The significance of determination of the fraction of creatinine-phosphokinase in patients with acute ischemic brain disease.

Heart and brain vascular diseases are the leading causes of mortality in the world. Cardiac complications can frequently occur during the development of cerebral ischemia. The aim of this study was to establish the possible changes in fractions of creatinine-phosphokinase as the sensitive laboratory index of parenchymal lesion of brain parenchyma and the presence/absence of risk factors for ischemic brain and heart disease. The study comprised 80 patients with acute ischemic brain disease (AIBD), without the history of previous coronary disease. Blood samples were taken in all patients within the first 48 hours from AIBD onset aiming to determine a total (muscular MM) and heart fraction of creatinine-phosphokinase (MB), and brain parenchyma ischemia was confirmed by CT or MR scan of the head. A detailed history of the risk factors for ischemic brain disease (IBD) and ischemic heart disease was taken from all patients with AIBD, and the profile of glycemia and lipid status were determined, and blood pressure was measured 6 times a day. Independent variables in statistical analysis were: age, degree of severity and the side of neurologic event, size of ischemic lesion and maximal values of systolic and dyastolic pressure. Dependent variables were the values of fractions of creatinine-phosphokinase (CPK). Control group (n = 40) comprised patients with neurologic diseases of non-vascular origin. All parameters as well as their interrelations were statistically analyzed. The results revealed significant correlation of the increased levels of CPK of MM and MB fraction with the size and place of ischemic lesion in the right cerebral hemisphere, which was highly significant for MB fraction in the total group of patients with AIBD, and for MM fraction, only for cases of more severe IBD. Highly significant increased values of those fractions were also observed compared to the control group of patients.

Brainstem auditory evoked potentials following head injury.

Brainstem auditory evoked potentials (BAEP) were examined in 40 patients with subjective disorders following closed head injury (CHI), with the established degree of recovery and performed CT-scan of the head. For all BAEP parameters the interval of normality was defined as 3 SD above and below mean value in the control group comprised of 20 healthy subjects. The upper limits of thus defined intervals of normality enabled the formation of four types of findings: type 1--normal finding that was registered in 23 (57.5%) patients; type 2 was a sum of individual findings with the prolonged interpeak latencies, but without the change of relative amplitude V:I--7 (17.5%) recordings; type 3--the findings where the fall of relative amplitude V:I was registered together with the prolongation of interpeak latency. It comprised of 4 (10%) recordings and the type 4 included 6 (15%) individual recordings with registered low RA V:I (0.8 or lower). The explanation of the most probable genesis of registered changes was presented.

[Therapeutic value of antioxidants and calcium channel blockers in patients in the acute phase of closed head injuries]. / Terapijska vrijednost antioksidanasa i blokatora kalcijumski kanala kod bolesnika sa zatvorenom povredom glave u akutnoj fazi.

Knowing that uncontrolled calcium signalization with excessive production of reactive oxidative matters is present in case of neurotrauma, aim of the investigation was to establish therapeutic value of combined administration of antioxidants (AO) and calcium channel blockers (CCB) in patients with closed head injury (CHI). Investigation comprised 120 patients with CHI who received AO (vitamins C and E) parenterally during 10 days and CCB (nimodipine), and control group was comprised of 60 patients with CHI who did not receive these medicinals in therapeutic program. We have established the influence of the therapy on neurologic and functional deficiency and consciousness disorder, respectively. Results of the investigation confirmed better recovery of all three observed parameters (degree of neurologic deficiency, degree of functional deficiency and consciousness disorder) in a group of patients receiving AO and CCB, which was statistically significant. It can be concluded that the administration of AO and CCB in patients with CHI in the acute phase should be included into therapeutic program of this significant clinical syndrome.

Plasma exchange in myasthenia gravis and multiple sclerosis.

During the last twenty-year period therapeutic plasma exchange (TPE) was used in the treatment of 68 patients with myasthenia gravis and 61 patients with multiple sclerosis. The therapeutic effects were evaluated on the basis of neurologic deficit changes, electrophysiological findings, necessary laboratory analyses and patient's general conditions. It was shown that the therapeutic effects mosty depended on the nature and stage of the basic disease, adequate selection of the patients and timely applied therapeutic procedure. Significant positive effects of the TPE treatment applied with the anti-inflammatory and immunosuppressive therapy were observed in patients with myasthenia gravis and multiple sclerosis upon clinical findings and some paraclinical tests.

[Multiple sclerosis and epilepsy]. / Multipla skleroza i epilepsija.

Epileptic seizures in the patients with multiple sclerosis (MS) were reported more than 100 years ago. The question of mutual physiopathologic association between MS and epilepsy is even nowadays controversial. The question is if epileptic seizures are the symptoms of MS or are just coincidential, i.e., are those two separate neurological diseases? The development of contemporary immunologic, electrophysiologic and neuroradiological diagnostic procedures enabled the diagnosis of MS to be much more certain, and in that way the differentiation of some symptoms and signs, as well as epileptic seizures in those patients became more reliable. In this report are presented three patients in whom the diagnosis of MS was confirmed by clinical, laboratory, immunological, electrophysiological and neuroradiological diagnostic analyses and procedures, and in whom were simultaneously clinically and/or electrophysiologically (EEG) registered epileptic seizures with specific alterations in EEG that were obviously associated with the development of primary disease--MS.

[Significance of proteinuria in patients with acute ischemic brain disease]. / Znacaj proteinurije kod bolesnika sa akutnom ishemijskom bolescu mozga.

Brain vascular diseases are ranked the third as the cause of morbidity and mortality in majority of the countries of the world. In about 80% of the cases of vascular brain diseases, it is ischemic brain disease (IBD). Atherosclerosis of main cerebral arteries is most frequently responsible for the occurrence and development of IBD. In recent years it was reported for the first time of the association of atherosclerosis and/or its complications and proteinuria. Assuming that there exists the significant association between the degree of proteinuria and clinical parameters of IBD, the aim of this study was to investigate the frequency and patterns of the association of proteinuria and clinical IBD parameters. The study was performed in 180 patients with IBD of atherothrombotic origin and 60 patients with the diseases of non-vascular origin, as the control group. In all patients quantitative determination of proteinuria was performed, and in the patients with IBD was determined the degree of IBD and afterwards the degree of functional and neurologic impairment prior to and at the end of treatment in acute phase using the standardized scales. The results of the study revealed the existence of significant frequency of proteinuria in the patients with IBD, as well as the significant association between the degree of proteinuria and severity of IBD. It was concluded that proteinuria in patients with IBD was probably associated with the atherogenic processes and physiopathologic processes of IBD, respectively, which could have predictive value for the outcome of the disease in the early stage.

[Role of nimodipine in the therapy of subarachnoid and intracerebral hemorrhage]. / Mjesto i vrijednost nimodipina u terapijskom programu subarahnoidne i intracerebralne hemoragije.

Syndromes of intracranial hemorrhage, and particularly subarachnoidal, i.e., intracerebral hemorrhage (SAH and IH) present clinical entities that are the most severe conditions in neurology. Timely recognition, diagnosis and adequate therapy are imperative. The most important factor that aggravates an already difficult prognosis of those entities is cerebral vasospasm. Upon the presented facts, the aim of this investigation was to establish the value and role of administration of selective calcium channel blocker--nimodipine in patients with SAH and IH compared to the degree of neurological and functional impairment, as well as the recovery of the function of consciousness compared to the patients with those syndromes from an earlier period, who were not treated with this medicament. Investigation comprised 30 patients who received nimodipine and 20 patients without this agent in therapeutic program. Results of the investigation confirmed significant difference concerning the neurological recovery, improvement of functional capability and recovery or consciousness disturbances, respectively, in patients who received nimodipine compared to the group without this agent. It can be concluded that nimodipine as calcium channel blocker with multitopic pharmacological effects on mechanism of SAH or IH development, respectively, as well as on the development of complications of those syndromes, particularly to the development of vasospasm and reactive ischemia, with the improvement of hemorrheologic disorders deserves to be included as the unavoidable segment of therapeutic program of SAH and IH syndrome immediately after clinical phenomenology is revealed.

The influence of the degree of cerebral atherosclerosis on the changes in hemostatic system in patients with ischemic brain disease and atherosclerotic encephalopathy.

Vascular brain diseases are ranked the third as the cause of morbidity and mortality, in spite of the progress in diagnostic, therapeutic and preventive procedures. In the majority of cases of vascular brain diseases, it is ischemic brain disease, which is the final and the most severe stage of cerebral arteries atherosclerosis. Etiopathogenesis of atherosclerosis is not closer defined yet, but oxidative hypothesis is distinguished among the numerous theories. Within this theory, main place is attached to oxidative modification of LDL and Lp(a), together with numerous physiopathologic facts with the central role of reactive oxidative matters, where endothelial dysfunction is the main disorder responsible for the onset of numerous impairments, such as changes in coagulation-anticoagulation system. Considering these facts, it was established the hypothesis that in patients with IBD existed changes in hemostatic system, which were in positive correlation with the degree of cerebral atherosclerosis. The study comprised 36 patients with acute IBD and 28 patients with atherosclerotic encephalopathy. Control group was comprised of 30 patients with non-vascular diseases of similar characteristics. We investigated the correlation of the changes in hemostatic system (platelet aggregation, anti-thrombin III, D-dimer, protein C, factor VII, factor VIII, PAI-1) compared to the degree of cerebral atherosclerosis (ultrasonographically) and compared to the observed groups of patients. On the basis of all, the results of this study revealed significant increase of procoagulant factors concentration in patients with IBD, and similar changes were observed in patients with atherosclerotic encephalopathy, but less pronounced. All these changes in the total sample of patients, and particularly in patients with the pronounced cerebral atherosclerosis, are of primary and chronic character.

[Magnetic resonance findings and cerebrospinal fluid parameters in the evaluation of blood-brain barrier status and multiple sclerosis activity]. / Nalazi magnetske rezonanci i likvorskih parmetara u proceni stanja krvno-mozdane barijere i aktivnosti multiple skleroze.

The diagnosis of disseminated demyelinating disease of central nervous system (DDD CNS) was established on clinical criteria, cerebrospinal fluid (CSF) analyses, electrophysiological and neuro-radiological examinations. The aim of this investigation was to perform an analysis of the state of blood-brain barrier and activity of demyelinating process in the patients, by the comparison of CSF findings and results of magnetic resonance (MR) examinations using paramagnetic contrast. Investigations were performed in 30 patients with DDD CNS in the phase of clinical impairment, without immunosuppressive/immunomodulatory therapy in the last 3 months. The results revealed the absence of correlation between CSF and MR findings, as in connection with the damage of blood-brain barrier, so in relation to immunologic activity of the disease. In the study are discussed the causes of these disparities that are the probable sequela of heterogenicity of physiopathologic events and disease forms inside DDD CNS.

Cerebral infarction vs. intracranial hemorrhage--validity of clinical diagnosis.

In aim to improve the validity of clinical diagnosis of acute supratentorial ischemic cerebral infarction vs. intracranial hemorrhage, two different scoring systems were analyzed, each separately and combined, on one hundred eighty-eight patients sample. Results suggested higher sensitivity and positive predictive value for Guy's Hospital score, giving it higher importance in detection of hemorrhage, while combined application of both systems, in cases with identical findings, provided sensitivity 0.95 and 0.92 negative predictive value, in certain diagnosis category. A review of complete results disclosed that application of both systems separately didn't provide satisfactory diagnostic gain in differential diagnosis of that syndrome on our sample, while combined application provided high level of accuracy, eliminating simultaneously a significant proportion of patients (43.62%), as a category of uncertain diagnosis.

Oxidative and antioxidative activity in the patients with disseminated demyelinating disease of central nervous system.

Considering the basic pathologic process and current knowledge of the physiopathologic mechanisms in the active phase of disseminated demyelinating disease of central nervous system, the increase of oxidative processes was assumed in the patients with that disease in the phase of clinical impairment. The aim of the research was to study some indices of oxidative processes and activity of antioxidative enzymes in such patients. The research was performed on blood samples (erythrocyte hemolysate and plasma) and cerebrospinal fluid of 30 patients with disseminated demyelinating disease of central nervous system during the clinical impairment and during the increase of immunologic activity in intrathecal space. The patients were of younger age, in the acute phase or with the shorter disease duration (up to 3 years). Control group was formed of 12 patients examined for lesions of intervertebral disks in lumbosacral region. The research results demonstrated the increase of superoxide anion production, the elevation of lipid peroxidation followed by the increase of superoxide dismutase and glutathione reductase activation. It was concluded that the signs of simultaneous increase of oxidative processes and antioxidative activity, but also the oxidative impairment of lipid structures existed in the studied patients during the acute phase.