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1

Health related quality of life of the patients after transient ischaemic attack: is carotid endarterectomy (CEA) or carotid artery stenting (CAS) more influential?

100%

Trystuła M.

Acta Neuropsychologica

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2018

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vol. 16(1)

61-68

EN

Although randomized trials have proven the benefit of revascularization with the use of carotid endarterectomy (CEA) or stenting (CAS) for appropriate patients, health care purchasers increasingly look beyond clinical outcome toward measures of health-related quality of life (HRQoL) in apportioning limited resources. 36 patients after TIA participated in this study. One group (n=18) had undergone CEA, whereas the second group (n=18) had undergone CAS. Both groups were matched according to age and sex. The Short Form 36 (SF-36) was used to assess the differences in patient-perceived HRQoL in two groups of patients who had suffered minor cerebral ischemic events. No significant difference in health profile between the CEA and CAS was detected for the eight SF-36 domains. However, the CEA group rated a significantly improved change in general health after one year compared with the CAS group (p<0.001). A greater proportion of the CEA group comparing to the CAS group thought their treatment had been successful and that their health had been improved (p<0.001). Both groups shared the same level of anxiety over potential future cerebral ischemic events (p=0.3). Patients' perception of HRQoL measured by the SF-36 domains was almost identical between the CEA and CAS apart from a small but significant improvement in self-reported overall health in the CEA group after one year follow up. HRQoL outcome measures may be of value in future clinical trials of cerebral revascularization to compare the effectiveness of carotid revascularization with the particular method of operation.

2

HEALTH-RELATED QUALITY OF LIFE IN A PATIENT FOLLOWING ANEURYSMOTOMY OF RARE MEGA-GIANT ANEURYSM OF THE COMMON CAROTID ARTERY

64%

Pąchalska M., Trystuła M.

Acta Neuropsychologica

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2020

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vol. 18(4)

411-423

EN

In the subject literature there are only a few articles devoted to the Health-Related Quality of Life (HRQoL) of patients with large ex- tracranial aneurysms of the carotid artery segment. There are no reports on the quality of life of patients with rare Mega-Giant Carotid Artery Aneurysms (MGCAA) manifesting themselves as chronically large and growing neck tumors. The aim of the research was an evaluation of the health related quality of life (HRQL) of a patient following aneurysmotomy of Mega-Giant Carotid Artery Aneurysms (MGCAA). An 82-year-old patient was referred to the Department of Vascular Surgery at the John Paul II Hospital in Krakow, due to the presence of a megagiant, painful tumor covering the entire left side of the neck. A physical examination and angio-CT confirmed the pres- ence of a pulsating tumor, which extended vertically from the level of the angle of the mandible to the clavicle, and horizontally from the trachea to the cervical spine. An aneurysmotomy and recon- struction of LICA with cerebral protection using a shunt catheter was performed. The patient was awakened from anesthesia and extubated shortly after the procedure, without any Central Nervous System neurological defects. The surgery was complicated by left recurrent laryngeal nerve paresis and aphonia without dyspnoea, which was only partially resolved around 3 months after the oper- ation itself. The postoperative period was uncomplicated. Health related Quality of Life (HRQoL) was studied using the 36-Item Short Form Health Survey (SF-36) to study both the clinical symp-toms and how these symptoms would be reduced in a year follow up after the aneurysmotomy. Despite the increasing availability of endovascular options and techniques, open surgical repair of ICA aneurysms, especially Mega- Giant Carotid Artery Aneurysms (MGCAA), using cerebral protection (shunts), remains a basic option, providing an opportunity to avoid major intraoperative and postoperative complications. The aneurysmotomy, despite laryngeal nerve paresis and aphonia without dyspnoea, improves the patient’s health-related quality of life.

3

FUNCTIONAL NEUROMARKERS OF POST-TRAUMATIC STRESS DISORDER (PTSD) IN A MAJOR ISCHEMIC STROKE SURVIVOR AFTER CAROTID ENDARTERECTOMY (CEA) REVASCULARIZATION

51%

Trystuła M., Góral-Półrola J., Kropotov J. D., Pąchalska M.

Acta Neuropsychologica

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2018

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vol. 16(4)

417-429

EN

The aim of this study was to test the hypothesis of developing Post-Traumatic Stress Disorder (PTSD) in a major right-hemisphere ischemic brain stroke survivor half a year after CEA revascularization, with the use of Event Related Potentials (ERPs). He was in a serious condition and had limited consciousness. Therefore, the doctor informed the patient's wife about the possibility of sudden death. The patient heard this information and remembered it, which was one of the main causes of the development of PTSD. On the basis of previous research amplitudes of P3 ERP, components elicited in the cued GO/NOGO tasks have been chosen as the candidate for PTSD neuromarkers . A 44-year-old patient had a major ischemic brain stroke while sizeable atherosclerotic plaque causing critical stenosis of the internal carotid artery in Angio-CT was dioscovered. The patient was urgently operated on using CEA. After the operation he had the opportunity to see the removed plaque which had been the cause of his stroke. Despite the positive postoperative recovery, half a year later, the patient began to complain of flashbacks, anxiety, trouble in falling and staying asleep, difficulty in concentration, a loss of interest. For the diagnosis of PTSD we used Checklist Specific for a stressor (PCL-S). Additionally we used Checklist according to the Diagnostic Statistical Manual-5 (DSM-5) classification, and the patient met the PTSD criteria. The cognitive profile of the patient was measured with the use of the Wechsler Memory Test – III (WMS-III). Subsequently, the patient participated in the cued GO/NOGO task (Kropotov, 2009) with a recording 19-channel EEG. The P3 GO and NOGO waves in this task were found to be significantly smaller at p<0.01 in comparison to a group of healthy control subjects of the same age (N=23) taken from the Human Brain Institute (HBI) normative database (https://www.hbimed.com/). The pattern of this neuromarker in our patient corresponds to the ERPs pattern found in PTSD patients. The ERPs in a GO/NOGO task can be used in the assessment of the functional brain changes induced by chronic PTSD.

4

Quality of life of a patient with persistent complications after SARS-CoV-2 infection requiring urgent surgical intervention – endarterectomy with emergency angioplasty of an inflamed, bleeding Right Internal Carotid Artery (RICA) using the Trans-Carotid Artery Revascularization (TCAR)

51%

Hydzik A., Opławski M., Trystuła M., Pąchalska M.

Acta Neuropsychologica

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2023

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vol. 21(3)

259-278

EN

SUMMARY The purpose of this study was to determine the quality of life of a patient with persistent complications of SARS-CoV-2 infection requiring urgens surgical intervention – endarterectomy with emergency angioplasty of an inflamed, bleeding Right Internal Carotid Artery (RICA) by direct access via Right Common Carotid Artery (RCCA), known as Transcarotid Artery Revascularization (TCAR). A patient in her 60s was infected with the SARS-CoV-2 virus and contracted COVID-19 in March 2022, as confirmed by RT PCR antigen test. The infection was followed by short- and long-term complications, many of which can be linked to COVID. These include significant weakness persisting for months after the illness, rapid weight loss of 25 kg, sleep disturbances, chronic fatigue, severe dizziness, onset of diabetes, decrease dimmunity with increased periodontal inflammation (including formation of a periapical abscess of a molar tooth) and secondary suppuration of the submandibular lymphnodes, one of which lying jacent to the right internal carotidartery (RICA). This accumulation of symptoms led the patient to seek medical and neuropsychological help. Test ingusing the Beck Depression Inventory (BDI) confirmed depression, with vegetative disorders being the most predominant. Eight months after undergoing COVID-19, the patient suffered a Transient Ischemic Attack (TIA). The accumulation of diseases (diabetes mellitus, stage III hypertension and TIA) had a dramatic impact on the patient's health, including life-threatening conditions.A vascular surgeon consulted the patient advised immediate surgical treatment: carotid endarterectomy. The urgency of the situation was exacerbated by bleeding during the operation from the operated, secondarily inflamed wall of the RICA (lying adjacent to the suppurated submandibular node). This prompted an emergency decision for an endovascular procedure: the implantation of a stent covered with water-proof material (peripheral stent graft). This was made by a direct access via puncture of the common carotid artery (RCCA) below the endarterectomy level (TCAR). The SF-36 questionnaire was chosen to measure health-related quality of life (HRQOL).The SF-36 results are presented in such a way that higher scores correspond to fewer complaints, indicating better health and higher quality of life. Before revascularization, the patient's HRQOL was found to be lower, which was related to the negative impact of long COVID, while after the procedure, the quality of life gradually improved in subsequent surveys. A significant difference was found in physical function, with a mean score of 66.0 (p<0.001) compared to a score of 94.9 (±9.4) for 100 age-matched health subjects. A similar result was found in the physical role (p < 0.001). The patient's overall quality of life score was 331.0 compared to a score of 578.0 (±111.9) for age-matched normal healthy people. Better quality of life in patients with long COVID is an important therapeutic goal that can be achieved through comprehensive, multispecialty treatment for both physical and psychological conditions.

5

NEUROMARKERS OF ANXIETY IN A PATIENT WHO HAD EXPERIENCED A TRANSIENT ISCHEMIC ATTACK (TIA) OF THE LEFT BRAIN HEMISPHERE AS A RESULT OF A CRITICAL STENOSIS OF THE INTERNAL CAROTID ARTERY (ICA) PERATED ON BY ENDARTERECTOMY (CEA)

51%

Wilczek-Rużyczka E., Mirski A., Korab M., Trystuła M.

Acta Neuropsychologica

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2021

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vol. 19(1)

1-9

EN

The search for neuromarkers is a very promising way to improve psychiatric and psychological care. They are now considered to be an innovative diagnostic tool in psychiatry and neuropsychology, but more broadly in all human health sciences. The aim of our study was to find the neuromarker of anxiety in a patient who had experienced a Transient IschemicAttack (TIA) of the left brain hemisphere as a result of a critical stenosis of the Internal Carotid Artery (ICA) operated on byendarterectomy (CEA). We will present the case of a 54-year-old man,an architect, who experienced a Transient Ischemic Attack (TIA) of the left brain hemispherecaused by a critical stenosis of theInternal Carotid Artery (ICA) and was treated successfully with surgical endarterectomy (CEA). One year after the surgery itself, the patient developed severe postoperative anxiety, headaches, difficulty in sleepingas well as the inability to continue working in his profession. Strong anxiety was notedon the adapted 100-millimeter Visual Analogue Anxiety Scale (VAAS). The patient was assessed using the Human Brain Index (HBI) methodology (Kropotov 2009; 2016; 2017; Pąchalska, Kaczmarek&Kropotov 2014) which consisted of recording 19-channel EEG in resting state conditions, during the cued GO/NOGO task and comparing the parameters of EEG spectra and Event-Related Potentials (ERPs) with the normative and patient databases of the Human Brain Index(HBI). No signs of cognitive dysfunction was found, however an excessive Rolandic beta was observed. In line with the working hypothesis as to the presence of an anxiety neuromarker, the patient’s studies confirmed an increased P1 time wave in the left hemisphere of the brain in ERP in response to visual stimuli, i.e. an anxiety neuromarker. Following the detection of this neuromarkera specific anodic Transcranial Direct Current Stimulations (tDCS) pro- tocol was proposed (see: Kropotov 2016; Pąchalska, Kaczmarek & Kropotov 2020). Ten tDCS sessions were performed and the postoperativeanxiety was found to be resolved. The patient returned to work. The use of Human Brain Index (HBI) methodologyenabling the isolation of the Event Related Potentials (ERPs) patterns revealed the presence of a distinct anxietyneuromarker. Neurotherapy with the use of tDCS allowed the reduction of anxiety symptoms and the patient’s return to work. The above case study indicates the necessity to use new neurotechnologies in the diagnosis of mental diseases, with particular emphasis on postoperative anxiety. ------------------------------------------------------------------------------------------------------------------------------------

6

HEALTH RELATED QUALITY OF LIFE OF THE PATIENT WITH IMMUNOGLOBULIN G4-RELATED CRANIAL HYPERTROPHIC PACHYMENINGITIS (IGG-HP) CAUSING DISTURBANCES OF COGNITIVE CONTROL TREATED WITH NEUROFEEDBACK

51%

Morga R., Radwańska E., Trystuła M., Pąchalska M.

Acta Neuropsychologica

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2021

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vol. 19(3)

373-388

EN

Health related quality of life (HRQoL) is the most desired patient centered outcome of medical care (Leplége et al. 1997). In patients with long term illness, such as Hypertrophic Pachymeningitis (HP) still under diagnosis, therefore no possible to properly cure, it might be the only outcome achievable (Netuveli et al. 2005; Trystuła 2017). The problem becomes even more serious when occurs in young person: starting a family and caring for children becomes hard or even impossible, because of his/her physical and psychical conditions. Most clinicians are aware of the importance for quality of life of this functional limitation, but there are no articles describing this problem in the literature. We aimed to fill this gap in knowledge. 29 year old patient, a car mechanic, married, with 4-year-old son, with the long his- tory of the illnes, and especially persistent, diffuse, non-specific headaches, frequent seizures and cognitive deterioration which have been particularly troublesome recently. He was finalny diagnosed with Hypertrophic Pachymeningitis (HP) associated with Immunoglobulin G4-related (IgG4) with the use of specific diagnostic criteria for HP associated with IgG4-RD (IgG4-HP), which rely on histopathologic analysis (Lindstrom et al. 2010; Lu et al 2014). Computed tomography (CT) of the head showed massive calcifications visible along the cerebellar tentorium on the right side, along the cerebral falx, as well as on dura mater on the cranial vault of both cerebral hemispheres. The patient was diagnosed with common variable immunodeficiency (D 83), thrombocytopenia, chronic EBV hepatitis and epilepsy. IgG4-HP was confirmed by CT, MRI and biopsy (IGg4-RHP antibody was detected). The treatment with steroids, and immunosuppressive therapy (RTX) was introduced (as it was suggested by Levraut et al. (2019). It should be stressed that he had a significantly reduced health-related quality of life (HRQoL), mainly because of long-lasting illness, diverse symptoms, often hospitalization, complex differential diagnosis, and especially biopsy which requires neurosurgical intervention, which affect his physical and mental well-being, especially cognitive control, and not possibility to take care of his family. To help the patient we introduce HBI methodology (Kropotov 2016), that is an evaluation of working brain in milliseconds. Quantitative electroencephalography (qEEG), event-related potentials (ERPs) and low-resolution sLORETA tomography were performed. We did not found any paroxysm of 3 Hz rhythm in Eyes Closed (EO) and in Eyes Open (EO) conditions, however the ERPs deviations from the reference indicate deficit of cognitive control (decrease of P3 NOGO wave in comparison to 100 persons from the normative data base from the Human Brain Index in Chur, Switzerland). Therefore, the patient was offered Transcranial Direct Current Stimulation (atDCS) combined with goal-oriented psychotherapy program. It was found that after 40 days of therapy, cognitive control returned, which was translated into a better quality of life related to the patient's health, measure in the 36-Item Short Form Survey (SF-36). The patient returned to his previous job as a head of car mechanic service. Final diagnosis of IgG4-HP and subsequently, proper farmacotherapy, and introduction of HBI methodology allowing for the selection of an adequate method of neurotherapy, for our patient the transcranial direct current stimulation (atDCS) combined with goal- oriented psychotherapy, was helpful in the improvement of his quality of life.

7

STROKE FOLLOWING PERIPHERAL ARTERIO VENIUS MALFORMATION ALCOHOL EMBOLIZATION – SHOULD WE LOOK FOR PERSISTED FORAMEN OVALE IN ADVANCE?

39%

Błaż M., Ostrowska M., Zasada J., Maciąg R., Komar M., Michalski M., Trystuła M.

Acta Neuropsychologica

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2022

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vol. 20(1)

81-85

EN

Stroke due to paradoxical embolism can be a complication of certain peripheral venous procedures in patients with coexisting patent foramen ovale. There is an established link between venous sclerotherapy and stroke, however there are no known reports of this complication following peripheral arteriovenous embolization.We present a case of a 36-year- old woman who experienced symptoms of disorientation and apraxia following a hypoxic event during percutaneous alcohol embolization of a large arteriovenous malformation in her right gluteal region. An MRI scan revealed multiple foci of restricted diffusion in both cerebral hemispheres corresponding to acute ischemic stroke lesions. As the subsequent work-up revealed patent foramen ovale, we speculate on the pathomechanism of stroke and conclude with a recommendation to screen for patent foramen ovale in patients undergoing peripheral venous procedures including arteriovenous malformation embolization.

8

Pain reduction as the main parameter for monitoring improvement in Health-Related Quality of Life (HRQoL) following endovascular treatment of Pelvic Congestion Syndrome (PCS)

39%

Opławski M., Hydzik A., Opławski M., Mazur-Nasilowska A., Morga R., Trystuła M.

Acta Neuropsychologica

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2023

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vol. 21(4)

489-503

EN

The purpose of this study was to evaluate pain reduction as the main parameter for monitoring improvements in Health-Related Quality of Life (HRQoL) in a female patient following endovascular treatment of Pelvic Congestion Syndrome (PCS). A 38-year-old female patient with chronic intermittent, “dragging” abdominal pain, lasting more than two years, mainly in the lower abdomen, radiating to the sacral region, underwent SARS CoV-2 infection in October 2021, and COVID-19, which lasted 10 days. Eight months later, complaints of pain in the lower abdominal area, during the menstrual cycle, during prolonged standing, after sports activities and during and after intercourse, increased. The patient was compelled to begin diagnosis of these complaints due to the severe pain and concerns about whether she had contracted cancer of the cervix uteri. She was diagnosed on transvaginal ultrasound-Doppler and Angio-MR of the pelvic vessels with PCS. Treatment was undertaken at the Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland. Intraoperatively, after confirmation through selective angiography, of previously diagnosed insufficiency of the left ovarian vein (LOV) and of the parametrial veins (PMV), the selective obliteration was performed with an adhesive dedicated to endovascular closure of veins and vascular malformations (Glubran®2). The range of pain intensity, according to theVisual Analogue Scale (VAS), in Exam. 1 (before surgery), was in the premenstrual period (BM) 7.0 points, which increased during menstruation (DM) or after intense activity (AIA) to 8.0 points, and occasionally during and after intercourse even to 9.0 points. These values were very high, indicating that pain significantly affected the patient's quality of life. The extent of pain severity decreased significantly in Study 2 (two months after surgery) and Study 3 (four months after surgery) and was 2.0 points in the premenstrual period (BM), which increased only slightly during menstruation (DM) or after intense activity (AIA) to 3.0 points, and decreased again to 2.0 points during and after intercourse. The patient reported that the procedure significantly and positively affected her functioning in daily life, especially in caring for a young child, which is evidence of the achievement of HRQoL improvement. Endovascular treatment for Pelvic Congestion Syndrome (PCS) was effective in reducing pain and improving the Health-Related Quality of Life (HRQoL) of a patient with PCS.

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The impact of iatrogenic embolisation and endovascular removal of a fractured central vein catheter on the Health Related Quality of Life (HRQoL)

39%

Muszyński T., Polak K., Tomala M., Iwaszczuk P., Kwiatkowski T., Trystuła M.

Acta Neuropsychologica

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2019

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vol. 17(1)

1-7

EN

Iatrogenic embolisation of the right ventricle of the heart by a fragment of one of the most basic ICU devices, which has fractured and detached the central vein catheter, is rarely described in subject literature. Removing such an element from the heart is highly risky and requires the use of very modern techniques and equipment. The Atrieve Vascular Snare™ was employed in the described patient. Therefore, it is necessary to present this process and its effectiveness through an evaluation of the health related quality of life (HRQoL) associated with the perception of health status by those patients. This is a requirement in modern medicine. The main aim of this paper was to evaluate the HRQoL after this embolisation. A 67-year-old patient was referred to the Vascular Surgery Department with Endovascular Interventions Ward, John Paul II Hospital in Kraków, after the defragmenting of the central vein catheter and replacement to the right ventricle of the heart. An endovascular approach through the right common femoral vein (RCFV) under local anesthesia of the groin was chosen as the preferred method for removing the broken catheter fragment. The right ventricle of the heart was reached using a 18-30mm Atrieve Vascular Snare™. A structure consisting of three loops facilitated the quick grasp and removal of the catheter fragment at the first attempt through the RCFV. Despite the short time needed for the procedure, the patient experienced periprocedural ventricular fibrillation (VF) with the necessity of defibrillation. After one successful defibrillation attempt, sinus rhythm was restored. The post-operative course showed no complications whatsoever, and the patient was sent to the General Surgery Ward in order for a new Hickman catheter to be implemented and further parenteral nutrition treatment to be carried out. The endovascular technique with the use of Atrieve Vascular Snare™ is an effective method which was used in the case of our patient under local anesthesia. It provides for the fast, safe and convenient removal of a disrupted and dislocated catheter fragment. It allows one to improve the patient’s HRQoL not only in the short term, but also in the longitudinal (6 months after surgery) follow up.

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Health related quality of life of the patients after transient ischaemic attack: is carotid endarterectomy (CEA) or carotid artery stenting (CAS) more influential?

HEALTH-RELATED QUALITY OF LIFE IN A PATIENT FOLLOWING ANEURYSMOTOMY OF RARE MEGA-GIANT ANEURYSM OF THE COMMON CAROTID ARTERY

FUNCTIONAL NEUROMARKERS OF POST-TRAUMATIC STRESS DISORDER (PTSD) IN A MAJOR ISCHEMIC STROKE SURVIVOR AFTER CAROTID ENDARTERECTOMY (CEA) REVASCULARIZATION

Quality of life of a patient with persistent complications after SARS-CoV-2 infection requiring urgent surgical intervention – endarterectomy with emergency angioplasty of an inflamed, bleeding Right Internal Carotid Artery (RICA) using the Trans-Carotid Artery Revascularization (TCAR)

NEUROMARKERS OF ANXIETY IN A PATIENT WHO HAD EXPERIENCED A TRANSIENT ISCHEMIC ATTACK (TIA) OF THE LEFT BRAIN HEMISPHERE AS A RESULT OF A CRITICAL STENOSIS OF THE INTERNAL CAROTID ARTERY (ICA) PERATED ON BY ENDARTERECTOMY (CEA)

HEALTH RELATED QUALITY OF LIFE OF THE PATIENT WITH IMMUNOGLOBULIN G4-RELATED CRANIAL HYPERTROPHIC PACHYMENINGITIS (IGG-HP) CAUSING DISTURBANCES OF COGNITIVE CONTROL TREATED WITH NEUROFEEDBACK

STROKE FOLLOWING PERIPHERAL ARTERIO VENIUS MALFORMATION ALCOHOL EMBOLIZATION – SHOULD WE LOOK FOR PERSISTED FORAMEN OVALE IN ADVANCE?

Pain reduction as the main parameter for monitoring improvement in Health-Related Quality of Life (HRQoL) following endovascular treatment of Pelvic Congestion Syndrome (PCS)

The impact of iatrogenic embolisation and endovascular removal of a fractured central vein catheter on the Health Related Quality of Life (HRQoL)