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.

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.

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.

The objective of the study was to analyze the doppler sonography findings of vertebrobasilar circulation (VB) in patients with Parkinson's disease. 40 patients were analyzed (25 men's and 15 women) with Parkinson's disease, average age was 61.9 years (SD=11.43), treated at the Clinic for Neurology in Tuzla. Device for doppler sonography was Multidop x 4. Doppler sonography findings of VB circulation were analyzed in order to computerized tomography (CT) findings of the brain (with or without ischemic lacunar lesions) and in order to presence of postural disturbances as one of dominant Parkinson's disease symptoms during actual hospitalization. Our results suggest that vertebrobasilar insufficiency is more frequent in patients with Parkinson's disease (no matter of type) and postural disturbances as a dominant symptom comparing to group of Parkinson's disease patients without postural disturbances. These results implicate the importance of doppler sonography findings of vertebrobasilar circulation in patients with Parkinson's disease and possibility of considering role of vertebrobasilar insufficiency in development of postural disturbances.

Intracerebral hemorrhage is the deadliest, most disabling and least treatable form of stroke despite progression in medical science. The aim of the study was to analyze the frequency, risk factors, localization and 30-day prognosis in patients with intracerebral hemorrhage. We analyzed 352 patients with intracerebral hemorrhage (ICH) hospitalized at the Department of Neurology Tuzla during a three-year follow up. The following data were collected for all patients in a computerized database: age, sex, risk factors (hypertension, heart diseases, diabetes and smoking) and CT findings. Stroke severity was estimated with Scandinavian Stroke Scale, ICH topography was specified by CT, and outcome at 1st month after onset included information on vital status and disability (modified Rankin Scale, mRS). The most frequent risk factors were hypertension (84%), heart diseases (31%), cigarette smoking (28%) and diabetes mellitus (14%). The most frequent localization of ICH was multilobar (38%), internal capsule/basal ganglia region (36%) and lobar (17%). Within first month died 147 patients (42%). The highest mortality rate was in patients with brain stem (83%) and multilobar hemorrhage (64%). Factors independently associated with mortality were age (odds ratio 1,05 (95% confidence interval 1,02 to 1,08); p=0,001), stroke severity (OR 0,93 (0,92 to 0,95); p<0,0001), multilobar hemorrhage (OR 5,4 (3,0 to 9,6); p<0,0001) and intraventricular hemorrhage (OR 3,9 (2,2 to 7,1); p<0,0001). Favorable outcome at first month (mRS < or = 2) had 45% of the surviving patients with ICH. The best outcome was for the patients with cerebellar hemorrhage (63%), while only 40% of the patients with hemorrhage in internal capsule/basal ganglia region had Rankin scale 2 or less. Hypertension is the most frequent risk factor in patients with ICH. ICHs are mainly localized in lobar and internal capsule/basal ganglia regions. Independent predictors of mortality following ICH are age, hypertension, intraventricular blood extension and stroke severity. Mortality, as well as good outcome at 1 month, is related to the localization of bleeding.

The aim of this study was to analyze: frequency of balance disorder (vertigo and disequilibrium), frequency of abnormalities in auditory evoked potentials (AEP) and magnetic resonance imaging (MRI) changes of the brain in multiple sclerosis (MS) patients with balance disorder, relation of patient's disability status to balance disorder and relation of the changes in MRI of the brainstem to AEP abnormalities. It was analyzed 60 patients with relapsing-remitting form of MS. Two groups of patients were made consecutively under Expanded Disability Status Scale score (EDSS): A (EDSS < or =4,5) and B (EDSS > or =5,0). The study was retrospective-prospective. After the neurological exam AEP and MRI of the brain have been done. Balance disorder has been verified as initial symptom in 29 (48,4%) and out of them disequilibrium experienced 24 (83,4%) patients. During the relapses balance disorder experienced 48 (80%) patients and in 37 (77,1%) it was disequilibrium. Among them 33 (68,7%) were with lower EDSS (< or =4,5) and 15 (31,3%) with higher EDSS score (> or =5). There is no correlation between disability status and vertigo which means that vertigo is not more frequent in more disabled patients and vice-versa. The AEP were pathological in 57 (95%) patients. Of all 29 patients with vertigo AEP were pathological in 28 (96,5%) while in 31 patients without vertigo pathological AEP were in 29 (93,5%) but it is not statistical significant. The most frequent characteristic of AEP changes were prolonged inter-peak latency III-V waves (48 patients or 80%). The plaque in brainstem visualized by MRI was found in 41 (71,8%) of patients (38 or 92,6% of them had pathological AEP and in three patients AEP were normal). In group of patients with pathological AEP, 38 (66,6%) of them had plaque in brainstem. In other three patients with normal AEP it was visualized plaque in brainstem. In the group of 29 patients with balance disorder, 20 (68,9%) had plaque in brainstem as well as 21 (67,7%) out of 31 patients without balance disorder had plaque in the brainstem. This difference is not statistical significant. It is concluded that the vertigo (including disequilibrium) is relatively often (48,4%) initial symptom of MS. Vertigo is not more frequent in patients with higher EDSS score and vice-versa. Pathological AEP are frequent neurophysiologic finding in both (95%) patients with (96,5%) and without (93,5%) vertigo. The most often pathological characteristic of AEP are prolonged interpeak latency of III-V waves (78,5%), as well as abnormalities of V and than IV wave. MS plaques in brainstem visualized by MRI technique are frequent in both groups of patients with and without pathological finding of the AEP.

Guillain-Barre syndrome (GBS) is an acquired immune-mediated inflammatory disorder of the peripheral nervous system. GBS is also called acute idiopathic polyradiculoneuritis. Cranial nerves are affected in over 50% of all cases, with the facial nerves being affected the most. Otherwise, oculomotor nerves affection is rare and might occur in about 10% of cases. In this case report we present 61 years old female with GBS (acute motor and sensory axonal neuropathy subtype) associated with bilateral oculomotor nerve palsy. At the admittance in the neurological status were flaccid paraplegia, tendon reflexes absent at legs and reduced at arms, sensory disturbances in a distal (stocking-glove) distribution and bilateral ptosis. The disease was diagnosed on clinical features, nerve conduction velocity test (NCV), electromyogram (EMG) and cerebrospinal fluid (CSF) tests. After treatment with intravenous immunoglobulins and physical treatment the patient improved. She was able to walk by her own, mild semiptosis remained and she had no paresthesia.

The objective of the study was to analyze the quality of life six months after stroke in survivors under sixty years of age, to determine which life activities was the most affected, as well as to correlate the neurological insufficiency and the quality of life. It monitored 200 stroke survivors under sixty years of age treated at the Department of Neurology, University Clinical Centre Tuzla. Average age was 51,83 years (+/-7,02). The ischemic stroke was diagnosed in 77,5% stroke survivors, cerebral hemorrhage in 15%, and subarachnoid hemorrhage in 7,5%. Five stroke survivors suffered hemiplegia (2,5%), 24 (12%) experienced moderate consequences and 143 (71,5%) had mild consequences. No neurological deficit had 28 (14%) stroke survivors. Six months after the onset of disease all stroke survivors have been followed-up and evaluated about quality of life by filling in a modified questionnaire: Questionnaire on Quality of Life after Stroke (2). The questionnaire contained 20 questions covering four fields of life: Working Ability, Home Activity, Family Relations and Leisure Activities. Six months after the onset of stroke a worse quality of life in comparison to the period before the disease was noted in 172 (86%) stroke survivors, the unchanged in 19 (9,5%) and better in 9 (4,5%). The most affected is the field "Leisure Activities", followed by "Family Relations", "Home Activity", and the least affected is "Work Ability". The neurological deficit significantly correlates to the "Home Activities" and "Leisure Activities".

The aim of the study was to analyze the 5-year survival after first-ever ischemic stroke and intracerebral hemorrhage. In this study 836 patients were analyzed with a first-ever stroke admitted at the Department of Neurology Tuzla, Bosnia and Herzegovina, from January 1(st) 1997 to December 31(st) 1998. Of these 613 (73,3%) were ischemic strokes and 223 intracerebral hemorrhages (26,7%) Subarachnoid hemorrhages were excluded. After hospitalization surviving patients examined periodically, and a final examination was performed 5 years after the stroke. Overall, case-fatility at the first month was 36% (301/836) and the mortality rate was significantly higher in the patients with intracerebral hemorrhage (58,3% vs. 27,9%, p<0,0001). The first year survived 60% patients with ischemic stroke, and 38% with intracerebral hemorrhage. After 5 years, 188 (31%) patients with ischemic stroke and 53 (24%) with intracerebral hemorrhage were alive (p=0,5), and the cumulative survival rate for the entire study was 29%. Among 30-day survivors (n=535) surviving rate after 5 years was significantly higher in patients with intracerebral hemorrhage (57% vs. 42,5%, p=0,01). The survival rate was the highest for those 50 years and younger (57%), and the lowest for those aged over 70 years (9%). Predictors of 5-year mortality were older age and hypertension for both types of stroke, heart diseases for ischemic stroke and diabetes for intracerebral hemorrhage. Long-term survival after first-ever ischemic stroke and intracerebral hemorrhage is similar. However, among 30-day survivors the 5-year survival is better in patients with intracerebral hemorrhage.

Initial data about organized health work in Tuzla area comes from nineteenth century. Priest Ivan Kljaie, military physicians Muhidin-bey, Mehmed Said-effendi and Ignatius Gulielmus Petelenz are mentioned in it. In Tuzla, Mehmed Sami Serbić in year 1874, found first hospital named Hastahana. As a physician and humanist he leaves indelible trace. Three female physicians: Anna Bayerova, Teodora Krajewska, and Jadviga Olszewska, after the annexing of Bosnia and Herzegovina by Austria-Hungary monarchy, were engaged to work in Tuzla area. Each of them gave important contribution to development of health care in Tuzla area and broader. Physicians Josip Lymberski and Jozef Foglar worked in so called Miners Hospital. Due to cholera and malaria epidemics during the year 1893, two epidemiologists-bacteriologists came in Tuzla. Their names were Rudolf Fisher and Jozef Katz. We believe, that this work contributes to saving the memory of the work of the physicians from the Tuzla area in nineteenth century.

INTRODUCTION Diabetes mellitus is a risk factor for stroke, but it is unclear whether stroke is different in diabetic and nondiabetic individuals. The aim of the study was to compare characteristics of stroke in patients with and without diabetes mellitus. METHODS This study included 833 acute stroke patients (697 [84%] had ischemic stroke, and 52% were females) admitted at the Department of Neurology Tuzla, Bosnia and Herzegovina, from January 1st 2003 to December 31st 2003. Risk factors, stroke severity (Scandinavian Stroke Scale, SSS)), stroke type, etiology, lesion topography and the outcome at 1 month (mortality and handicap) were assessed in all patients. RESULTS Overall, diabetes mellitus was present in 194 patients (23.5%). Females were overrepresented in the diabetic group of stroke patients (66% vs 48%, p = 0.0001). Initial stroke severity and lesion topography were comparable between the two groups. The diabetic patients reported a significantly lower current smoking (21% vs 29%) and alcohol intake (4.5% vs 9%) (p < 0.05). Patients with diabetes mellitus compared with patients without diabetes had more frequently atherothrombotic stroke (62% vs 33%, p < 0.0001), but less frequently embolic stroke (10% vs 17.5%, p = 0.02) and intracerebral hemorrhage (10% vs 18.5%, p = 0.005). Mortality at 1 month was higher in patients with diabetes mellitus (38% vs 26%, p = 0.001), and diabetes increased the relative death risk by 1.53 (95% confidence interval, 1.19 to 1.96). At the other hand, handicap (Rankin Scale) in surviving patients was insignificantly higher in diabetic group (2.7 vs 2.4, p = 0.07). Older age (70 vs 66 years, p = 0.008), atherothrombotic stroke (76% vs 53%, p = 0.002), and severe strokes (SSS 20.5 vs 39, p < 0.0001) were more associated in died stroke patients with diabetes mellitus compared with surviving diabetic stroke patients. CONCLUSION Diabetes mellitus is present in one fourth of acute stroke patients. Stroke patients with diabetes mellitus are associated with specific patterns of stroke type, etiology and mortality but not with stroke severity and handicap.

A group of 103 adolescents who have been exposed to war trauma was examined by a specialist of physical medicine and rehabilitation and pedagogue-psychologist, in relation to deformities of spinal cord and other inborn anomalies. Repeated screening and retest on the level of stress and depression was done after two years. In the meantime, majority of adolescents was on physical and psychological treatment. It was established that 47 adolescents (45.6%) have simultaneously had flat back and flat feet, and that 12 of them (25.5%) from the same group had had 4 traumatic experiences. During the first testing, the medium stress level was established with 48 adolescents (46.6%), and during the retest this was established with 60 adolescents (58.2%). At the same time, we used Birleson scale of depression and established that 57 (55.3%) adolescents have had normal results; after the retest 66 (64.1%) adolescents have had normal result and this difference is statistically significant (p<0.002). When we analyzed diagnosis after the two screenings we did not found significant differences. Based on the results of this research, better programs for the team work with adolescents with deformities of spinal cord and depression can be made.

INTRODUCTION Numerous studies showed EEG changes in patients with Parkinson's disease, in comparison with healthy subjects of same age. The most often presented change is generalised (or localised) slowing of frequency. AIM To show the correlation of EEG frequency and Mini Mental Status (MMS) in patients with Parkinson's disease. PATIENTS AND METHODS 32 patients with Parkinsons disease were analysed. An average age was 64.63 +/- 10.01 years, and most of them were men (24 or 75%). On the basis of MMS score, two groups were selected: with and without signs of dementia. For both groups, EEG frequency values were determined. RESULTS There were 11 patients without dementia (MMS score = 23-30) with average age of 64.63 +/- 9.54 years; and with dementia (MMS score < 24) 21 patients (average age was 62.71 +/- 10.04 years). In patients without dementia, diffuse slowing down of frequency was found in one patient (9.1%); localised in three (90.9%). In dementia patients, four patients (19.04%) had diffuse slowing of EEG and seven (80.96%) had localised. A positive correlation of EEG frequency and MMS score was found (r = 0.46), and Parkinson's disease patients with dementia had more frequently EEG with slowing frequency than non-dementia patients. CONCLUSION EEG slowing frequency is more frequent in Parkinson's disease patients with than without dementia.

INTRODUCTION Period after ischemic stroke and myocardial infarction is followed by different psychological reactions. Anxiety represents one possible psychological problem. AIM To investigate presence of anxiety in patients within period from 48 hours till 15 days after ischemic stroke and myocardial infarction. SUBJECTS AND METHODS Fourty patients formed analyzed group. Their average age was 65.3 +/- 10.3 years (33-83). Twenty of them were females. Thirty patients formed controled group. Their average age was 57.46 +/- 10.6 years (42-78). Eleven of them were females. Twenty questions self-assessment Zung scales were used for anxiety levels determination, Responses were scored by points, which were summarized as final result. Final score of 50 and more points suggested that anxiety was present. RESULTS Average self-assessment anxiety score within 48 hours since ischemic stroke was 44.4 +/- 8.8 points, and 15-th day 42.2 +/- 7.7 (p=0.237). In twelve patients (30%) anxiety was found during the first surveying, and in 10 patients (25 %) during the second the surveying. Average self-assessment anxiety score within 48 hours since myocardial infarction was 43.1 +/- 8.3 points, and 15-th day 43.2 +/- 6.7 (p=0.959). In seven patients (23.3%) anxiety was found during first surveying, and in 5 patients (16.7%) during second surveying (p=0.52). CONCLUSION Anxiety represents important psychological problem for patients after ischemic stroke and myocardial infarction. Aldo number of anxiety patients is larger within 48 hours after ischemic stroke and myocardial infarction, average value in anxiety scale stays unreduced even 15 days after the beginning of the disease.

The period following ischemic stroke can be considered as a reaction to a stressful event. Changes in cortisol secretion are one of the indicators of stress reaction. The aim of the study was to determine morning serum levels of cortisol in stroke patients within 48 hours and 15 days of ischemic stroke onset. Study group included 40 patients, 20 of them were females, mean age 65.3 +/- 10.3 years. The patients did not receive any corticosteroid agents or spironolactone, and did not suffer from Cushing's or Addison's syndrome. Ischemic stroke was verified by computed tomography of the brain. The fluorometric method with DELFIA Cortisol immunoassay was used to determine morning serum cortisol levels. Reference values of the measured hormone were 201-681 nmol/l. The mean level of serum cortisol within 48 hours of stroke was 560.9 +/- 318.9 nmol/l, and on day 15 it was 426.2 +/- 159.3 nmol/l, i.e. significantly lower (p < 0.02). On the first measurement, the level of serum cortisol was elevated in 32%, and on the second measurement in only 7.5% patients, which was also significantly lower (p < 0.001). It was concluded that the stress reaction in ischemic stroke patients was more pronounced within the first 48 hours of stroke onset. Judging from the morning cortisol levels, the reaction to stress was considerably less pronounced 15 days after stroke onset.