Current Journal of Neurology
Volume:9 Issue: 29, 2010

22 patients (35-75 years old) were selected and transferred to CT scan for tumor ablation. on time of ablation after prep and drep under the local anesthesia and mild sedation in proper position small incision made and special needle inserted and guided by proper direction to the core of the tumor then laser probe inserted through the needle and laser energy delivered. Although we have not a good prognosis in metastatic tumors but post operative follow up and brain CT scan is established the effect of laser on resection and evaporation and diminution of mass effect in tumor lesions.

In this article we report a patient presented with cord compression due to granulocytic sarcoma in M4 subtype, without a history of diagnosed acute myelocytic leukemia. Granulocytic sarcoma in M4 subtype especially when the first presentation is cord compression, is too rare. So this rare tumor should be considered in the differential diagnosis of an epidural mass with cord compression, with or even without acute leukemia.

Radiculopathy is one of the common diagnosis referred to any electromyography (EMG) Laboratory. The clinical hallmark of cervical radiculopathy includes pain and paresthesias radiating in distribution of a nerve root. The C5, C6 and C7 roots are the ones most commonly involved in cervical spondylosis. Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Patients with CTS may present with a variety of symptoms and signs. Paresthesias are frequently present in the median nerve distribution. Double crush Syndrome (DCS) is referring to the coexistence of dual compressive lesions along the cours of the nerve. This syndrome (DCS) causes that results of patient s treatment, is less predictable. In this study frequency of CTS is determined in patient referring to clinical symptoms of cervical radiculopathy to evaluate double crush hypothesis on the basis of meaningful statistical relation of them. In this study 242 subjects from patients referred by physicians to electro diagnostic center, with clinical symptoms of cervical radiculopathy is evaluate with EMG, NCV. Frequency of CTS was calculated after data collection. Implicitly, frequency of CTS and cervical radiculopathy was evaluated by chi square statistical test in men and women and based on patients s age Category. Frequency of CTS in patients referring with clinical symptoms of C6, C7 or C8 cervical radiculopathy, was 15. 3% (37 objects). Frequency of CTS in patients with C6 or C7 radiculopathy, was 13. 22% and in the patient with C8 radiculopathy was 2. 07%. It is determined by chi square test, that is not seen an meaningful statistical relation of CTS and cervical radiculopathy. (P=0. 571) The Double Crush syndrome is not supported in patients who have coexisting cervical radiculopathy and CTS.

Stab wound spinal injuries are somewhat rare and management of such patients have been controversial and challenging because of their complications. One of hazardous complication of stab wound spinal injuries is CSF leakage headaches. Methods and Materials: A 17-year-old man came to emergency clinic with server headache which it was resolving rapidly in supine position. On the basis of thoracic MRT findings, CSF leakage was considered. Symptoms and signs of patient of patient completely improved with bedridden and hydration. CSF leakage resulting from stab wounds completely improved with conservative treatment.

Coronary artery disease (CAD) is a major source of morbidity and mortality all over the world. Nowadays, coronary artery bypass grafting (CABG) is the most frequently performed cardiac operation. The most significant and disabling complication of CABG remain cerebral injury and especially stroke. CAD patients with the history of neurologic disease, advanced age, hypertension, diabetes, peripheral vasculature and pulmonary diseases are at the highest risk of stroke. The aim of our study was to determine the prevalence of stroke following CABG and also to evaluate the possible risk factors of post-CABG stroke in a sample of Iranian CAD patients. Methods and materials: In this cross-sectional study, all CAD patients who underwent CABG surgery in Imam Khomeini Hospital during the years 1998-2000 were recruited. In addition to the incidence of stroke, other variables including age, sex, hypertension, diabetes, hypercholesterolemia, previous history of cerebrovasculature attack (CVA), diseases of peripheral vasculature, number of grafted coronary arteries, left ventricular ejection fraction, NYHA classification, length of cardiopulmonary bypass (CPB) and history of carotid endarterectomy were recorded based on patient’s medical document. Data were codified and entered in SPSS 16 software and variables were analyzed with Chi2 and independent T-test. From 1400 patients who were studied, 1028 (73.4%) were male and 372 (26.6%) were female with the mean age of 58.38 (SD=9.63) years. Twenty patients (1.6%) had stroke during their hospitalization. There were no significant relationship between age, sex, hypertension, diabetes, number of grafted coronary arteries, left ventricular ejection fraction, NYHA classification, length of CPB and the incidence of stroke after CABG (P>0.05). While, hypercholesterolemia (P=0.016, OR=6.25), previous history of CVA (P=0.008, OR-5.55), diseases of peripheral vasculature (P=0.005, OR=6.25) and history of carotid endarterectomy (P=0.005, OR=6.25) significantly increased the incidence of stroke. Unlike some previous studies, there was no significant association between age and stroke in this study which could be related to the lower age of CABG in Iranian patients. On the other hand, results of present study showed that hypercholesterolemia, previous history of CVA, diseases of peripheral vasculature and history of carotid endarterectomy significantly increased the incidence of stroke.

Esthesioneuroblastoma or olfactory neuroblastoma is a rare cancer arising from the neuroepithelium of the olfactory epithelium of the nasal cavity. Esthesioneuroblastoma occurs in all age group with a peak incidence in the age group of 11 to20 years old and again between 51 to 60 years old. Computed tomography (CT) and magnetic resonance imaging (MRI) usually show a homogenous soft tissue mass in the nasal cavity producing some erosion of the lamina papyracea, cribriform plat and fovea ethmoeidalis. The purpose of this paper is to present a 41 year old woman case of a Esthesioneuroblastoma filling the cavity of concha bullosa mimicking mucocele of middle turbinate, treated with endoscopic surgery. The chif complain of this patient was seizure that is very rare manifestation of this tumor.

Within the last decade, three beta-interferon (IFN-b) formulations –Avonex, Rebif, Betaferon– have emerged as first-line therapies for the treatment of remitting-relapsing multiple sclerosis (RRMS). The aim of this study was to compare the effect of disease-modifying treatment with interferon (IFN) beta-1b(Betaferon) and beta-1a(Rebif) on the sites of brain MRI lesions in patients with RRMS. Method and Material: This semi-experimental study was conducted on 112 patients with definite RRMS during a 24 month period. Patients were assigned in three groups: 37 patients under therapy with IFN beta-1a(Rebif) 44 mcg subcutaneously every other day (group A), 21 patients under therapy with IFN beta-1b(Betaferon) 250 mcg subcutaneously every other day (group B) and 54 patients without disease-modifying treatment (group C). Changes of brain MRI findings at the beginning and the end of study were evaluated in regard to the site of demyelination. A significant amelioration was seen in juxta-cortical (PA=0.001, PB<0.001), cerebellar-brainstem (PA=0.015, PB<0.001) and periventricular (PA<0.001, PB<0.001) lesions in both groups A and B. Comparison of the effects of betaferon and rebif demonstrated that none of the patients in group B (betaferon) have experienced deterioration of spinal cord lesions, while, 7 patients (18%) in group A (Rebif) have more lesions in spinal cord at the end of follow-up (P=0.041). Based on literatures our study is one of the first that compared the effect of IFN beta-1a and beta-1b on the location of brain lesions in MS patients. Betaferon was more effective in improving brain lesions especially spinal plaques.

Cerebral vasospasm is one of the most dreaded complications during the clinical course of aneurysmal Sub-Arachnoid Hemorrhage (SAH). Evaluation of the relationship between presence of vasospasm in Transcranial Doppler (TCD) and Delayed Brain Infarction (DBI) was the aim of this study. Methods and Materials: Consecutive patients with Subarachnoid Hemorrhage (SAH) admitted in Ghaem hospital, Mashhad during 2005-2010 enrolled in a prospective clinical study. Diagnosis and work up of SAH was performed by neurologists. All of the SAH patients underwent serial TCD during 4-14 days post events by certified neurosonologists blinded to the angiographic results. Presence of DBI was confirmed on neuroimaging by neurologists. Vasospasm in TCD was found in 56 patients (30.9%). Brain infarction in brain CT was observed in 17 SAH patients;12 females and 5 males (9.4%) with mean age 51.6 ±7.1 years. The mean time from SAH onset to development of vasospasm on TCD and mean time from occurance of vasospasm on TCD to development of brain infarction on brain CT was 8.51±2 and 9.06±4 days respectively. Difference in distribution of BDI based on the presence and severity of vasospasm on TCD was significant; p<0.001. Moderate and sever vasospasm on TCD had low sensitivity and high specificity for prediction of DBI. While, mild vasospasm on TCD had high sensitivity and moderate specificity for prediction of DBI. Although DBI in SAH patients is usually found in patients with vasospasm on TCD. However, Presence of any degree of vasospasm on TCD had low PPV for prediction of DBI in our SAH patients.

Congenital Myasthenic Syndromes (CMS) are a heterogeneous group of genetic neuromuscular disorders characterized by impaired neuromuscular transmission. This heterogeneity has made definitive diagnosis very difficult. In spite of great advances in classification and diagnosis of CMS in the world, there are many difficulties in ascertaining diagnosis and classification. These disorders are often misdiagnosed as myasthenia gravis, congenital muscular dystrophy and congenital myopathy and this may result in mismanagement and iatrogenic complications. We gathered information of 39 patients who were clinically and electrodiagnostically compatible with CMS. For 23 of these patients, DNA samples were sent for genetic analysis. So far we have received 9 genetic results from which 8 had positive results. 5 of them were postsynaptic due to Mutation of CHRNE, and 3 of them were synaptic due to mutation of COLQ.

During the last decades it is shown that the gonadal steroids affects the nervous system. Gonadal steroids easily cross the brain blood barrier and insert their effects on morphometric parameters of the certain areas of the mammalian brain despite their direct or indirect roles in sexual behavior, the effects that generally called sexual dimorphism (SD). Among the different brain neurotransmitter system, serotonergic system is of more inertest to study for SD due to its extensive projections and the role of its neurotransmitter, serotonin (5HT), in different physiological and pathological conditions including neuronal firing, human emotional control, and affective disorders. Although the fact that 5HT is affect by the sexual gonadal steroids, it is not known whether the nuclei related to this system also influenced by gonadal hormones. Median raphe nucleus (MRN) is the largest one among the other nuclei in human brain and involves in many important functional roles. There are not enough evidences regarding the SD in median raphe nucleus of mammalian brain and also the influence of gonadal steroids on its morphometric parameters. The present study was supposed to answer the mentioned doubtfully questions. Sixty adult male and female Sprague-Dawelly rats (200-230g) were used in this study. The animals randomly were divided to four groups including normal female group, normal male group, ovariectomized group (OVX) and sham surgery group. For SD the animals of normal male and female groups were compared and for the study of the effects of female gonadal steroids the normal female group compared with OVX group. The animals perfused and fixed transcardially, brain stem was removed, coronal sections were obtained and processed for light microscopic study. Nissl and Golgi staining used for study morphometric and neuronal morphologic parameters of MRN. Data analyzed and the results presented by means± SD. Based on our findings MRN showed sexual dimorphism and gonadal steroid deprivation via ovariectomy significantly influenced certain morphometric parameters of MRN. According to the results of this study, sexual dimorphism of MRN and the influence of female gonadal steroids on serotonergic nuclei should consider in normal and pathological conditions.

Intruduction: Multiple sclerosis (MS) is one the most common disabling neurologic disorders, which is characterized by a triad of inflammation, demyelination, and gliosis(scaring). MS affects More than 2.5 million individuals worldwide. Its highest prevalence is in young adults.. Fatigue is experienced by 75-90% of MS patients in various degrees. Although fatigue is the most common cause of disability in MS patients, But yet clinicians have problems in its diagnosis and treatment. MRI is a non invasive appropriate method for MS diagnosis, and shows 95% of lesions. Considering some studies showed quality of life in MS patients is correlated to lesions in MRI, it can be expected that fatigue is indirectly correlated to cerebral lesions too. As limited studies were done in this field, more studies are required; so we decided to study the relationship between fatigue and cerebral and spinal MRI findings in patients with multiple sclerosis. This study is analytical cross-sectional that has been done on 36 patients with multiple sclerosis and various degrees of fatigue. Exclusion criteria in this study were depressed patients & Patients used anti depressant drugs or amantadin, pemolin, methylphenidate, modafinil for them fatigue.At first, level of fatigue was defined with standard FIS (Fatigue Impact Scale) and FAI (Fatigue Assessment Instrument) questionnaire. Then EDSS (the Expanded Disability Status Score) was computed. Finally lesions'' load & region in brain & cervical spinal cord, & Atrophy of these places in MRI of patients were assessed by our radiologist. Results indicate that high fatigue score & EDSS was not significantly associated with high brain & cervical lesions'' load; as well sa high Fatigue score with atrophy of brain, cervical spinal cord. But there was significant correlation between right periventricular area and fatigue score, and also between EDSS and brain atrophy(p<0.05), and as well as between fatigue score and pyramidal function (p<0.01)& mental func.(p<0.05), and also between EDSS and pyramidal function, bowel-bladder function, cerebellar function(p<0.01) & between this score and mental func.,brain stem func.(p<0.05).Finally in this study highly educated patients were significantly less fatigued (p<0.05). As it was shown in our results, there was significant correlation between right periventricular area and fatigue score, and also between EDSS and brain atrophy.But high fatigue score & EDSS was not significantly associated with high brain & cervical lesions'' load; as well sa high Fatigue score with atrophy of brain, cervical spinal cord. And highly educated patients were significantly less fatigued.