Ischemic stroke (IS) is defined as rapid development (focal or global) of clinical signs of brain function disorder with symptoms lasting 24 hours or longer, or leading to death, without other clear causes except destruction of blood vessel.1 Anxiety does occur in patients with IS, but not in those with intracerebral hemorrhages.2 Astrom found symptoms of anxiety in 28% of patients in acute phase of stroke.3 The aim of this study was to analyze anxiety in patients within 48 hours (hyperacute and acute phase) and 15th day (subacute phase) after the IS in relation to gender and location of the lesion. PATIENTS AND METHODS

Aim: To determine the frequency of delirium in patients with acute stroke. Patients and methods: We assessed delirium prospectively in a sample of 233 consecutive patients with an acute (≤ 4 days) stroke using the Delirium Rating Scale R-98 and the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition criteria for delirium. Results: Delirium was diagnosed in 59 (25.3%) patients. Patients with delirium were older comparing to those without delirium (70.0±11.3 vs. 64.7±10.4 years of age; p=0.001). Delirium was significantly more frequent in hemorrhagic comparing to the ischemic type of stroke (41.6% vs. 22.3%, p=0.02). In patients with the ischemic stroke, the delirium was more frequent among those with right hemispheric lesion (26.2% vs. 20.5%, p=0.0006); however, in hemorrhagic stroke delirium was more frequent in patients with left hemispheric lesion (42.9% vs. 27.8%, p=0.002). Delirium was also more frequent in patients with ischemic stroke in the anterior than posterior cerebral circulation territory (22.7% vs. 5.6%, p=0.0001). Conclusion: Delirium develops in approximately one quarter of patients in the acute phase of stroke. Possible factors which predispose the occurrence of delirium are ages over 65 years, hemorrhagic stroke, ischemic stroke in anterior cerebral circulation, lesion of right hemisphere in ischemic stroke and left hemisphere in hemorrhagic stroke.

hospitalization. Ten patients could function independently and perform daily activities, with minor or more serious motor problems, while one patient needed help during movement. Upon release from the hospital, all patients took routine laboratory tests, including among other things liver enzyme values and creatine kinase. All tests showed normal values, and thus there was no need to terminate the Atorvastatin(Atorvox) therapy. Conclusions: Analysis of recorded cases during the urgent ICV treatment, regardless of the etiology (ischemic or hemorrhagic) showed that early Atorvastatin administration, practically immediately upon insult, in a maximum one-off daily dose of 80 mg is safe from the aspect of increase in liver enzyme values. Thus, there were no cases of hepatotoxicity related to myolysis cases recorded in literature, and creatine kinase was observed. The observed group was relatively small and the observance period too short, and thus the total assumed effect, given the farmacological effects, could not be fully evaluated.

Multiple sclerosis (MS) is the most common chronic inflammatory disease of the central nervous system affecting young adults. Although adults and children share important features of the disease, they also differ in some clinical, radiological and laboratory aspects. This review focuses on the neuroimmunological findings in the cerebrospinal fluid of children with MS pointing out that there is already at earliest time of clinical manifestation a neuroimmunological pattern, which differs only in intensity of the humoral immune response but not in frequency and does not support a neuroimmunological difference between early onset from adult onset MS. The humoral immune response with intrathecal IgG and IgM class response and the polyspecific production of antibodies against a wide range of antigens (MRZ antibody response) further helps to differentiate childhood MS from ADEM as the main differential diagnostic challenge. Introduction: Adult MS patients have a relapsingremitting (80%) and less frequently a primaryprogressive course of the disease (20%) (1). Children with MS have also a predominantly relapsing– remitting course. No reports on a primary-progressive course below the age of 10 years do exist. Even between 10 and 16 years of age a primary-progressive course of the disease is exceedingly rare (2). Children with MS have a longer disease duration until they enter a phase of secondary-progression compared to adults (2,3). Children with MS reach an expanded disability status scale (EDSS) 4 after a much longer time than adults (20.2 vs. 10.7 years), but are still significantly younger (median 31.6 years) than adults (median 41.1 years) when they suffer from significant disability (2,3). When children enter the phase of secondary progression they appear to follow the same time course as adults (3). Children more often than adults present initially with more than one functional system involved (4). In a cohort of 132 patients reported by Pohl and colleagues 67% of children with MS had a polysymptomatic manifestation (5). Cerebellar and brainstem symptoms in pediatric MS are more and pyramidal symptoms less frequent than in adults with MS (2,5). Children with MS have a higher relapse rate in the first 2 years, which in general correlates with a faster disease progression, than in adults (6). Before the age of 10 years a male preponderance exists. During and after puberty (between 15 and 16 years) several studies report a rise in the female/male ratio to 2.1:1 to 2.4:1, which is slightly higher compared to adults with MS (2,5). Of particular diagnostic relevance is the observation that children with MS often do not meet the McDonald MRI criteria for dissemination in space at the time of their first exacerbation or their MS diagnosis (7). This underscores the importance of other diagnostic features such as the presence of oligoclonal bands for an accurate diagnosis also in view of the broad differential diagnosis in pediatric MS. The most frequently considered differential diagnosis is acute dissem-

The aim of the study was to determine duration of delirium in patients with acute stroke according to sex, age, type and localization of lesion. We assessed delirium prospectively in a sample of 233 consecutive patients with an acute (< or =4 days) stroke using the Delirium Rating Scale (DRS-R-98) and Diagnostic and Statistical Manual of Mental Disorders (DSM IV). The average duration of delirium was 4 days in patients with ischemic stroke and 3 days in patients with hemorrhagic stroke. There was no statistically significant difference in delirium duration between these two patient groups. A longer duration of delirium was recorded in women and in patients older than 65. The period of delirium was longer in patients with right hemispheric lesions. Patients did not differ according to delirium duration, sex, age, type and localization of stroke. In two thirds of patients, the symptoms of delirium completely disappeared on medicamentous treatment, while in the remaining one third of patients certain symptoms of delirium persisted at discharge (p=0.003). Mortality rate was significantly higher in patients with delirium in the acute phase of stroke than in those without delirium (p=0.009). In conclusion, delirium is a temporary manifestation in two thirds of patients in the acute phase of stroke. Patient sex and age, and type and stroke localization have no influence on delirium duration.

Generally, Arnold – Chiari malformation associated with syringomyelia is not rare. In this case report we present a 52 years old female patient with a history of neck-pain, low-back pain, pain in both arms as well as frequent numbness in the lateral regions of both arms. She also experienced walk disturbance and in her previous history she reports a car accident, twenty-eight years ago. She broke windshield with her forehead, but remained conscious at the time. At the time of admittance at the Department of Neurology, her neurological status was remarkable for cerebellar symptomatology (ataxia, positive Romberg-sign, «finger–nose» test which she did with tremor and was not able to perform «tandem-walk»), hypoestesia of the right side of the body, hyper-reflection of both arms and legs, bilaterally, more pronounced at the right side; right foot subclonus and spastic-ataxic walk. Neurological status could not be explained by previously performed tests: x-ray of cervical spine, lumbal myelography, computerized tomography (CT) of the brain. However, magnetic resonance imaging (MRI) of the brain and cervical spine verified Arnold-Chiari malformation (type I) associated with syringomyelia from C3 to C7. Patient was referred to surgery and subsequent physical rehabilitation.

Bosnia and Herzegovina (BH) is located on the western part of the Balkan Peninsula. It has an area of 51 210 km2 and a population of 3 972 000. According to the Dayton Agreement of November 1995, which ended the 1992–95 war, BH comprises two ‘entities’ – the Federation of Bosnia and Herzegovina (FBH) and the Republic of Srpska (RS) – and the District of Brcko. The administrative arrangements for the management and financing of mental health services reflect this. The FBH, with 2 325 018 residents, is a federation of 10 cantons, which have equal rights and responsibilities. The RS has 1 487 785 residents and, in contrast, a centralised administration. Brcko District has just under 80 000 residents.

AIM The aim was to analyse contacts network and satisfaction with contacts among children of parents with post traumatic stress disorder (PTSD). SUBJECT AND METHODS The sample consisted of 100 pupils (age 10 to 15) from two randomly chosen schools. Children were selected from general population, lived with both parents who have had war traumatic experiences. They agreed to participate in psychometric research. We divided them in two groups: observed (0) group of children (N=50) whose parents were showing symptoms of post traumatic stress disorder (PTSD) and control (C) group of children (N=50) whose parents did not show symptoms of PTSD (evaluated by Harvard trauma questionnaire-BiH version). Contact network was examined by a Map of Contact Network which includes contact and satisfaction with persons in close environment. In relation to gender representatives of fathers and mothers, sample was homogenous. RESULTS The most important persons in children whose parents are showing symptoms of PTSD were schoolmates (88.0%), home mate (86.0%), mother (72.0%), and father (2.0%). At children whose parents did not show symptoms of PTSD, most important persons were schoolmate (94.0%), mother (80.0%), brother (6.0%), grandfather (8.0%), and father (14.0%). The most distinct disappointment in contacts in children with parents with PTSD symptoms were family, relatives and friends, in school and formal contacts (p < 0.001). CONCLUSION Children of parents who have had symptoms of post traumatic stress disorder (PTSD), the most important persons that they communicate were schoolmates and they had problem in communicating with fathers and males. According to satisfaction children whose parents suffered from PTSD were showing distinction in contacts with their families, relatives, schoolmates and formal contacts.

INTRODUCTION Aphasia is a common and serious condition, associated with all forms of cerebrovascular disease. Capability of speech is one of the most important characteristics of human kind, it is logical that the recovery from a disease as serious as cerebrovascular insult (CVI) is by no means complete without the satisfactory recovery of the speech. Basic goal of the study was to analyze the incidence and clinical phenomenology of aphasic disorders after CVI. PATIENTS AND METHODS We retrospectively analyzed 993 patients with CVI hospitalized in Neurology Clinic in Tuzla in the period from 1 January 2004 to 31 December 2004. All the patients were tested for aphasia by the International aphasia test. RESULTS AND CONCLUSION Obtained data showed that the incidence of aphasia was 20.34%, and that aphasic disorders were significantly more common in female patients. The most frequent type of aphasia was global (48.51%), then Broca's (23.26%), and Wernicke's (8.41). Transcortical sensory, transcortical motor and conductive aphasia were diagnosed in small number of patients in acute phase of CVI. Aphasia was more frequently seen in patients with hemorrhagic stroke (28.14%), compared to the ones with the ischemic stroke (20.58%), but the difference is not statistically significant. In patients with subarachnoidal hemorrhage aphasic disorders were not present in any patient.

AIM To analyze the impact of risk factors on the survival rate within a period of five years after hemorrhagic stroke (HS). PATIENTS AND METHODS In this study 303 patients were analyzed with a first ever hemorrhagic stroke admitted at the Department of Neurology Tuzla, from January 1st 1997 to December 31st 1998. Data were collected from patient's medical records, whereas the final examination of all patients, who survived HS, took place five years after stroke. Medical history was obtained and presence of risk factors was evaluated on the day of admission. Computed tomography (CT) of the brain was performed in all patients during hospitalization. The average age of patients was 62 +/- 11 (from 31 to 90) years, 180 (59%) were women. The most frequent risk factor was hypertension, registered in 252 (83%) patients, followed by history of heart diseases in 182 patients (60%), smoking in 72 (23.8%), diabetes mellitus in 26 (8.5%), history of transient ischemic attack in 24 (8%) and alcohol intake in 13 (4.3%) patients. The risk factors were not registered in 22 (7.3%) patients. RESULTS Five years after HS 82 (26.7%) patients survived. No statistical significance was found in survival between men and women (p = 0.2). The lowest number of patient that survived were over 70 years old (9%), while the highest number of survived was between 41-50 years (60.5%). The average number of risk factors was 2.5 +/- 1.0 and significantly higher in men compared to women (2.7 +/- 1 : 2.3 +/- 1) (p < 0.001). Significant difference was found in patients with hypertension (n = 252) (p < 0.0001), alcohol intake (n = 13) (p = 0.0170), as well as in patients with diabetes mellitus (n = 26) (p = 0.005). Regarding other risk factors such as heart diseases, cigarette smoking and transient ischemic attack there were no significant difference in survival in patients with hemorrhagic stroke (p = 0.2; p = 0.7; p = 0.8; retrospectively). CONCLUSION We found that hemorrhagic stroke is associated with a very high risk for death in the acute and subacute phase. The survival rate after hemorrhagic stroke was 26.7% within a period of five years. Long-term survival rate prognosis is significantly better among the younger patients, without hypertension, alcohol intake and diabetes mellitus.

The consequences of hard hearing disturbances on psychological restructures were signed when it all is about communication in social interactions, cognitive development and certain characteristics of personality. Certain psychological characteristics were analyzed at deaf by testing deaf and hearing ones. Testing sample (N=45) had been chosen randomly and there were both male and female 18 to 55 years old, with target to prove certain psychological characteristics of deaf in relation to social interactions. For that purpose has been created this measurement: “Estimation scale of psychological characteristics at deaf”, tipe of Likerts, which is consisted of 15 variables. The results of sub samples of tested ones on used variables have been described by descriptive and comparative analysis, but hypothesis about not existing statistical important differences between hearing and deaf tested ones in estimation of psychological characteristics at deaf has been tested by discriminative analyses. The results of survey point that there is no statisticaly important differences in estimation of psychological charakteristics at deaf, beteween two used samples in subject survey.

Introduction: Subarachnoid haemorrhage presents urgent state in neurology, with dramatic clinical picture and high mortality. Aim of this study was to analize role of the risk factors in prognosis of patients with spontaneous subarachnoidal haemorrhage. Patients and Methods: It was analyzed 48 patients with spontaneous subarachnoidal haemorrhage which are cured on Neurological clinic in Tuzla in period from January 1. 2001 till December 31. 2002. Mean age of patients was 57.6 +/-12. years. Results: It was shown that the most frequent risk factors were hypertension (72.9%), heart diseases (54.1%) and smoking (39.6%). From all 48, 21 (43.7%) patients died. At survived patients, one month from begining of disease, cases. Survived had significant lower mean age (p= .009) and Hunt Hess score (p=0.001) at admission than the died. Patients with complexity find by computed tomography had bad prognosis. Conclusion: Older age of patients, higher number of risk factors, higher Hunt Hess score at admission, and blood in the ventricular system on CT are risk factors for poor prognosis of patients with subarachnoidal haemorrhage.

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.

Aim:  To evaluate whether microalbuminuria could be a marker of early tubular damage in individuals at risk of developing Balkan endemic nephropathy (BEN).