Creutzfeldt-Jakobova bolest: prikaz slučaja i pregled literature

Creutzfeldt-Jakob disease (CJD) is a rare, fatal neurodegenerative disease caused by an infectious protein called prion and is characterized by spongiform changes, neuronal loss, reactive astrocytic proliferation and accumulation of pathologic cellular protein, occurring in 3 general forms: sporadic or spontaneous, genetic or familial, and acquired form including a variant form of CJD. Clinical presentation of CJD is characterized by progressive dementia, neurologic symptoms and visual impairment, development of akinetic mutism, and eventually death, usually from respiratory infection. The diagnosis is based on clinical presentation, electroencephalogram, and typical cerebrospinal fluid and magnetic resonance imaging findings. A case is presented of a 56-year-old woman with progressive dementia, typical neurologic symptoms, positive cerebrospinal fluid and typical magnetic resonance imaging findings. The clinical, pathologic and imaging findings of this rare condition are also discussed.Creutzfeldt-Jakobova bolest (CJD) je rijetka i smrtonosna neurodegenerativna bolest koju uzrokuje infektivna bjelančevina nazvana prion, a obilježena je spužvastim promjenama, gubitkom neurona, reaktivnom proliferacijom astrocita i nakupljanjem patološke stanične bjelančevine. Bolest se javlja u tri glavna oblika: sporadični ili spontani, genetski ili obiteljski, te stečeni oblik uključujući varijantni oblik CJD. Klinički je CJD obilježena progresivnom demencijom, neurološkim simptomima i poremećajem vida, razvojem akinetskog mutizma, te konačno smrću, najčešće zbog dišne infekcije. Dijagnoza se temelji na kliničkim značajkama, elektroencefalogramu, te tipičnim nalazima likvora i magnetske rezonancije. Prikazuje se slučaj 56-godišnje bolesnice s progresivnom demencijom, tipičnim neurološkim simptomima, te pozitivnim nalazima likvora i magnetske rezonancije. Također se raspravlja o kliničkim i patološkim nalazima, te nalazima slikovnog prikazivanja u ovoj rijetkoj bolesti

Endoskopsko liječenje krvarenja iz gastroezofagusnih varikoziteta

Current concepts of endoscopic treatment of gastroesophageal variceal hemorrhage are discussed. There are two major endoscopic treatments of gastroesophageal varices: endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). EIS and EVL alone are equally effective in controlling acute variceal bleeding; however, EVL is superior to EIS because it achieves variceal obliteration faster and with a lower rate of complications and rebleeding. Considering combined technique of EVL and EIS, it appears that initial EVL followed by long-term EIS on later sessions, when banded varices have become smaller, probably is a wiser approach for safe and long-lasting variceal eradication. Histoacryl as a tissue glue is the only endoscopic treatment that has been proved to be effective for gastric varices. The use of endoscopic clips alone in the treatment of varices remains uncommon. The role of endoscopic ultrasound increases in the evaluation of portal hypertension, and it may gain a role in choosing an optimal treatment approach for individual patients.Prikazane su suvremene mogućnosti endoskopskog liječenja krvarenja iz gastroezofagusnih varikoziteta. Dva su glavna načina endoskopskog liječenja gastroezofagusnih varikoziteta: endoskopska injekcijska skleroterapija i endoskopska ligacija varikoziteta. Endoskopska skleroterapija i ligacija varikoziteta kao samostalne metode podjednako su učinkovite u zaustavljanju akutnog krvarenja iz varikoziteta, no endoskopska ligacija varikoziteta bolja je metoda u odnosu na skleroterapiju jer se njome obliteracija varikoziteta postiže brže i u manjem broju tretmana te s manjim brojem komplikacija. Glede kombinacije ligacije i skleroterapije, inicijalna ligacija, a potom postupci skleroterapije kad podvezani varikoziteti postanju manji, vjerojatno je prikladniji postupak za sigurno i dugotrajno iskorjenjivanje varikoziteta. Obliteracija varikoziteta Histoacrylom jedini je potvrđen i djelotvoran način endoskopskog liječenja varikoziteta želuca. Upotreba endoskopskih klipsa kao samostalan način liječenja još uvijek nije preporučljiva. Uloga endoskopskog ultrazvuka u procjeni portalne hipertenzije raste, a isti može steći ulogu u odabiru najboljeg pristupa liječenju svakog bolesnika pojedinačno

Endoskopsko liječenje krvarenja iz gastroezofagusnih varikoziteta

Current concepts of endoscopic treatment of gastroesophageal variceal hemorrhage are discussed. There are two major endoscopic treatments of gastroesophageal varices: endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). EIS and EVL alone are equally effective in controlling acute variceal bleeding; however, EVL is superior to EIS because it achieves variceal obliteration faster and with a lower rate of complications and rebleeding. Considering combined technique of EVL and EIS, it appears that initial EVL followed by long-term EIS on later sessions, when banded varices have become smaller, probably is a wiser approach for safe and long-lasting variceal eradication. Histoacryl as a tissue glue is the only endoscopic treatment that has been proved to be effective for gastric varices. The use of endoscopic clips alone in the treatment of varices remains uncommon. The role of endoscopic ultrasound increases in the evaluation of portal hypertension, and it may gain a role in choosing an optimal treatment approach for individual patients.Prikazane su suvremene mogućnosti endoskopskog liječenja krvarenja iz gastroezofagusnih varikoziteta. Dva su glavna načina endoskopskog liječenja gastroezofagusnih varikoziteta: endoskopska injekcijska skleroterapija i endoskopska ligacija varikoziteta. Endoskopska skleroterapija i ligacija varikoziteta kao samostalne metode podjednako su učinkovite u zaustavljanju akutnog krvarenja iz varikoziteta, no endoskopska ligacija varikoziteta bolja je metoda u odnosu na skleroterapiju jer se njome obliteracija varikoziteta postiže brže i u manjem broju tretmana te s manjim brojem komplikacija. Glede kombinacije ligacije i skleroterapije, inicijalna ligacija, a potom postupci skleroterapije kad podvezani varikoziteti postanju manji, vjerojatno je prikladniji postupak za sigurno i dugotrajno iskorjenjivanje varikoziteta. Obliteracija varikoziteta Histoacrylom jedini je potvrđen i djelotvoran način endoskopskog liječenja varikoziteta želuca. Upotreba endoskopskih klipsa kao samostalan način liječenja još uvijek nije preporučljiva. Uloga endoskopskog ultrazvuka u procjeni portalne hipertenzije raste, a isti može steći ulogu u odabiru najboljeg pristupa liječenju svakog bolesnika pojedinačno

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

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

Intracranial mature teratoma in an adult patient: a case report

Introduction: Primary intracranial teratoma is a subtype of germ cell tumors, classified into three subtypes. They occur very rarely, with only several reported individual cases in adults. ----- Case Description: We present a patient with an intermittent headache in the right frontal region. Magnetic resonance imaging (MRI) revealed a right sided high frontal parasagittal mass that compressed the falx, the right lateral ventricle, as well as the brain parenchyma. Patient underwent surgical treatment. Histopathological analysis described mature teratoma. Four months after the surgical treatment there were no signs of residual intracranial mass or relapse. ----- Discussion: Primary intracranial teratoma in adults has a nonspecific clinical presentation. MRI reveals a solitary irregular mass with multilocularity and mixed signals derived from different tissues. The patients age, biochemical markers, and patohistological analysis are necessary to confirm the diagnosis. ----- Conclusion: Teratoma treatment strategy still remains controversial. It includes radical resection whenever possible. Since the residual portion of mature teratoma may contain part of immature or malignant tissue, tumor recurrence after surgical removal is possible. Also, new tumor mass could occur at other sites intracranial after the initial one was removed. Thus, although patients usually recover, they should be followed-up for a long period of time

Magnetna rezonancija tehnikom „zadržavanja daha“ u dijagnostici i preoperativnoj procjeni proširenosti malignih tumora bubrega [Magnetic resonance imaging in diagnosis and preoperative staging of renal cell carcinoma using “breath-hold” technique]

Renal cell carcinoma is the most common primary malignant neoplasm of the kidney and accounts for 2-3% of all cancer diagnosed. Its incidence is constantly increasing over the last three decades. The aim of this study was to assess the sensitivity, specificity, accuracy, positive and negative and positive predictive value of MRI in diagnosis and preoperative staging of renal cell carcinoma using the 2002 TNM staging system, with pathological staging as the gold standard. Fifty-five patients, mean age 56.3 years, with 64 renal tumors underwent MRI for diagnosis and preoperative staging. MRI detected 51 solid and 7 cystic renal tumors, 3 complex cysts, 3 doubtful findings. MRI tumor mean size was 45.7 mm. MRI staged 53 tumors as T1, 5 as T2, and 6 as T3 stage: (3/6 T3a, 3/6 T3b). Sixty-two tumors were staged N0, two were staged N2. 1/64 was staged M1 (distant liver metastases), 63/64 were staged M0. Pathological findings revealed 6 benign and 58 malignant renal tumors. Pathologic tumor mean size was 43.7 mm. Pathologist staged 51 tumors as T1, 3 as T2, 4 tumors as T3 stage. One tumor was staged N2 and one was staged M1, all the rest were staged N0 and M0. In our study most of the patients were staged T1N0M0 by MRI and pathological findings, and kappa test revealed excellent agreement between all three classes of the TNM staging system. Sensitivity of the MRI in preoperative staging of renal cell carcinoma is 93.1%, specificity is 100%, accuracy is 93.7%, positive predictive value is 100%, negative predictive value is 60%. In conclusion, the role of MRI in renal imaging has changed over time and it has become an important modality for evaluating renal masses and for staging patients with RCC