epileptičnog statusa: prikaz slučaja

Creutzfeldt-Jakob disease is the most common form of human prion diseases. A 57-year-old woman was transferred to our Department from a local hospital, where she had been treated for two weeks due to consciousness disorders and convulsive epileptic attacks that progressed to refractory status epilepticus. Electroencephalography showed diffuse spike-wave complex discharges and development of nonconvulsive status epilepticus. The causes of metabolic encephalopathy and paraneoplastic syndrome were ruled out. A combination of clinical features and findings of diagnostic procedures including electroencephalography, biomarkers in the cerebrospinal fluid and magnetic resonance imaging suggested with great probability that the patient was affected with sporadic Creutzfeldt-Jakob disease.Creutzfeldt-Jakobova bolest je najčešći oblik prionske bolesti u ljudi. Prikazuje se slučaj bolesnice koja je prevezena u našu Kliniku iz manje bolnice, gdje je bila liječena dva tjedna zbog poremećaja stanja svijesti i konvulzivnih epileptičnih napadaja koji su progredirali do epileptičnog statusa koji je bio refraktoran na primijenjenu terapiju. Elektroencefalografija je prikazala difuzna izbijanja kompleksa šiljak-val i razvoj nekonvulzivnog epileptičnog statusa. Koristeći kombinaciju kliničkih značajka i nalaza dijagnostičkih pretraga uključujući elektroencefalografiju, biomarkere u cerebrospinalnoj tekućini i nalaze magnetske rezonance zaključeno je s velikom vjerojatnošću da se radi o sporadičnom obliku Creutzfeldt-Jakobove bolesti

Sporadični oblik Creutzfeldt-Jakobove bolesti u bolesnice s ispadima nekonvulzivnog epileptičnog statusa: prikaz slučaja

Creutzfeldt-Jakob disease is the most common form of human prion diseases. A 57-year-old woman was transferred to our Department from a local hospital, where she had been treated for two weeks due to consciousness disorders and convulsive epileptic attacks that progressed to refractory status epilepticus. Electroencephalography showed diffuse spike-wave complex discharges and development of nonconvulsive status epilepticus. The causes of metabolic encephalopathy and paraneoplastic syndrome were ruled out. A combination of clinical features and findings of diagnostic procedures including electroencephalography, biomarkers in the cerebrospinal fluid and magnetic resonance imaging suggested with great probability that the patient was affected with sporadic Creutzfeldt-Jakob disease.Creutzfeldt-Jakobova bolest je najčešći oblik prionske bolesti u ljudi. Prikazuje se slučaj bolesnice koja je prevezena u našu Kliniku iz manje bolnice, gdje je bila liječena dva tjedna zbog poremećaja stanja svijesti i konvulzivnih epileptičnih napadaja koji su progredirali do epileptičnog statusa koji je bio refraktoran na primijenjenu terapiju. Elektroencefalografija je prikazala difuzna izbijanja kompleksa šiljak-val i razvoj nekonvulzivnog epileptičnog statusa. Koristeći kombinaciju kliničkih značajka i nalaza dijagnostičkih pretraga uključujući elektroencefalografiju, biomarkere u cerebrospinalnoj tekućini i nalaze magnetske rezonance zaključeno je s velikom vjerojatnošću da se radi o sporadičnom obliku Creutzfeldt-Jakobove bolesti