Olfactory dysfunction in essential tremor versus tremor dominant Parkinson disease.

BACKGROUND: Essential tremor (ET) and tremor dominant Parkinson disease (TDPD) variant constitute the main causes of geriatric tremor which differentiation is not always an easy mission. The objective of this work was to study the olfactory performance in ET and PD patients for possible consideration as a differentiating biomarker. METHODS: This study was performed on 36ET, 22 TDPD variant and 24 healthy controls subjects (HCS) submitted to extended n-butanol Sniffin' Sticks test (SST) and olfactory bulbs volumetry (OBV). RESULTS: There were significant decreases in SST threshold, discrimination, identification and TDI variables in TDPD patients compared to ET and HCS. ET patients showed significant decrease in the same variables compared to HCS. Regarding OBV, there were significant decreases in TDPD patients compared to ET and HCS with nonsignificant difference between the 2-latter groups. Our results showed that TDI score of 25 can differentiate between TDPD and ET patients with sensitivity and specificity (94 %, 91 %) respectively. CONCLUSION: Olfactory assessment is a rapid, safe, and easily applicable biomarker that could differentiate TDPD from ET in doubtful cases.

Vasospasm following aneurysmal subarachnoid hemorrhage: prediction, detection, and intervention.

BACKGROUND: Vasospasm of the cerebral blood vessels is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) which results in delayed cerebral ischemia (DCI) and worsening of the outcome. METHODS: This study was performed on 41 aSAH patients diagnosed by non-contrast brain CT, CT angiography, and digital subtraction angiography followed by interventional aneurysmal embolization. Patients were followed up for 20 days by clinical assessment, EEG monitoring, and transcranial duplex studies (TCD) for early detection of vasospasm and DCI. RESULTS: The most common ruptured aneurysmal sites were middle cerebral, anterior communicating, posterior communicating, terminal internal carotid, and anterior cerebral arteries respectively. The incidence of vasospasm was 36.8% of the included cases; 57% progressed to DCI while 43% passed a spontaneous regressive course. The most common arteries undergoing vasospasm were the MCA followed by the ACA, ICA, and lastly the basilar arteries. The mean time of vasospasm development as detected by EEG monitoring and/or TCD was 8.4 ± 2.8 days which was earlier than clinical signs by 12.5 ± 5.3 h in those progressed to DCI. CONCLUSION: Continuous EEG monitoring and TCD are valuable methods for early detection of vasospasm and they allow for early therapeutic intervention before irreversible ischemic neurological deficits take place.

Stroke onset to needle delay: Where these golden hours are lost? An Egyptian center experience.

BACKGROUND: The use of intravenous recombinant tissue plasminogen activator (IV r-tPA) in early acute ischemic stroke (AIS) management faces a lot of difficulties in developing countries due to lessened guideline development with consecutive pre- and intra-hospital delay. OBJECTIVES: The objective was to identify the barriers facing proper utilization of IV r-tPA for AIS in Tanta University Hospitals. METHODS: The study was conducted on 4124 AIS patients eligible to use IV r-tPA divided to group-I consisting of 442 patients who arrived the hospital within <3.5 h from the stroke onset and group-II consisting of 3682 patients who arrived >3.5 h from the stroke onset. The former group was further subdivided to 238 patients who received IV r-tPA (group-Ia) and 204 patients who did not receive IV r-tPA (group-Ib) due to different obstacles. RESULTS: The main causes of pre-hospital onset to arrival delay were stroke unawareness, long travel time, incorrect beliefs, non-available neurologists, stroke onset during sleep and multiple causes (18.2%, 20.5%, 12.7%, 9.1%, 16% and 23.5% of cases, respectively). Causes of non-administration of IV r-tPA in eligible patients includes prolonged door-to-needle time, financial restraints, minor strokes, unavailable beds and fear of complications (41.2%, 26%, 12.7%, 11.3% and 8.8%, respectively). CONCLUSION: Increasing the chance of utilizing IV r-tPA for AIS patients' needs regular updating of the stroke chain of survival system to get the highest benefits from the available resources.

Sleep disturbances in diabetic peripheral neuropathy patients: a clinical and polysomnographic study.

BACKGROUND: Disordered sleep breathing is a common complication of diabetic peripheral neuropathy (DPN) manifested by excessive daytime sleepiness, morning headache, morning dizziness, cognitive decline, and mood changes. METHODS: This study was performed on 30 non-obese type 2 diabetic patients; 20 with clinically evident DPN and 10 without. Ten age-, sex-, and body mass index-matched healthy control subjects were also included. Patients and control were subjected to history taking, neurological examination, glycated hemoglobin, and clinical assessment of the sensori-motor manifestations by the neuropathy symptom score and neuropathy disability score. The autonomic nervous system was evaluated clinically by the systolic blood pressure response to standing and heart rate response to each of standing, Valsalva, and deep breath. Finally, sleep was assessed by one-night polysomnogram (PSG) followed by multiple sleep latency test in the next day. RESULTS: The study showed significant increase in sleep apnea syndromes in diabetic peripheral neuropathy patients compared to diabetic neuropathy free patients and healthy control (p < 0.0001). The sleep apnea was mainly obstructive and to a little extent mixed (obstructive/central) sleep apnea. The severity of sleep PSG abnormalities was positively correlated with the severities of sensory, motor, and autonomic manifestations. CONCLUSIONS: Non-obese type 2 diabetic patients complicated by peripheral neuropathy especially those having dysautonomia are at increased risk of developing sleep disordered breathing resulting in their excessive daytime sleepiness, decreased productivity, and poor glycemic control.

Sleep and psychiatric abnormalities in Gullian Barré Syndrome.

BACKGROUND: The sensori-motor manifestations of Guillain Barré Syndrome (GBS) are usually severe enough to mask the psychiatric and sleep problems which are in need for more attention for better functional outcome. METHODS: This study was performed on 20 GBS patients and 10 healthy controls. Patients were evaluated initially before immunotherapy using the Overall Disability Sum Score (ODSS), Neuropathy Pain Scale (NPS), Hamilton Anxiety Scale (HAS), Montgomery-Åsberg Depression Rating Scale (MADRS) and one-night polysomnography (PSG) followed by the multiple sleep latency test (MSLT) to evaluate the mean sleep latencies. Reevaluation was done using the same parameters 1 month after completing immunotherapy. RESULTS: The study showed significant increase in HAS in GBS patients which were positively correlated with the degree of motor disability. The mean sleep latencies of MSLT were significantly shortened and PSG showed shortening of the total sleep time, sleep efficiency, lowest O2 saturation and pulse transit time with increased wake after sleep onset, sleep stage transition index, apnea hypopnea index, desaturation index, arousal index, snore index and periodic limb movement index. One month after immunotherapy, the anxiety symptoms and sleep abnormalities showed non-significant improvements which were not correlated with the improvements in the sensori-motor manifestations. CONCLUSIONS: GBS patients usually have sleep and psychiatric abnormalities which may take longer time to improve than the sensori-motor manifestations. So, they need more attention in the management protocol for early patients' independence and return to usual daily activities.

Cerebral border zone infarction: an etiological study.

BACKGROUND: Border zone infarcts (BZI) are ischemic lesions at the junction between two main arterial territories which may be either cortical or internal BZI. METHODS: This study was conducted on 76 cerebral BZI patients and 20 healthy control subjects. Patients were divided to group I included 26 internal BZI, group II included 19 cortical BZI and group III included 21 mixed internal/cortical BZI patients. Included subjects were submitted to neurological examination, laboratory investigations, ECG, echocardiogram, brain CT and/or MRI and extra and intracranial blood vessels imaging by duplex and CT angiography. RESULTS: Hypertension was significantly higher among groups I and III compared to group II while atrial fibrillation (AF) was significantly higher in groups II and III than group I (p < 0.05). Sonographic duplex assessment of extra and intracranial blood vessels revealed significant increase in mean flow velocities of CCA, ICC and MCA on both side in groups I and III compared to group II (p < 0.05). CT angiography revealed non-significant differences between BZI patients and control as well as in between the three BZI patient's groups regarding the existence of vertebral artery hypoplasia and/or circle of Willis anomalies. CONCLUSIONS: Vascular stenosis is the main etiological factor in internal BZI while AF is the predominant etiological factor of cortical BZI. Congenital vascular anomalies play roles in the localization of BZI but cannot predispose to it except when comorbid with hemodynamic disturbances.