Effects of kinesiotherapy on muscle strengthening in patients with Parkinson disease.

Aim To investigate the effect of kinesiotherapy on muscle strengthening in patients with Parkinon's disease. Methods This clinical retrospective - prospective study was based on collected data from medical histories and included 40 patients, who, beside medicaments, had undergone kinesiotherapy. This study analysed age, gender, duration of the rehabilitation and estimation of the gross muscle strength at admittance and discharge using Manual Muscle Test (MMT). Results Females was slightly more represented in the total sample without significant statistical difference. After kinesiotherapy significant statistical difference in muscle strength was observed, average MMT of the upper extremities increased from 3.25±0.6 to 3.53±0.8 and on the lower extremities from 2.9±0.8 to 3.3±0.9. The analysis of the gender on the higher score of MMT showed that gender does not affect the score of MMT. Correlational analysis of the age and duration of hospitalization on the score of MMT showed that patients with longer hospitalization had better improvement. Conclusion Results of the study showed that kinesiotherapy has positive effect on muscle strength in patients with Parkinson's disease.

Platybasia and Klippel Feil-syndrome: case report.

A case is presented of a 35-year-old woman diagnosed with platybasia associated with Klippel-Feil syndrome type I. She was admitted to University Department of Neurology for clinical examination because of walking difficulties, dizziness, and intermittent vision disturbances. Neurological examination revealed a predominance of cerebellar symptomatology. Relevant diagnostic work-up included craniogram, cervical spine x-ray, computed tomography (CT) of the brain and craniocervical junction, magnetic resonance imaging of the brain, electroencephalography, ophthalmologic examination, urinary tract ultrasonography, laboratory tests, and psychological testing. CT of the craniocervical junction showed platybasia, congenital fusion of the second and third cervical vertebrae, and basilar invagination of dens axis. Platybasia is leveling of the angle between the floor of the anterior cranial fossa and posterior cranial fossa in the area of sella turcica, which is normally at 115-140 degrees. Basilar impression or invagination is moving up of the basis of the occiput and occipital condyles into the cranium, which means that the borders of the foramen magnum, condyles and adjacent bone are invaginated into the posterior fossa. Klippel-Feil syndrome type II is massive fusion of two of seven cervical vertebrae associated with short neck and low hair line.

[Epidemiology of multiple sclerosis in Bosnia and Herzegovina]. / Epidemioloske karakteristike multiple skleroze u Bosni i Hercegovini.

In order to examine precipitating factors for occurrence of multiple sclerosis or inception of a relapse in patients suffering from multiple sclerosis a specially designed questionnaire was used, including history records of patients with multiple sclerosis treated at the Clinic of Neurology of the Clinical Center of Sarajevo in the period between January1st and December 31st 2006. The number of patients with MS was 71 (48 women and 23 men). An infection as a precipitating factor was noted in 21 (29.57%) cases, stress was noted in 12 patients (16.9%) whereas 43 patients (60,12%) had the RR type of the disease. Nine patients were treated with interferon therapy (12.67%) and 47 patients (66.1%) with high doses of metilpredinisolone . Depression disorder was noted in 23 (32.9%) patients whereas 7 patients had cognitive dysfunction (9.86%). Results of this study, which have shown epidemiological characteristics of multiple sclerosis for the first time in Bosnia and Herzegovina, indicate that there is a need to create a unified register of patients and to request compliance with therapeutic guidelines.

Stroke at a younger age.

Stroke is a suddenly developing disorder, caused by focal disturbance of cerebral circulation, followed by neurologic deficits of varying intensity with duration longer than 1 hour; it mostly occurs in old and middle age, and rarely at a younger age. The aim of the study was to analyze the occurrence of stroke at a younger age (18-49 years). We analyzed all stroke patients aged 18-49 treated at University Department of Neurology in Sarajevo during 2009, including analysis of their risk factors. During the one-year period, there were 820 stroke patients in total, 132 (18.5%) of them aged 18-49, male to female ratio 51.35%:48.65%. The majority of strokes were of ischemic type (94.59%), with only 5.41% of hemorrhagic stroke. The following risk factors were confirmed in study patients: hypertension (64.86%), smoking (57.76%), dyslipidemia (48.65%), ischemic heart disease (43.32%), psychological stress (29.73%), diabetes mellitus type 2 (24.43%), previous stroke including transient ischemic attack (21.62%), and others. During the one-month follow-up, 27.03% of patients achieved complete recovery, whereas mild neurologic signs were retained in 54.05%, signs of severe deficit requiring assistance in 13.51%, and 5.41% of patients died. In conclusion, stroke occurs even at a younger age in certain percentage. Along with smoking, diabetes, dyslipidemia and stress, hypertension is one of the leading risk factors for stroke also at a younger age. Timely and appropriate treatment contributes to faster recovery and shorter hospital stay, while reducing overall stroke sequels. The best prevention is primary, i.e. fighting risk factors and healthy lifestyle.

Acute polyradiculoneuritis in Sarajevo during the war.

Acute polyradiuloneuritis is acute inflammatory demyelinizing polyneuropathy, with still unknown cause, and which main pathophysiological disorder is degeneration of axons which affects peripheral nerves. Most frequently it occurs as acute, several days or weeks after viral, respiratory or gastrointestinal infections. Survival rate is in the world between 95-98% of cases. The goal of the research is to determine by retrospective study number of cases of acute polyradiculoneuritis during the war in the Sarajevo under the siege and their outcome. In this paper we have analyzed total number of acute polyradiculoneuritis cases within the period since April 1992 until April 1996, when the city of Sarajevo was completely under siege. Diagnostic criteria's besides anamnesis was detailed neurological exam, blood tests, analysis of the cerebrospinal liquor, EMG, ECG and cardiac tests. Within the above mentioned period there was 17 cases of polyradiculoneuritis, 13 male and 4 females, age between 14-65 years. Motor weakness and parestesias was most dominant in clinical image. Number of cases increased during the years and it was greatest during 1995. Previous infections were noted in 6 cases, and 5 of those respiratory, and one case of gastrointestinal. Proteinorahia in liquor was found among 10 cases (4 during first and 6 during the second week of illness). Pathological EMG was found in 8 cases. Milder form of illness had 4 patients, while 13 patients had more severe form. In total 7 patients survived, 2 of them without consequences, 3 with milder and 2 with more severe consequences while in 10 cases there was a lethal outcome.

[Multiple sclerosis therapy]. / Terapija multiple skleroze.

Although still with the unclear etiology, multiple sclerosis (MS) is, according to the majority of researchers, autoimmune disease which affects people with the genetic predisposition. This is illness of the white mass of the brain and spinal cord which is causing damage to the myelin, but also to the degeneration of the axons, with the accompanying inflammatory reaction. Clinical course of the illness is characterized by wide distribution in time and space. It is more common among women than man (in some cases that ratio could be (3:1), among white than black, and it shows different geographical distribution. It is most frequent at the age from 20 to 40 years, but it is not uncommon in younger and older ages. Related to its still unknown ethiology the therapy in best case is imunomodulational or immunosuppressive, but in the majority of cases symptolmatological. After all of this question occurred: WHEN AND WHICH THERAPY WE SHOULD USE FOR THE PATIENTS?

Transcranial Doppler sonography as diagnostic method.

Having in mind the fact that cerebrovascular disease (CVB) takes today in medicine, in spite of diagnostic and therapeutic modernisation, the third place of mortality causes in the world (behind cordial and malignant diseases, but in front of depressions), and the second place of invalidity cause (right after trauma) as well as the second place of dementia cause (after Alzheimer disease), it urges primary prophylaxis. Developing countries, but before all countries of East and Middle Europe, where is our country, are highly risked areas where CV disease has trend of incidence and total frequency increase. In the neighbouring Croatia today CV disease is at the first place of mortality causes. In the world today 5 million people annually suffer CV disease, in Europe about 700.000, but frequency of suffering on Balkan is about 5 prom. Age of CV disease effecting unfortunately moved towards young age, and today 49% of effected by CV disease are of 46 to 59 years of age. Early detection and treatment of risk factors (before hypertension, smoking, diabetes mellitus, hyperlipidaemia, stress and physical non-activities) are the first aspect of CV disease prophylaxis. Together with this aspect of primary prophylaxis is early detection of complications of mentioned risk factors on the walls of blood vessels, before all changing in sense of arteriosclerosis, with consequence of disorder of cerebral haemodynamics. With that objective - verification of circulator and total haemodynamic disorders, there is obvious disclose of non-invasive diagnostic methods, and one of them is Transcranial Doppler Sonography (TCD). TCD is method comfortable for patient, reliable and rather precise, dynamic, and can be repeated several times, without side effects and in comparison with others rather cheap.