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Introduction: Nummular headache is a type of primary headache of chronic character, with a large number of described varieties in the clinical picture, and therefore the differential diagnostic consideration must include a large number of disorders related to changes in epicranial structures. Certain dermatological disorders can also include pain in a limited area of the scalp with itching, burning or burning sensation, such as Lichen Planopilaris. Case report: This is a report of a patient who was initially diagnosed with Lichen planopilaris, but after determining the parameters of the distinction and the necessary additional diagnostic procedures, a diagnosis of Nummular headache was made. Conclusion: In this presentation, we have presented another important differential diagnostic item and we believe that the work is a small contribution to everyday practice, but also to further research.

Introduction. At the very beginning of the Corona virus epidemic there was not enough data on whether hemodialysis patients have a higher risk for Corona virus infection and which factors may affect the severity of clinical picture. Objective. The aim of the study was to determine the significance of the Modified Early Warning Assessment (MEWS) score for the assessment of coronavirus disease exacerbation. Methods. The research was conducted in COVID dialysis, as a retrospective, descriptive-analytical study, at the University Clinical Center Kragujevac, Serbia, which was organized ad-hoc for treatment of SARS-Cov-2 infection positive patients, which are transfered from Center for Hemodialysis "Ćuprija". They were evaluated routine laboratory findings, demographic and gender structure, arterial blood pressure, presence of comorbidities and residual diuresis, duration of dialysis, radiological evaluation of lungs, determination of MEWS score were the parameters that were monitored. The results were monitored on admission and and in the end of treatment. Results. A statistically significant difference was registered in serum lactate dehydrogenase concentration (486 ± 107.62 vs. 423.7 ± 92.4 U/L); p = 0.022 and absolute monocyte count (0.46 ± 0.15 vs. 0.67 ± 0.34 x 103; p = 0.008). The significant increase in MEWS score was also found (b = 0.017; p = 0.030). There was a positive correlation between increase of MEWS score and age (b = 0.027; p = 0.002) and arterial hypertension as a concomitant comorbidity (b = 0.700; p = 0.033). Conclusion. In the observed period, there was a significant increase in the degree of MEWS score of dialysis patients who had SARS-Cov-2 infection.

Objective: In the available literature data, there is not much information about problems of patients with end stage kidney disease in relation to oral health. Our objective was to show the importance of oral diseases for patients on hemodialysis. Data sources: In this review article, the sources of data are review articles and scientific articles in the English language published in MEDLINE database. The choice of studies was based on keywords: Chronic kidney disease, Hemodialysis, Oral health, Periodontal diseases. Results: It is assumed that almost 90% patients with chronic kidney disease manifest some symptoms of oral disease. Therefore, it is important to determine the impact of periodontal disease on the progression of kidney failure in these individuals, to evaluate inflammatory parameters in this patient population, to assess the degree of bone loss and periodontal disease index, to determine the presence of bacterial strains, paradontopathy of gingival fluid and antibody titers, to examine correlations of proinflammatory cytokines in the gingival sulcus and serum, as well as to determine the relationship between periodontal tissue and inflammatory mediators. Periodontal diseases can increase the possibility of developing chronic kidney disease by 1.5 to 2 times. These oral diseases include gingival hyperplasia, periodontitis, xerostomia, unpleasant breath, changes in the oral mucosa, malignancies, oral infections, dental abnormalities and bone lesions. Conclusion: This requires serious cooperation between nephrologists and dentists to make proper communication possible, in order to provide quality dental care for this growing patient population in accordance with new treatment strategies.

Introduction: The emergence of brain infarction depends to a great extent on the status of collateral blood circulation and is associated with hemodynamic instability. This kind of brain infarction is usually found in border vascular zones. Infarction of borderline fields arises between vascular territories ACA and ACM or between ACM and ACP, deep paraventricular infarcts in internal border zones, wound or triangular cortical infarcts, as well as major infarctions involving the entire irrigated territory of ACM. Aim:To define the atherosclerotic stenosis of the inner carotid artery and its significance in brain infarction genes in the borderline of supratentorial localization. Material and methods: Inclusion criteria for inclusion in the study are the existence of an infarct lesion in a predetermined border cortical and subcortical area of supratentorial localization. Data on extracranial atherosclerotic carotid disease were obtained by ultrasonographic inspection of a commercially available apparatus, 7-9 and 9-14 MHz probes/catheter. As a criterion for assessing the degree of carotid stenosis, the formula of the apparatus software was used: 100 x (A - B) / wherein Ais the area of the cross-section of the artery at the site of the largest stenosis, and the B surface of the free lumen artery cross section on the largest stenosis site. Results: The study included 30 selected patients, 12 (40%) females, aged 47-79, (± 62.3 years) and 18 (60%) male, aged 43-79 (± 58.7 years). Cortical infarction of the frontal border region (ACA - ACM) was seen in 11 (36.6%), 15 (50%) ACM - ACP infarct, while subcortical infarction between the surface and deep branches a. Cerebri media ACM - ACM), seen in 4 (13.4%) patients. Carotid atherosclerosis in the form of occlusion or significant stenosis with unilateral localization was observed in 6 (26%) patients, while bilateral changes were present in 17 (74%) patients. In the ACA + ACM group (ACM + ACM), a statistically significant increase in bilateral carotid artery involvement was observed in the group of patients with cerebral infarction of the last ACM-ACP border region (p = 0.018). Conclusion: The two-sided significant steno-occlusive atherosclerotic disease of the inner carotid artery is a very common and statistically significant finding in patients with endocardial infarction of supratentorial localization. This finding corroborates the pathophysiological explanation of this entity and opens up adequate therapeutic perspectives in the prevention and treatment of this kind of stroke.

Introduction: Clinical features of the ischemic neurovascular syndromes is constant and dependable from vascular territory of the affected blood vessel. Best examples are sensory and motor hemisyndromes and vision disturbances. Aim: To define motor, sensory and visual disturbances' in patients with ischemic stroke in the border zone of the middle cerebral artery. Material and methods: Border zone ischemic stroke diagnosis was based on clinical and neurological examination and confirmed with brain computerized tomography. Estimation of the symptoms was obtained by history, and degree of functional (neurological) deficit was estimated based on NIH-NINDS scale. Results: In total 30 patients were included in the study, 12 (40%) were females 47-79 years of age (±62.3 years) and 18 (60%) males 43-79 years of age (± 58.7 years). Neurological features were clearly different based on the side of the infarct. In the group with (ACA+ACM) + (ACM+ACM) infarct localization hemiparesis is significantly more frequent. In the group with ACM+ACP infarct localization homonymous hemianopia is significantly more frequent. Initial symptom of the reversible loss of consciousness in duration of several minutes was observed in 14 (46.6%) patients. Focal seizures (clonic seizures of the face, arm and leg) were detected in 4 (13.3%) patients (all with infarcts in the anterior border zone ACA-ACM). Headache was rare manifestation seen in 5 (16.6%) patients with 4 having posterior border zone infarcts. Conclusion: Supratentorial border zone infarcts have high specificity in clinical manifestations. The implicates therapeutical approaches which are prone to specific procedures.

Introduction: During the course and development of diverse cardiological diseases different central nervous system complications may develop. These are most frequently related to the nature of the cardiovascular entity itself. Aim: To evaluate the association between atherogenesis factors and border zones strokes within the cerebral medial artery vascularization territories. Methods: In total 30 patients were enrolled in the study. Stroke diagnosis was based according to clinical and neurological examination and brain CT findings. The study analyzed risk factors correspondingly to World Health Organization criteria. Results: In majority of patients (18; 60%) arterial hypertension was diagnosed. Additionally, following condition and risk factors were identified: cardiological diseases (17; 23.3%), cigarette smoking (13, 43.3%), hypercholeterolaemia (9; 30%) and diabetes (7; 23.3%). In the group with cardiological diseases most frequent was myocardial infarction (9; 56.2%), AV block II and III (5, 29.4%), atrial fibrillation with slow ventricular response (3; 17.6%). Conclusion: Results of the study point to conclusion that myocardial infarction, AV block II and III, atrial fibrillation with slow ventricular response, iatrogenic hypertension and traditional risk factors for atherogenesis significantly influences presentation of the border zone strokes within the cerebral medial artery vascularization territories.

A case of a patient is shown, who was admitted for neurological exploration, with clinical manifestations of the cerebrovascular accident in the posterior circulation (TIA V-B vascularisation). In accordance with diagnostic protocol, an endocranial CT was performed. The results of the brain CT indicated an existence of an alteration in the right pontocerebellar angle area, which was subsequently diagnosed as a n. vestibularis schwannoma in an NMR examination. After a neurosurgical deliberation, the patient was treated with a gamma knife. After this surgery, which was done in a local anesthesia, the patient's condition was well and he was discharged. Control examinations have shown minor difficulties during the stimulation of the left ear auditive structures. Control examinations involving NMR showed no signs of recidivate focal findings.

Arachnoid cysts are cavities filled with liquor, usually localized on the floor of the middle cranial fossa. Clinically, they are usually asymptomaticand can sometimes be presented with increased intracranial pressure syndrome and epileptic seizures. We present a patient who, after a slight head injury in a accident develops an increased intracranial pressure syndrome followed by an epileptic seizure. Based on the clinical course and diagnostic processing, we want to draw attention doctors who are in a position to inspect these patients that apparently slight head injuries can be complicated and dangerous for the lives of the premorbid intracranial condition of the injured.

Since it has been recognized as a separate disease during the Korean war hemorrhagic fever with renal syndrome (HFRS) has often been discovered among the members of different armies in various countries, military personnel being the highest risk group for the disease. In the period from March to May 1999 we treated 6 soldiers coming from the military formation stationed at Kosovo and Metohia. The reaction of indirect hemagglutination test proved the presence of antibodies against Hantavira in each of them. They were infected during the stay in a dugout in the area with great population of field rodents. Only one patient was slightly ill, on the admission to the hospitalall. The others had severe clinical and laboratory findings: several days lasting fever, strong abdominal pain, as well as the pain in the loins dyspeptical discomfort, manifold increased blood urea nitrogen and serum creatinine values, thrombocytopenia, etc. Oliguria occurred in 4 patients. Hemorrhagic manifestations were slight (epistaxis, petechial rash conjunctival injection), or absent. Because of the aggravation of the acute renal failure, hemodialysis was performed in 3 patients, while other 3 underwent conservative treatment. Two of the patients had severe anemia because of which transfusions of erythrocytes and plasma were performed. Complications occurred in 2 patients (convulsive crises and lung infections). All patients recovered completely.

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Introduction: Synovial cysts of the facet joint are rare benign changes occurring in the spinal synovial joints, predominantly in the lumbar region. Although these cysts are generally benign, intracystic hemorrhages are extremely rare and can lead to severe complications. Case Presentation: This case report details a patient who developed cauda equina syndrome due to hemorrhage within a synovial cyst in the lumbar spine.The patient’s symptoms included acute radicular pain and neurological deterioration. Diagnostic imaging revealed a large synovial cyst with evidence of intracystic bleeding. Conclusion: Acute radicular pain and rapid neurological deterioration can result from a synovial cyst in the lumbar spine, particularly when complicated by intracystic bleeding. Urgent decompressive surgery and removal of the cyst resulted in complete recovery for the patient.

Background: Previous studies have indicated that changes in the expression of certain inflammatory biomarkers are associated with cognitive impairment (CI), but only a limited number of studies were conducted in patients with acute ischemic stroke (AIS). The present study aimed to evaluate the potential association between serum levels of several inflammatory markers and cognitive impairment in AIS patients. These markers included interleukin 6 (IL-6), C-reactive protein (CRP), plasma fibrinogen, erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count., Subjects and Methods: All participants were prospectively recruited from the Department of Neurology, Clinical Center University of Sarajevo. A total of 100 patients with first-ever AIS were included in stroke group and 30 in the non-stroke control group. Each patient underwent a comprehensive cognitive assessment and laboratory tests (IL-6, CRP, fibrinogen, ESR and WBC) within the first three days of admission. Cognitive status was assessed using cognitive instruments: the Mini-Mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery, and the Addenbrooke's Cognitive Examination-Revised., Results: Female stroke patients with CI had higher levels of IL-6 compared to those without CI and controls (p<0.017). AIS patients with CI had significantly higher plasma fibrinogen (p<0.001) and CRP levels (p<0.001) than controls, whereas there was no significant difference in comparison with cognitively intact patients. There were no statistical differences in ESR or WBC count between groups., Conclusions: Of the inflammatory markers, only IL-6 levels were associated with CI in AIS patients. Measuring circulating IL-6 could be used as a screening test to identify all such patients.

Since it has been recognized as a separate disease during the Korean war, hemorrhagic fever with renal syndrome (HFRS) has often been discovered among the members of different armies in various countries, military personnel being the highest risk group for the disease. In the period from March to May 1999 we treated 6 soldiers coming from the military formation stationed at Kosovo and Metohia. The reaction of indirect hemagglutination test proved the presence of antibodies against Hantavira in each of them. They were infected during the stay in a dugout in the area with great population of field rodents. Only one patient was slightly ill, on the admission to the hospital. The others had severe clinical and laboratory findings: several days lasting fever, strong abdominal pain, as well as the pain in the loins, dyspeptical discomfort, manifold increased blood urea nitrogen and serum creatinine values, thrombocytopenia, etc. Oliguria occurred in 4 patients. Hemorrhagic manifestations were slight (epistaxis, petechial rash, conjunctival injection), or absent. Because of the aggravation of the acute renal failure, hemodialysis was performed in 3 patients, while other 3 underwent conservative treatment. Two of the patients had severe anemia because of which transfusions of erythrocytes and plasma were performed. Complications occurred in 2 patients (convulsive crises and lung infections). All patients recovered completely.