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V Mihaljevic

Publications and source records attributed to V Mihaljevic.

3 recordsLinked to original sources

[Petit mal status in hyperthyroidism].

A 68-year-old woman who, for the first time, had a generalized tonic-clonic seizure and persisting confusional state was found to have nodular enlargement of the thyroid and a tachycardic arrhythmia. Electroencephalography (EEG) demonstrated a continuous irregular polyspike wave pattern. Total T4 concentration was elevated to 23 micrograms/dl. Consecutive Administration of 250 mg phenytoin, 4 mg clonazepam and 7.5 mg midazolam changed neither the clinical nor the EEG findings. But after general intensive care measures and high-dose thyrostatic treatment (40 mg thiamazole intravenously every four hours) the clinical and neurological status became normal. Serial EEGs over the subsequent weeks and months showed gradual disappearance of the abnormal changes with increasingly prolonged periods of normal activity.

Aged

[Thyroxine vs iodine and thyroxine. Comparison of the TSH suppression test].

In a crossover study 20 subjects (12 with non-toxic goiter) were given 150 micrograms levo-thyroxine (LT4) or a combination of 100 micrograms LT4 and 100 micrograms iodide daily for 8 weeks. Group I took 150 micrograms LT4 and group II the combination. After 4 weeks the two groups switched medications. A clinical examination, an intravenous TRH test and thyroid sonography were performed before the start of the study and 4 and 8 weeks thereafter. 150 micrograms LT4 daily resulted in significantly higher TSH suppression than the combination. A decrease in thyroid volume from 45 ml (mean range 24-85) to 26 ml (17-70 ml) was registered after as little as 4 weeks' therapy in 12 of 20 subjects with goiter.

Adult

Exophthalmos and basilar impression. A contribution to differential diagnosis of endocrine orbitopathy.

We report on a male patient with exophthalmos of unclear etiology, basilar impression, syringohydromyelia and type II Arnold-Chiari malformation. Two diseases involving the orbital region were to be considered in differential diagnostic terms: endocrine orbitopathy and osseous orbit dysplasia. The typical physical appearance associated with basilar impression as well as suppurative keratitis in Lagophthalmos was striking. Tetraspasticity with pareses, bulbar symptoms, proximally pronounced muscular atrophy as well as a left hemihypesthesia was shown neurologically. Although the orbit CT was normal, sonography revealed thickened ocular muscles. There was euthyroidism in diffuse goiter with negative thyroid autoantibody findings. Because of lack of definitive detection of muscular swelling, tumor, or vascular anomaly in the various images, orbital dysplasia in the context of a malformation syndrome affecting several organs is suggested as the cause of the exophthalmos.

Arnold-Chiari Malformation