Responses of people with epilepsy to the COVID-19 pandemic in the time of national lockdown.

The aim of our study was to gather information on how people with epilepsy (PwE) responded to the COVID-19 pandemic during the national lockdown. An online questionnaire was therefore offered to the visitors of the Croatian Association for Epilepsy's website. The 22-items questionnaire was designed to acquire information from adults with epilepsy living in Croatia on demographic data, cognitive, emotional and behavioral responses to the pandemic, and communication problems between patients and their neurologists during the lockdown. Perceived anxiety and fears were expressed with the Likert scale (1-5) and the results of specific fears added to make the Total Fear Score. Results: Out of 186 respondents in total, only 2.8% did not comply with the lockdown measures, and all of those respondents stated that they did not feel any anxiety related to COVID-19. A canceled neurologist examination during the lockdown was significantly associated with pandemic-related anxiety (2.9 ±â€¯1.28 vs. 2.3 ±â€¯1.19, U = 3039, p = 0.001) and fears (Total Fear Score 31.4 ±â€¯9.70 vs. 28.4 ±â€¯9.79, U = 3341, p = 0.036), and 87.4% of respondents expressed the wish to communicate with their neurologist, either by phone/video call (53.0%) or email (34.4%). Conclusion: We think the results of our survey show that the responses from PwE point to a social responsibility appropriate for the existing situation. During future pandemics, telemedicine could have an important role in tackling the fears and anxieties caused by the cancelation of examinations, which corresponds to the wishes expressed by the great majority of our respondents.

Epidemiology of Pharmacological Treatment of Multiple Sclerosis in Croatia.

Treatment of multiple sclerosis has been a dynamic field lately, with many new and emerging treatment options. In this study, we investigate the use of disease modifying therapies (DMTs) for multiple sclerosis in Croatia. The data on DMT use was provided by the Agency for Medicinal Products and Medical Devices of Croatia (HALMED). The data from 2005 to 2016 was available. Consumption of DMTs (in DDD/1000/day) has been increasing by 9% annually on average since 2005. In the same period, the annual cost for those drugs has been increasing by 14.6% annually on average. The consumption of IFN-beta 1-a has been increasing by a much steeper rate than IFN-beta 1-b. Until 2010 the consumption of glatiramer acetate has been negligible, with a steep increase between 2011 and 2014, and a steady rate of consumption since. Recently, several new DMTs became available, namely dimethyl fumarate, teriflunomide and fingolimod. Natalizumab became available after 2010, and its consumption has been growing steadily, but its consumption figures are exceeded by alemtuzumab. New DMTs are not as readily available in Croatia as they are in some countries. However, there is a continuous increase in the number of prescriptions, along with growing costs in pharmacological treatment of multiple sclerosis, and this can be expected to become even more pronounced in the following years, due to the abundance of new therapeutic options that are steadily becoming available.

Labels and epilepsy - An online survey of patients and those close to them.

Publications on the topic of appropriate labels for someone with diagnosed epilepsy have so far almost exclusively consisted of views of professionals in this field. We conducted an online study of patients treated for epilepsy and persons close to them with the aim of identifying which label they prefer, whether they oppose the term "epileptic", and which characteristics are related with their preferences. In total, 328 responses were analyzed. Subjects mostly favored "person-first" terminology ("person having epilepsy" and "person with epilepsy"), and 53.9% disapproved of the term "epileptic". Parents of patients are more likely than patients themselves to favor the label "person having epilepsy" and to disapprove of the label "epileptic". These results can help with shaping future terminology recommendations.

Women with epilepsy in childbearing age: Pregnancy-related knowledge, information sources, and antiepileptic drugs.

Pregnancy-related issues in epilepsy (PRIE) are essential for management of epilepsy in women. We conducted a study among women with epilepsy (WWE) aged 15-45years about their knowledge, sources, and needs for information regarding PRIE, which included their current antiepileptic drugs (AEDs) usage. Women with epilepsy, visitors of Croatian Association for Epilepsy webpage, were offered an online questionnaire, and 200 responses were analyzed. The mean number of correct answers about PRIE was 3.5 out of 5. Main predictors of knowledge on PRIE were a prior consultation with a neurologist and higher usage of books/brochures. A prior neurologist consultation on PRIE was stated by 45% of subjects. As the preferred future mode of being informed on PRIE, majority of women (61%) chooses their neurologist, 22% written materials distributed by a neurologist, and only 13% Internet. Levetiracetam was the most commonly used AED (34.5%). Valproate was used by 26%, and of those 59% stated no previous consultation on PRIE with their neurologist. In summary, we believe our study shows that knowledge of PRIE among WWE in their childbearing age is unsatisfactory, as are the neurologist consultation rates about PRIE. Our results demonstrate that, despite modern technologies, educational activities should be based on neurologist consultations and providing the patients with appropriate written materials. This is especially true for the relatively large proportion of women still taking valproate.

Epidemiological Characteristics of Dementia Treatment in Croatia.

BACKGROUND: In spite of the increase in the number of patients with dementia in countries with older population, basic epidemiologic data are still scarce. The objective of this paper is to investigate pharmacoepidemiological characteristics of treatment of dementia in Croatia, and to present them in the context of certain epidemiological characteristics that illustrate the growing pressure this disease exerts on the healthcare system. SUBJECTS AND METHODS: Data on medication utilization were taken from Croatian Health Insurance Fund (HZZO) and Agency for Medicinal Products and Medical Devices of Croatia (HALMED). Data on the number of hospital stays were supplied by Croatian Institute of Public Health (HZJZ). Internal data on the number of outpatient examinations from the Clinical hospital "Sveti Duh" were used as well. RESULTS: In the observed period (2012-2014), 4568 patients were treated with anti-dementia medications, of which 1275 (32%) with donepezil, and 2753 (68%) with memantine. According to HALMED, the utilization of those medications is constantly increasing, and has increased manifold from 2005 to 2014. The estimate of the proportion of treated patients with dementia aged 60 years and over is around 9.2%. The number of dementia-related hospital stays is also increasing, and has increased by 9.6% in the last 5-year period, compared to the preceding 5-year period. The number of outpatient examinations in Clinical Hospital "Sveti Duh" grew from 351 in 2007 to 1151 in 2015 (January 1(st) - October 26(th)). CONCLUSION: The strain this condition exerts on the healthcare system is increasing yearly. In spite of the large increase in the medication utilization over the previous years, the proportion of treated patients is still small, and further increase in their use is to be expected. It is necessary to monitor this in the years ahead.

Transient Obstructive Hydrocephalus in Patients with Intracerebral Hemorrhage: Report of Two Cases

Obstructive hydrocephalus is a relatively common complication of intraventricular hemorrhage resulting in high morbidity and mortality. We report two cases of transient obstructive hydrocephalus caused by obstruction of mesencephalic duct in patients that presented with altered consciousness which resolved spontaneously in a few hours. In very rare cases, obstructive hydrocephalus due to intraventricular hemorrhage may be transient and does not need neurosurgical or invasive procedures for lowering raised intracranial pressure, which otherwise are currently preferred treatment options.

Asymptomatic dissecting intimal lesions of common carotid arteries after carotid endarterectomy.

PURPOSE: Carotid endarterectomy is a standard treatment for symptomatic high-degree internal carotid artery stenosis. The aim of this article is to present possible intimal lesions after carotid endarterectomy. These lesions could be manifested as intimal flaps, intimal steps or dissections with or without occlusion or stenosis of the artery. METHODS: The evaluation of the frequency and characteristics of the asymptomatic dissecting intimal lesions of the common carotid arteries was performed in a sample of 100 patients who underwent endarterectomy for symptomatic high-grade stenosis of the internal carotid artery. RESULTS: We found five patients with asymptomatic dissecting intimal lesions of the common carotid arteries. CONCLUSION: The most common causes of these intimal lesions were shunting and prolongation of the clamping time. Routine carotid ultrasound follow-up exams are necessary because of the potential need for a change in the antithrombotic therapy or due to a need to perform an endovascular treatment.

[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.

Acute oxcarbazepine-induced hepatotoxicity in a patient susceptible to developing drug-induced liver injury.

Oxcarbazepine (OXC) is generally accepted as a drug without risk of severe drug-induced hepatotoxicity, but according to recently reported pharmacovigilance data this statement has been challenged. However, in the literature there have been no reports of acute OXC-induced hepatotoxicity without systemic manifestations of Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome. We present a female with seizures one month after delivery who had borderline elevated liver enzymes prior to the initiation of OXC treatment. Two weeks after introducing OXC, highly elevated liver enzymes were found. After discontinuation of OXC the enzymes continued to rise for another week, and afterward gradually decreased. The causal relationship with OXC intake was determined to be highly probable. Two years later, the transitory elevation of liver enzymes was observed during the treatment of acute tonsilopharingitis with amoxicillin + clavulanic acid. The repeated elevation of liver enzymes related to use of different drugs might indicate patients susceptibility for drug induced liver injuries. We suggest that monitoring of liver function tests would be clinically rational for early detection of acute OXC-induced liver hepatotoxicity in the patients with clinical and/or laboratory features which might be interpreted as possible risk factors of the increased susceptibility to drug induced liver injuries.

Association between hyperuricemia, prediabetes, and prehypertension in the Croatian adult population--a cross-sectional study.

BACKGROUND: The association between hyperuricemia, hypertension, and diabetes has been proved to have strong association with the risk for cardiovascular diseases, but it is not clear whether hyperuricemia is related to the early stages of hypertension and diabetes. Therefore, in this study we investigated the association between hyperuricemia, prediabetes, and prehypertension in Croatian adults, as well as that between purine-rich diet and hyperuricemia, prediabetes, or prehypertension. METHODS: A stratified random representative sample of 64 general practitioners (GP) was selected. Each GP systematically chose participants aged ≥ 40 year (up to 55 subjects) . Recruitment occurred between May and September 2008. The medical history, anthropometric, and laboratory measures were obtained for each participant. RESULTS: 59 physicians agreed to participate and recruited 2485 subjects (response rate 77%; average age (± standard deviation) 59.2 ± 10.6; 61.9% women. In bivariate analysis we found a positive association between hyperuricemia and prediabetes (OR 1.66, 95% CI 1.09-2.53), but not for prehypertension (OR 1.68, 95% CI 0.76-3.72). After controlling for known confounders for cardiovascular disease (age, gender, body mass index, alcohol intake, diet, physical activity, waist to hip ratio, total cholesterol, low density lipoprotein, high density lipoprotein, and triglycerides), in multivariate analysis HU ceased to be an independent predictor(OR 1.33, CI 0.98-1.82, p = 0.069) for PreDM. An association between purine-rich food and hyperuricemia was found (p<0.001) and also for prediabetes (p=0.002), but not for prehypertension (p=0.41). The prevalence of hyperuricemia was 10.7% (15.4% male, 7.8% female), 32.5% for prediabetes (35.4% male, 30.8% female), and 26.6% for prehypertension (27.2% male, 26.2% female). CONCLUSION: Hyperuricemia seems to be associated with prediabetes but not with prehypertension. Both, hyperuricemia and prediabetes were associated with purine-rich food and patients need to be advised on appropriate diet. TRIAL REGISTRATION: Current Controlled Trials ISRCTN31857696.

Impact of partial liberalization of driver's license regulations on the driving behavior of people with epilepsy: experience from Croatia.

Until 2005 Croatia had a driving ban for people with epilepsy (PWE) on antiepileptic therapy. To investigate the impact of partial liberalization of legislation, the results of polling performed in 1999 and 2009 were compared. The results revealed that in 1999, despite the driving ban, 46.9% of respondents had a driver's license, whereas in 2009, the majority of respondents with a driver's license (60.2%) fulfilled the requirement criterion of 2 years' remission. In both pollings, one-third of respondents answered that they were driving less often than other drivers. The rate of PWE who were driving was inversely proportional to the seizure rate. In 2009 a greater proportion stated that they drove motorcycles, and few PWE (<5%) declared they were driving more often than others. The inefficiency of rigid legislation and indicators of self-restraint of PWE may be arguments in favor of liberalization, but liberalization should be accompanied by appropriate education programs.

Continental-Mediterranean and rural-urban differences in cardiovascular risk factors in Croatian population.

AIM: To compare the distribution of cardiovascular disease (CVD) factors between continental and Mediterranean areas and urban and rural areas of Croatia, as well as to investigate the differences in achieving treatment goals by the general practitioners (GP) in different settings. METHODS: A multicenter prospective study was performed on 2467 participants of both sexes ≥40 years old, who visited for any reason 59 general practices covering the whole area of Croatia (May-July 2008). The study was a part of the Cardiovascular Risk and Intervention Study in Croatia-family medicine (CRISIC-fm) study. Patients were interviewed using a 140-item questionnaire on socio-demographics and CVD risk factors. We measured body mass index (BMI) and waist circumference and determined biochemical variables including blood pressure, total, high-density lipoprotein-, and low-density lipoprotein-cholesterol, triglycerides, glycemia, and uric acid. RESULTS: Participants from continental rural areas had significantly higher systolic and diastolic blood pressure (P<0.001), obesity (P=0.001), increased waist circumference (P<0.001), and more intense physical activity (P=0.020). Participants from coastal rural areas had higher HDL-cholesterol, participants from continental rural and coastal urban areas had higher LDL-cholesterol, and participants from rural continental had significantly higher BMI and waist circumference. CONCLUSION: Prevalence of CVD risk factors in Croatian population is high. Greater burden of risk factors in continental region and rural areas may be partly explained by lifestyle differences.

[Central sleep apnea (Ondine's curse syndrome) in medullary infarction]. / Centralna apneja u spavanju (sindrom Ondinine kletve) kod infarkta produzene mozdine.

Ondine's curse syndrome primarily refers to cases with congenital central alveolar hypoventilation, but the term can also be used for acquired cases and implies central sleep apnea that occurs as a manifestation or complication of focal lesion in the area of the dorsolateral segment of medulla oblongata. It occurs rarely, but can lead to fatal outcome. Based on our own case report, the aim of this article is to review its clinical symptoms, and appropriate diagnostic and therapeutic procedures. We present a patient who had symptoms of vascular lesion of the dorsolateral segment of the medulla, which was verified by magnetic resonance imaging. On day 12 of his hospital stay, in the early morning, rapid development of coma was observed, which was an expression of serious respiratory failure with dominant hypercapnia. In the beginning, urgent intubation and mechanical ventilation were necessary, while in the later course of the disease breathing was assisted by noninvasive methods of Bilevel Positive Airway Pressure (BiPAP) and Continuous Positive Airway Pressure (CPAP). Throughout the night, polygraph recording confirmed the diagnosis of the central sleep apnea syndrome. The course of the disease was favorable, with a very slow but constant improvement of respiratory function. According to literature data, the disease course is not always favorable. There are published cases where it was concluded that ventilatory support was no longer needed but after a long period of normal breathing hypoventilation and death occurred suddenly during sleep. The treatment of central hypoventilation consists of ventilatory support, but there were also attempts of medicamentous treatment with the common aim of raising alertness and reactibility of the automatic breathing center. It is important to emphasize that patients with the risk of central sleep apnea should not be supplied with oxygen without arterial blood gas monitoring because of the possibility of delaying the right diagnosis. The use of oxygen in patients who already have hypercapnia due to hypoventilation could further intensify hyporeactivity of the breathing center and lead to respiratory arrest.

Antithrombotic therapy in patients with non-traumatic intracerebral haemorrhage and atrial fibrillation: A retrospective study.

INTRODUCTION: The aim of the study was to determine the outcome, prescribed therapy, and localization of non-traumatic intracerebral haemorrhage in patients with atrial fibrillation. PATIENTS AND METHODS: This retrospective study enrolled patients with atrial fibrillation hospitalised for non-traumatic intracerebral haemorrhage from 2004 to 2013. We compared the patients according to previous antithrombotic therapy, demographics, previous CHADS2 score, comorbidities, the international normalised ration, localisation of intracerebral hamorrhage, stroke severity, prescribed antithrombotic therapy and outcome. RESULTS: A total of 85 patients were enrolled and assigned to an AT+ group (n = 49; 14 on aspirin, 35 on warfarin) and an AT- group (n = 36; without antithrombotic therapy prior to hospitalisation). The latter had a lower proportion of known atrial fibrillation (90% vs 47%, P < 0.001). The mean INR was 2.6 ± 1.5. The in-hospital mortality rates in both groups were high: 43% in AT+ group and 47% in AT- group. There were no significant differences in any of the predefined comparisons. CONCLUSION: Treating patients with intracerebral haemorrhage and atrial fibrillation is challenging due to higher mortality rates and issues regarding the use of antithrombotic treatment in stroke prevention. Based on our data, prior antithrombotic therapy was not associated with increased in-hospital mortality rates or poorer functional outcome at hospital discharge in comparison with no prior antithrombotic therapy.

Age-related pattern of the antiepileptic drug utilization in active epilepsy: a population-based survey.

The aim of this study was to investigate the relationship between antiepileptic drug (AED) utilization and patient age in a population of patients treated by primary health care physicians. Data were collected by using questionnaires completed by family physicians and paediatricians working in primary health care. Only patients with active epilepsy confirmed previously by neurologists or neuropaediatricans were included. One hundred and twenty-three physicians provided the requested data for 966 patients (range 1-92 years). Most frequently prescribed AEDs were barbiturates (BARB) (37%) and carbamazepine (CBZ) (37%). Valproic acid derivates (VPA) were prescribed in 28%, but the rate was higher (51%) in children. By calculating the correlation between age and the prescription of single AEDs across the whole sample, linear correlations were found for BARB (r = 0.94; p < 0.01), VPA (r = -0.93; p < 0.01) and for topiramate (TPM) (r = -0.90; p < 0.01). Since our results showed significant correlations between age and the use of the majority of AEDs, we concluded that the age may be considered a methodological bias in the presentation of data. Therefore we calculated AED utilization as the age-adjusted prevalence rates (per/1000 inhabitants). For the most commonly prescribed AEDs they were: BARB 1.8 (95% CI 1.6-2.0), CBZ 1.9 (95% CI 1.7-2.1), VPA 1.3 (95% CI 1.1-1.5), lamotrigine (LTG) 0.7 (CI 95% 0.6-0.8), TPM 0.6 (CI 95% 0.5-0.7). In conclusion, the age of patients has a significant impact on the prescription patterns not only between children and adults, but at every age. Therefore we suggest that reporting of AED utilization pattern should also include age-standardized prevalence rates of individual AED utilization.

[Specificity of hyperglycemia treatment in acute stroke patients]. / Posebnosti lijecenja hiperglikemije u bolesnika s mozdanim udarom.

INTRODUCTION: Although most of clinical studies suggest that hyperglycemia is associated with poor clinical outcome in acute stroke patients, there still are many theoretical and practical doubts that are reflected in some differences in treatment recommendations from clinical guidelines developed in Europe (European Stroke Initiative, Croatian Association for Neurovascular Disorders) and in the USA (American Stroke Association). PURPOSE: To point to the most important acts and doubts related to the acute treatment of hyperglycemia in stroke patients. METHODS: On literature review, the following databases were used: Medline (1976-2006), National Guideline Clearinghouse and Stroke Trials Registry-Internet Stroke Center. Selection of the articles depended on clinical experience and knowledge of the authors. RESULTS: The most important facts indicating a high prevalence of glucose regulation disturbances in stroke patients are highlighted, along with data on the reactive and iatrogenic pathophysiological mechanisms leading to hyperglycemia. Literature data that undoubtedly suggest an association of hyperglycemia with poor clinical outcome and the unfavorable effect of hyperglycemia on the outcome of thrombolysis are pointed out. Some contradictory data on the postulated pathophysiological mechanisms by which hyperglycemia causes cerebral damage are reviewed, especially regarding the role of tissue lactic acidosis induced by hyperglycemia. The favorable results of insulin therapy in critically ill patients are presented, along with the fact that there is still no definitive evidence that strict control of hyperglycemia can improve the outcome in stroke patients. DISCUSSION: At present, it is not possible to claim whether hyperglycemia contributes to the poor outcome of acute stroke as an independent factor or it is just a marker of the disease severity. It seems that the unfavorable effect of hyperglycemia is not only associated with the level of the brain lactic acidosis. Rather, a complex interaction of several different mechanisms appears to be involved. The threshold of blood glucose concentration at which it becomes a predictor of unfavorable outcome has not yet been exactly established. The different levels of hyperglycemia recommended to be treated with insulin partly reflect different evaluation of the guidelines regarding the potential risks of insulin-induced hypoglycemia and further iatrogenic metabolic disorders. It might be expected that the results of ongoing randomized controlled trials should contribute to developing of more precise and more harmonized clinical guidelines for the treatment of hyperglycemia in stroke patients.

[Seizures in the peracute stage of stroke: incidence and effect on inpatient mortality]. / Epilepticki napadaji u perakutnoj fazi mozdanog udara: incidencija i utjecaj na unutarbolnicki letalitet.

INTRODUCTION: According to literature data, the effect of seizures on inpatient mortality has not yet been not definitly determined and data on seizure incidence significantly vary with different methods used in various studies, AIM: Our aim was to determine the effect of seizures in the peracute stage of stroke on inpatient mortality and to detect the possible association of seizure incidence and stroke subtype, age and sex. SUBJECTS AND METHODS: Medical documentation of patients hospitalized at the ward for cerebrovascular diseases, Department of Neurology, Sveti Duh General Hospital from 1998 to 2005 was retrospectively analyzed. There were 3,542 patients with hemorrhagic or ischemic stroke. Seizures were defined as seizures occurring immediately before or within the first 24 hours of the neurological deficit development. Patients were subdivided into two groups, with and without seizures. Patients with a previous history of seizures were excluded from the study. RESULTS: In a total of 3542 patients, there were 1885 (53.21%) male and 1657 (46.78%) female patients, mean age 70.06+11.03 in the non-seizure group and 67.93 +/- 13.02 in the seizure group. Seizures were significantly more frequent (p = 0.0002, OR 2.63) in patients with hemorrhagic stroke. Seizures were observed in 42 of 2931 (1.43%) patients with ischemic stroke and in 23 of 611 (3.76%) patients with hemorrhagic stroke. Total inpatient mortality was 21.4% in the group without seizures, and 30.8% in the group with seizures (p = 0.04). The ischemic stroke inpatient mortality in the seizure group was 19.5% (17.4% in non-seizure group), and hemorrhagic stroke inpatient mortality was 52.2% in the seizure group (41% in non-seizure group). There was no significant age and sex difference between the groups with and without seizures. DISCUSSION: The rate of seizures has been estimated 1.7% to 8.9%. Different incidence rates are the result of different methods and different seizure definitions used in various studies. In our study seizures were significantly more frequent in patients with hemorrhagic stroke than in those with ischemic stroke, which is comparable to other studies. The slightly higher percentage of seizures reported in other studies is the result of the fact that they have analyzed seizures occurring from 48 hours to up to 30 days from stroke onset. The influence of seizures on inpatient mortality remains uncertain since different studies used different definitions of seizures and analyzed different stroke subtypes. Some studies found that seizures were associated with increased inpatient mortality; after accounting for stroke severity, population-based studies found no association between seizures and lethality. Our results support the conclusion that seizures cannot be taken as a prognostic factor in stroke. CONCLUSION: The incidence of seizures during the first 24 hours of stroke onset was statistically significantly higher in patients with hemorrhagic stroke than in those with ischemic stroke. When all patients irrespective of stroke subtypes were analyzed, total inpatient mortality was statistically significantly higher in the seizure group. However, there was no statistically significant difference in inpatient mortality when ischemic and hemorrhagic groups were analyzed separately. There was no age and sex difference in the rate of seizures,

Impact of troponin I on outcome of ischemic stroke patients.

INTRODUCTION: Stroke is one of the leading causes of morbidity and mortality. Cardiac troponins have been found to be increased in other conditions apart from the cardiac diseases, such as stroke. The aim of the study was to assess the correlation between elevated troponin I levels and stroke outcome. METHODS: This retrospective study included 198 acute ischemic stroke patients in whom troponin I levels have been obtained at admission. Exclusion criteria were concomitant acute coronary syndrome, congestive heart failure, pulmonary embolism, renal failure, rhabdomyolysis and septic conditions. RESULTS: There was a statistically significant difference in the proportion of deaths during hospitalization (p = 0.041) and modified Rankin Scale scores (p = 0.016) between the group of patients with elevated troponin I levels and the control group. Prior ischemic strokes were more common in the group with elevated troponin I levels (p = 0.032). No other differences were observed. CONCLUSIONS: Our study showed that patients with elevated initial troponin I levels are associated with unfavorable outcome or death. Stroke may be associated with mild elevation of troponin levels, contrary to higher levels which are usually related to other conditions.

Online epilepsy counseling in Croatia: What do users want to know?

PURPOSE: The purpose of this study is to better understand which specific epilepsy-related issues are cause for seeking out professional advice online. METHOD: An online epilepsy counseling service introduced by the Croatian Epilepsy Association allows users to anonymously submit questions related to epilepsy via e-mail or online contact form, which are later answered by an epilepsy professional. The questions were classified both by inquirers and by content. Inquirers were classified as patients, patient's parents, family members, partners, and friends of patients with epilepsy. In terms of content, questions were divided into three groups: medical, socially-oriented, and unclassifiable questions. RESULTS: In sum, 355 e-mails, which included 513 questions, were analyzed. The vast majority of inquirers were patients themselves (48%) and parents of patients (28%). While 76% of questions concerned the medical aspects of epilepsy, there was as well significant interest in administrative and practical issues associated with the diagnosis of epilepsy. Among medical questions, the most popular concerned prognosis (15%) and second opinions (14%); among socially-oriented questions, inquirers were primarily interested in matters associated with their profession (28%). As well, the parents of patients were more likely to question an epilepsy diagnosis than the patients themselves (p<0.001). CONCLUSION: According to the results of this study, it is clear that epilepsy professionals should invest more time in discussing with patients the topics which interest them the most, as well as refer them to other professionals that can help them with non-medical epilepsy-related issues, and advise them on reliable Internet sources.

Carotid Body Tumor as a Cause of Stroke.

We herein report a case of a 78-year-old woman who was admitted to our hospital due to a stroke with left-sided hemiparesis. Ultrasound of the carotid arteries showed a carotid body tumor on the bifurcation of the right common carotid artery, which was subsequently confirmed by a further neuroradiological investigation. Magnetic resonance imaging of the head confirmed an acute ischemic lesion located in the right periventricular region. The carotid body tumor (CBT) was surgically removed and confirmed on histopathology. Our case reveals the role of carotid ultrasound in the diagnosis of a CBT, which may be a potential cause of stroke.