سکته مغزی

Decompressive craniectomy (DC) is a therapeutic approach for patients with raised intracranial pressure and cerebral edema. Although DC is not a complicated procedure, it is associated with significant complications and morbidities that significantly affect clinical outcomes. This study investigates the frequency of cerebrospinal fluid (CSF) circulation disorders after DC and evaluates related factors.

This cross-sectional analytical study was conducted on 79 patients who underwent DC at Shohadaye Haftome Tir Hospital, one of the main trauma centers in Tehran. The patients' files and the Picture Archiving and Communication System (PACS) were reviewed to collect demographic, clinical, and radiologic data. After identifying patients with post-operative (after DC) CSF circulation disorders, the relevant factors were determined using multivariate logistic regression.

Overall, seventy-nine patients were studied. The mean age of patients was 40.56±12.64 years and 82.3% were male. Forty-seven patients (59.5%) underwent DC due to traumatic causes and thirty-two patients (40.5%) due to vascular pathologies. In total, 36.7% (nineteen) of patients were affected by some degree of subdural hygromas of which 13 patients (44.8%) progressed to clinical and radiologic hydrocephalus. 19% (fifteen patients) developed hydrocephalus within the first six months after surgery. Considering the clinical variables, the GCS of patients was the only one that showed a significant relationship with CSF circulation disorders. Regarding radiological variables, the presence of intraventricular hemorrhage (IVH) was the only relevant factor. In addition, from the surgical perspective, performing duraplasty (autograft or allograft) and reoperation demonstrated significant relationships with CSF circulation disorders. The results of multivariate logistic regression showed that having intraventricular hemorrhage (OR, 6.15-6.9414: CI95%, P=0.003) and reoperation (75.91: OR, 3.88-3.6, 1485/43: CI95%, P=0.004) were two independent factors associated with hydrocephalus in DC patients.

In patients who have undergone decompressive craniectomy, intraventricular hemorrhage (IVH) and reoperation can be independent risk factors for CSF circulation disorders. Although the incidence and presence of IVH cannot be controlled, careful and meticulous surgical technique and skill can significantly improve the outcome of decompressive craniectomy by reducing the need for reoperation

Stroke survivors with right hemisphere damage exhibit specific working memory deficits, often manifested as difficulty recognizing visual targets during monitoring.

This study aims to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on working memory in stroke patients with
hemineglect.

This experimental study involved 60 stroke patients with hemiplegia, who were randomly divided into two groups: 30 in the rTMS (experimental) group and 30 in the sham group. Both groups received treatment with rTMS at 0.9 frequency, three times a week for 10 minutes over 15 sessions. In the sham group, the rTMS device was turned off after 30 seconds, leading participants to believe they were receiving real treatment.

The results indicated a significant difference between the pre-test and post-test working memory components for both the experimental and sham groups (P≥0.05). Additionally, the post-test comparisons revealed significant differences between the experimental and sham groups in terms of correct answers, unanswered cases, and response time (P≥0.05). Moreover, within the experimental group, the difference between post-test and pre-test scores for correct answers and errors was also significant (P≥0.05).

This study provides preliminary evidence that rTMS effectively enhances working memory in stroke patients with hemineglect, contributing to the expanding research on non-invasive brain stimulation in neurorehabilitation and underscoring the necessity for further investigation.

Stroke is the leading cause of death and long-term disability in adults, and ranks among the top causes of death worldwide, after cancer and heart attack. Following a stroke and a decrease in oxygen supply to brain tissue, changes occur in energy production mechanisms, leading to an increase in the production of free radicals. When the production of free radicals increases, the body's defense mechanisms become insufficient, making it possible for the body's biomolecules to be destroyed and cell function to be disrupted, which will ultimately cause a disruption in motor functions.

In this review, 70 articles indexed in scientific databases, including ISI, PubMed, and Scopus, were reviewed from 2018 to 2024. Eighty percent of these studies were conducted on animal models, and 20% were clinical studies. Given the importance of the topic, this review focuses on the protective effects of natural compounds on stroke-related damage.

Natural compounds, which have fewer side effects than other stroke-related drugs, may have significant protective effects in the treatment of stroke and improve the damage caused by it by affecting the complex processes that occur during a stroke.

By exhibiting anti-inflammatory effects, preventing edema, and reducing the volume of tissue damage, natural compounds can have protective effects on stroke and warrant further study as an ideal option.

The COVID-19 pandemic significantly affected the treatment and care of many patients. This study aimed to compare pre-hospital delays (the time from symptom onset until hospital arrival) and in-hospital delays (the time from hospital arrival until alteplase injection) in patients with acute ischemic stroke, both before and during the COVID-19 pandemic in Kashan, Iran.

In this cross-sectional study, 202 patients with acute strokes who were referred to Shahid Beheshti Hospital in Kashan, Iran, were included based on inclusion criteria using a census method. The data were collected over two one-year intervals: before (n=100) and during (n=102) the COVID-19 pandemic. The researcher compiled demographic and clinical information using a researcher-designed questionnaire, which was completed through patient medical files, the information system of the Kashan Emergency Medical Center, and communication with patients or their companions.

No significant differences were observed between patients before (n=100) and during (n=102) the COVID-19 pandemic regarding the time intervals between symptom onset and hospital arrival (pre-hospital delay), as well as the time from hospital arrival to CT scan (P≥0.05). However, the interval from hospital arrival to alteplase injection (in-hospital delay) during the COVID-19 pandemic was significantly shorter than that observed prior to the pandemic (P<0.05).

The interval from hospital arrival to alteplase injection significantly decreased during the COVID-19 pandemic. In contrast, the time intervals from hospital arrival to CT scan and from symptom onset to hospital arrival did not show significant differences.

stroke causes damage to the sensory and motor systems and motor and cognitive disabilities due to impaired blood supply to an area in the brain. The aim of the present study was to investigate the effect of exercises at home with functional overload on acute stroke patients.

In the present semi-experimental study conducted in 2024, as a pre-test and post-test with intervention and control groups, the statistical population included stroke patients referred to the clinic of Shohdai Eshair Hospital in Khorramabad. The statistical sample included 24 acute stroke patients who were randomly divided into two groups (intervention and control). In two stages of pre-test and post-test (after 12 weeks of training), leaf balance test, measurement of functional independence, dolly walking test and electromyography examination of anterior tibialis muscle and quadriceps femoris were performed in both groups.The collected data were analyzed using independent t and Kolmogorov-Smirnov statistical tests.

The balance examination with a significant level (p = 0.0001), in the walking test with a significant level (p = 0.0001) and in the functional independence test with a significant level (0.0001) p=0/) in the experimental group, the situation was better. Electromyography examination of quadriceps muscle nerve with a significant level (p=0.01) and anterior tibialis muscle nerve with a significant level (p=0.01) revealed that the muscle amplitude of the control group was better.

The results of the present study indicated that in addition to clinical exercises, home-based exercises using a weight or weight cuff improve independent performance, walking, and balance in acute stroke patients, which was associated with positive changes in muscle electromyography.

Identifying factors that influence the length of hospital stay for suspected stroke patients is crucial for optimizing the utilization of hospital resources. This study aimed to determine the factors associated with the length of hospital stay for suspected stroke patients transferred to Qaem Hospital in Mashhad through emergency services using survival analysis.

In this historical cohort study, general information was gathered for all suspected stroke patients who sought emergency services in Mashhad, the largest city in northeast Iran, from March 21, 2018, to March 20, 2019, and were then transferred to the Emergency Department of Qaem Hospital. Pre-hospital emergency data were integrated with hospital records using the mission ID. The primary outcome assessed in the study was the length of hospital stay, with model implementation carried out using the statistical software Stata.

The median hospitalization time until patients' recovery was  seven days. Out of the 578 participants, 386 cases (66.8%) recovered, while the remaining 190 cases (33.2%) were censored (83 individuals had died during the study, and 107 individuals had exited the hospital for other reasons). The average age of patients at the time of hospitalization was 71.13±13.01 years. Statistical analysis employing Log-rank and Breslow tests identified a significant difference in hospitalization duration among patients receiving various levels of care and based on their insurance status. During multivariate analysis, the Cox regression model was considered unsuitable due to some variables not meeting the proportional hazards assumption, leading to the utilization of AFT models. Following the evaluation of AFT models, including Log-normal, Log-logistic, Exponential, and Weibull, the log-normal model emerged as the most suitable choice, exhibiting AIC and BIC values of 1273.909 and 1356.740, respectively. Significant variables influencing length of stay included patient admission priority, insurance status, season, and residency status.

The study suggests that parametric survival models are effective for analyzing lifetime data. Additionally, in light of the significant variables identified, enhancing facility readiness and resource allocation could facilitate more efficient planning and implementation.

The emergence of thrombolytic drugs has opened new horizons in the treatment of patients with acute ischemic stroke, and this study was conducted with the aim of evaluating the barriers of receiving tissue plasminogen activator in patients with acute ischemic stroke in Imam Khomeini Hospital of Urmia.

This descriptive-analytical, cross-sectional study was conducted from April 21, 2015 to March 19, 2016 on patients with acute ischemic stroke referred to the emergency department of Imam Khomeini Hospital in Urmia using census sampling method. To collect data, a checklist containing demographic information was used. After collecting the data, it was entered into SPSS 18 and analyzed with the help of descriptive statistics.

In this study, the results showed that out of 100 patients, most of the participants were male (58%)58 and the rest were female, and the average age was 63.71±17.3 years, and 86% were in the age range of 18-80 years, which was the appropriate age to receive or thrombolytics. and the rest were over 80 years old. The fastest visit time was 25 minutes and the latest was 10080 minutes (168 hours). Among these 40 people, only four people (40%) were in the golden time period of thrombolytic drug, i.e. Three hours from the onset of symptoms to the final evaluation. Among the four people who were placed in the golden time, in 50% of the cases there was a history of taking anticoagulants, in 25% a history of head injury, in 50% of the blood sugar less than 50 and finally 1 person (25% of the people placed in the golden time) that is, 1% of all patients were eligible to receive rtPA. About 24% of patients had NIHSS<4 and 2% had NIHSS>25, and the average number obtained was 10.

The most important obstacle in the timely initiation of thrombolytic therapy is the delay in visiting the emergency room. Therefore, public education in order to improve the level of general awareness of the society can be effective in reducing this time delay.

Strokes are among the most destructive health problems. They can especially have detrimental effects on the occupational performance of sufferers. The experiences of patients suffering from stroke regarding the impact of the disease on their occupational performance, especially the barriers and facilitators of this performance, can help understand this phenomenon better and design client-centered interventions in this field. Nevertheless, a limited body of literature has investigated the encounters of these individuals and their familial caretakers within this domain. Therefore, the objective of this research is to synthesize the available research evidence regarding the experiences of stroke survivors and their family caregivers regarding barriers and facilitators of occupational performance after stroke.

All published articles were searched from 4 databases without a time limit according to the determined keywords. Among the 70 articles found, only 22 were included in the study and analyzed based on the quality indicators.

The analysis of extractive studies led to the emergence of two categories of barriers to occupational performance with subcategories of individual obstacles, contextual barriers, and rehabilitation barriers and facilitators of occupational performance with subcategories of educational strategies, development of environmental support, and strengthening of individual strategy. 

Clients with stroke have many barriers in their occupational performance, and the barriers that are related to the context of rehabilitation are significant. In addition to these important barriers, the existence of supportive and educational facilitators can help improve the client’s occupational performance. A better understanding of the factors related to the occupational performance of patients suffering from stroke requires more studies, especially in the relationship between the context and professional issues of occupational therapy and clients’ occupational performance.

The family caregivers of stroke patients experience a high care burden that has negative effects on their lives. Resilience is a factor that seems to be able to help them adapt to these conditions. The present study aims to determine the role of resilience in predicting the care burden of family caregivers of stroke patients.

In this descriptive-correlational study with a cross-sectional design, 194 family caregivers of stroke patients in Besat Hospital in Hamedan, Iran, in 2023 participated. The patients had moderate disability (A score of 61-90 based on the Barthel index). Participants were selected by a convenience sampling method. Data collection tools included a demographic form, Novak and Guest’s care burden inventory, and the Connor-Davidson resilience scale. Data analysis was done in SPSS software, version 25 using descriptive statistics, Pearson correlation test, and linear regression analysis.  

The age of caregivers was 42.53 years; 52% were male and 26.8% had a high school diploma. The mean scores of care burden and resilience were 86.35±13.09 and 42.56±10.38, respectively. The relationship between care burden and resilience was inverse and significant (P<0.05, r=-0.185). Resilience was found to be the predictor of care burden (β=-0.233). 

Given that resilience is one of the effective factors in reducing the care burden of the family caregivers of stroke patients, it is recommended that health care providers, by identifying effective strategies, help caregivers of these patients to strengthen their resilience to reduce their care burden and help them in caring for their patients.

Despite advances in medical treatments, readmission of stroke patients remains high and has been reported between 31% and 56.1% during the first year after discharge. The difference between the risk factors of readmission and the risk factors of stroke is not clear. The purpose of this study is: 1) to determine the preventable risk factors associated with stroke readmission and 2) to provide a conceptual model for preventable factors that effective in the readmission of stroke patients.

This integrated review was performed according to Whittemore and Knafl (2005) method in five stages including problem identification, literature search, data evaluation, data analysis, and presentation. In order to find relevant articles, PubMed, Web of Science, CINAHL, Scopus databases and Google Scholar search engine were searched. The search was conducted using the keywords "stroke," "readmission," "recurrence," "re-hospitalization," "review," and "systematic review," for the period between January 2023 and September 2023, following the PRISMA guidelines. In addition to providing a qualitative synthesis of readmission factors categorized into categories, a conceptual model of these factors was also presented.

Out of a total of 3785 article titles, 38 articles were included in the study for the final analysis after screening and removing duplicates. The most important risk factors for readmission in four categories: (1) knowledge deficit about the comorbidities (such as hypertension, atrial fibrillation, diabetes), (2) unhealthy diet and medicine, (3) high-risk behaviors (smoking, alcohol consumption, and tobacco use disorder), and (4) psychological distress (depression and worry about the future). In addition, the conceptual model showed that the most important preventable factor in readmission of stroke patients is of knowledge deficit about comorbidities (especially hypertension). 

The most important preventable risk factors that are effective in the readmission of stroke patients are knowledge deficit regarding clinical risk factors, especially high blood pressure, high-risk behaviors and unhealthy diet and medicine. Therefore, more detailed care and follow-up programs should be designed for stroke patients after discharge.

Post-stroke rehabilitation plays a crucial role in helping individuals regain motor functions and improve their quality of life. Recent advancements in technology, particularly the emergence of virtual reality (VR), have shown significant potential in enhancing the effectiveness of post-stroke rehabilitation programs. This study aims to explore the potentials and opportunities created by VR-based interventions in the post-stroke rehabilitation.

In this review study, a total of 349 articles related to the study objectives were obtained by searching databases including Web of Science, PubMed, Science Direct, and Google Scholar using the keywords "Rehabilitation," "Post-stroke," "Motion Disability," and "Virtual Reality" from 2015 to 2023. After conducting refinement steps, eliminating non-relevant studies, and aligning with the objectives of the present study, 67 articles were selected. The findings were analyzed, and the results were formulated in the current article.

The findings highlighted the potential of designing interactive multidimensional environments tailored to daily activities, and free from constraints and risks of real-world environments. Personalizing exercises according to each patient's specific condition, addressing psychological barriers, empowering and facilitating rapid patient adaptation to the virtual environment, providing tele-rehabilitation services and monitoring by specialized centers, as well as the ability to record and display progress in rehabilitation treatments were among the potential benefits of utilizing VR in rehabilitation settings.

Post-stroke rehabilitation utilizing VR as a treatment option, in line with technological advancements, offers an effective platform for the recovery of stroke patients. It allows each patient to choose their personalized treatment option in an engaging and motivating environment. By specifying the type, number, and intensity of exercises, receiving feedback on performance, and monitoring progress, patients can pursue the optimal path towards achieving their functional goals.

Caregiver burden reduces the stability of family caregivers of stroke survivors in life. Resilience helps them to strengthen stability and adapt to life's adversities. Due to the spread of Internet, It seems that providing educational interventions with virtual approach and aim of effectiveness on resilience and caregiver burden of caregivers, be useful.

In this clinical trial, 86 family caregivers of stroke survivors in Hamadan Besat Hospital were selected by convenience method and randomly assigned to intervention and control groups. Before the intervention, data were collected by Modified Rankin disability scale, demographic form, Connor-Davidson resilience and Novak & Guest caregiver burden questionnaires. Then, the intervention group received virtual training and telephone follow-up for a month. At the end of the intervention, two weeks and one month later, resilience and caregiver burden were re-examined. Data analysis was done by descriptive statistics, Independent t-test, Chi-Square, Fisher's Exact Test and Repeated Measure ANOVA in SPSS 25.

Before the intervention, there was no significant difference in resilience and caregiver burden between two groups. After the intervention a significant difference in direction of increasing resilience in the intervention group and decreasing it in the control group and also decreasing caregiver burden in the intervention group and increasing it in the control group, was observed (P < 0.001).

Considering the positive effect of virtual training and telephone follow-up on caregivers' resilience and caregiver burden, it is suggested that health care providers especially nurses, use this method in their training.

Brain stroke is the second most common cause of death and the first cause of disability in Iran. Most stroke-related deaths occur in low- and middle-income countries. This epidemiological study was conducted due to insufficient studies and generally with a small sample size in the country, aiming at identifying the main risk factors for stroke in East Azarbaijan province.

This cross-sectional study was performed using data gathered from 5430 patients with a definite diagnosis of brain stroke registered in the Tabriz Stroke Registration System (TSR) between February 2015 and June 2021 in the referral hospitals of East Azerbaijan. Analyses were performed using STATA software (version 17). Descriptive statistics were calculated, and a chi-square test was run. It is worth mentioning that any P<0.05 was considered statistically significant.

The epidemiological profile of the main risk factors was presented in the framework of clinical trials and findings, clinical risk factors, and behavioral risk factors associated with brain stroke. The mean age of the patients was 69.52±15.72 years; 47.15% were female and 52.85% were male. The most common risk factors include: having high blood pressure (67.81%), snoring (32.06%), diabetes mellitus (22.23%), familial history of stroke (18.78%), ischemic heart disease (17.55%), aspiration pneumonia (15.32%), smoking (13.65%), atrial fibrillation (10.15%), and hyperlipidemia (8.42%). Ischemic brain stroke (68.20%) was more common than hemorrhagic brain stroke (31.80%). Smoking was significantly higher in men than women (P<0.001). The prevalence of hypertension (P<0.001), atrial fibrillation (P=0.001), and hyperlipidemia (P<0.001) was significantly higher in women than men. There was a direct and significant relationship between atrial fibrillation and age (P<0.001) and female gender (P=0.001).

  The main risk factors for brain stroke include high blood pressure, snoring, diabetes mellitus, ischemic heart disease, aspiration pneumonia, smoking, atrial fibrillation, and hyperlipidemia, respectively. Hypertension is the most common risk factor among patients, so screening for asymptomatic cases is recommended. Educating people about common clinical manifestations can help expedite their early referral and treatment.

The present study aims to compare the effects of cognitive-behavioral therapy (CBT) plus transcranial direct current stimulation (tDCS) or pharmacotherapy on depression symptoms, inhibition and cognitive flexibility of stroke patients

This is a randomized controlled clinical trial with a pre-test/post-test/follow-up design. The study population consists of all stroke sufferers referred to Dr. Hashemzehi's clinic in Zahedan, south of Iran, in 2022. The samples were 45 eligible patients who were selected by a convenience sampling method and randomly divided into three groups of 15 including CBT+tDCS, CBT+pharmacotherapy, and control. To measure depression, inhibition, and cognitive flexibility, we used Beck’s depression inventory, go/no go test, and Stroop test in the pre-test, post-test, and 2-month follow-up phases. The CBT was provided at 12 sessions according to Kootker et al.'s CBT protocol for stroke patients. The tDCS program was 20 sessions of anodal stimulation over the left dorsolateral prefrontal cortex. The pharmacotherapy was the administration of 10 mg citalopram daily for three weeks. 

The results indicated the short-term and long-term effectiveness of both CBT+tDCS and CBT + pharmacotherapy in reducing depression symptoms (P<0.05), and there was no significant difference between their effectiveness of . Only the CBT+tDCS had a short-term effect on improving inhibition and cognitive flexibility. 

Both CBT+tDCS and CBT+pharmacotherapy (10 mg citalopram) can be useful for reducing depression symptoms in stroke sufferers.

Today, stroke is one of the most important challenges in human health and is one of the main causes of disability in societies. The Aim of this study was to investigate the pharmaceutical history of patients with stroke.

In this descriptive study, the records of patients admitted with a stroke diagnosis in Imam Khomeini Hospital of Urmia were examined regarding medical history. For this purpose, the records of 200 hospitalized patients in the first six months of 2019 were recorded in terms of the drugs used and the frequency of the drug classes. In addition, the variables of age, gender, and underlying diseases were also recorded and analyzed. In this research, incomplete or unreadable files were considered as exclusion criteria.

Our results showed that in terms of gender, 107 patients (53/5%) were men and 93 (46/5%) were women, and in terms of age, 13 patients (6/5%) were less than 45 years old, 76 patients (38%) were in the age range of 45-65 years and 111 patients (55/5%) were over 65 years old, which shows that men with the age of 65 years were more frequent. The examination of the underlying diseases of stroke patients showed that the most common underlying diseases include high blood pressure, diabetes mellitus, history of previous stroke, and ischemic heart diseases. In terms of drug history, the most used drugs were: atorvastatin, losartan, aspirin, metoprolol, and metformin.

The most drug classes used in the studied patients include statins, angiotensin receptor blockers, antiplatelets, beta blockers, and biguanides, most of which have protective effects on strokes. Also, high blood pressure and diabetes mellitus were the most frequent disorders in the examined patients, so it is suggested that these patients be screened and controlled more to reduce the incidence of strokes in the society.

Stroke is a sudden and unfortunate event that places a heavy care burden on individuals, families, and society. As the aging population grows and the number of underlying diseases in the elderly rises, the risk of experiencing this condition is also increasing. Chronic illnesses, because of their disabling effects, can impact every facet of a person’s life. Numerous stroke survivors are left managing at least one lasting issue from the stroke, and they are sent home from hospitals with this complication. At home, care will vary and will rely more on individual capabilities. Thus, the capacity to self-care is affected by numerous factors and can differ among individuals. This policy brief outlines strategies and solutions to enhance the well-being of elderly stroke patients.

Stroke is one of the most important causes of chronic pain. In patients with chronic pain medical therapy with analgesic drugs, anti-epileptic drugs, and serotonin receptor modulators is the first choice. However, for patients who are refractory to the usual medical treatments, different strategies have been proposed to treat these pains. One of these treatments involves the implantation of deep brain electrodes and deep brain stimulation in the thalamus nucleouses. In this article we are reviewing the first case done in Iran.

A 51-year-old male presented with sudden-onset left side hemiparesis and impaired sensation on the left side of the body, eight years ago. He complained of gradually developing pain on the left side of the body, adding to his symptoms. In his examination, he had dysarthria and his left extremities were spastic and their forces were decreased. Despite numerous medical treatments with gabapentin, pregabalin, duloxetine, carbamazepine and the replacement of an intrathecal baclofen pump during the last few years, he didn't respond very well. This goes so far as to induce severe depression symptoms, which disturbed his daily routine and even induced suicidal ideas. Due to the debilitating symptoms which were resistant to medical treatment, the patient underwent deep brain electrode implantation and deep brain stimulation in the ventral posterior lateral/posterior medial nucleuses in April 2023 at Imam Khomeini Hospital. No remarkable adverse effects were observed after implantation. In the patient’s follow-up, he had a significant improvement in pain and some other symptoms.

Deep brain stimulation of the thalamus nucleus is a known treatment in patients with Parkinson's disease and dystonia. However, for patients with chronic refractory pain, deep brain stimulation is a controversial therapy and has been introduced recently as an effective alternative treatment. In our patient, who suffers from severe unilateral refractory pain after stroke, a deep brain electrode was implanted and after deep brain stimulation significant improvement in pain was seen.

Fatigue is common after chronic stroke, which may cause upper extremity sensory-motor dysfunction, as well as decreased independence in activities of daily living (ADLs) and participation. This study aimed to investigate the effects of upper extremity exercises based on fatigue prediction on sensory-motor functions and ADLs in subjects with chronic stroke.

This is a pilot study. Twenty subjects with chronic stroke (11 male and 9 female) with mean age of 56±14.09 years and mean time since the stroke of 71.05±53.5 months were randomly assigned to either the control group (receiving conventional rehabilitation) or intervention group (receiving unimanual exercises based on fatigue prediction) using the Kinect Upper extremity motor function. Fine and gross manual dexterity, grip strength, shoulder and elbow proprioception, independence in ADLs, participation, and fatigue severity were assessed before the interventions, after the interventions (6 week, each weak 3 session, for 45 minute) and 6 weeks following the completion of the interventions (i.e. follow up). 

In both control and intervention groups, a significant improvement was observed in all assessments (P≤0.05), except for independence in ADLs. Moreover, the decrease in fatigue severity and improvement in fine manual dexterity was significantly greater in the intervention group compared with the control group (P≤0.05). 

The results of this study indicated that upper extremity exercises based on fatigue prediction led to an improvement in upper extremity sensory-motor functions, manual dexterity, and participation as well as a decrease in fatigue severity in subjects with chronic stroke.

Stroke is the second leading cause of death in the world. The aim of this study was to compare anxiety sensitivity, defense styles and ego strength in patients with stroke of Educational and Treatment of Valiasr in Zanjan city and healthy people in Zanjan.

The current research is descriptive-comparative. The statistical population of this research included stroke patients hospitalized in the Stroke Care Unit and Neurological Department of Educational and Treatment of Valiasr and healthy people in Zanjan city in 2019. In the present study, 280 people (140 people with stroke and 140 healthy people) were included in the study by non-random and convenience sampling method, with homogenization of age, gender and marital status. Data collection instruments included demographic questionnaire", "Anxiety Sensitivity Index", "Defense Style Questionnaire" and "Ego Strength Scale". The validity of "Anxiety Sensitivity Index" and "Defense Style Questionnaire" were sufficient for previous studies. For "Ego Capability Scale", the content validity index was evaluated by Waltz & Bausell method. The reliability of "Anxiety Sensitivity Index" and "Defense Style Questionnaire" were calculated by internal consistency method by calculating Cronbach's alpha coefficient and "Ego Empowerment Scale" was calculated by Kuder-Richardson method. Data analysis was performed in SPSS.24.

The two groups (patient and healthy) differ in terms of the components of "anxiety sensitivity index" with a significant level of value (P<0.01) and stroke patients have a higher mean. In the "Defense Style Questionnaire", stroke patients with a significant level of level (P<0.01) had a higher mean than healthy individuals in all three styles of development: immature, immature and neurotic. Also, the mean ego power in patients with stroke and healthy individuals did not differ significantly and both groups were moderate.

Anxiety sensitivity, defense styles were significantly different between the two groups of stroke patients and healthy individuals, and stroke patients had a higher mean, but in terms of ego strength, both groups were moderate. It is suggested that psychological interventions be used to prevent the consequences of this disease.

This study aimed to investigate a case of neuro-Behçet’s disease misdiagnosed as acute ischemic stroke or multiple sclerosis (MS). The studied case was a 29-year-old man with subacute onset of hemiparesis, dysarthria, and ataxia who was diagnosed as acute ischemic stroke at first. Due to no significant improvement, the patient was managed as an MS case, but he did not experience any improvements again. We noticed a history of oral and genital aphthous and cascade sign appearance in his brain MRI. Then, Behçet’s disease with secondary parenchymal involvement of brainstem was confirmed. The patient received infliximab, which resulted in clinico-radiological recovery.

Practical Implications.

 Given the prevalence of Behçet’s disease in the Middle East, the possibility of its diagnosis should be considered in patients with atypical history or imaging for ischemic stroke or MS.