Outcomes after reperfusion therapies in patients with ACA stroke: A multicenter cohort study from the EVATRISP collaboration.

BACKGROUND: Patients with stroke secondary to occlusions of the anterior cerebral artery (ACA) often have poor outcomes. The optimal acute therapeutic intervention for these patients remains unknown. METHODS: Patients with isolated ACA-stroke were identified from 10 centers participating in the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) prospective registry. Patients treated with endovascular thrombectomy (EVT) were compared to those treated with intravenous thrombolysis (IVT). Odds ratios with 95% confidence intervals (OR; 95%CI) were calculated using multivariate regression analysis. RESULTS: Included were 92 patients with ACA-stroke. Of the 92 ACA patients, 55 (60%) were treated with IVT only and 37 (40%) with EVT (±bridging IVT). ACA patients treated with EVT had more often wake-up stroke (24% vs. 6%, p = 0.044) and proximal ACA occlusions (43% vs. 24%, p = 0.047) and tended to have higher stroke severity on admission [NIHSS: 10.0 vs 7.0, p = 0.054). However, odds for favorable outcome, mortality or symptomatic intracranial hemorrhage did not differ significantly between both groups. Exploration of the effect of clot location inside the ACA showed that in patients with A1 or A2/A3 ACA occlusions the chances of favorable outcome were not influenced by treatment allocation to IVT or EVT. DISCUSSION: Treatment with either IVT or EVT could be safe with similar effect in patients with ACA-strokes and these effects may be independent of clot location within the occluded ACA.

Focal epileptic seizures, electroencephalography and outcome of sepsis associated encephalopathy-A pilot study.

OBJECTIVES: Sepsis associated encephalopathy (SAE) represents a diffuse and/or multifactorial cerebral dysfunction during response to systemic infection. Study aim was to compare clinical and electroencephalogram (EEG) characteristics and intrahospital survival rate among SAE patients. PATIENTS AND METHODS: A prospective study, during 42 months' period, included 39 SAE patients assigned in two groups according the outcome (survival: 19, and death: 20 patients). All the patients' features were registered: demography, neurological status, infection type, seizure appearance, brain computerized tomography (CT), EEG, EEG reactivity, Glasgow Coma Score (GCS) and Acute Physiology and Chronic Health Evaluation II (APACHE II) Score. The analysis included EEGs obtained during patients' consciousness change (improvement or deterioration) and the level of consciousness during and at the end of hospitalization. RESULTS: SAE was detected in 29.5% of patients with encephalopathy (2.8% of all patients hospitalized). Patients with lethal outcome were more likely to be female (p=0.0011), to have focal seizures (p=0.034), lower values of GCS during hospitalization (p<0.05) and longer lasting nosocomial infections (p=0.029). At the time of clinical exacerbation, patients were more likely to have suppression on EEG and less likely theta activity. Delta waves, TW waves and suppression of EEG activity were the most common findings 24h prior to death (p=0.0004). The lack of EEG reactivity was associated with death (p=0.00043). CONCLUSION: Presence of focal seizures, EEG suppression at the time of exacerbation in SAE elderly patients, particularly women, with longer infection duration and lower values of GCS, is associated with intrahospital death.

Genetic heterogeneity in ten families with myoclonus-dystonia.

BACKGROUND: Myoclonus-dystonia (M-D) is a movement disorder with autosomal dominant inheritance and reduced penetrance but may also occur sporadically. Recently, mutations in the epsilon-sarcoglycan gene (SGCE) were shown to cause M-D. Furthermore, single variants in the dopamine D2 receptor (DRD2) and DYT1 genes were found in combination with SGCE mutations in two M-D families, and another M-D locus was recently mapped to chromosome 18p11 in one family. METHODS: The authors clinically and genetically characterised ten consecutive cases with myoclonus-dystonia; seven familial and three sporadic. Twenty nine M-D patients and 40 unaffected family members underwent a standardised clinical examination by a movement disorder specialist. Index cases were screened for mutations in the SGCE, DYT1, and DRD2 genes and for deletions of the SGCE gene. Suitable mutation negative families were tested for linkage to the SGCE region and to chromosome 18p11. RESULTS: Two SGCE mutations were detected among the seven familial but no mutation in the sporadic cases. Haplotype analysis at the new M-D locus was compatible with linkage in two families and excluded in another family, suggesting at least one additional M-D gene. There were no obvious clinical differences between M-D families with and without detected mutations. CONCLUSION: M-D is genetically heterogeneous with SGCE mutations accounting for the disease in only part of the clinically typical cases.

Hormone receptors in benign intracranial meningiomas.

PURPOSE: Although some embryologic data suggest that the neural crest elements, which are not a target tissue for estrogen and progesterone, participate in the forming of meningothelial cells, meningiomas show hormone receptors. The aim of this study was to investigate the estrogen (ER) and progesterone receptors (PR) content of benign meningiomas (WHO grade I) which were completely resected. MATERIALS AND METHODS: Paraffin-embedded tissue sections of 30 intracranial meningiomas were examined immunohistochemically using monoclonal antibodies for ER and PR. RESULTS: All 30 (100%) tumor samples were ER-negative. Seventeen (57%) of them were positive for PR. These receptors were found in 8 of 17 (47.50%) tumors in female patients and in 9 of 13 (69.23%) tumors in male patients (Mann-Whitney p <0.05). Age, localization of tumors and histological subtype did not correlate with PR status. CONCLUSION: This study demonstrated complete absence of ER in benign meningiomas. In contrast, PR were positive in more than half of the patients. PR positivity was significantly higher in male patients.

[Significance of sensory evoked potentials in determination of the level of brachial plexus injuries]. / Znacaj senzorno evociranih potencijala u visinskoj leziji brahijalnog pleksusa.

The aim of this work is to show the highlights of electrophysiological diagnostics, i.e. its potentials in level diagnostics of traumatic disfunction of brachial plexus (BP). In that manner we have analyzed the results of electrophysiological research, made on 53 patients with different levels and grades of traumatic lesion of brachial plexus. We have also analyzed the authors' opinions and points of view who have contributed in solving these problems. Brachial plexus is a complex, vulnerable nerve structure that is often, in life, exposed to direct or indirect influence of mechanical force. Preserved integrity of bone structures of a shoulder protects BP from longitudinal forces, which are the most common causes of injury of this structure. Traction mechanism of the injury is always up to date in the cases of fractures and dislocation of the skeleton in this region. In the early childhood, mechanical injuries of brachial plexus are caused by distocia in the second delivery period, while in adulthood most common injuries are caused by sudden and intensive forces, which cause disfunction of plexus by traction mechanism (dislocation of a shoulder and clavicular fracture) and by direct action (stabing and piercing injuries). Slowly progressive, expansive, degenerative and inflammatory processes of neighbouring organs are causing the disfunction of the plexus as well. Traction actions are aimed mostly at radiculars as a vulnerable structure that is placed between relatively mobile shoulder joint and rigid cervical part of vertebral column. Complex anatomical structure and mutual overlapping of radicular motor and sensitive innervation of muscles and dermatoms, make the diagnostics of disfunction of this periphery nerve structure very difficult and complicated. Disfunction of neighboring bone, vascular and muscle elements as well as the nearness of vital organs, which complicates even more the diagnostics. Taking into account the general analysis of all electrophysiological results of the research on 53 patients with an PB injury, we have concluded that none of the functional methods is not sovereign, i.e. the contribution of this research is complementary also with roentgenological results. Clinical data are unavoidable, but they are not enough without good argumentation, especially for the level of lesion, pre- or postganglionary. Electromiography gives reliable results for the phase and the grade of denervation of particular muscle groups, and that way it is possible to conclude, indirectly, which part of the plexus is in disfunction. Special attention should be paid to EMG of paraspinal muscles, where the signs of denervation are aleays indicating intradural lesion of the radicular. In the examined group, 52% of the patients with radicular disfunction had the signs of denervation in paraspinal muscles. Examination of the sensitive action potentials is another method by which we can see the disfunction level of the plexus in an anesthetical region. In a group with preganglionary root disfunction, 48% of the patients had preserved sNAP response. In a group with postganglionary disfunction, 36% of the patients had no sNAP response. Somatosemsory evoked potentials are addition to EMG and ENG research and they are efficient in the primary phase, when electromyographic and electroneurographic examinations are not offering relevant data. Checking of the early diagnostics of the pre- and postganglionary lesions with somatosensory evoked potentials wasn't possible in this group because the first examinations of these patients in our laboratory were mostly made couple of months after the injury. Disfunction of the ratio amplitudes N9 and P/N13 in the group with preganglionary lesion was found in 31%, with postganglionary in 42.2% and with both in 10% of the patients.

[Multifocal localization of tumors of Schwann cell origin]. / Multipla lokalizacija tumora porekla svanovih celija.

Neurofibromatosis (disease of Von Recklinghausen) was considered to be a unique disease. Today, however, it is known that it consist of two clinically and genetically different diseases. Neurofibromatosis type 1 is a more frequent disease formerly known as peripheral, while neurofibromatosis type 2 (bilateral acoustic neurinoma) is significantly less frequent. In this case report we present a 30-year old female patient who had several tumours with the following localizations: 1. the pontocerebellar angulus; 2. the left foramen jugular; 3. the anterior part of the spinal canal; 4. the soft tissue of the neck; 5. falx cerebri. The tumor in the neck was removed completely by ENT surgeon while the others were partly removed by neurosurgeon. In this case report we described diagnostic and therapeutic problems in the treatment of this patient with the long-lasting hoarseness and difficult swallowing.

[A double abscess of the cerebellum of otogenic origin]. / Dvostruki apsces malog mozga otogenog porekla.

Brain abscess is a rare, extremely aggressive lethal infection. It is especially important in case of otogenic abscesses. It is known that the problem of otitis existed already thousands of years before Christ, and it is still a current problem. Otogenic brain abscess is the most common otogenic complication encompassing 40-80% of all brain abscesses in adults. In 50-80% of these cases COM (chronic otitis media) with cholesteatoma is found. In the last 20 years CT is of the first rank in diagnosis. Brain abscess can be treated conservatively and surgically; but the ear has to be treated operatively. In this article we present an interesting case from our practice, a double abscess of the cerebellum of otogenic origin, which was successfully treated by simultaneous approach of neurosurgeon and otosurgeon.