COMPLETE ATRIOVENTRICULAR BLOCK AND ASYSTOLE DURING EPILEPTIC SEIZURE: A CASE REPORT.

Cardiac arrhythmias during or after epileptic seizures are one of the possible pathomechanisms of sudden unexpected death in epilepsy. These arrhythmogenic epilepsies are most commonly associated with sinus tachycardia, but atrioventricular block and asystole can also be seen. Although a rare occurrence, these arrhythmias can lead to significant morbidity and mortality, but also can be potentially preventable with pacemaker implantation. Here we describe a patient with recurrent epileptic seizures, diagnosed with ictal third-degree atrioventricular block and asystole during seizure, which required a permanent cardiac pacemaker.

Quality of life assessment in migraine and relapsing remitting multiple sclerosis: self-perceived health is similar.

OBJECTIVE: The aim of this study was to compare self-perceived health between migraine and early stages of relapsing-remitting multiple sclerosis (RRMS) and to explore whether and how accurate those health domains predict overall quality of life. METHODS: Ninety patients aged 18-55 years were enrolled in this cross-sectional study. Thirty follow-up outpatients were recruited with migraine (with or without aura), 30 patients with RRMS, and 30 healthy subjects. They were asked to complete the Health status questionnaire (SF-36) and Personal Wellbeing Index (PWI). RESULTS: Patients with RRMS and migraine had significantly worse self-reported health regarding role limitation due to physical problems and general health than the healthy control group. Additionally, migraine patients had more bodily pain, while RRMS patients expressed more difficulties regarding physical functioning. Differences between migraine and RRMS patients were not significant. Hierarchical regression analysis revealed that role limitation due to physical problems, mental health, and general health represents significant predictors of overall quality of life. CONCLUSIONS: Migraine may affect quality of life similarly to early stages of RRMS. Bio-psycho-socio-medical understanding of the two diseases and their impact on patients QoL should be reconsidered.

Quality of life and health of patients in early stages of Multiple sclerosis.

BACKGROUND: Multiple sclerosis is a chronic neurologic condition with a variety of symptoms which have a great impact on quality of life even in the early stages. The aim of this study was to investigate, and to compare overall subjective quality of life with self-perceived health in patients with early stages of MS. SUBJECTS AND METHODS: Thirty patients with MS (22 women, 8 men; mean age 37.3±9.7years; relapsing-remitting MS; EDSS<2.5; all on immunomodulatory therapy: IFN, GA) were enrolled in the study. The QOL was assessed using the Personal well-being index (PWI) and health was measured by the Short Form 36-Item Health Survey (SF-36) questionnaire. RESULTS: Results indicate that MS patients in early stage experience similar health and quality of life, comparing to the general adult population. Analysis of self-reported change in health by categories showed that 50% patients access their health about the same as a year before, 9 rate their health as worse as one year before and 5 rate their health even better. Correlation analysis revealed that SF-36 domain Mental health correlates with most PWI domains. CONCLUSION: This study demonstrates that MS patients in early stage experience similar quality of life as general adult population. Also, it was revealed that health domain Mental health is correlated with various quality of life domains, suggesting that mental health is of great significance for subjective quality of life perception. However, it is important to emphasize the distinction between the health and quality of life, due to the fact that one can perceive his/hers own health as impaired, but at the same time can have satisfactory quality of life.

SUCCESSFUL TREATMENT OF ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM) BY PROMPT USAGE OF IMMUNOGLOBULINS - CASE REPORT AND REVIEW OF THE LITERATURE.

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that usually affects children and young adults. It most commonly has a monophasic course, although relapses are reported. Clinical presentation of the disease includes encephalopathy and multifocal neurological deficits. There are no established reliable criteria for diagnosis of ADEM and sometimes it is difficult to distinguish it from first attack of multiple sclerosis, especially in adults. The diagnosis of ADEM is based on clinical, radiological and laboratory findings. In the treatment of ADEM, high doses of corticosteroids, plasmapheresis and immunoglobulins are used. We report a case of a young adult female patient with ADEM who fully recovered after prompt administration of high dose methylprednisolone and immunoglobulins.

P300 Wave Changes in Patients with Parkinson's Disease.

INTRODUCTION: Parkinson's disease (PD) is chronic progressive neurodegenerative disease. In patients with Parkinson's disease among other symptoms occur cognitive dysfunctions, which can be shown by P300 wave changes. AIM: The aim of this study was to demonstrate that patients with Parkinson's disease have reduced amplitude and prolonged latency, longer than 300 ± 10 ms. MATERIAL AND METHODS: The study included 21 patient suffering from Parkinson's disease. After reviewing the medical records and analyzes the inclusion and exclusion criteria, patients were subjected to the same procedure examining auditory cognitive potentials (P300 wave) and the results were analyzed and compared to reference value for healthy population. RESULTS: We have shown that patients with Parkinson's disease have prolonged P300 targeted and frequent stimulus latency compared to reference value for healthy population. From 21 patient 18 had a pathological P300 target stimulus amplitude, and even 20 patients had pathological P300 frequent stimulus amplitude. CONCLUSION: People with Parkinson's disease have altered P300 which indicates the presence of cognitive dysfunction in these patients.

Categorization of Ischemic Stroke Patients Compared with National Institutes of Health Stroke Scale.

INTRODUCTION: Scientific guidelines recommend the National Institutes of Health Stroke Scale (NIHSS) for ischemic stroke (IS) assessment. In Clinical Department of Neurology of Split University Hospital Center nurses use the categorization of patients (COP) according to individual needs for health care. AIM: The aim of this study was to demonstrate that there is a positive correlation between the COP and the NIHSS in IS patients. METHODS: We analyzed NIHSS scores and COP findings in 325 participants (median age 77 years, min-max: 37-95 years) with acute ISs. RESULTS: There is a statistically significant correlation between the NIHSS score at admission and COP at admission (ρ=0.717; P<0.001). There is a statistically significant correlation between the NIHSS score at discharge and COP at discharge (ρ=0.762; P<0.001). Median of NIHSS scores at admission is higher in females than in males for 2 (Z=4.45, P<0.001) and at discharge is higher for 2 (Z = 4.1, P<0.001). Median of COP at admission is higher in females than in males for 1 (Z=4.7, P<0.001) and at discharge is the same (Z=4.7, P<0.001). CONCLUSION: There is a significant association of NIHSS scores and COP in IS patients. This association exists at admission and at discharge from the hospital.

Spontaneous Splenic Rupture Following Intravenous Thrombolysis with Alteplase Applied as Stroke Therapy - Case Report and Review of Literature.

INTRODUCTION: Stroke is a medical emergency in neurology, and is one of the leading causes of death nowadays. At a recent time, a therapeutic method used in adequate conditions is thrombolysis, a treatment of an emerging clot in the brain vascular system by alteplase. The application of alteplase also has a high risk of life threatening conditions. CASE REPORT: This is a brief report of a case with thrombolysis complication which manifested as a spleen rupture.

MULTIPLE INTRACRANIAL SCHWANNOMAS: CASE REPORT.

Schwannomas are benign encapsulated tumors arising from the sheaths of peripheral nerves. They present as slowly enlarging solitary lumps, which may cause neurological defects. Multiple schwannomas in non-neurofi bromatosis type 2 patients are extremely rare. We report a case of a 60-year-old female patient, without any family history of neurofibromatosis or schwannomatosis, presented with trigeminal neuralgia and progressive facial nerve palsy. Magnetic resonance imaging revealed the presence of acoustic schwannoma involving facial nerve and trigeminal schwannoma of the cisternal part of the nerve involving gasserian ganglion (Meckel's cave). After gamma knife radiosurgery, trigeminal neuralgia was relieved completely with improvement of facial nerve palsy.

Transcranial sonography and the pocket smell test in the differential diagnosis between parkinson's disease and essential tremor.

The aim of this study was to determine the specificity and sensitivity of transcranial sonography (TCS) and the Pocket Smell Test (PST) in differing Parkinson's disease from essential tremor. The results were compared with the dopamin transporter scan (DaTSCAN) findings. Based on the DaTSCAN finding we formed a group of patients with essential tremor (51 patients) and a group with the Parkinson's disease (59 patients). The control group consisted of 26 healthy one. To evaluate the olfactory dysfunction the PST was used, whereas by TCS the substantia nigra hyperechogenicity was marked. The sensitivity and specificity of each diagnostic method was statistically calculated. In confirming Parkinson's disease the specificity of TCS was 88.2 % and the sensitivity 94.9 %. The specificity of PST was 80.4 % whereas the sensitivity was 74.6 %. TCS and PST should be performed to evaluate which patients need to be examined by DaTSCAN.

Functional Changes of P300 Values among Young Football Players as a Measure of a Cognitive Function.

Numerous studies have shown that evaluation of evoked potentials (EP) is an excellent estimation tool for a cognitive function. During daily practices footballers are exposed to headers that can leave mild head traumas. In this study, young footballers were examined, while the control group included their coevals who don't practice contact sports. Results of the study have shown that footballers have longer latency value of the P300 wave when target stimulus is presented on N1, N2 and P3, but not on P2. Also, they have longer latency values when non-target stimulus is presented. Amplitude values of target stimulus are not different, but footballers have lower amplitudes of non-target stimulus. This study suggests that EP evaluation method can be used to detect first and mild changes of the brain function.

Morphological manifestations of the Dandy-Walker syndrom in female members of a family.

The Dandy-Walker syndrome (DWS) is a hereditary disorder, appearing somewhat more frequently in women. The most important characteristics of the DWS are the lack of the cerebellar vermis, varying from a partial lack to a complete agenesis, and enlargement of the cerebrospinal spaces, especially in the fourth ventricle. The above mentioned morphological changes clinically manifest in ataxia, increased intracranial pressure and hydrocephalus. Here is presented a family with DWS, where the disease is contracted only by female members, in two generations, whereas no signs of DWS have been noticed in male family members. DWS is clinically manifested from early childhood to middle age, with the morphological changes varying from hypoplastic cerebellar vermis to widening of the brain ventricles and hydrocephalus and arachnoid cyst in the occipital part.

Psychometric validation of the Croatian version of the Quality of Life in Epilepsy Inventory (QOLIE-31).

The primary goals of this study were to adapt the Quality of Life in Epilepsy Inventory-31 items (QOLIE-31) questionnaire to the Croatian language and to assess the translated questionnaire's psychometric properties. Translation/retranslation of the English version of the QOLIE-31 was done, and all steps for cross-cultural adaptation process were performed properly by an expert committee. Later, QOLIE-31 questionnaires and previously validated Short Form-36 (SF-36) outcome instruments were given to 200 patients with epilepsy. 172 patients (86%) responded to the first set of questionnaires, and 114 of the first time respondents (66%) returned their second survey. The two measures of reliability as internal consistency and reproducibility were determined by Cronbach alpha statistics and intraclass correlation coefficient, respectively. Concurrent validity was measured by comparing with a SF-36 questionnaire, and measurement was made using the Pearson correlation coefficient (r). The study demonstrated satisfactory internal consistency with high Cronbach a values for all of the corresponding domains (seizure worry 0.84, medication effects 0.80, emotional well-being 0.73, energy/fatigue 0.76, cognitive functioning 0.71, social functioning 0.77, overall quality of life 0.65). The intraclass correlation coefficient for six domains of QOLIE-31 questionnaire demonstrated excellent test/retest reproducibility (ICC > or = 0.75), and good test/retest reproducibility (ICC 0.71) in one domain (cognitive functioning). Considering concurrent validity, three domains had excellent correlation (r = 0.75-1), while 11 had good correlation (r = 0.50 to 0.75), and 3 had moderate correlation (r = 0.25-0.50). This study demonstrated that, if measures are to be used across cultures, the items must not only be translated well linguistically but also must be culturally adapted to maintain the content validity of the instrument at a conceptual level across different cultures. Croatian version of QOLIE-31 will be a valuable contribution to outcome measurement in epilepsy patients, particularly in the context of treatment trials, but als in a wider research context.

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.

Importance of circulating platelet aggregates and haemodynamic changes in ophthalmic artery and progression of visual field loss at pseudoexfoliation glaucoma.

The aim of this work is to examine the role of circulating platelet aggregates (CPA) at pseudoexfoliation glaucoma (PXG), haemodynamic changes in the ophthalmic artery by ultrasonic color Doppler, searching for visual field progression. Vascular component at PXG and its role in VF progression dynamics has not been sufficiently explained, as well as CPA influence to ischaemic events related to optic nerve damage and VF progression. The examination included 80 patients, where of 35 (44%) men average age 68.3 +/- 7.0 and 45 (56%) women average age 65.7 +/- 7.0 (t = 1.66; p = 0.101). Forthy of them suffered from primary open angle glaucoma (POAG) as a control group (healthy), and 40 from pseudoexfoliative glaucoma (PXG) as an experimental group. All the examinees underwent complete ophthalmological examination: visual acuity, ocular fundus, intraocular pressure measured, anterior eye segment biomicroscopy with gonioscopy performed. Also VF examination was performed three times at 6 months intervals. Laboratory testing of CPA proportion values was performed by means of Wu an Hoak method and ultrasonic measurement of blood perfusion in the carotid tree, particularly concerning ophthalmic artery by means of color Doppler. Obtained decreased values of CPA proportion resulted in hypercoagulability of blood in PXG group. At PXG were also found increased blood flow resistivity indexes in ophthalmic artery (RI AO) and internal carotid artery (RI ACI), resulting with ischemia and hypoxia and finally progression of the visual filed damage. In conclusion, our study shows that examining CPA and ultrasonic monitoring of vascular parameters in ophthalmic artery with color Doppler may be the way of better understanding the vascular role in PXG prognosis.

[Comparative follow-up study of unselected male population with congenital defective color vision from inland and Mediterranean areas of Croatia]. / Komparativna studija pracenja kongenitalnih kolornih poremecaja vida neselektirane muske populacije kontinentalne i mediteranske Hrvatske.

AIM: The aim of this ten-year study (from the end of 1998 to the end of 2008) was to assess the prevalence of congenital dyschromatopsia in unselected healthy male population aged 15-45 from two Croatian regions, i.e. inland and Mediterranean parts of Croatia. Results collected in these two regions were compared and respective conclusions drawn. The results primarily referred to the prevalence of color vision disturbances and their differences according to the main color groups (dichromacy and anomalous trichromacy) and subgroups (protanopia, deuteranopia, protanomaly, deuteranomaly, and others). To our knowledge, no such a long-term study in a large population sample has been carried out in southeast Europe to date. METHODS: Color vision was examined after complete ophthalmologic examination in all subjects presenting for examination required for amateur driver license. Color vision examination was performed by use of pseudoisochromatic Ishihara tables, Nagel II anomaloscope and Panel D-15 color test at industrial medicine offices and ophthalmology departments in the two regions. There were 12,974 and 9,974 subjects in inland and Mediterranean Croatia, respectively. RESULTS: The results confirmed the hypothesis and clinical perception of a lower prevalence of color vision disturbances in southern parts, i.e. in Mediterranean Croatia (8.50%) as compared with inland Croatia (8.90%). The rate of dichromacy was higher in Mediterranean Croatia (2.40%), while the rate of anomalous trichromacy was greater in inland Croatia (6.93%). CONCLUSION: The results of this study provide better insight in the status of color vision disturbances and possible differences between the relatively close areas of north (inland) and south (Mediterranean) Croatia.

[Lumbosacral spine herniation--computed tomography diagnostics]. / Hernije lumbosakralne kraljeznice--analiza temeljem CT dijagnostike.

The aim of this retrospective study was to establish the incidence of particular types of disk radicular conflicts of the lumbar region. The study showed no patient sex or age differences. Disk radicular conflicts were most commonly diagnosed at L5-S1 and L4-L5 levels. Study results pointed to dorsomedial protrusion of the intervertebral disk to be most common in the study region, followed by dorsolateral one, whereas foraminal protrusion of the intervertebral disk was the rarest one. Study results suggested that there was no significant age or sex difference in the incidence of disk radicular conflicts of the lumbar region.

Schizophrenia spectrum psychosis in a Croatian genetic isolate: genealogical reconstructions.

BACKGROUND: Schizophrenia spectrum psychosis is a chronic mental disorder, based on a range of genes whose expression can be altered by different environmental factors. SUBJECTS AND METHODS: In this archival and demographic study of genetic isolate we show an incidence of schizophrenia spectrum psychosis in a minority population and transmission of schizophrenia spectrum psychosis through several generations of two families in an isolated rural area of Dalmatia from the second half of 19th and the first half of 20th century. RESULTS: The incidence of schizophrenia spectrum psychosis was between 0.58 and 2.58 per 1000 inhabitants. The genogram of Family 1 shows that out of 182 descendants in six generations, there were 27 people with schizophrenia spectrum psychosis. Schizophrenia spectrum psychosis occurred in two men who were born from a relationship of a mother with her relative. The genogram of Family 2 shows that 19 out of 86 descendants in five generations suffered from schizophreniform psychosis. CONCLUSION: The high occurrence of schizophrenia spectrum psychosis in an isolated village in central Dalmatia is in accordance with the results of earlier studies in that region. The fact that psychosis occurs in varying frequency, without obvious regularity, can be explained by the irregular expression of risk genes as well as by exogenous factors which may affect the activity of the key chromosome areas. Occurrence of psychosis in people born from incestuous relationships indicates the importance of genetic factors in the development of the disorder.

Neuropsychiatric systemic lupus erythematosus: diagnostic and clinical features according to revised ACR criteria.

Neuropsychiatric disorders appear in about 70% of the patients diagnosed with systemic lupus erythematosus (SLE). The aim of this study was to evaluate morphological and functional abnormalities of central nervous system (CNS) in SLE patients with neuropsychiatric manifestations (NP) of disease by testing their relationship. We tested 10 patients (9 females, 1 male) with clinical manifestations of neuropsychiatric systemic lupus erythematosus (NP-SLE). That means clinical evaluation of symptoms, standard immunoserological tests, electroencephalogram (EEG), component of audio--evoked potentials P300, MMPI-202 test, Rey Complex Test and magnetic resonance imaging (MRI). MRI abnormalities were seen in all of our patients, while in 9 patients abnormalities in neuropsychological and neurophysiologic tests have been proved. The most common structural brain change, detected by MRI, was cortical atrophy (in 8 out of 10 patients). According to revised classification of the American College of Rheumatology (ACR) NP-SLE, the most frequent disorder was cognitive dysfunction (in 9 out of 10 patients). Cortical atrophic brain changes have been established in 7 out of 9 patients with cognitive dysfunction. Because of already known correlation of cortical atrophy with cognitive dysfunction in SLE patients, without neuropsychiatric manifestation, we can conclude that neuropsychological examination is required in every patient with systemic lupus erythematosus.

[Epilepsy in the Split-Dalmatia county--prevalence and therapeutic approaches]. / Epilepsija u Splitsko-dalmatinskoj regiji--prevalencija i terapijski pristupi.

The aim of the study was to determine the prevalence of epilepsy in the Split-Dalmatia County. The study was carried out in a sample of 140,493 County inhabitants. There were 883 epilepsy patients in the study sample, showing a male predominance. The prevalence of epilepsy was 6.29/1,000 inhabitants, roughly corresponding to the results recorded in other populations. The highest prevalence was found in Vrlika, where patients with severe mental retardation are institutionalized. Other places showed a uniform distribution. The mean patient age was 41.02b +/- 3.4 years, with a mean of 1.33 drugs per patient. There was no statistically significant sex difference in the number of drugs used. The largest number of patients were on monotherapy, wherease only 0.45% of patients were taking no therapy at all. Study results are consistent to those reported in developed countries.