Tachycardia as a Negative Prognostic Factor for Stroke Outcome.

INTRODUCTION: The outcome of stroke, especially lethal one is significant, as in the hemorrhagic as well as in ischemic stroke. GOAL: was to show the impact on the stroke outcome of tachycardia correlated with lesion localization. MATERIAL AND METHODS: Material for our work was patients who were treated due to the stroke at the Neurology Clinic Sarajevo in the period from 31 March 2015 until 01 January 2016. A total of 544 stoke patients were treated in the reporting period, 221 (44.6%) died. There were 70.9% patients with ischemic and 29.1% with hemorrhagic stroke. Each patient underwent ECG, which registered tachycardia during admission and on third day of hospitalization. RESULTS: In relation to the presence of tachycardia on admission there were statistically significant differences in the group of patients with hemorrhage and ischemia in relation to presence of tachycardia (p <0.01). In the group of patients with hemorrhage coma was more present (78.9%), while tachycardia was statistically more often in those with loss of consciousness than in the group with coma. Group of patients with ischemia has 52.75% of the patients with tachycardia without statistical correlation between the presence and absence of disorders of consciousness. Midline lesions were statistically more often associated with paroxysmal tachycardia in relation to the lateral lesions (p <0.01). Statistical analysis shows that there are statistically significant differences between observed groups χ2=35.576, p=0.0001. Lethal outcome of hemorrhagic stroke was 55.45%, 32.6% for ischemia. A significant statistical significance of ischemic and hemorrhagic stroke compared to the lethal outcome correlated with the registered tachycardia and medial lesion localization. CONCLUSION: Tachycardia on admission in patients with stroke is a relevant negative predictor for stroke outcome. Medial localization of changes significantly affects the occurrence of tachycardia and lethal outcome of stroke which is statistically significantly more associated with hemorrhagic stroke.

Post stroke depression.

INTRODUCTION: Comorbidity of depression and stroke significantly reduces the quality of life of patients after the stroke. Squeal after stroke also determines the quality of life and have impact on the occurrence of depression after the stroke. In our study we investigated the occurrence of depression in patients after different types and subtypes of stroke measured by the Hamilton scale compared to the level of disability measured by NIHSS scale. GOAL: The goal was to make a comparative analysis of depression after stroke, according to gender and age, side of the lesion and the severity of neurological deficit. MATERIAL AND METHODS: Material for our work are 210 patients with stroke treated at the Neurology Clinic, Clinical Center of Sarajevo University in 2012, 105 male and 105 female. The mean age of the patients was 67.12 +/- 9.5 years. Ischemic stroke was present in 65% cases. There was no statistically significant difference between ischemic and hemorrhagic stroke among genders. In case of hemorrhagic M-56.7%, F-43.3%; ischemic M-48.3%, F-51.7% (chi-square = 6.563, p = 0.082). Depression was more prevalent among younger patients (52-60 years) with 39.2% then in the group of older patients (61-70 years) with 32% of depressed. In relation to gender there was significantly more patients with depression among women compared to men (63.8:27.2%, chi-square = 14.38, p = 0.00019). Depression was more frequent in patients with stroke in the left hemisphere medial localization (63%). NIHSS scale average was 16.07 with the minimum of 11 and maximum of 22, F = 52.56, p = 0.001. CONCLUSIONS: We can conclude that depression after stroke is more frequent in younger patients, female patients, patients with localized stroke in the medial left hemisphere and with higher disability score.

Stress as provoking factor for the first and repeated multiple sclerosis seizures.

INTRODUCTION: Multiple sclerosis is an inflammatory, autoimmune, disease of the white mass of the brain, which sometimes may involve the gray matter (subcortical and ones in the anterior horns of the spinal cord) with the chronic nature and generally with progressive course. As a possible cause of this disease state are listed genetic predisposition, early viral infections and environmental factors, with special effects of stress as a provoking factor in first episode of the disease and relapses because stress leads to modulation of the immune system and immune response to various causes. GOAL: To determine the existence of intense stressful events as a factor in the development of the first episode of illness and worsening of the seizures. MATERIAL AND METHODS: We analyzed all newly discovered cases of multiple sclerosis over a two year period (January 2010 - December 2011) during the first or second hospitalization, and worsening of seizures for previously diagnosed patients in this period. In order to confirm the MS diagnosis are taken history, neurological examination, MRI of the brain, VEP, CSF examination and for those with repeated hospitalization only follow-up of EDSS scores trough neurological examination. RESULTS: During the two year period there were 109 newly diagnosed cases of MS from which 80 F and 29 M (ratio 2.7:1), aged 17-59 years, mean age 32.93±9.69 years and 41 patients (29 F and 12M with seizures worsening in previously diagnosed disease. Disease duration was from 6 months to 17 years. 72.94% had relapsing-remitting course of the disease (RRMS) and 27.1% had secondary progressive type (SPMS). Stress as a provoking factor preceded in 47.44% the first episode of the disease, infections (respiratory) in 18.3%, and the pregnancy with postpartum period in 8.77% women, whereas in the group of patients with previously diagnosed illness relapse (n=41) showed that the infection is most common precipitating factor which preceded relapse in 58.54% of patients, stress in 29.02%) and the pregnancy with postpartum period in 12.5% of patients. CONCLUSION: An intensive stressor is certainly one of the triggers for the development of Multiple Sclerosis, as the first episode and worsening of previously established disease.

[Quality of life in multiple sclerosis: relation to the clinical parameters of the disease]. / Korelacija objektivnih klinickih parametara i kvaliteta zivota oboljelih od multiple skleroze.

PURPOSE: Multiple sclerosis is a chronic progressive disease with multiple neurological and psychological impairments. The object of this study was to investigate the relation between quality of life of MS patients and main clinical parameters of the disease. METHODS: The study included 100 patients diagnosed with multiple sclerosis who were treated at the Department of Neurology, Clinical Center University in Sarajevo. Quality of life was evaluated by using MSQOL-54 questionnaire. Internal consistency of Bosnian MSQOL-54 version was evaluated. Associations between disability level (EDSS score), clinical type, disease duration, presence of pain and sphincteral problems and the MSQOL-54 physical and mental health composite scores were determined. RESULTS: The MSQOL -54 questionnaire, translated to Bosnian, proved to be highly reliable (Cronbach alfa > 0.75 on all scales). All clinical determinants used in the sudy proved to be significantly related to the quality of life scores based on the Mann-Whitney test (p < 0.05). Method of linear regression analysis showed presence of pain and EDSS score as the most significant independent predictive factors of the physical health composite score (R2 = 0.827). The presence of pain and clinical type of disease, proved to be independent predictive factors of the mental health composite score with present, but less significant role of EDSS score (R2 = 0.598). CONCLUSION: The presence of pain retained the most significant role in the prediction of both physical and mental composite scores, which proved the importance of pain management in treatment of MS patients. Disability level (EDSS score) showed minor importance in predicting mental health composite scores which proved deficiency of clinical scales and emphasize the importance of the quality of life measures as independent criteria in the evaluation of multiple sclerosis patients.