Papers by Vladimira Vuletić
Lijec̆nic̆ki vjesnik, 2008
Acta Clinica Croatica, Mar 1, 2006
Modani udar je vodeaei uzrok smrtnosti i invalidnosti u Slavoniji i Baranji. Cilj istraivanja je ... more Modani udar je vodeaei uzrok smrtnosti i invalidnosti u Slavoniji i Baranji. Cilj istraivanja je bio utvrditi riziène èimbenike te podtipove modanih udara u regiji. U studiju je bilo ukljuèeno 130 oboljelih od modanog udara prosjeène starosne dobi od 67 godina, lijeèenih na neurolokim odjelima u Osijeku i Slavonskom Brodu tijekom 2003. godine. Pri postavljanju dijagnoze modanog udara kompjutorizirana tomografija mozga je uèinjena kod 100%, ekstrakranijska obojena doplerska sonografija krvnih ila kod 44,1%, transkranijska dopler sonografija kod 55,2% te laboratorijska obrada kod svih bolesnika. Bolesnike smo klasificirali na one koji su preboljeli hemoragièni odnosno ishemièni modani udar. U skupini s hemoragiènim modanim udarom izvrili smo podjelu u dvije podskupine, tj. na one koji su preboljeli subarahnoidno krvarenje i one koji su preboljeli intracerebralno krvarenje. Pri klasifikaciji bolesnika s ishemiènim modanim udarom rabili smo klasifikaciju TOAST koja ima 5 podtipova: modani udar velikih krvnih ila, malih krvnih ila, kardioembolièni, ostalih poznatih uzroka, te vie uzroka i/ili nepoznatih uzroka za nastanak modanog udara. Rezultati su pokazali kako je najèeaei èimbenik rizika kod ispitanika bila arterijska hipertenzija (èak 77,69%), te potom kardiomiopatija (46,15%), hiperkolesterolemija (45,28%), tjelesna neaktivnost (39,23%), hipertrigliceredemija (34,62%), debljina (32,31%), puenje (28,46%), te pozitivno obiteljsko naslijeðe i atrijska fibrilacija (svaki po 16,92%). Treba osobito istaknuti kako je èak 50,10% bolesnika imalo 3 i vie èimbenika rizika u anamnezi. Hemoragièni modani udar je preboljelo 17,69% ispitanika, i to subarahnoidno krvare
Uvod: Moždani udar je vodeci uzrok invalidnosti u danasnjem modernom drustvu. Rano lijecenje je b... more Uvod: Moždani udar je vodeci uzrok invalidnosti u danasnjem modernom drustvu. Rano lijecenje je bitno za bolji ucinak danasnje terapije. Ucinkovita trombolitska terapija ovisi o pravovremenom (unutar 3 sata od nastanka simptoma) davanju rekombinantnog tkivnog aktivatora plazminogena (rt-PA) Nas cilj je bio utvrditi da li smo spremni za uvođenje trombolize kod lijecenja akutnog moždanog udara (AMU) u nažoj županiji koja je najduža i najuža u Hrvatskoj. Ispitanici i metode: Gledali smo vrijeme od nastanka simptoma do dolaska u nasu Hitnu ambulantu tako sto smo pregledali povijesti bolesti svih bolesnika primljenih na nas odjel 2006. godine pod slikom AMU. Rađena je i statisticka analiza. Rezultati: Prije je vec nađeno nedovoljno poznavanje simptoma MU kao i rizicnih faktora. Nasli smo visok postotak bolesnika (35%) koji su dosli nakon 24 sata od nastanka smetnji. 15% bolesnika s akutnim ishemijskim MU je doslo unutar 3 sata a samo 4% su zadovoljavali ostale kriterije za primjenu tromb...
Pathogens
Our aim was to determine the frequency and characteristics of neurological post-COVID-19 syndrome... more Our aim was to determine the frequency and characteristics of neurological post-COVID-19 syndrome and the diagnostic and therapeutic measures that were used for the treatment of these patients. Data were collected for 243 patients examined during the period of 11 May 2021 to 22 June 2022. The inclusion criteria were COVID-19 illness and neurological symptoms associated with COVID-19. The exclusion criteria were non-neurological symptoms, patients who did not suffer from COVID-19, and symptoms that occurred after vaccination against the SARS-CoV-2 virus. Data for 227 patients with neurological post-COVID-19 symptoms were analyzed. Most patients presented with multiple symptoms, most often headache, cognitive impairment, loss of smell, paresthesia, fatigue, dizziness, and insomnia. Patients were most often referred for consultative examinations, neuroradiological imaging, and EEG. The therapy was mostly symptomatic. Most patients had no change in their symptoms on follow-up visits (53...
Medicina Fluminensis
Cilj: Prikazati slučaj pacijenta s medikamentozno refrakternim esencijalnim tremorom kod kojega j... more Cilj: Prikazati slučaj pacijenta s medikamentozno refrakternim esencijalnim tremorom kod kojega je duboka mozgovna stimulacija dovela do uspješne kontrole tremora i značajno popravila kvalitetu života unatoč starijoj dobi, izraženoj atrofiji mozga, perioperacijskim i poslijeoperacijskim komplikacijama. Prikaz slučaja: Muškarac u dobi od 72 godine došao je na drugo mišljenje zbog dugogodišnjeg bilateralnog tremora ruku, vođenog kao Parkinsonova bolest, koji mu je onemogućavao svakodnevno funkcioniranje. Fizikalnim i neurološkim pregledom utvrđen je posturalni i akcijski tremor, bez bradikineze i povišenog tonusa. Magnetska rezonancija mozga pokazala je atrofiju, a Dopamin Active Transfer scan i laboratorijske pretrage bili su uredni. Postavljena je dijagnoza esencijalnog tremora. Tijekom dvije godine pacijent je u terapiji uzimao propranolol, klonazepam, primidon te topiramate, što nije pokazalo učinka. Detaljnom evaluacijom multidisciplinarnog tima indicirana je duboka mozgovna stim...
Neurodegenerative diseases - dementias : proceedings of the 2nd Rijeka Forum on Neurodegenerative Diseases held on 17th October 2018 in Rijeka, 2019
Croatian Medical Journal, 2022
AimTo assess the effect of social isolation due to the coronavirus disease 2019 (COVID-19) pandem... more AimTo assess the effect of social isolation due to the coronavirus disease 2019 (COVID-19) pandemic on physical and mental health of Parkinson’s disease patients treated at the University Hospital Center Rijeka.MethodsThis cross-sectional telephone study involved Parkinson’s disease patients who had at least one control examination at University Hospital Center Rijeka in 2020 and were Croatian citizens. A questionnaire was used to obtain data on the socio-demographic characteristics and the severity of motor, anxiety, depression, and non-motor symptoms.ResultsThe final sample included 87 patients. Most patients reported subjective worsening of motor symptoms. Patients who lived alone had worse motor scores than those not living alone. The majority of patients reported worsening of anxiety symptoms. Significant worsening of anxiety symptoms was found in patients who lived alone, had a longer disease duration, and had avoided check-ups. Fewer patients had depression symptoms than motor and anxiety symptoms. Significantly higher Hamilton Depression Rating Scale scores were observed in patients with a longer disease duration. Significant worsening of non-motor symptoms was identified in patients who lived alone, were less educated, had a longer disease duration, and had a higher Charlson comorbidity index.ConclusionPatients who live alone, have longer disease duration, are less educated, avoid check-ups, and have more comorbidities are more vulnerable to the negative effects of social isolation.
Medicina Fluminensis, 2021
Vitamin D nužan je nutrijent potreban za homeostazu kalcija i zdravlje koštanog sustava, no sve s... more Vitamin D nužan je nutrijent potreban za homeostazu kalcija i zdravlje koštanog sustava, no sve se češće potvrđuje njegova uloga u neurološkim bolestima. U središnjem živčanom sustavu prisutni su svi čimbenici metabolizma vitamina D te je djelovanje moguće parakrinim i autokrinim putem. Vitamin D utječe na razine neurotrofnih čimbenika, regulaciju imunološke funkcije te na homeostazu središnjeg živčanog sustava. Manjak vitamina D i njegova nadoknada predmet je istraživanja većine neurodegenerativnih bolesti te je manjak povezan s povećanim rizikom nastanka bolesti. Dosadašnja su istraživanja nadoknađivanja vitamina D obećavajuća, no postoji nedostatak visokokvalitetnih studija za čvrste dokaze i smjernice.
Hrvatska Revija Za Rehabilitacijska Istraživanja, Jan 15, 2014
Rad Hrvatske akademije znanosti i umjetnosti. Medicinske znanosti, 2021
Movement disorders constitute a large group of diseases that affect the control of voluntary moto... more Movement disorders constitute a large group of diseases that affect the control of voluntary motor activity without a direct impact on sensation and strength. Usual clinical course is slow, progressive and can be treated in an outpatient clinic. However, there are several emergencies regarding movement disorders that are serious medical conditions and may result in death if not recognized and treated promptly. Every neurologist should be aware of these states because they can develop during the course of a patient's illness. The aim of this review is to provide key features of the most common emergencies in movement disorders, including drug-induced emergencies, emergencies in Parkinson's disease, chorea and ballismus, tics, myoclonus and dystonia.
Medicina Fluminensis
Vrtoglavica i omaglica jedni su od najčešćih razloga zbog kojih bolesnici traže liječničku pomoć ... more Vrtoglavica i omaglica jedni su od najčešćih razloga zbog kojih bolesnici traže liječničku pomoć te su uzrok otprilike 3,5 % svih posjeta hitnoj medicinskoj službi. Veoma je bitno prepoznati životno ugrožavajuće vrtoglavice, koje zahtijevaju neposredno zbrinjavanje, te ih razlikovati od „benignih“, samolimitirajućih stanja. Upravo stoga bolesnici s akutnom vrtoglavicom često predstavljaju dijagnostički i terapijski izazov nadležnom liječniku. Aktualan pristup bolesniku s akutnom vrtoglavicom ne uzima u obzir samo kvalitetu simptoma, već stavlja naglasak i na vrijeme nastanka tegoba, trajanje, provokacijske čimbenike, prateće simptome i informacije o potencijalnim prijašnjim epizodama. S obzirom na vrijeme trajanja simptoma i provokacijske čimbenike, akutne vrtoglavice možemo svrstati u tri skupine: akutni (jednokratni) vestibularni sindrom, spontani povratni vestibularni sindrom i izazvani povratni vestibularni sindrom. Akutni vestibularni sindrom (AVS) označava iznenadnu pojavu vrt...
Archives of Psychiatry Research
The influence of sex differences in movement disorders is still under-recognized. There are signi... more The influence of sex differences in movement disorders is still under-recognized. There are significant sex differences in the pathophysiology, epidemiology, clinical manifestations, and treatments outcome of many of movement disorders especially Parkinson’s disease. Importance of sex specific differences in invasive treatment outcomes emphasize the importance of their considering when devising patient’s individual management strategies. Increased recognition and future prospective studies specifically addressing sex differences in invasive treatments’ outcomes may help and provide a tailored therapeutic and precision medicine approach to movement disorders. We highlight the most relevant invasive treatment’s effects in advanced movement disorders that differ between men and women. But also, the differences in selection of invasive methods. Increased recognition of sex differences and their impact on treatment of advanced phase of movement disorders, that are very disabling, is very...
Rad Hrvatske akademije znanosti i umjetnosti. Medicinske znanosti
Stroke is one of the major public health problems and it is the leading cause of death in the wor... more Stroke is one of the major public health problems and it is the leading cause of death in the world with around 6.5 million deaths per year. Age-speci c mortality rates increase with age and are higher in men than in women for all age groups, except at the age of 80+ when the mortality rates in women are higher than in men. Women live longer and therefore have a higher lifetime risk of stroke than men. Women have sex-speci c risk factors as well as some unrecognized risks that contribute to poor stroke outcomes. Among the traditional risk factors that have a greater impact on stroke in women are hypertension, atrial brillation and diabetes mellitus. Risk factors unique to women include pregnancy, gestational diabetes, hypertensive disorders of pregnancy, eclampsia and preeclampsia, changes in hormonal status, postmenopausal hormone use and oral contraceptive use. Although in both sexes stroke is most often presented by weakness of one side of the body, face or speech disorders, women may also present with more atypical symptoms of acute stroke compared to men. Women also have a longer delay to treatment, and less frequently receive acute stroke evaluation than men.
Rad Hrvatske akademije znanosti i umjetnosti. Medicinske znanosti
Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions, l... more Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions, leading to abnormal involuntary movements or postures. Although the pathogenesis of dystonia is not entirely understood, lack of intracortical inhibition, aberrant sensory integration and derangement of neural plasticity are known to contribute. Etiologically, dystonia can be idiopathic, acquired or hereditary, most commonly occurring with TOR1A, THAP1, GCH1, and KMT2B mutations. e classi cation of dystonia is based on two main axes: clinical features (Axis I) and etiology (Axis II). When it comes to treatment a variety of therapeutic options are available, including oral medication therapy, intramuscular injections of botulinum neurotoxins (BoNTs), physical and occupational therapy and invasive neurosurgical treatment. Deep brain stimulation (DBS) is an established neurosurgical treatment for medication-refractory dystonia. As more evidence suggests that DBS treatment outcomes may be related to a hereditary basis, genotype determination is an important factor to consider in patient selection and prognostic counselling.
Journal of the Neurological Sciences, 2009
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Papers by Vladimira Vuletić