Damage to the somatosensory nervous system poses a risk for the development of neuropathic pain. Such an injury to the nervous system results in a series of neurobiological events resulting in sensitization of both the peripheral and central nervous system. The symptoms include continuous background pain (often burning or crushing in nature) and spasmodic pain (shooting, stabbing or "electrical"). The diagnosis of neuropathic pain is based primarily on the history and physical examination finding. Although monotherapy is the ideal approach, rational polypharmacy is often pragmatically used. Several classes of drugs are moderately effective, but complete or near-complete relief is unlikely. Antidepressants and anticonvulsants are most commonly used. Opioid analgesics can provide some relief but are less effective than for nociceptive pain; adverse effects may prevent adequate analgesia. Topical drugs and a lidocaine-containing patch may be effective for peripheral syndromes. Sympathetic blockade is usually ineffective except for some patients with complex regional pain syndrome.

The objective of the study was to analyze the doppler sonography findings of vertebrobasilar circulation (VB) in patients with Parkinson's disease. 40 patients were analyzed (25 men's and 15 women) with Parkinson's disease, average age was 61.9 years (SD=11.43), treated at the Clinic for Neurology in Tuzla. Device for doppler sonography was Multidop x 4. Doppler sonography findings of VB circulation were analyzed in order to computerized tomography (CT) findings of the brain (with or without ischemic lacunar lesions) and in order to presence of postural disturbances as one of dominant Parkinson's disease symptoms during actual hospitalization. Our results suggest that vertebrobasilar insufficiency is more frequent in patients with Parkinson's disease (no matter of type) and postural disturbances as a dominant symptom comparing to group of Parkinson's disease patients without postural disturbances. These results implicate the importance of doppler sonography findings of vertebrobasilar circulation in patients with Parkinson's disease and possibility of considering role of vertebrobasilar insufficiency in development of postural disturbances.

Intracerebral hemorrhage is the deadliest, most disabling and least treatable form of stroke despite progression in medical science. The aim of the study was to analyze the frequency, risk factors, localization and 30-day prognosis in patients with intracerebral hemorrhage. We analyzed 352 patients with intracerebral hemorrhage (ICH) hospitalized at the Department of Neurology Tuzla during a three-year follow up. The following data were collected for all patients in a computerized database: age, sex, risk factors (hypertension, heart diseases, diabetes and smoking) and CT findings. Stroke severity was estimated with Scandinavian Stroke Scale, ICH topography was specified by CT, and outcome at 1st month after onset included information on vital status and disability (modified Rankin Scale, mRS). The most frequent risk factors were hypertension (84%), heart diseases (31%), cigarette smoking (28%) and diabetes mellitus (14%). The most frequent localization of ICH was multilobar (38%), internal capsule/basal ganglia region (36%) and lobar (17%). Within first month died 147 patients (42%). The highest mortality rate was in patients with brain stem (83%) and multilobar hemorrhage (64%). Factors independently associated with mortality were age (odds ratio 1,05 (95% confidence interval 1,02 to 1,08); p=0,001), stroke severity (OR 0,93 (0,92 to 0,95); p<0,0001), multilobar hemorrhage (OR 5,4 (3,0 to 9,6); p<0,0001) and intraventricular hemorrhage (OR 3,9 (2,2 to 7,1); p<0,0001). Favorable outcome at first month (mRS < or = 2) had 45% of the surviving patients with ICH. The best outcome was for the patients with cerebellar hemorrhage (63%), while only 40% of the patients with hemorrhage in internal capsule/basal ganglia region had Rankin scale 2 or less. Hypertension is the most frequent risk factor in patients with ICH. ICHs are mainly localized in lobar and internal capsule/basal ganglia regions. Independent predictors of mortality following ICH are age, hypertension, intraventricular blood extension and stroke severity. Mortality, as well as good outcome at 1 month, is related to the localization of bleeding.

The aim of this study was to analyze: frequency of balance disorder (vertigo and disequilibrium), frequency of abnormalities in auditory evoked potentials (AEP) and magnetic resonance imaging (MRI) changes of the brain in multiple sclerosis (MS) patients with balance disorder, relation of patient's disability status to balance disorder and relation of the changes in MRI of the brainstem to AEP abnormalities. It was analyzed 60 patients with relapsing-remitting form of MS. Two groups of patients were made consecutively under Expanded Disability Status Scale score (EDSS): A (EDSS < or =4,5) and B (EDSS > or =5,0). The study was retrospective-prospective. After the neurological exam AEP and MRI of the brain have been done. Balance disorder has been verified as initial symptom in 29 (48,4%) and out of them disequilibrium experienced 24 (83,4%) patients. During the relapses balance disorder experienced 48 (80%) patients and in 37 (77,1%) it was disequilibrium. Among them 33 (68,7%) were with lower EDSS (< or =4,5) and 15 (31,3%) with higher EDSS score (> or =5). There is no correlation between disability status and vertigo which means that vertigo is not more frequent in more disabled patients and vice-versa. The AEP were pathological in 57 (95%) patients. Of all 29 patients with vertigo AEP were pathological in 28 (96,5%) while in 31 patients without vertigo pathological AEP were in 29 (93,5%) but it is not statistical significant. The most frequent characteristic of AEP changes were prolonged inter-peak latency III-V waves (48 patients or 80%). The plaque in brainstem visualized by MRI was found in 41 (71,8%) of patients (38 or 92,6% of them had pathological AEP and in three patients AEP were normal). In group of patients with pathological AEP, 38 (66,6%) of them had plaque in brainstem. In other three patients with normal AEP it was visualized plaque in brainstem. In the group of 29 patients with balance disorder, 20 (68,9%) had plaque in brainstem as well as 21 (67,7%) out of 31 patients without balance disorder had plaque in the brainstem. This difference is not statistical significant. It is concluded that the vertigo (including disequilibrium) is relatively often (48,4%) initial symptom of MS. Vertigo is not more frequent in patients with higher EDSS score and vice-versa. Pathological AEP are frequent neurophysiologic finding in both (95%) patients with (96,5%) and without (93,5%) vertigo. The most often pathological characteristic of AEP are prolonged interpeak latency of III-V waves (78,5%), as well as abnormalities of V and than IV wave. MS plaques in brainstem visualized by MRI technique are frequent in both groups of patients with and without pathological finding of the AEP.

Guillain-Barre syndrome (GBS) is an acquired immune-mediated inflammatory disorder of the peripheral nervous system. GBS is also called acute idiopathic polyradiculoneuritis. Cranial nerves are affected in over 50% of all cases, with the facial nerves being affected the most. Otherwise, oculomotor nerves affection is rare and might occur in about 10% of cases. In this case report we present 61 years old female with GBS (acute motor and sensory axonal neuropathy subtype) associated with bilateral oculomotor nerve palsy. At the admittance in the neurological status were flaccid paraplegia, tendon reflexes absent at legs and reduced at arms, sensory disturbances in a distal (stocking-glove) distribution and bilateral ptosis. The disease was diagnosed on clinical features, nerve conduction velocity test (NCV), electromyogram (EMG) and cerebrospinal fluid (CSF) tests. After treatment with intravenous immunoglobulins and physical treatment the patient improved. She was able to walk by her own, mild semiptosis remained and she had no paresthesia.

Background: Majority of Bosnia-Herzegovina (BH) residents were exposed to cumulative traumatic events during and after the (1992-1995) war, which demanded emergency organizing of psychosocial support as well as psychiatric-psychological treatment of psychotraumatized individuals. Objectives: To describe organizing of psychosocial help during and after the BH war, institutional treatment of psychotraumatized in the frame of mental health service reform program with an overview on the model of psychosocial support and psychiatry-psychological treatment of psychotraumatized persons of Tuzla Canton region. Subjects and methods: The retrospective analysis of functioning in the Department for traumatic stress disorders on the Psychiatry Clinic in Tuzla for the 1999-2003 period has been described in regard of number, gender, age and trauma related mental disorders of referred patients. Results: In the observed period, 8.329 of patients in the outpatient care program were included, 617 of inpatients were treated in the Clinic, while 301 of patients in the Partial hospitalization program were included. Mean ± standard deviation of patients’ age was 45±8.06 years. More psychotraumatized women (60.8%) were encompassed in the partial hospitalization program than in inpatients (23.9%) or outpatients (18.3%) care programs. In regard of trauma related mental disorders, majority outpatients had Posttraumatic stress disorder (PTSD) in co morbidity with other mental disorders (72.5%), PTSD was presented amongst the majority of inpatients (64.5%) and in partial hospitalization program there were (47.5%) patients with PTSD. Conclusions: In the treatment of psychotraumatized persons, in the organizing of health care system schema in postwar Bosnia and Herzegovina, meaningful obstacles are presented still today on the both, social and political level, despite mental health service reform performed in Bosnia-Herzegovina. The stigmatization of mental health issues is an important problem in treatment of traumatized individuals especially among war veterans. The lack a single Center for psychotrauma in postwar BH shows absence of political will in BH to resolve the problem of war veterans with trauma related psychological disorders.

Body dissatisfaction can be defined as a perceptive component of body image, as a difference between ideal body and a current body size. Body dissatisfaction is present not only in women who have eating disorders but in non-clinical population as well and to such extent that many American psychologists consider it a normative aspect of women's identity. The goal of this study was to investigate the presence of body dissatisfaction in non-clinical population of women in Bosnia and Herzegovina and to determine the differences in the level of body dissatisfaction between younger and mature women. It was predicted that body dissatisfaction would be present in women regardless of their age and that young women would demonstrate higher levels of body dissatisfaction than older women. 215 women were divided into young (≥25) and mature (≤40) groups and completed Stunkard's body figure rating scale and a demographic questionnaire. Results were consistent with the hypothesis. Women showed body dissatisfaction while age showed to be a significant factor. Socio-cultural perspective on body dissatisfaction was used in discussing the results.

The objective of the study was to analyze the quality of life six months after stroke in survivors under sixty years of age, to determine which life activities was the most affected, as well as to correlate the neurological insufficiency and the quality of life. It monitored 200 stroke survivors under sixty years of age treated at the Department of Neurology, University Clinical Centre Tuzla. Average age was 51,83 years (+/-7,02). The ischemic stroke was diagnosed in 77,5% stroke survivors, cerebral hemorrhage in 15%, and subarachnoid hemorrhage in 7,5%. Five stroke survivors suffered hemiplegia (2,5%), 24 (12%) experienced moderate consequences and 143 (71,5%) had mild consequences. No neurological deficit had 28 (14%) stroke survivors. Six months after the onset of disease all stroke survivors have been followed-up and evaluated about quality of life by filling in a modified questionnaire: Questionnaire on Quality of Life after Stroke (2). The questionnaire contained 20 questions covering four fields of life: Working Ability, Home Activity, Family Relations and Leisure Activities. Six months after the onset of stroke a worse quality of life in comparison to the period before the disease was noted in 172 (86%) stroke survivors, the unchanged in 19 (9,5%) and better in 9 (4,5%). The most affected is the field "Leisure Activities", followed by "Family Relations", "Home Activity", and the least affected is "Work Ability". The neurological deficit significantly correlates to the "Home Activities" and "Leisure Activities".

AIM To assess the frequency of silent brain infarcts and cerebral cortical atrophy in psychiatric patients with cognitive dysfunction. METHODS One hundred and ninety four patients with cognitive dysfunction determined by the use of the Benton Visual Retention Test and Wechsler Memory Scale were analyzed according to age, gender, education, duration of psychiatric treatment, presence of mental disorders, neurological findings, and CT scan of neurocranium. The results were analyzed using descriptive statistics. RESULTS Average age of the group of patients studied was 48+/-9.7 years, and average duration of psychiatric treatment was 6+/-7.3 years. Regarding mental disorders, patients suffered from posttraumatic stress disorder (PTSD) in comorbidity with depression (21.1%), depressive disorder (14.4%), Complex PTSD (13.9%), PTSD (11.3%), and post-concussion syndrome (7.7%). Cerebral cortical atrophy was determined in 47.4%, silent brain infarct in 3.6%, whereas the combination of cerebral cortical atrophy and silent brain infarct was found in 26.3% of patients. In 22.6% of patients with cognitive dysfunction on the Benton Visual Retention Test and Wechsler Memory Scale CT scan findings were completely normal. Cerebral cortical atrophy was more frequent in patients with PTSD in comorbidity with depression (43%), PTSD (39.0%), Complex PTSD (26%), depression (25%), whereas the silent brain infarct was more frequent in patients with post-concussion syndrome (53.3%) and depression (42.8%). CONCLUSION Cerebral cortical atrophy and silent brain infarct are frequent findings in computerized tomography of the brain in psychiatric patients with cognitive dysfunction. Cerebral atrophy is frequent in patients with PTSD, whereas in patients with depression, besides cerebral atrophy, silent brain infarct is also frequently present.