Journal of Research in Medical Sciences
Volume:18 Issue: 3, Mar 2013

Alzheimer''s disease (AD) is a progressive neurodegenerative disease in which endothelial cell (EC) can be affected. In brain, functional changes in ECs contribute to reductions in resting blood flow. Furthermore, angiotensin-converting enzyme inhibitors (ACE-I) have beneficial effects on endothelial dysfunction. This is the first study that presents direct experimental evidence associating endothelial apoptosis as a basis of AD pathogenesis and response to an ACE-I therapy. Human umbilical vein ECs (HUVECs) were treated with sera from AD patients and sera from healthy volunteers (each group, n = 10). Apoptosis was determined by annexin V–propidium iodide staining and cell death detection kit. The effect of 50 µM enalapril on endothelial apoptosis was assessed. Nitrite (NO2−) levels were determined in the culture supernatants. Enalapril suppressed the induction of apoptosis by the serum of patients only when used before treating HUVECs with the sera of AD. Mean ± SD of apoptosis induction in the control group was 6.7 ± 3.69; in the group treated with sera of AD for 24 h was 47.78 ± 0.65; in the group wherein sera from AD was added (pretreatment) after exposure of HUVECs by 50 µM enalapril for 24 h was 26.6 ± 2.63; and in the group wherein HUVECs were exposed in the sera of AD for 24 h and then 50 µM enalapril was added to these cells for another 24 h (post-treatment) was 56.87 ± 5.51. Also, the mean ± SD of NO2− concentration showed significantly greater levels of dissolved NO2/NO3 metabolite in the culture media of untreated HUVECs by enalapril (1.03 ± 0.06) as compared with control (0.26 ± 0.13; p < 0.05), while the rate of nitric oxide (NO) significantly decreased when enalapril was presented in culture both in the pretreatment (0.07 ± 0.003) and in the post-treatment group (0.06 ± 0.005; p < 0.05). It could be concluded that EC treated with sera from AD patients activates apoptosis in HUVECs; this effect was reversed by enalapril pretreatment. This can be proposed as a therapeutic approach for Alzheimer`s patients.

There are contrary results about the role of CACNA1A gene in the causation of common migraine in different populations. However, migraine may be genetically heterogeneous and more studies in different families and populations are required for a definite conclusion. The aim of this study was to surveyed leukocyte genomic DNA mutation of CACNA1A in Iranian migraine patients with [MA] and without aura [MO] who has family history of migraine and we performed a narrative review of all studies that evaluated CACNA1A gene, non-hemiplegic migraine [MA and MO] and FHM [familial hemiplegic migraine]. The 30 patients with family history of migraine were selected for mutations analysis for CACNA1A gene by PCR method. For review, we searched MEDLINE-PUBMED, ISI, Scopus and Cochrane databases up to December 2012. Mutation analysis of the 4 exons of the CACNA1A gene in these patients revealed no mutations in this gene. Direct sequencing revealed a polymorphism previously reported G to A transition in the exon 16 [nt2369, G→A] in 9 patients. In review, the correlation of FHM loci [CACNA1A gene] with MA and MO has been showed in different population and only small population from Caucasians presented this correlation. CACNA1A is most likely not a major susceptibility gene for common migraine in Iranian maigrainous. It’s essential to study more on larger series and covering all 47 exons of the CACNA1A gene to confirm this hypothesis.

Migraine is a common neurological disorder with a significant genetic component. Less information is known about the contribution of minor genetic variations, such as single nucleotide polymorphism (SNP) on the migraine process. In the present study, we aim to investigate the role of CACNA1A gene polymorphism on severity and related factors in family positive migraine patients. We included 74 common migraine patients consequently. Headache severity was evaluated according to Headache Impact Test (HIT6) questionnaire and quality of life of patients was investigated according to MSQ (Migraine-Specific Quality of Life Questionnaire v2.1) questionnaire. Thirty patients with positive family history of migraine were selected and sequencing analysis after DNA extraction was performed. Direct sequencing revealed a known SNP G to A transition in the exon 16 (nt2369, G→A) in 9 patients. There was no significantly correlation between polymorphism and type of migraine, severity, frequency, duration and quality of life in family positive migraine. Evaluated migraine severity by HIT6 questioner couldn’t act as a risk factor for this polymorphism (OR: 0.93, CI%95 0.82-1.06 P value=0.3). In Iranian population no significant association was seen between Thr698Thr (nt2369) polymorphism and head pain severity in familial migraine. Confirmation of this hypothesis needs further investigation.

Aging induces physiological changes and affects all of organs. Nutritional status and mental health deteriorate with aging. As malnutrition and depression are main problem in elderly this study was performed to assess the association between malnutrition and depression among rural elderly. Three hundred and seventy rural elderly aged over 60 years were examined in a cross-sectional study by systematic sampling method and using mini nutritional assessment (MNA), which is a standard questionnaire for evaluating nutrition status. Depression was evaluated by a validated questionnaire in the elderly. Correlation between Socio-demographic characteristic, diseases, and nutrition status was obtained by t-test, Chi-square test and logistic regression in elderly population. Mean ± SD age was 70.6 ± 7.3 years. Frequency of malnutrition was similar in both genders. According to MNA, 3.8% of subjects suffered from malnutrition, 32.7% were at risk of malnutrition and 63.5% were well-nourished. Nutrition status correlated with body mass index (P = 0.028) and depression (P = 0.001).The risk of severe depression in patients with malnutrition was 15.5 times higher than non-depressed persons (OR: 15.5; 95% CI: 2.9-82.5). Depression could act as a powerful risk for malnutrition in elderly population that it should be controlled by physicians.

previous studies confirmed that neural gene expression in embryonic stem cells (ESC) could influence by chemical compounds through stimulating apoptotic pathway. We aimed to use ESCs-derived neural cells by embryoid body formation as an in vitro model for determination of neural gene expression changes in groups that treated by sera from Alzheimer’s patients and compare with healthy individuals. ESC line which was derived from the C57BL/6 mouse strain was used throughout this study. ESC-derived neural cells were treated with serum from Alzheimer’s patient and healthy individual. Neural gene expression was assessed in both groups by quantitative real-time polymerase chain reaction analysis. The data was analyzed by SPSS Software (version 18). Morphologically, the reducing in neurite out-growth was observed in neural cells in group, which treated by serum from Alzheimer’s patient, while neurite growth was natural in appearance in control group. Microtubule-associated protein 2 and glial fibrillary acidic protein expression significantly reduced in the Alzheimer’s patient group compared with the control group. Nestin expression did not significantly differ among the groups. Neural gene expression could be reduced in serum treated ESC in Alzheimer''s patients.

To evaluate seizure characteristic among multiple sclerosis patients with coexistent seizure activity compared to control group. This study is a cross-sectional study which was conducted by reviewing the clinical records of patients with definite diagnosis of MS according to McDonald’s criteria from March 2007 to June 2011, who referred to the MS clinic of the university. A total of 920 patients with a diagnosis of MS were identified, among whom 29 patients (3.15%) with seizure activity (case) due to MS with the mean age of 32.6 ± 6.23 years were analyzed. Also, fifty MS patients without any seizure occurrence with the mean age of 33.7 ± 7.4 years were used as our control group. In case group, seizure was general tonic clonic in 23 patients (79.3%), complex partial in four (13.8%), and simple partial in two (5.9 %). The 26 available interictal EEGs in MS patients showed abnormal EEG pattern in 22 (84.6%) of them, including focal epileptic form discharge or focal slowing in 10 (38.5%), generalized discharge (spike-wave, polyspike, or general paroxysmal fast activity) in 10 (38.5%), and general slowing activity in 10 record (38.5%). MRI reviews of the 26 available brain MRIs showed subcortical white mater lesions in 22 (84.6%) of patients with seizure. All MRIs were performed within one month after the first seizure episode.Amongst 48 available MRIs in our control group, 91.7% (44 cases) showed periventricular lesions and in 8.3% (4 cases) subcortical white matter lesions were reported. The results of this study demonstrated that seizures occur mostly in early stages of MS and most of them have a benign nature with good responses to antiepileptic treatment.

Headache is one of the most common complaints during medical curriculum and it occurs due to numerous psychological and physical stressors, which are more common in medical students than general population. The purpose of this study was to evaluate the frequency of different types of headache and associated factors. This cross-sectional study was conducted in Isfahan University of Medical Sciences, from September 2011 to January 2012. First- to seven-year medical students who have experienced some forms of headache in their life and had headache attacks during the past 6 months were included in this study. All medical students completed a structured check list, which consisted of demographics data, associated factors, and headache characteristics. A total of 480 (258 [53.8%] males and 222 [46.2%] females) students (93.7%) were evaluated. The prevalence of headache was 58.7%, the prevalence of migraine, and tension-type headache was 14.2% (10.5% in male vs. 18.5% in female, P = 0.08) and 44.2% (49.2% in male vs. 39.2% in female, P = 0.006), respectively. A family positive history was found in 9.5% of students with headache. The lower socio-economic status, year of study (3rd and 5th year students), was seemed to had higher prevalence in students with headache. There was no significant difference between headache and concomitant disease. The results demonstrate that prevalence of headache is high among medical student. Socio-economic and the year of study might be significant factors in the prevalence of headache. Further multicenter studies would be necessary to evaluate headache epidemiology among medical students in the whole country.

The study on transcranial sonocraphy (TCS) as a diagnostic test for Parkinson’s disease (PD) has been neglected in some hospitals. The current study was conducted as the first study to investigate the utility of TCS for diagnosis of PD and its ability to distinguish PD from essential tremor (ET) in an Iranian population. TCS of substantia nigra (SN) was performed on 50 PD, 48 ET, and 50 healthy controls by two blinded investigators. Bilateral SN margin over 0.20 cm2 was found in 39 (90%) and 7 (15%) in PD and ET patients, respectively. Furthermore, 4 (8%) of healthy control displayed this particular echo feature as well (false positives). SN hyperechogenicity ≥0.20 cm2 was considered as a cut-off point to detected PD. Accordingly, TCS proved 90% (95% confidence interval [CI]: 77.85-97.35) sensitive and 92% (95% CI: 80.75-97.73) specific for the detection of PD by visualizing the SN. SN hyperechogenicity ≥20 cm2 is a specific feature of PD. Since, the symptoms of PD and ET might be overlapping; this method seems to be reliable to confirm PD diagnosis in doubtful clinical cases. Further studies in years to come are warranted to shed light on standardized data for Iranian to enhance the validity of TCS.

Epilepsy is the second most common type of chronic neurological disease. Its diagnosis carries an excess mortality, which is 2-3 times higher than that of general population. Mortality rates are increased among patients with uncontrolled seizures. The aim of this study was to characterize the electrocardiogram (ECG) changes during pre-ictal, ictal and post-ictal states in pharmaco-resistant epilepsy patients. This retrospective study conducted by Department of Neurology and Department of Cardiology of Isfahan Medical University from September 2008 to December 2012, patients with medically refractory epilepsy who underwent standard pre-surgical assessment from Epilepsy ward of Kashani hospital in Isfahan city were recruited in this study. The heart rate (HR) varied significantly throughout the record. Significant difference in HR was identified between ictal and pre-ictal periods (P = 0.000), furthermore, the difference between ictal and pre-ictal HR {mean = 63.867 ± 0.061, P = 0.000}, ictal and post-ictal HR {mean = 38.833 ± 0.067, P = 0.003}, and between pre- and post-ictal HR {mean = 25.033 ± 0.089, P = 0.000}, was significant. ECG monitoring should be a part video- (electroencephalography) EEG monitoring to identify serious cardiac abnormalities, particularly in patients with refractory epilepsy.

This study was aimed at assessing the accuracy of Provocative Tests in diagnosis of acute or chronic Cervical Radiculopathy (CR) based on an electrodiagnostic reference criterion. Shoulder Abduction Test (SAT), Spurling Test (ST), Upper Limb Tension Test (ULTT), and electromyography were done on 97 patients who referred to Electrodiagnostic center in the university hospital from January 2010 to March 2011. All of the participants had neck and radicular pain for at least 3 weeks. They were classified according to electrodiagnostic findings. Then diagnostic values of provocative tests were assessed in diagnosis of acute or chronic CR on the basis of reference criterion. SAT and ST were more specific (85%) compared to ULTT, while ULTT was more sensitive (60.46% in acute and 35.29% in chronic) than the other two. SAT and ST had a significant accuracy for comparison between acute and chronic CR (P<0.05). ULTT is suitable for screening of CR, while SAT and ST can support diagnosis. SAT and ST are good diagnostic tests for comparison between acute and chronic CR.

Vitamin D insufficiency and serum calcium disturbance have been reported to be more common in Parkinson’s disease (PD) patients than in healthy control subjects, which may be due to a chronic disease or reduced mobility contributes to these relatively disturbances. Because of the high-vitamin D insufficiency in our population, we aimed to compare a biochemical levels which are related to bone metabolism, in PD patients in comparison with age-matched healthy controls, for the 1st time in a Middle East population. This case-control study was involved 105 (20 were excluded) PD patients, who were age- and -sex matched with 112 controls. 25-hydroxyvitamin D (25OHD) and parathyroid hormone analyzed by enzyme immunoassay; another laboratory data including, calcium, phosphorous, and alkaline phosphatase were performed by spectrophotometric methods. There was no significant difference in 25OHD between PD patients and control group (P = 0.071). 25OHD level was not significantly different in PD patients compared to controls {odds ratio 1.003, (confidence interval [CI], 0.98-1.02), P value 0.793}. None of the other biochemical levels did not induce more chance for PD, only we observed in men has more risk of PD than women (odds ratio 2.53, [CI, 1.27-5.03], P value 0.008). Our data do not support a possible role of vitamin D insufficiency in PD. Regarding to variable changes in biochemical markers in PD patients than in controls; further studies are suggested to determine any plausibility role of them as a causal relationship or as an outcome of PD.

Steroids are commonly used in the treatment of cervical radiculopathy (CR), but there is limited information in this regard. We evaluated the efficacy of oral prednisone in the treatment of CR. This randomized, double-blinded, placebo-controlled trial was conducted on adult patients with neck/shoulder pain for at least 1 month with no alarm symptoms/sings of malignancy, infection, or severe myelopathy, and no contraindication for corticosteroid use. Patients were allocated to receive prednisolone 50 mg/day for 5 days that was tapered within the following 5 days, or placebo. All patients also received acetaminophen 325 mg three times a day and ranitidine 150 mg two times a day. Neck disability index (NDI) and the verbal rating scale (VRS) were used to evaluate the outcomes. A total of 59 patients (31 female, mean ± SD age = 46.2±9.0 years) completed the study. A significant decrease was observed regarding the NDI and VAS scores from baseline to the end of study in both groups (P < 0.001). However, for both the NDI (35.7±21.4 vs. 12.9±10.2) and VRS (4.4±2.7 vs. 1.6±1.2), the amount of decrease was greater in the prednisone compared with the placebo group (P < 0.001). Based on the clinically important change in NDI, pain was improved in 75.8% (22/29) of the prednisolone and 30% (9/30) of the placebo group (P < 0.001). A short course of oral steroid therapy with prednisolone is highly effective in reducing pain in patients referring with uncomplicated CR. Further studies are warranted on dosing, duration, and long-term efficacy and safety of oral steroid therapy, compared with injection approach.

Neuropsychiatric abnormalities are among the most common manifestations of systemic lupus erythematosus (SLE). They have been proposed to be associated with impaired cerebral blood flow (CBF). Cerebral vasomotor reactivity (VMR) is a hemodynamic parameter effective in the autoregulation of CBF. The aim of the present study is to determine and compare the VMR of women with stable SLE and normal women. According to the study criteria 60 women in each group entered the study. VMR was evaluated with Transcranial Doppler (TCD) at rest and after one minute of breath holding. There was no significant difference in the mean of age between two groups (31.76 ± 7.50 years in the SLE group versus 32.43 ± 4.55 years in the control group, p-value: 0.64). The mean duration of SLE in the case group was 5.40 ± 3.60 years. The means of the Breath-Holding Index (BHI) in the SLE and control groups were 0.842 ± 0.72% and 0.815 ± 0.26%, respectively, which was not significantly different (p-value: 0.82). This study indicates that the VMR of women with stable SLE is not significantly different from the age- and sex-matched normal population. However, further investigations on patients with longer SLE duration and more neuropsychological abnormality rates are suggested.

Stroke is one of the most common causes of disabilities and death all over the world. The mortality rate of stroke is predicted to be doubled by 2030 in the Middle East countries. Nutrition is an effective strategy in prevention and management of stroke. This study assessed the relationship between various protein types and stroke risk. This hospital-based case-control study was performed in a University hospital. The data regarding consumption of usual food intake of 69 cases (46 men and 23 women) and 60 controls (30 men and 30 women) was collected with a food frequency questionnaire (FFQ). The mean consumption of red and white meat and vegetable and processed proteins consumption were compared between two groups. The percent of total of daily protein intake were lower in patients with stroke in both sexes (25.92% vs 30.55% in men and 30.7% vs 31.14% in women). Lower protein consumption may be observed in patients with stroke patients in both sex.

Experimental studies provide evidence of a relationship between stroke and mineral intake but this information in human are still limited and inconsistent. The purpose of this study was to investigate sodium, calcium and iron intake and stroke in Iranian patient and control population. In a case-control study with 46 stroke men (aged 56±18 years) and stroke women (aged 52±7 years) and 60 healthy people, we investigated the sodium, calcium and iron intake inthe patients. after adjustment for age,sex and cardiovascular disease we found that a high sodium intake was associated with a statistically significant higher risk of stroke (P< 0/05). We saw a significant association between iron intakes in men (P< 0/05). And calcium was not significant associated with risk of stroke (P for trend >o/o5). These findings in men and women suggest that a low sodium intake may play a role in primary prevention of stroke.

Stroke happens when blood flow to parts of brain stops. Stroke is sometimes called «brain attack.» Risk factor is something that increases the chance of getting a disease. Some risk factors for stroke cannot be changed, but some can be altered. The chance of stroke is higher in people who live an unhealthy lifestyle by: Being overweight as a result of over-eating, eating too much fat, smoking, etc. Therefore, we compared the fat intake between patients with stroke and normal population. Sixty nine patients with stroke (46 men and 23 women) as cases and 60 subjects (30 men and 30 women) as controls during April 2009 and May 2010 from Alzzahra hospital, Isfahan, Iran were evaluated. Dietary intakes were collected using a food frequency questionnaire (FFQ) through their close relatives such as spouse, daughter or mother. Also, anthropometry measurements such as weight, height and waist extracted from their medical files, however, body mass index (BMI) and waist to hip ratio (WHR) were calculated. The intake of saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) both in men and women with stroke were significantly higher than controls (P = 0. 04 and P = 0. 03 for men and P = 0. 05 and P = 0. 02 for women, respectively). Also, the mean intake of hydrogenated fats, butter, cream, mayonnaise sauce and nuts were higher in men with stroke with respect in control group; while, women with stroke consumed more hydrogenated fats, vegetable oils, cream and mayonnaise sauce than controls. Increased fat intake was observed in patients with stroke compared with normal population.

Exposure to some environmental agent such as different nutrition and contact with allergens may have a role in developing multiple sclerosis (MS). The present study was aimed to evaluate the cow’s milk allergy (CMA) in MS patients compared to healthy controls. Between March 2012 and July 2012, 48 MS patients were selected and compared with 48 healthy subjectsto assess the frequency of CMA in MS patients compared to healthy control.Cow’s milk specific immunoglobin E (IgE) was determined by Immuno CAP. Sex and the frequency of CMA were compared between study groups by Chi-square test. Total of 96 subjects were assessed (22% male and 78% female). The mean age of the study subjects was 30.8± 6.6 years. Mean age of case and control groups was 30.7 (±6.9) versus 30.9 ± 6.3, respectively (P value = 0.83). There were no detection of cow’s milk specific IgE in serum of MS patients and healthy subjects. There was no difference between MS and healthy subjects regarding CMA.

Migraine is common worldwide. In recent years, vitamin D deficiency has been determined as a global health problem. A few studies have shown inverse relationship between serum vitamin D levels and headache. Thus, in this study, we assessed relationship between serum vitamin D levels with migraine. The present study was a cross-sectional. Seventy-six migraine patients aged 10–61 years were included. The multiple linear regression was used to show association between serum 25-0H-D3 and migraine. Adjustments were performed for age, sex, waist circumference, body mass index (BMI), number of chronic diseases, and education level. The positive weak relationship was observed between serum vitamin D and headache diary result (P=0.042, r=0.19). But, no significant relationship was observed between serum vitamin D and migraine severity (P=0.741). High levels of serum 25-OH-D3 was related to higher headache diary result. After adjustment for confounding variables, this significant association remained. No significant relationship was shown between serum vitamin D and migraine severity.

Circadian rhythm sleep disorders are a presentation of sleep disorders in patients with multiple sclerosis (MS). This study aims to compare this problem in MS patients with healthy people and to determine its association with chronic fatigue in MS patients. A case-control study was performed on 120 MS patients and 60 healthy subjects matched for age and sex, in 2009 in MS Clinic Alzahra Hospital. Sleep quality, rhythm and fatigue severity were assessed using PSQI (Pittsburgh sleep quality index) and FSS (Fatigue severity Scale) questionnaires, respectively. Its reliability and validity has been confirmed in several studies (Cronbach’s alpha = 0.83). This index has seven sections including patient’s assessment of his/her sleep, sleep duration, efficacy of routine sleep, sleep disorders, use of hypnotic medication, and dysfunction in daily activities. Circadian rhythm sleep disorder was more frequent in MS patients relative to healthy subjects (P: 0.002). It was higher in MS patients with severe fatigue relative to MS patients with mild fatigue (P: 0.05). Fatigue severity was 49.9 ± 8.2 and 22.5 ± 7.4 in the first and second group, respectively. PSQI index was 7.9 ± 4.5 in patients with severe fatigue and 5.9 ± 4.5 in patients with mild fatigue and 4.5 ± 2.4 in the control group (P: 0.0001). Circadian rhythm sleep disorders are more frequent in MS patients and those with fatigue. Recognition and management of circadian rhythm sleep disorders in MS patients, especially those with fatigue may be helpful in improving care of these patients.

One of the frequent symptoms of Multiple Sclerosis (MS) is tremor which can severely cause disability. Treatment of tremor in MS patients is still very challenging to manage. In this study, we sought to determine the efficacy of Levetiracetam on treatment of MS-related tremor. This clinical trial study was conducted among 22 patients from July 2012 to April 2012 in Alzahra-Hospital, Isfahan, Iran. Patients were given 500 mg Levetiracetam twice a day for 1 week. The drug dosage increased 1000 mg per week until reaching the peak dose of 50 mg/kg. After a 2 week period of washout, first phase was repeated. The subjects were assessed at baseline, after first intervention, after wash-out period, and after second intervention. A total of 20 patients (17 females and 3 males) were enrolled in our study. There was a significant difference among tremor rate before and after intervention (P=0.001). The drug was well tolerated and without any serious side effect during follow-up. Our findings suggest that although Levetiracetam caused a decrease tremor rate in MS it surged again after washout period.

Carbamazepine has been used as AEDs since 1965, and is most effective against partial seizures. Two basic mechanisms of action have been proposed: 1) enhancement of sodium channel inactivation by reducing high-frequency repetitive firing of action potentials, 2) and action on synaptic transmission. The aim of this study was to provide a review of carbamazepine pharmacokinetics and its management guidelines in an Iranian epileptic population. Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO), Web of Science were searched; 1600, 722 and 167 research and review articles relevant to the topics; carbamazepine pharmacokinetics, carbamazepine pharmacokinetics in epilepsy and review on carbamazepine pharmacokinetics in epilepsy were found, respectively. Carbamazepine is highly bound to plasma proteins. In patients the protein-bound fraction ranged from 75-80% of the total plasma concentration. Bioavailability ranges from 75-85%. The rate or extent of absorption was not be affected by food. It is completely metabolized and the main metabolite is carbamazepine-epoxide (CBZ-E). Carbamazepine induces its own metabolism, leading to increased clearance, shortened serum half-life, and progressive decrease in serum levels. Increases in daily dosage are necessary to maintain plasma concentration. Severe liver dysfunction may cause disordered pharmacokinetics. In cardiac failure, congestion of major vital organs, including kidneys, may result in abnormally slow absorption and metabolism. Carbamazepine shows variability due to its narrow therapeutic window. Therefore clinical management in a3n Iranian epileptic population should focus on results derived from therapeutic drug monitoring in order to reduce inter and intra- individual variability in plasma drug concentrations.

Spinal hematoma is a rare and usually severe neurological disorder that, without adequate treatment, often leads to death or permanent neurological deficit. Epidural as well as subdural and subarachnoid hematomas have been investigated in some studies. A 66-year-old man referred to our hospital because of acute onset paraplegia and incontinency started 3 h before admission. With impression of spinal hemorrhage, emergent cervicothoracic spinal MRI performed. On magnetic resonance imagination (MRI) mixed hyper/iso intense lesion in anterior subarachnoid space from C7 to T5 was seen. On brain A computerised tomography (CT) scan, subarachnoid hemorrhage and intraventricular hemorrhage in posterior parts of brain was seen. Unfortunately, the patient died 10 days later. About our patient, severe back pain accompanying by immediate paraplegia, sphincter disturbances, sensory level, and prominent meningeal signs guided us clinically to spinal subarachnoid hemorrhage. Further brain CT scan revealed diffusion of blood to brain subarachnoid space and ventricles. An outstanding finding on brain CT was the presence of blood only in posterior horn of lateral ventricles and dorsal fissures of brain supporting our theory that blood has diffused from spinal subarachnoid space to dorsal subarachnoid space of brain because of supine position of patient. In this patient anticoagulation may be the only sinister factor for developing complications.

Epilepsy is more common in patients with multiple sclerosis (MS) than in the general population, occurring in 2%–3% of patients. Convulsions may be either tonic–clonic in nature or partial complex. In these individuals, seizures most likely result from lesions present in the cerebral cortex and subcortical white matter. A Jacksonian seizure is a type of simple partial seizure characterized by abnormal movements that begin in one group of muscles and progress to adjacent groups of muscles. We describe a case of Jacksonian seizure as the relapse symptom of MS. Focal motor seizures of this patient have been observed before and presumably marking the clinical onset or during acute bouts of MS. In this case, Jacksonian seizures appear to be the sign of a flare of MS, while the majority of seizures had been reported occur unrelated to MS relapses.

Radiation therapies are commonly used for malignant or metastatic brain tumors for curative and palliative use. The radiation-induced neurotoxicity includes both parenchymal and vascular damage. Here we report the case of a 43-year-old woman who developed Multiple sclerosis (MS) 9 months after she underwent the last session of radiotherapy for the diagnosed meningioma. Conventional doses of radiation might trigger MS.