[Cerebrovascular accidents in Sarajevo during the war]. / Accidents vasculaires cérébraux à Sarajevo pendant la guerre.

PURPOSE: Neurologists in the main hospital in Sarajevo (Bosnia-Herzegovinia), we worked in the neurological department throughout the war and the siege of the town, from 1992/4/6 to 1995/12/15. We report on strokes which happened during that period, comparing stroke incidence and severity in relation to those two years before. We reviewed 3002 cases of stroke recorded in the neurological department registry from 01/01/90 to the end of the war. RESULTS: The activity of the department was reduced by about 40 p. 100, as was the population of the town. Yet the number of strokes decreased only by 26.5 p. 100. The comparative incidence of strokes increased by 25 p. 100 during the war. Sex ratio and age incidence were the same. The relative role of atherosclerosis, cardiac embolic sources, intracranial and meningeal hemorrhage remained the same. The incidence of intracranial hemorrhage increased by 20 p. 100. Death, evaluated after one month, increased by 36 p. 100. Death by intracranial hemorrhage increased by 30 p. 100, those by cardiac embolic infarction by 26 p. 100 and those by atherosclerosis by 20 p. 100. At the end of the first year of the war, mortality was 65 p. 100 in comparison with the previous year and death by meningeal hemorrhage increased by 74 p. 100 for the first two years of the war. The major changes in life conditions have produced change in medical conditions. Patients had to stop their treatment because there was no more medecine in the city, and, among others, no more drugs for anticoagulation, diabetes mellitus, cardiopathy.... In the hospital, medical doctors, nurses, drugs, food and even heating were missing. So stopping the treatment for vascular disease together with the high level of stress generated by daily shelling can explain the increase in stroke incidence and especially, the hemorragic cases. The poor life conditions which weakened people and the lack of treatment at the acute stage of the disease and also later, when secondary events occurred, can explain the high mortality observed. CONCLUSION: We recognize the bias of our study: the war itself, the condition in which we have carried out this work and the use of a hospital registry. Nevertheless, it seems that morbidity not directly due to the battle can change during a war like this one. This study also demonstrates, "a contrario", that preventive treatment and care of stroke at the acute phase, as they are currently recommended, are useful.

[The Miller-Fisher syndrome (clinical report)]. / Sindrom Miller-Fisher (klinicki prikaz).

The authors present a case report of two female patients, aged 16 and 33. Both patients had the same sudden onset of illness, with diplopia and nystagmus and very severe ataxia. The younger patient had absent tendon reflex, while the older one had the tendon reflex preserved. The younger patient had the triparesis present, both patients had no sphincter disorders. They did not have sensibility disturbances, except that the younger patient had hypesthesia of the soft palate (the motor function was preserved). The first patient was somnolent at the beginning. The clinical course being favourable, the younger patient recovered faster than the older one. Electoencephalogram was normal in both patients. CT of the brain was changed at one moment, locking like inflammatory changes. CSF of the younger patient, done twice, was normal. Serologic findings on viruses were normal. Electromyography in both patients showed, beside good motor velocity, the marked sensory velocity which recovered at the control check-ups. The authors present these two cases and they consider the differential-diagnostic difficulties of Fisher's syndrome compared to "brain stem encephalitis".

[Takayasu's disease and cerebromeningeal hemorrhage]. / Maladie de Takayasu et hémorragie cérébroméningée.

A 53-old-woman with both Takayasu disease and intracerebral hemorrhage is reported. Non-specific aorto-arteritis was acquired, while aneurysm on arteria cerebri media is probably of congenital origin. The association of these two syndromes is, judging by this facts, accidental. Nevertheless, it should be taken into consideration than panarteritis had a significant role in formation of aneurysm and favored the appearance of hemorrhage.