Terson's syndrome is commonly seen in patients with aneurysmal subarachnoid hemorrhage, leading to varying degrees of intraocular hemorrhage. Although in many cases the course of the disease is benign and may resolve without the need for surgical intervention, some patients may experience complications that necessitate surgery. Early confirmation of the diagnosis and appropriate intervention are crucial to avoiding complications and improving the quality of life.The gold standard for diagnosis is fundoscopy. However, since patients with subarachnoid hemorrhage are often in intensive care and require constant neurological monitoring, this method is not always feasible. The aim of this study is to present our experience in using ocular ultrasound and computed tomography as diagnostic methods for patients with Terson's syndrome. A retrospective study was conducted on the database for the period from May 2021 to December 2023, including all patients admitted to our clinic with a diagnosis of aneurysmal subarachnoid hemorrhage confirmed by computed tomography (CT), CT angiography, or digital subtraction angiography. We collected data on standard demographic characteristics of the patients, aneurysms, and clinical status. CT and ultrasound examinations of the visual apparatus were performed, and the results were compared with fundoscopy findings. Out of 171 patients examined during the study period, intraocular hemorrhage was detected in 16 (9.4{\%}) of them. The diagnosis was confirmed through ultrasound examination in all these cases. In contrast, changes were observed in 6 (37.5{\%}) out of these 16 patients, using computed tomography. Ocular ultrasound is an effective method for detecting intraocular hemorrhage in patients with Terson's syndrome, both as a primary diagnostic tool and for patients who are not suitable for other methods. Computed tomography should not be overlooked as a diagnostic method and understanding its limitations and appropriate timing for its application must be considered.
Introduction: Ischemic stroke (IS) is a leading cause of mortality and disability worldwide. Although the incidence of stroke has been decreasing in developed countries, there is evidence that the number of stroke cases among young and middle-aged populations is increasing. Inflammatory markers such as C-reactive protein (CRP) and leukocytes play a significant role in the pathophysiology of stroke and may serve as potential predictors of clinical outcomes. Objective: To evaluate the role of CRP and leukocytosis as predictors of mortality in young and middle-aged patients with acute ischemic stroke. Methods: This retrospective study includes 168 patients aged 18 to 59 years with acute IS, hospitalized at University Hospital "St. Marina", Varna, during the period 2017-2022. They were further divided into two groups: the target group, consisting of 67 patients who died during hospitalization, and the control group, comprising 101 patients who survived the acute phase. CRP and leukocyte levels were measured within 24 hours of hospitalization. Logistic regression was used to assess the association between these markers and mortality. Results: Mean levels of CRP and leukocytes were significantly higher in the target group compared to the control group (p<0.001). Logistic regression indicated that elevated CRP levels (coefficient 0.0241, p<0.001) and leukocyte counts (coefficient 0.1075, p=0.014) were significant predictors of mortality in ischemic stroke. The ROC analysis of the model based on these markers showed good prognostic ability (AUC=0.75). Conclusion: This study emphasizes the importance of CRP and leukocyte levels as easily accessible and reliable predictors of mortality in ischemic stroke among young and middle-aged patients.
Introduction: Spinal cord infarction is a rare, but severely disabling disease. It is characterized by sudden disruption of its circulation resulting in insufficient blood flow, respectively of oxygen and glucose to the spinal cord. Aortic dissection is one of the numerous etiological factors leading to spinal vascular damage. Clinical case: A 71-year-old female patient was urgently hospitalized because of a sudden onset of lower flaccid paraplegia. A a spinal stroke with hyperintense T2 signal of the myel & ocy;n was revealed by magnetic resonance imaging (MRI) from the Th9 level to the conus medullaris, mainly of the gray matter and anterior horns. A dissection of the ascending aorta Stanford Type A with wall d delamination to the Adamkiewitz artery and upper lumbar arteries originating from the false lumen was established by CT aortography. The patient underwent emergency cardiac surgery with a vascular prosthesis implanted. Discussion: Aortic dissection is a rare cause of spinal cord infarction but it should be considered in the differential diagnosis of patients with arterial hypertension, acute onset of debilitating neurological symptoms with paraparesis or paraplegia, accompanied or not by back pain. The gold standard for diagnosing a spinal cord infarction is MRI. Early diagnosis and timely treatment - conservative and/or surgical, are crucial in preventing life-threatening conditions and debilitating complications. Conclusion: Spinal cord infarction in aortic dissection though a rare condition should be included in the differential diagnosis of patients with sudden onset paraparesis/ paraplegia. A multidisciplinary approach is necessary to evaluate the most appropriate and timely therapeutic behavior in order to provide adequate diagnosis and therapy.
Aim: To investigate and compare the effects of tissue flossing with assisted stretching massage on the knee dysfunction. Materials and methods: Sixteen patients were studied, divided into two groups: Group A - control (n=8, men/women=5/3) with a mean age of 36 +/- 4.2 years and Group B - experimental (n=8, men/women=4/4) with a mean age of 38 +/- 3.8 years. All patients had impaired knee joint function with varying degrees of pain, limited range of motion and reduced muscle strength. The control group of patients was treated with the generally accepted effective stretching massage, and the experimental group - with the relatively new physiotherapeutic method of tissue flossing, applied to the entire lower limb, and not to one joint, as in previous studies. Before and after treatment, we measured the intensity of pain in the knee joint using a visual analog scale (VAS), the volume of motion (VOM) using knee goniometry, and muscle strength using dynamometry. Results: Both therapy modalities applied to the experimental and control groups showed positive impact on the patient's condition with slightly better results in the experimental group. A significantly better effect in patients treated with tissue flossing was found regarding pain intensity, knee flexion range of motion, and muscle strength. Conclusion: A positive effect on the impaired functionality of the knee joint was established after the application of both physiotherapeutic methods of tissue flossing and stretching massage. Tissue flossing therapy is more effective compared to stretching massage, it has a better effect on the intensity of pain, it increases and normalizes the volume of movement in the joint, increases muscle strength and control more significantly, which is why we recommend its use as a main or additional treatment modality.
The aim of this study was to evaluate the effect of dry needling (DNT) as an adjunctive therapy in reducing pain, improving function, and quality of life in patients with chronic lumbosacral pain. Material and methods: A total of 35 patients with chronic lumbosacral pain (LSP), radiating along the sciatic nerve, and with impaired sensorimotor function were studied, divided into two groups: Group K-control (n=15, 9 men and 6 women) and Group E-experimental (n=20, 11 men and 9 women). All patients were treated with classical therapeutic massage of the lumbosacral region and a complex of physical exercises, and those from Group E additionally by placing dry needles in the most painful muscle trigger points (TP) and along the sciatic nerve. To assess the effect of physiotherapy, all subjects were examined before and after treatment about: pain intensity on a visual analog scale (VAS), range of motion (ROM) by goniometry, and muscle strength in hip flexion and extension by dynamometry, and the overall subjective assessment by the Roland-Morris Disability Questionnaire (RMDQ). Results: All patients improved significantly but those from the experimental group more pronounced regarding: pain intensity by 1.12 points on the VAS; ROM in the hip joint goniometrically by 9.02 degrees in flexion and by 3.5 degrees in extension; and the overall subjective assessment of the therapeutic course by RMDQ; but not significantly for leg muscle strength in hip joint. Conclusion: Both therapeutic approaches reliably reduce pain and improve mobility in patients with chronic lumbosacral pain syndrome, but the additional application of DNT to classical therapeutic massage and physical exercises to increase leg muscle strength significantly enhances the effect of the standard intervention and reliably increases the therapeutic effect by significantly reducing pain symptoms, increasing mobility and functionality of the lower back and limb.
