Cerebrovascular accidents or stroke is an important healthcare concern. Ischemic stroke is an acute neurologic deficit that results from focal cerebral ischemia leading to permanent tissue damage (infarction). The cause is commonly associated with atherothrombotic occlusion of large arteries, cerebral embolism (embolic infarction), non-thrombotic occlusion of small, deep cerebral arteries (lacunar infarction), and proximal arterial stenosis with hypotension that decreases cerebral blood flow in arterial watershed zones (hemodynamic stroke). Stroke is being observed as a rapidly growing problem and an important cause of illness and death in Saudi Arabia. The aims of this cross-sectional study were to establish the prevalence and prognosis of cerebrovascular accidents and its subtypes in Hail Region, Saudi Arabia. Data were collected on all patients who experienced CVAs between September 2017–January 2018, used the diagnosis coding program in King Khalid Hospital in Hail, Saudi Arabia. Out of 190 patients 63.7% were male and 36.3% were female. The overall incidence of ischemic stroke after acute myocardial infarction was 85.26%. Hypertension, diabetes mellitus were shows as more risk factors for ischemic stroke type compared with hemorrhagic stroke, and embolic stroke. The overall status of stroke patients were shown 92.1% live and 7.9% were dead. Incidence of complicating hospitalizations with cerebrovascular accident continues to grow and is associated with increased mortality and adverse discharge. This highlights the need for early diagnosis, better risk stratification, and preparedness for need for complex long-term care in this vulnerable population.
Occurrence of spasticity of the hand after a stroke event is recognized as a major cause of functional limitations which reduces the quality of life in patients.Dynamic splints are among the alternative rehabilitation treatments for reducing spasticity of the hand.However, evidence supporting their effectiveness in restoring hand functionality, their long-term and short-term effects is limited.Moreover, standardized methods of designing dynamic splints are currently lacking.This review describes the methods used to design dynamic splints, their functionality and the current issues surrounding their application to post-stroke patients with spasticity of upper limbs.In so doing, we provide the foundational knowledge which may be tested in future clinical trials and in splint edifications to enhance the efficiency of splints to improve the quality of life in stroke patients.When properly designed to fit a patient, a dynamic splint can promote the functional recovery of a spastic hand.Further research is required to deepen our understanding on the clinical utility of dynamic splints in post-stroke patients to optimize their recovery outcomes.
Introduction: Central retinal vein occlusion is one of the major causes of severe vision impairment and blindness in adults. Case presentation: We present a case of unilateral ischemic central retinal vein occlusion in a 33-year-old man without any acquired ischemia risk factors and glaucoma. Laboratory tests including homocysteine and lipoprotein (a) were increased. Conclusion: Our case illustrates an interesting presentation of unilateral ischemic central retinal vein occlusion, without main risk factors. Thrombophilia screening may be considered in selected cases.
Background: Cancer-related cognitive dysfunction (CRCD) refers to cognitive difficulties experienced by patients following cancer or its treatment. This study reports on a newly developed psychoeducational intervention intended to help breast cancer survivors manage CRCD symptoms. Objective: We conducted a pilot study to examine preliminary efficacy of this intervention and consider implementation challenges. Methods: Breast cancer survivors reporting cognitive difficulties were assessed before, immediately after, and one-month following the intervention. Primary outcome measures were participant-reported cognitive function and quality of life. Secondary outcome measures included knowledge of CRCD, memory systems and strategies, and healthy lifestyle activities. Follow-up interviews were conducted. Results: Five of the seven women who enrolled completed the intervention and three women returned for the one-month post-intervention testing. Immediately post-intervention, participants showed increased confidence in memory abilities, improved functional abilities, and increased CRCD knowledge. Qualitative analyses revealed four themes underscoring participant’s experience with this intervention: intentional behavioral changes, normalization and validation, changed relationship to self and others, and perceived lack of support from the medical community. Conclusion: This pilot study suggests this intervention benefits survivors in multiple ways. A randomized controlled design with a larger sample size is needed to replicate and understand the reliability of changes over time.
Tetanus is a disease caused by a neurotoxin produced by the Gram-positive bacillus (C. tetani), found in the soil and human and animal feces. C. tetani is a mobile, spore-forming obligate anaerobe. Under anaerobic conditions as in necrotic and infected tissue, the tetanus bacillus secretes two toxins: tetanospasmin and tetanolysin. Tetanospasmin leads to the clinical syndrome of tetanus comprised of a triad of rigidity, muscle spasms and, if severe, autonomic dysfunction. We describe a case of a 31-year-old patient who presented with painful stiffness especially of the trunk, intermittent diffuse muscle spasms, difficulty swallowing and opening his mouth. After clinical workup a diagnosis of tetanus was made. The patient was treated with active vaccination by tetanus toxoid (TDaP), and passive vaccination (Tetanus Immune Globulin -TIG), antibiotics, pain relief agents and muscle relaxants and his symptoms resolved gradually. He was discharged from the hospital in a good condition 14 day after his admission.
This review summarizes the existing available data on the use of transcranial Direct Current Stimulation (tDCS) as a treatment for migraine symptoms both with and without aura. 27 studies were examined and 5 were included in the review (which satisfied the inclusion criteria, i.e., duration of tDCS, intensity of stimulation, type of stimulation and stimulated cerebral area). The visual cortex was stimulated in 4 of the 5 analyzed studies. All these studies reported a 1 mA current flowing (anodic stimulation), with a duration of 15-to-20 minutes but not the same montage protocol. The sessions were then repeated 2-4 times a week, for a variable period of 4-8 weeks. The other study adopted a cathodic stimulation on the primary motor cortex with an intensity of 2 mA. Both anodic and cathodic stimulations on the visual cortex provided important results: repeated series of preventive anodic stimulations resulted in a decrease in the regularity of migraine attacks, duration and pain perceived by the patient. The study about the stimulation of the motor cortex pointed out a decrease in the regularity and duration of attacks. Overall, the tDCS can be considered as a useful instrument, capable of bringing benefits to patient suffering from migraine; however, the duration of the obtained benefits was limited in all the cases reported and the size of sample was too small. Further studies are therefore needed to better comprehend the mechanisms involved in the pathogenesis of migraine symptoms.
Guillain Barre syndrome (GBS) is relatively a common motor neuropathy in western world but it is rarely found in developing countries. It is an acute ascending symmetrical paralysis of multi-factorial etiology. We conducted this review to discuss the prevalence, etiology, severity, prognosis and treatment of GBS in Pakistan. Literature search was conducted on searching engines like Pubmed, Google scholar, embase and medline. Articles were searched from year 1995 to 2015. MeSH and Non-MeSH terms like Guillain Barre syndrome (GBS), Campylobacter jejuni, acute flaccid paralysis was used. From the review of evidence, it was found that GBS is more prevalent in Sindh and KPK province however some familial cases of GBS were also reported in addition to sporadic cases. Regarding the treatment, IVIG and plasmaphresis has no significant difference in relation to therapeutic efficacy. It was concluded that GBS is a rare but a morbid disease in Pakistan which is associated with poor prognosis due to poor health care facility.
A 52-year-old hypothyroid presented with episodes of seizures in last ten days with altered behavior. CT scan of brain showed cerebral atrophy and MRI of brain revealed non-specific changes. In EEG, there was slow wave pattern. CSF study showed increased cell count with all lymphocytes and raised protein with normal glucose. Anti- TPO Antibody was positive. All relevant investigations like HIV, HBsAg, Anti- HCV Ab, ANA (Hep2 method), ANA profile, P-ANCA, c-ANCA, VGKC (voltage gated potassium channel) Ab, NMDA Receptor/Anti- Glutamate Antibody) Ab, VDRL were negative. She was given pulse doses of methylprednisolone followed by maintenance prednisolone. Then her GCS improved followed by sudden deterioration. Repeat CSF showed marginal decrement of protein and cell count. Then she was given IV Immunoglobulin and patient improved. At discharge her CSF study normalized. Anti-TPO Ab titre came to normal level and EEG normalized. Hashimoto’s encephalopathy(HE) should be suspected in a case of sub-acute encephalopathy with high levels of anti-thyroid antibodies may be with normal thyroid functions. Here the patient did not have improvement on steroids. The patient needed immunoglobulin to improve.
Innate immune response mediated by Toll-like receptors (TLRs) has been implicated to be the therapeutic targets for Alzheimer’s disease (AD). TLR9 agonist cytosine-guanosine-containing DNA oligodeoxynucleotides (ODNs) have been shown to be effective in reducing AD pathology in three AD animal models. To interrogate the involvement of TLR9 in AD, we measured the difference in methylation level of CpG probes in the promoter regions of TLR9 and demonstrated that hypermethylation of cg11855705 (p=0.003) and hypomethylation of cg08721301 (p=0.03), and cg22484793 (p=0.03) in postmortem brain tissue from the superior temporal gyrus (STG) region in AD subjects comparing to cognitively normal control subjects. These results provided an independent line of evidence in the potential role of TLR9 in AD pathology.
The ventral tegmental area (VTA) is the origin of the mesolimbic dopaminergic system known to play an integral role in mediating reward and development of drug addiction. Although the differences in neuronal plasticity of VTA at various ages remain to be understood, age is known to influence the effects of chronic opioids. In addition, adaptations associated with exposure to opioids within glial populations located in the VTA are poorly understood. The objective of the study was to determine if there are changes in astrocytic immunofluorescent labeling in the VTA following chronic morphine administration in a rat model at different ages: newborn at postnatal day (PD)7 and adult (estimated PD57). We hypothesized that increased immunohistochemical labeling of an astrocytic marker, glial fibrillary acidic protein (GFAP) in the VTA following chronic administration of morphine will not differ with age. Two groups of rats were analyzed: chronic morphine and saline control treatment groups. Either morphine (10 mg/kg) or equal volume of saline was given subcutaneously twice daily for 6½ days. On the 7th day of treatment, animals were anesthetized and perfused at one hour after the final drug injection. Coronal sections of the midbrain were processed for immunofluorescent identification of GFAP that was noted at both ages. We report an increase in both (1) GFAP labeling intensity, as well as (2) the percent area occupied by astrocytes that are immunoreactive for GFAP following chronic morphine when compared to saline treatment in the VTA only for the adults (n=6/group) but not infant rats at PD7 (n=5/group). Our findings suggest that adaptations in the mesolimbic dopaminergic system produced by repeated exposure to opioids may be associated with changes in glial function that differ with age.
According to the World Health Organization violence is one of the main factors that contribute to death, disease and disability. The Mexican National Survey on Violence reported that up to 33% of health care users experience abuse from their current partner. In 2012, the American Academy of Neurology underscored that patients with neurologic disabilities are more vulnerable to abuse or neglect Multiple sclerosis (MS), is a chronic disabling disease with an unpredictable course that affects young adults, frequently disrupting their social, occupational and family areas of functioning. The type of disabilities that persons with MS (PwMS) exhibit make them more susceptible for physical, psychological and sexual abuse from diverse perpetuators: family members and partners to society in general. Comprehensive neurorehabilitation programs need to be implemented.
Autism spectrum disorders (ASDs) are a group of neurodevelopmental disabilities characterized by deficit in social communication and social interaction across contexts, restricted, repetitive patterns of behaviors, interests or activities, atypical sensoriality with symptoms present in early childhood but that could be not fully manifest until social demands exceed limited capacities (DSM 5).
Subdural arteriovenous fistulas (SDAVF) represent a rare disease of the spinal cord with diverse neurological complains resembling polyneuropathies of myelopathies. Due to the absence of specific clinical signs the diagnosis relies upon the MRI findings, which consists of the following classical triad of 1) dilated vessels in the subdural space, 2) central spinal cord edema and 3) contrast enhancement of the affected segments. A fourth yet inconsistent finding is an enlarged conus medullaris. The triad is however often incomplete and in the absence of the engorged perimedullary vessels the diagnosis can remains elusive for an extensive period of time and until an advanced level of clinical disability is reached. Unlike most other immune of infectious causes of medullary dysfunction, SDAVF is a treatable condition, surgical treatment usually stopping the progression of neurological complains. Therefore, an early diagnosis is the most important factor associated with neurological recovery. The aim of this case report is to illustrate how essential a prompt diagnosis is by presenting two patients with very different clinical outcomes based on the time from the initial complains to the correct diagnosis.
Early life stress (ELS) causes multiple epigenetic modifications (e.g. methylation of genes and histones) in a developing child’s genome. Early life stress comes in various forms: Serious physical and mental abuse for example by parents, relatives, or caregivers; a poor social environment involving drug addicts and gang warfare; or loss of all parents and close relatives. This brief review is an attempt to update the information in the above-mentioned opus with a focus on in part on events in the brain and emphasizes that dissociable domains compose executive function
Cerebral ischemia may be due to primary thrombosis in carotid artery.This results in cerebral hypoxia and thus leading to cerebral infarction/ischemic stroke.The effect of CGE (C.glandulosum extract) on antioxidant status in I/R (ischemia-reperfusion) injury in the rat forebrain have been investigated.Further, its effect was assessed on behavioural parameters, infract size and histopathological parameters.Bilateral carotid artery occlusion followed by reperfusion produced significant cerebral infarction and impaired short term memory, motor co-ordination and lateral push response CGE markedly attenuated I/R induced cerebral injury in terms of decreased infarct, size.The result suggests that the use of CGE protect ischemia reperfusion induced cerebral injury with comparable potency.
We live in the era of evidence-based medicine where technology adds or could add a layer of objectivity to quantification, assessment and evaluation of symptoms. This evidence is provided through critical, systematic, scientific inquiry into the disease process and its underlying mechanisms. These discoveries then help clinicians and scientists alike to develop sensitive and reliable measures for diagnosis and treatment, as part of clinical care for patients. The current standard of care in the neurology and neurorehabilitation scenarios such as motor assessments of tremors, balance, postural sway and control remain subjective and depend on the observer’s experience, clinical judgment and occasionally trial and error. While, technology is fast paced and has the potential to augment the clinical measures, it needs to be scientifically validated prior to implementation. On that note, how valid and reliable are the current subjective clinical measures? Nevertheless, scientific method is rigorous, discoveries occur over significant time. Thence, translational implementation to augment patient caredelivery continues to remain a challenge for a multitude of reasons beyond scientific inquiry. Researchers and clinicians continue to look for biomarkers that would identify, diagnose and help determine prognosis and recovery. Furthermore, that creates the need to study the biomarkers and their assistance in understanding the long-term effects of neurological insults, and their progression or recovery. All other things being equal, clinical adoption of technology requires the objective tools to be cost and time effective for the technologically savvy clinician to augment clinical care. So, is there added value in the usage of objective measures to augment the current standard of clinical care?
The primary subject matter of this case concerns a new approach to neurorehabilitation using trans-lingual neuro-stimulation (TLNS) Technology. Secondary issues examined include the recovery and enhancement of cognitive functioning in a subject with chronic stroke. The case has a difficulty level of four, appropriate for senior level courses who have already covered the topics of neurorehabilitation and neuroplasticity. The case is designed to be taught in one class hour and is expected to require zero hours of outside preparation by students, aside from foundational knowledge of neurorehabilitation techniques and neuroplasticity mechanisms.
Objectives: To observe the effectiveness of different targeted temperature management (TTM) methods in patients with acute cerebral infarction (ACI) and explore the most feasible cooling strategies for ACI. Methods: We retrospectively analyzed the effectiveness of different TTM strategies for ACI patients treated in the Neuointensive Care Unit of South Hospital of Southern Medical University from June 1, 2012 to May 31, 2015. Patients were divided into four groups according to the presence or absence of fever and the cooling method: control group (n=63, normal body temperature), group A (ibuprofen alone, n=53), group B (ice bag alone, n=49), and group AB (ibuprofen + ice bag, n=62). We measured rectal temperature at admission and 1 h, 2 h, 4 h, 6 h, 12 h, 48 h and 72 h after admission in the control group. In groups A, B, and AB, we measured rectal temperature immediately after cooling and 1 h, 2 h, 4 h, 6 h, 12 h, 48 h, and 72 h after cooling. Results: Body temperature showed no significant difference immediately after cooling among groups A, B, and AB (P>0.05); however, cooling effectiveness was significantly different at multiple time points after cooling (P<0.05). Body temperature decrease was greater in group A, in which cooling effectiveness was more obvious. During cooling, body temperature in group B was slightly lower than that in group A, but the difference was not statistically significant. After cooling, body temperature decrease was significantly greater in group A than in groups B and AB (P<0.05). Conclusion: For ACI patients, ibuprofen alone is superior to ice-bag cooling or ibuprofen + ice bag cooling.
Over more than fifteen years of my Career in Neurosurgery I focused my efforts on the causation of surgical pathologies (biological bases). Idiopathic intracranial hypertension is embarrassing, that whatever the neurosurgeon does, still some end with big disability, the blindness. My vision is based on two, first, as the histopathology of brain parenchyma say presence of long standing water in extracellular spaces without trauma or toxins, the logic explanation for that is the chronic inflammatory process. The second base, I concentrated on the patient as a whole rather than on CNS only trying to discover the relation between this CNS inflammatory process and presence of any systemic disease which make this CNS impairment as a complication to it. By taking a strict history, systemic review and physical examination I concluded the presence of a chronic or sub-acute general disease which in my career it was chronic Brucellosis however (pre- PCR era in Iraq) serology is negative in most, for that anti Brucella trial treatment was adopted to result in a very high success rate in mild to moderate cases which are several tens in number, three severe cases who end with blindness then regained their full vision over the last ten years. Complete work up done to exclude other entities, fundus camera to register and follow optic disc edema or atrophy.
