GJorcheva, Irena
Preferred name
GJorcheva, Irena
Official Name
GJorcheva, Irena
Main Affiliation
Email
irena.gjorceva@medf.ukim.edu.mk
8 results
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Item type:Publication, Case report-patient with cerebellar stroke and percutaneous enterogastric tube(2017); ; ; Babunovska MarijaAbstract Introduction: Cerebellar strokes occur in 1,5-2,3% of all ischemic stroke cases. Aim: We present 74-year-old male patient, admitted at the University Clinic of neurology due to acute ischemic cerebellar stroke with speech and swallowing difficulties, disturbed balance, weakness of the left side extremities, impaired consciousness. Case report: On admission the patient was presented with clinical picture of left hemicerbellar syndrome with compression of the medulla. Computer tomography of the brain (CT)on admission was with normal finding. Control CT of the brain after 48 hours showed irregular ischemic lesion in the left cerebellar hemisphere. Nuclear magnetic resonance imaging (MRI) of the brain confirmed the CT findings. Color duplex sonography of the vertebral arteries (VA)showed reduced Doppler signal in the left VA,finding conclusive with distal occlusion and compensatory increased blood flow velocity in the right VA. CT angiography of vertebral arteries showed hypoplastic extracranial segment of the left VA, while its intracranial segment could not be visualized. Posterior inferior cerebellar artery (PICA) was not visualized intracranially as well, finding conclusive with its occlusion. The right VA on CT angiography was seen with compensatory increased lumen. Patient was treated with usual therapy for ischemic stroke during a period of 3 weeks. Due to dysphagia, nasogastric feeding tube was placed. During the stay in hospital, the patient's physical and neurologicl status gadually improved, But, dysphagia still persisted and according to current guidelines for stroke treatment, together with the specialists from the Clinic of Gastroenterohepatology, we decided to place a percutaneous enterogastric tube (PEG). The intervention went very well and the patient was discharged for home treatment. He came for regular control check-ups every month for a period of 1 year. His physical and neurological symptoms gradually improved, and his swallowing function recovered. After 6 months, the PEG probe was taken out, and the patient continued to eat and swallow normally. Discussion: Dysphagia is a serious complication after stroke. It carries risk for aspiration and occurrence of pneumonia. Placement of nasogastric feeding tube is recommended in patients who have swallowing difficulties in the acute phase of stroke. Placement of PEG tube is recommended 2 weeks after stroke occurrence. Studies so far have shown that feeding through the PEG tube is more efficient than feeding through the nasogastric tube in terms of improved nutritive status and has lower complication risk. Conclusion: Successful treatment of stroke depends on many factors. Particular attention should be brought to the food and beverage intake, and assessment of early signs and risk factors of dysphagia in order to take appropriate therapeutic measures. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Transcranial color duplex sonography in post-stroke cognitive impairment(2015); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Clinical Characteristics, risk factors and outcome in patients with in tracerebral haemorrhage(Leage against epilepsy of Macedonia, 2015); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, BASELINE STROKE SEVERITY BEFORE AND AFTER INTRAVENOUS THROMBOLYSIS(League against epilepsy of Macedonia, 2017); ; Mitrevska Velkov JasminaAbstract Introduction Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke. Recanalization strategies such as intravenous recombinant tissue-type plasminogen activator (rt-PA), attempt to establish revascularization so that cells in the ischemic penumbra can be rescued before irreversible injury occurs. The National Institutes of Health Stroke Scale (NIHSS) is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit. Aim To evaluate and compare the baseline stroke severity-NIHSS score in acute stroke patients before and after application of intravenous thrombolysis. Material and methods We made a retrospective analysis of 1058 acute stroke patients, hospitalized during a period of April 2014-February 2016, at the Department for Urgent Neurology, University Clinic of Neurology, Skopje. Of them, 27 patients met the inclusion criteria for rtPA application according the guidelines. Results I.v. thrombolysis was administered in 27 patients (2,5%). 9 (33,3%) patients had mild stroke (NIHSS 5-10), 11 (40,7%) patients had moderate stroke (NIHSS 10-15) and 7 (25,9%) patients had severe stroke (NIHSS > 15). After the administration of rtPA, we registered improvement on the NIHSS score in 20 patients (74%). Most of them (18-90%) were improved by 3 points on the NIHSS score (range 1-10 points). Best response to therapy had patients with mild and moderate stroke according to NIHSS scores. In unchanged condition after rtPA application were 2 patients (7,4%) with NIHSS score of 10 and 12, respectively. Worsening of the neurological deficit was registered in 1 patient (3,7%), who had initial NIHSS score of 9 and 1 hour after application of rtPA his NIHSS score increased to 12. 4 patients (14,8%) had lethal outcome. Discussion and conclusion Our study shows the initial experience with i.v. thrombolysis in eligible patients with acute ischemic stroke. More than 70% of the thrombolysed patients improved their functional deficit after the treatment. Intravenous thrombolytic therapy with rtPA is the only approved therapy so far approved for treatment of acute ischemic stroke. Meta-analysis of the trials so far have confirmed the benefit of i.v. thrombolytic therapy in selected patients with acute ischemic stroke. All agree that the earlier the therapy is given, the results are better and the health systems should increase their percentage of stroke patients treated within 60 minutes of presentation to hospital until application of thrombolytic therapy. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Atrial fibrillation and risk for ischemic stroke(League against epilepsy of Macedonia, 2017); ; Cheperganova Changovska, TatjanaAbstract Objective: To investigate the frequency of atrial fibrillation in patients who develope acute ischemic stroke, associated risk factors and their outcome. Material and methods: A retrospective study was conducted at the University Clinic of Neurology Clinic, Department for Urgent Neurology.We analyzed medical records of acute ischemic stroke patients hospitalized between April 2014 and April 2016. Statistical analysis was performed with the programme Statistica for Windows 12. Results: Of the 1102 patients in the study,219 (19.8%) had atrial fibrillation. Of them, 109 (49,8%) were males and 110 (50,2%) were females. The mean age of those patients was 65±14 years compared to 60±16 years for the rest. Patients with AF had higher modified Rankin Scale(mRS) score on admission and at discharge from the hospital and had lethal outcome in higher percentage, compared to the rest (p<0.05). Conclusion: AF significantly increases the risk of stroke and affects its prognosis and outcome. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, VESTIBULAR MIGRAINE-CASE REPORT(2016); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, A young female adult patient with an ischaemic stroke and patent foramen ovale: a case report and literature review(Croatian Academy of Sciences and Arts – Medical Sciences, 2022-06-30); Strokes in young adults are relatively rare. We present a 36-year old female patient, who came to the urgent neurological outpatient office of the Clinic for neurology due to symptoms presented two hours prior to the examination. The symptoms consisted of inability to move the left arm, partial motor weakness of the left leg, slurred speech and difficulty swallowing. The urgent CT scan result was normal. Despite the fulfilled conditions, thrombolysis was not possible. Brain MRI results revealed a small hypersignal lesion in FLAIR with diffusion restriction on the right, cortically to subcortically, in gyrus praecentralis. The genetic testing for cardiovascular diseases showed that the patient is a homozygote for the mutation C677T (OMIM® 607093.0003) in the gene for methylenetetrahydrofolate reductase (MTHFR) and heterozygote for the mutations eNOS G894T and LTA. The following gene polymorphisms were typed: PAI 5G/4G, HPA1 1b/1a, ACE deletion/insertion, EPCR A4600G A/A, EPCR G4678C C/G and APOE E3/E4. Trans-esophageal echocardiography discovered an aneurysm of the interatrial septum, with a present PFO channel, with a diameter of 6.8 mm. The bubble test was positive, and there were no visible thrombi in the left auricle. The cardiologist recommended closing of the PFO with a device and therapy with acetylsalicylic acid. The cause of the stroke was found and measures for secondary prevention were taken. The patient has returned to her work and private obligations. She upholds neurological consultations regularly and her recovery is closely observed. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Acute encephalitis caused by Streptococcus pneumoniae: case report and review of the literature(Croatian Academy of Sciences and Arts – Medical Sciences, 2022-06-30); ;