Current Journal of Neurology
Year:2009 | Volume:8 | Issue:26-27|Papers Count:13

Introduction: Surgical intervention is a routine treatment in patients with Subarachnoid Hemorrhage (SAH). However influence of aneurysm surgery in the developing counties may be different than developed countries. Decision for surgical intervention in patients with Intracerebral Hemorrhage (ICH) is a subject of controversy.Methods and materials: Consecutive patients with SAH or ICH admitted in Ghaem hospital, Mashhad during 2005-2009 enrolled in a prospective clinical study.Diagnosis and work up of SAH and ICH was performed by neurologists. Decision for performing aneurysm surgery and evacuation of hematoma was made by neurosurgeons. All of the SAH or ICH patients received a standard conservative medical management. Frequency of complications and mortality was compared in medical and surgical groups of SAH patients.Results: 120 SAH patients (52% females) with mean age of 50.6±7 years were evaluated and 46.6% of them underwent aneurysm surgery. The effect of therapeutic type on mortality of SAH patients was not significant; X2=1.8, df=1, p=0.17.Difference in frequency of rebleeding in two therapeutic groups of our patients was not significant; X2=0.37, df=1, p=0.54. The influence of rebleeding in mortality of our patients was significant; X2=4.50, df=1, p=0.048. 193 ICH patients (52% females) with mean age of 61±3 years enrolled the study and 62.7% of them underwent surgery. Frequency of mortality was not significantly different in two therapeutic groups of ICH patients; X2=2.34, df=1, p=0.126. The influence of surgery on mortality of the ICH patients was not significant in lobar, putaminal, cerebellar and thalamic subtypes of our patients (X2=0.16, df=1, p=0.77), (X2=2.34, df=1, p=0.126), (X2=0.01, df=1, p=1) and (X2=3.09, df=1, p=0.08) respectively.Conclusion: Influence of aneurysm surgery in frequency of death is not significant in Iranian patients with SAH which could be due to delay in performance of surgery in Iranian neurovascular centers. Influence of surgery in frequency of death is not significant in our patients with ICH. Surgical intervention is not usefull in patients with lobar, putaminal and cerebellar hemorrhage and may be harmful in patients with thalamic hemorrhage.

Introduction: Moyamoya disease (MMD) is a progressive intracranial vasoocclusive condition which may lead to ischemic or hemorrhagic insults. The vast majority of these patients also have well recognized associated conditions as the risk factors. Hereby we report a case of MMD presented with cerebral ischemic attack.Widespread investigations did not show any associated risk factors other than a history of idiopathic thrombocytopenic purpura (ITP) which has not been reported previously as a risk factor.

Introduction: Multiple sclerosis (MS) is a chronic and often debilitating demyelinating disease of the central nervous system (CNS). Many of the current treatments are costly, limited in efficacy, and possess unpleasant side effects. These drawbacks bring the protective strategies into the center of attention. Genistein is one of the components of soy bean which happen to have anti-inflammatory, antioxidant and neuroprotective properties. We conducted this study to assess the potential role of genistein in protection against MS.Methods and Materials: We used Experimental Autoimmune Encephalomyelitis (EAE) -an inducible CD4+ T cell-mediated autoimmune disease with pathological features similar to MS. Oral administration of 20 mg/ kg genistein to MOG-immunized mice was started 21 days before the induction of disease and continued for 42 days.Results: It significantly prevented mice from prolonged neurological sequel by postponing the disease onset, attenuating EAE course and alleviating the severity of clinical and histological signs of EAE. Genistein impose its beneficial role by modulating T-helper1/T-helper2 balance by decreasing CD4+ T-helper 1 cells. Furthermore it inhibited encephalogenic and systemic release of IFN-g and IL-12 and encephalogenic secretion of TNF-a. On the contrarily it increase the production of IL-10 in central nervous system and spleen.Conclusion: Taking together, these results suggest that genistein may represent a new protective approach for MS by anti-inflammatory and immune-modulating properties.

Introduction: Neuromyelitis optica (NMO) or devic disease is a relatively uncommon neurologic disease that often mimicks multiple sclerosis (MS) in clinical practice. It usually presents with recurrent attacks of optic neuritis and myelitis but unlike MS the attacks are often associated with some degrees of sequelae and there is no involvement of nervous system outside of the optic nerves and spinal cord particularly in the earlier phase of the disease. the constellation of findings including characteristic clinical behavior, imaging findings of the brain and spinal cord and the recent finding of antibody against aquaporin-4 water channels differentiates this disease from MS.Response of the attacks to corticosteroid may be inadequate and we may need plasma exchange for better symptomatic remission of acute attacks. To prevent further attacks, prophylactic treatment with immunosuppressive agents may be helpful.Two cases of NMO with characteristic clinical and neuroimaging features are presented that mimicked MS at first and with good response to plasma exchange despite the inadequate improvement following corticosteroid pulse therapy.

Introduction: Previous studies showed that besides Garlic therapeutic effects on cardiovascular diseases, it is also effective on Central Nervous System (CNS) disorders like depression, Alzheimer and Parkinson. This study was done for evaluating Garlic effects on depression.Methods and materials: In an experimental study for evaluation of anti-depression effects of Garlic, it's hydro-alcoholic extract was prepared, concentrated and different dilution was made. Forty two Sprauge-Dawley rats with weight average of 200-250 grams were selected and randomly divided into seven groups each with six members.In six groups of them, depression was induced by treating with 10mg/kg of reserpine. Four groups of depressed animals received 50, 100, 150 and 200mg/kg of weight of garlic extracts intra-peritoneally (IP) daily. 150 and 200mg doses in early days leaded to death of majority of animals and so, these concentrations omitted from study.Treatment of depression with 50 and 100mg doses continued and one group of animals treated by Amytriptylline IP daily.Results: Garlic treated group with 100mg/kg, cured after 9 days and reduced signs of depression like diarrhea, weight loss, eye hemorrhage, sedation and righting reflex was observed in comparison with untreated reserpine group significantly (P<0.01, P<0.001). In reserpine treated group with 50mg/kg of Garlic, reduction of depression signs was observed but it was not significant. 100mg/kg of Garlic extract produced better function in foot and hand hemorrhage, sedation and righting reflex than amytriptylline (P<0.05, P<0.001) while hanging from tail and feet, and eye hemorrhage in amytriptylline treated group was better than Garlic extract group (P<0.05). In weight loss and reduction of diarrhea, Garlic extract was better than amytriptylline (P<0.05, P<0.001).Conclusion: Garlic extract in reasonable doses can reduce many signs of depression.

Introduction: Idiopathic Parkinson is an age-related, common progressive neurodegenerative disease whose probable causes are yet unknown. Also, it is not yet clears whether specific language disturbances form part of Parkinson’s disease (PD) cognitive profile. This disease leaves several impacts on the speech of its patients; many of such impacts have not undergone a serious study in different languages.Methods and materials: The ultimate goal of this article is provision of the prosodic features of Persian – speaking Parkinsonian patients, using 4 major tasks to evaluate their production and perception impairments. The tasks include "spontaneous speech", "fluency task (DDK)","production and perception of emotional prosody", and "production of high-low vs. low-high vowels". In order to carry out this research, the above-mentioned tasks were administered to 5 non-demented patients with idiopathic Parkinson and 5 healthy people, as the control group, and the results were compared and analysed.Results: The results share the idea with the previous findings which indicated that these patients show greater deficiencies in language production. Especially they appear to have difficulties in producing emotional prosody as well as the production of low-high vowels. The findings of this research also reveal that such patients do not have much difficulty in perception of emotional prosody, which is in contrast with some previous findings such as that of Breitenstein et al. (2001), Davis Garret et al.(2002) and Harel et al.(2004).Conclusion: This research concludes that the patients seem to have impairments in concentration during all stages. i.e., their cognitive abilities are mostly impaired due to their lack of selective attention.Based on the results of this research, it is inferred that some specific speech defects are common in moderate and advanced PD patients, including disturbances of respiration, phonation and articulation. Vocal tremor was identified on narrow band spectrogram for 2 subjects in early moderate and late moderate stage.

Neuroacanthocytosis is a progressive multisystem disease with a wide range of symptoms. The descriptive name of the disease refers to the presence of acanthocyt in peripheral blood .A full spectrum of movement disorders may be seen mainly oromandibular dystonia.we report a case of neuroacanthocytosis that manifested with orolingual dystonia and weight loss after dental extraction. Botulinum toxin injection was performed and led to dramatic resolution of his symptoms and disappearance of dystonia, but paroxysmal dyskainesia emerged after injection that entailed to occasionally tongue biting.

Introduction:Migraine is one of the most common headaches, and is one of the most common disabling medical conditions worldwide. Migraine has two types, with aura and without aura. Nearly 15% of migraines are with aura, and the most common aura is visual. Patent Foramen Ovale (PFO) is the most common defect in atrial septum of heart, and prevalence rate population is 25%. Lately PFO has been recognized to be a risk factor for migraine with aura.Methods and mareials: This study is cross sectional and has been done on 50 patients of migraine with aura, and 25 normal people (without migraine) as control group. We used saline agitated test by Doppler sonograph for recognizing PFO.Results: The rate of PFO in patients’ group was 44% and in control group was 20%. The rate of PFO is more in patients with rate of headaches more than 3 times in a month.Conclusion: migraine with aura has relation with PFO, especially for patients with frequent attacks more than 3 times per months. The closure of PFO in these patients needs to be studied more, especially that there are feasible procedures available now.

Introduction: Neurofibromatosis is a genetic disease that is found in two separated types with different prevalences. In various societies and with attention to both types of Neurofibromatosis, they divulge their proper clinical remarks separately. Presence of mentioned remarks in the patients is of interesting points that available conditions are seen rarely in affected persons to Neurofibromatosis.Case report: The patient was a 26-year-old boy who seemed younger. He suffered from severe hiccups since three days ago, tension headache in frontal region, nausea and elastic sudden vomiting. Other important clinical points in the patient was the presence of skin wastage of Neurofibromatosis in six separate sites with approximate dimension of 7 to 8 cm, café au lait from the time he was 3 years old, cardiac tumor in dimensions of 1×2 cm in right auricle and a pile in dimension of 7cm at right parietal lobe.Discussion: According to the patients biography, presence of mentioned remarks and progressive process of disease which culminate to death four days after diagnosis, so pathogenesis and process of disease fulminant and death of patients clearly were not distinguished and it is seemed that disciple of recent reports about mentioned new types on the subject of Neurofibromatosis. This instance also should be under consideration on title of new type of Neurofibromatosis.

Introduction: Vertigo and dizziness is prevalent in all countries and many patients are referred to physician offices or emergency departments for this problem annually.These symptoms make a lot of distress for patients. Grossly vertigo is separated to peripheral and central and this division is clinically very important. Evaluation of vascular problem in vertigo is very important and Doppler ultrasonography is used widely.Material and methods: This study is a retrograde study with use of files recorded in Mustafa Khomeini hospital Emergency or neurology department in three years duration. Patients selected according to their chief complaint at the time of admission to the hospital. Patients with complaint of dizziness, vertigo, ataxia and imbalance were selected. And data in relation of their symptoms, risk factors and demographic information registered separately for each patient.Results: There were 332 patients recorded in a three years period. There were 179 (54%) female and 153 (46%) male patients. chief complaint in 183 (55%) were dizziness and 101 (30%) had vertigo and 48 (15%) had complaint of ataxia and imbalance. stroke was seen in 53 (16%) of patients.among patients without stroke most common diagnosis were labyrinthitis 53 (19%), BPPV 89 (32%)and metabolic and electrolyte imbalances 137 (49%). Doppler ultrasonography showed abnormal finding in only two patients with stroke and was normal in patients with another diagnosis.Conclusion: This study shows us that peripheral vertigo is more prevalent than central type's .there is many misdiagnoses in relation with differentiation of these two types of vertigo that is a warning for better education in medical courses in university. Doppler ultrasonography of Vertebrobasilar system is recommended only in central problem and it is not necessary for all patients and also it is not helpful in differentiation of central and peripheral problems.

Introduction: The aim of our study was to evaluate the effect of disease-modifying treatment with interferon (IFN) beta-1b (Betaferon) on relapses, progression of disability and brain MRI findings in patients with relapsing-remitting multiple sclerosis (RRMS).Patients and Methods: This cohort study was conducted on 41 patients who had RRMS determined using McDonald criteria. They were evaluated during a 24-month study period from January 2004 to January 2006. Patients were assigned in two groups: 21 patients under disease-modifying therapy with IFN beta-1b (Betaferon) 250 mcg subcutaneously every other day (group A) and 20 patients without disease-modifying treatment (group B). Neurological and clinical assessments were done at baseline, 12th, 18th and 24th month of follow-up. For this purpose, number of new attacks, changes of brain MRI findings and Kurtzke Expanded Disability Status Scale (EDSS) were evaluated.Results: Patients in group A represent lesser number of attack (0.76, SD=0.70 vs. 2.05, SD=0.76; P<0.001), more reduction in EDSS (2.09, SD=0.77 vs. 0.12, SD=0.65; P<0.001) and number of ventricular plaques in brain MRI (3.29, SD=1.35 vs. 0.15, SD=0.87; P<0.001) in comparison with group B. The course of EDSS changes was significant in both groups A and B during the study period (PA<0.001 and PB=0.019). But, only patients in group A expressed improvement of brain lesions in MRIs, such as juxta-cortical (P<0.001), cerebellar (P=0.008), brain-stem (P=0.004), spinal-cord (P=0.008) and corpus callosum (P=0.016).Conclusions: Our result demonstrated disease-modifying treatment for RRMS patients may lead to beneficial results. And also IFN beta-1b significantly delayed progression to disability, reduced incidence of new relapses and improved brain lesions especially juxta-cortical and brain-stem plaques.