Background Idiopathic intracranial hypertension (IIH) is seen typically in obese women in their child-bearing age, management of patients with IIH during pregnancy can be problematic. Objective The purpose of this study is to assess spinal tapping as a single modality for treatment of IIH during pregnancy. Patients and methods This was a prospective case series of seven pregnant women with IIH who underwent full neurological and ophthalmological evaluation including perimetry and neuroimaging studies. They were followed up and treated using only spinal tapping. Results Spinal tapping either single or multiple sessions can control IIH safely during pregnancy with a success rate of 86%. Conclusion Spinal tapping is recommended as a single treatment modality in pregnant women with IIH.

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Background Stereotyped cognitive schemes are the main cause of casting out patients with mental illness. Educational psychiatry programs have to be re-evaluated as medical students often have misconceptions about psychiatry. Objective The aim of the present study was to examine the attitude of fifth-year medical students toward psychiatric patients and disorders, and to reveal the influence of psychiatric study experience on their attitudes. Participants and methods In this interventional study, 300 fifth-year students from Ain Shams University Medical School were enrolled. Sociodemographic data sheet, Fahmy and El Sherbiny's Social Classification Scale, and the Mental Illness Clinician Attitude Scale-2 were used on the first and last day of a 3-week clinical psychiatric round. Results Data before and after the round were compared and showed no significant change in Mental Illness Clinician Attitude Scale-2 scores among the studied sample after the psychiatric round. Only 4% of the students chose psychiatry as a future career with neutral attitude and had worse attitude after rotation. Students who had significant positive attitude at the beginning of the round ended up with a significantly more negative attitude, whereas those with significantly negative attitudes improved at the end of the round. Conclusion Three weeks may not be sufficient time to allow students to follow up the patients to notice their improvement as regards treatment and return to their functional baseline. Thus, students perceived mentally ill patients being untreatable. Greater emphasis on doctor-patient relationship and exposure to patients with psychiatric illness, which responds rapidly to treatment and students taking direct patient responsibility, may lead to the production of more favorable attitudes.

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Background Stroke is a major cause of mortality and morbidity worldwide. Poor knowledge of stroke risk factors, symptoms and appropriate response to stroke are possible causes of poor outcome. Objective The aim of this study was to evaluate the knowledge and attitude towards different aspects of stroke in a sample of Cairo University Hospitals' workers. Patients and methods A structured self-administered questionnaire was administered by 111 workers who were classified into clinical workers (physicians, house officers, nurses, laboratory technician and pharmacists) and nonclinical workers (administrative, sanitary and security workers). Results Out of 111 participants, 92 completed the questionnaire. Most participants had heard of stroke (91.3%), mostly through encountering a family member with a stroke rather than through mass media (10.9%). Hypertension was the most common identified stroke risk factor (66.3%). Clinical workers were more likely to identify risk factors. The most common identified stroke symptoms were slurring of speech (38.5%) and elevated blood pressure (38.5%). Clinical workers were more likely to identify symptoms such as slurring of speech (P = 0.042) and altered state of consciousness (P < 0.001). The most frequent response to an attack of stroke was transferring the patients to a hospital (59.8%). Conclusion Knowledge and perception of stroke in Cairo University Hospitals' workers appear to be poor, especially among nonclinical workers. Planning educational programs for raising the level of knowledge and awareness of stroke, both on the level of hospital workers and on the public level, is important to improve stroke management and outcome.

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Background Poor behavioural inhibition is the central impairment in attention deficit hyperactivity disorder (ADHD). At present, there is no reliable objective measure to detect ADHD. A proper pinpointing evaluation for ADHD depends mainly on the history from parents, family members as well as teachers and schoolmates, by means of questionnaires and conduct rating scales. Objective The aim of this study was to detect continuous performance task (CPT) (test of variants of attention) changes in children suffering from ADHD compared with normal children. Patients and methods CPT, Conners' parent rating scale and Wechsler intelligence scale were done for two groups of children each containing 39 children, a group of ADHD children and the other a normal control group. Results We found a significant difference between the mean total IQ score among the ADHD patients group compared with control group. Comparing both groups revealed statistically significant increase in omission, commission and reaction time among patients. A significant negative correlation was found between age on one side and IQ, hyperactivity and psychosomatic subscales, hyperactivity and total DSM-IV scores on the other hand and between commission and opposition, restlessness subscales and ADHD index and also between reaction time and restlessness and emotional index. There was a significant positive correlation between omission and hyperactivity and anxiety subscales, restlessness and emotional indices and DSM-IV hyperactive and total scores. In addition, there was a significant positive correlation between perfectionism and commission and also between reaction time and inattention and social problems subscales. Conclusion CPT can have a substantial role in objective identification of ADHD.

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Background Atherosclerosis involves various vascular segments. The association of carotid artery disease (CAD) to peripheral arterial disease (PAD) is not well investigated in Egyptian patients. Objective In this pilot study, our aim was to examine the relationship between PAD and CAD in an Egyptian population. Patients and methods We examined 37 consecutive patients with PAD for the presence of CAD. Vascular and neurologic examination and duplex assessment of extracranial and intracranial carotid system and ankle-brachial index measurement were carried out to determine whether CAD is symptomatic or not. Results CAD was found in 20 (54.1%) patients. Eight (21.6%) patients had significant extracranial internal carotid stenosis and 13(37%) had intracranial stenosis and were more significantly above the age of 60 years. All patients with intracranial stenosis were men. PAD with RC6 was significantly associated with cerebrovascular events (P = 0.001) and significant extracranial stenosis (P = 0.013) and intracranial internal carotid stenosis (P = 0.001). Conclusion Intracranial and extracranial carotid stenoses are commonly present in patients with critical PAD. Duplex ultrasound screening for CAD presence and severity may be of great benefit, especially in the elderly and patients with critical limb ischemia. These findings need to be further confirmed in a study on larger population of Egyptians.

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Background Amblyopia is a unilateral or bilateral reduction of best-corrected vision that cannot be attributed only to a structural abnormality of the eye. It is a common childhood problem, and can be reversed if treated while the visual system is still maturing. Objective The aim of the present study was to investigate the role of pattern visual evoked potential (PVEP) in the assessment of visual function after occlusion therapy for children with unilateral strabismic amblyopia. Patients and methods Visual function was assessed clinically and using monocular PVEP, elicited by high-contrast checkerboard-patterned stimuli, before and after occlusion of the healthy eye for 1 week for every year of life in 20 children presenting with unilateral strabismic amblyopia. Results PVEP responses were significantly prolonged in latency in amblyopic eyes after the first assessment compared with nonamblyopic eyes. There was no significant difference in the interside amplitude. Assessment after occlusion showed a statistically significant reduction in the latency of the amblyopic eye and statistically significant improvement in the visual acuity. Conclusion PVEP can be used as a method of assessment of visual function after the occlusion therapy for children with unilateral strabismic amblyopia.

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Background Sleep complaints are frequent among chronic kidney disease (CKD) patients. Objective We aimed to subjectively and objectively assess sleep disturbances in CKD patients and compare them between those who undergo hemodialysis (HD) and those who do not. Patients and methods The study was conducted on 40 CKD patients who were subdivided into two groups; group I included patients not undergoing HD (n = 20), and group II included patients on regular HD (n = 20). A total of 20 matched healthy volunteers participated as controls. Patients completed Epworth Sleepiness Scale, a sleep questionnaire, and underwent an attended polysomnography. Results All patients had sleep complaints in the form of excessive daytime sleepiness, difficulty falling asleep, early morning awakening, jerking leg movements, and fragmented sleep. CKD patients had lower total sleep time, sleep efficiency, slow wave sleep (SWS) percentage, oxygen desaturation, and higher respiratory distress and periodic limb movement (PLM) indices compared with controls. Group II patients showed a higher Epworth Sleepiness Scale and more frequent complaints of leg jerks. Furthermore, group II patients showed higher sleep efficiency and PLM compared with group I. Patients' age positively correlated with respiratory distress index and negatively correlated with total sleep time and oxygen saturation. The duration of illness and duration of dialysis positively correlated with the number of awakenings. Conclusion There is a high prevalence of sleep disorders in CKD patients whether they were on regular PLMs. Achieving a more complete understanding of sleep problems experienced by these patients can improve quality of life and patient survival.

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Background The multifocal visual evoked potential (mfVEP) is a useful tool for evaluating optic nerve disease and visual defects secondary to optic nerve or retinal ganglion cell damage. Objective The aim of this study was to establish technical guidelines and normative values of the peak time and amplitude of the mfVEP in adolescents. Participants and methods This is a prospective study conducted on 20 healthy adolescents (40 eyes) 10 girls and 10 boys. Their age ranged between 10 and 15 years with a mean of 12.50 ΁ 1.48. Monocular mfVEP was obtained from each eye separately. The peak time and amplitude of the P1 wave of each individual response were measured and then expressed in the form of four quadrants. Results The peak time and amplitude of the P1 wave showed no statistical differences between the four quadrants and no correlation to the age. There were no statistically significant differences between girls and boys or between left and right eyes regarding the peak time and the amplitude of the P1 wave. Conclusion We obtained normative data of mfVEP of the adolescents in our lab as a preliminary work for further application in different neuro-ophthalmological disorders.

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Background Diabetic retinopathy (DR) is one of the leading causes of new blindness. The multifocal electroretinogram (mfERG) has been demonstrated to be useful in objective assessment of various retinal disorders. Objective To evaluate the retinal function by mfERG in adolescents with insulin dependent diabetes mellitus type 1 (IDDMT-1) without clinically evident DR. Patients and methods A case/control study carried out on 30 adolescents (30 eyes) with IDDMT-1 for 5 years' duration or more in comparison with 20 healthy adolescents (40 eyes). Cases with DR were excluded based on ophthalmological examination, slit-lamp biomicroscopy and fluorescein angiography. mfERG-P1 wave-peak time and amplitude were measured and expressed in the form of four quadrants and fovea. Results In diabetic adolescents, mfERG-P1 wave had small amplitude in the four examined quadrants. The foveal response was small in amplitude and delayed in time as well. There is a significant negative linear correlation between the ages of the diabetic adolescents, the duration of illness, the glycosylated hemoglobin level and the amplitude of mfERG-P1 wave in the upper nasal quadrant only. Conclusion Homogeneous reduction of the amplitude of the mfERG test in IDDMT-1 goes with the diffuse nature of the microvascular affection of the retina even before the retinopathy becomes clinically evident.

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Background Platelets play an important role in the pathogenesis of ischemic stroke. Mean platelet volume (MPV) values in association with both thrombosis and inflammation have become a point of interest in the last few decades, and some studies have reported MPV values significantly higher in patients with stroke compared to controls. Objective The aim of this study was to investigate the association between MPV and the functional outcome of different types of acute ischemic brain stroke. Patients and methods Ninety patients with the diagnosis of first-ever acute ischemic stroke were included. Those patients were divided into three equal groups. The first includes patients with lacunar stroke, the second includes patients with large vessel disease, and the third includes cardioembolic stroke patients. They were 35 female (39%) and 55 males (61%). Their age ranged from 29 to 87 years with median value 60 years. MPV was measured on admission. All patients were followed for 3 months then functional outcome was measured using the modified Barthel index. Results There was a significant inverse relation between MPV and modified Barthel index score (P < 0.01) only in patients with lacunar stroke. Regarding the other two groups, such correlation is not present. Conclusion MPV may be used as early predictor of outcome only in patients with small vessels disease.

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Background Renal dysfunction has been implicated as a risk factor for adverse outcomes after numerous cardiovascular events including stroke. However, most of the stroke studies have focused on ischemic stroke but no enough studies were done on intracerebral hemorrhage. Objective We aimed to determine if renal dysfunction can affect the prognosis after intracerebral hemorrhage especially on the short-term period. Patients and methods A total of 60 patients with the diagnosis of intracerebral hemorrhage for the first time were included in this study. They were 17 female (28%) and 43 males (72%). Their age ranged from 35 to 89 years with median value of 60 years. On admission, all patients were subjected to full clinical assessment and brain computed tomography scan to measure the size of hematoma and calculate the intracerebral hemorrhage score. Glomerular filtration rate was estimated on admission using the Cockcroft-Gault equation. Results There was a significant inverse relation between estimated glomerular filtration rate and hematoma size; also significant negative correlation was found between estimated glomerular filtration rate and intracerebral hemorrhage score (P < 0.05).On the other hand increase in serum creatinine was significantly associated with increase in the hematoma size and increase in the intracerebral hemorrhage score (P < 0.05). Conclusion Renal dysfunction has negative impact on the prognosis of intracerebral hemorrhage.

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Background Diagnosis of the epileptogenic zone is the main aim of the presurgical evaluation in patients with drug-resistant epilepsy. Different diagnostic tools are being used to identify it. Objective This study aimed at studying the value of long-term scalp video-electroencephalography (video-EEG) monitoring to diagnose laterality and locality of the epileptic focus by comparing its results with other noninvasive methods, including interictal magnetoencephalography (MEG), interictal iodine-123 iomazenil single-photon emission computed tomography ( ¹²³ I-IMZ SPECT), and interictal fluorine-18 fluorodeoxyglucose ( ¹⁸ F-FDG) PET. Patients and methods A total of 24 patients with drug-resistant epilepsy were included in this study; 17 had mesial temporal lobe epilepsy, whereas the remaining seven had neocortical epilepsy. All patients were admitted to Jichi University Hospital in Japan for the presurgical evaluation and surgical intervention. All patients were subjected to clinical evaluation, brain MRI, and long-term scalp video-EEG monitoring; a total of 23 patients had interictal ¹²³ I-IMZ SPECT, 19 had interictal MEG recording, and 10 had interictal ¹⁸ F-FDG PET. The laterality and locality of the epileptogenic area predicted by these methods were defined in relation to the resected area. Results Long-term scalp video-EEG monitoring was significantly superior to interictal ¹²³ I-IMZ SPECT and interictal ¹⁸ F-FDG PET in diagnosing laterality and locality of the epileptogenic zone and superior to interictal MEG in patients with mesial temporal lobe epilepsy and patients with epileptogenic MRI findings. Conclusion Long-term scalp video-EEG monitoring is the cornerstone in the presurgical evaluation of epilepsy surgery.

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