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Background: Worsening of acute stroke early in its course (within 48–72 h of its onset) is a common occurrence and haspotentially serious short term and long term consequences. The incidence of early neurological deterioration (END) amonghospitalized patients varies widely in different studies between 13% and 38%. Aim of the Work: To define incidence and timing of END in relation to acute ischemic stroke (AIS) onset. To identify possible causes and predictors associated with END. To assess the relation between END and the patient functional level at three months post stroke. Patients and Methods: Three hundred patients were recruited into this hospital prospective comparative study. Clinical history,laboratory indices, structural brain imaging, Magnetic Resonance Angiography (MRA) and Carotid Duplex ultrasonography were done. Patients were examined on NIHSS and Glasgow Coma Scale (GCS) in day 1, 2, 3 and patients with END did a follow up (MRI diffusion film or CT brain) at day4 or 5 and all patients were followed up by Modified Rankin scale (MRs) at three-month post stroke. Results: Of the Three hundred patients included in the study, the incidence of END was 16.7%. The median NIHSS on admission was 9.25. END was associated with long duration of DM (P 0.012), IHD (p 0.015), AF (p 0.048), severe stroke (p 0.0044), low blood pressure on admission (p 0.0079), high uric acid (p 0.033) and MCA occlusion(p 0.0007). END was associated with significant increase in MRS at 3 month (p

Background Contrast-enhanced transcranial duplex (c-TCD) might be more sensitive than transesophageal echo (TEE) for detection of right to left shunting (RLS), which misses some cases with substantial RLS and might be valuable for prediction of recurrent stroke or transient ischemic attack in patients with PFO. Our aim is to detect sensitivity and specificity of contrast-enhanced TCD in detection of RLS among stroke patients with patent foramen ovale (PFO) in comparison to TEE. Methods TEE and contrast-enhanced TCD for cryptogenic stroke patients with PFO were done to detect right to left shunting. Results On testing characteristics of TCD in detecting RLS compared to the gold standard of TEE, TCD sensitivity was 85.7%, specificity was 100%, negative predictive value was 96.55%, and positive predictive value was 100%. Conclusion We concluded that PFO is considered an important hidden etiology for ischemic stroke. Contrast-enhanced TCD is considered sensitive method for detection of right to left shunting among PFO patients.

Few studies examine health-related quality of life (HRQoL) in Arabic-speaking multiple sclerosis (MS) patients. However, HRQoL tools such as the Short Form-36 QoL instrument (SF-36) and the Multiple Sclerosis International QoL (MusiQoL) questionnaire have been validated in other languages. The primary objective of this study was to prospectively assess HRQoL using the MusiQoL questionnaire among Arabic-speaking MS patients treated with subcutaneous interferon (sc IFN β-1a) over 12 months, as part of a prospective, multinational, multicenter cohort study. Patients’ clinical parameters and HRQoL were assessed at baseline, 6 months, and 12 months. Changes in MusiQoL total and subdomain scores were compared using a Friedman test. Correlation between MusiQoL total score and Expanded Disability Status Score (EDSS) was also evaluated. In total, 439 patients from four Arabic-speaking countries were included. The mean age was 32.44 (±0.34) years, 71.5% were female, and 63.1% had an education level of university or above. The mean MS duration was 4.13 (±0.12) years, mean age at first attack was 27.35 (±0.26) years, and mean baseline EDSS score was 2.05 (±0.04). MusiQoL total score significantly improved at 6 months; however, this diminished at 12 months ( 65.67 ± 0.8 at baseline vs. 67.21 ± 0.79 at 6 months and 65.75 ± 0.8 at 12 months; p = 0.0015 ). Several aspects of patients’ HRQoL including activity of daily living, physical well-being, symptoms, and coping improved. Overall HRQoL measured using SF-36 remained generally unchanged over time ( p = 0.215 ). There was a statistically significant inverse relationship between change in EDSS score over time and change in overall MusiQoL score over time. In summary, findings confirm the utility of using MusiQoL for assessing changes in HRQoL during treatment with sc IFN β-1a in Arabic-speaking patients with MS.

Background The apolipoprotein A1 level is recognized as a better indicator of cardiovascular disease than other cholesterol measures. Objectives To assess the serum level of ApoA1 in acute stroke patients and correlate it with the degree of vessel stenosis, stroke severity, prognosis, and functional outcome. Patients and methods We prospectively included 60 patients with first-ever cerebrovascular ischemic stroke, and they were matched with 30 healthy individuals matched in age and sex. Patients’ neurological status was assessed via National Institute of Health and Stroke Scale (NIHSS). A venous blood sample was taken within the first 24 h of stroke onset and assayed for ApoA1 level by Human ApoA1 ELISA kit. Results ApoA1 level could be used to discriminate between cases and controls at a level of 6.2 μg/ml, with 94.9% sensitivity and 86.6% specificity. Furthermore, there is an inverse relationship between the level of ApoA1 and the clinical outcome expressed by NIHSS score and their prognosis after 3 months. Finally, there is an inverse relationship between ApoA1 level and the degree of stenosis whether intracranial or extracranial. Conclusion ApoA1 level can be used as a predictor of ischemic stroke and as a prognostic tool for those patients with ischemic stroke.

Background: epileptic patients suffer from many autonomic symptoms either during the seizure or in between seizures. Interictal autonomic cardiac changes may cause arrhythmia which may be life threatening. Aim of the work: to recognize the presence of cardiac autonomic changes in patients with temporal lobe epilepsy and to find the relation between autonomic cardiac changes and different variables. Patients and methods: Twenty patients with well controlled TLE and twenty patients with uncontrolled TLE were subjected to standard 12-lead ECG and 24 hour holter ECG. Results: QTc was significantly shorter in patients with uncontrolled TLE than in patients with well controlled TLE. Patients with uncontrolled TLE had a faster heart rate than patients with well controlled TLE. Patients with uncontrolled TLE showed significant less SDNN, rMSSD and PNN50 than those with well controlled seizures.On the other hand, LF and LF/HF ratio was significantly more in uncontrolled group than the controlled group. Conclusion: There is an interictal alteration in autonomic control of the heart in TLE. This alteration is corrected with proper control of seizures

Objective: The prevalence of non-motor symptoms (NMSs) and their impact on health-related quality of life (HRQoL) in Parkinson's disease (PD) has been reported inconsistently among different populations. In this study, we aimed to investigate the NMSs and HRQoL profiles and their correlations in Egyptian PD patients, using a culturally adapted Arabic version of the 39-item Parkinson’s disease questionnaire (PDQ-39)). Methods: Ninety-seven PD patients were rated using the Unified Parkinson's Disease Rating Scale (UPDRS), the Non-Motor Symptoms Scales (NMSS), Beck Depression Inventory (BDI), and the Arabic version of PDQ-39. We used the Spearman’s rank correlation and multiple linear regression analyses to evaluate the relationship between NMSs domains and HRQoL dimensions. Results: Fatigue/sleep (91.3%) and mood/cognitive disturbances (87%) were the most frequently and severely affected NMSS domains. Other NMSs included urinary (75.9%), memory/attention (72.4%), gastrointestinal (67.8%), and cardiovascular problems (64.8%). The total NMSS scores were positively correlated with UPDRS I, II, and III scores. Depression assessed by BDI was prevalent in 76.7% of PD patients. Moreover, Aall enrolled PD patients reported impairment in different HRQoL dimensions, especially mobility (98.9%), activities of daily living (97.8%) and emotional well-being (95.5%). The summary index of PDQ-39 (PDQ-SI) was correlated to the total NMSS, UPDRS-I, UPDRS-II Off, UPDRS-III (Off and On states) and BDI scores. Conclusion: This study showeds the high prevalence of NMSs and the value of NMSS and BDI scores as predictors of HRQoL inof Egyptian PD patients. Therefore, Identifying characterizing the NMSsnon-motor profile is essential for tailoring management strategies offor PD patients.

BACKGROUND Despite the high prevalence of viral hepatic cirrhosis all over the world, the characteristic motor features of related Parkinsonism (extrapyramidal manifestations) are not well described. The current study aimed to characterize such disorder in a sample of Egyptian patients with chronic viral liver disease (CLD), and their clinical correlates. METHODS Ninety-six (96) patients with CLD were examined for the presence of extrapyramidal signs. Parkinsonism was assessed using the UPDRS-III scale and its sub scores. Ataxia and dystonia were also assessed by related scales. Patients with Parkinsonism were compared to other patients and correlations with clinical features of CLD were done. RESULTS The clinical diagnosis of extrapyramidal manifestations was justified in 57 patients (59.4%) with predominant akinetic rigid syndrome (ARS) (87.7%). Bradykinesia and axial features were the most frequent signs (89.5% and 70.2%, respectively). 38.6% of patients had postural tremors, whereas only 3.5% had rest tremors. Gait and postural abnormalities were detected in 38.6% and 36.8% respectively. Parkinsonism was associated with advanced hepatic cirrhosis (p=0.02) and increased episodes of hepatic encephalopathy (HE) (p=0.006). Severity of parkinsonian features was correlated to patients' age, age of onset of CLD and rapid progression, while impaired speech and gait were rather correlated to a number of episodes of HE. CONCLUSION Advanced viral cirrhosis is associated with high prevalence of parkinsonism that is characterized by symmetrical ARS with frequent axial features, postural tremor, gait and postural impairment. Severity of these signs is correlated to age, age of onset, rapid progression and frequency of HE.

Objective. Our aim is to assess the optimal discriminatory sonographic criteria and relevant threshold values in patients with carpal tunnel syndrome (CTS) and to evaluate quantitative ultrasonography (US) as a tool for diagnosis and treatment of patients suffering from carpal tunnel syndrome in comparison with electrophysiological study. Methods. Seventy-eight patients with CTS and 78 asymptomatic controls were assessed and underwent ultrasonography of the wrists. All patients and controls completed a self-administered questionnaire. Electrophysiological testing was done for all patients and control subjects. Data from the patient and the control groups were compared to determine the diagnostic relations in patients with CTS and the grade of severity. Results. There was a high degree of correlation between the conduction abnormalities of the median nerve as detected by electrodiagnostic tests, self-administered assessment and the measurement of the cross-sectional area of the nerve by US (P

Objectives: The objective of the following study is to determine the effect of continuous insonation using 2-MHz transcranial Doppler-ultrasound (TCD-US) on the recanalization rate and the short-term outcome in subjects with acute ischemic stroke due to middle cerebral artery (MCA) occlusion. Materials and Methods: A total of 42 patients with acute ischemic stroke due to MCA occlusion within 24 h were recruited and randomly allotted to two groups (21 patients in each group). Group 1 included patients who received 1 h continuous TCD-US for MCA and Group 2 included patients who did not receive 1 h continuous TCD-US. Patients in both groups were received MCA insonation and TCD study to measure mean flow velocity (MFV) in MCA one after the initial study at 20 and 60 min. All patients received aspirin (150-325 mg). The clinical course during hospital stay was assessed before and after 1 h of US insonation, at 24 h after symptom onset using the National Institutes of Health Stroke Scale. Results: Change in MFV after insonation for Group 1 in comparison to Group 2 at 3 time points was significantly high (P < 0.001). Conclusion: Sonothrombolysis is a therapeutic option to improve the outcomes in patients with acute ischemic stroke due to MCA occlusion.

Background The diagnosis of carpal tunnel syndrome (CTS) continues to be neurophysiologically and clinically controversial. Earlier data concluding that the higher prevalence of persons with symptoms suggestive of CTS but without evidence of median mononeuropathy highlights the need for a better understanding of the underlying pathophysiology and natural history of CTS to provide a less empirical foundation for diagnosis and clinical management. Objective To examine the relationship between the clinical manifestations of CTS with the outcome of the diagnostic tools (nerve conduction tests and ultrasonography), and its implication for clinical practice. Methods Two-hundred and thirty-two patients (69 male and 163 female, ages ranging between 20 and 91 years) with CTS manifestations and 182 controls were included in this study. Diagnosis of CTS was based on the American Academy of Neurology clinical diagnostic criteria. All patients and controls completed a patient oriented questionnaire, were subjected to clinical testing for provocative tests for carpal tunnel syndrome (Tinel's, Phalen's, Reverse Phalen's and carpal tunnel compression tests), blood check for secondary causes of carpal tunnel syndrome, nerve conduction testing as well ultrasonographic assessment of the carpal tunnel and median nerve. Results One-hundred and seventy-seven out of 232 (76.3%) had abnormal nerve conduction studies. Forearm symptoms and tenosynovitis confirmed by US examination were found in 51.3% of cases. No significant difference was found on comparing anthropometric measures in the affected hands to the control group hands. A higher prevalence of positive Phalen's and CT compression were found in patients suffering from tenosynovitis regardless of their nerve conduction study results. Sensitivity of Tinel's, Phalen's, Reverse Phalen's and carpal tunnel compression tests was higher for the diagnosis of tenosynovitis than for the diagnosis of CTS (Tinel, 46% vs. 30%; Phalen's, 92% vs. 47%; Reverse Phalen's, 75% vs. 42%; carpal tunnel compression test, 95% vs. 46%). Similarly, higher specificity of these tests was found with tenosynovitis than CTS. Conclusion The results of this study revealed that Tinel's, Phalen's, Reverse Phalen's and carpal tunnel compression tests are more sensitive, as well as being specific tests for the diagnosis of tenosynovitis of the flexor muscles of the hand, rather than being specific tests for carpal tunnel syndrome and can be used as an indicator for medical management of the condition.