Mazyar Hashemilar; Parla Tohidi; Nasrin Forghani; Elyar Sadeghi-Hokmabadi; Ehsan Sharifipour
Abstract
Background: Cerebral border zone infarctions (BZIs) are a subtype of acute ischemic stroke that occur at the junction between two major cerebral arterial territories. Internal and external BZIs are defined based on the known patterns in brain magnetic resonance imaging (MRI). However, the etiology and ...
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Background: Cerebral border zone infarctions (BZIs) are a subtype of acute ischemic stroke that occur at the junction between two major cerebral arterial territories. Internal and external BZIs are defined based on the known patterns in brain magnetic resonance imaging (MRI). However, the etiology and pathophysiology of these two types of BZI are still debated. This study aimed to determine the etiologic differences of two types of BZI to guide tailor appropriate treatment strategies for these patients.Methods: In this prospective study, patients with BZIs were enrolled from patients with acute ischemic stroke admitted to the hospitals affiliated with Tabriz University of Medical Sciences, Tabriz, Iran, from 2017 to 2019. Appropriate clinical and laboratory workups were applied to determine possible etiologies of ischemic stroke according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system.Results: The study included 106 patients with BZI, 53 patients in each group. Both types of BZI were more frequent in males. However, there was no significant difference between the two types concerning sex, age, and profile of major stroke risk factors. The results showed no correlation between the type of BZI and hemodynamic factors (P = 0.086). However, large artery atherosclerosis (LAA) was the most frequent etiology within each subtype of BZI; LAA in internal (P = 0.016) and cardioembolism (P = 0.046) in external BZI were more frequent etiologic subtypes of cerebral infarction.Conclusion: LAA might be the most common etiology for internal and external cerebral BZIs. Cardioembolism might have a more important etiologic role in the external subtype.
Mazyar Hashemilar; Afshin Partovi; Nasrin Forghani; Ehsan Sharifipour
Abstract
Background: Atherosclerotic involvement of large and small cerebral arteries leading to infarction is among the most prevalent subtypes of stroke worldwide. The hemodynamic changes due to these arterial pathologies can be studied non-invasively and in real-time by using transcranial Doppler (TCD) techniques. ...
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Background: Atherosclerotic involvement of large and small cerebral arteries leading to infarction is among the most prevalent subtypes of stroke worldwide. The hemodynamic changes due to these arterial pathologies can be studied non-invasively and in real-time by using transcranial Doppler (TCD) techniques. TCD indices of the studied arteries may guide the clinician in differentiating these two underlying arterial pathologies. Methods: A cross-sectional study of patients with small and large vessel types of cerebral infraction based on the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) stroke classification was undertaken in the inpatient population of neurology service of Razi Hospital, Tabriz, Iran, from October 2018 to October 2019. After clinical diagnosis, all cases underwent TCD studies, brain magnetic resonance imaging (MRI), and brain and cervical four-vessel magnetic resonance angiography (MRA). The results of TCD indices related to major arteries of the circle of Willis were tabulated and compared between large and small vessel subtypes of cerebral infarction. Results: A statistically significant difference between right middle cerebral artery (MCA) pulsatility index (PI), left MCA PI, right internal carotid artery (ICA) PI, end-diastolic velocity (EDV), left ICA PI, left ICA EDV, left anterior cerebral artery (ACA) PI, and right vertebral artery (VA) PI measures of the two groups was seen (P < 0.05). In comparison to the large vessel group, left ACA, right VA, and bilateral MCAs and ICAs in the small-vessel stroke group demonstrated an elevated PI. Conclusion: A significant increase of PI occurs in the majority of intracranial arteries of patients with small vessel stroke. This makes PI a valuable marker for differentiating strokes with different underlying pathophysiologies.
Mazyar Hashemilar; Saeid Charsouei; Darioush Savadi-Oskouei; Elyar Sadeghi-Hokmabadi; Mohammad Farzipour
Abstract
Background: Psychogenic non-epileptic seizures (PNES) are manifested as paroxysmal alterations in motor, sensory, autonomic, and/or cognitive and behavioral signs and symptoms, without associated ictal epileptiform discharges. A misdiagnosis of PNES as epilepsy results in a prolonged and unnecessary ...
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Background: Psychogenic non-epileptic seizures (PNES) are manifested as paroxysmal alterations in motor, sensory, autonomic, and/or cognitive and behavioral signs and symptoms, without associated ictal epileptiform discharges. A misdiagnosis of PNES as epilepsy results in a prolonged and unnecessary (antiepileptic) drug treatment and social and psychological stigma of epilepsy in these patients. This study aimed to determine the epidemiology, clinical manifestations, and associated factors of PNES in hospitalized patients in the video-electroencephalography (EEG) monitoring (VEM) service of Razi Hospital, Tabriz, Iran. Methods: In this cross-sectional descriptive study, 55 patients with a final diagnosis of PNES were selected from the patients referred to the VEM unit of Razi Hospital for the evaluation of epilepsy. The study was performed from May 2017 to June 2019. Patient information included demographic data and medical history (drug history, comorbidities, trauma, and family history). The clinical manifestations (semiology and duration of attacks) and EEG findings, as recorded by VEM during hospitalization, were collected. Results: 55 patients with PNES were studied with VEM, 27 (49.1%) of which were men, and 28 (50.9%) were women. The mean and standard deviation (SD) of age of the patients was 34.16 ± 12.64 years. No significant differences were observed in the semiology of PNES between men and women. Depression was the most common psychiatric comorbidity. Conclusion: The clinical manifestations of PNES in the present study were similar to those in most previous studies from other countries. The culture and sex of the patients did not seem to be a contributing factor in PNES semiology.
Mehdi Farhoudi; Homayoun Sadeghi-Bazargani; Mazyar Hashemilar; Manouchehr Seyedi-Vafaee; Elyar Sadeghi-Hokmabad; Reza Rikhtegar; Babak Saber-Maroof; Mohammad Abutalebi; Mahsa Rezaei; Sahar Vaferi; Alireza Aghili; Omid Ebrahimi; Alireza Majdi; Mohammad Hasan Mokhtare; Hadiseh Kavandi; Hadi Ahmadi; Ramak Barnous
Volume 16, Issue 3 , July 2017, , Pages 112-117
Abstract
Background: Stroke is the second most common cause of death and first cause of disability in adults in the world. About 80% of all stroke deaths occur in developing countries. So far, the data on stroke epidemiology have been limited in Iran. Therefore, this study was focused on stroke demographic data, ...
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Background: Stroke is the second most common cause of death and first cause of disability in adults in the world. About 80% of all stroke deaths occur in developing countries. So far, the data on stroke epidemiology have been limited in Iran. Therefore, this study was focused on stroke demographic data, risk factors, types and mortality.Methods: A retrospective study was done in two university tertiary referral hospitals in Tabriz, northwest of Iran, from March 2008 to April 2013. Patients diagnosed with stroke were enrolled in the study. Demographic data, stroke subtypes, duration of hospitalization, stroke risk factors and hospital mortality rate were recorded for all the patients.Results: A total number of 5355 patients were evaluated in the present study. Mean age of the patients was 67.5 ± 13.8 years, and 50.6% were men. Final diagnosis of ischemic stroke was made in 76.5% of the patients, intra-cerebral hemorrhage (ICH) with or without intra-ventricular hemorrhage (IVH) in 14.3% and subarachnoid hemorrhage (SAH) in 9.2%. Stroke risk factors among the patients were hypertension in 68.8% of the patients, diabetes mellitus (DM) in 23.9%, smoking in 12.6% and ischemic heart diseases (IHD) in 17.1%. Mean hospital stay was 17.3 days. Overall, the in-hospital mortality was 20.5%.Conclusion: Compared to other studies, duration of hospital stay was longer and mortality rate was higher in this study. Hypertension was the most common risk factor and cardiac risk factors and DM had relatively lower rate in comparison to other studies. Because of insufficient data on the epidemiology, patterns, and risk factors of stroke in Iran, there is a necessity to develop and implement a national registry system.
Sousan Salehi; Ali Jahan; Najva Mousavi; Mazyar Hashemilar; Zohreh Razaghi; Maryam Moghadam-Salimi
Volume 15, Issue 4 , October 2016, , Pages 183-188
Abstract
Background: As there is no standard aphasia screening tool for Azeri language yet, the aim of this study was to develop an aphasia screening test with acceptable validity and reliability.Methods: The present study was conducted in two phases. In the first phase, by literature search, the screening test ...
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Background: As there is no standard aphasia screening tool for Azeri language yet, the aim of this study was to develop an aphasia screening test with acceptable validity and reliability.Methods: The present study was conducted in two phases. In the first phase, by literature search, the screening test was designed and to obtain validity it was peer reviewed by expert panel. After collecting experts’ ratings and comments, appropriate modifications were applied. For test-retest reliability in the second phase, edited test was administered in 32 patients with brain injuries, then the retest was performed two weeks later.Results: The developed test had eight subscales including: A) picture description, B) syntax, C) linguistic reasoning, D) descriptive naming, E) perception of minimal pairs, F) comprehensive vocabulary, G) expressive vocabulary, H) verbal fluency. Each section had five questions except verbal fluency which had 3 items. Content validity ratio (CVR) according to Lawshe’s approach, was 82% for the whole test. Intraclass correlation for all subscales were more than 0.8. Cronbach’s alpha coefficient for internal reliability was 0.901.Conclusion: This aphasia screening test seems to have acceptable psychometric properties. This test can probably be used in clinical setting by specialists.
