Prevalence and prognosis of cerebrovascular accidents and its subtypes among patients with systemic lupus erythematosus in Isfahan, Iran: a hospital clinic-based study

The aim of the present study was to determine the prevalence and prognosis of cerebrovascular accident [CVA] and its subtypes among Iranian patients with systemic lupus erythematosus [SLE]. In a cross-sectional study, medical records of 575 SLE patients were reviewed. The patients developing CVA in their course of disease were extracted. In these patients, data about demographic features, lupus anti bodies, duration of the disease until CVA, CVA manifestation[s] and follow-up duration were gathered. In the next step, patients with any kinds of CVA were summoned to Neurology clinic to identify the grade of disability in each patient with CVA. We identified 38 patients with CVA of which 6 [15.8%] were men and 32 [84.2%] were women. The most common subtype of CVA was small vessels thrombosis [21.05%] among the study patients and hemi paresis was the most prevalent initial presentation [39.47%]. In 11 [28.9%] patients, SLE was initiated with CVA and in 3 [7.9%] patients CVA had happened in the 1st year of SLE. Anti-phospholipid antibodies [APLA] were positive in 29 [76.3%] patients. Mean modified Rankin Scale in patient with positive and negative serology for APLA was 0.93 +/- 1.11 and 0.22 +/- 0.66 respectively [P = 0.006]. Our study shows that 6.6% of Iranian SLE patients have CVA during their course of the disease. Small vessels thrombosis is the most common CVA subtype and hemi paresis is the most prevalent initial presentation. Moreover, we showed that the prognosis of CVA in Iranian SLE patients is not unfavorable

Efficacy of enalapril in migraine prophylaxis: a randomized, double-blind, placebo-controlled trial

Some angiotensin converting enzyme [ACE] inhibitors have previously been shown to be effective in migraine prophylaxis. The aim of this study was to evaluate whether Enalapril is effective in migraine prophylaxis. In this randomized, double-blind, placebo-controlled clinical trial, the effects of 10 mg Enalapril given daily were compared with those of matched placebo in 40 migraineurs for 2 months. Response to treatment was assessed at 0, 1, and 2 months after the start of intervention according to headache parameters like frequency, severity, and duration. This trial is registered with Iranian Registry of Clinical Trials [IRCT], number IRCT138711011570N1. A significant effect on reducing migraine attack more than 50% at first and second months [P=0.016] occurred in Enalapril group. Indeed, at the first and second months of treatment, the severities [P=0.000 and P=0.000] and duration [P=0.037 and 0.003] in the Enalapril treated group were significantly lower than in the placebo group. Enalapril may be effective in migraine prophylaxis according to its effect in decreasing the frequency, severity, and duration of headaches. The results support the previous suggestions on usage of ACE inhibitors in migraine prophylaxis

case-control study on potato consumption and risk of stroke in central Iran

Background: potato, a high- glycemic index [GI] food, is one of the most widely used starchy foods worldwide. Previous studies on the association of dietary intakes with stroke have mostly focused on the dietary GI and there is no information regarding the association between potato consumption and risk of stroke. This case-control study was conducted to evaluate the association between potato consumption and risk of stroke in an Iranian adult population

Methods: in this case-control study, 195 patients with stroke, hospitalized in the Neurology Ward of Alzahra University Hospital and 195 controls from other wards of the hospital with convenience non-random sampling method were enrolled. To assess participants' dietary intakes, a validated food frequency questionnaire was used. Information on socioeconomic and demographic variables, physical activity pattern, and smoking were collected by the use of questionnaires. Logistic regression method in different models was applied to explore the associations between potato intake and stroke. First quartile of potato intake was used as a reference in all models. Mantel-Haenszel extension chi-square test was used to assess the overall trend across quartiles of potato consumption

Results: individuals with stroke were more likely to be male [60% vs. 46% , P < 0.05] and older [68.0 +/- 1.0 vs. 61.5 +/- 0.8 y, P < 0.001] as compared with controls. They had lower body mass index [BMI] [25.2 +/- 0.3 vs. 28.5 +/- 1.0 kg/m2, P < 0.05], and were less likely to be obese [11.3% vs. 29.2% , P < 0.001] compared with controls. The mean potato consumption was 31.1 +/- 3.4 and 23.4 +/- 1.3 g/d for cases and controls, respectively. Participants with the highest potato consumption were younger and more likely to be physically active. High potato consumption was associated with higher intakes of energy, fruits, vegetables, pulses, and grains. After adjustment for age, sex, and total energy intake, we found that individuals with the highest potato consumption were more likely to have stroke as compared with those with the lowest consumption [OR: 1.9; 95% CI: 1.0 – 3.6]. The correlation between physical activity and potato consumption was 0.03, P = 0.54 and that of smoking and potato intake was -0.004, P = 0.94. Even after additional control for smoking and physical activity, the association remained significant [OR: 1.9; 95% CI: 1.0 – 3.6]. Further adjustment for dietary intakes made the associations non significant [OR: 1.1; 95% CI: 0.5 – 2.5]. However, when BMI was taken into account in the final model, we found that individuals in the third quartile of potato consumption were significantly more likely to have stroke [OR: 2.2; 95% CI: 1.0 – 4.7]

Conclusion: we found evidence indicating that there is a marginally significant independent association between potato consumption and risk of stroke. Prospective studies are required to confirm this finding

effect of statin therapy in stroke outcome: a double blind clinical trial

Through a clinical trial we evaluated statin therapy benefits over stroke outcome. All patients with moderate stroke in Middle Cerebral Artery [MCA] were registered during February 2006 to February 2008, in Al Zahra Hospital, Isfahan, Iran. Among 55 patients who were enrolled in the present study, 25 subjects received 20 mg lovastatin daily, for 90 days after stroke attack [group 1] and 30 patients received no treatment [group 2]. Patients were assessed at admission, 7 and 90 days after stroke. National Institutes of Health Stroke Scale [NIHSS] score was recorded in the day 1 and 7 in the hospital with a questionnaire and BARTHEL index was estimated 90 days after stroke incidence by a telephone survey or in an outpatient visit. Data were analyzed by means of Chi[2], 't' test and Independent 't' test. NIHSS score measured in first day immediately after stroke attack and following 7 days, did not differ significantly in two groups. Moreover, BARTHEL index recorded within 90 days was not also different comparing group 1 and 2. After 90 days, no mortality was recorded in group 2, while one patient expired in group treating with statins [P=value>0.05]. We did not find statins administration to play any role in stroke recovery and consequent long term prognosis. More researches with larger samples are needed to establish the possible favorable outcome of statins when administered in cerebrovascular diseases

Cerebral venous thrombosis associated with oligodendroglioma and pregnancy

Until now, cerebral venous sinus thrombosis [CVST] was principally an autopsy diagnosis; however, with the introduction of MRI and angiography, as well as enhanced clinical attentiveness, it is now reliably diagnosed during life. Herein, we describe a case of CVST accompanied by oligodendroglioma and pregnancy. In our patient, the following factors contributed to the formation of CVST: First, the pregnancy state, which is a known risk factor for developing venous thrombosis; and secondly, the oligodendroglioma could have changed the architecture of adjacent sinus [right lateral sinus] and provocation of the development of clot in the sinus

High frequency of IgM antiphospholid antibodies in young Iranian patients with stroke

To investigate the presence of IgG and IgM types of anticardiolipin [aCL] and antiphospholipid [aPL] antibodies in younger Iranian patients with ischemic stroke. Both IgG and IgM types of aPL [cardiolipin, anti phosphatidyl inositol, anti phosphatidyl serine, anti phosphatidic acid and beta 2-glycoprotein I [B2-GPI]] and aCL alone [cardiolipin and B2-GPI] were measured in 117 patients with ischemic stroke [aged <45 years] during an 18-month period from September 2002 to March 2004 in Al-Zahra Hospital, Isfahan, Iran. The demographic, clinical, and laboratory characteristics of patients with a positive titer were recorded. Seven men and 16 women [23 patients, 19.6%] had increased IgG types of aPL antibodies. Increased titers of IgM and IgG were found in 19 [82.6%] and 6 [26%] patients for aPL antibodies and in 15 [83.3%] and 8 [44.4%] cases for aCL alone. Despite European studies, high titers of IgM aPL antibodies found in a large number of patients can be caused by the presence of unknown triggering factors [infections or poisons], that are more prevalent in developing countries compared to developed countries. This hypothesis remains to be investigated further

Orthostatic hypotension in Iranian patients with Parkinson's disease

To prospectively investigate the prevalence and clinical relevance of orthostatic hypotension [OH] in Parkinson"s disease [PD] in Isfahan, Iran. We investigated 150 consecutive patients with PD [42 women, 108 men] in Al-Zahra Hospital, Isfahan, Iran from January 2002 to January 2004. Blood pressure was measured first in a supine position following a rest of at least 10 minutes, and then after 3 minutes of active standing. Data concerning the age, gender, duration of disease, and drug consumption were recorded in a questionnaire. Orthostatic hypotension in PD is more frequent in women, patients taking a higher dose of levodopa, in higher age groups, and patients with longer duration of the disease, however, a statistically significant difference was seen in the female group and patients taking a higher dose of levodopa. Orthostatic hypotension is mainly related to PD pathology and the clinical relevance of OH to gender, age, and disease duration may be due to the natural course for progression of human autonomic dysfunction during life. Higher doses of levodopa may increase the risk of OH

Epidemiology of familial and sporadic restless legs syndrome in Iran

Restless legs syndrome is one of the most common sleep and movement disorders. For lack of sufficient information on this syndrome in Iran, this study was conducted at Alzahra Hospital, Isfahan, Central Iran, to determine the epidemiology of idiopathic, familial and sporadic forms of the syndrome. From September 1999 to April 2003, 61 patients in two groups were selected. A questionnaire with emphasis on sleep history and neurological history was completed and a thorough physical examination was performed for each patient. Familial and sporadic groups had mean +/- SD ages of 22 +/- 2.1 and 41 +/- 3.2 years, respectively [P < 0.05]. Female to male ratio was 2:1. The mean +/- SD ages for women and men were 31 +/- 5.3 and 42 +/- 6.1 years [P < 0.05], respectively. Our findings support the current opinion that restless legs syndrome should be divided into the early-onset disease with a clear genetic component and the late-onset disease with an unclear etiology