[Low-pressure] variant of idiopathic intracranial hypertension: a unique subtype of chronic daily headache

Headache, papilledema and elevated CSF pressure above 200 mm H2O [250 mm H2O in obese patients] in a patient with normal neurological examination and neuro-imaging meet the international headache society [IHS] diagnostic criteria for idiopathic intracranial hypertension [IIH]. However variants of the classic syndrome have been reported i.e apapilledimic [without papilledema] and pure ophthalmic [without headache]. The aim of this study was to investigate a series of patients with refractory chronic daily headache [CDH] without papilledema, and with borderline CSF pressure [160-200 mm H2O in non-obese patients; 160-250 mm H2O in obese patients] to highlight their clinical, and neuroimaging findings. Twenty five cases with refractory chronic daily headache [CDH] who presented at the neurosurgery and neurology outpatient clinics were included in the study. All patients were evaluated clinically and radiologically and CSF manometry was recorded. All patients had unclassified chronic daily headache, visual field defects, a partial empty sella on imaging studies and borderline CSF pressure [160-200 mm H20 in non-obese patients; 160-250 mm H2O in obese patients]-. The majority of patients showed headache improvement after treatment with medications that lower intracranial pressure in combination with their conventional headache therapy regimens. The constellation of chronic daily headache, field defects, a partial empty sella and borderline CSF pressure in a patient with normal neurologic examination may constitute a [low-pressure] variant of idiopathic intracranial hypertension

Treatment and different prognostic factors affecting Guillain-Barre syndrome

Guillain-Barre syndrome [GBS] is an acute immune mediated disease of the peripheral nervous system with a wide range of clinical symptoms and great variability in outcome. Despite effective therapies, such as intravenous immunoglobulins [IVIg] and plasma exchange [PE], acute mortality remains relatively high and about 20% of hospitalized patients may have a long term disability. To study different modalities of treatment and their effect on the prognosis of GBS. The study included twenty five patients with GBS. Patients were subjected to history taking and thorough neurological examination. Cerebrospinal fluid analysis, nerve conduction and electromyography were also done. The patients were randomly assigned plasma exchange [PE] or intravenous immunoglobulin [IVIg]. Hughes functional grading scale was applied to GBS patients on admission, at end of 4 weeks from onset of neuropathy and at the end of 8 weeks for follow up and to assess prognosis. The study included twenty five GBS patients. Their age ranged from 10 to 72 years with a mean of [36.11 +/- 21.55]. They consisted of 13 males [52%] and 12 females [48%]. Sensory deficit was reported in 7 patients [28%], autonomic manifestations were present in 9 patients [36%]. Respiratory dysfunction was present in 7 patient [28%], 6 of them [85.7%] needed mechanical ventilation. Demyelinating type of electrophysiology was seen in 17 patients [68%] while, axonal type was seen in 8 patients [32%]. Plasma exchange were done to 17 patients [68%] while, IVIgs were received by 8 patients [32%]. Hughes score was significantly lower [clinical improvement] at the end of 4 weeks and 8 weeks. Number of patients with good recovery was significantly higher in IVIg group than plasma exchange group. Number of patients with good recovery was significantly higher in those starting treatment early in their course of the disease. The prognosis of patients without autonomic manifestations was better than those with autonomic manifestations, and it was statistically significant. The prognosis of patients with demyelinating type of electrophysiology was better than patients with axonal type, which showed statistical significant difference. Prognostic factors such as severity of symptoms on admission, need of mechanical ventilation, presence of autonomic manifestation, axonal type of electrophysiology were not significantly influenced by the type of treatment. Immunomodulatory treatment [IVIg or PE] significantly improve the prognosis of GBS patients. The early start of treatment the better the prognosis of GBS. Certain prognostic factors such as severity of symptoms on admission, need of mechanical ventilation, presence of autonomic manifestations, and axonal type of electrophysicology did not significantly influenced by the choice of treatment [PE or IVIg]

Motor evoked potential in presymptomatic spondylotic cervical cord compression

Cervical spondylotic myelopathy [CSM] is the most severe consequence of degenerative disease of cervical spine as it is usually a chronic and progressive disease. Despite advances in diagnosis and surgical treatment, many patients still have severe permanent neurologic deficits caused by this condition. An early measure [s] is highly needed to detect preclinical manifestations of such condition. is to investigate whether electrophysiological parameters of Motor Evoked potential [MEP] could detect clinically asymptomatic [preclinical] spondylotic cervical cord compression before progression to symptomatic myelopathy and to compare between MEP and Somatosensory Evoked Potential [SEP] in this regard. Twenty patients with clinical and radiological [plain X-ray and MRI] features of spondylotic cervical root compression, but without clinical or radiological evidence of cervical myelopathy were included in the study. Fifteen healthy subjects, matching in age and sex were included as a control group. A modification of the Japanese Orthopedic Association Scale [mJOA] was used to confirm the functional status of the patients. The following procedures were carried out bilaterally for patients and unilaterally for control subjects. Percutaneous transcranial magnetic stimulation [TMS] was carried over the corresponding motor cortices of the upper and lower limbs to elicit MEP. SEP of both median and posterior tibial nerves was recorded as well. The mean age of patients was 52.7 +/- 6.2 years; the majority of them were males [60%]. The mean duration of illness was 3.36 +/- 1.5 years. There were 6 patients [30%] with mJOA score of 17 and 14 patients [70%] with mJOA score of 18. The mean score of mJOA scale was 17.73 +/- 0.45. The mean age of control subjects was 48.8 +/- 4.5 years. Both plain X- ray and MRI revealed cervical spondylotic changes from C4 to C7 in the form of intervertebral disc degeneration and osteophytosis of vertebral bodies. Indentations of the dural sac on MRI were observed at C5/6, C6/7 and C4/ 5 intervertebral levels in order of incidence. However, the cord was reportedly normal. Central motor conduction time [CMCT] was prolonged in 6 patients. Three of those patients had bilaterally prolonged CMCT. In the other 3 patients CMCT was unilaterally prolonged. MEP amplitude didn't show significant abnormality among patients. There was no significant difference in patients' SEP latencies or amplitudes when compared to control subjects. MEP provides an objective and quantitative approach to assess the motor functional integrity of the corticospinal pathways. Measurement of CMCT could serve as a detector of subclinical spondylotic cervical cord involvement before progression to symptomatic mylopathy even earlier than SEP can do

Study of the correlation between risk factors and clinical manifestations in different ischemic stroke subtypes

The aim of the present work was to identify risk factors in different ischemic stroke subtypes, namely; cortical, large subcortical and lacunar infarctions and to correlate between clinical presentation and radiological findings in each of the previous stroke subtypes. Eighty one patients were included in this study. According to computed tomography and/or magnetic resonance imaging results, the patients were subdivided into cortical, large subcortical and lacunar infarct groups. Risk factors were studied according to Stroke Risk Assessment Form. The clinical picture was studied according to Mini-Mental Scale and Canadian Neurological Scale. In cortical infarctions, atrial fibrillation and high mean platelet count were more common. In large subcortical infarctions, oral contraceptives were more commonly used. Pure lacunar infarctions were more related to positive history of hypertension, and high mean systolic blood pressure. As regards Mini-Mental Scale; orientation, registration and total score were lower among cortical infarctions. There were no statistically significant difference between the three groups as regards the Canadian Neurological Scale; mentation score, total motor score with or without comprehension deficit. There are differences between different stroke subtypes as regards clinical picture and risk factors