Showing papers in "The Egyptian Journal of Neurology, Psychiatry and Neurosurgery in 2016"

Attitude of medical students toward mentally ill patients: impact of a clinical psychiatric round

Abstract: Background Stereotyped cognitive schemes are the main cause of casting out patients with mental illness. Educational psychiatry programs have to be re-evaluated as medical students often have misconceptions about psychiatry. Objective The aim of the present study was to examine the attitude of fifth-year medical students toward psychiatric patients and disorders, and to reveal the influence of psychiatric study experience on their attitudes. Participants and methods In this interventional study, 300 fifth-year students from Ain Shams University Medical School were enrolled. Sociodemographic data sheet, Fahmy and El Sherbiny's Social Classification Scale, and the Mental Illness Clinician Attitude Scale-2 were used on the first and last day of a 3-week clinical psychiatric round. Results Data before and after the round were compared and showed no significant change in Mental Illness Clinician Attitude Scale-2 scores among the studied sample after the psychiatric round. Only 4% of the students chose psychiatry as a future career with neutral attitude and had worse attitude after rotation. Students who had significant positive attitude at the beginning of the round ended up with a significantly more negative attitude, whereas those with significantly negative attitudes improved at the end of the round. Conclusion Three weeks may not be sufficient time to allow students to follow up the patients to notice their improvement as regards treatment and return to their functional baseline. Thus, students perceived mentally ill patients being untreatable. Greater emphasis on doctor-patient relationship and exposure to patients with psychiatric illness, which responds rapidly to treatment and students taking direct patient responsibility, may lead to the production of more favorable attitudes.

Primary fatigue contributes to cognitive dysfunction in patients with multiple sclerosis

Abstract: Background A rising concern about quality of life of multiple sclerosis (MS) patients has emerged. Cognitive dysfunction and primary fatigue have been largely related to each other. Objective The aim of the present study was to examine the relationship between primary fatigue, cognitive dysfunction, and inflammatory biomarkers for patients with MS. Patients and methods A total of 40 Egyptian MS patients (Expanded Disability Status Scale 36) and those without fatigue (G2; FSS<36). Patients with depression and sleep problems were excluded from the study. Cognitive functions were assessed for both groups using the computer-based 'RehaCom' software, using which the following tests were carried out: (a) attention/concentration tests and (b) reaction behavior tests. The serum levels of tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) were analyzed for all MS patients. Results A statistically significant decrease in cognitive functions was found in G1 compared with G2 ( P < 0.001), as well as a statistically significant higher level of TNF-α and IFN-γ in G1 compared with G2. FSS was positively correlated with the attention/concentration test. Correlative study also indicated a strong relation between the level of cytokines and FSS but not cognitive dysfunction. Conclusion Primary fatigue contributes to cognitive dysfunction in patients with MS and is associated with elevated serum level of TNF-α and IFN-γ

Transcutaneous nerve stimulation versus aerobic exercise in diabetic neuropathy

Abstract: Background Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, which is frequently associated with pain. Studies targeting the painful DPN are necessary to support clinical decision-making. Objective The aim of the present study was to investigate the efficacy of transcutaneous electric nerve stimulation (TENS) versus aerobic exercise, and to compare them with regular pharmacological therapy in patients with DPN, using sensory nerve conduction study and the visual analogue scale (VAS). Patients and methods This study included 60 diabetic patients with a history of DPN for 5 years. Patients were divided into three equal groups, all receiving regular pharmacological therapy. Group A received TENS of both lower limbs, three times per week. Group B received aerobic exercise. Group C received only pharmacological therapy. Patients were assessed before and 8 weeks after treatment. The VAS was used to measure the pain intensity before and after treatment, and the medial plantar nerve conduction velocity (NCV) to assess nerve function. Results Group A and B only showed a significant statistical difference between pretreatment and post-treatment pain intensity on VAS, with 41.67 and 16.67% improvement on the VAS, respectively. There was no statistically significant difference in pretreatment and post-treatment as regards the medial plantar NCV in any of the groups. Conclusion TENS, of moderate intensity, carried out at 14 Hz, with a pulse width of 250 ms, for 30 min and three times a week is more efficient than aerobic exercise training program in relieving pain in patients with DPN, whereas neither TENS nor exercise showed any significant effect on medial plantar conduction velocity (CV) in patients with DPN.

Knowledge and attitude towards stroke among workers in Cairo University Hospitals

Abstract: Background Stroke is a major cause of mortality and morbidity worldwide. Poor knowledge of stroke risk factors, symptoms and appropriate response to stroke are possible causes of poor outcome. Objective The aim of this study was to evaluate the knowledge and attitude towards different aspects of stroke in a sample of Cairo University Hospitals' workers. Patients and methods A structured self-administered questionnaire was administered by 111 workers who were classified into clinical workers (physicians, house officers, nurses, laboratory technician and pharmacists) and nonclinical workers (administrative, sanitary and security workers). Results Out of 111 participants, 92 completed the questionnaire. Most participants had heard of stroke (91.3%), mostly through encountering a family member with a stroke rather than through mass media (10.9%). Hypertension was the most common identified stroke risk factor (66.3%). Clinical workers were more likely to identify risk factors. The most common identified stroke symptoms were slurring of speech (38.5%) and elevated blood pressure (38.5%). Clinical workers were more likely to identify symptoms such as slurring of speech (P = 0.042) and altered state of consciousness (P Conclusion Knowledge and perception of stroke in Cairo University Hospitals' workers appear to be poor, especially among nonclinical workers. Planning educational programs for raising the level of knowledge and awareness of stroke, both on the level of hospital workers and on the public level, is important to improve stroke management and outcome.

Cortisol level in depressed patients and its relation with suicidal risk and anhedonia

Abstract: Context In recent times, there has been an increased interest in research related to anhedonia. Nevertheless, its linkage to major depressive disorders and underlying neurobiology are still not well understood. High levels of cortisol are associated with an increased risk for suicide as evidenced by several studies; however, others have not found this association between cortisol levels and suicidality. Aim The aim of this work was to examine whether there is an increased activity of the hypothalamic–pituitary–adrenal axis in major depressive disorder patients and to detect the presence of an association between the level of cortisol and thoughts of death and anhedonia in at-risk patients with major depressive disorder. Settings and design This case–control study that was conducted on 20 patients with major depressive disorder, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision, in comparison with 20 controls. Patients and methods All patients were assessed using the Present State Examination 10th revision of the Schedules of Clinical Assessment in Neuropsychiatry, Snaith Hamilton Pleasure Scale, Beck’s Suicidal Ideation Scale, and Beck’s Depressive Inventory. Blood samples were collected to assess plasma cortisol level in the morning and evening. Statistical analysis Statistical calculations were carried out using SPSS, version 15. Results There were increased levels of morning and evening cortisol in major depressive disorder patients. Thoughts of death were positively associated with elevated morning cortisol in depression. Anhedonia was associated with higher evening cortisol level in depressed patients in the studied sample. Conclusion There are relatively increased levels of morning and evening cortisol in major depressive disorder patients in comparison with controls; thoughts of death are positively associated with elevated morning and evening cortisol level.

Self-reported quality of life of patients with multiple sclerosis with mild disability

Abstract: Background The quality of life (QoL) of the patient is a reflection of the severity of multiple sclerosis (MS) and predicts its prognosis; it is related to various factors that vary across cultures. Objective The aim of the current study was to evaluate the QoL of ambulatory and mildly disabled patients with relapsing remitting multiple sclerosis (RRMS), and explore the related factors and cultural characteristics. Patients and methods Sixty Egyptian patients with a definitive diagnosis of RRMS were recruited and assessed for disability using Expanded Disability Status Scale, their QoL using Multiple Sclerosis Quality of Life Inventory (MSQLI), and depression using the Beck Depression Inventory scale. Patients’ QoL was compared with that of 30 matched controls. Results The QoL of MS patients was significantly impaired in all domains compared with that of controls (P Conclusion Mildly disabled Egyptian patients with RRMS have a high prevalence of depression and considerable impairment of mental and physical components of the QoL, such as disease disability, depression, fatigue, and perceived cognitive impairment.

Correlation between clinical neuropathy scores and nerve conduction studies in patients with diabetic peripheral neuropathy

Abstract: Background Diabetic peripheral neuropathy (DPN) represents one of the most common complications of diabetes mellitus. Objective The aim of this study was to assess the correlation between clinical neuropathy scores and nerve conduction studies (NCS). Patients and methods This study included 30 (12 men and 18 women) Egyptian patients with type 2 diabetes mellitus complaining of symptoms suggestive of DPN. All patients underwent a clinical evaluation using three clinical scores: the Neuropathy Disability Score (NDS), the Neuropathy Impairment Score in the Lower Limbs (NIS-LLs), and the Diabetic Neuropathy Examination (DNE) score. Neurophysiological studies using NCS as well as measurement of glycated hemoglobin (HbA1C) were carried out. Results HbA1C was significantly correlated with NDS, NIS-LL, and DNE. The NDS was statistically correlated to median nerve sensory amplitude, sensory conduction velocity; ulnar nerve sensory amplitude, sensory conduction, motor amplitude, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. NIS-LL was significantly correlated with median nerve sensory amplitude, sensory conduction velocity; motor amplitude, motor conduction velocity; ulnar nerve sensory amplitude, sensory conduction velocity, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. DNE was significantly correlated with median nerve sensory amplitude, sensory conduction velocity, motor amplitude, motor conduction velocity; ulnar nerve sensory amplitude, sensory conduction velocity, motor amplitude, motor conduction velocity; and peroneal nerve sensory amplitude, sensory conduction velocity, motor amplitude, and motor conduction velocity. Conclusion Clinical neuropathy scores represent a simple tool for evaluation and follow-up of patients with DPN in comparison with NCS, and we recommend the use of these scores in clinical practice on a routine basis.

Lumbar puncture as a single modality for treatment of idiopathic intracranial hypertension during pregnancy

Abstract: Background Idiopathic intracranial hypertension (IIH) is seen typically in obese women in their child-bearing age, management of patients with IIH during pregnancy can be problematic. Objective The purpose of this study is to assess spinal tapping as a single modality for treatment of IIH during pregnancy. Patients and methods This was a prospective case series of seven pregnant women with IIH who underwent full neurological and ophthalmological evaluation including perimetry and neuroimaging studies. They were followed up and treated using only spinal tapping. Results Spinal tapping either single or multiple sessions can control IIH safely during pregnancy with a success rate of 86%. Conclusion Spinal tapping is recommended as a single treatment modality in pregnant women with IIH.

Vitamin D levels in a sample of Egyptian patients with multiple sclerosis

Abstract: Background Environmental factors such as vitamin D deficiency have been linked to the etiology of multiple sclerosis (MS) through interaction with genetic factors. Researches must be carried out to answer the question whether the relationship between vitamin D and MS is consistent and reproducible. Objective The aim of the present study was to assess the level of vitamin D in Egyptian MS patients. Subjects and methods In total, 111 patients with MS and 33 normal subjects were included in this study. Vitamin D level was estimated for each participant using the enzyme linked immunosorbent assay technique. Results Vitamin D levels were significantly lower among MS patients (ranging from 5 to 75 ng/ml with a mean ± SD of 26.4 ± 18.5) when compared with controls [ranging from 25 to 80 ng/ml with a mean of 51.2 ± 19.6 (P < 0.001)]. High expanded disability status scale scores were found to be related to low vitamin D levels. Conclusion Patients with MS tended to have lower vitamin D levels, and those with higher (expanded disability status scale) scores were more likely to have lower levels of vitamin D.

Anatomical resection in glioblastoma: extent of resection and its impact on duration of survival

Abstract: Introduction Glioblastoma is still a disease without a cure despite the use of a multimodal approach. The extent of resection has been the only modifiable factor in the different variables that affect survival. Cellular tumour infiltration beyond the visible enhancing excisable lesion remains the cornerstone for inevitable disease recurrence and progression. Patients and methods We prospectively evaluated the impact of the extent of resection beyond the visible enhancing tumour on the survival. We evaluated 59 patients with glioblastoma who were operated upon by maximum possible safe excision of the tumour and the surrounding involved gyri or lobe as long it was not considered eloquent. We followed the patients until recurrence and death. Results Fifty-nine patients, 43 men, mean age 48 years, were studied. Overall, 28.8% of the tumours were frontal, 20% were parietal, 37.2% were temporal and 14% were occipital. The median preoperative contrast-enhancing tumour volume was 42.36 ml. Twenty patients (34%) underwent anatomical excision, 21 patients (36%) underwent gross total excision, 14 patients (24%) underwent subtotal and four patients (7%) underwent surgical debulking. In all, 79.66% of the patients died. There was a statistically significant reduction in the mean survival with less aggressive resection, for which the average survival was 16.5 months for the anatomical resection group, 12.09 months for the gross total excision group, 7.34 months for the subtotal excision group and 4.67 months for the debulking group ( P = 0.002). Conclusion Total tumour resection with extra margin of tumour-infiltrated gliotic tissue, followed by adjuvant radiochemotherapy leads to longer survival than less radical excision.

Frequency and determinants of subclinical neuropathy in type 1 diabetes mellitus

Abstract: Background Diabetic neuropathy is the most common complication of diabetes. We hypothesized that uncontrolled diabetes is associated with subclinical diabetic neuropathy that is influenced by duration of disease. Assessment of the prevalence and associated determining factors will be important for the prevention and treatment of neuropathy. Objective This aim of this study was to assess the frequency and determining factors of subclinical peripheral neuropathy in type 1 diabetic (T1DM) patients. Patients and methods The current hospital-based, case–control study was conducted at Zagazig University Hospitals. It included three age-matched and sex-matched groups. Each group comprised 30 participants: group A included diabetic patients with a duration of T1DM of 5 years or less; group B included patients with a duration of T1DM of more than 5 years; and the control group included normal healthy individuals. Clinical assessment was carried out to exclude symptoms and signs of neuropathy. Laboratory investigations including fasting and 2-h postprandial blood glucose level, glycosylated hemoglobin (HbA1c), lipid profile, liver function, kidney function, and nerve conduction studies were carried out for every participant. Results The frequency of subclinical neuropathy in group A and group B was 46.6 and 76.6%, respectively, and this difference was statistically significant (P=0.03). Univariate analysis revealed significantly higher levels of HbA1c, dyslipidemia, and nerve conduction parameters in group B compared with group A and the control group. Multivariate logistic regression analysis showed that duration of diabetes (P=0.02) and HbA1c (P=0.02) were the only independent factors associated with subclinical neuropathy. Conclusion The high frequency of subclinical neuropathy in diabetic patients highlights the importance of nerve conduction studies for the early detection of neuropathy in T1DM.

Prognostic value of D-dimer measurement in patients with acute ischemic stroke

Abstract: Background D-dimer, a marker of plasmin-mediated fibrin degradation, is cross-linked to fibrin degradation products and indicates vessel occlusion. Objectives The purpose of this study was to evaluate the role of D-dimer serum level as a serological marker in the diagnosis and prognosis of acute ischemic stroke in Egyptian population. Patients and methods This prospective observational case–control study was conducted on 50 patients with acute ischemic stroke. Ten healthy age-matched and sex-matched individuals were taken as controls. The patient and control groups were subjected to detailed history taking, examination, and D-dimer level assessment. Neurologic examination using the National Institutes of Health Stroke Scale was carried out at admission and on discharge after treatment. Serum D-dimer level was evaluated within the first 24 h of admission. The outcome of the patients was graded using the modified Rankin scale on admission and 1 month of treatment. Results The mean D-dimer level was significantly higher in the patient group than in the control group ( P P = 0.002) and the initial infarct volume in MRI of the brain ( P = 0.000). The mean D-dimer level was significantly higher in patients with unfavorable outcome than in patients with favorable outcome, measured using the modified Rankin scale ( P = 0.029). Conclusion Plasma D-dimer levels were significantly higher in patients with acute ischemic stroke than in controls. D-dimer levels increased with increasing severity of stroke and with increasing infarction volume. Moreover, D-dimer level could predict stroke outcome.

A study on serum levels of testosterone and prolactin hormones in male epileptic adolescents

Abstract: Background Testosterone and prolactin hormone abnormalities have been noticed in some epileptic patients and were attributed to either the direct effect of the disease or the effect of antiepileptic drug therapy. Objective The aim of this study was to evaluate the potential endocrinal dysfunction in nonmedicated male adolescents with idiopathic generalized epilepsy as well as those on valproate treatment. Patients and methods This study was performed on 40 epileptic patients, 20 newly diagnosed nonmedicated and 20 treated with valproate, who attended the epilepsy clinic in the Department of Neuropsychiatry, Tanta University Hospital. Twenty age-matched male healthy controls were also included. Patients were subjected to full history taking, neurological examination, evaluation of testosterone and prolactin blood levels, and electroencephalography. Results The serum levels of both free and total testosterone were higher in valproate-treated patients compared with nonmedicated patients and healthy controls. The levels were significantly lower in the nonmedicated group compared with the control group. The serum level of prolactin in both patient groups was significantly higher when compared with the healthy control group, with no statistically significant difference between the two patient groups. Conclusion The exact etiology of hormonal abnormalities in men with epilepsy appears to be multifactorial, including the disease and antiepileptic drug effects. Neuroendocrine regulation in men with epilepsy may be important not only for reproductive function but also for optimal management of seizure disorders.

Effects of vitamin D deficiency on the relapse, severity, and disability of multiple sclerosis

Abstract: Background Multiple sclerosis (MS) is a long-standing inflammatory disease of the white matter and affects more than two million people worldwide. Upcoming evidence proposed that 25-hydroxy-vitamin D 3 (25HVD 3 ) deficiency could be one of the most crucial environmental elements for the pathogenesis of MS. Objective The aim of this study was to compare 25HVD 3 levels in MS patients and controls and to detect the association with relapse, severity, and disability in MS patients. Patients and methods Mansoura Neurology Department data sheet was collected and all patients were assessed using the Expanded Disability Status Scale (EDSS) at the onset. 25HVD 3 levels in the blood were evaluated for all patients and controls using the chemiluminescent immunoassay test. Results A total of 50 MS patients were included in this work and matched with 25 controls. There was a statistically significantly lower mean serum 25HVD 3 level in MS patients in comparison with the controls (20.5 ± 16.8 and 42.9 ± 17.9 ng/ml, respectively; P = 0.002). In addition, there was a statistically significantly lower level of 25HVD 3 (18.4 ± 17.7) in severe cases of MS (EDSS ≥ 6; P P P 3 deficiency ( Conclusion Our results showed that there is an inverse correlation between 25HVD 3 level and EDSS score. In addition, lower 25HVD 3 levels are associated with increased relapse risk in MS.

Incidence and clinical predictors of outcome of Bell's palsy, Al-Quseir City, Red Sea Governorate, Egypt

Abstract: Background Bell's palsy (BP) is one of the most common causes of acute-onset unilateral facial weakness Through this study we aimed to estimate the incidence of BP in Al-Quseir City, Red Sea Governorate, Egypt Patients and methods A project was undertaken to assess the epidemiology of major neurological disorders A total of 33 285 eligible patients were screened through a door-to-door survey (every door) by three specialists in neurology and 15 social workers All patients were subjected to detailed history taking and a meticulous neurological examination by means of a specific questionnaire designed for this study Results Within 1 year, 27 patients were diagnosed with BP This yielded an incidence rate of 989/100 000 population (aged 9 years and older) The incidence was higher in the male population than in the female population (1164 and 812/100 000, respectively) Age-specific incidence of BP showed that its peak was between the ages of 18 and 60 years About 78% of patients with BP recovered completely within 6 months after onset There was no significant difference between male and female patients Conclusion The incidence rate for BP was 989/100 000 among those aged 9 years and older Most affected cases were older than 18 and less than 60 years

Is peripheral arterial disease associated with carotid artery disease in Egyptians? A pilot study

Abstract: Background Atherosclerosis involves various vascular segments. The association of carotid artery disease (CAD) to peripheral arterial disease (PAD) is not well investigated in Egyptian patients. Objective In this pilot study, our aim was to examine the relationship between PAD and CAD in an Egyptian population. Patients and methods We examined 37 consecutive patients with PAD for the presence of CAD. Vascular and neurologic examination and duplex assessment of extracranial and intracranial carotid system and ankle-brachial index measurement were carried out to determine whether CAD is symptomatic or not. Results CAD was found in 20 (54.1%) patients. Eight (21.6%) patients had significant extracranial internal carotid stenosis and 13(37%) had intracranial stenosis and were more significantly above the age of 60 years. All patients with intracranial stenosis were men. PAD with RC6 was significantly associated with cerebrovascular events ( P = 0.001) and significant extracranial stenosis ( P = 0.013) and intracranial internal carotid stenosis ( P = 0.001). Conclusion Intracranial and extracranial carotid stenoses are commonly present in patients with critical PAD. Duplex ultrasound screening for CAD presence and severity may be of great benefit, especially in the elderly and patients with critical limb ischemia. These findings need to be further confirmed in a study on larger population of Egyptians.

Helicobacter pylori infection in Egyptians with Parkinson's disease: incidence and the effect on motor fluctuation and response to levodopa

Abstract: Background Gastrointestinal tract infection with Helicobacter pylori (HP) can inhibit levodopa (LD) in Parkinson's disease (PD) patients, leading to motor fluctuation. Objectives The aim of this study was to identify the incidence of HP in PD patients compared with healthy controls and its effect on motor fluctuation, response to treatment, and quality of life. Patients and methods Serum IgG Abs against HP urease were detected using enzyme-linked immunosorbent assay. We compared the incidence of HP infection in PD patients and controls. We compared PD patients with positive HP (PD positive) and PD patients with negative HP infection (PD negative) with regard to clinical features, the Unified PD Rating Scale (UPDRS) scores, Hoehn and Yahr (H and Y) stages, PD Questionnaire for the quality of life (PD-Q39), and PD Nonmotor Symptoms Questionnaire (PD NMSQ). Results Fifty Egyptians with PD were included. Forty-six percent of patients were HP positive compared with 20% in the control group; the difference was statistically significant ( P = 0.043). In PD-positive patients, the total UPDRS and PD-Q39 scores were significantly higher in comparison with PD-negative patients ( P P < 0.001, respectively). The differences were not significant with regard to the total PD NMSQ score and H and Y stages between the two groups of patients. The LD onset period was significantly greater in PD-positive patients by nearly 14 min in comparison with PD-negative patients. There was a significantly prolonged on-duration time in PD-positive patients in comparison with PD-negative patients. Conclusion There is a high incidence of HP infection in PD. HP affects the response to LD and can deteriorate motor manifestations and the quality of life.

Monitoring occlusion therapy in amblyopic children using pattern visual evoked potential

Abstract: Background Amblyopia is a unilateral or bilateral reduction of best-corrected vision that cannot be attributed only to a structural abnormality of the eye. It is a common childhood problem, and can be reversed if treated while the visual system is still maturing. Objective The aim of the present study was to investigate the role of pattern visual evoked potential (PVEP) in the assessment of visual function after occlusion therapy for children with unilateral strabismic amblyopia. Patients and methods Visual function was assessed clinically and using monocular PVEP, elicited by high-contrast checkerboard-patterned stimuli, before and after occlusion of the healthy eye for 1 week for every year of life in 20 children presenting with unilateral strabismic amblyopia. Results PVEP responses were significantly prolonged in latency in amblyopic eyes after the first assessment compared with nonamblyopic eyes. There was no significant difference in the interside amplitude. Assessment after occlusion showed a statistically significant reduction in the latency of the amblyopic eye and statistically significant improvement in the visual acuity. Conclusion PVEP can be used as a method of assessment of visual function after the occlusion therapy for children with unilateral strabismic amblyopia.

Visual dysfunction and neurological disability in multiple sclerosis patients in correlation with the retinal nerve fiber layer and the ganglion cell layer using optical coherence tomography

Abstract: Aim The aim of this study was to measure retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) complex thickness with Cirrus optical coherence tomography (OCT) in Egyptian multiple sclerosis (MS) patients, and to correlate the OCT findings with the visual functions and neurological conditions. Patients and methods This study design was a cross-sectional one. A total of 40 eyes of 22 MS patients diagnosed according to the McDonald criteria were included in this study. Exclusion criteria were as follows: optic neuritis less than 6 months ago; best-corrected visual acuity (BCVA) less than 0.5; intraocular pressure more than 21 mmHg; cup-to-disc ratio more than 0.5; myopia more than 5 D; and eyes with other ocular or central nervous system diseases. All patients were subjected to the following: full history taking; complete ophthalmic examination, including visual functions (BCVA, color vision, and contrast sensitivity), intraocular pressure, and anterior and posterior segment examination; ophthalmic investigations using the Cirrus OCT (peripapillary RNFL thickness and macular GCL complex thickness); and complete neurological examination containing Expanded Disability Status Scale (EDSS). Results There were statistically significant negative correlations (which is mostly still thickened or biased with BCVA selection) between BCVA and the GCL complex of the superior areas among the studied patients. There were statistically significant negative correlations between color total errors and the GCL complex of the inferior temporal areas among the studied patients. No statistically significant correlations between contrast or EDSS and the GCL complex of any area were found among the studied patients. Conclusion GCL complex thickness is correlated better compared with RNFL thickness in MS patients with their visual functions (mainly color vision with the inferior temporal area of the GCL complex), and visual function is better correlated with them than with neurological disability measured using EDSS.

Barriers for acute ischemic stroke treatment using recombinant tissue plasminogen activator in Mansoura Emergency Hospital: prehospital and inhospital delay factors

Abstract: Introduction Effective treatment must start as early as possible as brain cells die rapidly after stroke. To increase the number of patients who are eligible to receive tissue plasminogen activator, measures are needed to reduce the prehospital and inhospital delay time. The study aimed to evaluate the possibility of thrombolytic therapy in acute ischemic stroke patients in Mansoura Emergency Hospital (MEH) by studying the effect of prehospital and inhospital delay factors. Patients and methods A standardized, structured questionnaire was completed for every stroke suspect; in it we documented the exact time of stroke onset, the way of referral and transport to hospital, and their demographic data. The exact time of patient arrival, time to neurology consultation, and detailed time delay inside MEH was marked on the forms of the hospital as well. Results In total, 435 patients had arrived MEH in less than 24 h, their mean age being 61.7 years. The median prehospital time was 2.7 h. Patients with younger age, locals, those who reached by private vehicle, or reached directly without any medical reference were significantly associated with early hospital admission. Sex, time of arrival, or severity of stroke had no influence on reaching hospital early. The median times to computed tomography request and acquisition were 20 and 35 min versus 25 and 45 min, respectively, National Institute of Neurological Disorders and Stroke recommendations. Conclusion Hyperacute treatment of ischemic stroke is possible in MEH. Methods to improve the emergency medical services and reduction of the patient circulation system in MEH will give more chance for these therapies by reducing prehospital and inhospital delay times.

Evaluation of neurotrauma in motorcycle-related accidents at a tertiary hospital in Egypt

Abstract: Background Although traffic laws in Egypt obligate drivers to wear helmets, they are not strictly followed, resulting in an increased incidence of neurotrauma during accidents. Objective The aim of the present study was to evaluate head and spine injuries as a result of motorcycle accidents in 1 year. Patients and methods This study was conducted in the Neurosurgical Emergency Department of Cairo University Hospitals. Only motorcycle-related neurotrauma patients were included. Demographic data, types of lesions inflicted, operations and procedures carried out, hospital stay, and outcome were investigated by analyzing admission files and operation records. The results were then compared with the published literature. Results Out of 117 patients, there were 93% males and 7% females. The age group 20–40 years represented 61.5% of the cases. Extradural hematoma was present in 42 (36%) cases, fissure fracture and base of skull fracture in 64%, brain contusion in 29%, and spine fracture in four (0.034%). Helmeted drivers represented only 9.5% of the patients. Thirty-nine percent of patients had other associated injuries than of head and spine. Operations were performed on 45 (38.5%). Nearly half of the operation procedures comprised evacuation of extradural hematoma. Others included elevation of depressed fracture, frontal sinus repair, decompressive craniotomy, and spinal fixation surgeries. Hospital stay ranged from 2 to 28 days with an average of about 4.5 days; furthermore, 22.2% of the victims became handicapped and dependent. Conclusion Following safety measures during motorcycling significantly reduces morbidity and mortality at time of accidents. Although these patients have a short median hospital stay but surgery rates are obviously high. Follow-up for victims may reveal other potential burdens and help in the reintegration of society.

Continuous performance task in attention deficit hyperactivity disorder children

Abstract: Background Poor behavioural inhibition is the central impairment in attention deficit hyperactivity disorder (ADHD). At present, there is no reliable objective measure to detect ADHD. A proper pinpointing evaluation for ADHD depends mainly on the history from parents, family members as well as teachers and schoolmates, by means of questionnaires and conduct rating scales. Objective The aim of this study was to detect continuous performance task (CPT) (test of variants of attention) changes in children suffering from ADHD compared with normal children. Patients and methods CPT, Conners' parent rating scale and Wechsler intelligence scale were done for two groups of children each containing 39 children, a group of ADHD children and the other a normal control group. Results We found a significant difference between the mean total IQ score among the ADHD patients group compared with control group. Comparing both groups revealed statistically significant increase in omission, commission and reaction time among patients. A significant negative correlation was found between age on one side and IQ, hyperactivity and psychosomatic subscales, hyperactivity and total DSM-IV scores on the other hand and between commission and opposition, restlessness subscales and ADHD index and also between reaction time and restlessness and emotional index. There was a significant positive correlation between omission and hyperactivity and anxiety subscales, restlessness and emotional indices and DSM-IV hyperactive and total scores. In addition, there was a significant positive correlation between perfectionism and commission and also between reaction time and inattention and social problems subscales. Conclusion CPT can have a substantial role in objective identification of ADHD.

Correlation between median nerve conduction studies and ultrasonography in cases of carpal tunnel syndrome

Abstract: Background Nerve conduction studies (NCS) have long been the only objective measure used to confirm the diagnosis of carpal tunnel syndrome (CTS), localize median nerve abnormalities, and exclude alternative diagnosis. Ultrasonography (US) can give information about the contents of carpal tunnel (CT) as well as aid in assessing the size of the median nerve (MN). Aim The aim of this study was to detect the relation between median NCS and cross-sectional area (CSA) of the MN measured using US in different grades of CTS. Patients and methods This study was a case–control, age-group matched, cross-sectional one. It included 60 wrists of 30 patients diagnosed with CTS and 60 wrists from 30 controls. Candidates were subjected to clinical assessment, median NCS, and measurement of CSA using US. Results There was a significant positive correlation between CSA of the MN at CT inlet and both motor and sensory responses latencies (r=0.638, P Conclusion US is highly correlated to NCS results in CTS. CSA of the MN at CT inlet measured using ultrasonography can be used as a screening tool for detection as well as discrimination of severe cases of CTS.

Rate of shunting and outcome after 2 years following excision of ventricular central neurocytoma

Abstract: Background Central neurocytoma (CN) is an intraventricular tumor that affects young adults. It has a favorable prognosis after adequate surgical intervention; however, an aggressive course may take place in some cases. Objective The aim of this study was to evaluate the rate of shunt insertion and outcome of control in CN excision. Patients and methods Ten patients were included in this study and followed up for 24 months. Data collected included age, sex, clinical presentation, early morbidity and mortality, and radiological findings (tumor location, features, residual, recurrence, and hydrocephalus). All patients underwent surgery for total or subtotal excision through a transcortical or transcallosal approach. An external ventricular drain was inserted and then removed and replaced by a shunt, if indicated. Histopathology and the MIB index were used to confirm diagnosis and guide the follow-up. Adjuvant radiotherapy or gamma knife radiosurgery was used for residual or recurrence. Results Patient ages ranged from 14 to 48 years and the mean age was 31 years. Two patients died early after total and subtotal excision from sepsis and thalamic infarction, respectively, and were excluded from the results. Six patients (60%) underwent total removal. Of them, two patients had a high MIB index and showed small recurrence at 12 and 18 months and received gamma knife. One case needed a shunt, and the other four cases were free. Subtotal excision was performed for the other four patients (40%). Early shunt was inserted for two cases. Radiosurgery was used to control the residual in one patient, whereas radiotherapy was used for three patients but failed in one patient who underwent surgery at 18-month follow-up. Conclusion CN may have favorable prognosis with a lower incidence of shunt insertion throughout its course compared with other intraventricular tumors if total removal is achieved.

The subclinical epileptiform discharges among nonepileptic cerebral palsy patients

Abstract: Background Subclinical epileptiform discharges (SEDs) are assumed to play a role in the development of cognitive dysfunction in cerebral palsy (CP) patients. Purpose The aim of this study was to estimate the prevalence of SEDs among nonepileptic CP patients and their cognitive correlates. Patients and methods Fifty-one nonepileptic CP patients were recruited. All patients were subjected to history taking, neurological examination, assessment using Gross Motor Function Classification System for CP, the Stanford–Binet scale (5th edition), encephalography, and MRI of the brain. They were divided into two groups: group 1, which included 19 CP patients without SEDs, and group 2, which included 32 CP patients with SEDs. A comparison between patients’ features studied in groups 1 and 2 was made using independent-samples t-test and the χ2-test. A correlation between SEDs and the studied features was made using Spearman’s rank correlation coefficient (ρ). Results The prevalence of SEDs among nonepileptic CP patients was 62.7%. The presence of MRI abnormality and moderate mental retardation showed a highly significant positive correlation with SEDs. Meanwhile, central nervous system malformation and severe mental retardation showed a significant positive correlation with SEDs. However, normal intelligence showed a highly significant negative correlation with SEDs. Kernicterus and dyskinetic CP showed a significant negative correlation with SEDs. Conclusion SEDs are a common finding among nonepileptic CP children. They are positively correlated to cognitive dysfunction. This finding supports the assumption that SEDs are therapeutic target in mentally subnormal children. Larger studies are needed to confirm our results and to evaluate the clinical benefit of treating SEDs.

Influence of cognitive dysfunction on spatiotemporal gait parameters in patients with diabetic polyneuropathy

Abstract: Background An accurate rehabilitation program of diabetic polyneuropathy (DPN) depends on a precise assessment of cognition and determination of its relation to gait using different objective and valid methods. Objective Our aim was to assess cognitive function and analyze the influence of cognitive dysfunction on the spatiotemporal gait parameters under three different gait conditions (walking without a cognitive task, walking with verbal fluency, and walking with an arithmetic task) in DPN patients. Patients and methods Twenty patients with type II diabetes mellitus with moderate polyneuropathy (PN) (group 1) and 20 matched patients with type II diabetes mellitus without PN (group 2) represented the sample of this study. Different cognitive domains of cognition were assessed using a computer-based RehaCom procedure. Spatiotemporal gait parameters were assessed using a 2D video-based motion analysis under the three different gait conditions. Results The results showed a significant decrease in all cognitive domains in the DPN patients (group 1) (P Conclusion There is an association between cognitive dysfunction and PN complications in diabetic patients. Spatiotemporal gait parameters are affected more in DPN patients, especially under dual-task conditions, than in diabetic patients without PN.

Phrenic neuropathy in comparison with peripheral neuropathy in patients with chronic renal failure on hemodialysis

Abstract: Background Uremia-induced phrenic neuropathy may account for diaphragmatic involvement in patients with end-stage renal disease who are on dialysis. Objective The aim of this study was to assess the occurrence of phrenic neuropathy and its relationship with hyperkalemia and frequency of dialysis in patients with chronic renal failure on dialysis. Patients and methods The study included 27 patients with chronic renal failure on dialysis and 27 controls. All patients and controls were subjected to history taking, neurological examination, laboratory tests, neurophysiological study of phrenic and peripheral nerves, and scales to assess the severity of symptoms and disability caused by peripheral neuropathy. Results Of the 27 patients, 70.4% had phrenic motor neuropathy, 33.4% had median motor neuropathy, 48.2% had median sensory neuropathy, 40.8% had peroneal motor neuropathy, and 66.7% had peroneal sensory neuropathy with highly statistically significant difference in neuropathy between patients and controls. Infrequent dialysis was the cause of bilateral mixed (44.4%) and axonal (33.3%) phrenic motor neuropathy. Bilateral mixed phrenic motor neuropathy was more frequent in the hyperkalemia group (31.2%). Conclusion Phrenic neuropathy is a frequent complication in chronic renal failure patients on dialysis, especially in those with hyperkalemia and undergoing infrequent dialysis.

Sleep disorders in chronic kidney disease patients

Abstract: Background Sleep complaints are frequent among chronic kidney disease (CKD) patients. Objective We aimed to subjectively and objectively assess sleep disturbances in CKD patients and compare them between those who undergo hemodialysis (HD) and those who do not. Patients and methods The study was conducted on 40 CKD patients who were subdivided into two groups; group I included patients not undergoing HD ( n = 20), and group II included patients on regular HD ( n = 20). A total of 20 matched healthy volunteers participated as controls. Patients completed Epworth Sleepiness Scale, a sleep questionnaire, and underwent an attended polysomnography. Results All patients had sleep complaints in the form of excessive daytime sleepiness, difficulty falling asleep, early morning awakening, jerking leg movements, and fragmented sleep. CKD patients had lower total sleep time, sleep efficiency, slow wave sleep (SWS) percentage, oxygen desaturation, and higher respiratory distress and periodic limb movement (PLM) indices compared with controls. Group II patients showed a higher Epworth Sleepiness Scale and more frequent complaints of leg jerks. Furthermore, group II patients showed higher sleep efficiency and PLM compared with group I. Patients' age positively correlated with respiratory distress index and negatively correlated with total sleep time and oxygen saturation. The duration of illness and duration of dialysis positively correlated with the number of awakenings. Conclusion There is a high prevalence of sleep disorders in CKD patients whether they were on regular PLMs. Achieving a more complete understanding of sleep problems experienced by these patients can improve quality of life and patient survival.

Social skills among epileptic adolescents

Abstract: Background Epilepsy has been increasingly suspected as a risk factor for psychological, academic, and poor social skills in epileptic adolescents. Objective The aim of the study was to assess the social skills of epileptic adolescents and compare them with those in nonepileptic healthy adolescents. Participants and methods The social skills of 86 epileptic adolescents (12–18 years) were compared with those of 86 age-matched and sex-matched healthy adolescents. Social skills were assessed using the Arabic-translated form of the Social Skills Rating System questionnaire – both student form (39 questions) and parent form (52 questions). Results The mean scores of the ‘student form’ subscales (cooperation, assertion, empathy, and self-control) and the mean scores of the ‘parent form’ subscales (cooperation, assertion, responsibility, self-control, externalizing behavior, and internalizing behavior) were highly significantly lower in epileptic compared with nonepileptic adolescents (P Conclusion Epileptic adolescents have poor social skills that require early assessment and intervention.