The aim of this study was to determine whether volume and localization of intracerebral hematoma affects the six-month prognosis of patients with intracerebral hemorrhage (ICH). Patients and Methods. The study included 75 patients with ICH of both sex and all age groups. ICH, based on CT scan findings, was divided in the following groups: lobar, subcortical, infratentorial, intraventricular haemorrhage and multiple hematomas. Volume of intracerebral hematoma was calculated according to formula V = 0.5 × a × b × c. Intracerebral hematomas, according to the volume, are divided in three groups (0–29 mL, 30–60 mL, and >60 mL). Results. The highest mortality rate was recorded in the group with multiple hematomas (41%), while the lowest in infratentorial (12.8%). The best six-month survival was in patients with a volume up to 29 mL, 30 of them (64%) survived. The highest mortality rate was recorded in patients with the hematoma volume >60 mL (85%). Kaplan-Meier's analysis showed that there was statistical significance between the size of the hematoma and the six-month survival (P < 0.0001). More than half of patients (61.1%) who survived 6 months after ICH were functionally independent (Rankin scale ≤2). Conclusion The volume of hematoma significantly affects six-month prognosis in patients with intracerebral hemorrhage, while localization does not.
Objectives. To determine the severity of stroke and mortality in relation to the type of disturbance of consciousness and outcome of patients with disorders of consciousness. Patients and Methods. We retrospectively analyzed 201 patients. Assessment of disorders of consciousness is performed by Glasgow Coma Scale (Teasdale and Jennet, 1974) and the Diagnostic and Statistical Manual of Mental Disorders (Anonymous, 2000). The severity of stroke was determined by National Institutes of Health Stroke Scale (Lyden et al., 2011). Results. Fifty-four patients had disorders of consciousness (26.9%). Patients with disorders of consciousness on admission (P < 0.001) and discharge (P = 0.003) had a more severe stroke than patients without disturbances of consciousness. Mortality was significantly higher in patients with disorders of consciousness (P = 0.0001), and there was no difference in mortality in relation to the type of disturbance of consciousness. There is no statistically significant effect of specific predictors of survival in patients with disorders of consciousness. Conclusion. Patients with disorders of consciousness have a more severe stroke and higher mortality. There is no difference in mortality and severity of stroke between patients with quantitative and qualitative disorders of consciousness. There is no statistically significant effect of specific predictors of survival in patients with disorders of consciousness.
1.1 Stroke According to the World Health Organization (WHO), stroke is defined as the sudden development of focal or global symptoms and signs of disturbance of cerebral function lasting more than 24 hours or leading to death, as a result of the pathological processes of vascular origin (Thorvaldsen et al., 1995). The basic classification of stroke, according to the type of pathological process, is into ischemic stroke, which comprises 70-85%, and hemorrhagic. An ischemic stroke develops due to the inability of supply to brain tissue oxygen and glucose due to occlusion vessel. If the "outbursts" of blood within the brain mass, there is intracerebral hemorrhage, which makes 15-20% of strokes, while the penetration of the blood in the subarachnoid space, usually as a result of aneurysm rupture, leading to a subarachnoid hemorrhage, which makes 5-10% of all strokes. Stroke leads to focal or multifocal neuropsychological disorders. Given that in clinical stroke in the forefront of motor deficits, disturbance of consciousness and disturbance of speech functions, a very common disorder and the function of other organ systems, most of the neuropsychological symptoms are observed after the acute phase when the general and neurological status stabilized, or when we are able to perform certain neuropsychological tests (Dostovic, 2007). Stroke leads to the different degree of physical, cognitive and psychosocial dysfunctioning. The recovery of patients depends on the severity of disability, the rehabilitation program, but also the subsequent maintenance of achieved function, as well as care and support of family and environment.
INTRODUCTION Multiple sclerosis (MS) and Parkinson's disease (PD) are chronic diseases with unpredictable course causing progressive physical disability and cognitive decline, and broadly affecting the patient's life, social interaction, recreational activities and overall life satisfaction. GOALS To examine the quality of life of patients with PD and MS, and investigate the existence of differences between the degree of impairment to the quality of life in PD and MS. METHODS A prospective study was conducted at the Neurology Clinic, University Clinical Center in Tuzla in the period from December 2005 until May 2007. The study included subjects with confirmed diagnosis of MS and PD. We analyzed 50 patients with PD and 50 patients with MS, with disease duration 1-5 years without any or with mild cognitive impairment. Quality of life was assessed using the SF-36 scale comprised of 36 questions in eight health profiles. RESULTS There was no significant difference in gender frequency in our study sample of patients with PD, while in MS group of patients there were a significantly more females. The average age of the PD patients was 63.18 +/- 10.42, and in patients with MS 37.4 +/- 8.65 years. In our study the relative influence of PD and MS on quality of life was similar after controlling the duration of the disease, and there were some differences in relation to the degree for clinical disability. Subjects showed reduced QoL independently of the duration of illness (patients with PD in 88% of cases, and multiple sclerosis in 84% of cases). There are significant differences in the occurrence of poor quality of life in patients with PD were in advanced clinical stages of disease for the physical, mental dimension of the SF 36 and the total score. Respondents in stages III-V of the disease were 5.23 times (23%) likely to experience reduced QoL compared to those with less physical disability. In subjects suffering from MS reduced QoL was not related to the degree of clinical disability in physical, nor the mental dimension of the SF 36 and the total score. These results in MS patients can be partially explained by the small sample size, on the other hand it is possible that patients with MS, although they have greater physical disability seen as a very difficult diagnosis which determines the entire life. CONCLUSIONS Patients who are treated for PD and MS had a high degree (> 80%) of reduction of the overall quality of life, and there were no significant differences in the extent of QoL reduction between these groups of patients. Reduced quality of life in patients with PD is observed during severe stages of the disease, while the QoL does not depent on the degree of clinical disability in MS patients. In both groups of patients the appearance patients reduced QoL does not depend on the duration of the disease.
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.
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
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