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Cerebellar mutism
Full text linkMed možganskimi tumorji so tumorji zadnje lobanjske kotanje najpogostejši možganski tumorji pri otrocih. Izbira zdravlje-nja je odvisna od mesta in načina rasti tumorja ter s tem povezane možnosti odstranitve z operacijo, od vrste in razširje-nosti tumorja in od otrokove starosti. Z operacijo skuša kirurg odstraniti celoten ali čim večji del tumorja, kar pa vedno ni izvedljivo, saj bi odstranitev lahko povzročila nesprejemljivo nevrološko okvaro. Najpogostejši zaplet po operaciji tumorja zadnje lobanjske kotanje je sindrom cerebelarnega mutizma. S predstavitvijo obravnave predšolske deklice, ki se je na Pediatrični kliniki v Ljubljani zdravila zaradi meduloblastoma in je po operaciji utrpela sindrom cerebelarnega mutizma, želimo poudariti pomen zgodnje in kontinuirane timske rehabilitacije za optimalno okrevanje. Članek zapolnjuje vrzel v slovenski in tudi mednarodni strokovni literaturi na področju rehabilitacije po nastanku cerebelarnega mutizm
Post-carotid artery stenting hyperperfusion syndrome in a hypotensive patient
Full text linkCerebral hyperperfusion syndrome (CHS) is a serious post-procedural complication of carotid artery stenting (CAS). The pathophysiological mechanisms of CHS in the absence of arterial hypertension (AH) remain only partially understood. We performed a systematic literature search of the PubMed database using the terms »cerebral hyperperfusion syndrome«, »hypotension«, »hyperperfusion«, »stroke«, »intracranial hemorrhages«, »risk factors«, »carotid revascularization«, »carotid stenting«, »carotid endarterectomy«, »blood-brain barrier«, »endothelium«, »contrast encephalopathy«, and combinations. We present a case of a normotensive female patient who developed CHS post-CAS for symptomatic carotid stenosis while being hypotensive with complete recovery. We identified 393 papers, among which 65 were deemed relevant to the topic. The weighted average prevalence of CHS after CAS is 1.2% [0.0–37.7%] with that of intracranial hemorrhage (ICH) being 0.51% [0–9.3%]. Recently symptomatic carotid stenosis or contralateral carotid revascularization, urgent intervention, acute carotid occlusion, contralateral ≥70% stenosis, and the presence of leptomeningeal collaterals were associated with CHS. A prolonged hemodynamic instability after CAS conveys a higher risk for CHS. However, none of the articles mentioned isolated hypotension as a risk factor for CHS. Whereas mortality after ICH post-CAS ranges from 40 to 75%, in the absence of ICH, CHS generally carries a good prognosis. AH is not obligatory in CHS development. Even though impaired cerebral autoregulation and post-revascularization changes in cerebral hemodynamics seem to play a pivotal role in CHS pathophysiology, our case highlights the complexity of CHS, involving factors like endothelial dysfunction and sudden reperfusion. Further research is needed to refine diagnostic and management approaches for this condition
Helicobacter pylori infection in children Versus adults, differences in management guidelines: risks and benefits of treatment in childhood
Full text linkHelicobacter pylori infection in children and adults differs in several aspects such as the natural history, prevalence, the clinical presentations and complications, antibiotic resistance rates, treatment options, and the success rates of treatment. Due to all the abovementioned differences, management guidelines and recommendations are different between children and adults. In parallel to the steady decrease in the rate of H. pylori infection in the Western world in recent years, both in children and adults, antibiotic resistance rates have risen to alarming rates. The risk and benefits of eradication treatment, especially in children, must be considered when deciding “to treat or not.” The risks include the negative effects of antibiotics, treatment failure, and reinfection as well as the possibility of losing the “protective effect” of H. pylori on atopy, allergy, and possibly on other gastrointestinal diseases. On the other hand, there are also many benefits of eradication therapy such as prevention of gastric complication and associated non-gastric complications as well as reduction of parental anxiety of nontreatment. This review summarizes the differences related to H. pylori in children versus adults and the risks and benefits of treatment in children
Lower extremity arterial disease perspective
Full text linkAtherosclerotic cardiovascular disease (ASCVD) is defined as coronary heart disease (CHD), cerebrovascular disease, or lower extremity arterial disease (LEAD) also named peripheral arterial disease (PAD). ASCVD is considered to be of atherosclerotic origin and is the leading cause of morbidity and mortality mainly for individuals with diabetes mellitus (DM). In this consensus document of the International Union of Angiology the authors discuss epidemiology, risk factors, primary and secondary prophylaxis, the correlation between diabetes mellitus and LEAD, conservative and surgical treatment
