Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 81 86 Mahnaz Talebi Associate Professor, Department of Neurology AND Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran. Masoud Nikanfar Associate Professor, Department of Neurology AND Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran Rana Sorkhabi Associate Professor, Department of Ophthalmology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Ehsan Sharifipour Resident, Department of Neurology AND Neurosciences Research Center (NSRC), Student Research Committee, Tabriz University of Medical Sciences, Imam Reza Hospital, Tabriz, Iran Mansour Bahrebar Resident, Department of Neurology AND Neurosciences Research Center (NSRC), Student Research Committee, Tabriz University of Medical Sciences, Imam Reza Hospital, Tabriz, Iran Ali Kiavar Resident, Department of Ophthalmology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Sasan Andalib PhD Student, Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran Hadi Mohammad Khanli Neurologist, Neurosciences Research Center (NSRC), Tabriz, Iran 2015 10 14 Background: Optical coherence tomography (OCT) is a simple, high-resolution technique to quantify the thickness of retinal nerve fiber layer (RNFL) and macula volume, which provide an indirect measurement of axonal damage in multiple sclerosis (MS). This study aimed to evaluate OCT finding in relapsing-remitting MS patients of the northwest of Iran and compare them with a normal control group. Methods:In a cross-sectional, descriptive, analytic study, 60 patients with MS as case group and 60 patients as controls were studied. Total macular volume (TMV) and retinal nerve fiber layer (RNFL) in perioptic disk area (3.4 millimeter around the disk) and macula was measured using Stratus 3000 in circular form. These findings were compared between the two groups and their relationship with the duration and severity of MS [based on Expanded Disability Status Scale (EDSS)] and history of optic neuritis were evaluated. Results:In total, 35 men and 85 women with a mean age of 34.8 years were evaluated.The mean RNFL in MS patients were 231.9 and 233.1 micrometers in right and left eyes; while they were 246.7 and 250.4 micrometers in right and left eyes of healthy subjects, respectively. This difference in thickness of RNFL in total measure and all quadrants around the optic disk and TMV between case and control groups was analytically meaningful (P = 0.001 and P = 0.001 for right and left eyes, respectively). The mean thickness of RNFL in patients with optic neuritis was significantly lower than other patients in right and left eyes (P = 0.042 and P = 0.005). There was a significant correlation between most of OCT findings and the MS disease duration and EDSS. Conclusion:Findings of the present study in the northwest of Iran buttress the idea that RNFL thickness can be greatly affected by MS. Our results also indicate that this effect is associated with ON and MS duration and severity. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/654 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/654/148

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 87 91 Kavian Ghandehari Professor, Department of Cerebrovascular Disease AND Neurocognitive Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Hamid Reza Riasi Assistant Professor, Department of Neurology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran Ali Noureddine Resident, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Shahram Masoudinezhad Resident, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Siamak Yazdani Resident, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Mousavi Mirzae Resident, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Atena Sharifi Razavi Resident, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Kosar Ghandehari Researcher, Neurocognitive Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 2015 10 14 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. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/653 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/653/149

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 92 97 Jaydip Ray Chaudhuri Department of Neurology,Yashoda Hospital, Hyderabad, India. Kandadai Rukmini Mridula Assistant Professor, Department of Neurology, Nizams’s Institute of Medical Sciences, Hyderabad, India Matapathi Umamahesh Department of Radiology, Yashoda Hospital, Hyderabad, India Alluri Swathi Clinical Register, Department of Neurology, Yashoda Hospital, Hyderabad, India Banda Balaraju Department of Medicine, Yashoda Hospital, Hyderabad, India Venkata Chandrasekher Srinivasarao Bandaru Research Coordinator, Department of Neurology and Clinical Research, Yashoda Hospital, Hyderabad, India 2015 10 14 Background: Stroke is a heterogeneous disease with several risk factors. High sensitivity C-reactive protein (hsCRP) is a marker for cardiovascular and cerebrovascular diseases. Recent studies have shown that high hsCRP level is a risk factor for ischemic stroke. The objective of our study was to investigate the association of high hsCRP (> 3 mg/L) levels with ischemic stroke and its subtypes in Indian patients. Methods: We recruited 210 consecutive acute stroke patients and 150 age and sex matched controls. Stroke patients were admitted within 72 hours of onset, at Yashoda Hospital, Hyderabad, India. The study period was from January 2011 to December 2012. All patients underwent tests as per standard protocol for stroke workup. Serum hsCRP level was assessed in all stroke patients and controls on the day of admission. Results:The mean hsCRP was significantly higher in stroke patients (3.8 ± 2.5) than controls (1.8 ± 1.5) (P < 0.001). High hsCRP had higher frequency in stroke patients 130 (61.9%) compared to controls 10 (6.6%), P < 0.001. High hsCRP level was more prevalent in the stroke subtypes of cardioembolic stroke (83.3%) and large artery atherosclerosis (72%). High hsCRP level was significantly associated with hypercholesterolemia (P = 0.001), age (P = 0.01), and mortality (0.04). After adjustment of regression analysis it was observed that high level hsCRP is independently associated with acute ischemic stroke (Odds 4.5; 95% CI: 2.5-12.2); especially the stroke subtypes of cardioembolic stroke, (odds ratio 3.4, 95% CI: 1.9-10.5) and large artery atherosclerosis (odds ratio 2.1, 95% CI: 1.5-3.8). Conclusion:High hsCRP level is strongly associated with and an independent predictor of acute ischemic stroke. The association was found in all ischemic stroke subtypes. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/652 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/652/150

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 98 101 Samaneh Aalami Harandi Cardiology Resident, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mansoureh Togha Professor, Department of Neurology AND Iranian Neurological Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Azadeh Sadatnaseri Department of Cardiology AND Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran S Hamed Hosseini Department of Epidemiology and Biostatistics, School of Public Health AND Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran Soodeh Razeghi Jahromi Endocrine and Metabolic Research Center, Obesity group, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2015 10 14 Background: Migraine with aura (MA) has been identified as a risk factor for cardiovascular disease. Previous observation has also found higher prevalence of cardiovascular risk factors in migraineurs without aura (MO), but the results have been conflicting. The present study was conducted to assess the association between cardiovascular risk factors and migraine without aura among Iranians. Methods: In our study the prevalence of cardiovascular risk factors, including hypertension, hyperglycemia, dyslipidemia, obesity, cigarette smoking, and family history of early coronary artery disease, were studied in 347 migraineurs without aura and 267 non-migraineurs. The odds ratio (ORs) with 95% confidence interval (95% CI) was used to assess the strength of the association. Results:Patients with migraine without aura were at an increased risk of developing hypertension (ORadj = 1.9; P = 0.029), but there was no difference in other cardiovascular risk profiles, including hyperglycemia, dyslipidemia, obesity, cigarette smoking, and family history of early coronary artery disease. Conclusion: Our study revealed that the prevalence of hypertension was higher in migraineurs without aura in comparison with non-migraineurs. Therefore, physicians are supposed to be more vigilant in examining these patients and take care not to prescribe medications that may provoke hypertension. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/651 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/651/151

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 102 105 Hosein Shamshiri Resident, Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Eshraghian Professor, Department of Statistics and Epidemiology, School of Health, Tehran University of Medical Sciences, Tehran, Iran Nastaran Ameli Department of Biostatistics and Epidemiology, Tehran University of Medical Sciences, Tehran, Iran Shahriar Nafissi Associate professor, Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 2015 10 14 Background: As a disease of motor nervous system (motor neuron  disease), amyotrophic  lateral  sclerosis (ALS)  has  a great  impact  on  several  aspects  of  quality  of  life (QoL). Generic questionnaires of QoL do not address all the especial features  of ALS and  therefore  translation  and  validation of disease specific questionnaires such as Amyotrophic Lateral Sclerosis Assessment  Questionnaire  40-item  (ALSAQ-40)  is necessary for assessment of patients with different languages. The aim of this study was to review the validation of the Persian version of the ALSAQ-40. Methods:  Meticulously  translated ALSAQ-40   was completed by 21 ALS patients. Internal reliability was evaluated   using  Cronbach’s  alpha  coefficient  and item- total correlation  was also used  to evaluate  the correlation of each  question  with total  score.Validity was evaluated through  comparison with Amyotrophic Lateral Sclerosis Functional Rating Scale-revised (ALSFRS-r)and the 36-Itemhort Form Health Survey (SF-36). Results: Cronbach’s alpha coe<cient was 0.91-0.96 for different scales of the ALSAQ-40. All the 40 questions of the questionnaire had correlation greater  than 0.5. Correlation coefficient of all the related scales of the Persian version of ALSAQ-40, SF-36 and ALSFRS-r was greater  than  0.59 with P value < 0.001. Conclusion: Measures of the Cronbach’s alpha coefficient and item-total correlation demonstrated reliability and consistency of the questionnaire, and correlation coefficients confirmed the validity of different items in the questionnaire. This study showed that the Persian version of the ALSAQ-40 is a reliable and valid questionnaire for the evaluation of QoL in ALS patients with Persian language. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/650 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/650/152

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 106 110 Farhad Assarzadegan Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mostafa Asadollahi Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Omid Hesami Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Omid Aryani Neurologist, Special Medical Center, Tehran, Iran Behnam Mansouri Neurologist, Special Medical Center, Tehran, Iran Nahid Beladi Moghadam Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2015 10 14 Mild (140 to 159/90 to 99 mmHg) or moderate (160 to 179/100 to 109 mmHg) chronic arterial hypertension does not appear to cause headache. Whether moderate hypertension predisposes patients to headache at all remains controversial, but there is little evidence that it does. Ambulatory blood pressure monitoring in patients with mild and moderate hypertension has shown no convincing relationship between blood pressure fluctuations over a 24-hour period and presence or absence of headache. However, headaches are associated to various disorders that lead to abrupt, severe, and paroxysmal elevations in blood pressure. In this paper, the secondary headaches attributed to acute crises of hypertension and the criteria for diagnosing each of them have been reviewed. These are headaches attributed to pheochromocytoma, hypertensive crisis without encephalopathy, hypertensive encephalopathy, pre-eclampsia, eclampsia, and acute pressure response to exogenous agents. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/649 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/649/153

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 111 113 Anahid Safari Department of Pharmacology, School of Medicine, Azad University, Kazerun Branch, Shiraz, Iran. Farhad Emadi Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Elham Jamali Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Afshin Borhani-Haghighi Research Center for Traditional Medicine and History of Medicine AND Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran 2015 10 14 A 50 year-old man was referred with history of acute ataxia and lower extremity paresthesia 10 days after general anesthesia with nitrous oxide. Cervical MRI showed long hypersignal lesion in posterior segment of the cord. Blood analysis revealed vitamin B12 deficiency. Nitrous oxide-induced myelopathy should be considered in patients who develop acute neurological manifestation after general anesthesia. It is recommended for physicians to think about symptoms and signs of B12 deficiency when evaluating patients in postoperative visits. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/648 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/648/154

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 114 116 Masoud Mehrpour Assistant Professor, Department of Neurology AND Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Motamed Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Mahboubeh Aghaei Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Zahra Badi Research Center for Traditional Medicine and History of Medicine AND Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran 2015 10 14 Stroke is an important cause of disability and death worldwide, with the majority of strokes occurring in older people. Thrombolysis with recombinant tissue plasminogen activator (r-TPA) is the approved treatment for acute ischemic stroke. A major concern of physicians, who treat acute ischemic stroke with recombinant tissue plasminogen activator (r-TPA,) is the risk of intracerebral hemorrhage. However, other adverse reactions, including anaphylaxis and angioedema, can also occur. Here we report an interesting soft tissue reaction to intravenous r-TPA in an 80 year-old male who was treated for acute ischemic stroke. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/647 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/647/155

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 117 118 Abdorreza Naser Moghadasi Sina MS Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Razieh Aghakhani Public Health and Sustainable Development Center, North Khorasan University of Medical Sciences, Shirvan, Iran Mahsa Owji Sina MS Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Mansoureh Togha Department of Neurology AND Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2015 10 14 #No Abstract# https://ijnl.tums.ac.ir/index.php/ijnl/article/view/646 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/646/156

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 119 120 Mansoureh Togha Professor, Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Abdorreza Naser Moghadasi Professor, Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2015 10 14 #No Abstract# https://ijnl.tums.ac.ir/index.php/ijnl/article/view/645 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/645/157

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 121 123 Vahidreza Ostovan Resident of Neurology, Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences AND Iranian Center of Neurological Research, Tehran, Iran. Ghaemeh Nabaei Resident of Neurology, Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences AND Iranian Center of Neurological Research, Tehran, Iran Akbar Soltanzadeh Professor, Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences AND Iranian Center of Neurological Research, Tehran, Iran 2015 10 14 #No Abstract# https://ijnl.tums.ac.ir/index.php/ijnl/article/view/644 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/644/158