OBJECTIVE The aim of this study was to determine the prevalence of symmetry, asymmetry and hypoplasia of the intracranial internal carotid artery (ICA), and the possible presence of other variants of the ICA by magnetic resonance angiography (MRA). SUBJECTS AND METHODS This prospective-retrospective study included 1000 subjects who underwent consecutively MRA of the cerebral arteries. 3D-time of flight angiograms were performed according to the standard protocol. We measured the diameter of the ICA and the diameter of the A1 segment of the anterior cerebral artery (ACA). The symmetry, asymmetry and hypoplasia of the ICA, as well hypoplasia of the A1 segment of the ACA were analysed using the vascular asymmetry coefficient. RESULTS The right and left ICA were symmetrical in 93.9% examinees, and asymmetrical in 6%, while ICA hypoplasia was found in only one patient (0.1%). Other variants of the ICA were not found. There was no significant difference in the prevalence of individual variations between male and female patients, and no significant frequency difference was found between anatomical variations in terms of the right and left ICA. In 38.3% patients with asymmetrical ICAs, aplasia or hypoplasia of the A1 segment of the ACA was found on the side of the ICA with a reduced diameter. CONCLUSION Congenital hypoplasia of ICAs is a very rare abnormality, while asymmetry of ICAs is more common. After evaluating severe asymmetry of intracranial ICAs by MRA, MRA of the neck is recommended, especially in patients with a complete anterior part of the circle of Willis.

INTRODUCTION Cerebral ischemic small-vessel disease (SVD), causing lacunar infarcts and white matter hyperintensities on brain magnetic resonance imaging (MRI), is a progressive disease associated with an increased risk of stroke, dementia and death. Increased arterial stiffness has been associated with ischemic stroke and cerebral SVD independently of common vascular risk factors. OBJECTIVE The aim of the study was to analyze arterial stiffness in our patients with symptomatic SVD. METHODS In a cross-sectional study design we included 30 patients with clinical and MRI evidence of cerebral SVD and 30 age-, gender- and risk factor-matched control subjects with no neurological diseases. Patients were evaluated at the Ultrasound Laboratory at the Neurology Clinic, Clinical Center of Serbia in Belgrade, during a three-month period (from September 1st to December 1st 2012). Baseline demographic and vascular risk factors were recorded. All patients underwent standard carotid ultrasound scans with measuring of intima-media thickness (IMT) and analysis of atheromatous plaques. Internal carotid artery stiffness was evaluated with the use of e-tracking option as beta stiffness index (BSI) value. RESULTS There were no differences between study groups in regard to degree of carotid stenosis and type of carotid plaques (p > 0.05). Patients in SVD group had significantly higher mean IMT (p = 0.0093) and mean BSI (p < 0.0001) than subjects in the control group. No significant correlation was detected between IMT and BSI in SVD group (r = 0.168; p = 0.376). Brain lesions severity correlated with BSI (r = 0.733; p < 0.0001). CONCLUSION Arterial stiffness is increased in symptomatic patients with SVD, independently of vascular risk factors and IMT.

Strokes in young adults are reported as being uncommon, comprising 10%–15% of all stroke patients. However, compared with stroke in older adults, stroke in the young has a disproportionately large economic impact by leaving victims disabled before their most productive years. Recent publications report an increased incidence of stroke in young adults. This is important given the fact that younger stroke patients have a clearly increased risk of death compared with the general population. The prevalence of standard modifiable vascular risk factors in young stroke patients is different from that in older patients. Modifiable risk factors for stroke, such as dyslipidemia, smoking, and hypertension, are highly prevalent in the young stroke population, with no significant difference in geographic, climatic, nutritional, lifestyle, or genetic diversity. The list of potential stroke etiologies among young adults is extensive. Strokes of undetermined and of other determined etiology are the most common types among young patients according to TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. Prevention is the primary treatment strategy aimed at reducing morbidity and mortality related to stroke. Therefore, primary prevention is very important with regard to stroke in young adults, and aggressive treatment of risk factors for stroke, such as hypertension, smoking, and dyslipidemia, is essential. The best form of secondary stroke prevention is directed toward stroke etiology as well as treatment of additional risk factors. However, there is a lack of specific recommendations and guidelines for stroke management in young adults. In conclusion, strokes in young adults are a major public health problem and further research, with standardized methodology, is needed in order to give us more precise epidemiologic data. Given the increasing incidence of stroke in the young, there is an objective need for more research in order to reduce this burden.

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-to-needle 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, ). 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.

The aim of the study was to analyze stroke in young adults in Tuzla Canton, Bosnia and Herzegovina. From January 2001 to December 2005, 3864 patients with first-ever stroke were admitted at the Department of Neurology Tuzla. A retrospective analysis of risk factors, stroke types, severity and one month outcome in all young adults (18-45 years of age) with first-ever stroke was carried out. Out of total, there were 154 (4%) young adults with stroke. Mean age was 38.8 +/- 5.7 years and 47% were women. The leading risk factors were smoking (56%) and hypertension (45%). Subarachnoid hemorrhage (SAH) was more frequent in young adults compared with older patients (> 45 years of age) (22% vs. 3.5%, p < 0.0001), intracerebral hemorrhage (ICH) was similar in both groups (16.9% vs. 15.8%, p = 0.7), but ischemic stroke (IS) was predominant stroke type in the older group (61% vs. 74%, p = 0.0004). Young adults had more frequent lacunar stroke (26.6% vs. 16.1%, p = 0.01) and stroke due to other etiology (8.5% vs. 1.8%, p = 0.0004) than stroke patients over 45 years of age. Stroke severity at admission was lower in young adults than in older patients (p < 0.0001), as well as mortality at one month (11% vs. 30%, p < 0.0001). Favorable outcome (modified Rankin Scale < or = 2) had 71% of young adults compared with only 53% of patients in the older group (p = 0.0003). Stroke in young adults in Tuzla Canton is rare. Risk factors profile, stroke types, severity and outcome at one month in young adults are different from those in older patients.

The aim of this study was to determine whether volume and localization of intracerebral hematoma affects the six-month prognosis of patients with intracerebral hemorrhage (ICH). Patients and Methods. The study included 75 patients with ICH of both sex and all age groups. ICH, based on CT scan findings, was divided in the following groups: lobar, subcortical, infratentorial, intraventricular haemorrhage and multiple hematomas. Volume of intracerebral hematoma was calculated according to formula V = 0.5 × a × b × c. Intracerebral hematomas, according to the volume, are divided in three groups (0–29 mL, 30–60 mL, and >60 mL). Results. The highest mortality rate was recorded in the group with multiple hematomas (41%), while the lowest in infratentorial (12.8%). The best six-month survival was in patients with a volume up to 29 mL, 30 of them (64%) survived. The highest mortality rate was recorded in patients with the hematoma volume >60 mL (85%). Kaplan-Meier's analysis showed that there was statistical significance between the size of the hematoma and the six-month survival (P < 0.0001). More than half of patients (61.1%) who survived 6 months after ICH were functionally independent (Rankin scale ≤2). Conclusion The volume of hematoma significantly affects six-month prognosis in patients with intracerebral hemorrhage, while localization does not.

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 < 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.

1.1 Stroke According to the World Health Organization (WHO), stroke is defined as the sudden development of focal or global symptoms and signs of disturbance of cerebral function lasting more than 24 hours or leading to death, as a result of the pathological processes of vascular origin (Thorvaldsen et al., 1995). The basic classification of stroke, according to the type of pathological process, is into ischemic stroke, which comprises 70-85%, and hemorrhagic. An ischemic stroke develops due to the inability of supply to brain tissue oxygen and glucose due to occlusion vessel. If the "outbursts" of blood within the brain mass, there is intracerebral hemorrhage, which makes 15-20% of strokes, while the penetration of the blood in the subarachnoid space, usually as a result of aneurysm rupture, leading to a subarachnoid hemorrhage, which makes 5-10% of all strokes. Stroke leads to focal or multifocal neuropsychological disorders. Given that in clinical stroke in the forefront of motor deficits, disturbance of consciousness and disturbance of speech functions, a very common disorder and the function of other organ systems, most of the neuropsychological symptoms are observed after the acute phase when the general and neurological status stabilized, or when we are able to perform certain neuropsychological tests (Dostovic, 2007). Stroke leads to the different degree of physical, cognitive and psychosocial dysfunctioning. The recovery of patients depends on the severity of disability, the rehabilitation program, but also the subsequent maintenance of achieved function, as well as care and support of family and environment.

INTRODUCTION 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. The study included subjects with confirmed diagnosis of MS and PD. We analyzed 50 patients with PD and 50 patients with MS, with disease duration 1-5 years without any or with mild cognitive impairment. Quality of life was assessed using the SF-36 scale comprised of 36 questions in eight health profiles. RESULTS There was no significant difference in gender frequency in our study sample of patients with PD, while in MS group of patients there were a significantly more females. The average age of the PD patients was 63.18 +/- 10.42, and in patients with MS 37.4 +/- 8.65 years. In our study the relative influence of PD and MS on quality of life was similar after controlling the duration of the disease, and there were some differences in relation to the degree for clinical disability. Subjects showed reduced QoL independently of the duration of illness (patients with PD in 88% of cases, and multiple sclerosis in 84% of cases). There are significant differences in the occurrence of poor quality of life in patients with PD were in advanced clinical stages of disease for the physical, mental dimension of the SF 36 and the total score. Respondents in stages III-V of the disease were 5.23 times (23%) likely to experience reduced QoL compared to those with less physical disability. In subjects suffering from MS reduced QoL was not related to the degree of clinical disability in physical, nor the mental dimension of the SF 36 and the total score. These results in MS patients can be partially explained by the small sample size, on the other hand it is possible that patients with MS, although they have greater physical disability seen as a very difficult diagnosis which determines the entire life. CONCLUSIONS Patients who are treated for PD and MS had a high degree (> 80%) of reduction of the overall quality of life, and there were no significant differences in the extent of QoL reduction between these groups of patients. Reduced quality of life in patients with PD is observed during severe stages of the disease, while the QoL does not depent on the degree of clinical disability in MS patients. In both groups of patients the appearance patients reduced QoL does not depend on the duration of the disease.