Tramadol-associated seizures in Egypt: Epidemiological, clinical, and radiological study.

BACKGROUND: Tramadol intake related seizures have emerged as a common cause of seizures in Egypt affecting mainly young men. OBJECTIVE: This study aimed to determine the percentage of tramadol induced seizures, and to compare the clinical, neurophysiological, and radiological features of tramadol induced seizures group with idiopathic epilepsy group. METHODS: Two phases study; at first phase, data analysis for all Kasr-Alainy epilepsy clinic patients in Cairo during the period from January 2012 through June 2014, then at second phase a group of tramadol induced seizures' patients were compared with a matching group of idiopathic epilepsy patients. Detailed history and examination, laboratory tests, electroencephalogram (EEG), Magnetic Resonance Imaging (MRI) of the brain, and Hamilton depression rating scale (HAM-D) were performed for both groups. RESULTS: Tramadol induced seizures represented 7% of all patients (103 out of 1480) and 12% of male patients. All cases were males. Occupational driving was the most common job. Seizures were generalized tonic clonic (GTCs) in 86%. Seventy-seven percent of tramadol induced seizures developed with toxic tramadol dose (>400 mg/day). Inter-ictal EEG was normal in most patients (87.5%). Depression and EEG abnormalities were significantly less than idiopathic epilepsy patients. MRI brain for both groups was normal. CONCLUSION: Tramadol induced seizures represented 7% of cases. This deviates the attention to the problem of tramadol addiction in Egypt and raises our awareness of tramadol induced seizures.

Multiparametric Approach Enhances Detection of Patients with Cerebral TIAs at Risk of Stroke: A Prospective Pilot Case Series.

BACKGROUND: Patients with transient ischemic attack (TIA) are generally clinically unstable, with fear of developing a handicapping stroke. Identification of those at highest and lowest risk of stroke in the first days and weeks after a TIA would allow appropriate use of worthy secondary prevention strategies. OBJECTIVE: Incorporation of a clinical scoring system, neurovascular imaging, and magnetic resonance-diffusion-weighted imaging (MR-DWI) to help predicting risk of developing an ischemic stroke following a TIA. SUBJECTS AND METHODS: A prospective observational study was conducted on 25 patients with TIAs, 64% were females, and 26% were males, with a mean age of 57±10.36. Patients were assessed clinically and an ABCD(2) score was applied. Patients have undergone diffusion-weighted imaging (DWI), within 24 h from the event, and intra- and extracranial duplex study. Patients were followed up at intervals of one week, three months, six months, and one year. RESULTS: Six patients (24%) developed stroke on their follow-up, most of them (83.3%) had their strokes within the first three months and had an initial ABCD(2) score of ≥4. The development of stroke was associated with the presence of significant extra and/or intracranial vessel disease (P=0.006) and the presence of acute lesions on their DWI (P=0.035). CONCLUSION: Incorporation of brain MR-DWIs and neurovascular imaging together with the ABCD(2) score improves prediction of ischemic stroke following TIA.

Prevalence of intracranial atherosclerosis among patients with coronary artery disease: a 1-year hospital-based study.

BACKGROUND: There are limited data on the prevalence of intracranial atherosclerotic disease (ICAD) in patients with coronary artery disease (CAD) worldwide and especially among Egyptians. The purpose of the present study was to determine the prevalence and correlates of ICAD in patients with CAD. METHODS: From January 1, 2012 to January 1, 2013, we recruited 118 consecutive patients who had ischemic heart disease. All patients were assessed for vascular risk factors and the existence of stroke or transient ischemic attack (TIA) and were evaluated by extracranial and transcranial color-coded sonography. All patients underwent coronary angiography. Clinical, echocardiographic and angiographic variables were tested by univariate and multivariate analysis. RESULTS: Out of 118 consecutive patients with CAD, intracranial disease was detected in 14 patients (11.9%). Eight patients (6.8%) had stenosis >50%, while 6 patients (5.1%) had stenosis <50%. The univariate analysis showed that the strongest variables associated with ICAD were the presence of recent or old stroke or TIA, followed by moderate or severe extracranial stenosis, and multivessel or left main CAD. CONCLUSION: We observed low prevalence (6.8%) of high-grade ICAD among Egyptian patients with CAD. Multivessel or left main CAD and moderate-to-severe extracranial carotid stenosis were the strongest predictors for the existence of ICAD among CAD patients.

Anabolic steroids abuse-induced cardiomyopathy and ischaemic stroke in a young male patient.

We report a case of a 37-year-old man presented with acute stroke and hepatorenal impairment which were associated with anabolic-androgenic steroids (AAS) abuse over 2 years. Despite the absence of apparent symptoms and signs of congestive heart failure at presentation, an AAS-induced dilated cardiomyopathy with multiple thrombi in the left ventricle was attributed to be the underlying cause of his condition. Awareness of the complications of AAS led to the prompt treatment of the initially unrecognised dilated cardiomyopathy, and improved the liver and kidney functions. However, the patient was exposed to a second severe ischaemic event, which led to his death. This unique and complex presentation of AAS complications opens for better recognition and treatment of their potentially fatal effects.