[Stroke as a probable cause of death in some Serbian medieval rulers].

The medical analysis of illnesses and causes of death of Serbian rulers in the Middle-Ages, is difficult. Only a tentative diagnosis can be made. In addition to their religious character old Serbian biographies offer many information; they are, however, often insufficient and fragmentary. While the true state of health of Serbian rulers cannot be known, there are some descriptions and documents useful for such attempts. Stroke was presumed to be the cause of death of some Serbian medieval rulers. According to his biographers, Teodosije and Domentian, King Stefan Prvovenchani (First-Crowned) (1217-1228) had two apoplectic accidents. When the first stroke occurred, he was paralytic, bedridden and loozing his general strenght. According to St. Sava he very well recovered after the first stroke. The second stroke, in the near future, was fatal. Some authors supposed the abuse as ethyl that impaired his health. King Stefan Urosh II Milutin (1282-1321) died as a seventy years old man. His biographer, Archbishop of Petsh, Danilo II wrote about a sudden onset of the disease. King Milutin was paralyzed and aphasic. In the terminal stage, he was unconscious and insensible. Preceding stresses may be an aetiological factor. According to Constantine the Philosopher, biographer of despot Stefan Lazarevitsh (1402-1427), this ruler died when he was 53 years old. The onset of the disease was sudden. Despot showed motor weakness, dyscoordinated movements, disordered balance and sensorium, speaking disturbances, and paralysis. He died in coma next morning, on July 18, 1427. This clinical feature suggests possible cerebro-vascular insult. It is not clear whether the existing rheumatic disease played a certain role in the aetiolotgy of stroke in this case. Some data suggested the emotional lability and incontinence as warning symptoms.