Background: More than 50% of stroke patients have sleep-disordered breathing.Aim: To determine whether the location and type of stroke affect the occurrence of sleep apnea.Patients and methods: We analyzed 110 patients with acute stroke and verified sleep apnea. Acute stroke has been verified either by computerized tomography or magnetic resonance imaging of the brain. Average age was 65.13±9.27 years and it was 59% men. Number of patients without apnea in control group was the same as well as gender distribution, with average age 64±8.69 years.Results: Apnea was verified in 22% patients. The largest number of patients with and without apnea had ischemic stroke 83.6%, while 16.4% of patients had hemorrhagic stroke. Of these, there were 86.2% men and 80% women with ischemic and 13.8% men and 20% women with hemorrhagic stroke. With apnea, the largest number had a lesion in two or more places 51.8%,as well as without apnea 45.45%, but the difference was not statistically significant. According to the acute stroke, the largest number of patients with and without apnea had lesions in the left and right hemispheres 45.4%. There was no statistically significant association between apnea and localization of stroke in the left or in both hemispheres. There is a statistically significant association of AS localization in the right hemisphere with the occurrence of apnea.Conclusion: There is a statistically significant association between the localization of stroke in the right hemisphere and the occurrence of apnea.

Introduction: One of the most important goals in rehabilitating patients affected by stroke is re-establishing independent movement by activating as many motor patterns as possible and changing existing preexisting abnormal motor patterns Objective:  To determine recovery level with the accent on motor functions recovery in a patient affected by an ischemic stroke for the first time. The study included patients with anterior circulation syndrome, posterior circulation syndrome, and lacunar syndrome in the acute and post-acute phases of physical therapy and rehabilitation.Material and methods: We conducted a prospective study, which included a total of 90 patients with the first onset of ischemic stroke. The first group consisted of 30 patients with the  anterior circulation syndrome of; the second group of 30 patients with the posterior circulation syndrome and the third group of 30 patients with the lacunar syndrome.  At the beginning of their early rehabilitation treatment at the Clinic of Physical Medicine and Rehabilitation, the Bamford Scale was used in the initial assessment of the clinical classification of stroke. After the rehabilitation treatment and six months after the stroke, an assessment of motor functions and improvement in overall functionality was performed using a six-minute walk test.Results: The six-minute walk test in all the studied groups showed significant improvement six months after the stroke compared to testing done immediately after their rehabilitation treatment (p = 0.01 anterior circulation, p = 0.05 posterior circulation, p = 0.01 lacunar syndrome). The six-minute walk test was statistically significantly better in patients with lacunar syndrome compared to patients with posterior circulation syndrome after the rehabilitation treatment (p = 0.005) and six months after stroke; p = 0.02.Conclusion: The importance of rehabilitation in the acute and post-acute phases of patients with first ischemic stroke is evident. The six-minute walk test in all studied groups showed statistically significant improvement after six months post-stroke period compared to post-rehabilitation testing. The results were statistically significantly better in patients with lacunar syndrome compared to patients with posterior circulation syndrome after the physical treatment and the time period of six months after the stroke.

Coronavirus disease 2019 (COVID-19) is primarily a disease of the respiratory system but severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may cause several immune-related complications including different neurological disorders, such as myelopathy with paraparesis.In this atypical case a female patient with progressive spastic paraparesis after COVID-19 infection, brisk reflexes and positive Babinski sign, reduced vibratory sensation to the thoracic level, elevated immunoglobulin levels (IgG) in cerebrospinal fluid, but negative magnetic resonance imaging (MRI) of the brain and spine, is presented. A 57-year-old woman with spastic paraparesis and inability to walk was admitted to our neurological department. About four months before hospitalization, she started feeling numbness and tingling in the feet and lumbar spine area. Gradually, numbness and tingling ascended to the thoracic spine level Th7/8, and she developed weakness mostly in her legs. In the neurological exam she had spastic paraparesis. MRI of the brain, cervical and thoracic spine did not reveal any signal abnormality. Serological testing for SARS-CoV-2 was performed and results were highly positive IgG and IgM+IgA levels. The lumbar puncture finding confirmed the suspicion of immune-related complications after SARS-CoV-2 infection (intrathecal IgG synthesis). This case draws attention to spastic paraparesis or progressive MRI-negative myelitis after SARS-CoV-2 infection, which obviously has immune-mediated pathogenesis that happen in response to the virus or its antibodies. Similarities in spastic paraparesis after human T-lymphotropic virus (HTLV-1) or human immunodeficiency virus (HIV-1) and SARS-CoV-2 infections were observed. The patient had a good response to corticosteroid therapy and had good recovery.

Background: Stroke patients have sleep-wake disorders, mostly in form of insomnia, excessive daytime sleepiness/fatigue, or hypersomnia (increased sleep needs). Objective: The aim of this study was to analyze types of sleep disorder (SD) and their frequency in patients with sleep apnea and acute stroke in relation to the type of stroke and side of lesion. Methods: The study analyzed 110 patients with sleep apnea and acute stroke hospitalized in the Clinic of Neurology, University Clinical Centre Tuzla. Acute stroke has been verified either by computerized tomography or magnetic resonance imaging of the brain. SD was verified according to the Berlin Questionnaire Test, The Epworth Sleepiness Scale, The Stanford Sleepiness Scale and the General sleep questionnaire. Strokes were divided by: a) type, into hemorrhagic and ischemic, and b) the localization of the stroke, to right and left cerebral hemispheres. Results: Of the total number of respondents, all had some sleep disorder. 20% of respondents had severe level of SD, 35.4% moderate, 37.3% moderate- severe and 7.3% mild problems. There were no statistically significant differences in the frequency of SD among patients with ischemic and hemorrhagic stroke (p = 0.58). In relation to the side of lesion, there was more patient with SD and stroke in the both sides, but there were no statistically significant differences (X2=1.98, p=0.161). According Epworth Sleepiness Scale, Stanford Sleepiness Scale and Berlin Questionnaire test snoring was present in 81% and daytime sleepiness in all patients. Conclusion: SD as a neuropsychological disorder has a significant incidence in the acute phase of stroke in patients with sleep apnea. Sleep disorder is more common in ischemic stroke and stroke in the both hemisphere, but it is not statistically significant difference. Daytime sleepiness, fatigue and snoring are the most common sleep problems in patients with acute stroke and apnea, but it is not statistically significant.

Background: More than 50% of stroke patients have sleep-disordered breathing (SDB), mostly in the form of obstructive sleep apnea (OSA). SDB represents both a risk factor and a consequence of stroke. The presence of SDB has been linked with the poorer long-term outcome and increased long-term stroke mortality. About 20 to 40% of stroke patients have sleep-wake disorders (SWD), mostly in form of insomnia, excessive daytime sleepiness/fatigue, or hypersomnia (increased sleep needs). Objective: The aim of this study was to analyze the frequency of risk factors in patients with acute stroke and sleep apnea. Methods: The study included patients without cognitive impairment or with mild cognitive impairment. The diagnosis of apnea syndrome was made on the basis of the Snoring and Apnea Syndrome Questionnaire, the Epworth Sleep Scale, the Berlin Questionnaire, the Stanford Sleepiness Scale, and the General Sleep Questionnaire. The severity of stroke was assessed by the National Institutes of Health Stroke Scale and the Rankin Disability Scale. Patients with a Glasgow score <8 on the day of neuropsychiatric examination were excluded from the study, as well as patients with epileptic seizures at the onset of stroke, with aphasia, with Mini - mental test <23, with verified previous dementia / cognitive impairment. Results: There is no statistically significant difference in the age of men and women, both with apnea and without apnea. In patients with apnea, heart disease was in the first place 91.8%, followed by hypertension 86.4%, Body mass index 79.1%, hyperlipidemia 50%, smoking 38.2 % and diabetes mellitus 20.9%. Hypertension was the most common risk factor in patients without apnea 83.6%, followed by heart disease 81.0%, Body mass index 60.9%, hyperlipidemia 48.21%, smoking 28.2 % and diabetes mellitus 20%. Conclusion: Heart diseases, hypertension and body mass index are significantly more frequent in patients with than in patients without sleep apnea.

Purpose Myasthenia gravis (MG) and amyotrophic lateral sclerosis (ALS) are two different diseases. The coexistence of both of them is extremely rare and represents a diagnostic challenge which requires thoughtful interpretation of clinical characteristics. Case report We present the case of a 46-year-old Bosnian male who developed ALS five months after MG. Diagnosis of MG was based on elevated titers of anti-AchR antibodies, positive edrophonium test, and decremental responses on a repetitive nerve stimulation test while the diagnosis of ALS was based on clinical and neurophysiological findings: upper motor neuron signs in the lumbar region, lower motor neuron signs in the bulbar and cervical regions, generalized fasciculations and muscle atrophy and progressive asymetric muscle weakness together with active and chronic denervation in the cervical and lumbosacral region determined by electromyoneurography. Conclusions The coexistence of MG and ALS is rare and request an adequate interpretation of clinical symptoms. The relationship between these two diseases in as interesting phenomen to present.

Marinacci anastomosis, also known as Ulnar-Median anastomosis, is an anastomosis in which the branch anastomotic originates proximally in the ulnar nerve and unites distally with the median nerve. A purpose of this study was to determine the incidence and  the characteristics of Marinacci anastomosis in the Bosnian population. The 60 anterior forearms of fresh frozen adult cadavers were dissected in the Department of Pathology,  University Clinical Centre Tuzla and the morgue of Tuzla during a time period of two years. The Marinacci anastomosis was evidenced in one male forearm in the right side behind the ulnar artery, following an transversal course of 5.2 cm until its connection with the median nerve in only one branch. The incidence of Marinacci anastomosis was 1.67%. Since this anastomosis can expalin some cases where injuries in the forearm nerves are not reflected in the hand muscles, it is important to study. Our study contributes to a limited research on the Marinacci anastomosis, a condition that is rarely found and reported in anatomical research.

OBJECTIVE The purpose of this study was to evaluate the efficiency of the anticholinergic therapy with oxybutynin and the effects of daily transcutaneous tibial nerve stimulation (TTNS) on the quality of life of patients with an overactive bladder (OAB) and multiple sclerosis (MS). PATIENTS AND METHODS The study was designed as a randomized controlled trial. The patients who suffer from MS underwent urodynamic tests which showed that they had an OAB. The tests used to assess symptoms and quality of life were Overactive Bladder Questionnaires (OAB-q) SF. Patients were divided into 2 groups of 30 patients each. The first group received a 5 mg oxybutynin tablet twice a day for 3 months and the second group had TTNS every day for 3 months. RESULTS The anticholinergic therapy showed a statistically significant improvement in all symptoms and quality of life (P<0.001). Side effects such as dry mouth were observed in about 35% of patients. The results of the study TTNS daily therapy showed good performance in the reduction all clin ical symptoms of the bladder and improved quality of life, with statistical significance (P<0.05) and with no side effects. It was found that the improved quality of life parameters and the reduced symptoms were more statistically significant in the treatment with oxybutynin tablets than TTNS therapy (P<0.001). CONLCUSION Our recommendation for the treatment of OAB is oxybutynin in doses of 2x5 mg. If a patient can not tolerate anticholinergic drugs, daily TTNS is recommended to reduce OAB symptoms and improve quality of life, without side effects.

Myopericytoma is a benign tumor with the most common presentation as a well-circumscribed, slow-growing mass. It is frequently misdiagnosed as a sarcoma. We presented a 23-year-old patient with a history of a sciatic pain of the right leg. A careful physical examination discovered tumor-like mass in the posterior part of the thigh. Neurological finding showed a reduction of myotatic reflexes on the right leg with a weaker muscle strength on the right leg. The right leg musculature was slightly hypotrophic in the range of 2-3 cm comparing to left leg. Initially electrophysiological and radiological diagnostic with magnetic resonance imaging (MRI) of the lumbar spine, pelvis and thighs were normal. Magnetic resonance imaging of the right thigh discovered a slow growing 2.1 × 3.8 cm sized mass that was initially described by radiologist as a neurinoma. Patient was admitted to department of neurosurgery and operated on for a tumor removal. Tumor was located intimately to femur and sciatic nerve and after careful dissection completely removed. Patient was doing well after surgery and discharge after three days from the hospital. In the postoperative period the symptoms disappeared. Histopathology showed a myopericitoma. Postoperative MRI after three months of follow up showed no tumor residues, and after 6 and 12 months there was no tumor recurrence. Myopericytoma behave in a benign fashion, but, because local recurrences and rarely metastases may occur in atypical and malignant neoplasms, a careful follow-up after radical resection is recommended.