Marina Titlić

P300 Evoked Potential in Patients with Mild Cognitive Impairment

CONFLICT OF INTEREST: NONE DECLARED Aim The aim of this study is to present differences of amplitude and latency of P300 wave between examinees with mild cognitive impairment and examinees from the control group. Methods A cross-section study was performed between April 1st and July 10th 2012, with the diagnosis of mild cognitive impairment as the main criterion for inclusion. In the twenty-two examinees who participated in the research, mild cognitive impairment was confirmed by neuropsychological testing, following which they were subjected to the examination of auditory evoked potentials. The control group consisting of 22 examinees, for which the lack of the same diagnosis was previously ascertained, was also subjected to the examination of auditory evoked potentials. The main findings were the differences in the latency and amplitude size of P300 wave targeted and non-targeted stimuli. Results The latency of P300 wave targeted stimuli in patients with mild cognitive impairment has, in statistical terms, proven to be significantly longer when compared to the control group. The average latency length in those with MCI amounted to 306.18 ms, whereas the latency in the control group came to 295.95 ms. Similarly, the latency length of non-targeted stimuli turned out to be statistically higher, with the length of 320.00 ms in the former group, and 301.36 ms in the latter. Amplitudes in patients with mild cognitive impairment were lower in comparison to the control group, with extremely low amplitudes recorded in 36.36% of patients. Conclusion In patients with mild cognitive impairment extended latency and lower amplitude of P300 wave are recorded.

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.

P300 wave changes in patients with multiple sclerosis.

Introduction: In patients with multiple sclerosis among other symptoms occur cognitive dysfunctions, which can be shown by P300 wave changes. Goal: The aim of this study was to demonstrate that patients with multiple sclerosis have reduced amplitude and prolonged latency, longer than 300 ± 10 ms. Methods: The study included group of patients with multiple sclerosis and control group. After reviewing the medical records both groups of 14 participants were subjected to the same testing procedures auditory cognitive potentials (P300). Results: We have shown that patients with multiple sclerosis don’t have prolonged P300 target stimulus latency, but they have a longer P300 frequent stimulus latency for 18 ms. From 14 patients seven had a pathological P300 target stimulus amplitude, and even 12 patient had pathological P300 frequent stimulus amplitude. Conclusion: People with multiple sclerosis have altered P300 which indicates the presence of cognitive dysfunction in these patients.

Colonoscopic Polypectomies and Recommendations on the Colonoscopy Follow-up Intervals Depending on Endoscopic and Histopathological Findings.

The Aim: To show histopathological diagnoses after colonoscopic polypectomy in the University Hospital Center (KBC) Split with recommendations on further follow-up colonoscopy depending on the endoscopic and histological findings. Patients and Methods: The study included 2842 patients who underwent colonoscopy in a two-year period (2008-2009), followed by a detailed analysis of 350 patients in which one or more polyps were simultaneously removed and 163 patients who were only sampled for histological analysis. Patients from the National Program for Colorectal Cancer Prevention and patients in which colonoscopy is indicated as part of daily outpatient or inpatient treatment were included as well. Results: During 2008 and 2009 in KBC Split, out of a total of 2842 colonoscopies, 350 patients underwent colonoscopic polypectomy, whereby 618 polyps were removed (1-8 polyps in individual patients), while in 163 patients only biopsy specimens were sampled. Out of the total of 557 polyps sent for histological analysis, 236 were hyperplastic (42%), 193 were identified as tubular adenoma (35%), 84 were tubulovillous (15%), 18 villous (3%), 9 were adenocarcinoma (2%) and other 17 (3%). In 35 (15.4%) polyps high-grade dysplasia was found. The largest number of nonpolypectomized changes confirmed the presence of adenocarcinoma (76-47%), adenomas and hyperplastic polyps were 37 (22%) and regular findings 23 (14%). Mucosal high-grade dysplasia was demonstrated in 35 (23.1%) biopsied changes. Conclusion: Colonoscopies with polypectomy decreased the risk of the formation of colorectal cancer in these patients almost to the level of risk in patients who have not even had a polyp during colonoscopy. Arguably the best method of prevention and early detection of colorectal cancer are already widely established national programs. The next qualitative level is constantly improving the quality of colonoscopy with clear criteria and the establishment of a body to evaluate the performers and the equipment, and making recommendations on the colonoscopy follow-up intervals depending on endoscopic and histopathological findings of patients who for any reason underwent colonoscopy.

Lower Contribution of Factor V Leiden or G202104 Mutations to Ischemic Stroke in Patients With Clinical Risk Factors Pair-Matched Case-Control Study

It was suggested that factor V Leiden and prothrombin G20210A mutations increase the risk of ischemic stroke only in combination with clinical risk factors of arterial ischemic disease. In these studies the controls were derived from the general population, with fewer clinical risk factors, which might have produced biased results. The factor V Leiden and prothrombin G20210A mutations were examined by polymerase chain reaction technique in 120 ischemic stroke patients and 120 controls younger than 65 years of age. Each patient had his own control, tightly matched in clinical risk factors. The prevalences of factor V Leiden and prothrombin G20210A mutations in patients were 8.3% (P = 0.02) and 7.5% (P = 0.04), respectively, and 2.5% for controls for both mutations. All carriers were single heterozygotes. In patients, but not in controls, the carriers of either mutation were mostly women and with fewer clinical risk factors for arterial ischemic events. In particular, considering both mutations as a single coagulation deficit, their presence increased the likelihood of ischemic stroke (odds ratio [OR] = 3.6; 95% confidence interval [CI] 1.4—9.3), especially among women (OR = 4.6; 95% CI: 1.2—17.8), normotensive persons (OR = 9.2; 95% CI: 1.1—17.8) and those having normal cholesterol (OR = 5.9; 95% CI: 1.6—21.2) and triglyceride serum concentrations (OR = 4.3; 95% CI: 1.5—12.8). In the studied sample of adult North Mediterranean population younger than 65 years the prevalences of factor V Leiden and prothrombin G20210A mutations were greater in patients with ischemic stroke than in matched controls. Unlike in studies with unmatched controls, we observed an apparently negative interaction of these mutations with clinical risk factors.

P300 Wave Changes in Patients with Parkinson's Disease

Introduction: Parkinson’s disease (PD) is chronic progressive neurodegenerative disease. In patients with Parkinson’s disease among other symptoms occur cognitive dysfunctions, which can be shown by P300 wave changes. Aim: The aim of this study was to demonstrate that patients with Parkinson’s disease have reduced amplitude and prolonged latency, longer than 300 ± 10 ms. Material and Methods: The study included 21 patient suffering from Parkinson’s disease. After reviewing the medical records and analyzes the inclusion and exclusion criteria, patients were subjected to the same procedure examining auditory cognitive potentials (P300 wave) and the results were analyzed and compared to reference value for healthy population. Results: We have shown that patients with Parkinson’s disease have prolonged P300 targeted and frequent stimulus latency compared to reference value for healthy population. From 21 patient 18 had a pathological P300 target stimulus amplitude, and even 20 patients had pathological P300 frequent stimulus amplitude. Conclusion: People with Parkinson’s disease have altered P300 which indicates the presence of cognitive dysfunction in these patients.

The Event-related Potential P300 in Patients with Migraine

Objective: Recording of event-related potentials by using oddball paradigm of auditory P300 has yielded conflicting results in migraine. The aim of this study was to demonstrate that migraine patients have reduced P300 amplitude and prolonged P300 latency, suggesting alterations of the cognitive-evaluative component. Methods: We recruited 29 migraine patients (24 females; median age 40 years) and 29 healthy age- and gender-matched participants. Participants were subjected to the same testing procedures of auditory P300 by discrimination the target auditory stimulus from the frequent stimulus, and analyzing P300 target/frequent stimulus amplitudes, and P300 target/frequent stimulus latencies. Results: Patients with migraine don’t have prolonged P300 target stimulus latency, but have a longer P300 frequent stimulus latency for 17.5ms. Out of 29 participants with migraine 8 had pathological P300 target stimulus amplitude, and 19 had pathological P300 frequent stimulus amplitude. Conclusion: People with migraine have altered the P300 which indicates the presence of cognitive dysfunction in these patients and importance of early diagnosis and intervention to preventing any deterioration in cognitive functions.

Differentiation of Tumefactive Demyelinating Lesions from Metastatic Brain Disease with FDG PET-CT: A Case Report

Tumefactive demyelinating brain disease can pose a diagnostic challenge in patients without a pre-existing diagnosis of multiple sclerosis by mimicking intra-cranial neoplasms, infarction, as well as infections. Choosing when to biopsy a tumefactive lesion to exclude alternative pathology can be difficult. Here we report a case of a 44 year old female patient without a previous history of multiple sclerosis who presented with two brain lesions mimicking metastatic brain disease which pose a serious diagnostic dilemma. FDG PET CT and follow up magnetic resonance imaging (MRI) helped to rule out tumor etiology of those lesions and spared patient from invasive procedures such as biopsy or radiotherapy.

Foramen Magnum Meningioma: a Case Report and Review of Literature

Introduction: Meningiomas are slow-growing benign tumors that arise at any location where arachnoid cells reside. Although meningiomas account for a sizable proportion of all primary intracranial neoplasms (14.3–19%), only 1.8 to 3.2% arise at the foramen magnum. Their indolent development at the craniocervical junction makes clinical diagnosis complex and often leads to a long interval between onset of symptoms and diagnosis. Case report: We report a case of a 79-year-old male patient, presented with ataxia and sense of threatening fainting during verticalization. Magnetic resonance imaging revealed the presence of meningioma in the right side of craniospinal junction.

Thrombosis of sinus sagitalis during puerperium caused by thrombophilic gene mutation.

Cerebral veno-sinus thrombosis (CVT) during puerperium may have fatal consequences. A nonspecific clinical picture must be complete with computed tomography of the brain and digital substract angiography of the brain blood vessels, and, once the clinical diagnosis is confirmed, coagulation tests and genetic analysis of the coagulation factor are to be made as well. Genetic polymorphisms associated with thrombophilia such as factor V Leiden, prothrombin G20210A, MTHFR C677T, ACE and PIA1/A2 may be the cause of the hypercoagulability that results in CVT.