Arnold-Chiari malformation - A case report

A case of a 14-year-old girl suffering from intense headaches is presented. At the first pediatrician\u27s examination, the patient had regular findings. Prolonged P100 wave latencies were found by testing the visual evoked potentials. After further examination following repeated headaches, Arnold Chiari type I malformation was diagnosed. Arnold Chiari malformation is classified as downward displacement of one or both cerebellar tonsils through foramen magnum. The most common symptom is occipital or suboccipital headaches that usually happens after hard physical effort. Changes in visual evoked potential latencies can be present before other clinical symptoms and can be a useful tool in the diagnostics of headaches in children and adolescents

Visual Evoked Potentials in the Diagnosis of Childhood Migraines

Glavobolja je jedan od najčešćih simptoma u neurologiji i vrlo čest uzrok recidivirajućih bolova u djece. Glava , lice i meki oglavak bogato su opskrbljeni receptorima za bol u odnosu na ostale dijelove tijela, što može objasniti zašto su bolovi tako često lokalizirani u glavi. Glavobolje su vrlo česte u djece i adolescenata. One imaju negativan utjecaj na učenje djeteta, pamćenje, osobnost, međuljudske odnose ili odnose s vršnjacima, kao i na izvršavanje školskih i izvanškolskih obveza. To, naravno, ovisi o etiologiji, učestalosti i intenzitetu glavobolje. Metode liječenja za različite tipove glavobolje su različite. Važno je prepoznati vrstu glavobolje, tako da se može tretirati na pravilan način. Svako dijete s glavoboljom treba individualan pristup. Pravodobno i pravilno liječenje čini bolest podnošljivijom i osigurava bolju kvalitetu života. Elektrofiziološke pretrage procjenjuju funkciju vidnog puta na određenom nivou. Vidni evocirani potencijali (VEP) predstavljaju kortikalni odgovor na vidni stimulus. Parametri VEP-a koji se analiziraju i opisuju su latencija, vremenski interval između stimulacije i pojave odgovora, te amplituda P 100 vala. U ovom istraživanju ispitivali smo VEP testiranjem promjene u vrijednostima amplitude i latencija P100 vala za vrijeme migrena i mirne faze u djece.Headache is one of the most common symptoms in neurology and a very common cause of recurrent pain in children. The head, face and soft head are richly supplied with pain receptors compared to other parts of the body, which can explain why pain is so often localized in the head. Headaches are very common in children and adolescents. They have a negative impact on the child’s learning, memory, personality, interpersonal relationships, or relationships with peers, as well as on the performance of school and extracurricular obligations. This, of course, depends on the etiology, frequency, and intensity of the headache. Treatment methods for different types of headaches are different. It is important to recognize the type of headache so that it can be treated properly. Each child with a headache needs an individual approach. Timely and proper treatment makes the disease more bearable and gi-ves a better quality of life. Electrophysiological tests evaluate the function of the visual pathway at a certain level. Visual evoked potentials (VEP) represent the cortical response to a visual stimulus. The VEP parameters that are analysed and described are the latency, the time interval between stimulation and the appearance of the response, and the amplitude of the P 100 wave. In this study, the VEP was examined by testing changes in the amplitude and latencies of the P100 wave during migraines and the calm phase in children

Promjenjivost kuta škiljenja u prijevremeno rođene djece s neurološkim oštećenjem i strabizmom: dvanaestogodiš-nje praćenje

The aim of this retrospective study was to determine the strabismus angle variability and rationality of surgical treatment of strabismus in prematurely born children with neurological impairment during 12-year follow up. Eleven premature infants born in 2003 were included in the study and treated with equal con-servative approach from 2005 until 2016. Initial esotropia was found in seven and exotropia in four of eleven children. Changes in the strabismus angle correlated significantly with aging of the children. In chil-dren with initial esotropia, the strabismus angle became less convergent (less positive), changed the orien-tation and became more divergent with aging. In those with initial exotropia, the angle became less diver-gent (more positive), changed the orientation and became more convergent. Moreover, a significant dif-ference in the strabismus angle was found during the 12-year follow up. Based on our results, due to the variability in strabismus angle, we did not find enough evidence for optimal timing or rationality of stra-bismus surgery in neurologically impaired children born prematurely.Cilj ovoga retrospektivnog istraživanja bio je odrediti promjenjivost kuta škiljenja i opravdanost kirurškog zahvata u prijevremeno rođene djece s neurološkim oštećenjem i strabizmom tijekom dvanaestogodišnjeg razdoblja praće-nja. Istraživanjem je obuhvaćena skupina od jedanaestoro prematurusa rođenih 2003. godine koji su praćeni od 2005. do 2016. godine i liječeni isključivo konzervativno. U sedmero djece je pri prvom mjerenju nađen konvergent-ni strabizam, dok je četvero preostale djece imalo divergentni strabizam. Kod sve praćene djece zabilježena je zna-čajna korelacija izmjerenog kuta škiljenja s vremenom praćenja, pričem je u djece s početnim konvergentnim stra-bizmom kut škiljenja postajao manje konvergentan (manje pozitivan) s rastućom dobi djeteta, mijenjao smjer i postajao sve više divergentan (više negativan). U djece s početnim divergentnim strabizmom kut škiljenja bio je sve manje divergentan (manje negativan) u odnosu na rastuću dob djeteta, mijenjao smjer i postajao sve više konver-gentan (više pozitivan). Tijekom dvanaest godina praćenja utvrđena je značajna razlika u medijanima kuta škilje-nja. Zbog promjenjivosti kuta škiljenja nije se moglo utvrditi optimalno vrijeme ni opravdanost operacijskog zahva-ta u korekciji strabizma prijevremeno rođene, neurološki oštećene djece

The Ophthalmic Anomalies in Children with Down Syndrome in Split-Dalmatian County

Our aim was to present the ophthalmic anomalies in patients with Down syndrome in Split-Dalmatia County born from 1992 until 2009 year. It was a cross-sectional study. 153 children with Down syndrome aged 0–18 years from the Split-Dalmatia County were examined. One hundred twelve participants were borne in Split,13 in Vrgorac,16 in Makarska, 12 in Sinj. All enrolled children underwent a complete ophthalmological examination (anterior segment, ocular motility, refractive status, fundus, measuring intraocular pressure (IOP). Of 89.5% percent of responders with refractive errors, 48.1% had myopia, 35.0% had hypermetropia, astygamtism in 16.7%, 28.7% strabismus, nystagmus (8.4%), cataracts (1.3%), glaucoma (1.9%), supernumerary optic disc vessels (24.1%) and keratoconus (1.3%). Conclusion: In patients with Down syndrome the prevalence of refractive errors (myopia prevalence), as well as other ophthalmological diseases was determined

Changes in the Eyelids and Conjunctiva Caused by Ultraviolet Radiation

The aim of this study was to show the frequency, sex and age distribution of eyelids skin tumor changes and degenerative changes of the conjunctiva for the period of three years (2011–2013) at the Department of Ophthalmology in Split. We analyzed the eyelids skin lesions in biopsy material at the Department of Pathology and the same were compared with the profession of the patients. In this period there were found 131 tumor changes of the eyelids. The most common tumor was the basal cell carcinoma (118) with the higher frequency in women. There were 10 squamous cell carcinomas with the equal representation among sexes and three melanomas. There were 79 female and 52 male patients. There were 299 pterygiums operated with the higher frequency in women (68.2%). Exposure to UV radiation, particulary UVB radiation is the most common causative factor for genetic abnormalities in cells and provoked factor in oncogenesis of skin tumors. In our research we found a correlation between changes in the eyelids and conjunctiva caused by UV radiation with the professional interest of the respondents. Due to high incidence of eyelids skin tumor changes in the population professionally exposed to UV radiation, medical professionals should be aware of the importance of the public education on the etiology of these tumors and the importance of the UV protection

Changes in the Eyelids and Conjunctiva Caused by Ultraviolet Radiation

The aim of this study was to show the frequency, sex and age distribution of eyelids skin tumor changes and degenerative changes of the conjunctiva for the period of three years (2011–2013) at the Department of Ophthalmology in Split. We analyzed the eyelids skin lesions in biopsy material at the Department of Pathology and the same were compared with the profession of the patients. In this period there were found 131 tumor changes of the eyelids. The most common tumor was the basal cell carcinoma (118) with the higher frequency in women. There were 10 squamous cell carcinomas with the equal representation among sexes and three melanomas. There were 79 female and 52 male patients. There were 299 pterygiums operated with the higher frequency in women (68.2%). Exposure to UV radiation, particulary UVB radiation is the most common causative factor for genetic abnormalities in cells and provoked factor in oncogenesis of skin tumors. In our research we found a correlation between changes in the eyelids and conjunctiva caused by UV radiation with the professional interest of the respondents. Due to high incidence of eyelids skin tumor changes in the population professionally exposed to UV radiation, medical professionals should be aware of the importance of the public education on the etiology of these tumors and the importance of the UV protection

The Ophthalmic Anomalies in Children with Down Syndrome in Split-Dalmatian County

Our aim was to present the ophthalmic anomalies in patients with Down syndrome in Split-Dalmatia County born from 1992 until 2009 year. It was a cross-sectional study. 153 children with Down syndrome aged 0–18 years from the Split-Dalmatia County were examined. One hundred twelve participants were borne in Split,13 in Vrgorac,16 in Makarska, 12 in Sinj. All enrolled children underwent a complete ophthalmological examination (anterior segment, ocular motility, refractive status, fundus, measuring intraocular pressure (IOP). Of 89.5% percent of responders with refractive errors, 48.1% had myopia, 35.0% had hypermetropia, astygamtism in 16.7%, 28.7% strabismus, nystagmus (8.4%), cataracts (1.3%), glaucoma (1.9%), supernumerary optic disc vessels (24.1%) and keratoconus (1.3%). Conclusion: In patients with Down syndrome the prevalence of refractive errors (myopia prevalence), as well as other ophthalmological diseases was determined

Modern Approach to Topical Treatment of Aging Skin

The main processes involved in skin aging are intrinsic and extrinsic. Apart from them, so called stochastic aging connotes cell damage caused by metabolic processes, free radicals and cosmic irradiation. The clinical expression of intrinsic aging include smooth, dry, and thinned skin with accentuated expression lines. It is inevitable and time dependent. Extrinsically aged skin shows signs of photodamage which include appearance of wrinkles, pigmented lesions, actinic keratoses and patchy hypopigmentations. Therapeutic modalities imply photoprotection with sunscreens that prevent sunburns and block ultraviolet irradiation. Other modalities include use of retinoids which regulate gene transcription with subsequent cellular differentiation and proliferation. The topical and peroral administration of »network antioxidants» such as vitamin E and C, coenzyme Q10, alpha-lipoic acid and glutathione, enhance antiaging effect. The other antioxidants such as green tea, dehydroepiandrosterone, melatonin, selenium and resveratrol, have also antiaging and anti-inflammatory effects. Topical bleaching agents such as hydroquinone, kojic acid and azelaic acid can reduce signs of aging. Studies confirm the efficacy of these topical agents in combination with superficial and/or medium depth or deep peeling agents for photodamaged skin treatment. Indications for type of chemical peels according to various clinical diagnosis are done, as well as advantages and disadvantages of differetn types of chemical peels