Role of some inflammatory markers in recent ischemic stroke

The onset of cerebral ischemia triggers a cascade of pro-inflammatory molecular and cellular events. Clinical studies suggest that the strength of this acute response is important in early and late clinical outcomes, early clinical worsening, and extent of brain damage. The aim of this work was to estimate the. role of some inflammatory markers in recent ischemic stroke, and to correlate these inflammatory markers with the short term outcome. Twenty sex patients presented with recent history of hemiplegia within 24 hours were included. The patient group was planned to contain 13 patients with the age between 20 and <40years and 13 patients with the age between 40 and 60 years. 15 subjects, [age and sex matched to the patients] were included in the study as control Neurological deficits were rated by Scandinavian Stroke Scale. Clinical assessments and serum levels of the inflammatory markers, Neopterin C -Reactive Protein [CRP], Tumor Necrosis Factor-alpha [TNF-alpha], Complement 4 [C-4], Interleukin-8 [IL-8], and Neopterin, were done at the time of admission, day 3, and day 7 from the stroke onset. Serum levels of neopterin started to increase from the 3 rd day and remained high to the end of the first week from the onset of the stroke. The increase was more obvious in the young aged patients. Serum levels of IL-8, raised rapidly in the acute phase of the stroke and then gradually decreased through the first wee and but still higher than the base line of the total patients and control. Serum levels of TNF-alpha and CRP had rapid significant increase from the first day to reach maximum levels in the 3 rd day and still significantly high till the end of the first week Serum CRP levels were higher in the old age group while serum C4 levels decreased from the 1 st day then gradually increased to reach maximum levels in the 7 th day, but still significantly lower than the control group. Also, there were statistically positive correlations between serum levels of neopterin and C-4 in the 3 rd sample with the Scandinavian scale in the 3 rd assessment. Brain ischemia induced an inflammatory cascade by the increase in serum levels of neopterin, IL-8, TNF-alpha, CRP and decrease in C4. This inflammatory response continued through the first week by the increase in the levels of complement -4. The inflammatory response was more obvious in the young aged patients. There were positive correlations between serum levels of neopterin, and C-4 with the short-term outcome of the stroke patients

Intellectual impairment among epileptic children correlation with age of onset and duration of epilepsy

Intellectual impairment among epileptic children has been a subject of study throughout the modern era of epileptology. Early age of onset and long duration of epilepsy have been implicated as possible contributors. To test for this hyposis, 45 epileptic children and 20 normal controls of the same age group [6-16 years] were studied using Wechsler Intelligence Scale for Children Revised [WISC-R]. Correlations between intellectual impairment and age of onset and duration of epilepsy were done. The results showed that epileptic children have significantly lower IQ than controls. Moreover, those with earlier seizure onset and longer seizure duration have significantly lower IQ. In conclusion, the earlier the age of onset and the longer the duration of epilepsy, the more the intellectual impairment

Management of occipital encephalocele

The clinical records, hematological and radiological investigation and operative notes of five patients [four females and one male] operated on were done. All cases were full-term newborns with a weight ranging from 2.270 to 3.552 g. The patients' mothers mean ages were 24.4 years [19-32 years]. A surgical intervention was done for all cases, an elliptic skin incision surrounding the occipital encephalocele was made along a vertical axis. The ellipse was performed narrow enough to allow skin closure at the end of the procedure, but broad enough to resect the total of the encephalocele. Ventriculo-peritoneal shunt operation was done for three cases that had hydrocephalus, but the other two cases had no hydrocephalus and did not develop after the operation. All cases discharged without any neurological deficit

Comparison of H-reflex latency with conventional motor nerve conduction study in diagnosis of diabetic neuropathy

Distal polyneuropathy is the most common neurologic complication of diabetes mellitus. Prolongation of H-reflex latency could be demonstrated at time when convential motor nerve conduction study may not show an abnormality. The aim of this work was to compare motor conduction study with H-reflex latency in diagnosis of diabetic neuropathy. This study was carried out on 44 patients with diabetes mellitus of both type 1 and type 2, they were 26 males with mean age 47.5 years and 18 females with mean age 43.4 years. A control group of 10 healthy subjects were chosen, six were males and 4 were females, the two groups were matched together as regard the age and sex. The patients and control groups were subjected to thorough clinical evaluation and electrophysiological testing for distal latency of the median and lateral popliteal nerves and their motor nerve conduction velocity as well as the H-reflex latency. Correlations between H-reflex and other variables including motor conduction velocity and type of diabetes were done. The results were: 30 cases showed peripheral sensory affection while 14 patients showed no symptoms of sensory affection, 27 patients showed motor manifestations, 6 patients showed cranial nerve affection and 5 patients showed manifestations of autonomic dysfunctions. The electrophysiological tests showed highly significant difference between control and patients groups regarding median nerve distal latency, median and lateral popliteal nerves motor conduction velocity and very highly significant difference between control and patients groups in H-reflex latency. Comparing H-reflex latency with motor nerve conduction velocity revealed significant superiority of H-reflex latency on motor conduction velocity in both clinical and subclinical cases of diabetic neuropathy. We concluded that H-reflex latency is of great diagnostic value in diabetic neuropathy. Furthermore, it is more sensitive than conventional motor nerve conduction study

Poor prognostics in patients with spontaneous lobar haemorrhages

The study included 30 consecutive patients presented with acute spontaneous lobar hemorrhages. Neurological deterioration was defined as a decrease in GCS sum score by two points, new neurological deficit and/or clinical signs of brain herniation. CT brain was done initially and thereafter whenever indicated. A univariate logistic regression analysis was performed. The results showed that 33.3% patients with lobar hemorrhages deteriorated after admission. In univariate analysis, only a Glasgow coma score <14 predicted deterioration [70% of deteriorates vs. 20% who did not deteriorate]. Initial CT characteristics predictive of deterioration included hemorrhage volume >60 ml [63% vs. 16%.]. Patients presented and deteriorated within 12 hours of ictus because of enlargement of hemorrhage. Those who deteriorated more than 12 hours after initial neurological symptoms showed increased mass effect secondary to edema

Caroticocavernous fistula management by detachable balloon at different clinical stages

The authors describe their first experience in transarterial balloon embolization in the treatment of CCF. Six patients presenting with traumatic CCF were included in the study during the period between 1990 and 1993. All had an established clinical diagnosis after thorough neurological and ophthalmological assessment together with positive radiological evidence through head computed tomography and cerebral angiography. They ranged in age between 15 and 55 years. All were males except one. They presented mainly with machinery bruit and exophthalmos. Proptosis was unilateral in five patients and bilateral in the remaining one. Favourable results were obtained. Post- embolization improvement, and even normalization, set-in in five of the six patients regarding bruit and proptosis without any resultant complications. Only in a single patient delayed balloon deflation and intracranial migration occurred with consequent major cerebral infarction and death. The authors conclude that transarterial balloon embolization remains the procedure of choice in the treatment of symptomatic CCF. However, transvenous embolization is an alternative when the arterial route fails