Search

Objective: Cerebral vascular events are the second leading cause of mortality worldwide and is increasing in developing countries. Epidemiological studies are important to improve outcomes and preventive and supportive strategies. This research was aimed to study epidemiology of stroke in Tabriz, Iran. Materials and Methods :This cross-sectional, analytic population-based study was performed from May 2009 to April 2010. Information about probable stroke events was obtained from 5000 randomly selected people. In a door-to-door process, questionnaires were completed by a trained team. Any probable stroke case was referred to a stroke expert for further evaluation. After diagnosing stroke cases, 214 healthy people were assembled for a control group to compare stroke related risk factors. Results :Out of 5000 studied people, 34(0.68%) stroke patients, with a mean age of 68.7 years (range: 38-85), were detected. Nineteen (56%) patients were male, 31 (91%) were ischemic, and 3 (9%) had hemorrhagic stroke. Six first-ever strokes occurred in the 1 year study period. Identified risk factors included hypertension in 25 (74%), hyperlipidemia in 11 (32%), diabetes mellitus in 9 (27%), smoking in 10 (29%) and coronary artery disease in 6 (18%). Conclusion : This report showed a high incidence rate of stroke of about 120 per 100,000 people and a remarkably high prevalence of hypertension. It speaks to the need to make special health system strategies to raise awareness for primary and secondary prevention of stroke.

Introduction: The aim was to determine whether secretory phospholipase-A2 (sPLA2) activity and fatty acids in cerebrospinal fluid (CSF) are correlated with liver enzymes tests. Methods: CSF and serum samples were collected from 49 patients (age 18-65) as part of routine diagnostic testing. Along with serum liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP), the fatty acid composition of CSF was measured by gas liquid chromatography. CSF enzyme activities of sPLA2 were measured using the standard assay with diheptanoyl thio-phosphatidylcholin as substrate. Results: The saturated fatty acids (SFAs) including palmitic acid and stearic acid were positively, and the unsaturated fatty acids including oleic acid and linoleic acid were negatively correlated with liver enzymes tests. In regression analysis with adjustment for body mass index (BMI), the elevated liver enzymes tests were positively associated with activity of sPLA2 (β > 0.31, P < 0.050) and total SFAs (β > 0.38, P < 0.010) and negatively with total monounsaturated fatty acids (MUFAs) (β < -0.40, P < 0.001) contents of CSF. Conclusion: CSF activity of sPLA2 and fatty acids may be linked to peripheral markers of liver function, suggesting an indirect impact of central fatty acids on hepatocytes function and metabolism.

Ocular symptoms are regularly observed inpatients with cavernous sinus dural arteriovenous fistulas (cDAVF). We aimed to evaluate the long-term efficacy and safety of endovascular approaches in patients with cDAVF presenting with different ocular symptoms. In a prospective study between June 2008 and March 2013, 46 patients with ocular symptoms due to cDAVF who were not eligible for conservative therapy, met the inclusion criteria and underwent endovascular treatment. They underwent a transarterial approach with histoacryl glue injections or transvenous coil embolization, all in one session. They were followed up for a mean period of 17.3 months (range 7 to 30 months) clinically and using angiography. The mean age of patients was 36.8 years (18–60) and 65% of them were male. All patients showed venous drainage into the superior and inferior orbital veins. Access to the cavernous sinus was transvenous in ten patients, transarterial in 26 patients, and mixed in ten patients. Initial symptoms were improved in 97.8% of patients and did not recur during the study follow-up. The procedural complications included: blurred vision, transient sixth nerve palsy and exacerbation of chemoproptosis in two, one and two patients respectively that completely resolved in initial weeks with no recurrence. No patient worsened or developed new symptoms suggestive of a recurrent fistula during the follow-up period. One patient experienced intracranial dissection of the internal carotid artery and ischemic stroke with an unfinished procedure. The relief of early presentation was durable in long-term follow-up and the cured lesions were stable in angiographic controls. Favorable and durable outcomes could be obtained following endovascular approaches for cDAVF presenting with different ocular symptoms.

Background: Atherosclerotic stenosis of the major intracranial arteries is the most common cause of ischemic stroke. There are limited treatments for severe intracranial stenosis, and stent placement versus medical treatment remains controversial. The aim of this study was to compare functional outcomes of these two modalities in patients with severe symptomatic intracranial stenosis. Methods: At a single center, between 2008 and 2011, patients with angiographically demonstrated severe (70–90%) symptomatic intracranial atherosclerosis were divided into two groups: group A, which received only medical treatment, and group B, which underwent endovascular stent implant treatment. The severity and location of the stenosis was determined by digital subtraction angiography and the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial criteria in all patients. The exclusion criteria were: specific causes other than atherosclerosis, such as artery dissection, fibromuscular dysplasia, vasculitis, radiation and intracranial hemorrhage, focal neurological deficit that did not correlate to internal carotid artery or middle cerebral artery stenosis. All procedures were done under light anesthesia. Technical success was defined as the reduction of stenosis to Results: Overall, 63 patients (29 in group A and 34 in group B) were evaluated and followed for a mean period of 15.22 months (range 6–25). The technical success rate was 97% in a total of 34 stents in 34 patients. There was no difference between the early (within 30 days) adverse event rates of the two groups. The median follow-up duration for the stent implant patients was 15 months (range 6–25), and for the medically treated cohort it was 14 months (range 8–25). The re-stenosis rate was 5.8% and the total number of late (>30 days) adverse events, including stroke, myocardial infarction and death, was 1 (2.9%) and 6 (20.7%) in the stent implant and medical groups, respectively (p = 0.042). The stent implant group had significantly better favorable functional outcomes according to the mRS than the medical group (93.9 vs. 63.0%). The cumulative secondary adverse event-free survival was significantly lower in the stent implant group. Conclusion: Stent implants can be considered more durable and safe for patients with symptomatic severe stenosis of the internal carotid artery or middle cerebral artery, despite optimal medical therapy. Randomized, multicenter trials are required to confirm these results.

Vitamin B12 deficiency (B12D) has wide variety of neurological and non-neurological signs and symptoms. We describe a 61-year-old man who was admitted to Emergency Department (ED) with trouble to walk independently, suffering from weakness and a long history of dyspepsia that had worsened in the last four weeks. He had mild impairment of cognitive functions; motor strength was normal and his patellar and achilles reflexes were absent, also the plantar reflexes were abolished. All blood tests were normal except hemoglobin concentration which showed mild anemia. At further studies regarding trouble walking of this patient, he was candidated for lumbar disk surgery based on mild disk bulging seen at L3-L4 level in the lumbar spine MRI. Further examinations before the surgery due to approach to anemia showed severely decreased serum vitamin B12 level. The patient's symptoms improved after treating with intramuscular cobalamin. Being a very commonly seen disorder in the general population, B12 deficiency should be born in mind as a probable diagnosis in patients with peripheral neuropathy and no clear underlying cause presenting to the ED. Therefore, simple screening with a CBC might decrease the neurologic complications, morbidity and inappropriate workups through early diagnosis and treatment.

Background Due to underlying autoimmune background of Guillain-Barré syndrome (GBS), the possible role of infectious agents cytomegalovirus (CMV) and Epstein-Barr virus (EBV) and also due to association of anti-ganglioside antibodies with GBS, the present study aimed to investigate the associations between serum anti-ganglioside antibodies (AGA) level, type of infection and electrodiagnostic (ED) findings with the severity and three-month functional outcome of patients with GBS. Methods In a prospective study, 30 patients with GBS were selected and before starting the treatment, baseline serum samples of patients were obtained for measuring the serum AGA including the antibodies against GQ1b, GT1b, GD1a, GD1b, GM1, GM2, GM3 and strains of CMV and EBV. All the patients were precisely examined for ED findings. Functional status of patients on admission and three months after admission were recorded according to the modified Rankin scale (mRS). Results The results of patients’ serum assessment revealed that CMV IgM was positive in one patient (3.3%), CMV IgG in 29 patients (96.7%) and EBV IgG in 27 patients (90%). Anti-GM1 was found in 3 patients (10%) and anti-GM3 was found only in one patient (3.3%). However, no statistical significant association was found between the AGA and strain of the disease and ED findings. Conclusion Despite the coexistence of AGA and serum antibodies against CMV and EBV in some GBS patients, there was not clear association in this regard. However, the AGA was positive in patients who suffered from severe phase of the disease.

Background. Intracranial artery dissections are rare and many controversies exist about treatment options. The aim of this study was to evaluate the efficacy and safety of the endovascular approach in patients with an intracranial dissection presenting with different symptoms.Methods. We prospectively evaluated the clinical features and treatment outcomes of 30 patients who had angiographically confirmed nontraumatic intracranial dissections over 4 years. Patients were followed up for 17 months, and their final outcomes were assessed by the modified Rankin Score (mRS) and angiography.Results. Sixteen (53.3%) patients had a dissection of the anterior circulation, whereas 14 (46.7%) had a posterior circulation dissection. Overall, 83.3% of the patients suffered a subarachnoid hemorrhage (SAH). Grade IV Hunt and Hess score was seen in 32% of the SAH presenting cases. Parent artery occlusion (PAO) with coil embolization was used in 70% of the cases. The prevalence of overall procedural complications was 23.3%, and all were completely resolved at the end of follow-up. No evidence of in-stent occlusion/stenosis or rebleeding was observed in our cases during follow-up. Angiography results improved more frequently in the PAO with coil embolization group (100%) than in the stent-only-treated group (88.9%) (P=0.310) and the unruptured dissection group (5/5, 100%) in comparison with the group that presented with SAH (95.8%) (P=0.833).Conclusion. Favorable outcomes were achieved following an endovascular approach for symptomatic ruptured or unruptured dissecting aneurysms. However, the long-term efficacy and durability of these procedures remain to be determined in a larger series.

Objectives: Intravenous thrombolytic therapy has established acceptable results in treating ischemic stroke. However, there is little information on treatment outcome especially in different subtypes. The aim of current study was to evaluate early and intermediate prognosis in intravenous thrombolytic therapy for acute ischemic stroke subtypes. Methodology: Forty eligible patients (57.5% male with mean age of 63.18±13.49 years) with definite ischemic stroke who were admitted to emergency department of Imam Reza University Hospital, in the first 180 minutes after occurrence received recombinant tissue plasminogen activator. All investigation findings were recorded and stroke subtypes were determined according to the Causative Classification of Stroke System. Stroke severity forms including modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores were recorded for all patients in first, seven and 90 days after stroke and disease outcome was evaluated. Results: The etiology of stroke was large artery atherosclerosis in 20%, cardio-aortic embolism in 45%, small artery occlusion in 17.5% and undetermined causes in 17.5%. NIHSS and mRS scores were significantly improved during time (P < 0.001 in both cases). Three months mortality rate was 25%. Among the etiologies, patients with small artery occlusion and then cardio-aortic embolism had lower NIHSS score at arrival (P = 0.04). Caplan-meier analysis showed that age, sex and symptom to needle time could predict disease outcome. Conclusion: Intravenous thrombolytic therapy is accompanied by good early and intermediate outcome in most patients with ischemic stroke. Small artery occlusion subtype had less disease severity and higher improvement.

Objective: C-reactive protein, a well known marker of inflammation is being investigated as a probable marker of predicting acute cardiovascular events and its severity. The aim of the present study was to assess the possible role of highly-sensitivity C-reactive protein (hs-CRP) in predicting short-term functional outcome of ischemic stroke. Methodology: A prospective study was conducted on subjects admitted with first attack of confirmed ischemic stroke. It included 50 male and 52 female. Serum hs-CRP was measured in the 2 nd (CRP-D2) and 5 th days (CRP-D5) post-stroke. Modified Rankin scale (MRS) was measured in all subjects in the 2 nd (MRS-D2), 5 th days (MRS-D5) and also 3 month (MRS-M3) after stroke to assess the short-term functional outcome and mortality of subjects. Results: The mean age of the patients was 71.75±11.44 years. The mortality rate was 47.1% in the third months after stroke. There was no significant correlation between CRP-D2 and MRS-M3 and also between CRP-D5 and MRS-M3 (P>0.05). However there was a significant association between high CRP-D2 (CRP>3) and MRS-M3 and also between high CRP-D5 and MRS-M3 (P

Cerebral venous thrombosis (CVT) is a potentially serious disease, with nonspecific clinical symptoms and an unpredictable outcome. Despite adequate anticoagulation, a patient's clinical condition can rapidly deteriorate. The aim of this study was to evaluate the efficacy of local thrombolysis in these patients. Consecutive patients with progressive cerebral venous thrombosis between October 2008 and January 2011 were enrolled prospectively. Progressive CVT was defined as the persistence of neurologic findings (headache, blurred vision, and visual field defects) despite at least four days (or 48 hours in patients with involvement of more than one sinus) on full anticoagulation therapy with heparin and development of focal neurologic deficits or cortical hemorrhage. We excluded patients with large hematomas and predisposing malignancies like leukemia. All patients underwent local thrombolysis with 30 mg recombinant tissue plasminogen activator (rtPA). Overall, 26 patients were enrolled with a mean age of 35.5 years (range 18 to 56 years). Six patients (23%) were male and twenty patients (77%) were female. The most common presenting feature was headache and the most common neurologic finding was papilledema, which was present in all patients. Eighty-five percent of women had a history of oral contraceptive pill consumption. Successful recanalization was achieved in all patients except one (96.2%). Neurological examinations and follow-up assessments were based on a modified Rankin scale (mRS). Favorable outcome and recovery was defined as a mRS score of 0–1. Follow-up assessments at the third week showed that 25 out of 26 recovered, with 18 having a mRS score of 0 and 7 with a mRS score of 1. There were no procedure-related neurological complications. Our results show that local thrombolysis is a safe and effective treatment modality for patients suffering from progressive CVT.