Differentiation of true transient ischemic attack versus transient ischemic attack mimics.

BACKGROUND: Previous literatures have shown a transient ischemic attack (TIA) mimic rate of 9-31%. We aimed to ascertain the proportion of stroke mimics amongst suspected TIA patients. METHODS: A prospective observational study was performed in Ghaem Hospital, Mashhad, Iran during 2012-2013. Consecutive TIA patients were identified in a stroke center. The initial diagnosis of TIA was made by the resident of neurology and final diagnosis of true TIA versus TIA mimics was made after 3 months follow-up by stroke subspecialist. RESULTS: A total of 310 patients were assessed during a 3-month period of which 182 (58.7%) subjects were male and 128 (41.3%) were female. Ten percent of the patients was categorized as a TIA mimic. The presence of hypertension, aphasia, duration of symptoms, and increased age was the strongest predictor of a true TIA. Migraine was the most common etiology of stroke mimic in our study. CONCLUSION: It seems that many signs and symptoms have low diagnostic usefulness for discrimination of true TIA from non-cerebrovascular events and predictive usefulness of any sign or symptom should be interpreted by a stroke neurologist.

Laypersons' esthetic perception of various computer-generated diastemas: a pilot study.

STATEMENT OF PROBLEM: Managing excess anterior spacing is a common problem in dental practice. During orthodontic or restorative treatment planning, clinicians must decide how to distribute this space. However, few reports are available in the dental literature about the attractiveness and esthetic impact of anterior spaces other than midline diastemas. PURPOSE: The purpose of this study was to compare the esthetic perception of 4 different anterior diastemas, including simian diastemas (symmetrical diastemas between lateral incisor and canine), diastemas suggested by Frush and Fisher (asymmetrical diastemas between lateral incisor and canine and between central and lateral incisor), and by Lombardi (slight midline diastema and 2 larger diastemas between central and lateral incisors), and a midline diastema. MATERIAL AND METHODS: A picture of a young woman's smiling face was modified by using photoediting software to create the 4 previously mentioned diastemas. The resulting pictures were presented to laypersons questioned in French public places. The participants were asked to rank the pictures from most to least attractive, then to rate them with a mark from 1 to 10. RESULTS: One hundred and five participants completed the questionnaire. The median ranks and scores attributed to the pictures from most to least attractive were as follows: simian diastemas, 1 and 8; Frush and Fisher diastemas, 2 and 7; Lombardi diastemas, 3 and 5; and midline diastemas, 4 and 4, respectively. The hierarchy (simian diastemas>Frush and Fisher diastemas>Lombardi diastemas>midline diastemas) could be established statistically for the scores (P=.03, P<.001, and P<.001, respectively) but not for the ranks when adjusting on subjects' sex and age (P=.11, P=.03, and P=.06, respectively). CONCLUSIONS: The results showed an esthetic hierarchy of anterior diastemas. The negative perception of anterior diastemas seems to mainly be related to the presence and width of a midline diastema. These results can guide clinical decisions for patients with excess anterior spacing.

Safety assessment of anticoagulation therapy in patients with hemorrhagic cerebral venous thrombosis.

BACKGROUND: Anticoagulation therapy is a routine treatment in patients with hemorrhagic cerebral venous thrombosis (CVT). However, fear of hemorrhagic complications and deterioration course following anticoagulation often disturbs the responsible physician. METHODS: This was a Prospective observational study on consecutive CVT patients with hemorrhagic venous infarction or subarachnoid hemorrhage (SAH) admitted in Ghaem Hospital, Mashhad, Iran, during 2006-2012. The diagnosis of CVT in suspected cases was confirmed by magnetic resonance imaging/magnetic resonance venography (MRI/MRV), and computerized tomography (CT) angiography following established diagnostic criteria. Demographic data, clinical manifestations from onset to end of the observation period, location of thrombus, location and size of infarction and hemorrhage, and clinical course during treatment were recorded. Choice of the treatment was left to the opinion of the treating physician. Clinical course during 1 week of treatment was assessed based on the baseline modified National Institute of Health Stroke Scale (NIHSS) score. Three or more points decrease or increase of modified NIHSS after 1 week of treatment was considered as improvement or deterioration courses, respectively. Other clinical courses were categorized as stabilization course. RESULTS: 102 hemorrhagic CVT patients (80 females, 22 males) with mean age of 38.6 ± 8 years were prospectively investigated. Of the 102 hemorrhagic CVT patients in the acute phase, 52 patients (50.9%) were anticoagulated with adjusted dose intravenous heparin infusion and 50 cases (49.1%) received subcutaneous enoxaparin 1mg/Kg twice daily. Decreased consciousness had a significant effect on the clinical course of the patients (X(2) = 9.493, df = 2, P = 0.009). Presence of SAH had no significant effect on the clinical course of our anticoagulated hemorrhagic CVT cases (X(2) = 0.304, df = 2, P = 0.914). Extension of Infarction in more than two thirds of a hemisphere had a significant influence on the distribution of clinical courses (X(2) = 5.867, df = 2, P = 0.044). Difference in distribution of clinical course among the two groups of our hemorrhagic CVT patients was not significant (X(2) = 8.14, df = 1, P = 0.87). CONCLUSION: Patients with hemorrhagic CVT without other contraindication for anticoagulation should be treated either with dose-adjusted intravenous heparin or body-weight-adjusted subcutaneous low molecular-weight heparin.