Current treatment of Acute Ischemic Stroke in Vojvodina

Introduction: Vertigo represents illusion or hallucination of movement caused by disturbance of perception of own movements or movements of observed object. It is caused by dysfunction of the inner ear vestibular apparatus (peripheral vertigo) or parts of central nervous system (central vertigo). Making distinction between these two types is very important for the making of rational decision by emergency medicine physician. Case report I: Female, 69 years of age is referred to neurologist in Emergency Center for attacks of acute onset rotatory vertigo, horizontal nystagmus and severe autonomic disturbances provoked by movement. Anamnesis, clinical, neuroultrasound examinations and CT scan showed no signs of acute neurologic disease. Treatment of peripheral type vertigo with vasodilators was indicated and further continued with otolaryngologist follow up. Case report II: Male, 72 years of age was treated on Clinic of Neurology for infarction of left cerebellar hemisphere. Symptoms at onset were vertigo, headache, diplopia, nausea and vomiting. Neurological examination revealed right sided horizontalrotatory nystagmus with fine vertical nystagmus, astasia/abasia and right sided hemiparesis. Treatment included thrombolytic, antithrombotic and anticoagulant therapy, as well as established vascular risk treatment. Conclusion: Role of emergency physician in establishing of etiology of vertigo at the place of onset is very important. Detailed anamnesis about onset of symptoms and their duration, clinical examination, diagnostic (ABCD2) score, and therapeutic repositioning (Epley) maneuver ensure fast triage and shorter transport delays if necessary.

Section: Prikaz Slučaja/case Reportunclassified

Differential diagnosis of vertigo: Case reports

Lučić-Prokin,

Popović,

Petrović

et al. 2023

“…Skew devijacija je vrlo specifičan znak centralne lezije (95-100%), ali se pojavljuje u samo u 40%. Čini se da je sledeći trijas: normalni HIT, nistagmus koji menja smer i skew devijacija, osetljiviji od MRI mozga u ranoj detekciji akutnog MU, u prvih 24-48 sati [18,19]. Packendorf i sar.…”

Section: Ménièr-ova Bolestunclassified

Differential diagnosis of vertigo

Lučić-Prokin

2022

Introduction: Although vertigo is most often of benign etiology and in most cases it is not necessary to have an emergency transport to the health facilities, there is still a huge burden on Emergency Medical Services (EMS). Vertigo can be caused by lesion or dysfunction in vestibular apparatus of the inner ear - peripheral vertigo, while changes in upper parts of the vestibular system define central vertigo. Usually, the description of vertigo complaints is unclear, so recognising central vertigo is a bit difficult, which can have fatal consequences. Distinguishing between the types of vertigo has a significant contribution to the EMS physician's decision-making. Consequently, the management of underlying condition causing central vertigo requires expedited approach by an interprofessional team including the emergency medicine team, the radiologists, the neurologist, and very often the interventional neuroradiologists. Objectives: By presenting the most common differential diagnostic vertiginous entities, the factors will be determined which can help EMS physicians to make the appropriate decision. Methodology: A systematic review of the professional literature was performed in the index databases and leading scientific journals. The findings were systematized based and commented on results and in the discussion. Results: The most common causes of peripheral vertigo are benign paroxysmal positional vertigo, acute vestibular neuronitis/labyrinthitis, Ménière's disease. Cerebrovascular diseases form the largest group of centrally caused vertigo. Using some of the simple diagnostic tests can be helpful in the differential diagnosis of vertigo (Dix-Hallpike maneuver, head-impulse test, ABCD2 score). Conclusion: Detailed anamnesis with data on duration and circumstances under which vertigo occurs, clinical examination and additional diagnostic tests ensure a rapid triage procedure and faster transport times to appropriate specialized institutions (if necessary).

“…U slučaju LVO, najčešće su u pitanju intrakranijalni terminalni deo unutrašnje karotidne arterije (ACI-T), proksimalni segment srednje moždane arterije (ACM-1), prednje moždane arterije (ACA), bazilarne arterije (AB) i zadnje moždane arterije (ACP) [6,9]. U upotrebi je nekoliko skala usmerenih ka prepoznavanju bolesnika sa LVO u prehospitalnim uslovima [13][14][15][16][17][18].…”

Section: Rezultatiunclassified

“…Large vessel occlusion, LVO) [5][6][7]. Intravenska trombolitička terapija danas predstavlja standardni pristup u svih bolesnika sa AIMU unutar prvih 4,5 sata od pojave simptoma [8][9][10][11][12]. Prošireni vremenski prozor unutar šest sati ili čak i duži, unutar šest do 16 sati ili šest do 24 sata za selektovane bolesnike, od poslednjeg poznatog normalnog stanja bolesnika, omogućava uspešnost endovaskularne MT u 70%-85%.…”

Section: Uvodunclassified

The significance of the RACE (Rapid Arterial Occlusion Evaluation) scale in acute ischemic stroke

Lučić-Prokin¹,

Petrović²,

Popović³

2019

Značaj RACE (Rapid Arterial Occlusion Evaluation) skale u akutnom ishemijskom moždanom udaruSažetak Uvod: Endovaskularna mehanička trombektomija sa ili bez intravenske trombolitičke terapije, značajno smanjuje invalidnost u bolesnika sa akutnim ishemijskim moždanim udarom (AIMU) i okluzijom velikog krvnog suda (LVO) u prvih 6 sati. Korist od ovih terapijskih modaliteta postaje značajno manja sa produžavanjem vremena od pojave prvih simptoma do terapijske primene. Identifikacija bolesnika sa AIMU i LVO na prehospitalnom nivou, presudna je za brži transport u odgovarajuće zdravstvene centre osposobljene za endovaskularno lečenje.Cilj rada: Ukazati na prednosti i pogodnosti primene RACE skale u prepoznavanju bolesnika sa AIMU i LVO u prehospitalnim uslovima.Metod rada: Izvršen je sistematski pregled stručne literature dostupne u indeksnim bazama i vodećim naučnim časopisima. Nalazi su sistematizovani kroz rezultate i komentarisani u diskusiji.Rezultati: Neurološki zlatni standard za procenu težine AIMU predstavlja NIHSS skala (National Institutes of Health Stroke Scale). Zbog svoje složenosti i dugotrajnog izvođenja u prehospitalnim uslovima, postoji njena modifikovana verzija -RACE (Rapid Arterial Occlusion Evaluation) skala; RACE skala predstavlja jednostavan i praktičan skrining test u predviđanju LVO, procenjujući 5 varijabli iz NIHSS skale: motorne ali i kortikalne funkcije mozga.Zaključak: Sa visokom senzitivnošću i nešto manjom specifičnošću, RACE skala može biti skoro idealan prehospitalni test u predikciji LVO. U našem okruženju, RACE skala bi trebalo da postane sastavni deo prehospitalnog algoritma i spona između lekara Hitne meicinske pomoći (HMP) i vaskularnih neurologa.