Ägeda isheemilise infarkti radiodiagnostika aspekte Euroopa radioloogia kongressil 2007

Ägeda isheemilise ajuinfarkti patofüsioloogia parem mõistmine on olnud aluseks ägeda isheemilise infarkti ravivõimaluste arengule. On kindlaks tehtud, et kiire reperfusioon isheemilise infarkti kollet ümbritsevas nn penumbra-tsoonis kolme esimese tunni jooksul pärast kliiniliste sümptomite tekkimist võib anda positiivse raviefekti. Selle aasta Euroopa radioloogiakongressil Viinis käsitlesid mitmed ettekanded ägeda ajuinfarkti diagnoosimise ja ravi nüüdisaegseid võimalusi. Eesti Arst 2007; 86 (6): 381–38

Primaarne süsteemne vaskuliit – Wegeneri granulomatoos. Haigusjuhu kirjeldus ja lühiülevaade haigusest

31-aastasel mehel tekkis 2004. aasta kevadel püsiv ninakinnisus. Samal ajal märkas ta vasakul õlal piirdunud sinakas-lillat laiku. Sama aasta novembris hakkas patsient tundma valu otsmiku piirkonnas. Perearst määras raviks gentamütsiinisüstid lihasesiseselt. Vaatamata ravile jäi püsima otsmikuvalu, lisandus pearinglus ja rohke kollakas eritus ninast. Patsient hospitali see riti kõrvakliinikusse, kuna eelnevalt tehtud nina kõrvalkoobaste ülesvõttel leiti põsk- ja otsmikukoobaste varjustus. Haiglas tehtud kompuutertomograafilisel (KT) uuringul ilmnes otsmiku urke, ülalõuaurke, etmoidaalrakustiku ja ülemiste ninakäikude varjus tus ning otsmiku urke sisekontuuri ebatasasus ja paksenemine. Eesti Arst 2006; 85 (1): 41–4

Koljusisesed verevalumid tõelise polütsüteemiaga haigel kerge trauma järel

Tõelise polütsüteemia diagnoosiga 54aastasel naishaigel kujunesid pärast kerget traumat – omalt jalalt kukkumist – ajusisene ja subduraalne verevalum vasemas ajupoolkeras. Hospitaliseerimise ajal oli haige teadvusel, pareesideta, esines sensomotoorne afaasia. Patsient oli polütsüteemia ravi katkestanud 5 aastat tagasi. Vereanalüüside järgi esines haigel trombotsütopeenia, trombotsüütide funktsiooni häire ja koagulopaatia. Vajalik oli vältimatu operatsioon ja vere hüübivuse parandamiseks manustati haigele värskelt külmutatud plasmat, desmopressiini ja traneksaamhapet. Operatsioon ja operatsioonijärgne periood kulgesid tüsistusteta, kõnehäire taandus. Hematoloogi hinnangul oli haigel polütsüteemia arenenud müelofibroosiks. Edasiseks raviks määrati hüdroksükarbamiid.Eesti Arst 2017; 96(8):474–47

Intraduraalne ekstramedullaarne meningeoom 36aastasel naisel

36aastane naine haigestus episoodiliselt esinevate valudega alaseljas. Umbes 6 kuu möödudes lisandusid sokitüüpi düsesteesiad labajalgades, ligi 10 kuu möödudes lisandusid vibratsioonitundlikkuse häire roidekaarest allpool ja kerges astmes püramidaalnähud ning süvenes vaagnaelundite kontrolli häire. Neuroloogiaosakonnas, umbes aasta möödudes esmaste sümptomite tekkest, tehti pea, kaela ja rindkere piirkonna MRT-uuring. Diagnoositi 6.–7. rinnalüli kõrgusel intraduraalne ekstramedullaarne tuumor. Operatsioonil kasvaja eemaldati, tegemist oli atüüpilise meningeoomiga, mis kuulus Maailma Terviseorganisatsiooni (WHO) klassifikatsiooni järgi G2-rühma. Adjuvantravi ei olnud vajalik. Umbes kuu möödudes operatsioonist oli haige kaebusteta, neuroloogiline leid oli taandunud.Eesti A rst 2016; 95(7):460–46

Võõrkeha kõrva-põse piirkonnas – haigusjuhu kirjeldus

Näopiirkonna mitteröntgenkontrastseid võõrkehi on raske avastada, kui neid ei ole võimalik manuaalselt kindlaks teha. Tavalised röntgenoloogilised meetodid ei suuda neid alati nähtavale tuua ning tihti avastatakse võõrkeha alles pärast paikse põletiku teket. Kergem on avastada röntgenkontrastseid võõrkehi. Võõr kehade invasiooni kudedesse võivad põhjustada liiklus- ja olmetraumad, mõni kord ka tööstustraumad. Enamasti on võõrkehad metallist või klaasist. Haigus loo kirjelduses käsitletakse 61aastase meespatsiendi diagnoosimise ja ravi käiku TÜ Kliinikumi kõrvakliinikus. Patsiendil tekkis traumajärgne põletikuline protsess põse ja kuulmekäigu piirkonnas, mille põhjuse diagnoosimisest võtsid osa mitme eriala esindajad. Eesti Arst 2006; 85 (3): 161–16

Kõnekeskuse lateralisatsioon ja kaugtulemused erineva vaskulaarse alatüübiga perinataalse insuldiga lastel

Eesti Arst 2022; 101(12):71

Ipsilesional volume loss of basal ganglia and thalamus is associated with poor hand function after ischemic perinatal stroke

Background Perinatal stroke (PS) is the leading cause of hemiparetic cerebral palsy (CP). Involvement of the corticospinal tract on neonatal magnetic resonance imaging (MRI) is predictive of motor outcome in patients with hemiparetic CP. However, early MRI is not available in patients with delayed presentation of PS and prediction of hemiparesis severity remains a challenge. Aims To evaluate the volumes of the basal ganglia, amygdala, thalamus, and hippocampus following perinatal ischemic stroke in relation to hand motor function in children with a history of PS and to compare the volumes of subcortical structures in children with PS and in healthy controls. Methods Term born PS children with arterial ischemic stroke (AIS) (n = 16) and with periventricular venous infarction (PVI) (n = 18) were recruited from the Estonian Pediatric Stroke Database. MRI was accuired during childhood (4-18 years) and the volumes of the basal ganglia, thalamus, amygdala and hippocampus were calculated. The results of stroke patients were compared to the results of 42 age- and sex-matched healthy controls. Affected hand function was evaluated by Assisting Hand Assessment (AHA) and classified by the Manual Ability Classification System (MACS). Results Compared to the control group, children with AIS had smaller volumes of the ipsi- and contralesional thalami, ipsilesional globus pallidus, nucleus accumbens and hippocampus (p 0.5; p < 0.05) and larger volume of the contralesional putamen and hippocampus (r < - 0.5; p < 0.05). In children with PVI, size of the ipsilesional caudate nucleus, globus pallidus, thalamus (p 0.55; p < 0.05) in children with PVI. Conclusions Smaller volume of ipsilesional thalamus was associated with poor affected hand function regardless of the perinatal stroke subtype. The pattern of correlation between hand function and volume differences in the other subcortical structures varied between children with PVI and AIS. Evaluation of subcortical structures is important in predicting motor outcome following perinatal stroke.Peer reviewe

Long-term neurodevelopmental outcome after perinatal arterial ischemic stroke and periventricular venous infarction

Background: Long-term follow-up data after different vascular types of ischemic perinatal stroke is sparse. Our aim was to study neurodevelopmental outcomes following neonatal and presumed perinatal ischemic middle cerebral artery territory stroke (arterial ischemic stroke, AIS) and periventricular venous infarction (PVI). Methods: A prospective consecutive cohort of 40 term-born children with perinatal stroke (21 AIS, 19 PVI) was identified through the Estonian Paediatric Stroke Database. While 48% of the children with AIS were diagnosed during the neonatal period, all the children with PVI had presumed perinatal stroke. Outcomes based on the Paediatric Stroke Outcome Measure (PSOM) and Kaufman Assessment Battery for Children Second Edition (K-ABC-II), in relation to extent and laterality of stroke, were defined. Results: At a median age of 7 years 6 months (range 3.6-13y), there was a trend towards worse neurodevelopmental outcome in participants with AIS when compared to PVI (mean total PSOM scores 3.1 and 2.2, respectively; p = 0.06). Combined deficits of motor, language and cognitive/behavioural functions were significantly more common among children with AIS (90%) when compared to children with PVI (53%, p = 0.007). General cognitive ability (by K-ABC-II) was significantly lower in the AIS subgroup (mean 79.6; 95% CI 72.3-87.0), but children with PVI (91.6; 95% CI 85.5-97.8) also had poorer performance than the age-equivalent normative mean. Large extent of stroke was associated with poorer neurodevelopmental outcome and lower cognitive performance in children following AIS but not in PVI. Conclusion: In this national cohort, poor long-term neurodevelopmental outcome after perinatal ischemic stroke was seen irrespective of the vascular type or time of diagnosis of stroke. However, the spectrum of neurological deficits is different after perinatal AIS and PVI, with combined deficits more common among children following AIS. (C) 2018 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Resting-State Functional Connectivity and Cognitive Impairment in Children with Perinatal Stroke

Perinatal stroke is a leading cause of congenital hemiparesis and neurocognitive deficits in children. Dysfunctions in the largescale resting-state functional networks may underlie cognitive and behavioral disability in these children. We studied resting-state functional connectivity in patients with perinatal stroke collected from the Estonian Pediatric Stroke Database. Neurodevelopment of children was assessed by the Pediatric Stroke Outcome Measurement and the Kaufman Assessment Battery. The study included 36 children (age range 7.6-17.9 years): 10 with periventricular venous infarction (PVI), 7 with arterial ischemic stroke (AIS), and 19 controls. There were no differences in severity of hemiparesis between the PVI and AIS groups. A significant increase in default mode network connectivity (FDR 0.1) and lower cognitive functions (p <0.05) were found in children with AIS compared to the controls and the PVI group. The children with PVI had no significant differences in the resting-state networks compared to the controls and their cognitive functions were normal. Our findings demonstrate impairment in cognitive functions and neural network profile in hemiparetic children with AIS compared to children with PVI and controls. Changes in the resting-state networks found in children with AIS could possibly serve as the underlying derangements of cognitive brain functions in these children.Peer reviewe

General ability and specific cognitive functions are lower in children with epilepsy after perinatal ischemic stroke

IntroductionEpilepsy develops in one third of children after perinatal stroke. Both epilepsy and stroke may be risk factors for impaired cognitive abilities. How the development of epilepsy is related to the cognitive profile of children with perinatal stroke is still unclear. The aim of the study was to evaluate general and specific cognitive functions in children with epilepsy and children without epilepsy after perinatal ischemic stroke.MethodsThe study group consisted of 51 children with perinatal ischemic stroke confirmed by magnetic resonance imaging: 27 (53%) children with arterial ischemic stroke and 24 (47%) with periventricular venous infarction. Magnetic resonance imaging and electroencephalography were performed in all patients after the neonatal period. Epilepsy was diagnosed if the child had at least two unprovoked seizures occurring &gt;24 h apart or one unprovoked seizure with a high recurrence risk. Cognitive assessments were performed using the Kaufman Assessment Battery for Children, Second Edition, at the age of ≥7 years. General ability (Fluid Crystallized Index, Mental Processing Index, Non-verbal Index) and specific cognitive functions (sequential processing, simultaneous processing, learning, planning, knowledge) were evaluated.ResultsAt the median age of 19.3 years (interquartile range 14.0–22) at the time of follow-up for epilepsy, 14 (27.5%) patients had developed epilepsy, and 37 (72.5%) patients were without epilepsy. All general cognitive ability scores were lower in children with epilepsy compared to children without epilepsy. Among specific cognitive functions, simultaneous processing, planning, and knowledge were lower in children with epilepsy compared to children without epilepsy: simultaneous processing mean [78.5, 95% CI: [69.8, 87.2], vs. 96.9, 95% CI [90, 103.9], p = 0.0018]; planning mean [82.5, 95% CI: [73, 92], vs. 96.2, 95% CI: [88.7, 103.6], p = 0.026]; knowledge median (25th, 75th percentile): 80.5 (75, 87) vs. 92 (84, 108), p = 0.023.ConclusionChildren with epilepsy after perinatal ischemic stroke have lower general cognitive abilities compared to children without epilepsy. The profile of the subscales indicates lower verbal abilities and executive functions in children with epilepsy. Children with post-stroke epilepsy need targeted cognitive monitoring for early aimed rehabilitation and for establishing an adapted learning environment