Goran Pavliša

The differences of water diffusion between brain tissue infiltrated by tumor and peritumoral vasogenic edema

The differences between peritumoral brain tissue infiltrated by tumor and vasogenic edema were prospectively evaluated by comparing the apparent diffusion coefficient (ADC) of peritumoral areas of infiltrative tumors (anaplastic astrocytomas and glioblastomas) to that of peritumoral areas of noninfiltrative tumors (metastatic carcinomas) on 54 patients. Peritumoral ADCs indicated the possibility of differentiation between tumor infiltration and vasogenic edema, as well as between primary gliomas and metastases.

Characteristics of typical and atypical meningiomas on ADC maps with respect to schwannomas

The differences in apparent diffusion coefficient (ADC) between typical and atypical meningiomas and schwannomas were investigated, with 41 patients included in the study. There were no significant differences in ADC values or ADC ratios between typical and atypical meningiomas. The discrimination between schwannomas and the typical and atypical meningiomas on ADC maps was reliable, with significant differences in ADC values and ratios and with the narrow range of ADC values in meningiomas.

Serum levels of VEGF and bFGF in hypoxic patients with exacerbated COPD

Hypoxia frequently complicates the course of chronic obstructive pulmonary disease (COPD). Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) are the two most potent angiogenic factors and may play a role in adaptation to hypoxia. The aims of the study were to assess the serum levels of VEGF and bFGF and to evaluate their mutual relationship in hypoxic patients with exacerbated COPD. The study group consisted of 50 hypoxic (PaO(2) 53 mmHg) patients with exacerbated COPD. Control groups were 30 stable COPD patients with PaO(2) 70 mmHg, and 30 healthy blood donors. The serum concentrations of VEGF and bFGF were measured using commercial enzyme-linked immunoassay kits. Patients with exacerbated COPD had significantly higher serum VEGF levels (1,089.16 +/- 1,128.03 pg/mL) compared to those with stable COPD (197.68 +/- 178.06 pg/mL) (p < 0.0001) and healthy blood donor group (257.69 +/- 170.4 pg/mL) (p < 0.0001). Serum bFGF levels were significantly higher in the exacerbated COPD group (6.15 +/- 2.56 pg/mL) compared to control groups (p = 0.0001). Basic FGF was undetectable in the stable COPD and blood donor groups. Since VEGF and bFGF correlated significantly with the majority of factors investigated in COPD patients, multivariate analysis was performed. According to the step-wise regression analysis, VEGF was best determined by PaO(2), WBC and IL-6. Basic FGF was best determined by PaO(2) and pH. The highly significant, simple correlation between VEGF and bFGF was lost in multivariate analysis. This suggests that their correlation is not independent, but due to factors that remain in the model after step-wise regression. These are essentially linked to the level of hypoxia. Results of our study suggest that VEGF and bFGF production is stimulated in hypoxic patients with exacerbated COPD. Elevated levels of VEGF and bFGF may activate the process of neoangiogenesis, which may lead to increased perfusion and an improvement in tissue oxygenation in this group of patients.

Long-term angiographic outcome of stent- assisted coiling compared to non-assisted coiling of intracranial saccular aneurysms

Aim To compare angiographic result at long-term follow-up, and rates of progressive occlusion, recurrence, and retreatment of stent-assisted coiled (SAC) and non-assisted coiled (NAC) intracranial saccular aneurysms. Methods Retrospective evaluation of department records identified 260 patients with 283 saccular intracranial aneurysms who had long-term angiographic follow-up (more than 12 months) and were successfully treated with SAC (89 aneurysms) or NAC (194 aneurysms) at the University Hospital Center Zagreb from June 2005 to July 2012. Initial and control angiographic results in both groups were graded using Roy/Raymond scale, converted to descriptive terms, and the differences between them were evaluated for statistical significance. A multivariate analysis was performed to identify factors related to progression of aneurysm occlusion and recurrence at follow-up, and those related to aneurysm retreatment. Results There were more progressively occluded aneurysms in SAC group (38 of 89 aneurysms, 42.7%) than in NAC group (46 of 194, 23.7%) (P = 0.002), but there were no significant differences in the rates of recanalization, regrowth, and stable result. Multivariate logistic regression identified the use of stent as the most important factor associated with progressive occlusion (P = 0.015, odds ratio 2.22, 95% confidence interval 1.17-4.21), and large aneurysm size and posterior circulation location as most predictive of aneurysm recurrence and retreatment. Conclusion The use of stent is associated with delayed occlusion of initially incompletely coiled aneurysms during follow-up, but does not reduce the rate of recurrence and retreatment compared to coiling alone. Long-term angiographic follow-up is needed for both SAC and NAC aneurysms.

Diffusion differences between pilocytic astrocytomas and grade II ependymomas

Diffusion differences between pilocytic astrocytomas and grade II ependymomas Background. The aim of our study was to differentiate between cerebellar pilocytic astrocytomas and grade II ependymomas on the basis of their diffusion properties. Patients and methods. The study prospectively included 12 patients with pilocytic astrocytomas and 5 with ependymomas. Apparent diffusion coefficients (ADC) were compared between tumour types. Results. ADC values were significantly higher in pilocytic astrocytomas than ependymomas, with almost no overlapping of the range of measured ADCs between the two tumour types. Conclusions. Significant diffusion differences between pilocytic astrocytomas and grade II ependymomas enable their preoperative distinction, in combination with conventional magnetic resonance images.

Migration of Enterprise stent in treatment of intracranial aneurysms: a report of two cases

Migration of Enterprise stent in treatment of intracranial aneurysms: a report of two cases Background. We present two patients with acutely ruptured complex aneurysms of the internal carotid artery, arising at the origin of the posterior communicating artery (PComA). Case reports. The aneurysms in both patients had a wide neck and the closed-cell stent (Enterprise) was delivered to assist in aneurysm coiling. In both patients an inadvertent migration of stent occurred, without periprocedural complications. Aneurysms were successfully embolized by endovascular coils. Conclusions. These cases highlight the flexibility of the stent, as well as the likelihood of stent migration in the setting of immediate coiling after the placement of stent, or in adverse anatomic relations.

Central positioning upbeat nystagmus and vertigo due to pontine stroke

We present a female patient with central positioning nystagmus and vertigo (c-PPV) due to a pontine stroke. To our knowledge this is the first report of central upbeat positioning nystagmus caused by pontine lacunar stroke. This report, together with those published previously, supports the existence of a crossing ventral tegmental tract in humans.

Late-onset Wilson's disease presenting with general anxiety disorder

Wilson’s disease (WD) is an autosomal recessive inherited disorder of copper metabolism due to mutations in the ATP7B gene. The disease usually manifests in the first or second decade of life, either as a liver disease or with neuropsychiatric disturbances. We present a 45-year-old female with general anxiety disorder as a first manifestation of WD with profound abnormalities on brain magnetic resonance imaging (MRI). A 45-year-old female was admitted to Psychiatry Department because of severe anxiety and fear of death. On examination she was oriented in time and place, restless and had a feeling of keyed-up, she was easily fatigued, had difficulty concentrating, showed increased irritability and muscle tension and had sleep disturbance. Her family members and co-workers noted in the couple of previous months that she was very irritable, had poor concentration and was forgetful. Standard laboratory findings revealed leucopenia and thrombocytopenia. Abdominal ultrasound showed diffuse hypoechogen nodules in the liver. Because she was noted to have short-term memory disturbance, brain MRI was performed to reveal T2 hyperintensities in the medulla, pons and both thalami. On admission to our department, neurological examination showed that she was oriented in time and place, her minimental state examination (MMSE) was 24/30 (−2 points on short term memory and −4 points on serial subtraction), the 3′ paced auditory serial addition test (PASAT) was 17/60, the clock drawing test was 8/10 and face recognition test was 18 in the first 90 s (5 s per face), and in 5 min was 51 (6 s per face) but she could not finish the test till the end. Cranial nerve examination was normal except saccadic pursuit eye movements and positive Kaiser-Fleischer rings bilateraly. She had brisk reflexes (3+), negative Babinski and truncal ataxia. Laboratory examination revealed leucopenia, elevated liver enzymes, serum copper levels and ceruplasmin levels were normal, but 24-h urin copper level was elevated. Repeated brain MRI showed T2 hyperintensities in the pons, crura cerebri and thalami bilaterally, which were hypointense in T1 sequences and did not show diffusion restriction (Fig. 1). Multisliced computed tomography of the liver showed numerous hypodense zones without contrast enhancemet, dilated portal and lineal veins and tortuous collateral veins

Endovascular treatment of AVM-associated aneurysm of anterior inferior cerebellar artery through persistent primitive hypoglossal artery

Abstract We present a patient with the combination of persistent primitive hypoglossal artery and the origin of left common carotid artery from the brachiocephalic trunk, who had subarachnoid haemorrhage caused by a ruptured aneurysm. The aneurysm was on distal anterior inferior cerebellar artery which was a feeder to cerebellar arterio-venous malformation.