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Background and Purpose: Patients with ischemic stroke frequently develop hemorrhagic transformation (HT), which could potentially worsen the prognosis. The objectives of the current study were to determine the incidence and predictors of HT, to evaluate predictor interaction, and to identify the optimal predicting models., Methods: A prospective study included 360 patients with ischemic stroke, of whom 354 successfully continued the study. Patients were subjected to thorough general and neurological examination and T2 diffusion-weighted MRI, at admission and 1 week later to determine the incidence of HT. HT predictors were selected by a filter-based minimum redundancy maximum relevance (mRMR) algorithm independent of model performance. Several machine learning algorithms including multivariable logistic regression classifier (LRC), support vector classifier (SVC), random forest classifier (RFC), gradient boosting classifier (GBC), and multilayer perceptron classifier (MLPC) were optimized for HT prediction in a randomly selected half of the sample (training set) and tested in the other half of the sample (testing set). The model predictive performance was evaluated using receiver operator characteristic (ROC) and visualized by observing case distribution relative to the models' predicted three-dimensional (3D) hypothesis spaces within the testing dataset true feature space. The interaction between predictors was investigated using generalized additive modeling (GAM)., Results: The incidence of HT in patients with ischemic stroke was 19.8%. Infarction size, cerebral microbleeds (CMB), and the National Institute of Health stroke scale (NIHSS) were identified as the best HT predictors. RFC (AUC: 0.91, 95% CI: 0.85-0.95) and GBC (AUC: 0.91, 95% CI: 0.86-0.95) demonstrated significantly superior performance compared to LRC (AUC: 0.85, 95% CI: 0.79-0.91) and MLPC (AUC: 0.85, 95% CI: 0.78-0.92). SVC (AUC: 0.90, 95% CI: 0.85-0.94) outperformed LRC and MLPC but did not reach statistical significance. LRC and MLPC did not show significant differences. The best models' 3D hypothesis spaces demonstrated non-linear decision boundaries suggesting an interaction between predictor variables. GAM analysis demonstrated a linear and non-linear significant interaction between NIHSS and CMB and between NIHSS and infarction size, respectively., Conclusion: Cerebral microbleeds, NIHSS, and infarction size were identified as HT predictors. The best predicting models were RFC and GBC capable of capturing nonlinear interaction between predictors. Predictor interaction suggests a dynamic, rather than, fixed cutoff risk value for any of these predictors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Elsaid, Fahmi, Shehta and Ramadan.)

Background: There is limited data regarding the association of Neutrophil-lymphocyte ratio (NLR) inflammatory marker with multiple sclerosis (MS) disability and activity., Objective: The aim of the present study was to evaluate validity of NLR as an inflammatory marker for MS disability and activity., Methods: A case-control study including 140 MS patients and 140 age, sex and body mass index matched healthy controls was performed. All participants were subjected to detailed history taking, complete general and neurological examination, laboratory and radiological investigations. Assessment of disease disability was performed using Expanded Disability Status Scale., Results: The NLR levels was significantly higher in MS patients compared to the controls and in patients with relapse compared to remission. Logistic regression analyses showed that NLR was significantly associated with disease disability (odds ratio (OR): 2.568; confidence interval (CI): 1.377 - 4.788; P: 0.003) and activity (OR: 3.603; CI: 2.086 - 6.226; P: 0.02). The cutoff value for the NLR to predict MS disability and activity was 3.12., Conclusion: NLR was significantly increased in MS patients compared to controls. The significant association of NLR with MS disability and activity suggest that it could be utilized as a simple, rapid and inexpensive inflammatory marker., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interests., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Intracerebral hemorrhage (ICH) is considered a devastating neurologic emergency and carried a higher morbidity and mortality rates. Early hematoma expansion (HE) is considered one of the poor prognostic factors after ICH. Consequently, determination of the possible risk factors for HE could be effective in early detection of high-risk patients and hence directing management course aiming to improving ICH outcome., Methods: One-hundred and thirty-six spontaneous ICH patients were included and prospectively evaluated for the presence of HE. Demographic, laboratory, and certain radiological factors were studied and compared between those with HE and those without, the in-hospital mortality rates were assessed as well., Results: HE was observed in 30% of the studied cohort, those who developed HE had more neurologic impairment (Glasgow coma scale, median 9; National Institute of Health Stroke Scale, median 34), and higher in-hospital mortality rate (53.6%) than those without HE. HE was related to the presence of higher red blood cell distribution width (RDW), reduced total cholesterol, low-density lipoprotein-C (LDL-C), and Ca levels. Among the radiological factors, hematoma density (heterogeneous), and shape (irregular) are highly related to the occurrence of HE. The computed tomography angiography (CTA) spot sign among patients with ICH was associated with HE development., Conclusions: Abnormal RDW; low cholesterol, LDL, and Ca level; heterogeneous density, irregular shape hemorrhage, and presence of CTA spot sign were associated with the development of HE in the setting of spontaneous ICH., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Cerebrovascular stroke is considered as the most common cause of symptomatic seizures. Post-stroke seizures herald a poor functional outcome, a high mortality rate, and a long in-hospital duration of stay., Aim: To assess the incidence and risk factors responsible for early seizures after the first-ever cerebral stroke, and its relation to the functional outcome and the in-hospital mortality following stroke as well as the duration of stay., Patients and Methods: 150 patients with first-ever stroke, who were admitted in an intensive care and stroke unit of the Neurology Department of Zagazig University Hospitals, Egypt, within the first 24 hours of stroke onset were included in the study. Early seizures (within 7 days of stroke onset), stroke severity (National Institutes of Health stroke scale; NIHSS), radiological data, functional outcome (Barthel index), in-hospital mortality and duration of stay were collected and analyzed., Results: The incidence of early seizures associated with first-ever stroke was 9.3%. Risk factors for early seizures were intracerebral hemorrhage (ICH) [odds ratio (OR) = 3.2, P = <0.001), cortical lesions (OR = 2.8, P = <0.05), and a large lesion size (OR = 2, P= <0.05). Patients with early seizures had lower scores on the Barthel index than those without seizures (7.5 ± 4.1 versus 10.5 ± 3.5), had higher discharge National Institutes of Health Stroke scale (NIHSS) scores, had a higher in-hospital mortality rate (35.7% versus 6.6% in patients without seizures) and duration of stay (19.4 ± 6.5 versus 10.7 ± 4.2 days respectively)., Conclusion: The incidence of early post-stroke seizures was high in our study and was positively associated with a poor functional outcome, a higher in-hospital mortality rate and a longer duration of in-hospital stay. The most important risk factors were ICH, the cortical site of involvement and a large size of the lesion., Competing Interests: There are no conflicts of interest

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. The aim of this study is to evaluate the body mass index (BMI) and vitamin D levels in CTS patients., Methods: The current study was conducted at Zagazig University Hospitals. It included 50 CTS patients and 50 controls. Clinical assessment was carried out to exclude symptoms and signs of neuropathy. Laboratory investigations including vitamin D levels, glycosylated hemoglobin, liver, and kidney function were carried out for every participant. All patients underwent electrodiagnostic study and completed Boston questionnaire to assess their pain sum score, symptom severity (SSS), and functional status (FSS)., Results: Patients had significantly higher BMI and lower vitamin D levels compared to controls ( p  = 0.003 and p  = 0.001, respectively). Those with severe CTS had a significantly higher BMI and lower vitamin D levels than the others ( p  = 0.03 and p  = 0.01 respectively). No significant difference was found between CTS subgroups regarding the SSS, while a higher significant FSS and pain sum score were reported in the severe CTS patients compared to the other two groups ( p  = 0.01 and p  = 0.04 respectively). A significant negative correlation was detected between vitamin D levels and both of BMI, and Boston pain sum scores ( p  = 0.01 and p  = 0.03 respectively). Also, an inverse correlation was detected between vitamin D levels and both of SSS and FSS ( p  = 0.14, p  = 0.06). Furthermore, a significant positive and negative correlation between vitamin D levels and both of conduction velocity and distal motor latency respectively was observed ( p  = 0.02 and p  = 0.01 respectively)., Conclusions: Carpal tunnel syndrome was significantly associated with hypovitaminosis D especially in patients with higher BMI. This highlights the importance of vitamin D supplements and weight loss regimes to minimize the severity of their pain., Competing Interests: A written consent was taken from all of the participants after explaining the details, benefits, and risks to them. The study was approved from the institutional ethics committee of Faculty of Medicine, Zagazig University. Consent for publication is not applicable in this section.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.