Prediktori ranog nastupa depresije nakon moždanog udara

Post-stroke depression (PSD) is a severe and frequent stroke complication and one of the crucial factors for the outcome of rehabilitation and life quality after stroke. However, mood disorders frequently remain unnoticed and therefore untreated. The aim of the study was to examine all the potential risk factors and determine the independent predictors of early-onset depression after first-ever stroke, which would help identify high-risk patients, establish early diagnosis and timely treatment that would improve the course and prognosis of this disorder. This prospective study included 60 patients treated for their first-ever stroke; there were 30 patients diagnosed with depression and 30 patients without depression. The study included collection and analysis of all socio-demographic and clinical risk factors for PSD. Testing was performed two weeks after stroke. Depression was diagnosed according to the Mini International Neuropsychiatry Interview, DSM-IV diagnostic criteria, and depression severity was quantified by the Hamilton Depression Rating Scale. Cognitive impairment was assessed by the Mini Mental State Examination. Neurological deficit was assessed by the US National Institute of Health Stroke Scale. Our results showed that the independent predictors of early-onset depression after stroke were previous depressive episodes, cognitive dysfunction, and more severe neurological deficit.Depresija nakon moždanog udara je teška i česta komplikacija moždanog udara i jedan od ključnih čimbenika za ishod rehabilitacije i kvalitetu života nakon moždanog udara. Međutim, poremećaji raspoloženja ostaju najčešće neprepoznati, a samim tim i neliječeni. Cilj ovoga istraživanja bio je ispitati sve potencijalne čimbenike rizika i utvrditi nezavisne prediktore depresije koja se javlja rano nakon moždanog udara, a koji bi omogućili identifikaciju visokorizičnih bolesnika, postavljanje rane dijagnoze i pravodobno liječenje, što bi unaprijedilo tijek i prognozu ove bolesti. Prospektivno istraživanje obuhvatilo je 60 bolesnika liječenih zbog klinički prvog moždanog udara, od toga 30 bolesnika s dijagnosticiranom depresijom i 30 bolesnika bez depresije. Istraživanje je obuhvatilo podatke o svim socio-demografskim i kliničkim čimbenicima rizika za nastanak depresije nakon moždanog udara. Testiranja su provedena dva tjedna nakon moždanog udara. Depresija je dijagnosticirana prema Mini International Neuropsychiatry Interview, DSM-IV dijagnostičkim kriterijima, težina depresije kvantificirana je Hamiltonovom ljestvicom za procjenu depresivnosti (HDRS). Kognitivni status procjenjivao se pomoću Mini Mental State Examination (MMSE). Neurološki status se procjenjivao pomoću Ljestvice za moždani udar Nacionalnog instituta za zdravlje, SAD (NIHSS). Rezultati našega istraživanja ukazuju na to da su nezavisni prediktori ranog nastupa depresije nakon moždanog udara ranije depresivne epizode, kognitivne disfunkcije i teži neurološki deficit

Naša iskustva s trombolitičkom terapijom – preliminarno izvješće

Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by acting on its cause using a very powerful weapon, thrombolytic therapy. The aim is to present a preliminary report of our experiences with thrombolytic therapy in patients with ischemic stroke. Results recorded in 20 patients who received thrombolytic therapy within three hours of stroke onset are presented. Nineteen patients survived and one patient died from therapy side effects, i.e. intracerebral hematoma. Seventeen of 19 patients were released from the hospital without any neurologic deficit, while two patients had Rankin score 2 (minimum disability) three months after stroke onset. Our experience confirms that thrombolytic therapy is the treatment of choice in patients with ischemic stroke if administered in accordance with precise protocols.Moždani udar je naglo nastali, akutni oblik fokalnog ili globalnog poremećaja moždane funkcije, koji traje duže od jednog sata, poremećaja koji nema drugog vidljivog uzroka osim vaskularnog. Predstavlja završnu fazu bolesti lokalizirane na moždanim arterijama, glavni je uzrok onesposobljenosti i drugi uzrok smrtnog ishoda. U današnje vrijeme postoji mogućnost veoma uspješnog liječenja ishemijskog moždanog udara primjenom moćnog oružja, kauzalne trombolitičke terapije. Ovdje se daje preliminarni prikaz naših iskustava u primjeni trombolitičke terapije kod bolesnika s ishemijskim moždanim udarom. U radu se prikazuju rezultati liječenja 20 bolesnika koji su primili trombolitičku terapiju u prva tri sata od početnih simptoma moždanog udara, od kojih je 19 preživjelo, a jedan bolesnik je umro od sporednih učinaka terapije, tj. intracerebralnog krvarenja. Kod 17 bolesnika došlo je do potpunog oporavka bez neurološkog deficita, dok su dva bolesnika imala minimalnu onesposobljenost, Rankinov zbir 2, nakon tri mjeseca od događaja. Trombolitička terapija je i prema našim prvim iskustvima terapija izbora u liječenju ishemijskog moždanog udara, ako se primjenjuje strogo prema propisanim uputama

Funkcionalni ishod nakon liječenja trombolizom

In this paper, we report our experience from a prospective study in 40 ischemic stroke patients admitted during the last two years at University Department of Neurology Stroke Unit, Banja Luka Clinical Center, in order to assess the safety and efficacy of thrombolytic therapy, the impact of age, sex and risk factors, and functional outcome at 6 months of intravenous tissue plasminogen activator treatment. According to the National Institutes of Health Stroke Scale, there were 5 mild, 22 moderate and 13 severe stroke cases in the study group. The outcome measures at 6 months of thrombolytic treatment were taken in 38 (100%) patients, yielding a Functional Independent Measure score ≥90 (good clinical outcome) in 21 (52.50%) and modified Rankin Score ≤2 (good clinical outcome) in 22 (55%) patients. The rate of symptomatic intracerebral hemorrhage in tissue plasminogen activator treated patients was 5%, with a mortality rate of 17.50%. The outcomes were comparable with those found in the NINDS t-PA trial. Current guidelines recommend a ‘door-to needle’ time of less than 60 minutes and emphasize that ‘time is brain’.U radu iznosimo naša iskustva iz prospektivne studije kod 40 pacijenata sa ishemičnim moždanim udarom, liječenih u Jedinici za moždani udar Klinike za neurologiju Kliničkog Centra Banja Luka tokom posljednje dvije godine, da bi se procijenila pouzdanost i efikasnost trombolitičke terapije šest mjeseci nakon intravenske primjene aktivatora tkivnog plazminogena, kao i uticaj životne dobi, spola i faktora rizika na funkcionalni ishod nakon moždanog udara. Među njima je, prema skali za moždani udar Nacionalnog instituta za zdravlje SAD, bilo pet blagih, 22 umjerena i 13 teških oblika moždanog udara. Efikasnost terapije nakon šest mjeseci od trombolize kod 38 preživjelih pacijenata prezentirana je zbirom Nezavisnog funkcionalnog mjerenja ≥ 90 (dobar klinički ishod) kod 21 (52,50%) pacijenta, te kao modificirani Rankinov zbir ≤ 2 (dobar klinički ishod) kod 22 (55%) pacijenta. Učestalost intrakranijalne hemoragije bila je 5%, sa stopom smrtnosti od 17,50%. Rezultati funkcionalnog ishoda su uspoređeni sa ishodom navedenim u studiji NINDS t-PA. Važeće preporuke savjetuju da vrijeme od “vrata do igle” bude kraće od 60 minuta, naglašavajući izreku “vrijeme je mozak”

Učinak liječenja relapsno-remitentne multiple skleroze interferonom beta-1b: rezultati trogodišnje studije praćenja

The aim of this prospective study was to evaluate therapeutic effects in a cohort of 32 patients with relapsing-remitting multiple sclerosis (RRMS) that were continuously treated with interferon beta-1b during a three-year period and to compare the results obtained with literature data available. Additionally, dropouts and side effects were assessed. The annual relapse rate at three years of treatment as the primary study end-point decreased by 60.5% compared with the relapse rate throughout the pretherapeutic course of disease (0.39±0.55 vs. 0.97±0.46; P<0.001) and by 71.3% compared with the relapse rate one year prior to treatment (0.39±0.55 vs. 1.34±0.65; P<0.001). The mean Extended Disability Status Scale (EDSS) increased significantly from 2.46±0.86 at baseline to 2.90±1.30 (P<0.01) at three years of treatment, whereas the mean progression index (EDSS/disease duration) decreased significantly from 0.76±0.50 prior to treatment to 0.43±0.24 (P <0.001), yielding a 56.6% improvement and proving the disease modifying effect of interferon beta-1b. Seventeen (53.12%) patients remained relapse-free during the course of therapy. Among patients that experienced disease relapse, the mean time to first exacerbation was 11.5±8.34 months. Our study results were consistent with similar studies performed worldwide, clearly indicating that Interferon beta-1b therapy decreased the disease activity and had a beneficial effect on the progression of RRMS, with low incidence and severity of serious side effects. This study has paved way for further long-term follow up studies at our institution.Cilj ove prospektivne studije bio je procijeniti učinkovitost terapije interferonom beta-1b u grupi od 32 bolesnika oboljela od relapsno-remitentne forme multiple skleroze liječenih tokom trogodišnjeg perioda, te dobivene rezultate usporediti sa rezultatima dostupnim u literaturi. Pacijenti kod kojih je iz različitih razloga obustavljena terapija također su detaljno obrađeni. Primarni pokazatelj, godišnja stopa egzacerbacije nakon tri godine terapije, pokazala je statistički značajan pad za 60,5% u odnosu na stopu egzacerbacije tokom cijelog trajanja bolesti (sa 0,97±0,46 na 0,39±0,55), odnosno za 71,3% u odnosu na godinu prije započinjanja terapije (sa 1,34±0.65 na 0,39±0,55; P<0,001). Prosječna vrijednost EDSS se značajno povećala od 2,46±0,86 prije započinjanja terapije do prosječnih 2,90±1,30 (P<0,01), ali je srednji indeks progresije bolesti (EDSS/ duljina trajanja bolesti) bio značajno niži nakon tri godine terapije (0,43±0,24) u odnosu na indeks progresije tokom cjelokupnog trajanja bolesti (0,76±0,50; P<0,001), što čini poboljšanje od 56,6% i ukazuje na pozitivan učinak interferona beta-1b u smislu modificiranja toka bolesti. Tokom provođenja terapije 53,17% (17 pacijenata) nije imalo egzacerbaciju bolesti. Prosječno vrijeme do prve egzacerbacije među pacijentima koji su imali egzacerbaciju bilo je 11,5±8,34 mjeseci. Rezultati ove studije su u suglasnosti sa rezultatima sličnih objavljenih prospektivnih studija i pokazuju da interferon beta-1b ima pozitivan efekt na aktivnost i progresiju multiple skleroze, kao i da se ozbiljna neželjena djelovanja lijeka rijetko javljaju. Ova studija otvara mogućnost za izvođenje dugoročnih studija praćenja

Slučaj vjerojatne neurosarkoidoze koji se manifestira kao jednostrana oftalmoplegija

Sarcoidosis is a multisystem disease of unknown etiology, characterized by the presence of noncaseating epithelioid granulomas and accumulation of T lymphocytes and mononuclear phagocytes, which damages the normal structure of tissues. Isolated form of neurosarcoidosis is very rare and difficult to diagnose and requires histologic confirmation of noncaseating granulomas in the nervous tissue. We report a case of a 55-year-old female who had probable isolated neurosarcoidosis based on magnetic resonance imaging findings of relapsing pachymeningitis with an inflammatory process in the apex of the right orbit and pseudotumor inflammation of the superior and lateral recti of the right eye. Diagnosis was further verified by positive response to dual corticosteroid and immunosuppressive therapy. Our case demonstrates the importance of considering isolated neurosarcoidosis as a potential underlying etiology of painful ophthalmoplegia, even without systemic manifestation of the disease.Sarkoidoza je multisistemska bolest nepoznate etiologije koju karakterizira prisutnost nekazeoznih epiteloidnih granuloma s nakupljanjem T limfocita i mononuklearnih fagocita te narušavanjem normalne tkivne arhitektonike. Izolirani oblik neurosarkoidoze je vrlo rijedak i teško ga je dijagnosticirati te zahtijeva histološku potvrdu nekazeoznih granuloma u živčanom tkivu. Prikazujemo slučaj 55-godišnje žene koja je vjerojatno imala izoliranu neurosarkoidozu, što je zaključeno na temelju nalaza magnetske rezonancije koji je pokazao recidivirajući pahimeningitis s upalnim procesom u vrhu desne orbite i pseudotumorskom upalom gornjeg i vanjskog ravnog mišića desnog oka. Dijagnoza je dodatno potvrđena pozitivnim odgovorom na dvojnu kortikosteroidnu i imunosupresivnu terapiju. Slučaj naše bolesnice pokazuje važnost razmatranja izolirane neurosarkoidoze kao potencijalnog etiološkog uzroka bolne oftalmoplegije, čak i bez sistemske manifestacije bolesti

Utjecaj komorbiditeta na ishod rehabilitacije nakon ishemijskog moždanog udara

Comorbidity decreases survival but it still remains unknown to what extent functional recovery after ischemic stroke is affected. The aim of this research was to determine the prevalence of the most common comorbidities in patients with ischemic stroke and to examine their predictive value on the functional status and recovery. In order to obtain relevant information for this research, we conducted a prospective study over a two-year period. It included patients with acute/subacute ischemic stroke who had inhospital rehabilitation treatment in our institution. Functional status of the patients was evaluated by the following three aspects at the beginning and at the end of rehabilitation treatment: Rivermead Mobility Index was used for mobility, Barthel Index for independence in activities of daily living, and modified Rankin Scale for total disability. Modified Charlston Comorbidity Index was used to assess comorbidity. Multivariate analysis was applied to evaluate the impact of recorded comorbidities on the patient functional outcome. Independent predictors of rehabilitation success in our study were the value of modified Charlston Comorbidity Index, atrial fibrillation and myocardial infarction. Our study demonstrated that patients with more comorbidities had worse functional outcome after stroke, so it is important to consider the comorbidity status when planning the rehabilitation treatment.Komorbiditeti smanjuju preživljavanje nakon ishemijskog moždanog udara, ali još uvijek ostaje nepoznato koliki je njihov utjecaj na funkcijski oporavak. Cilj ovoga istraživanja bio je utvrditi učestalost najčešćih komorbiditeta u bolesnika s ishemijskim moždanim udarom i ispitati njihovu prediktivnu vrijednost na funkcijski status i oporavak. U cilju dobivanja relevantnih podataka za ovu studiju proveli smo prospektivno istraživanje u razdoblju od dvije godine. Studija je uključila bolesnike s akutnim/subakutnim ishemijskim moždanim udarom koji su imali bolnički rehabilitacijski tretman u našoj ustanovi. Funkcijsko stanje bolesnika je ocijenjeno s tri aspekta na početku i na kraju rehabilitacijskog tretmana: Indeks mobilnosti Rivermead je primijenjen za mobilnost, Barthelov indeks za neovisnost u aktivnostima svakodnevnog života, a modificirana Rankinova ljestvica za ukupnu onesposobljenost. Charlstonov indeks komorbiditeta modificiran za moždani udar je primijenjen za procjenu komorbiditeta u bolesnika. Multivarijatna analiza primijenjena je za procjenu utjecaja ispitivanih komorbiditeta na funkcionalni ishod bolesnika. Nezavisni prediktori uspjeha rehabilitacije u našem istraživanju bili su vrijednost Charlstonova indeksa komorbiditeta modificiranog za moždani udar, atrijska fibrilacija i infarkt miokarda. S obzirom na to da je naše istraživanje pokazalo kako bolesnici s većim brojem komorbiditeta postižu lošiji funkcijski ishod nakon ishemijskog moždanog udara, bitno je razmotriti komorbiditetni status pri planiranju rehabilitacijskog tretmana

Utjecaj depresije nakon moždanog udara na funkcionalni ishod i kvalitetu života

In spite of being a common and important complication of stroke, post stroke depression is often overlooked, so its impact on stroke outcome remains under recognized. The aim of the study was to determine the effect of depression on functional outcome and quality of life in stroke patients. The study included 60 patients treated for their first clinical stroke, 30 of them diagnosed with depression and 30 patients without depression. Testing was done in all patients two and six weeks after stroke. Depression was diagnosed according to the Mini International Neuropsychiatry Interview, DSM-IV diagnostic criteria, and depression severity was quantified by the Hamilton Depression Rating Scale; functional impairment was determined by the Barthel Index; and post stroke quality of life was assessed by the Short Form 36 (SF-36) questionnaires. The patients with depression had significantly more severe functional disability both at baseline and after rehabilitation treatment, although the potential for functional recovery in depressed patients was less than in non-depressed ones. The quality of life in patients with post stroke depression was impaired more severely in all SF-36 domains compared with non-depressed stroke patients, with the domains of the role of emotional functioning and social relations being most severely affected.Dijagnoza depresije nakon moždanog udara često se previdi, iako se radi o čestoj i važnoj komplikaciji moždanog udara, tako da je i njezin utjecaj na ishod moždanog udara zanemaren i podcijenjen. Cilj ovoga istraživanja je bio utvrditi utjecaj depresije na funkcionalni ishod i kvalitetu života bolesnika s moždanim udarom. Prospektivno istraživanje obuhvatilo je 60 bolesnika liječenih zbog klinički dijagnosticiranog prvog moždanog udara, od toga 30 bolesnika s dijagnosticiranom depresijom i 30 bolesnika bez depresije. Testiranja su provedena dva i šest tjedana nakon moždanog udara. Depresija je dijagnosticirana prema mini međunarodnom neuropsihijatrijskom intervjuu, DSM-IV dijagnostičkim kriterijima (MINI), a težina depresije kvantificirana je Hamiltonovom ljestvicom za procjenu depresivnosti. Funkcionalni status je procjenjivan pomoću Barthelova indeksa, a kvaliteta života nakon moždanog udara upitnikom Short Form 36 (SF-36). Značajno teža funkcionalna onesposobljenost zabilježena je u skupini bolesnika s depresijom, i to na početku kao i nakon završenog rehabilitacijskog tretmana. Potencijal za funkcionalni oporavak kod depresivnih bolesnika nije manji, iako je na kraju rehabilitacijskog tretmana stupanj funkcionalnih sposobnosti u ovoj skupini bio niži. Kvaliteta života depresivnih bolesnika značajno je smanjena u svim domenama upitnika SF-36 u odnosu na nedepresivne bolesnike, pri čemu je najteže oštećena uloga emocionalnog funkcioniranja te socijalni odnosi

A Case of Probable Neurosarcoidosis Presenting as Unilateral Ophthalmoplegia

Sarcoidosis is a multisystem disease of unknown etiology, characterized by the presence of noncaseating epithelioid granulomas and accumulation of T lymphocytes and mononuclear phagocytes, which damages the normal structure of tissues. Isolated form of neurosarcoidosis is very rare and difficult to diagnose and requires histologic confirmation of noncaseating granulomas in the nervous tissue. We report a case of a 55-year-old female who had probable isolated neurosarcoidosis based on magnetic resonance imaging findings of relapsing pachymeningitis with an inflammatory process in the apex of the right orbit and pseudotumor inflammation of the superior and lateral recti of the right eye. Diagnosis was further verified by positive response to dual corticosteroid and immunosuppressive therapy. Our case demonstrates the importance of considering isolated neurosarcoidosis as a potential underlying etiology of painful ophthalmoplegia, even without systemic manifestation of the disease

Impact of Individual Headache Types on the Work and Work Efficiency of Headache Sufferers

Background: Headaches have not only medical but also great socioeconomic significance, therefore, it is necessary to evaluate the overall impact of headaches on a patient&rsquo;s life, including their work and work efficiency. The aim of this study was to determine the impact of individual headache types on work and work efficiency. Methods: This research was designed as a cross-sectional study performed by administering a questionnaire among employees. The questionnaire consisted of general questions, questions about headache features, and questions about the impact of headaches on work. Results: Monthly absence from work was mostly represented by migraine sufferers (7.1%), significantly more than with sufferers with tension-type headaches (2.23%; p = 0.019) and other headache types (2.15%; p = 0.025). Migraine sufferers (30.2%) worked in spite of a headache for more than 25 h, which was more frequent than with sufferers from tension-type and other-type headaches (13.4%). On average, headache sufferers reported work efficiency ranging from 66% to 90%. With regard to individual headache types, this range was significantly more frequent in subjects with tension-type headaches, whereas 91&ndash;100% efficiency was significantly more frequent in subjects with other headache types. Lower efficiency, i.e., 0&ndash;40% and 41&ndash;65%, was significantly more frequent with migraine sufferers. Conclusions: Headaches, especially migraines, significantly affect the work and work efficiency of headache sufferers by reducing their productivity. Loss is greater due to reduced efficiency than due to absenteeism