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.

Neoplasms in the clinical material of neurology clinic, Clinical Center of University of Sarajevo in the period 1990-2009.

INTRODUCTION: Brain tumors are a unique and heterogeneous group of tumors with which face a variety of specialties, mostly oncologists, neurologists and neurosurgeons. Due to their specific location all brain tumors are malignant, regardless of their malignant potential, because any expansion process within the skull, increased intracranial pressure and destruction of surrounding structures, which can cause neurological, quantitative disturbances of consciousness or death. GOAL: The goal of this study was to record neoplastic processes of the central nervous system in patients of Neurology Clinic, Clinical Center of Sarajevo University in the twenty-year period (January 1st 1990-December 31st 2009). The study was partly retrospective and partly prospective determined by three time periods. MATERIAL AND METHODS: We reviewed medical records and documentation of patients treated at Neurology Clinic, which has 102 beds. All patients' data were collected using a specially designed questionnaire for this study. RESULTS AND DISCUSSION: The number of secondary tumor process for the period 2000-2005 is greater than in the period 1990-1999, while in the period 2000-2009 is increasing (17.2%-30.3%). The male-female ratio is 52:48. During the first two monitoring period there were statistically significantly more men, and in the last monitoring period there were more women. The mean patient's age was 60 years. The most common symptom was hemiparesis for all observed periods evaluated with standard diagnostic tests: CT and MRI. CONCLUSION: We can conclude that CNS neoplasms in patients of Neurology Clinic, Clinical Center of Sarajevo University are present in the twenty-year period with total of 1.47%, and showed a decrease of 2.7% (1990-1999) to 0.47% for the period 2006-2009.

Betahistine or Cinnarizine for treatment of Meniere's disease.

INTRODUCTION: Meniere's disease is a condition with sudden attacks of vertigo with nausea and vomiting accompanied by loss of hearing and buzzing sensation in the ears, most commonly unilateral. The exact cause of the disease is unknown. Betahistine is the analogue of histamine with weaker agonistic effect on histamine H1 receptors and stronger effect on histamine H3 receptors, while Cinnarizine has more effective effect on H1 receptors. GOAL: The aim is to determine which drug is more effective in the treatment of Meniere's disease Betahistine or Cinnarizine. MATERIAL AND METHODS: This study evaluates the effectiveness of Betahistine in 37 patients with the Meniere's syndrome accompanied by classic triad of symptoms treated in hospital conditions and Cinnarizine effect in 36 patients with a less severe clinical picture, which were treated as outpatients. To all patients were conducted laboratory tests, brain CAT (to exclude possible expansive process, MS or stroke) and TCD in order to eliminate any possible circulatory disturbances in VB basin. Group with classic Meniere's syndrome was treated at a dose of Betahistine of 3 x 16 mg and followed 8 weeks, while the second group was treated with Cinnarizine at a dose of 2 x 75 mg and also followed for 8 weeks. CONCLUSIONS: Already after one month of therapy was noticed better effect in case of Betahistine in terms of symptoms reduction compared to the Cinnarizine effect.

Interferon treatment of multiple sclerosis.

INTRODUCTION: IN THE TREATMENT OF MULTIPLE SCLEROSIS (MS) DIFFER: treatment of relapse, treatment slow the progression of the disease (immunomodulators and immunosuppression), and symptomatic treatment. THE AIM: The aim of this study is to analyze the application of interferon therapy in the treatment of MS-E: Process the disease, patients with multiple sclerosis who have passed the commission for multiple sclerosis at the Neurology Clinic of Clinical Center of Sarajevo University as a reference center for referral to the Commission for multiple sclerosis from the Federal Ministry of Health in 2009 year in terms of total number examined, gender differences, diagnostic tests (MRI, CSF, EP), neurological findings and EDSS scores. Provide a section through the continuous support and education of patients during the introduction Betaferon in therapy with the goal of education for self-use and reduce the incidence of side effects of interferon therapy. MATERIALS AND METHODS: The material for the work they were histories of patients who are registered as patients who have undergone a commission for MS at Department of Neurology, University Clinical Center in Sarajevo. The evaluation was retrospective. It was used a specially designed form, which is usually applied to patients referred to this committee. After the collected material was carried out data processing. The study comprised 34 patients who have undergone a commission of which 16 patients received interferon therapy. RESULTS: In 2009 at the Neurology Clinic CCUS have treated 34 patients who passed the committee for recommendation to interferon therapy (25 women and 9 men). The diagnosis of multiple sclerosis is safe based on the criteria of international panel in 2000. EDSS Average score for men was 1.8, 1.9 for women, the total EDSS score was 1.8. The gender ratio is 3:1 in women than in men. Sixteen patients received interferon by the Commission for multiple sclerosis, the Federal Ministry of Health and their therapy was initiated at the clinic. CONCLUSION: For the period of 2009, a total of 34 patients were examined with multiple sclerosis who received interferon treatment recommendations at the expense of the Federal Solidarity Fund at the Neurology Clinic CCUS Sarajevo. The average EDSS score was 1.8. There were no significant differences in neurological findings between patients who were previously treated with interferon and patients who were waiting for treatment.

Depression in multiple sclerosis patients.

INTRODUCTION: Multiple sclerosis (MS) manifests also with the symptoms of affective disorders. Depression is the most common mental disorder among patients with MS and it has negative impact on their working ability, social relations and quality of life. The aim of this study is to investigate gender, age, marital status, education level and employment related to patients with depressive symptoms in population of MS, treated at the Department of Neurology, Clinical Center University of Sarajevo. METHOD: In the study it was analyzed 50 randomly selected patients with various types of multiple sclerosis. Severity of depression was evaluated using the Beck Depression Inventory (BDI). RESULTS: The study included 33 female and 17 male patients aged 21 to 60 years. In the sample of MS patients there were 56% with depressive disorder. There is no statistically significant difference between patients gender. Depression is more frequent among younger and middle age patients, while all the patients older than 51 years are in a normal mood (total 31.9%). Significantly higher percentage of non-depressive patients (72.2%) are married, while depression is present among all divorced patients (10.7%), majority of single (35.8%) and widowers (21.4%). Taking into consideration level of education, there is a statistically significant difference as follows: depression is more frequent among patients who graduated university (46.4%) and secondary school (50%) compared to ones who finished only primary school (3.6%). There is significantly higher number of unemployed and retired patients with depressive symptoms (75%) in comparison to the employed ones. CONCLUSION: Depression occurs more frequently among MS patients who are younger, unemployed, highly educated and without spouse. There is no statistically significant difference between male and female patients.

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.

Statistical evaluation of olanzapine efficacy in catamnesticly investigated patients.

The aims of this research are: a) To compare GAF (Global Assessment of Functioning) score after the olanzapine treatment with the GAF score recorded after the treatment conducted by typical antipsychotics; b) To compare CGI (Global Clinical Impression) score after the treatment with CGI subsequent to treatment by typical antipsychotics; c) To compare number of hospitalizations of patients during the treatment with olanzapine with the number of hospitalizations during previous treatment; and 4. To monitor and record the possible weight gain of patients who were taking olanzapine. The research was conducted in the period from 2004 to 2007 in the Department of Psychiatry of the University Clinical Center in Sarajevo. Research subjects were patients with diagnosed schizophrenia who did not have expected response to the treatment with conventional antipsychotics, or who experienced serious adverse effects in the course of this treatment. Daily dosage of olanzapine was adjusted to the clinical condition of the patient and it varied from 5 to 20 mg a day. Clinical assessment is done once a month with CGI scale and GAF scale. During follow-up the possible weight gain was also followed. Statistically significant difference was found (p<0.001).

Bilateral retrobulbar optic neuritis as first signs of Lyme disease.

Bilateral retrobulbar optic neuritis in young adults are most often caused by demyelinate disease (MS). In all cases where MS was eliminated, we have used selected tests regarding to history, clinical findings and differential diagnosis. Diagnosis of Lyme disease is approved by diagnostic criteria proposed by Center for Control and Prevention of disease. In our case diagnosis of Lyme disease was established by history of illness, clinical findings and positive serlological tests.