Introduction: The silent brain lesions detected by MRI were fairly common not only in first-ever stroke but also in normal elderly subjects. Some recent studies show the possible role of silent sub-cortical brain infarction in ischemic stroke. The aim of this study was to evaluate the frequency of silent sub-cortical brain infarction in acute first-ever ischemic stroke.Methods: In this descriptive study, frequency of silent sub-cortical brain infarction was determined with brain MRI in 200 patients with acute first-ever ischemic stroke. Furthermore, demographic features and frequency of risk factors of ischemic stroke were evaluated. The data were analyzed by SPSS software version 16, using of t-test and Fisher Exact test.Results: In this study, 43% of our participants were men and the rest were women. The mean age of men was 68.75±8.53 and the mean age of women was 66.15±12.45.38.5% of patients with acute ischemic stroke had silent sub-cortical brain infarction. There was no significant relationship between silent sub-cortical brain infarction and risk factors of ischemic stroke.Conclusion: The frequency of silent sub-cortical ischemic brain lesions was high in ischemic stroke. Silent sub-cortical ischemic brain lesion may be a risk factor for ischemic stroke.

Background: Hemorrhagic Brain Infarction (HBI) is an important finding which has been reported mainly in cardioembolic strokes. Although clinical status of the patients is not often deteriorated, however decision making for anticoagulation's difficult in HBI patients.Materials and Methods: This descriptive-cross sectional study, was carried out in 100 consecutive patients with HBI admitted in Valie Asr Hospital, Khorasan during 2003-2004. HBI was diagnosed by CT scan within 24-48 hours of stroke onset and the arterial territory of the infarct was confirmed by topographic maps of brain in CT. Clinical status of the patients was evaluated each 12 hours during hospitalization, period. Etiologic work up of our stroke patients included routine blood chemistry and hematologic tests, ECG, transthoracic echocardiography and carotid duplex and transcranial Doppler sonography.Results: 54 females and 46 males with mean age 62.3 had HBI. 88% of the HBI occurred within MCA territory. The lenticulostriate artery was involved alone in 46% and with other MCA branches in 23% of cases. In patients with HBI, clinical status was deteriorated in 16%, recovered in 38% and stabilized in 46%, during hospitalization period respectively.The cardio embolism consisted 40% of etiologies in our HBI patients.Conclusion: Cardioembolism was not the main etiology in our patients with HBI. This finding reduces generality of the Fisher-Adams hypothesis. HBI infrequently leads to clinical deterioration of the patients.

Background: Stroke in young adults causes morbidity in this socioeconomically-active age group. Etiologic frequency of ischemic stroke in young adults is different around the world. This study was conducted to determine the causes of stroke in Iranian young adults. Methods: The study population consisted of 314,000 young adult residents in the Southern Khorasan Province, East of Iran. All the patients with stroke, admitted to Vali-e-Asr Tertiary Care Hospital, entered this study. Demographic data, clinical presentation, and investigations of consecutive patients aged 15 – 45 years, presented with ischemic stroke, were registered in Southern Khorasan Stroke Database between 2000 and 2005. All the patients underwent a standard battery of diagnostic investigations by a stroke neurologist. Etiologic classification of stroke in the patients was made based on the Practical Iranian Criteria. Results: One hundred and twenty-four patients (60 females and 64 males) were prospectively investigated during a 5-year period. The incidence of ischemic stroke in young adults was 8/100,000 per year. Cardioembolic mechanism constituted 54% of all stroke etiologies in young adults. Rheumatic valvular heart disease was present in 32% of the patients and caused 2.5 preventable stroke cases per 100,000 young adults per year. Conclusion: Rheumatic valvular heart disease is the most common cause and a preventable etiology of stroke in Iranian young adults.      

Bee stings are commonly encountered worldwide. Various manifestations after bee sting have been described including local reactions which are common, systemic responses such as anaphylaxis, diffuse intravascular coagulation and hemolysis. We report a case of a 74-year-old man who developed neurologic deficit 5 hours after bee stings, which was confirmed to be left frontal infarction on brain CT-scan. The case does not follow the reported pattern of hypovolemic or anaphylactic shock, hemolysis and/or rhabdomyolysis, despite the potentially lethal amount of venom injected. Diverse mechanisms have been proposed to give an explanation to all the clinical manifestation of both toxic and allergic reactions secondary to bee stings. Currently, the most accepted one state that victims can develop severe syndrome characterized by the release of a large amount of cytokines.

Silent Brain Infarcts (SBI) are associated with an increased risk of subsequent stroke. SBI are incidentally revealed by CT or MRI executed in stroke patients. A prospective study was undertaken involving 200 consecutive patients aged >45 years with brain infarct admitted in University of Alberta Hospital, Canada (100 patients) and Valie-Asr Hospital, Iran (100 patients) in 2003. Patients were divided in age groups aged <65 and >65. All of the patients underwent brain CT.A stroke neurologist with knowledge of stroke history subsequently reviewed the scans and diagnosed SBI. The relations of race, gender and age groups with SBI were analyzed with chi-square and Fisher exact tests.SBI were present in 26.9% of patients aged <65 and 48.6% of patients aged >65. Canadian patients were significantly more preponderant to SBI in age group> 65 (p=0.013). The mean age of Canadian patients was significantly higher than Persians (p<0.001). Within a total of 200 patients the female gender was significantly more preponderant to SBI (p= 0.02) which was not related to age and race groups. Small vessel territory infarct was present in 87% of our patients with SBI. SBI are common in stroke patients. The frequency of SBI is higher in female gender and the elderly.

Background and Aim: Increasing evidence has demonstrated that activation of peroxisome proliferator-activated receptor alpha (PPARα ), which belongs to the nuclear receptor family of ligand-activated transcription factors, after cerebral ischemia exhibit neuroprotective functions including anti-oxidative, anti-apoptotic and anti-inflammatory effects. The aim of this study was to evaluate the pretreatment effects of PPARα agonist, fenofibrate, on brain infarction, tissue swelling and brain edema in an experimental model of ischemic stroke. Materials and Methods: The study included three groups of rats (N=36); sham, control ischemic and treated ischemic groups. Brain ischemia was induced by 90 min middle cerebral artery occlusion (MCAO) followed by 24 hours reperfusion. Rats received fenofibrate (200 mg/kg/day) by oral route for 4 days before induction of MCAO. Neurological deficit score (NDS), infarct volume (TTC staining method), tissue swelling and brain edema were assessed 24 hours after termination of MCAO. Results: MCAO induced neurological dysfunction (2. 83± 0. 16), brain infarction (282± 30 mm3), brain swelling (15. 13± 2. 29 %) and edema (17. 23± 1. 97%) in control ischemic group. Administration of fenofibrate in the treated ischemic rats significantly reduced neurological dysfunction (2. 14± 0. 14), brain infarction (92± 28 mm3), brain swelling (4. 35± 1. 42%) and edema (5. 49± 1. 44) compared to the rats in the control ischemic group. Conclusion: Our findings indicated that activation of PPARα by specific agonist, fenofibrate, effectively decreased the cerebral ischemia-reperfusion injuries as well as brain swelling and edema in an experimental model of ischemic stroke.

Background: The one-third middle cerebral artery (1/3 MCA) method and Alberta Stroke Program Early Computed Tomography Score (ASPECTS) were used to detect significant early ischemic changes on brain computed tomography (CT) of patients with acute stroke. We designed the Persian Early CT Score (PECTS) and compared it with the above systems. Methods: The tomograms were chosen from the stroke data bank of Ghaem Hospital, Mashhad, in 2008. The inclusion criteria were the presence of MCA territory infarction and performance of CT within 6 hours after stroke onset. Axial CTs were performed on a third-generation CT scanner (Siemens, ARTX, Germany). Section thickness above posterior fossa was 10 mm (130 kV, 150 mAs). Films were made at window level 35 HU. The brain CTs were scored by four independent radiologists based on the ASPECTS, 1/3 MCA method, and PECTS. The readers were blinded to the clinical information except the symptom side. Cochrane Q and Kappa tests were used for statistical analysis. Results: Twenty four CT scans with sufficient quality were available. The difference in distribution of dichotomized £7 and >7 ASPECT scores between the four raters was significant; Q=13.071, df=3, P=0.04. The difference in distribution of dichotomized >1/3 and £1/3 MCA territory involvement between 4 raters was also significant; Q=13.5, df=3, P=0.004. Distribution of dichotomized <6 and ³6 scores based on PECTS system between the four raters was not different; Q=6.349, df=3, P=0.096. Conclusion: PECTS method was more reliable than ASPECTS and 1/3 MCA methods in detecting major early ischemic changes in stroke patients who were candidated for thrombolysis therapy.

INTRODUCTION: Transient ischemic attacks (TIA) are warnings of future stroke. There is no difference in risk factors, pathophysiology and prevention between TIA and brain infarction.METHODS: Consecutive patients with brain infarction admitted to Ghaem Hospital, Mashhad, Northeastern Iran, were enrolled in a prospective study during 2006.Diagnosis of ischemic stroke was established by a neurologist who also obtained history of TIA and vascular risk factors. All of the stroke patients underwent a standard battery of diagnostic investigations and etiology of ischemic stroke was determined by the Practical Iranian Criteria classification. Fisher’s exact test was used for statistical analysis.RESULTS: 348 stroke patients (186 women, 162 men) were studied. History of TIA was present in 42 patients (29 women, 13 men), i.e. 12% of the stroke patients. TIA was more common in women (df=1, P=0.02). The frequency of hypertension, diabetes and ipsilateral carotid stenosis was not significantly different between patients with history of TIA and other stroke patients (P=0.87, P=0.64 and P=0.61, respectively). Hypercholesterolemia and smoking were significantly more frequent in stroke patients with history of TIA (P=0.011 and P=0.014, respectively). The frequency of TIA was not significantly different among patients with lacunar, versus large vessel territory infarcts (df=1, P=0.84). There was no significant difference in the frequency of various stroke etiologies in patients with and without history of TIA (df=4, P=0.61).CONCLUSIONS: Stroke patients with history of TIA have vascular risk factors similar to other stroke patients. A positive history of TIA does not affirm any specific etiology of ischemic stroke.

Background: Stroke is the third common cause of disability and death. Diagnosis of stroke is based on its clinical manifestations and/or observation of infarct in the neuroimaging. Standard battery of diagnostic investigations and classification criteria is required for detection of stroke etiology.Materials and Method: This review article deals with the diagnosis and management of brain infarction particularly in our country and is provided for non-neurologists. Using online scientific search engines and in some parts referring to laboratory archives constituted base of this review article.Results: Acute stroke management is almost similar in its various etiologies. Neuroprotective drugs have little value in acute stroke management. At present time, a few Iranian medical centers have infrastructure of thrombolysis therapy. Prevention of stroke is based on the detection and control of its risk factors. Aspirin, 80 mg per day is the most common drug for stroke prevention. Co-administration of aspirin 80 mg/d and Dipyridamole 200-400 mg/d increases the preventive effects of aspirin. Clopidogrel 75 mg/d is the stroke preventive drug of choice in patients with peptic ulcer and coronary artery disease. Co-administration of aspirin and clopidogrel is more effective in stroke prevention but has more hemorrhagic complications. Using warfarin for stroke prevention is suggested only in patients who have facilities for repetitive coagulation tests. Carotid endarterectomy is indicated in symptomatic patients with more than 70% stenosis of extracranial internal carotid artery, if performed only by vascular surgeons experienced in carotid surgery.Conclusion: Many stroke patients are managed by general practitioners and non-neurologists, e.g. internists, cardiologists and neurosurgeons. This review article provides continuous medical education according to Iranian medical curriculum.