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   2015| October-December  | Volume 52 | Issue 4  
    Online since November 27, 2015

 
 
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ORIGINAL ARTICLES
Admission leukocytosis, C-reactive protein and erythrocyte sedimentation rate in acute noncardioembolic cerebral ischemia: influence on early outcome
Magdy A Mostafa, Mohamed K Elewa, Nevine Ahmed Mohamed
October-December 2015, 52(4):223-227
DOI:10.4103/1110-1083.170651  
Background There is growing evidence regarding the role of inflammation in the pathogenesis of ischemic stroke, especially nonembolic types of ischemic stroke. Despite this, there is a need to investigate the direct impact of inflammatory markers on the early outcome in nonembolic ischemic stroke. Objective The aim of the present study was to determine whether positive inflammatory markers such as raised erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and leukocytosis could be used as biochemical predictors for poor early outcome in patients with acute noncardioembolic ischemic stroke. Patients and methods A total of 60 patients(40 men and 20 women; median age: 64.5 years) with first attack of noncardioembolic ischemic stroke were included in the study. Full clinical assessment and routine laboratory investigation were conducted for all patients. MRI of brain, ECG, and cardiac echo were carried out to confirm the diagnosis and exclude cases with embolic stroke. Blood samples for all patients within the first 24 h of onset of symptoms were taken for assessment of ESR, qualitative CRP, and leukocyte count on admission. National Institute of Health Stroke Scale was used for all patients after 7 days. On the basis of their scores patients were divided into two groups: 40 patients with favorable outcome were included in the first group and 20 patients with bad outcome in the second group. Results There was significant difference between the two groups regarding ESR value, and the leukocyte count was higher in the group with bad prognosis. In addition, positive CRP was associated more with the same group in statistically significant way. Conclusion Inflammatory markers play an important role in detecting the early outcome of noncardioembolic stroke.
  2,994 1,100 3
Polysomnography and antidiuretic hormone secretion pattern in children with primary nocturnal enuresis
Hanan M Hamed, Amany M Abd Al-Aziz, Ayat A Motawie, Amany A. A. Fatouh, Mona A. M. Awad, Lamia Afifi
October-December 2015, 52(4):258-263
DOI:10.4103/1110-1083.170658  
Background Nocturnal enuresis (NE) is one of the most common pediatric sleep-related problems. Data on sleep patterns in children with NE are conflicting. Objective We aimed at studying the sleep architecture, associated breathing problems, and its relation to antidiuretic hormone (ADH) in children with primary NE. Patients and methods This study included 31 children aged 6-18 years with primary monosymptomatic NE and 16 healthy matched controls. They were subjected to a single overnight polysomnography and assessment of ADH levels at 9-11 a.m. and 9-11 p.m. Results Enuretic children had significantly prolonged sleep latency and higher stage N1 percentage, less total sleep time, lower sleep efficiency, and lower rapid eye movement sleep percentage compared with the control group. Ten (32.2%) NE children had nocturnal arrhythmia, whereas six (19.35%) had a respiratory distress index more than 5. Reversed ADH secretion pattern was present in 82% of the NE children. Children with reversed ADH secretion had lower stage N1 and respiratory distress index, and higher sleep efficiency, compared with NE children with normal ADH rhythm. Conclusion Primary NE is associated with disturbed sleep architecture. NE could be a presenting symptom for hidden sleep disordered breathing. The association of NE with cardiac arrhythmia is an interesting finding that requires further research. Most NE children have a reversed pattern of ADH secretion.
  3,177 219 3
Migraine comorbidity in patients with multiple sclerosis
Lobna M El-Nabil, Ghada Ashraf, Khaled O Abdulghani, Ayman Nasef, Mohammad Ossama Abdulghani
October-December 2015, 52(4):264-269
DOI:10.4103/1110-1083.170659  
Background Migraine headache is a common feature in multiple sclerosis (MS) patients, with variable prevalence among studies. It can influence the diagnosis, radiological evaluation, treatment, and quality of life of these patients. Objective The aim of the study was to assess the frequency and severity of migraine in a sample of Egyptian patients with MS and to study the clinical and radiological characteristics in those patients. Patients and methods We studied 55 patients with MS. They were subjected to full clinical and neurological assessment, including the diagnosis of migraine. Migraine diagnosis was made using a questionnaire based on criteria proposed by the International Classification of Headache Disorders, 2nd ed. Neurological impairment was evaluated with the Multiple Sclerosis Severity Scale; migraine severity evaluation was made using the Migraine Disability Assessment Scale. MRI of the brain and spinal cord was also performed. Results Migraine headache was present in 19 (34.5%) patients. Our results indicate that the majority of patients with coexisting migraine and MS develop migraine years earlier. There was no statistically significant difference between patients with migraine and those without with respect to the age at onset of MS, duration of illness, annual relapse rate, Expanded Disability Status Scale, and Multiple Sclerosis Severity Scale. However, midbrain periaqueductal affection in MRI was more prevalent among MS patients with migraine. Conclusion Migraine is comorbid in patients with MS. The exact etiology and pathogenesis of these two seemingly disparate disorders has not been completely understood.
  2,916 250 -
Value of seizure semiology and ictal source analysis in lateralizing and localizing the epileptic zone
Khaled O Abdulghani, Ahmad A Gaber, Azza A Abdulaziz, Heba H Afeefy, Taha K Alloush, Amira A Zaki, Mohammad Ossama Abdulghani
October-December 2015, 52(4):243-248
DOI:10.4103/1110-1083.170655  
Background Sophisticated analysis of seizure semiology and electroencephalography (EEG) has a significant role in lateralizing and localizing the epileptogenic zone. Hence, understanding the pathophysiology of epileptogenic dysrhythmia requires thorough knowledge of how to put the very different pieces of the puzzle together. Objective The aim of the study was to investigate the concordance between seizure semiology, electrophysiological generator, anatomical lesions, and neuropsychological evaluation in patients with partial epilepsy, and to identify the importance of ictal EEG recording and the diagnostic yield of other electrophysiological techniques. Patients and methods Thirty patients with a diagnosis of intractable partial epilepsy and lesional MRI were prospectively included. All of them were clinically evaluated and identified according to semiological seizure classification. Long-term video digital EEG with ictal recording was done, along with a source analysis (SA) study. Results Clinical evaluation by seizure semiology lateralized 73% of the cases and localized 80%. Ictal EEG lateralized 80% of cases and localized 66.9%. SA revealed a much superior power to lateralize and localize (96.7%) the epileptogenic zone, but what is more important is the added value of SA, as it lateralized and localized 96-100% of the cases that failed on semiology. SA has the highest expected value for additional lateralizing and localizing information ( ±7.73 and ±7.30, respectively). Conclusion Seizure semiology and ictal EEG recording with SA are the most accurate ways to lateralize and localize the epileptogenic zone in intractable partial epileptic cases, giving the patient a respectable chance to avoid other invasive diagnostic techniques.
  2,561 282 -
Serum matrix metalloproteinase-9 in acute ischemic stroke and its relation to stroke severity
Maged Abdelnaseer, Nervana Elfayomi, Eman Hassan, Manal Kamal, Ahmed Hamdy, Enji Elsawy
October-December 2015, 52(4):274-278
DOI:10.4103/1110-1083.170661  
Background Thrombolytic therapy is currently the only FDA-approved treatment for acute ischemic stroke. Hence, early diagnosis and risk stratification is of great importance in management. Objective The aim of this work was to study serum level of matrix metalloproteinase-9 (MMP-9) within 24 h of acute ischemic stroke onset and its relation with clinical severity. Patients and methods Thirty patients with acute ischemic stroke were subjected to measurement of serum MMP-9 within 24 h of stroke onset and clinical assessment of stroke severity. Thirty healthy volunteers of matched age and sex were included as controls. Results Fifteen male and 15 female patients with a mean age of 61 ± 7.11 years were studied. The mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 11.17 ± 4.76. The mean serum level of MMP-9 in patients was 998.8 ± 154.72 ng/ml, which was significantly higher compared with the serum level of MMP-9 in controls (P = 0.003). The mean NIHSS of patients with normal serum level of MMP-9 was less than the mean NIHSS in patients with high MMP-9 serum levels (P = 0.003). There was a significant positive correlation between serum level of MMP-9 and NIHSS score (r = 0.5; P = 0.005) even after adjustment of other variables )age, sex, diabetes, hypertension, fasting blood sugar, uric acid, serum triglycerides, serum cholesterol, and right and left carotid intima media thickness( (r = 0.48; P = 0.032). Conclusion Serum MMP-9 level was found to be high in acute ischemic stroke patients and correlated with clinical stroke severity.
  2,359 312 5
Diagnostic value of optical coherence tomography in patients with idiopathic intracranial hypertension
Dalia M Labib, Dalia H Abdel Raouf
October-December 2015, 52(4):249-253
DOI:10.4103/1110-1083.170656  
Background Idiopathic intracranial hypertension (IIH) is characterized by raised intracranial pressure in the absence of space-occupying lesions or other known etiology. It mainly affects young obese women, and may cause visual loss due to secondary optic atrophy. Objective The aim of the study was to investigate optical coherence tomography (OCT) and perimetry changes in patients with IIH at admission and 6 months later and highlight the relationship between OCT changes and severity of visual dysfunction measured by automated perimetry. Patients and methods This study included 30 female patients with IIH. Cerebrospinal fluid opening pressure was recorded. Complete ophthalmic evaluation included assessment of best-corrected visual acuity, perimetry, and retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness within 3-4 days of performing the lumbar puncture. Thirty age-matched healthy women underwent a similar ophthalmological evaluation. Results In IIH patients the initial RNFL thickness was significantly higher, whereas GCC was significantly lower than that of controls (P = 0.045 and 0.004, respectively). The value of intracranial pressure measured was found to be positively correlated with the stage of papilledema (r = 0.494, P = 0.000). The final recordings showed significant decrease in GCC and RNFL values (P = 0.000 and 0.002, respectively) and improvement in mean deviation (P = 0.003). Conclusion GCC and RNFL thickness abnormalities in IIH patients were quantitatively correlated with visual field sensitivity losses. OCT is an effective tool for quantifying parameters of optic nerve damage.
  2,071 197 1
Effect of glycemic control on the severity and outcome of stroke in Saudi Arabia
Magdy A Mostafa, Nevine A Mohamed
October-December 2015, 52(4):228-231
DOI:10.4103/1110-1083.170652  
Background Diabetes mellitus (DM) is a well-known risk factor of ischemic stroke. However, the effect of glycemic control regardless of the presence of DM on the clinical picture of stroke and its impact on the severity and outcome of stroke is not fully investigated. Objective The aim of this study was to assess the impact of prestroke glycemic control regardless of the presence of past history of DM on the size of infarction, stroke severity, and functional outcome in patients with acute ischemic stroke. Patients and methods We measured glycosylated hemoglobin (HbA1c) level as an indicator for glycemic control in the last 3 months before stroke in 56 patients with the diagnosis of the first attack of acute ischemic stroke. There were 26 female and 30 male patients between 45 and 94 years of age. After history taking and full clinical examination, the size of infarction was measured using computed tomography scan of the brain. Stroke severity within 72 h from onset of symptoms was assessed using the National Institute of Health Stroke Scale and outcome of stroke after 2 months was assessed using the modified Barthel Index, both of which were assessed for each stroke patient. Results There was a significant positive correlation between the value of HbA1c and both the size of infarction and National Institute of Health Stroke Scale score assessed within 72 h from symptom onset (P < 0.01). In contrast, increased HbA1c value was significantly associated with a decrease in the modified Barthel Index score assessed after 2 months (P < 0.001). Conclusion Glycemic control has a significant effect on ischemic stroke severity and outcome.
  1,966 237 -
Sleep-related breathing disorders in stage II essential hypertension
Amira Labib, Lamia Afifi, Reham Shamlool, Mona M Nada, Hanan A Amer, Saly H ElKholy
October-December 2015, 52(4):232-237
DOI:10.4103/1110-1083.170653  
Background Sleep-related breathing disorders (SRBDs) are reported to be common among patients with hypertension (HTN). Objective Our aim was to use polysomnography (PSG) to objectively study the frequency and types of SRBDs in essential stage II HTN. Patients and methods We used an attended full PSG recording in a group of 20 patients suffering from stage II HTN and in a group of 20 age-matched and sex-matched controls. The Berlin Questionnaire was also administered to the patients. The patients were assessed for a history of smoking, fasting blood sugar, and BMI. Results We found that 70% of HTN patients had SRBDs: 15% had mild, 30% had moderate, and 25% had severe SRBDs. As for the controls, we found that 40% of controls had SRBDs: 20% had mild, 15% had moderate, and 5% had severe SRBDs. The overweight patients with HTN had a significantly higher hypopnea index compared with normal weight patients. The diabetic hypertensive group showed a lower sleep efficiency. In addition, all the high-risk patients identified by the Berlin Questionnaire showed evidence of SRBDs, but not all SRBD patients were identified as high-risk patients by the Berlin Questionnaire. Conclusion SRBD is very common in stage II HTN. Clinicians should be aware of this high prevalence and make use of the Berlin Questionnaire and PSG, as treatment for SRBDs can have a profound impact on these patients.
  1,850 171 1
Preoperative sleep quality and inhalation anesthetic requirements: a sleep electroencephalography study
Mohamed A Maher, Eman A Maher, Ahmed Aabdelaal Ahmed Mahmoud
October-December 2015, 52(4):254-257
DOI:10.4103/1110-1083.170657  
Background On the night before surgery, poor sleep quality due to anxiety is a frequently encountered problem. Objective This study aimed at determining the effect of preoperative sleep quality on intraoperative isoflurane requirements in patients undergoing elective surgeries and also offers an electroencephalography (EEG)-based classification of sleep quality. Patients and methods Twenty-seven adult male patients scheduled for elective open cholecystectomy with ages ranging from 20 to 40 years were included in this study. The night before the operation, the patients were subjected to an at least 8 h sleep EEG, which was scored for the following: total sleep time, percentage of slow wave sleep, and percentage of rapid eye movement sleep. Intraoperative isoflurane requirements were determined by recording the amount of inspired isoflurane concentration (every 2 min) needed to achieve an intraoperative bispectral index value between 40 and 60. Patients were classified according to sleep EEG into good sleepers and bad sleepers. Isoflurane requirements were first correlated with the EEG and then compared between the two groups. Results The inspired concentration of isoflurane in good sleepers was 1.15% (1.01-1.22%), whereas in bad sleepers it was significantly lower, at 0.99% (0.87-1.18%) (P = 0.003). There was a positive correlation between isoflurane requirements and both slow wave sleep percentage (r = 0.693; P = 0.003) and rapid eye movement sleep percentage (r = 0.687; P = 0.005). Conclusion Patients suffering from poor sleep quality on the night before surgery need less intraoperatively inspired isoflurane concentration. This finding may have clinical importance in adjusting the isoflurane dose to meet patients' requirements, avoiding intraoperative complications. In addition, an EEG-based classification of sleep is offered.
  1,760 164 1
Quantitative electroencephalographic changes in attention deficit hyperactivity disorder children
Ann A Abdel Kader, Nagwa A Mohamed, Omnia R Amin, Basma B El Sayed, Islam F Halawa
October-December 2015, 52(4):270-273
DOI:10.4103/1110-1083.170660  
Background The electroencephalogram (EEG) has long been used to pick up and analyze the electrical activity of the outermost layer of the brain. Attention deficit hyperactivity disorder (ADHD) patients revealed increased power in the lower frequency bands (δ and θ power) and a raised θ/β ratio. Objective The aim of this study was to detect the quantitative EEG changes in children with ADHD compared with normal children. Patients and methods The sampled group consisted of 45 children suffering from ADHD and represented the patient group, and 45 normal children represented the control group. EEG was recorded under resting conditions for all participants. Data from frontal areas were digitally processed and analyzed to calculate the four frequency bands' power (β, α, θ, and δ) and then θ/β ratio was computed. For the patient group, the Wechsler Intelligence Scale for Children was applied and parents of these patients filled out the Arabic version of Conners' Parent Rating Scale-revised-long version. Results The patient group showed significantly higher θ/β ratio in frontal areas compared with the control group (P < 0.05). There was a significant negative relation between age and θ/β ratios and a significant negative relation between age and Conners' hyperactivity subscale (P < 0.05). There was a significant positive relation between Conners' hyperactivity subscale and mean θ/β ratio (P < 0.05). Conclusion Quantitative EEG markers - namely, the θ/β ratio - could play a role in the understanding and identification of ADHD.
  1,690 177 -
Impact of early stages of (mild) hepatitis C viral infection on neurocognitive functions in otherwise healthy patients: an Egyptian magnetic resonance spectroscopy study
Hatem Anwar ElMassry, Nahla Elsayed Nagy, Walaa Mohamed Sabry, Reem Hassan El-Ghamry
October-December 2015, 52(4):238-242
DOI:10.4103/1110-1083.170654  
Background The alterations in cerebral function in patients with chronic hepatitis C virus (HCV) infection may be due to a direct effect of HCV on the brain, or due to neurotoxic-related systemic inflammation. Objective This study aimed to assess central nervous system involvement through brain magnetic resonance spectroscopy (MRS) as well as cognitive functions in HCV-infected patients with mild liver disease. Patients and methods Twenty-eight HCV-infected patients with slightly elevated liver enzymes were recruited from the outpatient Hepatology Clinic, Beni Sweif University Hospitals and Ain Shams University Hospitals. They underwent cognitive examination by means of the Wechsler attention, concentration, and memory subscales, as well as cerebral MRS. The results of all investigations were compared with corresponding results of 15 matched normal controls. Results The results showed mild but significant elevation of liver enzymes in the patient group compared with the control group with impaired levels of attention, concentration, and memory determined by the subscales. MRS findings showed elevated choline and myoinositol in the basal ganglia, decreased N-acetyl aspartate, and abnormal N-acetyl aspartate/creatine ratio. Conclusion Treatment plans for HCV should consider neuropsychological complications.
  1,628 188 -