Vlasta Vuković

Prevalence of Vertigo, Dizziness, and Migrainous Vertigo in Patients With Migraine

Objective.— The aim of this study was to determine the lifetime prevalence of vertigo and dizziness in patients with migraine as compared with controls and to establish the lifetime prevalence of migrainous vertigo.

Polymorphism of apoprotein E (APOE), methylenetetrahydrofolate reductase (MTHFR) and paraoxonase (PON1) genes in patients with cerebrovascular disease.

Abstract Although controversial, data on the genetic polymorphism of apoprotein E (APOE), methylenetetrahydrofolate (MTHFR) and paraoxonase (PON1) genes implicate their role in the development of cerebrovascular disease. The aim of this study was to assess the association of polymorphism of APOE, MTHFR and PON1 genes in 56 stroke and 36 carotid stenosis patients, and in 124 control subjects by PCR-restriction fragment length polymorphism analysis. In the stroke group a significantly different MTHFR genotype distribution (p=0.004, odds ratio for T/T of 17.571), but no significant difference in APOE and PON1 allele and genotype distribution compared to the control was found. The carotid stenosis group exhibited a significantly different APOE allele and genotype distribution (p=0.023, odds ratio APOE∊3∊4 of 4.24), but no significant difference in the MTHFR and PON1 allele and genotype distribution from the control group. The preliminary results obtained in this study revealed an association of the MTHFR and APOE gene polymorphism with cerebrovascular disease, suggesting a significant risk for stroke in subjects who are homozygous for the T allele and for carotid stenosis in subjects having APOE∊3∊4 genotype. Additional studies in larger patient groups are needed to confirm these observations.

Role of Vertebral Artery Hypoplasia in Migraine

The role of cerebral hypoperfusion in the posterior circulation has not been clearly established in migraine. The purpose of this study was to determine the role of vertebral artery (VA) hypoplasia in the pathogenesis of migraine. We studied the extracranial part of VA in 59 migraine patients (17 with and 42 without aura) using color Doppler. In migraine with aura, 29% of patients had hypoplastic VA, and in migraine without aura 7%. In migraine with aura, mean diameter of the right VA was 2.7 ± 0.7 mm, and of the left 3.3 ± 0.7 mm; in migraine without aura mean diameter was 3.1 ± 0.5 mm on the right, and 3.3 ± 0.6 on the left, In migraine with aura, mean systolic blood flow velocity was 55 ± 16 cm/s on the right, 60 ± 17 cm/s on the left, in migraine without aura 57 ± 18 cm/s on the right, 57 ± 18 cm/s on the left. We observed higher frequency of hypoplastic VA in migraine with aura, suggesting that hypoplasia of VA may be an additional factor which can lead to hypoperfusion in the posterior circulation during the aura phase.

Brainstem raphe lesion in patients with major depressive disorder and in patients with suicidal ideation recorded on transcranial sonography

Recent transcranial sonography (TCS) studies showed that disruption of echogenic midbrain line, corresponding to basal limbic system and raphe nuclei (RN) within, might represent functional marker for the development of depression. Major depressive disorder (MDD) is one of the most common psychiatric disorders associated with suicidal ideation. We initiated this study to assess the usefulness of TCS recording in a group of MDD patients and in MDD patients who also reported suicidal ideation, on the assumption that TCS might serve as a screening method for differentiating patients at risk of suicide. Altogether 71 subjects: 17 patients with MDD, 14 patients with MDD who also reported suicidal ideation and 40 healthy controls, were studied using TCS by two independent physicians. Reduced raphe echogenicity was found in 8 of 17 (47%) of the patients with MDD but only in 6 of 40 (15%) controls. In patients with suicidal ideations that finding was even more pronounced (12 of 14, 86%) with the highest frequency of completely not visible TCS RN finding (10 of 14, 72%). Data showed that altered echogenicity of the RN is frequent in patients with suicidal ideation. Normal RN echogenicity in MDD patients was associated with less severe depressive symptoms and rarely with the presence of suicidal ideations. As far as we know, these are the first ever obtained results which show that TCS might help differentiating MDD patients with suicidal risk or eventually predict good disease recovery based on the findings of RN hypo- or normoechogenicity.Recent transcranial sonography (TCS) studies showed that disruption of echogenic midbrain line, corresponding to basal limbic system and raphe nuclei (RN) within, might represent functional marker for the development of depression. Major depressive disorder (MDD) is one of the most common psychiatric disorders associated with suicidal ideation. We initiated this study to assess the usefulness of TCS recording in a group of MDD patients and in MDD patients who also reported suicidal ideation, on the assumption that TCS might serve as a screening method for differentiating patients at risk of suicide. Altogether 71 subjects: 17 patients with MDD, 14 patients with MDD who also reported suicidal ideation and 40 healthy controls, were studied using TCS by two independent physicians. Reduced raphe echogenicity was found in 8 of 17 (47%) of the patients with MDD but only in 6 of 40 (15%) controls. In patients with suicidal ideations that finding was even more pronounced (12 of 14, 86%) with the highest frequency of completely not visible TCS RN finding (10 of 14, 72%). Data showed that altered echogenicity of the RN is frequent in patients with suicidal ideation. Normal RN echogenicity in MDD patients was associated with less severe depressive symptoms and rarely with the presence of suicidal ideations. As far as we know, these are the first ever obtained results which show that TCS might help differentiating MDD patients with suicidal risk or eventually predict good disease recovery based on the findings of RN hypo- or normoechogenicity.

Croatian population data for the C677T polymorphism in methylenetetrahydrofolate reductase: frequencies in healthy and atherosclerotic study groups

BACKGROUND The aim of this study was to investigate the frequency of C677T methylenetetrahydrofolate reductase (MTHFR) mutation in healthy Croatian volunteers and in patients with atherosclerosis. METHODS The C677T MTHFR gene mutation was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in 640 subjects, residents of the Zagreb city or Zagreb surroundings. Control group (n=298) was healthy blood donors. Patients (n=342) were divided into two groups of those with coronary heart disease, CAD (n=247) and those with >60% carotid stenosis, CS (n=95). RESULTS CC genotype was recorded in 45% of healthy volunteers and 46% of patients (46.3% with CS and 46.2% with CAD). TC genotype was found in 49% of healthy volunteers and 45% of patients (46.3% with CS and 44.9% with CAD). There was no significant difference (p>0.05) from the control group in the genotype or allele frequency either for the overall group of patients with atherosclerosis or for the patient subgroups. CONCLUSION The preliminary study of MTHFR polymorphism in control subjects and cardiovascular disease/carotid stenosis patients revealed that in Croats there was a low frequency of TT genotype (6% in controls vs. 9% in patients) and T allele (31% for cases and controls). Additionally, our results did not show significantly higher frequency of MTHFR mutation in CAD and CS studied groups.

Perception of stroke in Croatia--knowledge of stroke signs and risk factors amongst neurological outpatients.

Background and purpose:  The aim of this hospital‐based survey was to determine baseline stroke knowledge in Croatian population attending the outpatient services at the Department of Neurology.

Transcranial Doppler as an Confirmatory Test in Brain Death

Brain death is defined as the irreversible loss of all brain functions, including the brainstem. The diagnosis of brain death allows organ donation or withdrawal of support. Therefore, the exact criteria for the diagnosis should be determined. In the Croatian legal acts on transplantation, repeated neurological examination must show the loss of brainstem reflexes, and one confirmation test has to be done. Several tests are available to show cessation of the brain or brainstem activity, or to confirm the cerebral circulatory arrest. Bedside evaluation is preferred, with the use of neurosonologic tests that show a high resistance pattern in hemodynamics, in parallel with the increase of intracranial pressure, eventually leading to cerebral circulatory arrest. Trained personnel and strict protocols are required. Bedside transcranial Doppler is presented along with the criteria and its value in brain death confirmation.

Frank's sign as a risk factor for cerebrovascular disease

Franks sign is a dermatological marker which is through many studies put in correlation with the coronary heart disease. The aim of this research carried out on a sample of 60 examinees is to define whether Franks sign belongs to the group of risk factors of cerebrovascular disease. The examinees with the presence of Franks sign were assinged to group A, while the examinees without the presence of Franks sign were assigned to group B, all of whom were subject to color Doppler examination of carotid arteries and also their carotid artery intimal wall thickness (IMT – “ intima-media thickness“ ) on a common carotid artery (ACC) was determined. The value of ACC-IMT taken as increased was the value exceeding 0.9 mm. Using a statistical analysis by performing the Pearsons Chi-square test, the value obtained was 11, 279 and p = 0, 001. By Franks sign validity assessment in predicting increased ACC-IMT the sensitivity determined reached 73%, a specificity of 70%, a positive predictive value of 71% and a negative predictive value of 72%. The research has shown statistically significant correlation of Franks sign and increased ACC-IMT supporting the hypothesis according to which this marker is an uncontrollable risk factor for cerebrovascular disease.

40 Increased donor rate in Clinical Hospital “Sestre Milosrdnice”

medical treatment. As a result, there are serious problems in the objective evaluation of permanent consequences of the injury. The study included 40 randomly selected whiplash injury victims without previous lesions of cervical spine, and 40 equally selected patients with previously confirmed cervical degenerative changes. They all suffered from permanent whiplash injuries and applied for reimbursement for non-material damage to Zagreb Insurance Company during 2001. Sixty-seven per cent of patients underwent continuous treatment for 5–6 months, however, the sequels of whiplash injury persisted in the form of decreased motility of cervical spine, arm paresthesia, vasospasm of vertebral arteries and permanently narrowed visual field. Pathological findings were verified by objective diagnostic methods: functional X-rays of the cervical part of the spinal cord, electromyoneurographiic examination of arms, transcranial Doppler sonography of vertebrobasilar arteries, visual field assessment by Goldman method, and clinical examination by medical censor. The treatment of injured patients with previous degenerative changes of cervical spine took a longer time, with a higher level of head and neck motility reduction. Ultimately, in terms of reimbursement, they were conceded a lesser degree of permanent physical damage than those without previous cervical spine lesions.

14 Surveillance of Croatian pregnant women with epilepsy and effects of antiepileptic drugs exposure in their offspring

characteristic for different pathological white matter processes. Conclusion: MRI is a very sensitive but unfortunately relatively unspecific method for evaluation of WML. As mentioned earlier, differential diagnosis of WML is a long list. Due to that the diagnosis of a specific pathological process characterised by one or more lesions in the white matter has to be made by combining clinical aspect and radiological assessment.