Current Journal of Neurology
Year:2006 | Volume:5 | Issue:15-16|Papers Count:13

Aims: Regarding the hazards of the issue of suicide as a psychiatric emergency, and also its known stresses and side effects, this study has been conducted on children referring to Loghaman Hakim Hospital due to suicide in 2001- 2004. Methods: We have reviewed the existing data on children definitely diagnosed as suicidal cases. The children's age, sex, the exact time and means of suicide, the way of parent's awareness source of suicidal behavior were all collected in a data sheet. Children Suicide Questionnaire (CSQ) Where the file was incomplete, it was ignored.Results: The files pertaining to 60 children 6-13 year old, had met our criteria, of whom 62% were male and the remaining 38% female. The results have revealed that suicides took place in autumns more than other seasons. The suicide attempts occurred in weekends and during 6 PM more frequent than the other time. We have faced disintegrated families and academic difficulties as the main stress factors. Suicide attempts were mainly practiced through the use of drugs (93.4%). Depression constituted the most common underlying disorder. Meanwhile, children had learnt about suicide attempts by watching TV, or witnessing suicidal attempts of their family members, especially those of their mothers.Suggestion: Further studies to determine the exact role of psychiatric, social and biological aspects of the problem are strongly recommended. However, an experimental study to assess family training could be helpful.

Background: Behcet disease is a vasculitis with mucocutaneous, ocular, arthritic, vascular, and other manifestations. Its neurologic manifestations (neuro-Behcet disease) are relatively rare, but they must be thoroughly investigated due to their grave prognosis.Review Summary: The frequency of neurologic manifestations, more common in tnale Behcet patients, is between 5% and 30%. Both the central and peripheral nervous systems can be involved. Central nervous system manifestations can be divided into 2 main groups: (1) parenchymal involvement, which includes brainstem involvement, hemispheric manifestations, spinal cord lesions, and meningoencephalitic presentations; (2) nonparenchymal involvement, including dural sinus thrombosis, arterial occlusion, and/ aneurysms. Peripheral neuropathy and myopathy are relatively rare. Cerebrospinal fluid analysis reveals pleocytosis and elevated protein levels. Magnetic resonance imaging is the investigation of choice which often reveals iso-/hypointense lesions in T1-weighted images and hyper intense lesions in T2-weighted images, mostly in the mesodiencephalic junction, cerebellar peduncles, and other parts the brainstem. Corticosteroids and adjuvant immunosuppressive therapy are used for parenchymal manifestations, and corticosteroids and anticoagulants are used for treatment of dural sinus thrombosis.Conclusion: Neuro-Behcet disease must be considered in the differential diagnosis of stroke in young adults, multiple sclerosis, movement disorders, intracranial hypertension, intracranial sinovenous occlusive diseases, and other neurologic syndromes.

Acute carbon monoxide (CO) poisoning is one of the most frequent causes of acute Intoxication .It has nonspecific and variable symptoms and can cause numerous complications among them neurological ones are especially considerable. Children are one of the most vulnerable groups. In this study we discuss the epidemiology, clinical characteristics and outcome of 52 children with carbon monoxide poisoning referred to Loghman hospital from 1999 to 2004. In our study CO exposure were mostly attributed to problems associated with gas Furnace and heat appliances. The most number of admitted patients (43.3%) were residents of south part of Tehran, a region which almost includes families with low income. The most common symptoms were lethargy (46.20/0) and vomiting (32.7 %). Headache, Dizziness, agitation and seizure were the other common findings. The survival rate is 94.3 % We concluded high frequency of poisoning among children between 6 - 14 years especially in south parts of Tehran. It necessitates promotion of primary and secondary preventive intervention in order to prevent the neurological and nonneurological sequels of CO poisoning.  

Background: Warfarin & Aspirin are both effective in the management of brain strokes. There is no consensus over Superiority of one agent over the other.Methods: this clinical trial was conducted on 80 patients with stroke in post circulation in 2 institutions (Kamkar&Shahid mostafa Khomeini hospitals) from 2002 to 2005. Patients were randomly selected in two groups. Group A treated with Aspirin 250 mg/d & group W with Warfarin (with targeted INR 2-3) .Both groups followed & compared with rankin score for six months. Data were analyzed wad SPSS software.RESULTS: There was 37 (46.3 percent) male & 43(53.8 percent) female, wit median age of 65/97±6(52-77). Total cholesterol level was above normal (>200) in 58 patients & there were 32 (40percent) patients with Diabetes & 41(51percent) with hypertension. Comparison of two groups at 8th hours,4th ,8th and 14th days and also 1sr, 2nd, 4th & 6th months after stroke did not demonstrate any significant statistical difference between two groups.Conclusion: Over a six month period, we found no difference between Aspirin & Warfarin in prognosis & progression of post circulation strokes between two groups in our study.

Introduction: Migraine is defined as an often familial symptom complex of periodic attacks of vascular headache, usually temporal and unilateral in onset. Approximately 12% of population or 27 million people in the United States alone have migraine headaches. Many studies have been done to evaluate different risk factors for migraine headaches. Recently, the probable association between migraine with aura and right to left shunts has been found. These shunts are usually across a large patent foramen ovale (PFO).Objectives: The aim of this study was to evaluate the prevalence of PFO among migraineurs by means of Transcranial Doppler Ultrasonography (TCD).Methods: A total of 56 migraine patients consecutively admitted to the neurology outpatient clinic of Firouzgar hospital were studied. The diagnosis of migraine was based on the criteria adopted by the International Headache Society (IHS). All the migraineurs underwent TCD in order to detect PFO in their atrial septum. Subsequently, Transesophageal Echocardiography (TEE) was done in migraineurs with TCD evidence of PFO. The data were analyzed using SPSS v.13 software. Chi2 'Independent T-test and Mann- Whitney U-test were used in analysis.Results: The mean age of the patients was 30.75(SD=1.17) years. The migraineurs were 14(25%) males and 42(75%) females. Additionally, 26(46.4%) had migraine with aura and 30(53.6%) had migraine without aura. The result of TCD shows that the prevalence of PFO was 32.1% (18 out of 56) in migraineurs; which is significantly higher than normal population (20%, P=0.023). By the way, the prevalence of PFO was higher in migraineurs with aura (38.5%) than migraineurs without aura (23.7%). PFO was confirmed in 14 out of 18 (77.8%) migraineurs with aura by means of TEE.Conclusion: PFO is more common in patients with migraine headache especially in migraineurs with aura. The association between migraine with aura and PFO suggests that the two entities are comorbid and may share a similar inheritance pattern. Many migraineurs may also benefit a significant improvement in frequency of headache attacks following PFO closure.

Background: Multiple sclerosis (MS) is the most common demyelinating disease. Autoimmune basis have been confirmed for the pathogenesis. Testosterone (TES) has the role in these immune mechanisms. Its serum level in MS had significant changes in other reports. The purpose of this study is to survey these changes in patients.Materials & Methods: In this cross sectional study 50 MS patients were selected for TES study. The same number of controls with sex and age matching were studied. Special diseases and drug users were excluded from our study. RIA was used for serum level determination of hormones.Results: In TES level survey, male patients had lower level of TES than controls significantly (3.01±1.45ng/ml versus 5.59±1.28ng/ml, P value< 0.0001). TES level female patents' had not significant changes. Conclusion: According to studied changes an hormone, TES have negative relation with MS in male patients. Further study for determination of causality relation and drug effect in endocrine system in MS pathogenesis are suggested.

Background: various investigations were done about the relation of infection with atherosclerosis .we will study about the role of one of these infection; helicobacter pylori in atherosclerotic plaque formation in right and left common carotid arteries (CCAs)and extracranial portions of internal carotid arteries(ICA s). Materials & methods: Antibody against Helicobacter pylori (HP.IgG) was measured in 42 cases that had a plaque in at least one of CCAs or ICAs and 82 control subjects doesn't have any plaque in those arteries. Results: In this study HP.IgG was positive in 69.5% of control subjects without any plaque and 69% of cases with an atherosclerotic plaque and there wasn't any significant difference (p=1.000).The means of HP.IgG titers were 53/80 in controls group and 45.36 in case subjects without any prominent difference (p=0.438) we compared the means of HP.IgG titers in patients with a plaque with stenotic severity <50%, between 50% and 75% and >75% and there wasn't any significant difference between these 3 groups (p=0.090). Also, similar assessment was done in females and males separately and any association between HP .IgG seropositivity and atherosclerotic plaque or its stenotic severity wasn't seen.Conclusion: HP.IgG isn't a predictor of atherosclerotic plaque formation and its progression in CCAs and ICAs.

Introduction: Migraine is a common disease with prevalence 18.2% in women and 6.5% in men. Recent studies have suggested an association between Helicobacter pylori and migraine and also usefulness of the eradication treatment on headache. The aim of the present study was to assess effect of H.P eradication versus effect of classic anti migraine drug on severedity and frequency and disability of migraine headache. materials and methods: A total 63 consecutive patient with migraine (with & without aura) with serologic evidence of HP infection divided to 3 equal groups (21subject) and were matched for sex and age and treated by 3 modality (Anti HP drugs, classic anti migraine drugs and combination of two drugs). HP infection was assessed by ELISA evaluation of specific IgG antibody and eradication control of HP was made by ELISA again after 6 month. The diagnosis and classification of migraine was made according to International headache society (HIS) criteria. Ne assessed the frequency and severity of clinical attacks of migraine according by MIDAS questionnaires before and after 3 modality of treatment during 6 month period of observation. Results: Approximately 66.7 of subject treated with Anti HP drugs had MIDAS score below 5 versus 61.7% of patients received classic anti migraine drugs (P<0.001). MIDAS Grad equal or less 2 observed in all eradicated patients. Effect of combination therapy was higher than effect of each therapy alone (P=0.015) and 81%of patient received combination therapy had MIDAS Grade equal one.Conclusion: Our study suggests H.P should be examined in migranous patients and eradication of the infection may be helpful for the treatment of the disease & effect of combination therapy is better.

Background: Stroke after heart disease & cancer is the third commonest cause of death. CT scan is utilized extensively for stroke diagnosis, because of it's availability & cost effectiveness after physical examination. Although in previous studies its capability for diagnosis has been approved, nevertheless there are a lot of cases which have no correspondence between the severity of clinical features and the size of lesion on CT scan. This study aimed to consider correlation between these two, from this aspect. Materials and methods: 265 patients admitted with cerbrovascular accident (Stroke) in hamadan Sina hospital during 84-85 years.All of patients were considered for exact physical examination & to evaluate of CT scan findings aspect of size & sort & territory of lesions. Results were excluded by the SPSS Soft ware (l3th ed) & compared with each other.Results: There was a clear association between lesion size on CT scan & clinical out come III 63/3%. But in 36/7%, couldn't justify severity of exams with vast of lesion on CT scan.The most correspondence was seen in patients with severe clinical manifestations (76/6%) further more the most justification between consciousness level decreasing and vast of lesion on CT scan existed in patients with severe decrease. (71/9%).Between Ischemic & hemorrhagic stroke was not observed significant difference about correspondence clinical feature and lesion size on CT scan.Conclusion: Although this study confirms the significant association of the lesion size on CT scan and severity of manifestations, which has been mentioned byrnany investigations, but the prominent number of patients who have no correspondence (one-third), reduces CT scan value as one of the best Paraclinic methods of diagnosis.Therefore combination of clinical and appropriate choose of imaging style to estimate clinical outcome in individual patients remains to be determined & widespread investigations about this is recommended.

Brainstem auditory evoked response (BAER) is one of methods for diagnosis of diseases of hrainstem, auditory nerve and many other disease of brain and measurement of normal values of BAER waves is necessary.Objective: This is a descriptive study and its objective is measurement of normal value of latency of waves I, III,V and inter waves latancy (1.W.L) of 1-III , III-V and 1-V in right and left ears in two gender divided in two age groups.Methods and materials: Fifty person’s volunteers with normal auditory among unsick and refferd persons to Poorsina hospital in Rasht for unrelated reasons is selected and after normal neurologic examination is tested with medele equipment. Test is performed separately in two ears.Results: In data analysis Mean of A.L of wave I in RT and LT ears were not different and value of I.W.L of I-III in both ears has not meaningful difference and difference of absolute latency of wave V in right ear between two gender is more than left ear and this result needs more survey. About age only meaningful difference is in absolute latency of wave I in left ear that may be due to age of persons. Conclusions: Measurement of normal values of BAER in normal persons in poorsina hospithal can be helpful in further evaluation of patients especially with regard to difference of absolute latency of wave V in right ear in two gender and A absoillte latency of wave I in left ear.

Introduction: Idiopathic facial nerve paralysis (Bell,s palsy) have been found as one of the most common form of the cranial nerve palsy. Upon our knowledge, there is not exact cause have been documented by know.currently reactivation of herpes simplex type 1have been suggested in which associated with inflammation, edema, and myelin nerve sheath destraction. To assess the efficacy of anti-inflmmatory (corticosteroids) and antiviral drugs for treating of Bell,s palsy, the present study was designed.Materials and Methods: the prospective study included patients with a diagnosis of Bell,s palsy was referred by neurology and ear, nose, throat outpatient department. Clinical and preclinical examination disclosed lack of intracranial structural lesion. Patients were randomly assigned to two groups to receive either steroids or acyclovir.The severity of facial paralysis was evaluated using the House-Brackmann classification before and after three months of the treatment. Regression to stage 1 or 2 disease was regarded as a successful response. Data were analyzed by the chi-square method and P<.0.05 was takenat-a -significant level. Results: 120 patients were treated by prednisolone (58 cases) and acyclovir (62 cases).Initial evaluation have shown that the severity of facial palsy was identical in both groups (p=0.1431). At the end of three months of treatment the results were statistically different from those of patients receiving acyclovir (p=0.0158). Moreover, the efficacy of acyclovir was more effective on improving the high grade of paralysis .There is no significant response between male or female (p=0.9456).Conclusion: although successful response was found in two treatment regimen ,but response to steroid therapy seemed to be better. Further studies with large patient series and long term follow up are needed to clarify the use of steroids or acyclovir in the treatment of idiopathic facial nerve paralysis.

Background: Regarding to sedentary lifestyle and its early complications, electro diagnostic studies can have valuable effects on prevention, diagnosis, follow up and treatment of neuromuscular disorders. This study aimed to compare nerve conduction velocity (NCV) of the posterior tibial nerve in athletes and nonathletes materials and Methods: Totally 237 university students, 124 with appropriate exercise activity from physical education students and 113 without appropriate physical activity from medical students were se1ceted. General data and data related to NCV of posterior tibial nerves in two groups were collected using a previously designed questionaire and neurogram test. Data were analysed by SPSS software using Mann- whithny test in order to compare means. Results: The results showed NCV of right and left on posterior tibial nerves in female students were more than male ones (P= 0.041, P=0.012 respectively). NCV of the right and left tibial in athletes and nonathletes females had not statistical differences (P=0.149, P=0/961 respectively). In male students there were significant differences in NCV of right and left tibial nerves of athletes and nonathletes (P=0.001) Conclusion: In regard to effect of exercise on increasing NCV and reducing reflective time, it is necessary that physical education centers improve their educational programes.

Although back pain during pregnancy is common, lumbar disc herniation is reported in only one in approximately 10,000 pregnancies, and 2% of lumbar disc herniations are leading to severe and/or progressive neurologic deficits.This case is a lumbar disc herniation who presented during pregnancy with profound neurological deficits which was managed with surgery and focus on the presentation, safety of imaging, positioning and anesthesia as well as the maternal and fetal' outcome. Physicians should be aware that neurological deficit can occur during pregnancy.They should be diagnosed and treated promptly without considering the stage of gestation.Pregnancy is not a contraindication to magnetic resonance imaging (MRI), anesthesia, and surgical disc excision. Surgery appears warranted in patients who present with a severe and/or progressive neurological deficit secondary to a lumbar disc herniation.