Current role of portable MRI in diagnosis of acute neurological conditions.

Neuroimaging is an inevitable component of the assessment of neurological emergencies. Magnetic resonance imaging (MRI) is the preferred imaging modality for detecting neurological pathologies and provides higher sensitivity than other modalities. However, difficulties such as intra-hospital transport, long exam times, and availability in strict access-controlled suites limit its utility in emergency departments and intensive care units (ICUs). The evolution of novel imaging technologies over the past decades has led to the development of portable MRI (pMRI) machines that can be deployed at point-of-care. This article reviews pMRI technologies and their clinical implications in acute neurological conditions. Benefits of pMRI include timely and accurate detection of major acute neurological pathologies such as stroke and intracranial hemorrhage. Additionally, pMRI can be potentially used to monitor the progression of neurological complications by facilitating serial measurements at the bedside.

Diagnostic Value of Ischial Spine Sign in Patients with Acetabular Retroversion.

BACKGROUND: Acetabular Retroversion (AR) is a hip disorder and one of the causes of pain in this area. Evaluation of positive Cross Over Sign (COS) on AP X-Rays of the hip is currently the best method of diagnosis of AR. Several studies have measured co-existence of Ischial Spine Sign (ISS) in patients with AR. In this study we evaluated the diagnostic value of ISS in confirmation of AR and compared it with the diagnostic value of COS. METHODS: In this study, 4120 AP hip X-Rays from Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, were studied. Based on radiologic criteria, 1180 X-Rays were considered as standards and evaluated for ISS, COS and PWS (Posterior Wall Sign). Data analysis was done for correlation between ISS and COS. RESULTS: A total of 1180 out of 4120 X-Rays were considered as standard; among which, 86 were diagnosed with AR based on positive COS in presence of PWS. Both ISS and COS were positive concurrently in 69 X-Rays. ISS was positive in absence of COS in 11 X-rays. No significant difference in diagnostic value for diagnosis of acetabular retroversion was found between ISS and COS (P<0.05). CONCLUSION: According to our results, both ISS and COS signs can be employed for diagnosis of AR (acetabular retroversion). Considering the absence of a significant difference between these two signs in confirmation of AR, it can be perceived that the diagnostic value of ISS in confirmation of AR is equal to COS. Validation of the mentioned results requires further studies.

Comparing Zonisamide With Sodium Valproate in the Management of Migraine Headaches: Double-Blind Randomized Clinical Trial of Efficacy and Safety.

BACKGROUND: Migraine is one of the most debilitating medical conditions and has a high socioeconomic burden. As conventional therapeutic methods do not entirely alleviate the symptoms, new alternatives are being considered. OBJECTIVES: This study evaluates the efficacy and safety of zonisamide compared with sodium valproate in the management of migraine headaches. PATIENTS AND METHODS: In the current double-blind, parallel, randomized, controlled trial, 96 patients with a migraine diagnosis based on the international headache society (HIS) criteria were selected. They were divided randomly into two groups; the case group was given zonisamide, and sodium valproate was given to a control group. In addition to the side effects of the drugs, the severity, duration, and frequency of migraine attacks were evaluated at baseline and at three months. RESULTS: The 96 selected patients were divided randomly into two treatment groups (zonisamide n = 48, sodium valproate n = 48). Seven patients were excluded from analysis because of early dropout, leaving 89 (n = 45; n = 44) patients for analysis. While using zonisamide, six (13%) patients complained of fatigue, and two (4%) patients encountered noticeable appetite and weight loss. In the control group, five (11%) patients reported dizziness, and four (9%) patients faced obvious appetite and weight gain. Both drugs were considerably efficient in reducing further attacks. There was no statistically significant correlation between frequency or severity of migraine attacks and the drug used for treatment in three months of follow-up. CONCLUSIONS: Both medications are effective in reducing migraine attacks. It will be important to consider the drugs' adverse effects and availability and patients' medical and socioeconomic condition to select the appropriate treatment.

Relation of Stroke Risk Factors with Specific Stroke Subtypes and Territories.

BACKGROUND: Although the risk factors of ischemic strokes are well defined, there is slight information about their relations with the etiologies of ischemic strokes. This study investigated the distribution of ischemic stroke risk factors and their connections to diverse etiologies of cerebrovascular attack (CVA) and specific ischemic regions of brain. METHODS: In this cross sectional study, we analyzed the data of patients with definite diagnosis of CVA, excluding hemorrhagic strokes, registered in Imam Hossein Medical Center in Tehran, Iran. The data were collected from entire archived medical records from March 2010 until September 2012, retrospectively. RESULTS: Out of 1696 cases a total of 1011 subjects, 487 (48.2%) males and 524 (51.8%) females with mean age of 68.91±13.54 yr were included in the study. Patients suffering from atrial fibrillation (AF), valvular heart disease (VHD), and dilated cardiomyopathy were more prone to develop cardioembolic stroke. Those with diabetes mellitus (DM), carotid artery stenosis and dyslipidemia (DLP) had a higher prevalence of macroangiopathic stroke. Ischemic heart disease (IHD), AF, and VHD were associated with stroke in the brain territory supplied by middle cerebral artery (MCA) while DM and carotid artery stenosis were correspondent with posterior cerebral artery (PCA) stroke. CONCLUSION: The diagnosis of the weight of each risk factor of ischemic strokes on different etiologies and territories of ischemia can assist care providers for a more efficient prevention of strokes. The results of this study can also be a basis for further investigations to corroborate the pathophysiology of such relations.

The Role of Antiepileptic Treatment in the Recurrence Rate of Seizures After First Attack: A Randomized Clinical Trial.

OBJECTIVE: Epilepsy is a serious, potentially life-shortening brain disorder that occurs in patients of all ages and races. A total of 2-4% of people have experienced seizures at least once in their lifetime. Although treatment usually begins after a seizure, it is an important question whether the first cases of seizure do need to be treated by antiepileptic drugs. In this manner, we compare the recurrence rates of epilepsy in first seizure patients treated with sodium valproic acid as an antiepileptic drug versus a placebo. MATERIAL & METHODS: In a randomized clinical trial study, 101 first seizure patients were randomly divided into two groups: one group was treated with antiepileptic drugs (sodium valproate 200mg, three times a day) and the other group was given a placebo. The recurrence rate of seizures was evaluated and compared between the groups after 6 months of follow up. RESULTS: Eight recurrence cases were detected. All recurrence cases came from the placebo group, with four patients suffering an additional seizure after four months and between 4-6 month follow up. A comparison of recurrence rate detected a statistically significant difference between the drug group and placebo group. CONCLUSION: Our data shows that the recurrences occurred only in the placebo group with the difference between the recurrence rates in the placebo versus drug-treated was significant. Our results suggest that drug therapy for people after their first seizure attack might reduce the probability of seizure recurrence.