The study of intermediate-term survival of the patients with cerebral venous sinus thrombosis

@#Objective: This study aimed to investigate the intermediate survival of patients with cerebral venous sinus thrombosis (CVST). Methods: This is a retrospective study recruiting patients with a definite diagnosis of CVST who were referred to teaching hospitals of “Shiraz University of Medical Sciences” from 2007 to 2017. Follow-up phone calls were conducted in March 2019 till June 2019. All-cause mortality, mortality due to CVST, and CVST recurrence were investigated. Results: Of the total of 301 patients, 213 (70.8%) were female. Patients’ age ranged from 1 to 95 year with a mean of 39.9 year. Intermediate follow-up (mean 46.9, 95%CI: 43.6-50.2 months) was done. Intermediate term mortality was 12.3%, mostly from CVST, and largely occurred within the first month. Age was a significant risk factor for survival (HR=1.056, 95%CI:1.037-1.075). The difference was not statistically significant in males in comparison to females (HR=1.3, 95%CI:0.67-2.60, P=0.41). Patients with recurrent CVST hada higher risk of mortality (HR=9.14, 95%CI:4.70-17.89, P<0.001). There was statistically higher risk of mortality in patients with deep vein thrombosis (DVT) (HR=8.97, 95%CI: 4.32-18.61, P<0.001). Although the risk of death for patients using oral contraceptives (OCPs) was 16% higher, this was not statistically significant (HR=1.16, 95%CI: 0.52-2.55, P= 0.21). Conclusions: Intermediate-term mortality was 12.3%, and associated with older age, recurrent CVST and DVT. The reasons for these findings need further investigation.

Facial emotion recognition in patients with relapsing-remitting multiple sclerosis

@#Objective: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system and the most common cause of disability among young adults. In addition to physical and cognitive disturbances, MS patients also have emotional processing deficits. Despite the rich knowledge available about cognitive impairments, little is known about emotion recognition in patients with relapsing-remitting MS (RRMS), despite the fact that it plays a key role in social behavior. The aim of our study was to investigate facial emotion recognition in patients with RRMS, compared with healthy controls. Methods: Facial emotion recognition abilities were studied in a homogeneous group of 51 RRMS patients and 51 healthy controls, using the Persian version of the Florida Affect Battery. We controlled both groups for physical symptoms, anxiety, depression and social dysfunction, using general health questionnaire (GHQ-28). Patients and healthy controls were matched according to age and gender. Early stage of the disease was defined as being diagnosed with RRMS and having an EDSS of 4 or lower. Results: MS patients performed as well as healthy controls in facial identity discrimination and facial emotion discrimination tasks, but showed significantly less performance in other subtests that required emotion recognition in comparison with healthy controls. Conclusions: Facial emotion recognition is impaired at early stages of MS. MS patients have problems in their emotional processing system. Deficits in facial emotion recognition merit attention because they might negatively influence interpersonal relationships and quality of life in MS patients.

Hypothalamic endocrinopathy in multiple sclerosis and neuromyelitis optica syndrome

Background: Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are twoinflammatory disorders of the central nervous system with different pathogenesis. The aim of thisstudy is to evaluate endocrinopathy in these patients. Methods: By convenient sampling method, 20MS, 20 NMOSD and 20 normal age and sex matched as control were enrolled in this study. Hormonalassay including TSH, free T3, free T4, , FSH, prolactin, cortisol, IGFI, thyroid-stimulating hormone(TSH), free T3, free T4, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin,cortisol, insulin-like growth factor I (IGF-I), urine specific gravity and anti-aquaporin immunoglobulinG (AQP4-IgG) level was measured. Also adrenocorticotropic hormone (ACTH) stimulation test wasdone for MS and NMOSD patients. Results: Hypothyroidism was prevalent and found in 30% of MS,40% of NMO patients, and only 9.5% of the controls. We detected greater rate of hypothyroidism inNMO patients compared to control (p=0.027). Mean level of anti-thyroglobulin antibody in MS andNMOSD patients was higher than control (p=0.037). One patient in MS group, 6 in NMOSD and 11control had IGFI level lower than lower limit of their age groups (p=0.001).Conclusions: Although the result of this study did not support significant hypothalamic-pituitary axisendocrinopathy in NMOSD compared to MS and controls, there is a higher prevalence of some hormonalabnormalities, especially thyroid dysfunction in NMOSD cases, that needs more clinicians’ attention.

The role of psychological resilience, severity of disease and treatment adherence in the prediction of health-related quality of life in patients with multiple sclerosis

Objective: This cross-sectional study aims to evaluate the impact of the disability status, psychological resilience, and treatment adherence on health-related quality of life (QOL) in patients with multiple sclerosis (MS). Methods: One hundred MS outpatients, 80 women and 20 men, referred to a clinic of Shiraz University of Medical Sciences, were eligible to participate. MS was diagnosed by 2010 revised Mc-Donald criteria. The QOL and resilience were evaluated by the Medical Outcomes Study Short-Form (SF-36) and Connor-Davidson Resilience Scale (CD-RISC) respectively. Medication adherence and severity of disease were assessed by the Morisky Medication Adherence Scale (MMAS) and expanded disability status state (EDSS) scores respectively. Results: Stepwise multiple regressions showed that in the first model, the disability status was the best predictor which accounted for 28.1% of the variance in QOL. In the second model, both the disability status and resilience explained 50.6% of the variation in QOL. Conclusion: The findings showed that the severity of the disease is a strong predictor which has adverse effects on the physical component of health-related QOL in the patients with MS. Both psychological resilience and treatment adherence have positive influence on mental component of QOL in these patients.

Evaluation of homocysteine level as a risk factor among patients with ischemic stroke and its subtypes

Background: Epidemiological research has shown that increased total homocysteine [tHcy] levels are associated with an increased risk of thromboembolic disease; however, controversy still exists over which subtype of stroke is allied to hyperhomocysteinemia. This study aimed to investigate whether elevated tHcy is an independent risk factor for ischemic stroke and to compare tHcy levels in patients with ischemic stroke subtypes

Methods: We performed a case-control study, in which 171 ischemic stroke patients aged over 16 years and 86 age and sexmatched controls were eligible to participate and were enrolled from January 2009 to January 2010. The patients' demographic data, traditional stroke risk factors, and the results of fasting tHcy, vitamin B12, and folate of serum were collected in the first 5 days after ischemic stroke. Stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment [TOAST] criteria. SPSS software [version 13] was used for the statistical analysis of the data, and a P value smaller than 0.05 was considered statistically significant

Results: The mean fasting Hcy levels was significantly higher in the cases [16.2 micro mol/L, 95% CI: 14.8 to 17.5] than in the controls [13.5 micro mol/L, 95% CI: 12.4 to 14.6] [P=0.013]. The mean Hcy levels was elevated significantly in those with cardioembolic strokes compared with the controls [17.7 micro mol/L, 95% CI: 14.8 to 20.5; P=0.010]. The plasma Hcy level was associated with an adjusted odds ratio of 2.17 [95% CI: 1.24 to 3.79; P=0.004] for Hcy above 15 micro mol/L concentration for all types of stroke

Conclusion: Our data showed that elevated serum Hcy is an independent risk factor for ischemic stroke and it has a strong association with cardioembolic subtype

Factor V G1691A and prothrombin G20210A gene polymorphisms among Iranian patients with cerebral venous thrombosis

Objective: Cerebral venous thrombosis (CVT) is an important cause of stroke, especially in young adults, that has many predisposing factors. G20210A mutation in prothrombin gene (Factor II) and G1691A mutation in Factor V Leiden (FVL) are two common hereditary causes of CVT. This study aimed to study the rate of these mutations in patients with CVT from Fars Province in southern Iran. Methods: In a case-control study, 57 case patients with defi nite diagnosis of CVT, confi rmed clinically and by MRI and MRV, and 50 sex and age matched healthy controls, with no family history of thrombosis, were enrolled from March 2008 to March 2010. G1691A mutation of FVL and G20210A mutation of factor II were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results: Mutation in G20210A of factor II was found in 3.6% of patients and 4% of the controls (P=1). For FVL mutation, 7% of the patients carried the mutant allele while this mutation was not found in the controls (P=0.12). Two and 4 patients were heterozygous for prothrombin G20210A and FVL G1691A mutations, respectively. Conclusions: It seems that G20210A mutation in Factor II and G1691A mutation in FVL are not responsible for CVT in the southern Iran population with predominant Fars ethnicity.

Cerebral venous-sinus thrombosis: a case series analysis

Cerebral venous-sinus thrombosis is an uncommon form but important cause of stroke, especially in young-aged women. We performed a retrospective descriptive-analytical study in which 124 patients with cerebral venous-sinus thrombosis, who referred to Nemazee Hospital, Shiraz University of Medical Sciences from January 2000 to March 2008, were included, and their demographic, etiologic, radiological and prognostic characteristics were evaluated. The patients' mean age was 34.01 +/- 10.25. Eighty seven [70.16%] were women and 37 [29.83%] were men. The most frequent clinical manifestations were headache, papilledema and seizures. Fifty seven [65.5%] women took oral contraceptive pills. Twenty of 57 women [35.08%] took the pill longer than one month to be able to fast in Ramadan or perform the Hajj ceremonies. In the mean time they developed cerebral venous-sinus thrombosis. Superior sagital sinus, with or without lateral sinuses, was the most involved area [70.96%]. High mortality and morbidity rates [14.51%] and 35.48%, respectively] were found in patients. Poor prognostic factors at the time of admission were stupor and coma [P=0.001] and evidence of hemorrhage in primary CT scan [P=0.005]. Taking oral contraceptive pills was a main factor associated with cerebral venous-sinus thrombosis. Clinical manifestations, prognostic factors, common involved sinuses and image findings of this study were similar to those of other studies. Health care policy makers should design a plan to warn susceptible women of the risk of cerebral venous-sinus thrombosis, and to educate them the ways to prevent it

Neurological manifestations of behcet's disease

To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behcet's disease. This prospective study was carried out in the Behcet's Research Clinic in Shiraz [south-west Iran] and included the patients referred from 1990-1999. The patients' clinical records, images, CSF analyses, and electrodiagnostic studies were reviewed. Eighteen [15 males and 3 females] out of 690 Behcet's patients [2.6%, 95% CI = 1.4-3.8%] were found to have neurological involvement. The mean +/- standard deviation age of these patients was 34.7 +/- 8.6 years. All fulfilled the criteria of the International Study Group of Behcet's Disease. Central nervous system involvement was more common than peripheral nervous system manifestations. Headache, weakness, tingling, and numbness were the most common symptoms. Hyperreflexia, upward plantar reflex, and somatosensory findings were the most frequent signs. Hemispheral and brainstem stroke-like syndromes and cerebral venous thrombosis were the major neurologic presentations. There were also cases of myelitic, pure meningoencephalitic, amyotrophic lateral sclerosis-like, multiple sclerosis-like, and Guillain Barre syndromes. Neuro-Behcet's disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies