Evaluation of Selenium Supplementation in Acute Ischemic Stroke Outcome: An Outcome Assessor Blind, Randomized, Placebo-Controlled, Feasibility Study.

Background: Selenium is a trace element that protects against cellular damage by oxygen radicals through selenoproteins. Ischemic stroke is associated with the generation of oxygen free radicals resulting in a condition of oxidative stress. Objectives: The present study aimed to evaluate the effect of selenium supplementation on short-term and long-term acute ischemic stroke outcomes. Methods: This was a randomized, parallel, outcome assessor blind, placebo-controlled feasibility study on ischemic stroke patients admitted in Bou-Ali Sina Hospital, Sari, Iran (2015-2017). Inclusion criteria were adults with accepted ischemic stroke by neuroimaging during the last 72h with a volume of at least one-third of MCA territory. The primary outcome was the short-term outcome measuring with the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) on day 7. The participants (44 patients) were randomized into two groups (22 in each group), one receiving intravenous selenium selenite for 5 days, and the other 40 cc normal saline as a placebo. Results: A total of 40 ischemic stroke patients (18 females, 22 males) with mean age of 68.2 ± 10 years were investigated. Selenium supplementation improved short-term outcome, 15.7% by using NIHSS (66% vs 42%, RR = 0.85 with CI = 0.54-1.35; NNT = 10; 95% CI = 5.15- 2.53, P = 0.51) and 46.3% by using mRS (57% vs 12%, RR = 0.52 with CI = 0.31-0.88; NNT = 3; 95% CI = 1.49 -7.59, P = 0.01). The long-term outcome did not change significantly by considering Barthel index >75 after 3 months in comparison to comparator group (33.3% vs 29.4%, RR = 1.13 with CI = 0.40-3.16; NNT = 26; 95% CI = 2.77 -3.54, P = 0.81]. Conclusions: Selenium selenite supplementation in acute ischemic stroke can improve short-term outcome but cannot influence the long-term outcome.

A Rare Case Report of Acute Necrotizing Encephalopathy of Childhood.

OBJECTIVE: Acute necrotizing encephalopathy of childhood (ANEC) is a fast growing disease, accompanied by progressive encephalopathy. The aim of this study was to report a rare case of ANEC in a four-year-old boy with bilateral thalamic necrosis and non-fatal outcomes. CASE REPORT: The patient was a four-year-old Iranian boy, without any history of health problems or hospitalization, except for jaundice and phototherapy in the neonatal period. He had no neurological signs or symptoms during admission, and he was admitted only with chief complaints of acute onset of fever, coryza, and icterus. In the neurological consultation, brain MRI was requested to analyze the possibility of brain damage. The results indicated the involvement of cerebellum, thalamus, and basal ganglia, which led to the diagnosis of ANEC. CONCLUSION: Based on our findings, although ANEC is a rare disease, it should not be underestimated.