Compromised quality of life in 1st- ever cerebral stroke with RT hemisphere ischemic lesion. in right-hemisphere ischemic stroke patients with unilateral visual neglect: are we neglecting neglect?

Unilateral Visual Neglect [UVN] is a common disabling consequence after right-hemisphere stroke that can disrupt many aspects of daily living and quality of life. It involves the inability to report, respond, or orient to visual stimuli, generally in the hemispace contra lateral to cerebral lesion. The present study was designed to evaluate the effect of persistent UVN on disability status and quality of life in patients with first-ever right-hemisphere ischemic stroke. A total of 45 patients with cerebral stroke with lesion, at least 6-months after stroke onset, were included in this cross-sectional study. The patients were subdivided according to the presence of UVN into 2 groups: [i] patients with UVN, and [ii] patients without UVN. Neurocognitive test battery was done including the following: the Line Bisection Test [LBT], Letter Cancellation Test [LCT] and Catherine Bergego Scale [CBS] for UVN, NIHS scale for stroke seventy, Barthel index [Bl] for disability and activities of daily living [ADL], Rivermead Mobility Index [RMI] for physical mobility, and Health Related Quality of Life Short Form-36 [HRQOL-SF-36]. Unilateral visual neglect was diagnosed in 21 [46.7%], out of 45 stroke patients. It was observed that the BI and RMI scores in UVN patients were significantly lower than the non-UVN patients [p < 0.05]. In patients with UVN, the SF-36 subgroups physical functioning [PF], general health [GH], vitality [V], and social functioning [SF] were negatively influenced significantly compared with those patients without UVN [p < 0.05]. There was a statistically significant correlation between the BI and the general health perception at last year in the non- UVN group [p < 0.05]. The present study concluded that the disability was higher in the stroke patients with UVN which has a negative impact on many subscales of HRQOL. As a consequence, it is recommended to do screening and behavioral battery for early detection and proper rehabilitation of disabling UVN

Prevalence and risk factors of vascular cognitive impairment without dementia in patients with first-ever stroke: a cross-sectional study

Cognitive impairment, no dementia [CIND] is common in stroke patients even after first-ever cerebrovascular stroke. Identifying the baseline factors associated with cognitive impairment in stroke patients would help to maximize the functional recovery of stroke patients. The aim of the study was to assess the prevalence of cognitive impairment, no dementia, and its baseline determinants after first-ever cerebrovascular stroke. A cross-sectional study of 141 stroke patients was conducted in Neurology Department of King Fahd general hospital [Saudi Arabia]. The study group comprised 141 of 216 stroke patients aged 41 to 87 years who 6 months after stroke completed a comprehensive neurocognitive test battery and brain imaging [C.T Scan or MRI], including medical, and neurological evaluations; clinical mental status examination; interview of a knowledgeable informant; detailed history of risk factors; and evaluation of stroke type, localization, and syndrome. Patients with a Mini Mental State Examination score 15; age older than 40 years and without pre-stroke dementia and other neurological or psychiatric disorders participated in this study. The patients were subdivided according to the presence of CIND into 2 groups: [i] patients with CIND, and [ii] patients without CIND. Validated tools of assessment were used in the study, viz. NIHSS for neurological impairment, Barthel Index for functional assessment, Abbreviated Mental Test [AMT] for cognitive impairment, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] and Clinical Dementia Rating Scale [CDRS] for exclusion of dementia, and Geriatric Depression Scale [GDS] for depression. Univariate and multivariate logistic regression analyses were performed to compare the two groups of patients [patients with cognitive impairment [CIND], and patients without cognitive impairment. The present study showed that 36.2% of stroke patients had cognitive impairment without dementia. In multivariate analyses, the independent significant predictors of cognitive impairment were age more than 81 years [OR=5.98, 95% C.I.- 2.11, 18.53]; lesser education [OR=4.15, 95% C.I- 1.14, 12.65]; severe neurological impairment [OR=5.16, 95% C.I-1.91, 14.93]; hypertension [OR=5.92, 95% C.I.-2.03, 17.98]]; diabetes mellitus [OR=4.82, 95%C.I.- 1.85, 14.02]; hypercholesterolemia [OR=3.92, 95%C.I.-1.74, 12.19]; and depression [OR=3.75, 95% C.I.- 1.72, 6.94]. Considerable proportion of stroke patients had cognitive impairment without dementia, which in turn is significantly determined by modifiable baseline factors like hypertension, diabetes, hypercholesterolemia and depression. Proper identification of these modifiable risk factors might help to delay progression of vascular cognitive impairment after stroke

Diagnostic parameters of minimal hepatic encephalopathy: clinical, electrophysiological, and neuroimaging study

Cirrhotic patients with minimal hepatic encephalopathy [MHE] have subtle cognitive deficits that can be detected by neuropsychometric tests, P300 event related potential, EEG, and increased signal on T1-weighted brain Magnetic Resonance Imaging. The present study was designed to assess the magnitude of cognitive dysfunction, a marker of minimal hepatic encephalopathy [MHE];to evaluate diagnostic usefulness of neuropsychological cognitive tests, EEG, P300 ERP latency, and MRI brain signs; and to investigate the clinical outcome of patients with MHE in terms of progression to overt encephalopathy. A total of 43 well-compensated cirrhotic patients without signs of encephalopathy were studied by neuropsychological cognitive test battery, P300 ERP latency, EEG, conventional MRI brain. The patients were followed-up for 2 yrs. to monitor subsequent episodes of overt encephalopathy. Child-Pugh classification was done throughout the study to assess severity of liver cirrhosis. Forty-six healthy subjects, age, sex, and education matched, served as a control group. Minimal HE was diagnosed in 21[48.8%], out of 43 cirrhotic patients. Inverted sleep rhythm was reported in 85.7%, of cirrhotic with MHE. Delayed P3ERP latency were seen in 38.1% of cirrhotic patients with MHE, while Number Connection Test [NCT-A and B] time were prolonged in 71.4% of the patients. EEG abnormality was detected in 47.6%, while MRI signs were reported in 80.9% of cirrhotic with MHE. Out of 43 patients, 18[41.8%] developed overt encephalopathy, 66.7% of the patients with MHE progressed to overt encephalopathy within a mean duration of 9 months, while only 13. 6% of the non-mHE patients did so. Of the patients who developed overt encephalopathy, 83.3% had abnormal EEG, 77. 8% had abnormal NCT, while 59. 3% had P3ERP latency prolongations. The results of the present study suggest that inverted sleep rhythm, abnormal NCT, slow EEG activity, and delayed P300 latency are valid tools for the screening of MHE in cirrhotic patients as there is a greater likelihood of overt encephalopathy development in patients with an abnormality detected by these tests than in patients without such abnormality. EEG is useful for follow-up screening and prediction of the development of overt hepatic encephalopathy