mohammad yazdchi

Fahr’s disease is a rare condition characterized by the symmetrical calcification of basal ganglia and dentate nuclei of the cerebellum calcification. It is usually manifested by involuntary movements and psychiatric symptoms. Ataxia has been reported as an uncommon manifestation of Fahr’s disease. Herein we introduce a 41-year-old man presenting with progressive gait disturbance who was finally diagnosed with Fahr’s disease.

Sleep disorders are major but neglected symptoms in patients with multiple sclerosis (MS). This study aimed to describe the sleep status in patients with MS. We selected mildly-disabled [Expanded Disability Status Scale (EDSS) score < 4] patients with relapsing-remitting MS (RRMS). After determining the level of vitamin D in a blood sample of the patients, the validated Persian versions of Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and snoring, tiredness, observed apnea, high blood pressure, body mass index (BMI), age, neck circumference, and gender (STOP-Bang) questionnaires were filled and the sleep condition was described. Besides, the impact of age, sex, disease duration, and EDSS on sleep status was determined. 37.87% of 103 included patients with MS had poor sleep quality. 21.35% rate of subthreshold, 10.67% rate of moderate, and 1.94% rate of severe insomnia were also observed. Only 1.94% of patients had a high risk of obstructive sleep apnea (OSA). There was a significant relation between Beck Depression Inventory (BDI) score with ISI (r = 0.45, P < 0.01), PSQI (r = 0.53, P < 0.01), and STOP (r = 0.20, P = 0.03). A significant correlation between STOP with BMI (r = 0.24, P = 0.01) and age (r = 0.21, P = 0.03) was also observed. Sleep status was not significantly different in groups of the patients based on vitamin D, overweight, or sex. Poor sleep quality is a common finding among mildly-disabled patients with MS. There is also a 33.99% rate of subthreshold or clinical insomnia in different severities. Quality of sleep and insomnia is not significantly correlated to BMI, level of vitamin D, and sex in patients with MS.

Decompressive Craniectomy (DC) is recommended for patients with extensive cerebral infarction. At this study, we aimed to assess the mortality and 3-month outcome of these patients who are not going under DC.

In this prospective descriptive study, all patients referred to Imam Reza Hospital in Urmia, Iran, from 2017-2019 with extensive ischemic stroke with refractory medical edema of the brain who did not undergo surgery were included. Patient’s demographic and other brain stroke-related data were recorded. Patients were evaluated for the improvement of brain stroke symptoms based on the comparison of National Institutes of Health Stroke Scale (NIHSS) criteria at the time of hospitalization with discharge time and also for the degree of disability and mortality at three months follow-up according to mRS criteria. P values less than 0.05 were considered statistically significant.

A total of 28 patients were enrolled in the study. Median age was 76 years. NIHSS score was 21 at admission and 18 at discharge (p<0.05). Of all 28 patient, 22 (78.6%) died during hospital admission and 24 (85.7%) died up to 3 month follow up. None of the 4 survived patients had a good and independent outcome along the 3-month follow-up (MRS<3).

Results of this study showed that in patients with extensive cerebral infarction with edema resistant to medical treatment, fail to perform decompressive craniectomy is associated with a very high mortality rate and poor prognosis.

Creutzfeldt-Jakob Disease (CJD) is a rare rapidly progressive neurodegenerative disease. The diagnosis of CJD is based on magnetic resonance imaging (MRI) findings, electro-encephalography (EEG), or 14-3-3 protein detection. We report a case of a previously-healthy 72 years old woman, with evidence of coronavirus disease 2019 (COVID-19), who complained of behavioral changes and rapidly progressive dementia. While hospitalization, she didn't have orientation to time and place and repeated an irrelevant sentence in response to questions. Also, anomia and impaired comprehension was observed. Myoclonic jerks, abnormal signal intensity at bilateral parieto-occipital cortices in MRI, periodic sharp wave complexes in EEG, and increased lactate dehydrogenase in cerebrospinal fluid (CSF), highly recommended CJD for her. This is the second case of CJD after COVID-19 during this pandemic, which can be an alarm to clinicians about the silent impact of COVID-19 on the central nervous system.

Stroke is the second leading cause of death worldwide and the number of stroke cases has increased remarkably over the last 20 years. This study aimed at identifying predictors of with 6‑month mortality of first‑ever stroke patients and the factors contributing to it in East Azerbaijan province.

A closed cohort study was carried out from April 2014 to December 2014. All cases of first‑ever diagnosed stroke were included in the study. Any transient ischemic attack, silent brain infarctions, and the stroke cases which were neither associated with trauma, blood disease nor with malignancy were excluded from the study. The variables of this study include participants’ demographic characteristics, stroke severity National Institutes of Health Stroke Scale (NIHSS), and stroke risk factors. Patients were followed up within 6 months. To determine the survival time, the log‑rank method was applied to compare intergroup differences. The tests include the univariate and multivariate analysis Cox regression. P < 0.05 were considered as statistically significant.

A total of 576 cases of stroke were included in this study. Average age of ischemic and hemorrhagic stroke was 70.15 ± 13.0 and 67.79 ± 12.69, respectively. Case‑fatality rate (CFR) of stroke patients was 49.2 and 21.7% in hemorrhagic and ischemic stroke types, respectively. Factors contributing to stroke mortality events include the severity of stroke (NIHSS categories 15–19 and ≥20), age over 65, being female, high body mass index and hyperlipidemia. In the final model, the severity of stroke (with NIHSS 15–19 with hazard ratio (HR) 4.22 (95% confidence interval [CI] 2.36–7.56) and NIHSS ≥20 with HR 5.34 (95% CI: 2.81–10.12) and age above 65 with HR 1.61 (95% CI: 1.02–2.51) were the most important predictors of 6‑month mortality.

Severity of stroke by NIHSS was the most prominent factor in stroke patients’ mortality. By increasing the follow‑up time, a better evaluation of the predictors of mortality after stroke can be achieved.

Tissue plasminogen activator (tPA) has been long approved as an efficacious treatment in patients with acute ischemic stroke (AIS); however, due to some serious complications, particularly intracranial hemorrhage (ICH), many physicians are still reluctant to use it liberally. This study sought to find potential prognostic factors in patients with AIS treated with tPA.

A retrospective, hospital-bases observational study was conducted. Consecutively, a total of 132 patients with AIS treated with intravenous tPA, form June 2011 to July 2015 were enrolled. Inclusion and exclusion criteria were based on updated guidelines. Probable prognostic variables were examined separately in three distinct groups; the occurrence of ICH within 24 hours after treatment, poor 3-month outcome on the basis of modified Rankin Scale (mRS) and 3-month mortality.

Patients were 83 men (62.9%) and 49 women (37.1%) with a median age of 66 years [interquartile range (IQR)of 55-72]. Any type of hemorrhage, symptomatic hemorrhage [based on the European Cooperative Acute Stroke Study III (ECASS III) definition] within 24 hours posttreatment, poor 3-month outcome (mRS 3-6), and 3-month mortality were documented in 10.6%, 4.5%, 53.2%, and 23.6% of patients, respectively. Increased baseline blood glucose was a significant but dependent predictor of hemorrhage within the first 24 hours posttreatment. Dependent predictors of a 3-month poor outcome were high age, the National Institutes of Health Stroke Scale (NIHSS) at baseline, decreased admitting glomerular filtration rate (GFR), and the presence of atrial fibrillation (AF) rhythm, and ICH within 24 hours posttreatment. Only age [Odds ratio (OR) adjusted 1.05] and initial NIHSS (OR adjusted 1.23), however, were recognized as the independent variables in this regard. The only independent predictor of 3-month mortality was the initial NIHSS (OR adjusted 1.18).

According to the findings of the present study, advanced age and high baseline NIHSS are two independent prognostic factors in patients with AIS treated with tPA.

Olfactory loss in patients with chronic rhinosinusitis has been measured by different methods. However, the results have been variable, and it is not clear whether endoscopic sinus surgery significantly improves olfactory function. This study was performed to evaluate the influence of endoscopic sinus surgery on olfactory function in patients with chronic rhinosinusitis.
In this prospective analytic study, 73 patients (mean age, 39.63±12.94 years) with a diagnosis of polyps and sinusitis during 2011 were studied. The olfaction test was performed with three solutions; one with no odor (water) and two with phenylethyl alcohol (50% and 90% dilution, respectively). The patients’ olfaction state were graded as no olfaction, or low, moderate or good olfaction before and 1 and 3 months after surgery, and was given scores between 0 and 3 and evaluated quantitatively.
Right-side olfaction was improved in 68.5% and left side in 67.1% of patients. Mean olfaction score on the right and left side was significantly improved after surgery in comparison with basic scores (before and after on the right side: 0.95±0.88 and 2.02±1.04; before and after on the left side: 1.02±0.84 and 2.00±1.21; both P In patients with rhinosinusitis, endoscopic sinus surgery has considerable effect in improving olfactory function.

Parkinsonism occurs in all races. Its prevalence in the United States and Western Europe is 2.1 persons per 1,000 populations. Approximately one third of patients have cognitive problems that often doubles after 4 years in 80% of patients with dementia and Parkinson’s disease (PD) occurs in the final stages. The aim of this study was to determine the relationship between visual evoked potential (VEP) and Somatosensory evoked potential (SSEP) findings in patients with Parkinson’s disease with dementia. In a case-control study that performed in neurology department of Tabriz University of medical sciences on patients with PD, the relationship between VEP and SSEP findings in patients with Parkinson's disease with dementia evaluated. Right VEP denotes AMP in 12 was abnormal and left VEP denote AMP was abnormal in 13 patients. No significant correlation line was found between MMSE score with left and right VEP 100, Left and right VEP AMP, right SSEP P40 and SSEP AMP but there was a significant line correlation between MMSE score with left SESEP and SSEP P40.Mean right VEP P100 was 104 + 24.18 and mean left VEP P100 was 104.94 + 24 and also, left and right VEP P100 were abnormal in 24(40). There was no significant difference in mean of P100 Latency in patients with and without functional disorder. No significant difference was observed between patients with Parkinson’s SSEP AMP with and without functional impairment.

Although cuff leak test has been proposed as a simple method of predicting the occurrence of postextubation stridor, cut-off point of cuff-leak volume substantially differs between previous studies. In addition, laryngeal ultrasonography including measurement of air column width could predict postextubation stridor. The aim of the present study was to evaluate the value of laryngeal ultrasonography versus cuff leak test in predicting postextubation stridor. In a prospective study, all patients intubated for a minimum of 24 h for acute respiratory failure, airway protection and other causes were included. Patients were evaluated for postextubation stridor and need for reintubation after extubation. The cuff leak volume was defined as a difference between expiratory tidal volumes with the cuff inflated and deflated. Laryngeal air column width was defined as the width of air passed through the vocal cords as determined by laryngeal ultrasonography. The air-column width difference was the width difference between balloon-cuff inflation and deflation. Forty one intubated patients with the mean age of 57.16±20.07 years were included. Postextubation stridor was observed in 4 patients (9.75%). Cuff leak test (cut off point: 249 mL) showed sensitivity and specificity of 75% and 59%, respectively. In addition, laryngeal ultrasonography (cut off point for air column width: 10.95 mm) resulted in sensitivity and specificity of 50% and 54%, respectively. Positive predictive value of both methods were <20%. Both cuff leak test and laryngeal ultrasonography have low positive predictive value and sensitivity in predicting postextubation stridor and should be used with caution in this regard.

This study evaluated the efficacy of focal intramuscular injection of botulinum (BoNT) toxin type A in comparison with oral tizanidine (TZD) in treatment of post-stroke upper limb spasticity. This was a double-blinded randomized clinical trial that recruited 68 patients with post-stroke upper limb spasticity. Thirty-four patients received BoNT (Dysport®) injections in affected muscles of upper limb at the baseline and week 12. Thirty-four patients were treated with tizanidine (Sirdalude) by gradual increase in dosage of 2mg/week to reach maximum 24mg at week 12. Modified Ashworth Scale (MAS) and Action Research Arm Test (ARAT) were evaluated at the baseline, week 12 and week 24 for all the participants. The mean score of MAS reduced from 3.32 and 3.13 at baseline to 1.79 and 1.56 at week 24 on elbow and wrist joints, respectively (P < 0.01). However, there were only reductions from 2.79 and 2.77 to 2.32 and 2.31(P < 0.001) in TZD group. ARAT increased from 1.79 to 10.97 (P < 0.001) in BoNT group. ARAT increased from 11.08 to 11.35 in TZD group (P = 0.026). BoNT injection was safe and effective in reducing post-stroke upper extremity spasticity in comparison with TZD.