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Background: Hypersensitivity pneumonitis (HP) refers to the inflammatory lung condition that results from inhalation of various (mostly organic) antigens leading to development of lymphocytic alveolitis and granulomatous pneumonitis. Pathogenesis of the disease is not fully understood and identification and removal of the causative agents remains the cornerstone of treatment and a major determinant of prognosis. Bronchoscopy and BAL can be used to characterize alveolitis and inflammatory cells infiltrate assuming to have a main role inthe pathogenesis of the disease process. Aim : to improve the characterization of alveolitis in HP on a number of patients with well-defined stages of disease activity and to assess the frequency of cellularity, CD4 and CD8 alveolitis. Subjects and methods: 88 HP cases diagnosed by thorough history, clinical examination, HRCT (with scoring system for each radiological pattern), spi rometry, and FOB with BAL for cellularity and flowcytometry (FCM) to determine CD4/CD8 ratio.Results: The mean total cell count (TCC)/cmm was (397±241) in subacute cases and (247±291) in chronic cases with statistically significant difference P-value 0.002. Mean lymphocytes percent was (45±19%) in subacute cases and 39±20% in chronic cases with no statistically significant value.

Objectives: To study relationship between carotid artery plaques characteristics and haemodynamic changes after carotid stenting. Patients and Methods: This observational prospective (pilot) study included 20 patients—who underwent CAS. The study was carried out in Ain shams university hospitals—Railway hospital (ERMED) and Suez insurance hospital from December 2018 to February 2020. Inclusion criteria, Symptomatic (defined as amaurosis fugax, TIA, Minor stroke or Major stroke) stenosis > 70%. Asymptomatic stenosis > 80% (accidentally discovered during pre-operative assessment for CABG and during full assessment for irrelevant stroke). Results: Regarding to plaque character for degree of stenosis, calcification and ulceration revealed significantly higher degree of stenosis in hemodynamic events group (P = 0.024). On the other hand, that there was no statistically significant difference between the two groups as regard calcification, ulceration and lesion location. Conclusion: The study revealed that HI is a common occurrence following CAS procedures and significantly higher degree of stenosis in hemodynamic events group. Plaque shape, ulcerations hardly affect haeodynamic instability after carotid stenting.

Background Ankylosing spondylitis (AS) is a chronic inflammatory disorder primarily involving the sacroiliac joints and spine. It is associated with both articular and extra-articular clinical manifestations. Pulmonary involvement is a well-recognized comorbidity of AS, even among patients with early disease. The availability of high-resolution computed tomography (HRCT) has enabled better visualization of the entire lung parenchyma and earlier identification of lung pathologies, ranging from mild to more severe involvement, which were previously missed on X-rays. The aim of the study is to establish the role of HRCT in the detection of pleuro-parenchymal manifestations of AS and to look for correlations between these findings and AS activity. Results Lung CT scans were done for all our patients and 27 patients (90%) had positive HRCT thoracic findings, while the remaining 3 patients (10%) had a normal HRCT thoracic study. Lower lobe fibrotic changes were the most common finding seen in 20 patients (66.7%) followed by bronchial wall thickening in 13 patients (43.3%) and upper and lower fibrotic changes seen in 9 patients (30%). HRCT thoracic findings were more prominent in late AS (disease duration ≥ 10 years) (13 of 13 patients); while 14 of 17 patients with early AS (disease duration p value = 0.5). Conclusion HRCT offers an accurate and safe method of assessment of lung disease in patients with AS and without respiratory symptoms. Although there was no correlation between pulmonary findings and AS activity assessed by BASDAI, a positive correlation, albeit insignificant, between pulmonary involvement and disease duration had been found.

Background Several Arab countries as well as many parts of the world are currently involved in armed conflicts. Characterization and documentation of combat-related injury patterns and their impact on healthcare are a difficult challenge. However, it is crucial in planning and developing of strategies capable of addressing the demands of ill-equipped medical facilities. The aim of this study was to record the different patterns of combat-related injuries sustained by civilians transferred to Egyptian tertiary hospitals for further investigation and definite treatment after primary stabilization by an emergency trauma team in their countries. Results Metallic foreign bodies were detected in different body locations in 49.1% of patients, while bullets were identified in 12.3%. Injuries involving the musculoskeletal system of the extremities were the most frequent (77.2%), followed in descending order by maxillofacial injuries (41%), thoracic injuries (32.1%), cranial injuries (31%), abdominal injuries (21.1%), spinal injuries (8.8%), and vascular injuries (4.7%). Among the extremities injuries, bone fractures were the most common (68.5%). Conclusion Radiological assessment aids in the evaluation of patients coming from conflict zones pre- and postoperatively, to recognize the precise sites and types of their injuries, the number and location of metallic shrapnel or bullets, and detection of possible associated complications, which aid in accurate demonstration of the extent and patterns of combat-related injuries and guide the management plan.

The aim of the study Is to compare the role of minimum intensity projection (MinIP) images with that of volumetric high resolution computed tomography (HRCT) images in the diagnosis of interstitial lung diseases (ILD). Patients and methods 180 patients (149 females and 31 males) were included in this prospective study that took place over a duration of two and half years. All patients underwent HRCT and MinIP images. The positive findings were compared recording which technique was better and if MinIP adds a value in reaching an accurate diagnosis. Results MinIP images showed better visualization of traction bronchiectasis, ground glass opacities and mosaic attenuation pattern, as well as, the cystic lung changes seen in LAM. While MinIP did not add a significant value in thick-walled cystic changes e.g.: honeycombing. Conclusion MinIP is one of the multiplanar techniques of HRCT that proved throughout our study to be an informative complementary tool increasing the observer confidence and agreement regarding some findings as compared with HRCT alone.

Aim of work To highlight the characteristic high resolution computed tomography (HRCT) findings in 15 patients diagnosed with lymphangioleiomyomatosis (LAM), narrowing the wide range of ILD and allowing accurate diagnosis preventing unnecessary interventional procedures. Patients and methods 15 female patients ranged in age from 17 to 55 years (mean age = 40.33 years). ILD was suspected based on clinical examination and chest radiographs. They were referred to do HRCT chest for further assessment. A 64 MSCT scanner was used. Results All patients showed bilateral multiple cysts showing upper lobar predominance in 13.3% of cases and lower lobar one in 6.7%. The size of the cysts ranged from few mms to 3 cm with variable wall thickness. Pneumothorax was reported in three patients and pulmonary hypertension in 15 cases. Conclusion HRCT is a valued diagnostic tool for diagnosis of LAM showing characteristic features for the disease.

The case study is aimed at providing a more thorough analysis of a case of Epilepsy presented with an unusual aura of cough. The study hopes to generate an interest for further studies into the topic and focuses on abnormal unusual presentations of auras. Cough as an aura is not a common presentation. Any stereotyped repeated clinical phenomenon should consider being epileptic in its origin.

Objectives: To study the ambulatory measured blood pressure (ABPM) profile in normotensive patients with mild cognitive impairment (MCI). Patients and Methods: The study was designed as a case control study including 50male patients with mild cognitive impairment in the age group of 30 - 50 years old. The control group included 30 volunteers with no cognitive impairment and in the same age group (30 - 50 years old) and same gender. Mini-mental estate examination, office and ABP monitoring (ABPM) and brain MRI scans were done for cases and controls. Results: Thirty patients (60%) with MCI revealed a non-dipper blood pressure pattern. Sleeping systolic blood pressure and sleeping systolic load were significantly higher in patients with MCI than in normal volunteers (p = 0.01). MRI brain showed more white matter lesions (WMLs) in patients with MCI than in normal volunteers; however, this didn’t reach significance level (p = 0.056). Conclusion: MCI in normotensive young adult patients could reflect an abnormal circadian blood pressure rhythm. Ambulatory blood pressure monitoring could be an essential investigation in young adult MCI patients.

The case study is aimed at providing a more thorough analysis of a case of lateral medullary syn-drome presented only with persistent hiccup after eating lunch the study hopes to generate an interest for further studies into the topic and focuses on abnormal unusual presentations of lateral medullary syndrome. Ethical committee has approved this case after taking consent from the patient and explaining to him the importance of the case in clinical practice.

Objectives To study the prevalence of intracranial venous stenosis in Pseudotumor cerebri patients. Patients and methods Thirty patients were diagnosed having PTC according to Dandy criteria. All underwent general and neurological assessment. Radiological assessment included CT scan brain ±MRI brain without contrast, MRV. All underwent digital subtraction angiography (DSA) (venous phase) to confirm the validity of filling gaps seen at the level of MRV. Results MRV brain showed that 24 patients (80%) showed filling gaps. Digital subtraction cerebral angiography (venous phase) showed 9 patients (30%) had stenosis in their dural sinuses. MRV showed to be a good screening tool since it had 100% sensitivity and negative predictive value. However, since it has a moderate specificity (62%) with a positive predictive value (PPV) of only 35%, then lesions detected should be confirmed with digital subtraction cerebral angiography (venous phase) particularly those involving the transverse and sigmoid sinus. Conclusion Studying the intracranial venous system in patients with PTC is an important step in understanding the pathophysiology of the disease. Detection of venous sinus stenosis opens the way to a novel therapeutic option for refractory patients like venous sinus stenting.

Introduction Bronchiolitis obliterans (BO), also known as constrictive bronchiolitis is a fibrosing form of obstructive lung disease that follows a severe insult to the lower respiratory tract. It occurs in a heterogenous group of lesions varying in their etiology, clinical settings and pathologic features but are centered in small conducting airways. Patients and methods The study included 20 patients 14 females and 6 males, mean age range 7–64 years (average of 39.25 years) with a variety of chest symptoms on whom HRCT was performed. Results Mosaic attenuation pattern was seen in all patients. Other HRCT findings included bronchiectasis, bronchial wall thickening and centrilobular nodules. Conclusion High-resolution CT is currently superior as an imaging modality in diagnosis of bronchiolitis obliterans, however, diagnosis of BO requires exclusion of other causes of chronic airway obstruction.

Objective: To study the effect of cerebral ischemic vascular insult on the localization of language areas as regard to automatic speech, initiation, and mutism. Materials and Methods: Seventy ischemic stroke patients were selected within the first 48 h of the onset of stroke with left hemispheric stroke with aphasia. Inclusion criteria: any age above seven years, both sexes, first ever clinical stroke, admitted within the first 2 days of stroke insult. Patients underwent careful history taking, neurological examination, routine laboratory investigations, echo cardiography, and carotid duplex and language assessments. Results: Automatic speech disorders were mainly seen along left insular, left supramarginal and left frontal inferior orbital lesions. Initiation difficulty is seen mainly along as left insular, left temporal superior and left periventricular lesions. Mutism is seen along left external capsule, left internal capsule, left pallidum, left frontal inferior orbital and left inferior trigone lesions. Conclusions: Deep periventricular white matter and insular area in the dominant hemisphere play an important role in many language tasks. Thus aphasia is not a mere cortical function.

Objectives: To study the prevalence of vitamin D deficiency among newly diagnosed multiple sclerosis patients. Patients and Methods: It is a case control cross matching age related study done on totally 40 subjects (20 patients are newly diagnosed as MS; patients don’t start any medication for MS (naive patients) and 20 subjects are controls with the same age and sex). Base line vitamin D level was measured (i.e. vitamin D, 25-OH (total)) and MRI brain with contrast was done for all patients. Results: Low total vitamin D level was seen among 65% of patients with MS (13/20); however, this was only 20% of normal controls (4/20). Conclusion: Hypovitaminosis D is common in MS patients.

Objectives: The aim of the study is to assess volumetric Corticospinal Tract infiltration by Astro-cytoma using Diffusion Tensor Tractography. Material and Methods: Preoperative, anatomic (T1- and T2-weighted) and diffusion tensor MRI were performed in 9 patients with supratentorial gliomas (WHO grade II and III). The tumors were manually segmented from the T1- and T2-weighted MRI, and their volume calculated. A three-dimensional tractography was performed in each case. A second segmentation and volume measurement was performed on the tumor regions intersecting adjacent white matter fiber tracts. Results: We identified that white matter tracts were infiltrated by 6 Astrocytoma tumors. The median tumor volume (±standard deviation) in our patient population was 33 ± 26.82 ml. The median tumor volume (±standard deviation) infiltrating white matter fiber tracts was 4.15 ± 9.23 ml. The median fraction of tumor volume infiltrating white matter fiber tracts was 26.3% ± 10.1%. Conclusions: Diffusion tensor MR Tractography is a reliable preoperative assessment tool since it detects extensive white matter infiltration by Astrocytoma irrespective of brain tumors volume. Recommendations: Prospective large population studies are required to clarify how infiltration relates to tumor location.

Objectives: To assess the impact of atrial fibrillation on stroke severity and short-term (1 month) mortality. Materials and Methods: Totally 200 patients admitted to Ain Shams University Specialized Hospital were recruited and diagnosed clinically to have acute ischemic stroke within 3 days. Patients with hemorrhagic infarctions were excluded. History taking about previous heart disease was taken, full general and neurological examinations were done. Full metabolic profile, full cardiac investigations, carotid duplex, MRI brain stroke protocol with initial clinical evaluation and after 1 month re-evaluation using (NIHSS ) scale. Results: All patients underwent transthoracic echocardiography which revealed absence of “A” wave corresponding to atrial fibrillation in 33 patients (16.5%). Those Patients with atrial fibrillation had a median NIHSS score of 11.00 with IQR of 6.00 - 18.50 at admission and 6.00 with IQR of 2.00 - 14.50 after one month. Patients with atrial fibrillation showed significantly higher NIHSS at admission than patients in sinus rhythm, P

Objective: To study the prevalence of silent cerebral infarction in Type II diabetes mellitus. Patients and Methods: The study was a prospective on 80 patients recruited from neurology, endocrine outpatient clinics. Patients were type II diabetics as described by the American Diabetes Association, 2011 criteria. All patients underwent full metabolic profiles to diagnose diabetes mellitus and MRI brain scans to detect cerebral infarction. Results: Silent cerebral infarctions were detected in 60% of patients (48/80 patients) predominately along periventricular white matter area and subcortical areas (Basal ganglia, Thalamus). Conclusion: Asymptomatic Type II diabetes mellitus patients could have vascular cerebral changes without neurological symptoms. MRI brain scans could be recommended as routine diagnosis (if possible) for early cerebral infarct detection in type II diabetic patients.

Objectives: To assess the impact of heart failure diseases on stroke severity and short term (1 month mortality). Materials and Methods: Totally, 200 patients admitted to Ain Shams university specialized hospital, were diagnosed clinically to have acute ischemic stroke within 3 days. History taking about previous heart disease was taken, and full general and neurological examinations were done. Full metabolic profile, cardiac examination and investigations were done. Carotid duplex, MRI stroke protocol and lastly clinical reevaluation using NIH Stroke Scale (NIHSS) after 1 month from stroke onset were done. Results: Patients with systolic dysfunction (EF ≤ 40%) had lacunar infarction in 18.75% of cases, partial anterior circulation infarction in 62.5% of cases, posterior circulation infarction in 6.25% of cases and total anterior circulation infarction in 12.5% of cases. Leucoaraiosis was present in 87% of cases and significant intracranial vessel stenosis was showed in 87.5% who had done MRI. Their median NIHSS score at admission was 10.5 with IQR of 5 - 21 and at follow-up it was 5 with IQR of 2.5 - 10.5. At follow-up 22.7% (5 patients) were dead. Conclusion: Systolic dysfunction (EF

Focal dystonia in young aged patients is considered to be the uncommon clinical presentation, unless a secondary cause is to be considered. Infarcts of the corpus callosum are rare and have not been well documented previously. As for a variety of signs and symptoms due to corpus callosum lesion, focal dystonia can be easily overlooked. The case is approved by ethical committee and explained to the patient with patient approval.

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.

Aim of the study Our aim was to assess the value of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurement for the characterization of small solid renal lesions. Patients and methods We prospectively evaluated 30 patients (18 men and 12 women). Their age ranging from 18 to 65 years (mean age of 49.6±12.9). They were examined by conventional MRI and DWI with b factors of 0, 600 and 1000 s/mm2. Mean ADC values of the normal renal parenchyma, benign, malignant small solid renal lesions were calculated Results The mean ADC value of normal renal parenchyma was significantly higher that of benign and malignant lesions. No statistical significance noted between the mean ADC values of benign and malignant renal lesions (P value=0.5). Among malignant lesions, the mean ADC value was highest in the RCC lesions (1.4±0.22) and lowest in the lymphoma lesions (0.679±0.08) showing statistical significance (P value=0.0001). The mean ADC values of RCC and TCC showed no statistical significance, whereas there was statistical significance was noted between RCC and pyelonephritis (P value=0.0004) , RCC and Angiomyolipomas (P value=0.0001), lesions. Conclusion DWI is a fast sequence that can be easily added to a routine MR imaging protocol. DWI is notably valuable in lesion detection and evaluation when gadolinium contrast medium cannot be administered. However, due to the overlap of ADC values between benign and malignant lesions, it cannot be used as a single diagnostic tool and should be concurrently interpreted in conjunction with conventional MRI for optimal characterization of renal lesions.