Current Journal of Neurology
Volume:10 Issue: 1, Spring 2011

Changes in the lipid profile have been suggested as a risk factor for developing ischemic stroke. Their role in intra-cerebral hemorrhage, however, is not clear. The present study was designed to evaluate the lipid profile levels of patients who had experienced an acute stroke during the first 24-hour and to compare these levels in different patients suffering from the stroke, either hemorrhagic or ischemic, and healthy individuals. In this cross-sectional study, 258 consecutive patients with acute stroke admitted to the neurology department of our center during September 2006 and September 2007 were studied. As for the control group, 187 apparently healthy subjects living in the same community and matched for age and sex were selected. Lipid profile was measured and compared between the three groups. In the patients’ group, 65 suffered from hemorrhagic stroke (group 1) and the other 193 had ischemic stroke (group 2). Except for TG values, there was no significant difference among the ischemic and hemorrhagic lipid profile. Age, cholesterol, and LDL influenced the risk of developing an ischemic stroke; TG was not reported as a risk factor or a protective one. While the comparison of data retrieved from patients suffering from hemorrhagic strokes with the controls, revealed LDL as the risk factor contributing to the development of ICH whereas TG was reported as a protective factor. It could be concluded that LDL level can be considered as a risk factor for both ischemic and hemorrhagic cerebral events.

Looking in literature reveals that aging is accompanied by olfactory dysfunction and hyposmia/anosmia is a common manifestation in some neurodegenerative disorders. Olfactory dysfunction is regarded as non-motor manifestations of Parkinson disease (PD). The main goal of this study was to examine the extent of olfactory dysfunction in Persian PD patients. We used seven types of odors including rosewater, mint, lemon, garlic which were produced by Barij Essence Company in Iran. Additionally, coffee and vinegar were used. Subjects had to distinguish and name between seven previously named odors, stimuli were administered to each nostril separately. Totally, 92 patients and 40 controls were recruited. The mean (standard deviation) (SD) age patients was 64.88 (11.30) versus 61.05 (7.93) in controls. The male: female ratio in patients was 50:42 versus 22:18 in control group. Also, mean UPDRS score (SD) in patients was 24.42 (5.08) and the disease duration (SD) was 3.72 (3.53). Regarding the number of truly detected odors, there were a significant higher number of correct identified odors in control group in comparison with the PD patients. Furthermore, there was a significant negative correlation between number of correct diagnosed smells and UPDRS (Pearson Correlation= -0.27, P=0.009); conversely, no significant correlation between the duration of Parkinson disease and number of correct diagnosed smells (P>0.05). smelling dysfunction is a major problem in Persian PD patients and it requires vigilant investigation for the cause of olfactory dysfunction exclusively in elder group and looking for possible PD disease.

we evaluated the diagnostic value of Electroencephalography (EEG), video-EEG monitoring (VEM) and Magnetic resonance imaging (MRI) of the brain with epilepsy protocol in patients with complex partial epilepsy. Forty-two consecutive patients underwent complete neurological examination, EEG, and MRI with a modified epilepsy protocol. A subset of these patients (n=29) also underwent VEM. Data were presented using descriptive statistics and were analyzed using Chi square and McNemar tests. Twenty-four women and eighteen men entered the study. The mean (±SD) age for patients, was 25.2(±10.1) and mean (±SD) age at onset was 10.9(±8.1). All patients had abnormal ictal or interictal EEG. Fifteen patients had normal MRI. Temporal lobe involvement was the most common involvement in both EEG (27 patients) and MRI (14 patients). Interictal EEG was abnormal in 81% of patients which showed epileptiform discharges in about half of the cases. In half of patients who had lateralized finding on MRI, site of the lesion was congruent between MRI and interictal EEG. Thirty-six patients had symptoms suggesting a specific lobe, of which interictal EEG was able to show the concordant lobe in 22 (61%) patients. McNemar test showed superiority of EEG over MRI in correct diagnosis of the involved lobe based on the clinical manifestations (P<0.01). In our setting, both ictal and interictal EEG perform better than MRI in evaluating complex partial epilepsy. In addition, combination of these tools may increase the yield of showing abnormality to near 100% in patients with complex partial epilepsy.

In patients with acute stroke and middle cerebral artery (MCA) stenosis, microembolic signals (MES) can predict further cerebral ischemia. Therefore, this study was designed to evaluate the prevalence of MES by transcranial Doppler (TCD) in patients with MCA stenosis under treatment of aspirin or clopidogrel. A randomized clinical trial was performed on 40 patients with acute ischemic stroke in MCA territory. They were randomly allocated in two groups that treated with aspirin (80 mg daily) or clopidogrel (75 mg daily). Clinical and diagnostic work up was included evaluation of cerebrovascular risk factors, echocardiography, carotid color Doppler and brain imaging. TCD was performed between day 3 and 7 after symptoms onset to detect MES. All high intensity transient signals (HITS) were saved and analyzed offline. Carotid stenosis was found in 13 (65%) patients of aspirin group and 12 (60%) of clopidogrel group. Four (30.8%) of aspirin group and 5 (41.7) of clopidogrel group had stenosis between 10%-50%. One patient in each group had more than 50% stenosis and the remainder had less than 10%. There was no significant difference between two groups. MES was detected in 6 (30%) of patients treated with aspirin and 4 (20%) of those treated with clopidogrel. It showed no statistically significant differences (P-value= 0.46). Our results indicate a similar effect of aspirin and clopidogrel on frequency of MES in patients with MCA territory ischemic stroke.

There is no documented demographical study on Iranian Parkinson’s disease (PD) patients, so this study was conducted to identify demographic information about patients with PD in Iran, and to explore demographical differences between PD patients in Iran and other countries. We reviewed medical records of 1656 patients diagnosed with PD, who referred from all parts of Iran to a referral Parkinson’s disease clinic in Tehran. We collected data about their age, gender, age of onset, side of motor symptoms’ onset, and drug history. This study was performed on 1656 patients with idiopathic Parkinson’s disease, and the results showed that, out of 1656 cases, 1132 patients were males (68.4%) and 524 patients were females (31.6%). The mean age of these patients was 65.16 ±11.9 years (16-99 years). The mean age of onset in these patients was 53.16 ±12.5 years (12-90 years). Among 697 patients, 345 patients (49.5%) had right onset PD, and the remaining 352 cases had left onset PD (50.5%). Side of motor symptoms onset was not associated with the age of the patients at disease onset (P>0.05). The incidence of right onset PD in males was 50.1% and 48.2% in females, although this difference was not statistically significant (P>0.05). There was no significant difference between males and females in age of onset (P>0.05). Our data suggests that the male to female ratio among Iranian Parkinson’s disease patients is much higher than other countries. Additional investigation is required in this field.

Several concomitant disorders especially thyroid abnormalities have been reported in patients with myasthenia gravis (MG). We aimed to estimate the frequency and pattern of thyroid disorders in Iranian patients with MG. All consecutive patients with MG referred to neurology clinic of Rasool-e-Akram Hospital during 2006- 2007 were enrolled. All patients underwent clinical assessment of thyroid gland as well as thyroid function test. AChR Ab titer was measured as well. Nerve conduction study (NCS), Electromyography (EMG), and Repetitive Nerve Stimulation (RNS) was done by a same neurologist. The diagnosis of MG was made on the basis of clinical examinations, an edrophonium chloride test and electrophysiological studies. The diagnosis of thyroid disorders were based on clinical presentation as well as thyroid function tests. Fifty eight patients (mean age [SD]: 37.1 [16.9], range: 10-80; female: 65.5%) were enrolled in this 12-month study. Four patients (6.9%) had abnormal thyroid function tests (Hypothyroidism: 3 [5.2%]; 4 females; 3 with hypothyroidism and 1 with hyperthyroidism). The mean age (SD) in men and women were 41.4 (21.3) and 34.9 (13.8) years (P: N.S.), respectively. In addition, once the MG patients are younger than 50, female gender is dominant while they are more than fifty, male is the dominant gender. Our results show that Iranian patients with MG tend to be female and young. Before sixth decade of life, women are the most presenting patients thereafter, men are the predominant gender. About 7 percent of them may suffer from concomitant thyroid problem especially hypothyroidism.

We intended to investigate the serum magnesium impact upon the disability after ischemic stroke. A total of 67 ischemic stroke patients who less than 6 hours had passed from their attacks participated in this cross sectional study. We have measured their serum magnesium level and determined its correlation with their Rankin Disability Score (RDS) in the first 72 hours (RDS0) and after 1 week (RDS1w) and its change in this period of time by using nominal regression method and repeated measure ANOVA in SPSS 17. There was a reciprocal statistical correlation between serum magnesium level and RDS0 and RDS1w. (P=0.000 & 0.002 respectively). But it hasn’t any significant statistical correlation with the changes of this score in this period of time (P=0.513). Serum magnesium level is a good predictor for patients’ abilities that involved by an ischemic stroke.

We describe a 40-year-old woman presenting with headache, nausea, episodic amnesia and blurred optic disc. Brain MRI disclosed diffuse leptomeningeal enhancement. CSF analysis showed aseptic meningitis with elevated ACE level. Neurosarcoidosis was diagnosed based on granulomatosis changes on tissue biopsy.

Interferon beta-la and -1b have been increasingly used for the treatment of multiple sclerosis (MS). The most frequent systemic adverse effects are flulike symptoms. Laboratory abnormalities include asymptomatic leukopenia and elevated hepatic transaminases. Myelodysplastic Syndrome (MDS) refers to a spectrum of hematological disorders which can occur in different situations. Several hematological abnormalities have been reported following interferon therapy. We report two cases of secondary MDS after long term interferon therapy by using the laboratory data and bone marrow results. Both of our cases were reversible; although treatment with IFN6-1a and-1b is safe and well tolerated in the majority of population, we should be careful about this premalignant hematological disorder.