Dear Editor, International Journal of Stroke readers will probably be surprised by the fact that Bosnia and Herzegovina is one of rare countries in Europe that does not have an official Stroke register, mainly because of a complex political system. Our country is divided in two entities of which one entity is separated in 10 cantons, besides Brčko District. Our clinic is located in Tuzla, the largest city of Tuzla Canton, that has 500 000 inhabitants. All patients with stroke in Tuzla region were hospitalized at our department. We did a few studies in domain of cerebrovascular diseases, but all the data were based on hospital records due to the aforementioned situation. Despite this situation, we are making efforts to keep up with the trends in domain of cerebrovascular diseases, and we managed to form a Stroke unit on our clinic and to start applying thrombolytic therapy for the last four-years. The main goal for this article is to show results in one of our studies about intracerebral hemorrhage, which is done in the Department of Neurology Tuzla, for the period June 1, 2007 to March 31, 2008. It was one of the first studies of this kind in our country and it contained analysis of clinical and neuroradiological characteristics of intracerebral hemorrhage (ICH) and its influence on short-term outcome. Based on 75 patients, we came up with following results: 40 patients (53·4%) were male, the mean age for all patients was 64·3 13·7 years, and men were older than women (P = 0·031). The disturbance of consciousness on admission significantly influenced the sixmonth outcome (P < 0·0001). Patients with multiple hematomas had higher mortality rate (41%); however, localization of hematomas did not have any significant influence on the six-month mortality. Surviving of patients highly depended of volume of hematomas (P < 0·0001). Less than half of patients (39%) who survived six-months after stroke were functionally depended (Rankin scale >2, Barthel Index <90). Predictors of poor six-month prognosis were brain edema (P = 0·002), intraventricural bleeding (P = 0·004), and Glasgow Coma Scale <8 (P < 0·0001) (Table 1). It can be concluded that there are certain clinical and neuroradiological predictors for short-term prognosis in intracerebral hemorrhage. Intracerebral hemorrhage has high mortality rate (52%), and most of the survivors are functionally independent six-months after stroke (61%). Our results do not differ from studies with similar design (1–3). Perhaps, we could provide better results, but due to the aforementioned shortcomings, we are limited to participation in larger multicenter studies.

The aim of the study was to analyze stroke in young adults in Tuzla Canton, Bosnia and Herzegovina. From January 2001 to December 2005, 3864 patients with first-ever stroke were admitted at the Department of Neurology Tuzla. A retrospective analysis of risk factors, stroke types, severity and one month outcome in all young adults (18-45 years of age) with first-ever stroke was carried out. Out of total, there were 154 (4%) young adults with stroke. Mean age was 38.8 +/- 5.7 years and 47% were women. The leading risk factors were smoking (56%) and hypertension (45%). Subarachnoid hemorrhage (SAH) was more frequent in young adults compared with older patients (> 45 years of age) (22% vs. 3.5%, p < 0.0001), intracerebral hemorrhage (ICH) was similar in both groups (16.9% vs. 15.8%, p = 0.7), but ischemic stroke (IS) was predominant stroke type in the older group (61% vs. 74%, p = 0.0004). Young adults had more frequent lacunar stroke (26.6% vs. 16.1%, p = 0.01) and stroke due to other etiology (8.5% vs. 1.8%, p = 0.0004) than stroke patients over 45 years of age. Stroke severity at admission was lower in young adults than in older patients (p < 0.0001), as well as mortality at one month (11% vs. 30%, p < 0.0001). Favorable outcome (modified Rankin Scale < or = 2) had 71% of young adults compared with only 53% of patients in the older group (p = 0.0003). Stroke in young adults in Tuzla Canton is rare. Risk factors profile, stroke types, severity and outcome at one month in young adults are different from those in older patients.

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.

Progressive supranuclear palsy (PSP) can occur with two main clinical presentations, classified as classical Richardson's syndrome (PSP‐RS) and as PSP‐parkinsonism (PSP‐P), the most common atypical PSP variant. The differential diagnosis between them is challenging. Therefore, we studied different ultrasound markers by transcranial sonography in individuals with PSP‐RS and PSP‐P, to test their value in the diagnostic work up of these patients.

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 Sleep disorders (SD) after stroke (stroke) are common occurrences, and most often in sleep apnea, insomnia and daytime sleepiness. GOALS. Research goals were to determine the types of SD and their frequency in patients with stroke in relation to the type of stroke and side of lesion. MATERIALS AND METHODS The study analyzed 200 patients with acute stroke hospitalized in the Clinic of Neurology, University Clinical Centre Tuzla in the period from 1st August 2007 to 1st June 2008. All patients have confirmed the existence of stroke by computerized tomography. SD was verified according to the General Curriculum of sleep, the Berlin questionnaire and Epvort scale. Stroke, by type, were divided into hemorrhagic and ischemic, and the localization of the stroke to right and left cerebral hemispheres. RESULTS Of the total number of respondents, 78% had SD. Very serious level of SD had 42% of respondents, 20% moderate, and 16% of medium-severe degree. There was no statistically significant differences in the frequency of SD among patients with ischemic and hemorrhagic stroke (76.8%: 82.5%, p = 0.58). In relation to the side of lesion there was more patient with SD and stroke in the right cerebral hemisphere, but there were no statistically significant differences (39.5%: 33%, p = 0.1). According Epvort scale sleep apnea and snoring was present in 86%, daytime sleepiness in 49.5% and narcolepsy 0.5%. CONCLUSIONS Sleep disturbance as a neuropsychological disorder has a significant incidence in the acute phase of stroke. SD is slightly more common in hemorrhagic stroke and stroke in the right hemisphere. Sleep Apnea and snoring are the most common types of SD in patients with stroke.

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.

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.

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%.

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.

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.