Changes of regional cerebral blood flow in acute ischemic stroke patients assessed by single photon emission computed tomography

Background: Tc-HMPAO SPECT has a potential diagnostic tool in early diagnosis of ischemic stroke. Several studies have supported the predictive value of SPECT in stroke prognosis

Purpose: studying the role of Tc-HMPAO SPECT in assessment of rCBF changes in acute stroke patients and evaluation of its r9le in early diagnosis and prognosis of stroke

Material and Methods: forty Egyptian patients presented with acute onset of first ever ischemic stroke classified according to The Oxford shire Community Stroke ·Project [OCSP] classification, were subjected to National Institutes of Health Stroke Scale [NIHSS] assessment, CT brain and single photon emission computed · tomography [SPECT] at day one of stroke onset. At day seven, 30 patients were reevaluated by NlHSS to assess the clinical outcome and SPECT to follow the pattern of cerebral perfusion

Results: at Day one: CT scans were positive in only 18 [45%] patients, while SPECT scans were positive in all 40 [100%] patients [p< 0.001]. NIHSS was significantly higher in patients with corticosubcortical hypo perfusion lesions than in patients with cortical hypo perfusion on SPECT [p< 0.01]. NIHSS was worst with large hypo perfusion than small hypo perfusion on SPECT [p< 0.001]. The less the radiotracer uptake on SPECT, the worse the NIHSS [p<0.01]. There was a statistically significant negative correlation between NIHHS and rCBF [r= -0.640]. At Day seven: rCBF was highly significantly better [r = 0.59]. NlHSS at day 7 was worse in patients with corticosubcortical hypo perfusion lesions than in patients with cortical hypo perfusion on SPECT at day 1 [p< 0.01]. The larger the size ofhypoperfusion on SPECT at day 1, the worse the NIHSS at day 7. [p<0.05]. The less the radiotracer uptake on SPECT at day 1, the worse the NIHSS at day 7[p<0.05]. The more the rCBF day 1, the less the NlHSS at day 7 [r=-0.685, p<0.001]

Conclusion: SPECT was more sensitive than CT in detecting acute cerebral ischemia. There was significant relation between clinical assessment of stroke patients and findings on SPECT at day one. Tc-HMP AO SPECT could predicts early clinical outcome of stroke

Dementia in Ismailia governorate: an epidemiological study

This cross sectional study was done to determine prevalence rate and demographics of dementia in the Ismailia Governorate. The study include 1000 persons over the age of sixty years [500 in a rural area and 500 in and urban area]. Mini mental state examination test was used as initial screening tool to pick up demented subjects who scored less than 24 points out of 30 [for literates] or scored less than 22 points out of 28 [for illiterates]. All demented subjects were subjected to full physical and neurological examination and computed tomographic brain scan. Prevalence of dementia among elderly over 60 years of age was 3.8 [2.5% vascular dementia and 0.8% Alzheimer's disease]. The mean age of demented subjects was 68.8 + 6.7 years. Dementia was significantly associated with age. Prevalence of dementia among age group of 60-64 years was 2.1%. while it was 30% among age group? 80 years. Vascular dementia was the most common type of dementia [65.8% of demented subjects] and its highest incidence was among the age group of 60-64 years old. Alzheimer's disease was the second most common type [21.1% of demented subjects] and its highest incidence was among the age group of 75-79 years old. Hypertension, diabetes mellitus and smoking and smoking were significantly associated with vascular dementia. No significant differences were found among demented subjects according to areas, gender and literacy

Genetic and etiologic classification of familial convulsions

This work included 53 subjects [26 patients with convulsions from 13 families and 27 relatives]. They were subjected to full clinical, genetic and neuropsychiatric examination, pedigree construction, electroencephalography [EEG] and metabolic screening for inborn errors of amino acid metabolism. The results added further evidence to genetic heterogeneity of familial convulsions. Consanguinity was found in 66.7% of cases suggesting a major role played by autosomal recessive genes in the etiology of convulsions in Egypt. Abnormal EEG was found in 61.5% of all the studied cases, and in 46% of the parents suggesting inherited susceptibility. Mental retardation was found in 53.8% of the cases, all of them had abnormal EEG. This shows significant association between mental retardation and EEG abnormality