Vascular Causes Research Articles

Que peut nous apprendre l’étude du métabolisme cérébral en TEP au 18F-FDG du syndrome de Lance-Adams ?

Lance-Adams syndrome, also known as “chronic post-anoxic myoclonus”, is a rare syndrome characterised by intention and action myoclonus following cerebral anoxia, leading to major disability. The cortical or subcortical origin of the myoclonus is still debated. Answering this question would open up new avenues of translational research to gain a better understanding of the pathophysiology of this syndrome and better guide the therapeutic management of patients. In addition to a neurological examination, the initial diagnostic work-up includes a biological work-up, electrophysiological investigations and brain imaging to rule out diGerential diagnoses. Cerebral MRI is the reference imaging technique. In the literature, more than a third of patients have a normal MRI. MRI is used to rule out a vascular cause and to look for atrophy or neuronal damage. Few data are available in the literature on the role of nuclear medicine. To date, 13 cases have been published using 18F-FDG PET and 4 using cerebral perfusion scintigraphy. Abnormalities of cortical and/or subcortical perfusion or metabolism are reported in 65% of cases; they are limited to the neocortex in 23% and aGect the cerebellum in 12% of cases. In this article, we present three patients who underwent cerebral 18F-FDG PET scans for Lance-Adams syndrome with normal MRI. The results of these examinations are discussed and compared with the data found in the literature.

Evaluation of the relationship between thrombophilia gene mutations and demographic data, imaging findings and stroke subtypes in young patients followed up with a diagnosis of stroke

Aims: A stroke is defined as a focal or generalized neurological deficit that develops suddenly, lasts for more than 24 hours, or ends in death within this period, with a cause other than a vascular cause. Stroke is among the leading causes of morbidity and mortality in the general population. In our study, we examined the prevalence of all prothrombotic gene mutations observed in patients with and without predisposing risk factors for young patients with stroke and discussed their roles in stroke formation in the context of existing literature. Methods: In the present study, we conducted a retrospective review of the medical records of 300 patients aged 18 to 49 years who were hospitalized in the neurology clinic of our hospital between June 2023 and June 2024 and diagnosed with acute arterial ischemic stroke based on anamnesis, neurological examination, and radiological imaging (CT and MRI) results. The study cohort comprised 47 patients (23 males, 24 females) aged between 18 and 49 years with a diagnosis of ischemic stroke. In our study, we examined ischemic stroke-related gene polymorphisms in patients with early-onset ischemic stroke (before the age of 50 years). This study aims to investigate the prevalence of Factor V-Leiden, prothrombin-G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T, MTHFR A1298C, SERPIN 1, and Factor II polymorphisms in young patients with ischemic stroke. Results: A total of 47 patients, comprising 23 males and 24 females, were included in the study. The mean age of the patients was 40.34 ± 6.37 years. According to the TOAST classification system, 17 patients (36.2%) were diagnosed with large artery atherothrombosis, one patient (2.1%) had a cardioembolic infarction, and 29 patients (61.7%) had a small artery occlusion. In our study, when evaluating the thrombophilia mutation subtypes in young ischemic stroke patients, 23.4% (n=11) of the patients were found to be heterozygous for the FVL mutation, while 76.6% (n=36) had no mutation. Concerning the SERPIN 1 mutation, 40.4% (n=19) of the patients were heterozygous, 23.4% (n=11) were homozygous, and 36.2% (n=17) exhibited no mutation. The distribution of patients according to MTHFR C677T mutation revealed that 57.4% (n=27) were heterozygous, 19.1% (n=9) were homozygous, and 23.4% (n=11) had no mutation. Considering the distribution of patients according to the MTHFR A1298C gene mutation, a total of 38.3% (n=18) of the patients were heterozygous, 14.9% (n=7) were homozygous, and 46.9% (n=22) had no mutation. Upon analysis of the distribution of patients according to factor XIII mutation, it was identified that 19.1% (n=9) were heterozygous, 2.1% (n=1) were homozygous, and 78.7% (n=37) of the patients exhibited no mutation. Upon analysis of the distribution of patients according to prothrombin (Factor II) mutation, it was identified that 8.5% (n=4) were heterozygous, while 91.5% (n=43) exhibited no mutation. Conclusion: Although stroke is less prevalent in young adults, the underlying etiology is highly varied. Further research, including the investigation of genetic and prothrombotic mutations, is vital for the prevention of recurrent strokes in young adults.

Occlusive lesions of retinal vessels: etiological and patogenetic factors

Background. Vascular pathology of the organ of vision is one of the most urgent problems of ophthalmology, as it is the main cause of vision loss and vision loss. Retinal vein occlusion ranks second after diabetic retinopathy in the world among vascular causes of vision loss. In a significant risk group for the occurrence of occlusions of the retinal vessels are patients with cardiovascular diseases. Today, treatment of patients with coronary heart disease and patho­logy of heart valves is impossible without surgical interventions, most of which require the use of artificial circulation (AC). During the operation of the AC due to prolonged hypothermia, hemodilution, prolonged hypotension, anemia, development of ophthalmologic complications in the early postoperative period is possible. The purpose of the study was to investigate etiological and pathogenetic factors of occlusive lesions of retinal vessels. Mate­rials and methods. The search for sources of Ukrainian and foreign literature for the ana­lytical review was conducted keywords using the open medical scientific database PubMed (USA). At the first stage, 211 sources were selected, of which 66 were selected for this article. Results. Occlusion of the central retinal vein (CVO) deve­lops in 214 people per 100,000 population, mainly in people over 65 years of age. The frequency of branh retinal vein occlusions (BRVO) is 67.2%, of which 82.4% is a occlusion of the superior temporal branch. The main risk factors of CVO are age, hypertension, diabetes, atherosclerosis, glaucoma, coronary heart disease. A small number of sources are found in the literature regarding complications from the organ of vision in patients after cardiac surgery with AC such us thromboembolism of retinal vessels, optic ischemic optic neuropathy, retinal ischemia, optic nerve atrophy, retinal detachment, proliferative vitreoretinopathy. The authors' research showed a multiple increase in blood markers of endothelial dysfunction, including vascular endothelial cadherin (VE-cadherin, VE-C) after surgery. Conclusions. Diseases of the organ of vision due to general or local blood circulation disorders account for 10 to 28%, 2.6% of which lead to blindness. There is a relationship between occlusive lesions of retinal veins and cardiovascular diseases. The main reasons for the development of retinal vein occlusion after cardiac surgery with coronary artery disease are acute inflammation occurring during and immediately after surgery and endothelial dysfunction.

Newest "Co-Members" of the 1000s Club: A Case of Severe Transaminitis Secondary to Epstein-Barr and Dengue Virus Co-Infection in a Returning Traveler.

Timely identification of the etiology of transaminitis is critical in informing subsequent management as strategies can vary from supportive care to urgent transplant assessment. This is especially important in returning travelers as there may be multiple causes of injury that need to be addressed. We present a case of severe transaminitis secondary to non-hepatitis viral co-infections. A 28-year-old south Asian male returning traveler presented with an acute liver injury (aspartate aminotransferase/alanine aminotransaminase levels of ≥4000 IU/l) and marked jaundice. A thorough and expanded work-up of acute hepatitis was negative aside from positive mononucleosis spot testing and positive dengue fever serologies. This atypical presentation of mononucleosis and dengue fever was managed conservatively, and the patient was discharged with outpatient follow-up after an eight-day admission. Usually, non-hepatitis viruses typically do not present with severe transaminitis or hyperbilirubinemia. These viruses, such as infectious mononucleosis and dengue fever, may work synergistically to cause an elevated inflammatory response, resulting in severe transaminitis in returning travelers. In the absence of a classic clinical presentation, clinicians should be aware of co-infections in returning travelers and test for them based on a thorough history and physical examination. The differential diagnosis for severe transaminitis is narrow and commonly includes viral hepatitis (A-E), drug-induced liver injury, vascular and autoimmune causes; however other causes exist, and greater clinical awareness is needed.This case study demonstrates that even in the absence of a classic clinical presentation; in returning travelers, clinicians should have a low index of suspicion to order appropriate screening serologies based on a thorough history and physical examination as they can be sensitive diagnostic tools in detecting the etiology of severe transaminitis.In rare cases, non-hepatitis virus may act synergistically to cause severe transaminitis and should be considered in returning travelers when viral hepatitis serologies are negative.

APPLICATION OF COMPUTERISED TECHNOLOGIES IN THE REHABILITATION OF PATIENTS WITH STROKE CONSEQUENCES

A stroke is a sudden onset of focal or generalized impairment of brain function due to vascular causes only, which is related to cerebral blood flow and lasts for more than 24 hours. Cerebral stroke remains the second leading cause of death and the third most significant cause of disability in the world. Over the past 30 years, the absolute number of cases of this disease has increased by 70%, the prevalence by 85%, with a 43% increase in mortality rates. According to the latest Global Burden of Disease (GBD) analysis, in 2019, there were about 12.2 million stroke cases, 143 million disability-adjusted life years and 6.6 million deaths worldwide, 86% of which occurred in low- and lower-middle-income countries. Purpose to analyse and systematise the use of computerised technologies in the rehabilitation of patients with stroke consequences. Materials and methods. To achieve the objectives of the research, the researchers analysed scientific literature and systematised information using electronic databases such as PubMed, Google Scholar and others. Research results. Traditional methods have proven their effectiveness and are widely used in the practice of rehabilitating patients after stroke. However, with the development of science and technology, there is a need to find new approaches to therapy that can provide a more comprehensive and effective treatment of this pathology. Today, computerized technologies deserve special attention in the rehabilitation of patients after stroke, namely robotic systems, specially designed video games and virtual reality, and TV rehabilitation. Robotic systems are devices that automate various tasks and processes. They can be programmed to perform certain functions with high accuracy and repeatability. In rehabilitation, such systems help to restore motor functions, support physical activity, and facilitate recovery from injuries or illnesses, including stroke. Video games and virtual reality technologies are examples of exciting and fun rehabilitation for stroke patients. Traditional therapies can be complex and tedious to repeat, making it less likely that patients will do them at home. Physical therapists are finding that video games are more engaging and easier to incorporate into home treatment regimens. Tele-rehabilitation after stroke is a form of remote medical care that allows patients to receive rehabilitation services via the Internet or other telecommunication technologies. This provides access to the necessary therapy regardless of the patient's place of residence. Conclusions. Computerized technology significantly improves the rehabilitation of patients with stroke. Robotic systems provide high precision and control during movements, which avoids incorrect exercise and reduces the risk of re-injury, regularity of training, and patient comfort. In addition, many robotic systems have built-in sensors that allow you to track the patient's progress and provide feedback to both the patient and the doctor. This helps to adjust the rehabilitation programme according to the patient's needs. The use of video games and virtual reality in stroke rehabilitation offers numerous benefits, including increased motivation, improved motor and cognitive function, psychological support, and social interaction. Tele-rehabilitation after stroke is an innovative approach to patient recovery, providing access to rehabilitation services regardless of where they live.

A Clinical-Electrographic Profile of Neonatal Seizures and Their Etiologies in a Single Level III Neonatal Intensive Care Unit

Background: Seizures are the most frequent neurological emergency in neonatal period and can be associated with significant mortality and subsequent neuro-developmental disability if not recognized and managed early. Repaid identification of neonatal seizures and evaluation is critically required to identify and treat the underlying etiology. Clinicians face a major challenge in diagnosing and treating neonatal seizure because of inconspicuous clinical presentation, variable electro-clinical correlation. Assessing the combination of clinical presentation, etiological factors, different diagnostic tools, and treatments, can broaden the knowledge and understanding towards neonatal seizure providing better management and outcome. Objective: To study the characteristics of clinical and electrographic profile of neonatal seizure and the relations to their etiologies in neonatal intensive care unit. Methods: This is a descriptive cross sectional retrospective study of electronic health records with ICD- 10 diagnosis of neonatal seizure from birth to 28 days, who were admitted to neonatal intensive care unit at Sheikh Shakhbout Medical City between January 2020 to December 2021. Clinical data obtained including basic demographics: gender, gestational age, mode of delivery, birth weight, and Apgar score. Onset and type seizure, type of antiepileptic drugs administered, EEG findings, brain imaging, results of relevant laboratory tests and etiology of seizure were collected. Results: Total 31 neonates included in the study. Majority were male (71%), term (87%), and birth weight >2,5 kg (90%). Seizure within 24 hours was 58% and semiology was focal clonic in 32% of patient. No events in EEG in 81% and 6% had electrographic seizure (n=2). 94 % were treated with anti-convulsant, 86% of them before EEG. The majority (86%) received phenobarbitone as 1st line treatment and 83% received monotherapy. Leading causes of seizure were HIE (48%) followed by Vascular causes (16%). Seizure within 24 hours caused mainly by HIE (61%) and 60% of neonates with vascular and all infectious and genetic causes had seizure after 24 hours. In vascular causes, (60%) presented with focal clonic seizure. 60% of Multifocal epileptiform activity seen in HIE whereas focal presented more in vascular patient (36%). In HIE cases, 53% had normal brain MRI and 47% were abnormal. All cases with vascular causes had diagnostic abnormal MRI. The majority of HIE cases (87%) and all vascular cases received monotherapy. Conclusion: In this descriptive study of neonatal seizure, certain demographic data, clinical and electrographic characteristics had established links to their etiologies. Clinical events captured during EEG with no electrographic seizure are classified as non-epileptic clinical phenomenon. Diagnostic utility of EEG is required in diagnosis of involuntary movements and avoid unnecessary anti-seizure medications. Understanding the clinical-electrographic profile of neonatal seizure helps in the early recognition of specific etiologies, allowing an early diagnosis by organized diagnostic approach and management.

Effectiveness Of Visual Feedback Balance Training On Equiboard Versus Traditional Balance Training In Post Stroke Patients- A Comparative Study

Background: A Stroke is classically characterized as a neurological deficit attributed to an acute focal injury of the central nervous system by a vascular cause and is a major cause of disability and death worldwide.(1) Balance problems are thought to be common after stroke and they have been implicated in the poor recovery of activities of daily living and mobility and increased risk of falls.(2) Postural sway for patients with hemiplegia can be twice that of their age matched peers. Many balance training are used but No general physiotherapy approach has proven to be superior for promoting balance recovery from stroke.(3)Novel biofeedback devices based on Virtual reality (VR)technology are now being used for neuromotor rehabilitation. Traditional balance training is based on the automatic repetition of specific movements. These methods can become repetitive and thus reduce the motivation of the patient and adherence to treatment. So the need of my study is to compare the effectiveness of visual feedback balance training on equiboard and traditional balance training in post stroke patients. Aims and objectives-To study and compare the effectiveness of visual feedback balance training on equiboard versus traditional balance training in post stroke patients. Methodology- 30 patients with stroke were equally divided into two groups. patients in group A received the conventional physiotherapy while the patients in group B received visual feedback balance training on equiboard. All the subjects were treated for 1 month, 5 days a week. BBS-Berg Balance Scale and step test was used as the outcome measure at the beginning and end of study. Results-Results showed significant improvement within both the groups for both the outcome measure(p,0.05), while there was no significant difference between two groups in BBS(p>0.5), but there was significant difference in the step test of experimental group(p<0.5) Conclusion-It can be concluded that visual feedback balance training is more effective than the traditional balance training alone in stroke patients.

Seeking a Treatable Cause of Out-of-Hospital Cardiac Arrest during and after Resuscitation

Out-of-hospital cardiac arrest (OHCA) represents a significant global public health burden, characterized by low survival and few established diagnostic tools to guide intervention. OHCA presents with a wide variety of etiologies in a heterogeneous population, posing a clinical challenge to care teams. In this review, we describe evolving research focused on diagnostic approaches to OHCA following resuscitation, including electrocardiography, coronary angiography, computed tomography, ultrasonography, and serologic biomarker assessment. These diagnostic tools have been employed in post-resuscitative efforts for diagnosing ischemic and non-ischemic cardiac, respiratory, neurologic, vascular, traumatic, and metabolic causes of arrest.

Эректильная дисфункция: современное состояние проблемы, методы диагностики и рентгенэндохирургического лечения

According to the Russian Society of Urologists, almost half of men aged 27 to 77 suffer from erectile dysfunction. ED should be considered not only as a medical nosology, but also as a socio-psychological problem with a demographic aspect. There are many methodsfor improving erectile function, including psychological consultations, drug therapy and penile prosthetics. Given the accumulated international experience,the key pointis an accurate diagnosis ofthe cause of erectile dysfunction to determine the correct approach to treatment. Among the many causes of erectile dysfunction, vascular causes are quite common. Given the rapid development of endovascular and low-traumatic approachesto vascular pathology,the technique of improving inflow and outflow obstruction in vasculogenic erectile dysfunction is becoming increasingly obvious and effective. The presented article discussesthe currentstate ofthe issue and possible prospectsfor endovascularsurgery for vascular erectile dysfunction, including significant venous leakage.

Secondary parkinsonism associated with focal brain lesions.

Focal imaging abnormalities in patients with parkinsonism suggest secondary etiology and require a distinctive clinical approach to diagnosis and treatment. We review different entities presenting as secondary parkinsonism associated with structural brain lesions, with emphasis on the clinical course and neuroimaging findings. Secondary parkinsonism may be due to vascular causes, hydrocephalus, space-occupying lesions, metabolic causes (including acquired hepatocerebral degeneration, diabetic uremic encephalopathy, basal ganglia calcifications, osmotic demyelination syndrome), hypoxic-ischaemic brain injury, intoxications (including methanol, carbon monoxide, cyanide, carbon disulfide, manganese poisoning and illicit drugs), infections and immune causes. The onset can vary from acute to chronic. Both uni-and bilateral presentations are possible. Rigidity, bradykinesia and gait abnormalities are more common than rest tremor. Coexisting other movement disorders and additional associated neurological signs may point to the underlying diagnosis. Neuroimaging studies are an essential part in the diagnostic work-up of secondary parkinsonism and may point directly to the underlying etiology. We focus primarily on magnetic resonance imaging to illustrate how structural imaging combined with neurological assessment can lead to diagnosis. It is crucial that typical imaging abnormalities are recognized within the relevant clinical context. Many forms of secondary parkinsonism are reversible with elimination of the specific cause, while some may benefit from symptomatic treatment. This heterogeneous group of acquired disorders has also helped shape our knowledge of Parkinson's disease and basal ganglia pathophysiology, while more recent findings in the field garner support for the network perspective on brain function and neurological disorders.

Coma Due to Artery of Percheron Infarction: An Unusual Case Report

Ischemic stroke attributable to obstruction of the artery of Percheron (AOP), an infrequent anatomical arterial variant perfusing both medial thalami, can pose difficult diagnostic challenges. Obstruction or occlusion of the AOP results in bilateral paramedian thalamic infarction which is an unusual and rare vascular cause of coma. We present a 65-year-old male patient who came to the emergency department with altered sensorium for 10 days. The initial computed tomography (CT) brain was normal, followed by subsequent CT revealing an ill-defined hypodensity in the ventromedial aspect of the left thalamus and ventral aspect of the midbrain. T2/fluid-attenuated inversion recovery magnetic resonance imaging illustrated hyperintensity in the mesencephalon and bilateral paramedian thalami with restricted diffusion, suggesting an AOP infarct.

Spontaneous spinal hematomas: A case series

PurposeSpontaneous spinal hematoma (SSH), a rare neurological disorder, demands immediate diagnostic evaluation and intervention to prevent lasting deficits. This case series analyzes instances, particularly highlighting cases where vascular causes were identified despite inconclusive initial imaging.MethodsIn a retrospective study of 20 patients treated for SSH at a Level I spine center from 01/01/2017 to 11/15/2023, we examined demographics, clinical presentation, imaging, and treatment details. Excluding traumatic cases, we present 4 instances of SSH associated with diverse vascular pathologies.ResultsPatient ages ranged from 39 to 85 years, with a median age of 66 years. 45% were male, and 55% were female. Among 20 cases, 14 were epidural hematomas, 4 subdural, 1 combined epidural and subdural, and 1 subarachnoid hemorrhage. 85% presented with neurological deficits, while 3 solely had pain-related symptoms. 55% were under anticoagulant medication, and vascular anomalies were found in 25% of cases. The cause of SSH remained unclear in 20% of cases. MRI was performed for all patients, and DSA was conducted in 25% of cases. The 4 highlighted cases involved individuals with distinct vascular pathologies managed surgically.ConclusionUrgent attention is crucial for SSH due to possible lasting neurological consequences. The study emphasizes comprehensive diagnostics and surgical exploration, especially in cases with unclear etiology, to identify and address vascular causes, preventing hematoma progression or recurrence. Despite their rarity, vascular malformations contributing to spinal hematomas warrant particular attention.

Neutrophil to lymphocyte ratio and five-year mortality in patients with acute ischemic stroke

BackgroundPrevious studies linked neutrophil to lymphocyte ratio (NLR) with short-term mortality after acute ischemic stroke (AIS), but its relationship with long-term mortality remains unclear. This study investigates the association between NLR and five-year mortality in AIS patients. MethodWe analyzed 416 AIS patients from April 2012 to January 2016 at Zhangjiagang TCM Hospital. Admission NLR was divided into quartiles: Q1 (<2.00), Q2 (2.00–3.05), Q3 (3.06–5.46), and Q4 (≥5.46). We assessed 5-year all-cause and vascular mortality using Kaplan-Meier, Cox regression, and receiver operating characteristic (ROC) curve analyses. ResultsOver five years, 134 (32.2 %) all-cause deaths and 114 (27.4 %) vascular deaths occurred. Elevated NLR was significantly associated with increased risks of all-cause and vascular mortality. Multivariate Cox analysis identified stroke history (HR: 1.57, 95 % CI 1.08–2.30), baseline National Institutes of Health Stroke Scale (NIHSS) score (HR: 1.09, 95 % CI 1.05–1.12), and NLR (HR: 1.09, 95 % CI 1.05–1.12) as independent risk factors for all-cause mortality. These factors also predicted 5-year vascular mortality: stroke history (HR: 1.65, 95 % CI 1.10–2.49), NIHSS score (HR: 1.10, 95 % CI 1.06–1.13), and NLR (HR: 1.08, 95 % CI 1.05–1.10). NLR quartiles were significantly linked to both outcomes: all-cause mortality HRs were Q2 (1.87, 95 % CI 1.00–3.51), Q3 (2.40, 95 % CI 1.31–4.39), Q4 (2.77, 95 % CI 1.47–5.24), P for trend = 0.001; vascular mortality HRs were Q2 (1.76, 95 % CI 0.88–3.55), Q3 (2.34, 95 % CI 1.14–4.40), Q4 (2.57, 95 % CI 1.28–5.16), P for trend = 0.002. Kaplan-Meier survival analysis revealed significantly higher mortality rates in higher NLR quartiles (log-rank p < 0.001). ROC analysis identified optimal NLR cutoff values of 3.42 for predicting 5-year all-cause mortality (AUC 0.689) and 3.51 for vascular-cause mortality (AUC 0.700), with moderate sensitivity and specificity. ConclusionsHigher NLR at admission was linked with five-year all-cause mortality and mortality attributed explicitly to vascular causes in AIS patients.

Deep learning-based segmentation in MRI-(immuno)histological examination of myelin and axonal damage in normal-appearing white matter and white matter hyperintensities.

The major vascular cause of dementia is cerebral small vessel disease (SVD). Its diagnosis relies on imaging hallmarks, such as white matter hyperintensities (WMH). WMH present a heterogenous pathology, including myelin and axonal loss. Yet, these might be only the "tip of the iceberg." Imaging modalities imply that microstructural alterations underlie still normal-appearing white matter (NAWM), preceding the conversion to WMH. Unfortunately, direct pathological characterization of these microstructural alterations affecting myelinated axonal fibers in WMH, and especially NAWM, is still missing. Given that there are no treatments to significantly reduce WMH progression, it is important to extend our knowledge on pathological processes that might already be occurring within NAWM. Staining of myelin with Luxol Fast Blue, while valuable, fails to assess subtle alterations in white matter microstructure. Therefore, we aimed to quantify myelin surrounding axonal fibers and axonal- and microstructural damage in detail by combining (immuno)histochemistry with polarized light imaging (PLI). To study the extent (of early) microstructural damage from periventricular NAWM to the center of WMH, we refined current analysis techniques by using deep learning to define smaller segments of white matter, capturing increasing fluid-attenuated inversion recovery signal. Integration of (immuno)histochemistry and PLI with post-mortem imaging of the brains of individuals with hypertension and normotensive controls enables voxel-wise assessment of the pathology throughout periventricular WMH and NAWM. Myelin loss, axonal integrity, and white matter microstructural damage are not limited to WMH but already occur within NAWM. Notably, we found that axonal damage is higher in individuals with hypertension, particularly in NAWM. These findings highlight the added value of advanced segmentation techniques to visualize subtle changes occurring already in NAWM preceding WMH. By using quantitative MRI and advanced diffusion MRI, future studies may elucidate these very early mechanisms leading to neurodegeneration, which ultimately contribute to the conversion of NAWM to WMH.

A Study of Neurological Involvement in Dengue and Chikungunya Infection.

Chikungunya virus (CHIKV) and dengue fever have been reported for recent epidemics worldwide, with varied clinical involvement. Chikungunya was first reported to affect the nervous system in the 1960s. The clinical profile of dengue with multi-organ involvement is varied with reported involvement of the central nervous system in some. The aim of this study was to study the frequency and pattern of neurological involvement in patients admitted with dengue and chikungunya in a tertiary care hospital. Patients admitted with confirmed chikungunya and dengue were evaluated clinically and investigations were enrolled in the study. Patients with preexisting neurological issues, obvious metabolic, vascular, or septic causes for neurological involvement were excluded from the study. A total of 309 patients with chikungunya were included in the study. Out of these, 11 (3.56%) patients were found to have neurological involvement. The most common presentations were altered sensorium (100%) followed by headache (81.81%). The relative risk of mortality in patients with neurological involvement due to chikungunya was 7.96. A total of 443 patients with dengue fever were enrolled in the study. Out of these, 5 (1.10%) patients were found to have neurological involvement. The most common presentations were altered sensorium and headache (100%), followed by vomiting (80%). The relative risk of mortality in patients with neurological involvement due to dengue was 5.15. The recent epidemic of chikungunya and dengue virus infections was associated with various neurological complications. Neurological involvement of chikungunya and dengue was identified to be a bad prognostic factor with significantly higher mortality. This is a single center study, involving only the patients admitted to the hospital. Furthermore, being an observational study, follow-up could not be done to look for neurological sequelae.

Role of digital subtraction angiography in acute cervical spinal cord ischemia.

Ascertaining the etiology of cervical spinal cord dysfunction presents a challenge to clinicians, as the list of differential diagnoses is extensive. Although compressive and inflammatory disorders are common and should be considered immediately, vascular causes are similarly important and acute. The overlap of clinical, magnetic resonance imaging, and cerebrospinal fluid features among the causes of myelopathies may lead to erroneous diagnoses. Such errors may be compounded if routine vascular imaging does not reveal the underlying vasculopathy. We present here three cases in which computed tomography angiography and magnetic resonance angiogram could not clarify the nature of an acute myelopathy, whereas digital subtraction angiography established the diagnosis of spinal cord ischemia.

A Case Study on Hemorrhage Due to Cerebrovascular Disease

Cerebrovascular disease includes some of the most common and devastating disorders: ischemic and hemorrhagic stroke. Stroke is the second leading cause of death worldwide, with 6.2 million dying from stroke in 2015, an increase of 830,000 since 2000. Stroke remains the most common disabling disease worldwide and in many forms is preventable. A stroke, or cerebrovascular accident, is defined as an abrupt onset of a neurologic deficit that is attributable to the focal vascular cause. Thus, the definition of stroke is clinical, and laboratory studies including brain imaging are used to support the diagnosis.

Superficial temporal artery aneurysm misdiagnosed in a patient with long-term migraine headache treatment: a case report

BackgroundSuperficial temporal artery aneurysm is a rare vascular abnormality without specific clinical symptoms. In this case report, we present the case of a patient with superficial temporal artery aneurysm who was diagnosed with migraine headache at first.Case presentationA 60-year-old Iranian man with a previous history of headaches, who did not respond properly to the treatments following the initial diagnosis of migraine, presented with a painless lump in the left temporal region, and he was diagnosed with superficial temporal artery aneurysm via Doppler ultrasound. Finally, surgical removal of the left superficial temporal artery aneurysm was performed.ConclusionsThis case shows the importance of vascular causes in the approach to headache etiologies, especially when the headache is prolonged without proper responses to treatment. Computed tomography angiography and magnetic resonance angiography are appropriate diagnostic methods for aneurysm detection that should be considered in future studies.

Brain-Derived Neurotrophic Factor as a Potential Diagnostic Marker in Minimal Hepatic Encephalopathy

Abstract Background Based on the etiology, liver cirrhosis is sub-classified into viral hepatitis (hepatitis B, C, and D), due to toxins (alcohol and drugs), autoimmune hepatitis, Cholestatic (primary biliary cholangitis, and primary sclerosing cholangitis), vascular (Budd-Chiari syndrome, sinusoidal obstruction syndrome, and cardiac cirrhosis), and metabolic causes (hemochromatosis, NASH, Wilson disease, alpha-1 antitrypsin deficiency, cryptogenic cirrhosis). Aim of the Work The aim of the current study is to detect Minimal Hepatic Encephalopathy (MHE) among cirrhotic patients of Child C with no or clinically manifest encephalopathy using Brain-Derived Neurotrophic Factor (BDNF) and study the diagnostic value of BDNF serum marker versus Psychometric Hepatic Encephalopathy Score (PHES) in detecting MHE. Patients and Methods 90 patients were enrolled into a clinical cross-sectional study. All patients gave informed written consent. Patients are divided equally into 3 groups, 30 patients each. Patients are either in-patient or out-patients in Ain shams University Hospitals. Group 1 The Examined Group (EG): includes 30 patients diagnosed as hepatitis C, cirrhotic, Child class C with no overt or clinically manifest encephalopathy. Group 2 The Hepatic Encephalopathy Group (HEG): includes 30 patients diagnosed as hepatitis C, cirrhotic, Child class C with overt or clinically manifest encephalopathy. Group 3 The Control Group (CG): includes 30 healthy individuals (volunteers). Results In the present study among the whole sample (n = 90), there was a significant positive correlation between PHES score &amp; BDNF serum level with Hb, platelet count and albumin. While, there was a significant negative correlation between PHES score and BDNF serum level with AST, ALT, total bilirubin, direct bilirubin, INR and Child’s Score. On the other hand, Stawicka et al. 2021, reported that BDNF had a negative correlation with bilirubin (R = –0.35, p = 0.005) and international normalized ratio (INR) (R = –0.37, p = 0.003), and positive with platelets (R = 0.36, p = 0.004), while no associations with age, sex, body mass index (BMI), waist-hip ratio (WHR), creatinine and ammonia. Conclusion MHE constitutes a significant medical problem in a common patient population. Unfortunately, it is often underdiagnosed, likely related to the notion that testing is time consuming requiring highly specialized personnel. Additionally, the term ‘MHE’ may create the impression that this condition has limited impact on patient’s wellbeing; however, it has been shown that MHE has clinical implications on the patient as well as public safety concerns. Diagnosing and treating MHE is difficult owing to the subclinical nature of the disease. The use of Psychometric Hepatic Encephalopathy Score (PHES) and Brain-Derived Neurotrophic Factor could be of great help in early detection of the condition and to give suitable preventive treatment.

Chronic Edema Management of the Lower Extremities.

Peripheral edema is a prevalent condition affecting patients dealing with an assortment of health conditions, such as congestive heart failure (CHF), liver disease, venous insufficiency, and postoperative surgical complications. Edema can present in a variety of ways, ranging from mild localized symptoms to severely debilitating forms that impact patients' daily lives. Despite the vast number of publications addressing the underlying causes of peripheral edema, there seems to be an absence of literature that presents the effectiveness and compliance of current management techniques. This paper aims to condense the current literature on the effectiveness and compliance of current edema management approaches across various common etiologies, with the intentionof identifying alternative therapies that could enhance the quality of care for patients with chronic lower extremity edema. Several promising new therapies such as exogenous calf muscle stimulation, leg raise exercises, high-dose albumin injections, and device-based negative pressure lymph drainage (NPLD), deviate from the currentestablished standard of care. This scoping review revealed diverse treatment methods tailored to the specific underlying etiology of edema. The use of diuretics and vasodilators has shown benefits in treating CHF-induced edema but failed to alleviate and prevent the recurrence of edema in hospitalized and recently discharged patients. Albumin injections have emerged as a potential alternative treatment for edema due to liver disease, addressing hypoalbuminemia symptoms caused by liver failure. Patients with vascular causes of edema are efficaciously treated conservatively with compression stockings, although patient adherence remains a hurdle. For postoperative edema, device-based NPLD appears promising, with potential benefits over elastic bandage wraps and kinesiology taping.