Stroke in Sarajevo during the war

Purpose: Neurologists in the main hospital in Sarajevo (Bosnia-Herzegovinia ), we worked in the neurological department throughout the war and the sieg e of the town, from 1992/4/6 to 1995/12/15 We report on strokes which happe ned during that period, comparing stroke incidence and severity in relation to those two years before. We reviewed 3002 cases of stroke recorded in th e neurological department registry from 01/01/90 to the end of the war. Results: The activity of the department was reduced by about 40 p. 100, as was the population of the town. Yet the number of strokes decreased only by 26.5 p. 100. The comparative incidence of strokes increased by 25 p. 100 d uring the war. Sex ratio and age incidence were the same. The relative role of atherosclerosis, cardiac embolic sources, intracranial and meningeal he morrhage remained the same. The incidence of intracranial hemorrhage increa sed by 20 p. 100. Death, evaluated after one month, increased by 36 P. 100 Death by intracranial hemorrhage increased by 30 p. 100 those by cardiac em bolic infarction by 26 p. 100 and those by atherosclerosis by 20 p. 100. At the end of the first year of the war, mortality was 65p. 100 in comparison with the previous year and death by meningeal hemorrhage increased by 74 p . 100 for the first two years of the war. The major changes in life conditions have produced change in medical condit ions. Patients had to stop their treatment because there was no more medeci ne in the city, and, among others, no more drugs for anticoagulation, diabe tes mellitus, cardiopathy... In the hospital, medical doctors, nurses, drug s, food and even heating were missing. So stopping the treatment for vascul ar disease together with the high level of stress generated by daily shelli ng can explain the increase in stroke incidence and especially, the hemorra gic cases. The poor life conditions which weakened people and the lack of treatment at the acute stage of the disease and also later, when secondary events occur red, can explain the high mortality observed Conclusion: we recognize the bias of our study: the war itself, the conditi on which we have carried out this work and the use of a hospital registry. Nevertheless, it seems that morbidity not directly due to the battle can ch ange during a war like this one. This study also demonstrates, "a contrario ", that preventive treatment and care of stroke at the acute phase, as they are currently recommended, are useful.