Endovascular treatment of internal carotid artery pseudo-aneurysm presenting with epistaxis. A case report.

Recurrent epistaxis is a rare presentation of internal carotid artery C4/C5 segment pseudo-aneurysm rupture. We describe a case of a traumatic internal carotid artery pseudo-aneurysm with recurrent epistaxis as a leading symptom that was finally managed with endovascular treatment with stent-assisted coil placement. Clopidogrel and acetylsalicylic acid orally were introduced in the therapy for further stent thrombosis prevention and epistaxis did not recur on six-month follow-up. Endovascular treatment with stent-assisted coil placement seems to be a good method for pseudo-aneurysm treatment while keeping the lumen of the parent artery patent.

Prevalence of genetic polymorphisms of CYP2C9 and VKORC1 - implications for warfarin management and outcome in Croatian patients with acute stroke.

BACKGROUND: Data on the prevalence of CYP2C9 and VKORC1 genes and their influence on anticoagulant effect and warfarin dose in stroke patients are scarce. The aim of this study was to determine the occurrence and significance of these gene polymorphisms and to establish pharmacogenetic algorithm to estimate the dose of introduction. Also, the goal was to determine tailored safety and intensity of anticoagulation response depending on the allelic variants and their impact on the clinical outcome in acute stroke patients in Croatia. METHODS: A total of 106 consented acute stroke patients were tested for CYP2C9 2, 3 and VKORC1 1173C>T gene polymorphisms. We estimated the dose of introduction and monitored anticoagulant effect obtained by INR values, time to reach stable dose, stable maintenance dose, time spent within the therapeutic/supratherapeutic INR range, occurrence of dosage side effects and clinical outcome depending on genotypes. RESULTS: We found that 83% of stroke patients in our study were carriers of multiple allelic variants. The predicted initial dose correlated with the stable warfarin maintenance dose (p=0.0311) and we correctly estimated the dose for 81.5% of 61.3% of study patients who required higher/lower doses than average. Warfarin dosage complications were slightly more frequent among the carriers of CYP2C9 2, 3 compared to the carriers of VKORC1 1173T alleles (68. 9% versus 62.5%), but their occurrence did not affect the final clinical outcome. CONCLUSION: Our data indicated rapid and safe anticoagulation achieved by using pharmacogenetically-predicted warfarin dose in high-risk acute stroke patients without increasing the risk of warfarin dosage complications in an elderly population.

An infrequent type of stroke with an unusual cause and successful therapy: basilar artery occlusion caused by a cardiac papillary fibroelastoma recanalized 12 hours after onset.

We herein report the case of a 32-year-old woman with sudden onset ataxia, limb dysmetria and somnolence. Emergency radiological findings showed bilateral cerebellar and thalamic infarctions as a result of a basilar artery occlusion. The patient was treated with intra-arterial (IA) and mechanical thrombolysis 12 hours after symptom onset and showed an excellent recovery. A diagnostic workup revealed a tumor mass on the mitral valve that was surgically removed, while a histological analysis confirmed a diagnosis of cardiac papillary fibroelastoma.

Systemic thrombolytic therapy in acute ischemic stroke--new experiences in spreading network of stroke units in Croatia.

BACKGROUND: The aims of this paper are: 1) to present the data of systemic thrombolysis for ischemic stroke in five Croatian centers from July 2008 till January 2010; 2) to compare the results between centers and; 3) to compare data with previously published results from 2006 to 2008 period from our center, and with the data from SITS (Safe Implementation of Treatments in Stroke). METHODS: We retrospectively reviewed the medical data of thrombolysed patients in following hospitals: University Hospital Center Zagreb (91 patients), University Hospital Split (25 patients), University Hospital Osijek (22 patients), General Hospital Varazdin (21 patient), and General Hospital Zadar (7 patients). RESULTS: The "time to door" for all centers was 79.71±38.63 min, the "door to needle" period was 64.39±24.18 min. Systolic and diastolic blood pressures at admission were 158.65±27.72 and 90.18±15.03 mm Hg, respectively. Systolic and diastolic blood pressures measured immediately prior to administering rt-PA were 152.19±23.17 and 85.40±15.27 mm Hg, respectively. Initial median NIHSS score was 12, median NIHSS 2h post thrombolysis was 8, and 7th day after rt-PA treatment 4. Intracerebral hemorrhages or secondary hemorrhagic transformations occurred in 21 (12.65%) patients, among which nine were symptomatic. In a 4.5h time window total of 17 patients were thrombolysed. We did not find any differences in outcome between this group and group of patients thrombolysed in the 3h time-window. The group of patients older than 80 years had a worse outcome. CONCLUSIONS: According to our data, treatment with rt-PA is safe, feasible and effective for stroke patients in both university as well as regional hospitals having stroke units established. Organization of stroke units in regional hospitals, as well as systematic education of public health workers and neurologists, leads to the possibility for each patient to reach the nearest stroke unit and gets the thrombolytic therapy in the therapeutic time window.

Epidemiology of renal disease in children in the region of southern Croatia: a 10-year review of regional renal biopsy databases.

BACKGROUND: Epidemiological data on some renal diseases in children are available from world national registries of renal biopsies. However, there is no publislhed study of biopsy-proven childhood glomerulonephritis in Croatia. This report is the first review of pathohistological data covering a pediatric population over a 10-year period in the Croatian region of Dalmatia. MATERIAL/METHODS: A retrospective study was done on all renal biopsies from 65 children under 18 years of age received by the Clinical Hospital Split between 1995 and 2005. The histopathological findings were reviewed to determine the pattern of biopsy-proven glomerulonephritis. Indications for renal biopsy and clinico-pathological correlations were studied. Data on serum creatinine concentration, 24-h proteinuria, hematuria, clinical diagnosis, pathohistological diagnosis, and post-biopsy complications were collected. RESULTS: The main indications for biopsy were nephrotic syndrome (41.5%), hematuria with proteinuria (23.1%), and isolated hematuria (12.3%). The most frequent renal diseases in decreasing order were mesangioproliferative glomerulonephritis (27.7%), IgA nephropathy (13.8%), and Henoch-Schönlein nephritis (10.8%). Tubulointerstitial nephritis, focal segmental glomerulosclerosis, and endoproliferative glomerulonephritis each accounted for 6.2%. Alport syndrome, fibrillary glomerulonephritis, and minimal change diseases were each found in 4.6% of cases. Other forms of glomerulonephritis were rarely found. CONCLUSIONS: The present data represent the basis for a future Croatian Registry of Renal Biopsies and are an important contribution to the epidemiology of renal diseases in south-eastern Europe. Three cases of fibrillary glomerulonephritis in children with steroid-dependent nephrotic syndrome, not reported in other countries' registries, were also found. The importance of ultrastructural analysis of biopsy specimens is emphasized.