SIALORRHEA AND XEROSTOMIA IN PARKINSON'S DISEASE PATIENTS.

Parkinson's disease (PD) is generally considered as a primary movement disorder, but the majority of patients also suffer from non-motor oral, salivary symptoms. The most common salivary symptoms, sialorrhea and xerostomia, have a considerable negative impact on the quality of life. Although these symptoms are completely opposite ones, both significantly impair oral health of patients. Sialorrhea is defined as an increased amount of the retaining saliva. It is related to salivary overproduction, or it may be associated with impaired clearance of saliva. Opposed to sialorrhea, xerostomia is subjectively defined as dryness of mouth and it is related to insufficient salivary secretion. Xerostomia promotes imbalance of oral microflora and oral pathology that often leads to malnutrition in PD patients. It is mostly related to autonomic dysfunction, or it might be considered as a side effect of dopaminergic or anticholinergic medication. In PD, different assessments are used for evaluation of sialorrhea and xerostomia, including validated scales for non-motor symptoms and standardized questionnaires on oral health. Consequently, treatment of salivary symptoms includes pharmacological and nonpharmacological approach, and surgical interventions. A multidisciplinary approach in clinical neurology and dental medicine, which includes accurate evaluation of salivary symptoms and effective treatment, indicates successful management of PD patients.

Cognitive Aspects in Multiple Sclerosis.

BACKGROUND: Cognitive dysfunction appears all through the course of multiple sclerosis (MS). Mild and moderate cognitive impairment is present in up to 40% of MS patients and severe cognitive decline affects more than 50% of patients in progressive course of the disease. The most common cognitive disorders in MS include diminished information processing speed, compromised word fluency, complex attention deficit and executive dysfunction. METHODS: In this mini review, we present the reader with the most common neuropsychological assessments for the evaluation of cognition in MS, addressing the question of cognitive relapse. Source of data presented in this review is PubMed search of the recently published literature on cognitive decline in MS. RESULTS: Patients with cognitive relapse often fail to meet diagnostic criteria for classical relapse in MS. Although, cognitive decline relates poorly to functional disability in MS, it correlates well with neuropsychological testing and with neuroimaging parameters of the disease. CONCLUSIONS: Cognitive decline might be considered as additional indicator of MS activity, and therefore evaluated routinely, irrespective of clinical presentation. Brief cognitive assessment, with confirmed psychometric qualities, might be useful in detection of cognitive relapse in MS patient.

THE RISK OF MULTIPLE INTRACRANIAL ANEURYSM FORMATION IN PATIENTS WITH MALIGNANT DISEASE UNDERGOING RADIATION THERAPY: A CASE REPORT AND LITERATURE REVIEW.

Neoplastic etiology of intracranial cerebral aneurysm is rare. Yet, the risk of its development is higher in malignant tumor patients receiving radiation therapy. Due to the possible negative effects of irradiation on intracranial vessel walls, the risk of aneurysm formation after radiation therapy, which is crucial for some types of breast cancer patients, continues to be a matter of debate. The aim of this study was to evaluate the hazard of multiple intracranial aneurysm development in patients with malignant disease undergoing radiation therapy. It is based on literature review and case report of a 77-year-old female patient who underwent surgery for multifocal invasive hormone-receptor positive ductal breast carcinoma of no special type, followed by chemotherapy, adjuvant radiation and hormone therapy. Her comorbidity included arterial hypertension and type 2 diabetes. Six unruptured intracranial aneurysms of different bilateral locations were diagnosed incidentally by multi-slice computed tomography angiography and digital subtraction angiography of cerebral vessels. Due to the bilateral aneurysm multiplicity, tumor characteristics and prognosis, comorbidity and relatively advanced age, the patient was not selected for active endovascular or microsurgical aneurysm treatment but only periodical clinical, oncologic and radiological follow-up was advised. In conclusion, the risk of multiple intracranial aneurysm formation in patients with breast cancer undergoing radiation therapy is low, but still possible. Long-term follow-up and regular cerebral angiographic check-up studies are necessary in selected malignant patients to decrease such a risk and to evade the worst outcome associated with aneurysm rupture.

Incidence of Stroke and Transient Ischemic Attack in Croatia: A Population Based Study.

The aim of this population based neuroepidemiological study was to establish the real incidence rates of acute cerebrovascular disease (CVD): stroke and transient ischemic attack (TIA) in the Republic of Croatia. Multicentric study included 89 501 persons of all ages in four regional centres in Croatia: Zagreb, Osijek + Slavonski Brod, Rijeka and Split. The following incidence rates of stroke, expressed at population of 100 000, have been established: Zagreb 290.52, Osijek + Slavonski Brod 302.14, Rijeka 219.65, Split 195.82. Incidence rate of stroke for the Republic of Croatia is 251.39. The following incidence rates of TIA, expressed at population of 100,000, have been established: Zagreb 87.15, Osijek + Slavonski Brod 156.53, Rijeka 90.11, Split 59.10. Incidence rate of TIA for the Republic of Croatia is 100.55. In the continental part of Croatia (Zagreb, Osijek + Slavonski Brod) incidence rate of stroke is higher by 45%, while incidence rate of TIA is higher by 82% than in the coastal part of Croatia, probably due to different lifestyle and environmental factors. The study has shown relatively high incidence rates of acute CVD (stroke and TIA) in the Republic of Croatia, which proves that CVD are a great public health problem.

[Guidelines for diagnosis, therapy and follow up of Anderson-Fabry disease]. / Smjernice za dijagnostiku, lijecenje i pracenje Anderson-Fabryjeve bolesti.

Fabry disease (Anderson-Fabry disease) is one of the most common lysosomal storage diseases (after Gaucher disease) caused by deficient activity of the α-galactosidase A (α-Gal A) enzyme, which leads to progressive accumulation of globotriaosylceramide in various cells, predominantly in endothelium and vascular smooth muscles, with multisystem clinical manifestations. Estimates of the incidence range from one per 40,000 to 60,000 in males, and 1:117,000 in the general population. Pain is usually the first symptom and is present in 60%-80% of affected children, as well as gastrointestinal disturbances, ophthalmologic abnormalities and hearing loss. Renal failure, hypertrophic cardiomyopathy, or stroke as the presenting symptom may also be found even as isolated symptoms of the disease. Life expectancy is reduced by approximately 20 years in males and 10-15 years in females, therefore enzyme replacement therapy should be introduced in patients of any age and either sex, who meet treatment criteria for Anderson-Fabry disease.

Psychological Stress and Hand Eczema in Physicians and Dentists: A Comparison Based on Surgical Work.

BACKGROUND: This research looks at the connection between psychological stress and the prevalence of hand eczema (HE) among physicians and dentists (surgeons, non-surgeons). METHODS: This cross-sectional field study involved 185 participants: physicians (surgeons, non-surgeons), dentists (surgeons, non-surgeons) and controls. Hand lesions were examined using the Osnabrueck Hand Eczema Severity Index (OHSI), and participants answered the Nordic Occupational Skin Questionnaire (NOSQ) and Perceived Stress Scale (PSS). Patch tests were performed using commercial contact allergens. RESULTS: The estimated prevalence of HE (self-reported) was 43.9% (physicians 44.6%; dentists 43.2%). HE was significantly more reported by surgeons than controls (p < 0.004; V = 0.288). Degrees of perceived stress (PSS) did not differ significantly between the groups, though physicians non-surgeons most exhibited high stress (50%), and physicians surgeons most exhibited low stress (22.5%). High stress was associated with 2.5 higher odds for self-reported HE (p = 0.008). Low stress was greater among physicians/dentists who did not report eczema (41.0% vs. 24.6%); moderate stress was more common among those who reported eczema (72.3% vs. 51.8%; p = 0.038; V = 0.210). CONCLUSIONS: Since high stress levels may negatively influence physicians'/dentists' work and quality of life, measures to decrease stress could be introduced into the treatment of healthcare workers who are prone to it.

A population-based prospective 24-month study of stroke: incidence and 30-day case-fatality rates of first-ever strokes in Croatia.

BACKGROUND: In Central/Eastern European countries, cerebrovascular diseases are among the leading causes of mortality. We aimed to determine the incidence of first-ever stroke (FES) in the north-western part of Croatia. METHODS: A population-based prospective incidence study was conducted between July 1, 2007, and June 30, 2009. Cases were sought from multiple overlapping sources. Incidence rates by stroke type and gender were calculated. RESULTS: A total of 1,487 events were recorded, 1,017 of which were FESs. European age-adjusted incidence rates (per 100,000 population) were: total FESs 223.6 [women/men rate ratio (w/m RR) = 0.65 (95% CI 0.57-0.73)]; ischemic stroke 162.4 (w/m RR = 0.65, 0.56-0.76); intracerebral hemorrhage 28.4 (w/m RR = 0.44, 0.30-0.63); subarachnoid hemorrhage 7.2 (w/m RR = 1.18, 0.55-2.54); unknown etiology 25.5 (w/m RR = 0.78, 0.54-1.14). Adjusted incidence rates of ischemic strokes by subtype were: cardioembolic 52.9 (w/m RR = 0.77, 0.59-0.99); large-artery atherosclerosis 14.4 (w/m RR = 0.22, 0.13-0.38); small-artery occlusion 24.5 (w/m RR = 0.53, 0.37-0.77) and 'other or uncertain causes' 70.6 (w/m RR = 0.77, 0.62-0.97). Thirty-day case-fatality rate was 23.5% overall and 17.1% for ischemic stroke. CONCLUSIONS: The incidence of FES and 30-day mortality of patients with ischemic strokes in the studied population is higher than in Western European countries.

Effect of elevated catecholamine levels on cerebral hemodynamics in patients with chronic post-traumatic stress disorder.

The aim of the study was to assess the correlation between the levels of catecholamines and cerebral hemodynamics in patients with chronic post-traumatic stress disorder (PTSD). The study included 50 patients with chronic PTSD hospitalized for psychiatric treatment for the first time, and 50 healthy control subjects. All study subjects were in the 30-50 age group. In PTSD group, determination of vanllylmandelic acid (VMA), an epinephrine and norepinephrine metabolite, in 24-h urine and transcranial Doppler (TCD) sonography of the circle of Willis vasculature were performed on the first day of hospital stay. The same diagnostic procedures were repeated upon the completion of 21-day medicamentous psychiatric treatment. Initial analysis revealed concurrently elevated 24-h VMA in 29 (58.00%) patients and increased values of the mean blood flow velocity (MBFV) in the circle of Willis vasculature in 34 (68.00%) patients, indicating a high correlation of the respective parameters (p = 0.3290). Second analysis performed after 21-day psychiatric treatment showed concurrently elevated 24-h VMA in eight (16.00%) patients and increased MBFV in the circle of Willis vasculature in nine (18.00%) patients, also pointing to a high correlation of the parameters observed (p = 0.7906). In the control group, only two (4.00%) subjects had elevated MBFV in the circle of Willis vessels, whereas the level of 24-h VMA was normal in all control subjects. Study results pointed to a significant association between elevated levels of stress hormones and increased MBFV in the circle of Willis vasculature caused by cerebral vasospasm. Medicamentous psychiatric treatment for PTSD administered for three weeks significantly reduced the proportion of PTSD patients with elevated levels of the catecholamine metabolite and cerebral vasospasm. Study results showed a high correlation between diurnal VMA level and elevated MBFV in the circle of Willis vessels, clearly demonstrating the effect of prolonged elevation of catecholamine levels on cerebral hemodynamics.

Brainstem raphe lesion in patients with major depressive disorder and in patients with suicidal ideation recorded on transcranial sonography.

Recent transcranial sonography (TCS) studies showed that disruption of echogenic midbrain line, corresponding to basal limbic system and raphe nuclei (RN) within, might represent functional marker for the development of depression. Major depressive disorder (MDD) is one of the most common psychiatric disorders associated with suicidal ideation. We initiated this study to assess the usefulness of TCS recording in a group of MDD patients and in MDD patients who also reported suicidal ideation, on the assumption that TCS might serve as a screening method for differentiating patients at risk of suicide. Altogether 71 subjects: 17 patients with MDD, 14 patients with MDD who also reported suicidal ideation and 40 healthy controls, were studied using TCS by two independent physicians. Reduced raphe echogenicity was found in 8 of 17 (47%) of the patients with MDD but only in 6 of 40 (15%) controls. In patients with suicidal ideations that finding was even more pronounced (12 of 14, 86%) with the highest frequency of completely not visible TCS RN finding (10 of 14, 72%). Data showed that altered echogenicity of the RN is frequent in patients with suicidal ideation. Normal RN echogenicity in MDD patients was associated with less severe depressive symptoms and rarely with the presence of suicidal ideations. As far as we know, these are the first ever obtained results which show that TCS might help differentiating MDD patients with suicidal risk or eventually predict good disease recovery based on the findings of RN hypo- or normoechogenicity.

[Transcranial sonography (TCS) in evaluation of patients with essential tremor]. / Transkranijska sonografija (TCS) u procjeni bolesnika s esencijalnim tremorom (ET).

Essential tremor is one of the most common movement disorders characterized by combination of postural bilateral action tremor with frequency 4-12MHz. Diagnosis is based on clinical examination, while neuroimaging methods so far have limited role. Recent reports showed that substantia nigra (SN) hyperechogenicity detected by transcranial sonography (TCS) is a specific finding of Parkinsons disease (PD). Usefulness of TCS in distinguishing some basal ganglia disorders is well documented. However, only a few studies showed its usage in the differentiation of the ET as a potential misdiagnosis of the PD. The aim of this study was to determine the reliability of TCS in the differentiation of patients with ET, PD and healthy controls. TCS and clinical examination was performed on 120 individuals, including 40 PD patients, 40 patients suffering from ET and 40 matched controls. Bilateral SN hyperechogenicity over the margin of 0.20 cm2 was found in 90% of PD patients, 10% of healthy subjects and in 17% patients with ET. Interobserver agreement for this method was significant. TCS may serve as a practical and sufficiently sensitive neuroimaging tool in ET diagnosing and in distinguishing it from PD, its repeatability and accuracy might add to its practical value.

[Tension-type headaches]. / Glavobolje tenzijskog tipa.

Tension-type headache is one of the most common and most significant primary headaches. Tension-type headache is a very heterogeneous disorder. It can be divided into episodic and chronic tension-type headache. The pain is a dull, pressing, tightening, typically band-like sensation. The pain is of non-pulsating quality, the location is bilateral, and there is no nausea, vomiting, phonophobia or photophobia. There are no prodromal symptoms or aura. The pain is mild to moderate and it does not aggravate with routine physical activities. Some patients have increased tenderness of pericranial muscles. Psychological factors are common in tension-type headache. Nitric oxide has an important role in the pathophysiology of chronic tension-type headache. Probably it promotes central sensitization and therefore increases nociception. In differential diagnosis of tension type-headache, all structural and metabolic diseases causing headache have to be ruled out, as well as all other primary headaches. All comorbid and coexistent states should also be considered. In the treatment of tension-type headache, pharmacological and non-pharmacological methods are employed. Analgesics, myorelaxants, anxiolytics and antidepressants are most commonly used, as well as physical therapy, massage, acupuncture, behavioral therapy and psychotherapy. Recently, the applications of botulinum toxin and acupuncture have been described in the treatment and prophylaxis of tension-type headache.

Hemispheric asymmetries in blood flow during color stimulation.

Visual stimulation influences mean blood flow velocities (MBFV) in posterior cerebral arteries (PCA). In 51 healthy, right-handed volunteers MBFV were measured in PCA with opened and closed eyes and while watching colored light (red, yellow, green, blue) for 1 minute. Volunteers had eyes closed 2 minutes between different colors. MBFV in left PCA was 41.2 +/- 8.6 cm/s (mean +/- 2SD) and 27.8 +/- 8.5 cm/s with eyes opened and closed, respectively. For red light MBFV in left PCA was 31.4 +/- 7.1 cm/s, for yellow 31.4 +/- 7.2 cm/s, for green 32.0 +/- 8.3 cm/s, and for blue 33.0 +/- 7.6 cm/s. MBFV in right PCA 41.7 +/- 8.9 cm/s and 28.2 +/- 9.1 cm/s with eyes opened and closed, respectively. For red light MBFV in right PCA was 39.4 +/- 8.4 cm/s, for yellow 38.9 +/- 9.2 cm/s, for green 37.8 +/- 9.4 cm/s and for blue 38.0 +/- 8.8 cm/s. There was no significant difference in MBFV between left and right PCA with eyes opened and closed, but MBFV were significantly higher in right PCA for each color than corresponding MBFV in left PCA. These findings could indicate the greater metabolism of visual cortex in right occipital lobe while watching colors. Visual cortex of right occipital lobe could have greater importance in color perception than visual cortex of left occipital lobe.

Efficacy and safety of Ginkgo biloba standardized extract in the treatment of vascular cognitive impairment: a randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVES: The aim of this randomized, double-blind, placebo-controlled trial was to determine the efficacy and safety of Ginkgo biloba extract in patients diagnosed with vascular cognitive impairment (VCI). METHODS: A total of 90 patients (aged 67.1±8.0 years; 59 women) were randomly allocated (1:1:1) to receive G. biloba 120 mg, G. biloba 60 mg, or placebo during a 6-month period. Assessment was made for efficacy indicators, including neuropsychological tests scores (Sandoz Clinical Assessment Geriatric Scale, Folstein Mini-Mental State Examination, Mattis Dementia Rating Scale, and Clinical Global Impression) and transcranial Doppler ultrasound findings. Safety indicators included laboratory findings, reported adverse reactions, and clinical examination. RESULTS: At the end of 6-month study period, G. biloba 120 and 60 mg showed a statistically significant positive effect in comparison with placebo only on the Clinical Global Impression score (2.6±0.8 vs 3.1±0.7 vs 2.8±0.7, respectively; P=0.038). The Clinical Global Impression score showed a significant deterioration from the baseline values in the placebo group (-0.3±0.5; P=0.021) as opposed to G. biloba groups. No significant differences were found in the transcranial Doppler ultrasound findings. Adverse reactions were significantly more common and serious in the placebo group (16 subjects) than in either of the two G. biloba extract groups (eight and nine subjects, respectively), whereas laboratory findings and clinical examinations revealed no differences between the groups receiving G. biloba extract and placebo. CONCLUSION: According to our results, G. biloba seemed to slow down the cognitive deterioration in patients with VCI, but the effect was shown in only one of the four neuropsychological tests administered. However, because of this mild effect in combination with a few adverse reactions, we cannot say that it is ineffective or unsafe either. Further studies are still needed to provide unambiguous evidence on the efficacy and safety of G. biloba extract.

Mean blood flow velocities in posterior cerebral arteries during visual stimulation.

Changes of mean blood flow velocities (MBFV) in the posterior cerebral arteries (PCA) recorded during visual stimulation in a group of 51 healthy, right-handed volunteers are presented. There were 27 (52.9%) males and 24 (47.1%) females, aged 20-59 years (mean age: 36.98 years). Measurements were performed with a hand-held 2 MHz transcranial Doppler (TCD) probe through the temporal window, with the subjects' eyes open and closed, and while they were looking at constant and at flashing white light. In half of the subjects, first the right PCA was insonated and then the left PCA, while in the other half the reverse procedure was used. Statistical analysis was done using Wilcoxon's matched-pair signed-rank test. Mean MBFV value in the left PCA was 41.2+/-8.6 cm/s (mean +/- SD) with eyes open, 27.8+/-8.5 cm/s with eyes closed, 42.3+/-9.1 cm/s while looking at constant white light, and 43.0+/-9.6 cm/s while looking at flashing white light. Mean MBFV value in the right PCA was 41.7+/-8.9 cm/s with eyes open, 28.2+/-9.1 cm/s with eyes closed, 42.4+/-8.8 cm/s while looking at constant white light, and 43.4+/-9.2 while looking at flashing white light. Value differences for the left PCA, between eyes open and closed and between looking at constant white light and looking at flashing white light were statistically significant (p<0.001, z= -6.2146, and p<0.001, z= -3.4836, respectively). For the right PCA, a value difference between eyes open and closed, and between looking at constant and flashing white light was statistically significant (p<0.001, z= -6.2146 and p<0.001, z= -3.6928), but there was no significant difference between eyes open and constant white light (p=0.03, z= -2.1693). The results showed that simple visual stimulation had an effect on blood flow velocities in PCA and that it could be measured with TCD.

Differences of blink-reflex abnormalities in patients suffering from idiopathic and symptomatic trigeminal neuralgia.

We investigated the brainstem blink reflex in patients suffering from idiopathic and symptomatic trigeminal neuralgia to establish possible dysfunction in the reflex cycle and determine eventual differences between the two disease types. The study included 35 patients with idiopathic disease and seven patients with symptomatic disease, their results compared with those of 50 normal controls. We stimulated the forehead afferents of the supraorbital nerve and recorded the response from both orbicularis oculi muscles. We tested latencies of bilateral late components (R2, R2'), irritative R3 component and the incidence of R3 component. The patients with idiopathic trigeminal neuralgia showed normal parameters of blink reflex, except for the greater incidence of R3 component. Patients with symptomatic trigeminal neuralgia showed prolonged latencies of R2, R2' and R3 components when stimulating the afflicted side, but no significant difference in incidence of R3 component compared with the control group. The results indicate that abnormalities of blink reflex are significantly different in the two groups of patients. The high incidence of R3 component seems to be typical of idiopathic disease, whereas the prolonged latencies of late reflex components after stimulation of the afflicted side seem to be typical for symptomatic disease. These results suggest that testing the blink reflex may prove a significant aid in distinguishing the idiopathic and symptomatic disease types.

Mortality of cerebrovascular diseases in Croatia--1958-1997.

The aim of this investigation was to analyze secular trend of mortality from cerebrovascular diseases in Croatia and its regional characteristics. The research comprised all deaths from cerebrovascular diseases in Croatia in persons aged between 35 and 74 years over the period 1958-1997. The investigated period is divided in eight 5-year periods, and for that 5-year periods proportional mortality rates, standardized mortality rates and specific mortality rates, according to the age and gender were calculated. Number of all deaths in the population aged 35-74 in Croatia, by 5-year periods rose from 18,913 to 26,788 (increase of 42%), deaths from cerebrovascular diseases from 2831 to 3959 (increase of 40%). Proportional mortality rate for this disease increased from 9.0% in the first 5-year period to 14.8% in the last 5-year period (increase of 64%). Standardized mortality rates for cerebrovascular diseases increased from 118 to 206 per 100,000 inhabitants (increase of 75%). The specific mortality rates over a 5-year period have shown a trend of increase in all men age groups and stagnation or decrease in women age groups. At the same time the rates standardized by age and sex increased by 62%. Standardized mortality rates for cerebrovascular diseases in continental communities (Osijek, Varazdin) are much higher (twice or even threefold) than those in coastal communities (Split, Rijeka). A data analysis showed that, although mortality trends of cerebrovascular diseases stagnated or even declined in some communities during the recent years, the secular trend for the entire country had a tendency of constant rise over the whole period of research. Therefore, the short-term prognosis predicts further increase of both the number and rates of deaths from cerebrovascular diseases in our country.

[Recommendations for care of patients with cerebral accident. Part One: Organization of care for patients with cerebral accidents, treatment of cerebral accident and neurorehabilitation]. / Preporuke za zbrinjavanje bolesnika s mozdanim udarom. Prvi Dio: Organizacija skrbi za bolesnike s mozdanim udarom, lijecenje mozdanog udara i neurorehabilitacija.

Stroke is the leading cause of disability in modern society. In developed countries stroke is the second or the third cause of death, and in Croatia it is the leading cause of death. Therefore, stroke is not only a great medical, but also economic burden. Figures show that the incidence of stroke in transitional countries is increasing, so the epidemic of stroke could be expected in the forthcoming years. The Croatian Society for Neurovascular Disorders of the Croatian Medical Association and the Croatian Stroke Society wrote the recommendations for stroke management. The first part presents the recommendations for organization of stroke care, stroke treatment and neurorehabilitation, and the second part will present the recommendations for prevention of stroke.

[Recommendations for management of patients with cerebral stroke. Part Two: Primary and secondary prevention of cerebral stroke]. / Preporuke za zbrinjavanje bolesnika s mozdanim udarom. Drugi Dio: Primarna i sekundarna prevencija mozdanog udara.

Despite the enormous progress done in the course of last years in diagnosis, treatment and rehabilitation of stroke patients, prevention is still main strategy in approaching the stroke. After the comprehensive review of the organization of stroke care, treatment and neurorehabilitation of stroke patients, this part shows the recommendations of the Croatian Society for Neurovascular Disorders of the Croatian Medical Association and the Croatian Stroke Society for primary and secondary prevention of stroke.

Person-oriented perspectives in neurology.

Person-oriented medicine is characterized by a holistic approach in patient ma- nagement that embraces physical, psychological, social and spiritual aspects of health and dise- ase. It responds to the needs of patients and health care workers to form an effective therapeutic relationship based on trust, empathy, compassion and responsiveness to the individual needs of a patient. Person-oriented perspectives in neurology include active collaborative partnership between a physician and a patient, and intuitive perception, which has a neurobiological correlate in the hu- man mirror neuron system, thus expressing a considerable impact on the quality of the physician's diagnostic and therapeutic activities. On the other hand, personalized approach in medicine implies integration of clinical information and personal genotyping. Personalized neurology provides gene- based preclinical prediction of disease with improved risk assessment, early detection of disease and targeted intervention. The combination of personalized approach and clinical information accelera- tes the translation of genetic discoveries into clinical practice, which ultimately results in improved health care system. Person-oriented perspectives contribute significantly to the growing pluralism of medical science and provide a greater humanization of medicine, individualized treatment and autonomy during therapeutic processes.

Hypertriglyceridemia as a possible independent risk factor for stroke.

There are no reliable data on the relationship between ischemic stroke and elevated triglyceride levels. Results of previous studies have shown that elevated total cholesterol, high low-density lipoprotein cholesterol (LDL-C) and low high-density lipoprotein cholesterol (HDL-C) are modifiable risk factors for ischemic stroke. Recent evidence suggests that hypertriglyceridemia correlates with an increased risk of cardiovascular disease, particularly if the levels of HDL cholesterol are low and the levels of LDL cholesterol are high. The role of hypertriglyceridemia as an independent risk factor for stroke remains questionable, although correlation between elevated triglycerides and recurrent ischemic stroke has been established. Hypertriglyceridemia is an essential feature of metabolic syndrome, the most important risk factor for atherosclerosis and prothrombotic state, and both correlate with the increased risk of stroke. Lowering triglyceride levels might have a positive effect in stroke risk reduction. Efficacy of gemfibrozil was demonstrated in secondary stroke prevention in patients with coronary heart disease and elevated triglyceride levels. Fibrate derivatives might be utilized in primary stroke prevention, but their efficacy has not yet been established. There is substantial evidence to conclude that hypertriglyceridemia might be an independent risk factor for stroke, but additional studies are mandatory to confirm this presumption.