Uklanjanje mikroembolijskih signala kombiniranom antikoagulantnom i bantitrombocitnom terapijom

The effect of antithrombotic treatment on cerebral microembolism detected by transcranial Doppler sonography (TCD) in a case of internal carotid artery siphon stenosis is reported. A 58-year-old man suffered acute visual impairment associated with acute transient right upper limb paresis and paresthesia. Ultrasound examination of the neck arteries, TCD and digital subtraction angiography showed stenosis of the siphon of the left internal carotid artery. The patient was administered aspirin as antiplatelet therapy for 40 days, followed by anticoagulant therapy. Subsequently, he experienced many recurrent cerebral ischemic events. TCD monitoring performed on 4 occasions revealed microembolic signals (MES) in the ipsilateral middle cerebral artery. Aspirin was added to anticoagulant therapy. Once the combined anticoagulant and antiplatelet therapy had been introduced, no recurrent events were recorded anymore and no MES were detected. In this case, the detected MES proved to be in close relationship with recurrent cerebral ischemia, and were eliminated by combined anticoagulant and antiplatelet therapy.U radu se izvještava o zapaženom utjecaju antitrombotskog liječenja na cerebralnu mikroemboliju, koji je otkriven transkranijskim Dopplerovim ultrazvukom (TCD) u slučaju stenoze sliva unutarnje karotidne arterije. U 58-godišnjeg muškarca nastupio je akutni poremećaj vida te akutna prolazna pareza i parestezija gornjeg desnog ekstremiteta. Ultrazvučni pregled vratnih arterija, TCD i digitalna subtrakcijska angiografija pokazali su stenozu sliva lijeve unutarnje karotidne arterije. Bolesniku je uvedena antitrombocitna terapija aspirinom kroz 40 dana, nakon čega je nastavio s antikoagulantnom terapijom. Naknadno je imao brojne opetovane moždane ishemijske ispade. Praćenje pomoću TCD provedeno u 4 navrata otkrilo je mikroembolijske signale (MES) u istostranoj središnjoj moždanoj arteriji. Antikoagulantnoj terapiji dodan je aspirin. Nakon što je uvedena kombinirana antikoagulantna i antitrombocitna terapija nisu više zabilježeni nikakvi opetovani ispadi niti su više otkriveni MES. U ovom slučaju se pokazalo da su otkriveni MES bili usko povezani s opetovanom moždanom ishemijom, a uklonjeni su kombiniranom antikoagulantnom i antitrombocitnom terapijom

Transkranijski Doppler kod tuberkuloznog meningitisa: prikaz slučaja

Tuberculous meningitis has a highly variable presentation. Difficulties in establishing the diagnosis of tuberculous meningitis have been well recognized. Unusual manifestations of tuberculous meningitis are nowadays quite frequently seen, with an increasing incidence of the disease in the general neurology practice. A 44-year-old woman presented with progressive loss of vision on the left eye in the past two days and two episodes of seizures (partial and secondary generalized). One week before that, she had transient diplopia, blurred right vision, and gait unsteadiness. There was no past history of systemic tuberculosis. Transcranial Doppler findings first suggested that it was a basal pathologic process with vascular involvement, which was not clear from clinical history and examination, computed tomography or angiography findings. Our opinion is therefore that every case of specific meningitis, infectious retrobulbar neuritis and opticochiasmatic arachnoiditis should be additionally examined with transcranial Doppler. Thus, more reliable information concerning complications due to specific arteritis could be obtained.Tuberkulozni meningitis pokazuje velike razlike u manifestaciji. Dobro su poznate teškoće u postavljanju dijagnoze tuberkuloznog meningitisa. Danas se vrlo često bilježe neuobičajene manifestacije tuberkuloznog meningitisa, uza sve veću incidenciju ove bolesti u općoj neurološkoj praksi. Žena u dobi od 44 godine primljena je s progresivnim gubitkom vida na lijevom oku kroz prethodna dva dana i dvjema epizodama konvulzija (djelomične i sekundarne generalizirane). Tjedan dana prije toga imala je prolazne dvoslike, zamagljen vid i nesiguran hod. Nije imala anamnezu sistemske tuberkuloze. Nalaz transkranijskog Dopplera je bio prvi koji je ukazao na to da se radi o bazalnom patološkom procesu sa zahvaćenim krvnim žilama, što nije bilo jasno iz kliničke anamneze i pregleda, kao ni iz nalaza kompjutorizirane tomografije i angiografije. Stoga je naše mišljenje da pregled transkranijskim Dopplerom treba provesti u svakom slučaju specifičnog meningitisa, infektivnog retrobulbarnog neuritisa i optikohiazmatskog arahnoiditisa. Time bi se dobili pouzdaniji podaci o komplikacijama uzrokovanim specifičnim arteritisom

Uklanjanje mikroembolijskih signala kombiniranom antikoagulantnom i bantitrombocitnom terapijom

The effect of antithrombotic treatment on cerebral microembolism detected by transcranial Doppler sonography (TCD) in a case of internal carotid artery siphon stenosis is reported. A 58-year-old man suffered acute visual impairment associated with acute transient right upper limb paresis and paresthesia. Ultrasound examination of the neck arteries, TCD and digital subtraction angiography showed stenosis of the siphon of the left internal carotid artery. The patient was administered aspirin as antiplatelet therapy for 40 days, followed by anticoagulant therapy. Subsequently, he experienced many recurrent cerebral ischemic events. TCD monitoring performed on 4 occasions revealed microembolic signals (MES) in the ipsilateral middle cerebral artery. Aspirin was added to anticoagulant therapy. Once the combined anticoagulant and antiplatelet therapy had been introduced, no recurrent events were recorded anymore and no MES were detected. In this case, the detected MES proved to be in close relationship with recurrent cerebral ischemia, and were eliminated by combined anticoagulant and antiplatelet therapy.U radu se izvještava o zapaženom utjecaju antitrombotskog liječenja na cerebralnu mikroemboliju, koji je otkriven transkranijskim Dopplerovim ultrazvukom (TCD) u slučaju stenoze sliva unutarnje karotidne arterije. U 58-godišnjeg muškarca nastupio je akutni poremećaj vida te akutna prolazna pareza i parestezija gornjeg desnog ekstremiteta. Ultrazvučni pregled vratnih arterija, TCD i digitalna subtrakcijska angiografija pokazali su stenozu sliva lijeve unutarnje karotidne arterije. Bolesniku je uvedena antitrombocitna terapija aspirinom kroz 40 dana, nakon čega je nastavio s antikoagulantnom terapijom. Naknadno je imao brojne opetovane moždane ishemijske ispade. Praćenje pomoću TCD provedeno u 4 navrata otkrilo je mikroembolijske signale (MES) u istostranoj središnjoj moždanoj arteriji. Antikoagulantnoj terapiji dodan je aspirin. Nakon što je uvedena kombinirana antikoagulantna i antitrombocitna terapija nisu više zabilježeni nikakvi opetovani ispadi niti su više otkriveni MES. U ovom slučaju se pokazalo da su otkriveni MES bili usko povezani s opetovanom moždanom ishemijom, a uklonjeni su kombiniranom antikoagulantnom i antitrombocitnom terapijom

Mezencefalni oblik meningoencefalitis a u bolesnice s HL A-B51 beh cetovom bolešću: prikaz slučaja

This case report is a detailed description of the clinical, laboratory, imaging and therapeutic characteristics of the sixth patient with neuro-Behcet’s disease reported by Bulgarian authors. The diagnosis was made in accordance with the international diagnostic criteria for Behcet’s disease and was verified by skin biopsy. Therapeutic response was followed up by clinical and magnetic resonance imaging data for 6 months. Discussed are differences in the classical Behcet’s disease presentation and other neuro-Behcet’s disease cases found in Bulgaria. The current case supports the wide clinical heterogeneity of the disorder and the variety of therapeutic options.U ovom prikazu slučaja daje se iscrpan opis kliničkih, laboratorijskih, slikovno prikaznih i terapijskih značajka šestog bolesnika s neuro-Behcetovom bolešću o kojem izvješćuju bugarski autori. Dijagnoza je postavljena na osnovi međunarodnih dijagnostičkih kriterija za Behcetovu bolest i potvrđena biopsijom kože. Odgovor na terapiju pratio se kliničkim podacima i nalazima magnetske rezonancije kroz 6 mjeseci. Raspravlja se o razlikama u manifestiranju klasične Behcetove bolesti i drugim slučajevima neuro-Behcetove bolesti u Bugarskoj. Prikazani slučaj govori u prilog velike heterogenosti ove bolesti te o potrebi vrlo raznovrsnih terapijskih pristupa