Faculty of Medicine

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Persistent foramen ovale as a cause of cerebral strokes in young individuals - case reports
(MIT University Skopje, 2025-03)
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Nikolovski, Robert
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Zhaku, Vegim
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Foramen ovale is a small congenital defect in the level of the interatrial septum of the heart that occurs as a result of the failure of fusion between the septum primum and septum secundum during embryogenesis. It is present in about 25% of the population and is usually clinically insignificant. However, in some cases, it can lead to paradoxical embolism, which may result in an ischemic stroke. Objective: To investigate the association between patients with persistent foramen ovale (PFO) and the occurrence of strokes in young individuals, with a case report. Case Report: A 27-year-old patient presented for a check-up with a history of multiple episodes, especially in the morning, of weakness in the left limbs, particularly the left arm, accompanied by dizziness. These symptoms spontaneously improved, but in the last episode, the symptoms lasted up to 5 hours from the onset. The patient lives in a small area at a higher altitude. The patient was referred for a neurological examination. The neurological examination was unremarkable at the time of the visit, but due to the recurring symptoms, the patient was referred for a magnetic resonance imaging (MRI) scan of the brain, where punctiform hyperintense lesions were detected. The patient was then referred to a cardiologist, where a transthoracic echocardiogram (TTE) revealed a thin septum, leading to a recommendation for transesophageal echocardiography (TEE). TEE showed the presence of a 2mm PFO, after which the decision was made to close it using an Amplatzer PFO Occluder – 25mm in size. Conclusion: Although rare, a transient ischemic attack (TIA) in younger individuals should prompt consideration of the potential existence of PFO. Timely diagnosis and treatment of PFO are crucial for the lives of these patients.
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RISK FACTORS IN HOSPITALIZED PATIENTS WITH STROKE POSITIVE ON SARS-COV-2-INFECTION
(Macedonian Association of Anatomists and Morphologists, 2023-11)
Monika Petrovska
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Miloshevski Petar
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Miloshevska Mila
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Stojkovska Frosina
Abstract Numerous reports indicate an increased number of strokes in the period after the peak of Covid 19, describing the presence of "COVID strokes" in young individuals with atypical thromboembolic events. The main goal of this investigation was to assess/identify risk factors and coexisting comorbidities, in patients first time hospitalized for diagnosis of stroke at the Neuropsychiatric Department at the Public Health Institution (PHI) General Hospital Ohrid, positive for Sars-Cov-2-infection, from 6 months prior to the day of hospital admission in comparison to Sars-Cov-2 negative patients who met the same criteria. All 54 patients who met the criteria to be included in the study, after giving written consent, answered the modified European Stroke Awareness Questionnaire (SAQ). Traditional stroke risk factors were highly prevalent in our cohort (Sars-Cov-2-infected patients with stroke) with more than 80% of individuals having had at least 1 documented risk factor such as obesity (significantly more prevalent in our cohort), sedentary lifestyle and presence of two or three coexisting comorbidities such as hypertension, dyslipidemia, diabetes, or heart disease. The investigation will contribute to the development of new models and strategies for the prevention of stroke in patients with Covid-19- infection.
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CIRCULATING OXIDIZED LOW-DENSITY LIPOPROTEIN LEVELS IN AN EARLY STAGE OF ACUTE ISCHEMIC STROKE
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2024)
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Kerala, Coskun
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Kostovska, Irena
Introduction: Atherosclerosis remains the most common cause of coronary artery disease (CAD) and cerebral or peripheral artery disease. At present, lipid peroxidation is considered one of the basic mechanisms involved in the initiation and progression of many diseases. An oxidative stress resulting in lipid peroxidation and protein modification is involved in the pathogenesis of atherosclerosis and cardiovascular diseases. Aim: The primary aim of this study was to determine the circulating levels of oxidized low-density lipoprotein (ox-LDL) in patients with acute stages of ischemic stroke. The secondary aim was to evaluate if there was an association between ox-LDL concentration and conventional lipid risk factors for cardiovascular diseases (CVD). Material and methods: Seventy-five patients with acute ischemic stroke (AIS) and ninety control subjects without cardiovascular risk factors were included in the study. Total cholesterol, triglycerides, HDL-cholesterol, and LDL-cholesterol were measured in patients as well as in control subjects by enzymatic methods on Roche C311 Cobas Analyzer. Ox-LDL was measured by the sandwich ELISA technique. Results: There was no significant difference in BMI, total cholesterol, triglycerides, HDLc, and LDL-c between the two groups. There was a significant difference between patients with AIS and the control group regarding ox-LDL concentrations (p=0.03). We did not find any significant correlation between plasma ox-LDL concentration and lipid parameters. Conclusions: Levels of circulating ox-LDL were elevated in patients with acute ischemic stroke. Ox-LDL levels were not statistically correlated with major lipid risk factors for CVD. Therefore, ox-LDL levels may represent a novel risk marker of CVD.
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Stroke and dementia
(League against Epilepsy of Macedonia, 2016)
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Chepreganovska-Changova, Tatjana
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Taravari, Arben
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Screening for obstructive sleep apnea as a stroke risk factor with Berlin questionnaire
(Congress of respiratory medicine of the Republic of Macedonia, 2016-10)
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Intracerebral hemorrhage and epileptic seizure : frequency, localization and seizure types
(Македонско лекарско друштво = Macedonian Medical Association, 2017-07)
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Taravari, Arben
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Coskun, Kerala
Introduction. Among 2.8-18.7% of the patients that suffered from spontaneous intracerebral hemorrhage (ICH) develop seizures. Previous studies suggest that most important contributors to developing subsequent seizures are: volume and localization of hematoma, cortical involvement and age. Aims: To determine the occurrence of new epileptic seizures in patients with spontaneous intracerebral hemorrhage and to analyze it with respect to the patient’s age, gender, presence of premorbid risk factors, localization of the hematoma and the type of the seizures. Methods. This study is retrospective in design, with study population of 308 patients with spontaneous intracerebral hemorrhage admitted to our clinic in the period between 2008 and 2014. Analyzed premorbid risk factors for ICH are: hypertension, smoking, alcohol uptake. According to the computer tomography (CT) of brain findings the patients was divided in two groups: lobar and thalamic (deep). By the time of presents of seizures, they were classified as early (within 1 week of ICH) or late (more than 1 week after ICH). Also we analyzed the seizures type and we divided them in four groups: simple partial, partial complex, secondary generalized and tonic clonic generalized seizures. Results. Arterial hypertension was revealed in 78% of the patients with spontaneous supratentorial ICH. Epileptic seizures developed in 8.2% of analyzed patients, most of them in the first week of brain bleeding. Lobar ICH had 78.6% of the patients, with frontal localization was 44% of patients with lobar ICH, and most of them had simple partial and partial complex seizures. Conclusion. Cortical involvement, large volume of hematoma, may be a factor for provoked seizures, especially in the first days of brain bleeding.

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