[Diagnostic value of physical examination for topographic detection of infratentorial lesions in patients with cerebrovascular syndromes]

The Detection of neurologic signs for topographical disorders in central nerves system can prevent unnecessary neuroimaging techniques such as MRI. This study was performed to determine the diagnostic value of physical examination for topographic detection of infratentorial lesions in patients with cerebrovascular syndromes. This descriptive study was done on 200 patients with cerebrovascular syndrome in Qaem Hospital in Mashhad, north-east Iran during 2011. Regarding to topographic physical examination, sensitivity, specificity, positive and negative predictive value and accuracy of signs of syndromes were compared to MRI as gold standard method. The accuracy of tetraparesis and crossed syndromes for localization of brain lesion in brainstem was 79% and 83%, respectively. The accuracy of hemiataxia for localization of brain lesion in ipsilateral cerebellar hemisphere was 98%. The accuracy of Wallenberg syndrome for localization of brain lesion in posterolateral medulla was 98%. Using clinical neuro-examination skills and accurate topographic physical examination can prevent unwanted MRI technique for the diagnoses of cerebrovascular syndromes

Khorasan posterior circulation stroke registry: a hospital-based study

Clinical information about stroke in the vertebrobasilar territory has lagged behind that for anterior circulation syndrome. This is the first report from posterior circulation syndrome registry in Iran. Consecutive patients with brain infarction in vertebrobasilar territory admitted to Ghaem hospital, Mashhad were enrolled in a prospective study during 2006-2007. Diagnosis of ischemic stroke in the posterior circulation was made by a stroke neurologist based on the clinical manifestations and neuroimaging. Vertebrobasilar territory infarcts were classified into five groups according to the location involved: brainstem, thalamus, cerebellum, posterior cerebral artery, and mixed categories. All of the stroke patients underwent a standard battery of diagnostic investigations and the etiology of ischemic stroke was determined by the Practical Iranian Criteria classification. The 72-hour stroke course determined as regressive, stable, and deteriorative. Total of 302 patients [147 females, 155 males] with mean age 62.5 years [ +/- 17.2] were investigated. Posterior cerebral artery, thalamus, brain stem, cerebellum, and mixed categories consisted 31.3%, 4.3%, 32.8%, 17.9%, and 13.9% of the stroke topographies respectively. Atherosclerosis consisted 50.6% of etiologies in our patients followed by uncertain [25.5%], cardioembolism [12.5%], both atherosclerosis and cardioembolism [6.3%], and miscellaneous causes [4.6%]. Rheumatic mitral stenosis was the cause in 34.2% of our patients with cardiac emboly. The distribution of stroke etiologies based on its localization was not significantly different [df = 16, and P = 0.421]. Stable status was the most common early stroke course [57.7%] followed by deteriorative [22.1%], and regressive [20.2%]. A significant association between stroke localization in the vertebrobasilar territory and its course was not found [df = 8, and P = 0.901]. Atherosclerosis is the most common cause of posterior circulation syndrome in Iranian patients. The cause of stroke in the posterior circulation could not reliably be derived from infarct topography

Reliability of Persian early computed tomography score in patients with brain infarction

The one-third middle cerebral artery [1/3 MCA] method and Alberta Stroke Program Early Computed Tomography Score [ASPECTS] were used to detect significant early ischemic changes on brain computed tomography [CT] of patients with acute stroke. We designed the Persian Early CT Score [PECTS] and compared it with the above systems. The tomograms were chosen from the stroke data bank of Ghaem Hospital, Mashhad, in 2008. The inclusion criteria were the presence of MCA territory infarction and performance of CT within 6 hours after stroke onset. Axial CTs were performed on a third-generation CT scanner [Siemens, ARTX, Germany]. Section thickness above posterior fossa was 10 mm [130 kV, 150 mAs]. Films were made at window level 35 HU. The brain CTs were scored by four independent radiologists based on the ASPECTS, 1/3 MCA method, and PECTS. The readers were blinded to the clinical information except the symptom side. Cochrane Q and Kappa tests were used for statistical analysis. Twenty four CT scans with sufficient quality were available. The difference in distribution of dichotomized 7 ASPECT scores between the four raters was significant; Q=13.071, df=3, P=0.04. The difference in distribution of dichotomized >1/3 and

[Effects of transcranial doppler on therapeutic decisions in neurologic patients]

TCD is an expensive diagnostic investigation for patients and health insurance companies. Based on the therapeutic view, cost-effectiveness of transcranial doppler [TCD] is important in patients with cerebrovascular disease. This descriptive study was conducted in Neurosonology Center, Ghaem Hospital, Mashhad, within 2006-2007. Indication of TCD was made by neurologists previously. 200 TCD on 166 patients was performed by neurosonologists based on the standard protocol with AKAI device, France and 2MHz probe. The effect of TCD results on changing the dose and type of medicine and neurosurgical consultation of the patients was recorded. Data was analyzed with descriptive statistics and frequency distribution tables. 166 patients [64 males and 80 females] with mean age of 53.4 years were investigated. Abnormal results were found in 27.5% of TCD. Performance of 3D TCD [15%] had influence on therapeutic decisions of the patients. Among this later group, 83% were patients with subarachnoid hemorrhage and 17% had high risk cardiac source of embolism or sever carotid stenosis with recurrent cererbral ischemic events. The cost of 200 TCD in non-private center was evaluated to be about 10 million thomans. Due to high expenses and low percentage of therapeutic influences, performance of TCD is recommended in a restricted group of patients. However TCD is a safe and non-invasive test for assessment of main cerebral arteries, which provide useful information

Relation of aphasia subtypes and disability score in stroke patients

Aphasia is a common manifestation of stroke. Aphasia increases the disability score in stroke patients due to communication disorders and associated right sided hemiplegia. This study was done to evaluate the relation of aphasia with disability score in the stroke patients. Consecutive stroke patients admitted in Valie-Asr hospital, Khorasan enrolled in a prospective study in 2005. Aphasia and its subtypes were detected by neurologist and linguistician based on the British criteria. Disability scored according to the Rankin scale 72 hours post stroke. Mean of disability score [MDS] was analyzed by Tuki range and Variance tests and p<0.05 was considered significant. Three hundred and twenty nine patients [175 females and 154 males] with stroke were evaluated. Aphasia was found in 106 [32%] of these patients. Stroke patients with aphasia had significantly higher MDS than other stroke patients; T=2.6, df=327, p=0.01. Patients with Global aphasia had significantly higher MDS than patients without aphasia and patients with Wernicke aphasia [p<0.001, p=0.006 respectively]. However, patients with Global aphasia had non-significant difference of MDS to patients with Broca aphasia [p=0.06]. Aphasia is an important effector in disability of stroke patients. Aphasia increases the stroke disability and reduces future recovery in the stroke patients following rehabilitation

[Comparison of the topography of carotid territory stenosis in north American and Iranian stroke patients]

Atherosclerotic stenosis of carotid territory is the most common cause of ischemic stroke. A higher frequency of intracranial arterial stenosis has been reported in Africa and the Far East. 304 geriatric ischemic stroke patients admitted in Mackenzie hospital, Canada and the same number of geriatric ischemic stroke patients with similar sex ratio admitted in Valie-Asr hospital, Iran during 2003-2005 were enrolled in a double center and prospective study. Diagnosis of brain infarction in the carotid territory was made by stroke neurologists. All of the patients underwent transcranial and carotid doppler studies. Doppler studies performed were based on the standard method by a neurosonologist. Fisher exact test served for statistical analysis and p<0.05 was declared significant. In Iranian group 71 patients [23.3%] and in North American group 83 patients [27.3%] had extracranial ICA stenosis without a significant difference df=1, p=0.305. Sever >/=70% Extracranial ICA stenosis was found in 14 Iranian patients [4.6%] and 23 North American patients [7.5%] without a significant difference. df=1, p=0.17. In Iranian group, 14 cases [4.6%] and in North American group 5 cases [1.6%] had intracranial stenosis in carotid territory which was significantly different df=1, p=0.038. Mixed intracranial and extracranial carotid territory stenosis was present in 2 Iranian and 1 North American patient. Atherosclerotic stenosis of intracranial branches of carotid territory is more common in Iranian than North American populations

[Evaluation of early seizures in stroke patients]

Seizure could occur in early stroke phase, which leads to clinical deterioration of the patients. In this prospective clinical study, consecutive 1000 patients with first ischemic stroke admitted in Valie-Asr hospital, Khorasan during 2000-2003. Diagnosis of stroke and early seizure was performed by neurologist. Topography of the ischemic lesions was detected by topographic maps of cerebrovascular territories in brain CT scan. 6.1% of the patients had seizure within first week of stroke. Partial seizures with or without secondary generalization consisted 60% of these early seizures. Within middle cerebral artery territory infarctions ischemic lesions with cortical involvement were 2.43 times more preponderant to early seizures [p=0.003]. Frequency of early seizure was not significantly related to diffuse extension of the ischemic lesions within middle cerebral artery territory infarctions. Early seizure is an infrequent complication of ischemic stroke which is more frequent in infarctions with cortical involvement

Silent brain infarction in stroke patients: a pilot double-center study

Silent Brain Infarcts [SBI] are associated with an increased risk of subsequent stroke. SBI are incidentally revealed by CT or MRI executed in stroke patients.A prospective study was undertaken involving 200 consecutive patients aged >45 years with brain infarct admitted in University of Alberta Hospital, Canada [100 patients] and Valie-Asr Hospital, Iran [100 patients] in 2003. Patients were divided in age groups aged <65 and >65. All of the patients underwent brain CT. A stroke neurologist with knowledge of stroke history subsequently reviewed the scans and diagnosed SBI. The relations of race, gender and age groups with SBI were analyzed with chi-square and Fisher exact tests.SBI were present in 26.9% of patients aged <65 and 48.6% of patients aged >65. Canadian patients were significantly more preponderant to SBI in age group> 65 [p= 0.013]. The mean age of Canadian patients was significantly higher than Persians [p<0.001]. Within a total of 200 patients the female gender was significantly more preponderant to SBI [p= 0.02] which was not related to age and race groups. Small vessel territory infarct was present in 87% of our patients with SBI.SBI are common in stroke patients. The frequency of SBI is higher in female gender and the elderly

Risk factors for leukoaraiosis in North American and Iranian stroke patients

Leukoaraiosis [LA] or white matter thinning and rarefaction are common in stroke patients. This pilot double- center study was designed to evaluate LA risk factors in stroke patients. This cross sectional study was conducted on 100 consecutive stroke patients in Walter Mackenzie Hospital, Canada and 100 consecutive stroke patients in Valie-Asr Hospital, Iran in 2004. Diagnosis of ischemic stroke and LA was performed by stroke neurologists using CT scan. The effects of race, gender, age groups, hypertension, diabetes, hypercholesterolemia and smoking on frequency rate of LA were evaluated. The frequency rate of LA was the same in stroke patients living in North America or Iran. But, the frequency of LA in female stroke patients was more frequent than males [p<0.005]. LA was significantly predominant in stroke patients with age >/= 65-yrs than those with age<65-yrs [p<0.05]. The frequency of LA was significant in hypertensive patients. However, the frequency rate of LA was not influenced by diabetes, hypercholestrolemia and smoking. Female gender, age and hypertension seem to be the main risk factors of leukoaraiosis. In addition, there was no difference between the frequency rates of LA in patients living in Iran or North America

Topographic evaluation of aphasia in 100 stroke patients

Aphasia is a common manifestation of stroke and evaluation of relationships of aphasia and brain topography could lead to better understanding of cognitive neurophysiology. 100 stroke patients with aphasia admitted in Valie-Asr hospital Khorasan since April 2003 were enrolled in this prospective cross-sectional study. Diagnosis of stroke and aphasia was made by a neurologist and topography of involved cerebrovascular territories confirmed by topographic maps of brain in CT scan. Global, Broca and Wernicke subtypes of aphasia constituted 52%, 40% and 6% of the cases, respectively. Based on the usual nourishment of Broca and Wernicke areas by anterior and posterior cortical branches of the middle cerebral artery, 79% of Global, 47% of Broca and 50% of Wernicke aphasias had compatible infarct topography. The infarct topography in other cases was not congruent with the involved linguistic areas of their brain. Specific cerebrovascular topography for subtypes of aphasia in stroke patients was not found. The effects of cerebrovascular lesions on linguistic functions are not predictable by their topography in CT scan

Etiology overlaps based on the brain infarct topography

Etiologic overlaps may occur in patients with ischemic stroke depending on the diagnostic investigations and classification criteria. Consecutive ischemic stroke patients admitted in Mackenzie hospital, Canada from August 2003 to August 2004 underwent a standard battery of diagnostic investigations by stroke neurologists. Stroke mechanism was defined based on the Toast criteria. Stroke topography subtypes were small and large artery territory infarcts. A total of 302 stroke patients [159 female, 143 male] were registered. Small and large artery territory infarcts consisted 25.5% and 74.5% of our topography respectively. Etiologic overlaps were found in 17.5% of the patients. Cardiac source of embolism was significantly more frequent in patients with large artery territory infarcts [p= 0.002] but frequency difference of corresponing large artery atherosclerotic stenosis was not significant in these topographies [p= 0.378]. Etiologic overlaps were more frequent in patients with small artery territory infarcts [p= 0.004].Etiologic overlaps are frequent and should be considered for optimal management of the ischemic stroke patients