The secular trend in the incidence of hemorrhagic stroke in the region of Osijek, Eastern Croatia in the period 1988-2000--a hospital based study.

The purpose of the study was to establish the possible environmental influences in the observed peculiar rising and falling oscillations in the numbers of hemorrhagic stroke (HS) in Eastern Croatia (region of Osijek) during the last thirteen-years' period (1988-2000). In this period 1,222 HS were registered and treated. A constant increase in the incidence of HS was observed, from 60 (in 1988) to 139 (in 1998), with an average annual proportion of 16.5% of all stroke cases. A sharp increase in proportion of HS in total stroke incidence was recorded during the war in Croatia (1991-1995), with a peak incidence of 27.4% in 1993. Typical hypertensive intracerebral hemorrhage (ICH) was the most common (57.1%), atypical ICH occurred in 26.4%, subarachnoid hemorrhage (SAH) in 16.5%. Analysis of the annual number of hypertensive-ICH and SAH disclosed peculiar rising and falling oscillations. These variations were in correlation with heavy living conditions. During the war-period the SAH incidence sharply rose. Immediately after the war it suddenly decreased. The authors named this phenomenon a "pool depletion", supposing the relatively stable proportion of the bearers of aneurysms in population. The observed variations seem to be the consequence of the war stress and other negative psychosocial and economic factors in post-war period, which increases the risk for SAH and typical hypertensive-ICH through complex pathophysiological mechanisms.

Changes in short-term memory processes in patients with multiple sclerosis.

In this study we compared the performance of 39 multiple sclerosis (MS) patients with 28 age-, sex- and education-matched controls on both the Mini-Mental State Examination, a global cognitive assessment tool, and the Sternberg Short-Term memory scanning task, a standardized test of short-term memory (STM) processes. While the STM span of our MS patients did not differ from that of our controls, STM scanning time of the MS group was reliably slower than that of the controls and a significant correlation was observed between STM scanning time and duration but not severity of illness. Our results suggest that processing stages other than the manipulation of data within the STM buffer are also affected by MS.

Influence of prolonged stress on risk factors for cerebrovascular disease.

The main purpose of this study was to analyze the influence of psychological and socio-economic factors on the frequency and characteristics of risk factors for cerebrovascular disease (CVD) among Croatians. A group of 120 war sufferers with signs of post-traumatic stress disorder and adaptation disturbances have been studied, and compared with a control group of 120 persons with no traumatic war experience. The risk factors for CVD were registered using epidemiological, clinical and functional measures, and level of the risk. In a displaced persons group a significant higher rates (p < 0.05) of arterial hypertension (AH), hyperlipidemia and obesity are found, with particularly higher rates of occurrence of AH and hyperlipidemia in younger individuals. Alcoholism was more frequent in the control group. Total risk for stroke was higher in the exposed group. The authors conclude that there is a need for undertaking intensive preventive measures in the risk population exposed to chronic stress and negative socioeconomic life conditions.

Influence of prolonged stress on cerebral hemodynamics.

The author has investigated the impact of psychological and socio-economic factors on cerebral hemodynamics and development of cerebrovascular disease (CVD). A group of 120 war sufferers with signs of post-traumatic stress disorder and adaptation disturbances, and 120 persons of the control group with no traumatic war experience have been studied. The blood flow velocity and various parameters of spectral frequency analysis have been measured, using the method of transcranial doppler sonography (TCD). A greater number of hemodynamical changes has been found in the group of subjects than in the control group (p < 0.05), in which increase of vasospasm is statistically significant probably as a result of predomination of the sympathetic system stimulation and nicotinic effect on the brain blood vessels. Flow disturbances are relatively more frequent in older subjects, which suggests the rapid development of the atherosclerotic process. The results suggest that exposure to prolonged stress and bad socio-economic factors, through different neurobiological mechanisms, increased the risk for stroke.

Tick-borne encephalitis in eastern Croatia.

92 patients treated for tick-borne encephalitis (TBE) in the Department for Infectious Diseases, University Hospital Osijek, over a 22-year period (1973-1995) were analysed. The patients were mostly forestry workers. The appearance of the disease followed the biological activity of the tick, with the largest number of affected individuals recorded between April and August. TBE in eastern Croatia is a relatively frequent infectious disease, appearing almost every year. In a smaller number (9.8%) of cases the clinical picture was aseptic meningitis, while in the majority of patients (90.2%) it presented as an acute meningoencephalomyelitic form. The course was relatively severe in the majority of the patients analysed, with disturbances of consciousness (32.6%) and transitory neurological signs (61.9%). Three patients died (3.3%) in the early phase of the disease. A monophasic course dominated. The clinical and epidemiological data were compared with the cases described in other parts of Croatia and regional differences were seen in the severity of illness. These variations could be due to the previously hypothesized different virus subtypes, or to some other unknown factors.

On the development of Croatian neurology.

The author depicts the roots and the development of modern Croatian neurology. On the ground of cultural and civilizational predispositions it achieved an exceptional development during the last three decades in the period after the World War II. Although clinical neurology may be traced only after the foundation of the first Croatian medical faculty in Zagreb in 1917, until 1971 within the common discipline of neuropsychiatry, a vast medical literature: reports on neurological problems both from literature and from everyday medical praxis were published in Croatian after the foundation of the Croatian medical journal "Lijecnicki vjesnik" in 1877, written by internists or general practitioners interested in neurology. First Croatian textbook in neurology was published by Ivo Glavan already in 1935 and new editions of this book have made it a popular handbook for many generations of medical students and physicians, not only in Croatia but also in other parts of the former Yugoslavia. In the sixties the concept of development of subspecialized disciplines prevailed: clinical neurophysiology, epileptology, neuromuscular diseases, cerebrovascular diseases and intensive neurology, child neurology. At that time a fast growing of man-power and institutions started, what made possible a modern concept of early neurologic diagnostics and treatment. The period was marked by intensive collaboration with teams of electrical engineers interested in bio-electronics, development of basic neurosciences, of neuroimaging technologies and neuroscintigraphy. Many initiatives came from Croatia for collaboration with neighbouring countries within the former Yugoslavia, but also with other neighbouring European countries, especially Austria, Italy and Germany, as well as with the American neurology.(ABSTRACT TRUNCATED AT 250 WORDS)