BackgroundThe use of intravenous recombinant tissue plasminogen activator (IV r-tPA) in early acute ischemic stroke (AIS) management faces a lot of difficulties in developing countries due to lessened guideline development with consecutive pre- and intra-hospital delay.ObjectivesThe objective was to identify the barriers facing proper utilization of IV r-tPA for AIS in Tanta University Hospitals.MethodsThe study was conducted on 4124 AIS patients eligible to use IV r-tPA divided to group-I consisting of 442 patients who arrived the hospital within <3.5 h from the stroke onset and group-II consisting of 3682 patients who arrived >3.5 h from the stroke onset. The former group was further subdivided to 238 patients who received IV r-tPA (group-Ia) and 204 patients who did not receive IV r-tPA (group-Ib) due to different obstacles.ResultsThe main causes of pre-hospital onset to arrival delay were stroke unawareness, long travel time, incorrect beliefs, non-available neurologists, stroke onset during sleep and multiple causes (18.2%, 20.5%, 12.7%, 9.1%, 16% and 23.5% of cases, respectively). Causes of non-administration of IV r-tPA in eligible patients includes prolonged door-to-needle time, financial restraints, minor strokes, unavailable beds and fear of complications (41.2%, 26%, 12.7%, 11.3% and 8.8%, respectively).ConclusionIncreasing the chance of utilizing IV r-tPA for AIS patients' needs regular updating of the stroke chain of survival system to get the highest benefits from the available resources.

No abstract

Background: Idiopathic intracranial hypertension (IIH) is a disorder of unidentified etiology characterized by raised intracranial pressure (ICP) without clinical, laboratory, or radiological evidence of intracranial pathology. The aim of this work was to determine the visual outcome in newly diagnosed IIH patients. Methods: The study included 68 IIH patients; 59 responded to medical treatment and nine needed lumboperitoneal shunting (LPS). Patients were submitted to papilledema grading using Frisén Scale, water CSF manometry, brain MRI/ MRV, mean deviation of visual field examination (MD-VFE), optic nerve sheath diameter (ONSD), average optic disc optical coherence tomography-retinal nerve fiber layer (OCT-RNFL) thickness, and pattern-reversal visual evoked potential (VEP). Results: Patients needed LPS showed statistically significant increase in baseline papilledema grade, MD-VFE, ONSD, average OCT-RNFL thickness, and P100 VEP latency. On the other hand, both studied groups showed statistically nonsignificant differences regarding the patients' ages and opening CSF pressure. Conclusion: Newly diagnosed IIH patients' evaluation must be based on multimodality neuro-ophthalmological assessment where papilledema grade, MD-VFE, and OCT-RNFL are valuable biomarkers of PVD while P100 VEP latency delay is a predictor of poor visual outcome and ONSD is an early indicator of elevated ICP regression after LPS surgery.

Background Stroke is the most common acquired neurological disease in the adult population worldwide with an incidence of 16 million new cases every year responsible for about 6.1 million deaths and 130.6 million disability-adjusted life-years (DALYs). The objectives of this work were to study the level of stroke awareness and the proper response for suspected stroke patients in urban and rural areas of Tanta City, Egypt. The study was conducted on 1869 Egyptian Citizens; 908 and 961 reside in urban and rural areas, respectively, who were submitted to a face-to-face interview using the stroke awareness questionnaire (Arabic version). Results Rural participants showed a significant reduction in acute cerebrovascular stroke (CVS) awareness and knowledge including the most affected organ by CVS, what are the risk factors, what are the early stroke symptoms, is there specific treatment for acute ischemic stroke, and what is the proper reaction when confronted with a case of acute CVS? Conclusion Urban populations have better recognition of stroke risk factors, early stroke symptoms, and the proper response when confronted with a case of acute CVS when compared with rural people possibly due to better socioeconomic status and higher educational levels.

Background Essential tremor (ET) is now considered as a slowly progressive neurodegenerative disorder with a variety of motor and non-motor manifestations. The objectives of this work were to study the existence of cognitive, mood, olfactory, and balance dysfunctions in ET patients and their relation to tremor severity as well as patients’ activity of daily livings. Methods This study was performed on 36 ET patients and 24 healthy controls subjects (HCS) submitted to The Essential Tremor Rating Assessment Scale (TETRAS), advanced activity of daily living scale (AADLs), Montreal cognitive assessment scale (MoCA), Montgomery–Åsberg Depression Rating Scale (MADRS), auditory mismatch negativity (MMN), Sniffin’ Sticks test (SST), computerized dynamic posturography (CDP), and brain MRI diffusion tensor tractography (DTT). Results ET patients showed significant decrease in AADLs, MoCA, SST (threshold, identification, and discrimination subscales) as well as visual and vestibular ratios of CDP compared to HCS. Auditory MMN showed significant reduction in the amplitude and prolongation of latencies while corticospinal tracts, thalamo-cortical connectivity, and middle cerebellar peduncles DTT revealed reduced fractional anisotropy in ET patients with normal tracts densities. Conclusion ET patients exhibit a wide variety of non-motor manifestations including cognitive impairment, depressive symptoms, hyposmia, and increased risk of falls with consecutive reduced activity of daily living beyond the deleterious effects of the kinetic tremor.

Background Subcortical vascular cognitive impairment (SVCI) is a subtype of vascular cognitive impairment associated with extensive cerebral small vessel diseases (CSVDs) imaging biomarkers. The objectives of this work were to study the existence and patterns of gait and balance impairments in patients with SVCI due to CSVDs. Methods The study was conducted on 28 newly diagnosed SVCI patients and 22 healthy control subjects (HCS) submitted to the advanced activity of daily living scale (AADLs), Berg balance test (BBT), Montreal Cognitive Assessment Scale (MoCA), computerized dynamic posturography (CDP), vision-based 3-D skeletal data gait analysis, and brain MRI volumetric assessment. Results SVCI patients showed a significant decrease in AADLs as well as total cerebral white matter volume, total cerebral cortical volume, and mean cortical thickness which were proportional to the degree of cognitive impairment as measured by the MoCA score. Regarding CDP analysis, patients with SVCI revealed prolongation of cancelation time and spectral power for mid- and high frequencies in dynamic positions. In respect to gait analysis, there were significant decreases in mean stride length and mean cadence as well as increases in mean step width and left to right step length difference in the SVCI group compared to HCS while doing a single task. These variables get highly significant during the dual-task performance with a p value < 0.001 for each one. Conclusion Patients with SVCI suffer from gait and balance impairments that are proportional to the severity of their cognitive decline and greatly impair their ADLs.

Background Omentin-1 is a novel adipocytokine that is related to atherosclerosis-based ischaemic cardiovascular disease and stroke. Previous studies have linked its lower levels with poor stroke outcomes. We aimed to assess the level of serum omentin-1 as a prognostic marker in patients with large artery ischaemic stroke. Methods Fifty ischaemic stroke patients suffering large artery ischaemic stroke and another 50 subjects without a prior history of strokes were recruited. All participants were subjected to neurological examinations, echocardiography and laboratory investigations including a lipid profile and HBA1c. Carotid intima-media thickness (IMT) was measured for all participants. Stroke patients were evaluated by the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Infarction volume was measured by magnetic resonance image (MRI) and serum level of omentin-1 was gauged for all participants. Results Carotid IMT significantly increased in stroke patients compared to control subjects. While serum omentin-1 levels were higher in control non-diabetic subjects, they were lower in diabetic patients with ischaemic stroke. Serum omentin-1 levels were inversely correlated with NIHSS, carotid IMT, infarction volume and mRS scores in all stroke patients. Serum omentin-1 level less than 24.5 ng/ml showed 93.7%sensitivity and 44.4% specificity in prediction of poor stroke outcome while values less than 27.8 ng/ml in non-diabetic stroke patients had sensitivity and specificity with 87.5% and 55.6% respectively. Conclusion Lower levels of serum omentin-1 are associated with increased ischaemic stroke severity and poor functional outcome.

No abstract