Aleksandar Jesic - Academia.edu (original) (raw)

Papers by Aleksandar Jesic

Journal of the Neurological Sciences, 2009

Acta Clinica Croatica, Jun 1, 2010

Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting... more Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by acting on its cause using a very powerful weapon, thrombolytic therapy. The aim is to present a preliminary report of our experiences with thrombolytic therapy in patients with ischemic stroke. Results recorded in 20 patients who received thrombolytic therapy within three hours of stroke onset are presented. Nineteen patients survived and one patient died from therapy side effects, i.e. intracerebral hematoma. Seventeen of 19 patients were released from the hospital without any neurologic deficit, while two patients had Rankin score 2 (minimum disability) three months after stroke onset. Our experience confirms that thrombolytic therapy is the treatment of choice in patients with ischemic stroke if administered in accordance with precise protocols.

Acta Clinica Croatica, Jun 28, 2011

Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting... more Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by acting on its cause using a very powerful weapon, thrombolytic therapy. The aim is to present a preliminary report of our experiences with thrombolytic therapy in patients with ischemic stroke. Results recorded in 20 patients who received thrombolytic therapy within three hours of stroke onset are presented. Nineteen patients survived and one patient died from therapy side effects, i.e. intracerebral hematoma. Seventeen of 19 patients were released from the hospital without any neurologic deficit, while two patients had Rankin score 2 (minimum disability) three months after stroke onset. Our experience confirms that thrombolytic therapy is the treatment of choice in patients with ischemic stroke if administered in accordance with precise protocols.

Acta Clinica Croatica, 2009

The aim of this prospective study was to evaluate therapeutic effects in a cohort of 32 patients ... more The aim of this prospective study was to evaluate therapeutic effects in a cohort of 32 patients with relapsing-remitting multiple sclerosis (RRMS) that were continuously treated with interferon beta-1b during a three-year period and to compare the results obtained with literature data available. Additionally, dropouts and side effects were assessed. The annual relapse rate at three years of treatment as the primary study end-point decreased by 60.5% compared with the relapse rate throughout the pretherapeutic course of disease (0.39±0.55 vs. 0.97±0.46; P<0.001) and by 71.3% compared with the relapse rate one year prior to treatment (0.39±0.55 vs. 1.34±0.65; P<0.001). The mean Extended Disability Status Scale (EDSS) increased significantly from 2.46±0.86 at baseline to 2.90±1.30 (P<0.01) at three years of treatment, whereas the mean progression index (EDSS/disease duration) decreased significantly from 0.76±0.50 prior to treatment to 0.43±0.24 (P<0.001), yielding a 56.6% improvement and proving the disease modifying effect of interferon beta-1b. Seventeen (53.12%) patients remained relapse-free during the course of therapy. Among patients that experienced disease relapse, the mean time to first exacerbation was 11.5±8.34 months. Our study results were consistent with similar studies performed worldwide, clearly indicating that Interferon beta-1b therapy decreased the disease activity and had a beneficial effect on the progression of RRMS, with low incidence and severity of serious side effects. This study has paved way for further long-term follow up studies at our institution.

Dementia and geriatric cognitive disorders, Jan 25, 2015

Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia (EOD), char... more Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia (EOD), characterized by behavioral changes (behavioral variant; bvFTD) or language deficits. A hexanucleotide repeat expansion in a noncoding region of chromosome 9 open reading frame 72 (C9orf72) has been proved to be a major cause of both familial and sporadic amyotrophic lateral sclerosis or FTD, with or without concomitant motor neuron disease (MND). The aim of this study was to assess the frequency of the C9orf72 hexanucleotide expansion in a cohort of 117 Serbian patients with EOD and to report phenotypic features of identified carriers. We identified 4 of 117 (3.4%) patients with EOD to have C9orf72 hexanucleotide expansions. All patients were classified in the FTD disease spectrum group (8.2%): 3 patients fulfilled the criteria for bvFTD, and 1 patient had FTD-MND. None of the patients with the C9orf72 hexanucleotide expansion fulfilled the diagnostic criteria for language variants of FTD, ...

sonography (TCS) is a reliable method in the diagnosis of Parkinson’s disease (PD)and the differe... more sonography (TCS) is a reliable method in the diagnosis of Parkinson’s disease (PD)and the differential diagnosis of atypical parkinsonism. Finding of hyperechogenicity of the substantia nigra (SN), which is the result of iron deposition in this midbrain structure, is highly suggestive of PD. We performed a study on 67 PD patients and 33 healthy controls in order to determine sensitivity and specificity of TCS in diagnosis of PD. Due to insufficient or completely impenetrable acoustic temporal bone TCS could not be performed in 10.2% of PD patients and 15.1% of healthy controls. Significant SN hyperechogenicity was recorded in 77.6% of PD patients and 12.1% of healthy controls. The sensitivity of TCS was 86.6% and specificity 86.2%, with the positive predictive value of 92.8%. In the PD group, SN hyperechogenicity was generally more pronounced on the side which was contralateral to the side of dominant clinical presentation. Our results are in line with the data reported by other inv...

Vojnosanitetski pregled, 2014

Introduction. Chronic post-anoxic myoclonus, also known as Lance-Adams syndrome, may develop foll... more Introduction. Chronic post-anoxic myoclonus, also known as Lance-Adams syndrome, may develop following hypoxic brain injury, and is resistant to pharmacological therapy. Case report. The patient we presented developed post-anoxic action myoclonus with severe, completely incapacitating myoclonic jerks. Myoclonus did not respond to the treatment with commonly used agents, i.e. valproate and clonazepam alone or in combination. Improvement of the action myoclonus was observed only after adding levetiracetam. Conclusion. Although Lance-Adams syndrome may not be fully curable at this point, levetiracetam appears to be a promising agent that can significantly improve functional level and overall quality of life of patients with this disorder.

Introduction: Atherothrombosis of vertebrobasilar (VB) system has a poor prognosis with high mort... more Introduction: Atherothrombosis of vertebrobasilar (VB) system has a poor prognosis with high mortality rate. The gold standard for diagnosing of VB stenosis remains digital subtraction angiography. TCD with power M-mode (PMD) can be used with high reliability. The goal of treatment for acute VB thrombosis is recanalization of occluded vessel. Case report: A previously healthy 64-year-old man was presented in the emergancy room 6 hours after onset of vertigo, nausea, vomiting, facial and tongue numbness followed by left-sided paresis. At examination the patient had a brainstem syndrome, with dysarthria, right internuclear ophthalmoplegia, and left hemiplegia (NIHSS 14). CT showed a mild infarct in the right pons. After admission, about 90 minutes later, progressive neurologic deterioration was noted, patient became somnolent, with a new severe right-sided hemiparesis and locked in syndrome (NIHSS 25). Repeated CT showed no change. PMD-TCD showed minimal flow signal of BA, blunted flo...

Medicinski pregled

Intravenous administration of recombinant tissue plasminogen activator, fastest and widely feasib... more Intravenous administration of recombinant tissue plasminogen activator, fastest and widely feasible treatment in acute ischemic stroke induces arterial recanalization, a prerequisite for neurological recovery. THE THERAPEUTIC ROLE OF ULTRASOUND AND POTENTIAL MECHANISM OF SONOTHROMBOLYSIS: Augmentation of recanalization can be achieved safely in combination with diagnostic transcranial Doppler by delivering mechanical pressure waves to the thrombus and exposing more thrombus surface to circulating drug. The addition of microspheres can further improve thrombolytic effect. International multicenter CLOTBUST trial showed that acute ischemic stroke patients treated with sonothrombolysis had higher rate of arterial recanalization and dramatic clinical recovery without increasing risk of symptomatic intracranial hemorrhage. A microsphere dose-escalation study called TUCSON showed that rates of recanalization and clinical recovery tended to be higher in target groups compared with controls...

Neurologia i neurochirurgia polska

A middle-aged man with pain in the right eye and right side of the neck was brought to the emerge... more A middle-aged man with pain in the right eye and right side of the neck was brought to the emergency department one hour after the onset of left-sided weakness. Computed tomography (CT) showed hyperdense right middle cerebral artery (MCA). On transcranial Doppler (TCD), occlusion of the right MCA and right internal carotid artery (ICA) was found. Thirty minutes after thrombolytic therapy was initiated, engagement of collateral circulation through the anterior communicating artery (AComA) was shown by TCD. Caro-tid duplex examination confirmed occlusion of the right ICA with intimal flap and intramural haematoma. CT angiography revealed flame-like occlusion of the right ICA, and occlusion of the right MCA with collateral supply from the left to right anterior cerebral artery through the AComA. Recanalization of the MCA and ICA was evident on both CT and ultrasound. Frequent ultrasound monitoring is useful for haemodynamic evaluation of carotid artery dissection, while TCD plays an im...

Acta clinica Croatica, 2011

Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting... more Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by acting on its cause using a very powerful weapon, thrombolytic therapy. The aim is to present a preliminary report of our experiences with thrombolytic therapy in patients with ischemic stroke. Results recorded in 20 patients who received thrombolytic therapy within three hours of stroke onset are presented. Nineteen patients survived and one patient died from therapy side effects, i.e. intracerebral hematoma. Seventeen of 19 patients were released from the hospital without any neurologic deficit, while two patients had Rankin score 2 (minimum disability) three months after stroke onset. Our e...

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2011

A 21-year-old woman taking oral contraceptives presented with headaches, nausea, vomiting and som... more A 21-year-old woman taking oral contraceptives presented with headaches, nausea, vomiting and somnolence. The next day she had a generalized tonic-clonic seizure after which her neurological condition deteriorated. CT and MRI showed multiple cerebral haemorrhages, while MR venography revealed extensive dural sinus and venous thrombosis involving almost all sinuses, great cerebral vein of Galen and internal cerebral veins. Two weeks after initiation of the anticoagulant treatment the patient recovered completely with complete recanalization of all cerebral sinuses and veins. Although the patient had conditions which were indicative of poor outcome, her neurological deficit improved completely, which correlated with recanalization of the thrombosed vessels.

Acta clinica Croatica, 2009

The aim of this prospective study was to evaluate therapeutic effects in a cohort of 32 patients ... more The aim of this prospective study was to evaluate therapeutic effects in a cohort of 32 patients with relapsing-remitting multiple sclerosis (RRMS) that were continuously treated with interferon beta-1b during a three-year period and to compare the results obtained with literature data available. Additionally, dropouts and side effects were assessed. The annual relapse rate at three years of treatment as the primary study end-point decreased by 60.5% compared with the relapse rate throughout the pretherapeutic course of disease (0.39 +/- 0.55 vs. 0.97 +/- 0.46; P<0.001) and by 71.3% compared with the relapse rate one year prior to treatment (0.39 +/- 0.55 vs. 1.34 +/- 0.65; P<0.001). The mean Extended Disability Status Scale (EDSS) increased significantly from 2.46 +/- 0.86 at baseline to 2.90 +/- 1.30 (P<0.01) at three years of treatment, whereas the mean progression index (EDSS/disease duration) decreased significantly from 0.76 +/- 0.50 prior to treatment to 0.43 +/- 0.2...

Medicinski pregled, 2010

A patent foramen ovale has been reported to be more frequently detected in cryptogenic stroke, wi... more A patent foramen ovale has been reported to be more frequently detected in cryptogenic stroke, with paradoxical embolism as the major pathogenetic mechanism. The standard procedure for the detection of a patent foramen ovale is transesophageal echo?cardiography. Transcranial Doppler sonography with bubble test is almost as reliable as transesophageal echocardiography. Seventeen patients with acute ischemic stroke and transient ischemic attacks hospitalized at the Department of Neurology in Novi Sad underwent examinations to detect a patent foramen ovale, which was found in 55.6% of patients with cryptogenic stroke. The average age of these patients was 30.6 years. Transcranial Doppler sonography showed 100% sensitivity and 100% specificity for the predicti?on of right-to-left shunts proven by transesophageal contrast echocardiography. Both positive and negative predictive values in our group of patients were 1. Transcranial Doppler with bubble test is a reliable method for the detec...

Medicinski pregled, 2012

Introduction. Extrapyramidal syndromes are significant side effects of antipsychotic therapy due ... more Introduction. Extrapyramidal syndromes are significant side effects of antipsychotic therapy due to their severity, frequent occurrence and complications. This paper gives a brief summary of the literature with the emphasis on epidemiology, etiology, diagnosis and differential diagnosis, as well as the treatment of extrapyramidal disorders induced by antipsychotics. Dystonia. Sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It may appear either as an acute or delayed, i.e. tardive sign. The incidence of dystonia is 2-3% among the patients treated with antipsychotics, and 50% among the ones cured with conventional antipsychotics. Akathisia. The main feature of this curious adverse effect is the psychomotor restlessness and the inability to remain motionless. Although akathisia is not very frequent, its incidence and prevalence ranges from 5 to 50% among the treated patients. It is most probably a result of the blockage of dopaminergic recept...

Medicinski pregled, 2014

Introduction. Deep brain stimulation is a stereotactic neurosurgical method used in the treatment... more Introduction. Deep brain stimulation is a stereotactic neurosurgical method used in the treatment of Parkinson?s disease and some other movement disorders. The application of deep brain stimulation in the treatment of certain psychiatric disorders has been intensively investigated taking into account the current knowledge of neurobiological basis of mood regulation, cognition, and behaviour. This paper has been aimed at presenting the available data on experience in the application of deep brain stimulation in the treatment of psychiatric disorders. It gives an overview of scientific and professional literature, bearing in mind all the contemporary approaches in the treatment of certain psychiatric disorders. Research results available so far in the treatment of treatment-resistant depression, obsessive-compulsive disorder, Gilles de la Tourette syndrome, addiction and Alzheimer?s dementia, are affirmative concerning the efficacy of the method and low risk of adverse effects. Deep b...

Medicinski pregled, 2011

Introduction. Spontaneous dissection of the cervical artery is a rare non-atherosclerotic vascula... more Introduction. Spontaneous dissection of the cervical artery is a rare non-atherosclerotic vascular disease of unknown aetiology and unclear pathogenesis that may be a cause of ischemic stroke in young adults. Diagnosis. Precise diagnosis of dissection of the cervical artery - carotid or vertebral - is possible with cervical axial magnetic resonance imaging and magnetic resonance angiography. Treatment. The recommended treatment in the acute phase of cervical artery dissection is anticoagulant or antithrombotic therapy, aimed at preventing a primary or recurrent ischemic event. There have been as yet no results of randomized controlled studies comparing efficacy of both treatments. An ongoing randomized multicentre study is expected to provide answers about the effects of these treatments in cervical artery dissection. Outcome. Complete resolution of arterial abnormalities is achieved in around 46% of stenoses, 33% of occlusions, and 12% of dissecting aneurysms. Recurrent events. Rec...

Movement Disorders, 2014

Consensus diagnostic criteria for multiple system atrophy consider dementia as a nonsupporting fe... more Consensus diagnostic criteria for multiple system atrophy consider dementia as a nonsupporting feature, despite emerging evidence demonstrating that cognitive impairments are an integral part of the disease. Cognitive disturbances in multiple system atrophy occur across a wide spectrum from mild single domain deficits to impairments in multiple domains and even to frank dementia in some cases. Frontal-executive dysfunction is the most common presentation, while memory and visuospatial functions also may be impaired. Imaging and neuropathological findings support the concept that cognitive impairments in MSA originate from striatofrontal deafferentation, with additional contributions from intrinsic cortical degeneration and cerebellar pathology. Based on a comprehensive evidence-based review, the authors propose future avenues of research that ultimately may lead to diagnostic criteria for cognitive impairment and dementia associated with multiple system atrophy.

Journal of the Neurological Sciences, 2009

Objective: To evaluate clinical outcome of acute stroke patients who recieved treatment in stroke... more Objective: To evaluate clinical outcome of acute stroke patients who recieved treatment in stroke unit with three months follow up period. Methods: A prospective study of acute ischemic stroke patients who admitted Sappasithiprasong Hospital Stroke Unit was done from September 2008 to February 2009. Thirty acute ischemic stroke patients who would like to participate the project and can regularly follow up during three months period were included. Datas of demographic data, risk factors, investigation, treatment and clinical outcome were recorded. Comparison of national institue of health stroke score (NIHSS), modified rankin scale and barthel index score at discharge and three months follow up period was done to ascess outcome of ischemic stroke. Datas were analysed by using SPSS programme. Results: Thirty acute ischemic stroke patients treatment in stroke unit of Sappasithiprasong Hospital were enrolled in this study. Mean age of stroke patients was 68.1 years (39-88) and 66.7% was male. Risk factors of stroke in our patients consisted of diabetes mellitus, hypertension, dyslipidemia, previous stroke, atrial fibrillation and rheumatic heart disease. All of the patients has done computer tomography of brain and recieved rehabilitation programme. One patient has hemorrhagic transformation while the of others has no acute complications. Comparison of NIHSS, modified rankin scale and barthel index score during discharge and 3 months follow up showed improvement with statistic significant of one tailed T-test (p= 0.000, p= 0.01 and p= 0.000 respectively). Mortality rate at 3 months period was 7%. Conclusion: Acute ischemic stroke patients treated in stroke unit has good clinical outcome with low mortality rate and complication. Professional stroke team and standard stroke care improve clinical outcome and reduce disability of stroke patients at three months.

Journal of the Neurological Sciences, 2009

Acta Clinica Croatica, Jun 1, 2010

Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting... more Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by acting on its cause using a very powerful weapon, thrombolytic therapy. The aim is to present a preliminary report of our experiences with thrombolytic therapy in patients with ischemic stroke. Results recorded in 20 patients who received thrombolytic therapy within three hours of stroke onset are presented. Nineteen patients survived and one patient died from therapy side effects, i.e. intracerebral hematoma. Seventeen of 19 patients were released from the hospital without any neurologic deficit, while two patients had Rankin score 2 (minimum disability) three months after stroke onset. Our experience confirms that thrombolytic therapy is the treatment of choice in patients with ischemic stroke if administered in accordance with precise protocols.

Acta Clinica Croatica, Jun 28, 2011

Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting... more Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by acting on its cause using a very powerful weapon, thrombolytic therapy. The aim is to present a preliminary report of our experiences with thrombolytic therapy in patients with ischemic stroke. Results recorded in 20 patients who received thrombolytic therapy within three hours of stroke onset are presented. Nineteen patients survived and one patient died from therapy side effects, i.e. intracerebral hematoma. Seventeen of 19 patients were released from the hospital without any neurologic deficit, while two patients had Rankin score 2 (minimum disability) three months after stroke onset. Our experience confirms that thrombolytic therapy is the treatment of choice in patients with ischemic stroke if administered in accordance with precise protocols.

Acta Clinica Croatica, 2009

The aim of this prospective study was to evaluate therapeutic effects in a cohort of 32 patients ... more The aim of this prospective study was to evaluate therapeutic effects in a cohort of 32 patients with relapsing-remitting multiple sclerosis (RRMS) that were continuously treated with interferon beta-1b during a three-year period and to compare the results obtained with literature data available. Additionally, dropouts and side effects were assessed. The annual relapse rate at three years of treatment as the primary study end-point decreased by 60.5% compared with the relapse rate throughout the pretherapeutic course of disease (0.39±0.55 vs. 0.97±0.46; P<0.001) and by 71.3% compared with the relapse rate one year prior to treatment (0.39±0.55 vs. 1.34±0.65; P<0.001). The mean Extended Disability Status Scale (EDSS) increased significantly from 2.46±0.86 at baseline to 2.90±1.30 (P<0.01) at three years of treatment, whereas the mean progression index (EDSS/disease duration) decreased significantly from 0.76±0.50 prior to treatment to 0.43±0.24 (P<0.001), yielding a 56.6% improvement and proving the disease modifying effect of interferon beta-1b. Seventeen (53.12%) patients remained relapse-free during the course of therapy. Among patients that experienced disease relapse, the mean time to first exacerbation was 11.5±8.34 months. Our study results were consistent with similar studies performed worldwide, clearly indicating that Interferon beta-1b therapy decreased the disease activity and had a beneficial effect on the progression of RRMS, with low incidence and severity of serious side effects. This study has paved way for further long-term follow up studies at our institution.

Dementia and geriatric cognitive disorders, Jan 25, 2015

Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia (EOD), char... more Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia (EOD), characterized by behavioral changes (behavioral variant; bvFTD) or language deficits. A hexanucleotide repeat expansion in a noncoding region of chromosome 9 open reading frame 72 (C9orf72) has been proved to be a major cause of both familial and sporadic amyotrophic lateral sclerosis or FTD, with or without concomitant motor neuron disease (MND). The aim of this study was to assess the frequency of the C9orf72 hexanucleotide expansion in a cohort of 117 Serbian patients with EOD and to report phenotypic features of identified carriers. We identified 4 of 117 (3.4%) patients with EOD to have C9orf72 hexanucleotide expansions. All patients were classified in the FTD disease spectrum group (8.2%): 3 patients fulfilled the criteria for bvFTD, and 1 patient had FTD-MND. None of the patients with the C9orf72 hexanucleotide expansion fulfilled the diagnostic criteria for language variants of FTD, ...

sonography (TCS) is a reliable method in the diagnosis of Parkinson’s disease (PD)and the differe... more sonography (TCS) is a reliable method in the diagnosis of Parkinson’s disease (PD)and the differential diagnosis of atypical parkinsonism. Finding of hyperechogenicity of the substantia nigra (SN), which is the result of iron deposition in this midbrain structure, is highly suggestive of PD. We performed a study on 67 PD patients and 33 healthy controls in order to determine sensitivity and specificity of TCS in diagnosis of PD. Due to insufficient or completely impenetrable acoustic temporal bone TCS could not be performed in 10.2% of PD patients and 15.1% of healthy controls. Significant SN hyperechogenicity was recorded in 77.6% of PD patients and 12.1% of healthy controls. The sensitivity of TCS was 86.6% and specificity 86.2%, with the positive predictive value of 92.8%. In the PD group, SN hyperechogenicity was generally more pronounced on the side which was contralateral to the side of dominant clinical presentation. Our results are in line with the data reported by other inv...

Vojnosanitetski pregled, 2014

Introduction. Chronic post-anoxic myoclonus, also known as Lance-Adams syndrome, may develop foll... more Introduction. Chronic post-anoxic myoclonus, also known as Lance-Adams syndrome, may develop following hypoxic brain injury, and is resistant to pharmacological therapy. Case report. The patient we presented developed post-anoxic action myoclonus with severe, completely incapacitating myoclonic jerks. Myoclonus did not respond to the treatment with commonly used agents, i.e. valproate and clonazepam alone or in combination. Improvement of the action myoclonus was observed only after adding levetiracetam. Conclusion. Although Lance-Adams syndrome may not be fully curable at this point, levetiracetam appears to be a promising agent that can significantly improve functional level and overall quality of life of patients with this disorder.

Introduction: Atherothrombosis of vertebrobasilar (VB) system has a poor prognosis with high mort... more Introduction: Atherothrombosis of vertebrobasilar (VB) system has a poor prognosis with high mortality rate. The gold standard for diagnosing of VB stenosis remains digital subtraction angiography. TCD with power M-mode (PMD) can be used with high reliability. The goal of treatment for acute VB thrombosis is recanalization of occluded vessel. Case report: A previously healthy 64-year-old man was presented in the emergancy room 6 hours after onset of vertigo, nausea, vomiting, facial and tongue numbness followed by left-sided paresis. At examination the patient had a brainstem syndrome, with dysarthria, right internuclear ophthalmoplegia, and left hemiplegia (NIHSS 14). CT showed a mild infarct in the right pons. After admission, about 90 minutes later, progressive neurologic deterioration was noted, patient became somnolent, with a new severe right-sided hemiparesis and locked in syndrome (NIHSS 25). Repeated CT showed no change. PMD-TCD showed minimal flow signal of BA, blunted flo...

Medicinski pregled

Intravenous administration of recombinant tissue plasminogen activator, fastest and widely feasib... more Intravenous administration of recombinant tissue plasminogen activator, fastest and widely feasible treatment in acute ischemic stroke induces arterial recanalization, a prerequisite for neurological recovery. THE THERAPEUTIC ROLE OF ULTRASOUND AND POTENTIAL MECHANISM OF SONOTHROMBOLYSIS: Augmentation of recanalization can be achieved safely in combination with diagnostic transcranial Doppler by delivering mechanical pressure waves to the thrombus and exposing more thrombus surface to circulating drug. The addition of microspheres can further improve thrombolytic effect. International multicenter CLOTBUST trial showed that acute ischemic stroke patients treated with sonothrombolysis had higher rate of arterial recanalization and dramatic clinical recovery without increasing risk of symptomatic intracranial hemorrhage. A microsphere dose-escalation study called TUCSON showed that rates of recanalization and clinical recovery tended to be higher in target groups compared with controls...

Neurologia i neurochirurgia polska

A middle-aged man with pain in the right eye and right side of the neck was brought to the emerge... more A middle-aged man with pain in the right eye and right side of the neck was brought to the emergency department one hour after the onset of left-sided weakness. Computed tomography (CT) showed hyperdense right middle cerebral artery (MCA). On transcranial Doppler (TCD), occlusion of the right MCA and right internal carotid artery (ICA) was found. Thirty minutes after thrombolytic therapy was initiated, engagement of collateral circulation through the anterior communicating artery (AComA) was shown by TCD. Caro-tid duplex examination confirmed occlusion of the right ICA with intimal flap and intramural haematoma. CT angiography revealed flame-like occlusion of the right ICA, and occlusion of the right MCA with collateral supply from the left to right anterior cerebral artery through the AComA. Recanalization of the MCA and ICA was evident on both CT and ultrasound. Frequent ultrasound monitoring is useful for haemodynamic evaluation of carotid artery dissection, while TCD plays an im...

Acta clinica Croatica, 2011

Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting... more Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by acting on its cause using a very powerful weapon, thrombolytic therapy. The aim is to present a preliminary report of our experiences with thrombolytic therapy in patients with ischemic stroke. Results recorded in 20 patients who received thrombolytic therapy within three hours of stroke onset are presented. Nineteen patients survived and one patient died from therapy side effects, i.e. intracerebral hematoma. Seventeen of 19 patients were released from the hospital without any neurologic deficit, while two patients had Rankin score 2 (minimum disability) three months after stroke onset. Our e...

Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2011

A 21-year-old woman taking oral contraceptives presented with headaches, nausea, vomiting and som... more A 21-year-old woman taking oral contraceptives presented with headaches, nausea, vomiting and somnolence. The next day she had a generalized tonic-clonic seizure after which her neurological condition deteriorated. CT and MRI showed multiple cerebral haemorrhages, while MR venography revealed extensive dural sinus and venous thrombosis involving almost all sinuses, great cerebral vein of Galen and internal cerebral veins. Two weeks after initiation of the anticoagulant treatment the patient recovered completely with complete recanalization of all cerebral sinuses and veins. Although the patient had conditions which were indicative of poor outcome, her neurological deficit improved completely, which correlated with recanalization of the thrombosed vessels.

Acta clinica Croatica, 2009

The aim of this prospective study was to evaluate therapeutic effects in a cohort of 32 patients ... more The aim of this prospective study was to evaluate therapeutic effects in a cohort of 32 patients with relapsing-remitting multiple sclerosis (RRMS) that were continuously treated with interferon beta-1b during a three-year period and to compare the results obtained with literature data available. Additionally, dropouts and side effects were assessed. The annual relapse rate at three years of treatment as the primary study end-point decreased by 60.5% compared with the relapse rate throughout the pretherapeutic course of disease (0.39 +/- 0.55 vs. 0.97 +/- 0.46; P<0.001) and by 71.3% compared with the relapse rate one year prior to treatment (0.39 +/- 0.55 vs. 1.34 +/- 0.65; P<0.001). The mean Extended Disability Status Scale (EDSS) increased significantly from 2.46 +/- 0.86 at baseline to 2.90 +/- 1.30 (P<0.01) at three years of treatment, whereas the mean progression index (EDSS/disease duration) decreased significantly from 0.76 +/- 0.50 prior to treatment to 0.43 +/- 0.2...

Medicinski pregled, 2010

A patent foramen ovale has been reported to be more frequently detected in cryptogenic stroke, wi... more A patent foramen ovale has been reported to be more frequently detected in cryptogenic stroke, with paradoxical embolism as the major pathogenetic mechanism. The standard procedure for the detection of a patent foramen ovale is transesophageal echo?cardiography. Transcranial Doppler sonography with bubble test is almost as reliable as transesophageal echocardiography. Seventeen patients with acute ischemic stroke and transient ischemic attacks hospitalized at the Department of Neurology in Novi Sad underwent examinations to detect a patent foramen ovale, which was found in 55.6% of patients with cryptogenic stroke. The average age of these patients was 30.6 years. Transcranial Doppler sonography showed 100% sensitivity and 100% specificity for the predicti?on of right-to-left shunts proven by transesophageal contrast echocardiography. Both positive and negative predictive values in our group of patients were 1. Transcranial Doppler with bubble test is a reliable method for the detec...

Medicinski pregled, 2012

Introduction. Extrapyramidal syndromes are significant side effects of antipsychotic therapy due ... more Introduction. Extrapyramidal syndromes are significant side effects of antipsychotic therapy due to their severity, frequent occurrence and complications. This paper gives a brief summary of the literature with the emphasis on epidemiology, etiology, diagnosis and differential diagnosis, as well as the treatment of extrapyramidal disorders induced by antipsychotics. Dystonia. Sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It may appear either as an acute or delayed, i.e. tardive sign. The incidence of dystonia is 2-3% among the patients treated with antipsychotics, and 50% among the ones cured with conventional antipsychotics. Akathisia. The main feature of this curious adverse effect is the psychomotor restlessness and the inability to remain motionless. Although akathisia is not very frequent, its incidence and prevalence ranges from 5 to 50% among the treated patients. It is most probably a result of the blockage of dopaminergic recept...

Medicinski pregled, 2014

Introduction. Deep brain stimulation is a stereotactic neurosurgical method used in the treatment... more Introduction. Deep brain stimulation is a stereotactic neurosurgical method used in the treatment of Parkinson?s disease and some other movement disorders. The application of deep brain stimulation in the treatment of certain psychiatric disorders has been intensively investigated taking into account the current knowledge of neurobiological basis of mood regulation, cognition, and behaviour. This paper has been aimed at presenting the available data on experience in the application of deep brain stimulation in the treatment of psychiatric disorders. It gives an overview of scientific and professional literature, bearing in mind all the contemporary approaches in the treatment of certain psychiatric disorders. Research results available so far in the treatment of treatment-resistant depression, obsessive-compulsive disorder, Gilles de la Tourette syndrome, addiction and Alzheimer?s dementia, are affirmative concerning the efficacy of the method and low risk of adverse effects. Deep b...

Medicinski pregled, 2011

Introduction. Spontaneous dissection of the cervical artery is a rare non-atherosclerotic vascula... more Introduction. Spontaneous dissection of the cervical artery is a rare non-atherosclerotic vascular disease of unknown aetiology and unclear pathogenesis that may be a cause of ischemic stroke in young adults. Diagnosis. Precise diagnosis of dissection of the cervical artery - carotid or vertebral - is possible with cervical axial magnetic resonance imaging and magnetic resonance angiography. Treatment. The recommended treatment in the acute phase of cervical artery dissection is anticoagulant or antithrombotic therapy, aimed at preventing a primary or recurrent ischemic event. There have been as yet no results of randomized controlled studies comparing efficacy of both treatments. An ongoing randomized multicentre study is expected to provide answers about the effects of these treatments in cervical artery dissection. Outcome. Complete resolution of arterial abnormalities is achieved in around 46% of stenoses, 33% of occlusions, and 12% of dissecting aneurysms. Recurrent events. Rec...

Movement Disorders, 2014

Consensus diagnostic criteria for multiple system atrophy consider dementia as a nonsupporting fe... more Consensus diagnostic criteria for multiple system atrophy consider dementia as a nonsupporting feature, despite emerging evidence demonstrating that cognitive impairments are an integral part of the disease. Cognitive disturbances in multiple system atrophy occur across a wide spectrum from mild single domain deficits to impairments in multiple domains and even to frank dementia in some cases. Frontal-executive dysfunction is the most common presentation, while memory and visuospatial functions also may be impaired. Imaging and neuropathological findings support the concept that cognitive impairments in MSA originate from striatofrontal deafferentation, with additional contributions from intrinsic cortical degeneration and cerebellar pathology. Based on a comprehensive evidence-based review, the authors propose future avenues of research that ultimately may lead to diagnostic criteria for cognitive impairment and dementia associated with multiple system atrophy.

Journal of the Neurological Sciences, 2009

Objective: To evaluate clinical outcome of acute stroke patients who recieved treatment in stroke... more Objective: To evaluate clinical outcome of acute stroke patients who recieved treatment in stroke unit with three months follow up period. Methods: A prospective study of acute ischemic stroke patients who admitted Sappasithiprasong Hospital Stroke Unit was done from September 2008 to February 2009. Thirty acute ischemic stroke patients who would like to participate the project and can regularly follow up during three months period were included. Datas of demographic data, risk factors, investigation, treatment and clinical outcome were recorded. Comparison of national institue of health stroke score (NIHSS), modified rankin scale and barthel index score at discharge and three months follow up period was done to ascess outcome of ischemic stroke. Datas were analysed by using SPSS programme. Results: Thirty acute ischemic stroke patients treatment in stroke unit of Sappasithiprasong Hospital were enrolled in this study. Mean age of stroke patients was 68.1 years (39-88) and 66.7% was male. Risk factors of stroke in our patients consisted of diabetes mellitus, hypertension, dyslipidemia, previous stroke, atrial fibrillation and rheumatic heart disease. All of the patients has done computer tomography of brain and recieved rehabilitation programme. One patient has hemorrhagic transformation while the of others has no acute complications. Comparison of NIHSS, modified rankin scale and barthel index score during discharge and 3 months follow up showed improvement with statistic significant of one tailed T-test (p= 0.000, p= 0.01 and p= 0.000 respectively). Mortality rate at 3 months period was 7%. Conclusion: Acute ischemic stroke patients treated in stroke unit has good clinical outcome with low mortality rate and complication. Professional stroke team and standard stroke care improve clinical outcome and reduce disability of stroke patients at three months.