فهرست مطالب

  • Volume:5 Issue:2, 2016
  • تاریخ انتشار: 1395/04/05
  • تعداد عناوین: 10
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  • Afshin Borhani, Haghighi Pages 1-2
    Stroke is a major health problem in Iran as other developing countries. Meanwhile, epidemiological characteristics of stroke in Iranian population are different with other countries. Both population-based and hospital-based studies showed that incidence and mortality of stroke in Iran is higher than most western countries [1,2]. Higher rates of patients with young-adult stroke in Iranian population are a prominent feature too [3]. In the same time, prevalence of cerebral venous sinus thrombosis is higher than western populations [4] but the frequency of the intracranial stenosis is more or less same as Europeans [5]. The high prevalence of atherosclerotic disease in Iran can be attributed to social and economic factors, including increased life span, changes in dietary habits and an increasingly sedentary lifestyle [6]. In the light of these changes, Iranian health policymakers should consider concerted primary and secondary preventive measures to reduce the impact of this increasingly problematic public health issue.
    Iranians who have had a stroke consider their social, financial and rehabilitative support to be inadequate. Moreover, awareness of the manifestations of stroke is poor in the Iranian general population [7]. Consequently, the clinical status of stroke patients by the time they are transferred to the referral center may be worse than it could have been. There is an urgent need for Iranian hospitals to develop better measures to manage acute stroke patients.
    The second international Iranian stroke congress was held from 23-25 September 2015 in Shiraz, Iran. This Conference was a joint effort of the Clinical Neurology Research Center of Shiraz University of Medical Sciences and Iranian Stroke Association.
    Here we presented some selected reviews from outstanding platforms of this congress. Ghandehari presented the epidemiology of stroke in Iran [8]. Safari et al presented a comprehensive review about immunology of stroke [9]. Abolhasani-Foroughi and Nazeri summarized the role of Computed topography scan for diagnosis and treatment planning of stroke patients [10].
    Lotfi discussed about pearls and pitfalls of color doppler sonography of cervical arteries [11]. We also have three reviews about clinical and radiologic aspects of cerebral venous sinus thrombosis [12-14]. Two reviews focused on importance of rehabilitation in new stroke era [15,16].
    Keywords: Stroke, prevalence, erebral venous sinus thrombosis
  • Kavian Ghandehari Pages 3-9
    Numerous hospital-based stroke registries have been developed in Iran during last decade. Khorasan Stroke Registry, Khorasan Posterior Circulation Stroke Registry, Khorasan Pediatric Stroke Registry and Khorasan Stroke in Young Adults Registry are among these published registries. Meanwhile, There is only one epidemiologic deigned study of stroke in Iran and Middle East. Based on this standard epidemiologic study; The crude annual incidence rate of First Ever Stroke (FES) is 139 (95% CI, 128 to 149) per 100 000; for men, 144 (95% CI, 128 to 159), and for women, 133 (95% CI, 118 to 148). The incidence rates increases significantly with each decade of life and is similar in men and women. Subtypes of FES in 81.9% of patients is ischemic stroke,12.7% is intracerebral hemorrhage, and 2.4% have subarachnoid hemorrhage. The crude annual incidence rate per 100 000 inhabitants is 113 (95% CI, 104 to 123) for ischemic stroke, 18 (95% CI, 14 to 21) for intracerebral hemorrhage and 3 (95% CI, 2 to 5) for subarachnoid hemorrhage. Ischemic strokes are occurring approximately 1 decade earlier in Iran than in other countries.
    Keywords: Stroke, Epidemiology, Iran
  • Anahid Safari, Rasool Safari, Afshin Borhani, Haghighi Pages 10-17
    Stroke, a multifactorial disease, has distinct pathophysiologic mechanisms, among which inflammation plays a pivotal role. Various types of inflammatory cells, substances, and molecules emerge in the ischemic stroke. Neutrophils, Tcell subtypes, macrophages, microglial cells, dendritic cell, mast cells, asrocytes, as influential cell, tumor necrosis factor_α, interleukin-17, interleukin-10, as released substances, and vascular cell adhesion molecule-1 (VCAM-1), leukocyte very late antigen-4 (VLA-4), and glial fibrillary acidic protein (GFAP), as cellular adhesion molecules. Lymphocyte's invasion to the ischemic brain tissue occurs as the result of VLA-4 ̶ VCAM-1 interaction. Regarding Tcell subtypes, CD4 cells have known detrimental effects in the ischemic area, while natural killer T cells (NKT cells) and γδ T cells have minor importance in the early stage of ischemia. While some studies proved the cerebroprotective impact of T regulatory cells, others refuted this by presenting a prominent harmful role of them. Bcells have important protective function by releasing IL-10. Neutrophils along with microglial cell, appearing as the first inflammatory cell in the ischemic tissue, and also macrophages deteriorate ischemia. Mast cells and dendritic cells are of great value in stroke progression. The resting astrocytes are neuroprotective, whereas the activated ones present detrimental function in the ischemic region by expression of GFAP. Hence, stroke consequences occur as the result of systemic inflammatory response. The more activation of this system, the poorer neurological outcomes would be observed. As expected, anti-inflammatory interventions in the experimental stroke in animals, have revealed successful results as less infarct size and attenuated neurological damages.
    Keywords: Stroke, Immunity, Immune system, Immune response, Cerebral ischemia
  • Amin Abolhasani Foroughi, Masoume Nazeri Pages 18-23
    In patients came with suspicious cerebrovascular accidents, CT scan can play a major roll for diagnosis and treatment planning. In these patients we can do non contrast enhanced CT scan followed by perfusion CT scan and CT angiography. This three step CT scanning can be called multimodal CT. This strategy can help us to roll out hemorrhage and other differential diagnosis, it is useful to detect the site of vascular occlusion, the infarcted zone and the at risk salvageable tissue, also we can assess collateral circulation. This multimodal CT scan take about 10 to 15minuts.
    Keywords: Cerebrovascular accident (CVA), Computed tomography, Brain CT Scan
  • Mehrzad Lotfi Pages 24-35
    Color Doppler study of carotid and vertebral arteries is a non-invasive, reliable and also easily available, cost-effective method for screening and follows up of patients at risk of stroke to differentiate patients need surgery or intervention from whom could be followed by medical management. I reviewed anatomy of cervical arteries and different techniques such as B- mode or gray scale scanning, color flow mapping and spectral analysis for evaluation of both carotid and vertebral arteries.
    Keywords: Color Doppler Sonography, Carotid, Vertebral, Stroke, Stenosis
  • Bahman Varavipour, Mohammad, Reza Gheini, Haniyeh Javanmardi Pages 36-42
    Intracranial arterial stenosis (ICAS) is one of the main causes of ischemic stroke According to western epidemiological studies, 8-10% of ischemic strokes are attributable to intracranial stenosis. Three modalities of treatment considered for intracranial atherosclerotic disease include; aggressive medical therapy, endovascular revascularization with angioplasty and stent, and extracranial-intracranial bypass surgery. At present, medical management should be the first line of therapy for the most patients with symptomatic intracranial arterial stenosis. Angioplasty and stenting can be considered in some patients that are unstable or have multiple ischemic events in the territory despite aggressive medical management.
    Keywords: Cerebrovascular accident, Stroke, Ischemic, Intracranial arterial stenosis, Angioplasty, Stenting
  • Mohammad Saadatnia Pages 43-47
    Early and correct diagnosis of cerebral venous and sinus thrombosis (CVST) is necessary for prompt management of this disorder. Neuro-imaging is a crucial part of diagnosis of CVST. I reviewed the findings of non-enhanced computerized tomography (CT), Contrast enhanced CT, CT venography (CTV), different techniques of magnetic resonance imaging (MRI), MR venography, and digital subtraction angiography. I also reviewed the potential pitfalls in image interpretation.
    Keywords: Cerebral venous, Sinus thrombosis, Computerized tomography(CT), Magnetic resonance imaging (MRI)
  • Golnaz Yadollahikhales, Afshin Borhani, Haghighi, Anahid Safari, Mohammad Wasay, Randall C.Edgell Pages 48-61
    Cerebral venous thrombosis (CVT) is occlusion of dural sinuses and/or cortical veins due to clot formation. It is a potentially life-threatening condition that requires rapid diagnosis and urgent treatment.
    Cerebral venous thrombosis is more common in females and young people. Pregnancy, postpartum state, contraceptive pills, infection, malignancy, hyper-coagulable state, rheumatological disorders, trauma are among the major etiologies of cerebral venous thrombosis. Headache, focal neurologic deficits and seizure were the most common clinical presentations. Different techniques of unenhanced and contrast enhanced brain computerized tomography(CT scan) and ,magnetic resonance imaging(MRI) are the most helpful ancillary investigations for diagnosis of Cerebral venous thrombosis.
    Specific treatment of the underlying cause of cerebral venous thrombosis should be considered as the mainstay of the treatment. Anticoagulation with heparin or low molecular weight heparinoids is the most accepted treatment. In acute phase, medical or surgical management to decrease intracranial pressure (ICP) is also recommended. If the patient's clinical condition aggravates despite adequate anticoagulation, thrombolysis or mechanical thrombectomy can be an additive option.
    Keywords: Cerebral venous thrombosis, Stroke, Hypercoagulable disorders, Virchow's triad
  • Sharareh Roshanzamir Pages 62-65
    The modern stroke rehabilitation programs focuses on specific bio-physiological targets. Modern rehabilitation programs mainly make use of its potential plasticity to compensate for injury. Constraint-induced movement therapy (CIMT), bilateral arm training, and task specific training of the paretic limb, are examples of rehabilitation techniques promoting brain neuro-plasticity. There are many tasks other than locomotor function to be addressed by rehabilitation team. Sensory deficits, speech deficits, dysphagia, memory loss, post stroke central pains and bowel and bladder derangements are among the most important of these challenges that makes a multidisciplinary approach to stroke patients necessary.
    Keywords: Stroke, Rehabilitation, Physical treatment, Neuroplasticity, Plasticity
  • Hooman Mahmoudi Pages 66-70
    During recent years, our understanding of recovery after stroke has changed dramatically. As a result, some new approaches and technologies have emerged to help stroke survivors improve even years after the accident. I am trying to introduce some of the most recent and scientifically investigated approaches and technologies used in stroke rehabilitation. Technologies and approaches such as intensive task-specific approach, repetitive Transcranial magnetic stimulation, transcranial direct current stimulation, virtual reality rehabilitation, robotic rehabilitation.
    Keywords: Stroke, Rehabilitation, transcranial stimulation, virtual reality rehabilitation, robotic rehabilitation