Background: Knowledge and awareness of cerebro-vascular stroke (CVS) warning symptoms and risk factors is deficient in the general population in the developing countries. Objective: To evaluate the knowledge and attitude about warning symptoms and risk factors of cerebro-vascular stroke among a sample of people living in Ismailia Governorate, Egypt. Methods: This study was conducted at two selected areas of Ismailia Governorate, an urban area and a rural area. Seven hundred and twenty participants were included in the study (360 form the urban area and 360 from the rural area). Face-to-face questionnaire-based interviews were administered to the participants. The survey tool is a 9item questionnaire translated in Arabic, designed to evaluate the knowledge and attitude about warning symptoms and risk factors of cerebro-vascular stroke. Results: According to the participants, the main source of knowledge about CVS was from seeing someone with stroke, the main risk factor of CVS was hypertension, the most frequent warning symptom of CVS was paralysis of one side, and the most frequent action to be taken with the onset of CVS was direct transfer to the hospital. Conclusion: Hypertension was the mostly known risk factor. Only few participants were aware of diabetes mellitus as a risk factor for cerebro-vascular stroke. This information will be useful for planning CVS prevention campaigns.
BackgroundCentral post-stroke pain (CPSP) is an under-recognized complication of stroke although it can lead to deterioration in quality of life and impairment in activities of daily living. Its estimated prevalence varies between 18.6 and 49%.ObjectiveTo investigate the prevalence and predictors of CPSP in ischemic stroke patients and to find its relationship with somatosensory evoked potentials (SSEPs) and magnetic resonance imaging.Patients and methodsSixty five consecutive patients with recent first attack of ischemic stroke who were admitted to the Neurology Department, Suez Canal University Hospitals were recruited. Patients were subjected to clinical assessment, Hamilton depression rating scale, brain MRI, short-form McGill Pain Questionnaire (SF-MPQ), daily pain rating scale (DPRS), stimulus evoked pain, and SSEPs.ResultsThe total prevalence rate of CPSP was 35.4% (n = 23). The mean age of the patients developed CPSP was significantly lower than those without CPSP (p = 0.004). Deep sensory dysfunction was statistically significantly higher among CPSP group than non-CPSP group (p = 0.001). CPSP group showed statistically significant higher prevalence of thalamic stroke (p = 0.007), as well as significant abnormalities in inter-peak interval (IPL) of median and tibial nerves SSEPs (p < 0.05). Thalamic group showed higher abnormalities in IPL of median and tibial nerves compared to extra-thalamic group, but without statistically differences.ConclusionThe prevalence of CPSP was found to be 35.4%. Predictors of CPSP include; deep sensory dysfunction, prolongation of tibial N21–P40 IPL, smoking history, age < 50 years, presence of thalamic stroke and prolongation of median N9–N20 IPL.
BackgroundCognitive decline could start or get worse among elderly patients with diabetes mellitus more than elderly without diabetes mellitus. So, those diabetic elderly patients have more risk to develop Alzheimer’s disease and vascular dementia.Patients and MethodsThis study included 48 elderly, grouped into three equal groups. First group included patients with diabetes mellitus and cognitive impairment. Second group included patients with diabetes mellitus and no cognitive impairment. The last group included the controls. Evaluation through Mini Mental State Examination, MRI brain, and Quantitative Electroencephalography (QEEG) recording was done for every studied elderly.ResultsMRI finding revealed that hippocampal atrophy was significantly more prevalent among diabetic patients with mild cognitive impairment (MCI) (37.5%). The QEEG showed increase in the distribution of alpha 1 (low alpha) waves among control and diabetic patients without MCI groups, while there was an increase in the distribution of alpha 2 (high alpha) among diabetic patients with MCI. The QEEG results revealed increased alpha 2/alpha 1 ratio among patients with hippocampal atrophy.ConclusionsType 2 DM was suggested to increase the risk of cognitive impairment. The cognitive impairment in patients with diabetes mellitus was associated with changes in hippocampal volume and QEEG changes.
Background: Discontinuation of aspirin was suggested to be a risk factor for recurrent ischemic stroke; however, it was underestimated by most physicians. Objectives: Study the effect of aspirin discontinuation in recurrence of ischemic cerebrovascular stroke. Patients and methods: This is a descriptive case-control study, including 104 patients with recurrent ischemic stroke and 104 controls. Both sexes were included with age over 18 years. The following information was collected: history of aspirin discontinuation and cause and time of discontinuation. Investigations included brain CT or brain MRI for all patients, and the site of infarction was classified according to the Oxford classification. Results: We found that 51% of patients discontinue aspirin compared to 28.8% of the control group. Nearly half of the patients (25/53) discontinue aspirin for 8-30 days before a stroke. Very high-risk patients were associated with stroke in 8-30 days of discontinuation, high-risk patients were associated with stroke in 181-365 days of discontinuation while moderate-risk patients were associated with stroke in 31-180 days of discontinuation. Conclusion: Discontinuation of aspirin especially for a period of 8-30 days could increase the risk of recurrent ischemic stroke in patients with very high-risk and high-risk factors. Physicians need to educate patients about the importance of adherence of aspirin therapy.
Background: Cerebrovascular diseases are well known all over the world to be among the top list of the causes of death. One third of ischemic stroke could be regarded to plaque rupture and embolization. The actual mechanisms have not been exactly understood, but inflammation plays a pathogenic role. Patients with hepatitis C virus (HCV) proved to have a high level of inflammation. Replication of HCV within the brain endothelial cells and carotid plaques and, recently, the consideration of HCV as playing a role in risking for atherosclerosis rose the question of the role of HCV in cerebrovascular diseases. Objective: Evaluating the role of infection with HCV among patients with stroke through assessment of carotid atherosclerosis. Patients and methods: A cross-sectional study was carried out on 100 patients with ischemic stroke, aged 40-60 years, enrolled from the Neuropsychiatry Department of Suez Canal University Hospital. Patients were classified into 50 HCV-positive patients and 50 HCV-negative patients. All patients were assessed for HCV and the traditional risk of stroke as they were subjected to complete neurological examination, assessment of vascular risk factors, and a full extracranial neurovascular ultrasonography. Features evaluated were isolated increase of common carotid artery mean intima-media thickness (IMT) and extracranial atheromatous plaques. Results: Intima-media thickness (IMT) was significantly higher in HCV-positive patients (1.04) than in HCV-negative patients (0.71). The percentage of plaque formation was insignificantly more frequent in HCV-positive patients (20%) than HCV-negative patients (10%). IMT and plaque formation were significantly increased in HCV-positive patients with high viremia. The multivariate analysis statistics concluded that infection with HCV was independently a risk factor for stroke. Conclusion: Patients with HCV infection are at higher and earlier risk of stroke. The key mediator is inflammation. Lastly, researchers and clinicians should take these new findings into their consideration.
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