Archives of Neuroscience
Volume:2 Issue: 2, Apr 2014

Fatigue and depression are common after spinal cord injury (SCI). However, their extent in individuals with spared ability to walk (assisted or nonassisted) has not yet been described in Iranian patients.. Our purpose was to evaluate fatigue, depressive mood, and neuropathic pain among Iranian patients with spared ability..Patients and Patients with traumatic SCI who had spared walking ability with spinal cord independence scores (SCIM) higher than 65, referred to Brain and Spinal Injury Research Center (BASIR) between September 2012 and October 2013 were entered to the study. Fatigue, depressive mood and pain were evaluated using modified fatigue impairment scale (MFIS) for SCI (MFIS-SCI), Beck depression inventory (BDI), and 0-10 numerical rating scale (NRS), respectively.. Among 30 patients who entered this investigation, 66.7% had normal moods (BDI < 10) and only 3.3% showed severe depression (BDI: 31-40). The mean total score of MFIS-SCI was 22.46 ± 15.76. Higher scores of BDI were significantly associated with higher scores of MFIS-SCI in all cognitive (P < 0.0001, r = 0.81), physical (P = 0.001, r = 0.58) and psychosocial (P = 0.001, r = 0.57) domains. Based on the previously measured cutoff point in MFIS-SCI, 53.3% of our patients were fatigued. Patients with cervical level injury had significantly higher fatigue impacts (P: 0.036).. This study showed that a majority of patients with traumatic SCI who had spared ability of walking were fatigued, while depressive mood was less frequent among these patients. Neuropathic pain was not a determinant for fatigue and depression. Although the extent of physical activity was relatively similar among these patients, those with higher injury levels had higher fatigue impacts..

Risk factors, diagnosis, treatment and outcome of patients with cerebral venous thrombosis (CVT) have always been challenging.. The present study aimed to report on the characteristics of CVT in the patients referring to the emergency unit of a teaching hospital to review and add to the current knowledge on this topic..Patients and This was a retrospective cross sectional study, which consisted of a series of 19 patients admitted to the emergency department during one year with the diagnosis of CVT. The required data were extracted from existing reports in the case files via manual-searching. All patients were re-evaluated prospectively with the goal of outcome assessment.. This study included 19 patients with CVT. Mean age of the cases was 38.7 ± 8.8 years (range 22 to 62 years) and they were predominantly women (84.2%). The most common chief complaint at presentation was headache, observed in 15 (78.9%) of the patients either solely or accompanied with other symptoms. Use of oral contraceptive pills (OCPs) was reported in more than half of the cases. The outcome was favorable in 18 (94.7%) of the cases and only one patient, despite appropriate five months of remedial measures, still suffered from visual disturbance.. Although many risk factors for CVT have been identified thus far, it seems that there are different patterns of frequency among ethnic groups. Thus, an inter racial comparison study is still needed. Likewise, with attention to the lack of proper studies and strong evidence regarding treatment options, conducting a multicenter prolonged study with a large sample size is apparently required..

Context: Involvement of reactive oxygen species (ROS) in a variety of physiological and pathological processes has attracted a growing interest. In fact, identification of this global signaling system has provided new insights into underlying pathophysiological mechanisms of various diseases such as Alzheimer’s disease (AD). Understanding this information may lead to the development of novel therapeutic strategies..Evidence Acquisitions: Limited efficacy of current medications for neurological disorders and dementias such as AD has led to considerable research interests in new drug development. Based on the modulatory effects of the Fenton reactions with transition metals such as iron, copper, zinc and aluminum on ROS and the effect of free radicals on neuroinflammatory and neurodegenerative processes, we hypothesized that pharmacological manipulation of the transition metals gated hydroxyl ion might be beneficial in treating neurological disorders such as AD.. Catalytic activities of transition metals gated by the Fenton reactions are involved in the survival and pathological signaling pathways, neural plasticity, and neuroprotection. Furthermore, ROS and RNS have proved to exhibit overwhelming pathological effects leading to a variety of neurological disorders.. In the present investigation, an overview was made on regulatory role of the Fenton reaction gated catalytic activities of transition metals and some evidence regarding their mechanisms leading to Alzheimer’s disease. Based on the neuroinflammatory and neurodegenerative effects of transition metals, drugs with antagonizing effects could be a promising therapeutic alternative for Alzheimer’s disease..

Context: Neuropathic pain is a common and disabling complication. To develop a better treatment of the neuropathic pain, a comprehensive understanding is essential. In this paper, we review pathophysiological principles of neuropathic pain, focusing on synaptic plasticity and long-term potentiation (LTP) in the nociceptive circuits. Finally, the role of glial cells on the synaptic plasticity in neuropathic pain is discussed..Evidence Acquisition: We searched the Cochrane and PubMed databases using the following terms: neuropathic pain, dorsal horn, LTP, synaptic plasticity, nociceptive circuits, glial cells, nerve injury, allodynia, hyperalgesia, nociceptive neurons, and rat. All of searches were limited to the animal studies in English articles. Full-text copies were obtained when the studies had possible relevance.. Analysis of our research showed that nerve injury-induced LTP decreased pain threshold and increased pain hypersensitivity to sub-threshold stimuli. In addition, cross talk between dorsal horn neurons and glial cells are pivotal for the induction of spinal synaptic plasticity and LTP.. It seems that LTP in the spinal nociceptive pathways constitutes cellular mechanisms that explains how acute pain may become chronic..

Laryngeal multiple mucosal neurinomas can make intubation difficult.. A 16-year-old female referred to the general surgery department complaining of hoarseness and itchy throat for the past 18 months. Her symptoms had not resolved after medical treatments. After examination, the patient was admitted to the hospital and radical neck dissection was scheduled for her. Since it was assumed that lesions similar to lesions of the tongue might exist in the patient’s respiratory tract, outpatient laryngoscopy and fibroscopy was performed. A yellow-white lesion was seen in front of the left-sided vocal cord. Pathological findings of the lesion confirmed neurinoma. Laryngoscopy and tube insertion were done using a GlideScope.. During the laryngoscopy, the neurinoma did not make any difficulty and the patient was intubated successfully..

Infection with Human Immunodeficiency Virus (HIV) causes a spectrum of clinical problems in multiple organs. It may affect the nervous system directly, producing distinct neurological syndromes, or indirectly, by causing immunodeficiency with a resultant susceptibility to opportunistic infections such as Toxoplasma gondii.. In this case study, we described a 47-year-old man who admitted to our emergency department with fever and confusion progressing from two days before the admission. He was candidate for biopsy 20 days before due to acute onset left-side hemiplegia and right-side ptosis and imaging findings consistent with a brain mass. Due to these findings and positive histories of lung tuberculosis and esophageal diffuse mucosal candidiasis, rapid HIV antibody test was requested, which had a positive result. Then we performed Magnetic Resonance Imaging (MRI) with intravenous contrast showing a ring enhancement lesion in the right basal ganglia suggestive of brain toxoplasmosis. It was confirmed with significant raising of anti-toxoplasmosis IgG.. Toxoplasma gondii infection is usually diagnosed by serologic tests. Although, brain imaging is necessary for proper diagnosis and management, its findings are not pathognomonic. Patients with toxoplasmic encephalitis typically experience rapid clinical and even radiologic improvement after initiation of appropriate therapy..

Temporal lobe epilepsy (TLE) presented with behavioral and psychiatric disorders is one of the most hectic forms of epileptic seizures, in which a uniform pathology cannot explain its manifestations, and structural underlying causes should be kept in mind.. This report described a 38-year-old female admitted to our department in emergency manner with episodic attacks of behavioral disorders and brief episodes of loss of consciousness each time accompanied with headache as a starting point, which lasted 5 to 10 minutes. Brain MRI showed a mass in the left temporal lobe finally diagnosed as a meningioma. After prescription of antiepileptic agents, headache, psychiatric disorders and hallucination attacks were stopped.. Temporal lesions with behavioral changes can cause complicated and difficult cases. There is limited data about this, but it seems that psychiatric features of temporal lobe epilepsy could be controlled and treated easily only by antiepileptic agents..

Spinal cord injury (SCI) imposes a tremendous burden on physical, mental and psychosocial aspects of life among affected individuals.. Until now, there was no statistics about the quality of life (QoL) in Iranian males with SCI. Here, we assessed the QoL among Iranian men with SCI and compared it with general population..Patients and Referred male patients with SCI to Brain and Spinal Injury Research Center (BASIR) were invited to participate in this investigation. The QoL was measured by the Short-Form 36-Item Health Survey (SF-36). One sample T-test was used to compare outcomes with normal distribution. Values in general population in Iran were extracted from previous literatures.. Total of 153 patients with mean age of 35.10 ± 16.20 years old participated in this study. The most common reason of trauma was road accidents (49.7%). Cervical level injury was seen in 47% of patients, thoracic level in 28.1% and lumbosacral level in 24.9%. QoL was assessed in eight domains. Mean scores in domain of physical functioning was significantly higher in general population (28.2 ± 25.3 and 87.8 ± 19.0 in SCI group and general population, respectively, P < 0.0001). Similarly, scores in domain of physical and emotional role functioning were higher in general population (P < 0.0001 and P = 0.002, respectively). No significant difference was seen between males with SCI and general population in domain of mental health (70.5 ± 19.6 and 69.2 ± 17.1 in SCI group and general population, respectively; P = 0.37).. This study shows that men with SCI have significant reduced QoL in comparison with general population. However, it seems that the scores in domain of mental health are not affected by SCI and this aspect of QoL is spared to some extents after injury..

Cerebrovascular accident (CVA), as a debilitating neurological impairment, is one of the most common causes of death in adults. It is observed that CVA is less well-documented in the developing countries compared to the developed ones and most of the available data are based on case series.. The current study aimed to evaluate the effectiveness, feasibility, outcome, and safety of intravenous recombinant tissue plasminogen activator (IV rt-PA) administration in patients with acute ischemic cerebrovascular accident (CVA)..Patients and All CVA patients referred three hours after onset of symptoms to the emergency department (ED) of Shohadaye Tajrish Hospital, Tehran, Iran, from February 2012 to March 2014 were included. The following data were collected using specific check list: demographic data, chief complaint, signs and symptoms, medical history, risk factors, focused neurologic examination, and the National Institutes of Health CVA Scale (NIHSS). Then, all patients received 0.9 mg/kg of rt-PA as a bolus intravenous dose and intravenous infusion under close monitoring in the ED. Outcomes were categorized as good (complete reversal of focal neurologic deficit), not bad (partial reversal of focal neurologic deficit), death, and unknown (missed follow up). Data were analyzed by STATA software version 11.. Fifteen patients with the mean age of 56.7 ± 18.9 years included in the study (male 66.7%). The most common chief complaints were left side hemiplegia (46.67%), right side hemiplegia (40%), and decreased level of consciousness (13.33%), respectively. The most common affected vascular territory was medial cerebral artery (MCA) (86.67%). There was no significant relationship between age (P = 0.06), gender (P = 0.08), NIHSS score (P = 0.07), location of infarct (P > 0.99) and mean time from admission to beginning the drug administration (P = 0.55) with the outcomes. The outcome in 26.7% of the patients was favorable and death (two of four) happened due to intra cranial hemorrhage (ICH) as rt-PA side effects.. It seems that intravenous rt-PA administered three hours after CVA is bemeficial in patients with CVA and by reducing the early evaluation time and brain imaging can overcome the CVA complications. However, any conclusion from this study is limited by the small population under study.

Deep venous thrombosis presents with different clinical symptoms and signs, which can be diagnosed incorrectly. Bilateral thalamus infarction is one of the rare manifestations which can be misinterpreted as a different diagnosis and lead to mismanagement..

We reported a 37-year-old female referred to the emergency department with headache, left side weakness, seizure and alteration of consciousness at the admission time. She had been misdiagnosed with brain tumor because of her imaging results at first. However, in the follow up, she was diagnosed with deep cerebral venous thrombosis of the vein of Galen based on the brain magnetic resonance imaging (MRI) result. Afterwards, she was treated by anticoagulant (heparin) and recovered well..

This case was presented to emphasize the importance of different manifestations of deep vein thrombosis which can lead to delayed appropriate treatment due to misdiagnosis..