Dragutin Kadojić

Transcranial Doppler ultrasound assessment of intracranial hemodynamics in patients with type 2 diabetes mellitus

BACKGROUND Diabetics have a 3-fold risk for cardiovascular diseases compared with non-diabetics. This study was designed to evaluate cerebral hemodynamic changes related to type 2 diabetes mellitus (DM) with transcranial Doppler ultrasonography (TCD). TCD is a highly sensitive and specific method of quick bedside assessment of cerebrovascular circulation hemodynamics. PATIENTS AND METHODS In a prospective study, we compared a group of 100 patients with the diagnosis of type 2 diabetes mellitus (aged 48 to 67 years) and an age- and sex-matched control group of 100 healthy subjects without diabetes mellitus. We measured flow velocities (Vm) and the Gosling pulsatility index (PI) of the middle cerebral artery (MCA). RESULTS The rate of TCD abnormalities was significantly higher in diabetic patients than in healthy control subjects (55% vs. 11%, P<0.05). The PI was significantly higher in diabetic patients than in healthy controls (P<0.001). Atherosclerotic changes were found in 34.0% and 71.4% of patients suffering from diabetes for <5 and ≥5 years, respectively. CONCLUSION This study suggests that TCD is a useful marker for the detection of diabetic cerebrovascular changes. The duration and type of diabetes were found to have an impact on the development of pathologic cerebrovascular changes.

Frequency and characteristics of emotional disorders in patients after ischemic stroke

Emotional disturbances in stroke patients may unfavorably affect the process of rehabilitation and longterm outcome of the disease. The aim of the study was to assess the prevalence of emotional disturbances and their characteristics in our stroke patients, according to hemispheric lateralization of cerebral lesion (as recorded by CT), patient sex and grade of neurological handicap (as assessed by Rankin scale). The study included 50 patients (29 men and 21 women, mean age 65.52 p ; 7.07 and 64.62 p ; 11.83 years, respectively) who had suffered ischemic stroke 3 weeks to 6 months before the study. The Crown-Crisp experience index which consists of six scales: scales of anxiety, phobia, obsession, somatization, depression and hysteria, were used for detection of emotional disturbances. Results showed a high prevalence of emotional disturbances in the study group. Depression was most common (36 of study patients), followed by generalized anxiety (n=29) and phobic disturbances (n=33). According to hemispheric lateralization of the cerebral lesion, a more intense emotional response was found in case of right hemispheric lesions, however, the difference was statistically significant only on the scale of somaticized anxiety (p<0.05). According to sex, a more intense emotional response was recorded in women. The difference being statistically significant on the scales of anxiety (p<0.05), depression (p<0.05) and phobia (p<0.01). An increasing tendency in the prevalence of emotional disturbances was observed with the increasing severity of neurologic deficit (p<0.05). Study results showed a high prevalence of emotional disturbances after ischemic stroke, among which the most common is depression.

Raspodjela rizičnih čimbenika za moždani udar u istočnoj Hrvatskoj

SUMMARY – The aim of this study was to determine the distribution of risk factors according to age, gender, subtypes and recurrence of stroke in eastern Croatia. The study included 250 acute stroke patients admitted to University Department of Neurology, Osijek University Hospital Centre in 2011. Patients were grouped according to age, gender, subtypes and recurrence of stroke. The study showed significant differences in the distribution of cigarette smoking, diabetes, cardiomyopathy and hyperuricemia according to patient age. According to gender, male patients had a significantly higher prevalence of smoking and alcohol abuse, whereas in female patients the prevalence of arterial hypertension, atrial fibrillation and hyperuricemia was significantly higher. Regarding stroke subtypes, significant differences were noticed in the prevalence of arterial hypertension, atrial fibrillation, cardiomyopathy and cerebral blood vessel stenosis. Atrial fibrillation was significantly more common in first-ever than in recurrent stroke. Study results identified the groups of patients requiring special attention regarding particular risk factors in eastern Croatia and emphasized the need of developing regional strategies of screening, prevention and holistic care for stroke patients.

PO31-FR-12 Stress hormones and cerebral hemodynamics in chronic PTSD

Cerebral hemodynamics was studied by transcranial Doppler (TCD) in 50 patients with chronic, previously untreated post-traumatic stress disorder (PTSD), with simultaneous determination of catecholamines by 24-hour urine analysis of vanillylmandelic acid (VMA) as the end-product of PTSD, pointing to the importance of the circle of Willis hemodynamics in this patient population. At the same time, increased levels of VMA were recorded in 58% and decreased levels of corticol in 56% of these patients. Following 3-week pharmacotherapy, elevated VMA and decreased cortisol persisted in 10% and 14% of patients, respectively. None of the control subjects had elevated VMA or decreased cortisol levels. Coexistence of the circle of Willis vasospasm, elevated VMA and decreased cortisol was initially observed in 50% of patients with chronic, previously untreated PTSD and none of the control subjects. Post-therapeutically, the same pattern persisted in 14% of PTSD patients. Study results pointed to the role of simultaneous analysis of cerebral hemodynamics, and cortisol and catecholamine levels in patients with chronic PTSD, catecholamine metabolism, and urine cortisol. The same analyses were performed in the patients following 3-week psychopharmacotherapy during their hospitalization at psychiatric ward, and in 50 healthy subjects as a control group. Vasospasm of the circle of Willis was observed in 68% and of vertebrobasilar basin in 22% of patients with chronic, previously untreated PTSD before therapy introduction. After 3-week psychopharmacotherapy, vasospasm of the circle of Willis and vertebrobasilar basis persisted in 18% and 10% of the patients, respectively. In the control group, vasospasm was recorded in only 4% of subjects. Statictical analysis yielded a statistically significant difference in the presence of the circle of Willis and vertebrobasilar basin vasospasm in patients with chronic, untreated PTSD, pointing to the importance of the circle of Willis hemodynamics in this patient population. At the same time, increased levels of VMA were recorded in 58% and decreased levels of corticol in 56% of these patients. Following 3-week pharmacotherapy, elevated VMA and decreased cortisol persisted in 10% and 14% of patients, respectively. None of the control subjects had elevated VMA or decreased cortisol levels. Coexistence of the circle of Willis vasospasm, elevated VMA and decreased cortisol was initially observed in 50% of patients with chronic, previously untreated PTSD and none of the control subjects. Post-therapeutically, the same pattern persisted in 14% of PTSD patients. Study results pointed to the role of simultaneous analysis of cerebral hemodynamics, and cortisol and catecholamine levels in patients with chronic PTSD.

26 Outcome of acute rehabilitation after stroke

associated with pronounced leukocytosis, hyponatriemia, elevated urea and creatinine.

4-37-01 Functional tests in the TCD analysis of the vertebrobasilar circulation

The study reviewed patients suffering from vertebrobasilar disorders - 38 patients experienced them after changing the head position, followed by 57 patients who had them resting - and the group of 59 healthy examinees. The transcranial Doppler (TCD) was used to measure the mean velocity (cm/s) of intracranial parts of vertebral and basilar arteries. The measuring was per-formed having the head in its physiological position, followed by the provoking test positions. The radiological neck spine findings were analyzed, and the electronistagmography and heat experiment were performed. The study results showed the significant changes of mean velocity in verte-bral arteries and basilar arteries intracranial parts, in patients comparing them to healthy group. The circulation velocity changes were more significant in the patients suffering from the vertebrobasilar disorders evident after assuming the head provoking positions than in the group of patients who had them resting. The result analysis obtained in the group of the patients with vertebrobasilar disorders, who were in the provoking position, suggest that the circulation disor-ders are related to the head positions and can be detected applying the Doppler circulation velocity measuring in the vertebral arteries, whereas the radiological finding of the neck spine showed far less visible changes in comparison to the healthy group. In the group of the vertebrobasilar patients, who were resting, the result analysis did not show any correlation between the disorders and circulation changes, that can be detected by Doppler circulation velocity mea-suring nor was the radiological neck spine finding of any importance, when we differentiated the sick ones from the healthy ones. The electronistagmographic finding and heat experiment did not help to detect and divide the patients with the vertebrobasilar disorders.