[Painful ophthalmoplegia--Tolosa-Hunt syndrome]. / Bolna oftalmoplegija--Tolosa-Huntov sindrom.

Tolosa Hunt syndrome is a rare disorder caused by nonspecific inflammation in the cavernous sinus/superior orbital fissure and/or orbital apex. It is clinically characterized by alternating remissions and exacerbations, and manifested as diplopia associated with unilateral periorbital hemicranial headache. The symptoms include blepharoptosis, which is usually mild if present, bulbomotor paresis involving the pupil, and loss of sensation in the area supplied by the first division of the trigeminal nerve. Therapy for Tolosa-Hunt syndrome are systemic steroids. The course of disease in a 25-year-old man hospitalized for painful ophthalmoplegia and diplopia is presented. The history included severe pain on rightward eye movement and parabulbarly on the right, considerable defect in the area supplied by the first division of the trigeminal nerve, right hemicrania, and diplopia on looking to the left, right, upward and downward that developed after four days. A month before, the patient was observed at neurology department for severe right hemicrania. Current status included severe pain parabulbarly on the right, discrete proptosis with mild ptosis on the right eye, restricted right eye bulbar motoricity on looking nasally, nasally upward and downward, and loss of sensation in the area supplied by the first division of the trigeminal nerve. Pupilar motoricity was normal. Upon admission, neuroradiologic examination (orbit CT) and brain MR were performed, and therapy with systemic corticosteroids was initiated ex iuvantibus, in consultation with a neurologist. At 24 hours of corticosteroid therapy, the pain subsided, whereas diplopia disappeared almost completely after 5 days, now being only occasionally recorded on looking to the left and upward.

Anxiety and depressive symptoms in acute ischemic stroke.

Inadequate attention is being paid to the anxiety and depressive symptoms in acute stroke, although these problems are known to influence the patients' neurological outcome. The aim of our study was to assess the prevalence of anxiety and depressive symptoms in the acute stage of ischemic stroke and to identify the factors associated with such problems. Anxiety and depressive symptoms were evaluated using the Hospital Anxiety and Depression Scale in 40 patients with acute ischemic stroke admitted during a period of one month. Statistical analyses were performed by the SigmaStat (Version 2.0) software. Study results showed 55% of study patients to suffer from depressive symptoms and 40% from both anxiety symptoms and depressive symptoms. There was a correlation of depressive symptoms (HADS-D score) with MMSE (p < 0.001), age (p = 0.003) and BI (p < 0.001), and of anxiety symptoms (HADS-A score) with MMSE (p < 0.001) and BI (p = 0.01). There was no significant association of HADS-A and HADS-D score with other patient characteristics. In conclusion, depressive symptoms were more frequent in the acute stage ofischemic stroke. Study patients had a high prevalence of both groups of symptoms. Therefore, attention should be paid to the anxiety and depressive symptoms in stroke units and try to relieve the patients' emotional stress and personal suffering, which could improve their neurological outcome.

Post-stroke fatigue.

Post-stroke fatigue is still a relatively unexplored, often neglected condition. The fatigue often manifests as physical and mental lack of energy, and many patients mention fatigue as one of the most difficult sequels to which they have to adjust. Our aim was to assess the fatigue in 35 three-month post-stroke patients and its relation to personal and stroke-related factors, and to compare them with 35 age- and sex-matched healthy control subjects. The main outcome measures for the fatigue were Fatigue Severity Scale (FSS) and Multidimensional Fatigue Inventory (MFI-20). Barthel index was used for functional status assessment, while anxiety and depressive symptoms were evaluated using Hospital Anxiety and Depression Scale (HADS). Study results showed fatigue to be frequent (45%) and often severe. Post-stroke patients showed higher values of general fatigue dimensions, physical fatigue and reduced activity. The number of subjects reporting fatigue problems on the FSS and MFI-20 scales was significantly greater in the stroke group (16/35; 45%) than in the control group (4/35; 11%; chi2 = 12.5; P < 0.001). Considering associations between fatigue and Barthel index score, age, sex, HADS-A (anxiety) and HADS-D (depression) scores, statistically significant associations were recorded between fatigue and anxiety (P = 0.01) and depression symptoms (P = 0.02). Global fatigue showed positive correlation with Barthel index score too (P = 0.01). Multivariate analysis showed that anxiety and depression symptoms could predict post-stroke fatigue (adjusted R2 = 0.556; P < 0.05). Clinical trials and follow-up studies to find an effective treatment for patients with post-stroke fatigue are warranted.

Are we ready for intravenous thrombolysis in acute stroke treatment in our region?

Acute stroke is the leading cause of disability in modern society. Early treatment is crucial to maximize the benefit of stroke intervention. Effective thrombolytic therapy is dependent on timely intervention and guidelines for the recommended use of recombinant tissue plasminogen activator therapy within 3 hours after onset of stroke symptoms. The aim of the study was to assess whether we are ready for the introduction of thrombolysis in our region. We investigated retrospectively the time from symptom onset to hospital arrival (delay time) for patients with acute stroke in our region. Medical histories of all patients admitted to the Department in 2006 with acute stroke symptoms were studied. Statistical analysis was performed by use of the SigmaStat (version 2.0) software. Study results showed that a very high rate of patients presented after 24 hours of stroke onset (35%); 15% of all acute ischemic stroke (AIS) patients arrived within 3 hours of stroke onset. Due to other exclusion criteria established, only 4% of all AIS patients were eligible for intravenous thrombolysis. Most patients arrived in the hospital too late to get maximum benefit from the emerging stroke therapies. This may be due to the failure to recognize signs and symptoms or the lack of awareness of the potential treatment benefits. Our further efforts should be focused on increasing public awareness of the stroke signs and symptoms and on reducing delay time.