zoheir reihanian

Traumatic brain injury (TBI) is a leading cause of mortality and morbidity worldwide. COVID-19 can impact the central nervous system (CNS) and hematologic system and appears to affect clinical outcomes and the average cerebral hemorrhage volume (ACHV) in patients with TBI.

Our study focused on evaluating the effects of COVID-19 on clinical outcomes and the ACHV in TBI patients.

In this study, we included TBI patients presenting to an academic trauma center in the North of Iran and categorized them into two groups: infected with COVID-19 and non-infected. A total of 128 TBI patients were identified during 19 months of the COVID-19 pandemic.

Road accidents account for 92.2% of TBI. Among different types of brain lesions, subdural hematoma (SDH) had a significant relationship with COVID-19 (P=0.043). Among patients, 13 (10.2%) were on anticoagulants, with no significant differences between the two groups. Among the COVID-19 patients, those who were anticoagulant users experienced a higher ACHV than those who did not use this medication (P=0.015). The two groups had no significant difference in the ACHV and mortality (P=0.758, P=0.601, respectively). The regression analysis indicates no statistically significant relationship between COVID-19 and ACHV (P=0.983) or between COVID-19 and the mortality rate of TBI patients (P=0.695).

The study highlights that TBI patients with COVID-19 on anticoagulants show higher ACHV levels than those without, a pattern missing in non-COVID patients. This finding suggests a possible synergistic interaction between COVID-19 and anticoagulation, with COVID-19 potentially worsening coagulation disorders.

Despite advancements in neuroimaging and surgical techniques, the management of meningioma in older patients remains challenging. In this study, we aimed to compare the impact of age on complications and outcomes of surgical resection of intracranial meningioma.

Methods and Materials/Patients: 

This retrospective cohort used medical records of 62 patients with confirmed intracranial meningioma who underwent surgical removal including 31 patients aged 18 to 65 (group 1) and 31 patients aged 65 and older (group 2). Demographic data along with discharge and six-month post-surgery Glasgow outcome scale (GOS) scores and complications were collected and compared between the two groups.

Group 1 included 8(42.11%) males and 23(53.49%) females with a mean age of 44.39±6.44 years. Group 2 had 11(57.89%) males and 20(46.51%) females with a mean age of 68.65±4.54 years. The discharge and overall six-month mortality rate were 0% in group 1 and 6.45% in group 2. Unfavorable outcomes (GOS scores of 2 and 3) were seen in 1(3.23%) of the younger and 1(3.45%) of the older groups. The prevalence of the recorded postoperative complications was 9.68% (peritumoral edema), 8% (cerebral hemorrhage), and 4.84% (wound infection) of the participants. There was no statistical difference between the study groups concerning postoperative mortality rate, outcomes, or complications.

Our results suggest that age does not increase the incidence of mortality, unfavorable outcomes, or surgical complications following meningioma removal. Regardless of age, proper patient selection for meningioma surgery may lead to favorable outcomes.

Axial neck pain due to degenerative cervical myelopathy can be improved after repairing anterior cervical discectomy with fusion (ACDF) surgery. However, whether changes in postoperative pain can be associated with improvement in the Cobb angle following surgery is still controversial. This study aims to assess the trends of the changes in pain severity and also Cobb angle and then test the relationship between the changes in two parameters.

Methods and Materials/Patients: 

This longitudinal study was performed on 60 consecutive patients who were scheduled to undergo ACDF surgery due to neck disc or degenerative cervical myelopathy (DCM) and had axial neck pain before the operation. Before operation as well as 2 weeks, 2 months and 6 months after surgery, the pain score and value of Cobb angle were measured.

Before surgery, the patients suffered from significant axial neck pain with a mean pain score of 7.47±2.02, but after surgery, patients experienced a downward trend of changes in pain score as the mean pain score of 0.92±1.46 at two weeks, 1.31±1.63 at two months and 1.32±1.64at six months after operation. The repeated measure analysis of variance (ANOVA) test showed a significant reduction in pain scores within follow-up time (P<0.001). A significant improvement was also revealed in the Cobb angle after the operation and the mean value of this angle was significantly lower at two weeks, two months, and six months after surgery than before surgery. Using the multivariate linear regression modeling with the presence of baseline parameters, the relationship between pain score and Cobb angle remained insignificant (P=0.387).

Following ACDF surgery, the improvement in axial neck pain and Cobb angle is predictable, but the relationship between these two indicators will not necessarily be significant.

Changes in the body fluid and serum electrolyte status following major operations, such as brain tumor resection, are always expected. These changes can increase post-operation morbidity and mortality.

We aimed to evaluate the changes in serum electrolyte levels and renal function parameters in brain tumor patients after operation.

This cross-sectional study was performed on 168 patients with supratentorial tumors in Poursina Hospital, Rasht City, Iran, in 2020. The study parameters included patients’ demographics, hemodynamic stability, serum sodium, potassium, blood urea nitrogen (BUN) and creatinine levels, urine specific gravity, and urinary output, measured immediately and 12 hours after the operation.

This study revealed statistically significant increases in serum sodium level (from 139.70±5.60 meq/L to 140.34±6.23 meq/L, P=0.002), urinary output (from 1043.70±455.00 mL to 1967.50±661.10 mL, P=0.008), urine specific gravity (from 1.010±0.007 to 1.012±0.008, P=0.011), and in serum BUN level (from 17.46±6.92 to 18.41±6.40, P=0.001), but significant decrease in serum potassium level (from 3.88±0.49 meq/L to 3.78±0.28 meq/L, P=0.017) during the first 12 hours after operation. However, the change in serum creatinine level was not significant (from 1.18±2.08 mg/dL to 1.17±2.08 mg/dL, P=0.787).

Significant changes in serum electrolytes (sodium and potassium) and renal function indicators (urine output, specific gravity, and serum BUN) are expected within the first 12 hours after brain tumor operation.

Although patients with mild traumatic brain injury (mTBI) rarely exhibit an identifiable lesion on neuroimaging, they frequently experience neurocognitive problems. The present study aimed to determine the cut-off point, sensitivity, and specificity of the Montreal Cognitive Assessment (MoCA) test in mTBI patients. In this cross-sectional-analytical study, the case group included 79 patients with mTBI were enrolled in the trauma, neurosurgery, and ICU ward of PourSina hospital (northern Iran), and there were 79 healthy individuals in the control group. Both groups were participating in this study were cognitively evaluated by the MoCA and MMSE test. Moreover, as retesting reliability and determining the concurrent and convergent validity of the MoCA, and Pearson correlation coefficient between two groups, MMSE test was performed on 20 mTBI patients with an average time interval of 3 days. The independent t-test, Cronbach’s alpha and discriminant analysis used for determining the distribution, internal consistency reliability and sensitivity, specificity, and diagnostic value of the MoCA test between groups respectively. The results showed a cut-off point of 26/27 as the probable point of cognitive impairment in mTBI. Also, in order to identify cognitive impairment in mTBI patients, this test reported sensitivity of 0.62 and   specificity of 0.81 with Youden's index of 0.43. In screening for possible mild cognitive impairment in mTBI patients, the MoCA is relatively useful and should not be used only as a substitute for a complete neuropsychological assessment with diagnostic purposes.

The emergency ward is one of the most important parts of the hospital, where people's activities can have many effects on the performance of other wards of the hospital and the satisfaction of patients. Changing lifestyle and transformation of cyberspace into one of the pillars of modern life has had a great impact on learning and teaching methods. To compare the level of theoretical emergency learning in medical students with two virtual and traditional methods.

This quasi-experimental study was conducted on 88 medical students who started their emergency rotation in two hospitals of Guilan University of Medical sciences in 2021. Both groups participated in the same exam before and after the basics of electrocardiogram (ECG), normal ECG, types of blocks, diagnosis of MI and arrhythmias education. After collecting the information from the questionnaires, the data analysis was performed via SPSS software with a significant P<0.05.

Out of 88 students, 56.8% were female, and 43.2% were male. The mean and median knowledge score before and after education was statistically significant in two groups (P<0.001). The virtual group represented a higher average score of knowledge than the traditional group. The student’ grade point average affected the result of the score after education (P=0.019, β =0.234).

The use of virtual education methods in combination with traditional methods might help to improve the learning process and knowledge of medical students in emergency department.

 Physicians whether during training years or working years are involved with the shift work system. Night shifts and the sleep deprivation that ensues have many adverse effects both physical and mental. Hence any decrease in doctors’ mental capacities will potentially put his and his patients’ health at risk, we decided to conduct a study to check medical interns’ Visual Short-Term Memory (VSTM) and Response Inhibition Functions changes after a night shift compared to the day before.

 In this study, 32 medical interns from the Guilan University of Medical Sciences were recruited by random sampling. Each participant completed a Pittsburgh Sleep Quality Index questionnaire and was asked about his/her smoking habit and prior night's sleep. Each examinee then was tested in the morning before and after the night shift for VSTM by forward Corsi Block Tapping Test (CBTT) and for Response Inhibition by Stroop Word/Color Test implemented in the PEBL software version 2beta6. The data were coded and analyzed in SPSS v21.

 There was no significant change in the intern's CBTT and Stroop Test results after a night shift and their VSTM and Response Inhibition Functions remained fairly intact. According to their PSQI results, 29 interns had poor sleep quality and only two had an acceptable PSQI score (5 or less).

 We argued that the consistent results of the CBTT and the Stroop Color Test could be due to many causes from small sample size to overall lower function under chronic sleep deprivation.

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system. COVID-19 has presented a significant challenge to the care providers of patients with MS.

The present study aimed to investigate the frequency of COVID-19 infection and its seropositivity in MS patients in Guilan, Iran, in 2021.

In this analytical-cross-sectional study, all patients with relapsing-remitting MS registered in the Guilan MS Association with an expanded disability status scale of less than 5 who were referred for evaluation participated in the study. Information related to the clinical and serological symptoms of COVID-19 infection, changes in drug use, and the occurrence of new attacks were collected. Serological results of COVID-19 (IgG) among them were registered.

In total, 260 patients with MS (78.8% women, and 21.2% men) with a Mean±SD age of 38.7±9.9 years, and a Mean±SD duration of MS of 8.9±4.9 years were investigated. The most commonly used drugs were Dimethyl fumarate, Interferon, and Rituximab, respectively. Thirty-three patients (12.6%) had a clinical COVID-19 infection, of which 32 people had a mild and only one had a critical infection. Eight patients (1.3%) had positive COVID-19 IgG tests. No significant relationship was found between the COVID-19 infection with the type of medication, medication change, clinical attack of MS, and co-morbidities (P>0.05).

A few patients had positive COVID-19 IgG tests and clinical COVID-19 infection. The vast majority had mild disease, and the clinical attack was not related to COVID-19 infection.

Appropriate clinical measures to prevent secondary brain damage in traumatic brain injury are of critical importance.

This study aims to investigate the relationships between serum electrolyte disturbances and Glasgow Coma Scale (GCS) score in patients with Diffuse Axonal Injury (DAI) at the time of admission and discharge.

In this retrospective cross-sectional study, we evaluated 101 patients with DAI having GCS score <15 admitted to Poursina Hospital in Rasht, Iran from 2019 to 2020. Based on the presence or absence of serum potassium (K), sodium (Na), magnesium (Mg), and zinc (Zn), disturbances on the first day of hospitalization, patients were divided into two study groups of with and without abnormal electrolyte levels. The GCS scores of the two groups at the time of admission and discharge were recorded and the relationship between electrolyte disturbances and GCS score was evaluated.

There were no significant differences in the mean GCS score at the time of admission and discharge between patients with and without disturbances in serum Na, K, Zn and Mg levels based on the crude analysis. Regarding the simultaneous effects of the study variables on the GCS score, only Mg serum level exerted a significant impact on the GCS score at the time of admission (P=0.041) and discharge (P=0.017).

The GCS score in patients with DAI at the time of admission and discharge has an association with the Mg serum level but not with Na, K, and Zn levels.

Traumatic brain injuries are one of the main causes of death and disability worldwide. Anemia may lead to worse outcomes in patients with traumatic brain injury. Considering that there have been limited studies on the role of anemia and blood transfusion in primary resuscitation of patients with traumatic brain injuries, the purpose of this study was to investigate the relationship between hemoglobin level and mortality rate in patients suffering from this condition.

This is a retrospective analytical cross-sectional study. The study population consisted of patients with traumatic brain injuries admitted to the emergency department of Poursina Hospital in Rasht, Iran, in 2017. Patients were classified into two groups, according to blood hemoglobin level, anemic (Hb ≤10) and non-anemic (Hb>10). Age, sex, clinical information, treatment measures, duration of hospitalization, and mortality rate in these two groups were recorded and compared. Also, in order to determine the risk factors for mortality in patients with traumatic brain injury, the above variables, along with laboratory findings, were compared in the two groups of patients with survival and death. Data were analyzed using SPSS21 software, and descriptive and inferential statistical tests.

The total number of participants in the study was 297 (249 (83.8%) male and 48 (16.2%) female), with a mean age of 41.8 ± 22.3 years. 120 (40.4%) patients had anemia. Patients without anemia had higher levels of consciousness than those with anemia (P <0.001). There was a statistically significant difference between the anemic and non-anemic patients in terms of the use of vasopressor and patient status at discharge (P <0.0001). The number of packed cells received showed a statistically significant difference between the patients with and without anemia (P <0.0001). Multivariate analysis based on logistic regression model showed that the duration of hospitalization, hypotension, blood transfusion, and hypothermia are risk factors associated with mortality.

The results of this study showed that although anemia is not a predictor of mortality, but blood transfusion is one of the most important factors associated with mortality in patients with traumatic brain injury.

The majority of the TBI patients are those with mild traumatic brain injury (mTBI). However, due to the absence of symptoms in brain imaging until long after the injury, the manifestations of cognitive impairments remain undiagnosed. Therefore, cognitive screening is considered a key measure in these patients. One of the common screening tools for evaluating cognitive impairments is the MMSE test. The present study aimed to determine the cut-off point, sensitivity, and specificity of the MMSE test in mTBI patients.

Methods and Materials/Patients:

In this observational and cross-sectional-analytical study, the statistical population was all patients with mTBI who were injured in the first half of 2022. The case group included 79 mTBI patients admitted to the trauma, neurosurgery, and ICU departments of Poursina Hospital in Rasht in the first half of 2022, who had been referred to the same hospital as well as the Velayat specialized clinic for rehabilitation and re-visit, and the control group included 79 normal healthy individuals. Both groups were cognitively evaluated by the MMSE test on two occasions with an average time interval of 2-3 weeks.

The results of the Discriminant analysis showed a cut-off point of 27/28 as the probable point of cognitive impairment. Also, for identifying the cognitive impairment in mTBI patients, this test reported low sensitivity of 0.43-0.58 and a moderate specificity of 0.69-0.80 in two tests.

 In screening for possible mild cognitive impairment in mTBI patients, the MMSE is relatively useful and should not be used solely to replace a comprehensive neuropsychological evaluation with diagnostic purposes.

It is still unclear whether the surgical or conservative approach has the best recovery and the least adverse outcomes after the treatment of patients with traumatic brain injury (TBI), especially the elderly. The use of invasive versus conservative therapies in elderly patients with TBI is controversial, and the current brain surgery procedures for the elderly require further evaluation.

Methods and Materials/Patients:

 In this retrospective cohort study, the medical records of 238 patients with TBI (119 surgical patients and 119 patients treated with conservative methods) over the age of 65 were reviewed. The patients were compared for the degree of recovery indicated by the Glasgow Outcome Score (GOS) and postoperative complications.

No difference was found in the primary Glasgow Coma Scale (GCS) between surgical and conservative approaches, but after two treatment protocols, the assessment of GCS and GOS showed a significant difference between the two groups; however, after adjusting baseline parameters in a multivariable logistic regression model, the difference between the two groups in CGS and recovery state turned to insignificance. There was no difference between surgical and conservative management in the post-treatment sequels, including contusion, hydrocephalus, myocardial infarction, pulmonary infection, and death. However, the recurrence of hematoma was significantly higher in those who were treated by the conservative method even after multivariate regression modeling.

In TBI patients aged over 65 years, surgical management can result in more favorable outcomes compared with the conservative approach.

Diagnosing the status of the posterior ligament complex (PLC) plays an essential role in the management of patients with thoracolumbar fractures. In this study, due to the inefficiency of existing imaging modalities in the accurate detection of PLC damage, we investigated the relevance of some imaging parameters to specific guidelines for rapid PLC injury detection.

Methods and Materials/Patients: 

In this study, 50 patients with and 50 patients without PLC injury were included. MRI, CT scan, and radiographic imaging of the thoracolumbar spine (T12-L1) were evaluated. The thoracolumbar injury classification systems such as Denis, TLICS (Thoracolumbar Injury Classification and Scoring System), and McCormack Load Sharing and radiographic parameters such as Superior Inferior Endplate Angle (SIEA), Body Height (BH), Local Kyphosis (LK), Interspinous Distance (ISD), and Interpedicular Distance (IPD) were investigated in these patients for each imaging method. Statistical analysis was performed using SPSS (Version 21).

The ISD and LK and BHp (Body Height Posterior) were significant predictors of PLC injury. On radiographs, the mean LK with and without PLC damage was 25.67° and 20.92°, respectively (p<0.001). The ISD difference was 6.75 mm in cases with PLC damage and 2.84 mm in cases with an intact PLC (p<0.0001). In CT images, the mean LK was 25.77° in cases with PLC damage and 18.63° in cases with an intact PLC (p<0.037). The ISD difference was 4.14 mm in patients with PLC damage and 2.19 mm in patients without PLC damage (p<0.002). The BHp difference was 9.44 mm in cases with PLC damage and 11.09 mm in cases without PLC damage (p<0.002).

The current study suggests formulating a predictive radiological index to identify PLC injury successfully. These guidelines can be very helpful in emergency room decision-makings, especially when the cost, availability, and time of performing MRI are important concerns in patients with multiple trauma.

Nonspecific chronic neck pain is increasing according to work-related gestures and modern lifestyle. Myofascial pain syndrome is a common problem and may be a primary disease. This study was designed to evaluate the prevalence of cervical myofascial pain syndrome in patients with chronic non-specific neck pain with normal MRI. We also examined the correlation between patients’ age as well as pain severity and duration. Patients with neck pain radiating to their upper extremity were examined despite normal MRI findings. We evaluated 10 different muscles based on myofascial pain syndrome criteria and also recorded pain intensity and functional ability using visual analogue scale and neck disability index, respectively. A physical therapist with at least 10 years of clinical experience with myofascial pain syndrome performed all physical examinations A total of 126 patients (69 females and 57 males) participated in this study, out of whom, 14 patients (11.1%) had no muscular involvement, while 112 cases (88.9%) revealed at least one trigger point. The infraspinatus and scalene muscles were the most commonly involved muscles accounting for 38.9% and 34.9% of all the involvements, respectively. The severity of pain was significantly associated with the disability of the patients (r=0.64, P<0.001). However, the correlation between pain and the number of trigger points was not significant (r=-0.19, P=0.31). Finally, the least significantly correlated variables were disability and the number of trigger points (r=-0.17, P=0.05). Patient’s age was significantly correlated neither with the number of trigger points (r=-0.04, P=0.62), nor the pain duration (r=0.07, P=0.39). Myofascial pain syndrome is a common disorder in patients with nonspecific chronic neck pain, despite normal MRI findings. Although, pain is not correlated with the number of trigger points in these patients, we demonstrated a small correlation between patients’ disability and the latter variable. Level of evidence: II

The Disability Rating Scale (DRS) is a short, efficient, and rapid instrument for assessing levels of functional disability, but little information is available on the translation and psychometric properties of its Persian version, especially for traumatic brain injury (TBI) patients. The aim of this study was to translate and adapt the Persian version of DRS and to determine the psychometric properties of the Persian version of this scale in patients with TBI.

In this analytical cross‑sectional study, 191 TBI patients(age range, 16–86 years) referred to the physiotherapy Center of PourSina Hospital in Rasht, Iran, were selected through census sampling. First, the DRS was translated into Persian, and then, the validity, reliability, and repeatability of DRS scores were evaluated. All patients were evaluated on admission and at discharge through the Glasgow Coma Scale (GCS) and Functional Independence Measure (FIM).

According to the reports of the translators, translation of the DRS into Persian language was easy. The quality of translation (including translation clarity, common language usage, conceptual equivalence, and overall quality of translation) was generally favorable. Inter‑raters’ reliability on admission and at discharge stages was excellent (intraclass correlation coefficient = 0.93–0.94). Cronbach’s alpha values for the internal consistency of DRS on admission and at discharge stages were 0.96 and 0.97, respectively. The results showed a strong inverse relationship of DRS scores on admission and at discharge with GCS and FIM scores (in all cases more than 0.70, P < 0.0001).

The validity, reliability, and repeatability of the DRS scores for the Persian version were confirmed. These results reflect that DRS can be used to determine the effects of therapeutic/rehabilitation interventions on levels of functional disability in Iranian patients with TBI.

Traumatic brain injury (TBI) in all degrees of injury severity mainly induces   deviant cognitive, emotional and behavioral alterations that lead to their respective disorders. This brief overview strives to define the variables that determine the risk of occurrence of these disorders and to describe the common patterns of these disorders and their relevant neuropathogenetic mechanism(s).  In addition, post-traumatic deficits can interact  and exacerbate the probability, , persistence and severity of each variable relative to  one another. Since, neural substrates and pathways further complicate these TBI sequels, identifying the neuropathogenetic basis of these deficits using human brain mapping techniques has been a milestone in the investigations of the TBI field.    It has been found that TBI-induced functional disturbance of one or more specific neural networks may cause a distinct disorder. However, this matter is a topic of discussion in TBI research. Evidently, prevalent, unpleasant TBI consequences such as motivational deficits, antisocial behaviors, aggression, disability of inhibitory control and executive function are mostly associated with the disruption of neural circuits originated from separate parts of the prefrontal cortex connected to thalamic nuclei and basal ganglia. Evidence strictly emphasizes the abnormality of the default mode network (DMN) either within the network or between it and other neural networks for a majority of cognitive, emotional and sleep disorders after TBI. Therefore, imbalanced neural circuits due to TBI may serve as diagnostic and prognostic biomarkers for post-traumatic neuropsychological and neuropsychiatric disorders as well as a guide for circuit-based neurotherapy.

Traumatic spinal cord injury (SCI) is one of the most traumatic events threatening patients’ well-being and places a financial burden on health care system. The first step in determination of the exact impact of SCI is to estimate the pattern of traumatic injuries in a population and also the type of frequently occurred co-injuries. Hence, this study was conducted to assess the frequency of anatomy, type of spine injuries, and associated co-injuries in patients with trauma in Poursina Hospital of Guilan province in Iran.

A descriptive cross-sectional study was carried out on traumatic spine patients admitted to the Poursina hospital of Rasht, a referral therapeutic center for trauma in north of Iran, in Rasht during 2015 to 2019. Data were extracted from the SCI registry of Poursina Hospital, Rasht, Guilan, Iran.

A total of 274 records were reviewed. Seventy-six patients were females and 198 patients were males. Mean±SD of age of the patients was 42.27±16.83 years. Based on this survey, most of the patients (43.8%) had SCI in lumbar region. Locked facet was seen in 12 patients. Fifty-seven patients (20.8%) complained about having pain. The median of VAS score was 6 (range=6). Co-existence of associated injuries (e.g. limb fractures, TBI, Internal bleeding, etc.) was found in 27.4% of the patients. According to ASIA (The American Spinal Injury Association) impairment scale, three patients (2.9%) had score A, and 100 patients (97.1%) had score E neurological defects.

The most telling reiteration to be drawn is that men mostly suffered from spine trauma. Lumbar region was the most susceptible location of SCI. Moreover, most of the patients experienced score E (normal neurological charcteristics) according to ASIA.

Pain is an experience often caused by tissue damage and is proportional to the severity of the injury. The role of underlying factors in severity of the pain such as prehospital factors have been discussed in some investigations. The current study aimed to assess the effect of different parameters on pain severity in patients with trauma. Methods and Materials/Patients: The current descriptive, cross-sectional study was conducted fully conscious 270 fully patients with trauma admitted to Poursina Hospital in Rast, Guilan, Iran, in 2016. They were assessed in terms of demographic and pre-hospital factors as well as mechanism and severity of trauma based on verbal rating scale. Linear regression analysis demonstrated that among various factors like age, sex, level of education, opium dependence, vehicle type, ventilation, blood pressure, pulse rate, mechanism of trauma, and type of trauma, the highest severity of pain was pertaining to the type of trauma such as multiple trauma and large bone fracture with mean scores of 9.26 and 9.13, respectively. It also revealed that among these parameters, mechanism of trauma, type of trauma, transfer time, type of vehicle, and pulse rate were significantly associated with the severity of the pain. The current study showed that increasing the quality of vehicle, decreasing the transfer time, and paying more attention to hemodynamic factors such as pulse rate, blood pressure, use of analgesic agents, and immobilization of damaged tissue can diminish the severity of pain in patients with trauma.

Hydrocephalus can cause ventricular expansion, which if not treated promptly, can result in brain damage. The hydrocephalus-induced damage is not fully improved, even by means of surgical procedures, leading to permanent damages to the brain.
Methods and Materials/Patients: The aim of this study was to evaluate the demographic characteristics as well as hydrocephalus in patients with head trauma in Poursina Hospital, Rasht. The information including age, sex, Glasgow Coma Scale (GCS), trauma mechanism and accompanying brain injuries on admission were recorded. Patients with hydrocephalus diagnosed by CT scan underwent further investigation and therapeutic approaches. The treatment-related results were collected based on the GOS scale. Finally, the data were entered into SPSS version 18, and the results were analyzed by Fisher’s exact test, and Independent t-test.
Of the 548 patients, hydrocephalus was observed in 14 patients (2.6%). The mean age of the patients was 44.07±24.48 years old. 31.1% of men (14 cases) had hydrocephalus, while none of women suffered from this complication. Car accidents (12 people) and fall (2 people) were identified as causes of incident in hydrocephalus patients. Head injury severity in most patients with hydrocephalus was mild (n=7, GCS=13-15) and moderate (n=6, GCS=9-12), and severe (n=1, GCS=3-8). Subarachnoid hemorrhage (n=5) and then epidural hematoma (n=4) and intracerebral hemorrhage (n=4) had the most severe damage to the skull. Most patients (n=11) were treated by surgery. Three patients recovered completely. Moderate disability, severe disability, vegetative state, and death occurred in 3, 2, 1, and 5 Patients, respectively. According to independent t-test, there is a statistically significant relationship between Glasgow Coma Scale and hydrocephalus (P=0.03). Fisher’s exact test also showed a statistically significant relationship between intracerebral hemorrhage (P=0.045) and intraventricular hemorrhage (P=0.013) on admission with hydrocephalic incidence.
This complication was mostly observed in young traumatic patients (younger than 40 years of age) and in patients with mild head injury. Therefore, it is necessary to pay attention to these people in order to detect hydrocephalus, if any, as soon as possible, and these patients be treated appropriately.

Variations of the brachial plexus are common and a better awareness of the variations is of crucial importance to achieve successful results in its surgical procedures. The aim of the present study was to evaluate the anatomical variations of the brachial plexus in adult cadavers.
Bilateral upper limbs of 32 fresh cadavers (21 males and 11 females) consecutively referred to Guilan legal medicine organization from November 2011 to September 2014, were dissected and the trunks, cords and terminal nerves were evaluated.
Six plexuses were prefixed in origin. The long thoracic nerve pierced the middle scalene muscle in 6 cases in the supra clavicular zone. The suprascapular nerve in 7 plexuses was formed from posterior division of the superior trunk. Five cadavers showed anastomosis between medial brachial cutaneous nerve and T1 root in the infra clavicular zone. Terminal branches variations were the highest wherein the ulnar nerve received a communicating branch from the lateral cord in 3 cases. The median nerve was formed by 2 lateral roots from lateral cord and 1 medial root from the medial cord in 6 cadavers. Some fibers from C7 root came to the musculocutaneous nerve in 8 cadavers.
The correlation analysis between the variations and the demographic features was impossible due to the small sample size. The findings of the present study suggest a meta-analysis to assess the whole reported variations to obtain a proper approach for neurosurgeons.

Using pharmaceutical agents in treatment of aphasia has caught the attention of many neurologists and neuroscientists. This short review study has sought the role of pharmacotherapy in treatment of aphasia, a linguistic impairment after acquired brain lesions. The pharmacological principles and mechanisms related to the effects of drugs used in aphasia rehabilitation are pointed. Then, some evidence of clinical trials on different drugs in this field is presented.Methods & Materials/Patients: A comprehensive search in databases including MEDLINE, Cochrane, PubMed, Scopus, EMBASE, Science Direct on experimental studies and clinical trials associated with pharmacotherapy of aphasia after neurological damages was performed. Pharmacological interventions through manipulating neurochemical levels in synapses, the pre- and post-synaptic spaces and even inside neurons start to modulate the disturbed balance of neurotransmitters due to brain lesions. Pharmacotherapy is based on the principle that drugs via balancing the molecular signaling cascades triggered due to neuronal damage can restore the function of neurons, facilitate the brain plasticity process and improve the linguistic deficits in aphasic patients. Among the drugs that have been studied in treatment of aphasia, those acting on central cholinergic and glutamergic systems were more effective and led to better clinical outcomes. Although existing evidence has proved the pivotal role of pharmacotherapy in treatment of aphasia after acquired brain lesions in adults, further research is required to assure the clinicians in using pharmacotherapy as a standard approach in treatment of aphasia.

Today, stem cell transplantation is a hot topic in scientific circles as a novel therapeutic approach to repair the structure and function of central nervous system. The safe and neuroprotective effects of cell therapy in models and traumatic brain injury patients were evaluated in many experimental and clinical studies in recent decade and somewhat promising results were provided to the scientific community. Nevertheless, there are still obstacles in translating experimental studies in the laboratory into clinical practice that should not be overlooked. In this review study, a brief explanation is provided about biological events and endogenic neurogenesis and angiogenesis after TBI; the performance of transplanted cells in restoration of damaged neurons; the role and potential use of mesenchymal stem cells as adult stem cells preferred in cell transplantation and clinical trials ever conducted in this area; features of cell transplant candidates who will most benefit from transplantation, the type of and proper time for cell transplantation, optimal method for conducting transplant to deliver cells to the brain, and the best dose for effectiveness of transplantation. Finally, the various neuroimaging techniques are discussed, which are used to track and evaluate the survival and implantation of transplanted cells.