Marijana Lisak

Vascular characteristics of patients with dementia

Arterial beta stiffness index is a potential risk factor for increased stroke occurrence. Vascular component appears to be significant in both Alzheimers disease (AD) and vascular dementia (VAD). We aimed to further explore vascular characteristics of patients with both types of cognitive decline using non-invasive neurosonological methods. There were 38 patients; 16 diagnosed with AD and 22 with VAD. Vascular risk factors were assessed and ultrasound measurements on common carotid artery (CCA) were performed using Aloka ProSound ALPHA 10 with 13 MHz linear probe. Among AD patients there were 5 with arterial hypertension (AH), 3 with atrial fibrillation (AF), 2 with diabetes mellitus (DM), 6 with hyper lipidemia and 1 smoker. Nineteen VAD patients had AH, 6 had AF, 12 had hyper lipidemia and one was diabetic. We found no statistically significant differences between groups regarding average body mass index (BMI), blood pressure, pulse pressure, intima-media thickness (IMT), CCA diameter or arterial beta stiffness indices. However, the trend of BMI increase, slight blood and pulse pressure decrease, CCA diameter increase and beta stiffness index increase was noted in VAD patients. Even though there was no significant difference found among two explored subgroups of patients with dementia, there was a tendency of greater systolic and diastolic diameters noted in VAD as well as greater stiffness, especially when measured in the right CCA. This indicates that VAD patients may have more prominent vascular changes that may help differentiate the type of dementia and further monitor these individuals. Further studies on a larger number of patients are needed support this evidence.

Tolosa-Hunt Syndrome – Case Report

This case report presents a patient diagnosed with Tolosa-Hunt syndrome (THS) after an extensive neuro-diagnostic and neuroimaging evaluation. Diagnostic work-up included thorough physical and neurological examination, complete laboratory serum assessments, neuroendocrine and immunohistochemistry analysis, cerebrospinal fluid analysis, neurophysiology assessment, ophthalmologist examination and neuroimaging. Th e most important diagnostic tool in deriving the diagnosis of THS was neuroimaging evaluation that included baseline and follow-up cranial contrast enhanced magnetic resonance imaging (MRI). Baseline cranial contrast enhanced MRI detected a nonspecific inflammatory granulomatous lesion in the right cavernous sinus extending basally towards the right trigeminal cave (Meckels cave) and anteriorly towards the apex of the right orbit. Systemic intravenous high-dose corticosteroid therapy was administered for 3 consecutive days and then tapered down to lower oral steroid doses. Following therapy, the patient experienced complete regression of symptoms. Follow-up cranial contrast enhanced MRI showed significant regression of inflammatory lesion in the area of right cavernous sinus, thus verifying the efficacy of the treatment applied. This paper shows that an extensive diagnostic schedule for THS must be conducted prior to therapeutic treatment, for the possibility of alternative diagnosis. Patients suspected of having THS require careful evaluation, appropriate treatment, and follow-up.

The First Hospital-Based Registry of Patients with Multiple Sclerosis in Croatia

The first hospital-based registry of patients with multiple sclerosis (MS) was established at the University Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia, in 2014. The aim of the registry was to continuously provide data on the number of hospital-managed MS patients, patterns of disease progression, predictors of disability progression, changes in lifespan and long-term outcomes. Relevant medical data included age and gender of MS patients, family history of MS, data on previous immunization, disease course, Expanded Disability Status Scale (EDSS) score, cerebral magnetic resonance imaging (MRI) lesion load quantification, and cerebrospinal fluid analysis. Lifestyle habits in MS patients including smoking and alcohol consumption were also analyzed. All data were obtained from primary medical records between January 1, 2014 and January 1, 2015, and entered into the database. Data were evaluated retrospectively according to age and gender differences. Results showed that the majority of patients enrolled in the registry had the remitting relapsing course of disease, with low EDSS score indicating no disability or minimal disability. Cerebrospinal fluid analysis showed that oligoclonal bands were present in the majority of MS patients, with affected blood-brain-barrier permeability. According to the remitting relapsing course of the disease, cerebral MRI quantitative analysis demonstrated a significant lesion load in the majority of patients. When stratified by lifestyle habits, smokers and alcohol consumers were more prevalent among male patients. Our hospital-based registry might be considered as a prototype for the national MS registry and should be improved for reliable statistical analysis.

Feasibility of transcranial Doppler and single photon emission computed tomography in compound neuroactivation task

The aim of this study was to test feasibility of transcranial Doppler (TCD) and single photon emission computed tomography (SPECT) during compound neuroactivation task. The study was performed in 60 healthy right-handed volunteers. Cerebral blood flow velocity was measured by TCD in both middle cerebral arteries (MCA) at baseline and during computer game. The same stimulus and response pattern was used in 15 subjects that additionally underwent brain SPECT. Percentage differences between measurements were determined through quantitative result assessment. Both methods detected a statistically significant cerebral blood flow increase during neuroactivation. Correlation of TCD and SPECT showed statistically significant correlation only for the increase of cerebral blood flow velocity in the right MCA and for the right-sided cerebral blood flow increase, demonstrating that both methods partially measure similar cerebral blood flow changes that occur during neuroactivation. Comparison of TCD and SPECT showed TCD to be inadequately sensitive method for evaluation of cerebral blood flow during complex activation paradigm.

Non-invasive assessment of cerebral blood flow changes during complex activation

BackgroundThe aim of this study was to cross-validate functional transcranial Doppler (FTCD) and brain single photon emission computed tomography (SPECT) using complex activation paradigm and to test the feasibility of FTCD in complex neuroactivation research.MethodologyThe study was performed in the group of 60 healthy, right-handed subjects. Cerebral blood flow velocity (CBFV) was measured in both middle cerebral arteries (MCA) during baseline and during computer game interaction, using FTCD. Identical stimulus and response patterns were used in the subgroup of 15 subjects that underwent brain SPECT. Quantitative assessment of results was done to detect the percentage variation between the two measurements.ResultsA statistically significant increase of cerebral blood flow (CBF) was detected by FTCD and brain SPECT (p<0.0001). In comparison between the two methods, statistically significant association (r=0.5608, P=0.030, coefficient of determination r2 = 0.3154) was detected only for CBFV increase in the right MCA and for the rightsided cerebral blood perfusion (CBP) increase, indicating that these two methods only partially measure the same characteristics associated with activation of specific brain areas.ConclusionIn comparison with SPECT, FTCD is not sufficiently sensitive method for evaluation of CBF changes during complex activation paradigm. Our study represents negative evidence and stand against the common belief that FTCD is as good as other neuroimaging methods used for CBF measurements during neuroactivation. Therefore, FTCD might not be a reliable and suitable method for evaluation of CBF changes during complex neuroactivation paradigm.

The role of increased cholesterol levels in Alzheimer's disease and vascular dementia

Recent studies have shown that vascular dementia (VD) and Alzheimers dementia (AD) might overlap in many aspects. Also it was suggested that elevated cholesterol levels could have some influence on AD onset and progression. The aim of this study was to evaluate the levels of cholesterol in patients with both types of dementia. Sixty-six patients with dementia were enrolled in this study. AD was diagnosed in 43 and VAD in 23 patients. In a group of 43 AD patients (22 males, mean age 72.79 +/-8.19) plasma values of cholesterol were analyzed. In AD group, 18 patients had normal, and 25 had elevated plasma cholesterol levels, while in VAD group 12 patients had elevated and 11 had normal plasma cholesterol levels. Mean plasma level of total cholesterol was 5.39 +/-1.05, LDL 3.33 +/- 0.95, and HDL 1.41 +/- 0-34 in patients with AD. In patients with VAD mean plasma level of total cholesterol was 5.78 +/-1.06, HDL 1.44 +/- 0.57, LDL 3.72 +/- 0.85. The levels of total cholesterol, LDL, HDL were higher in a group of patients with VAD, but the difference did not reach statistical significance. Vascular risk factors are known to be associated with VAD. Our data, however, show that patients with AD also have elevated plasma levels of cholesterol. Our results support the idea that cholesterol could have some influence on etiology, onset and progression of both AD and VAD, thus implying similarities in pathogenesis of both diseases.