Study of the short-term impact of intensive glycemic control on nerve conduction type 2 diabetic patients

Diabetic polyneuropathy is one of the serious chronic complications of diabetes mellitus resulting from the interplay between metabolic factors and structural changes. The underlying metabolic facto rs include activation of the polyol patlway, diminished sodium potassium [Na-K] ATPase activiand microangiopathies of the vasa nervosa supplying the peripheral nerves. Intensive insulin therapy can resu4 in rapid reversal of the Na-KATPase activity. The objective of this study was to assess any possible short-term irhpact of intensive glycemic control on the nerve conduction in a sample of type 2 diabetic patients having polyneuropathy. This study was conducted on 60 type 2 diabetic patients having diabetic polyneuropathy attending the Main University Hospital Out-patients Clinics [Diabetes Clinic and Neurology Clinic]. All the patients were submitted to full history taking and complete general and neurological examination. Laboratory investigations mci uded fasting and postprandial plasma glucose, glycated hemoglobin [HbAlc], urea, creatinine, ALT and AST. All other causes of peripheral neuropathy were excluded from the study. Nerve conduction study of the sural, peroneal and posterior tibial nerves in both lower limbs as well as median and ulnar nerves in both upper limbs was done using standardized techniques before and after intensive insulin therapy. One month after the start of insulin therapy, there was a significant improvement in F-wave latencies of the median, ulnar, tibial and common peroneal nerves. The distal latencies of the sensory nerve action potential [SNAP] and compound muscle action potential response also significantly improved. The nerve conduction velocities were signficantly faster after intensive insulin therapy. Amplitude of motor and sensory responses did not change significantly. Hyperglycemia can alter the nerve function due to slowing of nerve conduction presumably caused by some metabolic factors such as diminished Na-K ATPase activity and altered polyol pathway. Fortunately, some of these changes can be reversed by implementing intensive glycemic control, resulting in significant improvement in nerve conduction velocities and F-wave latencies even after a short time of properly-designed intensive insulin therapy

Stydy of clinical, biochemical, electroencephalographic, radiological and electron microscopic features in patients with batten disease

Neuronal ceroid lipofuscinoses "NCLs" are a group of common hereditary neurodegenerative metabolic disease. Batten disease is its juvenile type that usually occurs between the age of 4-10 years. The aim of this work is to study the clinical picture, biochemical, enzymatic changes, electroencephalographic abnormalities, neuroradiological imaging and ultrastructural alterations in skin biopsies using transmission electron microscope. Methods: The study was carried out on five patients suspected having neuronal ceroid lipofucinoses. All patients subjected to complete history taking, with special concern to detailed family history. Full physical, neurological, ophthalmologic examination was done with developmental assessment. Routine lab investigations as well as a batteries of metabolic screen and MRI were performed. Electroencephalogram examination was done under standerd conditions with different provocations. Skin biopsies were taken for histological and ultrastructural examination using transmission electron microscope. The current study included 5 males aged between 6 to 13 years with a mean of 8.5 +/- 1.2 years, two of them had positive family history. The main presentations were; epilepsy in all cases [100%]; generalized tonic clonic convulsion in 3 cases [60%] and myoclonic epilepsy in 2 cases [40%]. Mental retardation and rapidly progressing visual loss were present in all cases [100%]. Motor deficits in the form of spastic quadriparesis were found in 4 cases [80%], extra pyramidal manifestations in one case [20%] and cerebellar ataxia manifested in one patient [20%]. MRI showed atrophic brain and cerebellar hemispheres in all cases. Light microscopic study of skin biopsies displayed unremarkable changes, while ultrastructural examination revealed presence of cytoplasmic membrane bound osmophilic granular, curvilinear and finger print inclusion bodies

Role of diffusion weighted MRI in early detection of ischemic cerebrovascular stroke

Is to evaluate the role of diffusion-weighted [DWI] MRI in early diagnosis of ischemic stroke. This study was carried out on one hundred and fifty patients presented with acute focal neurological deficits suggestive of ischemic vascular origin. Brain MRI and diffused weighted images were done to all patients. Brain MRI showed negative results in forty two patients, diffused weighted images were positive in all cases and differentiate multiple age indeterminate ischemic lesions. Also, lesions appeared larger and more conspicuous on DW MRI sequences. Diffusion weighted MRI is superior to the conventional MRI imaging in early detection of ischemic cerebrovascular stroke