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Creutzfeldt-Jakob disease is the most common form of human prion diseases. A 57-year-old woman was transferred to our Department from a local hospital, where she had been treated for two weeks due to consciousness disorders and convulsive epileptic attacks that progressed to refractory status epilepticus. Electroencephalography showed diffuse spike-wave complex discharges and development of nonconvulsive status epilepticus. The causes of metabolic encephalopathy and paraneoplastic syndrome were ruled out. A combination of clinical features and findings of diagnostic procedures including electroencephalography, biomarkers in the cerebrospinal fluid and magnetic resonance imaging suggested with great probability that the patient was affected with sporadic Creutzfeldt-Jakob disease.

A case is reported of a 72-year-old woman who presented with severe vertigo, vomit, and mild neck and occipital pain. She had a medical history of hypertension, angina pectoris, cholelithiasis, gastric ulcer, pyelonephritis and periodical mild dizziness. Neuroimaging revealed right vertebral artery occlusion, right cerebellar stroke and basilar impression. The therapeutic approach chosen in our patient was conservative, with non-steroid anti-inflammatory drugs and neck collar. Although our patient's prior risk factors for stroke supported a diagnosis of vertebrobasilar stroke, it is possible that the vertebral artery occlusion was the result of changes in the atlantoaxial anatomy and that cerebellar infarction was secondary to craniocervical anomaly. Although the presence of vertebral artery occlusion, cerebellar stroke and basilar impression in our patient may have been coincidental, we suggest that patients with basilar impression and craniocervical anomalies in general may be at an increased risk of vertebrobasilar vascular disease and vertebrobasilar stroke.

Creutzfeldt Jakob disease (CJD) is the most common form of human prion diseases. A 57 year old woman was transferred to our Department from a local hospital, where she was treated for two weeks due to consciousness disorders and convulsive epileptic attacks that were progressed to refractory status epilepticus. Th e electroencephalography showed diff use outbreak spike- wave complexes and a development of nonconvulsive status epilepticus. We excluded the causes of metabolic encephalopathy and a paraneoplastic syndrome. Using a combination of clinical features and the fi ndings of diagnostic procedures, including electroencephalography, biomarkers in the cerebrospinal fl uid and MRI fi ndings, we could conclude with great probability that patient was aff ected with sCJD.

This paper deals with the most common symptoms of pineal gland cyst.

We have recently reported that transcranial sonography (TCS) is a method competitive to magnetic resonance neuroimaging (MRI) in the evaluation of pineal gland lesions. The aim of the present is study was to assess the usefulness of TCS in a larger patient sample during a two-year follow up. Twenty patients with incidental pineal gland cyst (PGC) detected by MRI scan of the brain and 40 healthy controls without any previous documented data on a disease related to pineal gland were evaluated by TCS and compared with MRI scans. There were no statistically significant differences in PGC size measured by TCS by two observers (p=0.475), PGC size measured by TCS and MRI (first observer, p=0.453 ; and second observer, p=0.425), size of the pineal gland measured by TCS and MRI in control group (first observer, p=0.497 ; and second observer, p=0.370), and pineal gland size measured by TCS by two observers in control group (p=0.473). Study results suggested TCS to be a suitable method in the evaluation of pineal gland lesions. Although its resolution cannot match the MRI resolution, its repeatability and accuracy might add to its practical value. We suggest that the repeat MRI scan of such lesions might be replaced by clinical and TCS follow up.

We had case report about young pregnant women who presented with neurologic deficit. She underwent MRI of the brain and MRI revealed tumor mass in lateral ventricules which features were of rare intraventricular neurocytoma.

The twin sisters developed the same histological type of tumor ten years apart.The development of the same hystological type of tumor at a similar site in monozygotic twin sisters undoubtedly confirms the importance of the genetic role in the occurence of this rare disease. We present a case report.

A 49-year-old female pateint complained of decreased visual acuity and dropping of the left eyelid over the two years...

The aim of this study is to present the results of the investigation and analysis of the size of hypophyseal microadenomas...

INTRODUCTION: Spindle cell hemangioma is a vascular tumor first described as a new entity in 1986 by Weiss and Enzinger, as a rare type of haemangioma. The tumor occurs usually in young adults and affects the subcutis of distal extremities or arose in the small bones of the hands, feet and tibia. Location within the canalis spinalis is extremely rare. CASE REPORT: A 31 year-old male patient complained on weakness of both legs that started in May 2005. In September 2005 he noticed paresthesias in both legs that slowly progressed toward his stomach. He was admitted at our Department of neurosurgery in March 2006 due to progressive weakness of his legs. Upon admission the neurological examination revealed a spastic paraparesis (3/5), hyperactive reflexes and paresthesias distal from Th10 dermatome. MR of the thoracic spine showed an intraspinal, extradural mass lesion, measuring 5, 3 x 1, 2 cm at the Th1-Th3 level. Intraoperatively, C7-Th3 laminectomy was performed. On the right side of the spinal canal, a purple-grayish tumorous lesion was visualized. It was located extradurally compressing the dura to the left. The lesion was well demarked from the dura, and it was removed completely in a microneurosurgical manner. Histologically H&E slides revealed a lesion which was composed of thin-walled cavernous vessels lined by flattened endothelial cells and containing thrombi. There were cellular spindled stromal areas between the cavernous spaces that were assumed to be representing collapsed small vascular canals. Some of endothelial cells contained prominent intracytoplasmatic vacuoles. Postoperative recovery was uneventful. Paresthesias regressed almost immediately after surgery and the amelioration of leg weakness was noticed. MATERIAL AND METHODS: Immunohistochemical analysis of CD 34, Vimentin, SMA and Ki - 67 (DAKO, Copenhagen, Denmark) was performed in formalin fixed and paraffin embedded tumor tissues. As a visualization system labeled streptavidin biotin method (LSAB) was used on Dako Tech Mate automatic immunostainer using microwave streptavidin immunoperoxidase-MSIP protocol. DISCUSSION AND CONCLUSION: occasionally the spindle cell hemangioma is associated with Maffucci syndrome and was also seen in the Klippel-Trenaunay syndrome. The tumor arose in the vicinity of clearly abnormal vessels, supporting the idea that the spindle cell hemangioma is most likely a vascular malformation in which variation in blood flow gives rise to alternating areas of vascular expansion and collapse. Although, usually it was believed to be a tumor with limited metastatic potential and it is regarded as a benign tumor, about 60% of spindle cell hemangiomas recur and there is no evidence that these lesions have the ability to metastasize. This case is reported as a unique location of this rare type of hemangioma in the spinal canal.

Vertebrobasilar acclusion is a life-treatening event that requeres prompt diagnostic evaluation and subsequent therapy. Advanced magnetic resonance imagin (MRI) methods, including diffusion-weighted imaging and magnetic resonance angiography (MRA), are highly sensitive for the detection of ischemic tissue injury, and for the detection and localization of intracranial arterial occlusion and stenosis.In the era of thrombolytic therapy , MRI and MRA provide useful information for therapeutic decision making in the early stage of stroke evaluation. This retrospective review included patients with posterior circulation symptomatology examined at our Department between July 2002 and January 2005, 8 female and 11 male, mean age 54, 9 years.The aim was to present the possibilities of mRI and MRA in the management of patients with iscemic stroke in posterior circulation.

iznose se podaci retrospektivne analize 15 reprezentativnih slučajeva bolesnika sa kliničkom slikom stražnje cirkulacije.Pomoću MRA je otkrila u 46, 6 % slučaja okluziju bazilarne arterije, 6, 6 % stenozu bazilarne arterije, u 13 % slučaja aterosklertoske promjene vertebrobazilarnog sliva, u 13 % okluziju vertebralne arterije.

The objective of the study was evaluation and radiologic - clinical correlation of brain computed tomography (CT) scans performed at emergency service. The relation between the number of urgent and total CT scans performed during a 2-year period (January 1, 2001 - December 31, 2002) was analyzed. Emergency brain CT scans were especially investigated according to clinical indications, requests from particular clinical specialties, and need of anesthesiologist's assistance. CT scans were correlated with clinical examinations and diagnoses as well as with literature data. During the study period, 15,933 CT scans were performed at our department, 3132 (19.66%) of them at emergency service (1757 male and 1375 female, mean age 56.97 years), and 2576 (82.25%) of the latter emergency brain CT scans (1398 male and 1178 female, mean age 57.80 years). Data analysis showed the following distribution of emergency brain CT scans according to hospital departments: neurology 1441 (55.94%), neurosurgery 632 (24.53%), internal medicine 186 (7.22%), surgery 138 (5.36%), other departments 150 (5.82%), and other institutions 29 (1.13%). Clinical diagnoses for emergency brain CT scanning were as follows: stroke 905 (35.13%), subarachnoid hemorrhage 128 (4.97%), head injury 617 (23.95%), consciousness disorders and convulsions 389 (15.10%), intracranial expansive lesions 234 (9.08%), headache and/or vertigo 141 (5.47%), cerebrovascular insufficiency 50 (1.94%), infectious disease 46 (1.79%), hydrocephalus 12 (0.47%), metabolic disorders 2 (0.08%), and lost or unavailable data at the time of the study 52 (2.02%). Anesthesiologist's assistance during emergency brain CT scanning was needed in 234 (9.08%) cases. Correlation of CT findings with clinical diagnosis yielded the following results: 96 (3.73%) lost or unavailable data at the time of the study, 639 (25.77%) normal findings, and 1841 (74.23%) pathologic findings. Study results showed the number of emergency brain CT scans to be quite high with a tendency of continuous growth (cerebrovascular disorders, new therapeutic approaches, head injury). Difficulties encountered on brain CT scanning because of the patient's state, and delicacy of the emergency interpretation of CT scans impose the need of higher availability of a neuroradiologist within the frame of the emergency state algorithm., Cilj ove studije bila je evaluacija i radiološko-klinička korelacija CT pretraga mozga u hitnoj službi. Tijekom dvogodišnjeg razdoblja (1. siječnja 2001. - 31. prosinca 2002.) analiziran je odnos hitnih i sveukupnih CT pretraga. Posebno su obrađeni hitni CT pregledi mozga prema kliničkim indikacijama, zastupljenosti pojedinih kliničkih struka i potrebi anesteziološke asistencije. CT nalazi su korelirani s kliničkim upitima i dijagnozama, te uspoređeni s literaturnim podacima. Tijekom 24 mjeseca na Kliničkom zavodu su izvedene 15.933 CT pretrage, od čega 3132 (19,66%) u hitnoj službi (1757 muškaraca i 1375 žena srednje dobi od 56,97 godina). Čak 2576 (82,25%) svih hitnih CT pretraga bile su hitne CT pretrage mozga (1398 muškaraca i 1178 žena srednje dobi od 57,80 godina). Raspoređenost hitnih CT pretraga mozga prema klinikama bila je slijedeća: neurologija 1441 (55,94%), neurokirurgija 632 (24,53%), interna medicina 186 (7,22%), kirurgija 138 (5,36%), ostale klinike 150 (5,82%) i vanjske ustanove 29 (1,13%). Kliničke indikacije za hitnu CT pretragu mozga bile su slijedeće: moždani udar 905 (35,13%), subarahnoidno krvarenje 128 (4,97%), trauma glave 617 (23,95%), poremećaj svijesti i konvulzije 389 (15,10%), intrakranijska ekspanzija 234 (9,08%), glavobolja i/ili vrtoglavica 141 (5,47%), cerebrovaskularna insuficijencija 50 (1,94%), infekcija 46 (1,79%), hidrocefalus 12 (0,47%), metabolične promjene 2 (0,08%) i nedostupni podaci u vrijeme studije 52 (2,02%). Anesteziološka asistencija pri hitnom CT pregledu mozga bila je potrebna u 234 (9,08%) slučaja. Korelacija CT nalaza s kliničkom dijagnozom (kliničkim upitom) pokazala je kako je 96 (3,73%) podataka bilo nedostupno u vrijeme studije, dok je od 2480 preostalih nalaza hitnih CT pregleda mozga bilo 639 (25,77%) normalnih i 1841 (74,23%) patoloških. Provedena je i usporedba s podacima iz literature. Zaključeno je kako je velik broj hitnih CT pretraga mozga s tendencijom stalnog porasta (cerebrovaskularne bolesti, novi terapijski pristupi, trauma glave). Otežano izvođenje pretrage zbog teškog stanja bolesnika i osjetljivost hitne interpretacije nalaza nameću potrebu veće dostupnosti neuroradiologa uz pridržavanje algoritma pretraga u hitnim stanjima.

iznose se podaci retrospektivne analize u procjeni diajgnostike cerebrovaskularnih bolesnika pomoću MR-a i MRA (angiografije) , na osnovu ispitivanja 278 bolesnika. Pomoću MRA otkriveno je 88 patoloških vaskularnih promjena (69 aneurizmi i 21 vaskularnu malformaciju.), 13 okluzija intrakranijskih arterija, 19 stenoza intrakranijskih arterija, te 14 slučaja aterosklerotskih promjena. Sama magnetska rezonanca (MR) otkrila je 114 cv.insulta, 14 vaskularnih malformacija, te 14 slučaja patologije malih krvnih žila. Na osnovu naših rezultata koja su sukladna s rezultatima iz literature zaključak je da su MR i MRA osnovne pretrage u dijagnostici cerebrovaskularne bolesti.

We observed the urgent cases with neurological signs: mostly-motor weakness, conscious disorders or headache type with vomiting in one year in the department with twenty beds. The investigation included brain imaging methods, cerebrospinal fluid examination, ultrasonographic extra and intracranial examination and other needed radiographic searches. There were fourteen patients with verified metastatic process by braincomputed tomography. In the two cases processes were of solitary type and the neurosurgical treatment was continued. The primary malignoma was mostly bronchal malignoma, but there were also the cancer of the ventricle, breast, colon, kidney, prostata, and in two cases the origin was unknown, even after all diagnostic procedures. The other group consisted of patients where we expected dissemination of malignant disease to the brain, but we had not proved it. This group consisted of twenty patients with treated extracerebral cancer. The most frequent was the breast cancer, in nine cases, with various time after the operation. The following was the paralel leukoproliferative process in hematologic treatment, other sources were colon, kidney, thyroid gland, prostata and buccal mucosa cancer. We want to point out that there were not the specific tumour onset, especially the fact that primary illness may be a long time silent. Parallelism of the two various processes in the same time, such as a cerebrovascular disorder and the extracerebral cancer in the higher number of cases, is present.

The aim was to compare US, CT and MR findings of cerebtovascular disease, particularly of its entities. The data on 20 patients (MIF 13/7) with the clinical history of transitory ischaemic attacks (TIA) or stroke were evaluated. Ten patients had TIA and ten CV stroke. The personal history was taken, clinical examinations and laboratory tests done, and followed by carotid and vertebral Colour Doppler Brain CT was done 24 to 48 hours afler the clinical manifestation of TIA or stroke. MR (1.0 T) was done 3 to 9 days afier the beginning of the disease. Colour Doppler showed subtotal intemal carotid artery stenosis in 14 patients, and vertebral artery occlusion in 6 patients. CT findings did not show isehaemic infarction lesions in 9 patients. Six patients had ischaemic infarction lesions and 5 patients had multiple white matter isehaemic lesions. MR showed ischaemic lesions in all patients: ishemic infarct lesions in l2 patients, white matter changes in 5, and lacune in 5 patients. Two patients had both ischaemic lesions and lacune. In several cases MR-angiography was done. CONCLUSION: Advantages of MRI over CT in t.he diagnosing cerebrovascular disease are in the fact that edematous changes in the region of the recent infarction can be detected much earlier on MR images. MR provides a better insight into the zones of petechial bleeding of infarction region in a subacute stage.

The aim of the study was to evaluate clinical. EEG and image tests features in patients with disorders of cortical development (DCD). We report on 8 DCD cases referred to our Neuropediatric Unit for neurological and epilepsy evaluation. Clinical data were collected by reviewing hospital records. Original CT/MR images were also reviewed and DCD was labelled for each patient, according to an existing system of classification. There were 8 patient aged 1-9 years at initial imaging, 5 female and 3 male. In 7/8 patients, the diagnosis of DCD was made by brain CT scan and confirmed by MRI. In 1/8 patient, DCD was diagnosed by MR 2 Tesla (two CT scans and MRI 0.2 Tesla were normal). Focal sub cortical heterotopia was found in 3/8 patients. Among them, 2/3 had normal neurological status and intellectual level ; 1/3 had hemiplegia and atrophy of the same side of the body and borderline intellectual functioning. Subependymal heterotopia and schizencephaly were found in 5/8 patients. Unilateral schizencephaly with fused lips was found in 3/5, and with cleft lips in 1/5 patient. Among them, 1/5 had normal neurological status and intellectual level, 3/5 had hemiplegia and atrophy of the same side of the body with normal intellectual level in 1 and borderline in 2 patients, and 1/5 had severe psychomotor retardation. Epilepsy was not present in 2/8 patients. Febrile seizures occurred in 3/8 patients between 8 and 18 months of age. Epilepsy. (partial, partial complex and partial complex with secondary generalization) occurred in 6/8 patients between 1.5 and 8 years of age. Among them, 4/6 patients had good epilepsy control, 2 with TPM and CBZ each. One patient was in remission for 6 years after VPA, and 1 had refractory epilepsy. DCD belongs to very significant causes of epilepsy in children, associated with neurological deficit, developmental delay and mental retardation. Different morphologic appearances of DCD do not result in distinct developmental of neurological manifestations. The clinical course is variable and unpredictable.

Ocjena dijagnostičkih vrijednosti CT-a u procjeni operabilnosti tumora paranasalnih šupljina

utvrđivanje reverzibilnosti morfoloških promjena mozga metodom CT-a u bolesnika s anoreksijom nervozo

100 skulls were examined and width of lateral lamina of pterygoid process were masured.

To evaluate preoperatively the apperance of transglottic carcinoma at computed tomography and low-field MRI in correlation with pathohistologically analysed macroscopic horizontal slices of the larynx postoperatively

Introduction: Anorexia nervosa (AN) is a complex psychosomatic disorder heavily influenced by cultural factors. Physical complications of AN involve every organ system in the body. The aim of this study was to identify electrophysiological and structural changes of the brain. Patients and methods: Chart of 52 adolescent girls seen at oru hospital since 1985 were analysed. Prenatal, developmental and medical histories were normal, including the neurological examination. Only one girl had previous history of epilepsy. The diagnosis of AN was based on the criteria listed in Diagnostic and Statistical Manual of Mental Disorders, done by American Psychiatric Association, revised in 1996 (DSM-IV-R). We have done the EEG and CT scan in the first week on admission to the hospital and control tests 6 to 10 weeks later, after weight restoration. Results: The mean age of presentation was 15,5 years (range 12 to 19), with abnormal feeding history from 2 to 43 months (mean 10,1). Body mass index ranges from 11,0 to 17,6 (mean 13,7). The EEg abnormalities consist mostly of low voltage and were found initially in 74% of 50 patients. After the weight gain the EEG was normal in 57% girls and 43% had low voltage. CT scan of the brain was done in 44 girls. Findings were normal in 24% and atrophy was found in 76% (slight changes 59%, moderate 32% and pronounced 9%). After the weight gain control CT was done in 12 girls - normal findings had 41% and slight cortical changes 59%. Conclusion: We could not find the relation between the degree of weight loss, duration or type of malnutrition and the degree of changes on EEG and CT scan. When the starvation is stoped, these alteration of CNS is reversed in most of the girls. Further studies are necessary to clarify the clinical significance of the EEG and CT changes in AN.