Ego Defence Mechanisms in Patients with Epilepsy.

BACKGROUND: In order to protect itself from the pain or discomfort that would result from the forbidden instinctual impulses, the ego developed defence mechanisms (DM). Mature DMs are associated with adaptive functioning. Immature and neurotic DMs are associated with maladaptive functioning. Our goal was to determine the intensity of the most frequently used immature, neurotic and mature ego DMs in patients with epilepsy. SUBJECTS AND METHODS: We examined 50 patients with epilepsy, using a Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humour, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The control group consisted of 36 healthy subjects. Groups are equal in age and level of education. RESULTS: Patients with epilepsy use neurotic (p=0.0290) and immature (p=0.0155) defensive styles significantly more. Individually, they most intensively use acting out, humour and sublimation, and statistically significantly more they use displacement (p=0.0161), denial (p=0.05) and somatization (p=0.0019). CONCLUSION: Patients with epilepsy use the neurotic and immature styles of ego defence more intensively. As such, they are less adaptable to new situations. Our knowledge can be useful for planning future interventions for people living with epilepsy.

Two year outcomes of poststroke writing and reading disorders.

Poststroke language disorders are frequent and include aphasia, alexia, agraphia, and acalculia. These disorders refer to an acquired inability to read, write and calculate. In this study, we evaluated the two year outcomes of writing and reading disorders in poststroke patients, the natural course, recovery and mortality. We evaluated all the patients with stroke who were admitted to the Department of Neurology, University Clinical Centre Tuzla in period of six months, who developed poststroke alexia, agraphia, acalculia, or different combinations of these language disorders. Outcome of these patients was evaluated again after 24 months. For clinical assessment of alexia, agraphia, and acalculia we used Minnesota Test for Differential Diagnosis of Aphasia. We investigated 59 (30.5%) of 193 stroke patients with alexia, agraphia, acalculia, and combinations. Outcome of these patients after 24 months was: 37 (62.7%) died, 13 (22%) fully recovered, and 9 (15.3%) of them retained the same disorder or developed dementia or blindness. Binary logistic regression analysis showed that patients with combined language disorders had significantly higher mortality. The main factors influencing language disorders recovery in this study are initial severity of reading, writing and calculation impairment, age, neglect, and level of education.

Neurobrucellosis and cerebral venous sinus thrombosis: a case report.

OBJECTIVES: To present a case of co-occurrence of neurobrucellosis and cerebral venous sinus thrombosis. METHODS: Case report. CLINICAL PRESENTATION:  We presented 49-year-old Caucasian domicile female-farmer with a history of headache, weakness, and vomiting for a period of three months. Also, she had significant papilledema. We diagnosed rare co-morbidity of neurobrucellosis (confirmed after ELISA-test in serum samples and CSF analysis of pleocytosis/increase in protein/decrease in glucose level) in the setting of cerebral venous thrombosis developed in left sigmoid/left transverse sinus (confirmed after MRV of brain). Favorable outcome was achieved by applying protracted polymicrobial antibiotic therapy and heparin. DISCUSSION: It may be challenging to diagnose neurobrucellosis, especially in patients with atypical presentation and abortive clinical forms. The co-morbidity of neurobrucellosis and cerebral venous sinus thrombosis is uncommon. However, it provides a possibility of brucella-colonization in cerebral venous sinuses as a potential hidden link between them. CONCLUSION: Patients with severe and persistent headache, as well as other neurological symptoms/signs should be considered for neurobrucellosis in endemic, but also in brucella non-endemic regions due to migrations. According to literature survey, this co-occurrence of neurobrucellosis and cerebral venous sinus thrombosis is third one reported from Europe.

Depression and dementia in Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative disorder causing not only motor dysfunction but also cognitive, psychiatric, autonomic and sensory disturbances. Depression is the most common psychiatric disturbance identified in patients with PD and has been shown to be more common in PD than in other chronic and disabling disorders, occurring in approximately 40% of PD patients. However, the prevalence and clinical features associated with depression in PD remain controversial. Dementia is increasingly recognized as a symptom associated with idiopathic PD, and is found in up to 40% of all patients suffering from that condition. The aim of this study was to estimate the prevalence of depressive and dementia symptoms in PD patients. The study included 35 consecutive patients with PD, 13 (37.4%) male and 22 (62.6%) female (mean age 62.9 ± 11.0, range 36-85 years), mean duration of disease 4.7 ± 2.9 (range 1-10) years, hospitalized during one year at Clinical Department of Neurology, Tuzla University Clinical Center, Tuzla, Bosnia and Herzegovina. The Mini Mental State Examination (MMSE) was used for assessment of cognitive deterioration and Beck Depression Inventory (BDI) for depression. Computerized tomography was performed in all patients. According to BDI scale, depressive symptoms were present in all 35 PD patients: minimal in 4 (11.4%), low in 7 (20%), moderate in 8 (22.8%), severe in 9 (25.4%) and extreme in 7 (20%) patients. On MMSE scale, 9 (25.4%) patients were free from cognitive deterioration and 26 (74.6%) patients had moderate to severe deterioration, but 21 (60%) patients (7 (33.33%) male and 14 (66.66%) female) had symptoms of dementia (MMSE score ≤ 23). Using MMSE scale, 8 (22.8%) patients were free from dementia and 27 (77.2%) patients had some cognitive deterioration. Very mild symptoms of dementia were found in 6 (25.9%) and overt features of dementia in 21 (74.1%) PD patients. So, out of 35 PD study patients, 21 (60%) (7 (33.3%) male and 14 (66.7%) female) had symptoms of dementia (MMSE score ≤ 23). In conclusion, depressive and dementia symptoms are common in PD patients.

Anton's Syndrome due to Bilateral Ischemic Occipital Lobe Strokes.

We present a case of a patient with Anton's syndrome (i.e., visual anosognosia with confabulations), who developed bilateral occipital lobe infarct. Bilateral occipital brain damage results in blindness, and patients start to confabulate to fill in the missing sensory input. In addition, the patient occasionally becomes agitated and talks to himself, which indicates that, besides Anton's syndrome, he might have had Charles Bonnet syndrome, characterized by both visual loss and hallucinations. Anton syndrome, is not so frequent condition and is most commonly caused by ischemic stroke. In this particular case, the patient had successive bilateral occipital ischemia as a result of massive stenoses of head and neck arteries.

[Obstetric lesions of brachial plexus]. / Porodajne lezije pleksusa brahijalisa.

BACKGROUND: Obstetrical brachial plexus lesion (OBPL) (also known in its various forms as Erb's palsy, Klumpke's paralysis, Erb-Duchenne palsy) complicates a very small proportion of births. Furthermore, it seems that more likely many cases recover with little in the way of remaining deficit, but it is equally certain that some cases will not recover. Electro diagnostic examinations are used as following the physical examination and can provide data on both the severity and timing of the injury. The initial study usually is performed 2-3 weeks after injury, when signs of enervation are seen in children with moderate or serious injuries. The incidence of obstetric brachial plexus palsy varies from 0.4 to 1 case per 1000 new born children. This incidence has remained unchanged since the beginning of this century despite current technologic advances. The aim of this paper is to review the literature and authors experience with OBPL. PATIENTS AND METHODS: The study included 30 children examined in last 10 years at Electro myoneurography laboratory, Department of Neurology, University Clinical Center Tuzla, Bosnia and Herzegovina. RESULTS AND DISCUSSION: Total out of 20 children (66.67%) were male, and 10 (33.3%) female; in 11 (36.67%) palsy was on left, and in 19 (63.33%) on right side. Erb's palsy was seen in 27 (90%) and total palsy in the remaining 3 (10%) limbs. Electromyography was very useful test not only for diagnosis, but also for evaluation of recovery. Good recovery was observed in majority of these children, but some children has difficulty with active shoulder abduction, forward flexion, symmetric elbow flexion and forearm supination at age of one year and more, and mild shortening and atrophy of the limb are also observed.

[Amyotrophic lateral sclerosis in younger age associated with abnormality of copper level]. / Amiotroficka lateralna skleroza u mladoj zivotnoj dobi udruzena sa poremecajem vrijednosti bakra.

Amyotrophic lateral sclerosis is a progressive degenerative neuromuscular disease in adults that occurs in familial and sporadic forms. The mean age of onset of symptoms is 56 years and the mean duration of disease is 3 years. One of the theories on the pathogenesis suggests on mutation in gene that encodes superoxide dismutase, which is involved in metabolism of free radicals (copper, zinc). In this article we showed patient with early onset of disease associated with abnormality of copper level. Co morbidity with Wilson disease has not been proved. According to this case it is possible to think about changes in cuprum level at ALS patients.