Values of vanillylmandelic acid and homovanillic acid in the urine as potential prognostic biomarkers in ischaemic stroke patients.

BACKGROUND: Suitable biomarkers that have prognostic values are one of the key points of interest in ischaemic stroke. Increased sympathetic nervous system activity in ischaemic stroke causes multiple local and systemic effects that can be detrimental to the outcome. The mechanism of action is increased secretion and activity of catecholamines, whose end metabolic products are vanillylmandelic acid and homovanilic acid. Aim of our study was to determine whether these compounds can be used as potential prognostic biomarkers in ischaemic stroke, as a unique insight into the activity of the sympathetic nervous system. METHODS: Urine samples of 96 patients with ischaemic stroke and transitory ischaemic attacks were analysed. Values of vanillylmandelic and homovanillic acids in urine were tested using liquid chromatography on the first and third day post-stroke. Severity of stroke was determined using the NIHSS scale, while functional outcome was determined using the Modified Rankin Scale. RESULTS: Values of vanillylmandelic and homovanillic acids positively correlated with functional outcome of ischaemic stroke. Favorable outcomes correlated with decreased values, on contrary to increased values, which were associated with unfavourable outcomes. CONCLUSION: Determining the values of these compounds in the urine is an easily available prognostic tool for the ischaemic stroke outcome, while also influencing potential therapeutic changes.

Incidence of Stroke and Transient Ischemic Attack in Croatia: A Population Based Study.

The aim of this population based neuroepidemiological study was to establish the real incidence rates of acute cerebrovascular disease (CVD): stroke and transient ischemic attack (TIA) in the Republic of Croatia. Multicentric study included 89 501 persons of all ages in four regional centres in Croatia: Zagreb, Osijek + Slavonski Brod, Rijeka and Split. The following incidence rates of stroke, expressed at population of 100 000, have been established: Zagreb 290.52, Osijek + Slavonski Brod 302.14, Rijeka 219.65, Split 195.82. Incidence rate of stroke for the Republic of Croatia is 251.39. The following incidence rates of TIA, expressed at population of 100,000, have been established: Zagreb 87.15, Osijek + Slavonski Brod 156.53, Rijeka 90.11, Split 59.10. Incidence rate of TIA for the Republic of Croatia is 100.55. In the continental part of Croatia (Zagreb, Osijek + Slavonski Brod) incidence rate of stroke is higher by 45%, while incidence rate of TIA is higher by 82% than in the coastal part of Croatia, probably due to different lifestyle and environmental factors. The study has shown relatively high incidence rates of acute CVD (stroke and TIA) in the Republic of Croatia, which proves that CVD are a great public health problem.

Spontaneous recanalization of internal carotid artery occlusion.

We present a case of spontaneous recanalization of the internal carotid artery (ICA) that occurred in a 51-year-old male patient. The occlusion of the right ICA was asymptomatic and was detected incidentally during imaging of the opposite carotid artery. The patient underwent neuroradiologic analysis and a tapered, flame-like occlusion suggestive of the right ICA dissection was detected. One month later, a carotid Doppler ultrasound demonstrated patent right carotid artery with normal spectral flow. Five-month follow-up showed that the ICA remained patent.

Trigeminal neuralgia secondary to meningioma of petroclival localization.

Trigeminal neuralgia is characterized by paroxysmal episodes of facial pain in the distribution of the trigeminal nerve. It can occur in either sex but is most frequently seen in women aged 50-60 years. This article presents case of trigeminal neuralgia in a 55-year-old female patient caused by meningioma of petroclival localization. The article underscores the importance of neurologic and neuroradiologic examination in diagnosing and managing patients with facial pain conditions.

Recurrent transient global amnesia at high altitude.

We report the case of a 57-year-old man who experienced recurrent episodes of memory loss that resemble transient global amnesia (TGA). The first episode lasted 20 minutes, and the second was 8 hours long.

Epidemiology of central nervous system tumors in Labin area, Croatia, 1974-2001.

AIM: To establish the incidence of tumors of the central nervous system (CNS) in the population of Labin area in Istria, Croatia, characterized by very little population migration. METHOD: We retrospectively analyzed data on 175 patients (102 men and 73 women) diagnosed with CNS tumor according to the World Health Organization's diagnostic criteria in the period 1974-2001. Patient data were retrieved from multiple sources: files of general practitioners in Labin area; registers of admissions and discharges of the Pula General Hospital and Rijeka University Hospital Center; and medical records of the Hospital Departments of Neurology, Surgery, Neurosurgery, Oncology and Radiotherapy, and Pathology. Annual incidence, anatomic location, and pathohistological classification of CNS tumors were determined, as well as age at disease onset. RESULTS: Out of 175 subjects, 95 had primary CNS tumors and 80 had metastases. Intracranial tumors were found in 88.4% of patients with primary CNS tumors (annual incidence, 11.8/100000 population) and intraspinal in 11.6% of patients (annual incidence, 1.6/100000). Similar distribution was observed for CNS metastases (70 intracranial vs 10 intraspinal), with annual incidence of 9.9 and 1.4/100000, respectively. The most frequent intracranial tumors were those of neuroepithelial tissue, accounting for 58.3% of all CNS neoplasms (annual incidence, 6.9/100000 population). The most frequent intraspinal tumors were tumors of the meninges (54.5%). There was no particular temporal clustering of CNS tumors. The age at disease onset corresponded with that reported in the literature: 50.5+/-17.0 years for primary intracranial tumors, and 59.7+/-12.2 years for primary intraspinal tumors. CONCLUSION: Primary CNS tumors showed high, but temporally stable incidence in population of Labin area over the last 27 years, indicating that the alleged increase in CNS tumors incidence was not true.

Make love to forget: two cases of transient global amnesia triggered by sexual intercourse.

Transient global amnesia (TGA) is characterized by a sudden onset and by a typical resolution within several hours. Several precipitating events have been proposed: physical exertion, emotional experiences, etc. The aim of this paper was to present two cases of TGA triggered by sexual intercourse and to suggest a possible mechanism for the development of TGA. In both patients, clinical examination revealed elevated blood pressure. Laboratory examinations and brain CTs were normal. EEG demonstrated diffuse dysrhythmia and slow spike-waves, respectively. SPECT revealed hypoperfusion in the left frontal and right medial temporal regions. Various explanations of the mechanism of TGA are discussed. Based on the observed hypoperfusion in the medial temporal regions, a new hypothesis is advanced, suggesting the possibility that TGA occurs due to a pathologically changed or less adaptable anterior chorioid artery, initially constricted by hypotension following a blood shift from the center towards periphery.

Epidemiology of primary central nervous system tumors in the Coast and Gorski Kotar County, Croatia, 1977-2000.

AIM AND BACKGROUND: To establish the incidence of primary tumors of the central nervous system (CNS) in the resident population of the Coast and Gorski Kotar County, Croatia, in the period 1977-2000. METHODS: A retrospective descriptive epidemiological study. Tumors were classified according to the World Health Organization's scheme. A total of 911 cases was identified. Information about patient gender and age at diagnosis, tumor location and histologic type was obtained from case histories, autopsy protocols and pathology reports. Age- and sex-adjusted incidence were determined by a direct standardization method. RESULTS: Histologic confirmation was obtained in 84.5% of cases. The most frequent tumors were glioblastoma in men (30.2%) and meningioma in women (29.5%). The average annual crude and world-standardized incidence was 11.2 (95% CI, 10.1-12.3) and 8.2/100,000/year (95% CI, 7.4-9.0), respectively. The highest specific age incidence was detected in the seventh decade of life, 24.7/100,000/year (95% CI, 21.4-28.8). The tumors occurred equally in each sex. The lowest incidence was detected on the islands, 7.4/100,000/year (95% CI, 5.9-9.2) and the highest along the coast, 12.7/100,000/year (95% CI, 11.4-14.0). The survey showed the highest incidence of these neoplasms in the coastal municipality of Senj, 14.7/100,000/year (95% CI, 10.3-20.5). CONCLUSION: The descriptive epidemiological incidence of primary CNS tumors in the Coast and Gorski Kotar County, Croatia, especially those of neuroepithelial and meningeal origin, correspond to the data reported in similar studies elsewhere in the world. The incidence of these neoplasms in the area investigated is uneven. Limitations in study design preclude definitive conclusions about the causes of these differences.