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Acta Clinica Croatica, Supplement
International Journal of Stroke
Introduction/Objectives: Th e central idea of our presentation is MCI -a conceptual and pathologi... more Introduction/Objectives: Th e central idea of our presentation is MCI -a conceptual and pathological entity defi ned by Petersen et al. in 1995 and still under debate, surrounded by a sustained attention mainly because it is a stage where suitable medical and nonmedical interventions could potentially be more successful by comparison with later stages in which the changes are more and more dramatic and less susceptible to be amended.
ABSTRACT Export Date: 18 October 2014
The aim of the study was to determine duration of delirium in patients with acute stroke accordin... more The aim of the study was to determine duration of delirium in patients with acute stroke according to sex, age, type and localization of lesion. We assessed delirium prospectively in a sample of 233 consecutive patients with an acute (≤4 days) stroke using the Delirium Rating Scale (DRS-R-98) and Diagnostic and Statistical Manual of Mental Disorders (DSM IV). The average duration of delirium was 4 days in patients with ischemic stroke and 3 days in patients with hemorrhagic stroke. There was no statistically significant difference in delirium duration between these two patient groups. A longer duration of delirium was recorded in women and in patients older than 65. The period of delirium was longer in patients with right hemispheric lesions. Patients did not differ according to delirium duration, sex, age, type and localization of stroke. In two thirds of patients, the symptoms of delirium completely disappeared on medicamentous treatment, while in the remaining one third of patien...
Acta clinica Croatica
The aim of the study was to determine duration of delirium in patients with acute stroke accordin... more The aim of the study was to determine duration of delirium in patients with acute stroke according to sex, age, type and localization of lesion. We assessed delirium prospectively in a sample of 233 consecutive patients with an acute (< or =4 days) stroke using the Delirium Rating Scale (DRS-R-98) and Diagnostic and Statistical Manual of Mental Disorders (DSM IV). The average duration of delirium was 4 days in patients with ischemic stroke and 3 days in patients with hemorrhagic stroke. There was no statistically significant difference in delirium duration between these two patient groups. A longer duration of delirium was recorded in women and in patients older than 65. The period of delirium was longer in patients with right hemispheric lesions. Patients did not differ according to delirium duration, sex, age, type and localization of stroke. In two thirds of patients, the symptoms of delirium completely disappeared on medicamentous treatment, while in the remaining one third o...
Medicinski arhiv, 2003
In the everyday practice among clinical and etiological classifications for ischemic stroke, the ... more In the everyday practice among clinical and etiological classifications for ischemic stroke, the terms strokes in the anterior and posterior cerebral circulation are also in use. The aim of this study was to analyze the frequency of ischemic strokes in the anterior and posterior circulation, their age and sex distribution, risk factors and hospital mortality. In the study it was analyzed 1772 patients with acute ischemic stroke hospitalized at the Department of Neurology Tuzla, Bosnia and Herzegovina, between January 1st 1996 and December 31st 2000. The mean age was 65.5 years (+9.9), 942 (55%) were females. Ischemic strokes for all patients were confirmed with computed tomography, while other data were collected from the standard patients' history charts. Anterior circulation stroke (ACS) had 1408 patients (81.8%), the rest of 314 (18.2%) had posterior circulation stroke (PCS). In the both types females were slightly overrepresented: 784 (56%) in ACS, and 158 (50.5%) in PCS. Mo...
Cardiovascular Psychiatry and Neurology, 2012
Objectives. To determine the severity of stroke and mortality in relation to the type of disturba... more Objectives. To determine the severity of stroke and mortality in relation to the type of disturbance of consciousness and outcome of patients with disorders of consciousness. Patients and Methods. We retrospectively analyzed 201 patients. Assessment of disorders of consciousness is performed by Glasgow Coma Scale (Teasdale and Jennet, 1974) and the Diagnostic and Statistical Manual of Mental Disorders (Anonymous, 2000). The severity of stroke was determined by National Institutes of Health Stroke Scale (Lyden et al., 2011). Results. Fifty-four patients had disorders of consciousness (26.9%). Patients with disorders of consciousness on admission (P &amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and discharge (P = 0.003) had a more severe stroke than patients without disturbances of consciousness. Mortality was significantly higher in patients with disorders of consciousness (P = 0.0001), and there was no difference in mortality in relation to the type of disturbance of consciousness. There is no statistically significant effect of specific predictors of survival in patients with disorders of consciousness. Conclusion. Patients with disorders of consciousness have a more severe stroke and higher mortality. There is no difference in mortality and severity of stroke between patients with quantitative and qualitative disorders of consciousness. There is no statistically significant effect of specific predictors of survival in patients with disorders of consciousness.
Medical Archives, 2011
2 i ntroduction: Multiple sclerosis (MS) and Parkinson's disease (PD) are chronic diseases with u... more 2 i ntroduction: Multiple sclerosis (MS) and Parkinson's disease (PD) are chronic diseases with unpredictable course causing progressive physical disability and cognitive decline, and broadly affecting the patient's life, social interaction, recreational activities and overall life satisfaction. Goals: To examine the quality of life of patients with PD and MS, and investigate the existence of differences between the degree of impairment to the quality of life in PD and MS. Methods: A prospective study was conducted at the Neurology Clinic, University Clinical Center in Tuzla in the period from December 2005 until May 2007.
Medical Archives, 2011
2 i ntroduction. Sleep disorders (SD) after stroke (stroke) are common occurrences, and most ofte... more 2 i ntroduction. Sleep disorders (SD) after stroke (stroke) are common occurrences, and most often in sleep apnea, insomnia and daytime sleepiness. Goals. Research goals were to determine the types of SD and their frequency in patients with stroke in relation to the type of stroke and side of lesion. Materials and methods. The study analyzed 200 patients with acute stroke hospitalized in the Clinic of Neurology, University Clinical Centre Tuzla in the period from 1st August 2007 to 1st June 2008. All patients have confirmed the existence of stroke by computerized tomography. SD was verified according to the General Curriculum of sleep, the Berlin questionnaire and Epvort scale. Stroke, by type, were divided into hemorrhagic and ischemic, and the localization of the stroke to right and left cerebral hemispheres. Results. Of the total number of respondents, 78% had SD. Very serious level of SD had 42% of respondents, 20% moderate, and 16% of medium-severe degree. There was no statistically significant differences in the frequency of SD among patients with ischemic and hemorrhagic stroke (76.8%: 82.5%, p=0.58). In relation to the side of lesion there was more patient with SD and stroke in the right cerebral hemisphere, but there were no statistically significant differences (39.5%: 33%, p=0.1). According Epvort scale sleep apnea and snoring was present in 86%, daytime sleepiness in 49.5% and narcolepsy 0.5%. Conclusions. Sleep disturbance as a neuropsychological disorder has a significant incidence in the acute phase of stroke. SD is slightly more common in hemorrhagic stroke and stroke in the right hemisphere. Sleep Apnea and snoring are the most common types of SD in patients with stroke.
ISRN Stroke, 2014
Aim. To demonstrate our experiences of thrombolytic therapy in acute ischemic stroke. Subjects an... more Aim. To demonstrate our experiences of thrombolytic therapy in acute ischemic stroke. Subjects and Methods. Patients with ischemic stroke treated with rt-PA, admitted at the Department of Neurology, Tuzla, Bosnia and Herzegovina, in the period between April 1, 2008, and December 31, 2012, were included. Results. Between April 2008 and December 2012, intravenous rt-PA was given to 87 patients with acute ischemic stroke, which represents 3.2% of patients with acute ischemic stroke admitted to our department in that period. Hypertension was the leading stroke risk factor. The mean NIHSS score before thrombolysis was 12 (range 4-21). Large artery arteriosclerosis was the most common stroke etiology. The mean door-to-needle time was 72 minutes and onset-toneedle time 152 minutes. Half of patients (44/87) had a significant improvement within the first 24 hours. Parenchymal hemorrhage occurred in 5 patients (6%) and was fatal in two cases. At 3-month follow-up, 45% of patients (39/87) had good outcome (mRS 0 or 1). Sixteen patients were dead at 3 months, and mean baseline stroke severity was significantly higher in patients who died (NIHSS 16.5 versus 11, = 0.003). Conclusion. The number of patients with acute ischemic stroke treated using rt-PA in the Department of Neurology, Tuzla, is lower than in developed countries. Thrombolytic therapy is safe and leads to favorable outcome in half of the patients.
… Med Sal, 2009
To determine the frequency of delirium in patients with acute stroke. Patients and methods: We as... more To determine the frequency of delirium in patients with acute stroke. Patients and methods: We assessed delirium prospectively in a sample of 233 consecutive patients with an acute (≤ 4 days) stroke using the Delirium Rating Scale R-98 and the Diagnostic and Statistical Manual of Mental Disorders -Fourth Edition criteria for delirium. results: Delirium was diagnosed in 59 (25.3%) patients. Patients with delirium were older comparing to those without delirium (70.0±11.3 vs. 64.7±10.4 years of age; p=0.001). Delirium was significantly more frequent in hemorrhagic comparing to the ischemic type of stroke (41.6% vs. 22.3%, p=0.02). In patients with the ischemic stroke, the delirium was more frequent among those with right hemispheric lesion (26.2% vs. 20.5%, p=0.0006); however, in hemorrhagic stroke delirium was more frequent in patients with left hemispheric lesion (42.9% vs. 27.8%, p=0.002). Delirium was also more frequent in patients with ischemic stroke in the anterior than posterior cerebral circulation territory (22.7% vs. 5.6%, p=0.0001). Conclusion: Delirium develops in approximately one quarter of patients in the acute phase of stroke. Possible factors which predispose the occurrence of delirium are ages over 65 years, hemorrhagic stroke, ischemic stroke in anterior cerebral circulation, lesion of right hemisphere in ischemic stroke and left hemisphere in hemorrhagic stroke.
International Journal of Stroke, 2013
Acta Med …, 2009
Aim: To analyze anxiety in patients within 48 hours and 15th day after the ischemic stroke (IS) i... more Aim: To analyze anxiety in patients within 48 hours and 15th day after the ischemic stroke (IS) in relation to gender and location of the lesion. Patients and Methods: We analyzed 40 patients (mean age 65.3±10.3 years) with gender ratio 20:20. Mean age of hospitalized women was 66.35±7.31 years and men 64.2±12.68 years (p=0.5). IS was verified by computerized tomography (CT) of the brain in all patients. Anxiety level was measured with self estimated Zung scale. Score 50 and higher was verification of anxiety. Criteria made by Domasio were used to determine location of the IS. Results: Mean value on anxiety within 48 hours was 44.4 ± 8.8 and 42.2 ± 7.7 15th day after the IS (p=0.237). In 12 (30%) patients anxiety was found during the first and in 10 (25%) during the second evaluation. Women had higher level of anxiety with significant gender differences within first 48 hours (47.75 ± 8.4 : 41.05 ± 7.9) (p=0.013). In 9 (45%) female patients and 3 (15%) male patients anxiety was present within 48 hours from disease onset (p=0.024). Mean level of anxiety 15th day after the stroke in women was 45.7 ± 8.34 what was significantly different to 38.7 ± 5.24 in men (p=0.0029). In 9 (45%) women and 1 (5%) men mild to moderate anxiety was present (p=0.015). Concerning the circulation (anterior/posterior) and side of lesion (right/left hemisphere) there were no significant differences in level of anxiety in patients with IS (p=0.583; p=0.678 and p=0.207; p=0.27, respectively) neither within 48 hours nor 15th day after the disease onset. Conclusion: Gender has significant influence on anxiety rising within 48 hours and 15th day after the ischemic stroke (IS). Women have higher level of anxiety at both periods of measurements. Number of anxious patients is somewhat higher within 48 hours after the stroke but it is not significantly lower 15th day after the IS as well. Location of IS has no significant influence on anxiety after IS.
Acta Clinica Croatica, Supplement
International Journal of Stroke
Introduction/Objectives: Th e central idea of our presentation is MCI -a conceptual and pathologi... more Introduction/Objectives: Th e central idea of our presentation is MCI -a conceptual and pathological entity defi ned by Petersen et al. in 1995 and still under debate, surrounded by a sustained attention mainly because it is a stage where suitable medical and nonmedical interventions could potentially be more successful by comparison with later stages in which the changes are more and more dramatic and less susceptible to be amended.
ABSTRACT Export Date: 18 October 2014
The aim of the study was to determine duration of delirium in patients with acute stroke accordin... more The aim of the study was to determine duration of delirium in patients with acute stroke according to sex, age, type and localization of lesion. We assessed delirium prospectively in a sample of 233 consecutive patients with an acute (≤4 days) stroke using the Delirium Rating Scale (DRS-R-98) and Diagnostic and Statistical Manual of Mental Disorders (DSM IV). The average duration of delirium was 4 days in patients with ischemic stroke and 3 days in patients with hemorrhagic stroke. There was no statistically significant difference in delirium duration between these two patient groups. A longer duration of delirium was recorded in women and in patients older than 65. The period of delirium was longer in patients with right hemispheric lesions. Patients did not differ according to delirium duration, sex, age, type and localization of stroke. In two thirds of patients, the symptoms of delirium completely disappeared on medicamentous treatment, while in the remaining one third of patien...
Acta clinica Croatica
The aim of the study was to determine duration of delirium in patients with acute stroke accordin... more The aim of the study was to determine duration of delirium in patients with acute stroke according to sex, age, type and localization of lesion. We assessed delirium prospectively in a sample of 233 consecutive patients with an acute (< or =4 days) stroke using the Delirium Rating Scale (DRS-R-98) and Diagnostic and Statistical Manual of Mental Disorders (DSM IV). The average duration of delirium was 4 days in patients with ischemic stroke and 3 days in patients with hemorrhagic stroke. There was no statistically significant difference in delirium duration between these two patient groups. A longer duration of delirium was recorded in women and in patients older than 65. The period of delirium was longer in patients with right hemispheric lesions. Patients did not differ according to delirium duration, sex, age, type and localization of stroke. In two thirds of patients, the symptoms of delirium completely disappeared on medicamentous treatment, while in the remaining one third o...
Medicinski arhiv, 2003
In the everyday practice among clinical and etiological classifications for ischemic stroke, the ... more In the everyday practice among clinical and etiological classifications for ischemic stroke, the terms strokes in the anterior and posterior cerebral circulation are also in use. The aim of this study was to analyze the frequency of ischemic strokes in the anterior and posterior circulation, their age and sex distribution, risk factors and hospital mortality. In the study it was analyzed 1772 patients with acute ischemic stroke hospitalized at the Department of Neurology Tuzla, Bosnia and Herzegovina, between January 1st 1996 and December 31st 2000. The mean age was 65.5 years (+9.9), 942 (55%) were females. Ischemic strokes for all patients were confirmed with computed tomography, while other data were collected from the standard patients' history charts. Anterior circulation stroke (ACS) had 1408 patients (81.8%), the rest of 314 (18.2%) had posterior circulation stroke (PCS). In the both types females were slightly overrepresented: 784 (56%) in ACS, and 158 (50.5%) in PCS. Mo...
Cardiovascular Psychiatry and Neurology, 2012
Objectives. To determine the severity of stroke and mortality in relation to the type of disturba... more Objectives. To determine the severity of stroke and mortality in relation to the type of disturbance of consciousness and outcome of patients with disorders of consciousness. Patients and Methods. We retrospectively analyzed 201 patients. Assessment of disorders of consciousness is performed by Glasgow Coma Scale (Teasdale and Jennet, 1974) and the Diagnostic and Statistical Manual of Mental Disorders (Anonymous, 2000). The severity of stroke was determined by National Institutes of Health Stroke Scale (Lyden et al., 2011). Results. Fifty-four patients had disorders of consciousness (26.9%). Patients with disorders of consciousness on admission (P &amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and discharge (P = 0.003) had a more severe stroke than patients without disturbances of consciousness. Mortality was significantly higher in patients with disorders of consciousness (P = 0.0001), and there was no difference in mortality in relation to the type of disturbance of consciousness. There is no statistically significant effect of specific predictors of survival in patients with disorders of consciousness. Conclusion. Patients with disorders of consciousness have a more severe stroke and higher mortality. There is no difference in mortality and severity of stroke between patients with quantitative and qualitative disorders of consciousness. There is no statistically significant effect of specific predictors of survival in patients with disorders of consciousness.
Medical Archives, 2011
2 i ntroduction: Multiple sclerosis (MS) and Parkinson's disease (PD) are chronic diseases with u... more 2 i ntroduction: Multiple sclerosis (MS) and Parkinson's disease (PD) are chronic diseases with unpredictable course causing progressive physical disability and cognitive decline, and broadly affecting the patient's life, social interaction, recreational activities and overall life satisfaction. Goals: To examine the quality of life of patients with PD and MS, and investigate the existence of differences between the degree of impairment to the quality of life in PD and MS. Methods: A prospective study was conducted at the Neurology Clinic, University Clinical Center in Tuzla in the period from December 2005 until May 2007.
Medical Archives, 2011
2 i ntroduction. Sleep disorders (SD) after stroke (stroke) are common occurrences, and most ofte... more 2 i ntroduction. Sleep disorders (SD) after stroke (stroke) are common occurrences, and most often in sleep apnea, insomnia and daytime sleepiness. Goals. Research goals were to determine the types of SD and their frequency in patients with stroke in relation to the type of stroke and side of lesion. Materials and methods. The study analyzed 200 patients with acute stroke hospitalized in the Clinic of Neurology, University Clinical Centre Tuzla in the period from 1st August 2007 to 1st June 2008. All patients have confirmed the existence of stroke by computerized tomography. SD was verified according to the General Curriculum of sleep, the Berlin questionnaire and Epvort scale. Stroke, by type, were divided into hemorrhagic and ischemic, and the localization of the stroke to right and left cerebral hemispheres. Results. Of the total number of respondents, 78% had SD. Very serious level of SD had 42% of respondents, 20% moderate, and 16% of medium-severe degree. There was no statistically significant differences in the frequency of SD among patients with ischemic and hemorrhagic stroke (76.8%: 82.5%, p=0.58). In relation to the side of lesion there was more patient with SD and stroke in the right cerebral hemisphere, but there were no statistically significant differences (39.5%: 33%, p=0.1). According Epvort scale sleep apnea and snoring was present in 86%, daytime sleepiness in 49.5% and narcolepsy 0.5%. Conclusions. Sleep disturbance as a neuropsychological disorder has a significant incidence in the acute phase of stroke. SD is slightly more common in hemorrhagic stroke and stroke in the right hemisphere. Sleep Apnea and snoring are the most common types of SD in patients with stroke.
ISRN Stroke, 2014
Aim. To demonstrate our experiences of thrombolytic therapy in acute ischemic stroke. Subjects an... more Aim. To demonstrate our experiences of thrombolytic therapy in acute ischemic stroke. Subjects and Methods. Patients with ischemic stroke treated with rt-PA, admitted at the Department of Neurology, Tuzla, Bosnia and Herzegovina, in the period between April 1, 2008, and December 31, 2012, were included. Results. Between April 2008 and December 2012, intravenous rt-PA was given to 87 patients with acute ischemic stroke, which represents 3.2% of patients with acute ischemic stroke admitted to our department in that period. Hypertension was the leading stroke risk factor. The mean NIHSS score before thrombolysis was 12 (range 4-21). Large artery arteriosclerosis was the most common stroke etiology. The mean door-to-needle time was 72 minutes and onset-toneedle time 152 minutes. Half of patients (44/87) had a significant improvement within the first 24 hours. Parenchymal hemorrhage occurred in 5 patients (6%) and was fatal in two cases. At 3-month follow-up, 45% of patients (39/87) had good outcome (mRS 0 or 1). Sixteen patients were dead at 3 months, and mean baseline stroke severity was significantly higher in patients who died (NIHSS 16.5 versus 11, = 0.003). Conclusion. The number of patients with acute ischemic stroke treated using rt-PA in the Department of Neurology, Tuzla, is lower than in developed countries. Thrombolytic therapy is safe and leads to favorable outcome in half of the patients.
… Med Sal, 2009
To determine the frequency of delirium in patients with acute stroke. Patients and methods: We as... more To determine the frequency of delirium in patients with acute stroke. Patients and methods: We assessed delirium prospectively in a sample of 233 consecutive patients with an acute (≤ 4 days) stroke using the Delirium Rating Scale R-98 and the Diagnostic and Statistical Manual of Mental Disorders -Fourth Edition criteria for delirium. results: Delirium was diagnosed in 59 (25.3%) patients. Patients with delirium were older comparing to those without delirium (70.0±11.3 vs. 64.7±10.4 years of age; p=0.001). Delirium was significantly more frequent in hemorrhagic comparing to the ischemic type of stroke (41.6% vs. 22.3%, p=0.02). In patients with the ischemic stroke, the delirium was more frequent among those with right hemispheric lesion (26.2% vs. 20.5%, p=0.0006); however, in hemorrhagic stroke delirium was more frequent in patients with left hemispheric lesion (42.9% vs. 27.8%, p=0.002). Delirium was also more frequent in patients with ischemic stroke in the anterior than posterior cerebral circulation territory (22.7% vs. 5.6%, p=0.0001). Conclusion: Delirium develops in approximately one quarter of patients in the acute phase of stroke. Possible factors which predispose the occurrence of delirium are ages over 65 years, hemorrhagic stroke, ischemic stroke in anterior cerebral circulation, lesion of right hemisphere in ischemic stroke and left hemisphere in hemorrhagic stroke.
International Journal of Stroke, 2013
Acta Med …, 2009
Aim: To analyze anxiety in patients within 48 hours and 15th day after the ischemic stroke (IS) i... more Aim: To analyze anxiety in patients within 48 hours and 15th day after the ischemic stroke (IS) in relation to gender and location of the lesion. Patients and Methods: We analyzed 40 patients (mean age 65.3±10.3 years) with gender ratio 20:20. Mean age of hospitalized women was 66.35±7.31 years and men 64.2±12.68 years (p=0.5). IS was verified by computerized tomography (CT) of the brain in all patients. Anxiety level was measured with self estimated Zung scale. Score 50 and higher was verification of anxiety. Criteria made by Domasio were used to determine location of the IS. Results: Mean value on anxiety within 48 hours was 44.4 ± 8.8 and 42.2 ± 7.7 15th day after the IS (p=0.237). In 12 (30%) patients anxiety was found during the first and in 10 (25%) during the second evaluation. Women had higher level of anxiety with significant gender differences within first 48 hours (47.75 ± 8.4 : 41.05 ± 7.9) (p=0.013). In 9 (45%) female patients and 3 (15%) male patients anxiety was present within 48 hours from disease onset (p=0.024). Mean level of anxiety 15th day after the stroke in women was 45.7 ± 8.34 what was significantly different to 38.7 ± 5.24 in men (p=0.0029). In 9 (45%) women and 1 (5%) men mild to moderate anxiety was present (p=0.015). Concerning the circulation (anterior/posterior) and side of lesion (right/left hemisphere) there were no significant differences in level of anxiety in patients with IS (p=0.583; p=0.678 and p=0.207; p=0.27, respectively) neither within 48 hours nor 15th day after the disease onset. Conclusion: Gender has significant influence on anxiety rising within 48 hours and 15th day after the ischemic stroke (IS). Women have higher level of anxiety at both periods of measurements. Number of anxious patients is somewhat higher within 48 hours after the stroke but it is not significantly lower 15th day after the IS as well. Location of IS has no significant influence on anxiety after IS.