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Background: A variety of ECG changes occur as an aftermath of stroke. Prolongation of the QTc interval is a well-documented change. We analyzed QTc interval prolongation among patients with acute hemorrhagic strokes. Methods: This observational study was conducted at the Emergency Department of Sulaymaniyah General Teaching Hospital and Shar Hospital from September 1st, 2014 to August 31st, 2015. Fifty patients who developed acute spontaneous hypertensive intracerebral hemorrhage (ICH) and 50 patients who developed acute non-traumatic subarachnoid hemorrhage (SAH) were included in the study. All patients underwent resting 12-lead ECG within half an hour of admission. The QTc interval was calculated and analyzed in those 100 patients. Results: Females (62%) outnumbered males (38%) with a female to male ratio of 1.6:1. Forty percent of the patients were between 60-69 years of age. Hypertension was seen in 82% of patients while left ventricular hypertrophy was documented in 40% of patients. The QTc was prolonged in 38 patients (17 patients in the ICH group and 21 patients in the SAH group). In both groups, males demonstrated QTc prolongation more than females. However, there were no statistically significant gender difference between both groups and within the same group. There was a statistically significant association between SAH and QTc prolongation (p-value

Introduction: Many electrocardiographic (ECG) changes have been observed after strokes. We analyzed the QTc interval prolongation following stroke. Aim: The study aimed to assess if the prolongation in QTc interval is related to the occurrence of acute ischemic stroke. Methods: This cross-sectional study was conducted from July to December 2018. We included 100 consecutive patients with first-ever ischemic stroke who were admitted to our emergency department, who were age-matched and gender-matched with a control group of 100 non-stroke patients that visited our outpatients department for diseases other than cerebrovascular or cardiovascular ones. A single 12-lead resting ECG examination was done in all patients at the time of their emergency department admission. Results: No significant difference between the two groups regarding the age distribution and mean age was found. 56.5% of the sample were males but the difference was not significant between both gender groups. The main presenting symptoms of stroke cases were right-sided weakness (47%), left-sided weakness (36%), and right-sided weakness and aphasia (10%). 34% of the cases had prolonged QTc interval while none of the controls had a prolonged interval (p-value

Ischemic strokes in the territories of the anterior cerebral arteries are rare and account for 0.5 to 3.0% of all ischemic strokes1. The recurrent artery of Heubner and medial striate arteries arise near the origin of the anterior communicating artery and supply the anteromedial portion of the caudate nucleus as well as the anterior limb of the internal capsule. The caudate nucleus receives an overlapping blood supply from the lateral lenticulostriate arteries (middle cerebral artery), anterior lenticulostriate arteries (anterior cerebral artery), and recurrent artery of Heubner (anterior cerebral artery)2.

Background: Pregabalin is a well-tolerated medication that is commonly used in the treatment of chronic pain, epilepsy, fibromyalgia, and generalized anxiety disorders. A variety of pregabalin-related cardiac side effects have been described in the literature and first-degree AV block is a well-known consequence. We aimed to investigate whether pregabalin prolongs the PR interval or not.Methods: This cross-sectional observational study was conducted at the Shorsh Military General Teaching Hospital, Iraq. A total of 80 patients, who had a multitude of cervical and lumbosacral radiculopathies were enrolled consecutively, from November 1, 2017, to January 31, 2019. Forty patients who were receiving pregabalin (the treatment group) were age-matched and gender-matched with another group of 40 patients who hadn’t been prescribed pregabalin (the control group). A single 12-lead ECG was done in all patients and the PR interval was calculated; a value of >0.20 second is considered a prolongation in the PR interval and defines first-degree AV block.Results: Thirteen patients (32%; 7 males and 6 females) demonstrated a prolongation in the PR interval in the pregabalin arm while the PR interval was prolonged in 5 patients only in the control group (12%; 2 males and 3 females). There was no statistical difference between the maximum PR prolongation in both groups (p-value=0.13; 95% CI, -0.0121 to 0.0317).Conclusions: This study hasn’t found a statistically significant prolongation in the PR interval among patients taking oral pregabalin monotherapy. Whether this observation is clinically significant or not, it needs further analytic studies to uncover its importance.

Background: In elderly people, falls have been recognized as one of the major causes of disability and potentially preventable mortality. Authors analyzed the incidence of falls in elderly diabetic people who have been receiving insulin therapy versus those on oral hypoglycaemic agents (OHGAs). Methods: This observational study was conducted at the department of neurology of Shorsh military general teaching hospital and its outpatients’ department, Iraq, from April 1 st to September 30 st , 2016. A total of 100 diabetic patients older than 65 years of age, who had a history of one or more falls, were included in the study. The duration of diabetes, mode of its treatment, and its complications all were analyzed in addition to the risk factors for falls. Results: Females (n=57) outnumbered males (n=43) and the mean age of the patients was (71.2±3.6) years. Increasing patient’s age, long-standing diabetes, poor glycaemic control, insulin therapy, and polypharmacy (of 3 and more antidiabetic agents) were significantly and statistically encountered and associated parameters for the risk of falls. The presence of additional risk factors for falls (e.g., previous stroke, alcoholism, cardiac dysrhythmia, and osteoarthrosis) augmented this risk. Conclusions: Diabetes and its treatment render older people more liable for falls. The longer duration of the disease and the higher patients’ age (which were the commonest risks) are irreversible and non-correctable parameters for falls. Further analytic studies are required to unveil the role of each risk factor authors have detected.

Background and objective: Early reperfusion has been shown to improve left ventricular function (LVF) and survival after acute myocardial infarction (AMI). We aimed to evaluate the influence of thrombolytic therapy (TT) on LVF in patients with AMI. Methods: This study involved 100 patients who were diagnosed with acute ST-segment elevation myocardial infarction (STEMI). Patients were allocated into 2 groups; group I (n=50 patients) who received intravenous TT, and this was further subdivided equally into groups Ia and Ib; and group II (n=50), who did not receive TT. An echocardiographicderived measurement of LVF at the end of the first and 6th weeks of the event was assessed. A left ventricular ejection fraction of ≥ 55% was considered a normal systolic function. Results: After adjusting for age and gender, approximately 85% of group Ia patients and 50% of group Ib patients demonstrated an EF of ≥ 55% while only 16% of patients in group II had an EF of ≥55%, regardless of the infarcted area/site. Conclusion: Thrombolytic therapy significantly improved LVF in patients with STEMI when it was administered within 12 hours of symptoms onset, than in those who did not receive this form of therapy.

Introduction More than 6000 years ago, the cradle of civilization, Mesopotamia, grew-up in what is known today as Iraq. The history of cerebrovascular diseases in Mesopotamia is insufficient to supply scholar needs. Therefore, the goal of this review is to highlight some remarkable points in the history of what we may coin as "stroke medicine" during the ancient Mesopotamian eras and to explore the knowledge and expertise of ancient healers. The neo-Sumerian period (2112-2004 BCE) documented, through clay tablets, many medical records about two kinds of medical specialists; the āsipu (exorcists) and the asu (physician-priests). Methods and findings The information herein was gathered through literature review using online resources, such as NCBI, Google Scholar, PubMed, UCLA, and HINARI. Initially, most of the knowledge we have got was acquired mainly from two well-known transliterated cuneiform texts. Both tablets had clearly addressed stroke. One tablet, part of the "diagnostic" series is currently in the Louvre Museum in Paris, while the other one is in the British Museum in London and is part of the "therapeutic" series. The Mesopotamians had noticed and documented vascular disorders of the brain and some pertinent diseases. The asu and the āsipu demonstrated an observational knowledge of anatomy and but no knowledge of the nervous system, the concept of pathology, or physiology as we call them today. Not all paralysis cases were viewed as a curse or an impact incurred by a supernatural deity. Physical treatment was mentioned to the patients. The familial occurrence of stroke was a well-known trait in that ancient period. Conclusion This descriptive review tells us that the history of stroke in the medical practice was well-encountered in the first half of the second millennium BCE and that physicians were keen observers to describe stroke presentation and prognosis.

Bilateral internal carotid artery occlusion (BICAO) is a rare disease that carries a gloomy prognosis. We report a case of a 52-year-old man who developed ischaemic infarction at the region of the right middle cerebral artery; he was found to have atherosclerotic occlusion of both internal carotid arteries on Doppler-duplex examination. He received medical treatment only. After 1 year, he developed a new infarction at the region of the left middle cerebral artery. Conventional angiography revealed bilateral occlusion of internal carotid arteries at their origin, approximately 50% stenosis of the common carotid bulbs and mild stenosis of the origin of external carotid arteries. The patient did not undergo any form of surgical revascularisation procedures and died of severe aspiration pneumonia approximately 2 months after the second stroke. BICAO portends a poor outcome and carries a risk of recurrent ischaemic events. The best management strategy for this vascular occlusion remains unclear.

Pancreatic insulinomas are rare endocrine tumors and their diagnosis needs a high index of suspicion. Several patients receive an initial misdiagnosis before the tumor is being finally detected. We report on two patients who presented with vague and bizarre personality and behavioral changes. One patient was initially diagnosed with hysteria and both eventually were diagnosed with complex partial epilepsy. They had not improved on anti-epileptic medications and their symptomatology continued to deteriorate. Their final diagnosis turned out to be pancreatic insulinoma. Because of the rarity of insulinomas as well as their diverse and non-pathognomonic symptoms, the diagnosis remains challenging and may quite well escape detection unless it is entertained., Pankreatik insülinom nadir görülen endokrin tümörü olup teşhisi ciddi anlamda yüksek şüphe gerektirmektedir. Hastaların çoğuna son aşamada gözlenen tümör bulgusundan önce yanlış teşhis konulmaktadır. Bu raporda belirsiz ve şüpheli davranış gösteren iki hastayı ele aldık. Hastanın birine ilk olarak histeri teşhisi konmasına ragmen sonunda her ikisine birden karışık kısmi epilepsi tanısı kondu. Her ikisine anti-epileptik ilaçlar verilmesine rağmen iyileşme gözlenmedi ve belirtileri bu durum daha kötü hale gelene kadar devam etti. Son olarak pankreatik insülinom hastası oldukları ortaya çıktı. İnsülinomlar farklı ve patognomonik olmayan belirtilerinin yanı sıra nadir görülmelerinden dolayı oldukça zor teşhis edilmektedirler ve çok belirgin olmadıkça gözden kaçabilmektedirler.

A 55-year-old man with hypertension was referred from a rural hospital. Two days before, he had developed a cardioembolic ischaemic stroke, which resulted in left-sided hemiparesis and hemianaesthesia. On the day of referral, he developed repeated vomiting and severe headache, followed by progressive obtundation and coma. There was papilloedema. Both planter reflexes were extensors. A non-contrast CT brain scan was done (figure 1). The initial CT brain scan was not available for comparison. The patient was outside the international guidelines on timing of decompressive hemicraniectomy (DCH) for ischaemic stroke and was extremely unwell. After a few hours, he died from ‘malignant middle …

A woman aged 71 years with hypertension developed sudden severe headache and right-sided weakness. The blood pressure was 210/135 mm Hg. She was drowsy. Examination revealed right-sided upper motor neuron facial weakness, hemiparesis, hemi-anaesthesia and extensor planter reflex. Urgent non-contrast CT brain scan was done as shown in figures 1 and 2. Figure 1 Urgent, non-contrast, axial brain CT scan of the patient. There are two left-sided hyperdense lesions which are indicative of acute intracerebral haemorrhages. Figure 2 Urgent, non-contrast, axial brain CT scan at the level of basal ganglia and thalami. There are …

A woman aged 70 years presented with several years' history of low back pain and bilateral lower limb pains. Her menstrual cycles ceased when she was 44 years of age. Plain X-ray of the lumbosacral spine revealed diffuse osteoporotic changes (figure 1). A battery of investigations was performed; the only abnormal results were slightly raised serum alkaline phosphatase (probably from vertebral fractures) and very low-serum 25-hydroxyvitmain D. Lumbosacral spine MRI was ordered (figure 2) and revealed several codfish vertebrae in addition to lumber spinal …

Amaç: Çeşitli çalışmalar, periferal arterler üzerinde romatoid artrit etkisini (RA) değerlendirmeyi araştırmış ve intimal kalınlaşmanın geç gelişimi ve ateroskleroz arasında bir ilişki bulmuştur. Biz romatoid artrit hastalarında subklinik periferik damar hastalığının (PVD) yaygınlığını ortaya çıkarmayı denedik. Materyal ve Metod : Bu vaka kontrol çalışmasına romatoid tanısı almış 60 hasta dahil oldu. Kırk yaş, cinsiyet ve vücut kitle indeksi uyumlu sağlıklı bireyler kontrol grubu olarak seçildi. Tüm katılımcılar sigara içmeyen, hipertansif ve diyabet olmayan, normal lipid profiline sahip bireylerdi. Periferik arter hastalığı varlığı alt ekstremitenin her arter düzeyinde ayak bileği-kol basınç indeksi (ABPI) ölçülerek değerlendirildi. 0.9 ≤ indeks anormal olarak kabul edildi ve PVD" nin altında yatan olası bir yansıma olduğu düşünüldü. Bulgular: 40 kontrol bireyin sadece 3"ünün (% 7.5) anormal sonuçları (p-değeri

Left ventricular hypertrophy (LVH) has been proposed to be associated with an increased risk of stroke. We compared the prevalence of LVH among patients with first-ever ischemic versus first-ever hemorrhagic strokes.This observational study, which was conducted at the Sulaimaniya general teaching hospital from November 2009 to March 2012, involved 100 consecutive patients with their first-ever stroke. Fifty patients had ischemic stroke while the rest (n = 50) developed hemorrhagic stroke. The presence of LVH was detected using transthoracic echocardiography and a comparison with respect to its prevalence between the 2 aforementioned groups was made.The mean age of patients in the hemorrhagic group was 61.7 +/- SD 11.2 years while in the ischemic group it was 63.9 +/- SD 6.1 years. Out of 100 patients, 66 (66%) patients were males (31 in the hemorrhagic group and 35 in the ischemic group) while the rest (n = 34; 34%) were females (19 in the hemorrhagic group and 15 in the ischemic one). Ninety one (91%) patients were hypertensive (47 in the hemorrhagic group and 34 in the ischemic group). Fifty three (53%) out of 100 patients demonstrated LVH (31 in the hemorrhagic group and 22 in the ischemic group). A head-to-head comparison between the two groups with respect to gender demonstrated no statistically significant difference in terms of the presence of LVH among patients with hemorrhagic versus ischemic strokes; males (P value0.26; 95% CI 3.4-39.3); females (P value0.43; 95% CI 16.7-43.8). However, a univariate analysis after correction for age and gender revealed a statistically significant difference between these groups (P-value0.001; 95% CI 2.7-46.2).LVH was more common in Kurdish patients with first-ever hemorrhagic stroke than in those who had sustained their first-ever ischemic stroke. Further analytic studies are required to clarify the prevalence of LVH in patients with ischemic stroke.

An 11-year-old girl was admitted to our acute and emergency department with a 12-h history of confusion and non-responsiveness. There was no fever or neck stiffness. The parents denied any history of head trauma. She was diagnosed with grand mal epilepsy at the age of 7 years and completed a 2-year course of oral sodium valproate. The patient's mother stated that for the last 2 years she was seizure-free. Routine blood tests, toxicology screen, 12-lead ECG and CT brain scanning were unremarkable. Therefore, she was diagnosed with acute …

A 34-year-old man developed three generalised seizures over a period of 2 weeks. He had generalised rigidity and mild bilateral symmetrical resting tremor. His deep tendon reflexes were normal with downward planter reflexes. His elder brother noticed that the patient had a progressive cognitive decline over the past few years. He resides in a village and works in a grocery store. His blood tests, including serum calcium, phosphate, alkaline phosphatase and parathyroid hormone, were within their normal …

A 47-year-old Iraqi Kurdish woman presented with a 1-day history of sudden onset of frequent, intermittent and painful abdominal wall jerky movements, 6 days after undergoing haemorrhoidectmy. During sleep, these movements were absent. The postoperative period was uneventful and the patient was discharged home on day 2 with oral clindamycine and metronidazole. The appearance of these movements prompted the AE the surgeon …

A 52-year-old right-handed hypertensive patient presented with sudden onset of dense flaccid left-sided weakness. There was atrial fibrillation, dysarthria, moderate left-sided facial weakness, left sensory hemineglect and left extensor planter. Her CT brain scan showed a hypodense comma-shaped area at the right basal ganglia. Her brain MRI (figure 1) and MR angiography (figure 2) were obtained on day 2 of admission. Figure 1 Axial T2-weighted MRI of our patient with right-sided striatocapsular infarction at the level of basal ganglia on day 2 of admission. Note the right-sided hyperintense comma-shaped sign that represents the infarcted right putamen–globus pallidus, anterior …

An 8-year-old girl had been experiencing a progressive impairment in stance and gait since the age of 20 months and a diagnosis of ataxic cerebral palsy was given accordingly. She had recurrent upper respiratory tract infections over the past few years. Her mother noted that the patient's eyes were red and her paediatrician told her that this is a chronic allergy (figure 1). The girl demonstrated a good sense of …

A 65-year-old woman comes for headache management. Few years ago, she was diagnosed with a ‘single benign tumour of the anterior part of the brain’. A new contrast CT brain scan was done (figures 1 and 2); as she was claustrophobic, brain MRI was not ordered. The mass they have referred to was most likely a falcine meningioma. In addition, there is an oval hyperdense mass at the right temporal area, which is diffusely and homogenously calcified and seems to sit on the pertrous temporal bone, a finding that may well refer to another meningioma. Figure 1 Contrast CT brain scanning of the patient. Note the …

Hypertensive intracerebral haemorrhage is usually a once in a lifetime event and recurrences are rare. Most recurrences usually develop within 2 years of the first event and the majority usually target the basal ganglia and thalami. Failure of blood pressure control is the most important, potentially preventable, culprit behind the development of primary intracerebral haemorrhages. However, the occurrence of a recurrent bleed in patients with optimally controlled hypertension should always prompt the physician to think of a new co-operating factor. We report on a 60-year-old hypertensive woman who developed right-sided thalamic haemorrhage 5 days after sustaining a lacunar infarct of the left thalamus for which she had been prescribed a dual antiplatelet therapy: aspirin and clopidrogrel. She had a history of two bilateral sequential hypertensive deep cerebellar haemorrhages which were developed 2 years ago.

Ischaemic stroke syndromes in the vascular territory of middle cerebral artery may have atypical presentation and radiographic findings because of the variable anatomy of that artery. Therefore, misdiagnosis of these syndromes as neoplastic or infectious processes is not uncommon. This case describes a 69-year-old comatose woman who was referred to us as having ‘a brain tumour with massive surrounding oedema.’ Further work-up revealed that she had a large left-sided lenticular nuclear infarction with some extension into the surrounding areas—the striatocapsular infarction.

Artery of Percheron is a normal variant of the paramedian branches of posterior cerebral artery. This artery supplies the paramedian areas of the thalami and upper midbrain. Occlusion of this artery is rare and results in a multitude of neurological signs and symptoms, which might prompt the physician think of an aetiology other than vascular insults, and therefore change the management plan. The authors report two ischaemic strokes, which developed because of this arterial occlusion; their presentation differed from each other.

Intracranial arachnoid cysts are rare but the widespread use of brain imaging has disclosed many asymptomatic cysts. The authors report the case of a 37-year-old woman who presented with features suggestive of relapsing–remitting multiple sclerosis (MS). Her brain MRI revealed a moderately large arachnoid cyst in the right frontal area in addition to the periventricular plaques of MS. The cyst was an incidental imaging finding and the patient was asymptomatic prior to the development of MS.

Cystic meningioma is an uncommon form of meningioma and the radiological appearance and location of the cystic/solid components of the mass may create a diagnostic dilemma. We report on the case of an 80-year-old left-handed man who presented with recurrent focal motor seizures and secondary generalisation. A large left-sided parieto-occipital cystic mass was detected on contrast CT of the brain. The appearance suggested a malignant tumour. However, brain MRI with gadolinium delineated the solid and cystic component precisely. A provisional diagnosis of cystic meningioma was made and this was confirmed histologically after resecting the tumour surgically. It was a benign WHO Grade I fibroblastic meningioma. The preoperative diagnosis of cystic meningioma is not that straightforward. Brain MRI with gadolinium has a better diagnostic yield than CT scanning. Histopathological examination of the tumour cells should always be performed to confirm the category and subtype of the tumour.

We report on the case of 71-year-old woman who had been experiencing pancephalic headache, progressive cognitive decline, and vague behavioural changes for few years. The family denied seizures. Her brain imaging revealed the presence of two frontal lobe meningiomas. One was typically benign-looking and located within the left frontal convexity. The other one was at the left frontal convexity and was surrounded by marked oedema; the appearance of the latter is consistent with secretory meningioma. The patient did not demonstrate any risk factors for multiple meningioma formation. She was illiterate and lived in a village near the Iraq-Iran border; this explained her relatively late presentation. To the best of our knowledge, this combination of two radiologically different meningiomas has never been reported in the pertinent medical literature.