Denisa Salihović

Does the Volume and Localization of Intracerebral Hematoma Affect Short-Term Prognosis of Patients with Intracerebral Hemorrhage?

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-Meiers 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.

Cognitive syndromes after the first stroke

AimThe aim of this study is to determine impairments of certain cognitive functions in certain vascular cognitive syndromes and to identify predictors of dementia.Patients and methodsOne-year prospective study included 275 patients, who were hospitalized at the Department of Neurology Tuzla and therefore fulfilled certain criteria. Patients were divided into following subgroups of vascular cognitive impairment (VCI): dementia of strategic infarct (DSI), cortical dementia (CD), sub cortical dementia (SCD), hemorrhagic dementia (HD), and patients without dementia. Each of the patients underwent the clinical examination and scoring with appropriate measurement scales.ResultsSome of the types of VCI were verified in 190 (69%) patients, and the most common was SCD (58%). There was statistically significant connection between the level of intelligence and occurrence of VCI in patients after stroke (p < 0.001). We found significant connection between occurrence of dementia and impairment in narrative memory, numerical memory, visual perceptive, and visual constructive functions in patients with dementia compared with non-demented (p = 0.0001). The executive functions were statistically impaired in patients with CD (p = 0.004) and SCD (p < 0.001). Patients without dementia have significantly better quality of life than the demented ones (p < 0.0001). The algorithm “tree of decision” can help us in the prediction of dementia based on the impairment of certain cognitive functions.ConclusionVascular cognitive syndromes are common after stroke. Some of the cognitive functions are significantly impaired in patients with dementia. Impairment of the certain cognitive functions can help in predicting the onset of dementia. Patients without dementia have better quality of life.

CHANGE OF THE WRITING-HAND: UNUSUAL MANIFESTATION OF HALLERVORDEN-SPATZ DISEASE

Hallervorden-Spatz disease (HSD) is a rare neurodegeneration with accumulation of iron in basal ganglia, dystonia, dysarthria, rigidity, and choreoathetosis. Syndrome may present in childhood and progress relentlessly culminating in early death (classical HSD) or in second or third decade with slow progression (atypical HSD) (Hayflick et al. 2003). Magnetic resonance imaging (MRI) appearance in HSD, revealing bilaterally symmetrical, hyperintense signal changes in the anterior medial globus pallidus, with surrounding hypointensity in the globus pallidus, on T2-weighted scanning. These features are fairly diagnostic of HSD and have been termed the „eye of the tiger“ sign (Dashti & Chitsaz 2014). Unfortunately, exact etiology, predictors, and biochemical markers are not known.

Intravenous thrombolytic therapy for acute ischemic stroke in Tuzla Canton, Bosnia and Herzegovina.

It is well known that thrombolysis with intravenous recombinant tissue plasminogen activator (rt-PA) is the first evidence-based treatment for acute ischemic stroke. In the European Union (EU), rt-PA was approved in 2002 and has been used widely since then. Bosnia and Herzegovina is one of the few European countries not yet part of the EU, and approval for rt-PA in acute ischemic stroke was granted in 2007 under the same conditions as in other European countries. We presented our results with the use of intravenous thrombolytic therapy in patients with acute ischemic stroke in Tuzla Canton, Bosnia and Herzegovina. Between April 2008 and December 2011, intravenous rt-PA was administered to 72 patients with acute ischemic stroke, which represents 3·5% of patients with acute ischemic stroke admitted to the Department of Neurology Tuzla in that period (2067 patients). Baseline characteristics of the patients treated with thrombolytic therapy are provided in Table 1. Figure 1 illustrates the three-month outcome of our patients treated with thrombolytic therapy in comparison with the results of the neighboring countries: Sestre milosrdnice University Hospital Zagreb, Croatia (1) and Institute of Neurology Belgrade, Serbia (2). We wish to emphasize that these are only the results from our department, not at the national level. Bosnia and Herzegovina is one of the few countries in Europe that does not have an official National Stroke register, primarily because of the political situation. Therefore, our participation in multicenter studies is limited. With this article we want to demonstrate that we are working in line with the established protocols and show that our results are approximate to the results of other countries, despite the aforementioned shortcomings. These are small steps for world’s neurology but big ones for neurology in Bosnia and Herzegovina.

Short‐term outcome of intracerebral hemorrhage: a hospital‐based study in Tuzla, Bosnia and Herzegovina

Dear Editor, International Journal of Stroke readers will probably be surprised by the fact that Bosnia and Herzegovina is one of rare countries in Europe that does not have an official Stroke register, mainly because of a complex political system. Our country is divided in two entities of which one entity is separated in 10 cantons, besides Brčko District. Our clinic is located in Tuzla, the largest city of Tuzla Canton, that has 500 000 inhabitants. All patients with stroke in Tuzla region were hospitalized at our department. We did a few studies in domain of cerebrovascular diseases, but all the data were based on hospital records due to the aforementioned situation. Despite this situation, we are making efforts to keep up with the trends in domain of cerebrovascular diseases, and we managed to form a Stroke unit on our clinic and to start applying thrombolytic therapy for the last four-years. The main goal for this article is to show results in one of our studies about intracerebral hemorrhage, which is done in the Department of Neurology Tuzla, for the period June 1, 2007 to March 31, 2008. It was one of the first studies of this kind in our country and it contained analysis of clinical and neuroradiological characteristics of intracerebral hemorrhage (ICH) and its influence on short-term outcome. Based on 75 patients, we came up with following results: 40 patients (53·4%) were male, the mean age for all patients was 64·3 13·7 years, and men were older than women (P = 0·031). The disturbance of consciousness on admission significantly influenced the sixmonth outcome (P < 0·0001). Patients with multiple hematomas had higher mortality rate (41%); however, localization of hematomas did not have any significant influence on the six-month mortality. Surviving of patients highly depended of volume of hematomas (P < 0·0001). Less than half of patients (39%) who survived six-months after stroke were functionally depended (Rankin scale >2, Barthel Index <90). Predictors of poor six-month prognosis were brain edema (P = 0·002), intraventricural bleeding (P = 0·004), and Glasgow Coma Scale <8 (P < 0·0001) (Table 1). It can be concluded that there are certain clinical and neuroradiological predictors for short-term prognosis in intracerebral hemorrhage. Intracerebral hemorrhage has high mortality rate (52%), and most of the survivors are functionally independent six-months after stroke (61%). Our results do not differ from studies with similar design (1–3). Perhaps, we could provide better results, but due to the aforementioned shortcomings, we are limited to participation in larger multicenter studies.