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Ischemic stroke seems to be one of the most serious neurologic complications in patients with COVID-19 infection. Herein, we report a series of 10 ischemic stroke patients with concomitant COVID-19 disease. Out of 10, 8 had large infarcts (3 massive middle cerebral artery, 2 basilar artery, 2 posterior cerebral artery, and 1 internal carotid artery infarct territory). Two had cardiogenic embolic stroke due to atrial fibrillation. Almost half of our patients did not have a vascular risk factor. Nine did not have fever and were diagnosed with COVID-19 upon admission for stroke. Stroke occurred in the first week of respiratory symptoms with moderate pulmonary involvement. Most Patients did not have hypoxia and did not establish respiratory failure or acute respiratory distress syndrome. The blood pressures were low and hemorrhagic transformation did not occur even after antiplatelet or anticoagulant therapy. Patients had markedly increased levels of lactate dehydrogenase, C-reactive protein, and D-dimer. Three patients died. It seems that ischemic strokes in COVID-19 patients tend to occur as large infarct and can be seen in patients with mild to moderate pulmonary involvement.

Background: Individuals with moderate to severe traumatic brain injury (TBI) often have prolonged cognitive impairments, resulting in long-term problems with their real-life activities. Given the urgent need for evidence-based recommendations for neuropsychological management of Iranian TBI patients, the current work aimed to adapt eligible international guidelines for cognitive assessment and rehabilitation of the TBI patients in Iran. Methods: The project was led by an executive committee, under the supervision of the Iranian Ministry of Health and Medical Education (MOHME). Following a systematic literature search and selection process, four guidelines were included for adaptation. Clinical recommendations of the source guidelines were tabulated as possible clinical scenarios for 90 PICO clinical questions covering all relevant phases of care. After summing up the scenarios, our initial list of recommendations was drafted according to the Iranian patients’ conditions. The final decision-making, with the contribution of a national interdisciplinary panel of 37 experts from across the country, was conducted in two rounds using online and offline survey forms (Round 1), and face-to-face and telephone meetings (Round 2). Results: A total of 63 recommendations in six sections were included in the final list of recommendations, among which 24 were considered as key recommendations. In addition, some of the recommendations were identified as fundamental, meaning that proper implementation of the other recommendations is largely dependent on their implementation. Conclusion: Iranian health policy makers and rehabilitation program managers are recommended to address some fundamental issues to provide the necessary infrastructure to set up an efficient cognitive rehabilitation service system.

The present study aimed to address the effect of Rituximab on the cognitive impairment in patients with secondary progressive MS (SPMS).The present interventional study used a convenience sampling method to select the study participants from SPMS patients. All these patients had progressive disability over the last two years before being admitted in the study. Prior to the administration of Rituximab, the minimal assessment of cognitive function in the multiple sclerosis (MACFIMS) test was performed for each patient who was a candidate to be included in this study. This test was repeated by passing 6 and 12 months from the initial treatment with Rituximab. Since the data needed for this study were obtained at different time intervals, so a linear mixed model was used for their analysis. Analysis of variance (ANOVA) was also used to investigate whether time and sex generally affect the cognitive impairments in SPMS patients. A p-value0.05 was considered as statistically significant in this study.Of the total 35 patients, 34% and 66% were men and women with a mean age of 41.33 and 41.39 years old, respectively. Rituximab showed a significant positive effect on a number of subgroups of MACFIMS test, including Controlled Oral Word Association Test (COWAT) (P-value: 0.038) and Brief Visuospatial Memory Test (BVMT-total) (P: 0.019).The present study revealed that Rituximab has a positive effect on the cognitive impairment resulted from MS in secondary progressive patients.

Background Sleep disturbances are common in neuromyelitis optica spectrum disorder (NMOSD) and have a great impact on patients’ quality of life. According to a report, there is a 64% prevalence of poor sleep quality in NMOSD patients. Therefore, this study was done to evaluate the effect of sleep disturbances on NMOSD acute exacerbations. Materials and Methods This case-control study was conducted at Sina Hospital in 2019. A total of 60 patients with NMOSD diagnosis were enrolled in the study (30 patients were in the remission phase while 30 patients were hospitalized due to acute attacks). Sleep disorders were evaluated in both groups. Sleep quality was assessed during the last month using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Data were analyzed by SPSS software version 21. Results Among 60 patients who were evaluated in both the control and attack groups, 86.7% were female. The duration of the disease was 68.23 ± 42.89 months in the control group and 69.83 ± 6.90 in the attack group. The mean age of patients was 34.15 years old. Sleep quality was unfavorable in 30% and 56% of patients in control and attack groups, respectively. There were significant differences between the two groups in sleep latency, habitual sleep efficiency, sleep duration, and sleep disturbance. Conclusion The present study revealed that there was a significant difference in sleep quality between controls and attack patients and could show a direct relationship between sleep disorders and NMOSD attacks.

Highlights • 90% of MS patients knew that COVID-19 is in a pandemic stage • 73% followed quarantine guidelines completely • All participants believed high person-to-person transmission rate of COVID-19

Neuromyelitis optica spectrum disorder (NMOSD) is known as an autoimmune astrocytopathic disorder involving central nervous system (CNS). The aim of this study was to compare Emotional Intelligence (EI) score between NMOSD patients and healthy individuals, and to find out the possible effect of this disease on EI.A total of 45 NMOSD participants and 48 healthy individuals were enrolled in this study. Demographic information (e.g., gender and age) of all participants as well as their level of education, and data on the patients' duration of disease were collected. EI of each participant was assessed using Persian version of Emotional Quotient inventory (EQ-i) questionnaire.The mean total EI score was significantly different between the participants and controls (322±36.7 vs 338±31.5, p value0.03). Compared to controls, patients had a poor performance in 4 of 15 EI subscales including emotional self-awareness (21.29±3.6 vs 22.85±3, p value0.03), optimism (22.4±4 vs 24.1±3.1, p value0.03), self-regard (22.7±4.6 vs 24.5±3.4, p value0.04), and impulse control (16.9±6.5 vs 19.5±5.5, p value0.05). No difference was found between anti-aquaporin-4 antibody (AQP4-IgG) positive and AQP4-IgG negative patients regarding EI score or its subscale scores, except for self-actualization (p value0.05).Our study showed that EI could be regarded as a tool for understanding emotions, thoughts, and behavior of NMOSD patients. It was implied that taking therapeutic steps could improve the performance of NMOSD patients with EI impairment in social life.

Background: The present study aimed to compare the clinical efficacy and safety profile of Ziferon and Betaferon. Objectives: In total, 41 consecutive patients with relapsing forms of Multiple Sclerosis (MS) were selected from the MS outpatient clinic affiliated to Tehran University of Medical Sciences. The patients were randomly assigned into two groups. Methods: Each group either received Ziferon 250 mcg Subcutaneously (SC) in alternate days or Betaferon 250 mcg SC on alternate days. Clinical and para-clinical outcomes, such as mean relapse rate/year score, mean Expanded Disability Status Scale (EDSS)/year score, the cumulative number, and the volume of gadolinium-enhancing lesions, in addition to the cumulative number of new T2 lesions and safety profile were evaluated for each group during the years of treatment. Results: There were no significant differences in Magnetic Resonance Imaging (MRI) outcomes (change in total lesion volume, new lesion per T2-weighted scan, and gadoliniumenhancing lesions per T1-weighted scan from baseline; P=0.236, P=0.56, & P=0.496, respectively was observed). There was no significant difference in the relapse rate between Ziferon and Betaferon treated groups (P=0.56). There were no unexpected safety events. The number of patients who discontinued the study due to adverse events occurrence was similar between the two groups. Conclusion: Evidence demonstrates the non-inferiority and bio-similarity of Ziferon (interferon beta-1b) to Betaferon in terms of efficacy and safety profile.

Introduction The mortality and morbidity rates of stroke in men and women have been reported differently and its effective factors have been discussed. The purpose of this study was to investigate sex differences in 28-day mortality of ischemic stroke and its associated factors. Materials and Methods This is a prospective cohort study conducted from June 2018 to September 2019 in patients with ischemic stroke referred to Firoozgar, Shariati and Sina hospitals in Tehran. Demographic data, risk factors, disease history, drug use, severity of stroke, and patient functional status were recorded in the hospital. The patients' functional status and severity of stroke were measured using the Modified Ranking Scale (MRS) and the National Institutes of Health Stroke Scale (NIHSS). After 28 days, the patients' survival status was monitored. Logistic regression was used to analyze the data. Results In this study, 703 patients were enrolled; of them, 260 (37.00%) were female and 443 (63.00%) were male. After 28 days, 21 female cases (8.17%) and 26 male (6.08%) ones died (P = 0.299). Functional status (OR = 4.65; 95%CI: 2.09 to 10.38), diastolic blood pressure (OR = 0.91; 95%CI: 0.85 to 0.96), warfarin use (OR = 0.15; 95%CI: 0.04 to 0.55), and hemoglobin (OR = 1.17; 95%CI: 1.02 to 1.35) were associated with 28-day mortality. Poor functional status in men had a greater association with 28-day mortality than women (OR 4.65 vs. 1.64). High diastolic blood pressure had a negative association with the 28-day mortality of cases and this association is more in women than in men (OR 0.88 vs. 0.91). High hemoglobin is a risk factor in men and a protective factor in 28-day mortality in women (OR 1.73 vs. 0.73). Smoking also had a greater association with 28-day mortality in women than men (OR 2.67 vs. 1.2). Discussion Twenty eight-day mortality was more in women than in men, but this difference was not significant. Women were older, had more severe stroke and poorer functional status than men. Variables including functional status, diastolic blood pressure, hemoglobin level, and smoking had interaction with sex, and their association with 28-day mortality rate was different between men and women. Sex differences should be considered, so that we can better manage stroke patients.

Intracranial arterial stenosis (ICAS) is one of the main causes of ischemic stroke According to western epidemiological studies, 8-10% of ischemic strokes are attributable to intracranial stenosis. Three modalities of treatment considered for intracranial atherosclerotic disease include; aggressive medical therapy, endovascular revascularization with angioplasty and stent, and extracranial-intracranial bypass surgery. At present, medical management should be the first line of therapy for the most patients with symptomatic intracranial arterial stenosis. Angioplasty and stenting can be considered in some patients that are unstable or have multiple ischemic events in the territory despite aggressive medical management.

Background Neuromyelitis Optica Spectrum Disorder (NMOSD), commonly characterized by affecting optic nerves and spinal cord can be regarded as one of uncommon diseases of the central nervous system. Although the evidence presented in the literature supports cognitive impairments, psychological aspects of the disease and its association with various manifestations of the disease have not been thoroughly studied. Therefore, the present study was conducted to investigate psychological aspects of patients with NMOSD compared to healthy individuals. Materials and Methods The patients’ demographic information including their age and gender as well as the information about their disease including duration of the symptoms, the age at onset of symptoms, and NMO antibody status were collected using a specific questionnaire. Then, age- and gender-matched control participants that neither themselves nor their relatives had mentioned disease were included in the study. Then, Symptom Checklist-90 (SCL-90) test was administered to both groups. Results A total of 36 patients including 32 females and 4 males participated in the NMOSD group. In the control group, 37 healthy individuals including 30 females and 7 males took part in the study. Findings of the present study indicated that, patients with NMOSD significantly suffered from psychological disorders such as depression, anxiety, hostility, and somatization compared to healthy controls. The phobic anxiety and psychoticism showed trends toward being worse. However, obsessive compulsive symptoms, interpersonal sensitivity and paranoid ideation did not have significant differences between the two groups. Conclusion According to results of the present study, as psychological disorders are common among patients with NMOSD, they should be thoroughly examined to offer more effective therapies in this regard. In addition, the psychological manifestations of NMOSD may influence patients’ relationship, occupation and treatment compliance. So, evaluation of these factors is important in these patients.

Background A large number of multiple sclerosis [MS] patients suffer from cognitive dysfunction affecting their routine life in family and society. Investigating modifiable factors for cognition decline and controlling them, could improve the quality of life in MS patients. Therefore, the present study was aimed to evaluate the association between lipid profile components and cognition in MS patients. Methods A cross-sectional study was conducted on 50 Relapsing-Remitting MS (RRMS) patients referred to Sina hospital, Tehran, Iran. The definite diagnosis of MS was done based on the revised McDonald criteria. Data on demographic and clinical data of patients were obtained. 5 cc blood samples were taken from all subjects after 10-hour night fasting, and lipid profile components including LDL, HDL, triglyceride, and total cholesterol were evaluated. The Persian version of the Minimal Assessment of Cognitive Functions in MS [MACFIMS] battery was administered to assess the cognitive function. Spearman and Pearson correlation tests were applied to investigate the correlation between lipid profile components and MACFIMS subtests or clinical features of MS patients. Results The mean age of subjects was equal to 32.26 years old, and 85% of them were women. There was no significant correlation between MACFIMS subtests results with disease duration, patient's disability according to Expanded Disability Status Scale (EDSS), annual attack rate, and disease-modifying drug onset year (P value >0.05). A significant inverse correlation was found between greater serum total cholesterol and lower scores of Symbol Digit Modalities subtest [SDMT] (P value 0.02; r: −0.31), the Delis–Kaplan Executive Function System [DKEFS] sorting (P value 0.01; r: −0.34) and DKEFS-descriptive (P value 0.04; r: −0.28) subtests. This significant inverse correlation was also found in terms of the correlation between higher serum LDL and impairment in the case of DKEFS-sorting score (P value 0.05; r: −0.27), and DKEFS-descriptive score (P value 0.05; r: −0.27). No significant correlation was found in case of serum HDL or triglyceride and MACFIMS subtests (P value >0.05). Discussion Our findings proposed a possible correlation between the increased serum LDL cholesterol, serum total cholesterol and cognitive dysfunction among MS patients.

Despite updating knowledge and a growing number of medications for multiple sclerosis (MS), no definite treatment is available yet for patients suffering from progressive forms of the disease. Autologous bone marrow derived mesenchymal stem cell (BM-MSC) transplantation is a promising method proposed as a therapy for MS. Although the safety of these cells has been confirmed in hematological, cardiac and inflammatory diseases, its efficacy in MS treatment is still under study. Patients with progressive MS (expanded disability status scale score: 4.0 –6.50) unresponsive to conventional treatments were recruited for this study. Twenty-five patients [f/m: 19/6, mean age: 34.7±7] received a single intrathecal injection of ex-vivo expanded MSCs (mean dose: 29.5×106 cells). We observed their therapeutic response for 12 months. Associated short-term adverse events of injection consisted of transient low-grade fever, nausea /vomiting, weakness in the lower limbs and headache. No major delayed adverse effect was reported. 3 patients left the study for personal reasons. The mean (SD) expanded disability status scale (EDSS) score of 22 patients changed from 6.1 (0.6) to 6.3 (0.4). Clinical course of the disease (measured by EDSS) improved in 4, deteriorated in 6 and had no change in 12 patients. In MRI evaluation, 15 patients showed no change, whereas 6 patients showed new T2 or gadolinium enhanced lesions (1 lost to follow-up). It seems that MSC therapy can improve/stabilize the course of the disease in progressive MS in the first year after injection with no serious adverse effects. Repeating the study with a larger sample size, booster injections and longer follow-up using a controlled study design is advised.

BACKGROUND: Numerous studies have reported higher lipoprotein (a) levels among stroke patients than controls, but it could be due to an acute phase reaction. The aim of this study was to compare lipoprotein (a) levels between patients with ischemic stroke and those with traumatic brain injury. METHODS: In this case control study from February 2010 to September 2010, 43 patients with traumatic brain injury and 48 patients with ischemic stroke aged above 45 years who had a neurologic attack and attended to hospital in less than 3 days were enrolled in the study. Demographic data were registered and lab tests such as lipoprotein (a) were done. The control group was patients with significant head trauma. Blood specimens were taken in less than 72 hours after admission. RESULTS: 91 patients were enrolled (43 with head trauma (female/male: 15/28, age: 39.17 +/- 19.3 years) and 48 with non-cardioembolic ischemic stroke (female/male: 30/18, age: 67.19 +/- 12.65 years)). In patients with stroke, there were no correlations between patients' age and gender with lipoprotein (a) levels. Lipoprotein (a) was significantly higher in patients with ischemic stroke than patients with head trauma (p = 0.012). CONCLUSIONS: The present study demonstrated that lipoprotein (a) level is significantly higher in patients with ischemic stroke than in patients with head trauma and the relation is not related to its inflammatory action. Language: en

There is strong evidence that diabetes mellitus increases the risk of cognitive impairment and dementia. Insulin signaling dysregulation and small vessel disease in the base of diabetes may be important contributing factors in Alzheimer’s disease and vascular dementia pathogenesis, respectively. Optimal glycemic control in type 1 diabetes and identification of diabetic risk factors and prophylactic approach in type 2 diabetes are very important in the prevention of cognitive complications. In addition, hypoglycemic attacks in children and elderly should be avoided. Anti-diabetic medications especially Insulin may have a role in the management of cognitive dysfunction and dementia but further investigation is needed to validate these findings.

In patients with severe concurrent coronary and carotid artery disease, two different treatment strategies may be used: simultaneous endarterectomy and coronary bypass surgery, and carotid stenting with delayed coronary bypass surgery after a few weeks. To evaluate the safety and efficacy of carotid stenting with delayed coronary bypass surgery after a few weeks in patients referred to Tehran Heart Center, Tehran, Iran and to determine the independent predictors that may be used to identify the appropriate treatment plan for such patients.This prospective study was performed from December 2003 through October 2004. Symptomatic patients with60% stenosis and asymptomatic patients with80% stenosis were included in this study. The risks and benefits of carotid stenting were explained. Patients were excluded from the study if any of the following was applicable: ageor =85 years, history of a major stroke within the last week, pregnancy, intracranial tumor or arteriovenous malformation, severely disabled as a result of stroke or dementia, and intracranial stenosis that exceeded the severity of the extracranial stenosis. Thirty consecutive patients who underwent carotid stenting were enrolled in this study.The mean +/- SD age of patients was 66.3 +/- 8 years. The procedural success rate was 96.7%. During a mean +/- SD follow-up period of 5.6 +/- 3.2 months, 4 (17%) deaths occurred; none of which were attributed to a neurologic causes. Moreover, 1 (3%) patient developed a minor nonfatal stroke with transient cognitive disorder. Most of patients (80%) with major complications acquired a score ofor =26.To reduce the rate of carotid stenting complications in high-risk patients with heart disease, to optimize the patient selections, and to determine the best treatment strategy, based on the clinical and lesion characteristics of patients, we proposed a new scoring system.