Background Spontaneous simultaneous bilateral basal ganglia hemorrhage (SSBBGH) is an extremely rare condition with only a few published case reports and series. However, there is no systematic review that has been published yet. Objective The study aims to conduct a systematic review on spontaneous simultaneous bilateral basal ganglion bleeding and a descriptive statistical analysis of collected data on epidemiology, clinical features, etiology, therapeutic approach and prognosis. This review aims to be a clinical reference for busy clinicians when they are faced with such a rare condition. Methodology This review has been carried out in accordance with recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results Review of 60 cases showed that SSBBGH affected predominantly male patients (70%) with an average age of 50.8 ± 15.33 years and the male-to-female ratio was 2.5:1. The female patients tend to be older with an average age of 54.22 ± 16.67 years. Location of SSBBGHwas more common in the putamen (90% vs 10% non-putaminal). SSBBGH posed a significant mortality rate (33.33%). Among patients who survived, only 40.6% (13/32 report) have had favorable outcomes (mRS ≤2) and the remaining 59.4% (19/32) ended up with poor functional status (mRS ≥3-5). The most common implicated etiologies were hypertension followed by alcohol intoxication. Conclusion SSBBGH is a rare clinical entity with significant morbidity and mortality. Systemic approach can lead to early recognition of etiology and prompt treatment. Hypertension and the putamen are the most common etiology and location of SSBBGH, respectively. History of hypertension and age can help narrow differential diagnosis and limit unnecessary testing or intervention.
Background: Pre-school children use digital devices both at home and in kindergarten for communication. However, such technologies can also be used for creativity learning and entertainment. Technology usage might exert a negative impact on the psychosocial development of pre-school children, thus necessitating parental monitoring. Previous studies have recommended early intervention for pre-school children by decreasing the duration of digital devices, spending more time with the family, and participation in motor activities to avoid the ill effects of technology.Aim: To investigate the impact of digital device use on the behavioral and sleep scores of preschool children as perceived by parents in Saudi Arabia (SA).Method: This cross-sectional study was conducted across two regions in SA. It was ethically approved by the ethical review board of Imam Abdulrahman Bin Faisal University. The participants were randomly selected from well-baby hospital records, surveyed and interviewed to obtain data for the following measures: demographic data, technology usage, sleep disturbance scale, and behavior scale. Children with special needs or comorbidities were excluded from the study. Descriptive and multivariate regression analysis were done.Results: We recruited 288 children. Most did not attend schools (63.2%), 22.6% were in kindergarten, and 14.2% were in nursery schools. Smart phones were the most commonly used device by the children (42.4%). Most used the technology for 2–3 h/days (34%). Cartoons were the most commonly sought content (42%). The behavior scores for children aged 18–36 months showed a mean value of 5.1, 3.7, and 4.6 for surgency, negative affect, and effortful control, respectively. Children aged 3–5 years showed a mean value of 4.3, 4, and 4.7 for surgency, negative affect, and effortful control, respectively. Sleep disturbance scores for all children showed a mean value of 12.4, 3.5, 3.8, 8, 7.3, and 2.7 on disorders of initiating and maintaining sleep, sleep-breathing disorders, disorders of arousal, sleep-wake transition disorders, disorders of excessive somnolence, and sleep hyperhidrosis, respectively. The mean total sleep score was 37. Multivariate regression analysis showed significant positive relationship between surgency and three factors namely family income of 10,000–15,000 SR (t = 1.924, p = 0.045), fathers' bachelor's degrees (t = 2.416, p = 0.16), and owning a video game device (t = 2.826, p = 0.005<0.05). Negative affect was significantly associated with fathers' diploma level of education (t = 2.042, p = 0.042). Negative significant relationship between effortful control and fathers' secondary level of education (t = −2.053, p = 0.041). There was a significant negative relationship between effortful control and owning a TV and video game device (t = −2.35, −2.855, p = 0.043, 0.005<0.05, respectively). A significant positive relationship was found between child's sleeping score (worse sleep) and watching technology between 3 and 5 h (t = 2.01, p = 0.045), and mothers' unemployment status (t = 2.468, p = 0.014).Conclusion: In conclusion, technology use is associated with a negative impact on children sleep and behavior. Owning a digital device, using tablets, screen viewing for more than 3–5 h, and watching movies were significantly associated with negative child's behavior and sleep.
Objectives: To identify epilepsy triggers prevalent in Saudi Arabia with a view to seizure prevention or achieving a reduction in their frequency. Methods: This is part of a cross-sectional study carried out in 2020 in a Saudi population in the Kingdom of Saudi Arabia (KSA). We used an online questionnaire to evaluate the most common seizure trigger factors. Results: A total of 546 Saudi patients with epilepsy participated in the study, of which 289 (53%) were women. Of them, 263 (48.1%) had no seizure in the previous 3 months. One hundred and thirty-six (25%) had a family member with epilepsy. The most-reported trigger factor was sleep deprivation reported by 285 (52%), followed by stress 225 (41%), missed medication 210 (38.5%), anxiety 209 (38.3%), and fatigue 184 (33.7%). Conclusions: Sleep deprivation is the most reported trigger factor for seizures in the KSA, followed by stress, followed by missed medication.
Background Severe acute respiratory syndrome coronavirus (SARS-CoV-2) due to novel coronavirus disease 2019 (COVID-19) has led to an unprecedented worldwide pandemic with diverse respiratory symptoms as well as systemic manifestations and complications. The neurological manifestations of COVID-19 include, but are not limited to, headache, cerebrovascular disease, and skeletal muscle injury. Case Report Herein, we present a case of stroke with large vessel occlusion in a middle-aged man, who recently recovered from severe SARS-CoV-2 infection. This patient is not known to have any medical illness or surgical history and has no cerebrovascular risk factors. Moreover, the patient underwent extensive investigations, including neuroimaging, cardiac and laboratory work-up with no evidence of stroke etiology. Conclusion The mechanism of cerebrovascular events in the setting of COVID-19 is still uncertain and probably multi-factorial. The prevailing hypothesis is a strong thrombotic tendency, which may even be prolonged after complete recovery. In our patient’s case, hypercoagulability in the context of viral infection is the most likely mechanism for the stroke. Further studies are needed to find out the exact pathogenesis of thromboembolic events in the setting of COVID-19 infection as well as the efficacy, safety, dosage, and duration of anticoagulants in such conditions.
A 34-year-old woman presented with acute onset left facial weakness and dysarthria. Examination showed diffuse livedo racemosa (figure, A). Brain MRI demonstrated right frontal acute stroke (figure, B), with numerous chronic ischemic lesions in the deep white matter (figure, C). CT angiogram revealed multiple irregularities along the cortical branches of intracranial vessels (figure, D and E). Skin biopsy was nonspecific. 1 Extensive immunologic, hematologic, and infectious workup was unremarkable. 2 The patient was diagnosed with Sneddon syndrome and discharged on aspirin.Sneddon syndrome is a noninflammatory arteriopathy presenting classic neurovascular and dermatological signs. Often associated with antiphospholipid syndrome or autoimmune disorders, its pathophysiology remains unknown.
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