BackgroundA high prevalence of epilepsy in children is frequently found in developing countries.ObjectiveThis study aimed to determine the prevalence and clinical pattern of childhood and adolescence epilepsy in Upper Egypt.MethodsThis is a door-to-door study conducted on all inhabitants < 18 years in Al Kharga district and Al Qusier city (36,195 subjects). The study was conducted through two stages; every stage consisted of two phases (screening and diagnostic).ResultsLifetime prevalence of childhood and adolescence epilepsy (children < 18 years) in Upper Egypt was 9.7/1000, with higher prevalence among children < 12 years (10.8/1000) than adolescents (7.2/1000). The age-specific prevalence was highest in early childhood (12.01/1000) and least at adolescence (7.2/1000). More than half of the patients (59.4%) had idiopathic epilepsy. The most frequent etiology for structural/metabolic epilepsy was perinatal complications, particularly in infancy, followed by central nervous system (CNS) infections, in childhood, and post-traumatic epilepsy in adolescence. Partial seizures were more frequent in infancy, while generalized seizures were more frequent in late childhood and adolescence. Generalized tonic-clonic seizures (GTCS) were the most frequent type of seizures.ConclusionPrevalence of childhood and adolescence epilepsy in Upper Egypt was not so much different from other developing countries. Idiopathic epilepsy was more prevalent than structural/metabolic cases. Perinatal complications, CNS infections, and head injury were the most frequent etiologies, and generalized tonic-clonic seizures were the most frequent seizure type.Electronic supplementary materialThe online version of this article (10.1186/s41983-018-0032-0) contains supplementary material, which is available to authorized users.

Background: Stroke is the most common reason for disability and the third cause of mortality in the world per year. Metabolic syndrome (MetS) is known as an independent risk factor of coronary artery disease and stroke. Aim of the work: To investigate the relationship between metabolic syndrome and risk of ischemic stroke, whether stroke patients with metabolic syndrome differ from other ischemic stroke patients in demographic variables, stroke presentation, stroke severity, neuroimaging, and prognosis. Patients and methods: This is a hospital-based, prospective observational study. The study population constituted of patients with first-ever atherothrombotic ischemic stroke who were admitted to the neurology department within 6 months (between January 1 st , 2016 and July 1 st , 2016). Patients were subjected to full neurological examination, assessment of stroke severity using National Institute of Health Stroke Scale (NIHSS), screening for MetS components, brain imaging, transthoracic echocardiography, and carotid duplex. Results: MetS was of higher frequency in atherothrombotic stroke patients compared to previous studies, more in females and older age. MetS with diabetes mellitus (DM) patients had the worst clinical presentation and the worst in-hospital outcome. High high-density lipoprotein cholesterol (HDL-C) was the predictor for worse clinical presentation. Conclusion: The higher the number of MetS components, the higher the risk of ischemic stroke. High HDL-C was the predictor for worse clinical presentation. Thus, diagnosing and adequately managing MetS is an important step in preventing cerebrovascular disease.

Background: Stroke is often considered a disease of older people, but an estimated 10% of patients with stroke are younger than 45 years. There is an evidence that the incidence of ischemic stroke in young adults is rising, although the reasons for that increase are unclear. Patients and Methods: We studied patients with acute ischemic stroke or transient ischemic attack who were admitted in the stroke unit -Neurology department, Kasr-Alainy hospital within the first week of acute event. The study was carried out during the period between December 2018 and December 2019. Results: Analysis was done for 70 ischemic stroke patients from urban and from rural area. Onset to door was shorter in urban. Urban patients showed an older age and higher prevalence of hypertension and diabetes (65.9%, 48.6% respectively), while rural patients were characterized by female preponderance (51.5%), more dyslipidemia, smoking 44.6%, stroke in young 20.5%, atrial fibrillation 23.8% % and recurrent stroke 44.3%. Rural cases showed a severer deficit at onset and poorer outcome. Conclusion: Vascular risk factors, stroke type, and presentation tend to differ in Egypt according to the geographic distribution whether urban or rural. Studying patterns of such difference may aid in planning specific targeted preventive and therapeutic strategies for stroke in urban and rural Egypt.

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Background: Stroke is frequently thought of as an old age disease, yet 10% of stroke victims are thought to be under the age of 45. Although the causes of this increase are unknown, there is evidence that the incidence of ischemic stroke in young adults is growing. A different strategy to inquiry and care is needed for stroke in the young compared to stroke in the old. Patients undergoing carotid revascularization operations benefit from the diagnostic and postinterventional evaluation of carotid artery disease provided by neurosonology. Objective: This study aimed at studying the risk factors and most common etiologies of stroke in young adults. Patients and Methods: We recruited patients with acute ischemic stroke or transient ischemic attack with age older than 18 and younger than 40 years old, who were admitted in the Stroke Unit -Neurology department, Kasr-Alainy Hospital within the first week of acute event.Results: Analysis was done for 70 ischemic stroke patients from urban and rural areas. In Males, cardio-embolic, drug-induced and undetermined causes were the most common etiologies for stroke representing together 63.3% (21 patients). While among females, about half of the cases (48.6%) were due to cardio-embolic etiology. Age was significantly lower in stroke of other determined etiology (p<0.01) and significantly higher in stroke of undetermined etiology (p=0.01). Conclusion: Stroke in young adult patients still has more specific causes, which are less common in the older age group. So, diagnosis needs a more oriented approach to reach the proper stroke etiology for further secondary prevention in those patients.

Background Migraine has been recently studied as a risk factor for ischemic stroke (IS) and a possible link to a broader range of ischemic vascular disorders including angina and myocardial infarction is suggested. Objectives to study migraine and its relation to other risk factors in patients with acute IS and acute coronary syndrome (ACS). Patients and methods We studied 200 patients, 114 patients had acute IS and 86 patients with ACS, in addition to 850 control participants. All patients were subjected to detailed clinical and laboratory evaluation; including evaluation of traditional risk factors. All stroke patients were subjected to CT scan. Diagnosis of acute coronary syndrome was established clinically by ECG and cardiac specific enzymes. Migraine was diagnosed according to the international headache society and assessment of migraine severity was measured by the Migraine Disability Assessment (MIDAS) questionnaire. Results In patients with ischemic stroke, Risk Ratios (RR) of migraine was 3.3 for all migrainous patients, higher for migraine with aura (MA). In the cardiovascular group, it was 2.75 and again higher in MA. A positive correlation between migraine severity and both stroke severity and cardiac affection severity was found though non-significant in the cardiovascular group. There was no significant difference in hospital outcome in migrainous patients in both groups. Conclusions Patients with migraine have higher risk than non-migrainous patients for both cerebrovascular and coronary vascular diseases. Risk is stronger in MA in both conditions. Considering migraine in risk stratification of cerebrovascular and cardiovascular diseases is recommended.

Background: Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. It has been shown that up to 50% of patients with chronic HCV infection experience neuropsychiatric issues.Objective: This study aimed to evaluate the cognitive impairment, extrapyramidal signs and their effects on patients' quality of life. Patients and Methods:The study included 60 untreated patients (20 chronic hepatitis, 40 patients with liver cirrhosis) and 20 healthy controls matched for age, sex, and educational level. Cirrhotic patients were graded according to the Child-Pugh classification. Patients underwent a thorough clinical and neurological evaluation, liver function tests, hepatitis markers, abdominal ultrasonography, psychometric tests and auditory p300 evoked potentials. Unified Parkinson's Disease Rating Scale (UPDRS) and chronic liver disease questionnaire (CLDQ) were used. Results: Patients had significant cognitive impairment that became greater with increased severity of liver disease. The extrapyramidal manifestations were absent in chronic hepatitis while present in cirrhotics and their frequencies were increased with cirrhotic severity (P~0.001). P300 latency was delayed in patients with and without extrapyramidal signs. Quality of life measured by CLDQ was significantly lower in all patients than controls (P~ 0.001), and became worse with increased severity of liver disease except worry increased in chronic hepatitis. Conclusion: Patients with HCV infection had cognitive impairment, which increased with chronic liver disease (CLD) severity. Extrapyramidal signs were absent in chronic hepatitis patients, while, present in cirrhotics and increased with increasing severity of cirrhosis. Cognitive impairment was not attributed to the extrapyramidal affection. The CLD and cognitive impairment had negative impact on the quality of life.