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Background: Headache is one of the most common disorders of the central nervous system and causes multiple levels of dysfunction. One of the most underestimated types of headaches is headaches due to CSF dysregulation disorders either idiopathic intracranial tension or spontaneous intracranial hypotension. Aim of the Work: Measurement of the prevalence of CSF dysregulation-related headaches in a hospital-based headache population, assessment of the demographic data of a group of headache patients, assessment of the correlation between CSF dysregulation headache and BMI, assessment of the correlation between CSF dysregulation-related headache and fundus examination, assessment of the correlation between CSF dysregulation-related headache and MRI brain& MRV findings and assessment of the correlation between IIH and optic nerve sheath diameter ONSD assessment by trans orbital sonography TOS. Patients and Methods: In our observational study, conducted between 1 November 2022 and 30 April 2023, at the headache clinic of Ain Shams University hospitals, we studied the prevalence of IIH among the headache population, demographic characteristics, sleep quality, MRI brain findings suggestive of IIH, fundus examination, opening pressure reading values, and efficiency of USG in the evaluation of patients with IIH. Results: Among the 168 headache patients, IIH prevalence came out to be 30.35%, IIH patients had higher age, with site of headache being vertical in most of cases, higher BMI, with the character of headache being throbbing in most cases. We found that the empty sella turcica sign has a sensitivity of 41.2%, specificity of 98.9%, transverse sinus stenosis sign has a sensitivity of 82.4%, specificity of 88.8%, posterior globe flattening sign has a sensitivity of 21.6%, specificity of 100.0%, Optic nerve head protrusion sign has a sensitivity of 27.5%, specificity of 98.9%, Optic nerve sheath distention, tortuosity sign has a sensitivity of 43.1%, specificity of 96.6% in the detection of IIH cases. Also, it shows that fundus examination has a sensitivity of 52.9%, specificity of 96.6%, in detection of IIH cases. Also, optic nerve sheath diameter assessment through sonography has sensitivity of 66.7%, specificity of 26.7%. Conclusion: Our study estimated the prevalence of CSF dysregulation headache disorder among headache patients showing that 30.35% of the included patients fulfilled the diagnostic criteria for IIH whereas 69.64% did not. We highlight the importance of neuroimaging signs in IIH as empty sella turcica sign, transverse sinus stenosis sign, flattening of the posterior aspect of the globe, optic nerve head protrusion sign, and optic nerve dilation and tortuosity sign were highly associated with IIH and elevated OP. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is characterized by a complex etiology that is reflected in the lack of consistently predictable treatment responses across patients of seemingly similar characteristics. Approaches to demystify the underlying predictors of aberrant treatment responses have made use of genome-wide association studies (GWAS), with imminent progress made in identifying single nucleotide polymorphisms (SNPs) associated with MS risk, disease progression, and treatment response. Ultimately, such pharmacogenomic studies aim to utilize the approach of personalized medicine to maximize patient benefit and minimize rate of disease progression. Objective: Very limited research is available around the long intergenic noncoding RNA (linc)00513, recently being reported as a novel positive regulator of the type-1 interferon (IFN) pathway, following its overexpression in the presence of two polymorphisms: rs205764 and rs547311 in the promoter region of this gene. We attempt to provide data on the prevalence of genetic variations at rs205764 and rs547311 in Egyptian MS patients, and correlate these polymorphisms with the patients' responses to disease-modifying treatments. Methods: Genomic DNA from 144 RRMS patients was isolated and analyzed for genotypes at the positions of interest on linc00513 using RT-qPCR. Genotype groups were compared with regards to their response to treatment; additional secondary clinical parameters including the estimated disability status score (EDSS), and onset of the disease were examined in relation to these polymorphisms. Results: Polymorphisms at rs205764 were associated with a significantly higher response to fingolimod and a significantly lower response to dimethylfumarate. Moreover, the average EDSS of patients carrying polymorphisms at rs547311 was significantly higher, whereas no correlation appeared to exist with the onset of MS. Conclusion: Understanding the complex interplay of factors influencing treatment response is pivotal in MS. One of the factors contributing to a patient's response to treatment, as well as disease disability, may be polymorphisms on non-coding genetic material, such as rs205764 and rs547311 on linc00513. Through this work, we propose that genetic polymorphisms may partially drive disease disability and inconsistent responses to treatment in MS; we also aim to draw attention towards genetic approaches, such as screening for specific polymorphisms, to possibly direct treatment choices in such a complex disease. [ABSTRACT FROM AUTHOR]

Background: Migraine is a common multi-factorial, neurovascular disorder with major individual and social effect. Although the mechanisms are unknown, activation of the TNC leads to peripheral release of calcitonin gene-related protein (CGRP), most likely from C-fibers. Topiramate is a first-choice oral medication for migraine prophylaxis. It is one of the most frequently prescribed preventative anti-migraine drugs. Other first-line, non-specific preventatives include b-blockers, flunarizine, and amitriptyline. All these medications are inexpensive treatment options, which are effective in a large population of patients. Objective: to study the effect of topiramate and propranolol on serum calcitonin gene related peptide (CGRP) level in peripheral blood in migraine in Headache outpatient clinic and neurology department at Ain Shams University hospital. Methods: it's a cross-sectional time interval study conducted between October 2022 to April 2023. we conducted our study on 50 patients at our outpatient headache clinic were diagnosed as migraine according to ICH-3rd edition. blood sampling was obtained from all 50 patients for estimation of CGRP in peripheral blood before receiving any medication then all patients received propranolol 40mg and topiramate 25mg after two months blood sample obtained for estimation of cgrp. Results: Highly statistical significant (p-value < 0.001) decreased CGRP (after medication) (mean = 141.1 6 62.5, range = 53 - 320) when compared with CGRP (before medication) (mean = 190.3 6 71.7, range = 92 - 395) in all studied patients Conclusion: both topiramate and propranolol show significant decrease in serum calcitonin gene related peptide in migraine patients. [ABSTRACT FROM AUTHOR]

Background: Ischemic strokes are common neurological disease and unless being managed fast enough within hours of onset a permanent deficit usually results. Such deficit impairs the patient independency to a great extent. Aphasia affects more than a quarter of acute stroke cases. Initially it is more prominent and with time its severity may subside, yet to which degree and what factors play a role in this severity reduction still needs further studies and is under postulations. Case presentation: Multilingual role in post-stroke aphasia recovery is presented in this case report where a trilingual female who acquired a foreign accent and who involuntarily uses code switching between Arabic, French and English in order to linguistically communicate; thus overcoming post-stroke language communication problems. The neurolinguistics data are taken from the results of the application of the Western Aphasia Battery-Revised scale in Cairene Dialect, in addition to extra language exercises including repetition, picture description and conversation with the patient. Linguistic analysis includes the investigation of morph syntactic constructions, phonetic deviations and semantic paraphasia. Linguistic analysis also revealed that the patient's aphasia disorder is of the conduction type and that she resorts to her second language (L2) namely French or her third language (L3) namely English if she finds it difficult to produce the Arabic word. Conclusion: Cognitive reserve and multilingualism may have a role in post-stroke aphasia recovery. [ABSTRACT FROM AUTHOR]

Purpose: Accurate data on the epidemiology of stroke in Egypt is scarce. The aim of this review is to address this issue based on available community-based studies and compare the resulting findings to those of other regional and international studies. Method: A systematic literature search was conducted to identify population-based epidemiological studies of stroke in Egyptians. Original articles published in English between 1990 and 2016 were included. Five studies from five different governorates in southern Egypt fulfilled the study criteria (Qena, Sohag, Assiut, New Valley and Red Sea). Results: The mean and median crude prevalence rates (CPRs) across the five studies, which were conducted in southern Egypt were 721.6/100,000 and 655/100,000, respectively. The mean and median crude incidence rates (CIRs) were 187/100,000 and 180.5/100,000, respectively. The average CPR weighted by sample population size was 613/100,000 and the average CIR weighted by sample population size was 202/100,000. Conclusion: The incidence and prevalence of stroke in Egypt are high. More population-based studies are urgently needed in northern Egypt and in Cairo -- the capital of Egypt. [ABSTRACT FROM AUTHOR]

Background The rate of alteplase (tPA) thrombolysis utilization in acute stroke in Egypt is <1%. We report on the causes of this low rate of reperfusion therapies and take corrective action to improve it. Methods Two prospective observational studies were conducted at Ain Shams University hospitals. The first included 269 acute stroke patients admitted to the hospital over a six-month period. Obstacles to reperfusion therapy were identified, and based on the results, a corrective action plan was implemented including making alteplase(tPA) available, training, and establishing a standardized local protocol for reperfusion therapy. A second study was then conducted that included 284 acute ischemic stroke patients over another six-month period. Results In the first study, 53/269 patients (19.7%) arrived at hospital within 4.5 h and were eligible for reperfusion therapy. Of those, seven (13.2%) received alteplase(tPA), representing 2.6% of the total ischemic stroke patients admitted. The main causes for not giving thrombolytic therapy was unavailability of alteplase(tPA) (56.5%), wrong treatment decision (17.4%), missed window while performing brain imaging (15%), and unavailability of intermediate care bed (10.9%). The second study showed that out of 284 cases admitted with acute ischemic stroke, 37 were eligible for thrombolysis and 35 received alteplase(tPA) (94.3%), representing 12.3% of the total ischemic stroke admissions. Conclusion A comprehensive action plan that centers around making the drug available and training resulted in a significant improvement of reperfusion therapy utilization in Egypt. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined a possible association between microembolic signals (MES) on transcranial Doppler and carotid plaque inflammation on 18F fluorodeoxyglucose positron-emission tomography (FDG PET) in recently symptomatic patients with carotid stenosis. Researchers found a link between in vivo measures of plaque inflammation detected by FDG PET and the presence of transcranial Doppler MES in the patients. The results support the notion that embolic events distal to carotid stenoses are related to plaque inflammation.

Objective: To assess the cerebral vasomotor response to ipsilesional repetitive transcranial magnetic stimulation (rTMS) on transcranial Doppler (TCD) in patients with recent ischemic stroke without carotid occlusive disease, and to compare this response in patients with cortical and subcortical infarcts. Methods: Consecutive patients with first-ever anterior circulation acute ischemic stroke (<3 days) and no extra- or intracranial arterial stenosis were prospectively recruited. Patients were divided into 2 groups: cortical infarct (CI, n = 15) and subcortical infarct (SI, n = 16). TCD cerebral blood flow velocity (CBFV) and pulsatility index were measured before and after 10-Hz suprathreshold rTMS over the dorsolateral prefrontal cortex. Results: ANOVA showed a greater percentage increase in middle cerebral artery (MCA) CBFV in the SI group than in the CI group following rTMS (p = 0.01). The percentage change in CBFV was significantly correlated between both MCAs in SI patients but not in CI patients (r = 0.8, p < 0.001 vs. r = 0.05, p = 0.9, respectively). Conclusions: 10-Hz rTMS induces significant bilateral hemodynamic changes in patients with acute ischemic stroke, which appear to be less prominent and less synchronous in patients with cortical infarcts. These findings may allow optimization of the use of TMS in acute stroke. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: One of the most underestimated types of chronic headaches is headaches as a result of cerebro-spinal fluid dysregulation disorders. Idiopathic intracranial hypertension (IIH) presents with headache and visual symptoms and usually is associated with papilledema. We identified patients with IIH in a chronic headache population presenting to a hospital-based headache clinic, and studied its associations with clinical, sonographic and magnetic resonance imaging (MRI) findings. Methods: Of 168 patients, 141 chronic headache patients were identified and completed the study procedures (semi-structured medical interview, fundus examination, MRI brain with magnetic resonance venography (MRV) and trans-orbital sonography (TOS)). Patients with abnormal findings underwent lumbar puncture for opening pressure. Results: The prevalence of IIH was 27%. IIH patients were of higher age, had gnawing/throbbing headache in the vertex in most cases, and had higher body mass index. Fundus examination had a sensitivity of 79% and a specificity of 98% for the detection of IIH cases. Approximately 23% of IIH patients had no papilledema. The most sensitive MR sign was found to be transverse sinus stenosis. TOS showed optic nerve sheath dilation in 35.7% of IIH without papilledema cases. Conclusions: The prevalence of IIH is high in the chronic headache population and should be suspected in the headache clinic setting, particularly because there is significant overlap with migraine symptomatology. MRI/MR venography and TOS can be useful adjunct tests to identify IIH patients. [ABSTRACT FROM AUTHOR]

There are limited data on the contribution of the African continent to neuroscience research and publications. This review aims to provide a clear view on the state of neuroscience research among African countries, and to compare neuroscience research within the 52 African countries. A literature review search was conducted for all published articles by African authors in both local and international journals using Medline and other primary databases. Neuroscience represents 9.1% of the total medical publications. The highest percentage of neuroscience publications comes from South Africa. There is a positive correlation between the Gross Domestic Product and the total number of neuroscience publications among African countries. There is therefore an urgent need to develop strategies to improve neuroscience research in African countries.

Objectives: The objective of the following study is to determine the effect of continuous insonation using 2-MHz transcranial Doppler-ultrasound (TCD-US) on the recanalization rate and the short-term outcome in subjects with acute ischemic stroke due to middle cerebral artery (MCA) occlusion., Materials and Methods: A total of 42 patients with acute ischemic stroke due to MCA occlusion within 24 h were recruited and randomly allotted to two groups (21 patients in each group). Group 1 included patients who received 1 h continuous TCD-US for MCA and Group 2 included patients who did not receive 1 h continuous TCD-US. Patients in both groups were received MCA insonation and TCD study to measure mean flow velocity (MFV) in MCA one after the initial study at 20 and 60 min. All patients received aspirin (150-325 mg). The clinical course during hospital stay was assessed before and after 1 h of US insonation, at 24 h after symptom onset using the National Institutes of Health Stroke Scale., Results: Change in MFV after insonation for Group 1 in comparison to Group 2 at 3 time points was significantly high (P < 0.001)., Conclusion: Sonothrombolysis is a therapeutic option to improve the outcomes in patients with acute ischemic stroke due to MCA occlusion.

Imaging has become a cornerstone of stroke management, translating pathophysiological knowledge to everyday decision-making. Plain computed tomography is widely available and remains the standard for initial assessment: the technique rules out haemorrhage, visualizes the occluding thrombus and identifies early tissue hypodensity and swelling, which have different implications for thrombolysis. Based on evidence from positron emission tomography (PET), however, multimodal imaging is increasingly advocated. Computed tomography perfusion and angiography provide information on the occlusion site, on recanalization and on the extent of salvageable tissue. Magnetic resonance-based diffusion-weighted imaging (DWI) has exquisite sensitivity for acute ischaemia, however, and there is increasingly robust evidence that DWI combined with perfusion-weighted magnetic resonance imaging (PWI) and angiography improves functional outcome by selecting appropriate patients for thrombolysis (small DWI lesion but large PWI defect) and by ruling out those who would receive no benefit or might be harmed (very large DWI lesion, no PWI defect), especially beyond the 3-hour time window. Combined DWI-PWI also helps predict malignant oedema formation and therefore helps guide selection for early brain decompression. Finally, DWI-PWI is increasingly used for patient selection in therapeutic trials. Although further methodological developments are awaited, implementing the individual pathophysiologic diagnosis based on multimodal imaging is already refining indications for thrombolysis and offers new opportunities for management of acute stroke patients.