Neurosyphilis in Anglo-American Composers and Jazz Musicians.

Syphilis is a sexually transmitted, systemic disease caused by the spirochete bacterium Treponema pallidum. The most common mechanism of transmission is sexual intercourse. Although there are several hypotheses, the exact origin of the disease remains unknown. Newly published evidence suggests that the hypothesis supporting the theory of the American origin of the disease is the valid one. Among 1500 analyzed pathographies of composers and musicians, data on ten Anglo-American composers and jazz musicians having suffered from neurosyphilis (tertiary stage of the disease) were extracted for this report. In this group of Anglo-American composers and musicians, most of them died from progressive paralysis while still in the creative phase of life. Additionally, diagnoses of eleven other famous neurosyphilitic composers, as well as basic biographic data on ten less known composers that died from neurosyphilis-progressive paralysis are also briefly mentioned. In conclusion, neurosyphilis can cause serious neurological damage, as well as permanent disability or death, preventing further work and skill improvement.

Stroke Caused by Lung Cancer Invading the Left Atrium.

We describe a 59-year-old stroke patient presented with sudden onset left side weakness and a speech disorder due to a major acute cerebral infarction in the area of the right middle cerebral artery, right posterior cerebral artery, and small infarctions in the area of the left middle and left posterior cerebral artery. For the previous month, the patient had been feeling weak and had no appetite. The patient had not been previously seriously ill. A chest x-ray showed a large mass in the upper zone of the right lung. Chest computed tomography scan and echocardiography were performed and revealed advanced lung cancer invading the left atrium. Spontaneous tumor embolism is a rare cause of stroke and should be considered in the differential diagnosis of stroke in a cancer patient. Also, sometimes stroke can be the first manifestation of advanced cancer.

General recommendations for the management of aneurysmal subarachnoid hemorrhage.

Subarachnoid hemorrhage is a neurologic emergency and a detrimental cerebrovascular event with a high rate of death and complications. Recommendations have been developed and based on literature search, evaluation of the results of large international clinical trials, collective experience of the authors, and endorsed by the Croatian Society of Neurovascular Disorders, Croatian Society of Neurology including Section for Neurocritical Care, Croatian Neurosurgical Society, Croatian Society for Difficult Airway Management and Croatian Medical Association. The aim of these guidelines is to provide current and comprehensive recommendations and to assist physicians in making appropriate decisions in the management of subarachnoid hemorrhage. Evidence based information on the epidemiology, risk factors and prognosis, as well as recommendations on diagnostic work up, monitoring and management are provided, with regard to treatment possibilities in Croatia.

Recommendations for the management of medical complications in patients following aneurysmal subarachnoid hemorrhage.

These are evidence based guidelines for the management of medical complications in patients following aneurysmal subarachnoid hemorrhage, developed and endorsed by the Croatian Society of Neurovascular Disorders, Croatian Society of Neurology including Section for Neurocritical Care, Croatian Neurosurgical Society, Croatian Society for Difficult Airway Management and Croatian Medical Association. They consist of recommendations for best monitoring, medical treatment and interventions based on the literature, evaluation of the results of large international clinical trials, and collective experience of the authors.

Acute polyradiculoneuritis syndrome: clinical observations and differential diagnosis.

Guillain-Barré syndrome (GBS) and neuroborreliosis may clinically manifest with symptoms related to acute polyradiculoneuritis. The aim and purpose of this study was analysis of clinical picture in patients with acute polyradiculoneuritis and their differential diagnosis into patients with GBS or meningoradiculoneuritis within the framework of neuroborreliosis. In this retrospective study, medical records of patients with acute polyradiculoneuritis hospitalized at University Department of Neurology, Sestre milosrdnice University Hospital Center during a 4-year period were analyzed. The study included data on 27 patients. Definitive diagnosis ofGBS was made in 23 patients and of neuroborreliosis in four (14.8%) patients. Acute inflammatory demyelinating polyneuropathy was recorded in 69% of GBS patients, Miller Fisher syndrome in four patients, and acute motor axonal neuropathy and/or acute motor and sensory axonal neuropathy in three patients. Clinically, patients with neuroborreliosis manifested flaccid tetraparesis, peripheral facial nerve paresis, bulbar paresis, ocular motility disorders, and sensory symptoms of radicular pain and paresthesias. Considering the relatively high prevalence of neuroborreliosis in north-west Croatia, it is important to exclude meningoradiculoneuritis caused by Borrelia burgdorferi on differential diagnosis of GBS in these patients.

Recommendations for the management of patients with carotid stenosis.

These are evidence based guidelines for the management of patients with carotid stenosis, developed and endorsed by Croatian Society of Neurovascular Disorders, Croatian Society of Neurology, Croatian Society of Ultrasound in Medicine and Biology, Croatian Society for Radiology, Croatian Society of Vascular Surgery and Croatian Society of Neurosurgery. They consist of recommendations for noninvasive screening of patients with carotid stenosis, best medical treatment and interventions such as carotid endarterectomy and stent placement based on international randomized clinical trials.

Thrombolysis for acute ischemic stroke--our experiences as part of SITS-MOST.

Thrombolysis with intravenous recombinant tissue plasminogen activator (rtPA) is the first evidence based treatment for acute ischemic stroke, which aims to reduce the cerebrovascular lesion. At University Department of Neurology, Sestre milosrdnice University Hospital, Zagreb, thrombolytic therapy with intravenous rtPA (alteplase) (Actilyse) for acute ischemic stroke was introduced in 2004. We present our results referring to demographic, time logistics and clinical outcome data as part of SITS-MOST (Safe Implementation of Thrombolysis in Stroke - MOnitoring STudy) and compare them with the results from other centers in Croatia and all other participating centers. Up to now, 56 patients (61% of male and 39% of female, average age 67 years) have been treated at our department with intravenous rt-PA (0.9 mg/kg body weight, maximum 90 mg), with 10% of the dose given as a bolus followed by 60-minute infusion. Our experiences with thrombolytic therapy with intravenous rt-PA (alteplase) (Actilyse) for acute ischemic stroke confirm the safety and the efficacy of this therapy.

Felix Mendelssohn Bartholdy (1809-1847)--Goethe's favorite.

Felix Mendelssohn, Goethe's favorite, who revealed the genius ofJohann Sebastian Bach after almost a century of oblivion, was of a fragile constitution. Last year of his life he was very depressed because of his sister Fanny's sudden death. The last month he had several attacks of severe headaches with agitation, anxiety, confusion and slow pulse. Last three days these episodes became more frequent and his overall health worsened. After stupor and coma, he died from probable subarachnoid (or cerebral) hemorrhage (with hypertension?), like his sister several months before.

Acute cerebrovascular incident caused by septic emboli: a case report.

Septic embolism is a rare disorder associated with infective endocarditis, urinary tract infections, bone infections, femoral thrombophlebitis and sinusitis. We present a 53-year-old patient with multiple systemic embolism and cerebral infarction resulting from aortal thrombus after surgical treatment of the right fibular malleolar fracture with osteosynthetic material placement. After the surgery, the patient became antisocial, with decreased appetite and substantial weight loss. Computerized tomography scan showed several small hypodense zones in the supratentorial and periventricular region of the brain as well as bilateral pleural effusion, large infarcts of the spleen and right kidney, smaller infarcts of the lower pole of the right kidney, discontinuity of the wall of the thoraco-abdominal aorta and a thrombus present in the distal part of abdominal aorta. The findings primarily indicated septic emboli. The right ankle x-ray showed still present postoperative fracture gap of the right fibular malleolus with reduced bone mineralization but no signs of bone destruction. Control MSCT of the abdomen showed a large spleen abscess of 10x6 cm in size. Due to edema of the right ankle, ultrasonography was performed to reveal a thick content in the joint. The patient was transferred to University Department of Surgery, where splenectomy with evacuation of the perisplenic abscess together with extraction of the osteosynthetic material of the right fibular malleolus was performed. If not promptly diagnosed, septic emboli can cause devastating neurologic damage. In our patient, early diagnosis and intensive physical therapy facilitated almost complete regression of his neurologic deficit.

Stroke unit--where all stroke patients should be treated.

Acute stroke is one of the leading causes of morbidity and mortality worldwide, and as the most important cause of morbidity and long-term disability imposes an enormous economic burden. Stroke units (SU) are an effective option to fight stroke. According to the European Stroke Organization, SU should provide coordinated multidisciplinary care provided by medical personnel specialized in stroke care. Helsingborg declaration from 1995 urged for organized management of acute stroke in order to reduce mortality below 20% (SU for all stroke patients) and to achieve independency in more than 70% of 3-month stroke survivors. At the beginning of 2001, the first Croatian SU was established at Sestre milosrdnice University Hospital in Zagreb as a hospital ward with dedicated multidisciplinary stroke team consisting of neurologists specialized in the management of cerebrovascular disease, trained nurses and rehabilitation personnel, together with other professionals to enable treatment of stroke patients according to current guidelines.

The evaluation of the stroke unit in Croatia at the University Hospital Sestre milosrdnice, Zagreb: 1995-2006 experience.

This study evaluate the effects of the Stroke Unit (SU) in Croatia by comparing the in-hospital case fatality rate in the period before (1995-2000) and after (2001-2006) the implementation of SU and to compare the prevalence of risk factors, such as hypertension, diabetes mellitus (DM), atrial fibrillation (AF) and ischemic heart disease (IHD) among the patients who died. The study was conducted in twelve-year period during which 10,901 stroke patients were admitted to hospital and 1818 of them died. The endpoints were in-hospital case fatality rate and prevalence of risk factors among the patients who died. Before the SU period the case fatality rate was 20.1%, whereas afterwards it decreased significantly to 12.8% (p < 0.001). The relative risk (RR) was 1.57, while the estimate of the odds ratio (OR) showed a 71% increase in chances of death in the pre-SU period. The prevalence of DM, IHD and AF increased significantly, while hypertension was the only risk factor which significantly decreased (p < 0.001). The results showed that the implementation of SU care is associated with a significant reduction of in-hospital case fatality rate of acute stroke patients which strongly suggests that development of the SU network in Croatia should be given priority in the health management.