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Background New-onset seizure (NOS) is defined as the first seizure within a 24-h period ever experienced by the patient. A first-ever seizure can be the first manifestation of epilepsy. Or it may be a symptom of a brain tumor, a systemic disorder, an infection, or a syndrome that deserves special attention and treatment. This study aims to identify the etiology of NOS among different age and sex groups of adult Egyptian patients. A hundred and twenty adult Egyptian patients (> 18 years) presented with acute NOS were enrolled in a hospital-based cross-sectional observational study from the emergency room and neurology outpatient clinics of our hospitals within a time period of 6 months from March till September 2018. All patients were subjected to neurological examination, laboratory, neuroimaging, and electroencephalogram investigations. Results Among 120 adult patients presented with NOS, males were prevalent (63%). Older adults (age group > 55 years) were the most prevalent cohort (60%). Cerebrovascular diseases (CVDs) were the most common identified etiology of NOS (44.17%), followed by idiopathic epilepsy syndrome (18.33%), symptomatic mainly “metabolic” (11%), brain tumors (9.17%), post-traumatic epilepsy (6.67 %), encephalitis (5.83%), and cryptogenic (5%). Idiopathic epilepsy syndrome was the most common etiology (55.56%) of new-onset seizures among the young adult age group ( 55 years). Also, CVDs were the most common etiology among males (43.4%) as well as females (45.4%). However, male predominance was the highest among post-traumatic seizures (87.5%). And female predominance was the highest among brain tumors identified etiology of NOS (54.5%). Conclusion NOS among adults are prevalent in elder males. CVDs are the most commonly identified etiology of adult NOS across males and females. Idiopathic epilepsy syndromes are the predominant etiology among younger adults.

Background New onset seizure (NOS) is defined as the first seizure within a 24-h period ever experienced by the patient. Cluster seizures (CS) or status epilepticus (SE) can be the first manifestation of epilepsy or it may be a symptom of a brain tumor, a systemic disorder, an infection, or a syndrome. This study aims to determine the etiology of CS and SE in NOS among adult Egyptians. One hundred twenty adult Egyptian patients presented with NOS were enrolled in a hospital-based cross-sectional observational study within a time period of 6 months from March till September 2018. All patients were subjected to neurological examination including mini mental status examination, laboratory, neuroimaging, and electroencephalogram. Results Among 120 adult patients presented with NOS, males were prevalent (63%). Older adults (> 55 years) were prevalent (60%). Of the patients, 25% presented by CS, while 11% presented by SE. Post-stroke epilepsy (41%) was the predominant etiology of NOS. Cerebrovascular diseases (CVDs) were the prevalent etiology of SE in NOS (35%). NOS presented by CS were more prevalent among patients with brain tumors (29%) in comparison to CVDs (25%). Conclusion CS represented 25% of NOS in adult Egyptian patients. SE is prevalent among 11% of NOS. Despite CVDs being the most prevalent etiology of NOS in adult population (41%) including those presented with SE (35%), brain tumors are the most prevalent etiology of new onset CS (29%).

Background Epilepsy is a serious common neurological disorder that can affect any age. Cognitive functions are highly prevalent in patients with epilepsy and is more likely to occur in patients with idiopathic generalized epilepsy (IGE). Associations were found between cognitive functions and brain volume loss in patients with epilepsy. Objective This work was carried out to assess the volumetric changes in brain of epileptic patients to use it as a biomarker for cognitive dysfunction in adult and adolescent patients with epilepsy. Patients and Methods A case control study was conducted to include 61 patients, 20 of which diagnosed with idiopathic generalized epilepsy (IGE), 21 with temporal lobe epilepsy (TLE) and 20 with frontal lobe epilepsy (FLE) who were selected from the epilepsy outpatient clinic in Ain Shams university hospitals along with 23 age and sex matched healthy controls. Both cases and control groups were subjected to Magnetic resonance imaging MRI brain volumetry and detailed cognitive testing. An informed consent was taken from each adult patient, guardian of adolescent patient and healthy control. Results Statistically significant difference in comprehension subcategory of the Wechsler adult intelligence scale (WAIS) between patients with IGE and healthy controls denoting poorer social judgment in the IGE group. The IGE group also showed poorer performance in digit symbol subcategory of the same test denoting worse psychomotor speed and sustained attention. Also, significant difference in similarities subcategory was found between TLE group and control group denoting poorer abstract thinking among the TLE group. The IGE and TLE groups also showed lower attention and concentration than control group in the mental control subcategory of the Wechsler memory scale (WMS) yet failed to show superiority over each other. No statistically significant difference was found on comparing the whole brain volume between cases and control groups. A statistically significant direct relationship was found between the arithmetic subcategory of WAIS and the whole brain volume of the patients among the patients of the FLE group. Conclusion Patients with IGE had worse psychomotor speed, sustained attention and concentration than healthy controls in addition to poorer social judgment. Also, patients with TLE showed lower attention and concentration together with poorer abstract thinking despite normal IQ. The study also concluded that increased whole brain volume in patients with frontal lobe epilepsy is associated with better mathematical problem solving.

Objectives We aimed to evaluate the clinical and etiological profile of new onset seizures in adults with the help of laboratory and neuroimaging studies in a tertiary care hospital in Cairo. Methods An observational hospital based cross sectional analytical study of 120 cases with new onset seizures were included in the study, who had their first seizure above the age of 18, and admitted to Neurology OPCs and ER of Ain Shams University and Nasr city Health Insurance Hospitals between March 2018 to September 2018. We determined the type of seizure and etiological factors. Results In the 120 patients, whose specific incidence of acute new onset seizures was found to be highest in males in the age group > 55 years 48 (66.67 %), we found the most common seizure type was generalized seizure 56 (46.67%) and the most common etiologic factor was cerebrovascular diseases 58 (48.33 %). Patients presented with cluster seizures was 31 (25.83 %) and status epileptics was 14 (11.67 %). The most common metabolic insult was hypocalcemia 12 (10%) and hyponatremia 8 (6.76%). Conclusion Cerebrovascular disease was the most common etiology after 55 years of age whereas Idiopathic epilepsy syndrome and Metabolic insults were common in younger individuals (18-35) years of age. Patients presented with cluster seizures were mostly found to have SOL.

Background Despite aggressive medical therapy, the risk of recurrent stroke in patients with symptomatic intracranial arterial (ICA) disease is as high as 15% per year. In patients with severe stenosis (>70%) and in certain high-risk groups, the risk of recurrent stroke has been reported to be as high as 25% per year. Objective Our study aimed to follow-up the patients after ICA stenting by using transcranial duplex (TCD). Patients and methods This is a retrospective single-center study carried out on data of patients recruited to Neurovascular Unit of El Mataria Teaching Hospital during the period from June 2015 to June 2016. A total of 25 patients were enrolled. TCD before and after stenting data were collected from the patients' files. Results Our study showed significant decreased in mean flow velocity and percent of stenosis after intracranial stenting. Conclusion Our study concluded that TCD is a good method for follow-up of patients after ICA stenting.

Purpose To assess the role of MRI DWI in detection and characterization of ICH. Patients and methods 61 patients with intracranial hemorrhage who underwent MRI (including DWI, ADC, and GRE) and CT were retrospectively included in this study. MRI DWIs were analyzed for age, type, (primary parenchymal hemorrhage or hemorrhagic lesion) and location of the hemorrhage. The results were compared with conventional MRI sequences, GRE, and CT to assess the diagnostic accuracy of DWI in assessment of patients with intracranial hematoma. Results We had 61 patients with intracranial hemorrhage, six cases were missed by DWI. MRI DWI was accurate for the detection of hyperacute, medium, large sized acute, early and late sub acute, subdural, hemorrhagic components of arterial and venous infarction, intraventricular hemorrhage. DWI showed low sensitivity in detection of subarachnoid and small intraparenchymal hemorrhage The ADC measurements in hyperacute, acute, early and late subacute hematoma were statistically equivalent and were significantly less than the late subacute hematoma as well as the contralateral white matter. Conclusion MRI DWI was accurate in detection, characterization and staging hyperacute, acute, subacute hemorrhage as well as hemorrhagic components of arterial and venous infarctions and of low diagnostic accuracy in subarachnoid and small parenchymal hemorrhage.