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 six-month 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).

Table 1. Analysis of six-month prognosis in patients with intracerebral hemorrhage
Variable (yes/no)Survived (N = 36)Died (N = 39)Total (N = 75)P
  1. GCS, Glasgow Coma Scale; CT, computed tomography.

Clinical characteristics       
Disturbance of consciousness5/3113·9/86·124/1561·5/38·529/4638·7/61·3<0·0001
GCS (≤8 or >8)3/338·3/91·722/1756·4/43·625/5033·4/66·7<0·0001
Brain edema17/2347·2/63·827/869·2/20·544/3158·7/41·30·002
Intraventricular bleeding8/2822·2/77·821/1853·8/46·229/4638·7/61·30·004

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.


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