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Kefah Al-Hayk,1 Mahmoud M Smadi,2 Lina M Elsalem,3 Ahmed Yassin,1 Suha Aqaileh,1 Deema H Obiedat,1 Ahmad Kefah Al-Hayk,4 Majdi Al Qawasmeh1 ,† Raid Kofahi,1 Khalid El-Salem1 1Neurology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Mathematics and Statistics, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan; 3Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 4Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan†Majdi Al Qawasmeh passed away on April 24, 2023Correspondence: Kefah Al-Hayk, Neurology Department- Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan, Tel +962-790606881, Fax +962 2-7095123, Email kaalhayk@just.edu.joPurpose: Procedure discomfort can limit electrodiagnostic studies. Reducing discomfort can maximize the benefits of these diagnostic tools. This study targeted the discomfort associated with nerve conduction studies (NCS).Patients and Methods: This was a prospective randomized double-blind placebo-controlled study comparing the effect of topical lidocaine gel (2%) versus analgesic-free lubricant gel (K-Y gel) on pain perception during NCS. Sequential patients (n=130) referred for routine NCS participated in the study. We applied 1 mL of lidocaine gel to one palm, and 1 mL of K-Y gel to the other as a control. After 20– 45 min of application, graded increments of electrical stimulation intensity were delivered to record the median and ulnar mixed palmar nerve responses. Patients were then asked to score the degree of pain felt from electrical stimulation over each palm using the Wong-Baker Faces Pain Scale (WBFPS) and the Numeric Rating Scale (NRS), independent of baseline pain.Results: Mean WBFPS and NRS scores for lidocaine-treated palms were significantly lower than those for controls using parametric paired t-test (3.79 vs 4.37 and 3.35 vs 3.78 respectively, all p-values< 0.05). Subgroup analysis showed a significant decrease in mean scores in females, patients aged ≤ 50 years, patients without a history of previous NCS, and patients without comorbidities (all p-values< 0.05). Median scores using nonparametric Wilcoxon ranked test also showed statistically significant differences (all p-values< 0.05).Conclusion: The results indicate that topical lidocaine 2% gel reduces discomfort associated with NCS. However, despite the statistical significance, clear clinical significance may be lacking. Clinical implementation may be considered for the subgroups that showed the greatest benefit. Further studies that incorporate more efficient drug delivery methods may yield better results.Keywords: topical lidocaine, nerve conduction study, discomfort, electrodiagnostic

Majdi Al Qawasmeh, Belal Aldabbour, Kefah Alhayek, Khalid El-Salem Department of Neurology, King Abdullah University Hospital (KAUH), Jordan University of Science and Technology (JUST), Irbid, JordanCorrespondence: Majdi Al QawasmehNeurology Department of KAUH, King Abdullah University Hospital, P.O. Box 630001, Irbid 22110, JordanTel +962 797477731Email m0alqawasmeh@just.edu.joAbstract: Encephalocraniocutaneous lipomatosis “ECCL” is a rare, sporadic neurocutaneous disorder that results from a lethal autosomal mutation surviving by somatic mosaicism. It is characterized by unilateral involvement of skin, eyes and central nervous system in addition to a propensity for mesenchymal tumors. A 30-year-old male with previously controlled epilepsy presented with recurrent seizures. Brain imaging revealed a left parietal parasagittal enhancing tumor, in addition to left sided gyriform calcifications, and bilateral cerebral atrophy and ventricular dilatation more prominent on the left side. He also presented multiple left sided sebaceous nevi and abundant subcutaneous lipomas in addition to left mandibular condylar cysts. The brain tumor was excised, and cytopathology revealed a WHO grade I fibrous meningioma. After a thorough evaluation and exclusion of alternative diagnoses, the patient was diagnosed with definite encephalocraniocutaneous lipomatosis as per Moog’s criteria. Several cases of ECCL recently presented with different intracranial neoplasms. Here we report the first case of ECCL in association with meningioma.Keywords: neurocutaneous syndromes, neurocutaneous disorders, encephalocraniocutaneous lipomatosis, Haberland syndrome

Khaled Alawneh,1 Bashar Abuzayed,2 Majdi Al Qawasmeh,3 Liqaa Raffee,4 Abdelwahab Aleshawi5 1Department of Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 2Department of Neurosurgery, The Specialty Hospital, Amman, Jordan; 3Department of Neuroscience, Division of Neurology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 4Department of Accident and Emergency, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 5King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Khaled AlawnehDepartment of Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, JordanTel +962795314555Email kzalawneh0@just.edu.joObjective: Treatment of brain arteriovenous malformations (AVMs) aims to abolish any risk for intracranial hemorrhage with the preservation of the patient’s functional status. We present the technique of pre-surgical endovascular devascularization through proximal feeder artery occlusion for the treatment of cranial AVMs rather than nidus occlusion. Also, we highlight the advantages and the possible clinical indications.Patients and Methods: Two patients with brain AVM and one patient with scalp AVM were treated by pre-surgical endovascular devascularization followed by surgical resection. Endovascular devascularization was performed by occlusion of the AVM feeders only with Liquid Embolic System Agent (Onyx®) 18 without entering and filling the nidus. During surgery, feeding arteries colored with the black color of the Liquid Embolic System Agent were clearly identified and cut. Dissection of the AVM was performed, and resection of the nidus was achieved.Results: Total resection of the AVM was achieved in all cases confirmed with follow-up angiographies, with no neurologic or systemic complications. Also, no major bleeding was detected. In addition, the surgical clips were avoided during surgery. Brain AVMs were safely resected in piecemeal fashion.Conclusion: Pre-surgical endovascular proximal feeder artery devascularization technique shows to be a safe, simple and effective technique for the management of cranial arteriovenous malformations. This technique simplifies both the endovascular and surgical approaches to complicated cranial AVM cases.Keywords: angiography, arteriovenous malformation, devascularization, endovascular, surgical resection

Background: Poststroke depression among patients is well-recognized, while caregiver depression is understudied. The interaction between patient and caregiver depression is also unclear., Methods: This cross-sectional and follow-up study recruited 108 patient-caregiver dyads after the first-ever stroke. Demographic and clinical data, stroke severity (NIH Stroke Scale score), functional outcome (Barthel Index), and residual disability (modified Rankin Score) were documented. Using the self-reported Patient Health Questionnaire-9, we screened patients and caregivers for depressive symptoms upon admission and after 1 month. Changes in the prevalence and severity of depression were calculated. The Pearson correlation test and logistic regression analysis were conducted to evaluate both the correlation between both groups and significant predictors of depression., Results: In total, 89 patients and 96 caregivers responded to both screenings. Depression was reported by 13.5% and 27.0% of patients on admission and after 1 month, and 9.4% and 18.8% of caregivers, respectively. Caregiver depression on admission was significantly correlated with patient depression on admission (P=0.031). In addition, depression in caregivers after 1 month was a significant predictor of patient depression (P=0.008). Predictors of caregiver depression after 1 month were female caregivers (P=0.026), caring for a male patient (P=0.045), higher mRS scores after 1 month (P=0.013), longer admissions (P=0.017), caregiver between 17 and 35 years of age compared with 54 to 70 years of age (P=0.030), and caring for a patient with poststroke depression at 1 month poststroke (P=0.003)., Conclusions: Both stroke survivors and their caregivers are at high risk for depression, with a potential interaction between depression in the 2 groups., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Guillain-Barré syndrome (GBS) is a major cause of acute flaccid paralysis that is encountered in all geographical areas. Very limited data about this syndrome has been reported from the Arab countries. This study is the first one trying to describe the clinical features and management outcomes of GBS in the Jordanian population., Methods: This retrospective study looks at adult patients admitted to a major tertiary referral hospital in the north of Jordan between 2013 and 2021., Results: A total of 30 patients met the inclusion/exclusion criteria. Males were predominantly affected (70%) with a male-to-female ratio of 2.33. Acute inflammatory demyelinating polyradiculoneuropathy variant was encountered in 60% of cases, whereas axonal variants, namely, acute motor axonal neuropathy and acute motor axonal and sensory neuropathy variants were seen in about 23% of cases. ICU admission was reported in 37% of patients and 6.7% required mechanical ventilation. Most patients had a favorable outcome with a GBS disability score of three or better at out-patient follow-up visits., Conclusion: Our cohort of patients showed a significant deviation in disease expression from that reported in other parts of the globe. This deviation was obvious in more prominent male predominance, frequencies of different GBS variants, and more favorable short-term morbidity/mortality outcomes. However, larger multicenter prospective studies are needed for confirmation of these results., Competing Interests: None of the authors have any conflict of interest or financial disclosures related to this study., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Bipolar disorder (BD) is a psychiatric disorder characterized by episodes of depression and mania, associated with impaired emotion processing. Several functional MRI (fMRI) studies have been used to investigate the structural and functional alteration in BD. Here, we aim to investigate the current fMRI findings of brain activation during emotion-regulation tasks between BD patients and healthy controls (HC)., Methods: A systematic search through PubMed database for fMRI studies on bipolar patients and HC yielded 685 studies. We performed an activation likelihood estimation (ALE) on 21 studies for emotion regulation in BD patients and HC. Furthermore, we performed subgroup analyses for task performances in response time and accuracy between bipolar patients and HC., Results: The total sample included 21 fMRI studies, comprising 543 BD patients, compared to 565 HC. ALE maps for emotion-related tasks showed hyperactivation in BD patients in the caudate, amygdala, precentral gyrus, middle frontal gyri, and sub-gyrus. Whereas hypoactivation was seen in the inferior frontal gyrus and anterior cingulate gyrus., Limitations: We could not apply a correction for p-value thresholds, as it needs large number of foci. Second, functional abnormalities were investigated for adult BD patients only, as BD patients have functional differences correlated with age., Conclusions: Our results showed that limbic and cortical regions can represent a potential biomarker for the diagnosis and management of BD, by showing clustered brain regions of abnormal patterns of increased activation between BD patients and HC., Competing Interests: Conflict of interest The authors declare no conflict of interest or any financial disclosure., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Migraine is a primary headache disorder that causes debilitating throbbing pain. Several functional MRI (fMRI) and voxel-based morphometry (VBM) studies have been used to investigate the structural and functional alteration in migraine. Here, we aim to study the converged brain regions of functional and structural abnormalities in gray matter volume (GMV) associated with pain processing and management in migraineurs and healthy controls (HC)., Methods: A systematic search through PubMed and Sleuth was carried out for peer-reviewed functional and structural neuroimaging studies on migraine patients and HC yielded a total of 1136 studies. We performed an activation likelihood estimation (ALE) meta-analysis on VBM and pain stimulation task-based fMRI studies to investigate the converged areas of GMV and functional abnormalities between migraineurs and HC. We performed two subgroup analyses between migraine with aura (MwA) and migraine without aura (MwoA) relative to HC, and between chronic migraine (CM) and episodic migraine (EM) compared to HC., Results: The total sample included 16 fMRI and 22 VBM studies, consisting of 1295 migraine patients, compared to 995 HC. In fMRI analysis, ALE maps for pain stimulation tasks revealed hyperactivation in migraineurs in the substantia nigra compared to HC, whereas hypoactivation was seen in the cerebellum. For the VBM analysis, ALE clusters of increased GMV in migraineurs were observed in the parahippocampus and putamen nucleus. Whereas clusters of reduced GMV in migraineurs were seen in the frontal gyri. Compared to HC, MwoA patients showed a GMV reduction in the insula, and anterior cingulate, whereas MwA patients showed GMV reduction in the cerebellum, cingulate gyrus, and insula. CM patients showed decreased GMV in the precentral gyrus, whereas EM patients showed decreased GMV in the parahippocampus, and inferior frontal gyrus when compared to HC., Conclusions: Our findings represent a potential biomarker for the diagnosis and management of migraine, by showing clustered brain regions of abnormal patterns of activation and GMV changes between migraineurs and HC which might be associated with hyposensitivity to pain in migraineurs. Further studies are required to determine disease progression or therapeutic interventions' effect on migraine., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

We assessed whether stroke severity, functional outcome, and mortality in patients with ischemic stroke differed between patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and those without. We conducted a prospective, single-center cohort study in Irbid, North Jordan. All patients diagnosed with ischemic stroke and SARS-CoV-2 infection were consecutively recruited from October 15, 2020, to October 16, 2021. We recorded demographic data, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, stroke subtype according to the Trial of ORG 10172 in Acute Stroke Treatment Criteria (TOAST), treatments at admission, and laboratory variables for all patients. The primary endpoint was the functional outcome at 3 months assessed using the modified Rankin Score. Secondary outcomes involved in-hospital mortality and mortality at 3 months. We included 178 patients with a mean (standard deviation) age of 67.3 (12), and more than half of the cases were males (96/178; 53.9%). Thirty-six cases were coronavirus disease 2019 (COVID-19) related and had a mean (standard deviation) age of 70 (11.5). When compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a higher median NIHSS score at baseline (6 vs 11; P = .043), after 72 hours (6 vs 12; P = .006), and at discharge (4 vs 16; P < .001). They were also more likely to have a higher median modified Rankin Score after 3 months of follow-up (P < .001). NIHSS score at admission (odds ratio = 1.387, 95% confidence interval = 1.238-1.553]; P < .001) predicted having an unfavorable outcome after 3 months. On the other hand, having a concomitant SARS-CoV-2 infection did not significantly impact the likelihood of unfavorable outcomes (odds ratio = 1.098, 95% confidence interval = 0.270-4.473; P = .896). The finding conclude that SARS-CoV-2 infection led to an increase in both stroke severity and in-hospital mortality but had no significant impact on the likelihood of developing unfavorable outcomes., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: COVID-19 pandemic has an overwhelming psychologic burden on healthcare workers (HCWs). This study aims to investigate the changes in the prevalence, estimates, severity, and risk factors of depressive symptoms among HCWs within the first year of the COVID-19 pandemic., Methods: An observational e-survey collected data on HCWs' socio-demographic characteristics, occupational situation, and depressive symptoms as measured by Patient Health Questionnaire-9 (PHQ-9). The e-survey was distributed one month after the onset of the COVID-19 pandemic (onset group) and again after one year (one-year group)., Results: A total of 422 HCWs were included (Mean (SD) age, 35.3 (9.9) years; 71.3% males), with 211 (50%) participants in each group. In the total cohort, the mean PHQ-9 score was 8.5, and 36.7% reported clinically significant levels of depressive symptoms with a PHQ-9 score of ≥10. Compared to the onset group, the one-year group reported a higher risk of major depressive disorder (41.7% vs . 31.8%; OR 1.538; 95%CI 1.032-2.291; p=0.034 ), a higher mean PHQ-9 score (9.5 (6.8) vs . 7.4 (5.3), p<0.001 ), and more severe depressive symptoms (p<0.005 ). Participants who were younger, unmarried, underwent testing for COVID-19, reported lower monthly income, did not receive special COVID-19 education, or had lower satisfaction with institutional preparedness had significantly higher depression scores and symptoms in both onset and one-year groups ( p<0.05 for each category). Female gender and direct contact with COVID-19 patients or samples were significant risk factors within the onset group. Occupation as a physician, history of COVID-19 testing or infection, and perception of significant changes in work schedule or intensity were significantly associated with higher depression scores and symptoms among the one-year group., Conclusion: This study sheds light on an unspoken but significant rise in prevalence estimates and severity of depressive symptoms among HCWs over a year of the COVID-19 pandemic and shows the vulnerable subgroups for whom a psychological intervention might be warranted., Competing Interests: The authors declare no conflict of interest, financial or otherwise., (© 2022 Al Yassin et al.)

Background: Multiple sclerosis (MS) is a chronic inflammatory neurodegenerative disease of the central nervous system. Vasoactive and intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide (PACAP) are neuropeptides that play roles in anti-inflammation and neuroprotection in MS. In this study, we aimed to determine the serum levels of VIP and PACAP in MS patients versus healthy controls and to correlate them with demographics and clinical characteristics., Methods: Serum samples were collected from MS patients (n = 145) and healthy controls (n = 73) to measure serum levels VIP and PACAP., Results: VIP serum levels were lower in MS patients than healthy controls (p < 0.001). Serum PACAP levels were the same among the two groups. Gender-based analysis showed that VIP levels were lower in healthy females (1238.840 pg/ml) than healthy males (3300.105 pg/ml; p < 0.001), and PACAP serum levels were significantly lower in male MS patients (48,516.214 fg/ml) than female MS patients (62,466.400 fg/ml; p = 0.029). ROC curve suggested that serum VIP level can discriminate patients with MS from healthy controls. Relapsing-remitting MS, progressive-MS, and clinically isolated syndrome groups were different in age, MS disease duration, EDSS score, and VIP levels (p < 0.05). MS disease type and history of previous relapses in the preceding 24 months predicted serum VIP levels, while gender predicted PACAP levels., Conclusion: VIP serum levels are decreased in MS patients and can be used to differentiate between MS patients and healthy controls. Further studies with larger sample sizes are required to investigate VIP as a marker to reflect MS disease progression., (© 2021. Fondazione Società Italiana di Neurologia.)

Poststroke depression (PSD) is common and remains a significant risk factor for poor outcomes. This prospective study is aimed at assessing the prevalence, severity, and predictors of PSD among Jordanian stroke survivors. A total of 151 patients who were consequently admitted to a tertiary teaching hospital with ischemic or hemorrhagic strokes were enrolled. Participants were screened on admission for premorbid depression using the PHQ-9 questionnaire; then, screening for PSD was repeated one and three months after stroke using the same tool. Depression prevalence at each screening was reported, and logistic regression analysis was conducted to evaluate for significant predictors. PHQ-9 scores suggestive of depression were reported by 15%, 24.83%, and 17.39% of respondents on admission and after one and three months, respectively. Scores suggesting severe depression were reported by 0.71%, 2.13%, and 6.52% of respondents, respectively. Significant predictors of PSD were having chronic kidney disease, current smoking status, moderate or severe disability (mRS score) at stroke onset, and severe dependence (BI) after one month ( p values 0.007, 0,002, 0.014, and 0.031, respectively). Patients with secondary and high school education levels were less likely to get depression compared with illiterate patients ( p 0.042). This study showed that nearly one in four Jordanian stroke survivors experienced PSD after one month. In contrast, while the overall PSD prevalence declined towards the end of follow-up period, patients who remained depressed showed a tendency towards higher PSD severity., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2022 Majdi Al Qawasmeh et al.)

Introduction: A single-lead electrocardiogram (EKG) is routinely recorded with electroencephalogram (EEG). This study investigates the frequency and types of EKG abnormalities during routine EEG., Methods: All routine EEGs (20-60 min) over one year were retrospectively analyzed. A blinded cardiologist interpreted EKG recordings. An epileptologist evaluated EEGs. Demographic data, underlying comorbidities, and indications for the EEG were extracted., Results: A total of 433 recordings for 365 patients were included. Mean (±SD) age was 46.8 (±21.3) years and 50.4% were females. EKG abnormalities were detected in 28.5% of patients; sinus tachycardia (11%), premature ventricular contractions (7.9%), atrial fibrillation (Afib) (6.3%), sinus bradycardia (2.2%) and premature atrial contractions (1.1%). Afib was more common in females than males (p = 0.020), confirmed in six out of seven patients and discovered in 17 patients. Age (OR: 1.67, 95%CI: 1.05-2.66, p = 0.031), prior diagnosis of epilepsy (OR: 2.25, 95% CI: 1.22 - 4.14, p = 0.009), history of seizure (OR: 1.97,  95%CI: 1.09-3.54, p = 0.024), abnormal EEG (OR: 2.14, 95%CI: 1.25 - 3.66, p = 0.005) and EEGs evaluating seizures/epilepsy (OR: 4.18, 95% CI: 1.32 - 13.21, p = 0.015) or syncope (OR: 3.21, 95% CI: 1.16 - 8.84, p = 0.024) were independently associated with abnormal EKG., Conclusion: The frequency of EKG abnormalities captured during routine EEGs was high, with Afib being the most significant. Older age, history of epilepsy or seizure, abnormal EEGs, and EEGs evaluating seizures/epilepsy or syncope were significant predictors. These findings suggest neurologists to become more vigilant to EKG recorded during routine EEG as such findings might have diagnostic and therapeutic implications., (Copyright © 2021 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

BACKGROUND Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) commonly occur in critically ill patients and can be distinguished from spontaneous epileptic seizures by continuous electroencephalogram (CEEG) monitoring. There are no current treatment guidelines for SIRPIDs. This report is of a 73-year-old woman with respiratory failure and without any detectable gross brain lesions. She had developed SIRPIDs, which were diagnosed through CEEG monitoring. She responded well to valproate, carbamazepine, and clonazepam. CASE REPORT A 73-year-old woman was admitted to the intensive care unit (ICU) with a chest infection. After 3 days, this infection was complicated by respiratory failure and coma, for which she was intubated. After that, recurrent brief episodes of abnormal head and right upper limb jerky movements with right gaze deviation occurred. Nurses noticed that these episodes occurred exclusively upon physical interaction with the patient, and lasted up to 3 minutes. No focal findings were noted on neurological examination. The brain computed tomography (CT) scan revealed no acute brain insult. CEEG revealed SIRPIDs, which abated with midazolam boluses, followed by infusion at 15 mg/hour. Later, they were controlled by valproate, carbamazepine, and clonazepam in succession, guided by CEEG data. CONCLUSIONS This report shows the importance of CEEG monitoring to diagnose SIRPIDs and monitor treatment response. It also suggests that SIRPIDs can occur even in the absence of gross brain pathology. Although there are no current treatment guidelines for SIRPIDs, the use of valproate, carbamazepine, and clonazepam can help control them, as evidenced in this case.

Objectives: This study examines the usefulness of computed tomography (CT) scans in evaluating patients with dizziness in the emergency department (ED)., Methods: Medical records of patients presented with complaints of dizziness or vertigo to the ED of a tertiary university hospital and underwent head CT scans from July 2015 to June 2018 were reviewed. The patients' demographic information, presenting symptoms, and final head CT scan and Magnetic resonance imaging (MRI) results were collected. Stepwise logistic regressions were used to analyze data., Results: A total of 326 dizzy patients were included in this study. The majority of the patients (83.1%) were older than 44 years. Acute vertigo pattern of dizziness was detected among 50.6% of the patients and was more common among females than males ( p  < 0.001). Of these 326 patients who underwent head CT scans, 49 (15%) had abnormal findings with acute ischemic stroke was the most common one. A total of 191 patients underwent follow-up studies. MRI accounted for 70% of the follow-up studies. Of the 134 patients who received MRI of the brain, 36 (27%) had abnormal findings. A significant correlation of RBCs level, presence of other symptoms, and frequency of episodes with the presence of vertigo ( p  < 0.001) was found., Conclusion: The study's findings indicate low effectiveness of head CT scan compared to MRI for dizziness management. Future studies are suggested to provide more insights into the cost-effectiveness and utility of head CT scans and MRI in providing valuable findings., Competing Interests: The authors declare that they have no competing interests., (© 2021 The Authors.)

Background: Assessing physical activity (PA) in people with multiple sclerosis (PwMS) is essential to follow-up the recommended PA level. The International Physical Activity Questionnaire (IPAQ) and the Incidental and Planned Exercise Questionnaire (IPEQ) have been widely used, but their validity has not been investigated previously in PwMS., Objective: This study aimed to assess the convergent and criterion validity of the IPAQ and the IPEQ in PwMS., Methods: 50 PwMS were asked to wear an Actigraph for seven days and to fill the IPAQ and IPEQ. Sedentary, moderate (MPA), vigorous (VPA) and moderate to vigorous PA (MVPA) levels were recorded., Results: Significant correlations were found between sitting time as reported by IPAQ and sedentary time as recorded by Actigraph (r = 0.41, p = 0.003), VPA by IPAQ and VPA as recorded by Actigraph (r = 0.46, p = 0.001), and MVPA by IPAQ and MVPA by Actigraph (r = 0.36, p = 0.011). IPEQ showed poor both criterion and convergent validity when compared to the Actigraph. Both IPAQ and IPEQ overestimate the intensities of PA for all the derived parameters., Conclusions: Findings of this study are important as they suggest that IPAQ in particular had convergent validity when compared to Actigraph data, but still had the problem of overestimating PA levels.

Background: Stroke is the leading cause of long-term disability worldwide. Stroke recurrence is a major health problem with devastating consequences. Adherence to secondary prevention guidelines reduced stroke recurrence. Data regarding prescriptions adherence to secondary prevention guidelines in the Middle East and North Africa is lacking., Objectives: The aim of this study is to assess the degree of physician adherence to ASA guidelines and the patient specific factors that affect their prescribing patterns in a major teaching hospital in Jordan., Methods: Ischemic stroke patients referring to King Abdullah University Hospital were approached and offered a description of the study to obtain their informed consent. After getting the informed consent, their prescription at the time of discharge was evaluated for adherence to secondary prevention guidelines and classified into adherent and non-adherent based on a composite score that included each of the guidelines which indicated therapeutic classes. Odds ratio for adherence and their 95%confidence intervals were calculated and adherence to specific therapeutics classes was evaluated., Results: Two hundred and seventy-five patients were included in this evaluation. Less than 50% of the patients received guideline's adherent prescriptions. Patients with hypertension and hyperlipidemia were associated with a lower probability were prescribed a guidelines adherent regimen (OR 0.485, 0.0.225, respectively). ACEI/ARBs combination with thiazides was prescribed to about 11.52% of the patients., Conclusion: Adherence to stroke secondary prevention guidelines was suboptimal especially in the antihypertensive prescription component. Further assessments and evaluations are required to improve guidelines adherence., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: To study the clinical, radiological, electroencephalographic, and cerebrospinal fluid (CSF) features of Human Herpes Virus 6 (HHV-6) encephalitis in leukemia patients underwent allogeneic hematopoietic stem cell transplantation (HSCT)., Methods: We retrospectively reviewed all leukemia patients who underwent allogeneic HSCT between January 2010 and December 2018. The clinical, radiological, electroencephalographic, and CSF features of those with HHV6 encephalitis were recorded., Results: A total of five cases of HHV6 encephalitis were identified. Three patients had Chronic Myelogenous Leukemia, one had Chronic Lymphocytic Leukemia and one had Acute Lymphoblastic Leukemia. All of them presented a few months after transplantation with altered mental status. Comorbidities included pancytopenia, sepsis, graft versus host disease, and multi-organ failure. EEG showed focal seizures originating from temporal lobes in two patients, generalized or focal periodic discharges in three patients, focal slowing in two patients, and diffuse slowing in three patients. MRI brain showed T2/FLAIR hyper-intensities in four patients; two of them in bilateral temporal lobes, one in the thalamus/hypothalamus/brainstem/cerebellum/basal ganglia, and one in the periventricular areas. CSF showed pleocytosis, high protein, and positive HHV-6 PCR. Foscarnet was used as an anti-viral agent. Anti-epileptics used were phenytoin, levetiracetam, and valproic acid. Four patients died in a few months, whereas one recovered completely., Conclusions: HHV-6 encephalitis can add significant morbidity and mortality to leukemic patients following allogeneic HSCT. Patients present with typical clinical features of encephalitis. Salient EEG characteristics include periodic discharges or overt temporal lobe seizures. MRI findings are T2/FLAIR signal hyperintensities, mainly in the temporal lobes., Competing Interests: The authors declare that they have no competing interests., (© 2020 The Authors.)

Multiple sclerosis (MS) is a clinically heterogeneous multifactorial disorder which is one of the most prevalent neurological disorders of females and young people. Both genetic and environmental factors are playing an important role in the pathophysiology of MS. The main objective of this study is to identify the relationship between numbers of genetic variants within different candidate genes (IL7R, LAG3, and CD40) and the risk of developing MS in the Jordanian Arab population. This case-control study consists of 218 MS patients chosen from neurology clinics at different hospitals in Jordan and ethnically matched 227 healthy controls. Genomic DNA was extracted from blood samples. Genotyping of the candidate gene polymorphisms was conducted using the Sequenom MassARRAY system. Statistical analysis was performed to identify the genetic association of the studied SNPs with MS. Twenty-one variants were studied, three of them were found to be associated with MS (rs6897932 (P-value = 0.01) and rs13188960 (P-value = 0.005) within IL7R gene and LAG3 rs2365095, (P-value = 0.03) within LAG3 gene). Moreover, no significant association was found between MS and the genetic polymorphisms of the CD40 gene. After correction for multiple comparisons, only rs13188960 SNP remained significantly with MS. This is the first study of the genetic association with MS in the Jordanian Arab population to provided evidence of the genetic association of IL7R (rs6897932, rs13188960) and LAG3 (rs2365095) gene polymorphisms with MS. These findings may contribute to our understanding of MS and optimize the therapy protocol for individuals., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier B.V.)

Introduction: Thrombspondin-1 (TSP-1) is a glycoprotein that has a variety of functions including suppression of angiogenesis and regulation of extracellular matrix deposition. These functions are central to the recovery process after stroke. Data regarding the association and predictive value of TSP-1 and stroke outcomes are limited., Patients and Methods: Patients with ischemic stroke who referred to King Abdullah University Hospital were evaluated for inclusion. The level of serum TSP-1 on admission was assayed using ELISA. Data regarding comorbid diseases as well as stroke severity at baseline, functional outcome and mortality at 6 months were collected prospectively. Favorable outcome was identified as NIHSS or mRS ≤ 1., Results: Ninety-six patients with an average age of 66.7 years were included. One-third of the patients (32 patients) had favorable outcome on admission. The serum TSP-1 levels in patients with favorable outcome were significantly higher (719.7 vs. 639.9; p  = 0.028). Similarly, patients with favorable outcome at 6 months had higher levels of TSP-1 at baseline (714.3 vs. 614.7; p  = 0.003). TSP-1 was identified as an independent predictor of favorable outcome at baseline (OR = 0.993, p  = 0.038) and after 6 months (OR = 0.99, p  = 0.008)., Conclusion: TSP-1 can predict favorable outcomes with regard to the initial severity and long-term functional outcome.

The burden of stroke can be substantially studied by establishing the functional consequences of stroke and its predictors on the population, economy and to guide rehabilitation efforts. This study aims to determine the subtypes, risk factors, and epidemiology of stroke in Jordan. Methods : A retrospective cohort study design was carried out to determine the risk factors and subtypes of stroke during 2017-2018. The study sample included 176 ischemic stroke patients of the King Abdullah University Hospital. Data was collected through medical records, which was then statistically analysed through frequencies and percentages. Results: Total 176 cases were identified out of which 101 (57.38%) were males and 75 (42.61%) were females and male to female ratio was 1.9:1. Hypertension was the commonest risk factor identified (50.56%), followed by diabetes mellitus (19.88%), hyperlipidaemia (15.34%), coronary artery disease (6.25%), atrial fibrillation (4.54%), and past history of stroke (1.13%). Risk factors such as hypertension (p = 0.007), diabetes (p = 0.000), coronary artery disease (p = 0.000) were significantly associated with subtypes of ischemic strokes. Conclusion: The study concludes that mean age of men was higher as compared to women in small vessel occlusion. The risk of ischemic stroke in patients with dyslipidaemia, diabetes mellitus, and hypertension was higher in middle-aged and old patients., Competing Interests: The authors declare no conflict of interest., (© 2020 The Authors.)

A 21-year-old male patient was operated for third ventricle tumor (central neurocytoma) and showed improvement in the early postoperative period. After 2 weeks of surgery, the patient neurologic status deteriorated with acute decreased level of consciousness. Neuroimaging of the brain revealed entrapped left temporo-occipital horns with adhesion bands at the level of the atrium. Patient was operated with neuronavigation-guided endoscopic approach to the left atrium through the left posterior parietal region. Band adhesiolysis was performed with no complications. The patient showed fast improvement, and follow-up brain magnetic resonance imaging after 2 years showed the release of the ventricular entrapment with significant regression of the left ventricle size., Competing Interests: Conflict of Interest None declared.

Background: Traumatic spinal epidural hematomas (TSEDH) are rare, with the reported incidence being < 1% of all spinal injuries. Causes of TSEDHs include vertebral fractures, obstetrical birth trauma, lumbar punctures, postsurgical bleeding, epidural anesthesia, and missile injuries. The retrodental location has not been reported as a location for spontaneous epidural hematoma., Case Report: A 4-year-old boy was admitted to our Emergency Department after falling down and experiencing head trauma. Glasgow Coma Scale score was 15/15 with no neurologic deficit. Brain computed tomography scan showed isolated hyperdense hematoma in the retrodental area without any fractures in the skull or cervical vertebrae. Brain and cervical magnetic resonance imaging showed a retrodental acute hematoma that was isointense in T1-weighted sequences and hypointense in T2-weighted sequences. The hematoma was in the epidural space with possible odontoid process intracapsular origin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Isolated retrodental epidural hematoma without dens fracture is an extremely rare pathology and finding, and to the best of our knowledge, this is the first case to be reported in the literature. Emergency physicians should consider this pathology for any patients presenting for head trauma with head hematoma., (Copyright © 2019 Elsevier Inc. All rights reserved.)

A 26-year-old female patient referred to our emergency service with complaint of increase headache and swelling of the left upper eye led. External examination of the head revealed left frontal scalp and left eye led swelling, which was soft and pulsatile. Brain computed tomography (CT) scan and magnetic resonance imaging showed left frontal soft tissue and left periorbital swelling with crowded left intraorbital contents. Brain CT angiography showed vascular mass lesion in the left frontal subcutaneous lesion. Six-vessel cerebral angiography showed left frontal scalp arteriovenous malformation (AVM) supplied from the right and left superficial temporal arteries from the external carotid artery and from the left supraorbital artery arising from the ophthalmic artery of the internal carotid artery. By endovascular technique, bilateral superficial temporal arteries were occluded with Onyx 18 (Micro-Therapeutics, Inc., Irvine, CA). The patient was operated after 2 days. Left eye-brow incision was performed and the supraorbital artery was exposed, ligated, and cut. Left fronto-temporal skin incision was performed and the AVM totally excised. No intraoperative nor postoperative complications seen. Follow-up cerebral angiography showed total resection of the AVM.

A 78-year-old woman with progressive worsening vertigo and new onset of diplopia. Neurological examination revealed bilateral abducens nerve paralysis and gait disturbance with truncal ataxia. Neuroimaging revealed a mass lesion within the clivus with brain stem compression. The patient was operated with provisional diagnosis of clivus chordoma by neuro-navigation-guided extended endoscopic endonasal approach. Subtotal resection of the tumor was achieved with no intra- or postoperative complications. Histopathologic examination revealed intraosseous meningioma (WHO grade I). To the authors' best knowledge this is the first case reporting clivus site of intraosseous meningioma.

Colour blindness is one of the common genetic disorders observed in all human populations. It is a sex-linked recessive trait. The genes are located on the X chromosome within the Xq28 band. 1,418 university students (1,200 female and 218 male) from Zarka Private University and the Hashemite University were randomly selected and tested for congenital red/green colour blindness, by using Ishihara pseudo-isochromatic colour plates. A total of 23 individuals were found to be colour blind. In females, 4 students (0.33%) were colour blind: 1 of them showed protanomalia, 1 protanopia and 2 deuteranomalia. In males, 19 students (8.72%) were colour blind: 4 showed protanomalia, 3 protanopia, 8 deuteranomalia and 4 deuteranopia. The allelic frequencies of the colour vision gene were found to be 0.087 in males, 0.003 in females and 0.016 in the total population. Studies on colour blindness in Jordan are very few; this population-based investigation is meant to fill a gap in this field.