Search

Uvod: Bolja perinatalna skrb dovela je do povećanog preživljavanja nedonoščadi. Ta djeca češće imaju različite motoričke, kognitivne i psihološke poremećaje. Perinatalna hipoksijsko-ishemijska encefalopatija (HIE) je osnovni uzrok ozljeda bijele tvari i dugotrajnih neuroloških deficita u djece. Cilj ove disertacije je analizirati moždane volumene i traktografske parametre kao glavno mjesto ozljede bijele tvari i usporediti ih s područjima u ponsu i malom mozgu kako bi se pronašla moguća selektivna vulnerabilnost za kortikospinalni put, kortikopontini put, medijalni lemnisk te za gornje, srednje i donje krakove malog mozga. Materijali i metode: Ovo istraživanje uključuje tri skupine ispitanika. Prva se grupa sastoji od 5 zdrave, terminske djece (kontrola), druga grupa uključuje 16 nedonoščadi bez perinatalne HIE (normotipična skupina), a treća skupina se sastoji od 22 nedonoščadi sa potvrđenom perinatalnom HIE (HIE skupina). Dijagnoza perinatalne HIE se temelji na MR i kliničkim nalazima. Dobiven je pristanak roditelja za MR snimanje, a sva snimanja i pregledi su kontrolirani i odobreni od strane Etičkog povjerenstva Medicinskog fakulteta Sveučilišta u Zagrebu. MR snimke su snimljene uređajem snage magnetskog polja 3T (Magnetom TrioTim, Siemens, Njemačka), a korištena je T1 MPRAGE sekvenca visoke rezolucije u sagitalnoj ravnini (veličina voksela = 1x1x1 mm) i dwi sekvenca (veličina voksala 1,6x1,6x3 mm). Sve grupe ispitanika su snimljene u dvije vremenske točke, najprije u terminskoj ili korigiranoj terminskoj dobi, a onda u dobi od dvije godine. Moždani volumeni su mjereni uz pomoć polu-automatskog volumetrijskog programa (MNI toolbox, Montreal, Canada), a volumen moždanog debla i njegovih dijelova uz pomoć volumetrijskog programa koji zahtijeva manualne metode segmentiranja (Analyze 8.1, Mayo Cllinic, USA). Aksonalni snopovi (kortikospinalni put, kortikopontini put, medijalni lemnisk, gornji, srednji i donji krakovi malog mozga) su rekonstruirani koristeći programe Diffusion Toolkit i TrackVis software. Rekonstruiranim aksonalnim snopovima izmjereni su parametri (volumen, frakcijska anizotropija, FA te difuzijski koeficijent, ADC, eng. apparent diffusion coefficient). Statistička analiza učinjena je programom MedCalc v12. Rezultati: Normotipična skupina ispitanika pokazuje smanjenje mjerenih volumena u korigiranoj terminskoj dobi u odnosu na kontrolnu skupinu, no ta razlika se smanji do druge godine života i ostaje diskretna. HIE skupina ispitanika pokazuje statistički značajnuredukciju mjerenih volumena korigiranoj terminskoj dobi u odnosu na kontrolnu skupinu, a to smanjenje se nastavlja i u dobi od dvije godine kada je značajano u odnosu na kontrolnu i normotipičnu skupinu. Volumetrijska analiza koja je pokazala navedeni obrazac uključuje moždano deblo (mezencefalon, pons, produljena moždina) i njegove segmente (baza, tegmentum, tektum) i mali mozak. Analizirani DTI parametri (volumen, FA, ADC) pokazuju sličan obrazac kod mjerenih aksonalnih snopova promatranih skupina. Zaključak: Ishodište, putanja i ciljno područje analiziranih aksonalnih puteva su reducirani nakon perinatalne HIE. Utvrdili smo da su svi izmjereni aksonalni snopovi redovito oštećeni u perinatalnoj HIE, kao dio opće patologije bijele tvari. Ovakvi rezultati potvrđuju da su putevi koji su dio periventrikularnog sustava vlakana i periventrikularnih raskrižja vulnerabilni u HIE. Također, zbog topografskog odnosa, oštećena periventrikularna vlakna pridonose smanjenju moždanog debla, napose ponsa te smanjenju malog mozga., Introduction: Improved perinatal care has led to increased survival of premature infants. These children often have different motoric, cognitive and psychological disorders. Perinatal hypoxic-ischemic encephalopathy (HIE) is a major cause of white matter injury and long-term neurological deficits in children. The aim of this study is to analyze cerebral volumes and DTI parameters as major site of white matter injury and compare them with recipient areas in pons and cerebellum in order to find possible selective vulnerability for corticospinal tracts, corticopontine pathways, medial lemnisci and superior, medial and inferior cerebellar peduncles. Material and methods: In our research we had three groups of participants. The first group consisted of 5 normal term infants (control), the second group included 16 normotypic premature infants without perinatal HIE lesions (normotypic), and the third group included 22 premature infants with perinatal HIE (HIE). Diagnosis of perinatal HIE was based on both MRI and clinical exams. Parental consent for MRI scanning was obtained and all examinations were controlled and approved by the Institutional Review Board of the University of Zagreb School of Medicine. MRI images were obtained using 3T MRI scanner (Magnetom TrioTim, Siemens, Germany), with high resolution T1 MPRAGE sequence in sagittal plane (voxel size = 1x1x1 mm) and dwi sequences (voxel size 1.6x1.6x3 mm). All groups were scanned at two different time points, first at the term or corrected term age and second at the age of two years. Cerebral and cerebellar volumes were measured using semi-automated software (MNI toolbox, Montreal, Canada), and brainstem (mesencephalon, pons, medulla oblongata) was measured using manual segmentation methods (Analyze 8.1, Mayo Clinic, USA). Axonal pathways (corticospinal tracts, corticopontine pathways, medial lemnisci and superior, medial and inferior cerebellar peduncles) were reconstructed and all parameters (volume, FA- fractional anisotropy and ADC-apparent diffusion coefficient) have been measured using Diffusion Toolkit and TrackVis software. Statistical analysis was done using MedCalc v12. Results: Normotypic group showed decreased volumes at corrected term age, but their volumes compensate during growth and at the age of 2 years correspond to control group. Unlike normotypic, group with HIE lesions shows statistically significant reduction of measured volumes during corrected term age comparing with normal group, and also at the age of 2 years comparing with both normal and normotypic group. Volumetric analysis of brainstem parts (mesencephalon, pons, medulla oblongata) and its layers (base, tegmentum, tectum) follows that pattern as well as volumetric analysis of brainstem in general, cerebellum and total brain volume. Parameters measured during DTI analysis (volume, FA- fractional anisotropy and ADC-apparent diffusion coefficient) for named axonal pathways showed similar pattern in observed groups. Conclusion: Origin, trajectory and termination areas of measured axonal pathways are reduced after perinatal HIE. We have found that all measured pathways are regularly damaged in perinatal HIE, as a part of general white matter pathology. Our finding is in the agreement that pathways which are part of the periventricular fiber system and periventricular crossroads are vulnerable in HIE. Also, due to the topographical relationship, damaged periventricular fibers will contribute to reduction of brainstem, expecially pons, as well as cerebellum.

It is widely accepted that neurogenesis in humans ends around the middle of gestation. However, the subventricular zone of some focal telencephalic domains continues with neuron production throughout the last trimester. We evaluated Nissl, Golgi and immunohistochemically stained human slides from the Zagreb Neuroembryological Collection to determine if late neurogenesis might also occur in the major proliferative zones of the telencephalon. Between 24-26 postconceptional weeks (pcw) a massive stream of densely packed cells was found leaving the ganglionic eminence (GE), a progenitor domain of the ventral telencephalon that is a major source of cortical GABAergic neurons. Between 32-36 pcw, the GE decreased in size but was clearly distinguishable, and a stream of non-radially oriented MAP-2 positive migratory-like cells still extended towards the dorsal telencephalon. Additionally, volumetric analysis on MRI images was performed to evaluate the developmental pattern of the GE in period from 13 to 34 pcw and found a persistent GE throughout the entire analyzed period. This suggests that the GE maintains its proliferative capabilities up to the end of gestation and that a significant production of cortical GABAergic neurons continues beyond the proliferative period of principal glutamatergic neurons. We propose that protracted neurogenesis from the GE contributes to the disproportional increase in the number of calretinin neurons, the most numerous GABAergic neuron population in primates. We further suggest that late fetal production of neurons is not restricted to neurons within the dentate gyrus and rostral migratory stream.

Spontaneous subarachnoid hemorrhage (SAH) can occur unexpectedly and independently of the classic risk factors. Several different factors could affect intracranial aneurysm (IA) rupture, such as morphological and hemodynamic factors. The aim of this study was to establish the potential association of meteorological data such as temperature, atmospheric pressure, and humidity, and the onset of clinical symptoms preceding hospital admission of patients with acute SAH due to IA rupture. This retrospective study included 130 consecutive patients admitted for non-traumatic SAH with a determinable onset of SAH symptoms. The effects of meteorological parameters of atmospheric pressure, ambient temperature, and relative air humidity on the day of acute SAH onset and 24 hours prior to the onset of symptoms were recorded and analyzed in each patient. Spearman rank correlation analysis was used to assess the risks of incident SAH on the basis of daily meteorological data. Seasonal incidence of acute SAH showed the peak incidence in winter and a trough in summer, with monthly incidence peak in January and December. The circadian rhythm analysis showed the peak incidence of SAH in the forenoon, followed by the evening. Acute SAH incidence showed moderate positive association with daily atmospheric pressure (p, Spontano subarahnoidno krvarenje (SAH) može nastati neočekivano i neovisno o klasičnim čimbenicima rizika. Nekoliko različitih čimbenika može utjecati na rupturu intrakranijske aneurizme (IA), poput morfoloških i hemodinamskih čimbenika. Cilj ovoga istraživanja bio je utvrditi potencijalnu povezanost meteoroloških podataka kao što su temperatura, atmosferski tlak i vlažnost te pojave kliničkih simptoma prije prijma u bolnicu bolesnika s akutnim SAH-om zbog rupture IA. Ova retrospektivna studija uključila je 130 uzastopnih bolesnika primljenih zbog netraumatskog SAH-a s vidljivim početkom simptoma SAH-a. Za svakog bolesnika zabilježeni su i analizirani učinci meteoroloških parametara atmosferskog tlaka, temperature okoline i relativne vlažnosti zraka na dan nastanka akutnog SAH-a i 24 sata prije pojave simptoma. Korelacijska Spearmanova analiza primijenjena je za procjenu rizika od incidentnog SAH-a na temelju dnevnih meteoroloških podataka. Sezonska incidencija akutnog SAH-a pokazala je vrhunac incidencije zimi i pad ljeti, s mjesečnim vrhom incidencije u siječnju i prosincu. Analiza cirkadijanog ritma pokazala je vrhunac incidencije SAH-a u prijepodnevnim satima, a zatim navečer. Učestalost akutnog SAH-a pokazala je umjereno pozitivnu povezanost s dnevnim atmosferskim tlakom (p

Epithelial to mesenchymal transition (EMT) is a leading process associated with invasive character of different cancer types and formation of metastasis. The cause of progression and expression of malignant character in a small group of meningioma is still unclear. To investigate the role of EMT in intracranial meningioma progression, main actors of cadherin switch, E- and N-cadherin, as well as EMT transcription factors TWIST1, SNAIL and SLUG, were studied. Analyzes of different meningioma grades revealed that genetic changes in CDH1 gene (E-cadherin) were usually accompanied with expression in relation to E-cadherin was shown. Reported low levels of expression or silencing of E-cadherin could be a result of strong TWIST1, SNAIL and SLUG expression. The increase in the TWIST1 expression was accompanied by an increase of the SNAIL and SLUG expression (p = 0.033). Strong expression of SNAIL and SLUG, especially when located in nuclei, was significantly associated with higher meningioma grades (p = 0.001). Still, meningiomas without CDH1 genetic changes were significantly more likely to lack nuclear SNAIL and SLUG expression or it was observed in less than 50% of nuclei, in contrast to samples with CDH1 gene changes (p = 0.000). Our results suggest the role of aberrant EMT in meningioma progression, emphasizing SNAIL and SLUG nuclear expression as potential prognostic marker.

Carotid-cavernous fistula (CCF) is a relatively rare pathology with a low incidence compared with other vascular pathologies. They can be classified based on hemodynamics as low- or high-flow fistulas, and anatomically as direct or indirect fistulas. Anatomy of the shunt somewhat dictates the selection of endovascular treatment, meaning the venous or arterial approach and selection of embolizing materials. Although there is general agreement as to when to access CCF transvenously or transarterialy, which depends on the shunt being direct or indirect, there is no uniform agreement on which occlusion method should be used. Herein, we report a case of an 80-year-old woman treated for indirect CCF using detachable coils. We also provide a brief review of the literature, including recent advances in treatment of said entities. In conclusion, selection of both the approach and material used depends on the operator’s experience and preference., Karotidno kavernozna fistula je relativno rijetka patologija s niskom incidnecijom u odnosu na ostale vaskularne abnormalnosti. Hemodinamski se dijele na niskoporotočne i visokoprotočne, a anatomski na direktne i indirektne. Anatomija fistule određuje vrstu endovaskularnog tretmana, dakle arterijki ili venski pristup, kaoo I vrstu materijala kojom se vrši embolizacija. Iako postoji opći konsenzus oko primjene arterijskog ili venskog pristupa, ovisno o tome je li fistula direktna ili indirektna, ne postoji uniformni dogovor koja bi se metoda trebala koristiti u pojedinačnim slučajevima. Ovim radom smo prikazali slučaj osamdesetogodišnje bolesnice koja je liječena radi indirektne karotidno kavernozne fistule koristeći zavojnice. Također, prikazan je pregled literature i recentnog napretka u liječenju spomenutih entiteta. Zaključno, kako izbor pristup tako i izbor materijala ovise o iskustvu te preference operatera.

Low-risk premature infants often develop visual deficits, even in the absence of ophthalmological complications and high-graded brain injury. These complications can be explained by the nature of subtle perinatal lesions and alterations of brain growth due to the prematurity. Subtle brain injuries and vulnerability of axonal pathways can be observed in spatiotemporal context of the white matter segments. The aim of this study was to examine the link between MRI quantitative (brain metrics data) and qualitative features (visibility of 2nd white matter segment - sagittal strata and periventricular crossroads C1-C6) and visual behavior in preterm neonates at term-equivalent age. Seventy-one very preterm infants without high-graded brain injury on MRI and no ocular pathologies were studies. The infants received MRI scans at term-equivalent age. MRI scans were analyzed using (a) simple brain metrics and (b) scoring the visibility of transient structural patterns (sagittal strata and periventricular crossroads). At the median age of 41+5 PMA weeks infants completed the Neonatal Visual Assessment. Results indicated that visibility of temporal crossroad area C6 and frontal and occipital sagittal strata was positively correlated with visual tracking skills in neonatal period. Furthermore, the visibility of frontal and occipital sagittal strata were strong predictors of total Neonatal Visual Assessment score. The findings confirmed that sagittal strata and periventricular crossroads prominence is a valuable additional marker in perinatal neuroimaging at term-equivalent age. Thus, alteration in MRI appearance of temporal crossroad and sagittal strata may be useful in predicting of visual behavior for very premature born infants.

Introduction: Our study analyzed the prevalence of sleep disorders (primarily insomnia and hypersomnia) in patients who tested positive for Covid 19, as well as the distribution of insomnia/hypersomnia in different subgroups of these patients (according to their age, gender, BMI, disease severity). Materials and methods: This prospective, noninvasive, cross-sectional study was conducted at the Emergency department, Respiratory Center, and Respiratory Intensive care Center of University Hospital Dubrava from December 2020. until March 2021. It included patients whose tested positive for Covid 19 and who reported at least one neurological symptom. Patients were examined, and interviewed face to face using a web-based structured questionnaire designed for the purposes of this study. Results: Of the 337 participants, 109 (32, 34%) reported one of two possible symptoms associated with a sleep disorder, primarily difficulty sleeping/insomnia ( dubbed „sleep disorder“) or sleepiness/ hypersomnia. Of the 337 participants, 61 (18%) reported sleep disorder while 48 (14%) reported hypersomnia. There was no statistically significant difference in the prevalence of sleep disorders between men and women (ꭓ2 = 0, 113, p = 0, 737). Hypersomnia was more prevalent in women (ꭓ2 = 8, 125, p = 0, 004). Patients who had sleep disorder had a lower median age by 5 years compared to patients who did not have a sleep disorder (z = 2, 6, p = 0, 009). Patients who had hypersomnia had a median of age lower by 9 years than patients who did not have hypersomnia (z = 4, 3, p =

The sphenoid bone development occurs in both prenatal and postnatal periods. Sphenoid bone openings are used as surgical landmarks and are of great importance for neurosurgeons in everyday practice. The aim of this study was to identify morphological characteristics, postnatal development and remodeling, as well as clinical aspect of the sphenoid bone openings and to investigate their relationship and difference in size. The macerated sphenoid bones analyzed in this study were scanned by micro-computed tomography. Areas and distance in-between foramen ovale and foramen rotundum were measured. In addition, different shapes of foramen ovale were described. The most common shape of foramen ovale on both sides was oval, followed by the round, almond and elongated shapes. Modest to strong positive correlations between all foramina and age for the whole sample and both subsamples were presented, except for the right foramen rotundum area in the male subsample, which did not show significant correlation with age. Our study revealed changes in postnatal development and anatomy of foramen ovale and foramen rotundum, primarily in the aspects of size and shape, and should contribute to reducing the risk of damage to neurovascular structures during surgical procedures., Razvoj klinaste kosti odvija se u prenatalnom i postnatalnom razdoblju. Otvori klinaste kosti se koriste kao kirurški orijentiri i od velike su važnosti za neurokirurge u svakodnevnoj praksi. Cilj ovoga istraživanja bio je prikazati morfološke karakteristike, postnatalni razvoj i preoblikovanje, kao i klinički aspekt koštanih otvora klinaste kosti te istražiti njihov odnos i razliku u veličini. Macerirane klinaste kosti analizirane u ovom istraživanju skenirane su mikroCT-om. Izmjerene su površine i udaljenost između ovalnog i okruglog otvora. Uz to, opisani su različiti oblici ovalnog otvora. Najčešći oblik ovalnog otvora obostrano je ovalni, potom okrugli, bademasti i izduženi oblik. Prikazane su umjerene do jake pozitivne povezanosti između svih otvora i starosti za cijeli uzorak i oba poduzorka, osim površine desnog okruglog otvora u muškom poduzorku koji nije pokazao značajnu povezanost s godinama. Naše istraživanje otkrilo je promjene u postnatalnom razvoju i anatomiji ovalnog i okruglog otvora, prvenstveno u pogledu veličine i oblika, što bi trebalo doprinijeti smanjenju rizika od oštećenja krvožilnih i živčanih struktura tijekom kirurških zahvata.

Introduction : Our study analysed the prevalence of sleep disorders (primarily insomnia and hyper- somnia) in patients who tested positive for Covid 19, as well as the distribution of insomnia/hyper- somnia in different subgroups of these patients (according to their age, gender, BMI, disease severity). Materials and methods: This prospective, noninvasive, cross sectional study was conducted at the Emergency department, Respiratory Center, and Respiratory Intensive care Center of University Hospital Dubrava from December 2020. until March 2021. It included patients whose tested posi- tive for Covid 19 and who reported at least one neurological symptom. Patients were examined, and interviewed face to face using a web – based structured questionnaire designed for the purposes of this study. Results: Of the 337 participants, 109 (32,34%) reported one of two possible symptoms associated with sleep disorder, primarily difficulty sleeping/insomnia ( dubbed „sleep disorder“) or sleepiness/ hypersomnia. Of the 337 participants, 61 (18%) reported sleep disorder while 48 (14%) reported hypersomnia. There was no statistically significant difference in prevalence of sleep disorder between men and women (ꭓ2 = 0,113, p = 0,737). Hypersomnia was more prevalent in women (ꭓ2 = 8,125, p = 0,004). Patients who had sleep disorder had a lower median age by 5 years compared to patients who did not have a sleep disorder (z = 2,6, p = 0,009). Patients who had hypersomnia had a median of age lower for 9 years than patients who did not have hypersomnia (z = 4,3, p =

INTRODUCTION: One of the most challenging pursuits in translational and clinical neuroscience is to find reliable criteria for prediction of neurological and cognitive outcome in prematurely born infants using available neuroimaging METHODS, such as magnetic resonance imaging (MRI). Previous studies showed that vulnerability of axonal pathways to hypoxic-ischemic events observed in spatiotemporal context of white matter segments described by Von Monakow could provide us more precise information about nature of perinatal lesions. Finding certain neuroimaging “biomarkers”, especially considering subtle lesions, would help us to design timely appropriate and targeted early intervention during period of optimal neuroplasticity. Patients/METHODS: In order to examine the associations between qualitatively defined visibility (not visible/poor visibility/good visibility) of 2nd white matter segment (sagittal strata and periventricular crossroads C1-C6) on MRI and neurodevelopmental outcome, we performed a prospective longitudinal pilot study in the group of 31 prematurely born infants (median age=28+5 gestational weeks). The infants were MRI scanned shortly after birth and at term-equivalent age, and brain injuries were classified as normal or mild according to standardized MRI scoring system. 48 % infants from our cohort had no evident brain injury, while 52% had mild brain injury at term- equivalent age, according to the scoring mentioned above. The Bayley Scales of Infant and Toddler Development-III (Bayley-III) and Hempel Neurological Assessment were performed at 2nd year of corrected age as a part of clinical follow-up. RESULTS: At 2 years of age, 30% of infants had minor neurological dysfunctions and 16% severe motor impairment according to Hempel assessment. On Bayley-III, 30% of infants had cognitive delay, 31% had language delay and 35% showed deficits in motor skills. As expected, increased severity of brain injury was associated with adverse outcomes on both assessments. In addition, the visibility of frontal and occipital sagittal strata at preterm MRI was positively correlated with better outcome on Bayley-III motor scale. This association was mediated by severity of brain injury. Furthermore, better visibility of periventricular crossroads C2 and C6 and frontal sagittal strata on MRI performed at term- equivalent age correlated with higher scoring points on Bayley-III language scale. CONCLUSIONS: Our findings suggest a role for sagittal strata and periventricular crossroads visibility in perinatal neuroimaging at preterm and term- equivalent age in risk stratification of language and motor skills for extremely premature and very premature infants. White matter segments and their developmental dynamics give us more precise insight in topography of developmental lesions and should definitely be considered as an additional tool in perinatal neuroimaging in prediction of neurodevelopmental risk.

The sphenoid bone development occurs in both prenatal and postnatal periods. Sphenoid bone openings are used as surgical landmarks and are of great importance for neurosurgeons in everyday practice. The aim of this study was to identify morphological characteristics, postnatal development and remodeling, as well as clinical aspect of the sphenoid bone openings and to investigate their relationship and difference in size. The macerated sphenoid bones analyzed in this study were scanned by micro-computed tomography. Areas and distance in-between foramen ovale and foramen rotundum were measured. In addition, different shapes of foramen ovale were described. The most common shape of foramen ovale on both sides was oval, followed by the round, almond and elongated shapes. Modest to strong positive correlations between all foramina and age for the whole sample and both subsamples were presented, except for the right foramen rotundum area in the male subsample, which did not show significant correlation with age. Our study revealed changes in postnatal development and anatomy of foramen ovale and foramen rotundum, primarily in the aspects of size and shape, and should contribute to reducing the risk of damage to neurovascular structures during surgical procedures.