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Melancholijos samprata ir gydymas Hildegardos Bingenietės (c. 1098-1179) raštuose Perception and treatment of melancholy in the writings of Hildegard of Bingen (c. 1098-1179) Sakalauskaitė-Juodeikienė E. Neurologijos seminarai 2021; 25(89): 121-129. Santrauka Viduramžių vienuolė ir abatė, mistike, kompozitorė, poetė ir medicinos knygų autorė Hildegarda Bingenietė (c. 1098-1179) buvo viena iš nedaugelio viduramžių epochos moterų, rašiusių ne vien teologinius, bet ir mokslinius, medicininius tekstus. Šiame straipsnyje nagrinėjau Hildegardos sudarytą Liber subtilitatum diversarum naturarum creaturarum („Įvairių prigimčių būtybių subtilybių knygą“), parengtą maždaug 1151-1158 m. ir susidedančią iš dviejų knygų – Physica ir Causae et curae. Siekiau sužinoti, kaip melancholijos fenomeną trimis jo prasmėmis (kaip organizmo skystį, charakterio tipą ir ligą) suvokė viena ryškiausių ir svarbiausių viduramžių mąstytojų. Melancholijos aiškinimui ir gydymo metodams pagrįsti Hildegarda pasitelkė ne tik Biblijos Pradžios knygą, bet ir iš antikos laikų atėjusią humoralinę doktriną bei viduramžių liaudies medicinos žinias. Melancholija Hildegardos moksliniuose tekstuose suvokta ir kaip širdies bei galvos smegenų liga, ir kaip vidaus organų patologija, kurią sukelia blužnyje gaminamos juodosios tulžies perteklius bei žalingas poveikis. Juodosios tulžies pertekliui mažinti ir melancholijai gydyti Hildegarda rekomendavo įvairias augalinės (pankolis, dedešva, raktažolė, našlaitė ir kt.), gyvūninės (stručio, garnio vidaus organai, skruzdėlės) ir mineralinės (oniksas) kilmės medžiagas. Autorė gydymo efektą aiškino, remdamasi tiek humoraline teorija, contraria contrariis principu, tiek viduramžių liaudies medicinos, žolininkystės bei religinio ir maginio gydymo žiniomis. Raktažodžiai: Hildegarda Bingenietė, viduramžiai, melancholija, juodoji tulžis, humoralinė teorija, Physica, Causae et curae. Summary Hildegard of Bingen (c. 1098-1179) was a medieval nun and an abbess, a mystic, a composer, a poet, an author of medical treatises, and one of the few women at the time who wrote both theological and scientific texts. In this paper, I analyze Hildegard’s book Liber subtilitatum diversarum naturarum creaturarum (Book of Subtleties of the Diverse Nature of Creatures), compiled around 1151-1158 and consisting of two books: Physica and Causae et curae. The aim of this study is to understand how the phenomenon of melancholy in its three meanings (as body fluid, character type, and a disease) was perceived by one of the brightest medieval thinkers. Even though Hildegard’s writings were influenced by deep knowledge of the Scripture, the abbess also accepted Greco-Roman medical system (classical humoral theory), astrology, medieval agricultural worldview, and the wisdom of folk medicine. Melancholy was interpreted in Hildegard’s medical texts as a heart and a brain disease which was caused by the overabundance of black bile produced in the spleen. The abbess recommended various medicinal herbs (fennel, mallow, primrose, rue, etc.) and substances of animal (ostrich, heron, ants) and mineral (onyx) origin in order to reduce excessive amount of black bile. Hildegard explained the mechanism of action of these medications using concepts of humoral theory, principle of contraria contrariis, as well as knowledge of medieval folk medicine and elements of religious and magical healing. [ABSTRACT FROM AUTHOR]

Neurosyphilis was an incurable and in most cases fatal disease until the beginning of the antibiotic era. The aim of this paper is to find out how the etiology and clinical symptoms of neurosyphilis were perceived, what diagnostic and treatment methods were used in Lithuania in the interwar period (1920-1939). We analyzed the first scientific medical journal Medicina in Lithuania and Baltic States. The main cause of neurosyphilis in the interwar period was identified as a consequence of untreated or undertreated syphilis. Wasserman, Pandy and Nonne-Apelt globulin reactions, as well as evaluation of cerebrospinal fluid cytosis were the most commonly used laboratory tests to diagnose the disease. Heavy metal therapy (arsenic, bismuth, mercury salts) and fever therapy (injections of the malaria agent, boiled cow's milk, neobenzinol and pyrifer) were used to treat neurosyphilis in Lithuania in the period of 1920-1939. [ABSTRACT FROM AUTHOR]

In this review article, we present the treatment of narcolepsy since ancient times when patients experiencing the phenomenon of incubus (today understood as sleep paralysis with hypnagogic or hypnopompic hallucinations) were “cured” during the sessions of exorcism. At the beginning of the 19th century, in Vilnius clinics, the incubus disease was treated by providing lifestyle, diet, and sleep hygiene recommendations, also using antiphlogistic methods, as well as antispasmodic medicine and quinine bark. It was not until the late 20th century, when narcolepsy was perceived as a central hypersomnia due to partial or complete loss of hypocretin-secreting neurons in the hypothalamus, that effective symptomatic treatment emerged. Psychostimulants such as modafinil, armodafinil, pitolisant, and sodium oxybate were the first-line strategies. In second line, methylphenidate could be used. Amphetamine mixed salts or D-amphetamine could only be used in the third line because of potential cardiovascular and psychiatric side effects. Sodium oxybate, pitolisant, and venlafaxine were the first-line medications recommended for cataplexy. Serotonin and noradrenaline reuptake inhibitors were also often prescribed to manage cataplexy, while low doses of tricyclic antidepressants were used as third-line treatment. In this paper, we also present new European management guidelines for narcolepsy presented in 17th European Narcolepsy Masterclass in Berlin in September 5, 2020. Pitolisant, one of the latest drugs used for the symptomatic treatment of type I and II narcolepsy in adults, is a unique histamine H3 receptor antagonist/reverse agonist, the only wake-promoting agent in the market without risk of abuse. Currently, the treatment of narcolepsy with pitolisant is reimbursed in Lithuania. In this article, we also review future perspectives for narcolepsy treatment including novel versions of sodium oxybate, the noradrenaline reuptake inhibitor reboxetine, the combination of modafinil and the astroglial connexins inhibitor flecainide, selective hypocretin-2 receptor agonists, and immune-based therapies. [ABSTRACT FROM AUTHOR]

Epilepsy is one of the most common chronic diseases in children and it affects approximately 6.1 per 1000 children in Lithuania as of 2018 data. The onset of epilepsy most often develops in children and older adults. The condition of epilepsy may be traced to various factors and seizure symptoms can vary widely. Controlled seizures are the main goal of epilepsy management. Children with uncontrolled seizures may develop speech, language, cognitive and behavioral dysfunction epileptic encephalopathies. Effective management of epilepsy in children not only improves condition of health, but also reduces social exclusion and helps integrate into educational activities. However, even if the disease is diagnosed early and appropriate antiepileptic drug therapy is prescribed, epileptic seizures persist in 20-40% of patients. For some of these patients, surgical treatment of epilepsy, such as resection or palliative surgery, may be effective in reducing seizures. Resection of a localized epileptogenic focus is an effective treatment for appropriate refractory cases. However, not all patients are candidates for the resection, for example, in the case of multifocal or rapidly generalizing seizures without a clearly identified epileptogenic focus. One of the most effective treatment for refractory epilepsy is corpus callosotomy. The corpus callosum is the most important pathway for the spread of epileptic activity between the two hemispheres of the brain. Its cutting precludes epileptic discharges from traveling between hemispheres (i.e., generalization). Overall, long-term follow-up studies after callosotomy have shown improvement in 80-90% of patients (seizure-free or reduction). The paper describes two pediatric patients treated in Vilnius University Hospital Santara Clinics, Department of Pediatric Neurology and Neurosurgery, who underwent a corpus callosotomy, and compares the outcome of these clinical cases with the results of recent clinical trials. [ABSTRACT FROM AUTHOR]

Narcolepsy is one of the central hypersomnias associated with a tetrad of symptoms: excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations. On average, the accurate diagnosis of narcolepsy is made after 10.5 years after the onset of the disease, therefore the treatment is delayed causing a reduced quality of life. In this paper we present a clinical case of narcolepsy type 1 causing both diagnostic and therapeutic challenges. Furthermore, the most common symptoms of narcolepsy, diagnosis, treatment options as well as possibilities to implement them in Lithuania are overviewed in this article. [ABSTRACT FROM AUTHOR]

Transient epileptic amnesia Is an adult onset form of temporal epilepsy which is characterised by recurrent acute seizure-induced amnesia often accompanied by ongoing memory disturbances of autobiographical, topographical amnesia and accelerated longterm forgetting. The first ease report of transient epileptic amnesia was described more than a hundred years ago. However, more extensively investigations of this type of epilepsy were started not long ago. In 1998 diagnostic criteria were formulated: 1) history of recurrent witnessed episodes of transient amnesia; 2) cognitive functions other than memory arc judged to be intact during typical episodes by a reliable witness; 3) evidence for a diagnosis of epilepsy, provided by one or more of the following: (a) wake or sleep electroencephalography; (b) the co-occurrence of other seizure types (if their roughly concurrent onset and/or close association with episodes of transient amnesia suggested a connection); (c) a clear-cut response to anticonvulsant therapy. From case reports that are analysed in literature it is not difficult to summarise clinical characteristics: transient epileptic amnesia usually starts later in life, more often in men than in women; amnestic episodes are brief, recurrent and often occur upon waking; memory loss is usually mixed type with anterograde and retrograde amnesia; in 65% of patients amnesia is associated with gustatory or olfactory hallucinations, deja vu, a brief period of unresponsiveness, automatisms; epileptiform abnormalities on electroencephalography were seen in 43% cases; although transient epileptic amnesia has an excellent response rate to anticonvulsant therapy, between episodes patients still suffer from accelerated long-term forgetting, remote memory impairment and topographical amnesia. Differential diagnostic of transient epileptic amnesia Is diverse and diagnosis Is usually inaccurate and overdue. Treatment with monotherapy often helps totally prevent recurrence of attacks. In the paper we review two case reports of patients with transient epileptic amnesia. [ABSTRACT FROM AUTHOR]

At the end of the 18 th and beginning of the 19 th centur ies, equipotent theory, which asserts that the soul resides throughout the brain, was still relevant and acceptable, and newer theories on cerebral localization were assumed to be materialistic, scandalous, and antireligious. Such was Franz Joseph Gall's (1758-1828) doctrine of organology. Gall proposed that the cerebrum is composed of different functional regions, each associated with a different faculty of mind, suggesttng that these regions could be identified by correlating bumps and depressions on the skull with human behaviors, such as vanity, worshipping, stealing, reasoning, etc. Since 1796 and untill 1802, Gall presented his new ideas in Vienna, Holy Roman Empire. Andrew Sniadecki (Jędrzej Sniadecki, Andrzej Sniadecki; 1768-1838), who later became Professor of Natural Sciences at the Imperial University of Vilnius, in 1795-1796 practiced in Vienna hospitals and got acquainted with Gall and his organology. In this paper, we anatyse the article Krotki Wyklad Systematu Galla z przylączeniem niektorych uwag nad iego Nauką (“Short Lecture on the System of Gall with some Comments about his Science") by Andrew Sniadecki, published in 1805 in the journal Dziennik Wilehski, and the article Rzut oka na naukę Galla (“On the Gall's Theory") by Stanislaw Borkowski (1782-1850), pubiished in 1815 in the same journal, and investigate how the new ideas of Gall's doctrine were disseminated in Vilnius. [ABSTRACT FROM AUTHOR]

One of the most important philosophers in the Imperial University of Vilnius in the age of Entightenment was Jan Sniadecki (1756-1830), a graduate of the University of Cracow, mathematician, astronomer, philosopher, and Rector of the Imperial University of Vilnius. Jan Sniadecki was the author of various treatises on algebra, trigonometry, geography, and philosophy. The Professor was probably the first who broadly analysed the functions of the human mind and clearly associated it with the activity of the nervous system in the beginning of the 19 th century in Vilnius. In this paper we anatyse “The Phitosophy of the Human Mind" by Jan Sniadecki (Filozofia umyslu ludzkiego czyli rozwazny wywod sit, i dziatan umyslowych, published in 1822 in Vilnius) and overview the principles of investigations on human cognition until the first half of the 19th century in Europe. [ABSTRACT FROM AUTHOR]

One of the most important stroke prevention strategies is antithrombotic therapy using antiplatelets and anticoagulants. Despite the fact that a lot of guidelines and recommendations on the topic have been published thus far, it is impossible to embrace every clinical case in the guidelines and to provide data from randomised controlled trials. Choosing treatment in the clinical setting, one has often to balance between prevention benefits and risk of complications. In this paper we review different opinions about strategies of antithrombotic therapy in complex clinical situations: anticoagulation resumption after different types of stroke and gastrointestinal bleeding; perioperational anticoagulation management; combined antithrombotic therapy. [ABSTRACT FROM AUTHOR]

Tumor-like multiple sclerosis is one of the rare variants of multiple sclerosis. It presents with a large intracranial lesion, more than 2.0 cm in diameter, with mass effect, perilesional edema, and/or ring enhancement. Diagnostics is challenging and invasive methods are often used. A case of tumor-like multiple sclerosis is presented in this paper. The diagnosis was established without a biopsy. Relapsing-remitting course developed in less than six months. Also most recent studies regarding tumor-like multiple sclerosis are discussed, with special focus on diagnostics and treatment options. [ABSTRACT FROM AUTHOR]

Status epilepticus (SE) is a life-threatening health condition requiring immediate therapeutic managament. In order to prevent any delay in starting interventions, today the working definition of SE uses the duration criterion of 5 min. of persisting seizure/s without regaining consciousness in between them. As the consequences and the prognosis of SE are very much time-dependent, the protocol of management and monitoring depends on the SE stages: early (impending) SE (5-30 min.), established SE (>30<90 min.), refratory SE (>90 min.) ; some authors mention also super-refractory SE. Based on the published scientific reviews and recommendations by international expert groups, this paper discusses modem approach to etiopathogenesis and management of SE. [ABSTRACT FROM AUTHOR]

Multiple sclerosis is a chronic inflammatory autoimmune demyelinating disease of the central nervous system, affecting myelin of the gray and white matter and causing axonal loss. Multiple sclerosis is the leading cause of acquired neurological dis ability in the young persons' group. Long-term studies of the natural disease course showed that the average time of relapsing-remitting disease progression to secondary progressive course is about 10 years and approximately half of untreated patients will require ambulatory assistance within 15 years of disease. The etiology of multiple sclerosis is still unknown, therefore the treatment that could cure the disease has not been established yet. Nevertheless, the discovery of disease-modifying therapy pro vides many benefits: prevents new relapses, progression of dis ability, etc. Relapsing-remitting multiple sclerosis patients are successfully being treated with the I-line therapy (interferons beta and glatiramer acetate parenterally) for more than 15 years. In 2011 the first oral drug fingolimod was approved by European Medicines Agency and is available as II-line therapy for multiple sclerosis patients with very active disease despite treatment with interferons, as well as those with rapidly progressive disease course. This article presents the algorithm of multiple sclerosis treatment and introduces the new drug fingolimod: mechanism of action, pharmacodynamics, pharmacokinetics, efficacy and safety in clinical trials, treatment initiation, first dose monitoring recommendations and its place in multiple sclerosis treatment algorithm. The new oral therapy (teriflunomide, BG-12, laquinimod and cladribine) created for multiple sclerosis treatment is also introduced and new treatment perspectives are dis cussed, brief summary of patients treated with fingolimod in VUH Santariskiu klinikos, indications of drug prescription, monitoring of the drug efficacy and safety are also presented in this paper. [ABSTRACT FROM AUTHOR]

Vestibular migraine is considered to be the most common cause of spontaneous episodic vertigo and the second cause of vertigo at all. Terms used to describe recurring vestibular symptoms in migraine, such as migraine-associated dizziness, migrainous vertigo and vestibular migraine, imply a causal link between migraine and the vestibular symptoms. Recent edition of the Inter national Classification of Headache disorders, published in 2013 included criteria for the diagnosis of vestibular migraine. Literature review of clinical presentation, management and prophylaxis of vestibular migraine is presented in the paper. [ABSTRACT FROM AUTHOR]

Although pulmonary tuberculosis is the most common form of this infectious disease, it can affect any organ or system of a human body. Central nervous system tuberculosis accounts for only a small part of all the cases, however, it is one of the most severe disease forms resulting in death or neurological sequelae in half of the patients. Rapid diagnosis of central nervous system tuberculosis is challenging due to non-specific symptoms and relatively insensitive or slow bacteriological diagnostic methods. Delay in antituberculous treatment is one of the most important predictive factors of poor outcome. An increasing multidrug-resistancy of mycobacteria brings new concerns regarding treatment options. In this paper, a review of medical literature and latest recommendations for tuberculous meningitis diagnosis and treatment are presented as well as four cases of tuberculous meningitis, treated at Kaunas 2nd Clinical Hospital in the year 2007-2009. [ABSTRACT FROM AUTHOR]

Background. Alzheimer's disease in early stages is known as mainly amnestic disorder. Common paper-pencil tests usually don't show frontal dysfunction in mild Alzheimer's dementia, but PET studies indicate heavy beta-amyloid load in temporal and frontal lobes even in early Alzheimer's disease. Having in mind that frontal dysfunction could have even more disastrous effect on daily activities than medial temporal amnestic syndrome, there is need for more sensitive frontal functions testing which could allow to assess mild decline in frontal cognitive functions. Possible methods for this purpose are computerized cognitive tests. Aim. To evaluate frontal functions in both, Alzheimer's disease (AD) patients and healthy individuals, compare them and relate to demographic characteristics, severity of dementia and depression. Materials and methods. A prospective research was performed in Vilnius University Hospital, Santari~kiq Klinikos, Centre of Neurology in 2009 -2010. There were 66 subjects participating, 30 of which had mild or moderate AD (76.93 ± 5.01 year old; 40% men, 60% women) and 36 were control subjects (74.81 ± 5.51 year old; 39% men, 61% women). Every subject was given CANTAB (Cambridge Neuropsychological Test Automated Battery) tests, evaluating visual memory, learning (PAL, PRM tests) and frontal functions (SOC test). The degree of dementia was assesed using MMSE, severity of depression Yesavage geriatric depression scale. Statistical analysis was made using Student t test, χ² test, Pearson correlation. Results. MMSE score in AD and control groups (C) was 20.1 ± 2.8 and 28.2 ± 1.9 points respectively (p < 0.00 1). The measures of visual memory, recognition and new learning (PAL, PRM tests) were significantly worse in AD group (p < 0.05). The significant difference between groups in Soc test (spatial planning and spatial working memory) was found for these measures: mean moves made by the subject to solve problems where the solution could be reached in a minimum number of 3 moves (AD: 3.71 ± 0.59; C: 3.43 ± 0.52; p = 0.0464) and problems solved in minimum (2) moves (AD: 1.67 ± 0.55; C: 1.92 ± 0.28; p = 0.0201). A significant positive correlation of MMSE score with problems solved in minimum (4) moves (SOC test) was deterniined in AD group (p = 0.002, r = 0.55 197). There was no significant relation of frontal function and age of the subjects. Severity of depression significantly correlated with these frontal measures (SOC test): problems solved in minimum (4) moves (r = -0.35 97; p = 0.003) and mean moves made by the subject to solve problems where the solution could be reached in a minimum number of 4 moves (r = -0.2568; p = 0.0439). Conclusions. Episodic, visual recognition memory and new learning were significantly worse in AD group. Impairment of spatial planning and decision making frontal functions in AD gronp was detected only for some of the measures when compared with the control group. Further and more detail investigations of greater sample size are necessary to assess the characteristics of early frontal dysfunction in AD. [ABSTRACT FROM AUTHOR]

The psychopathological syndromes named after cities and states where the syndromes were observed or described as well as some incidents happened are collected in this study based on literature. Some of these syndromes such as Jerusalem syndrome, Paris syndrome, and Indian syndrome are related to travels. Other syndromes are related to the national identity as Israel or Escape to Israel syndrome, or Oslo syndrome. Some syndromes are close or paralleled to posttraumatic stress disorder such as Vietnam syndrome, Gulf War syndrome, Stockholm syndrome or Lima syndrome. Some names of syndromes were derived from political or public events and were named after politicians or journalists. Pisa syndrome is classified as extra pyramidal phenomenon and is named after a tonic flexion of a trunk to the side and the similarity of human posture to Pisa tower. The paper is illustrated by paintings of artists. [ABSTRACT FROM AUTHOR]

The article presents a complex clinical case of the successful treatment of the basilar artery acute thrombosis which caused the vertebrobasilar ischemic stroke. The mortality from this disease without treatment is 90%. Paper also presents short overview of clinical symptoms, modern diagnostics and novel therapeutic methods of basilar artery thrombosis - intravenous and intra-arterial thrombolysis, mechanical thrombus extraction, percutaneous angioplasty and stenting, as well as concept of a bridging revascularization therapy. [ABSTRACT FROM AUTHOR]

At the present time, the question of chronic mental stress links with various kinds of somatic diseases and parallels between panic disorder, and cardiac diseases especially, arises. It is emphasized that panic disorder is one of the states which provide a clinical model of recurring stress responses. There is 4.7% prevalence of panic disorder in general population. The rate of panic disorder among cardiac patients is three times more frequent in comparison to general population. The aim of the paper is to discuss biological and psychological peculiarities of the stress response and to define the link between cardiac diseases and panic disorder. In both conditions there is the arousal of the sympathetic nervous system, in crease of CO2, lactate, cortisol and adrenalin synthesizing hormone concentrations in blood. The mental stress initiates an increase in oxidative stress parameters and alters the defence mechanisms in myocytes, the malfunction of endothelium leading to cardiovascular events. There is evidence that the inflammatory component as well as oxidative parameters play an important role in panic disorder and cardiovascular diseases pathogenesis. As far as panic disorder is seldom discussed, it is important to diagnose and estimate the high risk groups and use the preventive means and treatment methods. [ABSTRACT FROM AUTHOR]

This article presents women suicide risk in Lithuanian administrative units in the context of the European Union by applying rarely used direct standartized cummulative risk method. This epidemiological descriptive paper is a result of a comprehensive analysis of statistical base sites of 25 EU member states, 10 Lithuanian counties and 60 regions and municipalities. There were 0.006% women who committed suicide in the whole European Union with the suicide cumulative risk of these women being 0.51%. The analysis showed that this risk was statistically significantly higher in the group of New EU Member States - 0.59 [0.57-0.611% than in Old EU ones - 0.49 [0.48-0.51%. Women suicide risk differed 50 times among EU countries. There was the lowermost suicide risk among Cyprus women - 0.025% and the uppermost among Lithuanian - 1.26% in EU. Suicide risk of Lithuanian women was almost the same as in Slovenia but statistically significantly higher compared to 23 Member States. Moreover, the classification for women's suicide cummulative risk indicators using Jenks' natural breaks method was developed and proposed. The mortality risk was very high in all 10 Lithuanian counties in the context of the European Union. The top women suicide risk was in four counties: Panevėžys - 1.74%, Utena - 1.71%, Šiauliai - 1.69% and Tauragė - 1.64%. Even 55 (91.7%) from 60 Lithuanian municipalities identified with very high suicide cumulative risk, only four municipalities with high - Neringa, Kaisiadorys, Marijam-polė, Vilnius, and only one municipality - Elektrėnai - with low risk. Such a situation indicates the so called "asthenia" of available preventive measures in Lithuania. Therefore it is very important to implement extra scientifically grounded suicide prevention programme at national level in Lithuania. [ABSTRACT FROM AUTHOR]

Eponyms of paraphilias that take their names from Greek and Romaine mythology, the Bible as well as from literature and history and are used in psychiatry and sexology are collected in this study. The origin of them and depiction in literature and art are described. The paraphilias involved in international classifications of diseases DSM-III-RICD-10 and are discussed. The paper is illustrated with famous art pieces. [ABSTRACT FROM AUTHOR]

Eponyms related with love and sexual life that take their names from Greek and Roman mythology, the Bible as well as from literature and history and are used in medicine, psychiatry and sexology are collected in this study. The origin of them and depiction in art are described. The sexual disorders included in International Classification of Diseases (ICD-10) are discussed. A case of nymphomania, treated by the author, is presented in the article. The paper is illustrated by famous art pieces. [ABSTRACT FROM AUTHOR]

The cases of well known art works damaged by mentally disturbed persons are described in this study. The oldest case in the world history of Herostratus (Herostratus syndrome) is discussed and compared with contemporary terrorism. The author tells about her personal participation in investigation of damaging Rembrandt's "Danaja" in Sankt Peterburg's Ermitage and presents the data from Lithuanian citizen Bronius M. illness case. The histories of damaged art works' creation and their restoration are described in this paper as well as their correlation with psychiatry. There are presented links of art works and their authors with Lithuania. Motives of art vandals and vandalism acts in Lithuania are discussed. [ABSTRACT FROM AUTHOR]

Malignant middle cerebral artery syndrome is a variant of stroke followed by a significant mortality. The main causes of fatality are brain edema and herniation. Malignant stroke is more prevalent in younger patients with a first episode of brain infarct. The progression of the disease is very rapid with the highest peak of symptoms on day 2 to 5. Current conservative management has a limited effect while most of the newer methods of treatment are experimental and not approved in clinical practice. Decompressive craniectomy decreases mortality but it is a life saving procedure only. There are no evidence based guidelines in which patient and when it should be used. This paper deals with the clinical signs, prognostic values, and ways of management of malignant stroke. [ABSTRACT FROM AUTHOR]

The term pathography in psychiatry and the connection between genius and insanity are discussed in the article. For the first time in Lithuanian psychiatry the paper analyzes the pathography of the famous Lithuanian painter and musician M. K. Čiurlionis on the ground of his letters and reminiscences of contemporary people. The author supposes that M. K. Čiurlionis suffered from schizoaffective disorder which was represented by affective disorders (manic and depressive periods, derealization and depersonalization), as well as cognitive disturbances typical of schizophrenia, and acute psychotic symptoms, episodes of katatonia and oneiroid. [ABSTRACT FROM AUTHOR]

Alzheimer's disease and vascular dementia are the most common causes of dementia syndrome. These patomorphologically distinct entities are interrelated not only by dementia syndrome, but also by some risk factors, frequent and clinically significant comorbidity. ApoE ϳ4, hypercholesterolemia, arterial hypertension, diabetes meilitus, hyperhomocysteinemia are known vascular risk factors. Large longitudinal, clinico - pathological studies and autopsy series had proven the relationship between these risk factors, associated cerebrovascular pathology and Alzheimer's disease. Mechanisms by which particular vascular risk factors contribute to the pathology of Alzheimer's disease are still unknown and remain the object of experimental studies. The reduction of the cognitive potential of the brain is the most presumable role of vascular pathology in Alzheimer's disease. Mixed Alzheimer's type and cerebrovascular pathology may contribute up to 40% of dementia cases. However, there is no consensus neither regarding the diagnostic criteria of this mixed pathology nor the terminology. In clinical practice the differentiation between Alzhemier's disease, vascular dementia and Alzheimer's disease with cerebrovascular disease is difficult enough and still remains a significant problem. The correct diagnosis is important not only in choosing an appropriate therapy but also for the prognosis and prophylaxis. The relationship between Alzhemier's disease and cerebrovascular pathology as well as the most important differential issues of Alzheimer's disease and vascular dementia are discussed in this paper. [ABSTRACT FROM AUTHOR]

The paper analyses medical aspects of probably neurological disorders (epilepsy, paralysis, headache, multiple sclerosis) described in XVII-XVIII c. Marian Miracle Books of the Great Duchy of Lithuania. [ABSTRACT FROM AUTHOR]