AIM To evaluate localization of certain zones of craniocerebral trauma and determine their importance for genesis ofposttraumatic epilepsy. PATIENTS AND METHODS Study encompassed 50 war veterans, with craniocerebral trauma and posttraumatic epilepsy. Control group included 50 war veterans, with war craniocerebral injury who have not experienced epileptic seizures. The craniocerebral trauma zone in every patient was registered by computerized tomography (CT) of the brain at the Clinic for Radiology of the University Clinical Centre Tuzla. For statistical analysis it was used chi2 test. RESULTS Average age in examinees' group was 29.92 (+/- 8.91); while in control group was 29.98 (+/- 9.97) (p > 0.05). Both, injury at several lobes and post-traumatic epilepsy were registered in 22 (44%) patients as well as in 8 (16%) patients in control group, which represents extra statistical significance (p < 0.05). Frontal lobe trauma in examinees' group had 7 (14%) patients and 15 (30%) patients in control group (p > 0.05). Temporal lobe trauma in examinees group had equal number of patients 6 in each (12%); parietal lobe injury was found in 14 (28%) patients with epilepsy and 11 (22%) patients without posttraumatic epilepsy (p > 0.05). Occipital lobe injury had one patient with posttraumatic epilepsy (2%) and 10 (20%) veterans in control group (p < 0.05). CONCLUSION Trauma of several brain lobes at the same time increases the possibility of posttraumatic epilepsy. Trauma of certain brain lobes is not significant risk factor for posttraumatic epilepsy, but trauma of occipital lobe is significantly more represented in group of patients without posttraumatic epilepsy.

Neuropsychology includes both the psychiatric manifestations of neurological illness (primary brain-based disorders) and neurobiology of "idiopathic" psychiatric disorders. Neurological primary brain disorders provoke broad spectrum of brain pathophysiology that cause deficit sin human behaviour, and the magnitude of neurobehavioral-related problems is a world wide health concern. Speech disorders of aphasic type, unilateral neglect, anosognosia (deficit disorders), delirium and mood disorders (productive disorders) in urgent neurology, first of all in acute phase of stroke are more frequent disorders then it verified in routine exam, not only in the developed and large neurological departments. 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. Unilateral neglect is a disorder that mostly effects the patient after the lesion of the right hemisphere, mostly caused by a cerebrovascular insult (infarct or haemorrhage affecting a large area - up to two thirds of the right hemisphere), and in general the left-side neglect is the most widespread neuropsychological deficit after the lesion of the right cerebral hemisphere. Reports on the incidence of visual neglect vary and they range from 13 to 85%. Anosognosia is on the second place as neuropsychological syndrome of stroke in right hemisphere, characterized by the denial of the motor, visual or cognitive deficit. This syndrome, defined as denial of hemiparesis or hemianopsia, is a common disorder verified in 17-28% of all patents with acute brain stoke. There are different reports on frequency of delirium in acute stroke, from 24 to 48%, and it is more frequent in hemorrhagic then ischemic stoke. Post stroke depression (PSD) is one of the more frequent consequences on the stroke, and the prevalence of PSD has ranged from 5 to 63% of patients in several cross-sectional studies, peaking three to six months after a stroke.

Although many aspects of stroke are similar at both sexes, however, there are some differences and characteristics as well. The aim of this study was to analyze sex differences in patients with acute ischemic stroke (IS) regarding to risk factors, subtypes, stroke severity and outcome. From January 1st 2001 to December 31st 2005 at the Department of Neurology Tuzla 2833 patients were admitted with acute ischemic stroke (IS). We were analyzed risk factors, subtypes, stroke severity (Scandinavian Stroke Scale), and thirty-day outcome. There were 1484 (52.3%) female, and they were older than male (67.8 +/- 10.6 vs. 65.7 +/- 10.5, p<0.0001). Hypertension (78% vs. 67%, p<0.0001), heart diseases (50% vs. 45%, p=0.009), atrial fibrillation (22% vs. 14%, p<0.0001) and diabetes mellitus (33% vs. 21%, p<0.0001) were frequently in female, while smoking (45% vs. 14%) and alcohol overuse (18% vs. 0,6%) in male (p<0.0001). Atherothrombotic type of ischemic stroke was frequently in male (37.4% vs. 31.6%, p=0.0013) and cardioembolic in female (21.7% vs. 15.5%, p<0.0001). At admission female had lower SS (SS 31.0 +/- 15 vs. 34.0 +/- 15, p<0.0001). Thirty-day mortality was significantly higher in female (23.3% vs. 18.4%, p=0.0015), and favourable outcome within one month (Rankin Scale <or= 2) had 58% male and 51% female (p=0.001). The frequency of ischemic stroke is higher in female who are older than male. There are some sex differences according to the distribution of risk factors and subtypes of ischemic stroke. Stroke severity at admission, thirty-day mortality, and disability are higher in female.

For thousands of years it has been known that aggression as a symptom appears in numerous psychiatric disorders and diseases. During the last decade the appearance of the aggressive behavior related to the posttraumatic stress disorder (PTSD) has been frequently investigated, often associated with war trauma. The goal of this study is to analyze the impact of alcoholism on a way war veterans suffering from chronic PTSD express and control aggression. The sample included 240 war veterans with chronic PTSD. The subjects were divided in two groups. PTSD group (n=147) and controlled group composed of those suffering from alcoholism in addition to PTSD (n=93). In this study, the following psychological instruments were used: The Harvard trauma questionnaire for PTSD diagnosis (HTQ); the questionnaire for self-evaluation of aggression (STAXI); The Profile Index Emotion (PIE); questionnaire for auto-diagnosis of alcoholism (CAGE). The obtained results indicate that subjects who have PTSD with co-morbid alcoholism are more deprived, aggressive (p < 0.001) and oppositional (p < 0.05) in comparison to subjects whose PTSD is not combined with alcoholism (PIE). The aggression is statistically more expressed in subjects with PTSD who have also been diagnosed with alcoholism on all subscales in comparison to subjects with PTDS who have not been diagnosed with alcoholism: the current state of aggression, the general state of aggression, aggression towards an unfair treatment, aggression directed inwards and outwards (p < 0.001); aggression towards nonspecific provocation and a general way of expressing aggression (p < 0.05) (STAXI). Subjects that had PTSD combined with alcoholism show a higher degree of aggression in comparison to subjects with PTDS who are not diagnosed with alcoholism.

The aim of this study was to determine the prevalence of alcohol abuse and alcoholism in the general population of Mostar region, Bosnia and Herzegovina. This study was conducted on a stratified sample of 704 participants. The prevalence of alcohol abuse was determined using standardized questionnaire on alcohol consumption--Michigan Alcoholism Screening Test. Prevalence of alcohol abuse with high risk for alcoholism was 9.9% and prevalence of alcohol addiction was 2.1%. In student population, there were 3.9% of alcohol addicts and 11.1% of persons with high risk of alcoholism. In high school population, there were 1.7% of alcohol addicts and 14.4% of persons with high risk of alcoholism. In Mostar region there was a high prevalence of alcoholism and problematic drinking, especially in high school and student population. There is a need for extensive preventive measures that have to include education, early diagnosis and intervention.

In clinical electromyography (EMG) musculus extensor digitorum brevis (MEDB) is known as "the marker" for L5/sl radiculopathy. Radiculopathy is mainly sensory syndrome in which the pain appears in innervation's zone of one or more spinal nerves. Moreover, in clinical practice it is also known that radiculopathy is not only sensory disorders but also may be followed by muscle weakness and atrophy. Since atrophy of MEDB is often seen clinical feature in careful neurological exam of the patients with lumbosacral radiculopathy, it is made attempt to determine usefulness of this sign, for clinical diagnosis of radicular lesions. For this purpose 100 patients with lumbosacral radiculopathy and MEDB atrophy and 100 patients with low back pain have been studied. Control group consisted of 50 healthy volunteers. The patients underwent neurological examination, CT scan of lumbosacral region and EMG including motor conduction velocity (MCV) of deep peroneal nerve (DPN), F-wave and H-reflex analysis. The most patients in first group had moderate and severe radicular lesions of radix L5/sl proved by EMG examination. MCV in DPN on atrophy side was 43.4+/- 2.65 m/sec, and on side without MEDB atrophy 47.18 +/- 1.63 m/sec (p < 0.001). MCV in control group was significantly higher then in both group of patients (left side - 47.65 +/- 1.53 m7sec: right side--47.70 +/- 1.59 m/sec) (p < 0.001). Significant correlation between the MEDB atrophy and MCV (r = -0.67) and F-wave latency (r = 0.86) and H-reflex latency (r = 0.87) has been proved. It is concluded that MEDB atrophy is very important parameter in clinical evaluation of patients with lumbosacral radiculopathy and could be clinical and electrophysiological marker for L5/Sl radicular lesions.

Slika 1. Klinika za plućne bolesti prije adaptacije i formiranja hospisa

INTRODUCTION The term «palliative» has its origins in Latin, from the Latin word pallium, meaning robe, cover, veil or coat. And indeed, in the palliative care the symptoms are “hulled”, “covered” with different treatments in order to increase the patient’s comfort or to remove unease, just like a coat shields the body from rain or cold. The word «hospice» is often used in the context of palliative care, and although it is used in several meanings (it sometimes refers to a building – «St. Christopher’s Hospice», sometimes to a group of people – «hospice team», and sometimes to a programme «hospice service»), hospice is first and most the elaboration of a philosophy that can be summarized, according to the Hospice Association of Southern Australia, as follows: «The hospice care accepts death as a normal process and understands it as the last life phase of the dying person, as a special time for integration and conciliation. It furthermore accepts the need of the dying to live a full, proud and comfortable life up to their death, it does not hasten nor defer death. And finally, it secures support to the grieving family and friends.» The term hospice also originates from the Latin word expressing welcome, hospitality to a stranger, the warm feeling between the host and the guest. It is interesting that palliative care and hospice are mostly connected with malignant diseases (in the perception of the general public, of lay persons, of health care workers and also in technical and scientific literature), although many other (non-malignant) internal or neurological diseases can and must be treated with “palliative” and/or “hospice” methods. According to a recent analysis of papers published in three important journals dealing with palliative care (from Great Britain, Canada and the USA), the most common primary interest of authors is the advanced malignant disease. Less than 5% of papers deal with non-cancerous states, mostly with respiratory, cardiac and renal diseases. The only neurological representative is the amyotrophic lateral sclerosis (ALS). On the other hand, the texts and articles published in the neurology field mostly deal with diagnostic procedures and the active treatment of diseases, they rarely include states related to the care of the neurological patient at the end of his life, the effective treatment of symptoms in the advanced stage of the disease. This is a problem in itself in need of a different approach so that neurologists, but also other doctors (e.g. general pracTHE DEVELOPMENT OF PALLIATIVE CARE AND DEVELOPMENT PERSPECTIVES OF PALLIATIVE NEUROLOGY IN TUZLA

The aim of the study was to analyze the usefulness and side effects of treatment with interferon beta 1B (Betaferon) in patients with the relapsing-remitting form of multiple sclerosis (RRMS). The study included 32 RRMS patients that had completed two-year therapy with interferon beta 1B or were still receiving this therapy. Every six months, patients were clinically evaluated and scored by the Expanded Disability Status Scale (EDSS). Two-year therapy was completed by 11 (34.3%) of 32 RRMS patients. Relapse was verified in 4 (36.36%) patients. The mean EDSS score was 2.45 +/- 1.03 at the beginning of therapy and 2.54 +/- 0.98 after two-year therapy; the difference was not statistically significant. In 2 (6.25%) patients on therapy for 18 months there was no relapse, and the mean EDSS was 1.75 +/- 0.35 (both at therapy introduction and at 18 months). Five (15.62%) patients were on therapy for one year. The mean EDSS was 1.6 +/- 1.08 at the beginning of therapy and 1.5 +/- 0.70 at one year. One patient experienced relapse. Two patients were on therapy for six months. They had no relapses with the same EDSS at six months as at therapy introduction (2.0). At the beginning of 2008, another 12 patients started therapy with interferon beta 1B. In conclusion, our experience with two-year interferon beta-1B therapy for RRMS is favorable, with a relatively low rate of relapses (36.36%) and without significant worsening on EDSS. The medication side effects were mild and transient.

OBJECTIVE To analyze the frequency, gender and age distribution, risk factors, and hospital mortality of different types of hospitalized patients with stroke. METHODS In this retrospective study, we analyzed the hospital records of 3864 patients with first-ever stroke admitted to the Department of Neurology, University Clinical Center Tuzla, Bosnia and Herzegovina, from January 2001 to December 2005. RESULTS Out of the total number of patients, 2833 (73.3%) had ischemic stroke (IS) 612 (15.8%) intracerebral hemorrhage (ICH), 163 (4.2%) subarachnoid hemorrhage (SAH), and 256 (6.6%) had unknown stroke. The mean age was 68+/-10 years in females, and 65+/-11 years in males (p=0.000). Overall, there were 2045 (53%) women (p=0.000). Women suffered from cardioembolic stroke more than men (21.7% versus 15.6%, p=0.000), and men were more affected by atherothrombotic stroke (37.4% versus 31.6%, p=0.000). The leading stroke risk factors were hypertension (70%), heart diseases (40%), smoking (28%), and diabetes mellitus (21%). The total hospital mortality was 29.6%, and hospital mortality in patients with IS was 20.6%, ICH 43.8%, and SAH 26.4%. CONCLUSION Women are older than men in all types of stroke. The leading risk factors for both genders are hypertension and heart diseases. The hospital mortality rate is lower than 30%.