Regresija asimetričnog tremora gornjih udova nakon transplantacije jetre u bolesnika s hepatalnom encefalopatijom: prikaz slučaja

Hepatic encephalopathy (HE) is a brain dysfunction caused by liver failure. Clinically, it can manifests as a wide spectrum of neurological or psychiatric abnormalities. This report presents a case of a 43-year-old male with HE and asymmetric kinetic, postural and resting tremor of upper extremities. Magnetic resonance imaging (MRI) of the brain showed signal abnormalities in numerous areas. The patient underwent liver transplantation and six months after normalization of liver function, tremor as well as brain MRI abnormalities almost completely regressed. This case report presents the asymmetric and reversible kinetic, postural and resting tremor of upper extremities as part of the spectrum of neurological abnormalities in HE.Hepatalna encefalopatija poremećaj je funkcije mozga uzrokovan jetrenom insuficijencijom. Klinički se može očitovati širokim spektrom neuroloških i psihijatrijskih poremećaja. Ovdje prikazujemo 43-godišnjeg muškarca s hepatalnom encefalopatijom i asimetričnim akcijskim, posturalnim i tremorom u mirovanju gornjih udova. Magnetska rezonancija (MR) mozga pokazala je promjene signala u brojnim arejama. Bolesnik je podvrgnut transplantaciji jetre i šest mjeseci nakon normalizacije jetrene funkcije tremor i MR promjene mozga gotovo su se potpuno povukle. Ovaj prikaz slučaja predočuje asimetričan i reverzibilan akcijski, posturalni i tremor u mirovanju gornjih udova kao dio spektra neuroloških poremećaja u hepatalnoj encefalopatiji

Incidencija tumora središnjega živčanog sustava u bolesnika hospitaliziranih u Kliničkom bolničkom centru Split od 1. siječnja 2004. do 31. prosinca 2013. godine

The aim was to evaluate the incidence and characteristics of central nervous system tumors in patients hospitalized at the Department of Neurology, Split University Hospital Centre, during a 10-year period. The study included data on 859 patients with the diagnosis of central nervous system (CNS) tumor. Diagnosis was based on the routine CNS neuroimaging methods (computed tomography/magnetic resonance imaging). Access to patient medical records provided demographic and clinical data, continued by collection of data on potential lethal outcome of patients at the Registrar’s Office. The study was conducted at the Department of Neurology, Split University Hospital Centre, from January 1, 2004 to December 31, 2013. There were 448 male and 411 female patients. Median age at the diagnosis was 65 (range, 18-95) years. Primary CNS tumors were diagnosed in 527 patients, including 30 primary recurrent tumors, whereas 328 patients had metastatic tumors; in 4 cases, it was impossible to determine whether the tumor was a primary one or metastasis based on CNS neuroimaging. The primary tumors proved to be more common than the metastatic ones (χ2-test, p<0.05). Multiple tumor transplants were more common than solitary (211 vs. 117; the conclusion was made at a 95% level of confidence; χ2-test, p<0.05). The majority of metastases originated from the lung (bronchus and pleura cancer; 46.41%; χ2-test, p<0.05; 95% CI). The most common localization of CNS tumors was supratentorial. Based on the double-logarithmic model, we proved with sta-tistical significance that there was an increase in the incidence of CNS tumors (p=0.001). The most common tumors studied were supratentorially localized meningiomas.Cilj je bio ispitati incidenciju i značajke tumora središnjega živčanog sustava (SŽS) u bolesnika hospitaliziranih u Klinici za neurologiju Kliničkoga bolničkog centra Split u desetogodišnjem razdoblju. U razdoblju od 1. siječnja 2004. do 31. prosinca 2013. godine u Klinici za neurologiju je bilo hospitalizirano 859 bolesnika s tumorima SŽS. Dijagnoza se temeljila na nalazima slikovnih dijagnostičkih metoda (kompjutorizirana tomografija/magnetska rezonancija mozga). Demografski i klinički podaci su prikupljeni iz povijesti bolesti bolesnika. S ciljem određivanja stope smrtnosti studija je nastavljena i ­prikupljanjem podatka iz Matične knjige umrlih. U promatranom razdoblju ukupno je bilo 448 muškaraca i 411 žena s ­tumorima SŽS. Prosječna dob postavljanja dijagnoze je bila 65 godina. Primarni tumori SŽS su dijagnosticirani u 527 ­bolesnika, uključivo 30 bolesnika s recidivirajućim primarnim tumorima, a 328 bolesnika je imalo metastatske tumore. U 4 bolesnika nije bilo moguće odrediti je li se radilo o primarnom tumoru ili metastazi na temelju neuroradioloških nalaza. Primarni tumori su bili češći od metastatskih (χ2-test, p<0,05). Multiple presadnice su bile češće od solitarnih (211 prema 117, 95% CI; χ2-test, p<0,05). Većina metastaza je bila podrijetlom iz tumora pluća (46,41%; χ2-test, p<0,05; 95% CI). Najčešći su bili supratentorijski lokalizirani tumori SŽS. Primjenom dvostruko-logaritamskog modela pokazali smo da postoji statistički začajan porast incidencije tumora SŽS u ispitivanom razdoblju. Od svih tumora SŽS najčešći su bili suptratentorijski meningeomi

TENSION-TYPE HEADACHE FROM THE ASPECTS OF PUBLIC HEALTH ISSUES AND TREATMENT POSSIBILITIES

Uvod: Tenzijska glavobolja (TTH) spada u skupinu primarnih glavobolja. Nastanak boli nije posve jasan kao ni patofiziološki proces nastanka boli. Glavobolja može biti epizodična (trajanje boli do 15 dana) ili kroničnog (trajanje boli 15 ili više dana) tipa. Cilj: Cilj ovog rada je procjena javnozdravstvenog problema tenzijske glavobolje kao i mogućnosti adekvatnog liječenja i profilakse tenzijske glavobolje. Metode: Za ovo ispitivanje koristili smo bazu podataka Pub med uzimajući pojmove; tenzijska glavobolja, prevalencija i liječenje (tension type headache, prevalence, therapy). Rezultati: Učestalost TTH značajno oscilira u ovisnosti o socioekonomskim uvjetima, a moguće i o rasnim razlikama. Učestalost raste sa životnom dobi. Češće se javlja kod žena. Liječi se analgeticima i nesteroidnim antireumaticima. Profilaksa kronične TTH provodi se primjenom amitriptilina, mirtazapina, venlafaksina. U slučaju potrebe uključuje se druga linija profilakse koja obuhvaća klomipramin, maprotilin i mianserin. Uz to koriste se i nemedikamentne mogućnosti liječenja kao što su akupunktura, biofeedback metode, kognitivno-bihevioralno liječenje, relaksacijski treninzi. Rasprava: Tenzijska glavobolja je relativno čest javno-zdravstveni problem u suvremenom svijetu čiji patofiziološki mehanizam nije posve rasvijetljen. Smatra se da je ova glavobolja multifaktorski uvjetovana. Osim epizodične glavobolje značajno veći problem je kronična tenzijska glavobolja koja zahtijeva kontinuiranu profilaksu. Nemedikamentne metode profilakse TTH su nedovoljno istražene i zahtijevaju kliničko-znanstvenu evaluaciju. Zaključak: U suvremenom svijetu tenzijska glavobolja, posebno kronična TTH, je javnozdravstveni problem koji treba zbrinjavati na adekvatan način. Uz široku lepezu medikamentne terapije nameću se i pomoćne metode liječenja koje treba dodatno evaluirati.Introduction: Tension-type headache (TTH) belongs to the group of primary headaches. The pain origin is not completely clear, nor is the pathophysiological process of its occurrence. The headache may be of episodic (lasting for up to 15 days) or chronic (lasting for 15 or more days) type. Aim: The aim of the study was to assess public health issues of TTH and the possibilities of its appropriate treatment and prophylaxis. Methods: In this research, we used the PubMed database and the words ‘tension-type headache, prevalence and therapy’. Results: The TTH prevalence signifi cantly oscillates depending on socioeconomic conditions and, possibly, race differences. The prevalence increases with age. It is more common in women. It is treated with analgesics and nonsteroidal antirheumatic agents. Chronic TTH prophylaxis includes amitriptyline, mitrazapine and venlafaxine. When necessary, second-line prophylaxis that includes clomipramine, maprotiline and mianserin is administered. Besides these, non-medicamentous treatment methods such as acupuncture, biofeedback, cognitive-behavioral treatment and relaxation trainings are also used. Discussion: In the modern world, TTH is a relatively often public-health issue the pathophysiological mechanism of which has not been clarifi ed yet. This headache is deemed to be of multifactorial cause. Besides episodic headaches, a much greater problem is chronic TTH that requires continuous prophylaxis. The non-medicamentous methods of TTH prophylaxis are insuffi ciently researched and require clinical scientifi c evaluation. Conclusion: In the modern world, TTH, especially chronic TTH, makes a public-health issue that is to be adequately treated. Besides the wide variety of medicamentous therapies, required are also auxiliary treatment methods that need to be additionally evaluated

TENSION-TYPE HEADACHE FROM THE ASPECTS OF PUBLIC HEALTH ISSUES AND TREATMENT POSSIBILITIES

Uvod: Tenzijska glavobolja (TTH) spada u skupinu primarnih glavobolja. Nastanak boli nije posve jasan kao ni patofiziološki proces nastanka boli. Glavobolja može biti epizodična (trajanje boli do 15 dana) ili kroničnog (trajanje boli 15 ili više dana) tipa. Cilj: Cilj ovog rada je procjena javnozdravstvenog problema tenzijske glavobolje kao i mogućnosti adekvatnog liječenja i profilakse tenzijske glavobolje. Metode: Za ovo ispitivanje koristili smo bazu podataka Pub med uzimajući pojmove; tenzijska glavobolja, prevalencija i liječenje (tension type headache, prevalence, therapy). Rezultati: Učestalost TTH značajno oscilira u ovisnosti o socioekonomskim uvjetima, a moguće i o rasnim razlikama. Učestalost raste sa životnom dobi. Češće se javlja kod žena. Liječi se analgeticima i nesteroidnim antireumaticima. Profilaksa kronične TTH provodi se primjenom amitriptilina, mirtazapina, venlafaksina. U slučaju potrebe uključuje se druga linija profilakse koja obuhvaća klomipramin, maprotilin i mianserin. Uz to koriste se i nemedikamentne mogućnosti liječenja kao što su akupunktura, biofeedback metode, kognitivno-bihevioralno liječenje, relaksacijski treninzi. Rasprava: Tenzijska glavobolja je relativno čest javno-zdravstveni problem u suvremenom svijetu čiji patofiziološki mehanizam nije posve rasvijetljen. Smatra se da je ova glavobolja multifaktorski uvjetovana. Osim epizodične glavobolje značajno veći problem je kronična tenzijska glavobolja koja zahtijeva kontinuiranu profilaksu. Nemedikamentne metode profilakse TTH su nedovoljno istražene i zahtijevaju kliničko-znanstvenu evaluaciju. Zaključak: U suvremenom svijetu tenzijska glavobolja, posebno kronična TTH, je javnozdravstveni problem koji treba zbrinjavati na adekvatan način. Uz široku lepezu medikamentne terapije nameću se i pomoćne metode liječenja koje treba dodatno evaluirati.Introduction: Tension-type headache (TTH) belongs to the group of primary headaches. The pain origin is not completely clear, nor is the pathophysiological process of its occurrence. The headache may be of episodic (lasting for up to 15 days) or chronic (lasting for 15 or more days) type. Aim: The aim of the study was to assess public health issues of TTH and the possibilities of its appropriate treatment and prophylaxis. Methods: In this research, we used the PubMed database and the words ‘tension-type headache, prevalence and therapy’. Results: The TTH prevalence signifi cantly oscillates depending on socioeconomic conditions and, possibly, race differences. The prevalence increases with age. It is more common in women. It is treated with analgesics and nonsteroidal antirheumatic agents. Chronic TTH prophylaxis includes amitriptyline, mitrazapine and venlafaxine. When necessary, second-line prophylaxis that includes clomipramine, maprotiline and mianserin is administered. Besides these, non-medicamentous treatment methods such as acupuncture, biofeedback, cognitive-behavioral treatment and relaxation trainings are also used. Discussion: In the modern world, TTH is a relatively often public-health issue the pathophysiological mechanism of which has not been clarifi ed yet. This headache is deemed to be of multifactorial cause. Besides episodic headaches, a much greater problem is chronic TTH that requires continuous prophylaxis. The non-medicamentous methods of TTH prophylaxis are insuffi ciently researched and require clinical scientifi c evaluation. Conclusion: In the modern world, TTH, especially chronic TTH, makes a public-health issue that is to be adequately treated. Besides the wide variety of medicamentous therapies, required are also auxiliary treatment methods that need to be additionally evaluated

Vrijeme do prijema u bolnicu kod bolesnika s akutnim moždanim udarom - opservacijska studija u Splitsko-Dalmatinskoj županiji, Hrvatska

The objective of this prospective observational study was to determine and document the time elapsed from symptom onset to hospital admission in patients with acute stroke. The study was conducted at Emergency Department, University Department of Neurology, Split University Hospital in Split, Croatia, from October 1, 2004 to December 21, 2004, and included 115 patients with acute stroke. Data on the time of onset of stroke symptoms, brain computed tomography finding and current clinical status were noted. Fifteen patients were excluded from the study because the exact time of symptom onset could not be determined. A standardized interview with patients and/or their relatives was taken to collect the information needed. Ischemic stroke was diagnosed in 82 of 100 patients. Only 13 patients arrived in hospital within 3 hours of stroke symptom onset, and 29 were admitted to hospital more than 24 hours of stroke symptom onset. Sex had no significant effect on arrival time. It was concluded that the majority of patients with acute stroke did not present to emergency department within 3 hours of symptom onset, the current time window for thrombolytic therapy. It seems crucial to identify the factors associated with late presentation to the hospital. Public recognition of stroke symptoms and understanding of the importance of early hospital admission are mandatory for improving the results recorded in this study with time elapsed from symptom onset to hospital admission and eligibility for thrombolytic therapy taken as the main outcome measures. Additional public education is needed to increase awareness of the stroke warning signs.Cilj ove prospektivne opservacijske studije bio je utvrditi i dokumentirati vrijeme proteklo od nastupa simptoma do prijema u bolnicu kod bolesnika s akutnim moždanim udarom. Studija je provedena na Hitnom odjelu Klinike za neurolog¬iju, Kliničke bolnice Split u Splitu od 1. listopada 2004. do 21. prosinca 2004. godine i uključila je 115 bolesnika s akutnim moždanim udarom. Bilježili su se podatci o vremenu nastupa simptoma moždanog udara, nalazu kompjutorizirane tomografije mozga i aktualnom kliničkom statusu. Iz studije je isključeno 15 bolesnika u kojih se točno vrijeme nastupa simptoma nije moglo utvrditi. Proveden je standardizirani razgovor s bolesnicima i/ili njihovom rodbinom kako bi se dobile potrebne informacije. Ishemijski moždani udar je utvrđen u 82 od 100 bolesnika. Samo je 13 bolesnika stiglo u bolnicu unutar 3 sata od nastupa simptoma akutnog moždanog udara, a 29 ih je u bolnicu primljeno vi.e od 24 sata od nastupa simptoma. Spol nije imao značajnog utjecaja na vrijeme dolaska u bolnicu. Rezultati su pokazali kako većina bolesnika s akutnim moždanim udarom nije pristigla na hitni odjel unutar 3 sata od nastupa simptoma, što danas predstavlja vremen¬ski okvir za trombolitičnu terapiju. Od ključne je važnosti utvrditi čimbenike koji su povezani sa zakašnjelim dolaskom u bolnicu. Opće prepoznavanje simptoma moždanog udara i shvaćanje važnosti ranog prijema u bolnicu neophodno je za poboljšanje rezultata dobivenih u ovoj studiji, u kojoj su glavne mjere ishoda bili vrijeme proteklo od nastupa simptoma do prijema u bolnicu i podobnost za trombolitičnu terapiju. Potrebna je daljnja izobrazba javnosti kako bi se povećala svijest o upozoravajućim znacima moždanoga udara

Uspješno liječenje akutnog diseminiranog encefalomijelitisa (ADEM) pravodobnom primjenom imunoglobulina – prikaz slučaja i pregled literature

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that usually affects children and young adults. It most commonly has a monophasic course, although relapses are reported. Clinical presentation of the disease includes encephalopathy and multifocal neurological deficits. There are no established reliable criteria for diagnosis of ADEM and sometimes it is difficult to distinguish it from first attack of multiple sclerosis, especially in adults. The diagnosis of ADEM is based on clinical, radiological and laboratory findings. In the treatment of ADEM, high doses of corticosteroids, plasmapheresis and immunoglobulins are used. We report a case of a young adult female patient with ADEM who fully recovered after prompt administration of high dose methylprednisolone and immunoglobulins.Akutni diseminirani encefalomijelitis (ADEM) je upalna demijelinizirajuća bolest središnjega živčanog sustava koja obično pogađa djecu i mlade odrasle osobe. Najčešće ima monofazni tijek, iako su zabilježeni i relapsi bolesti. Klinička prezentacija bolesti uključuje encefalopatiju i multifokalne neurološke deficite. Pouzdani kriteriji za dijagnozu ADEM-a nisu utvrđeni i ponekad ga je teško razlikovati od prve atake multiple skleroze, osobito kod odraslih. Dijagnoza ADEM-a temelji se na kliničkim, radiološkim i laboratorijskim nalazima. U liječenju ADEM-a primjenjuju se visoke doze kortikosteroida, plazmafereza i imunoglobulini. Prikazujemo slučaj mlade odrasle bolesnice kod koje je potpun oporavak uslijedio nakon pravodobne primjene visoke doze metilprednizolona i imunoglobulina

Psychometric Validation of the Croatian Version of the Quality of Life in Epilepsy Inventory (QOLIE-31)

The primary goals of this study were to adapt the Quality of Life in Epilepsy Inventory – 31 items (QOLIE-31) questionnaire to the Croatian language and to assess the translated questionnaire’s psychometric properties. Translation/ retranslation of the English version of the QOLIE-31 was done, and all steps for cross-cultural adaptation process were performed properly by an expert committee. Later, QOLIE-31 questionnaires and previously validated Short Form-36 (SF-36) outcome instruments were given to 200 patients with epilepsy. 172 patients (86%) responded to the first set of questionnaires, and 114 of the first time respondents (66%) returned their second survey. The two measures of reliability as internal consistency and reproducibility were determined by Cronbach a statistics and intraclass correlation coefficient, respectively. Concurrent validity was measured by comparing with a SF-36 questionnaire, and measurement was made using the Pearson correlation coefficient (r). The study demonstrated satisfactory internal consistency with high Cronbach a values for all of the corresponding domains (seizure worry 0.84, medication effects 0.80, emotional well-being 0.73, energy/fatigue 0.76, cognitive functioning 0.71, social functioning 0.77, overall quality of life 0.65). The intraclass correlation coefficient for six domains of QOLIE-31 questionnaire demonstrated excellent test/retest reproducibility (ICC 0.75), and good test/retest reproducibility (ICC 0.71) in one domain (cognitive functioning). Considering concurrent validity, three domains had excellent correlation (r=0.75–1), while 11 had good correlation (r=0.50 to 0.75), and 3 had moderate correlation (r=0.25–0.50). This study demonstrated that, if measures are to be used across cultures, the items must not only be translated well linguistically but also must be culturally adapted to maintain the content validity of the instrument at a conceptual level across different cultures. Croatian version of QOLIE-31 will be a valuable contribution to outcome measurement in epilepsy patients, particularly in the context of treatment trials, but als in a wider research context

Kompletni atrioventrikulski blok i asistolija tijekom epileptičkog napadaja: prikaz slučaja

Cardiac arrhythmias during or after epileptic seizures are one of the possible pathomechanisms of sudden unexpected death in epilepsy. These arrhythmogenic epilepsies are most commonly associated with sinus tachycardia, but atrioventricular block and asystole can also be seen. Although a rare occurrence, these arrhythmias can lead to significant morbidity and mortality, but also can be potentially preventable with pacemaker implantation. Here we describe a patient with recurrent epileptic seizures, diagnosed with ictal third-degree atrioventricular block and asystole during seizure, which required a permanent cardiac pacemaker.Srčane aritmije tijekom ili nakon epileptičkih napadaja jedan su od mogućih patomehanizama neočekivane smrti u bolesnika s epilepsijom. Ove aritmogene epilepsije najčešće su povezane sa sinus tahikardijom, ali se mogu uočiti i atrioventrikulski blok i asistolija. Iako se rijetko pojavljuju, ove aritmije mogu dovesti do značajnog pobola i smrtnosti, ali se također mogu prevenirati ugradnjom srčanog stimulatora. Ovdje opisujemo bolesnika s ponavljajućim epileptičkim napadajima i dijagnosticiranim atrioventrikulskim blokom trećeg stupnja i asistolijom tijekom napadaja kojemu je bilo potrebno ugraditi trajni srčani stimulator

Psychometric Validation of the Croatian Version of the Quality of Life in Epilepsy Inventory (QOLIE-31)

The primary goals of this study were to adapt the Quality of Life in Epilepsy Inventory – 31 items (QOLIE-31) questionnaire to the Croatian language and to assess the translated questionnaire’s psychometric properties. Translation/ retranslation of the English version of the QOLIE-31 was done, and all steps for cross-cultural adaptation process were performed properly by an expert committee. Later, QOLIE-31 questionnaires and previously validated Short Form-36 (SF-36) outcome instruments were given to 200 patients with epilepsy. 172 patients (86%) responded to the first set of questionnaires, and 114 of the first time respondents (66%) returned their second survey. The two measures of reliability as internal consistency and reproducibility were determined by Cronbach a statistics and intraclass correlation coefficient, respectively. Concurrent validity was measured by comparing with a SF-36 questionnaire, and measurement was made using the Pearson correlation coefficient (r). The study demonstrated satisfactory internal consistency with high Cronbach a values for all of the corresponding domains (seizure worry 0.84, medication effects 0.80, emotional well-being 0.73, energy/fatigue 0.76, cognitive functioning 0.71, social functioning 0.77, overall quality of life 0.65). The intraclass correlation coefficient for six domains of QOLIE-31 questionnaire demonstrated excellent test/retest reproducibility (ICC 0.75), and good test/retest reproducibility (ICC 0.71) in one domain (cognitive functioning). Considering concurrent validity, three domains had excellent correlation (r=0.75–1), while 11 had good correlation (r=0.50 to 0.75), and 3 had moderate correlation (r=0.25–0.50). This study demonstrated that, if measures are to be used across cultures, the items must not only be translated well linguistically but also must be culturally adapted to maintain the content validity of the instrument at a conceptual level across different cultures. Croatian version of QOLIE-31 will be a valuable contribution to outcome measurement in epilepsy patients, particularly in the context of treatment trials, but als in a wider research context

Incidence of Central Nervous System Tumors in Patients Hospitalized at Split University Hospital Centre During a Ten-Year Period (January 1, 2004 – December 31, 2013)

The aim was to evaluate the incidence and characteristics of central nervous system tumors in patients hospitalized at the Department of Neurology, Split University Hospital Centre, during a 10-year period. The study included data on 859 patients with the diagnosis of central nervous system (CNS) tumor. Diagnosis was based on the routine CNS neuroimaging methods (computed tomography/magnetic resonance imaging). Access to patient medical records provided demographic and clinical data, continued by collection of data on potential lethal outcome of patients at the Registrar’s Office. The study was conducted at the Department of Neurology, Split University Hospital Centre, from January 1, 2004 to December 31, 2013. There were 448 male and 411 female patients. Median age at the diagnosis was 65 (range, 18-95) years. Primary CNS tumors were diagnosed in 527 patients, including 30 primary recurrent tumors, whereas 328 patients had metastatic tumors; in 4 cases, it was impossible to determine whether the tumor was a primary one or metastasis based on CNS neuroimaging. The primary tumors proved to be more common than the metastatic ones (χ2-test, p<0.05). Multiple tumor transplants were more common than solitary (211 vs. 117; the conclusion was made at a 95% level of confidence; χ2-test, p<0.05). The majority of metastases originated from the lung (bronchus and pleura cancer; 46.41%; χ2-test, p<0.05; 95% CI). The most common localization of CNS tumors was supratentorial. Based on the double-logarithmic model, we proved with sta-tistical significance that there was an increase in the incidence of CNS tumors (p=0.001). The most common tumors studied were supratentorially localized meningiomas