Current Journal of Neurology
Year:2017 | Volume:16 | Issue:4|Papers Count:10

Background: The most common entrapment mononeuropathy of the upper extremity is carpal tunnel syndrome (CTS). It consists 90% of entrapment neuropathies. The purpose of this study was to compare cross-sectional area (CSA) of the median nerve at the wrist in CTS patients and healthy controls and define the best cut-off point of CSA to differentiate patients and controls in Iranian population. Methods: In this study, 45 patients with confirmed idiopathic CTS and 62 healthy controls were evaluated. Based on electrophysiological findings, patients were divided based on CTS severity into three groups of mild, moderate and severe. The largest CSA was measured at the level of distal wrist crease which is consistent with carpal tunnel inlet. Results: Mean CSA was 0. 124 ± 0. 031 mm2, 0. 146 ± 0. 028 mm2 and 0. 194 ± 0. 062 mm2 in mild, moderate and severe CTS patients respectively, and 0. 077 ± 0. 011 mm2 in controls. Our results showed that participants with CSA > 0. 010 had CTS with 100% specificity and 83. 12% sensitivity. Conclusion: It is possible to diagnose CTS by measuring CSA and using above-mentioned cut-off point.

Background: There is a suggestion for a role of abnormal cranial venous drainage in the etiopathogenesis of multiple sclerosis (MS). Moreover, it seems that cerebral developmental venous anomaly (DVA), a cerebrovascular malformation, is frequently seen in the magnetic resonance imaging (MRI) of MS patients. This study is set out to evaluate the relationship between MS and cerebral DVA, with its possible role in the MS diagnosis. Methods: We compared MRI of 172 MS patients and of 172 age-and sex-matched subjects without MS. Then, we recorded and analyzed the presence, number, and location of developmental venous anomalies. Results: Frequency of DVA did not have a significant statistical difference (P = 0. 148) in subjects with MS (12. 21%) and without MS (7. 55%). Moreover, a difference of anatomic distribution of supratentorial developmental venous anomalies was not statistically significant (P = 0. 690, for juxtacortical, P = 0. 510 for subcortical, and P = 0. 420 for periventricular DVAs) in two groups. Conclusion: Our investigation does not provide supporting evidence for a relationship between etiopathogenesis of MS and DVA. Furthermore, it may not be possible to use cerebral DVA as ancillary MRI finding to make MS diagnosis simpler and more accurate.

Background: Alzheimer disease (AD) is a progressive neurological degenerative disorder and the most common form of dementia. There are about 100 genes linked to AD including apolipoprotein E (ApoE). This gene exists in the form of three allele polymorphisms of ε 2, ε 3 and ε 4 and six genotypes of ε 2ε 3, ε 2ε 2, ε 3ε 3, ε 2ε 4, ε 3ε 4, and ε 4ε 4. We aimed to study the association of ApoE polymorphism with AD in Guilan province, Iran. Methods: The study group consisted of 70 AD patients and 100 healthy individuals as a control group. All subjects were recruited from 21 March to 22 September 2015 at Imam Reza Clinic, Rasht, Iran. The genomic deoxyribonucleic acid (DNA) was extracted from peripheral blood leucocytes, and subsequently, subjects were genotyped for ApoE using tetra-primer amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). The association between the risk allele and AD was assessed using the MedCalc software. Results: The distributions of ε 3ε 3, ε 3ε 4, ε 2ε 2, ε 2ε 4, ε 4ε 4 and ε 2ε 3 Genotypes among patients were 55. 7%, 30. 0%, 1. 4%, 2. 9%, 8. 6%, 1. 4% and in the controls were 79. 0%, 8. 0%, 0%, 1. 0%, 1. 0%, 11. 0%, respectively. The genotype frequencies were significantly different between cases and the controls (P < 0. 001). The individuals with the ε 4ε 4 and ε 3ε 4 genotypes had a greater risk for AD as compared to others; odds ratio (OR) = 12. 15, 95% confidence interval (CI): 1. 41-104. 50, P = 0. 020; OR = 5. 32, 95% CI: 2. 16-13. 08, P = 0. 003. In addition, the ε 4 allele is significantly associated with higher AD risk among the studied population (OR = 5. 63, 95% CI: 2. 74-11. 58, P < 0. 001). Conclusion: This case-control study suggests that the subjects with ε 4ε 4 and ε 3ε 4 genotypes had an increased risk for AD in Iranian population.

Background: Swallowing and swallowing-related quality of life studies following stroke were almost always performed by including both patients with brainstem and cortical involvement. It was aimed in this study to show the presence of dysphagia in patients with only cortical ischemic stroke and to investigate the interaction between dysphagia and quality of life as well as to evaluate the effect of a rehabilitation program in the acute phase. Methods: Seventy-two patients with cortical stroke (between 0 and 30 days) and dysphagia were included. Swallowing function of patients was assessed by dysphagia screen questionnaire and fiberoptic endoscopic assessment. Also, functional impairment and swallowing quality of life were assessed. The swallowing rehabilitation program for 4 weeks was given to all patients. Results: All patients demonstrated disorders related to oral phase (n = 69, 95. 8%), pharyngeal phase (n = 4, 5. 6%) or both phases. The swallowing function, swallowing quality of life and functional impairment were improved at the end of therapy. Conclusion: Swallowing quality of life is severely affected in cortical hemispheric stroke patients and can be improved with an early rehabilitation program.

Background: To investigate ictal onset patterns (IOP) in scalp electroencephalography (EEG) of patients with temporal lobe epilepsy (TLE) and their prognostic effect on the postoperative outcome. Methods: We conducted a retrospective cohort study between 2011 and 2015 in our referral Epilepsy Surgery Center enrolling adult patients with refractory TLE and a visible epileptogenic lesion in magnetic resonance imaging (MRI), who underwent epilepsy surgery. Demographic, clinical and MRI findings were collected and ictal findings during video-EEG monitoring were reviewed in detail. The correlation between preoperative findings and the postsurgical outcome was analyzed. Results: We reviewed 303 seizures in 93 patients. Rhythmic theta and rhythmic spike/sharp and wave were respectively the most common initial ictal pattern and late significant discharges. Engel class I outcome was observed in 88. 2% of patients. Female sex, aura, the absence of secondary generalization, rhythmic theta as initial ictal pattern and concordance of ictal-interictal EEG findings were correlated with favorable 1-year postsurgical outcome. Conclusion: Preoperative clinical and EEG findings can provide valuable information regarding postsurgical prognosis in TLE patients.

Background: Neurodegenerative disorders (NDs) are categorized as multifactorial conditions with different molecular and environmental causes. Disturbance of important signaling pathways, such as energy metabolism and inflammation induced by environmental agents, is involved in the pathophysiology of NDs. It has been proposed that changes in the lifestyle and nutrition (metabolism) during mid-life could trigger and accumulate cellular and molecular damages resulting in NDs during aging. Methods: In order to test the hypothesis, we investigated the expression level of two energy metabolism-related [forkhead box O1 (FOXO1) and forkhead box O3 (FOXO3A)] and two pro-inflammatory cytokines [interleukin 1β (IL-1β ) and IL-6] genes, using quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR). Furthermore, changes in the ionic concentration of three essential heavy metals [iron (Fe), copper (Cu), and zinc (Zn)] by atomic absorption spectroscopy in patients with NDs, depression, obesity, and diabetes type II, were evaluated and compared with the results of normal individuals. Results: More than half of the participants in obesity, depression, and ND groups had significant up-regulation of FOXO1 and FOXO3A, down-regulation of IL-1β and IL-6, and higher levels of Fe and Cu in their blood. This pattern of gene expression was not repeated in diabetic patients. Conclusion: It could be concluded that individuals affected with different levels of obesity and depression have increased risk of developing NDs later in life, probably through changes in energy metabolism, inflammatory pathways, and ionic concentrations.

Background: As there was no evidence of long-term studies on stroke trend, stroke subtypes and its relationships to stroke risk factors and demographic characteristics in Iran, we aimed to evaluate 10-year trend of stroke incidence and stroke subtypes in Isfahan, Iran. Methods: In a hospital-based retrospective study, 24186 cases with the first-ever stroke were analyzed. We assessed the incidence trend of annual stroke and its subtypes [ischemic stroke )IS(, subarachnoid hemorrhage (SAH), and intracranial hemorrhage )ICH(] during the years 2003 to 2013 by sex, and studied the association of demographic and major stroke risk factors with incidence and mortality rate of stroke. Results: The mean age was 69. 46 ± 14. 87 years, and 49. 29% of patients were women. IS was the most frequent type among all the types of strokes (76. 18%). Stroke and its subtypes had decreasing incidence trend during the study period, except for SAH that increased. In addition, stroke and its subtypes had decreasing mortality trend during the study period, except for SAH that did not change anymore. Stroke mortality and incidence rates were lower in urban inhabitants compared to residents of rural areas [odds ratio (OR) = 0. 763, P < 0. 001]. Conclusion: Despite the relatively high incidence of stroke over the study period, the incidence rate of stroke, especially ICH subtype, had a decreasing trend over the last decade in Isfahan. However, given the current young population in Iran, we can expect that the incidence of stroke would have an escalating trend in future.

Migraine is a common chronic inflammatory neurological disease with the progressive and episodic course. Much evidence have shown a role of inflammation in the pathogenesis of migraine. Omega-3 fatty acids are an important components of cell membranes phospholipids. The intake of these fatty acids is related to decrease concentration of C-reactive protein (CRP), proinflammatory eicosanoids, cytokines, chemokines and other inflammation biomarkers. Many of clinical trials have shown the beneficial effect of dietary supplementation with omega-3 fatty acids in inflammatory and autoimmune diseases in human, including Parkinson’ s disease (PD), amyotrophic lateral sclerosis (ALS), Alzheimer’ s disease (AD), multiple sclerosis (MS) and migraine headaches. Therefore, omega-3 fatty acids as an alternative therapy can be potentially important. This review focuses on the pathogenesis of a migraine, with an emphasis on the role of omega-3 fatty acid and its molecular mechanisms.

Background: Several studies indicate contribution of hypothalamus-pituitary-adrenal (HPA) axis in multiple sclerosis (MS) disease. This study was designed to determine whether there is an effective difference in pituitary height, shape, and anteriorposterior diameter (APD) between patients with MS and the control group. Methods: In this study, sagittal pituitary height and APD of 134 men and women (64 patients with MS and 70 healthy subjects as control group) were measured by T1 sequence magnetic resonance imaging (MRI). All the subjects were free of sellar or parasellar pathology without a history of surgical intervention or prolactin affecting drugs like bromocriptine and cabergoline or corticosteroid consumption. Results: Mean height of pituitary gland was 6. 62 ± 1. 43 and 5. 78 ± 1. 15 mm for patients and the control group, respectively, and the difference between the two groups was statistically significant (P = 0. 001). Mean APD was 10. 40 ± 1. 29 mm for the group of patients and 10. 25 ± 1. 41 mm for the control group, respectively, without significant differences. 46. 9%, 37. 5%, and 15. 6% of patients had flat, convex, and concave hypophyseal surfaces, respectively. This rate was 50%, 30%, and 20% among the control group, respectively. There was no significant difference between our measurements among patients on whom imaging study was performed at time of disease onset with others. Conclusion: Mean height of pituitary gland among patients with MS was significantly greater than the control group (P = 0. 001). So can we consider the same etiology for pituitary hypertrophy among patients with MS as a hypothesis?

Anterior cervical discectomy with fusion (ACDF) is an established intervention for cervical degenerative disease. However, on rare occasions, complications, including dural tear, esophageal injury, and dysphagia, may occur. 1 Here, we report a case of cerebellar infarction due to vertebral artery (VA) occlusion that was diagnosed 2 days after ACDF. . . .