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Background: Optic neuritis is an inflammation of the optic nerve. Because of importance of vision for human, management of optic neuritis is an important issue in neurology. Objectives: This study aimed at assessing the effect of oral steroid treatment after intravenous (IV) methylprednisolone therapy on demyelinating optic neuritis. Materials & Methods: 60 Patients with first episode of acute demyelinating optic neuritis who referred to a neurology clinic in an academic hospital in south-west of Iran in 2015-2016 included in this randomized double-blind clinical trial study (No: IRCT2015102724735N1). They were divided into two groups with (A) and without (B) tapering oral steroid treatment after IV methylprednisolone. Visual acuity and color vision were measured before treatment, before oral tapering, 1 and 3 months after treatment. Independent t-test in SPSS software version 20 was used to analyze the data. P0.05).Frequency of color vision abnormality in groups A and B were at baseline (53.3% vs. 56.6%) (P=0.796), before oral tapering (43.3% vs. 30%, P=0.284), 1 month after treatment (23.3% vs. 30%, P=0.559), 3 months after treatment (0% vs. 23%, P=0.011). Conclusion: Oral steroid treatment after IV methylprednisolone pulse therapy improves color vision after 3 months in patients with demyelinating optic neuritis but has no effect on visual acuity.

BackgroundTreatment switching is a common challenge and opportunity in real-world clinical practice. Increasing diversity in disease-modifying treatments (DMTs) has generated interest in the identification of reliable and robust predictors of treatment switching across different countries, DMTs, and time periods.ObjectiveThe objective of this retrospective, observational study was to identify independent predictors of treatment switching in a population of relapsing-remitting MS (RRMS) patients in the Big Multiple Sclerosis Data Network of national clinical registries, including the Italian MS registry, the OFSEP of France, the Danish MS registry, the Swedish national MS registry, and the international MSBase Registry.MethodsIn this cohort study, we merged information on 269,822 treatment episodes in 110,326 patients from 1997 to 2018 from five clinical registries. Patients were included in the final pooled analysis set if they had initiated at least one DMT during the relapsing-remitting MS (RRMS) stage. Patients not diagnosed with RRMS or RRMS patients not initiating DMT therapy during the RRMS phase were excluded from the analysis. The primary study outcome was treatment switching. A multilevel mixed-effects shared frailty time-to-event model was used to identify independent predictors of treatment switching. The contributing MS registry was included in the pooled analysis as a random effect.ResultsEvery one-point increase in the Expanded Disability Status Scale (EDSS) score at treatment start was associated with 1.08 times the rate of subsequent switching, adjusting for age, sex, and calendar year (adjusted hazard ratio [aHR] 1.08; 95% CI 1.07–1.08). Women were associated with 1.11 times the rate of switching relative to men (95% CI 1.08–1.14), whilst older age was also associated with an increased rate of treatment switching. DMTs started between 2007 and 2012 were associated with 2.48 times the rate of switching relative to DMTs that began between 1996 and 2006 (aHR 2.48; 95% CI 2.48–2.56). DMTs started from 2013 onwards were more likely to switch relative to the earlier treatment epoch (aHR 8.09; 95% CI 7.79–8.41; reference = 1996–2006).ConclusionSwitching between DMTs is associated with female sex, age, and disability at baseline and has increased in frequency considerably in recent years as more treatment options have become available. Consideration of a patient's individual risk and tolerance profile needs to be taken into account when selecting the most appropriate switch therapy from an expanding array of treatment choices.

Background and Objective: Stroke has a high prevalence and is associated with a high premature mortality rate. Thus, it is important to identify the effective factors in increasing the incidence of stroke. The aim of this study was to investigate the role of seasonal changes and environmental factors in the occurrence of stroke. Methods: This descriptive-analytical study was done on 3,639 patients including 3,102 (85.3%) with ischemic stroke, 472 (12.9%) with intracerebral hemorrhage and 65 (1.9%) with subarachnoid hemorrhage patients. After measuring environmental factors such as air temperature, air pressure, humidity and geomagnetic field, admission data of stroke patients between 2015-2019 were extracted from the Sayyad Shirazi Hospital information system. Results: The mean occurrence of intracerebral hemorrhage was highest in winter, especially in January and March, and lowest in summer, especially in July and August. Intracerebral hemorrhage had a positive significant correlation with air pressure (P=0.001, r=0.452) and a negative correlation with ambient temperature (P

Background: There is an increased attention to stroke following SARS-CoV-2. The goal of this study was to better depict the short-term risk of stroke and its associated factors among SARS-CoV-2 hospitalized patients. Methods: This multicentre, multinational observational study includes hospitalized SARS-CoV-2 patients from North and South America (United States, Canada, and Brazil), Europe (Greece, Italy, Finland, and Turkey), Asia (Lebanon, Iran, and India), and Oceania (New Zealand). The outcome was the risk of subsequent stroke. Centres were included by non-probability sampling. The counts and clinical characteristics including laboratory findings and imaging of the patients with and without a subsequent stroke were recorded according to a predefined protocol. Quality, risk of bias, and heterogeneity assessments were conducted according to ROBINS-E and Cochrane Q-test. The risk of subsequent stroke was estimated through meta-analyses with random effect models. Bivariate logistic regression was used to determine the parameters with predictive outcome value. The study was reported according to the STROBE, MOOSE, and EQUATOR guidelines. Findings: We received data from 26,175 hospitalized SARS-CoV-2 patients from 99 tertiary centres in 65 regions of 11 countries until May 1st, 2020. A total of 17,799 patients were included in meta-analyses. Among them, 156(0.9%) patients had a stroke—123(79%) ischaemic stroke, 27(17%) intracerebral/subarachnoid hemorrhage, and 6(4%) cerebral sinus thrombosis. Subsequent stroke risks calculated with meta-analyses, under low to moderate heterogeneity, were 0.5% among all centres in all countries, and 0.7% among countries with higher health expenditures. The need for mechanical ventilation (OR: 1.9, 95% CI:1.1–3.5, p = 0.03) and the presence of ischaemic heart disease (OR: 2.5, 95% CI:1.4–4.7, p = 0.006) were predictive of stroke. Interpretation: The results of this multi-national study on hospitalized patients with SARS-CoV-2 infection indicated an overall stroke risk of 0.5%(pooled risk: 0.9%). The need for mechanical ventilation and the history of ischaemic heart disease are the independent predictors of stroke among SARS-CoV-2 patients. Funding: None.

Background. Insufficient received ultraviolet B radiation (UV) is regarded as the main environmental risk factor (RF) for MS in vitamin D deficiency hypothesis. Nevertheless, geomagnetic disturbance (GMD) has also been proposed as a potential trigger for MS in GMD hypothesis. The aim of this study was to investigate which of these mentioned RF is correlated with long-term ultradecadal MS incidence. Methods. After a systematic search, long-term incidence reports of the United Kingdom (UK), Denmark, Tayside County, Nordland County, the Orkney, and Shetland Islands were selected for this retrospective time-series study. Possible lead-lag relationships between MS incidence, GMD, and UV were evaluated by cross-correlation analysis. Results. Significant positive correlations between GMD and MS incidence were seen in Tayside County (at lag of 2 years: rS = 0.38), Denmark (peak correlation at lag of 2 years: rS = 0.53), and UK (at lag of 1 year: rS = 0.50). We found a positive correlation between received UV and MS incidences in the Nordland at lag of 1 year (rS = 0.49). Conclusion. This study found significant positive correlations between alterations in GMD with alterations in long-term MS incidence in three out of six studied locations and supports the GMD hypothesis. The observed significant correlation between MS and UV is positive; hence it is not supportive for UV related vitamin D deficiency hypothesis.

Background and PurposeSickle cell disease (SCD) is strongly linked to stroke across all haplotypes in the pediatric population. Transcranial Doppler (TCD) ultrasound is known to identify the highest risk group in African-Americans who need to receive and stay on blood transfusions, but it is unclear if the same flow velocity cut-offs can be applied to the Iranian population. We aimed to evaluate baseline TCD findings in Iranian children with SCD and no prior strokes.MethodsChildren with genetically confirmed SCD (Arabian haplotype, homozygote) and without SCD (controls) were prospectively recruited from pediatric outpatient clinic over a period of 9 months. We performed TCD in both groups to determine flow velocities in the middle cerebral (MCA) and terminal internal carotid arteries (TICA).ResultsOf 74 screened children, 60 met the inclusion/exclusion criteria (62% female; mean age 10±4 years). Baseline characteristics did not differ between the cases and controls, except hemoglobin (Hb) which was significantly lower in the SCD group (P

مقدمه: آرتریت روماتویید (RA یا Rheumatoid Arthritis) یک بیماری التهابی درگیرکننده‌ی عروق کوچک و متوسط پوست و سیستم عصبی محیطی است. درگیری مغزی به دنبال بیماری RA یک یافته‌ی نادر است و تأخیر در درمان آن با مرگ و میر و نقص عملکردی بالایی همراه است. گزارش مورد: آقایی 65 ساله با سابقه‌ی آرتریت روماتویید و مصرف روزانه‌ی پردنیزولون به مدت 10 سال، به دنبال سردرد منتشر نبض‌دار، خواب‌آلودگی و افت هوشیاری به بخش مراقبت‌های ویژه منتقل گردید و مورد مشورت نورولوژی قرار گرفت. در ابتدا بیمار همی‌پارزی راست به همراه فلج فاشیال مرکزی همان سمت داشت. طی مدت 72 ساعت با وجود مصرف آنتی‌پلاکت و آنتی‌کواگولان با دوز درمانی، علایم عصبی بیمار تشدید یافت و بیمار دچار همی‌پارزی چپ، افزایش خواب‌آلودگی و اختلال در Gaze افقی و عدم شناخت اطرافیان گردید. با توجه به سابقه‌ی بیماری کلاژن واسکولار و عدم وجود عوامل خطر آترواسکلروز، بیمار با شک به واسکولیت مغزی تحت درمان با پالس متیل پردنیزولون قرار گرفت. پس از دریافت دوز سوم علایم لترالیزه‌ی وی کاهش یافت، حرکات چشم طبیعی گردید و سطح هوشیاری بیمار ظرف مدت 9 روز پس از بستری بهبود یافت. تشخیص احتمالی بیمار (واسکولیت مغز) با نمای عروقی مشهود در سی‌تی آنژیوگرافی تأیید گردید. نتیجه‌گیری: به نظر می‌رسد که درگیری سیستم عصبی مرکزی در بیماری آرتریت روماتویید نادر باشد ولی در نبود سایر علل آترواسکلروز و پیشرفت سریع علایم عصبی به همراه آنسفالوپاتی در بیماران با سابقه‌ی مثبت اختلالات کلاژن واسکولار، همواره باید این تشخیص را مد نظر قرار داد. با توجه به مرگ و میر بالای این بیماران ضمن پی‌گیری و رد نمودن سایر علل عفونی و عروقی، باید درمان این بیماران با پالس متیل پردنیزولون هرچه سریع‌تر آغاز گردد. واژگان کلیدی: آرتریت روماتویید، واسکولیت مغزی، پالس کورتون، پالس سیکلوفسفاماید.