Evaluation of transcranial doppler in neuro-Behcet's disease patients

To study the value of transcranial Doppler [TCD] in patients with neuro-Behcet's disease [Neuro-BD] and to correlate the findings with the MRI results. This study included 15 patients fulfilling the diagnostic criteria of international study group for Behcet's disease. MRI brain was done and evaluated for the presence of parenchymal lesions. Bilateral transcranial Doppler ultrasound of the middle [MCA], anterior [ACA] and posterior [PCA] cerebral arteries were performed in patient and control groups. TCD parameters were compared between 15 patients and age and sex matched control subjects. We found 12 [80%] patients had single or multiple brain lesions on MRI. Most of these lesions were of high signal intensity on T2-weighted images and located in the brainstem, basal ganglia and deep white matter region. TCD findings were abnormal in 5 [33.3%] patients. Pulsatility and resistivity indices of the MCA were significantly higher in patients than in normal control [p<0.001]. The mean blood flow velocity of the MCA and ACA was marginally reduced in patients with neuro-BD than in healthy controls, but did not reach a statistical significance [p>0.05]. No significant relation was found between abnormal MRI lesions and TCD parameters. Cerebral hemodynamics might be affected in patients with Behcet's disease compared with healthy controls. TCD may be a useful tool in the evaluation of patients with neuro-Behcet's disease

Isokinetic muscle strength assessment of lower limbs in diabetic neuropathy

Motor dysfunction is a late and rare feature in diabetic distal sensory polyneuropathy. Early impairment of motor function in diabetic sensory neuropathy is largely unknown. We studied sixty patients with diabetic distal polyneuropathy, 30 patients with subclinical and 30 with clinical overt diabetic neuropathies. Thirty age and sex matched healthy subjects were used as a control group. Quantitative assessment of maximal muscle strength of extensors and flexors at knee and ankle was measured by isokinetic dynamometry in all patients and control subjects. The degree of neuropathy was determined by clinical and electrophysiological studies. Maximal isokinetic muscle strength in all patients was reduced by 14% for the ankle extensors [p<0.03] and by 17% for the ankle flexors [p<0.02]. At the knee, strength of extensors and flexors was reduced by 7% [NS] and 14% [p<0.05], respectively when compared with the control group. Muscle strength was significantly reduced in clinical diabetic neuropathy when compared with the control [p<0.05]. Impaired muscle strength was closely related to the severity of neuropathy. Amplitude of the compound muscle action potential was related to the strength at the ankle [r = -0.45, p< 0.01] and knee [r = -0.42, p< 0.02]. Diabetic patients may have early muscle weakness at the ankle and knee related to the presence and severity of diabetic neuropathy. Isokinetic dynamometry is a useful tool for evaluating muscle strength in early diabetic sensory neuropathy

C-reactive protein in acute ischemic stroke: correlation with the risk factors and stroke outcome

The aim of our study was to evaluate serum C reactive protein [CRP] levels in acute ischemic stroke and to correlate the values with stroke severity, outcome and other generally known risk factors. We studied 100 patients who were admitted with acute ischemic stroke. All patients underwent a clinical evaluation, laboratory investigations and radiologic examination in the first 12 hours of acute ischemic stroke. Neurological status was evaluated by modified Rankin Scale [m-RS] on admission and after one month. CRP was abnormally increased in 35% of our study patients. Elevated CRP levels were significantly associated with severe disability on admission and were also associated with large cortical and subcortical infarcts. We found a significant correlation between CRP, WBC as well as fibrinogen levels and stroke outcome as measured by m-RS after one month [P <0.0001]. Carotid atherosclerosis was significantly frequent in patients with elevated CRP when compared with those with normal CRP [P <0.0001]. The mean systolic or diastolic blood pressure irrespective to the history of arterial hypertension was significantly higher in patients with increased CRP levels when compared with those with normal CRP [P <0.0001]. We conclude that elevated CRP levels are associated with severe functional disability, poor outcome and predict a larger infarct size. Elevated CRP is a significant index for carotid atherosclerosis and may be one of underlying processes related to the inflammatory response after acute ischemic stroke