Precipitating and relieving factors of migraine headache in 200 Iraqi Kurdish patients

To study the precipitating and relieving factors of migraine headache in a group of Iraqi Kurdish patients including the effect of fasting in Ramadan, and to estimate the percentage of family history of migraine. A series of 200 migraine cases from different parts of the Kurdistan region in the North of Iraq attending the out-patient Neurology clinic at Rizgary Teaching Hospital and a private Neurology clinic at Erbil City was carried out between October 2007 and May 2008 were reviewed. The precipitating factors and relieving factors for migraine headache were registered and tabulated to be compared with others. Case definition of migraine was based on the International Headache Society [IHS] criteria. 33% of the patients were aged between 30-39 years, while 40.5% of patients experienced their first attack aged between 20-29 years. Stress or psychological upset was the commonest triggering factor [80%], followed by increasing physical activity [68%], change in weather [65.5%], and in relation to fasting [65%]. Fasting in Ramadan was a triggering factor for headaches in 65% of patients. However, there was no significant association between the triggering factors with regards to sex difference. Relief of migraine in the studied sample was achieved using NSAIDs in 50% of patients, and sleep [45.5%]. Hence, 61% of the study population had positive family history of migraine, 32.5% of them reported maternal history of migraine. Psychological upset, stress and excessive physical activity were the commonest triggering factors of migraine headache, while NSAID was the commonest relieving factor of migraine in this population. Family history was present in 61% of migraine patients based mainly from maternal root

Are left atrial abnormalities a risk for stroke?

To show that echocardiographic left atrial enlargement [Echo-LAE] and electrocardiographic left atrial abnormalities [ECG-LAA] may be probable new risk factors for ischemic and hemorrhagic stroke. This descriptive prospective case study included 140 CT or MRI-confirmed hemorrhagic and ischemic stroke patients, who were admitted to Rizgary Teaching Hospital, Erbil, Iraq from January 2008 to January 2009. Twelve lead EGG and 2-dimensional transthoracic Echo were performed for all patients. Electrocardiographic LAA were identified when the P terminal force in lead V[1] [PTFV[1] was >40 mm.ms. Echocardiographic LAE was identified when the left atrial index was more than 2.3 cm/m[2]. Electrocardiographic LAA were significantly higher in ischemic stroke patients in comparison with the hemorrhagic strokes. Causes of ECG-LAA were found to be as follows in order of frequency; hypertension [56%], advanced age [47%], coronary artery disease [27%], diabetes mellitus [26%], obesity [21%], valvular heart disease [21%], and 2.6% of patients had no identifiable cause. Echocardiographic-LAE was seen in 34% of ischemic strokes, and 30% of hemorrhagic strokes with no significant difference. Although ECG-LAA [PTFV[1]>40 mm.ms] is significantly associated with ischemic stroke, it may not be an independent risk factor for stroke as it rarely occurred without other risk factors. Echocardiographic LAE is associated with both ischemic and hemorrhagic strokes equally

Prevalence of silent stroke in Kurdistan, Iraq

To measure the prevalence of silent strokes in the Iraqi Kurdish population, and to identify silent stroke risk factors. This cross-sectional study was carried out in Rizgary Teaching Hospital, Erbil, Iraq from January to June 2009. A sample of 200 patients attending the outpatient clinic was taken. The results of CT and MRI were analyzed, and the proportion of silent infarcts was measured. Patients were interviewed for presence of hypertension, diabetes, ischemic heart disease, alcohol drinking, and smoking. Body mass index and serum lipid levels were calculated. Out of 200 subjects, 19% showed silent infarct[s]. Logistic regression analysis showed significant association between hypertension and old age with presence of silent infarcts. The age of affected individuals was significantly higher than the age of the non-affected individuals. The percentage of silent infarcts among apparently normal individuals in the Kurdish population is around 19%, and physicians must always keep this diagnosis in mind, especially among hypertensive and older aged patients

Evaluation of neurogenic dysphagia in Iraqi patients with acute stroke

To clinically assess neurogenic dysphagia, and to correlate its presence with demographic features, different stroke risk factors, anatomical arterial territorial stroke types, and pathological stroke types. Seventy- two stroke inpatients were studied between July 2007 and February 2008, at the Departments of Medicine and Neurology at Al-Yarmouk Teaching Hospital, Baghdad, and Rizgary Teaching Hospital, Erbil, Iraq. All patients were assessed using the Mann Assessment of Swallowing Ability score [MASA], Modified Rankin Scale, and the Stroke Risk Scorecard. All patients were reassessed after one month. There were 40 males and 32 females. Sixty-eight patients had ischemic stroke, and 4 had primary intracerebral hemorrhage [ICH]. According to the MASA score, 55% of anterior circulation stroke [ACS] cases were associated with dysphasia, and 91% of lateral medullary syndrome cases were associated with dysphagia. Fifty-six percent of ACS dysphagic cases improved within the first month. Forty percent of dysphagic patients died in the one month follow up period, and in most, death was caused by aspiration pneumonia. We observed no significant differences regarding demographic features of dysphagia. Dysphagia can be an indicator of the severity of stroke causing higher mortality and morbidity in affected patients. It was not related to the stroke risk factors and the type of stroke. It is essential from a prognostic point of view to assess swallowing and to treat its complications early

Pattern of migraine headache in a group of Kurdish Iraqi patients

To study the pattern of migraine, and to show the effect of age and duration of illness on the evolution of migraine symptoms. A review of 200 migraine cases [attending the outpatient neurology clinic at Rezgary Teaching Hospital, and Kurdistan Private Neurology Clinic] was carried out during the period between October 2007 to May 2008. Case definition of migraine was according to the International Headache Society [IHS] criteria. The majority [77%] of the studied sample was female. The mean age [ +/- SD] at onset was 22.33 +/- 9.52 years. The most common type of migraine observed was migraine without aura [72%]. Different symptoms like phonophobia [92%], nausea [86.5%], photophobia [84%], vertigo [78%], scalp tenderness [75%], attacks of facial pallor [64%], sweating [57%], vomiting [50%], pain in the arms [39%], and pain in the chest [6%] was studied in relation to age at presentation and duration of illness in years. No significant association was found between the duration of illness and age at presentation and evolution of migraine symptoms. No significant association was found between the duration of illness and frequency of the attacks. Many migraine symptoms remain the same in each attack no matter the duration of illness and age at presentation, except for bouts of vomiting, which may be less common in younger patients

Multiple sclerosis in Jordan and Iraq. Clinical and ccoial overview

To verify clinical features of multiple sclerosis [MS] patients throughout the course of their illness and to study the socioeconomic status of MS patients in Jordan and Iraq. Fifty-two patients were examined by 2 neurologists looking for the clinical and radiological features of MS at Al-Bashir Teaching Hospital, Amman, Jordan [35 patients], and Rezgary Teaching Hospital-Erbil, Kurdistan, Iraq [17 patients] from January 2004 to July 2007. The study design was based on full clinical examination of MS patients, investigate the signs, and symptoms, tabulating them, and show the percentage of their presence in all patients, and then comparing the results with other findings through systematic review of the available data from other reviews. The percentage of different symptoms, signs, and radiological features of the 52 MS patients were recorded. Weakness in one limb, mostly the leg [90.4%] was the most common symptom described by our patients, while hyperreflexia was the most prominent sign in MS patients [75%]. Higher level of school performance, and moderate to good socioeconomic status were the common status between MS patients. The MRI results were interpreted according to the anatomical sites, and according to different MRI sequences, and the MRI showed MS plaques in almost all patients. This study showed comparable findings with other studies, except nystagmus, which was less observed in Jordanian and Iraqi patients