Prevalence and clinical characteristics of headache in adolescents: a Croatian epidemiological study.

BACKGROUND: Headaches are often under-diagnosed in adolescents. The aim of this study was to examine the one-year prevalence of primary headaches among high school students in the city of Zagreb, the capital of Croatia. METHODS: This was a population-based, cross-sectional study. A total of 2350 questionnaires consisting of questions on demographic data, the presence and clinical characteristics of headaches were distributed among students in eight high schools; 2057 (87.5%) questionnaires were eligible for analysis. RESULTS: The mean age of the students was 17.2 ± 1.2 years; 50.2% were female. The prevalence of recurrent headache was 30.1% (620/2057), girls 35.1%, boys 25.2%. Among students with headache, 291 (46.9%) had migraine, and 329 (53.1%) had tension-type headaches (TTHs). The mean frequency of headaches was 5.66 per month in girls and 4.42 in boys; mean duration of a headache attack was 8.94 hours in girls and 8.37 hours in boys (NS). Unilateral headache was present in 31.6%, throbbing quality in 22.6%, dull in 34.4% of students; 22.4% had severe intensity and 70.3% moderate. Nausea was present in 4.0% always and in 14.7% frequently (girls 18.8%), photophobia in 41.3%, phonophobia in 63.2%, osmophobia in 23.9% (NS among genders). Almost 30% of students were disabled and stayed at home, more frequently boys. Girls (33.4%) were more likely to take drugs for every attack; number per month was 3.7. The results of this study showed that the prevalence of migraine among adolescents in Croatia was 16.5% for girls and 11.8% for boys; the prevalence of TTH was 18.4% for girls and 13.4% for boys. CONCLUSIONS: The prevalence of self-reported headache among high school students in Zagreb is relatively high. Significant gender differences in frequency and clinical characteristics were observed. Primary headaches among adolescents are an important public health problem and should receive more attention from school and health authorities.

Use of cerebrospinal fluid biomarker analysis for improving Alzheimer's disease diagnosis in a non-specialized setting.

Low levels of amyloid-beta42 (Abeta42) and high total-tau (t-tau) or phosphorylated-tau (p181-tau) levels in cerebrospinal fluid (CSF) were shown to be characteristic for Alzheimer's disease (AD) patients and for mildly cognitively impaired (MCI) or non-demented individuals who will progress to AD. The goal of this study was to evaluate the benefit of CSF biomarker testing in a setting with no specialized dementia centers, in order to improve the accuracy of AD diagnosis and to identify individuals with incipient AD. Using ELISA assay we analyzed CSF Abeta42, t-tau and p181-tau levels among clinically diagnosed non-demented individuals, AD patients and individuals with uncertain dementia (n=36). CSF cut-off values of low Abeta42 (less than or equal to 530 pg/mL) and high t-tau (less than or equal to 350 pg/mL) or p181-tau (less than or equal to 52 pg/mL) were used to identify individuals with AD/MCI-CSF profile, regardless of clinical diagnosis. APOE genotyping was performed using PCR-RFLP method. In accord with previous studies we detected significantly decreased levels of CSF Abeta42 and increased tau and p181-tau levels in clinically diagnosed AD group vs. non-demented controls. CSF profiling identified individuals with a typical AD/MCI-CSF pattern in clinically referred non-demented group (9 percent) and among patients with uncertain dementia (41.7 percent). APOE epsilon4-allele was associated with the CSF biomarker changes typical for AD. This study shows that in a non-specialized setting CSF biomarker testing may be used as a screening tool for improving the accuracy of AD diagnosis and for predicting individuals with incipient Alzheimer's disease who need to receive further clinical follow-up.

Development of postoperative internal carotid artery occlusion due to the presence of risk factors.

Postoperative internal carotid artery (ICA) occlusion is a rare condition with few data on the risk factors. The aim of the study was to analyze risk factors and ischemic symptomatology in patients with postoperative ICA occlusion. During one year period, 33 patients with postoperative ICA occlusion were examined at Cerebrovascular Laboratory. Medical history, clinical findings and atherosclerosis risk factors were compared with data on 33 patients with satisfactory postoperative finding. Student's t-test was used on data comparison (P < 0.05). In 31 of 33 patients, ICA occlusion was recorded on the first postoperative examination, 3 months after carotid endarterectomy (18 right and 15 left). In 8 patients, combined occlusion of the common carotid artery and ICA was found (4 right, 4 left). One patient ICA developed occlusion during the first and third postoperative year each. Clinically, three patients presented with ischemic symptoms (one stroke and two transitory ischemic attacks (TIA)). The following risk factors were present in the group with postoperative ICA occlusion: hypertension in 18, smoking in 10, hyperlipidemia in 8, diabetes mellitus in 9, history of stroke in 13, TIA in 3, heart attack in 4 and coronary disease in 3 patients; the respective figures in the control group were as follows: 25, 11, 16, 7, 7, 3, 4 and 3. There was no significant between-group difference in the presence of risk factors. Study results suggested that postoperative ICA occlusion was not caused by atherosclerosis risk factors but by perioperative complications.

Serum HDL, LDL and total cholesterol in patients with late-life onset of Alzheimer's disease versus vascular dementia.

Patients with cerebrovascular risk factors are nowadays recognized as being at an increased risk of developing cognitive decline of both types. In this pilot study, we evaluated the levels of cholesterol (total, HDL, LDL) in patients with both vascular dementia (VD) and Alzheimer's type of dementia (AD). Cognitive decline was assessed using Mini Mental State Examination (MMSE) as a standardized method. The study included 66 patients diagnosed with dementia. AD was diagnosed in 43 patients (22 male and 21 female) mean age (+/- SD) 72.79 +/- 8.19 years and VD in 23 patients (mean age +/- SD, 77.43 +/- 7.58 years). In AD group, 18 patients had cholesterol values within the normal range, whereas 25 patients had elevated levels of cholesterol. The mean value of total plasma cholesterol was 5.39 (SD = 1.05), LDL cholesterol 3.33 (SD = 0.95) and HDL cholesterol 1.41 (SD = 0.34). In VD group, 11 patients had cholesterol values within the normal range, whereas 12 patients had elevated levels of cholesterol. In this group, the mean value of total plasma cholesterol was 5.78 (SD = 1.06), HDL cholesterol 1.44 (SD = 0.57) and LDL cholesterol 3.72 (SD = 0.85). Total cholesterol, LDL cholesterol and HDL cholesterol levels were higher in the group of patients with VD, however, the difference was not statistically significant.

Median nerve imaging using high-resolution ultrasound in healthy subjects.

Although electroneuro- and electromyography are still the leading diagnostic methods for investigation of peripheral nerve function, they do not provide information on their morphology. This study was conducted to evaluate the suitability of ultrasonography in visualization of median nerve in healthy volunteers. Twenty-five asymptomatic volunteers (17 women and 8 men), age range 21-47 years, participated in the study. Body height was measured and handedness ascertained, as well as average time spent daily working on a computer. The device used was Aloka Prosound Alpha10 Premier with a 13-MHz probe, using custom preset for musculoskeletal sonography. The following dimensions of median nerve at the pisiform bone level were measured bilaterally: cross-sectional area (CSA), circumference, and longer and shorter diameter. Using the latter values, the flattening ratio (FR) was calculated. Median nerve and the surrounding soft tissue structures were easily depicted in all study subjects. The mean median nerve CSA was 9.70 mm2 (range 5-15 mm2, SD 2.25 mm2), mean FR (longer/shorter diameter) 4.04 (range 2.16-6.08), and median height 172.72 cm. Only one subject was left-handed. The mean time spent daily working on a computer (overall mean of 3.2 h/day) did not correlate with either CSA or FR for the dominant hand. In four subjects, an aberrant artery accompanying median nerve was visualized. High-resolution sonographic imaging is a fast and noninvasive method for assessment of various morphological properties of median nerve and can be used to enhance diagnostic efficiency.

Blood flow velocity in middle cerebral artery during visuo-motor tasks using a mirror: a transcranial Doppler study.

Mirror illusion means that standing in front of a mirror placed in sagittal plane, with the head tilted on one side and one arm stretched forward, one side of the body is reflected as if it were the other side by mirror visual feedback. The aim of this study was to monitor blood flow changes in middle cerebral artery (MCA) by use of transcranial Doppler (TCD) in individuals during motor tasks and tasks using mirror visual feedback. Eight young healthy volunteers (four male and four female) were included in the study. TCD recording in MCA was done during each task consisting of various motor and visuomotor activities using mirror illusion. Both MCA mean blow flow velocity (MBFV) was measured while the subjects were seated in a comfortable chair. The MCA MBFV recordings are presented as baseline values. During the illusion of motor hand activation, when the subject was making right hand flexions and watching its reflection in the mirror, with the left hand immobile, an increase was observed the contralateral MCA MBFV (task 3, +4.5% baseline value; P = 0.017). Furthermore, when the subject made left hand flexions while watching the reflection of the immobile right hand in the mirror, there was an increase in the right MCA MBFV (+5.6% baseline value; P = 0.044), which was more pronounced than during the illusion of motor hand activation (task 3) and less than during direct vision of hand flexion (task 2, +6.3% baseline value; P = 0.005). Our data showed that visual illusion of action, as well as direct action observation could increase the MCA MBFV, which brings forward the possible usage of mirror illusion as a tool in motor neurorehabilitation.

Parkinson's disease.

Parkinson's disease is one of the most common neurodegenerative diseases caused by degeneration of dopaminergic neurons in substantia nigra. The neuropathologic hallmark of Parkinson's disease is the presence of Lewy bodies composed mostly of alpha-synuclein and ubiquitin. It is believed that the occurrence of Parkinson's disease is due to a combination of genetic and environmental factors, but the exact mechanism of Parkinson's disease development is not fully elucidated. The most characteristic motor symptoms for Parkinson's disease include bradykinesia, rigidity, resting tremor and postural instability, while many patients also have non-motor signs and symptoms. The key therapeutic agent in the treatment of Parkinson's disease is L-dopa, and the others are dopaminergic agents, monoamine oxidase-B (MAO-B) inhibitors, catechol-O-methyltransferase (COMT) inhibitors, amantadine and anticholinergic agents.

[Dynamics of the internal carotid artery postoperative occlusion development]. / Dinamika nastanka postoperativne okluzije karotidne arterije.

The incidence of postoperative occlusion of carotid artery is low (0.5%-0.6%) and is rarely symptomatic. The aim of this study was to analyze the dynamics of the internal carotid artery (ICA) postoperative occlusion development. During one-year period, 8 000 patients were examined at Cerebrovascular Laboratory, University Department of Neurology. Among them, 33 patients (25 male and 8 female) with postoperative ICA occlusion were detected by color Doppler. We retrospectively analyzed the dynamics of ICA occlusion development from the first postoperative follow-up. The risk factors for atherosclerosis were analyzed. In 31 of 33 patients, postoperative ICA occlusion was recorded on the first follow-up examination, 3 months of carotid endarterectomy (18 right and 15 left). In 8 patients, combined occlusion of the common and ICA was detected (4 right and 4 left). One patient developed occlusion during the first year of follow-up, and in one patient it was detected 3 years after the surgery. Eight patients had also had surgery on the contralateral ICA and showed satisfactory findings. In 19 patients, mild atherosclerotic changes were found contralaterally, 5 had moderate stenosis, and 1 patient had subtotal ICA stenosis. The early onset of postoperative ICA occlusion most likely is not caused by atherosclerosis risk factors but by perioperative complications.

[Pain and ischemic symptoms in craniocervical artery dissection]. / Bol i ishemijski simptomi u bolesnika s disekcijom arterija glave i vrata.

Arterial dissections of craniocervical arteries are being increasingly identified due to the growing awareness of the clinical picture and advances in imaging technologies. During a one-year period, we observed 20 patients with craniocervical artery dissection at cerebrovascular laboratory. Clinical picture, localization of the dissection and follow up studies were analyzed. Twenty study patients were divided into four groups: in group 1, all 4 patients with common carotid dissection with or without aortic dissection presented with pain; in group 2 with internal carotid dissection, pain was present in 5 out of 11 patients, ischemic symptoms in all 11 patients, and Horner syndrome or lower cranial nerve palsies in 3 of 11 patients; in group 3, all 4 patients with dissecting plaque were free from pain but had ischemic symptoms; and in group 4 there was only one patient with isolated vertebral artery dissection who had no pain but presented with stroke. Pain was the most prominent symptom in patients with lower craniocervical artery dissection. Ultrasound enabled follow up of the dissection.

Transcranial sonography in the evaluation of pineal lesions: two-year follow up study.

We have recently reported that transcranial sonography (TCS) is a method competitive to magnetic resonance neuroimaging (MRI) in the evaluation of pineal gland lesions. The aim of the present is study was to assess the usefulness of TCS in a larger patient sample during a two-year follow up. Twenty patients with incidental pineal gland cyst (PGC) detected by MRI scan of the brain and 40 healthy controls without any previous documented data on a disease related to pineal gland were evaluated by TCS and compared with MRI scans. There were no statistically significant differences in PGC size measured by TCS by two observers (p = 0.475), PGC size measured by TCS and MRI (first observer, p = 0.453; and second observer, p = 0.425), size of the pineal gland measured by TCS and MRI in control group (first observer, p = 0.497; and second observer, p = 0.370), and pineal gland size measured by TCS by two observers in control group (p = 0.473). Study results suggested TCS to be a suitable method in the evaluation of pineal gland lesions. Although its resolution cannot match the MRI resolution, its repeatability and accuracy might add to its practical value. We suggest that the repeat MRI scan of such lesions might be replaced by clinical and TCS follow up.