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McCleery Syndrome Caused by Pectoralis Minor Hypertrophy Treated with Multimodal Physical Therapy—A Case Report
No full textWe present a case of a healthy young male professional water polo player who presented with swelling and pain in the upper arm and elbow after vigorous exercise. Diagnostic workup included an MRI and dynamic duplex ultrasound, which revealed compression of the axillary vein by a hypertrophic pectoralis minor muscle without thrombosis, constituting McCleery syndrome. This is a rare entity within the multiple thoracic outlet syndrome aetiologies. Taking a detailed history and physical examination complemented with diagnostic imaging are vital to the diagnosis. Afterward, the patient was treated with multimodal physical therapy and fully recovered and even exceeded his previous training and play level
RASOPATHIES- RAS/MAP KINASE SIGNAL PATHWAY DISORDERS
No full textRASopatije u svom primarnom značenju jesu poremećaji RAS- MAP kinaznog signalnoga puta. To je put kojim se odvija unutarstanično signaliziranje koje započinje vezanjem liganda za specifični receptor, a nastavlja se nizom kaskadnih reakcija koje u konačnici dovode do promjena u genskom izražaju stanice. Prijenos signala može dovesti do nekog od brojnih ishoda kao što su diferencijacija stanice i usmjeravanje prema specifičnoj staničnoj lozi, proliferacija, izražaj proteina, zastoj staničnog ciklusa i posljedična apoptoza. Zbog genetičkih promjena u određenim segmentima RAS/MAP kinaznog signalnoga puta može doći do fenotipskih manifestacija različitih poremećaja. Klinički entiteti koje obuhvaća pojam RASopatija jesu neurofibromatoza tip I, Noonan sindrom, Legius sindrom, kardiofaciokutani (CFC) sidrom, kapilarne malformacije- arteriovenozni malformacijski sindrom (CM-AVM sindrom) i SYNGAP1 intelektualne teškoće. Sveukupno gledajući, s učestalosti 1:1000, ovo su česte bolesti iako se svaka rijetko pojavljuju u općoj populaciji. Svi ovi poremećaji dijele neke zajedničke, slične karakteristike kao što su: sklonost malignim alternacijama i povećani rizik od nastanka tumora uz koje se veže uz otprilike 30% poremećaja upravo ovog signalnoga puta. Nadalje, poremećaji su karakterizirani kraniofacijalnim dismorfijama koji se s većom ili manjom učestalosti pojavljuju kod svakog pojedinog sindroma. Česti su neurološki deficiti- bilo da se radi o zastoju u neurološkom razvoju ili pak intelektualnim teškoćama koje variraju u težini. Ključno je poznavati genetičku podlogu svake pojedine RASopatije zbog terapijskog pristupa bolesti i djelovanju na specifične komponente signalnoga puta. Danas se u svrhu liječenja RASopatija koriste tri klase lijekova- inhibitori aktivacije RAS-a, izravni inhibitori RAS-a i inhibitori MAPK puta. Efikasnost ovih lijekova još uvijek se ispituje s obzirom na svaku pojedinu bolest koja se ubraja pod entitet RASopatija, a osim specifičnog modaliteta liječenja, istraživanjem je dokazano da je važno i vrijeme primjene lijeka tj. započinjanja terapije kako bi se spriječile ili ublažile pojedine manifestacije kliničke slike nastale zbog poremećaja u signalizaciji.RASopathies in their primary meaning are disorders of the RAS-MAP kinase signaling pathway. It is the path through which intracellular signaling takes place, which begins with the binding of ligands to specific receptors, and continues with a series of cascade reactions that ultimately lead to changes in the cell's gene expression. Signal transduction can lead to any of a number of outcomes such as cell differentiation and targeting to a specific cell lineage, proliferation, protein expression, cell cycle arrest and consequent apoptosis. Due to genetic changes in certain segments of the RAS/MAP kinase signaling pathway, phenotypic manifestations of various disorders can occur. Clinical entities that encompass the term RASopathy are neurofibromatosis type I, Noonan syndrome, Legius syndrome, cardiofasciocutaneous (CFC) syndrome, capillary malformation-arteriovenous malformation syndrome (CM-AVM syndrome) and SYNGAP1 intellectual disability. Overall, with a frequency of 1:1000, these are common diseases, although each one rarely appears in the general population. All these disorders share some common, similar characteristics, such as: a tendency to malignant transformations and an increased risk of tumor formation, which is associated with approximately 30% of disorders of this particular signaling pathway. Furthermore, the disorders are characterized by craniofacial deformities that occur with greater or lesser frequency in each individual syndrome. Neurological deficits are common - whether it is a delay in neurological development or intellectual difficulties that vary in severity. What is crucial is to know the genetic basis of each individual RASopathy because of the therapeutic approach to the disease and the action on specific parts of the signaling pathway. Today, three classes of drugs are used for the treatment of RASopathy - RAS activation inhibitors, direct RAS inhibitors and MAPK pathway inhibitors. The effectiveness of these drugs is still being tested with regard to each individual disease that is included under the RASopathy entity, and in addition to the specific method of treatment, research has proven that the time of drug administration, i.e. starting therapy, is also important in order to prevent or alleviate certain sequelae caused by signaling disturbances
Spinal muscular atrophy: from clinical presentation to gene therapy
No full textSpinalna mišićna atrofija pripada skupini mišićnih bolesti koju karakterizira propadanje motornih neurona leđne moždine. Nasljeđuje se autosomno recesivno, a u otprilike 2% slučajeva nastaje de novo. Bolest je uzrokovana varijantama sekvence SMN1 gena unutar 5q13 regije 5. kromosoma. SMN1 gen je zadužen za produkciju SMN proteina, koji ima ulogu u održavanju alfa-motoneurona u prednjem rogu leđne moždine. Uslijed nedostatka SMN proteina, dolazi do gubitka motoričkih neurona uz posljedičnu denervaciju mišićnih vlakana i pojavu atrofije mišića i mišićne slabosti. Funkcionalni nedostatak SMN1 gena djelomično kompenzira SMN2 gen, a broj njegovih kopija korelira s težinom kliničke slike bolesti. SMA pokazuje značajnu fenotipsku varijabilnost. Klinički je podijeljena u četiri osnovne fenotipske skupine te tip 0 kao najteži oblik bolesti. Podjela se temelji na razlici u broju kopija SMN2 gena, vremenu nastupa znakova i simptoma bolesti te s obzirom na dosegnuti stupanj motoričkog razvoja.
Najbolji uspjeh u liječenju postiže se postavljanjem dijagnoze u presimptomatskoj fazi što je omogućeno novorođenačkim probirom. Molekularno genetičko testiranje predstavlja standard u postavljanju dijagnoze. Liječenje može biti suportivno, a temelj liječenja predstavljaju lijekovi koji mijenjaju prirodni tijek bolesti: nusinersen, risdiplam i onasemnogen abeparvovek. Rano postavljanje dijagnoze i promjena prirodnog tijeka bolesti doveli su do velikog iskoraka u liječenju oboljelih od SMA.Spinal muscular atrophy belongs to a group of muscle diseases characterized by the destruction of the motor neurons of the spinal cord. It is an inherited autosomal recessive disease, and in approximately 2% of cases it occurs de novo. The disease is caused by sequence variants of the SMN1 gene within the 5q13 region of chromosome 5. The SMN1 gene is responsible for the production of the SMN protein, which has a role in maintaining alpha-motoneurons in the anterior horn of the spinal cord. Due to the lack of SMN protein, there is a loss of motor neurons which leads to denervation of muscle fibers and the appearance of muscle weakness and atrophy. The functional deficiency of the SMN1 gene is partially compensated by the SMN2 gene, and the number of its copies correlates with the severity of the clinical presentation of the disease. SMA shows phenotypic variation, and it is classified clinically into four SMA types, with type 0 as the most severe form of the disease. The classification of SMA subtypes is determined by the number of copies of the SMN2 gene, by the age of onset, as well as clinical severity.
Early identification of affected infants prior to the presentation of clinical symptoms has been accomplished by newborn screening. Methods of molecular genetic testing are standard in diagnostic testing. Treatment can be supportive, and the greatest emphasis is on disease-modifying agents: nusinersen, risdiplam and onasemnogen abeparvovec. Early diagnosis and disease-modifying agents have led to a major breakthrough in the treatment of SMA patients
Fractures of the Upper Extremity
No full textPrijelomi gornjeg ekstremiteta spadaju u dosta česte ozljede u općoj populaciji. Najčešći uzorci prijeloma su padovi, sportske ozljede, degenerativni procesi u kostima (osteoporoza) i prometne nesreće. Simptomi uključuju bol, modrice, oticanje i smanjena funkcionalnost zahvaćenog dijela. Dijagnoza se u većini slučajeva postavlja pomoću rendgena. Liječenje se može podijeliti na konzervativno (imobilizacija) i kirurško (razne osteosinteske metode). Neovisno o kakvom je tipu liječenja bila riječ, bolesnik mora u što ranijem vremenskom razdoblju započeti s fizikalnom terapijom kako bi se ozlijeđeni ud vratio u prvobitno stanje. Oporavak je veoma dug i zahtjevan, no uz motiviranost pacijenta i pravilno vođenje u većini slučajeva daje izvrsne rezultate.Fractures of the upper extremity are quite common injuries in the general population. The most common types of fractures are falls, sports injuries, degenerative processes in the bones (osteoporosis) and traffic accidents. Symptoms mostly include pain, bruising, swelling and reduced functionality of the affected limb. In most cases, the diagnosis is made using X-rays. Treatment can be divided into conservative (immnobilization) and surgical (various osteosynthesis methods). Regardless of the treatmennt type, patients must start physical therapy as soon as possible in order to return the injured limb to its original state. Recovery is very long and demanding, but with the adequate motivation and proper management, in most cases the results are excellent
The impact of the COVID-19 pandemic on the treatment of muscle-invasive bladder carcinoma at the Clinical Hospital Center Rijeka
No full textCilj istraživanja: utvrditi u kojoj mjeri je pandemija COVID-19 utjecala na liječenje mišićno – invazivnog karcinoma mokraćnog mjehura u KBC-u Rijeka. Bilo je za očekivati kako će restrikcije u kretanju, strah od zaraze u zdravstvenim ustanovama i preopterećenost zdravstvenog sustava rezultirati odgodom traženja medicinske pomoći.
Ispitanici i metode: podaci su prikupljeni preko Bolničkog informacijskog sustava (BIS), pregledom patohistoloških nalaza pacijenata nakon radikalne cistektomije u 2018. i 2021. godini, na Klinici za urologiju i Kliničkom zavodu za patologiju i citologiju KBC-a Rijeka.
Rezultati: nije dobivena statistički značajna razlika u spolnoj (p=0.07) i dobnoj strukturi (p=0.126) niti u lokalizaciji i veličini tumora. Također, nema statistički značajne razlike u broju TURBT-a po mjesecima (p=0.423) kao ni u usporedi T1 i T2 stadija uzoraka dobivenih TURBT-om. Među raspodjelom broja cistektomija po mjesecima nema statistički značajne razlike (p=0.171). Prema Mann Whitney testu postoji značajna razlika u prosječnom broju dana, odnosno distribuciji, između TURBT-a i cistektomije u 2018. i 2021. godini (p=0.0123). Provedenom statističkom analizom utvrđeno je da nema statistički značajne razlike u PHD (T)-u za 2018. i 2021. (p=0.740), a ni raspodjela pacijenata obzirom na PHD (N) nije statistički značajna (p=0.299).
Zaključci: pandemija je značajno utjecala samo na broj dana između TURBT-a i radikalne cistektomije, dok na samu konačnu dijagnozu nije.Diploma thesis title: to determine the extent to which the COVID-19 pandemic has impacted the treatment of muscle-invasive bladder cancer at the Clinical Hospital Center Rijeka. It was anticipated that movement restrictions, fear of infection in healthcare facilities, and healthcare system overload would result in delays in seeking medical assistance.
Participants and Methods: data were collected through the Hospital Information System (HIS), reviewing the pathological findings of patients undergoing radical cystectomy in 2018 and 2021 at the Clinic for Urology and the Clinical Department for Pathology and Cytology of the Clinical Hospital Center Rijeka.
Results: there was no statistically significant difference in the gender (p=0.07) and age structure (p=0.126), nor in tumor localization and size. Additionally, there was no statistically significant difference in the number of TURBT procedures per month (p=0.423) or in the comparison of T1 and T2 stage samples obtained by TURBT. There was no statistically significant difference in the distribution of the number of cystectomies per month (p=0.171). According to the Mann-Whitney test, there was a significant difference in the average number of days between TURBT and cystectomy in 2018 and 2021 (p=0.0123). Statistical analysis revealed no significant difference in definitive pathology (T) between 2018 and 2021 (p=0.740), and the distribution of patients based on definitive pathology (N) was also not statistically significant (p=0.299).
Conclusions: the pandemic significantly affected only the number of days between TURBT and radical cystectomy, but not the final diagnosis itself
Emergencies in pediatric endocrinology
No full textPedijatrijska endokrina hitna stanja su akutna, po život opasna stanja koja zahtijevaju hitnu medicinsku pomoć. U ovom radu opisana je DKA, tiroidna oluja i adrenalna kriza. Prepoznavanje njihove kliničke slike, razumijevanje temeljnih patofizioloških mehanizama i liječenja ključno je za poboljšanje ishoda bolesnika. DKA teška je komplikacija šećerne bolesti, prvenstveno ŠB1, koju karakteriziraju hiperglikemija, ketoza i metabolička acidoza. Prezentira se simptomima poput poliurije, polidipsije, bolovima u trbuhu, povraćanjem, dehidracijom, promijenjenim mentalnim statusom te kliničkim znakovima kao što su tahikardija, Kussmaulovo disanje i zadah mirisa acetona. Nedostatak inzulina, koji pokreće patofiziologiju DKA, dovodi do hiperglikemije , razgradnje masti, stvaranja ketona i acidoze. Glavne terapijske mjere kod liječenja DKA su rehidracija, terapija inzulinom te nadoknada elektrolita, poglavito kalija. Tiroidna oluja je rijetka i opasna egzacerbacija hipertireoze, a prezentira se hipertermijom, groznicom, tahikardijom, hipertenzijom, agitacijom, delirijem, proljevom i povraćanjem. Prekomjerne razine hormona štitnjače dovode do povećane brzine metabolizma i adrenergičke aktivnosti, a precipitirajući čimbenici uključuju infekciju, operaciju ili prekid uzimanja antitireoidnih lijekova. U liječenju se koriste beta-blokatori za kontrolu adrenergičkih simptoma te antitiroidni lijekovi. Suportivne mjere uključuju nadoknadu tekućine, antipirezu i liječenje precipitirajućih uzroka. Adrenalna kriza je akutna insuficijencija hormona nadbubrežne žlijezde. Od simptoma i znakova prevladavaju slabost, bol u trbuhu, mučnina, povraćanje, hipotenzija, hipoglikemija, smetenost, dehidracija i hiperpigmentacija (kod kronične adrenalne insuficijencije). Okidači mogu uključivati infekciju, traumu ili iznenadni prekid terapije kortikosteroidima. Hitna primjena intravenskog hidrokortizona te nadoknada tekućine i elektrolita temeljni su terapijski koraci.Pediatric endocrine emergencies are acute, life-threatening conditions that require immediate medical attention. This master's thesis describes DKA, thyroid storm and adrenal crisis. Recognizing their clinical manifestation, understanding the underlying pathophysiological mechanisms and treatment is essential to improve patient outcomes. DKA is a severe complication of diabetes, primarily DMI, characterized by hyperglycemia, ketosis, and metabolic acidosis. It presents with symptoms such as polyuria, polydipsia, abdominal pain, vomiting, dehydration, altered mental status, and clinical signs such as tachycardia, Kussmaul breathing, and acetone-smelling breath. Insulin deficiency, which triggers the pathophysiology of DKA, leads to hyperglycemia, fat breakdown, ketone formation, and acidosis. The main therapeutic measures in the treatment of DKA are rehydration, insulin therapy and replacement of electrolytes, especially potassium. Thyroid storm is a rare and dangerous exacerbation of hyperthyroidism, and is presented by hyperthermia, fever, tachycardia, hypertension, agitation, delirium, diarrhea and vomiting. Excessive thyroid hormone levels lead to increased metabolic rate and adrenergic activity, and precipitating factors include infection, surgery, or discontinuation of antithyroid medication. In treatment, beta-blockers are used to control adrenergic symptoms along with antithyroid drugs. Supportive measures include fluid replacement, antipyresis and treatment of precipitating causes. Adrenal crisis is an acute adrenal insufficiency. The most common symptoms and signs are weakness, abdominal pain, nausea, vomiting, hypotension, hypoglycemia, confusion, dehydration and hyperpigmentation (in chronic adrenal insufficiency). Triggers may include infection, trauma, or sudden discontinuation of corticosteroid therapy. Immediate administration of intravenous hydrocortisone and replacement of fluids and electrolytes are fundamental therapeutic steps
ABDOMINAL AORTIC ANEURYSM
No full textGlobally, abdominal aortic aneurysms (AAA) pose a significant health threat, with mortality rates among affected individuals surpassing those of the general population. Thus, early identification and intervention are essential for the effective therapy of these patients. AAA arises from aortic wall degeneration, resulting in irreversible dilation, exceeding normal diameter by over 50%. Predominantly affecting males, its occurrence ranges from 4 to 8 percent, with smoking as a key factor. AAA is multifactorial in origin, with genetic predisposition, advancing age, gender, smoking, and ethnicity. The pathogenesis of infrarenal aortic aneurysms involves factors such as tissue susceptibility, inflammation, and irreversible breakdown of ECM via proteolysis and apoptosis of VSCM in the aorta. Clinical presentation varies from asymptomatic to symptomatic, guiding treatment pathways. The gold standard diagnostic tools include ultrasound and CTA. Treatments encompass conservative measures, pharmacological intervention, and invasive options like endovascular repair (EVAR) or open surgery. Post-EVAR complications are characteristically endoleaks and stent migration, while groin hematoma, infection, dissection, pseudoaneurysm formation, bowel and spinal cord ischemia along with renal artery occlusion and limb thrombosis are additional possibilities. Specific complications of open surgery include wound complications, incisional hernia, and end-organ ischemia. In the case of ruptured AAA (rAAA), prompt assessment of hemodynamic stability and anatomical suitability is crucial for determining the optimal surgical approach. An emphasis on anatomical suitability guides the choice of surgical method. Overall, understanding the complexities of AAA management and promptly preventing the rupture of the aneurysm is critical for optimal patient outcomes
Biological therapy of psoriasis
No full textPsorijaza je upalna multifaktorijalna bolest kronične prirode koja može biti klinički heterogena. U preko 80 % pacijenata bolest se prezentira kao plak psorijaza, međutim može biti i kapljičasta, eritrodermijska, pustularna i artropatska. Psorijaza je obilježena opsežnom upalom, proliferacijom i poremećenom diferencijacijom epidermisa. Psorijatični plakovi se obično nalaze na vlasištu, donjem dijelu trupa i ekstenzornoj površini ekstremiteta, a obilježava ih dobra ograničenost, simetrična pojava, eritem, infiltracija i ljuskanje. U procjeni težine bolesti najčešće se koriste sustavi bodovanja BSA, PASI i DLQI. Dijagnoza se uobičajeno postavlja detaljnom anamnezom i fizikalnim pregledom, a iznimno i biopsijom. U pacijenata je potrebno utvrditi prisutnost komorbiditeta, a u nekim slučajevima razmišljati i o diferencijalnoj dijagnozi psorijaze. Tradicionalno se patogeneza psorijaze opisuje kroz fazu inicijacije i fazu održavanja bolesti. Već su 80-te i 90-te godine prošlog stoljeća donijele spoznaju o psorijazi kao imunosno posredovanoj bolesti, iz čega je uskoro proizašao razvoj biološke terapije. Biološka terapija psorijaze donijela je značajne pomake u terapiji umjereno teške do teške plak psorijaze. Danas se u terapiji psorijaze koriste lijekovi iz skupina inhibitore TNF-α, inhibitora IL-17, inhibitora IL-23, inhibitora IL-12 i -23 te inhibitora IL-36, dok se aktualno ispituju i novi lijekovi.Psoriasis is a chronic inflammatory multifactorial disease that can be clinically heterogeneous. In over 80 % of patients, the disease is presented as plaque psoriasis, but it can also be guttate, erythrodermic, pustular and arthropathic. Psoriasis is characterized by extensive inflammation, proliferation and impaired differentiation of the epidermis. Psoriatic plaques are usually found on the scalp, lower trunk, and extensor surfaces of the extremities. They are characterized by well-defined, symmetrical appearance, erythema, infiltration, and scaling. BSA, PASI and DLQI scoring systems are most often used to assess the severity of the disease. The diagnosis is usually established by a detailed history and physical examination, and exceptionally by a biopsy. In patients, it is necessary to determine the presence of comorbidities and, in some cases, to think about the differential diagnosis of psoriasis. Traditionally, the pathogenesis of psoriasis is described through the initiation and maintenance phases of the disease. Already in the 80s and 90s of the last century, psoriasis was already recognized as an immune-mediated disease, which soon led to the development of biological therapy. Biological therapy for psoriasis has brought significant advances in treating moderately severe to severe plaque psoriasis. Today, drugs from the group of TNF-α inhibitors, IL-17 inhibitors, IL-23 inhibitors, IL-12 and -23 inhibitors, and IL-36 inhibitors are used in psoriasis therapy, while new drugs are currently being tested
Clinical characteristics, diagnostics and treatment of cervical artery dissections
No full textUvod: Disekcija krvnih žila vrata karakterizirana je naglim istezanjem, edemom te razdorom
stijenke arterije i pojavom krvarenja unutar stijenke arterije što može rezltirati infarktom
mozga. Uobičajena pojavnost je u mlađoj i populaciji srednjih godina s vrhom incidencije 50-
ih godina. Lokalizacije disekcije najčešće su u području najveće mobilnosti.
Svrha rada: Cilj istraživanja 23 pacijenta zahvaćenih disekcijom krvnih žila vrata jest spoznati
učestalost pojave nastalih disekcija, uzroke i predisponirajuće faktore. Opisati najčešću
simptomatologiju, pojavu infarkta mozga, provedenu dijagnostiku te način liječenja. Rezultati
su se usporedili s drugim provednim istraživanjima.
Ispitanici i metode: Istraživanje se odnosilo na analizu 23 pacijenta disekcije krvnih žila vrata
u trogodišnjem razdoblju od 1.1.2021. do 31.12.2023. na Klinici za neurologiju Kliničkog
bolničkog centra Rijeka. 13 pacijenata imalo je disekciju vertebralne arterije, a 10 pacijenata
disekciju karotidne arterije vrata.
Rezultati: S obzirom na dob i spol učestalost disekcija češća je u muškog spola (78,26%).
Prosječna starosna dob svih pacijenata zahvaćenih disekcijom iznosi 59 godina i 2 mjeseca.
Ukupno gledajući, 20 pacijenata od ukupno 23 imalo je spontani nastanak disekcije (86,96%),
a 3 pacijenta traumatsku podlogu nastanka (13,04%). Jedanaest pacijenata s disekcijom
vertebralne arterije rezultiralo je infarktom mozga, a 8 pacijenta s disekcijom karotidne arterije,
pri čemu je jedan pacijent preminuo. Vodeći simptomi disekcije vertebralne arterije su
vrtoglavica priustna u 5 pacijenata (38,46%) i hemipareza u 5 (38,46%). Pacijenti s disekcijom
karotidne arterije također pokazuju prevalenciju hemipareze prisutnu u 5 pacijenata (50%).
Najčešće korištena dijagnostička metoda je CTA. Kod disekcije vertebralne arterije korištena
je u 12 pacijenata (92,30%), a kod disekcije karotidne arterije u 9 pacijenata (90%). Analizom
pacijenata disekcije vertebralne arterije antiagregacijski lijekovi (84,61%) prednjače u malom
postotku u odnosu na antikoagulacijsku terapiju (76,92%). Svim pacijentima s disekcijom
karotidne arterije primijenjena je kombinirana antikoagulacijska i antiagregacijska terapija
(100%).
Zaključak: Istraživanje obuhvaća 23 pacijenta s disekcijom krvnih žila vrata. Prevalencija
disekcija odnosi se na muški spol (78,26%). 20 pacijenata je imalo spontani nastanak disekcije
(86,96%). 11 pacijenata imalo je hipertenziju kao vodeći čimbenik rizika (47,83%). Vodeća
simptomatologija obje skupine pacijenata je hemipareza, 5 pacijenata (38,46%) skupine
disekcija vertebralne arterije i 5 pacijenata disekcije unutarnje karotidne arterije (50%). Osim
hemipareze, pacijenti s disekcijom vertebralne arterije imaju vrtoglavicu kao vodeći simptom s
jednakom učestalošću (38,46%). 19 pacijenata rezultiralo razvojem infarkta (82,61%), a jedan
pacijent iz skupine disekcija unutarnje karotidne arterije je preminuo (4,35%). Dijagnostika
CTA korištena je u 21 pacijenta (91,30%), a MRA druga je po zastupljenosti primijenjena u 10
pacijenata (43,48%). Liječenje obje skupine disekcija većinom je provedeno sukladno
smjernicama dvojnom antiagregacijskom terapijom koja je slijedila kombinacije
antikoagulacijskih i antiagregacijskih lijekova uz dvoje bolesnika u kojih je prethodno učinjena
mehanička trombektomija sukladno smjernicama za liječenje moždanog udara.Introduction: Dissection is characterized by the rupture of the first layer in contact with the
blood and the entry of blood between the layers of the artery wall, visible in the form of a
hematoma. In most cases, it results in brain infarction. The usual occurrence is in the younger
and middle-aged population with the peak incidence in the 50s. Localization of dissections are
most common in the area of greatest mobility.
Purpose: The aim of the study of 23 patients affected by dissection of blood vessels in the neck
is to find out the frequency of occurrence of dissections and their previous causes. Describe the
most common symptomatology, occurrence of brain infarction, performed diagnostics and
method of treatment. The results were compared with other conducted researches.
Subjects and methods: The research referred to the analysis of 23 patients with dissection of
blood vessels of the neck in a three-year period from January 1, 2021. until 31.12.2023. at the
Neurology Clinic of the Rijeka Clinical Hospital Center. 13 patients had dissection of the
vertebral artery, and 10 patients had dissection of the carotid artery of the neck.
Results: With regard to age and sex, the frequency of dissections is more common in men
(78.26%). The average age of all patients affected by dissection is 59 years and 2 months.
Overall, 20 patients out of a total of 23 had a spontaneous onset of dissection (86.96%), and 3
patients had a traumatic origin (13.04%). 11 patients with vertebral artery dissection resulted in
brain infarction. 8 patients with carotid artery dissection resulted in brain infarction, with one
patient dying. The leading symptoms of vertebral artery dissections are dizziness (38.46%) and
unilateral weakness (38.46%), the carotid artery also shows unilateral weakness (50%) as
leading. The most frequently used diagnostic method is CTA. In vertebral artery dissection, it
was used in 12 patients (92.30%), and in carotid artery dissection in 9 patients (90%). Analyzing
patients with vertebral artery dissection, antiplatelet drugs (84.61%) lead in a small percentage
compared to anticoagulation therapy (76.92%). All patients with carotid artery dissection
received anticoagulation and antiplatelet therapy (100%).
Conclusion: The research includes 23 patients with dissection of blood vessels of the neck. The
prevalence of dissections refers to the male gender (78.26%). 20 patients had spontaneous onset
of dissection (86.96%). 11 patients had hypertension as the leading risk factor (47.83%). The
leading symptomatology of both groups of patients is hemiparesis, 5 patients (38.46%) of the
vertebral artery dissection group and 5 patients of internal carotid carotid artery dissection
(50%). In addition to hemiparesis, patients with vertebral artery dissection have dizziness as the
leading symptom with equal frequency (38.46%). 19 patients resulted in the development of a
heart attack (82.61%), and one patient from the internal carotid artery dissection group died
(4.35%). Diagnostic CTA was used in 21 patients (91.30%), and MRA was the second most
frequently used in 10 patients (43.48%). The treatment of both groups of dissections mostly
focused on the use of a common combination of anticoagulation and antiplatelet drugs, of which
a small number of patients were previously exposed to the mechanical thrombectomy
procedure
