Current Journal of Neurology
Year:2003 | Volume:3 | Issue:7|Papers Count:11

A 23 years old female was referred to the Gheam medical center and admitted in the ICD and then in Neurology ward. She was a thing girl that has been suffering from progressive external ophtalmoplegia from age 13. Clinical manifestations include ptosis, restriction of ocular movement, retinitis pigmentosa, myopathy and neuropaty, increased bowel sounds, nausea and systolic heart murmur in the left sternal border. Paraclinical findings include increaed FBS, decreased parathormone, chronic compensated hypercapnea, VSD and valvular disorders and myogenic and neuragenic changes in electrodiagnositc exams. There is family history of the same disorder with maternal inheritance and her brother had exactly the same disease with cataract. All findings are not compatible with the known mitochondrial syndrome so it could be considered as a new unusual form of mitochondrial disorder.      

Cerebrovascular accidents (CVA) constitute the commonest debilitating disease of the nervous system. Most prevalent among the elderly, CVA occurs in 10 out of every 10 thousand people and is associated with wide- ranging complications. Hence, the use of advanced procedures of treating patients with CVA, in conjunction with complementary therapeutic methods has become the focus of attention. Since surgical management of subarachnoid hemorrhage (SAH) is often inevitable and complementary treatments can reduce the risk of rebleeding due to aneurysmal rupture, there has been a rise in application of microscopic surgery and complementary treatments such as the use of Nimodepine for reducing vasospasm. This study was conducted to compare the old and new methods of treating patients with SAH. This is a 10-year cross-sectional study of 100 patients in two groups. Each consisting of 50 patients. The first group was treated using microscopic surgery and complementary drugs such as Nimodepine. The second group underwent non microscopic surgery and was not treated with complementary drugs. Methods of study, outcome of surgery, complications, length of hospitalization and patient mortality rate were compared in respect of surgical technique and demographic indices. Data were analyzed with SPSS software package using T-student test. Women accounted for 56% and 66% of patients treated with the new and old methods. The majority of patients in both groups were aged between 40 and 60 years. Post operation complications developed in 30% of patients treated with the old method and 22% of those treated with the new method using Nimodepine (P>0.05). Mean length of hospitalization was 15.34 and 14.38 drugs in the old and new methods, respectively. Effort and advancements in treating patients with SAH and preventing rebleeding (which is associated with a high mortality rate) have led to development of microscopic surgical techniques alongside complementary treatments. However, climatic conditions, Lack of trained and well-coordinated surgical teams, limited resources and facilities, as well as underlying risk factors have contributed to high mortality rate due to SAH in Iran.                

Multiple Sclerosis is a chronic disease with unknown etiology. There are some reports that brain tissue Magnesium is decreased in these patients. Evaluation of serum Calcium and Magnesium in 50 clinical definite multiple Sclerosis patients (39F , 11M) with mean age of 31.8 years, showed that comparing with control group serum Mg was decreased in these patients. There was no significant difference in serum calcium level between patients, and control group. There was also no significant difference between serum Magnesium in gender, clinical manifestation, type of progression and disability of the patients.      

Diabetic Neuropathy is the most frequent chronic complication of diabetes mellitus and polyneuropathy is the most common form of neuropathy in diabetic patients. The Present study was carried on 118 diabetic patients referring to Shariati Hospital Endocrine Clinic from Mehr of 1375 to Mehr of 1376. The frequency and influencing factors on polyneuropathy among diabetic patients were evaluated. The patient's age were between 18-65 years. All patients were evaluated for clinical symptoms and signs of polyneuropathy. Elecotrophysiologic study was performed for 64 patients. The most common symptom of polyneuropathy was paresthcia in distal part of limbs (66.5%) The most common sign of polyneuropathy was the absence of ankle jerk (40.95%) The prevalence of polyneuropathy was 35.0% according to clinical signs and 56.25% according to nerve conduction study. All patients with clinical symptoms and signs of polyneuropathy had polyneuropathy electrophysiologically. This study showed that 29.8% of diabetic women and 43% of diabetic men have suffered from polyneuropathy. There is statistically significant correlation between age and polyneuropathy and length of disease and polyneuropathy. There is no significant correlation between polyneuropathy and smoking. According to above findings, it seems. That electrophyslotogic study may be unnecessary in diabetic patients with clinical signs of polyneuropathy.        

Come is one of the most common causes of medical emergency. Loss of consciousness is from lethargic to deep coma. Management of patients with loss of consciousness needs early diagnosis, treatments and special care. In this study frequency and causes of coma was evaluated. And outcome of patients studied too.      

Evaluation of 8 Functional Systems (FS) that may involve in MS is essential for detecting neurological impairment and scaling disability. Also it is possible to determine the patterns of involvement by FS type with 8-digit binary number; each system as just involved (1) or not involved (0). To assess one way for helping in evaluating the disability determined the course and predict the prognosis of patients. Over a 2- year follow-up of 277 definite MS- patients, evaluation of pattern of involvement by FS from Neurologic examination were determined with this sequence; pyramidal (P)-cerebellar (CLL)- Brain Stem (BS) - Sensory(S)- Bowel & Bladder (BB)- visual (V)-cerebral or mental (Cb)- Others (O). 29% of our patients had 2 or 3 FS involvement (mild), 55% had 4,5 or 6 FS (Moderate) and 16% had 7 or 8 FS (severe). Also the 4 most common patterns were; 11010100-00010100-10010100-11111111. Careful attention to FS and patterns of involvement is a useful marker in evaluation of disability of patients and an important factor in estimating the course and prognosis of disease.      

Considering that more than 85 percent of ischemic strokes take place in the territory of middle cerebral artery and Transcranial Doppler Sonography (TCD) is a sensitive and non aggressive method for detection of flow of cranial vessels, the aim was assessing flow alterations of these arteries in ischemic strokes of middle cerebral artery (MCA) to enable an accurate and quick method to for cast happening of any stroke and it's Prognosis. In this study, designed in descriptive method, the anterior circulation arteries of 44 patients who suffered ischemic infarction in the territory of MCA were insonated by TCD. Patients with first stroke were included and sampling was non probability testing on consecutive patients. Brain axial CTS can was performed on all patients on first and third days of stroke and TCD was performed on days 3 to 6 and the results were as following: Peak Systolic Velocity (PSV) and Mean Flow Velocity (MFV) of ipsilateral MCA were reduced resulting in asymmetry of flow more than 15% in 61.4% of cases (P value <0.005) . PSV and MFV of ACA were increased resulting in increased ratio of ipsilateral to contralateral ACA (ACAVR) in 72.2% of cases. (P value < 0.005) Pulsatility index (PI) of ipsilateral MCA to contralateral MCA had a significant increase. (P value=p.005) indicating distal vascular resistance. Resistance Index (RI) of ipsilateral MCA and contralateral MCA didn't have any significant difference (P value = 0.05) 1- Ischemic MCA infarcts reduce PSV, MFV in ipsilateral MCA and increase PSV, MFV in ipsilateral ACA, resulting in increased ipsilateral ACAYR. 2- The most valuable parameter in determining MCA infarct is ACAVR (Sensitivity=72.2%), the next one being MCA flow asymmetry> 15% (Sensitivity=61.4%) 3- RI Value had no relation to the final size of infarct. Further studies evaluating normal values of TCD parameters in Iranian people are recommended to compare these indexes with normal ones.  

Recently pseudoseizure has been considered as a interesting subject among most neurologists and psychologists. According to researchers, this disease unbelievably resembles to true seizure, so is one of important differential diagnosis. Since the patients with pseudoseizure may take anti-epileptic drugs for many years, this research has been designed to show the number of pseudoseizure patients that diagnosed and treated as true seizure who had been admitted in Shahid Beheshti hospital of Kashan during 1371-1372. This research is concentrated on data and history of all admitted patients in Shahid Beheshti hospital of Kashan during 1371-1372 and demographic specification of study group, including paralytic limbs, chest pain, family history, EEG records, tonic-clonic movements, are checked and recorded. The research was performed on 94 patients with seizure: 22 patients (23.4%) had pseudoseizure and 72 patients (76.6%) had true seizure. Between 22 patients with pseudoseizure, 14 patients were female (63.6%) and 8 patients were male (36.4%) and maximum incidence was in 4 th decade of life (30-39). 68% were resident In kashan and 32% in villages of Kashan. Pseudoseizure may be misdiagnosed in every patient that suffer from seizure, and treatment is recommended if symptoms of pseudoseizure existed.      

Cerebrovascular accidents are the most prevalent disabling disease of the nervous system causing high mortlalities and imposing high expences. The present study is a descriptive one, performed to compare the seasonal prevalence of the disease in two winters and two summers and to determine the risk factors involved. Using the existing files, 111 patients with thrombotic brain strokes were studied. The files were reviewed considering the clinical symptoms and stroke risk factors. The risk factors included High Blood Pressure (HBP), diabete, History of cerebrovascoular diseases, and hyperlipidemia. The results revealed that in the two Winters and two Summers of 1998& 1999. 111 patients with thrombotic strokes were admitted in the Neurology Ward of Logman Hospital including 70 patients in Winter and 41 Patients (37%) in Summer. The majority of the patients were between 50-80 years old (92.79% were over50). 45% of the patients showed a history of diabet, 70.27% a history of Hypertension, 39 patients (35.14%) with hyperlipidemia, And 23 patients (27.72%) showed a history of cerebrovascular accidents.    

Stroke ranks in the top four causes of death in most countries so especially in VBI cases urgent management will be necessary. Recently the evaluation of stroke on the basis of knowledge of the physiology of an ischemic event has changed dramatically. New noninvasive techniques such as ultrasound, MRA and evoked potentials are useful in this way. TCD with reported 70-80% sensitivity and 90-97% specificity has been applied to patients with VBI from 1980 and clinical utility of BAEPs stems from the close relationship between the EP waveforms and specific anatomic structures, in addition BAEPs are very resistant to alteration by anything other than structural pathology in related structures such as drug effects. Due to multiple reports this test can show pathologic findings in cases of vertebrobasilar TIA when clinical examination is normal. The aim of our study is to evaluate TCD and BAEP results of 42 patients with VBI to discuss diagnostic roles of these noninvasive tests in VBI. We studied 42 patients, 31 men and 11 women, who had clinical diagnostic criteria of VBI during May 2001 - March 2002. Average age was 65.9 years. In all patients other patologies usings a neuroimaging method were ruled out or ischemic lesions in posterior circulation distribution were detected. TCD and BAEP (using monaural 10/s click rate stimulation) studies were performed for all patients during 1 to 8 days after stroke. We used Pittsburgh criteria for TCD results evaluating and also interpeak latencies I-III (>2.2 ms), III-V (>1.9ms) in BAEP results interpretation. By clinical evaluation 11 patients had signs of brainstem involvement. Clinically, side of involvement was left in 19 cases, right in 19 cases (in 3 cases side of lesion was not detected). There was TCD abnormality in 10 cases. It showed basilar artery stenosis in 5 cases and vertebral or PCA stenosis in other cases. A relative correlation between side of lesion in clinical evaluating and TCD was seen. Only in 1 patient who had clinical signs of brainstem involvement TCD abnormality was seen. There was BAEP abnormality in 24 patients. A lack of correlation between clinical side of lesion and side of TCD abnormality was found but there was considerable correlation between clinically evaluated brainstem involvement and BAEP abnormality although analysis of TCD and VAEP abnormality did not reveal any correlation between there results. We found meaningful differences in interpeak latencies I-III and III- V between our patients and normal population. This differences also were seen in mean velocities of posterior circulation arteries between patients and normal population. Both BAEP and TCD are useful and complementary diagnostic techniques in evaluating of VBI patients especially BAEP that can detect brainstem lesions.