Introduction: Rehabilitation of patients after the stroke is very demanding and complex process, because in addition to damage of motor functions, the patients suffer from the range of other dysfunctions and complications. Timely and early initiation of rehabilitation treatment can reduce the degree of disability; it can result in increased mobility, independent functioning and shorter period of hospitalization. Aim: of this study was to determine the outcome of early rehabilitation treatment of patients suffering from ischemic and hemorrhagic stroke, in relation to their age, sex, degree of disability, and activities of daily living. Subjects and methods: This was a prospective study, which included 50 patients suffering from ischemic stroke and 50 patients suffering from hemorrhagic stroke. All patients were tested on admission and discharge from the hospital. Age and sex of the patients was analyzed, in addition to Rankin scale, used for evaluation of functional disability, and Barthel index used for evaluation of activities of daily living. Results and discussion: The outcome of early rehabilitation treatment was negatively influenced by the older age of patients (p=0.03). Males showed significantly better functional recovery from females (p=0.03). The values of Rankin scale and Barthel index showed significant recovery in all patients on discharge ((p< 0.001), however, these values were statistically more significant in patients with hemorrhagic stroke (Rankin scale p=0.03; Barthel index p=0.04). Conclusion: Older age of patients negatively affects the outcome of early rehabilitation treatment. Male stroke patients showed better results of early rehabilitation treatment. The degree of disability is significantly reduced, while the degree of activity of daily living is significantly improved with the early rehabilitation treatment. However, this was more prominent in patients suffering from hemorrhagic stroke.

UNLABELLED THE AIM of this study was to analyze the fall frequency and some of its characteristics in hospitalized acute stroke patients. PATIENTS AND METHODS It was analyzed 1809 acute stroke patients hospitalized at the Department of Neurology in period of one year. A fall was defined as any unplanned "touch to the floor" of any part of a patient's body, excluding the feet. RESULTS Out of 1809 acute stroke patients, 1544 (85.35%) had cerebral infarction (CI) and 265 (14.65%) intracerebral hemorrhage (IH). In group of patients that fell (61/3.3%), 49 (80.33%) had infarction and 12 (19.67%) (p = 0.25) had hemorrhage. Out of 61 patients that fell, 42 (68.86%) suffered from impaired spatial orientation and 47 (77.05) were aphasic. The neurological deficit, impairments of spatial orientation and presents of aphasia were highly correlated with falls (p < 0.001). The most frequent falls occurred by night night (38 or 62.29%) and in the first five days of hospitalization (44 or 72%). In most cases (52%) the falls caused minor injuries like contusion and lacerations of skin and did not require special medical treatment. CONCLUSION Hospitalized acute stroke patients have no high risk of falling (3.3%), and the incidence of serious injury is low. The falls are more frequent in the first five days of hospitalization (72%) and occur mostly during the night (62.29%). Severity of neurological deficit, impaired spatial orientation and aphasia are highly correlated with falls.

Wallenbergs syndrome (also called lateral medullary syndrome and posterior inferior cerebel- lar artery/PICA syndrome) is neurological condition caused by a stroke in the teritory of posterior inferi- or cerebellar artery vascularisation. In this report we presented a case of 45 years old women who was ad- mitted at our Clinic due to sudden onset of dizziness, nausea and vomiting, as well as nystagmus and un- steadiness gate. By computerized tomography (CT) of the brain it was visualized ishemic lesion in righ cer- ebellar hemisphere, but clinically also posible brainstem lesion (numbness of the rihgt side of the face, diffi - culties with swallowing) was confi rmed by magnetic resonance (MR) imaging of the brain. Th is case report emphasizes the importance of correlation between clinical fi ndings and anatomic localisation of lesions vi- sualized by CT and MR imaging.

BACKGROUND To assess the expression of psychosocial problems among children of parents with posttraumatic stress disorder (PTSD). MATERIAL AND METHODS A group of 100 children of school age (from 10 to 5 years old) from two randomly chosen schools has been analyzed. Children from complete families whose parents accepted psychometric measurement related to trauma have been chosen. Subjects were divided into two groups: a group of children whose parents express the symptoms of posttraumatic stress disorder (PTSD)-experimental group (N = 50) and group of children whose parents are not suffering from PTSD-control group (N = 50). The assessment of PTSD symptoms and parental traumatisation is done by Harvard Trauma Questionnaire-version for Bosnia and Herzegovina (B&H) (Allden et al., 1998), behavioral problems were assessed by Child Behavior Checklist--as reported by parents (CBCL, Achenbach, 1991), the level of traumatisation and posttraumatic symptoms in children by the Impact of Event Scale (Horowitz, Wilner, Alvarez, 1979), and neurotism and extraversion is estimated by Neurotism and Extraversion Scale (HANES). With regard to gender and parental participation the sample is homogenous. Data are processed by descriptive statistics method. RESULTS Children whose parents are suffering from PTSD symptoms show statistically significant increase in behavioral problems such as withdrawal, somatic complaints, thought problems, delinquent and aggressive behavior (p < 0.001), anxiety/depression, attention deficit and problems in social relations (p < 0.005). Male subjects showed more prominent delinquent behavior (p < 0.01). Children whose parents have PTSD symptoms show significantly expressed internalisation (p < 0.001) and higher level of stress (Chi2 = 23.528, p < 0.001), compared to children of parents without PTSD. There is statistically significant difference regarding the mean (M) of symptom groups among the analyzed groups of subjects related to the symptoms of intrusion (p < 0.01) and symptoms of avoidance (p < 0.001). Significantly expressed neurotism is present in children of parents with PTSD (p < 0.001). CONCLUSION The results show that children of parents with PTSD express a significant behavioral problems, higher level of neurotism, internalisations, posttraumatic stress reactions, symptoms of intrusion and avoidance as well as significantly higher level of stress compared to children of parents without PTSD.

The aim of the research is to examine depression in parents of children with cerebral palsy, with hypothesis to have more depressive symptom among mothers of children with cerebral palsy. The sample of examinees (between 23 and 62 age) was used in this research. The first subsample of examinees (N=23) was made of mothers (average 33±5.83) of children with cerebral palsy. The second subsample of examinees (N=12) was made of fathers of children with cerebral palsy (average 38±9.8). The third subsample of examinees (N=16) represented the control group, and it was made of mothers of children without disorders (average 38±6.57). For the purpose of quantitative measurement of depression, the Zung self-evaluated method for depression was applied. All data research were processed by parametric and nonparametric statistics. The frequencies and percents were also calculated, and Kruskal-Valis single-factor analysis of variants was applied for checking the hypothesis. According to the results of this research, it was concluded that there was no statistically significant difference in the evaluation of depression between mothers and fathers of children with cerebral palsy, as well as there is no statistically significant difference in relation to mothers of children without disorders.

The aim of the study was to determine the incidence and types of speech disorders in patients with acute stroke. The study was performed in 936 acute stroke patients admitted to University Department of Neurology, Tuzla University Clinical Center, in the period from January 1, 2007 through December 31, 2008. Out of 936 study patients, speech disorders were verified on admission in 771 (82.37%) patients. Dysarthria was present in 540 (57.69%) and aphasia in 231 (24.67%) patients. In the group with speech disturbances, dysarthria was present in 70.04% and aphasia in 29.96% of patients. During hospital stay, lethal outcome was recorded in 51 patients, significantly higher in the group with speech disorders (P = 0.004). At discharge from the hospital, speech disorders persisted in 671 (75.81%), dysarthria in 468 (69.75%), and different types of aphasia in 203 (30.25%) of 885 surviving patients. Among patients with aphasia at both admission and discharge, global aphasia was most common, followed by motor aphasia (Broca's aphasia) and nominal aphasia. Although the rate of patients with speech disorders was lower at discharge, the difference was not statistically significant. On admission, 82.37% of patients were considered to have a speech-language disorder, dysarthria being most common. Concerning the type of aphasia, global aphasia was most frequent. Study results suggested the importance and need of speech-language therapy in the early rehabilitation of post-stroke patients; it should be initiated during their hospital stay and continued at long-term.

BACKGROUND Increased activity of angiotensin-converting enzyme (ACE) in the blood and cerebrospinal fluid of patients with multiple sclerosis (MS), and the inhibition of ACE in experimental autoimmune encephalomyelitis, suggested that ACE may play a role in the pathogenesis and progression of MS. We recently published the first report on the potential association of MS and ACE I/D polymorphism in Slovenian and Croatian patients with MS, in which it was shown that the DD genotype might contribute to a higher risk of developing MS in men. To confirm these findings in a similar ethnic population, we analyzed ACE I/D gene polymorphism in patients with MS from Bosnia and Herzegovina. SUBJECTS AND METHODS One hundred and seventy patients with MS and 170 healthy controls were genotyped by the polymerase chain reaction method. RESULTS There was no significant difference in the distribution of ACE I/D genotypes (p=0.783) or in the allelic frequencies (p=0.538) between patients with MS and control subjects. When patients with MS were stratified by sex, no statistically significant differences in allele or genotype distributions were observed. Finally, there was no indication of an impact of the ACE I/D genotype on disease course or severity. CONCLUSION The ACE I/D polymorphism is not a risk factor for development of MS, nor does it contribute to disease severity in this Bosnia and Herzegovina population.

Objective. To examine whether short-term postnatal health-related quality of life differed among women after different methods of cesarean sections. Methods. One hundred forty-five women were evaluated with previous CS (85 by Misgav Ladach and 60 by Pfannenstiel–Dörffler). Short-time quality of life was measured using the Croatian version of Short Form Health Survey (SF – 36). Short-term postoperative recovery was assessed using two criteria: febrile morbidity and degree of pain. Incidence of peritoneal adhesions was assigned using Bristow scoring system. Results. Four weeks after delivery women with previous Misgav Ladach cesarean section significantly scored higher on the bodily pain (72.4 vs. 56.7, p < 0.05), social functioning (71.5 vs. 60.4, p < 0.05), and the vitality (61.7 vs. 50.3, p < 0.05) subscales. These differences disappeared in the second assessment (12-weeks postpartum) except in the bodily pain (74.7 vs. 61.2, p < 0.05) subscale. There was a significant trend toward a higher requirement for postoperative analgesics in the Pfannenstiel–Dörfler group (doses: 5.4 vs. 8.7, p < 0.05; hours: 17.9 vs. 23.3, p < 0.05), and they had a significantly higher rate of febrile morbidity than the Misgav Ladach group (5.7 vs. 9.4%, p < 0.05). Hospitalization time was reduced in the Misgav Ladach group (4.2 vs. 7.3, p < 0.05). The incidence of adhesions was significantly lower in patients who had undergone a previous operation using the original Misgav Ladach method (0.47 vs. 0.77, p < 0.05). Conclusion. Misgav Ladach cesarean section method might lead to better short-time quality of life resulting in reducing postoperative complications compared to Pfannenstiel–Dörfler cesarean section method.

Abstract: Psychological trauma and post-traumatic stress disorder (PTSD) may have an intensive negative impact on a patient‟s spiritual beliefs or his/her belief in God; this effect may diminish the social and professional skills of many survivors. In the same time researches showed that religion plays a coping role among patients with medical and mental health illnesses. During the war in Bosnia-Herzegovina (1992-1995) the whole population, regardless of age, gender, nationality or profession, suffered severely. During the pre-war period in communistic Yugoslavia religious believes altered with atheistic public life styles. Additionally, war traumatization had a negative impact on spirituality and religious beliefs. In the series of case reports we intended to describe and assess the impact of a session of group psychotherapy, with spiritual topics and content, which was offered to patients who needed to reestablish religious beliefs. The patients who come to the Psychiatry Clinic because of trauma-induced mental health problems and who we are interested in strengthening their spirituality met each other in the group regardless of their religious or spiritual conviction. We described the conceptualization and development of such a group and present some self-reported views of clients who took part in these groups. The supportive and empathetic presence of such group in the community helps to prevent withdrawal and isolation, alienation and deviation of traumatized persons. The presence of

4 th international epilepsy symposium in Pula – how to start seizure treatment Stroke is the third most common cause of death worldwide (after coronary heart disease and all cancers combined) and the major cause of disability. Th e incidence of stroke varies somewhat from region to region, but has been accurately measured in only a few populations. In western countries incidence for people aged 55 years or more ranges from about 4.2 to 6.5 per 1000 pupulation per annum. Approximately 20% of stroke patients die within one month and about 30% within one year.About one-third remain disabled; the remaining third either recover fully or regain independence of daily living. Post-stroke language disorders are frequent and include aphasia, alexia, agraphia and acalculia. Th ere are diff erent defi nitions of aphasias, but the most widely accepted neurological and/or neuropsy-chological defi nition is that aphasia is a loss or impairment of verbal communication which occurs as a consequence of brain dysfunction. It manifests in impairment of almost all verbal abilities-abnormal verbal expression, diffi culties in understanding spoken or written language, repetition, naming, reading and writing. During the history, many classifi cations of aphasia syndromes were established. For practical use classifi cation of aphasias according to fl uency, comprehension and abilities of naming it seems to be most suitable (nonfl uent aphasias: Broca's, transcoritcal motor, global and mixed transcortical aphasia; fl uent aphasias: anomic, conduction, Wernicke's, transcorti-cal sensory, subcortical aphasia). Aphasia is common consequence of left hemispheric lesion and most common neuropsychological consequence of stroke, with prevalence of one third of all stroke patients in acute phase although exist reports on greater frequency. Many speech impairments have a tendency of spontaneous recovery. Spontaneous recovery is most remarkable in fi rst three months after stoke onset. Recovery of aphasias caused by ischemic stroke occurs sooner, and it is the most intensive in the fi rst two weeks. In aphasias caused by hemorrhagic stroke, spontaneous recovery is slower and occurs in the period from the fourth to the eighth weeks after the stroke. Th e course and the outcome of the aphasia depend a lot on the type of aphasia. Regardless of the fact that a significant number of aphasias spontaneously improves, it is necessary to start the treatment as soon as possible. Th e writing and reading disorders in stroke patients (alexias and agraphias) are more frequent ten it verifi ed in routine …

Post-stroke language disorders are frequent and include aphasia, alexia, agraphia and acalculia. There are different definitions of aphasias, but the most widely accepted neurologic and/or neuropsychological definition is that aphasia is a loss or impairment of verbal communication, which occurs as a consequence of brain dysfunction. It manifests as impairment of almost all verbal abilities, e.g., abnormal verbal expression, difficulties in understanding spoken or written language, repetition, naming, reading and writing. During the history, many classifications of aphasia syndromes were established. For practical use, classification of aphasias according to fluency, comprehension and abilities of naming it seems to be most suitable (nonfluent aphasias: Broca's, transcortical motor, global and mixed transcortical aphasia; fluent aphasias: anomic, conduction, Wernicke's, transcortical sensory, subcortical aphasia). Aphasia is a common consequence of left hemispheric lesion and most common neuropsychological consequence of stroke, with a prevalence of one-third of all stroke patients in acute phase, although there are reports on even higher figures. Many speech impairments have a tendency of spontaneous recovery. Spontaneous recovery is most remarkable in the first three months after stroke onset. Recovery of aphasias caused by ischemic stroke occurs earlier and it is most intensive in the first two weeks. In aphasias caused by hemorrhagic stroke, spontaneous recovery is slower and occurs from the fourth to the eighth week after stroke. The course and outcome of aphasia depend greatly on the type of aphasia. Regardless of the fact that a significant number of aphasias spontaneously improve, it is necessary to start treatment as soon as possible. The writing and reading disorders in stroke patients (alexias and agraphias) are more frequent than verified on routine examination, not only in less developed but also in large neurologic departments. Alexia is an acquired type of sensory aphasia where damage to the brain causes the patient to lose the ability to read. It is also called word blindness, text blindness or visual aphasia. Alexia refers to an acquired inability to read due to brain damage and must be distinguished from dyslexia, a developmental abnormality in which the individual is unable to learn to read, and from illiteracy, which reflects a poor educational background. Most aphasics are also alexic, but alexia may occur in the absence of aphasia and may occasionally be the sole disability resulting from specific brain lesions. There are different classifications of alexias. Traditionally, alexias are divided into three categories: pure alexia with agraphia, pure alexia without agraphia, and alexia associated with aphasia ('aphasic alexia'). Agraphia is defined as disruption of previously intact writing skills by brain damage. Writing involves several elements: language processing, spelling, visual perception, visuospatial orientation for graphic symbols, motor planning, and motor control of writing. A disturbance of any of these processes can impair writing. Agraphia may occur by itself or in association with aphasias, alexia, agnosia and apraxia. Agraphia can also result from 'peripheral' involvement of the motor act of writing. Like alexia, agraphia must be distinguished from illiteracy, where writing skills were never developed. Acalculia is a clinical syndrome of acquired deficits in mathematical calculation, either mentally or with paper and pencil. These language disturbances can be classified differently, but there are three principal types of acalculia: acalculia associated with language disturbances, including number paraphasia, number agraphia, or number alexia; acalculia secondary to visuospatial dysfunction with malalignment of numbers and columns, and primary anarithmetria entailing disruption of the computation process.

Skripta sadrže cjelovit pristup klinickom prepoznavanju, dijagnostici i molekularnoj potvrdi facioskapulohumeralne misicne distrofije.Narociti naglasak je bio na novim saznanjima molekularne osnove o cemu je pisao i govorio pozvani predavac na nasem tecaju I kategorije i eminentan znanstvenik na podrucju istraživanja FSHD dr.Richard J.L.F.LEMMERS iz Leiden Univ. Medical Center, Dept of Human Genetics