Clinical Presentations and Phenotypic Spectrum of Multiple Sclerosis at a University Hospital in Saudi Arabia

BACKGROUND AND PURPOSE: The objective of this study was to determine the frequencies of different clinical presentations and the phenotypic spectrum of multiple sclerosis (MS). METHODS: This cross-sectional study was performed in the Neurology Department of King Fahd Hospital of University Alkhobar in the Kingdom of Saudi Arabia (KSA). Data of 190 MS patients who fulfilled the McDonald criteria were retrieved from medical records and analyzed. RESULTS: The age at disease onset was 26.27±8.2 years (mean±SD) and disease duration was 6.38±5.10 years. The male-to-female ratio was 1:1.6. Optic neuritis and myelitis were the most-frequent first clinical presentations. Sensory (73.1%), motor (61%), and visual (58.4%) symptoms were the most-frequent established clinical symptoms. Relapsing-remitting multiple sclerosis (RRMS) was present in 75% of the cases. Supratentorial T2-weighted white-matter lesions and deep-gray-matter or juxtacortical lesions were the most-frequent magnetic resonance imaging (MRI) lesions, comprising 28% and 23.7% of all MRI lesions observed in 93.6% and 79.4% of the cases, respectively. The scores on the Expanded Disability Status Scale were within the range of 1.0–5.5 in 82.1% of the patients. There were 145 (76.3%) patients taking interferon β therapy. CONCLUSIONS: MS presenting in the hospital setting is more common in KSA than reported previously, and the number of diagnosed cases in increasing. It is therefore an emerging and disabling neurological illness in KSA with clinical characteristics not dissimilar to those in other middle eastern countries. A decrease in the frequency of patients with secondary progressive multiple sclerosis (SPMS) indicates either that more new cases of RRMS are being diagnosed or that adequate treatments of RRMS are preventing the evolution to SPMS. Further larger and population-wide epidemiological and clinical studies with the long-term follow-up of MS patients are required to better assess the clinical spectrum of MS in KSA.

Relationship between glycated haemoglobin and carotid atherosclerotic disease among patients with acute ischaemic stroke

Objectives: This study aimed to determine the relationship between glycaemic control and carotid atherosclerotic disease among patients with acute ischaemic stroke [AIS]

Methods: This retrospective crosssectional study took place in the Neurology Department of King Fahad Hospital of University, Khobar, Saudi Arabia, from April to October 2017. Data were collected from the medical records of 244 patients with a diagnosis of AIS confirmed by computed tomography. Doppler ultrasounds of the carotid artery were performed to determine the presence of increased carotid intima media thickness [CIMT] and plaques

Results: Significantly higher mean glycated haemoglobin [HbA1c] levels were noted in cases with high CIMT values [P = 0.002], but not in cases with carotid plaques [P = 0.360]. In addition, there was a significant association between diabetes mellitus [DM] and high CIMT [P = 0.045], but not with carotid plaques [P = 0.075]. Finally, while dyslipidaemia and age were independently correlated with high CIMT values [P = 0.034 and <0.001, respectively] and carotid plaques [P <0.001 each], no independent relationships were noted in terms of gender and other risk factors like DM, hypertension and smoking [P >0.050 each]

Conclusion: High HbA1c levels were associated with high CIMT values, but not with carotid plaques. Therefore, HbA1c levels may be useful as an indirect marker of the initial stages of carotid artery atherosclerosis

Pattern of stroke in type 2 diabetic subjects versus non diabetic subjects

Diabetes mellitus is a well-recognized risk factor for ischaemic stroke. Stroke in diabetic patients is different from stroke in non-diabetics from several perspectives. There is no local study on this topic. This is the first study from Pakistan, in which pattern of stroke in diabetics have been described and compared with non-diabetics. The object of this study was to compare pattern of stroke in diabetic subjects with non-diabetics. This is a prospective comparative cross sectional study, carried out at Liaquat national hospital, Karachi, neurology department from October to March 2006. Fifty patients were enrolled in diabetic group and 50 in non-diabetic. Clinical features, risk factors and stroke patterns were identified. Mean age was 59.5 [ +/- 11.82] in diabetics and 60.4 [ +/- 14.8] in non diabetics. There was slight preponderance of male patients in non diabetic group. Out of 50 diabetic patients, 44 [88.0%] had ischaemic stroke and 6 [12.0%] had intracerebral haemorrhage. In non-diabetics, 29 [58.0%] had ischaemic stroke while 21 [42.0%] had intracerebral haemorrhage. On further analysis of ischaemic stroke, cortical infarcts [CI] was found in 22, sub cortical infarcts [SCI] in 14, brainstem in 5 and cerebellar in 2 diabetic patients. CI was also the commonest subtype of ischaemic stroke in nondiabetics. Patterns of stroke in diabetics are different from non-diabetics. Ischaemic stroke is more prevalent than hemorrhagic stroke in diabetics. Sub cortical infarcts are more common in diabetics than non diabetics [p=0.04]