Background Anterior circulation infarction (ACI) accounts for almost 70% of all strokes, whereas posterior circulation infarction (PCI) accounts for 20% of the strokes, with heterogeneous clinical manifestations. Objectives The aim of the present study was to compare the clinical characteristics of ACI with PCI, and to detect the diagnostic importance of specific symptoms and signs for PCI. Patients and methods We prospectively analyzed acute ischemic cerebral stroke (AICS) patients, enrolled in the study from the convalescence and critical cases of Mansoura University Hospitals (CCCB-MUH) during a 1-year period. Patients were analyzed for ischemic stroke subtypes (ACI and PCI), demographic data, risk factors, and clinical characteristics. All patients underwent an assessment by using the Glasgow Coma Scale and the National Institutes of Health Stroke Scale at the onset of AICS. Results The study included 234 patients with AICS (174 belonging to the ACI subtype; 60 to the PCI subtype). PCI patients were often men, had a higher presence of cervical spondylosis, lower mean National Institutes of Health Stroke Scale, and a lower mean Glasgow Coma Scale. PCI patients had a greater frequency of diabetes and smoking. Among the PCI patients, ataxia, vertigo, unsteadiness, nystagmus, crossed motor, and sensory deficits were statistically significant compared with the ACI patients. As regards speech disturbances, aphasia occurred in a low percentage of the PCI patients, and no statistically significant difference regarding dysarthria was found in the two groups. The neurological deficits favoring the diagnosis of PCI were nystagmus, crossed motor and sensory deficits, ataxia, vertigo, unsteadiness, diplopia, Horner's syndrome, and oculomotor nerve palsy. Conclusion There is an apparent difference in the frequency of the most common manifestations between PCI and ACI patients. Some neurological deficits were highly specific for diagnosing PCI.

Background Bell's palsy (BP) is one of the most common causes of acute-onset unilateral facial weakness. Through this study we aimed to estimate the incidence of BP in Al-Quseir City, Red Sea Governorate, Egypt. Patients and methods A project was undertaken to assess the epidemiology of major neurological disorders. A total of 33 285 eligible patients were screened through a door-to-door survey (every door) by three specialists in neurology and 15 social workers. All patients were subjected to detailed history taking and a meticulous neurological examination by means of a specific questionnaire designed for this study. Results Within 1 year, 27 patients were diagnosed with BP. This yielded an incidence rate of 98.9/100 000 population (aged 9 years and older). The incidence was higher in the male population than in the female population (116.4 and 81.2/100 000, respectively). Age-specific incidence of BP showed that its peak was between the ages of 18 and 60 years. About 78% of patients with BP recovered completely within 6 months after onset. There was no significant difference between male and female patients. Conclusion The incidence rate for BP was 98.9/100 000 among those aged 9 years and older. Most affected cases were older than 18 and less than 60 years.

Background A rising concern about quality of life of multiple sclerosis (MS) patients has emerged. Cognitive dysfunction and primary fatigue have been largely related to each other. Objective The aim of the present study was to examine the relationship between primary fatigue, cognitive dysfunction, and inflammatory biomarkers for patients with MS. Patients and methods A total of 40 Egyptian MS patients (Expanded Disability Status Scale<5) were divided into two groups according to the Fatigue Severity Scale (FSS), into patients with fatigue (G1; FSS>36) and those without fatigue (G2; FSS<36). Patients with depression and sleep problems were excluded from the study. Cognitive functions were assessed for both groups using the computer-based 'RehaCom' software, using which the following tests were carried out: (a) attention/concentration tests and (b) reaction behavior tests. The serum levels of tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) were analyzed for all MS patients. Results A statistically significant decrease in cognitive functions was found in G1 compared with G2 (P < 0.001), as well as a statistically significant higher level of TNF-α and IFN-γ in G1 compared with G2. FSS was positively correlated with the attention/concentration test. Correlative study also indicated a strong relation between the level of cytokines and FSS but not cognitive dysfunction. Conclusion Primary fatigue contributes to cognitive dysfunction in patients with MS and is associated with elevated serum level of TNF-α and IFN-γ

Background Testosterone and prolactin hormone abnormalities have been noticed in some epileptic patients and were attributed to either the direct effect of the disease or the effect of antiepileptic drug therapy. Objective The aim of this study was to evaluate the potential endocrinal dysfunction in nonmedicated male adolescents with idiopathic generalized epilepsy as well as those on valproate treatment. Patients and methods This study was performed on 40 epileptic patients, 20 newly diagnosed nonmedicated and 20 treated with valproate, who attended the epilepsy clinic in the Department of Neuropsychiatry, Tanta University Hospital. Twenty age-matched male healthy controls were also included. Patients were subjected to full history taking, neurological examination, evaluation of testosterone and prolactin blood levels, and electroencephalography. Results The serum levels of both free and total testosterone were higher in valproate-treated patients compared with nonmedicated patients and healthy controls. The levels were significantly lower in the nonmedicated group compared with the control group. The serum level of prolactin in both patient groups was significantly higher when compared with the healthy control group, with no statistically significant difference between the two patient groups. Conclusion The exact etiology of hormonal abnormalities in men with epilepsy appears to be multifactorial, including the disease and antiepileptic drug effects. Neuroendocrine regulation in men with epilepsy may be important not only for reproductive function but also for optimal management of seizure disorders.

Background Gastrointestinal tract infection with Helicobacter pylori (HP) can inhibit levodopa (LD) in Parkinson's disease (PD) patients, leading to motor fluctuation. Objectives The aim of this study was to identify the incidence of HP in PD patients compared with healthy controls and its effect on motor fluctuation, response to treatment, and quality of life. Patients and methods Serum IgG Abs against HP urease were detected using enzyme-linked immunosorbent assay. We compared the incidence of HP infection in PD patients and controls. We compared PD patients with positive HP (PD positive) and PD patients with negative HP infection (PD negative) with regard to clinical features, the Unified PD Rating Scale (UPDRS) scores, Hoehn and Yahr (H and Y) stages, PD Questionnaire for the quality of life (PD-Q39), and PD Nonmotor Symptoms Questionnaire (PD NMSQ). Results Fifty Egyptians with PD were included. Forty-six percent of patients were HP positive compared with 20% in the control group; the difference was statistically significant (P = 0.043). In PD-positive patients, the total UPDRS and PD-Q39 scores were significantly higher in comparison with PD-negative patients (P < 0.005 and P < 0.001, respectively). The differences were not significant with regard to the total PD NMSQ score and H and Y stages between the two groups of patients. The LD onset period was significantly greater in PD-positive patients by nearly 14 min in comparison with PD-negative patients. There was a significantly prolonged on-duration time in PD-positive patients in comparison with PD-negative patients. Conclusion There is a high incidence of HP infection in PD. HP affects the response to LD and can deteriorate motor manifestations and the quality of life.

Background Type 2 diabetes mellitus (T2DM) has various effects on the vascular tree, both macrovascular and microvascular and both intracranial and extracranial circulation. Metabolic syndrome is a combination of medical disorders that, when occurring together, increases the risk of developing cardiovascular diseases including stroke. Objectives In this study, we aimed to estimate the site and degree of intracranial arterial stenosis among patients clinically diagnosed as acute ischemic stroke patients with metabolic syndrome with or without T2DM. Patients and methods This cross-sectional study included 100 patients admitted in Ain Shams University Specialized Hospital-Stroke Unit with the diagnosis of clinically first-ever cerebral infarction and metabolic syndrome with or without T2DM. All patients were subjected to detailed medical history, thorough general and neurological examination, full laboratory investigations, computerized tomography, MRI, and magnetic resonance angiography of the brain, carotid duplex, ECG, and echocardiography. Results Small vessel disease (lacune) was present more frequently in patients with T2DM than in those without T2DM, and this showed a statistically significant difference (P = 0.008). It was found that intracranial stenosis was statistically significantly higher compared with extracranial carotid stenosis in patients with T2DM with total or near-total occlusion, with P values less than 0.05. These stenoses or occlusions also tend to be multiple in the same group of patients with T2DM (P = 0.033). Conclusion Diabetic patients with acute ischemic stroke have a higher severity of intracranial arterial stenosis, higher incidence of multiple intracranial arterial stenoses, and lastly higher tendency to have obstructive intracranial arterial lesions.

Background For 30-50% of patients with brain tumors, epileptic seizures are the presenting clinical sign of a tumor; 10-30% of patients develop seizures later during the disease course. Slow-growing tumors, (i.e. low-grade gliomata) are the most epileptogenic, although the high frequency of epilepsy in these patients might be related to longer survival from low-grade tumors. This study bears on this controversy through a prospective strategy in which patients were treated with excision of lesion together with epileptogenic area around, as defined using intraoperative electrocorticography. Patients and methods This is a prospective study designed to treat patients presenting between January 1997 and December 2011 with drug-resistant epilepsy (defined as failure to attain a seizure-free status utilizing adequate trials of two tolerated and appropriate antiepileptic drugs). Surgical procedure consisted of maximal resection of the tumor and any resectable surrounding associated with epileptogenic cortex, identified by means of intraoperative electrocorticography. Results Fifty-four patients were operated upon and followed up for a mean of 40 months (range = 6-72 months). Thirty-two tumors (59.2%) were located in the temporal lobe, 15 (27.8%) in the frontal lobe, and seven (13%) in the parietal lobe. The histopathology confirmed low-grade astrocytoma (WHO grade I or II) in 38.9% (n = 21) of patients, oligodendroglioma in 24% (n = 13), ganglioglioma in 20.4% (n = 11), and dysembryoplastic neuroepithelial tumor in 16.7% (n = 9) of patients. Gross total resection was achieved in 64.8% (n = 35) of patients and subtotal resection in 35.2% (n = 19) of patients. There was no death and five patients had permanent deficit. At follow-up, according to Engel's seizure outcome scale, 77.8% (n = 42) of the patients had good seizure control (classes I and II), and, collectively, 90.7% (n = 49) of patients had more than 75% reduction in seizures (class I-III). Conclusion In our series, we had a relatively high rate of gross total resection, which was associated with worthwhile seizure control, which compares favorably with a recent work that showed that the extent of resection significantly predicts seizure freedom following surgery. The favorable seizure outcome is tentatively attributed to the fact that all identified areas harboring epileptogenic activity around tumors were resected along with tumor resection.

Background Few data on the association between vitamin D levels and peripheral nerve function are available from human studies, although diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus. Unfortunately, pharmacological treatment is often partially effective or accompanied by unacceptable side effects, and a new concept for the management of DPN is imperative. The purpose of this study was to clarify the impact of hypovitaminosis D correction on DPN in type 2 diabetic (DM2) patients. Materials and methods Fifty patients with a mean age of 54.72 ± 9.00 years with DM2 (disease duration 14.62 ± 5.95 years) were recruited. They were assessed clinically for neuropathy using the Michigan Neuropathy Screening Instrument, the Toronto Clinical Score System, and nerve conduction study (NCS) of the sural, popliteal, and ulnar nerves. At same sitting, vitamin D was assessed by measuring 25-dihydroxy, and then repeat Toronto Clinical Score System and NCS were carried out after vitamin D correction. Results Neuropathy severity was significantly improved after vitamin D supplementation. The mean ± SD neuropathy severity was 11.60 ± 2.90 before treatment and 10.82 ± 3.31 after treatment. Moreover, there was improvement of NCS in mild DPN after vitamin D correction but failed to show the same effect in moderate and severe cases. Conclusion Normalization of low vitamin D level has a potential beneficial effect in reducing neuropathy severity in DM2, and hence serum 25-hydroxyvitamin D level should be tested and low levels should be corrected to improve neuropathy symptoms. Further studies in a larger scale are required to confirm these results and re-evaluate patients with severe and moderate DPN.

Background Environmental factors such as vitamin D deficiency have been linked to the etiology of multiple sclerosis (MS) through interaction with genetic factors. Researches must be carried out to answer the question whether the relationship between vitamin D and MS is consistent and reproducible. Objective The aim of the present study was to assess the level of vitamin D in Egyptian MS patients. Subjects and methods In total, 111 patients with MS and 33 normal subjects were included in this study. Vitamin D level was estimated for each participant using the enzyme linked immunosorbent assay technique. Results Vitamin D levels were significantly lower among MS patients (ranging from 5 to 75 ng/ml with a mean ± SD of 26.4 ± 18.5) when compared with controls [ranging from 25 to 80 ng/ml with a mean of 51.2 ± 19.6 (P < 0.001)]. High expanded disability status scale scores were found to be related to low vitamin D levels. Conclusion Patients with MS tended to have lower vitamin D levels, and those with higher (expanded disability status scale) scores were more likely to have lower levels of vitamin D.

Background Central nervous system tumors represent a major public health problem as they bear unfavorable clinical prognosis merely by their localization. Epidemiological data of central nervous system tumors in Egypt have been rather incomplete, although there are some regional reports. Objective The aim of this study was to investigate the relationship between suspected risk factors including cell phone use and primary brain tumors. Patients and methods This study included 100 patients with a settled diagnosis of primary brain tumors and 100 controls. They were subjected to the following: detailed medical and neurological history taking with special emphasis on risk factors that are common with primary brain tumor. Data were obtained by means of personal interviews, designed to take full data about the suspected risk factors. Thorough general and neurological examination was carried out. All patients were investigated using routine laboratory investigations and MRI of the brain. Histopathological studies were carried out to confirm the nature of brain tumors. Patients with metastatic brain tumor and/or cancer outside the brain were excluded. Results Our study showed that urban residence was more prevalent in the patient group. Meningioma was higher among female patients, whereas other types of primary brain tumors were higher among male patients. Risk for primary brain tumors was significantly higher among patients with ipsilateral regular cell phone use of more than 10 years. The risk significantly increased in astrocytic tumors in relation to meningioma and other types of primary brain tumors. Conclusion Significant risk factors for primary brain tumors in our study were urban residence, female sex in meningioma, and ipsilateral regular cell phone use more than 10 years.

Background Central neurocytoma (CN) is an intraventricular tumor that affects young adults. It has a favorable prognosis after adequate surgical intervention; however, an aggressive course may take place in some cases. Objective The aim of this study was to evaluate the rate of shunt insertion and outcome of control in CN excision. Patients and methods Ten patients were included in this study and followed up for 24 months. Data collected included age, sex, clinical presentation, early morbidity and mortality, and radiological findings (tumor location, features, residual, recurrence, and hydrocephalus). All patients underwent surgery for total or subtotal excision through a transcortical or transcallosal approach. An external ventricular drain was inserted and then removed and replaced by a shunt, if indicated. Histopathology and the MIB index were used to confirm diagnosis and guide the follow-up. Adjuvant radiotherapy or gamma knife radiosurgery was used for residual or recurrence. Results Patient ages ranged from 14 to 48 years and the mean age was 31 years. Two patients died early after total and subtotal excision from sepsis and thalamic infarction, respectively, and were excluded from the results. Six patients (60%) underwent total removal. Of them, two patients had a high MIB index and showed small recurrence at 12 and 18 months and received gamma knife. One case needed a shunt, and the other four cases were free. Subtotal excision was performed for the other four patients (40%). Early shunt was inserted for two cases. Radiosurgery was used to control the residual in one patient, whereas radiotherapy was used for three patients but failed in one patient who underwent surgery at 18-month follow-up. Conclusion CN may have favorable prognosis with a lower incidence of shunt insertion throughout its course compared with other intraventricular tumors if total removal is achieved.

Background Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, which is frequently associated with pain. Studies targeting the painful DPN are necessary to support clinical decision-making. Objective The aim of the present study was to investigate the efficacy of transcutaneous electric nerve stimulation (TENS) versus aerobic exercise, and to compare them with regular pharmacological therapy in patients with DPN, using sensory nerve conduction study and the visual analogue scale (VAS). Patients and methods This study included 60 diabetic patients with a history of DPN for 5 years. Patients were divided into three equal groups, all receiving regular pharmacological therapy. Group A received TENS of both lower limbs, three times per week. Group B received aerobic exercise. Group C received only pharmacological therapy. Patients were assessed before and 8 weeks after treatment. The VAS was used to measure the pain intensity before and after treatment, and the medial plantar nerve conduction velocity (NCV) to assess nerve function. Results Group A and B only showed a significant statistical difference between pretreatment and post-treatment pain intensity on VAS, with 41.67 and 16.67% improvement on the VAS, respectively. There was no statistically significant difference in pretreatment and post-treatment as regards the medial plantar NCV in any of the groups. Conclusion TENS, of moderate intensity, carried out at 14 Hz, with a pulse width of 250 ms, for 30 min and three times a week is more efficient than aerobic exercise training program in relieving pain in patients with DPN, whereas neither TENS nor exercise showed any significant effect on medial plantar conduction velocity (CV) in patients with DPN.

Background The pathophysiology of migraine is influenced by many factors. Multiple genetic and environmental factors may contribute to the etiology of migraine. The beneficial effects of angiotensin-converting enzyme (ACE) inhibitor drugs on migraine attack frequency have been shown, and hence ACE gene polymorphism was studied for its possible effect on migrainous patients. Objective We aimed to study the relationship between the ACE gene polymorphism and migraine pathophysiology. Patients and methods The ACE genotypes of 30 migraine patients (17 cases of migraine without aura and 13 cases of migraine with aura) and 30 age-matched and sex-matched normal volunteers as a control group were studied. All patients were subjected to full clinical assessment to calculate the score on the Migraine Disability Assessment Test as an indicator of the severity of migraine and its impact on the patient life. Results The frequency of DD genotype of ACE gene was significantly higher in migraine patients, including both cases of migraine with aura and those without aura compared with the control group, but no association was found between any of the genotypes of ACE gene and the degree of migraine severity or disability. Conclusion ACE gene polymorphism may confer risk for the occurrence of migraine attacks, without affecting the symptomology or the severity of migraine.