Obostrana disekcija vertebralnih arterija – višestruko zahvaćanje arterija ili rana rekurencija?

In a certain percentage of patients with craniocervical artery dissection, dissections affect multiple arteries. Some investigators consider that the dissections diagnosed as multiple might have occurred sequentially within a short time frame. We describe an oligosymptomatic patient with bilateral progressive vertebral artery dissection. Careful history taking added new data on transient left arm weakens two months earlier, as a possibility of the earlier disease onset.U određenom postotku bolesnika s disekcijom kraniocervikalnih arterija disekcija zahvaća više arterija. Neki ispitivači smatraju da su disekcije koje su bile dijagnosticirane kao višestruke vjerojatno nastale jedna za drugom unutar kratkog razdoblja. Opisuje se oligosimptomatska bolesnica koja je imala obostranu disekciju vertebralnih arterija koja je progredirala. Pozorno uzimanje anamneze dodalo je podatke o prolaznoj slabosti lijeve ruke dva mjeseca prije hospitalizacije kao mogućnost ranijeg početka bolesti

Psihoneuroimunološki aspekti kožnih bolesti

As mental and psychological issues are important in the development of many dermatologic diseases, these factors are of special interest in research. Psychoneuroimmunology is the study of interaction between psychological processes and the nervous and immune systems of the human body, and it was comprehensively described for the first time about 30 years ago. Communication between the mind and the skin involves the psycho-immuno-endocrine-cutaneous system, encompassing the activities of the brain, the immune system and the skin, with participation of different neuropeptides, interleukins, and immune system messengers. Many common dermatologic diseases have some form of psychomediated pathogenesis that partially accounts for the development of skin lesions. There is a link between emotional stressors (acute or chronic), psychiatric diseases, and dermatoses (e.g., psoriasis, atopic dermatitis, urticaria, viral warts, herpes simplex, vitiligo, acnes, alopecia, prurigo, etc.) and different cytokines and mediators produced in the skin and involved in their pathogenesis. A prominent role is played by those agents that belong to the hypothalamic-pituitary-adrenal axis.S obzirom na to da su mentalne i psihološke značajke važne u razvoju mnogih dermatoloških bolesti, ovi čimbenici su od posebnog interesa za istraživanja. Psihoneuroimunologija obuhvaća međudjelovanje psiholoških procesa, živčanog i imunog sustava te ljudskog tijela, a prvi put je jasno opisana prije oko 30 godina. Komunikacija između psihe i kože uključuje psihološki-imuni-endokrini-kožni sustav obuhvaćajući aktivnosti mozga, imunog sustava i kože, uza sudjelovanje različitih neuropeptida, interleukina i posrednika imunog sustava. Mnoge česte dermatološke bolesti imaju neki oblik psihološki uvjetovane patogeneze koja dijelom doprinosi razvoju kožnih promjena. Pritom postoji veza između emocionalnih stresora (akutnih ili kroničnih), psihijatrijskih bolesti i dermatoza (npr. psorijaza, atopijski dermatitis, urtikarija, akne, virusne bradavice, herpes simpleks, vitiligo, alopecia, prurigo itd.) te različitih citokina i medijatora stvorenih u koži koji su uključeni u njihovu patogenezu. Istaknutu ulogu imaju tvari koje pripadaju osi hipotalamus-hipofiza-nadbubrežna žlijezda

Je li anemija zbog nedostatka željeza povezana s menstrualnom migrenom? – post hoc analiza opservacijske studije za procjenu kliničkih značajka bolesnica s menstrualnom migrenom

The aim of this study was to determine the relative prevalence and clinical characteristics of patients with pure menstrual migraine (PMM) and menstrually related migraine (MRM), and to compare them with the women free of it in an outpatient clinic-based population. Adult menstruating women with ICHD-2 migraine were included. Demographic data were obtained by verbal report. Study women were asked to keep a headache diary for 6 months, in which they recorded information on headache characteristics, medication use and presence of menses. Iron deficiency anemia was considered to be present if the patient had received therapy for iron deficiency anemia or laboratory tests indicated low iron and/or hemoglobin levels (within one year). A total of 289 women were included, 52 (18.0%) with PMM and 116 (40.1%) with MRM, whereas 121 (41.9%) women had not observed any relationship between migraine and their menstrual cycle (non- MM). Duration of migraine attacks was longer in PMM/MRM patients (P<0.0001). No significant difference was observed according to other migraine-associated symptoms. Women with PMM/ MRM took significantly more tryptans (P<0.0001) and iron deficiency anemia was significantly more common in women with PMM/MRM (P=0.008). In conclusion, this study supported earlier findings that PMM/MRM has similar clinical characteristics as non-MM, except for longer duration. In addition, iron deficiency anemia is more common in women with PMM/MRM, which may be an underlying mechanism aggravating migraine attacks.Cilj ove studije bio je utvrditi relativnu učestalost i kliničke značajke bolesnica s isključivo menstrualnom migrenom (IMM) i mentrualno povezanom migrenom (MPM) u odnosu na ostale bolesnice s migrenom. U studiju su bile uključene žene reprodukcijske dobi s migrenom prema kriterijima ICHD-2. Sudionice su zamoljene da vode dnevnik glavobolja tijekom 6 mjeseci u koji su zapisivale karakteristike glavobolja, lijekove koje su uzimale i datume menstruacije. Sideropenična anemija je evidentirana ako su laboratorijski testovi u posljednjih godinu dana ukazivali na niske razine željeza i/ili hemoglobina. U studiju je bilo uključeno 289 žena, 52 (18,0%) s IMM i 116 (40,1%) s MPM, dok 121 (41.9%) žena nije primijetila povezanost između migrene i menstrualnog ciklusa (ne-MM). Trajanje migrenskih napadaja je bilo duže kod bolesnica s IMM/MPM (P<0,0001). Nije zabilježena značajna razlika u odnosu na druge prateće simptome migrenske glavobolje. Žene s IMM/MPM značajno su češće uzimale triptane (P<0,0001). Sideropenična anemija bila je značajno češća kod žena s IMM/MPM (P=0,008). Zaključeno je kako uz duže trajanje glavobolja žene s IMM/MPM imaju i druge slične kliničke značajke kao i ne-MM. Također, sideropenična anemija bila je češća kod žena s IMM/MPM, što može biti potencijalni mehanizam koji pogoršava migrensku glavobolju

Microembolus detection by transcranial doppler sonography: review of the literature. Stroke Res Treat 2012: 382361

Transcranial Doppler can detect microembolic signals which are characterized by unidirectional high intensity increase, short duration, random occurrence, and a &quot;whistling&quot; sound. Microembolic signals have been detected in a number of clinical settings: carotid artery stenosis, aortic arch plaques, atrial fibrillation, myocardial infarction, prosthetic heart valves, patent foramen ovale, valvular stenosis, during invasive procedures (angiography, percutaneous transluminal angioplasty), surgery (carotid, cardiopulmonary bypass, orthopedic), and in certain systemic diseases. Microembolic signals are frequent in large artery disease, less commonly detected in cardioembolic stroke, and infrequent in lacunar stroke. This article provides an overview about the current state of technical and clinical aspects of microembolus detection

Prevalence of Chronic Headache in Croatia

Background. Chronic headache describes the presence of headache for >15 days per month on average for >3 months and fulfills the rest of the IHS criteria. The prevalence of chronic headache is within the range of 0.5–7.3% worldwide. The aim of this study was to determine the 1-year prevalence of chronic headache in adult Croatian population. Methods. The data were collected from a cross-sectional survey of an adult population (>18 years of age) sample. Randomly selected patients from the general population in four Croatian cities were asked to fulfill a self-completed questionnaire. The prevalence of chronic headache was calculated in the sample representing 3 383 769 Croatian adults. Results. The total sample included 1542 responders among which 616 were with headache. The 1-year prevalence of chronic headache was 2.4%, and 0.9% of responders declared having headache 30 days per month. According to these results, 81 192 adult inhabitants in Croatia suffer from chronic headache. Conclusions. The prevalence of chronic headache in Croatia is comparable to other countries worldwide. These patients require special attention and should be offered multidisciplinary medical support