Spontaneous recanalization of the occluded internal carotid artery. A report of two cases.

Spontaneous recanalization of the occluded internal carotid artery (ICA) is more frequent than is generally believed. The timing of spontaneous recanalization remains unclear but it may occur as either an early or a late event. The aim of this case report is to emphasize the importance of spontaneous recanalization and its consequences. From September 2008 to November 2010 we prospectively followed patients with old ICA occlusion. The diagnoses of an occlusion were based on duplex scan findings and were confirmed by CT angiography and digital subtraction angiography (DSA). ICA occlusions secondary to dissection, inflammatory process, like fibromuscular dysplasia, previous stenting or endarterectomy and trauma, were excluded from the study. All patients had a scheduled carotid duplex scan every six months. Overall 65 patients were enrolled. Two patients showed evidence of spontaneous recanalization. A 55-year-old man with a known history of transient ischemic attack had occlusion in the left side ICA. He presented with another TIA eight months later. Investigations showed evidence of rcanalization of occluded ICA. This artery underwent uneventful stenting. In another patient recanalization was heralded by global aphasia and right side hemiplegia. He was a 70-year-old man with a history of recurrent TIA. Carotid duplex scan and DSA showed recanalization of the occluded left ICA accompanied by occlusion of the ipsilateral middle cerebral artery. He remained profoundly disabled with severe neurological deficits. In conclusion, spontaneous recanalization of the occluded internal carotid artery is a potentially complicated event that may lead to severe neurological disability.

Polycystic ovary syndrome and migraine headache, is there any correlation?

BACKGROUND: To evaluate the role of some sex hormones in migraine headaches, the aim of this study was to assess the prevalence and characteristics of headache, especially migraine, in patients with polycystic ovary syndrome (PCO) compared with women without this disease. METHODS: One hundred and thirty-three women with PCO and 107 controls were interviewed by 2 neurologists experienced in headache diagnosis. The headache disorders were classified according to the International Headache Society criteria. The statistical significance was determined using the chi(2) test, and a p value of <0.05 was considered significant. RESULTS: Forty-five women (33.8%) of the 133 cases without PCO complained of headache. Of the PCO patients, 48 women (44.9%) suffered from headache. The prevalence of headache was not significantly higher among women with PCO (p = 0.85). The same results were found for migraine headache (p = 0.13). CONCLUSION: Migraine is not more frequent in women with PCO. It was concluded that male sex hormones and especially testosterone do not play an important role in the exacerbation of migraine headache.

Investigation on the relationship between diabetes mellitus type 2 and cognitive impairment.

OBJECTIVE: The incidence of cognitive impairment is increasing with age; however, little is known about the role of hyperglycemia in cognitive impairment. This study focuses on investigating the relationship between diabetes mellitus type 2 and cognitive impairment. METHODS: 60 diabetic patients, amongst whom, 30 had a well-controlled diabetes status and the other 30 had not. These patients were compared to 60 non-diabetic controls whose age, sex and educational class matched with the individuals of the first group. Patients with important risk factors for cognitive disorders (renal failure, major depressive disorders and psychoactive drug users, cerebrovascular accident history, etc.) were not included in the study. Modified Mini Mental Status examination (mMMSE) was done for all patients by a blinded expert examiner. RESULTS: Subjects with diabetes (n=60) had lower MMSE score than those without diabetes (P<.01). Diabetes was also associated with increased odds of cognitive decline as determined by MMSE scores (odds ratio=1.9; CI=95%, 1.01-3.6). A significant correlation between duration of disease and cognitive dysfunction was observed, P=0.001. Also, the same correlation was found for quality of diabetes control, P=0.002. CONCLUSION: Diabetes mellitus is associated with lower levels of cognitive function.

Association between infection with Helicobacter pylori and cerebral noncardioembolic ischemic stroke.

BACKGROUND: Helicobacter pylori infection has been associated epidemiologically and pathogenetically with atherosclerosis of coronary arteries but data regarding chronic infection with this organism and cerebral noncardioembolic ischemia are not clear. AIMS AND DESIGN: In this study we have investigated the association of this pathogen and noncardioembolic ischemic stroke under a case-control study. METHODS AND MATERIAL: Samples are taken among patients who were admitted in our hospital due to their first ischemic stroke during 2003-04. Patients with a known cardiac origin for cerebral emboli and those with major risk factors of ischemic strokes were excluded. Controls were selected from the study population and matched for age, sex, and area of residence. IgG and IgA antibodies to H. pylori were measured by enzyme immunoassay. STATISTICAL ANALYSIS: The t and c - tests and Odds ratio were applied to examine variables differences. RESULTS: A total of 91 cases (43 women, 48 men) and 80 controls (40 women, 40 men) were included for analysis (P = 0.8). The mean age of cases was 64.3+/-10 years and of controls was 61.73 +/- 10.3 years (P = 0.1, CI = 95%). There was seropositivity for H. pylori (IgG or IgA) in 66 patients (72.5%) but they were positive only in 45 controls (56.3%) (P =0.04). Mean of serum IgG levels was significantly high in stroke group (P < 0.005) but the IgA antibody elevation against H. pylori did not show any risk. CONCLUSIONS: Our case-control study provides evidence of an association between the immune response to H. pylori , a marker of prior infection with this organism and noncardioembolic ischemic stroke.