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Stroke is a medical condition in which occluded blood flow to the brain causes cell necrosis. The main types of stroke are ischemic (due to lack of blood flow with much higher prevalence) and hemorrhagic (due to bleeding with low prevalence). Ischemic stroke is caused by the reduction of blood to the brain tissue or complete occlusion of brain vessels by a blood clot following arterial plaques rapture of cerebral arteries due to atherosclerosis, cerebral myocardial infarction and small vascular lesion infarction. Inflammatory reactions, increased oxidative stress, cell death and autophagy are the most aggravating factors in this condition. Instead, hemorrhagic stroke is caused by spontaneous intracranial hemorrhage and subarachnoid hemorrhage, highly common in men. To prevent the possible causes of stroke, investigators attempted to study about the ways that may decrease the risk factors such as trauma, high arterial hypertension, alcohol, low-density lipoprotein and glycerides, tobacco and drugs. Physical activity is a potent inhibitory factor which reported to be effective in prevention of stroke and post-stroke rehabilitation. Aerobic, combined or strenuous activities protect brain tissue by balancing apoptotic and anti-apoptotic pathways, stimulating angiogenesis, reducing oxidative stress, increasing antioxidant activity, optimizing Integrity and preservation of the blood-brain barrier, improving nerve functions and preventing neuronal death. The mechanisms involved in rehabilitation after ischemic stroke with physical activity mostly refer to improved dendrites and synapses, synaptic flexibility, regulation of inotropic receptors with glutamate, increased BDNF, GAP43 and insulin-like growth factor. In patients with cognitive impairments following acute ischemic stroke, high intensity exercise improves processing timing and attention allocation, self-independence, walking ability, aerobic power and reduces memory degradation. Moreover, early start of physical activity after ischemic stroke inhibits the initial physiological response to stroke and prevents optimal recovery. In contrary, reports show positive effects of onset of physical exercise a day after stroke. In hemorrhagic stroke, exercise reduces systolic blood pressure, moderates resting blood pressure via parasympathetic regulations and triggers angiogenesis in the nervous system. Light to moderate or long-term physical training is recommended in comparison to short-term high-intensity training. In addition, early onset of physical activity during recovery after stroke may be beneficial.

Stroke is a medical condition in which occluded blood flow to the brain causes cell necrosis. The main types of stroke are ischemic (due to lack of blood flow with much higher prevalence) and hemorrhagic (due to bleeding with low prevalence). Ischemic stroke is caused by the reduction of blood to the brain tissue or complete occlusion of brain vessels by a blood clot following arterial plaques rapture of cerebral arteries due to atherosclerosis, cerebral myocardial infarction and small vascular lesion infarction. Inflammatory reactions, increased oxidative stress, cell death and autophagy are the most aggravating factors in this condition. Instead, hemorrhagic stroke is caused by spontaneous intracranial hemorrhage and subarachnoid hemorrhage, highly common in men. To prevent the possible causes of stroke, investigators attempted to study about the ways that may decrease the risk factors such as trauma, high arterial hypertension, alcohol, low-density lipoprotein and glycerides, tobacco and drugs. Physical activity is a potent inhibitory factor which reported to be effective in prevention of stroke and post-stroke rehabilitation. Aerobic, combined or strenuous activities protect brain tissue by balancing apoptotic and anti-apoptotic pathways, stimulating angiogenesis, reducing oxidative stress, increasing antioxidant activity, optimizing Integrity and preservation of the blood-brain barrier, improving nerve functions and preventing neuronal death. The mechanisms involved in rehabilitation after ischemic stroke with physical activity mostly refer to improved dendrites and synapses, synaptic flexibility, regulation of inotropic receptors with glutamate, increased BDNF, GAP43 and insulin-like growth factor. In patients with cognitive impairments following acute ischemic stroke, high intensity exercise improves processing timing and attention allocation, selfindependence, walking ability, aerobic power and reduces memory degradation. Moreover, early start of physical activity after ischemic stroke inhibits the initial physiological response to stroke and prevents optimal recovery. In contrary, reports show positive effects of onset of physical exercise a day after stroke. In hemorrhagic stroke, exercise reduces systolic blood pressure, moderates resting blood pressure via parasympathetic regulations and triggers angiogenesis in the nervous system. Light to moderate or long-term physical training is recommended in comparison to short-term high-intensity training. In addition, early onset of physical activity during recovery after stroke may be beneficial. [ABSTRACT FROM AUTHOR]

Coronavirus disease 19 (COVID-19) is one of the deadliest viral diseases that has made serious problems in all aspects of human life since its emergence. The occurrence of neurological problems in the central nervous system (CNS) is one of the most dangerous and disturbing problems in patients with severe types of the disease, which can manifest in various forms including mental disorders, hemorrhagic and ischemic strokes, posterior reversible encephalopathy syndrome (PRES), cerebral venous sinus thrombosis (CVST), general disorders of the CNS (such as seizures, meningitis, encephalitis), peripheral neuropathies (Guillen Barre syndrome and cranial neuropathies), and many post-infection consequences (long-term COVID-19). New findings show that the neural invasion of the SARS-CoV-2 into the CNS can occur through different mechanisms, including entering the olfactory nerve, vascular endothelial contamination, and passing infected leukocytes through the blood-brain barrier (BBB). Better attention and recognition of these disorders can reduce the morbidity and mortality rates of the disease, as well as help in reducing the problems related to patients so that they can return to normal life as soon as possible. Emphasizing the importance of proper clinical management of these disorders in survival and improving the life quality of patients with this disease, the current study reviews the most important findings of studies related to neurological and CNS disorders from COVID-19. [ABSTRACT FROM AUTHOR]

Background: Hypertension is an important and controllable risk factor for heart diseases, stroke, renal failure and peripheral vascular disease. The aim of this study was to determine the level of awareness of patients with hemorrhagic stroke to control blood pressure and to provide solutions to improve patients’ awareness. Methods: This study is a descriptive cross-sectional study that was conducted to evaluate the knowledge of patients with hemorrhagic stroke about the use of antihypertensives. The study population consists of all patients with hemorrhagic stroke, who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran from September 2020 to March 2021. Data related to blood pressure awareness and drug history was completed by the researcher through the method of direct contact with the patients or their relatives. In this study, 17 patients diagnosed with hemorrhagic stroke due to hypertension who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran, were included. The extent of the exact treatment adherence was assessed using the Morisky questionnaire. Results: In this study, the median of patients age was 67 and 10 (58.82%) of them were women. The median systolic and diastolic blood pressures were 170 and 95 mmHg on admission. 4(23.53%) subjects were not aware of the disease. Out of 13 people who were aware of their hypertension, 11(64.71%) were under the supervision of a physician. However, 7(63.64%) of the subjects, despite being under the supervision of a physician and acceptable drug adherence, did not have controlled blood pressure and expired. Conclusion: This study is a warning for patients and health care providers to pay more attention to blood pressure control. Furthermore, educating the community as well as medical staff about the importance of timely diagnosis and accurate treatment of hypertension is highly recommended.

Background: Hypertension is an important and controllable risk factor for heart diseases, stroke, renal failure and peripheral vascular disease. The aim of this study was to determine the level of awareness of patients with hemorrhagic stroke to control blood pressure and to provide solutions to improve patients’ awareness. Methods: This study is a descriptive cross-sectional study that was conducted to evaluate the knowledge of patients with hemorrhagic stroke about the use of antihypertensives. The study population consists of all patients with hemorrhagic stroke, who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran from September 2020 to March 2021. Data related to blood pressure awareness and drug history was completed by the researcher through the method of direct contact with the patients or their relatives. In this study, 17 patients diagnosed with hemorrhagic stroke due to hypertension who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran, were included. The extent of the exact treatment adherence was assessed using the Morisky questionnaire. Results: In this study, the median of patients age was 67 and 10 (58.82%) of them were women. The median systolic and diastolic blood pressures were 170 and 95 mmHg on admission. 4(23.53%) subjects were not aware of the disease. Out of 13 people who were aware of their hypertension, 11(64.71%) were under the supervision of a physician. However, 7(63.64%) of the subjects, despite being under the supervision of a physician and acceptable drug adherence, did not have controlled blood pressure and expired. Conclusion: This study is a warning for patients and health care providers to pay more attention to blood pressure control. Furthermore, educating the community as well as medical staff about the importance of timely diagnosis and accurate treatment of hypertension is highly recommended. [ABSTRACT FROM AUTHOR]

Background and Objective: Hyponatremia is associated with adverse outcomes and increased mortality in acute stroke patients. However, the role of hyponatremia as a negative prognostic indicator has been controversial. This study was conducted to determine the relationship between serum sodium level and impairment and disability in stroke patients in Babol, northern Iran. Methods: This cross-sectional study was conducted in 6 months on 125 stroke patients admitted to Ayatollah Rouhani Hospital in Babol. The National Institutes of Health Stroke Scale and the Modified Rankin Scale were used to determine the impairment and disability caused by stroke. Venous blood was collected to determine the serum concentrations of sodium. The normal ranges were defined as 135-145 mEq/L. Findings: Of 125 stroke patients, 108 cases (86.4%) were ischemic stroke. Eighty-two cases (65.5%) had hyponatremia. The type of stroke showed statistically significant difference with hyponatremia in 14 hemorrhagic stroke cases (17%) versus 68 ischemic stroke cases (83%) (p=0.01). Furthermore, the difference in gender showed statistically significant difference with hyponatremia in 49 women (59%), and 33 men (41%) (p=0.02). In hyponatremic patients, the severity of impairment at admission (p=0.01) and disability at discharge time (p=0.02) was higher than patients with normal sodium serum level. In patients with a history of smoking, 9 cases (21%) had normal sodium level while 33 cases (79%) had hyponatremia (p=0.03). Conclusion: The results of the present study showed that the severity of impairment and disability at the time of discharge in stroke patients is related to serum sodium level. Therefore, paying attention and correcting serum sodium level should be considered more in acute stroke patients.

Background and purpose: Stroke is the most common neurological disease. This study aimed to investigate the relationship between serum C-reactive protein (CRP) as a prognostic factor and ischemic and hemorrhagic cerebrovascular accident (CVA). Materials and methods: This cohort study was performed in patients over 18 years of age with symptoms of ischemic and hemorrhagic CVA attending the emergency department in Mashhad Ghaem Hospital during the first 6 hours of the onset of symptoms. CRP levels and prognosis of serum CRP levels were determined in diagnosing the severity of ischemic and hemorrhagic lesions in CVA patients. The severity of CVA was determined based on MRS and NIHSS scales. Patients' follow-up was considered 6 months later. Results: There were no significant differences between gender and age in study groups (P> 0.05). The median scores for MRS and NIHSS were significantly higher in hemorrhagic patients than ischemic patients. Analysis of CRP level in univariate regression model showed that CRP level is a bad prognosis for stroke (β = 0.149, P= 0.027). Mean age, gender distribution, type of stroke, symptoms, and underlying diseases were not significantly different between the group with and without stroke (P> 0.05). There were significant differences in CRP level and recurrence of stroke after 6 months between the groups studied (P= 0.009). Conclusion: Monitoring of CRP levels can be effective in early diagnosis and control of recurrent stroke.

Background and purpose: Stroke is the most common neurological disease. This study aimed to investigate the relationship between serum C-reactive protein (CRP) as a prognostic factor and ischemic and hemorrhagic cerebrovascular accident (CVA). Materials and methods: This cohort study was performed in patients over 18 years of age with symptoms of ischemic and hemorrhagic CVA attending the emergency department in Mashhad Ghaem Hospital during the first 6 hours of the onset of symptoms. CRP levels and prognosis of serum CRP levels were determined in diagnosing the severity of ischemic and hemorrhagic lesions in CVA patients. The severity of CVA was determined based on MRS and NIHSS scales. Patients' follow-up was considered 6 months later. Results: There were no significant differences between gender and age in study groups (P> 0.05). The median scores for MRS and NIHSS were significantly higher in hemorrhagic patients than ischemic patients. Analysis of CRP level in univariate regression model showed that CRP level is a bad prognosis for stroke (β = 0.149, P= 0.027). Mean age, gender distribution, type of stroke, symptoms, and underlying diseases were not significantly different between the group with and without stroke (P> 0.05). There were significant differences in CRP level and recurrence of stroke after 6 months between the groups studied (P= 0.009). Conclusion: Monitoring of CRP levels can be effective in early diagnosis and control of recurrent stroke. [ABSTRACT FROM AUTHOR]

Background and Objective: Evidence is indicative of the positive effect of citicoline administration in stroke patients; however, there are controversies over this issue. Regarding this, the present study was conducted to investigate the efficacy of citicoline in acute stroke patients. Materials and Methods: This randomized clinical trial was conducted on 160 patients with hemorrhagic and ischemic stroke. The participants were randomly assigned into two groups of intervention and control. The intervention group daily received 1 g citicoline injections for 10 days, in addition to the standard therapy. The baseline severity of the disease was determined by the National Institutes of Health Stroke Scale, and the outcome of the disease was assessed using the Modified Rankin Scale and Barthel Index on the 1st, 10th, and 90th days post-intervention. Statistical analysis was performed using Stata software (version 11.1). P-value less than 0.05 was considered statistically significant. Results: According to the results, there was no significant difference between the two groups in terms of gender, mean age, hypertension, diabetes, smoking, hyperlipidemia, and mortality after stroke (P>0.05). Regardless of the type of stroke, the severity of the disease decreased over time in both groups. However, at the end of the study (the 90th day), the intervention group had lower disease severity, compared to the control group (P

Background & Objectives: Although there is no prolonged time elapsed from propagation of oral contraceptive pills (OCP), case reports demonstrated occurrence of pulmonary embolism and cerebral infarction in women using these pills. Present study was done to specify distributive frequency of oral contraceptive pills consumption in women with cerebrovascular events admitted in Farshchian hospital of Hamadan between 1997 to 2007. Materials & Methods: Every woman with cerebrovascular events during years 1997-2007 who was admitted in Farshchian hospital of Hamadan and her dossier was present in archive of hospital, were carefully checked and those who hadn’t exclusion criteria, were include in this study, a total of 1587 of them with respect to their Characteristics such as type of cerebrovascular event, age, type of oral contraceptive pill and duration of pill use were extracted from patient dossier and registered in respective checklist. Results: 24.1% of patient used oral contraceptive pill and 76.9% of patients were non users. Mean age of OCP users and non users were 45 years. Mean duration of pill use among these patients was 33 months. In assessing type of vascular events, in the group OCP users 73.1% and non users 66.4% had ischemic stroke.Which was statistically significant. In the group OCP users 24.6% and non users 29.1% were hemorrhagic stroke.. Also in the group OCP users 2.3% and non users 4.5% were affected sagital sinuses thrombosis that showed no significant difference. Among OCP users 85% of the patients used OCP, LD and 15% of the patients OCP, HD. Conclusion: The present study showed, the ischemic stroke rate of the patients with OCP consumption were significantly more than those of non users.

Background: Globally, stroke is the second leading cause of death. The aim of the present study was to determine the lipid profile in a group of Iranian patients with ischemic and hemorrhagic stroke. Methods: This study was performed in Alzahra University Hospital (Isfahan, Iran) in 2007. We included subjects with proved ischemic and hemorrhagic stroke. Blood samples were drawn within 24 h of admission for measurement of triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol. Data were analyzed by Student t-test and Mann-Whitney U test. Finding: Two hundred and fifty one patients were included (129 Men and 122 women). Mean age was 69.97 ± 10.63 years. There were 207 patients with ischemic stroke and 44 cases of hemorrhagic stroke. TG was higher in patients with ischemic stroke than in cases with hemorrhagic stroke (133.91 ± 67.84 mg/dl vs. 112.86 ± 40.92 mg/dl, P < 0.01). Patients with hemorrhagic stroke had higher levels of HDL than ones with ischemic stroke (55.43 ± 77.76 mg/dl vs. 39.78 ± 10.52 mg/dl, P < 0.01). LDL was higher in patients with hemorrhagic stroke than in cases with ischemic stroke (131.36 ± 45.98 mg/dl vs. 116.94 ± 40.02 mg/dl, P < 0.05). Mean TC did not differ significantly in two groups of patients. Conclusion: According to the present study patients with hemorrhagic stroke have higher HDL and LDL levels than ones with ischemic stroke. In contrast, TG is found to be higher in ischemic stroke cases than patients with hemorrhagic stroke.

Stroke, though rare in children is among the top 10 causes of death in childhood. Incidence of ischemic and hemorrhagic stroke is the same in children .We report a case of hemorrhagic stroke in a two year old girl who presented with a limp, inability to stand on the left leg and left hemiparesia. Her complaint began 10 days ago after a bout of left clonic seizure. She had been admitted to the hospital for a week due to delayed hemorrhage of the umbilical stump at the age of 18 days. Brain CT scan showed a round, hyper dense area with mass effect in the right supraparietal region. Craniotomy revealed a hemorrhage and report of pathology was hematoma. Considering the delayed umbilical cord bleeding and normality of usual tests for hemostasis and partial deficiency of factor XIII in both parents, the problem was diagnosed as homozygote severe deficiency of factor XIII.

Background and Objective: The aim of this study was to evaluate the effect of albumin in hematom volume after hemorrhagic stroke. Subjects and Methods: The study was conducted in a randomized clinical trial; patients with hemorrhagic stroke in 24 hours of onset were included. Patients were divided into two groups, the first group was treated with intravenous albumin (1 g/Kg) and second group treated similarly with normal saline as placebo. Hematom volume was calculated before and at the end of treatment. Analyzes of data was made using Chi square and T-Test. Level of disability at baseline and end of treatment were compared with the NIHSS. Results: From 61 patients were studied; 31 patients treated with albumin and 30 patients received placebo. Patients were matched for age, sex and risk factors. Mean changes in hematoma volume in the control group was 2.88(SD=1.42)ml and in the placebo group was 1.75(SD=1.27) ml. The differences observed between the two groups was statistically significant (P= 0.002). In the control group the mean change in NIHSS was 2.83(SD=1.26) and the median change was 3 and in the case group the mean change in NIHSS was 1.59(SD=1.21) and the median changes was 1. The difference between the two groups was statistically significant (P <0.001). Conclusion: The results of this study showed that the use of intravenous albumin in patients with hemorrhagic stroke can further reducing the size of the hematoma and the patient's neurological deficits with possible better outcomes. [ABSTRACT FROM AUTHOR]

Background and Objective: The aim of this study was to evaluate the effect of the albumin in clinical function after acute intracerebral hemorrhage. Subjects and Methods: The study was a double-blind clinical trial in two group of patient with hemorrhagic stroke, including those with stroke occurred in the last 24 hours. The first group treated with albumin infusion with total dose of 1 g/Kg body weight for two hours per day and the second group was treated with normal saline with the same dose. The treatment duration was 7 days. Functional outcome of the first day, 8th days and 3 months after treatment were investigated on the basis of NIHSS. By Chi square and T-Test tatistical analyses and evaluation of the effectiveness of the intervention in the two groups were studied. Results: Each arm of study contained 30 patients. Both groups were the similar in age, sex and risk factors. There were not significant difference in mortality rate (P=0.353), hospitalization duration (P=0.343) and hematoma size before (P=0.596) and after (P=0.483) treatment in two groups. NIHSS of the first day (P=0.474) and after 3 months (P=0.095 following treatment did not show significant differences among both groups. However, the result at the 8th day of treatment showed significant differences (P=0.025). Conclusion: The findings of this study confirmed that, intravenous albumin used in the initial days in the patient with hemorrhagic stroke would improve short-term clinical and functional outcome, but this positive effect is diminished in the long-term. [ABSTRACT FROM AUTHOR]

Background: Globally, stroke is the second leading cause of death. The aim of the present study was to determine the lipid profile in a group of Iranian patients with ischemic and hemorrhagic stroke. Methods: This study was performed in Alzahra University Hospital (Isfahan, Iran) in 2007. We included subjects with proved ischemic and hemorrhagic stroke. Blood samples were drawn within 24 h of admission for measurement of triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol. Data were analyzed by Student t-test and Mann-Whitney U test. Findings: Two hundred and fifty one patients were included (129 Men and 122 women). Mean age was 69.97 ± 10.63 years. There were 207 patients with ischemic stroke and 44 cases of hemorrhagic stroke. TG was higher in patients with ischemic stroke than in cases with hemorrhagic stroke (133.91 ± 67.84 mg/dl vs. 112.86 ± 40.92 mg/dl, P < 0.01). Patients with hemorrhagic stroke had higher levels of HDL than ones with ischemic stroke (55.43 ± 77.76 mg/dl vs. 39.78 ± 10.52 mg/dl, P < 0.01). LDL was higher in patients with hemorrhagic stroke than in cases with ischemic stroke (131.36 ± 45.98 mg/dl vs. 116.94 ± 40.02 mg/dl, P < 0.05). Mean TC did not differ significantly in two groups of patients. Conclusion: According to the present study patients with hemorrhagic stroke have higher HDL and LDL levels than ones with ischemic stroke. In contrast, TG is found to be higher in ischemic stroke cases than patients with hemorrhagic stroke. [ABSTRACT FROM AUTHOR]