Introduction Glioblastoma is still a disease without a cure despite the use of a multimodal approach. The extent of resection has been the only modifiable factor in the different variables that affect survival. Cellular tumour infiltration beyond the visible enhancing excisable lesion remains the cornerstone for inevitable disease recurrence and progression. Patients and methods We prospectively evaluated the impact of the extent of resection beyond the visible enhancing tumour on the survival. We evaluated 59 patients with glioblastoma who were operated upon by maximum possible safe excision of the tumour and the surrounding involved gyri or lobe as long it was not considered eloquent. We followed the patients until recurrence and death. Results Fifty-nine patients, 43 men, mean age 48 years, were studied. Overall, 28.8% of the tumours were frontal, 20% were parietal, 37.2% were temporal and 14% were occipital. The median preoperative contrast-enhancing tumour volume was 42.36 ml. Twenty patients (34%) underwent anatomical excision, 21 patients (36%) underwent gross total excision, 14 patients (24%) underwent subtotal and four patients (7%) underwent surgical debulking. In all, 79.66% of the patients died. There was a statistically significant reduction in the mean survival with less aggressive resection, for which the average survival was 16.5 months for the anatomical resection group, 12.09 months for the gross total excision group, 7.34 months for the subtotal excision group and 4.67 months for the debulking group (P = 0.002). Conclusion Total tumour resection with extra margin of tumour-infiltrated gliotic tissue, followed by adjuvant radiochemotherapy leads to longer survival than less radical excision.

Background D-dimer, a marker of plasmin-mediated fibrin degradation, is cross-linked to fibrin degradation products and indicates vessel occlusion. Objectives The purpose of this study was to evaluate the role of D-dimer serum level as a serological marker in the diagnosis and prognosis of acute ischemic stroke in Egyptian population. Patients and methods This prospective observational case–control study was conducted on 50 patients with acute ischemic stroke. Ten healthy age-matched and sex-matched individuals were taken as controls. The patient and control groups were subjected to detailed history taking, examination, and D-dimer level assessment. Neurologic examination using the National Institutes of Health Stroke Scale was carried out at admission and on discharge after treatment. Serum D-dimer level was evaluated within the first 24 h of admission. The outcome of the patients was graded using the modified Rankin scale on admission and 1 month of treatment. Results The mean D-dimer level was significantly higher in the patient group than in the control group (P < 0.001). There was a positive correlation between the levels of D-dimer and the National Institutes of Health Stroke Scale scores (P = 0.002) and the initial infarct volume in MRI of the brain (P = 0.000). The mean D-dimer level was significantly higher in patients with unfavorable outcome than in patients with favorable outcome, measured using the modified Rankin scale (P = 0.029). Conclusion Plasma D-dimer levels were significantly higher in patients with acute ischemic stroke than in controls. D-dimer levels increased with increasing severity of stroke and with increasing infarction volume. Moreover, D-dimer level could predict stroke outcome.

Background In the last two decades the relation between chronic Helicobacter pylori (HP) infection and migraine has been studied, but the results of these studies are controversial. Objective The aim of this study was to determine whether current or previous exposure to HP infection is a risk factor in women with nonmenstrual migraine (NMM) without aura, a concise subgroup in which environmental factors are dominant. Patients and methods A total of 24 women, with ages ranging from 19 to 60 years, affected by NMM without aura were evaluated in comparison with 24 control women, with ages ranging from 20 to 59 years, without any history of primary headache. In both cases and controls HP infection was evaluated by detection of HP antibodies in serum and HP antigen in stool. Results The prevalence of HP infection was nonsignificantly higher in the migraineurs without aura compared with controls (P = 0.24 and 0.33). Regarding the intensity, duration, and frequency of attacks of migraine no differences were detected between the two groups. Conclusion Our findings do not support HP infection to be a risk factor for NMM without aura.

Background An Egyptian normative database for ulnar nerve conduction studies (NCSs) considering the influence of age and sex is still absent. Objectives The aim of our work was to assess the normal variations of motor and sensory ulnar NCSs in a sample of normal Egyptian individuals at Zagazig University Hospitals. Methods This study was carried out at Zagazig University Hospitals on 110 individuals. Motor and sensory conduction studies of the ulnar nerve in the dominant hand were assessed. Results Motor latencies in male patients were longer than those in female patients and the difference was significant. No significant difference between male and female patients in any of the other ulnar nerve parameters was found. A significant positive correlation was found between age and motor latencies. Negative correlations were found between age and sensory amplitudes and with sensory conduction velocities. White collar workers had the slowest motor and sensory conduction velocities. Conclusion We conclude that age, sex, and occupation caused variability in ulnar NCSs in our studied group of normal Egyptians at Zagazig University Hospitals, but using the same reference data in patients of different ages and sex may result in inaccurate interpretation of ulnar NCSs, which is a common pitfall in our clinical practice.

Background The quality of life (QoL) of the patient is a reflection of the severity of multiple sclerosis (MS) and predicts its prognosis; it is related to various factors that vary across cultures. Objective The aim of the current study was to evaluate the QoL of ambulatory and mildly disabled patients with relapsing remitting multiple sclerosis (RRMS), and explore the related factors and cultural characteristics. Patients and methods Sixty Egyptian patients with a definitive diagnosis of RRMS were recruited and assessed for disability using Expanded Disability Status Scale, their QoL using Multiple Sclerosis Quality of Life Inventory (MSQLI), and depression using the Beck Depression Inventory scale. Patients’ QoL was compared with that of 30 matched controls. Results The QoL of MS patients was significantly impaired in all domains compared with that of controls (P<0.001), except for Social Functioning. Most of the physical components of the QoL were strongly correlated with Expanded Disability Status Scale, fatigue, and perceived cognitive impairment, and mental components were correlated with depression (P<0.001), fatigue, and perceived cognitive impairment. An overall 81% of MS patients had depression that correlated with disability (P=0.012) and fatigue (P=0.001), and correlated moderately with perceived cognitive impairment. Women reported more anxiety (P=0.038) and less perceived social support (P=0.012), whereas men stated more sexual dissatisfaction (P=0.001). Conclusion Mildly disabled Egyptian patients with RRMS have a high prevalence of depression and considerable impairment of mental and physical components of the QoL, such as disease disability, depression, fatigue, and perceived cognitive impairment.

Background Cognitive impairment (CI) is a common manifestation of multiple sclerosis (MS) and can occur early or late in the disease course. Objective The aim of this study was to evaluate the types and severity of CI in different MS subtypes. Patients and methods This study was conducted on 40 MS patients and 20 healthy controls. Physical disability was assessed using the Expanded Disability Status Scale and cognitive functions were assessed using the Montreal Cognitive Assessment, the Wechsler Memory Scale-Revised, the Wisconsin Card Sorting Test, and the Bender-Gestalt test. Event-related potential p300, MRI, and brain magnetic resonance spectroscopy (MRS) were also performed. Results There was significant CI in MS patients when compared with controls. The most commonly affected cognitive domain was information-processing speed, which led to impairment in memory, attention, and visuospatial and executive functions. MRS showed decreased N-acetyl aspartate (NAA)/creatine (Cr) and NAA/choline (Cho) ratios and increased Cho/Cr ratio in MS patients. Secondary progressive multiple sclerosis patients seemed to have more CI compared with other types. Conclusion CI is a common MS manifestation occurring early in the disease course and in all MS subtypes. The degree of CI is positively correlated with axonal loss in MRS, as evidenced by reduction in NAA/Cr ratio.

Background Multiple sclerosis (MS) is a long-standing inflammatory disease of the white matter and affects more than two million people worldwide. Upcoming evidence proposed that 25-hydroxy-vitamin D₃ (25HVD₃) deficiency could be one of the most crucial environmental elements for the pathogenesis of MS. Objective The aim of this study was to compare 25HVD₃ levels in MS patients and controls and to detect the association with relapse, severity, and disability in MS patients. Patients and methods Mansoura Neurology Department data sheet was collected and all patients were assessed using the Expanded Disability Status Scale (EDSS) at the onset. 25HVD₃ levels in the blood were evaluated for all patients and controls using the chemiluminescent immunoassay test. Results A total of 50 MS patients were included in this work and matched with 25 controls. There was a statistically significantly lower mean serum 25HVD₃ level in MS patients in comparison with the controls (20.5 ± 16.8 and 42.9 ± 17.9 ng/ml, respectively; P = 0.002). In addition, there was a statistically significantly lower level of 25HVD₃ (18.4 ± 17.7) in severe cases of MS (EDSS ≥ 6; P < 0.05) with certain significant clinical features such as older age (P < 0.001) and longer disease duration (P < 0.001). The incidence of 25HVD₃ deficiency (<20 ng/ml) in MS patients was 60%. Conclusion Our results showed that there is an inverse correlation between 25HVD₃ level and EDSS score. In addition, lower 25HVD₃ levels are associated with increased relapse risk in MS.

Background Uremia-induced phrenic neuropathy may account for diaphragmatic involvement in patients with end-stage renal disease who are on dialysis. Objective The aim of this study was to assess the occurrence of phrenic neuropathy and its relationship with hyperkalemia and frequency of dialysis in patients with chronic renal failure on dialysis. Patients and methods The study included 27 patients with chronic renal failure on dialysis and 27 controls. All patients and controls were subjected to history taking, neurological examination, laboratory tests, neurophysiological study of phrenic and peripheral nerves, and scales to assess the severity of symptoms and disability caused by peripheral neuropathy. Results Of the 27 patients, 70.4% had phrenic motor neuropathy, 33.4% had median motor neuropathy, 48.2% had median sensory neuropathy, 40.8% had peroneal motor neuropathy, and 66.7% had peroneal sensory neuropathy with highly statistically significant difference in neuropathy between patients and controls. Infrequent dialysis was the cause of bilateral mixed (44.4%) and axonal (33.3%) phrenic motor neuropathy. Bilateral mixed phrenic motor neuropathy was more frequent in the hyperkalemia group (31.2%). Conclusion Phrenic neuropathy is a frequent complication in chronic renal failure patients on dialysis, especially in those with hyperkalemia and undergoing infrequent dialysis.

Background Different studies have reported the incidence and predictors of seizures in cases of spontaneous intracerebral hemorrhage (sICH) with the possibility of increase in mortality and neurological and medical complications. Objective This study was designed to identify the incidence and predictors of acute seizures in patients with sICH. Patients and methods We retrospectively evaluated patients with first-ever sICH hospitalized at the Mansoura Neurology Department (Egypt) over a 1-year period. Important data like age, sex, vascular risk factors, clinical scale scores such as the National Institutes of Health Stroke Scale and the modified Rankin scale scores, intracerebral hemorrhage volume, site, and location, and seizure types were collected. Results A total of 360 patients with hemorrhagic stroke were studied, comprising 201 men and 159 women, of a mean age of 67.3 ± 12.7 years. The incidence of seizures in sICH was 9%, with statistically significant difference with regard to type (lobar) and location (cortical) of the hematoma (30 and 17 patients, P = 0.002 and 0.003, respectively). In multivariate analysis, the only factors appearing to be independent seizure predictors were cortical hematoma and lobar hematomas. Conclusion We concluded that relatively old patients with definite lobar and cortical hematomas run a risk for immediate seizures irrespective of hematoma size or clinical state.

Background Epilepsy has been increasingly suspected as a risk factor for psychological, academic, and poor social skills in epileptic adolescents. Objective The aim of the study was to assess the social skills of epileptic adolescents and compare them with those in nonepileptic healthy adolescents. Participants and methods The social skills of 86 epileptic adolescents (12–18 years) were compared with those of 86 age-matched and sex-matched healthy adolescents. Social skills were assessed using the Arabic-translated form of the Social Skills Rating System questionnaire – both student form (39 questions) and parent form (52 questions). Results The mean scores of the ‘student form’ subscales (cooperation, assertion, empathy, and self-control) and the mean scores of the ‘parent form’ subscales (cooperation, assertion, responsibility, self-control, externalizing behavior, and internalizing behavior) were highly significantly lower in epileptic compared with nonepileptic adolescents (P < 0.01). The mean scores of all student form subscales were highly significantly lower in epileptic adolescents with partial seizures with secondary generalization, with generalized tonic clonic seizures, and in those on polytherapy medications (P < 0.01). The mean scores of cooperation, assertion, and empathy of the student form subscales were highly significantly lower in epileptic adolescents with seizure frequency of greater than 4 per year. There was no significant difference in the mean scores of the student form subscales with respect to sex or residence of the epileptic adolescents. Conclusion Epileptic adolescents have poor social skills that require early assessment and intervention.