Multifaceted Cerebral Venous Thrombosis With Extensive Intra-cerebral Hemorrhage in a Young Man With Mitral Valve Replacement Due to Thrombosis and IgA Nephropathy: A Challenging Case Report From Saudi Arabia.

Cerebral venous thrombosis (CVT) is a cerebrovascular condition characterized by cerebral venous sinus thrombosis, resulting in venous infarction. The condition can manifest through a range of signs and symptoms such as headaches, benign intracranial hypertension, subarachnoid hemorrhage, localized neurological deficits, seizures, unexplained changes in consciousness, and meningoencephalitis. Its causes are linked to numerous different conditions and factors. We report a complicated case and course of antiphospholipid antibody syndrome in a young patient. The case began two years prior, involving a 33-year-old man who had chronic kidney disease due to IgA nephropathy, pneumonia, and a large mass on his native mitral valve. He developed deep vein thrombosis (DVT) in his upper limb, for which he was prescribed warfarin. He was transferred to our hospital with a five-day history of severe headaches followed by a decrease in consciousness and seizures requiring intubation. He was found to have a subdural hematoma with a high international normalized ratio (INR). He underwent hematoma evacuation and a right decompressive craniotomy. CT of the brain via CT venography revealed intracerebral haemorrhage along with ischemic infarction in the right frontal-parietal and temporal lobes and cerebral venous thrombosis. He was treated with heparin infusion but later developed heparin-induced thrombocytopenia (HIT) and was switched to fondaparinux. Plasma exchange and intravenous methylprednisolone were given. His hospital course was complicated by recurrent infections, a new left intraparenchymal hemorrhage with intraventricular extension, and the need for extra ventricular drainage (EVD). The diagnosis of antiphospholipid antibody syndrome was confirmed. This case report provides invaluable insights into managing a complex scenario that requires balanced decisions between anticoagulation in the context of severe ICH and the necessity of immunosuppressive therapy. The emphasis is on the significance of using a personalized and multidisciplinary strategy to address CVT situations and their issues.

An Uncommon Coexistence of Ischemic Stroke in a Multiple Sclerosis Patient With Duplicated Superior Cerebellar Artery: A Case Report From Saudi Arabia.

The case describes a middle-aged man with well-managed multiple sclerosis who experienced an acute ischemic stroke attributed to a rare anatomical variant - a duplicated left superior cerebellar artery (SCA). Despite his prior lack of neurological issues, the patient presented with severe headaches and walking difficulties. Imaging confirmed the ischemic stroke in the left SCA territory and revealed the duplicated left SCA. This case highlights the importance of considering cerebrovascular anatomy in stroke risk assessment, especially in individuals with unique vascular features such as duplicated SCAs, which can predispose to vascular complications.

Perception of Saudi Population about COVID-19: A Cross-Sectional Study.

Background: The evolving COVID-19 outbreak requires a high level of population awareness and other measures to protect public health. Objectives: In this study, we aimed to identify knowledge, awareness, and fears of the Saudi population regarding COVID-19 during this pandemic. Methods: A cross-sectional survey study was conducted from April to May 2020 in different Saudi areas. Data were collected via online survey software (Google Forms), and the data collection tool was developed and validated by the study authors to fulfill the study objectives. Data were analyzed using SPSS version 21.0. Descriptive statistics and Chi-square tests were used for comparison between groups. The statistical significance was considered when the P value ≤0.05. Results: Study participants included 2982 people with 66.8% females. The average percentage of the awareness levels of the current study population was 68%. The vast majority (95.1%) did not know how the virus spread while 94.7% of the participants know the distance that a person should maintain from another person. Significantly higher percentages (70%) knew about and were aware of the prevention methods, including social distancing and hand hygiene, and 73.5% knew that elderly people with chronic diseases are the highest risk group to become infected. The highest significant fear of COVID-19 was from lack of treatment, which was reported by 77.5% of the participants with a P value of <0.05. Conclusions: Our study shows that the population has acceptable knowledge about COVID-19. Education and work-based awareness programs about COVID-19 are needed, especially for prevention and treatment aspects.

Does Caffeine Intake Increase the Incidence of Tinnitus? A Systematic Review.

Introduction Excessive caffeine intake has been thought to be a contributory factor for tinnitus. However, there has been no systematic review to elucidate the causal relationship between caffeine intake and the incidence of tinnitus. Objectives We performed the current review aiming at evaluating the evidence from the current literature for the relationship between caffeine intake and the incidence of tinnitus. Data Synthesis Databases including PubMed, Scopus, and Google scholar were searched for relevant articles. A total of 142 studies were screened for eligibility, of which four articles met our inclusion criteria: two were prospective cohorts and two were cross-sectional studies. Although one study found no association between caffeine consumption and the incidence of tinnitus, an inverse relationship was reported by two population-based studies. Concerning patients with preexisting tinnitus, reduction of caffeine intake in a subset who consumed 150 ml to 300 ml/day of coffee yielded a favorable outcome in tinnitus severity. However, those with higher dose intake were less prone to have improvement in the severity of tinnitus. Conclusion Although the current review was inconclusive, it appears that the incidence of tinnitus in previously unaffected individuals might be prevented by a high dose of caffeine intake. However, in preexisting tinnitus, a high dose of caffeine may adversely interfere with the efficacy of caffeine reduction.

Prevalence of depression among epileptic patients in Taif City, Saudi Arabia.

OBJECTIVES: To assess depression and its relation with different factors among people with epilepsy in wider range of ages. METHODS: A cross-sectional study was conducted in Taif city. The sample size was 150; the inclusion criteria were ≥18-year-old patients diagnosed with epilepsy. The data were collected by interviewing patients following up from rural and urban areas of Taif in neurology clinics at King Faisal Medical Complex (KFMC) and King Abdul-Aziz Specialist Hospital (KAASH). The PHQ-9 score was used to screen for depression. RESULTS: Our study showed that approximately 76.7% (n=115) of the patients had some form of depression. A severe form of depression was identified in 8.7% (n=13) of the patients, and a moderately severe form was observed in 13.3% (n=20) of the patients. There was no significant association between depression and gender, duration of epilepsy, type of epilepsy, and medications for epilepsy, while there was a statistical association between depression and age, stress level, and employment status (p<0.044, p<0.001, p<0.008, respectively). CONCLUSION: Depression is common in people with epilepsy. Regular screening for depression is recommended in people with epilepsy for early detection and treatment.

Risk Factors and Complications Among Pediatric Patients With Sickle Cell Anemia: A Single Tertiary Center Retrospective Study.

Background and objective Sickle cell anemia (SCA) is one of the common genetic diseases in the Kingdom of Saudi Arabia (KSA). This disease results from a genetic mutation that causes malformation of the red blood cells (RBCs), leading to various systemic complications, including vaso-occlusive crisis (VOC), acute chest syndrome (ACS), osteomyelitis, avascular necrosis (AVN), and stroke, to name a few. The leading cause of mortality in SCA is these systemic complications rather than the disease itself. Understanding the risk factors of these complications can help reduce mortality in these patients and improve their quality of life. In this study, we aimed to determine the risk factors of SCA complications among pediatric patients with SCA at King Abdulaziz University Hospital (KAUH) in Jeddah, KSA. Methods This retrospective study was carried out from January 2012 till June end 2019. It was conducted among pediatric patients with SCA. Patients were screened for eligibility, and we excluded those with thalassemia and those who had a medical history of chronic diseases. Data were collected from patients' electronic medical records. Results The study included 102 pediatric patients with SCA; their mean age was 7.88 ±4.22 years; almost half of them were females (56%) and 44% were males. The dominant body mass index (BMI) classification among them was normal (49%). Urinary tract infection (UTI) was the most common complication with 38 cases followed by VOC with 32 cases. Other complications observed were ACS (25.5%) followed by stroke (15.7%). HbSS was the most prominent genotype among these patients, and it was associated with a higher rate of complications. However, there was no significant relationship between genotype and patients developing complications. Finally, patients with high white blood cell (WBC) counts, elevated systolic blood pressure (SBP), and hypoxia developed more complications, and there was a significant relationship between these conditions and the development of complications (p<0.05). Conclusion Based on our findings, patients with high WBC count, elevated SBP, and hypoxia are at greater risk of developing complications. Accordingly, healthcare providers should consider putting in place all measures required to provide a good quality of life for these patients, including raising awareness about the risk factors that lead to these complications, appropriate immunizations, and precautionary measures to promote these patients' welfare.

Knowledge and awareness of brain death among Saudi population.

OBJECTIVE: To examine the knowledge and awareness of brain death among the Saudi population and to identify what is needed to improve awareness in this community. METHODS: We conducted a cross-sectional study across various regions of the Kingdom of Saudi Arabia from July-December 2018. Data was collected from a sample of the general population via a questionnaire, which obtained sociodemographic data and included questions about assessments and guidelines for brain death. We conducted descriptive statistics, as well chi-square tests to compare between groups, with statistical significance considered at p less than or equal 0.05. RESULTS: We recruited 1244 participants with a mean age of 27.17+/-9.84 (female: n=992; 79.7%, male: n=252; 20.3%). Of these, 1208 (97.1%) were Saudi, 444 (35.7%) were married and 800 (64.3%) were single. The majority had a university degree (n=837; 67.3%), 676 (54.3%) were currently students, approximately a third of whom were from health specialties (n=393; 31.6%), and 192 (15.4%) were unemployed. A mean score of knowledge of 5.53+/-2.61 was observed, equivalent to 42%. There was a significant difference in total knowledge score depending on marital status, region, and educational level and specialization. In contrast, there was no significant difference in knowledge depending on gender, age, nationality, or place of work. CONCLUSION: Our results suggest that Saudi Arabians have little to moderate knowledge about brain death. Education and work-based awareness programs about brain death are needed, particularly regarding prevention and causes.