Brachial Plexus Schwannoma - Case Report and Literature Review.

Schwannoma as an extracranial nerve sheath tumor rarely affects brachial plexus. Due to the fact that brachial plexus schwannomas are a rare entity and due to the brachial plexus anatomic complexity, schwannomas in this region present a challenge for surgeons. We present a case of a 49-year-old female patient with a slow growing painless mass in the right supraclavicular region that was diagnosed as schwannoma and operated at our department. The case is described to remind that in case of supraclavicular tumors, differential diagnosis should take brachial plexus tumors, i.e. schwannomas, in consideration. Extra caution is also required on fine needle aspiration procedures or biopsies of schwannomas due to the possible iatrogenic injury of the nerve and adjacent structures. On operative treatment of schwannoma, complete tumor resection should be achieved while preserving the nerve.

Is Apolipoprotein E ε2 Associated with Delayed Onset of Non-Lesional Temporal Lobe Epilepsy?

The aim of the study was to evaluate the possible association between Apo E polymorphisms and age at seizure onset in patients with non-lesional temporal lobe epilepsy. Eighty patients with non-lesional temporal lobe epilepsy with or without bilateral tonic-clonic propagation were analyzed. Age at seizure onset was defined as age at the first unequivocal seizure (excluding febrile convulsions). ApoE alleles were determined by a procedure where genome DNA was amplified by chain reaction along with polymerase, using the LightCycler kit (Roche) for ApoE mutations on codons 112 and 158. There was a statistically significant difference between the groups of patients with ApoE ε2/3 and ε3/4 genotypes (p=0.03), but not between patients with ApoE, ε2/3 and ε3/3, and those with ApoE ε3/4 and ε3/3. In conclusion, the results of our study suggested positive association of a specific ApoE genotype and onset of non-lesional temporal lobe epilepsy.

Brainstem nuclei changes in migraine detected by transcranial sonography.

The aim of this study was to estimate the role of transcranial sonography in detecting basal ganglia changes as structural biomarkers in migraine. Transcranial sonography was performed on Aloka prosound α-10. Semiquantitative and planimetric methods were applied when basal ganglia changes were detected. Comparison between groups was performed by unpaired Student's t test and Spearman's correlation test. We analyzed 30 migraine patients and 30 age-/sex-matched controls. Substantia nigra hyperechogenicity was detected in 36.7% migraineurs and in 13.3% controls (t test, p = 0.036888). Hyperechogenic substantia nigra was found in 70% aura patients and in 20% patients without aura (p = 0.007384). Mean substantia nigra echogenic size of all migraine patients was 0.16 ± 0.07 and 0.12 ± 0.043 cm2 in controls (t test, p = 0.0011). Lentiform nucleus hyperechogenicity was seen in 50% migraine patients and 13.3% controls (t test, p = 0.002267). Mean lentiform nucleus echogenic size of all migrenous patients was 0.34 ± 0.08 cm2 and in controls 0.20 ± 0.008 cm2 (t test, p = 0.0021). Caudate nucleus hyperechogenicity was found in 26.7% migraine patients and in 6.6% controls (t test, p = 0.037667). Mean frontal horn width in migraine patients was 8.73 ± 1.76 mm and in controls 7.10 ± 1.71 (t test, p = 0.0006). Substantia nigra hyperechogenicity correlated with disease duration (rho = -0.35521, p = 0.05467) and third ventricle width (rho = -0.68221, p = 0.02976). No other differences between migraineurs and controls were found. Our study has revealed differences in transcranial findings between migraineurs and controls, but overall significance of those findings are still to be evaluated.

Cognition in Parkinson's disease.

AIM: Studies of accentuated drop in cognitive functioning of Parkinson's disease patients mostly use global intelligence measures that have a masking effect on differential drop in specific cognitive abilities. The goal of this study was to investigate the possible differential drop in different types of cognitive tasks. Applied tests tapped fluid and crystallized intelligence, memory, and metacognition. METHOD: A sample of 116 participants participated in the study. Half of the participants were diagnosed with Parkinson's disease (average duration of disease 6.5 years) and control group participants equaled them in age, sex, and education level. All participants were tested using Raven's Colored Progressive Matrices (CPM), Crichton Vocabulary Scale (CVS), memory subtests from Wechsler Adult Intelligence Scale (WAIS DS-F, WAIS DS-B), and Mini-mental Status Examination (MMSE). Participants, and in the case of clinical group their caregivers as well, were asked questions concerning their metamemory and metacognition. RESULTS: Parkinson's disease patients scored lower than control group on all instruments used but the difference was significant only on CPM (F[1,114]=19.14, p=0.001) and MMSE (F[1,110]=4.04, p=0.047). CONCLUSION: Patients with Parkisons' disease have greater cognitive damage in fluid intelligence than in crystallized intelligence. They seem to have relatively accurate metamemory and metacognition.

ApoE genotyping and response to galanthamine in Alzheimer's disease--a real life retrospective study.

This study was undertaken to evaluate the effect of galanthamine, a new cholinesterase inhibitor on cognitive performances in 84 patients with various apoE genotype and Alzheimer's disease (AD) during the six-month treatment. The diagnosis of AD was made on the basis of NINCDS/ADRDN criteria. ApoE4 genotype was determined by PCR procedure. The cognitive performance was assessed MMSE at baseline and six months later. The difference among the groups was statistically analyzed by ANOVA model and Pearson's chi2-test. The MMSE at baseline in all completes was 18.0 +/- 3.73, whereas the mean value of MMSE after 6 months was 16.4 +/- 5.61 indicating significant deterioration (p < 0.01). Of the 84 patients, 14 (169%) were apoE4 homozygous, 41 (49%) were heterozygous, whereas 29 (35%) were apoE4 negative. The significant number of responders was observed among apoE4 homozygous patients (71%; chi2 = 6.89; p = 0.032). The subgroup of apoE4 homozygous patients with AD in its mild to moderate stage may be considered as responders to galanthamine.

[Pharmacotherapy of Alzheimer's disease--an evidence based approach]. / Farmakoterapija Alzheimerove bolesti--pristup temeljen na dokazima.

The aim of this article is to provide evidence-based recommendations for early diagnosis of Alzheimer's disease (AD) and hereby to give clinican guidelines for optimal detection of patients with AD. Our intention is also to unify diagnostic schemes in accordance with our objective and specific possibilities. Basic diagnostic procedures primarily are anamnesis and clinical examination with rational usage of neuroimaging, electrophysiological and laboratory procedures. Using these guidelines in medical practice in Croatia would be a good basis for future epidemiological and clinical multicentric studies.

[Isolated cervical spinal cord hemangioblastoma--case report]. / Izolirani hemangioblastom vratne kraljeznicne mozdine--prikaz bolesnika.

Hemangioblastomas are rare tumors which account for 0.9-2.1% of central nervous system neoplasms. The most common site of hemangioblastomas is the cerebellum, while they are rarely located in spinal cord, cerebrum and brain stem. Hemangioblastomas occur as a sporadic entity, and as a manifestation of von Hippel-Lindau syndrome. A 33-year old patient with isolated cervical spinal cord hemangioblastoma is presented.