Caspian Journal of Neurological Sciences
Volume:8 Issue: 30, Jul 2022

Lumbar Canal Stenosis (LCS) is the most common reason for spinal surgery in older patients. Identifying factors influencing the outcome of surgical management is important in clinical research.

This study aims to identify the factors affecting the outcome of surgical management for LCS.

This prospective non-randomized cohort study was conducted at the spine center of Imam Khomeini Hospital in Tehran, Iran from March 2017 to January 2019 on 135 patients with symptomatic LCS, confirmed by MRI. Clinical and functional outcomes were measured using the 12-Item Short form Health Survey (SF-12), Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) the day before surgery, and 12 and 24 months after surgery. Radiographical parameters was assessed by measuring lumbar lordosis, sacral slope, pelvic tilt and pelvic incidence.

Of 135 patients, 120 completed the follow-up. Patients treated surgically had significant improvement in SF-12, ODI and VAS scores after 2 years of follow-up. Higher values of BMI (P=0.031), symptom duration >1 year (P=0.045 for SF-12, P=0.031 for ODI), and smoking (P=0.033 for SF-12, P=0.028 for ODI) were associated with poor outcome. Patients with higher pre-operative SF-12, ODI and VAS scores (P=0.007 for SF-12, P=0.003 for ODI, P=0.050 for VAS) and lower lumbar lordosis (P=0.055) showed significant improvement after surgery.

Patients with LCS showed significant improvement in outcomes after decompression surgery. Higher values of BMI, symptom duration >1 year, and smoking are associated with poor outcome, while higher pre-operative disability score and lower lumbar lordosis are associated with better outcome after surgery.

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.

Although pregnancy is a normal function in women, it is considered as a stressful experience which is associated with many psychological and physical changes in pregnant women.

This study aims to investigate and compare cognitive function in different trimesters of pregnancy.

This was a longitudinal cohort study. Participants were 76 pregnant women with a mean age of 30.09±6.23 years referred to Al-Zahra Hospital in Rasht, Iran during 2019-2020. Participants were assessed in three trimesters of pregnancy using the Wechsler Memory Scale (WMS) and Mini-Mental State Exam (MMSE). The multilevel mixed-effects linear regression and repeated measures ANOVA were used for data analysis. All analyses were done in SPSS software v. 19 and Stata v. 14.

The mean score of WMS was significantly lower in the third trimester (84.95±12.07) than in the first and second trimesters (89.34±13.13 and 88.72±13.24, respectively) (P=0.001). The results of linear regression analysis showed no significant difference in MMSE score between different trimesters of pregnancy (P>0.05), while the WMS score was significantly different between different pregnancy trimesters; the change in WMS score was statistically significant only in the third trimester (P= 0.04).

No impairment in general cognitive function occur during pregnancy, but memory impairment may occur. In the third trimester, pregnant women have the poorest memory function.

Electroconvulsive Therapy (ECT) is a successful treatment option for various psychiatric disorders. It is performed under general anesthesia where succinylcholine is the preferred muscle relaxant in this process. However its several contraindications and potential adverse effects, and the fact that it is not always available should be considered. Therefore, finding an effective and safe alternative is crucial.

This study aims to assess the safety and efficacy of atracurium in ECT.

This single-blind clinical trial was conducted at Shafa hospital affiliated to Guilan University of Medical Sciences from November 2020 to April 2021. Participants were 67 eligible patients with ECT, randomly assigned into two groups receiving succinylcholine (0.5 mg/ kg), and atracurium (0.2 mg/kg). Seizure duration, hemodynamic parameters, the time to return to spontaneous breathing, and recovery time were assessed and compared between the two groups.

Seizure duration was longer in the succinylcholine group (P=0.071), while the time to return to spontaneous breathing (P=0.0001) and the recovery time (P=0.0001) were significantly longer in the atracurium group. The trend of changes in the Mean Arterial Pressure (MAP) and Heart Rate (HR) were significant over time; however, the difference between the two groups was significant only in HR one minute after the seizure induction (P=0.001). None of patients was reported serious adverse effects.

When succinylcholine can't be used, atracurium can be a safe alternative in the ECT process.

One of the most common symptoms of COVID-19 infection is Olfactory Dysfunction (OD).

This study aims to investigate OD and phantosmia in COVID-19 cases from northern Iran.

In this cross-sectional study, participants were 400 patients with COVID-19 infection in Rasht, Iran from March 2019 to September 2020. All the patients were evaluated in terms of OD and then followed up for 3 months face-to-face, by telephone call, or online.

Among 400 patients, 37.75% had OD (19% hyposmia, 10.75% primary phantosmia, and 8% anosmia) during the initiation of the disease, but 121 (30.25%) including nearly 65% of anosmic and/or hyposmic cases reported phantosmia at different time intervals of followup visits. Moreover, 65.38% of patients reported acute onset of OD. The prevalence of OD was significantly higher in patients aged <40 years (P=0.001) and in females (P=0.002). OD improved in about 90% of patients within 3 months. Peripheral oxygen saturation was better in anosmic cases and C-reactive protein level was higher in normosmic cases at their first visit. No significant difference was found in terms of other laboratory results.

OD is a common complication of COVID-19 infection, but seems not to be permanent. It is more common in young patients, females, and those with mild COVID-19 infection.

Knowledge of the functional balance tests for the patients with Multiple Sclerosis (PwMS) may provide useful and accurate information about the balance function of these patients under different situations.

This study aims to review the functional balance tests for PwMS.

This is a systematic review. The search was conducted in PubMed, Scopus, LILACS, CINAHL, CENTRAL, Web of Science, PEDro, and Google Scholar databases on relevant studies published until November 2021.

Twenty-five articles and 25 different tests were found to evaluate the functional balance of PwMS. It was found that the studies used 6 tests to assess the static balance, 13 tests to assess dynamic balance, and 6 multi-item tests to assess functional balance in PwMS. Single-leg stance test, balance error scoring system test and steady stance test is a test battery for static balance; six-spot step test, timed up and go test, and figure-of-8 hop test are better for dynamic balance, and the balance evaluation systems test is a better multiitem test to assess the balance of PwMS by examining the postural control components.

Single-limb standing test, balance error scoring system (BESS) test and steady stance test provide accurate data on static balance; six spot step test, Timed Get up and go test and figure-of-8 hop test provide valuable data on the dynamic balance and Balance Evaluation Systems Test (BESTest) is a valid test to assess the balance of PwMS from the perspective of the review of posture control components.

Von-Willebrand Disease (VWD) is the most common inherited bleeding disorder with an autosomal inheritance pattern. Multiple Sclerosis (MS) is a neurological disease, causing neurodegeneration and demyelination of the central nervous system through autoimmune mechanisms, and is a major cause of non-traumatic disabilities in youths. Some studies have shown the higher plasma activity of Von-Willebrand Factor in the active phase of MS. However, we could not find any study reporting co-occurrence of VWD and MS.

 In this case report, we present a woman with VWD who had optic neuritis 8 years ago and a new onset right-side hemiparesis. She was finally diagnosed as a new case of MS.

There is a case of both VWD and MS; however, further investigation is needed regarding the association of VWD and MS.

Knowledge about Immune-Mediated Necrotizing Myopathy (IMNM) has received significantly attention in recent years. In this study, we report a rare case of IMNM with increased Creatine Phosphokinase (CPK) and positive Signal Recognition Particle (SRP).

The case was a 67-year-old male patient referred to Firozgar hospital affiliated to the Iran University of Medical Science, Tehran, Iran in June 2018 with a chief complaint of pain in the proximal lower extremity. According to Medical Research Council Scale for muscle strength, the motor function of proximal upper extremities was 4/5 and for the proximal of the lower extremities, it was 3/5. Laboratory findings showed an increase in CPK, CK-MB, lactate dehydrogenase, creatinine, alanine aminotransferase, aspartate aminotransferase and aldolase levels. Six days after admission, autoantibody test was requested which showed positive SRP. In muscle biopsy, the myopathic atrophy with multiple necrotic and many degenerative/regenerative fibers was associated with mild endomysial fibrosis, and no inflammation was observed. Two g/kg dose of Intravenous Immunoglobulin (IVIG) was administrated after diagnosis of IMNM. Prednisone 50 mg/day orally, calcium vitamin D daily, pantoprazole 40 mg/day, physiotherapy, and occupational therapy were administrated for after discharge.

Reporting a case of anti-SRP associated IMNM and reviewing its pathophysiology, diagnosis and treatment options can help increase the physicians’ knowledge of this rare and debilitating condition.