Convulsive syncope as presenting symptom of carotid body tumors: Case series.

Carotid body tumor (CBT) is paraganglioma and mainly found in the carotid bifurcation. The manifestations of the tumor are variable; in most cases, it presents as a non-symptomatic slow-growing mass, rarely compression of carotid body induces bradycardia and hypotension and repeated syncope, prolonged syncope can cause convulsion. Convulsive syncope occurred in 0.03% of patients with syncope. In this paper, we report three cases with CBT and convulsive syncope for which surgery was done and patients did not experience syncope again.

Electrocardiographic changes in patients with refractory epilepsy.

BACKGROUND: Epilepsy is the second most common type of chronic neurological disease. Its diagnosis carries an excess mortality, which is 2-3 times higher than that of general population. Mortality rates are increased among patients with uncontrolled seizures. The aim of this study was to characterize the electrocardiogram (ECG) changes during pre-ictal, ictal and post-ictal states in pharmaco-resistant epilepsy patients. MATERIALS AND METHODS: This retrospective study conducted by Department of Neurology and Department of Cardiology of Isfahan Medical University from September 2008 to December 2012, patients with medically refractory epilepsy who underwent standard pre-surgical assessment from Epilepsy ward of Kashani hospital in Isfahan city were recruited in this study. RESULTS: The heart rate (HR) varied significantly throughout the record. Significant difference in HR was identified between ictal and pre-ictal periods (P = 0.000), furthermore, the difference between ictal and pre-ictal HR {mean = 63.867 ± 0.061, P = 0.000}, ictal and post-ictal HR {mean = 38.833 ± 0.067, P = 0.003}, and between pre- and post-ictal HR {mean = 25.033 ± 0.089, P = 0.000}, was significant. CONCLUSION: ECG monitoring should be a part video- (electroencephalography) EEG monitoring to identify serious cardiac abnormalities, particularly in patients with refractory epilepsy.

Oral prednisolone in the treatment of cervical radiculopathy: A randomized placebo controlled trial.

BACKGROUND: Steroids are commonly used in the treatment of cervical radiculopathy (CR), but there is limited information in this regard. We evaluated the efficacy of oral prednisone in the treatment of CR. MATERIALS AND METHODS: This randomized, double-blinded, placebo-controlled trial was conducted on adult patients with neck/shoulder pain for at least 1 month with no alarm symptoms/sings of malignancy, infection, or severe myelopathy, and no contraindication for corticosteroid use. Patients were allocated to receive prednisolone 50 mg/day for 5 days that was tapered within the following 5 days, or placebo. All patients also received acetaminophen 325 mg three times a day and ranitidine 150 mg two times a day. Neck disability index (NDI) and the verbal rating scale (VRS) were used to evaluate the outcomes. RESULTS: A total of 59 patients (31 female, mean ± SD age = 46.2 ± 9.0 years) completed the study. A significant decrease was observed regarding the NDI and VAS scores from baseline to the end of study in both groups (P < 0.001). However, for both the NDI (35.7 ± 21.4 vs. 12.9 ± 10.2) and VRS (4.4 ± 2.7 vs. 1.6 ± 1.2), the amount of decrease was greater in the prednisone compared with the placebo group (P < 0.001). Based on the clinically important change in NDI, pain was improved in 75.8% (22/29) of the prednisolone and 30% (9/30) of the placebo group (P < 0.001). CONCLUSION: A short course of oral steroid therapy with prednisolone is highly effective in reducing pain in patients referring with uncomplicated CR. Further studies are warranted on dosing, duration, and long-term efficacy and safety of oral steroid therapy, compared with injection approach.

Seizure characteristics in multiple sclerosis patients.

BACKGROUND: To evaluate seizure characteristic among multiple sclerosis patients with coexistent seizure activity compared to control group. MATERIALS AND METHODS: This study is a cross-sectional study which was conducted by reviewing the clinical records of patients with definite diagnosis of MS according to McDonald's criteria from March 2007 to June 2011, who referred to the MS clinic of the university. RESULTS: A total of 920 patients with a diagnosis of MS were identified, among whom 29 patients (3.15%) with seizure activity (case) due to MS with the mean age of 32.6 ± 6.23 years were analyzed. Also, fifty MS patients without any seizure occurrence with the mean age of 33.7 ± 7.4 years were used as our control group. In case group, seizure was general tonic clonic in 23 patients (79.3%), complex partial in four (13.8%), and simple partial in two (5.9%). The 26 available interictal EEGs in MS patients showed abnormal EEG pattern in 22 (84.6%) of them, including focal epileptic form discharge or focal slowing in 10 (38.5%), generalized discharge (spike-wave, polyspike, or general paroxysmal fast activity) in 10 (38.5%), and general slowing activity in 10 record (38.5%). MRI reviews of the 26 available brain MRIs showed subcortical white mater lesions in 22 (84.6%) of patients with seizure. All MRIs were performed within one month after the first seizure episode. Amongst 48 available MRIs in our control group, 91.7% (44 cases) showed periventricular lesions and in 8.3% (4 cases) subcortical white matter lesions were reported. CONCLUSION: The result of this study demonstrated the higher rate of subcortical whit matter lesion in MS patients with seizure occurrence compared to control group.

The role of melatonin in the pathogenesis of multiple sclerosis: a case-control study.

BACKGROUND: The association between the prevalence of multiple sclerosis (MS) and latitude gradient indicates the importance of environmental factors in MS susceptibility. Sunlight's ultraviolet radiation, its ability to influence melatonin, and an imbalance of melatonin in the central nervous system (CNS) may be involved in this process. METHODS: This case-control study was conducted in Isfahan MS Society (IMSS), Isfahan, Iran. Enrollment was limited to patients with MS referring to the MS clinic of Alzahra and Kashani hospital during January and February 2012. RESULTS: Thirty-five patients with MS and 35 healthy individuals were included in our study. The melatonin levels were analyzed using enzyme-linked immunosorbent assay (ELISA) kits. There was no significant difference between saliva melatonin level of two groups (patients and healthy individuals) (P = 0.417); however, after controlling the effect of age, a significant difference (P = 0.022) was found. CONCLUSIONS: In the present study, it is proposed that environmental conditions in Isfahan city might have increased the susceptibility to MS, but more studies in different parts of the world are needed to evaluate this claim.

Prediction and control of stroke by data mining.

BACKGROUND: Today there are abounding collected data in cases of various diseases in medical sciences. Physicians can access new findings about diseases and procedures in dealing with them by probing these data. This study was performed to predict stroke incidence. METHODS: This study was carried out in Esfahan Al-Zahra and Mashhad Ghaem hospitals during 2010-2011. Information on 807 healthy and sick subjects was collected using a standard checklist that contains 50 risk factors for stroke such as history of cardiovascular disease, diabetes, hyperlipidemia, smoking and alcohol consumption. For analyzing data we used data mining techniques, K-nearest neighbor and C4.5 decision tree using WEKA. RESULTS: The accuracy of the C4.5 decision tree algorithm and K-nearest neighbor in predicting stroke was 95.42% and 94.18%, respectively. CONCLUSIONS: The two algorithms, C4.5 decision tree algorithm and K-nearest neighbor, can be used in order to predict stroke in high risk groups.

Short-term safety of pulse steroid therapy in multiple sclerosis relapses.

OBJECTIVE: To determine the short-term safety of high-dose intravenous methylprednisolone in acute attacks of multiple sclerosis (MS). METHOD: In a prospective study, we evaluated the patients with MS who received high-dose intravenous methylprednisolone for acute attacks. By repeated physical and laboratory examinations and history taking, patients were assessed for adverse effects that would be related to pulse therapy before, within, and 3 months after the treatment. RESULTS: Sixty-four patients with definite MS with acute attack were enrolled in the study in which 46 (71.9%) were female. Fifty-eight patients (90.6%) developed minor adverse effects of which the most common were palpitation, flashing, dyspepsia, insomnia, and virulent taste. On the other hand, 12 patients (18.75%) developed major adverse effects, and the most common was sinus tachycardia. Six patients (9.3%) were without any adverse effects. There was a significant relationship between the dosage of methylprednisolone (3 or 5 g) and the occurrence of major adverse effects (P = 0.025). CONCLUSION: This study approved that high-dose intravenous methylprednisolone is a safe treatment in MS attacks and the short-term adverse effects were mostly minor and transient.

Seizure in Iranian patients with multiple sclerosis.

BACKGROUND: There is a broad variation in reported frequencies of seizure in multiple sclerosis (MS). In this study, the seizure and its characteristics analyzed among a large group of patients with MS. PATIENTS AND METHODS: We reviewed the medical records of all definite MS patients referred to the MS Clinic of Kashani hospital, Isfahan, Iran, between 2007 and 2011. RESULTS: Altogether, 34 cases with seizure activity identified among the 920 definite MS subjects (3.69%). Five excluded due to the other probable etiologies rather than MS. In the remained 29 patients (3.15%), the type of seizure was mostly generalized (79.3%); interictal electroencephalography showed an abnormal pattern in 84.6%, brain magnetic resonance imaging revealed subcortical white mater lesions in 84.6% of patients. The mean duration of MS onsets was 8.17 years and the mean interval between MS onset and the first seizure occurrence was 3.7 years. In general, response to antiepileptic treatment was excellent. CONCLUSION: Seizures can occur at any stage during the course of MS, but it is more common during the early stages.

Multiple intracranial hemorrhages in a normotensive demented patient: A probable cerebral amyloid angiopathy.

Cerebral amyloid angiopathy (CAA) is the most common cause of lobar intracerebral hemorrhage. Repeated bleeding may be presented with vascular dementia. We have reported a 68-year-old normotensive demented patient with probable CAA presented with hemiparesia, headache and vomiting. According to the experience of this case, it is recommended to consider CAA for normotensive elderly patients presented with multiple and superficial intracerebral hemorrhage.

Iatrogenic botulism after the therapeutic use of botulinum toxin-A: a case report and review of the literature.

Local injection of botulinum toxin-A is an accepted treatment for hyperhidrosis. We report 2 cases of primary hyperhidrosis who developed iatrogenic botulism after the therapeutic dose of onabotulinumtoxinA (Botox). This case report highlights the necessity of clinicians having sufficient information of potentially adverse effects, optimal dose, and correct preparation and injection of botulinum toxin-A.