BackgroundBorder zone infarcts (BZI) are ischemic lesions at the junction between two main arterial territories which may be either cortical or internal BZI.MethodsThis study was conducted on 76 cerebral BZI patients and 20 healthy control subjects. Patients were divided to group I included 26 internal BZI, group II included 19 cortical BZI and group III included 21 mixed internal/cortical BZI patients. Included subjects were submitted to neurological examination, laboratory investigations, ECG, echocardiogram, brain CT and/or MRI and extra and intracranial blood vessels imaging by duplex and CT angiography.ResultsHypertension was significantly higher among groups I and III compared to group II while atrial fibrillation (AF) was significantly higher in groups II and III than group I (p < 0.05). Sonographic duplex assessment of extra and intracranial blood vessels revealed significant increase in mean flow velocities of CCA, ICC and MCA on both side in groups I and III compared to group II (p < 0.05). CT angiography revealed non-significant differences between BZI patients and control as well as in between the three BZI patient’s groups regarding the existence of vertebral artery hypoplasia and/or circle of Willis anomalies.ConclusionsVascular stenosis is the main etiological factor in internal BZI while AF is the predominant etiological factor of cortical BZI. Congenital vascular anomalies play roles in the localization of BZI but cannot predispose to it except when comorbid with hemodynamic disturbances.

Background: CVT represented 1% of all strokes. The most frequent risk factors associated conditions for CVT are genetic prothrombotic conditions, antiphospholipid syndrome and other acquired prothrombotic diseases, including cancer, oral contraceptives, puerperium and pregnancy, infections and trauma.Aim of the Work: Is to study possible etiologies, risk factors, clinical presentations, radiological features and outcome of cerebral venous thrombosis during child bearing period. Patients and Methods:This study was conducted in the Neuropsychiatric Department Tanta University Hospital on 82 patients with CVT, aged from 15-45 years. They were classified into female and male groups plus 20 control group matched with age. All patients were subjected to full history taking, neurologic examination including evaluation by Glasgow coma scale (GCS) and National Institute of Health Stroke Scale (NIHSS), laboratory investigations, neuroimaging including: CT, MRI, MRV were done and follow-up by Modified Rankin Scale (MRS) after 3 months.Results: OCP was the most common risk factor followed by postpartum state. Single risk factor was presented in 48.8% and multiple risk factors were presented in 22%. Headache was the most common presenting symptoms followed by GTCS and motor deficit. Headache, GTCS, motor deficit and encephalopathy were more in females while papilledema, focal seizures, sensory deficit and aphasia were more in males. Hypercoagulable state was the most common etiology followed by antiphospholipid syndrome and SLE. Hypercoagulable state was most common in both sex, while sepsis and Behcet were significantly more common in males. Superior sagittal sinus (SSS) was the most common affected sinus followed by transverse and sigmoid sinuses. Single affected sinus was in 65.9%, while multiple affected sinuses was in 31.7% of patients. 12 patients (14.6%) were died. The most common cause of death was herniation followed by uncontrolled seizures. Factors associated with poor outcome were GCS less than 10 and NIHSS more than 14.76%. Hypercoagulable state is the most common etiology followed by antiphospholipid syndrome and SLE. SSS is the most common affected sinus then transverse sinus and sigmoid one. Female sex, GCS less than 10, NIHSS more than 14 and patients presented by headache have poor outcome.

Introduction: Autoimmune epilepsy was an under-recognized condition, and its true incidence was unknown in pediatrics. Serum antibodies suggesting a potential autoimmune etiology were detected in 34.8% of patients presented by epilepsy of unknown etiology. Diagnosis of autoimmune epilepsy would be of great value in the search for potential preventive treatments for disabling seizures and cognitive impairment. Autoimmune epilepsy was characterized by a depressed or altered level of consciousness, lasting more than 24 h, lethargy, or change in personality or behavior and at least one of the following features: neuropsychiatric symptoms, seizures, movement disorder, or cognitive dysfunction. Patients were excluded if an alternative diagnosis was made. The presence of neuronal antibodies and MRI changes supported the diagnosis. This study aimed to assess the possible role of immunity in the pathogenesis of pediatric drug resistant epilepsy through clinical electroencephalographic, neuroimaging and neuro-immunological testing. Subjects and Methods: This study was conducted on twenty-four drug resistant epileptic children with suspected autoimmune etiology over the period from 2016-2018. The control group comprised twenty four children with idiopathic controlled epilepsy matched to the drug-resistant epilepsy sample for age and gender. Both groups were subjected to clinical examination, neuronal antibodies in serum and CSF, Mini-Mental State Examination (MMSE), Chalfont seizure severity scale (CSSS), EEG, and brain MRI studies. Results: There was a large percentage of autoimmune epilepsy in pediatric cryptogenic drug-resistant epilepsy. 55% of DRE cases presented with mild pleocytosis and elevated CSF proteins. Serum and CSF neuronal antibodies were positive in about 66.63% and 65% of cases respectively. Serum neuronal antibodies to GAD were positive in 8.33%, NMDA Abs were positive in 33.3%, and VGKC Abs were in 25.0% of cases. In the CSF, GAD antibodies were positive in 10%, NMDA antibodies in 40%, and VGKC antibodies in 20% of cases. Seizures reduction was achieved with immunotherapy, also was prevalent in seropositive cases. Conclusion: Pediatric patients presented by drug-resistant epilepsy should receive immunotherapy for a definite diagnosis. MRI changes in the form of temporal hyperintensity, claustrum, cortical hyperintensities were a common finding in pediatric patients presented by drug-resistant epilepsy. CSF changes in the form of elevated proteins and /or mild pleocytosis signified inflammatory changes in the CNS and blood brain barrier (BBB) disruption. Steroid responsiveness played a major role in the diagnosis of autoimmune epilepsy, especially seronegative cases.