Baló Concentric Sclerosis Mimicking Encephalitis with Seizures and Progressive Aphasia in a 26-Year-Old Woman: A Challenging Diagnostic Dilemma.

Introduction: Baló's concentric sclerosis (BCS) is a rare subtype of multiple sclerosis characterized by inflammatory demyelination within the central nervous system. Case Presentation: This case report presents a challenging diagnostic scenario involving a 26-year-old woman diagnosed with BCS. Despite treatment, her condition did not ameliorate, and magnetic resonance imaging (MRI) findings remained unchanged. A subsequent stereotactic biopsy revealed tumefactive Balo disease, highlighting the intricate diagnostic and therapeutic issues surrounding BCS. Conclusion: The juxtacortical location of the BCS lesion, as observed in our case, suggests an unfavourable prognosis due to treatment-resistant seizures.

Visceral leishmaniasis in Kosovo: A case of misdiagnosis and diagnostic challenges.

Introduction: Visceral leishmaniasis (VL) is a parasitic disease caused by various Leishmania species and is a potentially life-threatening condition. The disease is highly endemic in several regions, including the Balkans, yet information regarding its prevalence in Kosovo is limited. Case presentation: In this case presentation, a 62-year-old man was admitted to a hospital in Kosovo due to a persistent high fever, and after extensive evaluations and treatments, he was diagnosed with fever of unknown origin (FUO) and transferred to a hospital in Turkey. An abscess of the psoas muscle caused by MRSA was found, however, pancytopenia persisted despite antibiotic treatment. Six months later, the patient was hospitalized again due to fever, chills, and night sweats. Microscopic examination and serological tests revealed the presence of Leishmania infantum in the bone marrow. Liposomal amphotericin B treatment resulted in a significant improvement in the patient's condition. Discussion: The diagnosis of VL can be challenging, and it can easily be misdiagnosed as other diseases, resulting in diagnostic delays and potentially fatal outcomes. In endemic regions such as the Balkans, it is crucial for physicians to be aware of this infection to avoid misdiagnosis or diagnostic delay. Early diagnosis and prompt treatment of VL are essential in preventing morbidity and mortality. Conclusion: This case highlights the significance of considering VL as a possible diagnosis in patients presenting with febrile illnesses accompanied by pancytopenia and splenomegaly, especially in endemic regions.

Chemotherapy-Induced Peripheral Neuropathy (CIPN) in Patients Receiving 4-6 Cycles of Platinum-Based and Taxane-Based Chemotherapy: A Prospective, Single-Center Study from Kosovo.

BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is most commonly associated with platinum-based drugs, taxanes, and vinca alkaloids. This prospective study from a single center in Kosovo aimed to evaluate CIPN in 120 patients receiving 4-6 cycles of platinum-based and taxane-based chemotherapy. MATERIAL AND METHODS One hundred twenty patients underwent neurological examination and nerve conduction studies (NCS) before chemotherapy, and after 4 to 6 cycles of treatment. Sixty patients were treated with platinum-based chemotherapy, 30 were treated with taxane-based chemotherapy, and 22 patients received a combination of platinum- and taxane-based chemotherapy. The most commonly used platinum-based compounds were oxaliplatin and carboplatin, whereas the most commonly used taxane medications were paclitaxel and docetaxel. Presence of neuropathy was confirmed with neurological examination of electrophysiological criteria applicable for polyneuropathies. Total Neuropathy Score (TNSr) was used to combine clinical and electrophysiological values. RESULTS Around 90% of patients self-reported neuropathic symptoms, and in 60% of them polyneuropathy was present in NCS. All sensory and motor nerves had significantly lower amplitudes (P<0.01). Platinum-based agents caused more pronounced decrease in ulnar nerve compound motor action potential (CMAP) (P<0.05); when used solely or in combination with taxanes, they caused significant decrease in tibial nerve CMAP (P<0.01). TNSr did not reach statistical significance between groups; only clinical muscle strength showed pronounced weakness in the combined protocol (P<0.05). CONCLUSIONS These findings support previous studies and show that CIPN, including sensory and motor symptoms, is commonly associated with chemotherapy. Platinum-based chemotherapy agents were more commonly associated with ulnar and tibial nerve damage in this study population.

A 14-Year-Old Male Patient with Kawasaki Disease Presented with Stroke after COVID-19.

According to several studies, children represent only about 2% of the patients affected by the current SARS-CoV-2, and most often, they are asymptomatic. However, there is a concern about a vascular inflammatory disease which is similar to Kawasaki disease observed in children and adolescents weeks after infection. We report a case of Kawasaki disease presented with ischemic stroke in a 14-year-old male patient following SARS-Cov-2 infection.

Association of depression, anxiety and post-traumatic stress disorder with migraine: Data from Kosovo.

INTRODUCTION: Migraine is ranked as the seventh leading cause of disability worldwide, and it is characterized by a manifestation of combined neurological, gastrointestinal, and autonomic symptoms linked with different provoking factors. AIM OF THE STUDY: This study investigates the association between migraine and PTSD, depression and anxiety in the Kosovo population during the post-war period. MATERIAL AND METHODS: 273 war survivors with headache were enrolled in the study and were divided into two groups: 153 individuals with confirmed migraine (the study group) and 120 individuals with non-migraine headaches (control group). All individuals were evaluated using the ICHD-II 2004 diagnostic criteria for migraine, as well as the mini-test for PTSD, MMPI (Minnesota Multiphasic Personality Inventory) for psychological evaluation, PAI (Personality Assessment Inventory) and Hamilton Scale for Depression. RESULTS: Among migraine patients, depressive disorders were present in 27.5% of patients, anxiety was found in 60.8%, and PTSD was present in 39.2%. While the prominence of depression was not different between groups, anxiety was significantly more common (p<0.05) in women from the control group. PTSD was significantly more common (p<0.001) in migraine patients overall, whereas the difference in PTSD prevalence between women from the migraine and control groups came close to significance (p=0.05). Females in the migraine group had higher incidences of aura (50% vs. 25.5%), whereas the incidence of aura in males in each group was approximately equal (9.8% vs. 7.84%). CONCLUSION: Based on our data, we can confirm an association between PTSD and migraine in a sample of patients from Kosovo.

Clinical Manifestations in 82 Neurobrucellosis Patients from Kosovo.

BACKGROUND: Central nervous system involvement is a serious complication of brucellosis with various incidence and various clinical presentations. PATIENTS AND METHODS: Hospitalized patients in University Clinical Centre, Clinic for Infectious diseases in Prishtina, with laboratory-confirmed brucellosis, were analyzed, a brucellosis-endemic region. Among the 648 confirmed cases with brucellosis during the period 1991- 2013, 82 patients (12.65%) were diagnosed with neurobrucellosis. The clinical manifestations in patients with neurobrucellosis were evaluated and compared with brucellosis patients. RESULTS: The major presentations among the brucellosis patients were headache, fever, sweating, nausea, weight loss and arthralgia, while from CNS predominant complains were: headache, vomiting, tremor, low back pain, hearing loss and visual disturbance. The mean age of 82 neurobrucellosis patients was 31.46 years with age distribution 12-71 years, from them 5 (6.1%), younger than 16 years, with a non-significant predominance of women (53.65%). The most common neurological findings were radiculopathies of legs (41.46%) neck rigidity (46.34%), agitation (25,6%), behavioral disorders (18.3%), disorientation (19.5%) and stroke (1.22%). Cranial nerves were involved in 20 of 82 patients (24.4%). Neurological consequences were evidenced in 5 (6.1%) patients. Three patients leave hospital with consequences of peripheral facial paresis, two with sensorineural hearing loss and one with left hemiparesis. Headache, nausea and vomiting and weight loss are significantly (p<0.001) more frequent complains in neurobrucellosis patients compare to patients with brucellosis. On the other hand, as regard to the physical findings and complications, meningeal signs and splenomegaly are significantly more frequent in neurobrucellosis (p<0.01) whereas the hepatomegaly and lymphadenopathy were more frequent (p<0.01) in brucellosis patients. Different significant correlations were observed among specific complains too. CONCLUSIONS: Our findings in regard to the specific associations of physical and clinical features in brucellosis patients in Kosovo, may serve as an indication for neurobrucellosis. In endemic areas for brucellosis patients complaining in radiculopathies, persistent headache, facial palsy, hearing loss or presenting stroke without risk factors, should be considered for screening for neurobrucellosis.

Tuberculous meningoencephalitis.

Tuberculous meningitis is an infection of the the membranes covering the brain and spinal cord (meninges). Tuberculous meningitis is a major global health problem and is the most severe form of extrapulmonary tuberculosis, with high rate mortality. Last years in Kosovo incidence of TB was decreased in less than 1000 cases per year and 10-20 cases per year of TB meningoencephalitis. Still Kosovo has limited numbers of TB. TBM is diagnosed on the basis of clinical features, cerebrospinal fluid (CSF) studies, and radiological findings. Clinical picture, neurological status, anamnestic data, suspect (but not specific) lab tests, and imaging new methods, together can give very valuable help to clinicians for early adequate and successful treatment.

Thrombosis of the superior sagittal sinus.

Thrombosis of the sinuses is a distinct cerebrovascular disorder that, unlike arterial stroke, most often affects young adults and children. The symptoms and clinical course are highly variable. During the past decade, increased awareness of the diagnosis, improved neuro-imaging techniques, and more effective treatment have improved the prognosis. More than 80% of all patients now have a good neurologic outcome. This review summarizes recent insights into the pathogenesis of sinus thrombosis, risk factors, and clinical and radiological diagnosis and discusses the current evidence and controversies about the best treatment.

Radiological imaging detection of tumors localized in fossa cranii posterior.

UNLABELLED: Intracranial tumors are characterized by a variety imaging aspects and their detection is always a challenge. Clinical application of Magnetic Resonance Imaging (MRI) and Computerized Tomography has provided an earlier detection and treatment of many CNS pathologies. The aim of this study is to estimate the role of CT and MRI in the determination of posterior fossa tumors. RESULTS: During period 2000-2005 in UCCK-Prishtina, 368 patients were diagnosed with intracranial tumors. Fifty-nine of them were found to have tumor localized in fossa crani posterior (FCP) without any significant difference between genders (50.8% female vs. 49.2% male, chi2 test=0.02 p=0.896). The average age of patients with FCP tumors was 33.1 (SD +/- 22.5, rank 1-70). The most of these patients were registered in 2003 (20.3%) whereas the least in 2000 (11.9%). The most affected age-group was 0-9 (25.4%) and 50-59 (23.7%) whereas the incidences was between 30-39 years of age (3.4%). Tumor types that more often were found in young's individuals were: Astrocytomas with a peak incidence in teenagers (average age was 12-year-old SD +/- 7.5, rank 3-23), next was Medulloblastomas (average age was 11-years-old, SD +/- 2.9, rank 6-16 years) and ependymomas (average age was 6.8-years-old, SD +/- 4.6, rank 1-12). Patients with osseous tumors are characterized by older age than median (61.0, SD +/- 4.2, rank 58-64), then metastases (53.0, SD +/- 5.3, rank 45-60) and meningiomas (50.8, SD +/- 7.7, rank 38-63). The overall average mortality was 0.41 cases per 100,000 inhabitants with variations through years from 0.30-0.50/100,000 inhabitants. CONCLUSION: Comparing with other countries, for some types of FCP tumors, lower morbidity is shown in Kosova, with mean incidence 0.41/100,000. The most frequent tumors in children were medulloblastomas, brainstem gliomas, astrocytomas and ependymomas whereas meningiomas and metastasis were most often found in adults. For FCP tumors detection, MRI had 100% sensitivity, specificity and predictive positive value, whereas brain CT was characterized by 95% sensitivity, 90.4 % specificity and 91% predictive positive value.