Ultrasonographic assessment of intracranial hemodynamics in acute stroke patients

Transcranial ultrasound [TU] is a noninvasive, easy-to-repeat diagnostic technique that is being used widely for the evaluation of cerebral heamodynamic. The aim of the study was to explore and demonstrate the findings that can be afforded by the Transcranial ultrasonography, the non imaging Transcranial Doppler sonography [TCD] and the imaging Transcranial color-coded Doppler sonography [TCCS], with more emphasis on the practical work of the TCCS. During a period of one academic year from October 2005 to October 2006, 50 non consecutive patients, seen at the stroke clinics of two medical institutions, were enrolled in the study. They were divided into two groups. The 1st group comprised of 25 patients recruited from Ain Shams specialized hospital who had TCD. The 2nd group comprised of another 25 patients recruited from Cairo University Hospital who had TCCS. Extra cranial Carotid Duplex had been done for both groups. In the two groups, the effect of the supplying artery on the insonated intracranial arteries was put in consideration whenever TCD or TCCS was done. Out of the 50 patients, 40 [80%] were successfully insonated yet in 10 [20%] patients, insonation through the temporal acoustic window failed; of which 6 [60%] were females and 4 [40%] were males. We found 11 [14%] MCAs which revealed abnormal waveform patterns [10 dampened and 1 blunted], reversal of flow in the ACA was noticed in three cases and a dampened waveform pattern in 12 PCAs. Regarding intracranial arterial stenosis, it was detected in 21 arteries [13 MCAs, 2 ACAs, 6 PCAs], 16 showed < 50% stenosis [9 MCAs, 2 ACAs, 5 PCAs] and 5 showed >/= 50% stenosis [4 MCAs, I PCAs]. We recommend that acute stroke patient, must perform a baseline TCU which, provide a hemodynamic intracranial image to what is present extracranially, Repeated examination can be achieved by TCU to serially monitor the therapeutic or spontaneous recanalization

Effectiveness of monochromatic infrared photo energy [MIRE] in improving balance of diabetic peripheral neuropathy

Patients with long standing diabetic peripheral Neuropathy suffers marked affection of lower limb proprioception and often develop balance problems that can significantly increase fall risk. The purpose of this study was to determine whether the application of Monochromatic infrared photo energy [MIRE] to the lower extremities of patients with diabetic peripheral Neuropathy would improve balance and gait patterns. The study conducted on 40 diabetic patients with peripheral neuropathy divided equally into two groups [20 patients each]. Group I received exercise program only, Group II received in addition to exercise program 30 minutes Monochromatic Infrared Photo Energy [MIRE] three times a week for one month. Tandem walk [TW] test was used to assess mean step width, speed and end sway pre and post therapy in both groups of patients. Both groups were selected to have identical clinical characteristics, mean of age, duration of both diabetes and peripheral Neuropathy, Blood sugar control. Highly statistical significant difference [p<0.0001] between the two groups regarding speed post therapy implicating the beneficial effect of Monochromatic infrared photo energy [MIRE] on balance parameters. As deducted from the observed data as well as from the reviewed literature we could recommend that the application of 12 photo therapy sessions induced improvement in balance and consequently decrease the incidence of falls in diabetic peripheral neuropathy

relation between nutritional factors and multiple sclerosis: an Egyptian study

No single environmental exposure has been consistently identified as a causal factor in MS. It has been suggested that nutrition and food patterns may play a role in the aetiology of MS. To explore the nutritional pattern of MS Egyptian patients in comparison with that of controls. The relation between nutritional factors and MS was studied among 30 MS patients and 30 matched controls in neurology department Cairo University between June 2006 and January 2007. Dietary information was collected by employing 24 hours recall method and food frequency questionnaire. MS patients were underbuilt with lower BMI as compared to controls. Also patients seem to consume less vitamin A, B1, C, carbohydrates, proteins and more fat. A significant negative correlation was found between patient disability as measured by EDSS and iron and B1 intake. We found no statistical significant difference between patients and controls in zinc, iron, calcium, vitamin A, B2, C carbohydrates, fat and protein on one hand and patient disability. The study generally supports a protective role for antioxidants and increased risk of MS with fat consumption

electro-physiologic study of trigeminal brainstem circuits in migraine

The study aimed at investigating functional changes in the trigeminal and optic nerves brainstem connections in migraine patients. Trigeminal somatosensory evoked potentials [TSER's], electric blink reflex [EBR] and light stimulus evoked blink reflex [LBR] were carried out interictally on 18 patients suffering from migraine without aura and 12 healthy controls. TSER's latencies [N1, P1, N2, and P2], EBR latencies [R1, ipsilateral and contralateral R2] as well as LBR latencies [direct and indirect responses] and their amplitudes were recorded and compared to healthy controls. The ipsilateral and the contralateral R2 components of the EBR [R2i, R2c] showed a highly significant delay as compared to the control group [p<0.000]. N1, P1 and N2 latencies in patients were significantly longer than the control group bilaterally. P1 latencies showed the most significant prolongation of latency [p<0.0000]. The latencies of the LBR direct and indirect responses were significantly prolonged in the patient group [p<0.000] and had a double fold amplitude compared to those of the control group. Migraine patients show a disruption in the central circuits not only at the level of the brainstem but possibly within the higher cerebral regions as well